IPA Journal Apr/May/Jun 2020 by Iowa Pharmacy Association

A Peer-Reviewed Journal | Vol. LXXV, No. 2 | APR.MAY.JUN 2020

INSIDE:

COVID-19 Pandemic IPA Annual Meeting Midwest Pharmcy Expo Recap

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 Allison Hale, Managing Editor Kate Gainer, PharmD Anthony Pudlo, PharmD, MBA Casey Ficek, JD Amanda Abdulbaki, PharmD

OFFICERS

COVER STORY The COVID-19 Pandemic pg. 16

Get all the details - What is it, how it spreads, infection rates and more.

Chairman Cheryl Clarke, EdD, RPh, FAPhA - Waukee PRESIDENT Connie Connolly, RPh, BCACP - DeWitt

PRESIDENT-ELECT Diane Reist, PharmD, RPh - Cedar Rapids TREASURER Tim Becker, RPh, FACP - Mason City

SPEAKER OF THE HOUSE Ashley Dohrn, PharmD, BCGP - Le Claire

VICE SPEAKER OF THE HOUSE Kristin Meyer, PharmD, CGP, CACP, FASCP Marshalltown

TRUSTEES

REGION 1 Sharon Cashman, RPh - Waverly

REGION 2 Shane Madsen, PharmD, BCPS - North Liberty REGION 3 Sally Haack, PharmD, BCPS - Norwalk REGION 4 Gary Maly, PharmD - Sioux City

AT LARGE Bill Baker, BS Pharm - Iowa City Craig Clark, RPh - Cedar Rapids Bill Doucette, PhD, RPh- Iowa City John Hamiel, PharmD - Waterloo HONORARY PRESIDENT Tony Beraldi, RPh - Council Bluffs

PHARMACY TECHNICIAN Jessica Burge, CPhT - Des Moines

STUDENT PHARMACISTS Joshua Hart - Drake University Crissy Lawson - University of Iowa

The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see www.iarx.org. “The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) publishes 4 issues per year: January/ February/March issue; April/May/June issue; July/August/ September issue; and October/November/December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices. POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly, The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by ColorFx; Graphic design done by the Iowa Pharmacy Association.

ANNUAL MEETING: The epicenter of pharmacy practice in Iowa - pg. 10

EXPO RECAP Recapping this year’s

2020 Midwest Pharmacy Expo - pg. 22

FEATURES

IPA Board Election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Student Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 COVER STORY: The COVID-19 Pandemic . . . . . . . . . . . 16 2020 Midwest Pharmacy Expo . . . . . . . . . . . . . . . . . . . . 22 CPESN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Legislative Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

IN EVERY ISSUE

President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes.

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presidentâ&#x20AC;&#x2122;s page

Encouragement, Enlightenment, Exceptionalism . . . Connie Connolly, RPh, BCACP

These are a few of the words I had been ruminating on as I considered my guideword for my last editorial in the IPA Journal. The events of the last four weeks have impacted all of us, and the landscape is changing daily. If you have been following along, my themes have been styled to follow the word CARE. I started with Care in my inaugural address, followed by Advocacy, Respect and now for the EExposure This was not exactly the topic I was looking to use in my editorial, but I donâ&#x20AC;&#x2122;t think any of us were exactly prepared for the direction our lives have been turned in this last month. Today, I listened to the first webinar presented by IPA over the COVID-19 pandemic. There are a lot of great questions but not a lot of concrete answers at this point. By the time this is published, I am sure the picture will look much different. Here are a few thoughts on how I think this pandemic will help the profession of pharmacy: EXPOSURE to what it is that we do EXPOSURE to what it is we can do if legal and system limits are removed EXPOSURE to the lengths we will go to keep our patients healthy EXPOSURE to the extensive networking we have in place to get each other through this Pharmacy is already being highlighted in both the hospital and community as a resource during this pandemic. We are working the front lines and advocating for better resources and supply chain fixes so that we can get crucial medications and care to our patients. People are seeing us in our traditional roles, but they are also being exposed

| The Journal of the Iowa Pharmacy Association

| IPA President

to pharmacists making therapeutic substitutions and therapy suggestions because of the shortages. I am confident that people will see even more of our expertise in action as we begin to administer COVID-19 tests and vaccines once they are available. If Congress and others can come to a compromise on legislation and rules, I am hopeful that we will finally be able to claim our provider status. It is in just a situation as we are finding ourselves in now for which this makes the most sense. We have always known we are the most accessible healthcare providers and now it is obvious to everyone else. If given the proper scope, I am confident that we can also be the most efficient at providing medication services. We have spent many years trying to enlighten our lawmakers about our expertise; I am seeing that this healthcare crisis can educate further as to the correct path to follow. I have never been prouder to say I am a pharmacist than I am right now. I am in awe of the extra effort, hours, risk taking and compassion that all of you are exemplifying in this time of need. Our patients are relying on us more than ever, and you are stepping up to the plate. You have earned my highest esteem. I am amazed at the networking that is happening. I am also heartened by the support that has poured out from all areas of pharmacy to help us all through the biggest stressor we have ever seen. Even though we are working at a high level, people are taking time to share stories, resources and are just willing to be a listening ear for those who need it. I know that I am personally taking advantage of the various meditation apps that have been made available free of charge to help cope with the added mental

president’s page

and physical load. Please find what makes you feel calm, and use those practices to take care of yourself as we are being called on increasingly to help others. We are so blessed that Cheryl Clarke and our IPA staff were so forward-thinking in putting together the resources in the last 18 months to help us get through this by protecting our well-being. These can be accessed on our IPA webpage, www.iarx.org/burnout. Together, we can be shining examples of what healthcare should be. I am confident that pharmacy will emerge as an even more trusted profession, and I am optimistic that this crisis will shine a light on the great contribution pharmacy is well prepared to add to the practice of healthcare. Thank you for allowing me to be in this seat to watch your finest moments of enlightenment, encouragement and exceptionalism be exposed. ■

EXPOSURE • to what it is that we do

• to what it is we can do if legal and system limits are removed • to the lengths we will go to keep our patients healthy • to the extensive networking we have in place to get each other through this

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CEO’s column

are associations essential? Kate Gainer, PharmD

Executive Vice President & CEO

IPA (along with numerous other associations) As I write this editorial, the state of Iowa is in its sixth have opened our member-only benefits to share week of a state declared public health emergency information with all pharmacy professionals in for the coronavirus pandemic. COVID-19 news floods need. IPA staff members spend our days providing our inboxes and daily video conferences. Nothing advocacy to state agencies including the Board of is ‘business as usual.’ Community pharmacies Pharmacy, DHS, Iowa Medicaid, the Insurance Division, remain open, many curbside or delivery only, to as well as the Executive Branch and the Governor’s provide essential medications and services to their staff. IPA has been in close communication with all patients. Health-system pharmacies move from the six members of Iowa’s congressional delegation preparatory phase to the planning phase and in some and their staff, and in daily communication with hospitals the surge phase, with policies around drug national pharmacy organizations to relay pressing shortages, personnel, and infection control changing concerns to federal daily. Senior care pharmacists agencies. Our highest face unique challenges as priority is to advocate for outbreaks hit nursing homes, you, as essential healthcare and pharmacists are not even “YOU, IPA members, providers, during this time. allowed inside to perform consulting. Regardless of are among the We’ve worked with practice setting, pharmacist healthcare heroes that CEImpact to create roles are different today than important education they were only a few weeks ago. will rise to take care related to COVID-19 clinical implications, case scenarios Just as a rise in COVID-19 of our state.” and treatment, as well as a cases is inevitable, it is also 30-minute training on point inevitable that pharmacists of care testing. will be front and center during this public health emergency and global We’ve extracted the most relevant updates for Iowa pandemic. Pharmacists and pharmacy technicians pharmacists and hosted weekly webinars with key are essential members of the healthcare team and pharmacy stakeholders – IPA, the Board of Pharmacy, essential members of the frontline workforce. YOU, IPA Wellmark, MCO’s, Colleges, CEImpact, and an IPA members, are among the healthcare heroes that will member now working for a NYC hospital. rise to take care of our state – one community, one facility, one patient at a time. We’ve shared press releases to keep the public informed of pharmacists’ important work during While pharmacists and pharmacy technicians are the pandemic and raised awareness of impending essential, what about the Association that represents drug shortages, COVID testing, and expanding you? Is an association essential? Six weeks ago, I pharmacists’ role to provide care during this thought the answer was going to be NO, and I felt pandemic. IPA facilitated a joint endorsement with guilty for not serving with colleagues on the frontlines. the two Colleges of Pharmacy and the Board of But in my fifteen years working at IPA, never have I Pharmacy for the CDC’s guidelines on infection witnessed more important advocacy, more relevant control in pharmacies. information sharing, and more timely education.

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ceo’s column

“Whether or not an association is defined as ‘essential,’ I am convinced that the work of our association is more important now than ever before.”

In addition to relevant information and important advocacy in real time, we’re doing what associations excel at – strategically planning for the future. Discussing long-term implications of COVID-19 on the pharmacy profession and what the ‘next normal’ looks like for pharmacists in Iowa. Whether or not an association is defined as ‘essential,’ I am convinced that the work of our association is more important now than ever before. We represent members of a profession who are 100% essential, and I have never been more proud to work on behalf of the pharmacy profession. IPA has embraced this additional and important work and the renewed purpose that comes with serving the profession. From the staff team at IPA – thank you – thank you for your dedication to all those you work with and serve. And thank you for the privilege of advocating on your behalf. ■

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ipa board election

congratulations to ipaâ&#x20AC;&#x2122;s newly elected leaders

IPA would like to thank each of the candidates who ran for office and board positions in the recent Board of Trustees election! Also, thank you to the IPA members who took the time to vote. The strong slate of candidates speaks to the professional leadership of IPA members across the state of Iowa.

President - Elect

Trustee - Region 1

Trustee - Region 3

Chris Clayton PharmD, MBA

Wes Pilkington PharmD

Candace Jordan PharmD, BCPS, MBA

Trustee - At Large

Pharmacy Technician

Emily Beckett PharmD, BCPS

Nancy Bell PharmD

Tammy Sharp-Becker CPhT, CSPT

Manchester

Johnston

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Waterloo

West Des Moines

Winterset

Des Moines

HealthCare Hot Topics

FDA: Stop Sale of Flavored E-Cigarettes

Amid the epidemic levels of youth use of e-cigarettes and the popularity of certain products among children, the FDA issued a policy on January 2, 2020, prioritizing enforcement against certain unauthorized flavored e-cigarette products that appeal to kids, including fruit and mint flavors. Under this policy, companies that do not cease manufacturing, distribution, and sale of unauthorized flavored cartridge-based e-cigarettes (other than tobacco or menthol) within 30 days risk FDA enforcement actions.

Cancer Mortality Continues Steady Decline

As reported by the American Cancer Society, the cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year reduction in cancer mortality ever reported. The news comes from Cancer Statistics, 2020, the latest edition of the American Cancer Society’s annual report on cancer rates and trends. The steady 26-year decline in overall cancer mortality is driven by long-term drops in death rates for the four major cancers -- lung, colorectal, breast, and prostate, although recent trends are mixed.

Florida Report Shows Impact of PBM Steering Practices

A recent independent study analyzing 359 million prescription drug claims in Florida highlighted predatory practices by pharmacy benefit managers (PBMs). The study, commissioned by the Florida Pharmacy Association (FPA) and American Pharmacy Cooperative Inc. with data obtained from the Agency for Health Care Administration (AHCA) by the Small Business Pharmacies Aligned for Reform (SPAR) highlights the predatory nature of a handful of vertically integrated PBMs and managed care organizations (MCOs). The study provides concrete evidence that PBMs use a process called “steering” to direct patients to their affiliated pharmacies by requiring that insurance plans cover certain medications only if the prescriptions are filled at those specific pharmacies.

