A Peer-Reviewed Journal | Vol. LXXV, No. 4 | OCT.NOV.DEC 2020
DIANE REIST
BS Pharm, PharmD
143
RD
PRESIDENT OF THE IOWA PHARMACY ASSOCIATION
INSIDE:
2020 IPA Annual Meeting Resident Spotlight 2021 PharmaCE Expo
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 Sharmi Patel, PharmD, MBA
COVER STORY 2020 IPA Annual Meeting pg. 12
OFFICERS
CHAIRMAN Connie Connolly, RPh, BCACP – DeWitt PRESIDENT Diane Reist, BS Pharm, PharmD – Cedar Rapids PRESIDENT-ELECT Christopher Clayton, PharmD, MBA – Manchester TREASURER CoraLynn Trewet, PharmD – Des Moines SPEAKER OF THE HOUSE Kristin Meyer, PharmD, CGP, CACP, FASCP – Marshalltown VICE SPEAKER OF THE HOUSE Deanna McDanel, PharmD, BCPS, BCACP – Coralville
TRUSTEES
REGION #1 Wes Pilkington, PharmD – Waterloo REGION #2 Shane Madsen, PharmD, BCPS – North Liberty REGION #3 Candace Jordan, PharmD, BCPS, MBA – Winterset REGION #4 Gary Maly, PharmD – Sioux City AT LARGE Emily Beckett, PharmD, BCPS – Johnston Nancy Bell, PharmD – West Des Moines Bill Doucette, PhD, RPh – Iowa City John Hamiel, PharmD – Waterloo HONORARY PRESIDENT Dan Murphy, RPh - Davenport PHARMACY TECHNICIAN Tammy Sharp-Becker, CPhT, CSPT – Des Moines STUDENT PHARMACISTS Courtney Temple – Drake University Alexis Clouse – 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.
2021 PHARMACE EXPO
- pg. 30
RESIDENT SPOTLIGHT - pg.42
FEATURES
IPA Board Election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Annual Meeting 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2021 PharmaCE Expo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 CPESN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Class of 2024 White Coat Ceremony . . . . . . . . . . . . . 34 Resident Spotlight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
IN EVERY ISSUE
President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . 55 Mission Statement
The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes.
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PRESIDENTIAL ADDRESS Diane Reist, BS Pharm, PharmD | IPA President
Thank you, Connie, and thank you to all of you who have shared your vote of confidence in me. I feel extremely honored to have served with President Connolly and Chairwoman Clarke over the past yearplus, but also saddened that because of our virtual world we haven’t been able to share some of the live experiences that we might otherwise have had. We will always have the milestone of being the first all women leadership team in the 140-year history of IPA. We have made a pact, however, that post pandemic we will shed our virtual personas and get together in person! I would like to introduce a couple of people to you. People who are my life, who support me, love me, tolerate me, and give me my purpose: Jeff, my husband of 35 years – How can that be? Yes, he was a student of mine, but no matter what he says, we did not start dating until after he had graduated. Many of you may know him as a professor of yours, as he teaches at the University of Iowa College of Pharmacy with a career in hospital, community, long-term care, and ambulatory care practice. Thank you, Jeff, for always listening to me but yet telling me, “You need to make the decision for yourself,” and for putting up with my crazy “extra-ness.” Lauren, my eldest daughter, who, whether either of us is willing to admit it, we are definitely cut from the same cloth. I am so proud of everything that you do, all of your hard work and your compassion for working with our elder citizens. Thank you for surprising your parents by applying to pharmacy school (after two other degrees and two more coming), and good luck as you have started your P3 year! I will truly be proud to call you a colleague and know that I would feel comfortable turning the care of my patients over to you.
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Hailee, my youngest daughter, who has always been a mystery and an open book at the same time, pushing me to keep up with her. She has helped me learn to love being a parent – with a few grey hairs. I am so proud of you as well for your endless drive and energy, for being our “Happy Hailee,” and your excellence in going up against the glass ceiling as you continue your residency in orthopedic surgery at the University of Vermont Medical Center. My sisters-in-law, nephews, nieces and all of their children. Church family who support me in all things. I love you ALL more than mashed potatoes and gravy! I must also mention those loves in my life that are no longer on this plane. My parents, Edwin and Martha Buresh – I came into their lives when they were thinking their child rearing days were coming to a close. I could not have asked for more support and love and a push to “always be nice to EVERYONE” and “go to church!” My parents-in-law, Charles and Emily Reist, who welcomed me into their family with open arms and total support. My three big brothers who always loved and supported their baby sister unconditionally, even when I annoyed them. Richard and wife Eutona, Dale, and Dennis. So wish you were all here to celebrate with me. A distant cousin, George – Our great and great-great grandfathers were brothers. When I decided to go to college, he, at eighty-years-old, shook me and said, “You go girl! I am so proud of you!” Thank you to all of my family and friends! So…two thousand and twenty…2020...Whoa…This has been quite a year hasn’t it? I never again want to hear the words “unprecedented” or “new normal” or definitely not “NO MORE MASKS.”
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As you heard Speaker Ashley Dohrn this morning in her address to the House of Delegates say, life has been turned upside down. Not only have we been challenged as a profession to deal with a pandemic illness that we had no cure for, no prevention, nor tried and true treatment for, nor even a way to test for, but we have also been challenged personally by learning to stay at home, wash our hands, cover our nose and mouth, stay home when sick, cook our own food, teach our children, and care about others more than ourselves…Sounds like lessons we should all have known already. When I was first elected, I thought, Wow, this is going to be great! The year 2020 will give me a great mantra for perfect vision into the future of our profession. We know exactly where we are going and how to get there. But as has happened many times – Life doesn’t always go as planned. In fact, does it ever really go exactly as planned? If this year has taught us anything it should be don’t get thrown by the unexpected, and expect that there will be unexpected – Plan for it, embrace it and soar with it! FLEXIBILITY is the name of the game. As I can recall telling my staff a long time ago when we were facing major challenges: CHANGE IS GOOD, CHANGE IS OUR FRIEND! I also remember thinking adults do not adapt well to change – that is why our keynote speakers this morning tried to impress upon us. Sometimes it is perfectly okay to be child-like but not childish. Over my career, I have seen many changes, and often we complain about those changes such as OBRA 87 that forced RPhs to have to do medication reviews of long-term care residents…Oh no! Every change we have weathered, however, has brought with it improvements too. As a colleague once said to me, “Why are you so positive? Why
are you trying to change things? Nothing is going to change but for the worse.” My answer to him was no, things won’t change if that’s the attitude that you will have. We must embrace every change or challenge that comes along and turn it to our advantage. OBRA 87 made it not only okay for pharmacists to use our drug knowledge but to share that with physicians and convince them to listen to us. We are now working on teams with providers and other health care workers and being listened to. One of the providers that I work with said to me the other day, “Why do you do so much? You didn’t leave anything for me to do.” I wasn’t exactly sure how to take that at first, but then they said, “I want to work with you all the time – You make my job so much easier!” That’s where I have been trying to get to for the last thirty-four years, but now I want you to pay me for doing that work as well! Luckily, our clinic bills are based on the CMS transitional Care Management service, and, therefore, we are reimbursed as a team for team care. One of my hopes and goals for this presidential year is to encourage us all to think of ways to create more opportunities for shared payments. We are, as has been said this week, the most under utilized health care professionals. We need to find ways to have our provider colleagues understand just how valuable we are on their team. Whether it is in the institutional setting – we have had a jump start here – But also in the community and primary care setting. All providers are being asked to show improved outcomes and meet performance measures for payment of services. Pay for Performance, ACO, Shared Risk, Shared Reward – Whatever the payor is calling their program. Many of the performance measures are governed by what medications are prescribed and if the patient is adherent. Who should be controlling this aspect of care? WE SHOULD. WE need to partner with PROVIDERS and show them how we can help them meet their expected performance measures – not for free but as a partner. Maybe it is time to move further into the provider office – not just down the street or in the same clinic
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but into the office (physically or virtually). We are all getting much better at that. Years ago, when I was trying to convince our physicians that we should have a pharmacist working right on the ICU floor to help them, I asked Dr. Beckett, a pulmonologist/intensivist, how we can be of service and be accepted by the doctors. He told me, “You need to be there at my side when I am making the medication decisions, not call me hours later after I have moved on to something else to tell me I didn’t make the right decision.” That is where we all need to be – by their side working at the start of the decision, not after the fact. Many pharmacists do enjoy this up-front relationship, but we do have even greater gains that we can make in other settings. I would like to challenge us as an association to think about this in all policies and decisions that we make. We are starting in a great place to make the changes that we need to.
We have all worked with patients that are eager to stay healthy but have absolutely no hope of obtaining that goal due to the social factors that they are surrounded by. Public health literature shows that everything that is provided to a patient by the health care system can only go as far as affecting the successful outcome of a patient’s health care goals up to 20%. Health care is “just a repair shop.” All that work that we all put in every day – doctor’s visits, hospital stays, pharmacist counseling, home health visits – still only helps achieve those positive outcomes up to 20%.
“THERE IS ABSOLUTELY NO INNOVATION WITHOUT FAILURE.”
Starting next week, pharmacists have volunteered to represent the association and Board of Pharmacy as we rewrite the Pharmacy Practice Act, the legal document approved by our Iowa legislature that governs what we can do in our practices. We have plans started for the board members from the Iowa Medical Society (physician’s state society) to meet with the board members from the Iowa Pharmacy Society to work on common ground issues. We need to be bold in our actions with these two initiatives. Everyone who has ever submitted a budget to their board knows you need to ask for the moon and grab a few stars along the way! A quote from Dr. Brene Brown to the Iowa Public Health Association: “There is absolutely no innovation without failure.” Expect that there will be the unexpected. Some may be good, some may be bad, but there can only be good for the patients when we are working together with the rest of the team.
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My other hope and goal for my presidential year is that we will be innovative in finding ways for our association and members to join the health care team in fighting for solutions to social determinants of health that affect our patients.
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The other 80% in ever-changing proportions is attributed to the environment in which a patient lives, works and ages: income level; access to housing and utility services; educational opportunities; occupation, employment status, and workplace safety; gender inequity; availability of transportation; early childhood experiences and development; access to safe drinking water, clean air, and toxin-free environments; social support and community inclusivity; crime rates and exposure to violent behavior; neighborhood conditions and physical environment; racial segregation; recreational and leisure opportunities. These are huge global issues that we all need to be concerned about, otherwise our heroic efforts are being wasted. I had the opportunity last week to totally geek out and be on a Zoom call with two of my idols in this area. I know I wasn’t actually side-by-side with them, but on the Zoom screen I was right in between. Dr. Donald Berwick, former Administrator of the Centers for Medicare and Medicaid Services (CMS) – Prior to his work in the administration, he was president and chief executive officer of the Institute for Healthcare Improvement (IHI), a not-for-profit organization Champion of the whole health care quality improvement movement, Berwick is best known as the
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champion of the triple aim—the idea that remaking America’s health care system requires the pursuit of three goals: improving the experience of care, improving the health of populations, and reducing per capita costs. And Dr. Rishi Manchanda, founder and president of HealthBegins, a social enterprise that provides training, clinic redesign, and technology to transform health care and the social determinants of health – the Father of Upstream-ism, moving upstream to prevent the social factor from throwing a person into the drowning situation before it happens. Dr. Berwick recently outlined seven steps to make change in the social and moral determinants of health: 1. Commit to human rights. 2. Push for universal coverage. 3. Combat climate change. 4. Back criminal justice reform. 5. Encourage inclusive immigration policies. 6. Take poverty head-on. 7. Defend civil institutions, like the right of every single person’s vote to count equally. Over the last couple of years, I have had the privilege of working with two physicians who also get geeked out by Berwick and Manchanda. We have been mentoring an interdisciplinary group of students from the colleges of medicine, pharmacy, social work, nursing, public health, health administration, and dietary. This group of students has volunteered in our upstream clinic.
positive for having social determinants that affect their health outcomes. This is a very passionate group that has made great strides in connecting patients with local community resources that can help them to overcome the social factors that drag them downstream. We work upstream to prevent the failures. I would like to challenge our association to incorporate upstream measures into all of our new policies and Forum discussions, and to find ways to highlight what we are already doing to help alleviate social pressures in our individual communities and create new methods for correcting the damage that social determinants cause our patients. I’ve often spoken about Servant Leadership. I believe we are all great examples of this. To be successful at what we do, we need to serve our patients, our coworkers and each other. I know that we have around 2,500 members in our association, and I hope that in some way, shape or form over the next two years, I can connect with every one of you to collect your positive ideas for change, your hopes, goals and concerns, and what expectations you have for unexpected challenges that we can overcome together. I can’t wait to hear from all of you! Thank you. ■
The students are present in our Women’s Health Services clinics and work with patients that screen
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CEO’S COLUMN
FREE MEMBERSHIP, INSANITY, AND ANNUAL REVIEWS Kate Gainer, PharmD
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Executive Vice President & CEO
Each December, I meet with the IPA Executive Committee for my annual review. I provide a written self-reflection on my individual performance and the overall performance of IPA as an organization. The seven categories which the Executive Committee evaluate IPA’s success and my leadership are: Financial strength, Membership growth, Membership satisfaction, Organizational harmony, Leadership training, External relations, and Staff stability. Each year, I’m proud of the achievements IPA has made across these categories as well as the goals set forth in our strategic plan. They are intrinsically linked.
increase membership had met Einstein’s definition of insanity: doing the same thing over and over again and expecting different results. Despite the best efforts of our Board leadership and IPA staff, we did not achieve this year’s goal of 20% growth in membership. And that’s how we tie together insanity, annual performance reviews and FREE membership. Part of IPA’s new membership offering is a FREE category of pharmacist membership – Informed. The other two tiers for pharmacist membership are Engaged (highest level) and Connected (mid-level).
Yet each year, when it comes to Membership growth, we’ve fallen a bit short… the last time IPA met every single membership goal within our strategic plan was in 2007. When presented in totality with other goals and priorities each year, this was accepted. IPA was still experiencing revenue increases, specific categories of membership were increasing, and some decreases were readily explained (i.e. pharmacy closures). Overall, the Association continues to achieve strategic priorities, advance and protect the profession, and remain financially strong, despite the inability to increase membership across all categories.
Membership dues is IPA’s highest revenue category. The risk in offering a free membership category is that IPA may lose revenue. The other side of that risk is success – increasing the number of pharmacists that join IPA, thereby participating in networking events, strengthening the professional collaboration in our state, seeking continuing education through IPA, and increasing the volume of our advocacy with more voices. These ‘increases’ may not be directly tied to IPA revenue. However, when pharmacists, technicians and pharmacies are successful in Iowa, IPA is stronger; and when IPA is stronger, the profession realizes greater success.
