The Kentucky Pharmacist Vol. 10, No. 1 by Kentucky Pharmacists Association

Y K C U T N E K THE T S I C A M R A PH Vol. 10, No. 1 January 2015

Get Involved Stay Involved

Membership Matters in YOUR KPhA News & Information for Members of the Kentucky Pharmacists Association

Table of Contents

January 2015 2015 KPhA Professional Awards Pharmacy Time Capsules Hub on Advocacy In Memoriam 2015 Kentucky Legislative Session Kentucky Renaissance Pharmacy Museum KPhA New and Returning Members Pharmacy Law Brief Pharmacy Policy Issues Pharmacists Mutual Cardinal Health KPhA Board of Directors 50 Years Ago/Frequently Called and Contacted

Table of Contents Table of Contents— Oath— Mission Statement President’s Perspective 2014 Bowl of Hygeia Winners Retirements and New Beginnings From your Executive Director APSC Technician Review Jan. 2015 CE — Diabetes Care Update January Pharmacist/Pharmacy Tech Quiz KPhA Emergency Preparedness Advocating for Our Profession: A Student Perspective Continuing Education Article Submission Guidelines

2 3 4 5 6 8 9 10 16 17 18 19

20 23 24 25 26 27 28 32 34 36 37 38 39

Oath of a Pharmacist At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy. I will consider the welfare of humanity and relief of human suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. I will keep abreast of developments and maintain professional competency in my profession of pharmacy. I will embrace and advocate change in the profession of pharmacy that improves patient care. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association The mission of the Kentucky Pharmacists Association is to promote the profession of pharmacy, enhance the practice standards of the profession, and demonstrate the value of pharmacist services within the health care system.

Editorial Office: © Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association. Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email ssisco@kphanet.org. Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research Foundation (KPERF), established in 1980 as a non-profit subsidiary corporation of the Kentucky Pharmacists Association (KPhA), fosters educational activities and research projects in the field of pharmacy including career counseling, student assistance, post-graduate education, continuing and professional development and public health education and assistance. It is the goal of KPERF to ensure that pharmacy in Kentucky and throughout the nation may sustain the continuing need for sufficient and adequately trained pharmacists. KPERF will provide a minimum of 15 continuing pharmacy education hours. In addition, KPERF will provide at least three educational interventions through other mediums — such as webinars — to continuously improve healthcare for all. Programming will be determined by assessing the gaps between actual practice and ideal practice, with activities designed to narrow those gaps using interaction, learning assessment, and evaluation. Additionally, feedback from learners will be used to improve the overall programming designed by KPERF. 2

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Presidentâ&#x20AC;&#x2122;s Perspective

January 2015

Past, Present Future PRESIDENTâ&#x20AC;&#x2122;S PERSPECTIVE

legislation passed last year. KPhA has developed a new strategy for 2015, which we hope will succeed. Once the bill is filed, KPhA will be sending out contact information for the members of the legislature. It is important to our success that you personally contact your representative and Robert Oakley senator to let them know you support this bill. On the naKPhA President tional level, a new Congress will start as well. Congressman Brett Guthrie from Kentucky has again filed his bill to 2014-2015 give health care provider status to pharmacists. Through It is hard to believe that the efforts of YOUR KPhA and its members, five out of the 2014 has come to a close. six Congressmen from Kentucky signed on as co-sponsors Where did the year go? I of the bill in 2014. There were over 120 co-sponsors of the think this is a good time to bill in 2014. Hopefully, this momentum will carry into 2015. give thanks for our blessings As the Protector of the Pharmacy Act, YOUR KPhA will from the past year, focus on continue to monitor proposed legislative and regulatory prothe present and look forward to the new year and new beposals, including but not limited to work on compliance isginnings. sues with the previously enacted MAC transparency legislation, to support efforts to advance medication synchroniThe past year has been a significant one for me and one to zation initiatives for patients and to support naloxone pregive many thanks, both on a personal and professional levscribing by pharmacists. el. In June, I was installed as the President of YOUR KPhA. It is a significant honor. It is hard to believe that I am half Looking forward into 2015, there are many exciting activiway through my term as President. October saw the celeties besides legislative initiatives that YOUR KPhA is workbration of my one year anniversary as Corporate Director of ing on. First, Bob McFalls and I have started a dialogue Pharmacy at Baptist Health after having served as Director with the presidents of the local associations to see what of Pharmacy at Baptist Health Louisville for more than 25 KPhA can do to help them. The goal is to create stronger years. In November, my wife (Janice) and I became first local associations, which in turn will help to make KPhA a time grandparents with the birth of Robert Shelton Oakley stronger state wide organization. Secondly, our memberIII (We will call him Shelton.). By the time this article is pub- ship committee, led by KPhA President-Elect Chris Clifton, lished, our son Rob and his wife Amanda will have complet- continues to focus on new ways to attract new members to ed their move from Baltimore to Louisville, which is even KPhA and retain existing members. If you have an idea that more exciting! Just as I have had reason to be thankful for you would like to share with us on how KPhA can better these many blessings in the past year, I think each of you serve YOU, our member, please let us know. will be able to find similar significant events in your life this The third area to look forward to in the coming year is the past year for which to give thanks. I would hope that each subject I first mentioned in the November issue of The Kenof you would take time from your busy lives to pause for tucky Pharmacist, our KPhA Rebuilding for the Future your own moment of personal reflection. I hope that you will Campaign. In my article, I looked back at the first 50 years be able to consider yourself as blessed as I find myself to of YOUR KPhA building and the efforts of the members to be. I also believe that this is a good time for reflection and get the job done. I think we benefit when looking forward by remembrance of those who are no longer with us, but they looking back first to see where we have been. Now it is were a special part of our lives. time to look to the future and to start planning for the next The present sees the start of a new calendar year and a 50 years. The key insight for me so far has been that if we new legislative year. YOUR KPhA once again will be look- want to be successful in our campaign, we have to take ing to champion legislation that advances the profession of time to do it right. The first step is to contact other state pharmacy. We will be introducing a bill again this year to make changes to the Collaborative Care Agreement to the Pharmacy Practice Act. We came very close to getting this

Continued on Page 7

THE KENTUCKY PHARMACIST

2014 Bowl of Hygeia Recipients

January 2015

THE KENTUCKY PHARMACIST

Retirements and New Beginnings

January 2015 Congrats on Retirement! Long-time Board of Pharmacy inspector Phil Losch retired at the end of 2014. He was recognized by 2014 Board President Cathy Hanna and Executive Director Mike Burleson at the Boardâ&#x20AC;&#x2122;s December meeting. His son, Andrew, and wife, Julie, helped celebrate. Also at the Boardâ&#x20AC;&#x2122;s January meeting, Burleson announced he will retire, effective August 1.

Pharmacy TAC orientation YOUR KPhA provided orientation materials to the members of the reinstated Pharmacy Technical Advisory Committee. Members are: Rob Warford, Cindy Gray, Suzanne Francis, Christopher Betz and Jeff Arnold (not pictured). President Bob Oakley and Roamey welcomed the group.

Information will be added to the Event Listing at www.kphanet.org soon! Hotel information is online now at

www.kphanet.org/?page=AnnualMeeting

THE KENTUCKY PHARMACIST

From Your Executive Director

January 2015

MESSAGE FROM YOUR

EXECUTIVE DIRECTOR Robert “Bob” McFalls

The Rewards of Giving It’s hard to believe that not only is it January 2015, but the month and year are already moving far too quickly. As we begin a new year, I like to pause and to hear the words of T.S. Eliot ringing out: What we call the beginning is often the end, and to make an end is to make a beginning. The end is where we start from… For last year's words belong to last year's language and next year's words await another voice (Little Gidding). The advent of a new year brings a time of resolve whereby we sort the “old” and ponder the “new” as we reflect on what has passed and think about what we might possibly accomplish in beginning a new chapter of our life’s journey. For many of us, it is a time for “new” resolutions accompanied by equal determination to improve ourselves either personally and/or professionally. And these principles are easily adaptable to renewing our commitment to causes we care about as we endeavor to serve our patients as well as to help others. History informs us that one can trace the origins of resolutions back to the ancient Babylonians who made promises at the start of each year. Likewise, during the medieval period, knights would reaffirm their “peacock vows” at the end of the Christmas season as they renewed their commitment to chivalry. Various cultures over time have adapted the resolution process accordingly, and our media-driven culture has certainly done its share to engage us in looking at how we might improve ourselves as we enter into a new year and its cycle of life.

at all times and in all places — indeed it is our honor and duty as a part of our oath — and in so doing to leave the world a better place than we found it. I find strong parallels here to the work that pharmacists do on a daily basis, and to your oath, in terms of devoting one’s self to a lifetime of service to others. Gallup released its annual Honesty and Integrity Survey in December, and we all read with humility and gratitude how pharmacists continue to maintain your high ranking of trustworthiness. Pharmacists continue to hold the second position — behind only nurses and tied with medical doctors. The exact question asked by Gallup is as follows: “Please tell me how you would rate the honesty and ethical standards of people in these different fields – very high, high, average, low or very low?” For pharmacists and medical doctors, 65-percent said “very high” or “high.” The survey measures the public’s trust of diverse professions, including but also well beyond healthcare, and the findings reaffirm the remarkable trust that patients have with their pharmacists. It is central to your oath; moreover, being accessible and providing meaningful service is highly valued by your patients and/or their caregivers.

During the holiday season, we also were reminded about how our giving can help others at all levels — whether we give through charitable donations, direct assistance or with our one-on-one volunteer efforts, we are often the ones who receive the benefit. Indeed, in this spirit of giving, we are reminded that giving also is beneficial for the giver’s well-being, mentally and physically. The giver finds his or Resolutions, promises and oaths come in a number of her own reward in giving. As cited by the Health Hub from forms in terms of eliciting our response, commitment and/or the Cleveland Clinic (12/2/14), studies find these health covenant. Our forefathers believed so much in honor that benefits associated with giving: lower blood pressure; inthey mutually pledged to each other in the Declaration of creased self-esteem; less depression; lower stress levels; Independence “…our Lives, our Fortunes and our Sacred greater happiness; and, longer life overall. The Health Hub Honor.” Reflections during the recent holiday season led goes on to report, “Biologically, giving can create a “warm me on a personal journey to my Scouting days with Lincoln glow,” activating regions in the brain associated with pleasCounty BSA Troop 91. As a Scout, Assistant Scoutmaster ure, connection with other people and trust. In a 2006 and Scoutmaster, I learned and taught others to do our best study, researchers from the National Institutes of Health 6

THE KENTUCKY PHARMACIST

From Your Executive Director

January 2015

studied the functional MRIs of subjects who gave to various charities. They found that giving stimulates the mesolimbic pathway, which is the reward center in the brain, releasing endorphins and creating what is known as the ‘helper’s high.’ And like other highs, this one is addictive, too.”

the years to come, let’s recommit to do so, remembering the words of a fellow Kentuckian, Muhammad Ali, who said, “Service to others is the rent you pay for your room here on earth.” We thank you for all that you do with and for your profession. If you would like to get more involved with YOUR KPhA, President Bob Oakley and I would love to hear from you!

