IPA Journal - Jul/Aug/Sep 2018 by Iowa Pharmacy Association

A Peer-Reviewed Journal | Vol. LXXIV, No. 3 | JUL.AUG.SEP 2018

Cheryl Clarke IPAâ&#x20AC;&#x2122;s 140th President

INSIDE: 2018 Annual Meeting Recap An Eventful Legislative Session Reports from First Outcomes Grant-Supported Projects

TABLE OF CONTENTS 8515 Douglas Avenue, Suite 16, Des Moines, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: ipa@iarx.org | www.iarx.org

PUBLICATION STAFF David Schaaf, Managing Editor Kate Gainer, PharmD Anthony Pudlo, PharmD, MBA, BCACP Laura Miller Casey Ficek, JD Shannon Rudolph, PharmD

Record-Breaking Annual Meeting pg. 8

A look at the policy discussions, awards, and memorable moments that made the 2018 IPA Annual Meeting a success!

OFFICERS CHAIRMAN Craig Logemann, RPh, BCACP, CDE - Ankeny PRESIDENT Cheryl Clarke, BS Pharm, RPh, FAPhA - Waukee PRESIDENT-ELECT Connie Connolly, RPh, BCACP - DeWitt TREASURER Tim Becker, RPh, FACP - Mason City SPEAKER OF THE HOUSE Jim Hoehns, PharmD, FCCP, BCPS - Cedar Falls VICE SPEAKER OF THE HOUSE Ashley Dohrn, PharmD, BCGP - Le Claire

TRUSTEES REGION 1 Sharon Cashman, RPh - Waverly REGION 2 Jim Mennen, RPh - Coralville REGION 3 Sally Haack, PharmD, BCPS - Urbandale REGION 4 Carol Anderson, PharmD - Mason City AT LARGE Bill Baker, BS Pharm - Iowa City Craig Clark, RPh - Cedar Rapids Deanna McDanel, PharmD, BCPS, BCACP - Coralville Heather Ourth, PharmD, BCPS, BCGP - Ackworth HONORARY PRESIDENT John Rovers, PharmD, MIPH - Des Moines PHARMACY TECHNICIAN Jessica Burge, CPhT - Des Moines STUDENT PHARMACISTS Bridget Tunink - Drake University Austin Miller - 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.

Legislative Session Recap A review of the pharmacy-related legislation passed in 2018. pg. 34

Thanks, Bill! A look back at Bill Wimmer’s impact after 38 years of representing IPA. pg. 36

FEATURES

2018 IPA Annual Meeting Recap . . . . . . . . . . . . . . . . . . . . . . . . . 8 Speaker’s Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Policies Adopted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 IPA Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Leading Outside the Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . 22 Student Pharmacist Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Commencement 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2018 Legislative Session Recap . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Thanks, Bill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Outcomes Grant Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

IN EVERY ISSUE

CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 IPA Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. JUL.AUG.SEP 2018 |

CEO’S COLUMN

WILL IT BE YOU?

hile all of IPA’s professional awards are unique and carry a distinct honor for the recipient each year, one award stands out to me as different from the others – the Bowl of Hygeia. The Bowl of Hygeia is not presented for professional achievements, rather for a pharmacist’s civic engagement and contributions to their community. The award was initiated in 1958 by E. Claiborne Robins, Sr., a pharmacist and then-president of A. H. Robbins Company whose dedication to community service was described as “fierce,” and the inaugural recipient nationally was Richard Hoffman of Ottumwa, IA. The Bowl of Hygeia is a national award, now sponsored by APhA and NASPA, presented annually to one pharmacist in all 50 states, and is considered one of the profession’s most prestigious awards. While most of IPA’s award recipients are selected by the IPA Board of Trustees, the Bowl of Hygeia is selected by an outside committee of Iowa civic leaders. This committee reviews nomination packets compiled, sometimes over several years, and in secrecy from the individual, often with 10-20 letters of support from community members, leaders, and volunteers. In Iowa, the Bowl of Hygeia recipient is not notified prior to the presentation, but rather learns of their award during the banquet at the IPA Annual Meeting. Without their knowledge, family members and friends are huddled in the back of the room as the award is presented to join them in the celebratory moment. Regular IPA Annual

Meeting attendees have fun trying to determine each year’s recipient as the night begins and as anticipation grows during the presentation of the award. In most states, the award is not a surprise. In some states, it’s a perfunctory award given each year to the association’s past president. Without a doubt, IPA has built the tradition and prestige of the Bowl of Hygeia into something truly special. I believe Mr. Robbins would be proud. Each year, when I learn of the recipient, I have the opportunity to read through their nomination packet. The letters are truly heartwarming with unbelievable gratitude for the contributions that each pharmacist has made in their communities, large and small. This year was no exception. IPA’s 2018 Bowl of Hygeia recipient was Mickey Cooper of Eagle Grove, Iowa. Since 1958, Mickey is only the third female pharmacist to receive the award in Iowa. Her letters of support came from community leaders, volunteers, patients and coworkers highlighting her contributions to the Eagle Grove and Wright County area. What also struck me was the multiple references to her family - her recently deceased husband “Coop” and her three children. Many of the letters mentioned how her commitment to their community was a family affair, something she included her children in from a young age. And now, her grown children are leaders and engaged in their own communities. I am inspired daily by IPA members and what they do for their patients and practices. Reading Mickey’s nomination packet inspired

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

me to strive to be a better parent and community leader. While IPA is focused on pharmacists as professionals, often sharing resources that pertain to their practice and work environment, the Bowl of Hygeia is an IPA award that reminds me IPA is also focused on pharmacists being just good people. And, in Iowa, we truly have the best of the best. I look forward to seeing the next generation of Bowl of Hygeia recipients. Will it be you? Congratulations to all of IPA’s 2018 award recipients (pg. 18); it is truly an honor to work on your behalf. ■

The Bowl of Hygeia on display at APhA headquarters in Washington, D.C.

JUL.AUG.SEP 2018 |

PRESIDENT’S PAGE

SHARPENING OUR TOOLS Cheryl Clarke, EdD, RPh, FAPhA Waukee IPA President

IPA President Cheryl Clarke’s inaugural address given at the 2018 IPA Annual Meeting on June 8, 2018, in Des Moines.

ood evening. Before I begin, I would like to introduce a few members of my family. First, my husband Doug. When I was elected, my first words to Doug were “I am sorry but you are going to have to dress up.” While a tuxedo is not his preferred apparel, I can always count on him to support me. We are also blessed to have our children here. Nick, his wife Michelle, Ben, and Sarah. This hour is too late for our grandson Elliot. I am also very lucky to have my parents here - Jerry and Karen Cahail. It was my dad who suggested to me as a young child that I become a pharmacist. I quickly told him I was not interested in farming. But he explained that you get “pink medicine” from the pharmacist. This simple conversation between a father and a daughter planted a seed, leading to this night when I begin service as the 140th President of the Iowa Pharmacy Association. I am very excited and honored to begin this journey but also know that this opportunity is not simply an honor. It is a pledge to join

| The Journal of the Iowa Pharmacy Association

forces with you to work tirelessly for our profession. Let’s talk about the important work we have ahead. In 2012, the Iowa Board of Pharmacy and IPA collaborated to create a task force focused on the influence of the practice environment on patient safety. There were two subgroups – one with practitioners and one with managers and administrators. President-elect Connie Connolly and I had the privilege of co-chairing the practitioner’s subgroup. When this subgroup met, we found a significant portion of the practitioners struggling with practice-based stress. At one point, a task force member said, “We just need to admit that pharmacists are burned out.” I will admit, at that moment, I was not ready to consider this could be the case; that perhaps other pharmacists might not feel the same way I felt about our profession. Six years later, those words continue to haunt to me. Since that time, I have learned more about the impact of burnout on patients. I now strongly believe that our profession must not just discuss this reality but must proactively work to resolve and prevent burnout before it jeopardizes patient safety. While you may not currently be struggling with professional burnout, I am fairly certain you know a colleague who is struggling. I urge you to listen and to act, regardless of your personal situation, as this is not an individual’s

problem - it is our profession’s problem. Therefore, IPA must take an active role as should every pharmacy professional. There are many terms associated with burnout – professional resiliency, clinician resilience and well-being, and compassion fatigue, to name a few. I tend to prefer professional resiliency as the term burnout may inaccurately suggest there is no recovery. Professional resilience is the capacity to thrive in situations of high demand and to recover from significant challenges. Professional resilience is the antidote for burnout. There is much to share related to professional resiliency but let’s focus on 3 broad concepts. First, professional resiliency is not just a pharmacy issue. It is a healthcare issue, found across the entire healthcare system and in all practice environments. The National Academy of Medicine has recognized this and joined forces with over 50 national healthcare organizations, including ASHP, to create the Action Collaborative on Clinician Well-Being and Resilience. Professional resiliency efforts are also underway at the state level. In February, IPA partnered with the Iowa Medical Society to host the Provider Burnout and Professional Resiliency Conference in Des Moines, with a variety of healthcare professionals including pharmacists in attendance. If you think this isn’t a problem for you, please think again.

PRESIDENT’S PAGE

- “If it is good for the patient, it is good for pharmacy.” Addressing professional resiliency is addressing patient well-being. Our patients deserve our best selves, and our patients deserve environments that support our best selves. These three broad concepts– professional resiliency is an issue across all pharmacy and all healthcare settings; professional resiliency is a complex issue involving individual and external factors; and patient well-being is dependent on clinician well-being – serve as the foundation as we consider how can we move forward to address professional resiliency on both an individual and organizational level. Figure 1: Factors Affecting Clinician Well-Being and Resilience. Source: National Academy of Medicine

We are all in this boat – all pharmacists, pharmacy technicians, and student pharmacists, across the entire profession. In addition, we are in this boat with all healthcare providers. To meet our patients’ needs, we must actively address issues of professional resiliency. The second concept to share is that professional resiliency is a complex issue. This is illustrated by the conceptual model endorsed by the National Academy of Medicine (Figure 1). It is easy to believe that professional resiliency is simply an individual’s problem. However, it is not so simple. Resiliency is impacted by many systemic factors, as noted by the yellow in the model. As an example, one systemic factor is the regulatory, business, and payer environment. We are all aware of the demands of the highly regulated healthcare environment as well as the continuous pressures on payment models. Resiliency is impacted by these as well as many other pressures within the healthcare system. While it may not be possible to eliminate these pressures, IPA, along with national pharmacy organizations, must advocate to improve these systemic factors as well as educate the profession on strategies to minimize their impact. Third, as illustrated by the model, patient well-being is dependent on clinician well-being. Bob Osterhaus’ often repeated statement from his IPA presidential address applies to professional resiliency

At an individual level, we often view our role as healthcare professionals as taking care of others, while sometimes jeopardizing our own self-care. We need to recognize that self-care is NOT selfish. Self-care is NOT weakness. Self-care is NOT optional. Let’s reframe the concept of self-care because self-care IS patient care. We cannot serve our patients and cannot reach our goals as a profession without the caring and innovative mindsets required to do so – these are our tools. Stephen Covey illustrated this concept as a person attempting to cut down a tree with a dull blade. Being inefficient and ineffective led to feelings of frustration and exhaustion. When it was suggested to sharpen the blade, the response was “I don’t have time.” Do you recognize this phrase, particularly related to your self-care? We must prioritize the sharpening of our tools, our caring and innovative mindsets. We must not just work hard – we need to work smart. I am asking each of us to commit to self-care. It is also time for each of us to take responsibility for the organizational cultures where we may practice. Structural elements of the workplace can be maintained while supporting a focus on learning, patient care, professional autonomy, and reasonable self-care. Respectful, open dialogue will be necessary to understand all perspectives. The reality is pharmacy, like all health care, is an environment where significant stress exists. Removal of stress is not a realistic goal. Implementing reasonable safeguards to lessen the impact of this predictable stress is a realistic goal and

is the responsibility of all members of the profession. I am asking each of us to proactively consider and improve the external factors that impact professional resiliency. From an IPA perspective, I will encourage the Board of Trustees and IPA staff to place an increased focus on professional resiliency including initiatives to support national organizations in these efforts; to educate members and nonmembers about professional resiliency; and to collaborate with other healthcare professional organizations in this regard. Your presence here may signal strong professional resiliency. Perhaps you came here because your tools needed to be sharpened. My personal belief is that professional involvement provides an effective safeguard against burnout. As an individual, I could feel powerless against the external factors that may damage professional resiliency, but together, we find strength, purpose, and perspective. Talk to your colleagues about professional resiliency to shine a light on this issue. If they are not IPA members, ask them to join us. We have work to do, we need sharp tools in all of our hands, and we need everyone on the team. During this year as IPA president-elect, I have contemplated the message I wanted to share tonight. Frankly, this wasn’t it. I wanted to talk about other priorities such as our ongoing advances in patient care, ways we will contribute to the healthcare team, and encourage us to take more risk to achieve our goals. However, these priorities will be stymied without sharping the tools of our profession caring hearts, innovative minds, and the desire to serve patients. During that 2012 task force meeting, I wasn’t ready to hear how professional burnout and lack of professional resiliency might be holding us back. Perhaps you are not ready now. But now is the time to do what our profession needs. Only proactive engagement will stop the impact of burnout - not just on our profession, but most importantly, on our patients. It is time to sharpen our tools. It is time to make sure your neighbor’s tools are sharp as well. It is time to get to work. ■

JUL.AUG.SEP 2018 |

Thank you to the over 200 IPA members who made the 2018 IPA Annual Meeting in Des Moines a record-setting success! Speaker of the House Steven Martens lead a passionate 2018 House of Delegates that featured lively policy discussion and timely keynotes that included a panel of statewide health organizations and Steve Mullenix. This, of course, was in addition to committee meetings, the exhibit hall and the poster program. Members celebrated the inauguration of Cheryl Clarke as IPAâ&#x20AC;&#x2122;s 140th president and then helped raise over $12,000 at the annual IPA Foundation Silent Auction. The 2018 Annual Meeting ended with the sweet conclusion of the IPPAC pie in the face fundraiser.

| The Journal of the Iowa Pharmacy Association

Adopted Policy . . . . . . . . . p. 13 Board Transition . . . . . . . . . p. 14 Awards . . . . . . . . . . . . . . p. 18 Silent Auction . . . . . . . . . . p. 48 JUL.AUG.SEP 2018 |

P.A.S.S.I.O.N. Steven Martens, PharmD Grundy Center 2017-2018 Speaker of the House

Speaker Steven Martens’ address during the first session of the 2018 IPA House of Delegates on June 8, 2018, in Des Moines

assion. Defining it is merely someone’s desire to describe what they feel when they’re in the zone, when they’ve found their true calling, when they’re next to the person they’re in love with. Whatever yours is, I know one thing: You need to follow it, put your heart and soul into that thing and dedicate as much time as you can. Passion is an emotion specifically intended to make you go crazy and work your butt off at something because your brain believes it could rock your world. That, like love, is a feeling worth fighting for. So, today, I want to use PASSION as an acronym. I love acronyms because

| The Journal of the Iowa Pharmacy Association

as a sufferer of self-diagnosed, nonmedicated ADHD, they help keep it simple for me. Acronyms make it easier to focus and to remember for future reference so I don’t keep chasing… “Well, hello, Susan[Vos]! Great job last year as our speaker. Hi, Andrew [Funk]! Thanks for coming! How’s it going, Abe…oh, never mind…I mean, Brett [Barker].”

past 16 years since I left Randy, Gary, Bill, Bruce, Bernard, Jay and many other great mentors at the University of Iowa. Why? It’s because of people like TJ Johnsrud, Rex McKee and Brian Wegmann that have allowed me and others to spread our wings, put us in places where we can succeed and surround us with many talented people.

People

Association

I truly enjoy most everyone I meet. Life is about relationships. My 7th grade girlfriend, Patricia Sue Keller, and Ashton (14), Preston (11), Weston (8), and Morgan (8) are the most important human beings in my world. Like most of you, family means everything to me. But there are so many other people I love to see on a regular basis, including my pharmacy family here today. I learned early on in life that no matter what career path I chose, it would always be about the people. Business is rarely about the product, but those working within the business. There are some amazing Shark Tank gadgets out there, but if they don’t have the right folks creating it or selling it, it doesn’t really matter. I look back on the company I’ve been blessed to work for my entire career. We’ve grown a good amount over the

It’s a group of people organized for a joint purpose. This house of delegates, for many decades, has set the tone for where we stand on a multitude of issues facing our profession and lays the groundwork for future initiatives we hope to accomplish in the years to come. But we don’t have an association or house of delegates without a great number of our pharmacists and technicians. Membership is vital to the success of all associations. I am always fascinated by how ants can carry up to 50 times their body weight. For one ant, that may mean a decent bread crumb, but when thousands work together, they carry a decent piece of timber over a good distance. IPA stands stronger than ever today because of the countless hours of leadership and dedication AND the hundreds and hundreds of members throughout our

2018 ANNUAL MEE TING history that have worked together for a joint purpose. There is absolute strength in numbers and I challenge you to recruit a friend or colleague that isn’t currently a member of our great association to join us soon.