In 2019 during my annual review, a different approach was taken. Recognizing the trend in membership, not just for IPA but for associations globally and particularly associations of health professionals, it was decided that a shortfall to our 2020 membership goals would lead to a radical change in the approach and structure of IPA’s membership categories. Afterall, our efforts to
Pharmacists – the choice is yours. You decide how to support and engage with your state professional society. You decide how to broadly spread IPA’s message and encourage more pharmacists and technician colleagues to join! Whether Informed, Connected or Engaged, the Iowa Pharmacy Association is here to serve you. ■
“WHEN PHARMACISTS, TECHNICIANS AND PHARMACIES ARE SUCCESSFUL IN IOWA, IPA IS STRONGER; AND WHEN IPA IS STRONGER, THE PROFESSION REALIZES GREATER SUCCESS.”
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IPA BOARD ELECTION
IPA BOARD OF TRUSTEES Chairman of the Board - Cheryl Clarke, BS Pharm, RPh, FAPhA, Waukee Treasurer - Tim Becker, RPh, FACP, Mason City
Speaker of the House - Ashley Dohrn, PharmD, BCGP, Woodland Park, CO Region 1 Trustee - Sharon Cashman, RPh, Waterloo
Region 3 Trustee - Sally Haack, PharmD, BCPS, Norwalk Trustee at Large - Bill Baker, BS Pharm, Iowa City
Trustee at Large - Craig Clark, RPh, Cedar Rapids
Honorary President - Tony Beraldi, RPh, Council Bluffs
Pharmacy Technician - Jessica Burge, CPhT, Des Moines Drake University Student Representative - Joshua Hart
University of Iowa Student Representative - Crissy Lawson
IPA would like to thank the outgoing trustees to the left for their dedication and service to the pharmacy profession in Iowa. With extended terms due to the COVID-19 pandemic, their leadership guided the association through a very challenging year, and their insight has been invaluable in strengthening pharmacy practice in our state.
Chairman of the Board - Connie Connolly, RPh, BCACP, DeWitt President - Diane Reist, BS Pharm, PharmD, Cedar Rapids
President-Elect - Christopher Clayton, PharmD, MBA, Manchester Treasurer - CoraLynn Trewet, PharmD, Des Moines
Speaker of the House - Kristin Meyer, PharmD, CGP, CACP, FASCP, Marshalltown Vice Speaker of the House - Deanna McDanel, PharmD, BCPS, BCACP, Coralville Region 1 Trustee - Wes Pilkington, PharmD, Waterloo
Region 2 Trustee - Shane Madsen, PharmD, BCPS, North Liberty
Region 3 Trustee - Candace Jordan, PharmD, BCPS, MBA, Winterset IPA welcomes the incoming Board of Trustee members and thanks them for their willingness to serve the profession this year. The board began their term with an orientation meeting on October 7th and gathered virtually for the board retreat November 4-5, 2020.
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Region 4 Trustee - Gary Maly, PharmD, Sioux City
Trustee at Large - Emily Beckett, PharmD, BCPS, Johnston Trustee at Large - Nancy Bell, PharmD, West Des Moines Trustee at Large - Bill Doucette, PhD, RPh, Iowa City Trustee at Large - John Hamiel, PharmD, Waterloo
Honorary President - Dan Murphy, RPh, Davenport
Pharmacy Technician - Tammy Sharp-Becker, CPhT, CSPT, Des Moines Drake University Student Representative - Courtney Temple University of Iowa Student Representative - Alexis Clouse
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HEALTHCARE HOT TOPICS
N.Y. Comptroller Finds MCOs/PBMs Led to $605 Million in Unnecessary Spending
Local pharmacies across the nation have struggled with pharmacy benefit managers (PBMs) for decades. Audit results recently released by New York State Comptroller Thomas P. DiNapoli show the state of New York unnecessarily paid $605 million to the state’s Medicaid managed care organizations (MCOs) and their PBMs over a four-year period. The results indicate the MCOs and PBMs made decisions to increase profits for themselves rather than working to save taxpayer dollars or increasing access to pharmacy services for beneficiaries. Legislature has enacted a bill set to begin in April 2021 that will carve pharmacy benefits from the Medicaid managed care program.
FDA Finalizes Rule for Canadian Drug Importation
In an attempt to lower drug pricing and improve patient care, HHS and FDA have completed rulemaking to allow states to import certain prescription drugs from Canada. The final rule will allow states, Indian tribes, and, in future circumstances, pharmacists and wholesalers to submit importation program proposals to the FDA for review and authorization. The rule includes conditions to ensure the importation poses no additional risk to the public’s health and safety, and that it will achieve significant cost savings to the American consumer.
HHS Publishes Report on Reduced Opioid Use in Medicare Part D
The Office of Inspector General (OIG) has been tracking opioid use in Medicare Part D throughout the opioid crisis. A report released by the OIG at HHS found that about 1 in 4 Medicare Part D patients received opioids in 2019, which is a decline from the prior three years, and spending dropped $2.8 billion, the lowest amount in ten years. However, 267,000 patients in the Part D program still receive high amounts of opioids. National Institutes of Health (NIH) issued a warning that individuals with opioid use disorder could be particularly hard-hit by COVID-19, as it is a disease that affects the lungs.
9-8-8 as the dialing number for the hotline, which is projected to be available across the country by July 2022.
Record Breaking U.S. Drug Overdose Deaths in 2019
According to the CDC, deaths from drug overdose jumped to a record high in 2019, reaching almost 71,000, which was up 4.6% from 67,000 in 2018. In particular, deaths involving synthetic opioids, such as fentanyl, continue to trend upwards and have increased from 31,000 in 2018 to roughly 36,500 in 2019.
Childhood Routine Care Plummets During Pandemic
CMS data from Medicaid and Children’s Health Insurance Program (CHIP) during March to May showed early childhood vaccinations fell by 22%, screenings for cognitive or developmental problems decreased by 44%, dental visits shrank by 69%, and there were 6.9 million fewer mental health visits. In an effort to increase access to lifesaving childhood vaccines, HHS issued an amendment to the PREP Act allowing pharmacists to administer vaccines to children three years and older. While more recent data has shown an increase in vaccinations since May, CMS has emphasized the need for catch-up vaccinations due to the potential for increased outbreaks.
How Can I Tell the Difference Between the Flu and COVID-19?
Influenza and COVID-19 have very similar symptoms including fever, sore throat, body aches, fatigue, shortness of breath, cough and headaches. Symptoms that are distinctive to COVID-19 can include change or loss of taste or smell, however some may not experience these symptoms. The only reliable measure to differentiate Influenza and COVID-19 is through testing, as co-infection is possible. ■
9-8-8 Designated as National Suicide Prevention Lifeline
Individuals in suicidal crisis will soon have a quick and easy three-digit number to reach the National Suicide Prevention Hotline rather than the current 10-digit number (1-800-273-8255). The Federal Communication Commission (FCC) has approved a plan to establish
FLU or COVID-19?
ANNUAL MEETING 2020
VIRTUAL
IPA ANNUAL MEETING 2020 To bring members safely together in a socially distant world, IPA hosted its 2020 Annual Meeting completely virtually September 14-18, 2020. Primary programming was held Thursday and Friday with additional networking opportunities offered Monday through Wednesday, including daily coffee, lunch and happy hours, a Connecting Over COVID-19 webinar with representatives from the Iowa Department of Public Health, and a special keynote presentation from MedPharm Iowa. Over 170 individuals were in attendance for this year’s virtual Annual Meeting. Thursday morning began with a coffee hour on forming professional networks in virtual times, followed by the day’s first keynote from Jason and Kim Kotecki, “A Chance of Awesome: How Changing the Way You See Changes Everything,” encouraging us all to stay child-like. Ashley Dohrn, 2019-2020 IPA Speaker of the House, welcomed attendees for the first House of Delegates session, including policy statements from committee chairs and a keynote presentation from Miss America 2020 and PharmD candidate, Camille Schrier. After breakout committee meetings and a virtual exhibit hall, Thursday concluded with a virtual 2020 President’s Reception & Annual Banquet. Diane Reist, BS Pharm, PharmD, was installed as the 143rd President of IPA. Members toasted IPA-blue drinks via Zoom to Diane, incoming and outgoing IPA board members, and 2020 IPA Award honorees. Peter Fay, RPh, was awarded the 2020 Bowl of Hygeia award with his friends and family in attendance. Connie Connolly, 2019-2020 IPA President, was presented with her Duffy caricature, and Bob Stessman, outgoing IPA Foundation Board of Directors Vice President, was recognized with his bobble head gift. On Friday morning, keynote speaker Scott Knoer, MS, PharmD, FASHP, APhA CEO & Executive Vice President, joined the coffee hour to interact with IPA members. During his keynote, he discussed being BOLD and spoke on the role of pharmacists and empowering them to care even more for their patients. The second House of Delegates session included active policy debate reflecting existing and upcoming issues of pharmacy, such as matters related to workplace violence, deprescribing, manufacturer co-pay assistance programs, and more. A panel discussion from representatives of Amerigroup and Iowa Total Care rounded out Friday’s keynotes.
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Miss America 2020, PharmD candidate, Camille Schrier
Pharmacists, pharmacy technicians and student pharmacists participated in daily coffee, lunch and happy hours during 2020 Annual Meeting.
OVER 170 INDIVIDUALS ATTENDED VIRTUALLY
Diane Reist, BS Pharm, PharmD, was installed as the 143rd President
Connie Connolly, 2019-2020 IPA President, was presented with her Duffy caricature
THANK YOU SPONSORS
Jason and Kim Kotecki, “A Chance of Awesome: How Changing the Way You See Changes Everything,”
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PharmServ Staffing CPESN-Iowa Independent Pharmacy Cooperative McKesson Alliance for Patient Medication Safety (APMS) Pharmacists Mutual Insurance Company LicenseTrak PharmWaste Technologies Janssen Pharmaceutical Companies of Johnson & Johnson Fresenius Kabi Amerigroup NACDS OCT.NOV.DEC 2020 |
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ANNUAL MEETING 2020
SPEAKER’S ADDRESS
Ashley Dohrn, PharmD, BCGP - Woodland Park, CO | 2019-2020 Speaker of the House
IPA Speaker of the House Ashley Dohrn’s address during the first virtual session of the 2020 IPA House of Delegates on September 17, 2020. Good morning everyone. Thank you, Vice Speaker Meyer, fellow delegates, student attendees, and all those joining us from near and far in this first ever virtual Iowa Pharmacy Association Annual Meeting. It is truly an honor for me to stand before you, or rather sit in front of my computer as in our new norm in 2020, as your Speaker. You are my collogues, friends, and family, and your dedication to this profession of ours is what emboldened and brought me here today. Over the past few years, we have heard motivating words from our Speakers that still resonate today. Dr. Susan Vos addressed mindsets for thinking and problem solving that can assist us today in crafting policy future generations can build upon, which positively impact our patients and that incorporate varied perspectives of our profession. Dr. Steven Martens utilized PASSION as an acronym to remind and encourage us all to find and follow our passions within the profession of pharmacy. He reminded us that NOW is the time to act! Dr. Jim Hoehns took us on a walk down pharmacy history lane while relating historical events to current aspects of our association. He motivated us to tackle the tough tasks, such as an Iowa Pharmacy Practice Act review and revision. Keeping these lessons in the forefront during our policy discussions today will help us work together, think forward, and appreciate alternative perspectives outside our own. Today, we will hear from the Policy Committee for Professional Affairs on workplace safety training, medication-assisted treatment, and deprescribing. Our Policy Committee for Public Affairs will present policy related to licensure mobility and portability, manufacturer copayment assistance programs, and advertisements from legal firms. We will also hear from the Policy Review Committee with their report on how to
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update our current policies and bring them forward with us. While each of these topics may not be at the forefront of your specific practice, they are issues that affect our profession and are very timely for us to debate. In 2020, I would be remiss if I did not address the strangeness of the state of the world and our “new normal.” The phrase “It’s a small world after all” is something that continues to play in my mind this year, and no, I won’t make this a sing-a-long, but it is a phase that resonates. The quick spread of the coronavirus showed us how interconnected we all are in this world and how one small event can ripple out and impact so many. For the previous six months, we have been inundated with infection reports, hospitalization and death rates due to the coronavirus and its quick spread. Often times, the information is scary and overwhelming, and I continue to wonder how we as a nation, world and how I personally will continue to manage life during this pandemic. The challenges have been and continue to be significant. A few quarantine lessons I have learned about myself: I am not wellequipped to manage home or online school, along with my own work and running a household for my family that includes a 10 and 12-year-old; I have a newfound appreciation for my house cleaner; and as much as I identify as an introvert, being without my community in person continues to be difficult. I truly miss the networking and opportunities to connect with you all during this Annual Meeting. So, how can we look at this spread or ripple effect and harness it in a positive manner? As pharmacists, technicians and students, we preform many small, often seemingly minute, tasks daily for our patients. If we inadvertently make a mistake, say enter a dose incorrectly into the software, the negative ripple effect could lead to severe patient harm, i.e. dispensing ten times the ordered warfarin dose. But what happens when we flip this narrative? That extra step you took to deliver a patient’s medications when they couldn’t get out of the house, stayed late to ensure a newly admitted patient received the correct opioid dose for their pain, or answered
ANNUAL MEETING 2020
calls afterhours to ensure the safe delivery of medications to our vulnerable long-term care patients. These small acts too have a ripple effect. We may not know the outcome of some of the small, positive acts we make, but that does not stop us. As pharmacy professionals, we continually work to bring positive change to our patients’ lives. During the pandemic, my work at Centralized Healthcare Solutions providing chronic care management has increased. We were well-poised to support our primary care partners as they moved into telehealth visits and supplement them with CCM. I want to share a brief patient story about a particularly challenged patient of mine, we will call her Betty. Betty has MS, is only mobile with her motorized wheelchair, lives on disability and has significant anxiety. I personally speak with her at least monthly, sometimes weekly, and have several times listened as she cried on the phone questioning the meaning of her life and if it is worth continuing. In my most recent call, she was struggling with medication adherence and did not fully understand that her provider agreed to continue telehealth visits as long as she wanted. Betty thought her PCP was not going to refill her medications unless she went in for a visit. I worked with Betty and her PCP to obtain new prescriptions for her chronic medications, was able to speak with her HyVee pharmacy and facilitate a medication transfer, and they kindly offered to contact Betty to arrange medications deliveries. I am not sure how
“wide” of a ripple effect this interaction will have, if any. It is just one example of small actions that we can make as pharmacists to positively impact our patients’ lives. This year, like none other, our profession has stepped up to the challenge, and I am proud to be part of this amazing group with you. Times of change, even forced change, bring about opportunity. What positive opportunities have you found this year? How can you continue to build upon those and improve yourself and our profession? For me, a personal positive change has been more family (or some may call it forced family) fun. And my family seized a “quarantine opportunity” to relocate to Woodland Park, Colorado. I am a mountain girl at heart and now live within ten minutes of my mom who passed her adventurous spirit on to me. Go out and find your quarantine opportunity! Lastly, I want to thank the IPA staff, my fellow board members, and the executive committee for the rewarding experiences over the last year. A big thank you is also due to our committee members, and particularly the committee chairs, Dena Dillon, Wes Pilkington and Dana McDougall, for your dedicated work in crafting and refining policy. I look forward to the debate and a lively House of Delegates! Thank you. ■
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HOUSE OF DELEGATES
FINAL POLICY STATEMENTS The following policy was adopted by the 2020 House of Delegates during IPA’s 2020 Annual Meeting.