The heart of any resolution is our individual resolve. As we continue to advance the profession, in this new year and in

funding needs, help set a fund raising goal and recognition for those who contribute to our Rebuilding for the Future fund. Once we have established these basic steps, we can proceed to the next phase of the campaign. If you are interested in serving on this Committee, please contact KPhA and let us know. We would love to have you serve. Thank you for your efforts to Get Involved/Stay Involved throughout the New Year!

Continued from Page 3 associations and learn from their fund raising efforts. We have received information from Ohio and Virginia, who had recent campaigns to build new offices. We have learned a significant amount of information in a short period of time. The first step will be the formation of a Building Fund Development Committee. This committee will help determine

Watch eNews and subsequent editions of The Kentucky Pharmacist for more information on ways YOU can help rebuild YOUR KPhA Headquarters!

The Kentucky Pharmacist is online! Go to www.kphanet.org, click on Communications and then on The Kentucky Pharmacist link.

Would you rather receive the journal electronically? Email ssisco@kphanet.org to be placed on the Green list for electronic delivery. Once the journal is published, you will receive an email with a link to the online version.

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APSC

January 2015

THE KENTUCKY PHARMACIST

Technician Review

January 2015

Technician Review From the KPhA Academy of Technicians Happy New Year from the Academy members. We hope that everyone had a safe and happy holiday season.

a mandatory criminal background check, but does still require full disclosure during the application process. Additional changes for 2015 include the reduction of permitted During the New Year, the Academy will continue to recruit CE’s obtained through in-services from 10 to 5 hours and new members to increase our foot print in the Commonwill decrease to zero hours in 2018. Upcoming changes for wealth and strengthen our voice. We look forward to anoth2016 include a reduction in the college/university courseer year of growth within our KPhA organization. work hours from 15 to 10 hours. PTCB is still on track to Currently, we are attending the Kentucky Board of Pharma- require completion of an ASHP/ACPE accredited pharmacy technician education program before applying for the certificy’s Advisory Council meetings to try and advance the cation exam by 2020. pharmacy technician profession. We have requested that KPhA change the membership fee requirements for stuA quick review of what it will take to recertify. Any certified dents attending a pharmacy technician education program pharmacy technician recertifying in 2015 must have one and will hear something back from them very soon. Our hour of continuing education in law and one hour in medimembers continue to be eligible for up to 10 hours of oncation safety as part of the 20 hours. Any CE’s acquired in line technician specific continuing education provided by 2015 must be technician specific. the Collaborative Education Institute. If you have any questions for the KPhA Pharmacy National changes to be aware of this year include the deci- Technician Academy or if you are interested in joining sion for PTCB requiring technician specific continuing eduthe Academy please contact Don Carpenter cation for 2015. The PTCB also has decided not to require at dacarpenter@st-claire.org.

KPhA Member Pharmacy Technicians

FREE CE

KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost. The mission of the KPhA Academy of Pharmacy Technicians is: To unite the pharmacy technicians throughout the Commonwealth to have one voice toward the advancement of our profession. To follow what is currently happening with your profession please read our newsletter articles and become involved.

For more information contact Don Carpenter via email at dacarpenter@st-claire.org 9

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update

January 2015

Diabetes Care Update By: Heather M. Bryan, Pharm.D candidate, Irina Yaroshenko, Pharm.D candidate, and Holly L. Byrnes, Pharm. D., BCPS, Jonathan S. Hayes, Pharm.D., BCPS, Sarah Raake, Pharm.D., LDE Sullivan University College of Pharmacy There are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity # 0143-0000-15-001-H01-P&T 2.0 Contact Hours (0.2 CEU) Goal: To aid pharmacists in distinguishing and understanding the updates in diabetes care to deliver optimal evidence-based care for diabetic patients. Objectives

KPERF offers all CE articles to members online at www.kphanet.org

At the conclusion of this article, the reader should be able to: 1. 2. 3. 4.

Discuss the recent main updates in diabetes care. Define the rationale for the revisions in the clinical practice recommendations for diabetes care. Describe the impact of the major updates on clinical practice. Discuss the place in therapy for the new and emerging medications for the treatment of diabetes.

lines still use BMI and waist circumference to classify overweight and obese patients while also identifying the risks of Diabetes care is continuously advancing as new evidence CVD, type 2 DM and all-cause mortality that is associated emerges. It is imperative for pharmacists to stay informed with obesity. The AHA/ACC/TOS classifies a BMI of >25.0on the most up-to-date information to provide ideal diabetes 29.9kg/m2 as overweight.3 care. This past year, information and guidelines surrounding diabetes were updated and this article provides an As in previous guidelines, lifestyle modifications are recomoverview of the updates in diabetic care. Some of the topics mended for all overweight and obese patients. Also pharthat will be discussed within the diabetes realm include: a macological and surgical interventions can be considered review of obesity management, antihyperglycemic therafor patients with comorbidities. Orlistat was the only drug pies, glycemic control goals and new antidiabetic agents. approved when the AHA/ACC/TOS obesity guidelines were developed so only a general statement is discussed stating Obesity Management that FDA-approved medication for weight loss can be recIn the spring of 2013, the American Association of Clinical ommended for individuals with a BMI ≥30 kg/m 2 or ≥27 kg/ Endocrinologists (AACE) published a new Comprehensive m2 with at least one obesity-associated comorbidity.3 These Diabetes Management Algorithm.1 The AACE stresses the therapeutic interventions for obesity management should importance of managing obesity because of the immense overall be considered and recommended for the treatment prevalence in the United States. According to the Centers of all levels of diabetes severity including pre-diabetes, diafor Disease Control and Prevention, more than 1/3 of adults betes and metabolic syndrome. in the United States are clinically obese, and their medical Currently, in terms of pharmacological options, there are costs are over $1,400 higher than those of normal weight.2 four medications available for weight loss (Table 1): orlistat The AACE has provided a thorough, step-by-step approach and phentermine for short-term treatment (<3 months) and to managing obesity instead of looking at BMI by recomlorcaserin and phentermine/topiramate extended release mending management for overweight or obese patients that for chronic use which are considered the newer anti-obesity focuses on obesity-related comorbidities which are classiagents becoming FDA-approved for weight management in fied into two categories: cardiometabolic disease and bio2012. Orlistat is available both as an over the counter and mechanical complication. The AACE classifies a BMI of prescription while phentermine is only available by prescrip27kg/m2 to <30 kg/m2 overweight and a BMI of ≥30 kg/m 2 tion. Although both have been approved by the FDA, their clinically obese.1 use has been less than anticipated due to their side-effect Along with the AACE, The American Heart Association profiles while both lorcaserin and phentermine/topiramate (AHA)/American College of Cardiology (ACC) Task Force ER have their place in diabetes therapy recognized by the on Practice Guidelines and The Obesity Society (TOS) AACE obesity algorithm. It is important to note that locaserpublished guidelines for the Management of Overweight in and phentermine/topiramate ER are recommended as and Obesity in Adults in November of 2013. These guideadjuncts to lifestyle modification (reduced-calorie diet and Introduction

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update increased physical activity).

Lipid Management In November 2013, the ACC/ AHA published new guidelines on the treatment of blood cholesterol with some major changes.7 The old lipid guidelines, the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program, recommended a specific LDL-C and/or nonHDL-C goals for different risk groups.8 The new ACC/AHA lipid guidelines recommend the removal of the treat-totarget approach for multiple reasons. One, because the treat-to-target paradigm does not consider the potential adverse effects from multidrug therapy required to achieve the lipid target. Also, the ACC/AHA used randomized control trials (RCTs) and found that CVD events were reduced by using the maximum tolerated statin therapy but there were no RCTs proving that the titration of drug therapy to specific LDL-C and/or non-HDL-C goals led to improved CVD outcomes.7

January 2015

Table 1 Name

Lorcaserin (Belviq)

Phentermine/topiramate ER (Qsymia)

Dosing/ Administration

10 mg ORALLY twice daily Discontinue at week 12 if 5 percent weight loss has not been achieved; Max 20 mg/day

Contraindications/ Precautions

Pregnancy Avoid in patients with severe renal impairment (CrCl <30 ml/ min)

Side Effects

Headache, back pain, nausea, dry mouth, constipation, hypoglycemia, cough and fatigue Advise patient to avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, confusion and somnolence

Initially: phentermine 3.75mg/ topiramate 23mg orally once daily for 14 days Maintenance: phentermine 7.5mg/ topiramate 46mg orally once daily; after 12 weeks at maintenance dose, if weight loss is not at least 3 percent of baseline, discontinue or escalate dose Concomitant use with MAOI therapy or within 14 days of discontinuation of MAOI Glaucoma Hyperthyroidism Pregnancy Constipation, Xerostomia, Insomnia, paresthesia, Nasopharyngitis, upper respiratory infection Drug may cause decreased visual acuity and/or cognitive impairment. Patient should avoid driving or other activities requiring clear vision, mental alertness or coordination until drug effects are realized

Clinical Teaching

Source 5,6

Table 2 High- Intensity Statin Therapy (Lowers LDL-C by ~ ≥50 percent) Atorvastatin 40-80mg Rosuvastatin 20mg

Moderate- Intensity Statin Therapy (Lovers LDL0C by ~30 to <50 percent) Atorvastatin 10mg Rosuvastatin 10mg Simvastatin 20-40mg

Instead of the treat-to-target Pravastatin 40mg approach, the ACC/AHA lipid Lovastatin 40mg guidelines have identified four Fluvastatin XL 80mg statin benefit groups (Table 2) and categorized statins into Fluvastatin 40 mg BID different intensities (Table 3). Pitavastatin 2-4mg The ACC/AHA lipid guideline ** Once-daily doses unless otherwise specified. recommends moderateSource 7 intensity statin therapy for most patients with diabetes and high-intensity statin thera- These lipid lowering agents provide no significant benefit py for patients with diabetes and estimated 10-year CVD when compared to the risk from adding these therapies. risk ≥7.5 percent.7 Please note that it is important to choose Glycemic Goals an appropriate intensity of statin therapy as patients with diabetes have shown high residual CVD risk due to inade- The 2013 AACE algorithm continues to support an A1C quate intensity of statin therapy. In addition, non-statin drug goal of ≤6.5 percent for patients who are young, healthy therapies such as fibrates, ezetimibe, niacin and bile acid and without comorbid disease states who have a low hyposequestrants are not recommended for CVD prevention. glycemic risk. In patients with a comorbid disease state 11