Service

Our mission to help others. The more you give, the more you live. Sometimes, that is a fine line to balance. You DO have to take care of yourself before you can best take care of others. But don’t use the excuse of being “busy” or that you “don’t have time.” Most everyone is “busy” or doesn’t have a lot of extra time on their hands after their job, kids and other obligations. It’s just too easy of an excuse. Think of others first and hopefully you will look at how you “can” vs. “cannot.” And make sure you remember what service is really all about….others. If you can’t serve others with a kind heart, then you probably shouldn’t be serving in this way. Be kind and get to know as many of your patients on a personal level. When you do this, the level of trust and care will only improve. And please don’t judge someone until you get to know them. You don’t know their story until they tell it to you.

Spirit

A person’s emotions and character... their soul. Last fall in the IPA journal, Kate shared about her dear friend, Ella, who suddenly died last year of sepsis at 5½ years old. My niece, Alexandria, would have become a teenager this past March, but unfortunately left this life to be with our Lord and Savior at the age of 3½ years young following complications after a routine tonsillectomy back in 2008. Both of these girls displayed a great deal of spirit and spunk at such a young age. Sure, we may have some days as a pharmacist that don’t start or end the way we’d like. But I want my dash between my start and end of life to be one that is full of positivity and zest instead of frustration, negativity and regret. Life is just too darn short to not love what we do. If you don’t love being a pharmacist today, then I challenge you this very moment to begin looking for a career that

will make you happy and strive to make the world a better place tomorrow than it is today.

to do this, but each of us must find the best way to be active stakeholders.

“If it is to be, it is up to me”

If not now, then when. Hundreds of issues present themselves to our profession each year. Some seem to loom larger than others. Each one of us has a certain level of passion related to these issues. What really stirs my passion is when I see other’s passion take over. Like on a Wednesday back in April, the 18th to be exact, when I stood in that room at the State Capitol and listened to the passion exuding from my colleagues discussing the unjust practices of PBMs. Real, heart-felt passion was on full display that day. Sometimes emotion can get the best of us and prevent our message from being heard, but Kate, Mark, Randy and John wore their hearts on their sleeves that day and that display of passion ignited a fire in me to keep pushing forward…forward for myself as a provider, forward for my colleagues as we work collaboratively to prove our worth and forward for our patients, so they know we want the best for them--physically, mentally and financially.

One of my all-time favorite lines to live by. All two-letter words, yet 10 twoletter words to remind us that we need to be the ones to create the change for better in our profession. We can’t leave important decisions regarding the future of pharmacy to be in the hands of others.

“We can’t leave important decisions regarding the future of pharmacy to be in the hands of others.” Our grassroots efforts over the past few decades have been tremendous in getting us situated for the present. But we can’t get complacent. When we do, it will lead us with an uphill battle that may be too steep to climb. No matter what area of pharmacy we practice, we need to realize that solutions to drug shortages, thirdparty reimbursement, provider status or DIR fees will not fix themselves. It will take work by each and every one of us to find the best solution for many of these challenges, but I can’t imagine a better village than one full of pharmacists to get the job done.

Ownership

We need to take ownership for our actions. We need to take ownership in our profession. If not us, then who? I urge you to get actively involved with this association, whether it be in the form of a committee, task force or local event coming to your hometown. If you can’t be active with your time, then I challenge you to be active with your money or other resources. Donate items for the silent auction or set aside your caffeine/candy money and donate to the IPA Foundation or Iowa Pharmacy Political Action Fund. This will go a long ways toward helping support our great profession in the best state to practice pharmacy. But it should be our duty, our obligation, to own our profession and invest in its future. There are many ways

NOW

Thanks to the entire staff at IPA for making these last two years the most enjoyable years I’ve been a part of the association. Your tireless efforts and positive attitudes are always appreciated and I look forward to many years of working side by side with you in the future. To the great Board of Trustees I’ve served with over the past two years and this year’s wonderful Executive Committee, it’s been a true pleasure working with each and every one of you. I thank you all for being here today as we embark on another great adventure here at annual meeting. Again, I love seeing so many familiar faces before me today and greatly look forward to meeting some new ones by the time I leave tomorrow. God bless you all! ■

JUL.AUG.SEP 2018 |

CELEBRATING LEADERSHIP Each year prior to Annual Meeting, IPA host its Leadership Dinner to recognize the past, present and future leadership within Iowa pharmacy and the association. Current board members, past presidents and honorary presidents, the deans from both Iowa colleges of pharmacy, and other distinguished guests gathered for this yearâ&#x20AC;&#x2122;s dinner at the Embassy Club in Des Moines. Among those recognized was IPA President Craig Logemann, who, like many IPA presidents before him, received his Duffy caricature. For completing a 9-year tenure on the IPA Foundation Board of Directors, Jay Currie received a custom bobblehead featuring his likeness in a new tradition for outgoing foundation directors.

Craig Logemann receives his Duffy caricature

Jay Currie receives his bobblehead

Then President-elect Cheryl Clarke (right) receives recognition from McKesson by (l-r) Jeff Aden, Christina Kunz, and Dave Kelley

Jerry Karbeling Leadership Award recipients Grant Jerkovich (l) and Michael Harvey (r)

Chris Decker and Tom Temple

Diane Reist, Class of 1990

Bob Stessman, Class of 1992

Tisha Field and Jennifer Alexander, Class of 2017

IPA also presented its Jerry Karbeling Leadership Award to Michael Harvey from Drake University and Grant Jerkovich from the University of Iowa.

CELEBRATING 30 Added to this yearâ&#x20AC;&#x2122;s dinner was a celebration of the 30th Leadership Pharmacy Conference. All past participants were invited to attend the dinner. Tom Temple and Chris Decker shared the origins of the conference and what it has meant to the profession in Iowa, Wisconsin, and the nation. Several past participants shared their experiences and how the conference affected their careers.

| The Journal of the Iowa Pharmacy Association

2018 HOUSE OF DELEGATES: POLICIES ADOPTED 18-U1: Patient Protection From Unfair Pharmacy Benefit Manager (PBM) Practices

1. IPA supports the right of patients to have unrestricted communication with pharmacists regarding all aspects of care within the practice of pharmacy, including the financial aspects of medications and services. 2. IPA opposes restrictions and barriers placed by PBMs on pharmacists and other healthcare professionals that limit access to and prevent the optimization of healthcare services for patients. 3. IPA supports public awareness efforts regarding PBM pricing formulas and their impact on access to pharmacy services. 4. IPA supports collaboration with patient advocacy groups and other healthcare provider organizations to bring transparency and appropriate oversight and regulation of PBMs. 5. IPA supports requiring PBMs to immediately notify the patient, prescriber, and pharmacy of all medication prior authorization decisions as a means of improving patient care.

18-U2: Expedited Partner Therapy (EPT)

1. IPA supports pharmacist-provided expedited partner therapy as a method of preventing and treating sexually transmitted infections when a patient’s partner(s) are unable or unwilling to seek medical care. 2. IPA supports collaboration with the department of public health and the board of pharmacy to provide regulatory guidance on expedited partner therapy for a pharmacy to dispense medication, provide appropriate counseling, and recommend monitoring.

18-U3: Diversity and Inclusion

1. IPA supports a diverse and inclusive pharmacy workforce whose backgrounds, perspectives, and experiences reflect the diverse patient population for whom pharmacists and pharmacy technicians provide care.

2. IPA supports education that helps pharmacists, student pharmacists, and pharmacy technicians develop and maintain competency in providing care and services to a diverse patient population. 3. IPA supports environments that identify individuals’ unique talents and encourage the personal and professional growth of all members.

18-R1: Advanced Technician Roles and Designation

1. IPA recognizes the evolving practice of pharmacy includes pharmacy technicians with advanced roles and responsibilities. 2. IPA supports advanced roles of pharmacy technicians to increase the availability of pharmacists to deliver patient care services. 3. IPA opposes the reduction of pharmacist personnel and hours due to pharmacy technicians performing advanced roles.

18-R2: Point-of-Care Testing (POCT) 1. Reaffirm IPA policy 06-R3

2. IPA supports pharmacists’ use of point-of-care testing to initiate treatment and/or provide a referral in accordance with outlined protocols or collaborative practice agreements while making efforts to reduce duplicative testing. 3. IPA supports results of point-of-care testing performed at any pharmacy practice be documented and communicated as appropriate to the patient or patient’s representative and members of the patient’s healthcare team. 4. IPA supports education and training for pharmacists and other pharmacy staff regarding point-of-care testing. 5. IPA supports fair, transparent, and timely compensation for point-of-care testing administered at a pharmacy practice, including but not limited to, supplies, administration, interpretation of results, and consultation.

JUL.AUG.SEP 2018 |

! S E E T S U R T F O D R A O B A IP U O Y THANK

Outgoing 2017-2018 Trustees IPA would like to thank the outgoing trustees listed below for their dedication and service to the pharmacy profession in Iowa. Their leadership guided the association through several important issues this year and their insight has been invaluable in strengthening pharmacy practice in our state. Rick Knudson, PharmD, BCPS, MS, MBA - Clear Lake Chairman of the Board Steven Martens, PharmD - Grundy Center Speaker of the House Christopher Clayton, PharmD, MBA Manchester Trustee - Region #1 Rachel Digmann, PharmD, BCPS, Ankeny Trustee - Region #3 Jessica Frank, PharmD - Winterset Trustee at Large Nora Stelter, PharmD, CHWC Urbandale Trustee at Large June Johnson, BS, PharmD, FASHP, FCCP, BC-ADM - Johnston Honorary President Meg Finn, CPhT - North Liberty Pharmacy Technician Michael Harvey, Student Pharmacist Drake University Grant Jerkovich, Student Pharmacist University of Iowa

| The Journal of the Iowa Pharmacy Association

Welcome 2018-2019 IPA Board of Trustees

IPA welcomes the incoming Board of Trustee members and thanks them for their willingness to serve the profession this year. The board began their term developing a strategic plan for the association at the board retreat on June 20-21 in Clear Lake. Chairman of the Board Craig Logemann, RPh, BCACP, CDE Ankeny

Trustee - Region #4 Carol Anderson, PharmD Mason City

President Cheryl Clarke, BS Pharm, RPh, FAPhA Waukee

Trustee at Large Bill Baker, BS Pharm Iowa CIty

President-Elect Connie Connolly, RPh, BCACP DeWitt

Trustee at Large Craig Clark, RPh Cedar Rapids

Treasurer Tim Becker, RPh, FACP Mason City

Trustee at Large Deanna McDanel, PharmD, BCPS, BCACP Coralville

Speaker of the House Jim Hoehns, PharmD, FCCP, BCPS Cedar Falls Vice Speaker of the House Ashley Dohrn, PharmD, BCGP Le Claire Trustee - Region #1 Sharon Cashman, RPh Waverly Trustee - Region #2 Jim Mennen, RPh Coralville Trustee - Region #3 Sally Haack, PharmD, BCPS Urbandale

Trustee at Large Heather Ourth, PharmD, BCPS, BCGP Ackworth Honorary President John Rovers, PharmD, MIPH Des Moines Pharmacy Technician Jessica Burge, CPhT Des Moines Student Pharmacist Representative Bridget Tunink Drake University Student Pharmacist Representative Austin Miller University of Iowa

PIE-PAC

THANK YOU! SPONSORS

Smith Drug Company Wellmark NACDS Hy-Vee NuCara Kowa Pharmaceuticals Drake University College of Pharmacy & Health Sciences University of Iowa College of Pharmacy SafeNetRx Onnen Company

EXHIBITORS

For the second year, the Iowa Pharmacy Political Action Committee (IPPAC) held its Pie in the Face fundraiser at Annual Meeting. Attendees voted via donation for who — Kate Gainer, Craig Logemann, Steven Martens, or Anthony Pudlo — would receive a pie in the face at conclusion of the House of Delegates session on Saturday. Martens “won” and graciously received his prize shortly after concluding his term as IPA Speaker of the House. Bob Greenwood was the lucky one chosen to deliver the sweet taste of victory to Martens. Over $2,700 was raised for the IPPAC, which supports IPA’s advocacy efforts by strengthening relationships with state legislators.

2017-2018 ANNUAL REPORT See the events, achievements and people that made 20172018 a great year at IPA!

Available online at

www.iarx.org/AnnualReport

AbbVie Women’s Health Team Astellas Pharma U.S., Inc Athenex Cardinal Health CSL Behring Fagron Sterile Services/JCB Laboratories Gilead Sciences H.D. Smith Healthcare Infection Control Solutions Iowa Board of Pharmacy & IMP3 Iowa Department of Public Health IPPAC IPA Foundation Janssen Pharmaceuticals Kowa Pharmaceuticals McKesson Novartis Pharmaceuticals Inc Novo Nordisk Diabetes Nutri-Dyn Omnicell Onnen Company Pfizer Pharmacists Mutual Insurance Company PharmServ Staffing Prescribe Right LLC Prescribe Wellness QS/1 SafeNet Rx Sanofi Smith Drug Company Sterling 340B Wockhardt USA LLC

SUPPORT FOR STUDENT ATTENDANCE Bruce Alexander Timothy Becker Mickey Cooper Robert Greenwood

Dennis Jorgensen Kristin Meyer Gary Milavetz

JUL.AUG.SEP 2018 |

2018 ANNUAL MEE TING APP PERSPECTIVE

Now that you’ve seen IPA’s recap of the 2018 IPA Annual Meeting, see the event through the eyes, or devices, of those who attended.

| The Journal of the Iowa Pharmacy Association

Thursday, June 20, 2019

SAVE THE DATE! 2019 IPA Annual Meeting

June 20-21, 2019

8:00-9:00 am

Registration/Breakfast

9:00-Noon

House of Delegates Session 1

12:30-1:30 pm

Lunch & Motivational Keynote

1:30-3:00 pm

Policy Committee on Professional Affairs

2:00-3:30 pm

Project Presentations

3:00-4:30 pm

Policy Committee on Public Affairs

5:00-6:00 pm

President’s Reception

6:00-8:00 pm

Annual Banquet

8:00-10:00 pm

Silent Auction

Cedar Rapids Marriott

Friday, June 21, 2019 7:00-8:00 am

Fun Run

7:00-8:00 am

Registration

8:00-9:00 am

Keynote - Breakfast

9:00-Noon

Project Presentations

• Engaging programming

Noon-1:00 pm

Lunch Keynote

• Business complete before the weekend!

1:15-3:30 pm

House of Delegates Session 2

3:30 pm

Adjourn

NEW Thursday-Friday Agenda! • New format

Agenda subject to change

JUL.AUG.SEP 2018 |

S D R A W A L A N IO S S E F O R P 2018

BOWL OF HYGEIA Michele Cooper, RPh, of Eagle Grove

ROBERT G. GIBBS DISTINGUISHED PHARMACIST

HONORARY PRESIDENT

William J. Wimmer, JD, of West Des Moines

June Johnson, BS, PharmD, FASHP, FCCP, BC-ADM, of Johnston

DISTUNGUISHED YOUNG PHARMACIST

EXCELLENCE IN INNOVATION

Morgan Herring, PharmD, BCPS, of West Des Moines

Michelle Bottenberg, PharmD, BCPS, of Waukee

Presented by Patrick Wilsbacher and Kim Dornbier of Pharmacists Mutual

HEALTH-SYSTEM PHARMACIST OF THE YEAR

Christopher Clayton, PharmD, MBA, of Manchester | The Journal of the Iowa Pharmacy Association

PATIENT CARE PARTNER Northeast Iowa Family Practice Center in Waterloo

PHARMACY TECHNICIAN OF THE YEAR Amanda West, CPhT, of Conrad

IPA takes great pride in recognizing individuals for their contributions of leadership, patient care, professional involvement and public service. The following awards were presented during the 2018 IPA Annual Meeting.

KARBELING LEADERSHIP AWARD

POSTER PRESENTATION

Michael Harvey, Drake University Grant Jerkovich, University of Iowa

“Pharmacist Led Medicare Annual Wellness Visits at a Family Medicine Clinic”

Presented by the IPA Foundation

Sara Wiedenfeld, PharmD, BCPS Presented by the IPA Foundation

APPRECIATION AWARD - INDIVIDUAL Thomas Evans, MD, FAAFP, of Des Moines

50 YEAR PHARMACISTS David Batman, Oskaloosa; Joseph Thompson, Urbandale; Jerry Donlon, Decorah; Gregory Hoyman, Emmetsburg; Susan Lutz, Altoona; Arden Jasper, Sioux City; Hazel Seaba, Iowa City; Galen McKee, Kahoka, MO; Ronald Mahrenholz, Panora; Leman Olson, Mason City; Joel Shields, Newton

APPRECIATION AWARD - CORPORATE Novo Nordisk Received by Mike Frey

Not Pictured: Dennis Albers, Plymouth, MA; Robert Bortz, Cedar Rapids; Jack Bosker, Jr., Beaufort, SC; Wayne Carlson, Jr., Afton; Larry Coppage, Burlington; Dwayne Dvoracek, Salisbury, NC; Frederick Frankenfeld, Tucson, AZ; William Haigh, Iowa City; Clifford Hart, Peosta; Calvin Kimura, Corpus Christi, TX; David Koch, Marquette, MI; Leon Kohlhoff, El Paso, TX; James Ludden, Grinnell; Roger Miller, Lincoln, NE; Curtis Olthoff, Iowa City; Wendell Riley, Spirit Lake; Dean Sieperda, Naples, FL JUL.AUG.SEP 2018 |

HEALTHCARE HOT TOPICS

OptumRx Creates New MTM Portal Optum has launched the OptumRx Medication Therapy Management Program (MTMP) platform. Like other MTM programs, the intent is to align with CMS requirements which are focused to improve outcomes for Medicare Part D patients. OptumRx beneficiaries qualify for MTMP if they have high drug expenditure, are taking multiple medications, and have one or more chronic conditions (such as diabetes, COPD, and high blood pressure). Optum’s goal for the MTMP is to improve their consumers’ health.