20-U1: Licensure Mobility & Portability 1.
IPA supports the nationwide harmonization of information systems across state boards of pharmacy and other pharmacy stakeholders to facilitate a process for expedited licensure or registration.
20-U2: Manufacturer Co-Payment Assistance Programs 1.
IPA supports education of pharmacists, prescribers, and other healthcare team members on manufacturer copay assistance programs and their full impact on a patient’s health plan benefits, patient accumulated deductibles, disclosure and collection of patient health data, and continuity of therapy. 2. IPA supports education of employers, health plan administrators, and patients on how manufacturer copay assistance programs impact patients’ health plan benefits and the collection and disclosure of patient health data.
20-U3: Advertisements from Legal Firms 1.
IPA supports a requirement that drug litigation advertising have appropriate and conspicuous warnings that patients should not discontinue medications without seeking the advice of their pharmacist or prescriber.
20-R1: Workplace Violence 1.
2.
3. 4. 5.
6.
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IPA supports workplace safety policies, programs, and provision of training to all pharmacy personnel and students to increase readiness in the event of pharmacy workplace violence. IPA supports the inclusion of identification of potentially violent situations and management of these situations through de-escalation techniques in all workplace violence training. IPA supports pharmacy personnel’s right to retreat or withdraw from workplace violence without employer retaliation or legal repercussions. IPA supports public education as a prevention strategy to decrease pharmacy workplace violence. IPA encourages development and maintenance of a communication network to share timely information about incidents of potential and real workplace violence. IPA encourages survivors of pharmacy workplace violence to seek appropriate professional services to assist with their recovery with support from their employers.
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20-R2: Medication Assisted Treatment (MAT) 1.
2. 3. 4. 5. 6.
IPA supports the role of the pharmacist in MAT for substance use disorder including patient assessment, education, prescribing, and monitoring of pharmacologic therapies. IPA supports the ability for pharmacists to become MAT providers, including allowing for the acquisition of a DEA Drug Addiction Treatment Act (DATA) waiver. IPA supports appropriate compensation for pharmacist provision of MAT services. IPA supports education and training for pharmacists involved in MAT services. IPA supports additional research on clinical outcomes of pharmacist-driven MAT. IPA supports required formulary inclusion of medications used in MAT.
20-R3: Deprescribing
1. IPA supports pharmacist initiatives in deprescribing. 2. IPA supports pharmacist education regarding safe and effective deprescribing practices. 3. IPA supports patient education on risks and benefits of deprescribing with shared decision making between pharmacists, patients, and prescribers. 4. IPA supports the role of the pharmacist in educating other healthcare providers regarding safe and effective deprescribing. 5. IPA supports timely communication between practice settings when medications are deprescribed. 6. IPA opposes penalties from third-party payers for appropriate continuation of high-risk medications or restarting of deprescribed medication therapies.
20-NBI-1: Racial Injustice & Health Disparities 1.
IPA acknowledges explicit and implicit biases exist that contribute to health care disparities. IPA calls upon pharmacies to support unconscious bias training to advance racial equity and inclusion. 2. IPA acknowledges that racism, discrimination, and inequities exist in healthcare systems. 3. IPA affirms that racism, discrimination, inequities and injustice exist, but in any form, they have no value in society and cannot be tolerated. 4. IPA commits to continually fostering a just and inclusive healthcare system and society.
ANNUAL MEETING 2020
AWARDS
With the 2020 IPA Annual Meeting held virtually, IPA Award presentations took on a different format. Throughout the week of September 14-18, 2020, IPA spotlighted this year’s award recipients on social media with a custom-made video including introductions from 2019-2020 Chairman of the Board Cheryl Clarke, EdD, RPh, FAPhA, and IPA Foundation Board of Directors President Steve Firman, BS Pharm, MBA, FAPhA. These videos are available on IPA’s Facebook page.
Bowl of Hygeia Peter Fay, RPh, Adair
Julie W. Kuhle, BS Pharm, Indianola
Honorary President
Excellence in Innovation
Patient Care Partner Award
Appreciation Award (Individual)
Tony Beraldi, BS Pharm, Council Bluffs
Michael Daly, PharmD, MSCI, BCPS, Des Moines
Distinguished Young Pharmacist of the Year
Health-System Pharmacist of the Year Andrew Miesner, PharmD, BCPS, Des Moines
Linda B. Kalin, BS, RN, CSPI, Sioux City
Senator Tom Greene, RPh, Burlington
Appreciation Award (Corporate)
Pharmacy Technician of the Year
Jerry Karbeling Leadership Award (Drake University)
Jerry Karbeling Leadership Award (University of Iowa)
Pamela Wiltfang, PharmD, MPH, BA, CHES, Coralville
Wellmark’s Value Based Pharmacy Program
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Robert G. Gibbs Distinguished Pharmacist
Macey Calderwood, CPhT, Traer
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Olivia C. Welter, PharmD Candidate 2021
Christine Lawson, PharmD Candidate 2021
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Robert Arnell, Hamilton, IL Dan Dowling, Ottumwa
Robert Duke, Tucson, AZ
William Fallgatter, Cape Coral, FL Linda Frankenfeld, Tucson, AZ Leon Galehouse, Cedar Falls
Judith Gunnarson, Hamilton, OH David Hentges, Venice, FL
James Kron, Loveland, CO
Marven Lightner, Napa, CA
Edward Maier, Emmetsburg
Richard Michael, Fort Dodge Keith Miller, Oskaloosa
Arlyn Picken, Urbandale
Jeanne Sandvig, Cypress, CA John Saur, Iowa City
Dennis White, Estherville
Poster Presentation Award (Presented by the IPA Foundation) “Community Pharmacist Use of Mobile ECG to Inform Drug Therapy Decision Making for Patients Receiving QTC Prolonging Medications” James Hoehns, PharmD, BCPS, FCCP Matthew Witry, PharmD, PhD Mary Oelmann, PharmD Ryan Froerichs, PharmD Joe Greenwood, PharmD Robert Nichols, PharmD Brianna Hostert, PharmD Jenna Beninga, PharmD Wesley Pilkington, PharmD Emily O’Brien, PharmD, BCACP Adam Froyum-Roise, MD, MPH
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IOWA PHARMACY NEWS
Derecho Impacts Iowa Pharmacies & Hospitals
Many Iowa pharmacies and hospitals were incredibly affected by the intense derecho storm that unexpectedly hit Iowa in early August. Not only did countless areas lose electricity for up to several weeks, but many facilities had significant structural damage that affected their abilities to provide services and meet the health care needs of their patients. Some pharmacies were forced to close indefinitely due to the severity of the storm. While many of IPA’s members volunteered to assist with cleaning up Iowa’s hardest hit areas, IPA also worked very closely with the Iowa Board of Pharmacy and the Governor’s office in providing resources and assisting pharmacies impacted by the storm. Social media was utilized to determine which pharmacies were still in need of supplies, and community pharmacies were encouraged to apply for local and national disaster relief funds for additional financial assistance.
IME Provider Enrollment Delayed
On February 20, 2020, the Iowa Department of Human Services (DHS) announced Iowa Medicaid’s new provider type for pharmacists and released an informational letter detailing the process for pharmacists to enroll as Medicaid providers. Pending required training, continuing education and certification requirements, this change allows pharmacists to provide services under Board of Pharmacy-approved statewide protocols, such as ordering and dispensing naloxone and nicotine replacement therapy and administering vaccines to Medicaid members. Due to COVID-19, implementation has been delayed, and the provider enrollment will not become active until June 1, 2021. IPA continues to work with IME to prepare pharmacists for enrolling and billing under statewide protocols to recieve fair compensation for services provided. Pharmacists are encouraged to begin the enrollment process immediately to prepare for payment for services occurring after June 1, 2021. Applying is free but only available via a paper application. This must be filled out correctly to prevent any delays in the enrollment process. For assistance, including an application template, visit IPA’s Medicaid enrollment resource page, www.iarx.org/provider_enrollment.
Drug Manufacturers Push Against 340-B Program Numerous hospitals from across the nation have submitted letters to Health and Human Services (HHS) in response to a growing number of pharmaceutical manufacturers taking action to place restrictions on the participants of the 340-B Drug Pricing Program. The main issues revolve around contract pharmacies and duplicate discounts. For example, AstraZeneca announced they will only process 340-B discounts
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through a single contract pharmacy of a covered entity that does not have their own on-site dispensing pharmacy. Eli Lilly and Company has ceased providing 340-B pricing to all contract pharmacies with the exception of insulin. Other manufacturers such as Merck, Sanofi, and Novartis have sent notifications to 340-B hospitals requiring claims data from contract pharmacies prior to continuing 340-B discounts. Under federal law, covered entities, including 340-B Program-participating hospitals, may elect to dispense 340B-Program covered drugs to patients through contract pharmacy services. A bipartisan group from Congress and the American Hospital Association (AHA) have submitted letters to HHS condemning the recent actions of drug makers, noting that the actions taken undermine the intended purpose of the 340B Drug Pricing Program. In early September, HRSA began inquiry into whether federal laws have been violated by pharmaceutical manufacturers. Many safety-net hospitals are dependent upon 340-B pricing to serve vulnerable populations and stay afloat, especially with the added strain of the COVID-19 pandemic. Hospitals may be stretched to a breaking point if further action is not taken to curb restrictions placed on 340-B discounts.
Falls Prevention Coalition Convenes
The Iowa Falls Prevention Coalition is a network of health care organizations with a mission to foster collaboration among state, community, and health care system partners to reduce falls by building awareness and providing education about falls prevention. The charter continues to meet every other month via a virtual format, with the last coalition convening on July 9, 2020. Leaders across health-systems, representatives of the Iowa Department of Public Health, Telligen, Iowa Healthcare Collaborative, and others attended the meeting to hear about topics ranging from the role of nutrition in falls prevention to grant opportunities for implementing educational programs aimed at reducing the risk of falls. During the meeting, the Falls Prevention Coalition announced the launch of their new website, chpcommunity.org, to serve as a centralized entity for evidence-based programs across the state. IPA Board member Kristin Meyer also announced that Drake University was looking to expand pharmacy student involvement in inpatient environments, specifically with a geriatric focus. Contact Kristin.meyer@drake.edu if you have an idea for potential partnerships. IPA looks forward to further contributing to the Falls Prevention Coalition by supporting strategies for medication management and educational opportunities in Iowa communities.
Iowa Pharmacy Stakeholder Group Update The Iowa Pharmacy Stakeholder group convened on July 14th, 2020. This was the first stakeholder meeting conducted in a virtual setting and began with updates
IOWA PHARMACY NEWS
from leaders of Iowa’s colleges of pharmacy, CPESN-IA, the Board of Pharmacy, CEimpact, and Iowa’s pharmacist legislators. Most of the meeting was spent discussing COVID-19’s impact on the pharmacy profession where concerns were expressed across a variety of areas, including student learning and barriers preventing pharmacists from administering COVID-19 testing and potential vaccines. The group was optimistic in predicting that the pandemic may encourage adaptability and innovation amongst practice settings, and everyone remained hopeful for positive outcomes for the profession as the public recognizes the role of pharmacists during this unprecedented time. Engagement and support across pharmacy stakeholders and organizations was encouraged throughout this time and beyond the pandemic.
Narcan Dispensing Program Launches
The Iowa Board of Pharmacy and Iowa Department of Public Health (IDPH) have partnered together to coordinate an effort for free naloxone (Narcan) dispensing within pharmacies across the state. This is an extension of a previous program that IDPH was implementing with the Iowa Hospital Association and Iowa Healthcare Collaborative in which naloxone was being provided to hospital emergency departments. This program will allow for individuals 18 or older to receive up to two naloxone nasal spray kits for free, once deemed
eligible by a pharmacist within community pharmacy settings. The state continues to work on strategies to reduce opioid overdose-related deaths, including providing kits to law enforcement, making the medication available without a prescription, and other training efforts in addition to this initiative. The Narcan dispensing program will provide greater access to the opioid overdose antidote and, more importantly, provide greater opportunities to help increase survival and promote recovery amongst at-risk individuals.
VA Expands Locations for Veterans to Receive Flu Shots
The VA has partnered with additional community pharmacies to expand access for veterans to receive influenza vaccinations. Every year, veterans continue to have increased infection and hospitalization rates during the flu season, and this year may bring increased risk of co-infection with COVID-19. Though many veterans may not live near VA medical centers, these partnerships with pharmacies hope to provide greater access for veterans to protect themselves from flu. Find participating community pharmacies at www.va.gov/communitycare/flushot.asp. Make sure to call ahead to determine eligibility. Most military insurance plans will provide the vaccine at no cost to the patient. ■
UPDATED COVID-19 RESOURCES In light of the ongoing changes and key issues regarding COVID-19, IPA utilizes its COVID-19 Resources webpage as the most timely source of information on testing, therapies, vaccines and government activity, as well as IPA’s COVID-19 Progress Tracker, workforce assistance and continued Connecting Over COVID-19 webinars. IPA encourages members to familiarize themselves with the updated www.iarx.org/covid19 webpage. If you have additional questions and are unable to find the answer, as always, please do not hesitate to reach out to IPA staff.
NEW PAGE FEATURES: - State and national testing guidance - Sample policies and procedures for administering Bamlanivimab - EUA releases for COVID-19 therapies - Anticoagulation protocols - Guidance for temperature excursions - COVID-19 vaccine news by manufacturer - And MORE!
Access resources, view workforce volunteers and register for upcoming webinars at www.iarx.org/covid19
PRACTICE ADVANCEMENT
1815 Update
IPA is working with the Iowa Department of Public Health (IDPH) to engage pharmacists in providing diabetes services. Implementation grants are available to launch these services, but IPA is specifically looking for pharmacists interested in participating in the implementation of the following evidence-based services and associated community education: Diabetes Prevention Program (DPP), Diabetes Self-Management Education and Support (DSMES), and/or medication therapy management (MTM). These programs aim to prevent or delay the onset of type 2 diabetes and to improve health outcomes for people diagnosed with diabetes. IPA hopes to gain the support of pharmacists in these patient-care processes to help people with diabetes manage their medications and facilitate support and referrals for enrollment and retention of participants in these lifestyle prevention and evidence-based treatment programs. For more information on receiving financial support to develop these programs in your pharmacy, please contact IPA’s Executive Fellow, Sharmi Patel, at spatel@iarx.org. IPA continues to work with University of Iowa for implementation of targeted hypertension services. We look forward to working synergistically with Bill Doucette, PhD, FAPhA, RPh, Division Head and Professor of the Department of Pharmacy Practice and Science, in improving the management of chronic care conditions that thousands of Iowans suffer from across the state.