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update

January 2015

Table 3

With these goals in mind, AACE established a Glycemic Control Algorithm and Profiles of Antidiabetic Medications.1 Statin Benefit Groups A1C is divided into three categories (<7.5 percent, 7.6 - 9 Individuals with clinical Arteriosclerotic cardiovascular percent, >9 percent) with a correlation of progression in disease (ASCVD) Individuals with primary elevvations of LDL-C ≥190 mg/dL disease state with worsening A1C levels. These also are considered AACE’s recommended starting points for theraIndividuals 40-75 years of age with diabetes with LDL-C py. In brief, antihyperglycemic therapy advances from sin80-189 mg/dL Individuals without clinical ASCVD or diabetes who are gle drug therapy to dual therapy, triple therapy and insulin 40-75 years of age with LDL-C 70-189 mg/dL and an therapy with or without additional agents. To clarify from estimated 10-year ASCVD risk of 7.5 percent or higher the previous statement, patients do not have to go through Source 7 three oral therapies prior to starting insulin. For example, who are at risk for hypoglycemia are recommended to have insulin will almost always be initiated with an A1c of >9 with an individualized A1C goal which can be >6.5 percent. 1 symptoms because the patient will not obtain a 3+ drop in This along with patient preference and life expectancy are A1C with oral therapies alone. Also, the risk associated other ways that the AACE algorithm uses the complications with the endpoint is always considered so if the patient’s -centric approach to the care of overweight/obese patients. A1C goal is higher than others with <8, insulin may not be These in addition to BMI assessment and obesity severity needed. have proven to be beneficial. The AACE algorithm recommends metformin as first-line In relation to the AACE algorithm, The American Diabetes Association (ADA) provides more detailed guidelines on A1C goals. Their recommendation is an A1C of <7 percent for most patients, <6.5 percent for lower-risk patients with a short disease duration, long-life expectancy and absence of CVD, and <8 percent for higher-risk patients with a shortlife expectancy, history of severe hypoglycemia, serious complications and multiple comorbid conditions.9 Since these medical organizations have some differences in recommendations, it’s important to recognize them and apply them in clinically appropriate settings where one recommendation may fit better than the other. Something else that is important to note, all organizations (ADA, AACE algorithm, and AHA/ACC/TOS) recommend that each patient should be managed with individualized goals that take the patients age, comorbidities and hypoglycemia risk into consideration. Antihyperglycemic Therapy In terms of A1C goals for patients with diabetes, the AACE algorithm is very adaptable to make sure each patient has individualized care. When discussing recommendations on antihyperglycemic pharmacotherapy, the AACE algorithm is much more specific. Four goals are identified, in addition to lifestyle modifications that should be considered in regards to hyperglycemic therapy.1 1. 2. 3. 4.

therapy, which is in agreement with the ADA.9 After metformin, incretin-based therapies (GLP-1 agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are placed above others in the hierarchy because they are widely accepted in diabetes care because of their effectiveness but their use is still limited in certain populations because of cost and route of administration. GLP-1 agonists also have shown to have more of an A1C-lowering effect and weight loss benefit compared to DPP-4 inhibitors making them prioritized over DPP-4 inhibitors in the AACE algorithm.8. Both have mechanisms of action that are favorable compared to other agents such as stimulating insulin secretion, reducing glucagon secretion and promoting satiety while also being relatively safe with regards to side-effect profiles compared to sulfonylureas or glinides. Sulfonylureas and glinides have common side effects such as weight gain and increased hypoglycemia risk which makes them disadvantageous and are thus considered to be the last line of therapy in the AACE algorithm.1 Although, all these appealing characteristics lean toward GLP-1 agonist, as pharmacists, we need to consider they are injectable while DPP-4 inhibitors are tablets which can effect medication adherence and gastrointestinal side effects (nausea/vomiting) are more commonly seen with GLP-1 agonists.10

Although sulfonylureas and glinides have fallen out of favor, the TZD class is holding steady in the hierarchy. Their Avoid hypoglycemia mechanism of improving insulin sensitivity without stimulatAvoid weight gain in persons who are obese and assist ing insulin release and increasing risk of hypoglycemia helps them to hold their own. The ADOPT trial tested the them with weight loss glycemic durability of rosiglitazone, metformin and glyAchieve clinical and biochemical glucose targets; and buride as monotherapy. The trial concluded that TZDs Reduce or avoid increasing CVD risk seem to be more durable in controlling glycemic levels in 12

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update

January 2015

comparison of the other two, giving the TZD class another incentive for use.9 In November 2013, the FDA officially required the removal of prescribing and dispensing restrictions on rosiglitazone after finding out that the recent data showed no increased risk of heart attack compared to metformin and sulfonylureas.12 The side effect profile of TZDs including weight gain, fluid retention leading to worsening or inducing heart failure and increased risk of bone fractures are all reasons limiting the use of TZDs in clinical practice.1

A1C reduction compared to the placebo group (difference: 0.41 percent, P <0.0001) with neutral effects on hypoglycemia and weight gain.13,14

therapy. Intensifying the regimen in patients with symptomatic hyperglycemia and an A1C that is not at goal to a basal-bolus insulin regimen is an option but the AACE algorithm recommends strong consideration be given to a regimen of basal and incretin-based therapy to avoid these serious adverse effects. This recommendation is based off a clinical trial that showed the addition of a GLP-1 agonist, exenatide, to basal insulin decreased A1C by 1.74 percent while the placebo group only decreased A1C by 1.04 percent and the addition of a DPP-4 inhibitor showed great

As of June 2014, the U.S. Food and Drug Administration approved a rapid-acting inhaled insulin to improve glycemic control in adults with diabetes mellitus: Afrezza (insulin human) Inhalation Powder.17 Afrezza is administered at the beginning of each meal and is not a substitute for longacting insulin. Afrezza must be used in combination with long-acting insulin in patients with type 1 diabetes, and it is not recommended for the treatment of diabetic ketoacidosis, or in patients who smoke. It should not be used in patients with asthma or chronic obstructive pulmonary dis-

The New Kids in Town

In March 2013, the US Food and Drug Administration (FDA) approved canagliflozin (Invokana) for the treatment of Type 2 Diabetes. It is the first drug approved in the United States belonging to a new class of drugs called sodiumglucose cotransporter 2 (SGLT2) inhibitors. The SGLT2 inhibitors lower the renal threshold for glucose and inThe 2013 AACE algorithm gives specific guidelines on the crease urinary glucose excretion by interfering with the readdition or intensification of insulin in patients with type 2 absorption of renally-filtered glucose. Compared to diabetes. For patients with A1C >9 percent, the presence of glimepiride (Amaryl), a 100 mg dose of canagliflozin diabetic symptoms usually determines whether or not to worked as well as glimepiride. Also, in patients already takinitiate insulin therapy. A symptomatic patient along with ing metformin and a sulfonylurea, 300 mg daily of canagliwhether or not the patient is experiencing these while alflozin lowered A1C as well as sitagliptin (Januvia) which is ready on two non-insulin antidiabetic agents also are concommonly prescribed.15,16 The usual starting dose of sidered because adding a third or fourth antidiabetic agent canagliflozin is 100 mg daily, taken before the first meal of is less likely to bring down a patients A1C to target range. the day. For people who tolerate the drug well with few side As stated earlier, patients with an A1C >9 who are symptoeffects and who generally have good kidney function, the matic are generally started on insulin therapy. Also, AACE dose can be increased to 300 mg daily if necessary. With guidelines suggest that non-insulin antidiabetic therapies that being said, people with severe kidney dysfunction be continued while initiating basal insulin with the exception should avoid canaglifozin entirely. of sulfonylureas and glinides. These increase the risk of hypoglycemia in conjunction with insulin and should be dis- In addition to better diabetes control, there are several other advantages with the use of canagliflozin. Weight loss is continued.1 The ADA/EASD statement differs reading that when basal insulin is initiated, sulfonylureas and glinides be one of the positive attributes with patients losing 2 – 4 percent of their body weight while taking 300 mg of canaglicontinued or reduced to prevent loss of control during the 9 flozin daily for six months in clinical trials. Another benefit titration period. during the clinical trials was that the drug lowered systolic The algorithm also recommends basal insulin at a starting blood pressure between 2 mmHg and 8 mmHg along with dose of 0.1-0.2 unit/kg for patients with A1C ≤8 percent and the rarity of hypoglycemic episodes. The most commonly a dose of 0.2-0.3 unit/kg for patients with A1C >8 perseen adverse effects of canagliflozin (occurring in more cent.This starting dose of basal insulin can be titrated up than 5 percent of patients) are related to the genitourinary every two to three days to achieve a fasting blood glucose tract. Vaginal yeast infections occur in approximately 10 <110 mg/dL. If hypoglycemia occurs, the basal insulin can percent of women who took canagliflozin and urinary tract be reduced by 10 – 20 percent for glucose levels <70 mg/ infections occurred in more than 5 percent of study particidL and by 20 – 40 percent for severe hypoglycemia with a pants. Other common negative side effects seen were vagiblood glucose level of <40 mg/dL.1 nal itching, thirst, constipation, nausea and abdominal pain.15 Hypoglycemia and weight gain are associated with insulin

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update

January 2015

ease (COPD) because of the acute bronchospasm that has been observed in patients with those disease states.17

ol to Reduce Atheroscleotic Cardiovascular Risk in Adults. Journal of the American College of Cardiology (2013), doi: 10.1016/j.jacc.2013.11.002.