FDA Approves New Anticoagulant Reversal Agent

The Optum Rx Clinical Portal is called MedMonitor and helps pharmacists queue up consultations, record patient notes, and track progress. The hope is to help pharmacists provide better quality-based care with payment. For more information, visit OptumRx’s healthcare professional portal which has more information on MedMonitor and how to take advantage of this program in your practice.

The FDA approved the recombinant modified human Factor Xa protein AndexxaTM (andexant alfa) under the FDA accelerated pathway in May 2018. This medication is approved for the reversal of life-threatening or uncontrolled bleeding caused by apixaban or rivaroxaban. Approval of Andexxa was based on two Phase 3 studies (ANNEXA-R and ANNEXA-A) both of which showed quick and significant reversal of anti-Factor Xa after administration of the drug. Andexxa will hit the market for early release in June 2018, and a larger commercial launch is predicted for 2019.

FDA Approves First Ever Cannabidiol Drug

CMS Increases Drug Pricing Transparency

On June 25, 2018, the FDA approved the first ever cannabidiol drug, Epidiolex. This drug is approved for treatment of two seizure disorders, Lennox-Gastaut syndrome and Dravet syndrome, in patients 2 years of age and older. FDA commissioner Scott Gottlieb, MD announced that this approval is based on the rigorous standards and programs of medical marijuana research supported by the FDA for many years. This drug approval paves the way for more medical marijuana research and use, but he clarifies that “this is not an approval of marijuana or all of its components. This is the approval of one specific CBD [cannabidiol] medication for a specific use.” Epidiolex is unique in that it is derived naturally from

marijuana so it’s not synthetic like other drugs, such as dronabinol. It contains no THC, the psychoactive component in marijuana, but it does have drug interactions with medications like warfarin, fluoxetine, carbamezapine, and various antivirals and antibiotics.

| The Journal of the Iowa Pharmacy Association

CMS redesigned its Drug Spending Dashboards to include “year-over-year information” highlighting when drug manufacturers increased their pricing. The new dashboard is an interactive online tool that reports the percentage change in spending on drugs per dosage unit. The dashboard also includes an expanded list of drugs to view. CMS will also increase transparency by updating their Part D Public Use File, which will summarize information on more than one million health care providers who prescribed drugs under Part D in 2016.

Arkansas PBM Law Ruled Preempted by ERISA On June 11, the U.S Court of Appeals for the 8th Circuit deemed the 2015 Arkansas PBM Act 900 to be preempted by ERISA

and Medicare Part D. This Act was intended to increase minimum acquisition cost transparency and ensure fair reimbursement to pharmacies. Pharmacy Benefit Managers and the Pharmaceutical Care Management Association claimed this would increase drug costs and reduce patient access and filed a lawsuit which led to the repeal. This is similar to the course of Iowa H.F 2297 which was passed in 2014 and repealed in 2017 after being deemed unconstitutional in its actions towards PBMs.

Updated Guidelines for C. difficile Updated guidelines for clostridium difficile were released early 2018 by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). With these updates, metronidazole is no longer recommended as an initial treatment option in adult patients but can still be utilized initially for non-severe infections in children. Initial treatment in adults is recommended as vancomycin 125mg four times daily or fidaxomicin 200mg twice daily for 10 days. Fulminant infections should be treated with Vancomycin 500mg four times daily +/metronidazole. Additionally, isolation of the infected patient and proper healthcare staff precautions are prioritized.

CMS Combats Opioid Crisis On June 11, 2018, CMS released guidance to states on designing practices to combat the opioid crisis. This guidance includes state specific information, and it ensures that states know what resources are available to counteract the opioid epidemic. CMS also issued a letter on how states can use federal funding to enhance Medicaid technology related to the prevention and treatment of adverse opioid outcomes. This guidance further builds on the commitment that CMS has to provide states with tools within the Medicaid program to fast-track states’ ability to respond to this national

HEALTHCARE HOT TOPICS

crisis and compliments a State Medical Director Letter, “Strategies to Address the Opioid Epidemic”. A new change is that states do not need to be participating in a section 1115 Substance Use Disorder demonstration project to take advantage of the additional funding.

to reduce medication burden and increase adherence rates. Additionally, generic formulations of Suboxone (buprenorphine sublingual film) should be coming to the market in the near future.

New Options in the Treatment of Opioid Use Disorder

During remarks on May 22, 2018 at the Alliance for Regenerative Medicine’s Annual Board Meeting, Food and Drug Administration (FDA) Commissioner Scott Gottlieb announced that the FDA plans to fast track “certain gene therapy products”. Also, the “FDA intends to release a suite of draft guidance documents articulating its framework for the manufacturing and clinical development of gene therapy products.”

Sublocade (Buprenorphine extendedrelease) by Indivior is the first oncemonthly injectable buprenorphine formulation. It was approved in November 2017 for the treatment of moderate to severe opioid use disorder (OUD) in patients who have initiated treatment with a transmucosal buprenorphine-containing product. Sublocade shows great potential

Commissioner Gottlieb: FDA to Fast Track Gene Therapy

This would shift focus to product issues versus the clinical focus in traditional drug review. It also represents a shift from using surrogate markers versus outcomes for drug approval, “It gives FDA the opportunity to approve very promising products earlier in the development process, based on a surrogate measure that’s reasonably likely to predict clinical benefit…. The first therapeutic area we’ll focus on is hemophilia, where factor production may be sufficient in some cases as a surrogate measure of benefit where a gene therapy product can potentially normalize factor production.” ■

JUL.AUG.SEP 2018 |

FEATURE

LEADING OUTSIDE THE PHARMACY:

HEALTH & PROFESSION BOARDS Iowa has no shortage of pharmacy practice leaders. It’s baked into our cultural DNA and attracts leaders to practice and students to enroll and excel in our two colleges of pharmacy. Those leadership skills and abilities are vital to a thriving pharmacy practice, but they are also vital to a thriving community in which to practice. This series of articles will look at how pharmacists are utilizing their skills and abilities to be leaders in their communities. You will read about pharmacists who have pursued outside interests and passions to meet the needs of their community beyond the pharmacy. In addition to the personal satisfaction and positive impact on the community, it’s an opportunity to showcase the professionalism and compassion of pharmacists. Active involvement in the community elevates the profile of the profession, shifting the public’s perception to a contemporary view as a vital and accessible resource for the community’s health and well-being.

s we all know, every good healthcare team needs the expertise of a pharmacist. Health and profession boards are a healthcare team of sorts, serving the interests of the “patient” – the citizens under their leadership and care. These boards govern how health care is practiced and ensure the safety and well-being of the public. They come in all shapes and sizes and are a prime opportunity for pharmacy professionals to showcase their leadership skills and expertise. Health profession boards, like the Iowa Board of Pharmacy, ensures safe professional practices and represents the public interests. These boards oversee professional licensing, address complaints, and adopt rules for their respective professions. In Iowa, members of health profession boards are appointed by the governor for a three-year term and can serve a maximum of three terms. Public health boards oversee their local public health departments and are charged with meeting their community’s health and wellness needs. These boards consist of local medical professionals who provide leadership and guide policy development, education, access to care, and anything else required to improve the health of the community. It’s easy to see the need for pharmacists to serve on any board or entity concerned with the public’s health and wellbeing. Connie Connolly, RPh, BCACP,

| The Journal of the Iowa Pharmacy Association

experienced this first hand when she served on the Iowa Board of Optometry as a public member. “The optometrists on the board were very gracious and actively sought my opinion when we had cases involving medication prescribing or use,” she explains. Connolly, who practices at Osterhaus Pharmacy in Maquoketa, Iowa, served on the optometry board for the maximum of nine years.

“The optometrists on the board were very gracious and actively sought my opinion when we had cases involving medication prescribing or use.” Connie Connolly

Pharmacy’s own professional board, by definition, needs the expertise of pharmacists, and now technicians, as it sets the regulatory path for the profession. Gayle Mayer, RPh, BS Pharm, from Spirit Lake, Iowa, feels that her depth of experience in hospital, community, and education settings bring value to the Iowa Board of Pharmacy. She is serving her first term on the board after being appointed by Gov. Terry Branstad in 2017. With the changes coming to the profession, Mayer says, “we need to be sure we can adapt our roles to provide the

FEATURE

fantastic pharmaceutical services that we currently supply and want to continue to supply and expand.” That expansion means involvement into public health and working together with other community providers and stakeholders to meet local healthcare needs. Terry Jacobsen, RPh, from Osceola, found some of his county’s board of public health goals mirrored activities that pharmacy profession was doing or eager to do. Jacobsen is serving on the Clarke County Board of Health and has led the board in coordinating diabetes care initiatives in the county. Michael Wolnerman, RPh, CCIM, a senior sales executive at ReMyHealth, chairs the Iowa State Board of Health and has found his experience as a pharmacist has been beneficial for the policymaking body of the Iowa Department of Public Health. His background has been significantly helpful during discussions on public health issues, especially on opioids, cannabidiol, and medication assisted treatment programs. “Pharmacists are absolutely knowledgeable in various areas and can certainly be beneficial to the citizens,” says Wolnerman.

“Pharmacists have a pretty broad view of most of the health care system and of so many diseases, situations, etc., that patients may be exposed to.” Gayle Mayer

As the most accessible member of the healthcare team, pharmacy professionals have a unique connection to the patient experience that other medical professions don’t. As Mayer explained, “Pharmacists

have a pretty broad view of most of the health care system and of so many diseases, situations, etc., that patients may be exposed to.”

“It doesn’t cease to amaze me how important it is to stay open to possibilities and other viewpoints.” Michael Wolnerman

Yes, pharmacy professionals have much to contribute to these boards, but, as those who have served in this capacity have discovered, serving has also contributed much to them as a pharmacy professional. Wolnerman credits his fellow board members with providing him with viewpoints that he would have not seen otherwise. “It doesn’t cease to amaze me how important it is to stay open to possibilities and others viewpoints,” he added. Connelly found it “eye opening” to see the type of complaints that the public brought before the optometry board and learn what she could and couldn’t do while serving in that capacity. Understanding what these types of boards do and the challenges that professions they represent experience opens the door to collaboration and elevating the profession. From a broader perspective, having pharmacists serve in leadership positions alongside fellow healthcare professionals provides exposure and elevates the perception of the pharmacy profession. The board can serve as a platform to educate other professionals – optometrists, physicians, etc. – on the role of pharmacists. Those professionals can see the value of having a pharmacist on the healthcare team first hand, if they haven’t experienced it yet.

Serving in a collaborative capacity like a board can be a catalyst for additional collaboration outside of the boardroom. Jacobsen values being able to see what is going on health-wise in his community. He was able to translate his interest and experience in diabetes care into an opportunity to expand the role of pharmacists in his community. Each of the pharmacists mentioned had different motivations and paths to their board appointments. One common thread, however, was that each of them made their professional interests and willingness to serve known to colleagues or their state representation. Connolly heard about the optometry board opportunity from Jerry Karbeling. Jacobsen put his name in after hearing about the board of health opportunity from a colleague. To find your path to serving on a board, or in any capacity, Mayer recommends just getting involved - attending meetings, providing a presence in your local community, or mentoring. Building a network and connecting with colleagues in other health professions is always important. Wolnerman suggests finding local or state board opportunities, which can usually be found within the county or state public health department. “I started with the Hearing Aid Dispensers Board because my Mom wore hearing aids my whole life and there are great dispensers and some not so great,” he explains. As healthcare continues to move to value-based care, it will be important for pharmacy professionals to take a leadership role and continue to integrate themselves into the patient care team. Providing leadership by serving on a health or profession board is one way to do it. ■

JUL.AUG.SEP 2018 |

IOWA PHARMACY NEWS

IPA Welcomes Kellie Staiert as Lead Project Manager

On May 16, Kellie Staiert joined the IPA staff as lead project manager. Kellie will lead the planning, application, oversight, administration and reporting of several IPA professional initiatives, including grant projects. She will work closely with IPA members as well as external partners to ensure all aspects of each project align with IPA’s strategic plan and vision. Kellie has a background in health and wellness project management and brings those skills to IPA members across all practice settings. One of Kellie’s initial projects will be a public health initiative that uses pharmacists to screen, test, and refer patients for HIV infections.

IPA Welcomes Matthew Pitlick as Executive Fellow

IPA welcomes Matthew Pitlick, PharmD, BCPS, as the association’s 20182019 executive fellow. As the IPA fellow, he will be immersed in the dayto-day activities of the association and work closely with IPA staff to continue advancing IPA’s mission. He will work to expand IPA’s clinical initiatives, attend state and national pharmacy meetings, gain exposure to all aspects of association work, and provide insight and assistance to the association. He will start with IPA on July 2, 2018. Pitlick is a 2008 graduate of the Drake University College of Pharmacy and Health Sciences and completed a PGY1 residency at the VA St. Louis Health Care System. Following his residency, he continued to practice at the VA in St. Louis from 2009-2015 and taught at the St. Louis College of Pharmacy as an assistant professor of pharmacy practice from 2009-2015 and as an associate professor of pharmacy practice from 2015-2017. He returned to Des Moines in July of 2017, working for Case Haub Consulting. Pitlick has a passion for connecting mentoring, coaching and guiding student pharmacists, pharmacy residents, and new pharmacists, as evidenced in his

| The Journal of the Iowa Pharmacy Association

teaching background and his time as residency preceptor. He brings a wealth of clinical experience from his time with the VA, including transitions of care, medication reconciliation, informatics and leading the ambulatory care clinical pharmacist team.

patients and the public as an important tool to combat opioid-related deaths. The event highlighted the availability of naloxone at pharmacies as many local news outlets picked up the story of their local pharmacies’ participation.

The IPA Executive Fellowship in Association Management was created to support the development of individuals interested in association management through training and experience in leadership, advocacy, professional affairs and problem-solving at IPA. Individuals who complete the fellowship will be well prepared for leadership positions in a variety of settings in the profession of pharmacy and health care. The fellowship is supported by IPA the IPA Foundation.

The Iowa Community Pharmacy Enhanced Service Network (CPESN) announced in June the hire of long-time community pharmacist Lindsey Ludwig (formerly Stephens) as executive director. This position is being funded by PrescribeWellness, a leading cloudbased patient relationship management solutions company that inspires collaboration between pharmacies, payers, providers, pharmaceutical companies, and their patients to achieve better health.

Iowa Sees Record Take Back Day

The Iowa Governor’s Office of Drug Control Policy (ODCP) announced that a record amount of unwanted and expired medications were collected during the DEA’s National Prescription Drug TakeBack Day on April 28. A total 12,333 pounds of medication was collected by 115 drop off locations across the state. The previous record was 11,710 pounds collected during the spring 2017 event. A new national record was set as well with 949,046 pounds collected. This was the 15th National Prescription Drug Take-Back Day since 2010. In Iowa, over 56 tons of medication have been collected during these events.