COVID-19 Vaccine Update
The WHO has stated widespread vaccinations against coronavirus should not be expected until mid-2021. However, high-risk and essential health care groups may see the first wave of vaccines prior to the end of the year in the U.S.
KEY HIGHLIGHTS:
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New technology is being used for COVID-19 vaccine production. Unlike previous vaccines such as live attenuated, inactivated whole virion, and subunit vaccines, many of the leading COVID-19 vaccine candidates are Nucleic-acid Vaccines (mRNA, DNA) and Viral-Vector Vaccines (incorporating a different virus that expresses a protein).
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When vaccine products come to market, they will not be interchangeable. Depending on the vaccine, one or two doses may be required.
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Iowa’s Immunization Registry Information System (IRIS) will be used to distribute, report doses administered, and assess and track vaccination coverage of COVID-19 vaccine.
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Many of the leading candidate COVID-19 vaccines will require cold storage beyond that of normal vaccines (-60 to -80 °C). State and Federal officials caution acquiring new ultra-cold storage equipment in anticipation of the COVID-19. It is expected the vaccines will be transported from manufacturers in cool boxes with dry ice that will last 10 days before replacement dry ice is needed.
Hepatitis C Testing Project
In conjunction with the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis, IPA launched an HIV screening project partnering with communitybased pharmacies across the state in January of 2019. In January of 2020, the project will include Hepatitis C testing. Greenwood Pharmacy in Waterloo, who has been offering HIV screenings since the launch of the project, will also be offering Hepatitis C testing. The project currently has 12 community pharmacies offering 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.
Rural Communities Opioid Response Program Update
IPA has extended its contributions to the Health Resources and Services Administration (HRSA)-funded grant, Rural Communities Opioid Response Program (RCORP) Opioid Use Disorder consortium, which has been scheduled to take place over the next three years. While Iowa Healthcare Collaborative will take leadership of the consortium, IPA will work with other healthcare organizations to target substance use and opioid use disorder prevention, treatment and recovery in three target Iowa counties: Lucas, Wayne, and Appanoose. IPA plans to work with local community
PRACTICE ADVANCEMENT
pharmacies and hospital pharmacies to increase access to treatment and support services to promote long-term recovery for new and at-risk individuals in these high-risk counties. If you are a pharmacist within these areas and would be interested in piloting implementation activities and best practices, please reach out to IPA’s Executive Fellow, Sharmi Patel, at spatel@iarx.org.
Is Your Pharmacy Ready to Implement Technician Product Verification?
Inside IPA’s TPV Toolkit, our Readiness Assessment will give you a gauge of your readiness to implement technician product verification to optimize patient care at your pharmacy practice. The assessment should be completed individually at each unique pharmacy
location with input from an owner/district supervisor/ pharmacy director, pharmacist-in-charge/pharmacy manager, and lead technician. With the use of this assessment, you will know that it is likely a good time within your pharmacy to consider utilizing technician product verification to optimize patient care delivered by your pharmacists. This readiness assessment is just the first step as you begin the implementation process. To learn more and to purchase the TPV Toolkit, visit www.iarx.org/TPV.
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FROM IPA EDITORIAL STAFF: This author acknowledged a recent JAMA article (JAMA. 2020;324(18):1844-1854. doi:10.1001/jama.2020.18889) that was not evaluated in time to be included in this review, but IPA encourages our readers to evaluate the JAMA article and share your thoughts with the corresponding author of this article, McKenna K. Brust, PharmD Candidate 2021, at email: McKenna.brust@cuw.edu
ANALYSIS OF THE PRIMARY LITERATURE AND LAY PRESS TO GUIDE DISCUSSIONS WITH PATIENTS ABOUT E-CIGARETTES AND THE VAPING CRISIS McKenna K. Brust, PharmD Candidate 2021, Michael C. Brown, PharmD, Lynne Fehrenbacher, PharmD Corresponding Author: McKenna K. Brust, PharmD Candidate 2021 Concordia University Wisconsin School of Pharmacy 12800 North Lake Shore Drive, Mequon, WI 53097 Email: McKenna.brust@cuw.edu Phone: 262-243-2770 Fax: 262-243-2752 Michael C. Brown, PharmD Interim Dean Professor of Pharmacy Practice Concordia University Wisconsin School of Pharmacy Lynne Fehrenbacher, PharmD Associate Professor of Pharmacy Practice Concordia University Wisconsin School of Pharmacy
The authors declare no funding received or conflict of interest relative to the content of this article. Article category preference: Special contributions Relevance to patient care: In the late summer of 2019, the United States saw a sharp increase in e-cigarette or vaping product use-associated lung injury. This left many to wonder about the safety of e-cigarettes or vaping product use. This manuscript discusses the safety of e-cigarettes, the use of e-cigarettes as a smoking cessation aid, and concludes with educational points for health care professionals to use when talking with patients.
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Abstract The objective of this study was to determine the difference in information found in the lay press and medical literature surrounding the vaping crisis and to provide a guide for health care professionals looking to educate patients on the safety of e-cigarettes. This research was conducted by gathering relevant lay press information via Google searches, Facebook links, and online news articles. To determine what was reported in the medical literature, searches were performed using Google Scholar, the Centers for Disease Control and Prevention (CDC), and PubMed. gov. Key topics throughout this article include the vaping crisis, risks of e-cigarettes, the use of vaping for a smoking cessation aid, and educational points for health care professionals to use when talking with patients. In regards to the vaping crisis, evidence indicates that vitamin E acetate was likely associated with cases of EVALI, though a definitive cause could not be named. E-cigarettes may be a safer alternative to conventional cigarettes, but are still not considered safe. FDA approved products and behavioral interventions remain the best options for smoking cessation treatment. E-cigarettes are battery operated devices that heat liquid and produce a vapor that the user inhales into their lungs.1 The first e-cigarette device was developed in 2003 by a Chinese pharmacist and became a part of the U.S. market by the mid2000s.2 Since 2007 the sale and use of e-cigarettes increased with the most growth in more recent years. E-cigarettes today are used to inhale a variety of different products including nicotine, tetrahydrocannabinol (THC), cannabidiol (CBD), flavorings, additives, and other substances like butane hash oils (dabs).3,4 E-cigarettes go by a
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variety of names such as e-cigs, e-hookahs, mods, vape pens, tank systems, and electronic nicotine delivery systems (ENDS). The action of inhaling these substances using e-cigarettes is commonly known as vaping. In the summer and early fall of 2019, there was a dramatic increase in the number of emergency department (ED) visits due to e-cigarette or vaping product use-associated lung injury (EVALI). There are still several questions surrounding vaping and the use of e-cigarettes as an alternative to conventional cigarettes or as a smoking cessation aid. Available information in both the medical literature and the lay press presents diverse information. This article provides a review of both the medical literature and the lay press from August 2019 to April 2020 so that providers and patients might better understand the information available regarding the safety and use of e-cigarettes. Relevant lay press information was gathered via Google searches, Facebook links, and online news articles, mirroring the sites many patients use to find information. To determine what was reported in the medical literature, searches were performed using Google Scholar, the Centers for Disease Control and Prevention (CDC), and PubMed.gov. The search terms in PubMed.gov included the words: vaping and e-cigarettes. The search terms in Google included the words and the phrases: vaping, is vaping better than smoking, vaping for smoking cessation, dangers of vaping, e-cigarettes, and e-cigarette history.
MEDICAL LITERATURE The Vaping Crisis
On April 21, 2019, the first four reported patients in the US with EVALI were admitted to the hospital.3 Cases continued to rise until September 22, 2019 when there was a gradual reduction. The CDC recorded cases associated with EVALI through February 18, 2020 where there was a total of 2,807 hospitalized cases or deaths reported across all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. The CDC reported that there were 68 confirmed deaths in 29 states and the District of Columbia. While a definitive trigger for EVALI has not been determined, there are reports that indicate vitamin E acetate, an additive to e-cigarette cartridges containing THC, likely played a role in the vaping crisis of 2019. A study looking at 98 EVALI cases in Wisconsin and Illinois started tracking reports of e-cigarette
associated pulmonary disease in July 2019.4 The ages of the patients ranged from 15-53 with a median age of 21 and the patient population was described to be generally young and healthy. Despite previously being in good health, these patients experienced significant severe illness including 2 fatalities. The majority (89%) of the patients reported that they had used e-cigarettes containing THC in the previous 90days, however other product use was also reported including nicotine and CBD. The frequency of THC use in the case series, while notable, cannot be clearly linked as the causative agent, as other excipients or THC preparation processes may have also contributed to EVALI. An independent cross-sectional study examined the bronchoalveolar-lavage (BAL) fluid in 51 patients with EVALI and 99 healthy individuals, 18 of whom were e-cigarette users, from 16 states.5 The BAL fluid from 48 of 51 EVALI patients contained vitamin E acetate, which was not present in any of BAL fluid from the 99 healthy individuals. Ninety-four percent EVALI patients reported using THC in their e-cigarettes within the past 90 days or had THC or its metabolites in their BAL fluid, and 64% of EVALI patients had nicotine or its metabolites in their BAL fluid. The study concluded that while vitamin E acetate is a likely contributor to the vaping crisis, it is possible there were other substances also involved.
Other risks of e-cigarettes
While studies suggest that the aerosols from e-cigarettes might contain fewer toxic chemicals than traditional cigarette smoke, e-cigarettes are not harmless.4 There might be other toxins from e-cigarettes that are unknown at this time. A population-based longitudinal cohort study of approximately 5,100 participants compared the estimated concentrations of tobacco-related toxicants in e-cigarette users to biomarker concentrations with individuals that used combustible cigarettes, used both e-cigarettes and combustible cigarettes, and individuals that never used tobacco.6 These biomarkers included nicotine, tobacco-specific nitrosamines (TSNAs), volatile organic compounds (VOCs), and polycyclic aromatic hydrocarbons (PAHs). There were a number of variables that were not accounted for including product type, frequency of use, interindividual and intraindividual variability, biomarker/chemical half-life, and the variability in lab methods. The study reported that biomarkers were highest in dual users, followed by those that used combustible cigarettes alone, e-cigarettes alone, and
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finally the individuals that had never used tobacco products. This information is important because e-cigarettes are sometimes seen as being water vapor, however this study shows that e-cigarettes still contain toxic chemicals that are harmful to the body. A different study reported the effects of e-cigarettes on the airway.7 Induced sputum samples from 14 cigarette smokers, 15 e-cigarette users, and 15 non-smokers were examined. Since the epithelium in the airway is one of the first parts of the body to come in contact with inhaled smoke or vapor, changes in the makeup of airway mucus can help to show biomarkers that might be associated with negative health effects. When the authors compared the abundance of altered innate defense proteins between the three groups, the number of altered proteins was significantly higher in the e-cigarette group than in the combustible cigarette or nonsmoker group. The e-cigarette group had roughly 80 altered proteins and the combustible cigarette group had roughly 40 altered proteins. The defense proteins that were altered in the e-cigarette group have been known to contribute to inflammatory lung diseases such as cystic fibrosis and COPD; however the study does not claim that e-cigarettes will definitively cause such diseases. The study is limited by its sample size and it is important to note that some of the e-cigarette users also used combustible cigarettes prior to or during the study. In conclusion, e-cigarettes are relatively new products and their long-term effects are yet to be determined. At this time, it is recommended for naĂŻve individuals to avoid e-cigarettes and for current e-cigarette users to refrain from switching or returning to combustible cigarettes.8
Using vaping as a smoking cessation aid
With the increasing popularity of e-cigarettes, literature has begun to emerge discussing whether they are a safe and effective option for smoking cessation. Currently the only FDA approved products for smoking cessation include nicotine replacement therapy (NRT), varenicline, and bupropion.9 A randomized trial of e-cigarettes vs NRT concluded that e-cigarettes are more effective than NRT in helping patients to stop smoking.10 The study followed 886 patients over the course of 52-weeks. After randomization, 439 patients were in the e-cigarette group and 447 patients in the NRT group. At the end of one year, the abstinence rate was 8.1% higher (18% vs 9.9%; P < 0.001) in the e-cigarette group. Despite these findings, there are many things to consider about this study when sharing this information to patients. First,
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the percentage of individuals still using their assigned product at 52 weeks was 71% higher in the e-cigarette group (80% vs 9%) suggesting that subjects simply moved from one nicotine product (cigarettes) to another (e-cigarettes) but were still therefore at risk albeit potentially different risk. The individuals in the e-cigarette group were given a starter kit with a 30-mL bottle of flavor e-liquid containing 18 mg nicotine/mL. Once the single bottle was gone, participants were encouraged to purchase their own e-liquid online or at local vape shops. They were encouraged to experiment with different flavors and strengths. According to the CDC, the manufacturer of an e-cigarette brand, JUUL (JUUL Labs Inc., San Francisco, CA), stated that a single JUUL pod contained as much nicotine as a regular 20 pack of combustible cigarettes.11 This indicates that patients who use JUUL for smoking cessation could be using more nicotine than they were before they started using e-cigarettes. With nicotine being the addictive component in both products, it is no surprise that the majority of e-cigarette users were still using their product at the end of 52 weeks. Another element that may have contributed to this was the lack of a taper strategy. Rather than the e-cigarette users quitting smoking completely, it is possible that they may have just made the switch from smoking to vaping. If the study subjects followed and were successful with the traditional NRT treatment regimen, they would have been done using their product at 12-weeks, long before the 52-week follow up.12 The article leads readers to believe that e-cigarettes might actually be better for smoking cessation than NRT, however the methods of the article fail to account for dosing, tapering, and typical treatment duration of NRT. It is still recommended to use FDA approved agents such as NRT, varenicline (ChantixÂŽ, Pfizer Inc, New York City, NY), and bupropion as first line smoking cessation agents.9 The question remains whether individuals who have repeatedly failed FDA approved agents could benefit from e-cigarettes as a quitting tool; further study of this concept is needed. Using clinical knowledge and the evidence previously stated, e-cigarettes might be an option for a very small subset of patients that cannot seem to quit with the FDA approved agents. It would be important for that individual to work closely with a medical professional that can help them select a product that would be safest for them and to work through a tapering strategy. Of clinical concern, the high nicotine content in e-cigarettes might make it unlikely that an individual would be able to stop using e-cigarettes without behavioral or pharmacological intervention.