Netflix Series Sheds Light on Unsung Heroes

Netflix’s The Pharmacist debuted on February 5, 2020, and is already making people think twice about this unsung health care professional. In today’s politicallycharged health care climate, it is easy for people to confuse “the pharmacist” with “big pharma” and see these doctors as “pill pushers” and one of the causes of the opioid epidemic. In reality, pharmacists often act as patient advocates and help them deprescribe— that means removing unnecessary or harmful medications.

BMJ Study: Vaccines Can Prevent Fatal Complications from Measles

A study in BMJ Case Reports reveals that nearly a third of all reported cases of measles have such complications as pneumonia, hepatitis, and viral meningitis. The researchers noted that antivaccination efforts constitute a significant factor in an upsurge in cases among children and adults and that complications occur most commonly in people younger than age 5 years or older than age 20 years. The reemergence of measles is happening in the United States and other countries around the world, including Madagascar, Nigeria, and Ukraine. CDC estimates that more than 140,000 people worldwide died from measles in 2018.

FDA Approves Treatment of Peanut Allergy for Children

On January 31, the FDA approved peanut (Arachis hypogaea) allergen powder-dnfp (Palforzia—Aimmune Therapeutics) for the treatment of allergic reactions, including anaphylaxis, that may occur with accidental peanut exposure in children. Treatment can be started in children aged 4–17 years with a confirmed diagnosis of peanut allergy and may be continued as a maintenance medication in those aged 4 years and older. Those who take the product must continue to avoid eating peanuts. When used in conjunction with peanut avoidance, Palforzia provides an FDA-approved treatment option to help reduce the risk of these allergic reactions in children with peanut allergy. ■ apr.may.jun 2020 |

feature

ipa annual meeting 2020 IPA’s Annual Meeting is the epicenter of pharmacy practice in Iowa. Each year pharmacists, pharmacy technicians, and student pharmacists come together from across the state to discuss policy, share innovative ideas, and make meaningful connections with colleagues and pharmacy leaders.

• House of Delegates: Session 1

Plan now to:

• Meet the Researchers – Poster Session

• Take an active role in setting policy that will steer association action now • Hear and share innovative ideas to implement at your practice and advance the profession • Recharge by connecting with like-minded colleagues to build your network and opportunities for collaboration Join us at Annual Meeting to advance and celebrate your profession and you’ll leave refreshed and invigorated to better serve your patients!

ADDITIONAL INFORMATION

Present Your Poster - If you would like to present a poster, please submit an abstract at www.iarx.org/IPAAnnualMtg by August 31, 2020.

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THURSDAY, SEPTEMBER 17, 2020

• Keynote: Escaping Adulthood – Jason Kotecki • Industry Symposium & Exhibits • Organized Networking

• Keynote: Iowa’s Managed Care System – MCO Panel • President’s Reception • Annual Banquet • Silent Auction

FRIDAY, SEPTEMBER 18, 2020 • Fun Run

• Keynote: Scott Knoer, APhA CEO-designate (invited) • Meet the Researchers - Poster Session

• Residents Meeting & Preceptor Programming • House of Delegates: Session 2

Please continue to watch IPA communications for event updates and a finalized agenda.

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Iowa Pharmacy News

Healthcare-Associated Infection & Antibiotic Resistance (HAI & AR) Advisory Group Convenes

In January 1998, the Iowa Antibiotic Resistance Task Force was first convened by the Iowa Department of Public Health to address the development of bacterial resistance to antibiotics in Iowa. The purpose of this task force was threefold: to evaluate and monitor the prevalence of resistance in Iowa, to monitor the status of the problem, and to develop strategies to diminish the risk to the population of Iowa. The goals of the Iowa Antibiotic Resistance Task Force were to facilitate the appropriate use of antibiotics, discourage prescribing practices that promote the development of antibiotic resistance and decrease the spread of antibioticresistant organisms with appropriate prevention and control measures. This group met consistently for over a decade and authored a statewide report providing antibiotic resistance information and guidance. In September 2009, a Healthcare-Associated Infections advisory committee was formed to develop a statewide plan to perform surveillance on healthcareassociated infections and to determine best practices to reduce and prevent HAIs in Iowa. Then the Council of State Territorial Epidemiologist issued a policy statement recommending that all state health departments evaluate and incorporate stewardship activities into their Healthcare-Associated Infection programs. This led to the Iowa Department of Public Health’s decision to combine the Iowa Healthcare Associated Infection Advisory Group and the Iowa Antimicrobial Resistance Task Force. In late 2019, IPA was invited to participate in the newly formed Healthcare-Associated Infection & Antibiotic Resistance (HAI & AR) Advisory Group. Stakeholders throughout the healthcare, public health, and animal health fields were invited to participate in the HAI & AR Advisory Group. The goals of the HAI & AR Advisory Group are to: • Promote awareness of ongoing HAI & AR prevention and education efforts occurring throughout Iowa. • Identify additional HAI & AR gaps that public health and/or stakeholders can fill. • Serve as a forum of stakeholders that are doing work in the HAI & AR arena in Iowa that IDPH can share ideas with and consult as relevant issues arise. The HAI & AR Advisory group met on January 28, 2020, and will plan to meet at least one additional time per year via teleconference. The group discussed many topics, including: Carbapenem-Resistant Enterobactoraceae investigation procedures and cases, Candida auris reporting mandate and

| The Journal of the Iowa Pharmacy Association

screening recommendations, Infection Control Assessment and Response (ICAR) efforts in Iowa, and education for Iowa Infection Prevention Professionals in hospitals and long-term care facilities. IPA described mechanisms that pharmacists across the state identify accurate medication allergies to ensure appropriate antibiotic selection and treatment regimens.

CMS Feedback on Scope of Practice

In January, IPA submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) on its request for feedback on scope of practice. The request by CMS was in response to President Trump’s Executive Order (EO) on Protecting and Improving Medicare for Our Nation’s Seniors, which required Medicare to examine regulatory barriers that are preventing healthcare practitioners from practicing at the top of their license. Many IPA members also submitted comments highlighting the important role that pharmacists play in patient care and outcomes when integrated into the health care team.

IPA Staff Changes

Welcome IPA’s new Director of Communications & Digital Engagement, Allison Hale! Allison is a recent graduate of the University of Northern Iowa with a B.A. in Interactive Digital Studies. She is passionate about print design, social media marketing, and web development and is extremely excited to join the IPA team. For the previous two years, she worked in the communications field in the non-profit sector. In her free time, she enjoys photography, hiking, traveling, and spending time with friends and family. As Director of Communications & Digital Engagement, Allison will be responsible for implementing a new marketing automation software for IPA, continuously updating IPA’s social media channels, and creating print material for IPA’s annual events. She has many great ideas to improve upon IPA’s current communications strategy.

SCOTUS Set to Hear Arkansas PBM Case

In January, the US Supreme Court announced it will hear a case in the coming months that could have a major impact on determining whether states have the right to regulate pharmacy benefit managers (PBMs). The case, Rutledge v. PCMA, concerns a challenge to an Arkansas law seeking to bring stricter regulatory control over PBM practices. As of now, the Supreme Court is still scheduled to hear oral arguments on April 27th. However, all hearings scheduled for March have been postponed, which could affect the rest of the Court calendar.

iowa pharmacy news

VAWD-Accredited Wholesalers in Iowa With the recent Iowa Board of Pharmacy regulations that took effect, requiring wholesalers to have VAWD accreditation through the National Association of Boards of Pharmacy (NABP), many hospitals and pharmacies are asking who are the VAWD Accredited Wholesalers.

You can search on NABP’s website for all VAWDaccredited wholesalers. This is a good practice to verify if your current primary and secondary wholesalers are in compliance. However, this NABP website doesn’t help you to know who is registered in Iowa as a wholesaler. The BOP’s website only allows you to verify if a specific wholesaler is currently licensed in Iowa. The Iowa BOP is willing to assist pharmacies in locating wholesalers who are both licensed in Iowa and VAWD accredited by providing a list upon request. Please contact Amanda Woltz at amanda.woltz@iowa.gov to request this current list.

Expedited Partner Therapy – Resources Available

On March 18, 2020, new Board of Pharmacy regulations took effect that allow a pharmacist to dispense a non-patient-specific prescription for the purpose of expedited partner therapy (EPT) to treat sexually transmitted infections (STIs), chlamydia or gonorrhea, in an unnamed partner or partners. EPT is the clinical practice of treating the sex partners of patients diagnosed with STIs by providing medications to the patient to take to his/her partner without the healthcare provider first examining the partner. While IPA offered a 2/2/2 webinar on February 11, 2020 regarding this rule change, IPA continues to work with the Iowa Department of Public Health to offer additional resources for your practice setting as you communicate with patients and other providers. A specific webpage of these resources s now available on IPA website. Visit www.iarx.org/EPT.

Immunization Stakeholder Meeting

On March 2, 2020, the Iowa Immunizes coalition convened at the IPA Headquarters. The coalition is supported by the Iowa Public Health Association and is comprised of multidisciplinary partners and stakeholders, including IPA, the colleges of pharmacy, Iowa Medical Society, American Academy of Pediatrics, Iowa School Nurse Organization, Iowa Hospital Association, Alliance for Patient Access, Telligen, UnityPoint Health, University of Iowa Health Care, Blank Children’s Hospital, Iowa Department of Public Health, and several others. The alliance discussed the goals and direction of the newly formed coalition, strategies to expand upon life course immunization advocacy efforts, and how county immunization rates

provided by IDPH can assist with delivering targeted education in the areas that need it most.

Mandatory Reporter Changes Trainings Available

With the newly effective (1/8/2020) Board of Pharmacy regulations that were updated on mandatory training for identifying and reporting abuse, pharmacists that determine themselves to qualify as mandatory reporters must use DHS-approved mandatory reporter trainings only. The Iowa Code defines this qualification for every health practitioner who, in the scope of professional practice, examines, attends, or treats a child and who reasonably believes the child has been abused. To learn more and to access free mandatory reporter training from Iowa DHS, visit https://training.hs.iastate. edu/login/index.php.

Medicaid Updated Q&A on Provider Status On February 20, 2020, Iowa Medicaid Enterprise (IME) released Informational Letter (IL) No. 2105-MC-FFS updating information on the process for pharmacists to be recognized and listed as a new provider in Medicaid, effective July 1, 2020. This recognition is in direct response to legislation that passed in 2018 creating pharmacist statewide protocols for immunizations, naloxone, and nicotine replacement therapy.

This IL provides additional details on the enrollment process and answers some questions that IPA members have asked. It includes a FAQ section answering general questions, managed care organization enrollment, pharmacist affiliation details, and continuing education requirements. IPA will continue to work with IME to ensure this is a smooth process for pharmacists. For more information on pharmacists enrolling as providers within Iowa Medicaid, you can review the recent feature within the 2020 Jan/Feb/March edition of The Journal of the IPA.