Iowa Pharmacies Give Away 2000 Kits During Narcan Access Day

On June 29, 2018, Iowa pharmacies handed out 2,000 free Narcan kits as part of Narcan Access Day. The event was a collaboration between the Iowa Department of Public Health, Iowa Pharmacy Association, and Iowa Board of Pharmacy in order to remove one of the barriers for patients to access this life-saving medication – the cost. The 350 participating pharmacies were encouraged to hand out the kits to patients who could not afford it otherwise. Narcan Access Day provided an opportunity to discuss naloxone with

CPESN Iowa Hires Exec. Director

In her new role, Ludwig will be responsible for expanding and supporting the performance of the network of 90 pharmacies in Iowa that offer important enhanced and preventive care services. She will also work to identify opportunities for these pharmacies to contract with payers and providers so they can be compensated for the valuable work they do and the outcomes they achieve. Ludwig’s decades-long career in pharmacy has been focused on elevating the role of the community pharmacist. While in college she started an osteoporosis screening company that expanded to offer other health screening and wellness programs for individuals and companies desiring prevention services. She served as director of best practices for Medicap Pharmacies, Inc., and Medicine Shoppe International (both Cardinal Health companies) expanding the services offered at their franchise locations. She also owned and operated a Medicap Pharmacy franchise and most recently has been working with Medicap LTC to expand pharmacy services into long-term care and assisted living facilities. She has long understood that enhanced services are both an important differentiator from the competition and an asset to the community. ■

IOWA PHARMACY NEWS

REFLECTIONS FROM IPA’S 2017-2018 EXECUTIVE FELLOW

t has been an absolute honor and pleasure to serve as the 2017-2018 IPA Executive Fellow. Coming to Iowa from New York and North Carolina, I was attracted to this position due to IPA’s recognition as a pioneer in pharmacy practice, advocacy, and innovation. And while this fellowship program certainly held true to this national reputation, I could have never expected to experience what I believe sets Iowa pharmacy apart more than anything: the Iowa pharmacy family. After spending a year with IPA, I wholeheartedly believe that this culture is at the foundation of what makes Iowa standout as a national leader in the profession. Thank you so much for adopting me into the Iowa pharmacy family this past year. It has been rewarding and humbling to spend this fellowship working alongside some of the most innovative and passionate pharmacy professionals. I have learned so much from the IPA members that I’ve worked with and enjoyed learning more about the pharmacy profession through each of your stories; I am

incredibly thankful for the relationships I’ve built this past year. I would also like to express my gratitude to Anthony Pudlo and Kate Gainer for being wonderful preceptors. First and foremost, thank you for implementing this unique fellowship program to help pharmacists develop the tools to be leaders in the profession. Thank you for your mentorship, for involving me in many impactful projects, and creating a program that is comprised of various aspects of the pharmacy profession and association management. To the entire IPA staff, thank you for always making me feel like part of the team. Between membership events and high ropes courses, and everything in between, I have really enjoyed working with each of you. To the 2017-2018 and 2018-2019 IPA Board of Trustees members, I have appreciated the opportunity to connect with you at the retreats, events, and meetings. Thank you for your dedication to IPA, but also for

Shannon Rudolph, PharmD 2017-2018 IPA Executive Fellow

sharing your insight and guidance with me this past year. At the conclusion of this fellowship, I will be moving to Sioux Falls, SD and have accepted a pharmacy manager position with Genoa Healthcare in Marshall, MN. This pharmacy is embedded in the Western Mental Health Center and is part of a network of pharmacies that primarily serve the behavioral health needs of individuals. I am looking forward to working in an environment that fosters coordination of care and collaboration with other providers to help optimize patient outcomes. My experiences with IPA, especially becoming certified as an instructor for Mental Health First Aid, will help me be successful in this new role. ■

Your Guide to the Iowa MPJE Everything that graduates and new-to-Iowa pharmacists need to prepare for the Iowa Multistate Pharmacy Jurisprudence Examination, including: •

Information on how to register for the exam

•

Questions in a table format to fill in your answers

•

Answers to each question with references to information in Iowa code and administrative code

•

Terminology section of key terms to know

IPA members enjoy a substantial discount!

Order & Download Yours TODAY at

www.iarx.org/MPJEStudyGuide

JUL.AUG.SEP 2018 |

PRACTICE ADVANCEMENT

State Innovation Model Community Care Coalition Initiative Grantees Lyon

Osceola

Dickinson

Sioux

O’Brien

Clay

Cherokee

Buena Vista

Plymouth

Woodbury

Monona

Crawford

Harrison

Shelby

Pottawattamie

Palo Alto

Kossuth Hancock

Poca- Humboldt Wright hontas

Howard

Floyd

Chickasaw

Franklin

Butler

Bremer

Grundy

Black Hawk

Carroll

AuduGuthrie bon

Cass

Boone

Greene

Adair

Mills

Montgomery

Adams

Fremont

Page

Taylor

Dallas

Polk

Winneshiek

Allamakee

Fayette

Clayton

Buchanan Delaware Dubuque

Marshall

Tama

Benton

Jasper

Powe shiek

Iowa

Jones

Linn

Jackson Clinton

Johnson

Cedar Scott Muscatine

Madison

Union

Story

Warren

Clarke

Ringgold Decatur

Marion Mahaska

Lucas Wayne

Keokuk

Washington

Monroe Wapello Jefferson Appanoose

Davis

Van Buren

Louisa

Henry Des Moines Lee

1. Community Partners of Sioux County

4. Linn County Board of Health

2. Dallas County Public Health Nursing Services

5. Marion County Public Health Department

3. Great River Health Center

6. Webster County Health Department

IPA Partners with Iowa Healthcare Collaborative on SIM

IPA is excited to announce that we will be continuing our work with the Iowa Healthcare Collaborative (IHC) during year 4 of an initiative known as the State Innovation Model (SIM). IHC was awarded this federal grant and has identified IPA as an important partner to help foster local relationships between pharmacists and other providers in Iowa communities. They are especially focused on the regions depicted above. Pharmacists are uniquely trained as the experts in medication management. By integrating pharmacists into communitybased, healthcare initiatives, patients will have a deeper understanding of their medications from both an effectiveness and safety standpoint. Pharmacists collaborate with other healthcare providers and community members to facilitate care coordination, aid in practice transformation, avoid medication-related readmissions, and reduce barriers to medication access.

HIIN Learning Community

On Tuesday May 9, IPA attended the Iowa Healthcare Collaborative’s (IHC) Compass Hospital Improvement Innovation Network (HIIN) Learning Community meeting. This learning community assists hospitals in growing their network and provides them with improvement initiatives in order to

Mitchell

Cerro Gordo

Calhoun Webster Hamilton Hardin

Sac

Ida

Emmet

WinnebaWorth go

| The Journal of the Iowa Pharmacy Association

carry out the national Partnership for Patients goals. These goals are focused on reducing hospital readmissions and decreasing inpatient hypoglycemia, supratherapeutic INRs, and other hospital-acquired conditions. Jennifer Brockman, IHC’s director of hospital services division, started the day with a challenge to be mindful on how to cultivate advocacy and leading change agents in your practice setting in order to develop and implement new patient-centered care strategies and improve safety in your practice site. The day was followed by many topics which included: healthcare-acquired skin injury prevention, knowledge networking between practice settings, techniques to engage your hospital board to drive change, care coordination with public health and pushing sites to leave in action. All pharmacists and healthcare providers are welcomed and encouraged to attend. Please watch IPA communications for information on future events.

Iowa Antimicrobial Stewardship Program Summit

On Tuesday, April 17, over 250 attendees gathered at the Community Choice Credit Union Convention Center in Des Moines for the Iowa Antimicrobial Stewardship Program Summit. The day-long educational programming was hosted jointly by the Iowa Hospital

Association (IHA) and IPA, and nearly 100 pharmacists were in attendance. Dr. James Keegan, MD, kickstarted the morning with an introduction to antimicrobial stewardship programs (ASPs) and how they promote patient safety within the healthcare system. This topic was expounded upon by Nancy Wilde of the Iowa Department of Public Health who addressed the prominence of antibiotic resistance nationwide and the concurrent presence of ASPs in Iowa. The breakout sessions that followed were provided by healthcare providers from various specialties of practice, including Iowa pharmacists Brian Hoff, PharmD, Mike Brownlee, PharmD, Lynn Hanish, RPh, Amanda Bushman, PharmD, Lance Fischer, PharmD, and Jeff Brock, PharmD. Each created a greater understanding of the development and implementation of ASPs while also focusing on the resulting benefits to patient care and overall health costs. Attendees were provided with Iowa’s ASP Toolkit, a packet of information that aids

Download the Iowa Antimicrobial Stewardship Program Toolkit IPA collaborated with the Iowa Hospital Association to create the Iowa Antimicrobial Stewardship Program (ASP) Toolkit. for healthcare professionals to build a business case for the stewardship program and a strategic plan for the program to continue to meet institution goals and milestones. The toolkit begins with a current assessment for the medical institution and includes documents that help identify key stakeholders in the ASP, interventions for the program, barriers to its success, and return on investment. Download the toolkit at www.iarx.org/ antimicrobialstewardship.

PRACTICE ADVANCEMENT

in both creating and sustaining an ASP. This packet of information uses easy-tofollow processes and charts to stimulate program progression. The toolkit can be downloaded from IPA’s website.

Pharmacists IMPACTing Immunization Rates

Throughout 2018, fifteen communitybased pharmacies across Iowa have partnered with IPA and the APhAFoundation to successfully complete Project: IMPACT Immunizations. The pharmacies involved have been using a platform that communicates bi-directionally with IRIS, the state immunization registry, to help pharmacists effectively and efficiently screen for gaps in immunizations. Over the project period, pharmacists documented (1) number of unmet vaccination needs, (2) number of vaccines that were administered at the time of assessment, and (3) any follow-up needs to re-assess immunization needs at a later date. While the results are not yet published, the data looks positive as it demonstrates the impact pharmacists can have on improving immunization rates all year-round (and not solely during the “flu shot” season). Pharmacies involved have attested that this project has helped them make sustainable changes to their workflow to proactively assess patients’ immunization needs. This project concluded in June 2018, but IPA is looking to partner with the APhA Foundation on a similar initiative in the upcoming year.

IPA; IDPH; Merck Partner to Offer Journey for Control Trainings

In collaboration with the Iowa Department of Public Health (IDPH) and their CDC 1305 grant, IPA will partner with Merck to offer the Journey for Control trainings on utilization of Conversation Maps to educate patients about diabetes self-care and management. Journey for Control’s U.S. Diabetes Conversation Maps is an interactive teaching tool that helps promote freeflowing dialogue between a healthcare

professional and a group of patients with diabetes, and helps fulfill the education requirement as an American Diabetes Association (ADA) recognized site for diabetes self-management education and training (DSME/T). Within the CDC’s 1305 grant, there is an organized effort to have pharmacists be more integrated in providing diabetes education, especially the components focused on diabetes medications. With these trainings, IPA hopes to see more pharmacists assist with their hospital’s DSME/T program or initiate a DMSE/T program within their pharmacy. The 3-hour Journey for Control trainings are limited to 50 individuals. The trainings have been scheduled for October 11 in Iowa City and October 25 in Des Moines. Watch for IPA communications on how to register for a training!

HIV/ Hepatitis C Pharmacy-Based Testing Initiative

Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. Delayed HIV diagnoses continue to be substantial for some population groups and prevent early entry to care to improve health outcomes and reduce HIV transmission to others. Those providing HIV testing can decrease diagnosis delays by implementing routine and targeted HIV testing. Pharmacists have unparalleled access to people in communities across the country and are well-positioned to be part of the solution. As seen in other areas of the country (e.g, Virginia), pharmacists have been able to successfully increase access and improve quality of care for this patient population. In collaboration with the Iowa Department of Public Health, IPA is partnering with community-based pharmacies to implement a scaled demonstration project across the state of Iowa with an initial focus on HIV testing with plans to add Hepatitis C testing in

subsequent years. An initial cohort of ten community-based pharmacies will be selected to participate based on the statistical data from the Iowa Department of Public Health. Based on this data, areas of focus include the surrounding areas of Fort Dodge and Waterloo, as well as the south-central area of the state. By the end of year one, IPA expects to add thirty additional sites. Pharmacies will receive a grant to help offset the costs of implementing the project. Throughout the initiative, IPA will seek to identify the barriers and successes of providing routine preventive screening services in community-based pharmacies across Iowa. IPA will seek to develop a framework for best practices to share with all community-based pharmacies across Iowa to help close the gap for linkage to care. ■ To participate in the project or to learn more, please contact Kellie Staiert, lead project manager at kstaiert@iarx.org.

GET THE INFORMATION YOU NEED, WHEN YOU NEED IT! The Iowa Health Information Network (IHIN) is a safe and secure system to give you access to your patient’s vital medical information, when and where it is needed most. The IHIN is the official statewide health information exchange (HIE) for the state of Iowa. IHIN aims to improve care, increase security, promote cost savings, streamline treatment and reduce medical errors through the secure exchange of electronic health information. This platform “Gives care for your patients even when you aren’t there”. IHIN allows hospitals and clinics to share patient health records securely and professionally with other IHIN Network Providers, giving them fast access to vital health information when it’s needed the most. To enroll in IHIN and to learn more, please visit www.ihin.org.

JUL.AUG.SEP 2018 |

RENEW YOUR MEMBERSHIP!

Renew your membership today and continue to receive important professional benefits like FREE relicensure or recertification CE in addition to maintaining a strong, unified voice to advocate for your profession. THANK YOU for your continued support of the Iowa Pharmacy Association

ADVANTAGES FOR YOU ADVOCACY FOR YOUR PROFESSION

of membership dues directly fund initiatives that advance the pharmacy profession

ADVANCEMENT FOR YOUR PRACTICE

RENEW TODAY AT

WWW.IARX.ORG Current memberships expire on December 31, 2018

Stop Getting Renewal Notices - Choose Auto Renewal! Pharmacists and Business Partner members can setup yearly or monthly automatic renewal for your IPA membership. Itâ&#x20AC;&#x2122;s the hassle-free way to ensure you continue to receive your membership benefits without interruption each year! Download and complete the form at www.iarx.org/join_renew Contact IPA if you have any questions at 515-270-0713.

PRACTICE ADVANCEMENT

NEW PRACTICE ADVANCEMENT FORUM PACKS MORE INNOVATION IPAâ&#x20AC;&#x2122;s Practice Advancement Forum was held on June 7, 2018, in Des Moines, Iowa, and featured a revamped agenda to squeeze in even more Iowa-based pharmacy practice advancements. Ninety pharmacists, technicians, and student pharmacists attended and were treated to an expansive slate of presentations and topics from a broad spectrum of practice settings and patient care initiatives. The forum was highlighted by two keynotes focused on the latest developments in diabetic care. For the first, Erin Newkirk, PharmD, from Froedtert and The Medical College of Wisconsin, presented on the advances in Continuous Glucose Monitoring (CGM) technology and how it can help patients manage their diabetes better. The second keynote speaker was Jon Knezevich, PharmD, BCPS, from Nebraska Medicine, who discussed opportunities for pharmacists to enhance patient care and improve related institutional glycemic outcome measures through diabetes stewardship programs. The rest of the day included three breakout sessions which each featured three tracks covering a different theme. Each of those tracks featured a 10-minute clinical pearl followed by focused presentations from Iowa pharmacy residents on their innovative research projects. Topics included transitions of care, medication management services, antimicrobial stewardship, and behavioral health. With the success of this yearâ&#x20AC;&#x2122;s forum, the format will be integrated into the revamped 2019 IPA Annual Meeting agenda. JUL.AUG.SEP 2018 |

STUDENT LOAN REFINANCING

Pay off student debt sooner. Save thousands. IPA and SoFi have teamed up to help you take down student debt—with student loan benefits, exclusively for IPA members, family and friends.

Why refinance student loans with SoFi?

Refinance student loans or Parent PLUS loans at sofi.com/IPA to receive a $1001 welcome bonus.

Serious savings.

Low rates.

Federal and private.

No extra fees.

Membership perks.

Members save

Low variable and fixed

You can consolidate and

No application/origination

Exclusive networking

thousands when they

rate options may reduce

refinance both federal and

fees or prepayment

events, financial

refinance.

your interest rate.

private loans.

penalties—ever.

workshops, and more.

How to apply: 1

Find your rate at sofi.com/XXX.

If approved, select your rate and term.

Upload identity, income, and loan information.

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

Celebrate your savings.