PEER REVIEW
THE LAY PRESS The Vaping Crisis
The media hype surrounding the vaping crisis was short-lived but the vaping crisis did damage the lives of the people that were affected by it. By September 27, 2019, there were 805 vaping related illness and 13 deaths, by January 9, 2020, those numbers rose to 2,602 cases and 59 deaths, and by February 18, 2020, there were 2,807 cases and 68 deaths.3,14,15 After February 18, 2020 no additional information was added to the CDC website because state health departments stopped systematically reporting EVALI cases to the CDC (CDC Office on Smoking and Health, e-mail communication, July 2020). During the vaping crisis, mixed information and opinions circulated in the lay press; however most were fairly consistent with the primary literature stating that THC vaping products seemed to be the main contributing factor in EVALI cases, and mentioned evidence that nicotine products were not safe.15 Other sources specifically stated that the vitamin E acetate detected in the THC e-cigarettes was believed to cause EVALI, but reported “even if we removed all of the vitamin E acetate from all of these products, we’re still not out of the woods.”16 Another source focused on the population that was most effected, adolescents and young adults, and spoke to the difficulty of tracking the problem due to the lack of diagnosis codes, reporting, and the differences in early symptoms.17 While overall lay press information was fairly consistent with the primary literature, many individuals may have mistaken the brevity of the issue to suggest that e-cigarettes were no longer problematic. Others may have believed that if their e-cigarette didn’t contain THC, they were safe, or if they were older, it wasn’t a problem for them. As health care professionals, it is important to fill in these gaps for our patients and make them aware of the current dangers of e-cigarettes. It is also important to let patients know that e-cigarettes containing nicotine, CBD, or other substances might not be safe and that people in all age groups have been impacted.
Using vaping as an alternative to traditional tobacco
The lay press had a general consensus in reporting when it came to determine that vaping is safer than smoking, but the wording in some articles could imply that there was a significant difference in safety between vaping and smoking. This is reflected by statements like “e-cigarettes are considered far less hazardous than the ones you light up” and “the CDC and FDA have a critical role to play in not just promptly investigating these incidents, but also
ensuring the adult smokers know that nicotine vaping products remain a far safer alternative to smoking.”18,19 E-cigarette aerosol does have less toxicants than conventional cigarette smoke, however it is not risk-free and contains many harmful chemicals just like conventional cigarettes. The long term effects of e-cigarettes are unknown at this time making the statement that they are “far safer” problematic. Talking with patients about the risks of both cigarettes and e-cigarettes is critically important to help them understand that e-cigarettes have not been proven safe and cessation is always the best option.
Using vaping as a smoking cessation aid
Interestingly, and perhaps not surprisingly, any position regarding vaping as a smoking aid can be reinforced through a Google search, sometimes with opposing views reported in the same article. Many articles stated that the patients in the end were likely using their e-cigarettes to feed their nicotine dependence rather than conventional cigarettes.18,19,20 On the other hand, the three previously cited articles also state that e-cigarettes might be better than NRT, leaving patients confused. The bottom line is that there are no published large, high-quality studies to prove that e-cigarettes are helpful for smoking cessation.1,20 The safest and most effective ways to stop smoking still include NRT, varenicline, or bupropion.20
Table 1: Frequently Asked Questions and Answers When Discussing E-Cigarettes with Patients
Talking to patients about all of this information can be overwhelming and challenging. Patients may question if certain e-cigarettes are safer than others, if they should be using e-cigarettes over combustible cigarettes, if there is a place for e-cigarettes in smoking cessation, or how to talk with teens about the dangers of e-cigarettes. There are many resources available to people that would like to get more information, but health care professionals can play a crucial role in getting these patients reliable information and offering support and guidance. Being informed and using these key conversation points can lead to successful conversation and relationship building with patients. continued on page 28
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PEER REVIEW
Table 1: Frequently Asked Questions and Answers Questions
Answers
Is it safe to use e-cigarettes that do not contain THC or vitamin E acetate?
No. Studies suggest that while vitamin E acetate was associated with the vaping crisis there is no definitive cause meaning that no e-cigarettes are considered safe.4,5 However, if an individual is going to use e-cigarettes it would be advised that they avoid e-cigarettes containing THC or vitamin E acetate.
Should patients be advised to use e-cigarettes instead of combustible cigarettes?
Neither e-cigarettes nor conventional cigarettes are considered to be harmless, but studies suggest there are less toxins in e-cigarettes aerosols than cigarette smoke.4 Patients that have never used e-cigarettes should not be advised to start, and current e-cigarette users should refrain from switching or returning to combustible cigarettes. Patients should be educated that the ultimate goal is to quit e-cigarette use.8
Should e-cigarettes be used as an alternative or before FDA approved tobacco cessation products for smoking cessation?
No. Per the American College of Cardiology (ACC) guidelines, the only FDA approved products for smoking cessation are NRT, varenicline (ChantixÂŽ, Pfizer Inc, New York City, NY), and bupropion.9 E-cigarettes have not been FDA approved for smoking cessation and therefore should be used with caution. Furthermore, preliminary data suggests e-cigarettes may be challenging to stop. FDA approved products should always be used first as they are proven to be safe and effective for smoking cessation.
Is there a place for e-cigarettes in smoking cessation?
If a patient has tried various FDA approved products and continues to struggle with tobacco cessation, e-cigarettes might play a role in helping the patient to quit smoking. E-cigarettes might also help patients that find comfort in or struggle to avoid the action of smoking. Given that e-cigarettes may contain nicotine, it would be advised to use behavioral interventions to reduce and eventually eliminate the use of nicotine over time.
How should an individual talk with their teen about e-cigarettes?
It is important that the individual having the conversation with the teen is setting a good example by remaining tobacco and e-cigarette free.21 Bring up the conversation when passing a vape shop, seeing a sign or advertisement about vaping or when vaping is brought up by the teen. This creates for a natural start to the conversation. It is important to be prepared, informed and ready to answer questions the teen might have. Some questions might include, what are the dangers of e-cigarettes, are e-cigarettes are safer than combustible cigarettes, or why the person talking with them cares, especially if they have personally used cigarettes or e-cigarettes. Lastly, remember that the conversation does not need to happen all at once. Continue to share facts, check in with the teen, and offer encouragement over time.
Table 2: Resources that patients can use to help with smoking/e-cigarette cessation
There are many resources available to patients, parents, and health care professionals to help guide conversation and obtain information about e-cigarettes. All of these resources focus on general information about e-cigarettes and tips and tricks for parents and teachers. Outlined below are unique features of each resource that might help determine which resource would be more appropriate for each individual.
Summary
After careful examination of the lay press and medical literature surrounding the vaping crisis and e-cigarettes, vitamin E acetate was likely associated with the cases of EVALI during the vaping crisis, however no definitive
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cause could be named. It may be concluded that e-cigarettes are a safer alternative to conventional cigarettes, but they are not considered safe and should not be initiated for individuals that do not currently smoke or vape. When used under the supervision of a health care professional, e-cigarettes may play a role in tobacco cessation for a small subset of individuals, however FDA approved products and behavioral interventions should always be used preferentially, with multiple attempts using FDA approved products being unsuccessful before e-cigarettes would be considered. In conclusion, more data and well-designed studies that provide better information regarding the safety of e-cigarettes and the potential role of e-cigarettes in smoking cessation is needed. â&#x2013;
PEER REVIEW
Table 2: Resources that patients can use to help with smoking/e-cigarette cessation Resource Title
Web Link
Unique features and Information
Centers for Disease Control https://www.cdc.gov/tobacco/ • E-cigarette fact sheets and Prevention (CDC) – basic_information/e• E-cigarette, or vaping, products visual dictionary Electronic Cigarettes cigarettes/index.htm Centers for Disease Control and Prevention (CDC) – Electronic Cigarettes: Quick Facts on the Risks of E-cigarettes for kids, teens, and young adults
https://www.cdc. gov/tobacco/basic_ information/e-cigarettes/ Quick-Facts-on-the-Risksof-E-cigarettes-for-KidsTeens-and-Young-Adults.html
• Flavors and marketing that make e-cigarettes appealing to the youth • Potential risks of long-term e-cigarette youth and implications for the future of youth that use e-cigarettes • E-cigarette regulation • Information about heated tobacco products
Smokefree.gov
https://smokefree.gov/
• Smokefree vet, smokefree women, smokefree teen, smokefree español, smokefree 60+ • Smokefree texting programs • Tools for building a quit plan • Information regarding nicotine replacement therapy • Join social media networks to stay connected with other individuals that are trying to become or stay smoke free • Smoke free apps • Information on handling the challenges with quitting
American Lung Association: E-Cigarettes and Vaping
https://www.lung.org/quitsmoking/e-cigarettes-vaping
• Information for health care professionals about e-cigarettes • How to avoid switching from combustible cigarettes to e-cigarettes and strategies on how to quit
References 1.
2. 3.
4. 5. 6.
7.
8. 9. 10. 11.
Gottschalk L, Fraga J-A, Hirschfield J, Zuckerman D. Is Vaping Safer than Smoking Cigarettes? National Center for Health Research. http://www. center4research.org/vaping-safer-smoking-cigarettes-2/. Accessed September 11, 2019. U.S Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General. Surgeon General’s Advisory on E-cigarette Use Among Youth. Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. Centers for Disease Control and Prevention. https://www.cdc. gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Published February 25, 2020. Accessed April 15, 2020. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report. New England Journal of Medicine. 2020;382(10):903-916. doi:10.1056/nejmoa1911614. Blount BC, Karwowski MP, Shields PG, et al. Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. New England Journal of Medicine. 2020;382(8):697-705. doi:10.1056/nejmoa1916433. Goniewicz ML, Smith DM, Edwards KC, et al. Comparison of Nicotine and Toxicant Exposure in Users of Electronic Cigarettes and Combustible Cigarettes. JAMA Network Open. 2018;1(8). doi:10.1001/ jamanetworkopen.2018.5937. Reidel B, Radicioni G, Clapp PW, et al. E-Cigarette Use Causes a Unique Innate Immune Response in the Lung, Involving Increased Neutrophilic Activation and Altered Mucin Secretion. American Journal of Respiratory and Critical Care Medicine. 2018;197(4):492-501. doi:10.1164/rccm.201708-1590oc. About Electronic Cigarettes (E-Cigarettes). Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/ about-e-cigarettes.html. Published February 24, 2020. Accessed April 17, 2020. Barua RS, Rigotti NA, Benowitz NL, et al. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment. Journal of the American College of Cardiology. 2018;72(25):3332-3365. doi:10.1016/j.jacc.2018.10.027. Hajek P, Phillips-Waller A, Przulj D, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. New England Journal of Medicine. 2019;380(7):629-637. doi:10.1056/nejmoa1808779. Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/ basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettesfor-Kids-Teens-and-Young-Adults.html. Published February 3, 2020. Accessed April 18, 2020.
12. Nicotine. In: Lexicomp, Lexi-drug [database online]. St. Louis, MO: Wolters Kluwer Health, Inc; 2005. http://online.lexi.com.cuw.ezproxy.switchinc.org/lco/action/ doc/retrieve/docid/patch_f/7365?cesid=9hFoepW1jJR&searchUrl=%2Flco%2F action%2Fsearch%3Fq%3Dnicotine%26t%3Dname%26va%3Dnicotine. Updated April 13, 2020. Accessed April 18, 2020. 13. Associated Press. US vaping illness count jumps to 805, deaths rise to 13. FOX40. https://fox40.com/news/national-and-world-news/us-vaping-illnesscount-jumps-to-805-deaths-rise-to-13/. Published September 27, 2019. Accessed September 28, 2019. 14. Corum J. Vaping Illness Tracker: 2,602 Cases and 59 Deaths. The New York Times. https://www.nytimes.com/interactive/2020/health/vaping-illnesstracker-evali.html. Published January 9, 2020. Accessed January 29, 2020. 15. O’Donnell J, Alltucker K. People are vaping THC. Lung injuries being reported nationwide. Why is the CDC staying quiet? USA Today. https://www.usatoday. com/story/news/health/2019/08/28/critics-cdc-silent-vaping-thc-injuriesmount/2121523001/. Published August 28, 2019. Accessed September 25, 2019. 16. Howard J, Gumbrecht J. This chemical is ‘key focus’ in vaping illness investigation, health officials say. CNN. https://www.cnn.com/2019/09/05/ health/vaping-chemical-new-york-investigation-bn/index.html. Published September 6, 2019. Accessed September 25, 2019. 17. Nedelman M. CDC: 153 cases of severe lung disease in 16 states possibly linked to vaping. CNN. https://www.cnn.com/2019/08/21/health/cdc-vapinglung-disease-update-bn/index.html. Published August 21, 2019. Accessed September 11, 2019. 18. Harris R. Study Found Vaping Beat Traditional Smoking-Cessation Options. NPR. https://www.npr.org/sections/health-shots/2019/01/30/690066777/ study-found-vaping-beat-traditional-smoking-cessation-options. Published January 30, 2019. Accessed September 9, 2019. 19. Majority of Wisconsin lung disease patients who reported vaping cite using THC products. FOX6Now.com. https://fox6now.com/2019/08/29/majority-ofwisconsin-lung-disease-patients-who-reported-vaping-cite-using-thcproducts/. Published August 30, 2019. Accessed September 11, 2019. 20. Shmerling RH. Can vaping help you quit smoking? Harvard Health Blog. https://www.health.harvard.edu/blog/can-vaping-help-you-quitsmoking-2019022716086. Published February 27, 2019. Accessed September 11, 2019. 21. Talk with Your Teen About E-Cigarettes: A Tip Sheet for Parents . Talk with Your Teen About E-Cigarettes: A Tip Sheet for Parents . https://e-cigarettes. surgeongeneral.gov/documents/SGR_ECig_ParentTipSheet_508.pdf. Accessed May 13, 2020.
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2021 PHARMACE EXPO
SAVE THE DATE FOR PHARMACE EXPO 2021 FEBRUARY 1 - 7, 2021 With a virtual Expo, we can expand programming to much farther than just the Midwest! This year, PharmaCE Expo will bring together pharmacists, pharmacy technicians and student pharmacists from across the country for one week of high quality live continuing education, engaging networking opportunities, and inspiring keynote speakers through digital platforms. Starting Monday, February 1 through Friday, February 5, a lively, 30-minute point-counter-point debate on a pharmacotherapy topic will be released each morning at 7:00 am. If you miss it live, you can listen to the recording throughout the day! 2.5 total hours of CE will be available for pharmacists throughout the week. Primary programming will take place on Saturday, February 6 with a morning and afternoon session and on Sunday, February 7 with a morning session. 7.5 hours of CE will be available during the two days for a total of 10 hours with 5 additional hours of on-demand opportunities. Stay tuned for more information and a detailed agenda!
LOU CARTA SCHOLARSHIP OPPORTUNITY The Southwest Iowa Pharmacists Association, based in Council Bluffs, is accepting applications for its twenty-first consecutive Lou Carta Scholarship. Students must be currently enrolled in their second year or above of pharmacy school with a minimum GPA of 2.5 to apply. Each applicantâ&#x20AC;&#x2122;s hometown must also be within approximately 100 miles of the Council Bluffs/Omaha metropolitan area. $1,000 will be awarded as one individual scholarship applicable to the fall 2021 term. A committee appointed by the association will conduct personal interviews to select the recipient. The application deadline is December 31, 2020. For more information, please contact Tony Beraldi, RPh, president of the association, at ztber@aol.com.