A total of 3,017 participants – 1,026 participants with type 1 diabetes and 1,991 patients with type 2 diabetes – were 8. Grundy SM, Cleeman Jl, Merz CN, et al; National 17 evaluated on the drug’s safety and effectiveness. The Heart, Lung, and Blood Institute; American College of Afrezza efficacy at mealtime was compared to mealtime Cardiology Foundation; American Heart Association. insulin aspart (fast-acting insulin) and both in combination Implications of recent clinical trials for the National with basal insulin (long-acting insulin) in a 24 week study. Cholesterol Education Program Adult Treatment Panel The treatment provided for type 2 diabetes patients in comIII guidelines. Circulation. 2004;110:227-239. bination of Afrezza with oral antidiabetic drugs showed a 9. Inzucchi SE, Bergenstal RM, Buse JB, et al. Managemean reduction in HbA1c that was statistically significantly ment of hyperglycemia in type 2 diabetes: a patientgreater compared to the HbA1c reduction observed in the centered approach: position statement of the American placebo group. Unfortunately, Afrezza provided less HbA1c Diabetes Association and the European Association for reduction than insulin aspart in type 1 diabetes patients, the Study of Diabetes. Diabetes Care. 2012;35:1364and the difference was statistically significant. Four more 1379. post-marketing studies are required by FDA on Afrezza.17 10. Deacon CF, Mannucci R, Ahrén B. Glycemic efficacy Conclusion of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors as add-on therapy to subDiabetes care will forever be changing as new drugs and jects with type 2 diabetes- a review and meta analysis. guidelines continue to emerge with the new evidence found Diabetes Obes Metab. 2012;14:762-767. from clinical trials. It is important as a pharmacist to stay up to date with these guidelines so that we can effectively 11. Kahn SE, Haffner SM, Heise MA, et al; ADOPT study practice evidence-based medicine with our diabetic patient group. Glycemic durability of rosiglitazone, metformin, base. or glyburide monotherapy. N Engl J Med. 2006;355:2427-2443. References 12. US Food and Drug Administration. FDA Drug Safety Communication; FDA requires removal of some prescribing and dispensing restrictions for rosiglitazonecontaining diabetes medications. http://www.fda.gov/ Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence drugs/drugsafety/ucm376389.htnm.Published Novemof obesity in the United States, 2009-2010. NCHS Data ber 25, 2013. Accessed July 15, 2014. Brief. 2012 Jan;(82):1-8. 13. Buse JB, Bergenstal RM, Glass LC, et al. Use of twiceJensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ daily exenatide in Basal insulin-treated patients with ACC/TOS guideline for the management of overweight type 2 diabetes: a randomized, controlled trial. Ann and obesity in adults: a report of the American College Intern Med. 2011; 154:103-112. of Cardiology/American Heart Association task force on practice guidelines and The Obesity Society. Circu- 14. Barnett AH, Charbonnel B, Donovan M, et al. Effect of saxagliptin as add-on therapy in patients with poorly lation. Published online November 12, 2013. controlled type 2 diabetes on insulin alone or insulin Colman E, Golden J, Roberts M, et al. The FDA’s ascombined with metformin. Curr Med Res Opin. sessment of two drugs for chronic weight manage2012;28:513-523. ment. N Engl J Med. 2012;367:1577-1579. 15. Cefalu WT, Leiter LA, Yoon KH, et al. Efficacy and Belviq (lorcaserin)[package insert]. Woodcliff Lake, NJ: safety of cangliflozin versus glimepiride in patients with Eisai Inc; 2012. type 2 diabetes inadequately controlled with metformin (CANTATA-SU): 52 week results from a randomized, Qsymia (phentermine and topiramate extendeddouble-blind, phase 3 non-inferiority trial. Lancet. 2013 release) [package insert]. Mountain View, CA: VIVUS, Sep 14;382 (9896):941-50. Inc; 2012.

1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocr Pract. 2013;19:327-336. 2.

5. 6.

7. Stone NJ, Robinson J, Lictenstein AH, et al. 2013 AC- 16. G Schernthaner, JL Gross, J Rosenstock, et al. Canagliflozin compared with sitaglitin for patients with C/AHA Guideline on the Treatment of Blood Cholester-

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Jan. 2015 CE — Diabetes Care Update

January 2015

tpe 2 diabetes who do not have adequate qlycemic control with metformin plus sulfonylurea: a 52-week randomized trial. Diabetes Care. 2013;10:2337-2344.

Afrezza to treat diabetes. June 27, 2014; modified June 30, 2014. http://www.fda.gov/newsevents/newsroom/ pressannouncements/ucm403122.htm Accessed August 11, 2014.

17. US Food and Drug Administration. FDA approves

January 2015 — Diabetes Care Update 1. Which statin listed below is considered a high-intensity statin and can lower a patient’s LDL-C by about ≥ 50 percent? A. Rosuvastatin 10mg B. Rosuvastatin 20mg C. Simvastatin 20mg D. Simvastatin 40mg 2. Which of the following is NOT a contraindication for the use of Qsymia? A. Pregnancy B. Hyperthyroidism C. Glaucoma D. CrCl <15ml/min 3. The recommended A1C for higher-risk patients with a short-life expectancy, history of severe hypoglycemia and multiple comorbid conditions is ______. A. < 7 percent B. < 6.5 percent C. < 8 percent D. < 5 percent 4. Which of the following medications is associated most with side effects of constipation, xerostomia, insomnia, paresthesia, nasopharyngitis and upper respiratory infection? A. Qsymia B. Atorvastatin C. Belviq D. Lovastatin

6. Which side effect is most commonly associated with canagliflozin? A. Vaginal itching B. GI side effects C. Dizziness D. Fatigue 7. Which class of medications below does the AACE algorithm recommend after metformin for the treatment of diabetes? A. Insulin B. DPP-4 C. Sulfonylureas D. Glinides 8. Which class of medications works by lowering the renal threshold for glucose and increasing urinary glucose excretion by interfering with the reabsorption of renallyfiltered glucose? A. Sulfonylureas B. GLP-1 agonists C. SGLT2 inhibitors D. Insulin 9. Orlistat and phentermine are approved for use up to ___ months. A. 3 B. 6 C. 9 D. 12

5. Afrezza is NOT recommended for the treatment of diabetes in which of the following patients? A. A patient with a history of COPD B. A patient just diagnosed with type 1 diabetes currently on a long-acting insulin C. A type 2 diabetic patient with gout D. A healthy type 2 diabetic patient

The February 2015 continuing education article will be in the March issue of The Kentucky Pharmacist. 15

THE KENTUCKY PHARMACIST

Jan. 2015 CE — Diabetes Care Update

January 2015

This activity is a FREE service to members of the Kentucky Pharmacists Association. The fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South, Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile. Expiration Date: January 30, 2018 Successful Completion: Score of 80% will result in 2.0 contact hour or 2.0 CEU. Participants who score less than 80% will be notified and permitted one re-examination. TECHNICIANS ANSWER SHEET. January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D

Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) PHARMACISTS ANSWER SHEET January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 2. A B C D 4. A B C D 6. A B C D

7. A B C D 8. A B C D

9. A B C D

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________

Personal NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD) The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education.

Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted.

THE KENTUCKY PHARMACIST

KPhA Pharmacy Emergency Preparedness

January 2015

Emergency Preparedness Training YOUR KPhA has developed two emergency preparedness training programs for the KPhA Pharmacy Volunteers that will be available online in the next few weeks. Watch eNews for more information on these programs. Also, KPhA Director of Pharmacy Emergency Preparedness, Leah Tolliver, is developing a new CE program that will roll out this winter and spring at our local organizations about preparing your pharmacy in the event of a disaster. These tips and procedures will be relevant to all pharma-

cies including retail, hospital, long term care and compounding. If you are interested in seeing this program at your local organization meeting, contact your local leader or KPhA! Please contact Leah to present at your district meeting, or to schedule a meeting in your area if there is no active district. This program also will be offered at the 137th KPhA Annual Meeting and Convention June 25-28, 2015 in Bowling Green!

KPhA Pharmacy Emergency Preparedness Initiative Interest Form Name: ______________________

Status (Pharmacist, Technician, Other): ___________________

Email: ______________________________ Phone: ___________________________ Interest in serving as a volunteer: Yes____ No ____ Interest in serving as a Volunteer District Coordinator: Yes____ No _____ You also may join the Medical Reserve Corps by following the KHELPS link on KPhA Website to register (www.kphanet.org under Resources) Please send this information to Leah Tolliver, KPhA Director of Pharmacy Emergency Preparedness via email at ltolliver@kphanet.org, fax to 502-227-2258 or mail at KPhA, 1228 US 127 South, Frankfort, KY 40601.

For more Emergency Preparedness Resources, visit www.kphanet.org, click on Resources and Emergency Preparedness. 17

THE KENTUCKY PHARMACIST

Advocating for our Profession

January 2015

Advocating for Our Profession: A Student’s Experience at the National Level My name is Caroline Beaulieu, and I am a thirdyear pharmacy student at the University of Kentucky College of Pharmacy. I have been a mem- While in Washington, DC, Caroline (far right) met with U.S. Rep. Andy Barr from Kentucky. Also pictured are Dr. Kelly Smith, Dr. Michelle ber of the Kentucky Alliance of Pharmacy StuFraley and Alexis Kjellsen (PY4). dents since my first semester in pharmacy school, and I continue to value my professional membership with various pharmacy organizations, includPPMI. ing the Kentucky Pharmacists Association. I am eager for I highly value the experience I gained throughout my internnew opportunities to advance the professional practice of ship. Not only did it expand my understanding of provider pharmacy and promote pharmacists’ role as direct patient status but it also motivated me to start advocating for our care providers. profession. After I realized the impact I could have as a This past summer, I had the honor to be selected to comstudent in supporting the expansion of pharmacists’ role, I plete the American Society of Health-System Pharmacists became determined to take another step forward. In Sep(ASHP) Summer Internship. As a member of the Patient tember, I decided to go back to Washington, D.C. to particiAccess to Pharmacists’ Care Coalition (PAPCC), ASHP is pate in ASHP’s legislative day with the Kentucky delegaone of the national professional associations actively intion. I was able to meet with Congress members and their volved in the pursuit of Provider Status, with headquarters staff to speak about the education that we receive as stulocated in our nation’s capital. Supporting patient access to dents and how it qualifies us to offer a broader range of pharmacists’ services and expanding pharmacists’ role in clinical services upon graduation. healthcare represent a few of their priorities. I participated My experience at the national level was an incredible eyein a 10-week long training program designed to provide opener. It made me realize part of what I can do as a stuexperience in various aspects of pharmacy including prodent to help expand the role of pharmacists and have the fessional and public affairs, medication information, publiservices we provide recognized under Medicare Part B. I cations and governmental affairs. now have a better appreciation for the importance of advoThroughout my internship, I had the opportunity to work on cating for our profession to promote what pharmacists can several projects related to pressing issues currently faced offer to improve patient outcomes. As I move forward with by the profession of pharmacy. I participated in collaboramy career, I plan on continuing to apply what I learned to tive efforts aimed at advancing patient care. I worked keep pharmacy unified and help take our place on the alongside leaders to develop various resources for stuhealth care team. I will remain politically active both dents, residents and residency program directors, create a throughout the remaining of my time in pharmacy school classification scheme to rank states according to their deand beyond graduation to keep advancing the professional gree of provider status, work on the Pharmacy Practice practice of pharmacy. I highly encourage everyone in our Model Initiative (PPMI) and participate in a visit with Conprofession to join political efforts aimed at advancing colgressional staff to advocate for provider status. In an effort laborative care in Kentucky and provider status at the Fedto help implement the latest philosophies of pharmacy lead- eral level. Together, we can help others understand our ership, I also wrote an article for the AJHP student column essential role on the healthcare team and help optimize to help pharmacy students maximize their potential to patient care. 18

THE KENTUCKY PHARMACIST

CE Article Guidelines

January 2015

YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to completing a continuing education article for publication in The Kentucky Pharmacist.  

 



Include a quiz over the material. Usually between 10 to 12 multiple choice questions.



Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers.

Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred). 

When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.

Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not pertinent to technicians, that needs to be stated clearly Articles should address topics designed to narrow at the beginning of the article. gaps between actual practice and ideal practice in Article should begin with the goal or goals of the pharmacy. Please see the KPhA website overall program – usually a few sentences. (www.kphanet.org) under the Education link to see Include 3 to 5 objectives using SMART and meas- previously published articles. urable verbs.



Articles must be submitted electronically to the KPhA director of communications and continuing education Feel free to include graphs or charts, but please submit them separately, not embedded in the text (ssisco@kphanet.org) by the first of the month preceding publication. of the article.

THE KENTUCKY PHARMACIST

2015 KPhA Professional Awards

January 2015

2015 KPhA Professional Awards Bowl of Hygeia Award Criteria – To recognize an individual who has demonstrated outstanding community service in pharmacy. Eligibility – The recipient must be an Active or Honorary Life member of the Association. The recipient must be a pharmacist with a current valid license to practice in Kentucky. The recipient must be living, awards are not presented posthumously. The recipient has not previously received the award and is not currently serving nor has he/she served within the past two years on the selection committee or as an officer of the Association in other than ex-officio capacity. The recipient has compiled an outstanding record of community service that apart from his/her specific identifications as a pharmacist reflects well on the profession. Bowl of Hygeia Previous Recipients Jerry White 2014 Leon Claywell 2013 George F. Hammons 2012 William I. McMakin, III 2011 Kim Croley 2010 Patricia Thornbury 2009 Dave Peterson 2008 Charles Fletcher 2007 Gloria Doughty 2006 Larry Hadley 2005 Harold Cooley 2004 Brian Fingerson 2003 Simon Wolf 2002 Richard Ross 2001 Tom Houchens 2000 Phil Losch 1999 Lucy Easley 1998 Nick Schwartz 1997 Michael Cayce 1996 Bill Borders 1995 Gerald Deom 1994 Kenneth Calvert 1993 Joseph G. Bessler 1992 Michel A. Burleson 1991 Lynn Harrelson 1990 William A. Conyers, Jr. 1989 Daniel R. Kovar, Jr. 1988 Martin W. Nie 1987 Ralph Schwartz 1986 Dwaine K. Green 1985 W. Vance Smith 1984 Richard L. Roeding 1983 William J. Farrell, Sr. 1982 Joseph L. Scanlon 1981

Joseph T. Elmes, Jr. H. Joe Russell Alvin R. Bertram Norman C. Horn H. Joseph Schutte D.H. "Sonny" Ralston Arthur G. Jacob James M. Brockman Richard E. Murray Randolph N. Smith Oliver E. Mayer Donald C. Morwessel James Phillip Arnold William D. Morgan Ernest M. Davis W.F. Bettinger Arvid E. Tucker Vernon B. Hager Sidney Passamaneck John H. Voige E. Crawford Meyer James J. Hamilton

1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959

R. David Cobb 1990 Joseph G. Bessler & Arthur G. Jacob 1989 Paul E. Davis 1988 Norman Horn & Robert E. Lee Sandlin 1987 Joseph V. Swintosky 1986 J.H. (Jack) Voige 1985 Charles T. Lesshafft, Jr. 1984 Jerry Budde 1983 William H. Nie 1982 R.N. (Randy) Smith 1981

Pharmacist of the Year Award

Criteria – To recognize a pharmacist for outstanding professional activities undertaken during the current or previous calendar year, which resulted in demonstrable benefit to the profession of pharmacy. Eligibility – Only Active or Honorary Life members of the Association shall be eligible for nominations and receipt Distinguished Service Award of this award. Criteria- To recognize individual mem- Pharmacist of the Year Previous Rebers who have made significant contri- cipients butions to the Association or the proJill Rhodes 2014 fession at large over an extended peri- Trish Freeman 2013 od of time. Alyson Schwartz 2012 Eligibility – Only Active or Honorary William Grise 2011 Life members of the Association shall Holly Byrnes 2010 be eligible for the award. No individual Dave Sallengs 2009 shall be a recipient of the award more Kelly Smith 2008 than once. Joseph Bickett 2007 Distinguished Service Award Paul Easley 2006 Previous Recipients John Anneken 2005 William Grise & Judy Minogue 2014 Kim Croley 2004 Catherine Hanna 2013 Ralph Bouvette 2003 Glenn Stark 2012 David Jaquith 2001 Kenneth Roberts 2011 Melinda Joyce 1999 Ann Amerson & Lynn Harrelson 2010 Michael Wyant 1998 Larry Hadley 2009 Phil Losch 1997 Dwaine Green 2008 Tom Houchens & Bob Kuhn 1996 John Brislin 2007 Don Ruwe 1995 Donnie Riley 2005 Mark Edwards 1994 Gloria Doughty 2004 C. Dave Peterson 1993 Coleman Friedman 2003 Brian Fingerson 1992 Joe Fink III 2002 Martin W. Nie 1991 Melinda Joyce 2002 Judy Minogue 1990 David Jaquith 1999 Paul Ruwe 1989 R. Paul Easley & Jeff Osman 1998 Joseph L. Fink III 1988 Ralph Bouvette 1997 Steven R. Adams 1987 Pat Chadwell 1996 William J. Farrell 1986 Jordan Cohen and Marty Nie 1995 Harold G. Becker 1985 Mike Montgomery 1994 Dwaine K. Green 1984 Richard Ross 1993 R. David Cobb 1983 Thomas Weisert 1991 Richard E. Murray 1982 20

THE KENTUCKY PHARMACIST

2015 KPhA Professional Awards Richard Rolfsen Gloria H. Doughty Joseph G. Bessler Emil Baker Robert L. Barnett Joseph L. Scanlon John B. Anneken Alvin R. Bertram Patricia A. Donahue H. Joseph Schutte Willard Alls Joe D. Taylor Richard L. Ross Ralph J. Schwartz George W. Grider Robert J. Lichtefeld E.M. Josey Julius T. Toll Charles E. Otto Charles F. Rosenberg R.N. Smith E. Crawford Meyer Charles A. Walton Ernest C. Williams George W. Grider Ray Wirth Nathan Kaplin Marion Hardesty

January 2015

1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954

Sullivan University College of Pharmacy student chapter of APhA-ASP 2012 Lynne Eckmann 2011 Gloria Doughty & Lynn Harrelson 2010 Jordan Covvey 2009 Jeff Mills 2008 Trish Freeman 2007 Sherry DeCuir 2006 Pete Orzali 2005 John Armistead, Don Kupper & Willie Newby 2004 Kroger Pharmacy Mid South Division, Holly Divine, Randy Gaither, Bill Grise & Laura Jones 2003 Jefferson County Academy of Pharmacy, Dean Ken Roberts 2002 Paul Easley, Bob Oakley and Michael Wyant 2001 Judy Minogue 2000 Ralph Bouvette 1999 Rodger Smith, Barbara Woerner, Mary Ann Wyant, and Rick Vissing 1998 Larry Spears 1997 John B. Anneken 1996 Phil Losch 1995 Jordan Cohen 1994 Judy Minogue 1994 Professional Promotion Award Kentucky Academy of Student Criteria – To recognize individuals or 1993 organizations who have exhibited out- of Pharmacy Celeste Flick & Clarence Sullivan III standing efforts to demonstrate the 1988 importance of pharmacy as a health William H. Nie 1987 care profession, and which promote 1986 proper application of pharmacists’ pro- Student Kentucky APhA Northern KY Pharmacists Association fessional services. 1986 Eligibility – Open to persons or organizations. Professional Promotion Previous Young Pharmacists of the Year Recipients Award sponsored by Cassandra Beyerle 2014 Pharmacists Mutual Insurance Julie N. Burris Company & Walgreens Corporation 2013 Criteria – To recognize a young phar-

macist’s outstanding contribution to the profession and/or community. Eligibility – The recipient must be an Active member of the Association. The recipient must be licensed to practice for nine years or less. The recipient must have a valid, active license to practice in Kentucky. The recipient must have demonstrated participation in a national pharmacy association, professional program(s) and/or community service. Distinguished Young Pharmacist Award Previous Recipients Chris Harlow 2014 Brooke Hudspeth 2013 Stacy Rowe 2012 Aimee Ruder 2011 Karen Hubbs 2010 Matt Martin 2009 Tiffany Self 2008 Angela Parrett 2007 Janet Mills 2006 Alyson Schwartz 2005 Nancy Horn 2004 Jennifer O’Hearn 2003 Karen Altsman 2001 Kim Wilson 1999 Kim Harned 1998 Michael Box 1997 Dan Yeager 1996 Dan Minogue 1995 Pan Haeberlin 1994 Kim Croley 1993 Phillip Sandlin 1992 Jeffrey W. Danhauer 1991 Mark S. Edwards 1990 Susan Murray Kathman 1989 Melinda Cummins Joyce 1987

Nominate your peers today! Email your letter of nomination with any supporting documents to ssisco@kphanet.org or submit to: KPhA Awards DEADLINE IS MARCH 31! 1228 US 127 South 21

THE KENTUCKY PHARMACIST

2015 KPhA Professional Awards Excellence in Innovation Award Sponsored by Upsher-Smith Laboratories Criteria – To recognize a pharmacist who has demonstrated innovative pharmacy practice resulting in improved patient care in the previous year or over an extended period of time. Eligibility – A recipient must be a pharmacist who is an Active or Honorary Life member of the Association. A recipient may receive the award more than once. Innovative Pharmacy Practice Award Previous Recipients Brooke Hudspeth 2014 Buddy Wheeler 2013 Lynn Harrelson 2012 James Nash & BC Childress 2011 Lynne Eckmann & Cathy Hanna 2010 Ann Albrecht 2008 Lisa Short 2005 Holly Divine, Amy Nicholas 2004 Judy Minogue 2003 Trish Freeman 2002 Mary Ann Wyant 2001 Joyce Korfhage Rhea 2000

January 2015 Cathy Edwards Celeste Flick Jeanne Zeis Dave Wren Preston Art W. Michael Leake

1999 1998 1997 1996 1995 1994

Cardinal Health Generation Rx Champions Award

Criteria – This award program recognizes excellence in community-based prescription drug abuse prevention at state pharmacy associations. This award honors a pharmacist who has Technician of the Year Award demonstrated outstanding commitment Criteria – To recognize a Certified to raising awareness of the dangers of Pharmacy Technician for outstanding prescription drug abuse among the professional activities. general public and among the pharmaEligibility – Only active Pharmacy cy community. The award is also inTechnician members of the Associatended to encourage educational pretion shall be eligible for nomination and vention efforts aimed at patients, youth receipt of this award. and other members of the community. Don Carpenter 2014 In addition to the award, to honor the Leslie Lochner & Robin Lillpop 2013 pharmacist’s work to fight prescription Patricia Robinson 2012 drug abuse, APMS, state pharmacy Jessica Salmons 2011 associations and the Cardinal Health Gwen Otter 2010 Foundation will donate $500 to a chariLisa Sawvel 2008 ty of the award recipient’s choice. Margaret Sinkhorn 2007 Cardinal Health Generation Rx Charlotte Bowling 2006 Champions Award Past Recipients Mary Jane Wathen 2005 Amber Cann 2014 Kent Williams 2004 Raymond Float 2013 Tammy Newsome 2003 Brian Fingerson 2012 Frank Ray 2002 Jane Woerner 2001

Kentucky Pharmacists Political Advocacy Contribution Form Name: _________________________________ Pharmacy: ___________________________ Address: _______________________ City: ________________ State: _____ Zip: ________ Phone: ________________ Fax: __--_______________ E-Mail: __________________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601

CONTRIBUTION LIMITS The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election. Individuals may contribute no more than $1,500 per year to all PACs in the aggregate. In-kind contributions are subject to the same limits as monetary contributions.