RALI Lecture

On March 4, 2020 in partnership with RALI Iowa, IPA presented on the pharmacists’ role in fighting the opioid crisis at the Iowa State Grange in Kellogg, Iowa. Among those in attendance were Representative Wes Breckenridge and Jasper County Lt. Aaron Groves. Attendees were informed of the importance of safe medication practices to help prevent misuse. IPA presented on how pharmacists in Iowa are helping prevent opioid misuse through patient counseling and education, utilization of the prescription drug monitoring program, ordering and dispensing naloxone pursuant to the statewide protocol, offering medication disposal receptacles, the electronic prescribing mandate, and dispensing limited quantities of controlled substances upon request pursuant to the federal CARA Act. ■

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student column

When I Flip, you Flip, we Flip Crissy Lawson, 2021 PharmD Candidate 2019-2020 Board of Trustees | University of Iowa – Student Pharmacist Representative

What is my pharmacy “why?” The limitless specialization of our healthcare system comes with the significant tradeoff of fragmented care. Our profession is in the best position to unite these fragments, as pharmacists are often the central touchpoint for patients across all specialties. As I think of the future of pharmacy and where I fit in that picture, I am particularly passionate about how we can shape the future of community practice. Lately, I have heard a lot about pharmacies being smothered by PBMs, and additional decreases in staffing while pushing prescription volume. While this seems like a step backward for community pharmacy, the profession is pushing back to propel us forward for the sake of our patients. Flip the Pharmacy (FtP) is a new practice transformation initiative that uses a scalable model to flip the focus of pharmacy from the “here-andnow” to the “down-the-line.” It is a joint effort funded primarily by the Community Pharmacy Foundation and coordinated through CPESN USA. Pharmacies work collaboratively and with guidance from coaches to focus on six transformation domains. In the beginning stages, the program hopes to achieve outcome-driven goals such as a collective reduction in systolic blood pressure of 1 million mmHg and a 50,000-percentage point A1c reduction. Another focus of the program is standardizing workflow via eCare Plan submissions. The program is highly datadriven, with hopes to have a broad reach of over 5,000 pharmacies in just five years. The two-year program was kicked off in October 2019 with a cohort of twenty Practice Transformation Teams spanning twenty-seven states and over 500 pharmacies. One of those twenty teams is

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the Iowa Practice Transformation Team, which consists of thirty pharmacies under the umbrella of CPESN Iowa. As of February 29th, these thirty pharmacies submitted an impressive number of over 10,000 eCare Plans. That represents about 12.5% of submissions from all twenty teams. Over 2,000 of these eCare Plans had documented blood pressure readings, approximately 50% of which were uncontrolled and resulted in patient education and contact with prescribers to optimize therapy. The pharmacies participating in FtP have taken some very impressive strides. So, what can we do as student pharmacists? First and foremost, we can talk about it. This program is all about collecting data, which is necessary to demonstrate our value to payors, legislators, patients, and colleagues. Second, we can act. As students, residents, and professionals, we can lead initiatives in the pharmacy in preparation for joining the FtP vision. Third, we can get involved in our state pharmacy association. Not only is IPA a proud supporter of the Iowa Practice Transformation Team, but they are here to provide professional capital. As future leaders of the profession, it is imperative that we work as a team to continue moving community pharmacies in the right direction. What a victory it would be to close our gaps in care by flipping the pharmacy. ■

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cover story

covid-19 & pharmacists on the front lines

Bret Lentz, Caitilin Carriel, and Spencer Endecott of Drake University College of Pharmacy & Health Sciences

Undoubtedly, the most newsworthy topic of the last three months has been the Coronavirus, or COVID-19. Rightfully so, the entire world has changed dramatically in a way that we have not seen at any point in history. Everything from businesses, cities and even entire countries have been placed on lockdown causing society to invent a term for staying home and avoiding unnecessary interactions - social distancing. Healthcare however, has dutifully stayed the course, although not without some major changes and challenges. Pharmacists are once again at the forefront of these changes, especially in the community as pharmacies are some of the only establishments still open and fully operational. Naturally, pharmacists are being asked a variety of questions regarding the pandemic. This article is by no means a one-stop-shop for all answers COVID-19, but it does provide some helpful background, current events, and perhaps a glimpse at what the future may hold. For the most upto-date information on COVID-19 visit IPAâ&#x20AC;&#x2122;s website with resources and weekly webinars at iarx.com/covid19.

Background

Letâ&#x20AC;&#x2122;s start with what the novel coronavirus is and how it is different from previous pandemics. There are a variety of coronaviruses that inhabit all kinds of mammals: humans, cows, bats, etc. This particular sequence is a betacoronavirus and like its two predecessors, MERS-CoV and SARS-CoV, it has been traced back to bats. This is why COVID-19 is occasionally referred to as SARS-CoV-2. The viral sequence in the United States, although slightly different, is similar to the one first found in Wuhan, China where the first outbreak of COVID-19 was reported. You may be wondering how this strain differs from its counterparts. For starters, this is the only coronavirus that has been classified as a pandemic. Before March 11, 2020, the World Health Organization had never classified a coronavirus outbreak as a pandemic. There have been four pandemics within the last century, all of which have been caused by a novel influenza virus. This suggests that this sequence of the coronavirus is far more contagious than its MERS and SARS relatives.

| The Journal of the Iowa Pharmacy Association

Signs/Symptoms Hallmark Symptoms 1. Fever 2. Cough 3. Shortness of Breath

Severe/Emergency Symptoms 1. Troubled Breathing 2. Persistent Chest Pain or Pressure 3. Cyanotic in Lips or Face 4. New Onset Confusion or Inability to Arouse So how does it spread? It has been reported by the CDC that COVID-19 spreads primarily personto-person via respiratory droplets. Generally, this involves close contact with an infected person (within 6 feet) where a cough or a sneeze can spread the infection.3 Most reports from the CDC have suggested that people are most contagious when they are the most symptomatic. There have been rare incidents where someone is spreading the disease while asymptomatic.3 This is all the more reason to educate our patients of these hallmark symptoms, encouraging them to stay home when feeling ill or to seek emergency medical care when symptoms are severe. Symptoms can appear anywhere between 2 and 14 days after first exposure to the virus, so it is important to stay home to limit the spread throughout the community. However if the patient reports severe symptoms, they should be taken to the nearest emergency department for immediate testing and care.4 Now more than ever, it is important for pharmacists to be able to recognize these tell-tale signs and symptoms in order to protect our communities, flatten the curve, and relieve some pressure on a healthcare system that is seeing an exponential growth in reported cases.

Global/National Infection Rates

As of March 31st, COVID-19 has had 750,890 confirmed cases across the globe. The global death

toll due to COVID-19 has reached 36,405. Currently, the U.S. has the most confirmed cases in the world with 186,101. According to a projection done from the Institute for Health Metrics and Evaluation (IHME) out of the University of Washington in Seattle, COVID-19 cases will peak in the second week of April and will last for approximately 4 more months. On March 31st, the Trump Administration predicted a best-case scenario of 100,000 to 240,000 fatalities in the United States. Trump and his coronavirus task force have claimed the community mitigation over the last 15 days have helped, and the continuous use of these techniques is essential. They have also stated that without these community mitigation techniques, the death toll could have reached 1.5 million to 2.2 million Americans because of COVID-19.

announced partial activation of state emergency operation (No cases reported in Iowa at this time). On March 15th, Legislative leaders announced they intended to suspend session for 30 days. Gov. Kim Reynolds recommended all schools close for 4 weeks. Then on March 17th, Gov. Kim Reynolds declared a public health disaster in the state of Iowa, limiting gatherings of more than 10 people. The state Legislative body voted to suspend the session and give Gov. Reynolds expanded power to respond to the crisis. Updates are continuing to be released each day, and the state and federal governments are constantly responding with new guidelines.

Unforeseen Challenges

On March 16th, President Trump issued coronavirus guidelines for the U.S. The guidelines were to be in place for 30 days in an attempt to slow the spread of the virus. One of the largest bills passed because of COVID-19 is the $2 trillion coronavirus bill signed on March 27th. As stated in this bill, more than 150 million households will receive checks under the legislation, resulting in payments of $1,200 sent to many individual Americans plus $500 for children. Individuals with incomes above $99,000 are not eligible, and the total benefit is phased out for individuals earning between $75,000 and $99,000. This legislation also provides $100 billion to hospitals; $350 billion to small businesses; $500 billion to corporations, including airline companies and cruise lines; and about $150 billion for state and local stimulus funds.

As COVID-19 continues to spread, pharmacists in all settings will see changes to practice as they know it. One challenge that has rapidly emerged is the shortage of personal protective equipment (PPE) such as eye protection, gowns, facemasks, respirators, and ventilators. Patient care needs have exceeded the rate of production and delivery. In response, the CDC has issued recommendations on how to limit products that are in highest demand for both the general public and healthcare professionals. Currently, the CDC recommends that only those who have confirmed or suspected COVID-19 should use facemasks while being medically evaluated. To conserve supplies, the general public should not use facemasks otherwise.5 N95 respirators should be reserved for healthcare providers directly caring for patients with confirmed or suspected COVID-19. To minimize consumption of other PPE, the CDC recommends considering extended use of these resources rather than single use.6

For the most part, Iowa government officials have been following the guidance of the CDC and federal government. On March 7th, Governor Kim Reynolds

COVID-19 test kits are also in low supply compared to the enormous demand. This relative shortage results from a number of factors, including a

U.S. Government/Public Health Reaction

apr.may.jun 2020 |

cover story

shortage of chemicals used to run the tests, transit time from testing site to large outside laboratories, and a limited number of authorized manufacturers, all compounded by an everincreasing demand for testing. In response, the Food and Drug Administration (FDA) is in search of more manufacturers to license under special emergency rules designed to expedite the authorization process. In addition, Abbott and other companies are designing rapid point-of-care tests, such as those used to diagnose influenza or strep throat.7 These developments will drastically shorten the time it takes the average American to get tested. Another developing concern is the possible shortage of drugs in the United States. To date, only one drug shortage attributed to COVID-19 has been reported in the US; the drug has not been disclosed. However, this number may grow as the FDA has identified about 20 drugs that source their active ingredients or finished drug products exclusively from China, which is still recovering from COVID-19. The FDA continues to closely monitor this situation.8 Perhaps one of the most emotionally challenging aspects of the current pandemic is the restriction on social contact. Many members of the public experience some confusion related to what distancing is expected of them in what situations. Below is a primer on some of the various types of distancing and of whom they are required.

Social distancing

• Required of everyone • Stay at least six feet away from those who do not live in your household; avoid crowds and crowded spaces • Recommended duration: until instructed otherwise by federal officials

Self-quarantine

• Required of those who have been exposed to COVID-19, are at higher risk of infection, or recently returned from an area with rapid spread of the virus • Practice standard hygiene including washing hands frequently and covering coughs and sneezes; do not share towels, utensils, etc; stay home; do not have visitors; stay at least 6 feet away from others in the household • Recommended duration: at least 14 days

| The Journal of the Iowa Pharmacy Association

Isolation

• Required of those who test positive for COVID-19 • Practice standard hygiene including washing hands frequently and covering coughs and sneezes; wear a facemask while being medically evaluated; do not share towels, utensils, etc; stay home; do not have visitors; stay at least 6 feet away from others in the household • May take place at home or at a healthcare facility depending on severity of illness • Recommended duration: until directed otherwise by a healthcare provider9

During this time, it may be beneficial to stay in touch with friends and family via phone calls, text messages, social media, and video calls.

Pharmacy and Healthcare Reactions

Although healthcare professionals have been deemed essential, pharmacies, clinics, and hospitals have not been immune to change. The primary goal has been to prevent community spread of COVID-19 with a variety of preventative measures. The CDC has issued some general guidance, primarily aimed at keeping patients spread apart. They suggest using telemedicine whenever possible and cancelling or rescheduling non-essential appointments and elective procedures. When patients do have to leave their homes to receive care, they must be managed carefully once they arrive. All community pharmacy settings should limit points of entry and restrict visitors. Additionally, staff member numbers should be as low as possible to minimize the concentration of people present. Furthermore, all patients should be screened for respiratory symptoms at arrival. If possible, those with suspected or confirmed COVID-19 should be put in private rooms with the door closed to minimize spread. Lastly, pharmacies should use signage to encourage patients to maintain a 6-foot distance from others, use tissues to cover coughs, and to utilize good hand hygiene. These measures will greatly reduce the risk of infection for both patients and providers.11

Statement/Information from Colleges Along with new business and educational strategies to prevent community spread, pharmacists have needed to be even more vigilant to ensure proper prescribing practices are taking place. There have

Cover Story

been multiple reports of prescribers inappropriately prescribing medications for themselves and their family members (typically chloroquine, hydroxychloroquine, and azithromycin) to prevent or treat COVID-19. Pharmacies and hospitals have also inappropriately been stockpiling these medications in expectation for future demand. The dilemma however, is that these medications do have a place in COVID therapy. On March 28, the FDA issued an Emergency Use Authorization (EUA) for the use of the oral cholorquines in hospitalized patients.10 Pharmacists now more than ever need to use their professional judgement to determine the validity of prescriptions written for these select medications and to inquire if there are any suspicions. Although treatment options have been limited during the pandemic, hope is on the horizon. Two vaccinations against COVID-19 are currently under research and development. SARS-CoV-2 mRNA1273 is currently in phase 1 clinical trials, but the US Department of Health and Human Services and its manufacturer, Moderna, are already preparing for phases 2 and 3 so that they may begin as soon as possible.12 It is being studied via an openlabel dose ranging clinical trial as two doses given intramuscularly in the upper arm about 28 days apart.13 Its phase 1 trial expected completion date is June 1, 2021.14 Another vaccine, Ad26 SARSCoV-2, is also under development. Its phase 1 trial is set to begin no later than fall 2020 with a goal of emergency use in early 2021.