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CPESN IOWA
CPESN® UPDATE 2020 has certainly been a year of disruption, but it is not the first. Iowa community pharmacy disruption began three years ago this fall when the CPESNIOWA Luminaries officially organized CPESN-IOWA into a local Clinically Integrated Network. This clinical integration was critical to signing the first statewide payer contract in 2018 with Tabula Rasa Health Care on behalf of 80 pharmacies. Over the past three years the CPESN-IOWA network has continued to grow in both numbers of member pharmacies as well as in pharmacy services provided. As we approach 120 pharmacies in our Iowa network, CPESN-IOWA is now the second largest “chain” of pharmacies in the state of Iowa. Our network, with the ability to sign a single signature contract with payers and providers across the state, is appealing to many, and our engagement and outcomes to date have been spectacular. CPESN-IOWA network pharmacists have gone from documenting just 3,000 care plans per year to over 40,000. They have also completed over 4,600 Medication Safety Reviews for high-risk attributed patients. Another disruption was created last fall when CPESN-IOWA received funding for a Team Iowa Flip the Pharmacy (FtP) transformation of practice grant. Team Iowa was granted a FtP Cohort 2 award again this year, which added another 15 pharmacies to the 30 pharmacies in Cohort 1. These 45 pharmacies will be working with nine Practice Transformation Coaches to continue to expand their practices beyond the traditional dispensing model to a patient-centered care model by enhancing their MedSync processes, engaging their non-pharmacist staff members, and working with local providers to optimize medications for their patients. To say the Flip the Pharmacy initiative has been impactful and disruptive is an understatement. One participating pharmacist mentioned their prescription and service capture rate has increased exponentially through participation in this grant, and their DIR fees dropped by almost 50%. Another pharmacy shared some impressive numbers after reflecting on the past year:
• • • • • •
1000+ pharmacist eCare plans submitted 733 Shingrix (shingles) vaccines administered 57 Naloxone doses dispensed 280 COVID tests performed 176 Medication Safety Reviews performed 100 new patients enrolled in medication synchronization
Yet another pharmacy grew their MedSync program from just 88 patients (~8% of total patients) in February to over 500 (~40%) by May, and their STAR ratings increased from 4.28 to 4.89. Even more impressive was the increase in care plan documentation due to their increased CPESN-IOWA efficiency. They went from completing 25-50 LUMINARIES care plans per month to Ryan Frerichs over 250 per month! Bob Greenwood
Randy McDonough
Network pharmacies Matt Osterhaus across the state have Cheri Schmit begun to disrupt traditional roles and contract directly with providers for pre-visit planning, Chronic Care Management and CPC+ services. Other network pharmacies have begun contracting directly with employers, providing alternative pharmacy benefits that carve out the traditional PBM and provide services along with a more reasonable medication cost to increase savings and maximize outcomes for the employer and their employees. I know we are all anxious to close the chapter on 2020. What an incredibly challenging and unique year it has been for all of us. However, this year has and is creating a needed disruption in health care and forcing transformation to happen at an expedited pace. For that, I am grateful, and I look forward to the opportunities that 2021 will bring! If you are interested in learning more about CPESN, visit www.cpesn.com or contact Lindsey Ludwig at lludwig@cpesniowa.com. ■
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CLASS OF 2024
DRAKE UNIVERSITY Drake University College of Pharmacy & Health Sciences launched its Pharmacy White Coat Ceremony live feed on Friday, August 21, 2020. Dean Renae Chesnut, EdD, began the program with a welcome, Olivia Welter, PharmD Candidate 2021 and 2020 Karbeling Leadership Award recipient, gave remarks, and IPA’s Kate Gainer, PharmD, recited the Pledge of Professionalism. Watch the ceremony at www.drake.edu/cphs/white-coatceremony. WELCOME PHARMD CLASS OF 2024 Anna Amos Olena Andrushko Taylor Baker Sam Barnes Keith Barnett Sarah Bayne Jacob Bennett Nirjan Bhattarai Sydney Blackmer Jordan Bloodgood Peyton Braun Iris Browning Marcus Burrow Elise Carter Ryan Christensen Annika Cook Alexis Cosatino Tiffany Dale Lexi Dauner Hunter Daws Mitchell DeKeyrel Nick Deveza Shannon Dicken Zoe Dittmar Brooke Doohen Callie Doohen Lyndy Elvebak Robin Fenton Esmeralda Flores Gustavo Flores Kelsie Fogo Kate Gallinero Emma Garcia Daniel Garcia Emelia Germer Timothy Giesen Kristen Giles Ali Goldensoph Kira Grefsheim
Rebecca Grenz Collin Havel Sarah Hennessey Hailey Hovland Yusuf Ibrahim Danielle Jenison Samantha Kelley Christopher Khuu Jonathan Klauke Caitlin Kramer Jana Kay Lacanlale AJ Landis Sabrina Larbi Ashley Lawler Maddie Lee Brayden Malone Erin Maxwell Grace McCollum James Nichols Eian O’Brien Kayla Olstinske Lucas Philip Courtney Polka Natalie Polich Isaac Ramos Marianna Rieser Abigail Riewer Jessica Roberts Lindsey Rowatt Meghan Ryan Ali Shishter Danielle Simon Thomas Smith Taylor Sorrells Ashley Szull Ann Taylor Braden Weiser Caesar Yeaman
CLASS OF 2024
UNIVERSITY OF IOWA On September 17, 2020, the University of Iowa College of Pharmacy held a White Coat Day. Students received their coats and official name tags and had their headshot taken by a professional photographer. At a later date, the college plans to host a traditional White Coat Ceremony where family and friends are able to attend, IPA will welcome them to the profession, and Dean Letendre will give an address. WELCOME PHARMD CLASS OF 2024 Sulafa Adam Victoria Adrian Logan Akason Savannah Anderson Blake Anderson Andjela Andric Bryce Andry George Appleseth Ali Barakat Jordyn Boge Karlee Boyle Shelbie Brotherson Sophia Brown Patrycja Buch Jacob Bulger Brittany Bullock Caden Burkamper Sara Carr Connie Chu Lauren Collier Alyssa Conaway Tyler Cooksley Chyan Decker Alison DeVore Kevin Dong Yue Dong Sarah Dumachi Lauren Duncalf Jack Dykema Kelsey Fausel Kathryn FitzPatrick Fabiola Gallardo Emily Gilbertson Caleb Ginn Zachary Glanz Delayne Glassgow Nevena Glavas Noah Goebel Austin Grossmann Jill Guetersloh Laurel Gunnerson Jilene Haas
Spencer Heggen Emilie Heggen Gabrielle Hiner MaKayla Hoing Kylie Juenger Kayli Kruser Lauren LaPointe Nathan Liberty Keegan Lilly Hsin Lan Lin Jennifer Lin Duachee Lo Alisha Lyons Cristina Markham Elijah Miller Hannah Minor Megan Mitchell Michelle Moon Sohida Muslem Ariba Naeem Mark Nagel Kendal Newman Brittany Nguyen Lan Anh Nguyen Thao Nguyen Zachery Nunemaker Carlos Nunez Aguillon Minh Pham Faith Poelker Ryann Powell Destanie Pringle Savannah Reicks Samantha Ritter Jacob Roher Caitlin Rohrbaugh Sydney Ross Jerrianne Sanger Gracie Schnell Jozey Seaton Paige Setchell Emma Smith Edward Stoll
McCaffery Townsend Tin Tran Tracy Tran Hannah Ungurean Tessa Vagasky Vanessa Van Holland Sidney Vancil Morgan VanZante Kim Vo Serena Webb Eric Weetman Destiny Welt Kindra Welter Samantha Whitcomb
OCT.NOV.DEC 2020 |
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PUBLIC AFFAIRS
BOARD OF PHARMACY: REGULATORY UPDATE The Iowa Board of Pharmacy convened for virtual open session on August 26, 2020 to discuss multiple requests, reports and several proposed rules.
Executive Director Update
Iowa Board of Pharmacy Executive Director Andrew Funk updated the Board on legislation passed last session dealing with the state medical cannabidiol program and implementation of the U.S. Health and Human Services Agency guidance expanding access to childhood vaccines during COVID-19 pandemic. Funk also discussed the joint effort between the Board of Pharmacy and IPA to begin working on adopting a new Iowa Pharmacy Practice Act through the Iowa Pharmacy Practice Act Modernization Task Force.
2021 Board of Pharmacy Legislation
The Board discussed their potential legislative agenda for 2021, including potential Board of Pharmacy legislation to update Iowa laws surrounding pharmacy support persons in telepharmacies and the ability of a pharmacist to delegate technical functions. The Board will submit legislation for prefiling in mid-November prior to session.
Proposed New Regulations
Nuclear Pharmacy Practice The Board voted to propose a notice of intended action to amend Chapter 16, “Nuclear Pharmacy Practice,” in the Iowa Administrative Code. The proposed amendment would include a requirement that nuclear pharmacies comply with the minimum standards identified in the United States Pharmacopeia General Chapter 825 which applies to radiopharmaceuticals and will be effective December 1, 2020. Controlled Substances The Board also voted to propose a notice of intended action to amend Chapter 10, “Controlled Substances,” of the Iowa Administrative Code. The proposed amendments make temporary amendments to the Iowa Code for scheduling action in the Iowa Controlled Substances Act to match similar action taken by the federal Drug Enforcement Administration. The proposed amendments add one substance (synthetic opioid) to Schedule I and remove FDA-approved cannabidiol products containing less than 0.1 percent tetrahydrocannabinol (THC). ■
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.
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PUBLIC AFFAIRS
Legislative Day 2021
IPA’s annual Legislative Day is the cornerstone of the association’s legislative and public policy efforts. With uncertainty regarding the ability of large groups to gather at the Capitol next year, IPA will transition to virtual programming and grassroots efforts. This will include guest speakers and legislative updates on January 27 (originally scheduled Legislative Day) and a virtual grassroots push to engage legislators. In addition to virtual Legislative Day content, IPA will also be providing engaging content from policymakers throughout the legislative session on a variety of topics during an Insight to Advocacy webinar series. Visit www.iarx.org/ipalegday for more information and a tentative schedule.
AmeriGroup Announces New Director of Pharmacy
A new Director of Pharmacy has been announced for AmeriGroup, one of Iowa’s managed care organizations. Lisa Todd has a demonstrated history of working in managed care and independent community pharmacies. She received her Bachelor of Science (BS) focused in Pharmacy (RPh) from the University of Kansas and a Bachelor of Business Administration in Marketing and Management from Washburn University. She previously worked as a Clinical Threshold Pharmacist for Hewlett Packard before joining Amerigroup as the Director of Pharmacy within the Kansas region. She recently transitioned into her current role as Pharmacy Director of Amerigroup Iowa but currently resides in Lawrence, Kansas with her family. IPA continues to have monthly communications with Lisa regarding collaboration opportunities and sharing important program and medication updates for IPA members. Welcome, Lisa!
SCOTUS Hears Landmark PBM Case
On October 6, 2020, the Supreme Court heard oral argument in PCMA v. Rutledge, a case concerning federal versus state regulation of pharmacy benefit managers (PBMs) and drug costs. The case originates from Arkansas, which passed a law in 2015 prohibiting PBMs from reimbursing local pharmacies at a lower rate than what the pharmacies pay to fill the prescriptions. The case was appealed from the Eighth Circuit Court of Appeals, which also ruled against Iowa and very similar law passed in 2014.
Arkansas. Arkansas’s position is further bolstered by attorney generals from forty-five states and the District of Columbia, both Democrats and Republicans, who signed on to an amicus brief supporting Arkansas’s appeal of the Eighth Circuit Court’s decision to the Supreme Court. IPA also joined other state and national associations in providing financial support to the Arkansas Pharmacists Association to aid in the legal battle. A potential decision in favor of Arkansas could have wide-ranging implications for state regulation of PBMs, including Iowa. The court, which is shorthanded after the death of Ruth Bader Ginsburg, will render a decision at the end of its term in June 2021, but could do so sooner. If the justices are tied, it could mean that the appellate court’s finding in favor of the PBM industry will stand.
Legislator Outreach – Building Towards Session! While this year has certainly presented challenges for meeting with legislators face-to-face, IPA staff and members have still had success finding creative ways to pass along our message.
Virtual Fundraisers In September, IPA hosted two virtual fundraisers to support health care leaders in the House. On September 3, IPA members joined Rep. Joel Fry and Rep. Shannon Lundgren to hear directly from two important committee chairs. Rep. Fry is co-chair of the Health and Human Services Appropriations Subcommittee, and Rep. Lundgren is Chair of the House Human Services Committee. During the week of IPA’s Annual Meeting, IPA was proud to host a virtual fundraiser for Iowa’s only pharmacist legislator, Rep. John Forbes. Rep. Forbes is the ranking member on the Health and Human Services Appropriations Subcommittee and is a major champion on all pharmacy issues. Pharmacy Visits There were still a few legislator and candidate visits that were held safely during the fall, including from Iowa Senate Candidate Theresa Greenfield at Scott Pharmacy and Congresswoman Abby Finkenauer at Greenwood Pharmacy.
Immediate reaction following the hearing was cautious optimism for a favorable ruling and high praise for the arguments laid out by those representing the state of
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TECHNICIAN CORNER
CALCULATIONS REVIEW From IPAâ&#x20AC;&#x2122;s September 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. As a pharmacy technician, medication safety is an important part of your job. Performing accurate drug calculations is one way you can help prevent medication dosing errors. In most healthcare settings, the use of smart pumps for administration of IV fluids reduces the need for hand calculations. Nevertheless, IV fluid calculations are important to master in preparation for the pharmacy technician certification exams and especially for potential situations when a smart pump is not available. For most drug calculations, there is more than one method of arriving at the correct answer. This review demonstrates one of the methods that can be used to calculate IV drip rates.
Note: Drips, drops and gtt all mean the same thing. Drop factor is the number of drops it takes to equal 1 mL with a specific type of IV tubing. The drop factor can be found on the tubing package or IV administration set label. On the PTCB or ExCPT exam, the drop factor for a specific IV administration set will be provided. Flow rate is expressed in mL/hr. However, it must be converted to mL/min before it can be used in the drip rate calculation.