STUDENT COLUMN

STUDENT PHARMACIST PERSPECTIVE

REFLECTIONS FROM SERVING ON THE IPA BOARD

ast month at the IPA Annual Meeting, I was asked what impact serving on the IPA Board of Trustees will have on my career as a pharmacist. Given that I am not quite a pharmacist, the answer to that question is obviously yet to be determined. Serving on the board this past year has taught me so much about this profession. I was able to see pharmacists from a variety of backgrounds come together to address numerous challenges that are facing pharmacy and healthcare while ensuring that IPA stays at the leading edge of innovation within the profession. Did we solve all of the problems with pharmacy and healthcare in Iowa and the United States during our board meetings? No, but if these problems were going to be solved over a couple eight-hour meetings, we had the right people in the room to do it. My journey on the board started on July 13, 2017, at the IPA board retreat, where we discussed IPA’s strategic plan and how to address advocacy, membership engagement, patient safety, collaboration and innovation. These discussions were candid and addressed the many areas where there may be room for improvement but also brainstormed new innovative ideas to tackle longstanding challenges. Time spent on the board also exposed me to the many ways in which pharmacy and politics can be intertwined. Casey Ficek, IPA’s director of public affairs, and Bill Wimmer, IPA’s legal and legislative counsel, kept the board updated

on the association’s legislative priorities but also on the constantly changing environment at the capitol. Serving on the board was a lesson in the importance of understanding local and state politics as much as national politics. The legislative and regulatory opportunities on the state and local level work on a quicker timeline with more ability to adapt to the rapidly changing healthcare industry. Knowing which proposed laws and regulations have the potential to impact our patients and our profession gives pharmacists the ability to help patients as much as counseling them on a new medication would. This responsibility of being an advocate for the patient when it comes to their medication management falls on the pharmacist. Another important lesson learned through experience on the board was to always have an elevator pitch ready to explain what it means to be a pharmacist and what pharmacists can do to help. As pharmacists, we have to be ready to advocate for ourselves and position ourselves to make an impact in the organizations where we work. This means being able to explain how pharmacists add value to healthcare for everyone, from those in the c-suite to a random person on the street. Speaking up and allowing pharmacists to make an impact when appropriate is one way that pharmacists have continued to push forward as a profession. Lastly, one of the most important lessons I learned throughout my year with the board was that we cannot do this alone. IPA places a large emphasis

Michael Harvey 2019 PharmD Candidate Drake University 2017-2018 IPA Board of Trustees

on innovation and collaboration and this was evident throughout my time on the board. The board spent time learning from representatives in all sectors of healthcare. At the monthly meetings IPA staff members shared information about many of the projects being worked on with a variety of organizations such as SafeNetRx, the Iowa Department of Public Health, the Iowa Healthcare Collaborative, the Iowa Medical Society, as well as many national organizations including national healthcare organizations. The collaborations make it possible for universal solutions to be reached. If all of these organizations are trying to address the same problems, we should be working together to achieve a greater impact. Serving as the Drake Student Representative on the IPA Board of Trustees for this past year will have an immeasurable impact on my career. I will go forward after graduation with a deeper understanding of how to be the best advocate for the patients I serve through the political process, I will be ready to articulate the value that pharmacists add to healthcare, and I will be prepared to collaborate with a variety of groups to find solutions to the complex problems facing healthcare. ■

JUL.AUG.SEP 2018 |

CLASS OF 2018

CONGRATULATIONS! Drake University College of Pharmacy and Health Sciences Class of 2018

Mark Adams Tori Adams Kyle Akker Collin Albrecht Jaclyn Aremka Kellie Arensman Natalie Arndt Samantha Austin Jason Babcock Fawad Baig Thomas Bernier Trevor Bridge Christopher Caracci Carley Castelein Robert Cobert Haley Countey Shelby Crane Elise Damman Sarah Dean Catherine DeFino Shelby Derrick Alexa DeVita Rebecca Do Kelley Dunlop Cassandra Effken Dalton Fabian John Farris Grace Fenner Joseph Fink Dayna Finley Scott Foley Nicholas Franz Tyler Goebel Jacquelyn Grimm Ashley Gupta Ryan Hannan

Shanda Harclerode Mitchell Hardie Kay Harper Zoe Harville Courtney Hasemann Christine Heath Lauren Holmes Kyle Hommer Kayla Hughes Devon Jacobs Alexi Johnson Brittany Judkins Megan Kriewald Amy Kukacka Jonathan Kusnierz Michael Labadie Maxwell Lasko Mackenzie Leal Benjamin LeMay Erin Lettow Calia Lewis Josie Lipp Margaret Lundholm Jenna Lundsgaard Michelle Mages Monika Makowiecki Katelyn McDaniel Danielle McMillen Connor Medernach Grayson Meunier Ethan Middleton Shannon Mohr Josephine Montgomery Taylor Naberhaus Cynthia Nediyakalayil Nathan Ngo

Kristina Nikl Kaylin Okuma Abigail Olszewski Emmeline Paintsil Shreeraj Patel Riley Poe Jake Powers Christopher Quenelle Katie Robison Jenna Romich Ellyn Ross Katherine Schlebecker Julianne Schlichting Jacob Schnackenberg Alexis Schrieber Taylor Schwebke Jessica Seadler Kaitlyn Serbin Jena Stallsmith Claire Steinbronn Anne Stella Austin Stremlau Jessica Thelemann Christina Tran Janelle Vircks Stephanie Wensing Adam Wiegmann Alyson Williamson Emma Winstead Katrina Zerwas Maria Zigas Carolyn Zuegner

Photos: Drake University College of Pharmacy and Health Sciences

| The Journal of the Iowa Pharmacy Association

CLASS OF 2018

CONGRATULATIONS! The University of Iowa College of Pharmacy Class of 2018

Samantha Alukas Maxwell Anderegg Emily Anderson Matthew Austin Sohyun Bae Abigail Baker Jessica Beadleston Sarah Bechtel Quinton Behlers Lindsy Benedict Jenna Beninga Brooke Bennett Kiley Boeding Alyssa Breitbach Emily Burger Alexandra Carlson Jenise Carmody Chloe Chabal Emily Dewall John Edge Jade Feller Lorin Fisher Quinton Franklin Joseph Frasher Zachary Garton Jiyeon Han Suzannah Hekel Abbey Hendrickson Emily Henningsen Thao Hoang Katie Horan Kathryn Husemann Cassandra Jenn Joshua Jou Nicholas Kayser Saam Keshavarzi Vilailack Kheuakham

Justin Kilburg Jungwon Kim Woorim Kim Kristin Klarenbeek Jillian Koos Samantha Koranda Margaret Langlois Suzie Lee David Liao Jonathan Lochner Ashley Lorenz Anh Luong Joseph Maigaard Cole McKenzie Chelsea Meade Laurel Meyer Morgan Miller Beth Miskimins Mills Merrill Montgomery Rob Nauman Whitney Jepchumba Ndoigo Landon Neese Adam Neubauer Nguyet Anh Ngo Kyle Nguyen Tyler Nichols Claire North Casey Oâ&#x20AC;&#x2122;Connell Nathan Okioga Kyle Parkin Leann Parks Rachel Parry Christopher Petersen Julia Pfluger Erica Pham Phu Ngoc Pham

Mara Plifka Torrey Puncochar Melanie Reineke Lynn Rich Alecia Rottinghaus Aaron Rusch Joanna Rusch Trevor Saathoff Ethan Sabers Christian Sandoval Casey Schug Eva Serem Krystal Shirrell Jody Siegrist Jaclyn Snyders Sarah Sorensen Amanda Stefl Sarah Sugden James Tabiri Kelly Tauer Lindsi Tillo Sarah Tortora Marisa Trautsch Stephen Vavroch Ashley Vold Leeta Votsmier Zoe Walters Daisy Wang Carly Watertor Claire Weidman Mylo Wells Mackenzie Welsh Angela Wojtczak Rochelle Yang

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

JUL.AUG.SEP 2018 |

2018 LEGISLATIVE SESSION

AN EVENTFUL 2018 LEGISLATIVE SESSION Casey Ficek, JD Director of Public Affairs Iowa Pharmacy Association

he 2018 legislative session proved to be an incredibly successful year for IPA and the profession of pharmacy in Iowa. IPA’s staff and lobbyists addressed a wide range of issues and helped enact several major pieces of legislation.

State Legislative Priorities

Statewide Protocols IPA’s bill, SF 2322, was passed by both chambers and was signed by Gov. Reynolds on May 15. Under this law, the Board of Pharmacy will now be authorized to develop statewide protocols for naloxone, nicotine replacement products, and immunizations. Once the statewide protocol for immunizations takes effect, pharmacists will have independent authority to provide immunizations, meaning a local protocol or a prescription from a physician is no longer required. Other major changes to the immunization law include allowing pharmacists to administer flu vaccines from age six months and above, as well as perform series completion for HPV vaccines to ages 13 and above. Enacting into law a framework for statewide protocols is the culmination of many years of groundwork by IPA

| The Journal of the Iowa Pharmacy Association

IPA’s bill, SF 2322, passes unanimously in the Iowa House.

and our members. This represents a major step forward in recognizing pharmacists as valued members of the healthcare team and will make it easier to add additional statewide protocols for other prescription drugs and services in the future. Technician Product Verification SF 2322 will also allow for technician product verification (TPV) to be implemented in general practice settings, as well as hospital settings in Iowa. The board will be authorized to adopt rules relating to implementation and development of TPV, including requiring a pharmacist in charge intending to implement a TPV program to submit a program plan demonstrating that pharmacist hours will not be reduced.

PMP Changes and E-prescribing IPA supported a major piece of legislation intended to help address the opioid crisis, HF 2377, also known as the comprehensive opioid bill. This bill incorporated much of what was introduced by the Board of Pharmacy relating to the PMP, opioids, and e-prescribing. Some of the highlights of the bill includes: 1) mandatory registration and use of the PMP for prescribers and pharmacists; 2) requiring prescribing practitioners to report controlled substance dispensing to the PMP; 3) mandating electronic prescribing of all prescriptions (both controlled and non-controlled) beginning January 1, 2020. The bill also creates a “good Samaritan law,” creating legal protections for those who report opioid overdoses.

2018 LEGISLATIVE SESSION

State Regulatory Priorities

Medicaid Pharmacy Reimbursement IPA worked with legislators on the Health and Human Services budget bill to maintain the statutorily established pharmacy reimbursement methodology for both Medicaid fee-for-service and managed care for pharmacies at Average Acquisition Cost (AAC) + Cost of Dispensing (COD) for prescription drugs. Due to recent examples of the millions of dollars now unaccounted for in states who gave control over pharmacy reimbursement to the MCOs like Kentucky, West Virginia, and Ohio, it is more important than ever to ensure Iowa’s system remains the same. This was emphasized to lawmakers and state officials throughout the session. Restrictions on PBMs IPA was successful in a late push to ban PBMs from “gag clause” and “clawback”

practices, prohibiting a pharmacist or pharmacy from providing a covered individual information regarding the amount of the covered individual’s cost share for a prescription drug, or from discussing any such information or from selling a more affordable alternative to the covered individual, if one is available (“gag clause”). Furthermore, any health benefit plan who provides coverage for pharmacy benefits shall not require a covered individual to pay a copayment for pharmacy benefits that exceeds the pharmacy’s or pharmacist’s submitted charges (“clawbacks”). This language was included in the final Health and Human Services budget bill, HF 2501 (pg 111). While IPA’s lobbying team had initially hoped for stronger and clearer language relating to “clawbacks,” compromise with PBM lobbyists became necessary to ensure any language remained in the bill.

Additional Issues

Board of Pharmacy Bill IPA supported the Board of Pharmacy’s bill, SF 2298, to add a certified pharmacy technician position to the composition of the board. The bill also revised Iowa’s wholesale distribution laws to reflect the federal Drug Quality and Security Act (DQSA).

Thank You Members

Thank you to all those who reached out to a Representative or Senator this year in support of IPA’s legislation, or any of these initiatives. This legislative session would not have been such a success without the support of our members. The legislation passed this year marks a major step forward in advancing the profession of pharmacy in Iowa. Please do not hesitate to contact IPA if you have any questions regarding these recent additions to the law. ■

STRENGTHEN ADVOCACY. STRENGTHEN PHARMACY.

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

JUL.AUG.SEP 2018 |

THANKS, BILL

THANKS, BILL D

id you give an immunization today? Or freely substitute a generic medication? Or treat a patient under a collaborative practice agreement? Or perform advanced functions as a certified pharmacy technician to free up pharmacists’ time? Or receive predictable payment for a Medicaid prescription from an MCO? Thank Bill Wimmer. For the last 38 years, Bill has served as IPA’s legal and legislative counsel, leading the association’s advocacy efforts and achieving legislative and regulatory advances that affects how each Iowa pharmacy professional practices on a daily basis. In fact, just this last legislative session, he helped IPA pass a bill to establish statewide protocols and technician product verification. These two initiatives will open doors to advancing pharmacist care and pharmacy technician roles in Iowa. The 2018 legislative session, with those two initiatives and a late-session PBM hearing (see pg. 42), was Bill’s last representing IPA as he retired on July 1 of this year. His impact on the profession cannot be overstated as his work in government affairs has allowed Iowa to build its reputation as an innovative leader in pharmacy practice.

About Bill

Bill is a Creston, Iowa, native and a founding partner of Wasker, Dorr,

| The Journal of the Iowa Pharmacy Association

Wimmer, and Marcouiller, a law firm in Des Moines, Iowa, where he specialized in government affairs and representing several state and national organizations. His undergraduate education focused on communication, debate, and political science at Southern Colorado State, Southwest Community College, Northwest Missouri State and the University of Nebraska. He then earned his law degree from the Cumberland School of Law at Samford University in Birmingham, Alabama.

Representing IPA

Advocacy is the only key value of the Iowa Pharmacy Association that can be drilled down into one word. That one word has remained prominent in IPA’s 138 years of existence and has been part of every strategic plan, every set of organizational values and each and every vision statement adopted by members of the profession. While other groups provide similar services as the Iowa Pharmacy Association, no other group provides statewide advocacy for pharmacy as well as IPA. While serving as IPA’s legal and legislative counsel, Bill was known as pharmacy’s voice (and eyes and ears) at the state capitol. In 1980, Bill was contracted by IPA’s thenCEO Tom Temple as the association’s first fulltime legislative advocate. In the decades that followed, Bill, as Temple puts it, “not only witnessed but has helped facilitate the transformation of the profession’s role in the health care system.”

• Enactment of Iowa’s Drug Dispensing Law • Passage of Iowa Pharmacy’s Revised Practice Act • Establishment of a Medicaid Professional Payment System known as Pharmaceutical Care Management or PCM • Creation of laws enabling collaborative practice, immunization authority, and therapeutic interchange • Several Medicaid Dispensing Fee increases • Numerous Medicaid reforms regarding unit dose reimbursement, electronic claims transmission, payment cycle enhancements, and coverage of OTCs • Enactment of a new Medicaid payment system protecting reimbursement for dispensing services • PBM regulation and passage of the most aggressive PBM bill in the nation In addition to these achievements, Bill also spearheaded several association initiatives to help IPA build and strengthen relationships with elected officials. He influenced the creation of IPA’s annual Legislative Day, which brings IPA members together to the State Capitol in Des Moines to speak with their legislators. This day has become a vital springboard for IPA’s legislative initiatives each year. Bill was a strong advocate

Bill’s list of legislative and regulatory achievements for Iowa pharmacy is extensive and include: • Enactment of Iowa’s Drug Product Selection Rules

Bill (l) with Tom Temple, IPA’s then-CEO

THANKS, BILL

“Bill has mentored me and countless IPA members, both pharmacists and students on effective advocacy...” Kate Gainer IPA’s executive vice president & CEO

of the Iowa Pharmacy Political Action Committee (IPPAC), which provides contributions to strengthen relationships with pharmacy-friendly state legislators. He was also instrumental in developing IPA’s Legislative Action Network to mobilize IPA members into grassroots advocacy, which has become one of the association’s strongest advocacy assets. “Bill has mentored me and countless IPA members, both pharmacists and students on effective advocacy - from legislative strategy and priority setting to PAC strategy, grassroots advocacy and communication,” IPA’s executive vice president and CEO Kate Gainer remarked.

Behind the Scenes

While Bill’s list of tangible legislative and regulatory achievements for Iowa pharmacy is impressive, perhaps his greatest impact on the profession was how he helped the association achieve them. With a positive, proactive, and ethical approach to professional representation, Bill established credibility with lawmakers on both sides of the aisle. His professionalism and integrity reflect well on the association and the pharmacy profession is held in high esteem with legislators and government officials in no small part due to Bill’s representation. As Tom Temple describes it: “Pharmacy’s integrity in the halls of state government stands among the very best of professional advocacy organizations and that, in large measure, is the result of Bill’s proactive and ethical approach to professional representation.” In addition to his work representing IPA directly, Bill provided his expertise serving on the “kitchen cabinets” of Gov. Tom Vilsack, Sen. Tom Harkin, Rep. Leonard Boswell, and other legislators. Though this was of Bill’s own accord, his influence in these circles also strengthened the pharmacy profession’s connection with key lawmakers.

Bill (l) speaks with Rep. Bob Osterhaus at the Iowa State Capitol

“Pharmacy’s integrity in the halls of state government stands among the very best of professional advocacy organizations and that, in large measure, is the result of Bill’s proactive and ethical approach to professional representation.” Tom Temple, IPA CEO from 1979-2011 While the nature of Bill’s work is behind the scenes, his professionalism that has benefitted the association has not gone unnoticed by his peers. Bill has received the highest awards from the Iowa Association of Justice, which represents trial lawyers and the Iowa Supreme Court. Last year, the Iowa Association of Justice renamed its Key Person Award the William J. Wimmer Key Person Award in recognition of Bill’s 40 years of service as their lobbyist. More evidence of how fortunate Iowa pharmacy is to have had Bill representing the profession.