Conclusion

All of this considered, there are still numerous unknowns in this new day and age with COVID-19. It is still extremely difficult to reasonably predict the next several weeks, not to mention the next several months due to the ever-changing landscape of COVID-19. Press releases from state and federal officials are always reactive. Policies for businesses, schools, and healthcare facilities continue to evolve based on new recommendations from the government and CDC. Now more than ever, it is important for pharmacists to be up-to-date on current events as patients will inevitably have more and more questions. Pharmacists need to also be flexible with the changing policies and recommendations. This is ultimately a waiting game as the world works to get a handle on the situation. In the meantime, social distance as much as possible, constantly use good hygiene, and continue to provide care for your communities as they need pharmacists now more than ever. â&#x2013;

References: 1. COVID-19 Background Information. (2020, March). Retrieved from https://www.aapmr.org/news-publications/covid-19/covid-19background-information 2. COVID-19 Situation Summary. (2020, March 26). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/ summary.html 3. How Coronavirus Spreads. (2020, March 4). Retrieved from https:// www.cdc.gov/coronavirus/2019-ncov/about/index.html 4. Symptoms of Coronavirus Disease 2019 (COVID-19). (2020, February 29). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/ about/symptoms.html 5. Healthcare Supply of Personal Protective Equipment. (2020, March 12). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ healthcare-supply-ppe-index.html 6. CDC 2019 Novel Coronavirus Response. (2020, February 11). Retrieved from https://www.cdc.gov/vaccines/videos/coronavirus/COVID-19webinar.pdf 7. Why It Takes So Long to Get Most COVID-19 Test Results. (2020, March 28). Retrieved from https://www.npr.org/sections/healthshots/2020/03/28/822869504/why-it-takes-so-long-to-get-mostcovid-19-test-results 8. FDA Reports First Drug Shortage Due to Coronavirus. (2020, March 9). Retrieved from https://www.pharmacist.com/article/fda-reportsfirst-drug-shortage-due-coronavirus 9. Coronavirus, Social and Physical Distancing and Self-Quarantine. (2020, March 31). Retrieved from https://www.hopkinsmedicine.org/ health/conditions-and-diseases/coronavirus/coronavirus-socialdistancing-and-self-quarantine 10. Joint Statement of FSMB and NABP on Inappropriate Prescribing and Dispensing of Medications During the COVID-19 Pandemic. (2020, March 30). Retrieved from https://nabp.pharmacy/newsroom/news/ joint-statement-of-fsmb-and-nabp-on-inappropriate-prescribingand-dispensing-of-medications-during-the-covid-19-pandemic 11. Interim Infection Prevention and Control Recommendations. (2020, April 1). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/ infection-control/control-recommendations.html 12. HHS Accelerates Clinical Trials, Prepares for Manufacturing of COVID-19 Vaccines. (2020, March 30). Retrieved from https://www. hhs.gov/about/news/2020/03/30/hhs-accelerates-clinical-trialsprepares-manufacturing-covid-19-vaccines.html 13. NIH Clinical Trial of Investigational Vaccine for COVID-19 Begins. (2020, March 16). Retrieved from https://www.nih.gov/news-events/newsreleases/nih-clinical-trial-investigational-vaccine-covid-19-begins 14. Safety and Immunogenicity Study of 2019-nCoV Vaccine (mRNA1273) for Prophylaxis SARS CoV-2 Infection. (2020, March 3). Retrieved from https://clinicaltrials.gov/ct2/show/NCT04283461?term=vaccine& cond=Covid-19&cntry=US&draw=2&rank=1 15. Global/U.S. Infection projection rates. (2020, March 31) Retrieved from https://covid19.healthdata.org/projections 16. U.S. Government Public Health Reaction. (2020, March 31). Retrieved from https://governor.iowa.gov/sites/default/files/documents/ Public%20Health%20Proclamation%20-%202020.03.31.pdf 17. Iowa Public Health Reaction. (2020, March 26). Retrieved from https://governor.iowa.gov/sites/default/files/documents/Public%20 Health%20Proclamation%20-%202020.03.31.pdf 18. Coronavirus Bill. (2020, March 27). Retrieved from https://www. nbcnews.com/politics/congress/house-gives-final-passage-2trillion-coronavirus-stimulus-bill-n1170281

apr.may.jun 2020 |

practice advancement

ASHP Releases PAI 2030 Recommendations

Every decade ASHP releases initiatives for the next 10 years, and in January 2020, the Practice Advancement Initiative (PAI) 2030 recommendations were released. The PAI 2030 categorizes their recommendations into five different sections: 1) patient-centered care, 2) pharmacist role, education, and training, 3) technology and data science, 4) pharmacy technician role, education, and training, and 5) leadership in medication use and safety. Highlights of each section include a need for pharmacists to lead medication management in all healthcare settings, a focus on changing the definition and role of the pharmacist within the healthcare team, increasing the use of technology in healthcare delivery, refining definitions of technicians and a push to increase utility, and further encouragement for a pharmacist to be involved in healthcare leadership and decision making.

HIV Project Expansion to include Hepatitis C Testing

In conjunction with the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis, IPA is partnering with community-based pharmacies across the state in offering HIV testing with plans to add Hepatitis C testing in 2020. Based on statistical data from the Iowa Department of Public Health’s epidemiology report, additional Hepatitis C testing is needed in Greene and Appanoose counties. The project launched in January of 2019 and includes two cohorts of twelve pharmacies that are currently offering free HIV screenings. With the goal of 40 sites providing HIV screenings, IPA is looking to gain more interest in offering HIV testing in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Wayne, Lucas, Monroe, Appanoose, Wapello. These are areas of the state that the Iowa Department of Public Health considers focus areas based on their epidemiology reporting. To participate in the project or to learn more, please contact Kellie Staiert, IPA’s Lead Project Manager at kstaiert@iarx.org.

CDC Continues to Work with Pharmacists to Control BP & Diabetes in Iowa Throughout 2020, IPA will continue to work with the Iowa Department of Public Heath (IDPH) to achieve the goals and objectives of the CDC 1815 grant focused on controlling blood pressure and diabetes in high-

| The Journal of the Iowa Pharmacy Association

risk communities around the state. Throughout this initiative, IPA and IPDH hope to increase pharmacist engagement with promotion and delivery of selfmanagement and medication management services related to these disease states. IPA will be working throughout 2020 to reach out to pharmacists to assist in initiating new referral processes for diabetes self-management education/ support (DSME/S) and CDC-recognized diabetes prevention programs (DPP). Watch for communications from IPA to seek your interest in this initiative.

Free Narcan Opportunity for Hospital ERs The Iowa Department of Public Health (IDPH), in collaboration with the Iowa Hospital Association (IHA) and the Iowa Healthcare Collaborative (IHC), have been working to resolve the issue of opioid misuse in Iowa, including preventing the deaths of Iowans struggling with an opioid use disorder.

As part of their ongoing Opioid Initiatives, IDPH is teaming up with IHA and IHC to help prevent fatal overdoses by offering free naloxone (Narcan nasal) kits to hospital emergency departments, to be distributed free of charge to persons being released from the emergency department following an opioid overdose. In addition to the Narcan kit, participating hospitals will be asked to distribute referral information provided by IDPH to help connect individuals with local treatment services. The distribution of the Narcan kits should be done in accordance with established hospital policies. All orders placed by hospitals are to be for the projected annual need, based on the number of prior opioid overdoses treated in 2019. Hospitals needed to submit their requests for kits by April 6, 2020.

Join the Hepatitis C ECHO Initiative

The Iowa Primary Care Association (PCA) is facilitating a Hepatitis C (HCV) ECHO initiative. This program is intended for primary care providers (and other providers) interested in learning more about HCV and how to treat/care for patients with HCV. Extension for Community Healthcare Outcomes (ECHO) is a movement to de-monopolize knowledge and amplify local capacity to provide best practice care for underserved people all over the world. This interactive web-based program provides community-focused primary care clinicians an opportunity to become experts in the delivery of Hepatitis C care through a mentoring-based initiative. Project ECHO, developed by Dr. Sanjeev Aurora at

Practice Advancement

the University of New Mexico (UNM) in 2003, provides a framework for sharing expertise across the state and as a result will help patients achieve a viral cure and avoid the downstream sequela associated with HCV without leaving the providers they trust and the communities where they live and work. Interested providers do not have to have any prior experience in treating Hepatitis C to participate in HCV ECHO. IPA would encourage you to join the HCV ECHO as Hepatitis C impacts many of the patients in your practice setting whether you may know it or not. If interested, contact ECHO@iowapca.org with your name, title, credentials, organization, and email.

IHC Opioid Response Program

IPA is participating as a Leadership Board member with the Rural Communities Opioid Response Program (RCORP) Iowa Opioid Use Disorder (OUD) Consortium. This one-year planning grant is funded by the Health Resources and Services Administration (HRSA) with current consortium efforts lead by the Iowa Healthcare Collaborative (IHC). The goals and objectives of the Iowa OUD Consortium are to convene statewide leaders, create a statewide strategic plan and sustainable model to address OUD prevention,

Burnout & Resiliency IPA Board of Trustees have adopted the issue of clinician well-being and burnout as a primary goal of IPA’s strategic plan. As IPA continues its mission to empower the pharmacy profession to improve health outcomes, we recognize this important issue and hope our members will find these resources helpful in addressing this important issue within our profession.

www.iarx.org/burnout

treatment and recovery. IPA is sharing pharmacy specific initiatives, gaps and solutions in support of this statewide OUD rural strategic plan.