Cash Contributions: $50 per contributor, per election. Contributions by cashier’s check or money order are limited to $50 per election unless the instrument identifies the payor and payee. KRS 121.150(4) Anonymous Contributions: $50 per contributor, per election, maximum total of $1,000 per election. (This information is in accordance with KRS 121. 150)

THE KENTUCKY PHARMACIST

Pharmacy Time Capsules

January 2015

Pharmacy Time Capsules 1990 OBRA 1990 passed. States required to offer prospective and retrospective DUR. Patient counseling mandatory for Medicaid patients. Society of Infectious Diseases Pharmacists founded. 1965 Title XVIII and XIX (Medicare and Medicaid) passed. Quaalude (methaqualone Rorer) named to invoke the phrase “quiet interlude” was approved. The drug was discontinued in 1985 because of its addictiveness and recreational use. 1940 Ida M. Fuller became the first person to receive an old-age monthly benefit check under the new Social Security law. 1915 Abraham Flexner refused to do a study of pharmacy similar to his study of medical education. He describes pharmacy as “nonprofessional because it is unintellectual, highly profit motivated, without a technique of its own and without a primary responsibility.”

By: Dennis B. Worthen, PhD, Cincinnati, OH One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America's history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org

THE KENTUCKY PHARMACIST

hubonpolicyandadvocacy

January 2015

Advocacy 101: How to set up a pharmacy visit Alka Bhatt

hubonpolicyandadvocacy

2015 PharmD candidate and APhA Extern

In early August, Stephen Gagnon, PharmD, received a “call to action” e-mail from APhA to contact his Member of Congress.

Interestingly, Gagnon’s answer to the question of the most underused service was the same. “Pharmacists are overutilized by patients for our knowledge, but underutilized by the rest of the medical community for what we know and are able to do,” he said.

A graduate of Albany College of Pharmacy and Health Sciences, Gagnon has been an employee of CVS Health for more than 14 years, five of those years as a pharmacist. Gag- Practice equals advocacy non also spends one day a week working at a compounding Pharmacy visits are a very strong tool in advocating for the facility, is a credentialed HIV pharmacist and is licensed in profession. Pharmacy visits do not require a pharmacist to both New York and Florida. be knowledgeable about politics or advocacy. They are an APhA’s e-mail was a template letter urging congressional opportunity to let the passion for patient care speak for support for H.R. 4190, the federal bill that would amend Title itself. XVIII of the Social Security Act to enable patient access to, APhA, through its website at pharmacist.com, can help you and coverage for, Medicare Part B services by statearrange a pharmacy visit. State-specific materials and inforlicensed pharmacists in medically underserved communities. mation, in addition to a how-to guide that offers valuable “I forwarded it on [to my U.S. representative], not thinking information, are available at www.pharmacist.com/how-setanything about it. I figured nobody is ever going to read this, your-pharmacy-visit. see this. It’s just spam mail, and it will be thrown out,” GagPositive response non said in an interview with Pharmacy Today. “But I sent it Always a supporter of the profession, Tonko officially signed anyway because it was the right thing to do for the profeson to cosponsor H.R. 4190 on September 16. The Member sion.” of Congress told Gagnon that he had been present when A week later, the office of Rep. Paul Tonko (D-NY) respondthe profession shifted from the 5-year BSPharm to the ed to the pharmacist. PharmD. With support from CVS Health corporate, Gagnon was able “I was glad to have the opportunity to meet with the team at to set up a pharmacy visit from his Member of Congress. On the Clifton Park CVS and learn more about their operations September 26, Tonko—by then one of the 116 cosponsors and what factors ultimately contribute to their successes,” of H.R. 4190—came to one of the busiest pharmacies in the Tonko told Today. “Our pharmacists have an important role Albany, N.Y., area. to play in our mission to expand access to quality care, but they need the tools to do so.” Community practice site The Clifton Park CVS/pharmacy store fills 5,000 to 5,200 prescriptions a week for patients in the community. This site offers many clinical services, including but not limited to drug utilization reviews and immunizations. The store does not house an automatic blood pressure machine, so pharmacists must manually take the reading, which offers a unique counseling opportunity outside of the dispensing role.

Tonko continued, “That is why I value my work with local pharmacists to pass H.R. 4190—legislation that would provide pharmacists across the nation with the tools they need to improve outcomes, enhance quality and reduce costs in our health care delivery system.”

Asked about the most used service at the practice site, Gagnon replied, “Pharmacists’ knowledge. Patients take advantage of how accessible pharmacists are. I can literally be in the middle of giving a flu shot, and I have a patient coming up to me. I have to ask them to give me a second to finish giving the flu shot before addressing their question. We’re so accessible [that] patients are always coming up to ask their pharmacist about every medical ailment. We do our best to provide what we can.” 24

Reprinted with permission from the Hub on Policy and Advocacy column in the November 2014 issue of Pharmacy Today (www.pharmacytoday.org). For more information about ways for pharmacists to follow and influence the federal, state, and local processes that are defining the structure of a reformed American health care system, access the Get Involved section of APhA’s website, www.pharmacist.com. Copyright © 2014, American Pharmacists Association. All rights reserved.

THE KENTUCKY PHARMACIST

In Memoriam

January 2015

In Memoriam KPhA offers its condolences to the family and friends for longtime member Jack Carver, who passed away Jan. 3, 2015.

KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA informed by sending this information to eramey@kphanet.org. Deceased members for each year will be honored permanently at the KPhA office.

Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________

Email: ______________________________________________________________ Address: _____________________________________________________________ City: ___________________________________________ State: _________ Zip: ____________ Phone: ________________ Fax: __--_______________ E-Mail: ______________________________ Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601

THE KENTUCKY PHARMACIST

2015 Kentucky Legislative Session

January 2015

2015 Kentucky Legislative Session The 2015 Kentucky Legislative Session began with an organizational week in early January. This session, which is a short 30-day session, runs through February and March, with sine die adjournment scheduled for March 24. YOUR KPhA will keep you abreast of all of the pharmacy related issues before the legislature through social media and weekly email updates. Follow KPhAâ&#x20AC;&#x2122;s Legislative Advocacy Twitter feed @KPhAGrassroots. Staff live Tweets committee meetings and general sessions of the legislature. Not receiving the Friday Legislative Update? Send your email address to Scott Sisco at ssisco@kphanet.org. Donate online to the Kentucky Pharmacists Political Advocacy Council! Go to www.kphanet.org and click on the Advocacy tab for more information about KPPAC and the donation form.

THE KENTUCKY PHARMACIST

Kentucky Renaissance Pharmacy Museum

January 2015

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's leading preservation organization for pharmacy. While contributions of any size are greatly appreciated, the following levels of annual giving have been established for your consideration.

Friend of the Museum $100  Proctor Society $250 Damien Society $500 Galen Society $1,000 Name______________________________________ Specify gift amount________________________ Address ____________________________________ City____________________Zip______________ Phone H____________________W________________ Email___________________________________ Employer name_____________________________________________________for possible matching gift. Tributes in honor or memory of_____________________________________________________ Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax deductible contributions will be mailed to you annually.

Questions: Contact Lynn Harrelson @ 502-425-8642 or Lharrelsonky@aol.com

For more information on the museum, see www.pharmacymuseumky.org or contact Gloria Doughty at g.doughty@twc.com or Lynn Harrelson at lharrelsonky@aol.com. Pharmacists Mutual Insurance offers Medicare Surety Bond In 2009 the Centers for Medicare and Medicaid Services (CMS) implemented Surety Bond Requirements for suppliers of Durable Medical Equipment, Prosthetics and Supplies (CMS-6006-F). This ruling requires that each existing supplier must have a $50,000 surety bond to CMS.

To see if you qualify for a $250 Medicare Surety Bond, or would like information regarding our other products, please contact us:   

Pharmacists Mutual Insurance Company, through its subsidiary PMC Advantage Insurance Services, Inc. d/b/  a Pharmacists Insurance Agency (in California), led the way to meet this requirement by negotiating the price of the bond from $1,500 down to $250 for qualifying risks.

Call 800.247.5930 Extension 4260 E-mail medbond@phmic.com Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/ services/ibs/Pages/Home.aspx In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

January 2015

KPhA Welcomes New and Renewing Members November-December 2014 Jamal Aboulhosn Louisville

Chris Bowling Barbourville

Heather Clayton Elkton

Donna Adams Sebree

Ngoc Anh Bradshaw Louisville

Richard Clement Cadiz

Matthew Andrews Fisherville

Jackson “Mac” Bray Frankfort

Robert Clement Cadiz

John Anneken Edgewood

Brenda Brewer Stanton

Kem Coe Tompkinsville

Paul Arthur Huntington, W. Virg.