A Fitting Tribute

Bill’s impact on the pharmacy profession in Iowa, as someone who is not a pharmacist, is unprecedented. It’s fitting then that the IPA Board of Trustees made an unprecedented move in 2018 and

Bill Wimmer gives his remarks after receiving the 2018 Robert G. Gibbs Distinguished Pharmacist Award

awarded Bill its highest honor, the Robert G. Gibbs Distinguished Pharmacist Award, selecting him as the first nonpharmacist recipient in the 40-year history of the award. In presenting the award at the 2018 IPA Annual Meeting in June, Chairman Rick Knudson said, “The IPA Board of Trustees believes that the service and contributions given from Bill to the profession of pharmacy are deserving of its highest honor.” Bill’s work on behalf of the pharmacy profession will be felt for generations of pharmacists and pharmacy technicians in Iowa and beyond. Iowa pharmacy owes an immeasurable debt of gratitude to its favorite honorary pharmacist. Thank you, Bill, for your unwavering commitment to the pharmacists, pharmacy technicians, student pharmacist and, ultimately, our patients you represented. Thank you for representing the profession of pharmacy with utmost integrity and reflecting its values of collaboration and patient care with government officials. Thank you for years of friendships created with IPA members and staff. Sincerely, Your Iowa Pharmacy Family

JUL.AUG.SEP 2018 |

PUBLIC AFFAIRS

BOARD OF PHARMACY: REGULATORY UPDATE The Iowa Board of Pharmacy convened for open session on May 23, 2018 to discuss multiple requests, reports and informational items, as well as several proposed rules.

Election of Officers and Board Re-appointments The board re-elected Sharon Meyer as chair and Jason Hansel as vice-chair. Executive director Andrew Funk also recognized Edward McKenna for being reappointed to the Board for a third term and Jason Hansel for being reappointed to the board for a second term. Board of pharmacy appointments are made by the Governors office and last for a term of three years.

Request to Waive PIC Requirements for Telepharmacy The board reviewed a request from Nucara Health Solutions to waive Rule 13.9.3. Iowa’s telepharmacy rules require the managing pharmacy’s pharmacistin-charge (PIC) to be the telepharmacy’s PIC. The board approved Nucara’s request for a waiver for a duration of five years.

Legislative Update The board reviewed SF 2298 (the Board’s bill), HF 2377 (the “opioid” bill), and SF 2322 (IPA’s bill), which were approved by both chambers and signed by Gov. Reynolds. The bills will become law on July 1, 2018. The board reviewed a summary of action and a proposed outline to timely complete the action.

Vote of Adoption on New Regulations Adoption and Filing of Expanded Practice Standards Chapter The Board approved the adoption and filing of Chapter 39 Expanded Practice Standards. This new chapter is in response to an overall review of the Board’s rules related to some of the clinical activities that not every pharmacy does. These new rules include standards on immunizations, collaborative practice agreements, the naloxone standing order, and pilot projects. The Board also discussed many of the comments received by the public related to this rulemaking. Termination of Proposed Rules Relating to VA Repackaging The Board terminated its rulemaking for Chapter 22, “Unit Dose, Alternative Packaging, and Emergency Boxes.” The Board based this action on the objection they received to the proposed rule during the open comment period. The amendment would have adopted 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. Repeal of Imitation Controlled Substance Chapter The Board adopted amendments for Chapter 1, “Purpose and Organization,” Chapter 3, “Pharmacy Technicians,” Chapter 4, “Pharmacist-Interns,” Chapter 5, “Pharmacy Support Persons,” Chapter 10, “Controlled Substances,” Chapter 17,

“Wholesale Drug Licenses,” Chapter 19, “Nonresident Pharmacy Practice,” and Chapter 41, “Outsourcing Facilities.” During the 2017 Legislative Session, Iowa Code chapter 124A relating to imitation controlled substances was repealed. These proposed amendments strike references in Board rules to the repealed Iowa Code chapter. Other Adoption and Filings The Board adopted and filed amendments for Chapter 10 “Controlled Substances,” Chapter 23 “Long Term Care Pharmacy Practice,” Chapter 18 “Centralized Prescription Filling and Processing.” The amendments update language for consistency, remove redundant rules, combine and condense rules where appropriate. The Chapter 10 “Controlled Substance” amendment also included prescription requirements for controlled substances to be consistent with federal regulations. ■

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

JUL.AUG.SEP 2018 |

PUBLIC AFFAIRS

PHARMACISTS AND TECHNICIANS ATTEND RURAL HEALTHCARE FORUM

IOWA DELEGATION ATTENDS NCPA CONGRESSIONAL PHARMACY SUMMIT A delegation of Iowa pharmacists and student pharmacists joined hundreds of pharmacists from 37 states in Washington, D.C., for NCPA’s 2018 Congressional Pharmacy Summit to urge Congress to support a pro-patient, pro-pharmacy agenda. IPA had its largest attendance yet, with 14 pharmacists and pharmacy owners from all four congressional districts. IPA held office meetings with all six of Iowa’s members of Congress and discussed provider status, PBM regulation, and the detrimental effects of direct and indirect renumeration (DIR) fees. In addition, IPA met with Senator Grassley’s office and Senate Judiciary Committee staff to discuss a potential hearing on anti-competitive PBM practices. Thank you to those who joined for representing Iowa pharmacy and making the trip so productive.

On June 26, IPA collaborated with the Iowa Hospital Association and Rep. Michael Bergan (R-Dorchester) to bring together lawmakers, officials from the Iowa Department of Human Services (DHS), and area pharmacists, technicians, and hospital staff to discuss a wide range of healthcare issues. The forum was held at the Winneshiek Medical Center and was targeted to draw from a six-county radius in northeast Iowa including Allamakee, Winneshiek, Howard, Chickasaw, Fayette, and Clayton counties. DHS Director Jerry Foxhoven led off the forum by highlighting the difficulties the transition to managed care in Iowa has presented for hospitals and pharmacies, and the positive steps he believes DHS and IME have taken since he assumed his role as Director. However, once the floor was opened for discussion, representatives of area hospitals made known the problems they are still encountering with the MCO’s in regards to enrolling providers and receiving payment owed to them by the MCOs. Josh Feldmann, pharmacist in charge of Central Community Hospital in Elkader, also highlighted the difficulty pharmacists face in receiving recognition and payment for the important services and products they provide aside from dispensing prescription medications. Director Foxhoven said he would like to keep an open dialogue with IPA in an effort to change this moving forward. ■

| The Journal of the Iowa Pharmacy Association

SEPTEMBER 21, 2018

Brown Deer Golf Club, Coralville, IA 10:00 am Shotgun start Register your foursome, 2+2-some or your awesome self at www.iarx.org/EGGolfClassic Donâ&#x20AC;&#x2122;t forget to purchase your mulligans when you register!

Proceeds benefit the IPA Foundationâ&#x20AC;&#x2122;s support of student pharmacists at Drake University & the University of Iowa.

PUBLIC AFFAIRS

IOWA HOUSE OVERSIGHT COMMITTEE HOLDS HEARING ON PBMS

n April 18, the Iowa House Government Oversight Committee held a hearing to examine possible abuses of public dollars by PBMs in Iowa. This hearing was the culmination of many hours of hard work by Rep. John Forbes (D-Urbandale) and the Iowa Pharmacy Association to investigate and uncover these unscrupulous billing practices. Upon learning of possible abuse of tax-payer money by CVS Caremark in Wapello County, Rep. Forbes began working with Rep. Bobby Kaufmann, chair of the House Government Oversight Committee, to determine if a full hearing and investigation was warranted. Upon further review, the scope of the abuse and possible implication of other counties made clear that a hearing was warranted. Both the Iowa House and Senate have standing government oversight committees. They exist as the main investigative committee of both chambers, even utilizing subpoena power when necessary. The committee’s government-wide oversight jurisdiction and expanded legislative authority make it one of the most influential and powerful committees in the legislature. Rep. Kaufmann and the committee then set a hearing date and took the unprecedented step of voting Rep. Forbes

| The Journal of the Iowa Pharmacy Association

onto the committee as an ad hoc member. While initially scheduled for a smaller room, the hearing had to be relocated to the old Supreme Court chamber in the capitol to accommodate the large crowd. First to testify was IPA’s executive vice president and CEO, Kate Gainer, beginning her remarks with an overview of PBM practices and the lack of regulation and transparency. Outlining how other states have recently begun to uncover millions of missing dollars in their Medicaid programs, Gainer stressed the importance for Iowa’s reimbursement methodology to remain as is. The recent reimbursement cuts by CVS/Caremark were also included in Gainer’s testimony, highlighting how CVS/Caremark is attempting to squeeze independent pharmacies into selling. She concluded by outlining what the profession hoped the committee would look into – are state dollars for prescription drugs being spent appropriately and do PBMs keep costs low or are they contributing the rapidly escalating costs of prescription drugs? Following Gainer’s testimony was Mark Frahm, RPh, from South Side Drug in Ottumwa. Frahm’s research into claims from the county jail served as the linchpin for the hearing. Frahm explained how he discovered severe discrepancies in what he was reimbursed for prescriptions filled for the county jail and what the jail

was then charged by the PBM. Frahm also provided a visual of the individual prescriptions with the most glaring examples of the spread. In one month, the PBM charged the jail $5,000 but only reimbursed the pharmacy $1,000. In some instances, CVS/Caremark was charging the jail upwards of $150 and reimbursing the pharmacy less than $5 for prescriptions. Gainer and Frahm’s testimony led Rep. Dave Heaton to inquire if “spread pricing” was occurring in Iowa’s Medicaid program. Gainer and Rep. Forbes explained how Medicaid in Iowa is shielded from the spread because of the statutorily established reimbursement formula. However, both emphasized how this illustrates the need to maintain the current system. Frahm was followed by Jerry Parker from the Wapello County Board of Supervisors, the public entity that oversees the county jail. Parker noted that since discovering the discrepancies, the jail has dealt directly with the pharmacy, saving the county thousands. Parker noted that the board doesn’t have the expertise to check all prescriptions to see where the county might be “taken.” Parker’s message to the committee was to, “help us, who can’t necessarily in these positions, help ourselves.”

PUBLIC AFFAIRS

Randy McDonough, PharmD, MS, CGP, BCPS, was next, evoking Iowa pharmacy legend and former state legislator Bob Osterhaus’ quote, “If it’s good for the patient, it’s good for the pharmacist.” McDonough provided insight into the relationship between pharmacies and PBMs. In addition to underwater reimbursements and DIR fees, he focused on the barriers PBMs create to treating his patients through mail order and specialty pharmacy. McDonough’s testimony, which was emotional at times, sparked several questions by committee members, with Rep. Vicki Lensing (D-Iowa City) raising concerns over the loss of patient relationships with their pharmacists and the fragmentation of care. The final speaker was CVS/Caremark executive Ron Ponesse. Ponesse didn’t deny spread pricing, or narrow networks, but stated that the plan sponsors choose the networks and pricing plans. Ponesse explained that while he believes the company provides quality service to patients, CVS/Caremark is still a forprofit company. Rep. Forbes continued to press Ponesse on the spread, repeatedly asking him to justify it. The back and forth culminated in an emotional exchange, with Forbes asking why appeals were ignored and prices were never adjusted. The hearing generated significant media attention in Iowa and even some national attention in larger outlets. Rep. Kaufmann has stated that the investigation will continue as needed, until it is clear that PBMs are not misusing Iowa’s tax dollars. IPA and Rep. Forbes are now seeking to uncover whether the same spread pricing tactics are occurring in other public entities like counties and cities. Included in the expanded legislative authority of both the House and Senate government oversight committees is the ability to hold hearings and committee meetings during the interim while the legislature is not in session. If more evidence of abuse is uncovered, it is possible another hearing could be held prior to the 2019 legislative session. ■

IPA WORKING FOR YOU Addressing Your Iowa Medicaid & MCO Concerns MCO Reimbursement for Diabetes Supplies

In May, pharmacies across Iowa received letters from AmeriHealth Caritas and Amerigroup seeking recoupment for “overpayment” of diabetes supplies such as test strips, lancets, and syringes. These letters stated that they would reprocess claims for diabetes supplies dispensed since April 2016 and begin reimbursing at the much lower state rate moving forward. Unfortunately, unlike other medical supplies, Iowa Medicaid has a ‘preferred brand’ for these diabetes testing supplies making it nearly impossible for pharmacies to competitively purchase these products for an amount that the state rate would adequately cover (ex. state rate is $20.82 for a 100ct. box of Freestyle test strips; pharmacy acquisition cost is over $100). IPA was successful in working with Iowa Medicaid to halt the recoupment of these payments by both MCOs retroactively. However, starting June 1, pharmacies saw reimbursement from Amerigroup at the state rate, which is far below their acquisition cost for the most commonly dispensed products. IPA met with Iowa Medicaid Enterprise (IME) Director Michael Randol and requested resolution for pharmacies related to preferred products and the state rate for diabetic testing supplies. IPA urged IME to reconsider the application of a state rate with preferred medical supplies and to ‘make whole’ pharmacies that dispensed prescriptions for diabetes supplies at a loss since June 1. Amerigroup has notified IPA that all such claims will be corrected retroactively to the previous rate by late October. IPA’s efforts help to ensure that pharmacies can continue to serve as a critical access point for these important supplies.

New MCO Announced

The Iowa Department of Human Services announced on May 21, that Iowa Total Care has been selected as the third MCO to administer Iowa’s Medicaid program and will begin coverage on July 1, 2019. Iowa Total Care is a subsidiary of Centene Corp., which has Medicaid contracts in 21 states. The company had bid on the initial Iowa Medicaid contract in 2015 but was not selected. Iowa Total Care will fill the void left by AmeriHealth Caritas’ exit from Iowa Medicaid in November 2017. IPA has already met with representatives from Total Care to discuss the important role pharmacy professionals in Iowa fulfill in both medication dispensing and patient care services. Total Care prides themselves on being a leader in value-based payment models across the country. We will begin gathering billing guidance, contact information, and other resources as soon as they become available.

JUL.AUG.SEP 2018 |

TECHNICIAN CORNER

TECH TIDBITS Highlights from IPA’s monthly e-newsletter specifically for pharmacy technician members. Think Shingrix to Prevent Shingles

Shingles commonly presents as a painful rash that is caused by varicella zoster virus, which is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus will stay dormant (inactive) in the body. Sometimes this virus will reactivate years later causing shingles. The Center for Disease Control and Prevention (CDC) states that about 1 out of every 3 people in the United States will get shingles in their lifetime and thus, shingles vaccination is the only way to protect against both shingles and complications of shingles. The new Shingrix vaccination is now preferred over the other available shingles vaccine, Zostavax, and is more than 90% effective at preventing both shingles and its common complication, postherpeptic neuralgia (PHN), which is a condition of recurring or persistent pain in area singles outbreak occurred. How should Shingrix be given? Intramuscular injection that requires 2 doses, separated by 2 to 6 months. Who should get Shingrix? Healthy adults 50 years and older even if in the past they: • Had shingles • Received Zostavax (Ensure it has been at least 8-weeks before administering Shingrix) • Are not sure if they have had chickenpox Note: There is no maximum age for getting this vaccine. How well does Shingrix work? • In adults 50-69 years old who got two doses, Shingrix was 97% effective in preventing shingles; among adults 70 years and older, it was 91% effective • In adults 50-69 years old who got two

| The Journal of the Iowa Pharmacy Association

doses, Shingrix was 91% effective in preventing PHN; among adults 70 years and older, it was 89% effective • Shingles prevention remains high at >85% in patients 70 years or older. How is Shingrix stored before reconstitution? BOTH suspension and antigen in separate vials - refrigerate between 2-8 degrees C (36-46 degrees F) Note: Do not freeze vaccination. Discard if vaccine has been frozen. Who will pay for Shingrix? Insured: Most Medicare Part D and some commercial plans will cover all or part of the Shingrix vaccination cost. However, it is important you educate the patient and contact their insurer to get full details on their personal coverage. Currently, Medicaid does not cover Shingrix administered within the pharmacy. Eligible patients will have to pay out of pocket for the vaccine or check to see if it will be covered if administered by their primary care provider. Uninsured: Some pharmaceutical companies provide vaccine assistance to eligible adults who cannot afford them. Check with GlaxoSmithKline about Shingrix. Note: Regardless of coverage, it is a good idea to confirm the out-of-pocket cost with the patient before preparing or administering the vaccine. Tips on starting the conversation about Shingrix. Talk about the benefits of Shingrix: Tell patients that a new shingles vaccine is available that is up to 90% effective at preventing shingles and its complications.

Marketing: Place signage around store or on front door, i.e. “Ask us about the new Shingles shot!” or “We carry the new Shingles vaccine.” System Flags: Some pharmacy systems can flag eligible patients based on patient specific factors, such as: • Patient’s >50 year of age • Patient has previous Zostavax administration Note: Ensure your practice setting: • Has Shingrix in stock prior to starting any conversation with your patients. Thus, if the patient is interested they can a get vaccination without delay. • Document completed vaccines in Iowa’s Immunization Registry (IRIS).