Wellmark VBPP Update

On Friday, February 7, 2020 during the Midwest Pharmacy Expo, Wellmark BCBS held a Value-Based Pharmacy Program (VBPP) Summit to conclude two years since the program’s initiation. At least one representative from over 70 participating pharmacies across Iowa attended the Summit. Highlights of the afternoon included presentations from Wellmark’s pharmacy leadership providing a recap of the program’s second year, research findings, and the incredible health outcomes data that Iowa pharmacies were directly involved in. Iowa pharmacies were pleased to learn that Wellmark plans to continue to offer value-based contracts to high performers, though details on what the new program will look like have not yet been finalized. To conclude the session, IPA’s CEO, Kate Gainer, thanked Wellmark for their leadership, vision, and partnership in launching the VBPP, as well as the Iowa pharmacies that demonstrated pharmacist interventions through significant improvement in patient outcomes and savings in total healthcare costs. ■

ResilienceRx Podcast iarx.org/podcasts “Fail Forward” interviews & personal growth/ wellbeing tips

Aveea Partners aveeapartners.com Wellness webinars, 1:1 coaching to uncover blind spots and build skills

IMP3 imp3.iowa.gov Support for physical & mental healthy recovery

IPA Resources iarx.org/burnout Information, tools to assess burnout, & resources to build resiliency

apr.may.jun 2020 |

midwest pharmacy expo

Firsts, Seconds, & Favorites at the 2020 Midwest Pharmacy Expo

Expo Recap

On February 7-9, 2020, nearly 300 pharmacists, pharmacy technicians, and student pharmacists from 17 states met at the Hilton Des Moines Downtown for the 2020 Midwest Pharmacy Expo. For the third year in a row, Expo Friday featured Clinically Intensive Workshops. These popular sessions feature high-level, clinically focused programming with topics this year covering chronic care management of diabetes and anticoagulation and medication misconceptions. Saturday took off with two Industry Symposium Breakfasts, followed by a keynote address on leading and working with a multigenerational team. The themes of the five breakout session tracks included innovative practice, challenging cases, nutrition/wellness, and professional roles and skills. Expo wrapped up on Sunday with long-time favorites including New Drug Update, and Gamechangers in Pharmacy. In between those two sessions was a very informative session on navigating the challenge of drug shortages. This year, not only were several Saturday sessions recorded, but all of Sundayâ&#x20AC;&#x2122;s sessions were included in IPAâ&#x20AC;&#x2122;s Expo On Demand package. Recordings of those sessions are available through CEImpact. Details on accessing the recorded sessions are available at www.iarx.org/ midwestpharmacyexpo.

join us in 2021

Save the Date: 2021 Midwest Pharmacy Expo February 5-7, 2021

Expo Food Drive

The Midwest Pharmacy Expo partnered with Pharm-to-Tables to hold a food drive during the event. With raffle gifts on the line, attendees generously donated 259 pounds of food and $260 to the Food Bank of Iowa. During the week leading up to Expo, both Drake University College of Pharmacy and Health Sciences and the University of Iowa College of Pharmacy competed in a friendly â&#x20AC;&#x153;Pharmacy Phood Phight.â&#x20AC;? With statewide bragging rights at stake, the colleges competed against each other by earning one point for each pound of food or dollar donated. The combined totals from the Phood Phight were 248.5 pounds of nonperishable food donations plus $912. Drake University delivered their donations to the Food Bank of Iowa, and the University of Iowa delivered theirs to the Food Pantry at Iowa. Ultimately, the winner of 2020 Phood Phight bragging rights is the University of Iowa. apr.may.jun 2020 |

CPESN IOWA

Synergy of CPESN® USA, Flip the Pharmacy, and ACT Accelerates Practice Transformation Jay Williams

Director, Marketing Communications, CPESN® USA

Pharmacy teams at CPESN® pharmacies understand the need for community pharmacy practice transformation and know there needs to be visible, coordinated efforts to make transformation real in communities nationwide. CPESN® USA and the pharmacy providers that lead it are building pharmacy networks and doubling down on payer engagements, with active payer or partner programs in 19 networks. Flip the Pharmacy is a Community Pharmacy Foundation supported initiative to bring coaches and resources directly to CPESN pharmacies to accelerate change. Flip the Pharmacy is transforming community-based pharmacies away from filling prescriptions at a moment in time to caring for patients over time, with a focus on workflow implementations and scaling innovation. Over 500 community-based pharmacies are engaged to-date, 30 of them from CPESN IOWA and the program aims

to impact over 5,000 pharmacies across America by the end of the 5-year initiative. The ACT (Academia-CPESN Transformation) Pharmacy Collaborative is a national collaborative bringing together faculty from colleges/schools of pharmacy with CPESN pharmacies and leaders to unite, mobilize, and amplify community pharmacy transformation efforts. This collaborative is supported by the Community Pharmacy Foundation, CPESN® USA, the American Association of Colleges of Pharmacy (AACP) and led by a team from the University of Pittsburgh. Over 80 colleges/schools of pharmacy have joined to date, including the University of Iowa and Drake University with each Dean stating their school’s commitment to community pharmacy practice transformation. ACT teams at these schools are ready and willing to support practice transformation— through engaging learners, reimagining curricula, encouraging innovation, and expanding communitybased pharmacy research. Team Iowa has coaches from both Colleges of Pharmacy working with participating Iowa sites. The moment is NOW. The momentum is REAL. Together CPESN® USA, CPESN IOWA, Flip the Pharmacy, and the ACT Pharmacy Collaborative are working daily to scale community pharmacy care delivery across the country! Together, we can accomplish more than we could alone. To join CPESN visit www.cpesn.com, and visit flipthepharmacy.com and actforpharmacy.com to learn more. ■

apr.may.jun 2020 |

PEER REVIEW

The Impact of Pharmacist Involvement in Professional Associations and Career Satisfaction Katlynn Johnson, Jaycee Mandernach, Andrew Sabers, & Sarah Tappe of the University of Iowa College of Pharmacy John Swegle, PharmD, BCPS, BCACP

Abstract

Background: Professional association involvement can be an integral part of a pharmacist’s career. However, not all pharmacists choose to be a part of these organizations. Professional association involvement and its impact on career satisfaction was evaluated. The primary outcome assessed how the number of associations and time involved with these associations impacted pharmacist’s career satisfaction. Secondary outcomes included assessments on the impact duration of pharmacy practice and practice type (i.e. community, hospital, etc.) have on career satisfaction. Methods: A Google forms survey was sent to Iowa Pharmacy Association (IPA) members via email two different times. There were 22 questions on this survey assessing various questions involving demographics, workplace information, involvement in organizations, and overall satisfaction. Questions about satisfaction included a scale from 1 to 5, with 1 being highly unsatisfied and 5 being highly satisfied. Descriptive statistics were used to analyze the survey data. Results: Twenty-eight pharmacists responded to the survey. Iowa pharmacists had a high level of satisfaction overall. A majority of pharmacists (89.3%) reported they were either highly satisfied or satisfied with their career. Only 3.6% reported that they were unsatisfied with their career. Satisfaction ratings remained similar across practice location (Avg. satisfaction rating; community: 3.71, ambulatory: 4.71, hospital: 4.67). Increased involvement (hours/month) showed no clear impact on satisfaction (0 hours: 4.75, 1-2 hours: 4.29, 3-4 hours: 5.0, ≥ 5 hours: 4.8). There was a trend toward increased satisfaction with

| The Journal of the Iowa Pharmacy Association

the greater number of associations a participant was involved in (1-2 associations: 4.29, 3-4 associations: 4.55, ≥ 5 associations: 5.0). Conclusions: Pharmacists involved in more professional associations showed a trend of being more satisfied with their careers compared to pharmacists involved in fewer professional organizations.

Introduction

In 2019, USA Today’s “Best Jobs” ranked pharmacist as #55.1 In 2017, pharmacist ranked as the second most promising profession, according to LinkedIn.2 Additionally, a recent Pharmacy Times survey found that only 51% of respondents were satisfied with their job. The top three reasons for dissatisfaction were workload, management, and the work-life balance.2 The top three drivers of satisfaction being pride in what they do, compensation, and colleagues.2 One potential option to boost career satisfaction is to be involved in one of the numerous professional associations. Professional association involvement can be a rewarding part of a pharmacist’s career, however, not all pharmacists are a part of these organizations. If pharmacists that are involved in a professional association are more satisfied in their career, this could provide useful information to promote professional engagement and aid in career satisfaction. Timothy Gauthier has hypothesized some variables that limit pharmacist involvement as their career progresses. Such variables include diminishing benefit, increasing personal and family activities, and the cost to be a member in the association.4

PEER REVIEW

The primary objective assessed how the number of professional associations a pharmacist is involved in impacts their career satisfaction. Secondary objectives assessed the impact of the duration and location of pharmacy practice on career satisfaction. It was hypothesized that increased involvement in professional associations would result in higher career satisfaction.

Methods

Pharmacists were surveyed in the state of Iowa. Those pharmacists were contacted through use of the Iowa Pharmacy Association’s (IPA) weekly “Top 5” e-mail. The survey (table 1) was e-mailed out twice using IPA’s mailing list. This e-mail was sent out once in January 2019 and once in February 2019. The survey was administered through a Google forms survey. There were 22 questions that were asked in the survey involving demographics, workplace information, involvement in organizations, and overall satisfaction. The demographics section included questions about gender, age, duration of practice, and degree type. The workplace information section included questions about practice location and the number of hours per week a pharmacist spent working. The involvement in organizations section included questions about the number of professional associations a pharmacist was involved in, type of association involvement, time dedicated to associations (hours per month), and reason for association participation. The satisfaction section utilized a 5-point Likert scale with 1 being highly unsatisfied, 2 being unsatisfied, 3 being neutral, 4 being satisfied, and 5 being highly satisfied. The questions included were about clinical service satisfaction, clinical skills enhancement, patient interaction opportunities, health care professional interactions, coworker or management interactions, motivation, benefits and/or salary, satisfaction with the future direction of pharmacy, and overall satisfaction. After the survey was sent out twice, the data was compiled and assessed using descriptive statistics.

Results

The survey had 28 respondents. Participant demographics and characteristics are described in table 2. Overall, career satisfaction was higher among pharmacists surveyed than the national average of 51%.2 Of the pharmacists that were surveyed, 60.7% reported they are highly satisfied with their career, 28.6% reported they are satisfied, 7.1% reported that they are neutral, and 3.6% reported that they are unsatisfied with their career.

The hours of association involvement and satisfaction are described in figure 1. Pharmacists with 3-4 hours of professional association involvement per month reported the highest level of satisfaction with an average satisfaction rating of 5.0 on a 5-point scale. Those with 5 or more hours of association involvement were the next highest with an average satisfaction rating of 4.8, followed by pharmacists with 0 hours of involvement with an average satisfaction rating of 4.75. The least satisfied group was that with 1-2 hours of association involvement with an average satisfaction rating of 4.13. Involvement in a greater number of associations displayed a trend of increased career satisfaction as shown in figure 2. Pharmacists involved in 5 or more associations had the greatest average satisfaction rating of 5.0 followed by pharmacists involved in 3-4 associations with an average rating of 4.55. The lowest rating came from those involved in 1-2 associations with an average rating of 4.29. There were some variations in satisfaction looking at different practice locations. Ambulatory care pharmacists reported the highest level of satisfaction at 4.71. This was followed very closely by hospital pharmacist with a satisfaction rating of 4.67. The greatest difference was seen amongst community pharmacists who reported the lowest average satisfaction rating at 3.71. Career satisfaction increased with increasing duration of pharmacy practice. Those with 20 or more years of practice had the highest average career satisfaction rating at 4.67. Pharmacists with 11-20 years of practice reported a satisfaction rating of 4.38. Those with 6-10 years of practice had the lowest rating at 4.0. Most pharmacists joined an association as an opportunity to give back (39.3%). Other common reasons were networking opportunities (32.1%) and clinical skills development (21.4%). Another less common reason for participation in an association was to shape the future of pharmacy (3.6%).

Discussion

The average satisfaction rating gathered from this survey was above the national average. This was likely due to survey participants being Iowa pharmacists. The state of Iowa has developed a strong pharmacy reputation nationally. Drug Topics ranked Iowa in the top 5 states to be a pharmacist

apr.may.jun 2020 |

PEER REVIEW

in 2019.5 Additionally, the use of IPA’s mailing list introduced bias as all respondents were a part of at least one organization which could have resulted in the higher satisfaction ratings. Being involved in a greater number of professional associations was linked to greater career satisfaction. The greatest amount of satisfaction was seen at 3-4 hours of association involvement per month. There is a difference in the reported satisfaction of pharmacist’s involvement in a professional organization of 0 hours (4.75) versus pharmacist’s involvement of 1-2 hours (4.13). This is a 13.1% decrease in their satisfaction from 0 to 1-2 hours spent. However, the low response rate of 4 and 15 participants spending 0 and 1-2 hours respectively may explain this finding. Additionally, the type of involvement was not specified. There cannot be a direct link stating more time spent means more satisfaction in one’s career. There is most likely a threshold to what this value is and needs to be further studied. Based off the results from this study, there is a possibility of a “sweet spot” of involvement. This amount of time could have many variables to it and could be a different number of hours spent based on personal characteristics previously discussed such as stable employment, personal activities, and the cost of the association. Within practice sites, ambulatory care and hospital care pharmacists were more satisfied than community pharmacists. The next step is to investigate why these practice sites differed in their career satisfaction as many variables are at stake. With increasing years of pharmacy practice, there was a trend of increasing satisfaction as the highest satisfaction was with 20+ years of experience. The greater satisfaction among the more experienced pharmacists could stem from more comfortability in their job. However, this is only speculation as the reasoning behind this difference was not addressed in the survey. Pharmacists in the survey had varying reasons as to why they wanted to be involved in a professional association with the most highly ranked reason being that they wanted to give back. It could be reasonable to think that a satisfied pharmacist in their career would want to spend more time with their career involvement whereas an unsatisfied pharmacist would not want to spend extra time related to their profession. This study has numerous limitations. The use of IPA’s mailing list is limited to Iowa pharmacists and prevents comparison to a control group.

| The Journal of the Iowa Pharmacy Association

Additionally, the survey had a poor response rate with only 28 respondents. Due to these limitations, any relationship between organization involvement and career satisfaction were not able to be investigated. Although this study does not have any immediate implications, it can serve as a foundation for future research in to the relationship between organization involvement and career satisfaction.