Ex. Calculate the drip rate of 1000mL IV solution ordered to be infused over 8 hours with a flow rate of 125mL/hr and a drop factor of 15gtt/mL. Convert: 125mL/hr to mL/min:
Step 1: Calculate the Flow Rate: The flow rate is the rate at which an IV fluid is administration expressed in milliliters per hour (mL/ hr). To calculate the flow rate, divide the total volume of solution by the total infusion time in hours (Round to the nearest whole number). Ex. Calculate the flow rate for 1000mL IV solution infused over 8 hours. 1000mL/8hr = 125mL/hr Flow Rate = 125mL/hr
Step 2: Calculate the Drip Rate: The drip rate is the number of drops per minute delivered in that IV administration set. It can be calculated using the equation: Drip rate (gtt/min) = Drop factor (gtt/mL) x Flow rate (mL/min):
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Drip rate = Drop factor x Flow rate (mL/min): Drip rate = 15gtt/mL x 2.08mL/min Drip rate = 31 gtt/min
Now test yourself!
Calculate the drip rate of 600 mL normal saline administered to a patient over 2 hours using a 10gtt/ mL set. (Answer: 50gtt/min)
TECHNICIAN CORNER
TECHNICIANS ADMINISTERING IMMUNIZATIONS From IPAâ&#x20AC;&#x2122;s October 2020 Tech Tidbits newsletter
Pharmacists are able to administer immunizations in every state, but what about pharmacy technicians?
In recent years, pharmacy technician roles and responsibilities have expanded rapidly to include many more higher-level activities, such as sterile compounding, product verification, and administration of vaccinations. In many situations, these expanded roles have been initiated due to a practice need and subsequent pilot programs, which have proven that pharmacy technicians are capable of performing these tasks and lessen the burden on pharmacists. Currently, three states (Idaho, Rhode Island, and Utah) allow pharmacy technicians to administer vaccinations under the supervision of the pharmacist. In Iowa, the Board of Pharmacy has only provided this authority through the approval of a research and demonstration project in 2020. Although pharmacy technicians are allowed to bill, document, and administer the vaccination, the pharmacist remains responsible for verifying that the correct vaccine is being administered and providing immunization counseling. Besides being nationally certified, these states have required pharmacy technicians to undergo training specific to the vaccine administration process as well as basic life support (CPR) training. The pharmacy profession is always evolving. With increased expansion of pharmacy technician roles across several states, it may only be a matter of time before Iowa and other states expand these roles and responsibilities further. References: 1. An Update on Technicians as Immunizers. Pharmacy Times. https:// www.pharmacytimes.com/publications/supplements/2019/ March2019/an-update-on-technicians-as-immunizers 2. Member Boards, NABP Continue to Explore Expansion of Pharmacy Technician Roles. National Association of Boards of Pharmacy. https://nabp.pharmacy/wp-content/uploads/2019/08/InnovationsNewsletter-August-2019.pdf 3. Transforming Pharmacy Practice: Advancing the Role of Technicians. PharmacyToday. https://www.pharmacytoday.org/article/S10420991(18)30793-X/fulltext
ADVANCE YOUR CAREER PATH
FREE TECHNICIAN CPE Join IPA Now and Get FREE CE! CEimpactâ&#x20AC;&#x2122;s Technician Catalog is an online subscription with accessible and convenient continuing education courses for technicians to recertify and advance their career path.
MEMBERS:
Login at www.iarx.org/cei_libraries to take advantage of this new benefit for members and spread the word to your colleagues.
OCT.NOV.DEC 2020 |
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TECHNICIAN CORNER
NEWLY CERTIFIED IOWA PHARMACY TECHNICIANS July 1, 2020 â&#x20AC;&#x201C; September 30, 2020
Congratulations to the following pharmacy technicians on becoming PTCB-certified!
Jordan Addy Kendra Allen Ike Appleton Megan Benavente Paige Boisen Ricci Booth Emma Brandt Aiden Brock Abbie Brooks Mitchell Coleman Glinda Cooley Sarah Corey Michele Dammeier Jennifer Davidson Calvin Davis Teresa Day Tia Desvignes Arida Dhanaswar Amy Donovan Ahmed Elmassry Timothy Fagundus Courtney Finnegan Sydney Foley Miguel Garcia Susan Griffith Ginger Gyorko Shelby Hainline Chenchen Hardi Veronica Harvey Sarah Hecht Shimaa Hefny Tammy Helm John Helmsley Scott Hennings
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Ciara Hess Gabrielle Hiner Codi Hitch Abigail Hogan Cally Holtrop Mary Johnson Alexia Kelly Ally Kinsey Christopher Kirschbaum Carter Klatt Molly Klooster Lynnsey Knockel Nicole Kramer Hanah Ladenberger Courtney Larson Olivia Lenz Alexis Lingner Tate Lobeck Jennifer Lopez Ramirez Nhu Luu Kaitlyn Mahany Claudia Martinez Reece Mattson Kellie McDermott Samantha McFadden Axel Milagros Samantha Mitchell Acacia Monson Malesssa Naovarath Cindy Nguyen Thanh Thanh Nguyen Jacquelyn Nguyen Jacquelynn Oberg Nicholas Ochoa Kimberly Orr Kelsey Parker Lacy Pettyjohn Lincoln Rahn Summer Rollins
The Journal of the Iowa Pharmacy Association
Elaina Rothmayer Angela Ryan Karina Salazar Megan Sampson Aneth Sanchez-Angulo Kaitlyn Sanford Antonio Santa Maria Kristy Schipper Hannah Schmidt Abigail Schupbach Paige Shelby Christiane Simaki-Amah Hannah Staley Sierra Stalkfleet Hannah Stimson Robyn Stoner Marie Tadlock Naomi Terpening Holly Theilen kenyatta Triplett Molly Trotter Ryanne Trpkosh Hannah Tucker Laura Tucker Toni Turck Brynn Van Eldik Hannah Vroom Abigail Wagner Diane Walker Margaret Wallace Angela Walsh Mikayla Ward Mena Waziri Dominque Weems Shayna Werner Brittany Wiersema Meredith Williams Kelly Williams Erin Wright
RESIDENT SPOTLIGHT
MEET THE 2020-2021 IOWA PHARMACY RESIDENTS IPA would like to introduce the 53 residents and fellows practicing in Iowa this year. Take a moment to review who they are and where they are practicing. The association wishes each of them the best of luck in their residency year!
Saidee Oberlander PGY1 - Iowa Methodist North Dakota State University
Haley Noeldner
PGY1 - MercyOne North Iowa Medical Center Drake University
Ryan Molander
PGY1 - MercyOne - Waterloo University of Iowa
Alexis Thumann
Christina Sudyk
Paul Scholbrock
Sarah Mooney
PGY1 - Iowa Methodist University of Minnesota
PGY1 - Mercy Medical Center - Cedar Rapids University of Iowa
McKenzie Magee
Ashraf Amadou
Hassaan Shaikh
Kristen Butler
Karli Welter
Brock Dantuma
Samantha Katzman
Hannah Hemry
Whitni Patterson
Cole Borchardt
Eesha Patel
PGY1 - MercyOne Waterloo University of Iowa
PGY1 Health-System Administration - University of Iowa Hospitals & Clinics University of Iowa
Madison McDonald
Ivy Xue
Nichole Nunemaker
PGY1 - Iowa Methodist University of Minnesota-Duluth
Victoria Smith
PGY1 - MercyOne Des Moines Drake University
PGY1 - MercyOne Des Moines Drake University
PGY2 Emergency Medicine - MercyOne Des Moines Creighton University
PGY1 - MercyOne North Iowa Medical Center University of Iowa
PGY1 Community Practice Greenwood Drug Butler University
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PGY1 - Mercy Medical Center Cedar Rapids University of Iowa
PGY1 - UnityPoint Allen Hospital South Dakota State University
PGY1 - UnityPoint Allen Hospital University of Iowa
PGY1 - UnityPoint Allen Hospital University of Iowa
Industry Fellowship Vanadro - Drake University UNC Eshelman
PGY2 Pediatrics - University of Iowa Hospitals & Clinics University of Michigan
PGY2 Pediatrics - University of Iowa Hospitals & Clinics Lake Erie College of Osteopathic Medicine
PGY2 Oncology - University of Iowa Hospitals & Clinics University of Kansas
PGY2 Health-System Administration - University of Iowa Hospitals & Clinics University of Wisconsin
PGY2 Health-System Administration - University of Iowa Hospitals & Clinics University of Iowa
Mohammed Fredericks
PGY1 Community Practice UnityPoint - Allen/Parkview Pharmacy University of Iowa
RESIDENT SPOTLIGHT
Elizabeth Wandling
Samantha Meyer
Jay Tieri
Meredith Frey
Leah Mouw
Haemy Chung
Taylor Smith
Emily Vahary
Annita Mathew
Jason Chau
Briana Negaard
Andrea Aguilar
Holly Polak
Sarah Ermer
PGY1 Health-System Administration - University of Iowa Hospitals & Clinics Cedarville University
PGY2 Ambulatory Care University of Iowa Hospitals & Clinics University of Wisconsin
PGY2 Ambulatory Care University of Iowa Hospitals & Clinics University of Kansas
PGY1 Ambulatory Care University of Iowa Hospitals & Clinics Texas Tech University
PGY1 Ambulatory Care University of Iowa Hospitals & Clinics South Dakota State University
Miranda Bowers
PGY1 - University of Iowa Hospitals & Clinics University of Wisconsin Madison
Kelsey Coffman
PGY1 - University of Iowa Hospitals & Clinics University of Iowa
PGY1 - University of Iowa Hospitals & Clinics University of Iowa
PGY1 - University of Iowa Hospitals & Clinics University of Iowa
PGY1 - University of Iowa Hospitals & Clinics Purdue University
PGY2 Emergency Medicine University of Iowa Hospitals & Clinics University of Iowa
PGY2 Pain and Palliative Care - University of Iowa Hospitals & Clinics Creighton University
Sarah Kadura
PGY1 Ambulatory Care Northeast Iowa Medical Education Facility & Waverly Health Center University of Iowa
Christopher Fox
PGY1 - Iowa City VA Health Care System University of Iowa
PGY1 - Iowa City VA Health Care System University of Iowa
PGY2 Psychiatry - Iowa City VA Health Care System University of Texas at Austin
PGY1 - Des Moines VA Health Care System University of Illinois - Chicago
PGY1 - Des Moines VA Health Care System Drake University
Emma Robasse
PGY1 Managed Care OutcomesMTM Drake University
Eric Mueller
PGY1 Community Practice Towncrest Pharmacy University of Oklahoma
Brett Becker
PGY1 Community Practice MercyOne Pharmacy University of Kentucky
Haley Fox
Michelle Jakaitis
Alex Wagner
Morganne Sindelar
Karla Knobbe
Amy Dunleavy
PGY1 - University of Iowa Hospitals & Clinics University of Illinois Chicago
PGY1 - University of Iowa Hospitals & Clinics Creighton University
Michael Boller
PGY1 Community Practice UnityPoint - Allen/Parkview Pharmacy University of Iowa
PGY1 - Iowa City VA Health Care System University of Iowa
PGY1 - Iowa City VA Health Care System Drake University
PGY1 Community Practice Hy-Vee Drug Store Drake University
PGY1 Community Practice Osterhaus Pharmacy University of Iowa
Sharmi Patel
Executive Fellowship Iowa Pharmacy Association Drake University
OCT.NOV.DEC 2020 |
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IPA FOUNDATION
STEP, CYCLE, SWING FOR STUDENT SCHOLARSHIPS RECAP The IPA Foundationâ&#x20AC;&#x2122;s latest fundraiser to support student pharmacists at Drake University and the University of Iowa was a great success! During the month of August, IPA members ran, biked, golfed, or got active however they enjoy to raise funds for student scholarships. As part of the fundraising event, participants posted on social media using the hashtag #IPAforStudentScholarships for the chance to win a prize.
TO VIEW ALL PHOTOS, USE
#IPAforStudentScholarships
Megan Castellano
STEP, CYCLE, SWING, as well as Step Up for Students, an additional one-day fundraising event and step count competition, brought in over $9,500 for the IPA Foundation. Over 90 members, both pharmacists and students, participated in this event. Although IPA hopes for in person fundraisers in the future, STEP, CYCLE, SWING for Student Scholarships is one the association plans to host again.
Brett B
Renae Chesnut Connie Connolly
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Barker
IPA RAGBRAI FOUNDATION 2019
Edie Schwickerath
Wes Pilkington
Isabelle Tharp
Matt and Marilyn Osterhaus
Nancy Bell
OCT.NOV.DEC 2020 |
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IPA FOUNDATION
Outcomes Innovative Pharmacy Grant
The grant program stems from the Outcomes Innovative Pharmacy Endowment that was established by the original investors of OutcomesMTM, a medication therapy management (MTM) service provider based in Iowa. In 1999, the Iowa Pharmacy Association provided seed money to support this innovative startup, which became a national leader in MTM services. Following the purchase of OutcomesMTM by Cardinal Health in 2015, the endowment was created as a way for those original investors to give back to the pharmacy profession and keep the innovative spirit and legacy of the company and Iowa pharmacy alive.
Farewell to IPAF Board Member Bob Stessman
IPA Foundation Vice President Bob Stessman of Manning, IA is leaving the board after nine years of service to the Foundation. His leadership, commitment and dedication lead to the growth and success of the Foundation and profession. Thank you and best wishes to Bob!
Applicants must be an Iowa-licensed pharmacist or an Iowa-based researcher working with Iowa pharmacists in an innovative pharmacy practice. Applicants must also be active members of the Iowa Pharmacy Association. The application deadline for the next grant cycle is December 1, 2020. Information can be found at www.iarx.org/outcomesgrant.
Save The Date - RAGBRAI XLVIII
Save the date for RAGBRAI XLVIII July 25-31, 2021! The route planned for 2020 will be used next summer, starting in Le Mars and ending in Clinton. The IPA Foundation team is still looking for a host in Iowa Falls. Contact IPA@iarx.org if you or someone you know is interested.
FOR SALE
Pharmacy Memorabilia • • • •
Schering mortars and pestles Conical graduates Eli Lilly, Sharpe & Dohme, Parke Davis, etc. bottles Other items
$5,000 Sell as one unit – no individual sales Contact Bernie Cremers, 319-338-0946
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IPA RAGBRAI FOUNDATION 2019
SILENT AUCTION
You can still donate to the IPAF! www.iarx.org/ ipafwaystodonate
2020 Silent Auction
Held completely virtually, the 2020 IPA Foundation Silent Auction was a great success. New this year, donors were able to select auction items on Amazon for IPA to ship to winning bidders. Some healthy competition was sparked among bidders of the Apple Airpods, a custom charcuterie board, the coveted Presidential jams, and many other items. Over $4,300 was raised for the IPA Foundation and student pharmacist scholarships. Missed the silent auction? You can still donate to the IPAF at www.iarx.org/ ipafwaystodonate.