Deborah Brewer Sandy Hook

Adam Coffman Nortonville

Heidi Bainer Pedro, Oh

Sam Brown Murray

Samuel Coletta Cincinnati, Oh

Chester Baltenberger Louisville

William Brown Wingo

Bonnie Collins Paris

Verlon Banks Whitesburg

Charles Bryant Cave City

Stephanie Collins Corbin

Stephanie Bargo Lexington

Jimmy Buchanan Prospect

George Combs Louisville

Jennifer Barker Morehead

Michael Burleson Lexington

David Conyer Paducah

Jessica Baugh Shepherdsville

Scott Burris Partridge

Karen Cornelius Harrogate, Tn

Walter Bauman Lancaster

Robert Burton Hazard

Charlotte Cornett London

Justin Bell Lexington

Ashley Calvert Bloomfield

Melvin Croley Park City

Danny Bentley Russell

Mashawna Caudill Isom

Matt Cull Owenton

Thomas Beringer Sparta

John Chaney Hazard

Dan Daffron Monticello

Robert Bero New Bern, Nc

Brian Cheek Louisville

William Danhauer Owensboro

Renee' Blair London

Janie Cheek Louisville

Marshall Davis Paducah

Bradley Boone Marion

Rebecca Cheek London

Kecia Dawson Prospect

Diana Bowles Sonora

William Clark Owensboro

Pamela Decker-Meadows Cynthiana 28

MEMBERSHIP MATTERS: To YOU, To YOUR Patients To YOUR Profession! Laura Dehart Paducah James Denton Georgetown Marie Denton Georgetown John Dickerson Olive Hill Alfred Diebold Louisville Brad Doering Burlington Walter Doll Lexington Kenneth Dove Winchester Ben Doyle Nicholasville Jane Dunbar-Suwalski Longmont, Co

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

January 2015

Paul Easley Fisherville

Mary Gilvin Mt. Sterling

Robin Hipps New Albany, In

Michael Keller Salem

Anna Eiler Shepherdsville

Amy Glaser Alexandria

Jody Holland Pikeville

Diane Kelly Evarts

Joseph Eiler Louisville

Rosemary Goble Inez

Sara Holliday Owensboro

Rene Kendrick Taylorsville

Suzanne Epley Russellville

Nevin Goebel Winchester

Celina Howell Pikeville

Melissa Kennon Lexington

Frank Facione Louisville

Michael Goeing Melvin

Taryn Howell Prestonsburg

Anita King Richmond

William Farmer Henderson

Wayne Gravitt Wheelwright

Travis Hudnall Smiths Grove

Ethan Klein Louisville

Lindsay Ferrell Owingsville

Gina Guarino Louisville

Melissa Hudson Villa Hills

James Knight Berea

Michael Fitch Lexington

Patty Guinn Somerset

John Hutchinson Lexington

John Knoop Louisville

Lindsey Flanders Bowling Green

Julie Hagan Paducah

Gerard Hyland Manchester

Don Kupper Louisville

Matthew Flanders Bowling Green

Cara Hale Inez

Bernard Hyman Louisville

Richard Lacefield Bowling Green

Martha Ford Fort Thomas

Eman H. Hammad Louisville

Arthur Jacob Louisville

Randall Lange Butler

Larry Fortenberry Pikeville

Catherine Hance Louisville

Kyla James Sellersburg, In

Amanda Leathers Lebanon

Andy France Covington

Robert Haney Bedford

Amanda Jett Louisville

Teresa Leslie Prestonsburg

Virginia France Covington

Amanda Harding Louisville

Ella Johnson Hazard

Martin Likins Greenville

Tom Frazier Salyersville

Ellen Harrison Tompkinsville

Frederick Johnston Georgetown

Michael Lin Louisville

Randy Gaither Louisville

Marla Helton Frenchburg

Linda Johnston Georgetown

James Litmer Edgewood

Judy Gallagher Madisonville

Clara Herrell Lexington

Constance Jones Russell Springs

Robert Little Berea

Timothy Gallagher Madisonville

Whitney Herringshaw Winchester

Kimberly Jones Williamsburg

Kay Lloyd Louisville

Milton Gardner Jeffersontown

Jennifer Hibbs Louisville

Misty Jones Aurora, Il

Morris Lloyd Louisville

Eric Gibbs Corbin

Linette Hieneman Flatwoods

Robin Justice Pikeville

Michelle Loos Covington

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

January 2015

Sheri Lucas Millstone

Jennifer Morgan Manchester

Kenneth Parsons Louisville

Gary Russell Madisonville

Mike Lusk Betsy Layne

Megan Morgan Manchester

Lindsey Peden Bowling Green

Paul Ruwe Covington

John Lutz Louisville

Jerry Morris Louisville

Alfred Pence Stanford

Wanda Salyer Flat Gap

Calvin Manis Barbourville

Wayne Morris Frankfort

David Peyton West Liberty

Christen Schenkenfelder Louisville

Jonathan Marquess Acworth, Ga

Sherri Muha Hazard

Ronald Poole Central City

Nicholas Schwartz Florence

Craig Martin Georgetown

Stephanie Myers Louisville

David Powers Jenkins

Benjamin Scott Lexington

Samantha Martin Greenville

Edwin Nickell Eddyville

Vicky Pulliam Bardstown

Ginger Scott Morgantown, W.Virg.

Tom Mattingly Olive Hill

Kenneth Niemann Harrodsburg

Jonathon Ratley Henderson

Kimberly Scott Frankfort

Nancy Matyunas Louisville

Leanne Nieters Louisville

Christi Ratliff Pikeville

Mary Scott Robinson Creek

Donald Mays Fort Thomas

Paul Nixon Tompkinsville

Fran Reasor Pikeville

Terrence Seiter Burlington

Thomas McCurry Harlan

Donald Noble Garrison

Ronald Renfrow Bowling Green

George Shackleford Corbin

Leeann McDonald Dunnville

Freddie Norris Glasgow

Herbert Rice Grand Rivers

Kent Shearer Albany

Clayton McKinney Shelbyville

Patricia Oldis Louisville

Jerry Rickard Madisonville

William Shely Morehead

Michael McWilliams Louisville

Charles Oliver Glasgow

Vendonna Rickard Madisonville

Jennifer Shown Hopkinsville

Beverly Meeks Paducah

Angela Onkst Louisville

Amber Riesselman Louisville

Michael Sizemore London

Ross Melton Mount Sterling

Peter Orzali Cold Spring

Donald Riley Russellville

Sharon Small Louisville

Paula Miller Fort Thomas

Lauren Otis Owingsville

James Robinette London

William Smallwood Independence

Parvin Mischel Kathleen, Ga

Staci Overby Paducah

Matthew Robinson Owensboro

Jamie Smith Booneville

Michael Montgomery Nicholasville

Yvonne Parmley Florence

Lynda Romeo Louisville

Jessica Smith Booneville

Jason Moore Corbin

Duane Parsons Richmond

Jesse Rudd Salyersville

Sarah Smith Louisville

THE KENTUCKY PHARMACIST

KPhA New and Returning Members

January 2015

George Snider Bardstown

Carolyn Taylor Crestwood

Anthony Warford Clay

Wayne Sparrow Eminence

David Taylor Crestwood

Rob Warford Goshen

Larry Spears Crittenden

Jason Taylor Pineville

Glenn Watson Crestwood

Cathy Spencer Louisville

Mark Taylor Danville

Susan Weaks Paducah

Kelley Spencer Versailles

Nicole Thacker Huntington, Wv

Stacy Wedeking Metropolis, Il

Nancy Stanton Holmes Mill

Paul Thompson Harrodsburg

Robert Weir Louisville

Janet Stephens Scottsville

Rick Timmons Paducah

Clayton Wells Inez

Quincy Stephenson Providence

Fred Toncray Maysville

Leslie Wells Mt. Sterling

Laura Willoughby Hardinsburg

Doris Stone Kevil

Sheryl Turley Horse Cave

Sara Wells Gilbertsville

Carol Wills Lexington

Cindy Stowe Louisville

Geanie Umberger Lexington

Brian Wesselman Florence

Randy Windham London

Amanda Sublett Lexington

G Underwood Louisville

William Wheeler Lexington

Christine Windham London

Clarence Sullivan Richmond

Gabe Van Lahr Webster

Tyler Whisman Union

Jessica Wiseman Dayton

Tracy Sullivan Paducah

Joseph Vennari Lexington

Jerrold White Russellville

Denton Wood Grand Rivers

William Sutherland Louisville

Benjamin Vice Manchester

Marcia White Richmond

Dachea Wooten Hazard

Evan Sweeney Madisonville

Frank Vice Flemingsburg

Amy Wilder Booneville

Greg Wright Paducah

Jessica Sweeney Madisonville

Steven Wagers London

William Wiley Glasgow

Joseph Wright Lucasville, Oh

Meghan Tarter-Marcum Russell Springs

Nancy Walker Cynthiana

Christie Wilkins Lexington

Navas Yoonus Elizabethtown

KPhA Honorary Life Members Ralph Bouvette Leon Claywell Gloria Doughty Ann Amerson Stewart

Laban Young Huntington, W.Virg.

Know someone who should be on this list? Ask them to join YOU in supporting YOUR KPhA! 31

Timothy Young Mount Vernon Arnold Zegart Prospect

THE KENTUCKY PHARMACIST

Pharmacy Law Brief

January 2015

Pharmacy Law Brief: Pharmacy and the “Alford Plea”

Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: I have seen in news reports some reference to something called an “Alford Plea” and now a student on rotation with me has told me that a reference to that even appears in Board of Pharmacy regulations. What is that and why is it important to pharmacists?

Submit Questions: jfink@uky.edu Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.

Response: The relevant provisions in Kentucky statutes the student is referring to are: K.R.S. 315.121 – Grounds for acting against licensee – Notification to board of conviction required – Petition for reinstatement – Expungement (1) The board may refuse to issue or renew a license, permit, or certificate to, or may suspend, temporarily suspend, revoke, fine, place on probation, reprimand, reasonably restrict, or take any combination of these actions against any licensee, permit holder, or certificate holder for the following reasons:

untarily, knowingly and understandingly consent to the imposition of a prison sentence even if he is unwilling or unable to admit his participation in the acts constituting the crime.” By using an Alford plea, a defendant does not admit guilt but concedes there is enough evidence for conviction.

Kentucky is in the majority of states that provide this option to one charged with a crime. In fact, all states except Indi(c) Being convicted of, or entering an “Alford” plea or plea ana, Michigan and New Jersey have adopted it. of nolo contendere to, irrespective of an order granting proWhen used during a criminal proceeding the courts require bation or suspending imposition of any sentence imposed the plea to be of a voluntary nature and based on factual following the conviction or entry of such plea, one (1) or evidence. The judge will make an effort to determine whethmore of the following: er the defendant is entering the plea of his own choice, and 1. A felony; that there is a factual basis for the plea; this is accomplished by questioning the defendant about his choice and 2. An act involving moral turpitude or gross immorality; or the prosecution about the potential case against the de3. A violation of the pharmacy, drug or home medical fendant. A court cannot accept an Alford plea unless there equipment laws, rules, or administrative regulations of is independent factual evidence of the defendant’s guilt. this state, any other state, or the federal government. Entering an Alford plea is slightly different from pleading K.R.S. 315.121(4) – Any licensee, permit holder or certifi- nolo contendere, meaning “no contest.” Under “nolo”, the cate holder entering an “Alford” plea, pleading nolo conten- defendant neither admits nor disputes the charges but dere, or who is found guilty of a violation prescribed in sub- agrees to being sentenced for commission of the crime. section (1)(c) of this section shall within thirty (30) days noOnce entered, the plea is treated as a standard guilty plea. tify the board of that plea or conviction. Failure to do so An Alford plea is an “adjudication of guilt” and therefore shall be grounds for suspension or revocation of the liwould have to be reported in response to this question of cense, certificate or permit. the Kentucky Board of Pharmacy’s Pharmacist License ReThe Alford plea came into being from a U.S. Supreme newal Application: “Have you ever been convicted of any Court ruling in North Carolina v. Alford, decided during law related to the practice of pharmacy, drugs or controlled 1970. An Alford plea permits a defendant to maintain his substances that you have not previously reported to the innocence while agreeing to forego his right to a trial. The Board?” Furthermore, an Alford plea can be counted as a Court said that “an individual accused of a crime may vol- prior sentence under the U.S. sentencing guidelines. 32

THE KENTUCKY PHARMACIST

KPhA Save the Date/Connect/ EPIC

January 2015

Save the Date 137th KPhA Annual Meeting & Convention June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY Visit www.kphanet.org for more information!