Conclusions

Iowa pharmacists involved in more professional associations showed a trend of being more satisfied with their careers compared to pharmacists involved in fewer professional organizations. The longer a pharmacist has been in practice showed a trend of more satisfaction in their career. Hospital and ambulatory care pharmacists have relatively similar levels of satisfaction in their career while community pharmacist have slightly less satisfaction. Further research needs to be completed to assess pharmacist satisfaction at a national level. Input from pharmacists that are not involved in professional organizations also needs to be assessed in order to further determine the relationship between organization involvement and career satisfaction.

Acknowledgements

Iowa Pharmacy Association (IPA) for allowing the investigators to distribute the survey. Contact IPA for a copy of the complete survey used.

References: 1. “Pharmacist Ranks Among Best Jobs of 2019.” U.S. News & World Report, U.S. News & World Report, money.usnews.com/careers/bestjobs/pharmacist. 2. “Pharmacists Rank Among Most Promising Professions of 2017.” Pharmacy Times, 24 Jan. 2017. https://www.pharmacytimes.com/ news/pharmacists-rank-among-most-promising-professionsof-2017. 3. Mollison, Caitlin. “Pharmacists Are Happy With Their Salaries, Less So With Their Jobs, Survey Shows.” Pharmacy Times, 12 Jan. 2019. 4. “Is It Worth Price Of Membership To Be In Pharmacy Organizations As A Pharmacist?” IDStewardship, 6 Dec. 2018, www.idstewardship.com/ worth-price-membership-pharmacy-organizations-pharmacist/. 5. Hamm, Nicholas “Top 10 Best States to Be a Pharmacist in 2019.” Drug Topics, 17 Oct. 2019. https://www.drugtopics.com/salary/top-10-beststates-be-pharmacist-2019.

PEER REVIEW

Table 2: Participant Demographics and Characteristics

Figure 1: Hours of Association Involvement

Figure 2: Number of Associations

apr.may.jun 2020 |

Public Affairs

Board of Pharmacy: Regulatory Update The Iowa Board of Pharmacy convened on January 7-8 and February 25-26 to discuss multiple requests, reports and informational items, as well as several proposed rules.

of the prescription. During the public comment period, the Board received a comment that sought a change in the language which the Board would like to more thoroughly review.

Board Member Terms and Appointments

Adoption of Rules

Two current Board members were reappointed by Governor Kim Reynolds to serve another term. Brett Barker, PharmD, is from Nevada and practices at NuCara Pharmacy. Gayle Mayer, RPh, is from Spirit Lake and most recently practiced at Spencer Hospital. Both Brett and Gayle were re-appointed to their second 3-year term on the board. LaDonna Gratias finished out her third and final term on the Board serving as public member. Sherill Whisenand of Des Moines was appointed to fill the public member vacancy.

Termination of Rulemaking

At the February 26 meeting, the Board voted to terminate a proposed rulemaking which would have sought to amend Chapter 6, “General Pharmacy Practice,” Iowa Administrative Code. The rulemaking proposed to allow one pharmacy to provide prescription drug order information to another pharmacy for a noncontrolled substance prescription for the purpose of providing a patient with a three-day supply of continuing medication without the process constituting a complete transfer

Expedited Partner Therapy The Board voted to adopt rules to further help implement expedited partner therapy in Iowa. The amendments allow a pharmacist to fill a nonpatient-specific prescription when the prescription is issued pursuant to Iowa Code section 139A.41 for the purpose of expedited partner therapy to treat a sexually transmitted chlamydia or gonorrhea infection in an unnamed partner or partners. Delivery of Prescription Drugs The Board also voted to adopt a rulemaking impacting several pharmacy-related administrative code sections. The adopted rules require a nonresident pharmacy applicant to identify a registered location located in Iowa and extend the time frame in which a pharmacy must respond to a request for original records from 48 to 72 hours. Furthermore, the rule amended language relating to requirements for closing a pharmacy which may be exempt in the event of an unforeseeable closure and simplified the rule relating to the delivery of prescription drugs. ■

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.

apr.may.jun 2020 |

LEGISLATIVE Day

legislative day 2020

IPA Awards First Annual Legislative Champion Award

On January 29, IPA members from across Iowa took the Capitol by storm to advocate for the profession of pharmacy. With over 200 pharmacists, pharmacy students, and technicians in attendance, nearly all of Iowa’s 150 legislators were engaged through face to face advocacy. The day started off at the Embassy Suites Des Moines with a new attendee and student orientation. Representative Joe Mitchell and Senator Zach Wahls provided insight into their experiences as young legislators and best practices for effective advocacy. IPA’s annual Good Government Award was presented to Rep. Bobby Kaufmann. IPA also recognized Mark Frahm with its first annual Legislative Champion Award for his work to uncover egregious PBM spread pricing in Wapello County. Following the Legislative Briefing by IPA’s Director of Public Affairs Casey Ficek and IPA Lobbyist Kate Walton, attendees heard from pharmacist legislators Rep. John Forbes and Senator Tom Greene for an update on current pharmacy legislation in the House and Senate. After heading to the Capitol and meeting with legislators in the afternoon, members were joined by legislators back at the Embassy Suites for IPA’s Legislative Reception. Thank you to all who attended and helped make the day a tremendous success. The feedback from legislators regarding the knowledge and passion of our group has been overwhelming. ■

| The Journal of the Iowa Pharmacy Association

IPA recognized Mark Frahm with its first annual Legislative Champion Award on January 29 in Des Moines. Frahm, a pharmacist at Southside Drug in Ottumwa, was crucial in spurring the 2018 Iowa House Government Oversight Committee investigation into the practices of pharmacy benefit managers (PBMs). In January of 2018, Mark helped uncover egregious examples of spread pricing in Wapello county when he compared what his pharmacy was reimbursed to what the county was being charged. This got the attention of legislators, eventually leading to the investigation and formal hearing in April. Mark testified before the committee, highlighting how taxpayer dollars were being taken advantage of. Mark’s story received national attention and was featured in media outlets across the country. Mark’s work is a direct contribution to the increased scrutiny of PBM practices both in Iowa and across the country. The association presented Frahm with the award during their annual Legislative Day at the Embassy Suites in downtown Des Moines, Iowa, with over 200 members in attendance.

LEGISLATIVE DAY

Rep. Bobby Kaufmann Recipient of IPA Good Government Award

IPA recognized Rep. Bobby Kaufmann with its 2020 Good Government Award on January 29th in Des Moines. The award is given annually to an Iowa legislator who has worked strongly on behalf of pharmacy and has demonstrated a commitment to health care issues. In 2018, Kaufmann served as the Chair of the Government Oversight Committee. During this time, the committee turned its attention to investigating the practices of pharmacy benefit managers (PBM) in Iowa. Spurred on by prescription drug â&#x20AC;&#x153;spread pricingâ&#x20AC;? uncovered in Wapello County by Ottumwa pharmacist Mark Frahm, Kaufmann worked closely with pharmacist and state representative John Forbes (D-Urbandale) on a formal investigation to bring accountability to PBMs who are responsible for state and taxpayer dollars. The investigation culminated in a hearing before the Government Oversight Committee in April of 2018. Independent pharmacy owners, state officials, and high-ranking PBM officials were all present to testify before the committee. The hearing garnered national attention and has contributed to the increased scrutiny of PBM practices both in Iowa and across the country. The association presented Rep. Kaufmann with the award during their annual Legislative Day at the Embassy Suites in downtown Des Moines, Iowa, with over 200 members in attendance.

apr.may.jun 2020 |

LEGISLATIVE DAY

CAPITOL SCREENINGS + networking with state legislators On March 10, University of Iowa College of Pharmacy and Drake University College of Pharmacy & Health Sciences students assisted IPA in administering nearly 50 health screenings at the Iowa State Capitol while networking with state legislators. This important outreach helps showcase the value of pharmacy to our elected officials, with students administering bone density tests, cholesterol tests, and point of care testing demonstrations, among others! â&#x2013;

apr.may.jun 2020 |

TECHNICIAN CORNER

A Newcomer’s Perspective on Expo 2020 By: Julie Lange, CPhT & Lori Foster, CPhT

During the 2020 Midwest Pharmacy Expo, I experienced a new Expo. I have been attending the event alone for years, but this year a technician friend of mine was able to attend with me. Because she had heard some of us talk about our previous experiences at Expo and decided to attend, I was given the opportunity to see Expo through the eyes of a newcomer. We split hotel expenses and splurged for both Friday and Saturday night at the Downtown Hilton. This worked out very nicely for attending the early-morning PTCB presentation and breakfast. We enjoyed the panelists, as well as the latest information on the advanced credentials PTCB is developing. When attendees started gathering for the keynote speaker, I noticed some friendly faces and found that she knew some of the same people. My friend confessed that having the “First Time Attendee” flag on her nametag helped her interact with strangers. Later, during lunch and the vendor fair, we collected freebies and visited with several vendors. We were excited to have the chance to speak with Ryan from PTCB in more detail. We had chosen to attend the same sessions that afternoon, and my friend commented how nice it was that the sessions started and ended as scheduled. We then had an early supper and rested up for Sunday. As always, the Sunday sessions were information-packed. As we were driving back, we talked over some of the things we had learned and experiences we had.

| The Journal of the Iowa Pharmacy Association

“From my perspective, I think she realized there is a lot of networking and learning to be gained all in one place.” Back at work, we had another chance to discuss Expo. I assisted her in entering the attendance codes for CPE credit. She was successful and greatly appreciated having the opportunity to evaluate the speakers through the follow-up survey. Although she did not get to use the Attendify app, I enjoyed it. From my perspective, I think she realized there is a lot of networking and learning to be gained all in one place. After Expo, my friend also chose to join the association. I hope each of you reading this will encourage someone you know to accompany you next year. ■

apr.may.jun 2020 |

TECHNICIAN CORNER

Coronavirus, Pandemics, and Patient Questions, Oh My! From IPAâ&#x20AC;&#x2122;s March/April 2020 Tech Tidbits newsletter

With coronavirus (COVID-19) causing quite the stir in the public attention, it could be helpful to review some facts about the illness, prevention, and how to answer questions that patients may come to the pharmacy with.

is to protect others from the risk of getting infected. The use of facemasks also is crucial for health workers and other people who are taking care of someone infected with COVID-19 in close settings (at home or in a health care facility).