OCT.NOV.DEC 2020 |
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IPA FOUNDATION
IPA EXECUTIVE INTERN REFLECTION
Isabelle Tharp | Student pharmacist at Drake University College of Pharmacy and Health Sciences
Remain Resilient: When I was a sophomore pre-
alone started a brand new internship virtually. Working from home presented its challenges: the biggest one pharmacy student at Drake University, I was deciding being my strong desire for social interaction. On the whether pharmacy was or was not the profession Myers-Briggs personality test, the first letter indicates for me. This was until I heard a presentation from whether you are extroverted or introverted. My MyersAnthony Pudlo and 2016-2017 Executive Fellow Shannon Briggs test has confirmed that I am 97% extroverted. Rudolph that same year in my CAPS III course. I heard Although I initially struggled working from home, I about the mission of the Iowa Pharmacy Association remained resilient and was able (IPA) and other unique career to find opportunities to connect opportunities within the field with the IPA staff, learn from of pharmacy. After that class, I “THE IPA EXECUTIVE many inspiring pharmacists, remember going up to Anthony INTERNSHIP WAS MY DREAM and participate in meaningful and Shannon to learn more projects. about IPA and specifically asked INTERNSHIP, AND I KNEW if IPA had an internship. Over Working with the IPA Staff was the next few years, I messaged PHARMACY WAS THE RIGHT one of my favorite aspects of Anthony on LinkedIn, attended this summer. I enjoyed getting to CAREER FOR ME.” IPA’s Legislative Day, and stayed know the staff on a personal level engaged with IPA. The IPA and learning about everyone’s Executive Internship was my hobbies, favorite potluck dishes (when potlucks were dream internship, and I knew pharmacy was the right still a thing), and many other fun stories. With COVID-19, career for me. most of the “typical” Executive Intern projects were no longer needed due to the cancelation of the Fun Run I was beyond excited to apply for the IPA Executive and RAGBRAI and the postponement of the Annual Internship as a first-year student pharmacist, but I was Meeting and IPA Board Retreat. I eagerly started not selected that year. I mention this because I think working on new projects, which included the creation of it is important for everyone to recognize whether you advocacy infographics, analysis of IPA’s strategic plan, a are a student pharmacist, pharmacy technician, or a compilation of educational materials on racial injustice, pharmacist, your path to reaching your goal is not going and assisting with the Policy Review Committee. I to go exactly as you plan, and resilience is vital to later enjoyed taking part in all of these projects, so much that reach those goals. I took that next year to further involve I kept working with IPA to help with the Health-System myself in IPA and seek more pharmacy leadership Leadership Forum throughout the fall! opportunities that interested me. I had a newfound love for pharmacy policy through experiences lobbying at Capitol Hill with the American Pharmacists Association – Academy of Student Pharmacists (APhA-ASP), attending IPA’s Annual Meeting, and serving as a Legislative Intern with Representative John Forbes at the Iowa State Capitol. This new passion translated into my interview with IPA and shaped many aspects of my internship with IPA this past summer. I was extended the internship offer the day before the COVID-19 shutdown in Iowa. To say this summer was not the IPA Executive Internship I expected would be an understatement. I had never worked from home, let
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Something I have said to myself many times throughout my pharmacy education and this past summer is, “Remain resilient.” You may be challenged in the moment, but remaining resilient will pay dividends in your future. Although this summer did not play out the way I expected, I am beyond thankful for the experiences and learning opportunities I had while working at IPA. All of the individuals I met with virtually throughout the summer, IPA members, and IPA staff truly made this a memorable internship. It was such a pleasure to be welcomed into the IPA family and serve as the 2020 Max W. Eggleston Executive Intern. ■
Nancy Bell
MEMBERS SECTION MEMBERS SECTION
MEMBER SPOTLIGHT:
Nathan Peterson, PharmD, BCPS, BCIDP
Nathan Peterson, clinical pharmacist at UnityPoint Sitting on the COVID-19 Therapeutics Committee is Health in the Quad Cities, is a man of many hats, and far from the only professional activity that Nathan the current COVID-19 pandemic is a perfect illustration is involved in outside of antimicrobial stewardship, of this. A native of Shenandoah, Iowa, Nathan however. He has become increasingly involved with graduated with his Doctorate of Pharmacy degree the Society for Infectious Disease Pharmacists (SIDP), from the University of Iowa in 2014. He then went on to serving on the strategic planning committee. He also complete a PGY1 residency at St. Elizabeth Hospital in serves as the vice president of the Project of the Quad Lincoln, Nebraska and a PGY2 residency in infectious Cities (TPQC), which is a community-based non-profit disease at Mercy Medical Center in Des Moines. These that services those at risk, impacted by, and living experiences allowed him to go on and spearhead the with HIV/AIDS. The service provides same-day testing antimicrobial stewardship program at UnityPoint Health and treatment of various STDs, HIV, and Hepatitis C in the Quad Cities, where he provides support and at no cost to the patient. He says they are planning expertise for various infectious on expanding into LGBTQ disease providers in the area, as primary care and specialty well as identifies opportunities care this fall. Nathan was also “FEELING TRUSTED TO HELP to improve antimicrobial awarded the Young Alumni MANAGE COVID-19 PATIENTS, prescribing at the four UnityPoint award from his alma mater, Health campuses in the Quad Wartburg College, this past ESPECIALLY EARLY ON WHEN Cities. When the COVID-19 year. PROVIDERS HAD LITTLE TO pandemic began to spread NO RESOURCES ON HOW TO across the state of Iowa in March, Despite being heavily Nathan saw his daily activities involved in the profession HANDLE THESE VERY SICK shift to a different, yet equally and his community, Nathan PATIENTS, HAS CERTAINLY rewarding role. still finds time to enjoy the BEEN ONE OF THE MOST outdoors when he can. As a REWARDING PARTS OF MY Nathan serves on the UnityPoint golf enthusiast, he spends Therapeutics Committee, which many weekends out on the JOB THUS FAR.” is responsible for creating links. He is also an avid reader guidance and best-practice and makes it a goal to read recommendations for COVID-19 patients. The every day no matter how hectic his schedule is. When committee meets three to four times per week, shifting not golfing or reading, he enjoys walks with his wife and through the good and the bad literature to make their new standard poodle puppy, Freida. recommendations while also dealing with the surge of patients. Being able to have a direct impact on patients Nathan, like many pharmacists across the state of during these unprecedented times has certainly been Iowa, has truly stepped up to the various challenges one of the most rewarding parts of his young career. that the COVID-19 pandemic has presented. His work “Feeling trusted to help manage COVID-19 patients, with antimicrobial stewardship in the region, as well especially early on when providers had little to no as his involvement with SIDP and TPQC, continue to resources on how to handle these very sick patients, demonstrate his diverse community involvement and has certainly been one of the most rewarding parts of commitment to providing care to patients who need my job thus far,” said Nathan. He added that, “Even with it most. It will certainly be rewarding to watch how he the now daily publications on COVID-19, pharmacy is continues to shape and advance the profession of almost always asked first on how/if the new literature pharmacy in the state for years to come. ■ should be applied. It’s been extremely collaborative.”
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MEMBERS SECTION
Apply for Executive Fellowship
Interested in being a leader in the health care system, helping individuals on a daily basis, and inspiring others within the profession? Apply for IPA’s Executive Fellowship in Association Management! The Iowa Pharmacy Association Executive Fellowship in Association Management is a postgraduate training program that provides individuals with association management experience in the areas of leadership, advocacy, professional affairs and problem-solving. The 2021-2022 Executive Fellowship will begin July 1, 2021 and end June 30, 2022. Applications must be submitted by January 1, 2021. Learn more at www.iarx.org/fellowship.
NEW IPA Member Forums
IPA is excited to announce a new membership engagement opportunity for 2020-2021! IPA Member Forums will provide a unique opportunity to come together (virtually, for now) with peers from across the state to learn, network, and engage. Each Forum will have a focused agenda with facilitated roundtables, mini-keynotes, breakout rooms, and open discussions. Save the Date for Upcoming Forums: Long Term Care Pharmacy Forum – January 20, 2021 Independent and Community Pharmacy Practice Forum – March 3, 2021 Payment for Pharmacy Services Forum – April 14, 2021 Specialty Pharmacy Forum – May 19, 2021 Pharmacy Technician Forum – November 10, 2021 The best part? Attendance is FREE for paid pharmacist, technician, and student pharmacist members! Learn more and register at www.iarx.org/forums.
WELCOME NEW IPA MEMBERS July 1, 2020 – September 30, 2020 Andrea Todd-Harlin Sandra Canally Zachary Robles Ella Fridman Mark Artessa Alice Callahan Nia Ortmann Julie Kuntz Kirsten Dougherty Davidine Johnson Nicole Olson McKenzie Magee Rachel Kunst Brett Becker Lisa Ejsmont Madison McDonald Joseph Corbino Samantha Katzman Michaela Hays Kathleen Franck BiologicTx
MEMBERS SECTION MEMBERS SECTION
MEMBER MILESTONES Congratulations to Jake Galdo, PharmD, MBA, BCPS, BCGP, as he starts with CEimpact as Course Content and Developer! Best of luck to Dawn Grittmann, as she and her family move to Gilbert, Arizona! Dawn most recently served as the Clinical Pharmacist at Iowa Total Care. Congratulations to Chris Clayton, PharmD, MBA, for his new role as Director of Pharmacy & Population Health at Buchanan County Health Center in Independence! Congratulations to Matt Pitlick, PharmD, BCPS, as he begins in his new role as Pharmacy Manager at MercyOne West Des Moines Medical Center! Congratulations to Lauren Cumings, PharmD, as she starts her new role as the Inpatient Supervisor at UnityPoint Health St. Luke’s in Cedar Rapids!
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Congratulations to Dean Letendre, BS Pharm, PharmD, FASHP, for being inducted into the University of Kentucky College of Pharmacy’s Hall of Distinguished Alumni for 2019–20! Congratulations to Bob Greenwood, RPh, owner of Greenwood Pharmacy in Waterloo, for being selected as the Waterloo/Cedar Falls Courier’s 2020 Best of the Best Pharmacist!
IN MEMORIAM It is with sad news that IPA shares the passing of Arlan ‘Jack’ Van Norman. Jack served as IPA’s Honorary President from 1987-1988, was an active member of the IPA House of Delegates, and served as a past chair of the Iowa Board of Pharmacy.
IPA IN ACTION
IPA GOES LOCAL
Stay tuned for IPA Goes Local 2021 information!
Due to COVID-19, live IPA Goes Local programming was impractical this year. Nonetheless, IPA was able to offer a virtual Goes Local program during the 2020 Annual Meeting. On September 15, MedPharm Iowa presented an hour-long accredited program on a variety of topics regarding the Iowa Medical Cannabis program, including patient eligibility and available cannabis products in the Iowa market. This program was open to all IPA members. Resources from the presentation are available at www.iarx.org/goeslocal.
IPA members receive a FREE subscription to CEimpactâ&#x20AC;&#x2122;s Pharmacist or Pharmacy Technician Course Catalog, which includes all required CPE for pharmacist relicensure and pharmacy technician recertification for FREE. In addition, you also receive FREE continuing education credit for IPAâ&#x20AC;&#x2122;s BOP: What, Why & How podcast series and select 2/2/2 webinar recordings!
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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.
DECEMBER 2020 1
Lunch & Learn with Allergan: Critical Care, Infectious Disease and DALVANCE for Injection
3
IMS & IPA Professional Burnout and Resiliency Programming
6-10 ASHP Midyear Clinical Meeting & Exhibition (Virtual)
8 2/2/2 Webinar – The Legality of CBD Sales in Pharmacies 15 17
Lunch & Learn with Rigel Pharmaceuticals: Stand Strong Against Platelet Destruction with TAVALISSE Lunch & Learn with Allergan: Clinical Profile Review of AVYCAZ
JANUARY 2021 12
20
2/2/2 Webinar – TBD Long-Term Care Forum
26-April 13: 27
BPS Study Group – Winter 2021
Legislative Day 2021 (Virtual)
FEBURARY 2021
1-7 PharmaCE Expo
3-April 7 IPA Technician Study Group - Spring 2021 9
2/2/2 Webinar – TBD
19 Insight to Advocacy Webinar – Rutledge v. PCMA
25-27 American College of Apothecaries Annual Conference and Expo 2021 Currently scheduled events are subject to change due to COVID-19. Please continue to watch IPA communications regarding any updates.
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PHARMACY TIME CAPSULE
20 10
Issues & events that have shaped Iowa pharmacy (or are fun to remember!)
JANUARY
Over 500 pharmacists, pharmacy technicians and student pharmacists attend the Iowa Pharmacy Association’s 2010 Educational Expo in Des Moines, IA. Nearly 50 speakers from across the state and country shared their expertise in an effort to improve patient care and health outcomes. Keynote speaker Congressman Bruce Braley spoke at the political leadership breakfast, acknowledging the importance of pharmacists in the health care system.
Des Moines, IA. Chestnut delivered her presidential address, “The I’s Have It For 2020 Vision – Innovate, Inspire, Involve, and Initiate,” where she makes reference to upcoming virtual participation during Annual Meeting.
JULY
Effective July 1, all pharmacy technicians practicing in Iowa were required to be certified. The pass rate in Iowa for the ExCPT Exam was 90%, compared to the national pass rate of 72%.
AUGUST
FEBRUARY
The Iowa Board of Pharmacy ruled in favor of making a recommendation to the Iowa legislature to move marijuana for medical purposes from Schedule I to Schedule II and the formation of a specialized task force to regulate and monitor the use of marijuana in the state of Iowa.
MARCH
Clinical pharmacy pioneer Mary Anne Koda-Kimble, PharmD, Dean of the School of Pharmacy at University of California, San Francisco, was awarded the 2010 Remington Honor Medal.
MAY
John Forbes, BS Pharm, owner of Medicap Pharmacy in Urbandale and currently Iowa’s only pharmacist legislator, received the Bowl of Hygeia Award for community service from the Iowa Pharmacy Association.
JUNE
Renae Chesnut, BS Pharm, EdD, MBA, was welcomed as IPA’s 131st President during IPA’s Annual Meeting in West
Pharmacists represented the state of Iowa at the Pharmacy Leadership Conference in Galena, IL. The conference was designed as an opportunity for pharmacists in their first 10 years of practice to develop organizational skills and become future leaders in the pharmacy profession. Pictured above: Rachel Digmann (Clive), Darla Eastman (Urbandale), Matthew Farndale (Pocahontas), Jessica Frank (Winterset), Megan Friedrich (West Des Moines), Danette Gibbs (Waterville), Heather Ourth (Indianola), Kim Spading (Coralville), and Jennifer Wick (Solon).
SEPTEMBER
Beginning September 1, all pharmacies in Iowa selling a product containing pseudoephedrine were required to participate in the real-time, statewide electronic tracking system of pseudoephedrine sales.
OCTOBER
A Drake University student pharmacist team was one of three finalists in a national business plan competition where students created a business model for buying an existing independent community pharmacy or developing a new pharmacy. The team (Victoria Erxleben, Travis Gau, Ryan Nimtz, and Kathryn McDonald) presented their plan at NCPA’s 112th Annual Convention in Philadelphia, PA.
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.
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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