A Refresher on ICD Codes

The International Code of Diseases, Clinical Modification (ICD-CM) is a system that correctly identifies and codes for specific symptoms, diseases, and procedures in healthcare. The coding system is based upon the International Classification of Diseases that is published by the World Health Organization (WHO) and utilizes three to seven digits to create more than 68,000 specific diagnoses. The first three characters categorize the injury, while the fourth through sixth characters detail its cause, location, and severity. The final character specifies an initial, subsequent or sequela treatment encounter. This structure is of the tenth revision of ICD-CM that was implemented in October 2015. Remember that ICD is unique from other coding systems in healthcare. Current Procedural Terminology (CPT) codes are utilized for reporting claims and receiving payment. They are often used in concurrence with ICD codes during the

TECHNICIAN CORNER

billing process. Alternatively, Healthcare Common Procedures Coding System (HCPCS) codes are an extension of CPT. They describe additional procedures not included within the CPT system and report any supplies, equipment and devices given to patients. In summary, ICD codes characterize the diagnosis, and CPT or HCPCS codes identify the related product, service, or procedure. Though ICD codes are not required by CMS to be present on prescription orders, they may be necessary for a certain payer, pharmacy, or state licensing agency. For example, an ICD diagnosis code is required for insurance submissions of nebulizers and diabetic supplies. They may also be needed for prescriptions requiring a prior authorization or on medication orders at specialty pharmacies. It may be helpful to have a pharmacy technician charged with the task of maintaining a list of the most current ICD codes, as they are updated on an annual basis. In addition, communication between providers and pharmacies is

essential to promote seamless billing and pharmacy practice. All updates to ICD coding will be posted to the ICD-10 website at www.ICD10Data.com.

OTC Burn Treatment

With summer upon us, patients with burns of all kinds are presenting at a pharmacy or hospital. Whether it be a burn from the sun, or a firework gone wrong, it is important to know about appropriate treatment of these wounds. Burns can be caused by heat, electricity, sunlight, chemicals, and radiation. Burns are commonly thought of as injuries of the skin, but they are also inhalational injuries that are caused by breathing in smoke.1 Burns are classified based upon depth of the injury on a person’s skin as well as the amount of skin surface that they cover. First degree burns that only affect the outer layer of skin and are less than 3 inches in diameter can be treated in an ambulatory setting such as a community pharmacy. Second and third-degree burns, or burns larger than 3 inches in diameter, require an emergency care visit. 2

Since burns affect the skin, which is the body’s first line of defense, there are many negative consequences that may occur without the proper treatment. Burns may cause swelling, blistering, scarring, shock, and even death in the most serious cases. Untreated burns may also lead to increased risk of infection due to skin damage and ability for bacteria to enter the body and the wound more easily. 1 There are many over-the-counter treatments for minor burns. These include skin protectants, antiseptics, and local anesthetics. There are also products that will help reduce the risk of burns, specifically sunburn, such as sunscreen or sun protectant. To learn more about burn treatment, Mayo Clinic released an article this January discussing both minor and major burns, and when to seek immediate care. References:

1. https://www-ncbi-nlm-nih-gov/ pubmed/22230304 2.https://www.mayoclinic.org/first-aid/first-aidburns/basics/art-20056649

CPhT Recertification CPE for FREE! Join IPA and receive CEI’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_buckets to take advantage of this new benefit for members and spread the word to your colleagues.

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

JUL.AUG.SEP 2018 |

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.

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.

TECHNICIAN CORNER

NEWLY PTCB CERTIFIED IOWA TECHNICIANS April 1 - June 30, 2018

Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Victoria Adrian Alex Ahlrichs Logan Akason Shaquita Alexander Ashley Ambroson Ismelda Andaya Samantha Anderson Melissa Anker Jessicca Benda Caitlin Bond Amie Bradley Jordan Brokaw Shannon Burnette Juanita Burroughs Rachel Cass Michaela Chambers Yuxiao Chi Zack Church Anna Clarke Patrick Conner Megan Conry Byron Cota

Jenna Courey Sara Cowles Sarah Cox Barbara Curry David Davis Kayla Deal Destiny Dominguez Alicia Easterday Katlin Eklofe Emma Erner Jenna Fenske Allison Freese Sherry Glanz Jeanne Gonwa-Reeves Alexander Goodenow Aleksandra Grady Laura Grove Nisha Gupta Abby Hall Javanti Hall Alex Harrison Melinda Hart

In a world where our patientsâ&#x20AC;&#x2122; health requires the best in care,

PTCB CHOOSES

EXCELLENCE. ptcb.org

Bridget Heidt Katherine Hemesath Erica Hess Miranda Hilton Sonny Hoang Karlann Hutchison Danielle Jenison Emily Joines Collin Jones Edina Jukic Rebecca Kennedy Yury Kim Kassidy Klaassen Maxim Kleinschmit Morgan Koenen Kyle Kregel Brooke Lawler Chelsey Lourens Cathryn Lyons Anna Mangelsen Coy McCarl Braiden McFarland

Lee McKee Nicholle McKoy Nathaniel Merten Lisa Meseck Eryn Mitzelfelt Michelle Moon Carol Morlan Stacey Mortensen Kaitlyn Mulder Brian Paulsrud Briana Peterson Creighton Pinney Rachel Cass Sara Ramirez Katherine Rawson David Reimers Sarah Rosborough Sarah Rotnicke Dipali Sabale Joshua Sandholm Kera Schachel April Schutt

Erin Sherman Desirae Simmons Brittany Skinner Avery Smith Blanca Somoza Osegueda Alessandro Soto Leslie Spahr Amy Sprague Josh Steeples Gail Sungram Anna Taylor Katelyn Thomson Tammy Tran Angela VandeHoef Haley Varo Sarah Wagner Ashlee Wall Leah Welch Brett Wessel Sierra Wolf Lindsey Zuidema

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.

ÂŽ

Choose PTCB. Choose Excellence. JUL.AUG.SEP 2018 |

IPA FOUNDATION

IPA FOUNDATION BOARD OF DIRECTORS TRANSITIONS TO 2018-2019 With the new administrative year comes a new IPA Foundation Board of Directors. The foundation would like to welcome new director Rick Knudson. Bill Baer will again serve as president with Steve Firman serving as vice president.

Bill Baer, RPh, CGP Chariton President

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

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

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

Kate Gainer, PharmD West Des Moines Secretary/Treasurer

Carl Chalstrom, RPh Anamosa

Bob Greenwood, RPh Waterloo

Tom Halterman, RPh West Des Moines

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

Julie Kuhle, RPh Indianola

Bob Stessman, RPh Manning

John Swegle, PharmD, BCPS Mason City

2018 SILENT AUCTION ACTION The 2018 IPA Foundation Silent Auction featured over 90 items up for bid and some friendly competition on several hot items. In addition to bidding on the fantastic array of items, the Silent Auction featured the Red Envelope Challenge, beer and wine ring toss and closed the evening with a rousing game of heads or tails. The foundation would like to thank everyone who donated items, placed winning bids, threw rings and accepted a new Red Envelope Challenge. Over $12,000 was raised to support foundation initiatives that support student pharmacists and practice advancement across the state!

| The Journal of the Iowa Pharmacy Association

IPA FOUNDATION

LEADERSHIP PHARMACY WELCOMES 2018 CLASS

Congratulations, Jen!

The Leadership Pharmacy Conference will welcome it’s 30th class on August 2-4, 2018, in Galena, IL. The IPA Foundation would like to congratulate the 2018 Leadership Pharmacy participants from Iowa: Abby Beane, PharmD - VA Medical Center – Iowa City Chelsea Cave, PharmD - Thrifty White Pharmacy – Paullina Courtney Gent, PharmD - University of Iowa Hospitals & Clinics Kyle Hilsabeck, PharmD - McCord Holdings Lynn Kassel, PharmD - Drake University College of Pharmacy and Health Sciences Ashley Loeffelholz, PharmD - NuCara Pharmacy – Ames Jen Morris, PharmD - Manning Pharmacy Nathan Peterson, PharmD - UnityPoint Health - Trinity Kathryn Stone, PharmD - CHI Health – Missouri Valley JP Webb, PharmD - Mercy Medical Center – Des Moines Leadership Pharmacy is a unique opportunity for pharmacists in their first three to fifteen years of practice that provides strong leadership training, increases awareness of state and national pharmacy issues, encourages involvement in professional and community activities, and develops new practitioners for leadership roles within the profession.

...on your selection to the 2018 Leadership Pharmacy Conference!

Jen Morris, PharmD

From your Manning Pharmacy family Bob, Lois, Connie, Susan, Megan, Connie, Karen, Janice, and Grace

Since its inception in 1989, over 350 Iowa pharmacists have completed Leadership Pharmacy and have gone on to become IPA presidents, board members, committee chairs, and leaders within their practice sites. This program is available to pharmacists in Iowa and Wisconsin who are interested in becoming leaders in their profession. Twenty pharmacists, ten from each state, are selected annually to participate.

Leadership Pharmacy appreciates the support of these sponsors:

JUL.AUG.SEP 2018 |

IPA FOUNDATION

SUMMARY REPORTS OF THE 2017 OUTCOMES INNOVATIVE PHARMACY GRANT AWARDEES In 2017, the IPA Foundation awarded its first grants through the Outcomes Innovative Pharmacy Grant program. A total of $38,000 was awarded between three innovative Iowa pharmacy practice initiatives. As required by the grant, each recipient has provided a summary of their project. Each recipient also presented a poster at the 2018 IPA Annual Meeting in Des Moines, Iowa.

OUTCOMES INNOVATIVE PHARMACY GRANT About the Outcomes Innovative Pharmacy Grant

The grant program stems from the Outcomes Innovative Pharmacy Endowment that was established by the original investors of OutcomesMTM, a medication therapy management, or MTM, service provider based in Iowa. In 1999, the Iowa Pharmacy Association provided seed money to support this innovative startup, which became a national leader in MTM services. Following the purchase of OutcomesMTM by Cardinal Health in 2015, the endowment was created as a way for those original investors to give back to the pharmacy profession and keep the innovative spirit and legacy of the company and Iowa pharmacy alive. Applicants must be an Iowa-licensed pharmacist or an Iowa-based researcher working with Iowa pharmacists in an innovative pharmacy practice. Applicants must also be active members of the Iowa Pharmacy Association. The application deadline for the next grant cycle is December 1, 2018. Information can be found at www.iarx.org/outcomesgrant.

| The Journal of the Iowa Pharmacy Association

Creation and Implementation of a Pharmacy Performance Network in Iowa Grantee: Randy P. McDonough

CPESN-Iowa was developed in response to a changing health care environment. As reimbursement for product distribution continues to be reduced from MAC pricing schedules and increases in DIR fees, the viability and sustainability of community pharmacy is being threatened. Health care is rapidly moving into a value-based reimbursement model whereby providers are reimbursed based on their abilities to affect patient clinical metrics and reduce total cost of care. In response to this changing reimbursement structure and the need to move into a patient-centric practice model, community pharmacies are transforming their practices to support enhanced services. Also, in order to compete at the local, regional, and national level, it became apparent that community pharmacies need to form a clinically integrated network in order to represent a group of community pharmacies with the vision to provide enhanced services. This led to the formation of CPESN-Iowa. The Luminaries of CPESN-Iowa sought funding from the Outcomes Innovative Pharmacy Grant to provide seed money to help create an infrastructure and foundation for which the organization can grow. There were four objectives for this grant: 1. Develop a business plan for Iowa CPESN. 2. Hire/Contract with a person/company to help the network with practice development initiatives to ensure that services are consistently provided using the criteria developed by the Service Set Workgroup of Iowa CPESN. 3. Develop Quality Improvement/Assurance initiatives and tools utilizing the criteria developed by the Quality Assurance Workgroup of Iowa CPESN. 4. Create a marketing plan complete with goals, objectives, and timeline and identify key targets and stakeholders. This will include identifying a marketing partner who can help the network develop marketing materials and provide marketing/promotional services. During Year 1, the Luminaries were able to develop one, three and five-year goals. They sought legal help and created a nonprofit corporation (501(c)4). A national advisory board was created. Initial marketing materials were created and distributed to CPESN-Iowa Sites. Quality assurance activities included site visits from volunteer members of CPESN-Iowa and the information was put into standardized form. An educational program, Make Every Encounter Count was developed and implemented for the first pharmacy cohort. Lastly, initial discussions with payers occurred. Year 2 is the year of action when the first contract will be signed, a consulting agreement will be formed with a company to help with quality assurance, practice site development and marketing activities. Overall, CPESN-Iowa continues to be a leader for Clinically Integrated Networks nationally.

IPA FOUNDATION

The goal of CPESN-Iowa is to improve the quality of patient care and achieve therapeutic outcomes related to medication use, enhance patients’ overall health trajectory, and reduce total costs of care. This will be accomplished through the active integration of community pharmacists with the larger health care team/ system including primary care and specialty providers, health systems, and ACOs. The ability of providers and payers to readily connect with a network of high quality pharmacies will support the success and growth of CPESN-Iowa.

An Examination of the Effect and Synergy of Combining a Medication Adherence Intervention and Group Diabetes Education Grantee: Melissa Ernzen, Anthony Pape, Matthew Witry

The objective of this project was to trial and assess the combination of group diabetes education and an enhanced medication synchronization program. We used a three group design in order to make comparisons. Participants completed surveys which assessed diabetes self-management activities, medication adherence beliefs, and satisfaction with pharmacy services. Participants in the group diabetes education group attended up to 8 sessions which were based on an established curriculum. These patients then participated in medication synchronization. The monthly follow-up calls included standard questions and also a series of 3 refresher topics on diabetes. In all, 16 patients completed group diabetes education, 15 comprised a medication synchronization only comparison group, and 13 comprised a control group. The group sizes were small which limited the power to do statistical comparisons. Patients receiving the group diabetes education reported engaging in 6 extra diabetes management activities per week compared to the control group. Those receiving the group diabetes education intervention also had greater improvements in their beliefs about medicines. These patients also agreed to strongly agreed that the added discussion about diabetes during the medication synchronization calls was helpful and they strongly agreed they would recommend group diabetes education from Mercy Family Pharmacy to a friend. While patients were positive and receptive about the new service combination, the pharmacy struggled to be reimbursed for the group diabetes education classes, despite CDE certification and registering with the state public health department. Claims were submitted to private insurers, HMOs, Medicaid managed care plans, and Medicare plans without success. Future plans include partnering with agencies and organizations to provide the service as a contract and grants to support group diabetes education for low income persons in the community. We will continue to offer medication synchronization in a patient-centered approach that allows for discussions with patients.

Pharmacist Led Medicare Annual Wellness Visits at a Family Medicine Clinic Grantee: Sara Wiedenfeld

Annual wellness visits (AWVs) are an annually covered service for Medicare beneficiaries. The purpose of the AWV is to provide a personalized prevention health plan for the patient. Pharmacist led AWVs were implemented and completed over a nine month period after receiving a generous Outcomes Innovative Pharmacy Grant. The goals of this project were to provide access to the important wellness services and to show that pharmacists’ provision of AWVs improved patient care and outcomes and is a sustainable service. Patients eligible for an AWV were identified from the electronic medical record. Patients were contacted via letters, phone call, or in person by their physician to explain the service and promote scheduling of their appointment. Appointments were offered two days per week. The pharmacist was supported by a certified medical assistant who updated the patient’s history, completed depression and fall risk screenings, in addition to taking the patient’s vitals. The pharmacist completed medication reconciliation, assessed cognitive function, reviewed for needed screening tests, and provided counseling and referrals. In the project period, 107 AWVs were conducted. An average of five medication changes were made to the medication history per patient. Vaccination history was reviewed and 138 vaccinations were recommended. A visit with the patient’s primary care provider was recommended 41% of the time. To date, $11,032 has been received for reimbursement for pharmacist led AWVs with additional claims pending. The average reimbursement per visit was $121. The most common interventions made were making a recommendation for chronic disease treatment optimization and medication monitoring. High-risk medications in the elderly were discontinued for 17 patients. Unnecessary medications were discontinued for 19 patients. Screening tests including colonoscopy, mammogram, DEXA, and hepatitis C antibody were often recommended and scheduled. In conclusion, pharmacist led AWVs are sustainable based on improved patient outcomes and reimbursement.

JUL.AUG.SEP 2018 |

MEMBERS SECTION

IPA MEMBER SPOTLIGHT:

Written by:

Asheigh Wallace 2019 PharmD Candidate University of Iowa

In a special Member Spotlight double feature, IPA recognizes Vinton, Iowa, pharmacists Jon Clingman and Mike LaGrange. The two independent pharmacy owners demonstrated the collaboration and patientcentered focus of the profession after Clingman Pharmacy was destroyed by a devastating fire on February 8, 2018.

ike LaGrange, RPh, graduated one year ahead of Jon Clingman, RPh, from the University of Iowa College of Pharmacy. Both came to Vinton, Iowa, at around the same time. LaGrange came to work at his father’s LaGrange Pharmacy in 1988 and Clingman purchased Wright Pharmacy in 1989 and changed its name to Clingman Pharmacy. With competing pharmacies just down the street from each other, they know each other well, respect each other, and work to promote their Vinton community.

| The Journal of the Iowa Pharmacy Association

Jon Clingman, RPh

Mike LaGrange, RPh

Last February, a devastating fire swept through historic buildings in downtown Vinton, one of which was home to Clingman Pharmacy. LaGrange was among the first to notice the fire and made two phone calls: first to the fire department and then to Clingman. Clingman was able to salvage a back up hard drive, but the pharmacy was a total loss. As Clingman and LaGrange watched the fire, “we both knew I didn’t have a plan ‘b’” recalled Clingman.

preparedness because it seemed like bad things kept happening to us.” He approached Clingman with an offer to enter into a mutual aid agreement, and Clingman agreed. LaGrange also has other mutual aid agreements with two pharmacies in communities close by Vinton for the same reason: if something happens, the pharmacies need a backup plan so they can continue serving their patients.