There are seven known types of coronavirus, four of which are very common with most people contracting at least one in their lifetime, and three (including COVID-19) are rare but more serious. Symptoms are general, including fever, cough, and trouble breathing. The virus is spread when an infected person coughs or sneezes, and tiny droplets are passed to a nearby person by the person touching the droplets to their mouth, nose, eyes, or inhaling them (generally about 6 feet maximum). The best way to minimize the risk of contracting the illness is to wash hands frequently with soap and water for at least 20 seconds and/or use an alcohol-based (at least 60-95%) hand sanitizer. Also, regularly clean all surfaces that are touched throughout the day. At this time, the risk for Iowans is low and only associated with travel to mainland China within the last 14 days; however, this is a dynamic and rapidly changing situation that could be updated at any moment so focus on staying up to date with the newest announcements from the CDC and the Iowa Department of Public Health.

Warm weather will stop the virus from spreading.

Mythbusters: The public should wear masks to avoid getting sick. BUSTED CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms. This

| The Journal of the Iowa Pharmacy Association

UNDETERMINED It is not yet known whether weather and temperature impact the spread of COVID-19. Some other viruses, like the common cold and flu, spread more during cold weather months, but that does not mean it is impossible to become sick with these viruses during other months. Packages from China may be infected with COVID-19. BUSTED People receiving imported goods from China are not at risk of contracting COVID-19. Coronaviruses do not survive long on objects such as letters or packages. I need to avoid animals if I contract COVID-19. TRUE You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus. Pregnant women are at higher risk. UNDETERMINED Pregnant women experience immunologic and physiologic changes, which might make them more susceptible to viral respiratory infections, including

Technician Corner

COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population, as observed in cases of other related coronavirus infections and other viral respiratory infections, such as influenza, during pregnancy. It is okay for a person who has been quarantined for COVID-19 to be back in the general public. TRUE For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period. **IPA recognizes this global threat is continually evolving, so please continue to watch for information from the CDC and public health officials on this urgent issue** ■ References: 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html 2. https://idph.iowa.gov/Emerging-Health-Issues/Novel-Coronavirus

free technician cPe Join IPA Now & Get FREE CE

CEImpact’s Technician Catalog is an online subscription with accessible and convenient continuing education courses for technicians to recertify and advance their career path.

Newly Certified Iowa Pharmacy Technicians January 1, 2020 – March 31, 2020

Congratulations to the following pharmacy technicians on becoming PTCB-certified! Mina Abdelmalek Jay Adams Rhett Allen Kelly Andersen Andjela Andric Elainia Barber Irene Bradley Leah Butler Barbara Carpenter Brandon Carson Marlene Cuauhtenango Meagan Davis Laura De Penning Savana Dettmann Destinee Fusaro Jodi Galindo Ali Goldensoph Cierra Gowin Alexis Hageman Ian Hantelmann Emilie Heggen Thuy Ho April Kress Crystal Kuster Madeline Lamson Olivia Laszlo Tom Le Courtney Lines Andrew Macmahon Brenda Mahecha Deanna Maher Benjamin Maliske Melanie Mensen Magdy Mesdary

Zachary Mitchell Jill Mouw Kendal Newman James Nichols Ethan Osuch Megan Peek Alexander Penk Dawn Phillips-Hite Karla Plender Amanda Prins Sheila Roe Meghan Ryan Brianna Sackett James Schafer Madison Shover Joshua Sikrisamouth Elissa Smith Kelly Smith David Strudwick Kali Thoma Jonte Toro Ciera Tripp Sidney Vancil Mary Vannice Jason Vipond Krista Waite Amber Wedo Linde Wilson Annabelle Wilson Stacy Woods

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

apr.may.jun 2020 |

TECHNICIAN CORNER

Heart disease is still the #1 cause of death in the United States, accounting for 1 in every 3 deaths. From IPA’s February 2020 Tech Tidbits newsletter

Five years ago, we introduced you to the Million Hearts Campaign – a nationally driven initiative launched in 2012 with a goal to prevent one million heart attacks and strokes by 2017. In this initial campaign, it is estimated that Million Hearts was able to help prevent a half a million cardiovascular events from 2012-2016. If you didn’t know, Million Hearts has been evaluated, analyzed, and revamped into Million Hearts 2022. Million Hearts 2022 builds upon the experience, expertise, partnerships, and progress of the first five years, and identifies three specific priorities for these next five years to reduce heart attacks and strokes. These include keeping people healthy, optimizing care, and improving outcomes for priority populations. “Keeping People Healthy” • Reduce the amount of sodium intake • Decrease tobacco use • Increase physical activity “Optimizing Care” • Improve use of ABCS (Aspirin, Blood pressure control, Cholesterol Management, and Smoking Cessation) • Increase use of cardiac rehabilitation • Engage patients in heart-healthy behaviors. “Improving Outcomes for Priority Populations” • African Americans • Patients aged 35-64 years old • Patients who have had a previous heart attack or stroke • Patients with mental illness • Patients with substance use disorders •

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The Journal of the Iowa Pharmacy Association

What can you do to make a difference? Pharmacy technicians can play an instrumental role in the Million Hearts 2022 Initiative. Talk to your patients – get to know them! When you see a patient picking up a prescription for heart-related medication, take the opportunity to educate them and provide resources. • Encourage your patients to get enrolled in medication synchronization (or a similar program) to help increase adherence to their medications • Discuss programs/services that your pharmacy may offer, such as smoking cessation classes, free blood pressure checks, cholesterol screenings, or dietician services • Consider a workflow that supports checking patients’ blood pressure with every vaccination or medication therapy management (MTM) session- even if they haven’t been diagnosed with hypertension! • Offer resources to your patients such as brochures on heart disease, information on the DASH diet, or website links (such as this Million Hearts Learn & Prevent tab) • Encourage your patients to talk with the pharmacist and ask questions about their medications and healthcare • Provide your patient with support and empathy when they have changes in their medication regimens and/or health status■ ■ Resources: https://millionhearts.hhs.gov/about-million-hearts/index.html https://millionhearts.hhs.gov/files/MH-Framework.pdf

IPA FOUNDATION

Welcome Isabelle Tharp, IPA’s 2020 Executive Intern Hello everyone! My name is Isabelle Tharp and I am beyond excited to serve as the Max W. Eggleston Executive Intern this upcoming summer. I have been an IPA member since 2017 and have enjoyed taking part in various IPA opportunities including IPA Annual Meeting, IPA Legislative Day and the Policy Committee on Public Affairs. I am from Dubuque, Iowa and currently am a secondyear student pharmacist at Drake University with a diabetes concentration. During pharmacy school, I have become extremely involved in the American Pharmacists Association – Academy of Student Pharmacists (APhA-ASP). I have served as Social Media Chair, President-elect and soon the President of the organization. I am looking forward to translating the skills I have learned from APhA-ASP into my work for IPA this summer! In the past, I worked at Hy-Vee pharmacy and Mercy Family Pharmacy (now MercyOne) back home in Dubuque, and I currently work at Methodist West Hospital and serve as a Legislative Intern for Representative John Forbes at the Iowa State Capitol. I have been fortunate to have a wide variety of pharmacy experiences and am excited to see a very different side of pharmacy while interning at IPA. Pharmacy policy has always been an interest of mine, but throughout my experience at the Capitol it has become a passion. I have seen how advocacy efforts from the pharmacy community influence legislators and their decision-making on legislation. While at IPA this summer, I hope to find ways to promote advocacy efforts among IPA members and learn how I can better serve the profession of pharmacy. I hope to connect with many of you this summer!

Eggleston-Granberg Golf Classic -

Watch IPA communications for new date!

The Eggleston-Granberg Golf Classic provides support to student pharmacists. This annual event has recently been held in the fall. It brings together student pharmacists, alumni, and friends for a fun-filled day at the golf course with a purpose. All proceeds benefit the IPA Foundation’s support of student pharmacists at Drake University and the University of Iowa.

| The Journal of the Iowa Pharmacy Association

Support the IPA Foundation’s educational and student programs by donating to the Foundation’s Silent Auction taking place during the 2020 Annual Meeting! If you or your pharmacy would like to donate to the silent auction, please contact IPA at ipa@iarx.org and provide a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the week of Annual Meeting (September 17-18, 2020), please notify IPA prior to September 1 in order to have your item listed in the silent auction catalog.

Make an impact today!

Make a donation or join the IPA Foundation Institute with your sustained gift. Your donation to the IPA Foundation supports initiatives to build strong leaders, invest in innovative practice initiatives and secure high-quality education for tomorrow’s practitioners.

iarx.org/IPAFoundation

IPA RAGBRAI FOUNDATION 2019

IPA Foundation Awards and Scholarships Congratulations to these student pharmacists who received an IPA Foundation scholarship this year!

Drake University

IPAF Eggleston-Granberg Scholarships Kendra Ford

Halling Harding

IPAF Mike & Terry Pursel Scholarship Rachel Wedemeyer

IPAF Russell E. Johnson Jr. & Lucille Johnson Scholarship Michaela Phelps

IPAF General Scholarships Rita Hammer

Katelyn Mouser Ann Radtke

Rachel Soppe

The University of Iowa

IPAF Eggleston-Granberg Scholarships Ben Fox

Chris Fox

IPAF General Scholarships Zac Anderson Tiffany Lee

The generosity of IPA members makes an impact. Here is what scholarship recipients say about how it has affected them: “This scholarship is highly valued and will serve me well as I continue to fulfill both academic and professional goals. Thank you for your generosity!” Rita Hammer, Drake University 2019-2020 IPAF General Scholarship “Through my involvement in RAGBRAI, IPA Legislative Day, and other IPA events, I have clearly seen the commitment and generosity that IPA members stand for, and I will implement these qualities into my own professional and personal life.” Ben Fox, The University of Iowa 2019-2020 IPAF Eggleston-Granberg Scholarship “It’s an honor to have been selected as a recipient of an IPA Foundation scholarship. I want to thank the IPA Foundation for their generosity and their continuing support for pharmacy education in the state of Iowa.” Chris Fox, The University of Iowa 2019-2020 IPAF Eggleston-Granberg Scholarship “I would like to thank you for this opportunity to receive financial support while pursuing my dreams in pharmacy school. I really appreciate this generous scholarship.” Michaela Phelps, Drake University 2019-2020 IPAF Russell E. Johnson Jr. & Lucille Johnson Scholarship

apr.may.jun 2020 |

MEMBERS Section MEMBERS Section

Wes Pilkington, PharmD The Pharmacy Family Man By: Alex Harlan, 2020 PharmD Candidate | The University of Iowa

The Pharmacy Family Man would be a title well-deserved by Waterloo native, Wes Pilkington. Upheld both in the pharmacy and in his personal life, he selflessly devotes his full service to his staff, patients, community, and family at home. “I just really enjoy taking care of people. I enjoy building those trusting relationships with people, and if they need help, I’m willing to do whatever I can. That’s my favorite thing about being a pharmacist,” said Wes. Already a veteran in the profession at the young age of 34, he has practiced at John Deere Pharmacy, CVS, and Greenwood Pharmacy, before landing his current role as Pharmacist in Charge at Evans Crossing Pharmacy in Evansdale, Iowa. His caring personality and his involvement in many leadership positions over the years strengthened his presence as a key member of the Iowa pharmacy family. He has sat in the vice-chair for IPA’s policy committee on professional affairs, graduated from the Leadership Pharmacy Conference, and sits on the Black Hawk County Board of Health. IPA members may recall that Wes recently also earned the Distinguished Young Pharmacist of the Year presented at the 2019 IPA Annual Meeting for his service to the profession. Part of being a member of a family means caring for the well-being of the whole team. For Wes, that means being passionate about the direction and future of his pharmacy family. When asked what his passions are in the profession, he answered, “Working to transform the pharmacy so each member can practice at the top of their license.” Evans Crossing pharmacy was one of the first to adopt the “Flip the Pharmacy” initiative through the Iowa Community Pharmacy Enhanced Services Network (CPESN), and Wes believes that it has forced a critical look at the operations within the pharmacy to creatively

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The Journal of the Iowa Pharmacy Association

experiment and adopt new services. “Not everything has worked, and that’s entirely okay,” he commented, as “We are doing our best to flip our pharmacy to best fit our staff and patients. I would strongly encourage every pharmacy to join CPESN. Doing so has led to many rewarding opportunities, [CPESN] has helped with those changes, and it has resulted in some pretty great income streams.” To fuel his energy within his profession, he immensely values time with his wife, Sarah, and their three kids, Jacob (4), Ryan (3), and Anna (<1), doing outdoor activities including growing a salsa garden every year and boating. Wes is an avid baseball fan, and he enjoys cheering on his favorite team, the Chicago White Sox. He is also a passionate Hawkeye fan stemming from his years as an undergraduate and student pharmacist at the University of Iowa. Wes recommends all pharmacy professionals find non-pharmacy related hobbies to help wind down. He also wants IPA members to know, “It’s okay to feel overwhelmed, and it’s okay to feel like you’re not getting everything done the way you want to. Do the best you can, and the positive results will follow.” He emphasized that the profession has improved tremendously in recognizing the need for a healthy work-life balance. Lastly, when asked for some parting advice for IPA members, he says, “Get involved. Put yourself out there. Join a committee. Go to the IPA Annual Meeting. These are great learning experiences. There are some very successful pharmacists out there who want to meet you. The profession benefits from having you contribute, but also you benefit from collaborating with so many great minds.” Wes Pilkington is undoubtedly The Pharmacy Family Man, and we are lucky to have him in the great state of Iowa. ■

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MEMBERS Section MEMBERS Section

MEMBER MILESTONES Congratulations to Eliza Dy-Boarman, PharmD, BCPS of Drake University College of Pharmacy & Health Sciences on receiving the American College of Clinical Pharmacy (ACCP) Leadership and Management Certificate! Congratulations to Jacqueline Gravert, PharmD, MPH on moving back to Iowa, and starting her new role as Director of Acute Care Pharmacy at University of Iowa Hospitals & Clinics! Congratulations to Nic Lehman, PharmD, BCACP being appointed to ACPE’s Continuing Pharmacy Education Commission. His term will occur from April 1, 2020 to December 31, 2022. Congratulations to Laicy Marotti, PharmD, the new Pharmacy Supervisor at the Iowa Veterans Home in Marshalltown! Congratulations to past IPA staff member Laura Miller as she pursues a new career opportunity as Executive Director of the Iowa Osteopathic Medical Association (IOMA)! Congratulations to Heather Ourth, PharmD, BCPS, BCGP of the Department of Veterans Affairs on being named a fellow of the American Society of Health-System Pharmacists (ASHP)! Congratulations to Nathan Peterson, PharmD, BCPS for being selected for the UnityPoint Health Innovation Fellowship Program! Congratulations to CoraLynn Trewet in her new role at Biogen as Senior Medical Science Liaison for Alzheimer’s Disease!

| The Journal of the Iowa Pharmacy Association

Congratulations to Dave Weetman, BS Pharm, MS, FASHP in his new role as Director of Medication Safety at University of Iowa Hospitals & Clinics! Congratulations to Adam Weinkauf, PharmD, BCPS as the new Director of Pharmacy at Mercy Iowa City Rehabilitation Hospital! Congratulations to Tim Welty, PharmD, FCCP, BCPS of Drake University College of Pharmacy & Health Sciences on being named a fellow of the American Epilepsy Society (AES)! Congratulations to Kim Zellmer, PharmD, BCPS, CSPI as the new PGY-1 Residency Program Director for UnityPoint – St. Luke’s in Sioux City!

In Memoriam Professor Emeritus Gilbert Banker, who served as the seventh dean of The University of Iowa College of Pharmacy, died at his home in Carmel, Indiana, on February 16, 2020. Dean Banker led the transition of the College’s curriculum from a five-year bachelor of science degree to a six-year doctor of pharmacy (PharmD) program. He was also instrumental in garnering support and overseeing construction of a 78,000 square-foot addition and other renovations to the then Pharmacy Building. It is with great sadness to share the news that David Schaaf, IPA’s director of communications, passed away on February 20, 2020. David was diagnosed with stage IV melanoma in late November 2019, and the cancer progressed aggressively.

MEMBERS SECTION

David was part of the IPA staff family for just over five years. While he preferred to be behind the scenes, he greatly enjoyed working with Iowa pharmacists and got to know many of our members at IPA events, board meetings and committee meetings. He was a skilled writer, designer, and social media expert and quickly learned the issues, priorities, and acronyms for the pharmacy profession. David’s sense of humor and witty one-liners provided laughs at the office each day. He is, and will continue to be, greatly missed. David was a devoted husband and father to his wife, Kristin and daughters Hannah (5) and Hailey (3). Raymond Foster, a University of Iowa graduate, passed away on Friday, February 21, 2020 at his home in Sun City, AZ. Ray worked as a pharmacist at both Fawcett’s Pharmacy and Perry Memorial Hospital in Princeton, IL.

Welcome New IPA Members January 1, 2020 – March 31, 2020 Ibrahim Aldulaimi Kenneth Anderson Samantha Barnes Jennifer Benjamin Brittani Bjelland Emma Clausen Stephanie Dowd Meredith Drummond Brandi Gobeli Christine Halverson Ashley Holombo Angela Luna Vienna Massner Lisa McTaggart Sandeep Misri Jennifer Nelson Onyeche Oche Samantha Patent

Thank you to Walgreens for supporting their Pharmacy Managers and Hy-Vee for supporting their pharmacy technicians as IPA members!

IPA Career Development Center Providing support for pharmacist and pharmacy technicians – whether early, mid, or late career – the IPA Career Development Center offers individual attention and direction while empowering IPA members to have control over their job search and professional development.

IPA has partnered with RxAshlee, a Career Pivot Expert and Interview Prep Coach, to offer unique coaching for pharmacy professionals looking to nail a job interview, finetune their resume, articulate their own unique brand, and level up their career!

What is RxAshlee? Ashlee Klevens Hayes, PharmD/MHA, is the founder of RXAshlee, a career development company that focuses on teaching professionals how to stand out in a busy marketplace. RxAshlee will emphasize several game-changing, career-building skills, including nailing your elevator pitch, crafting amazing answers, and confidence/mindset master. Learn more at www.iarx.org/careercenter

Allison Purcell Kylie Richmond Becky Rule Vikki Schmidt Taylor Smith Jamie Sorensen Meleah Stuckey Andrew Tenpas Sarah Tierney Cheryl Tilley Kelsie Tingle Derek Townsend Katie Treinen Cindy Uetz Jennifer Urmie Samantha Wheeler Shanna Zwanziger

PLATINUM BUSINESS PARTNER

Elevate the level of care you provide your patients.

www.iarx.org/platinum Platinum Business Partners receive all the benefits of a standard business partner plus access to higher level of services and resources from IPA. Here’s what some of our Platinum Business Partners have to say: “Although IPA is well positioned to address many of our hospital pharmacy concerns, one area we really needed their assistance was with getting a pharmacy residency program started. IPA customized our platinum business partner membership to meet our specific needs and created a detailed proposal for us that included planning for accreditation, staffing, and budget requirements for us to present to our executives for final approval. IPA’s help has been instrumental in providing us with insight and resources for us to foster innovation to across our pharmacy department and further drive the mission and vision of our institution.”

“Our company joined as a Platinum Business Partner with IPA approximately one year ago. Not only do we feel more connected to what’s going on in the industry, legislature, and within the organization, we also have a direct line of communication for any questions/concerns or help on matters that affect our business. One example is the help that we received from IPA in bridging some communication problems we were having with the MCO’s regarding DME billing. Thanks to the contacts they have established with members of those organizations, we were able to get the assistance we needed for billing claims. We gain a lot of information through our quarterly touch-base phone calls and also appreciate the discounts on various resources thanks to our PBP membership!”

– Doug Wetrich, Director of Pharmacy Mary Greely Medical Center

– Heather Storey, Pharmacy Manager, Clinical Consultant Lewis Drug

IPA in ACTION

ipA GOES LOCAL UPDATE IPA Goes Local is a partnership between IPA and Iowa’s regional pharmacy associations to bring a live CPE program to locations across the state and see what our members are doing on a local level. In 2020, IPA Goes Local, in partnership with MedPharm, will explore the state’s medical cannabidiol program from the logistics of the program, current products offered, and the legal aspects to the program.

Update:

Due to COVID-19, live IPA Goes Local programing will be suspended through 2020. IPA is considering a virtual program format. Stay tuned for updated communications. For more information, visit www.iarx.org/GoesLocal.

IPA MEMBER BENEFIT Have You Accessed Your FREE Continuing Education Beneﬁts Yet? WWW.IARX.ORG/ACCESSCPE

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

apr.may.jun 2020 |

Calendar of events

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

may 2020 5-6

Iowa Board of Pharmacy Meeting

IPA 2/2/2 Webinar

P4 MPJE-NAPLEX Virtual Review Course

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What can Onnen do for you? Prescription Labels and Forms. Laser and Thermal formats available.

14-16 NABP Annual Meeting (Baltimore, MD) - CANCELLED 20-21 Iowa Breastfeeding Conference (Ankeny, IA) - CANCELLED May 20-July 22

Technician Spring Study Group 2020 - NEW DATE

June 2020 4

Working Together to Improve Diagnosis - CANCELLED

6-10 ASHP Summer Meeting - CANCELLED 12-14 Unify Conference - CANCELLED TBD

Wide selection of Prescription Equipment and Compounding supplies.

Eggleston-Granberg Golf Classic

23-24 Iowa Board of Pharmacy Meeting (Des Moines, IA)

July 2020

July 7-Sept 22

BPS Study Group

18-22 AACP Annual Meeting (Long Beach, CA) RAGBRAI POSTPONED until 2021

Annual Meeting rescheduled for September 17-18, 2020 Currently scheduled events are subject to change due to COVID-19. Please continue to watch IPA communications regarding any updates.

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| The Journal of the Iowa Pharmacy Association

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Pharmacy Time Capsule

19 63

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

February

Michael Jordan was born on February 17th, 1963.

March

The Iowa Pharmacy Association’s 84th Annual Convention took place in Des Moines, IA, and the House of Delegates unanimously approved IPA (then IPhA) affiliations with APhA. Glenn Llewellyn Jenkins of Sparta, Wisconsin received the Remington Award.

April

Dean Louis C. Zopf, along with other professors, attended the Johnson County Pharmaceutical Association meeting in Iowa City, IA. Dean Zopf was presented with an Honorary Past President Key during the program.

May

A bill passed limiting the right to fill prescriptions to strictly pharmacists and interns under the supervision of a pharmacist. The law previously allowed anyone to fill prescriptions if done under “immediate personal supervision of a licensed pharmacist.”

June

Vernon O. Trygstad, Director of Pharmacy Service at the Veterans Administration in Washington, D.C., received the Harvey A.K. Whitney Award.

Photograph of the then brand-new SUI College of Pharmacy building.

July

The University of Iowa College of Pharmacy moved its department into the “new” building on the west side of campus. The United States Postal Service also launched the ZIP code system.

August

IPhA and APhA’s affiliation was adopted. Martin Luther King, Jr.’s “I Have a Dream” speech was given at the Lincoln Memorial.

November

The State University of Iowa College of Pharmacy building was dedicated. APhA’s student branch stated, “We are proud of this new building as a symbol of an increasing public interest in pharmacy as a profession.” The tragic assassination of President John F. Kennedy threw the country into grievance.

Photos of the dedication ceremony outside the SUI College of Pharmacy, inside the practice lab, and in the lecture halls that still stand today.

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

apr.may.jun 2020 |

IPA Journal Apr/May/Jun 2020

Articles inside

Pharmacy Time Capsule

Calendar of Events

IPA in Action

Peer Review

Public Affairs

Technician Corner

IPA Foundation

Legislative Day

CPESN

COVER STORY: The COVID-19 Pandemic

2020 Midwest Pharmacy Expo

Health Care Hot Topics

Iowa Pharmacy News

Practice Advancement

CEO’s Column

Student Column

President’s Page