“We both knew I didn’t have a plan ‘b.’” Jon Clingman

The fire happened late Thursday evening. By Friday morning, Clingman pharmacy was up and running down the street, sharing space with LaGrange Pharmacy. LaGrange and Clingman have a mutual aid agreement, if one pharmacy needs help due to disaster, the other will step up to help. This agreement grew out of previous disasters that have affected Vinton in recent history. The floods in 2008, and another unusual occurrence of a wind microburst that brought 120 mph winds that knocked out the power grid for days in Vinton, had LaGrange thinking that a backup plan needed to be in place. LaGrange said that these disasters, “caused us to look at disaster

Both pharmacies have been in Vinton for a number of years. LaGrange Pharmacy was established in 1922 by LaGrange’s grandfather and has stayed in the family since then. LaGrange’s son, Dan, is preparing to take over the business very soon as LaGrange transitions into retirement. Clingman Pharmacy’s predecessor, Wright Pharmacy had been at that location since 1940. Each pharmacy, with their long history in Vinton, has strong ties to the community, so they knew that they needed to continue serving their community and patients despite this setback. LaGrange and Clingman talked extensively on how to integrate the two pharmacies under one roof. They both had similar software systems and the same wholesalers, so that transition would be okay. But the biggest problem was space and how to separate workflow and business functions between the

MEMBERS SECTION “They were as concerned about our well-being as we were about theirs.” Mike LaGrange

two. Luckily, LaGrange Pharmacy had enough space to accommodate both pharmacy operations, and the next morning, both pharmacies were working on this transition. “I was amazed at how resilient they were. They were as concerned about our well-being as we were about theirs,” LaGrange said of the Clingman staff. Both staffs got along really well, and actually learned from each other along the way. Each pharmacy’s workflow was a little different, but they learned that those differences could be beneficial in their own process. The patients were very receptive too. “I had a number of patients from Clingman who thanked me for keeping them going,” LaGrange said. “The response from the community was very positive.” LaGrange said the biggest takeaway from the whole situation was that, “you really need to be prepared for disasters that do happen in Iowa. You have to really think on your feet and make changes immediately.” He suggested that all pharmacies should have disaster preparedness plans in place, to really think about what needs to happen and be prepared to put that plan into action at any moment. To LaGrange, helping Clingman “was worthwhile doing because it was the best outcome for his patients and for my patients too.”

“...it was the best outcome for his patients and for my patients too.”

WELCOME NEW IPA MEMBERS! APRIL 1 - JUNE 30, 2018: Jen Aultman, Algona Katelynn Aycock, Urbandale Jared Butler, Waukee Macey Calderwood, Traer Bailey Calvin, Des Moines Michele Cooper, Eagle Grove Elizabeth Eichfeld, Moorestown Lisa Flanders, Ames Philip Greazel, Iowa City Lindsay Hagberg, Des Moines Davin Holman, Omaha Laura Hummelgard, Sheldon Michael Kuntz, West Des Moines Addison Leners, Des Moines Paul O’Rourke, Sigourney Charmi Patel, East Dubuque Tawnee Siegler, Omaha Jennifer Stilphen-Wildes, Iowa City Sherry StotlerFrew, Rockford Cheryl Strandberg, Dayton Paige Vortman, Pella, IA Brittani Weichman, Des Moines, IA The Prescription Shoppe Telepharmacy LLC, Postville, IA CVS Pharmacy/Target #16022 , Dubuque, IA Anglemyer Pharmacies LLC , Jefferson, IA

Mike LaGrange

The two pharmacies shared space for three weeks until Clingman Pharmacy found a new location to operate from while Clingman determines the next steps for the pharmacy. He recalled the unique situation of working with the insurance company and planning the future of his business in the basement of his “competitor.” It served as an example of their community focus and that often times in a small town, where everyone knows everyone, the guy down the street is more of a comrade than a competitor. The resiliency of the Clingman Pharmacy staff and the kindness from the LaGrange Pharmacy staff were what turned this tragic situation into a win for their patients and their community. Their dedication and hard work allowed them to overcome a seemingly impassable obstacle, and to continue serving their community in a difficult time. Thank you to Mike LaGrange and Jon Clingman for their collaboration with each other, their dedication to their patients, and for representing the profession in such a unique and positive way. ■

THANK YOU FOR SUPPORTING IPA!

MEMBER MILESTONES Jeffrey Halverson, RPh, MBA, (Waterloo) received the Iowa Medical Society’s 2018 John F. Sanford Award. Congratulations Jeffrey! Congratulations to Donald Letendre, PharmD, dean of the University of Iowa College of Pharmacy, who was named a 2018 ASHP Fellow. Ashley Lorenz, PhamD, who recently graduated from the University of Iowa College of Pharmacy, received a 2018 ASHP Student Leadership Award. Congratulations Ashley! If you have a member milestone to share, please submit it to ipa@iarx.org JUL.AUG.SEP 2018 |

IPA IN ACTION

Iows’s ASHP delegates (l to r): Jamie Sinclair, Lisa Mascardo, and Shane Madsen

Elevate Your Practice: Recap of 2018 ASHP Summer Meeting

The 2018 ASHP Summer Meetings and Exhibition offered four content-targeted conferences that are held concurrently on June 2-6 in Denver, CO. Iowa pharmacists were in full force at the event; participating in the education and networking events with other health-system pharmacists from across the country.

interested healthcare professionals. While many aspects of genomic science were discussed, part of the day included a presentation specifically on pharmacogenomics. During this presentation, the challenges of how to best store pharmacogenomic testing results in an EHR and the need for increased clinical knowledge across providers about how to appropriately use the data were addressed. IPA’s own Mike Brownlee served on a panel entitled The User of Smart Data in Precision Medicine. This was UIHC’s first Precision Genomic Medicine Conference, but there are plans of continuing such programming as an annual event.

Katy the Kangaroo Visits Pre-K

(l to r) Ashely Wengrove, Katie McDaniel (as Katy), and Jenna Beninga

Iowa pharmacists celebrate Donald Letendre being named an ASHP Fellow

This year, Iowa pharmacists were represented in the ASHP House of Delegates by Shane Madsen (Iowa City), Lisa Mascardo (Coralville), and Jamie Sinclair (North Liberty). While much work was conducted during the conferences, there was reason to celebrate as well. Donald Letendre, dean at the University of Iowa College of Pharmacy, was named a Fellow of ASHP!

Katy the Kangaroo was at it again! Katy (played by student Katie McDaniel) visited pre-K and 1st grade classrooms around the Des Moines area with her special friends, student pharmacists Jenna Beninga and Ashley Wengrove. She educated children on the role of pharmacists and the importance of medication safety.

Precision Medicine Conference

On April 27, the Iowa Institute of Human Genetics at UIHC convened an interdisciplinary Precision Genomic Medicine Conference. In attendance were pharmacists, physicians, researchers, genetic counselors, and many other

| The Journal of the Iowa Pharmacy Association

IPA developed Katy’s Kids in 1988 and continue to evolve as a program to teach

young children about medicines and medication safety.

Compass PTN Learning Community Healthcare professionals gathered at the Iowa Hospital Association Conference Center in Des Moines on April 11 for a day of networking, sharing ideas, and exploring the movement of healthcare. Tom Evans, MD, president and CEO of the Iowa Healthcare Collaborative (IHC), started the event with a reflection of 2017 and encouragement to keep moving forward in practice. The speakers that followed expounded upon his words, providing best practices for responding to errors made in practice, involving patients in care delivery, reducing unnecessary costs, and utilizing data to create improvement.

As reimbursement moves from a feefor-service towards a value-based model, IHC strives to serve as a resource to healthcare providers through collaboration of Compass Practice Transformational Network (PTN) and implementation of the Transforming Clinical Practice Initiative (TCPI). Compass PTN is a local execution of TCPI, a federal program that supports providers and clinics during the transition to value-based reimbursement and aids in rapid-cycling process improvement.

IPA, McKesson Bring RxOwnership Series to Student Pharmacists

In April, IPA worked with the student NCPA chapters and McKesson to sponsor the RxOwnership series. Student pharmacists from University of Iowa and Drake University enjoyed presentations led by McKesson/HealthMart representatives. The discussions focused on the benefits of pharmacy ownership, what interested students should start considering now, and financial principles. Student pharmacists from both colleges asked very insightful questions that led to active dialogue. IPA would like to thank Nick Seacrest, Jeff Aiden, Karen Merrill, Christina Kunz, and Kyle Shinn from McKesson for hosting these student events.

IPA IN ACTION IHC Care Coordination Conference

in transitions of care in the community setting. Two IPA members, John Swegle and Jeffery Reist, gave presentations at the conference focused on opioid agreements and patient safety in combatting opioids.

Medication Safety at Waukee Middle School John Swegle presents at the IHC Care Coordination Conference

IPA attended the Iowa Healthcare Collaborative’s Care Coordination Conference on June 12 in Ankeny, Iowa. Healthcare professionals from across the country came to speak on the importance of collaboration of care between healthcare professionals. Pharmacists were discussed as having a critical role within the healthcare team, specifically

IPA rotation students Katie McDaniel and Ashley Wengrove partnered with APhA-ASP at Drake University to present Medication Safety Classes at Waukee Middle School. The presentation encouraged teenagers to use prescription and OTC medications safely, providing them with education on reading prescription and OTC medication labels. Common drug abuse myths were addressed. The students also learned about how to measure doses and the best places to store their medications.

Governor’s Conference on Public Health Strengthens Partnerships

On April 10-11 in Des Moines, several IPA members and staff attended the Iowa Governor’s Conference on Public Health. With multiple public health initiatives that are embracing the role of the pharmacist, current relationships strengthened and new discussions developed regarding new opportunities for pharmacists in a team-based care delivery system. While keynote addresses focused on social determinants of health and making Iowa the healthiest state, attendees had the chance during several breakout sessions to discuss infectious disease prevention, opioid abuse and misuse, falls prevention, and childhood development. ■

ADDRESSING MENTAL HEALTH CARE WITH MHFA TRAINING In April, IPA kicked off a series of Mental Health First Aid trainings across the state that will continue throughout 2018. Nearly 50 Iowa pharmacists, pharmacy technicians, and student pharmacists have taken advantage of trainings in Des Moines, Waterloo, Mason City, and Davenport. Similar to traditional physical First Aid and CPR, Mental Health First Aid is provided to a person developing a mental health problem or experiencing a crisis until professional treatment is obtained or the crisis resolves. The program was created in Australia and managed by Mental Health First Aid USA through the National Council for Behavioral Health Through role-playing and simulations, this 8-hour course teaches a five-step action plan to help someone who may be experiencing a mental health or substance use challenge. The program also teaches participants how to recognize risk factors and warning signs of specific illnesses including anxiety, depression, substance use, bipolar disorder, eating disorders and schizophrenia. The initiative was implemented by IPA in order to equip Iowa’s pharmacy professionals (and other providers) to better address gaps in mental healthcare in Iowa. Additional trainings are scheduled for Iowa City (Sept. 20) and Spencer (Oct. 3) and those interested can register at www.iarx.org/MFHATrainings. Based on the success and feedback from previous sessions, IPA is looking expand and schedule additional trainings in 2019.

JUL.AUG.SEP 2018 |

IPA ACTION

CALENDAR OF EVENTS Find addtional details to these events and more at www.iarx.org. Click on the “Calender of Events” link under the Events tab. 9

SEPTEMBER 2018

20-23 ACCP Global Conference on Clinical Pharmacy - Seattle, WA

12-14 “Stepping On” Falls Prevention Leader Training West Des Moines, IA 20

Mental Health First Aid Training - Iowa City, IA

IPA Goes Local: JCPA - Iowa City, IA

Eggleston-Granberg Golf Classic - Coralville, IA

2/2/2 Webinar: Choosing Wisely Campaign

22-25 AMCP Nexus - Orlando, FL

NOVEMBER 2018

24-25 2018 Iowa Cancer Summit - Ankeny, IA

1-4

ASCP Annual Meeting & Exhibition National Harbor, MD

HIIN Learning Community - Des Moines, IA

Iowa Healthcare Collaborative Annual Conference

Iowa Board of Pharmacy Meeting - Des Moines, IA

SIM Learning Community - Ankeny, IA

IPA Residents Meeting - West Des Moines, IA

2/2/2 Webinar: Human Trafficking: How to Help

28-29 Bill Burke Student Leadership Conference - Coralville, IA

Iowa Board of Pharmacy Meeting - Des Moines, IA

OCTOBER 2018

Iowa Rural Health Association 2018 Annual Conference - Grinnell, IA

Iowa Diabetes Summit - Des Moines, IA

USP 800 Compliance Workshop - Johnston, IA

Mental Health First Aid Training - Spencer, IA

IPA Goes Local: NIPA - Spencer, IA

DECEMBER 2018

4-5

Geriatric Psych Conference - Dses Moines, IA

NCPA Annual Convention - Boton, MA

2-6

ASHP Midyear Clinical Meeting & Exhibition - Anaheim, CA

2/2/2 Webinar

IPA’s free monthly webinar series held on the second Tuesday of every month at 2:00 p.m. CST. September 11, 2018: PBM Contracts October 9, 2018: Choosing Wisely Campaign November 13, 2018 Human Trafficking: How to Help Register for an upcoming 2/2/2 or view previous webinars at www.iarx.org/222.

IPA GOES LOCAL 2018:

UNDERSTANDING MENTAL HEALTH CARE ACCESS IN IOWA Remaining Dates: Sept. 20, 2018: Johnson County Pharmacy Association (Iowa City) Oct. 3, 2018: Northwest Iowa Pharmacy Association (Spencer)

PHARMACY TIME CAPSULE

19 79

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

JANUARY

While regulations that mandated continuing education were implemented in 1978, IPA assembled a committee on CE in early 1979 to evaluate and expand access to continuing education. Throughout the year, IPA provided continuing education in various platforms such as: home study programs, home town conferences, an annual meeting and exhibit, a midyear meeting and special interests seminar.

MARCH:

The Scott County Pharmaceutical Association conducted a study to document the need for increased reimbursement under prescription drug programs that operate in the Quad City area. It was determined that the average fee charged was $3.01, with a range of $2.00 to $4.30 over 23 pharmacies surveyed.

MAY:

The American Association of Colleges of Pharmacy and the American Pharmaceutical Association published Standards of Practice for the pharmacy profession. This six-year endeavor served as the basis for creating C.E. programs, reviewing of pharmacy curriculum and licensing examinations, and allowing pharmacists to evaluate their own professional practice.

JUNE:

Eli Lilly presented a commemorative apothecary jar to Iowa Methodist Medical Center in Des Moines for filling 5 million prescriptions. The 100th IPA Annual Meeting was held on June 1-3 at Lake Okoboji. The IPA officers that were announced included President-elect Tom Vlassis of Des Moines, Vice-president Lanny Larsh of Mount Pleasant and Treasurer Jack Bare of Pleasantville. Methodist Medical Center in Des Moines recognized by Eli Lilly for filling 5 million prescriptions

OCTOBER:

A consumer brochure was developed jointly by IPA and the Iowa Medical Society to educate patients about the Iowa drug product selection law and generically equivalent medications. The IPA encouraged distribution of this brochure to maintain public relations and show concern for the patient and their right to know as a consumer.

DECEMBER:

The Flying Pharmacists of America created a special niche for some pharmacists recently. Membership to this organization was open to registered pharmacists, their spouses and pharmacy students with an interest in flying and promoting professional service and education through combined pharmacy and flying activities. Flyer developed by IPA & IMS on the Iowa drug product selection law

Milton W. Skolaut was the recipient of the Harvey A.K. Whitney Lecture Award.

The Iowa Pharmacy Association Foundation is committed to the preservation of the rich heritage of pharmacy practice in Iowa. By honoring and remembering the past, we are reminded of the strong tradition we have to build upon for a prosperous future for the profession.

JUL.AUG.SEP 2018 |

ADVERTISER

Your Next Great Hire is Here 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

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.

| The Journal of the Iowa Pharmacy Association

Protect your patients. Protect your pharmacy. ERROR S CAN I NJU R E PAT I ENTS AN D P U T YOU R PHAR M ACY I N FI NANCIAL J E OPA R DY.

The PQC+ QA program can improve efficiency and increase patient safety as well as help you meet accreditation, credentialing, PBM and state Quality Assurance requirements. • Training, Quality Assurance CE, and resources • Patient Safety Organization protection for your QA work • Practical tools to collect and analyze patient safety data

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