Are you connected to YOUR KPhA? Join us online!

Facebook.com/KyPharmAssoc

@KyPharmAssoc @KPhAGrassroots

KPhA Company Page

THE KENTUCKY PHARMACIST

Pharmacy Policy Issues

January 2015

PHARMACY POLICY ISSUES: The 340(B) Program Author: Ekim Ekinci is a third professional year PharmD student at the University of Kentucky College of Pharmacy and is concurrently pursuing a Master of Science in Pharmaceutical Outcomes and Policy. Ekim is a native of Antalya, Turkey. She earned her Bachelor of Science in Chemistry from Rice University in Houston, Texas and completed post-baccalaureate coursework and doctoral classes in History of Medicine at University of Houston before starting pharmacy school. Issue: I’m a community pharmacist and I keep hearing and reading about the 340(B) program, something that did not exist when I was in pharmacy school. I had the impression that this was a hospital pharmacy issue with no relevance to community pharmacy practitioners. But a colleague recently told me that was not the case at all. Can you shed some light on this program, which I assume is a federal program of nation-wide application? Discussion: The 340(B) Drug Discount Program was Have an Idea?: established in 1992 with the enactment of a federal bipartiThis column is designed to address timely and practical san law. The program requires drug manufacturers to proissues of interest to pharmacists, pharmacy interns and vide outpatient drugs to eligible health care organizations pharmacy technicians with the goal being to encourage at significantly reduced prices. The cost savings allow eligithought, reflection and exchange among practitioners. ble organizations to stretch their scarce federal resources, Suggestions regarding topics for consideration are welreach more patients in their communities and provide more come. Please send them to jfink@uky.edu. comprehensive clinical services to all individuals without regard to ability to pay. Before delving into the details of this complex law, it may prove useful to briefly review cer- 340(B) discounted drugs. Thus a community pharmacy tain terminology. These terms include “covered entities,” practice may now dispense 340(B) covered outpatient “eligible patients” and “covered outpatient drugs.” drugs to eligible patients so long as it has a written contractual agreement with a covered entity, remain compliant with The term “covered entities” usually refers to nonprofit all federal requirements and maintain auditable records health care organizations that have certain federal designadocumenting their compliance. tions or receive funding from specific federal programs, and are therefore eligible to purchase drugs through the 340(B) Contract pharmacies allow a covered entity to reach out to program at discounted prices. a broader area. Covered entities will refer their eligible pa“Eligible patients” are those who are eligible under law to receive 340(B) covered outpatient drugs. To be eligible, a patient has to be receiving services from a health care professional associated with a covered entity, such that the responsibility of care remains with the covered entity. However, if the only health care service received by the patient through the covered entity is the dispensing of a drug for self-administration, the patient is not considered eligible.

tients to contract pharmacies, which provides clinic and community pharmacies with an incentive to become contract pharmacies. While each covered entity may have their own contract provisions, some may be willing to provide financial incentives as well.

Both the covered entity and the contract pharmacy carry the responsibility to ensure against illegal diversion of drugs obtained under 340(B) pricing to ineligible patients. It “Covered outpatient drugs” are any FDA-approved pre- is important for contract pharmacies to ensure 340(B) scription and over-the-counter drugs, and biological prod- drugs are dispensed only to eligible patients of the covered ucts (except vaccines) for which the patient has a prescrip- entity. This may require the pharmacy to keep two separate inventories, one dedicated only to 340(B) discounted drugs tion, as well as clinic-administered drugs. and the other for drugs purchased at regular market prices. A complete list of eligible organizations, patient eligibility requirements and covered outpatient drugs can be found Covered entities and contract pharmacies also need to enon Health Resources and Services Administration (HRSA) sure that Medicaid rebates are not paid on drugs purchased at 340(B) prices. Each state is specific in their Medwebpage3. icaid Program requirements to avoid such “duplicate disAt the time of its enactment 340(B) indeed did not apply to counts.” community pharmacy practitioners. However, the law has been greatly expanded over the years to now allow cov- With so many stakeholders involved, it is not surprising that ered entities to contract with multiple clinic or community the 340(B) Drug Discount Program is surrounded by conpharmacies that would normally not be eligible to receive troversies. Stakeholders disagree on the intent of the law, 34

THE KENTUCKY PHARMACIST

January 2015

Pharmacy Policy Issues

as well as on the definitions introduced by it. The main rather keep the money as savings for themselves. conflict, however, seems to stem from a disagreement on The 340(B) Drug Discount Program plays an important role who the law is meant to serve. in supporting those institutions that serve the most vulneraAccording to Safety Net Hospitals for Pharmaceutical Ac- ble patients. The law has been and still is a topic of heated cess, 340(B) makes safety net providers eligible for the debate due to the many stakeholders involved who do not program, not just uninsured patients. Under the law any agree on how the law should be applied. The only aspect patient of the covered entity may be provided the discount- of 340(B) on which all parties agree is that the rules goved drugs, without regard to patient’s health insurance sta- erning the program are in need of improvement. One thing tus. Opponents argue that the law is meant to serve the that is for certain is that unless changes are made to the uninsured, and therefore 340(B) discounted drugs should law to put an end to all the controversies, our most vulneronly be provided to uninsured patients of the covered enti- able patients’ health will remain at stake. ty. Opponents suggest that some hospitals use 340(B) Individuals who are interested in learning more about the drugs for both insured and uninsured patients, and thus program are encouraged to check out the 340(B) Universieffectively make money when insurance companies reimty,2 an in-depth educational program created by a nonprofit burse them for these medications at market rates. organization that serves as the exclusive contractor for the Proponents of the law state that Congress’s intent in imple- Health Resources and Services Administration’s 340(B) menting 340(B) was to reduce costs of eligible organiza- Prime Vendor Program. tions in recognition of their mission to serve low-income References and vulnerable patients. According to their argument, 340 (B)’s purpose has always been to enable hospitals to 1. "340B Drug Pricing Program." 340B Drug Pricing Program. Health Resources and Services Administration, n.d. Web. 25 stretch their scarce resources without dictating the exact Aug. 2014. <http://www.hrsa.gov/opa/>. 4 manner in which the savings should be spent. On the other hand, opponents argue that more control over utilization 2. "340B University." 340B PVP. Apexus Inc., n.d. Web. 10 Sept. 2014. <https://www.340bpvp.com/340b-university/>. of savings is needed, because the intent of 340(B) was to ensure that discounted drugs are provided to uninsured 3. "Eligibility & Registration." Eligibility & Registration. Health Resources and Services Administration, n.d. Web. 5 Sept. patients who cannot afford them, not to those who are in2014. <http://www.hrsa.gov/opa/eligibilityandregistration>. sured, and certainly not to hospitals. 4.

Another major argument focuses on taxpayer money. Proponents of the law argue that 340(B) reduces taxpayer burden as discounted drugs and expanded clinical services 5. with the use of 340(B) savings help keep underserved populations healthy. The counter argument suggests that many hospitals do not expand their clinical services, but

Setting the Record Straight on 340B: A Response to Critics. N.p.: Safety Net Hospitals for Pharmaceutical Access, July 2013. PDF. Wright, Elizabeth. "What is the 340B Program and Why You Need to care." What is the 340B Program and Why You Need to Care. Citizens Against Government Waste, 14 May 2014. Web. 27 Aug. 2014. <http://swineline.org/?p=8853>.

respective risk of economically-motivated adulteration, based on a multi-factorial risk-based model we developed. Scott, as a follow up of the November article, “New Federal A subset of these high-risk ingredients is targeted for addiLegislation Targets International Counterfeiting of Pharmational sampling and testing at the border. ceuticals” by Claire Hafner, could it be possible to expose those companies that have been counterfeiting, in order In addition, FDA is working to reduce the risk that counterthat the public would not be at least dealing with them any- feit or adulterated drug products reach consumers in the more??? - Jacob Wishnia US market by developing standards for track and trace sysLoyal KPhA member writes from Florida:

Joe Fink responds for Claire, who is in the middle of exams as this issue is assembled, with this: Jake's suggestion is a good one but I suspect that the highly devious individuals who operate such firms would quickly change the company name to continue operations. The FDA has taken an active approach, focusing on the medication rather than the firm, announced by Commissioner Hamburg this way: "The FDA has systematically ranked more than 1,000 active pharmaceutical ingredients in order of their

tems that enable the identification of these products and facilitate efforts to recall them." This product-focused approach is probably a wise one. We've recently seen reports of counterfeit Cialis®, a drug product much more likely to be targeted by counterfeiters than a medication in some other therapeutic categories. KPhA expresses thanks to Jake for following up his reading of the article with an insightful question. 35

THE KENTUCKY PHARMACIST

January 2015

Pharmacists Mutual

THE KENTUCKY PHARMACIST

Cardinal Health / Generation Rx Champions Award

January 2015

THE KENTUCKY PHARMACIST

KPhA Board of Directors/Staff

January 2015

KPhA BOARD OF DIRECTORS

HOUSE OF DELEGATES

Duane Parsons, Richmond dandlparsons@roadrunner.com

Chair 502.553.0312

Ethan Klein, Louisville kleinethan@gmail.com

Speaker of the House

Bob Oakley, Louisville Boakley@BHSI.com

President

Chris Harlow, Louisville cpharlow@gmail.com

Vice Speaker of the House

Chris Clifton, Villa Hills chrisclifton@hotmail.com

President-Elect

KPERF ADVISORY COUNCIL

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Secretary

Kim Croley, Corbin kscroley@yahoo.com

Glenn Stark, Frankfort glennwstark@aol.com

Treasurer

Kimberly Daugherty, Louisville kdaugherty@sullivan.edu

Raymond J. Bishop raybishop13@gmail.com

Past President Representative

Mary Thacker, Louisville mary.thacker@att.net

Directors

Matt Carrico, Louisville matt@boonevilledrugs.com

Matt Carrico, Louisville* matt@boonevilledrugs.com

KPhA/KPERF HEADQUARTERS 1228 US 127 South, Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.twitter.com/KPhAGrassroots www.youtube.com/KyPharmAssoc

Tony Esterly, Louisville tonye50@hotmail.com Matt Foltz, Villa Hills mfoltz@gomedcare.com Chris Killmeier, Louisville cdkillmeier@hotmail.com Mallory Megee, Nicholasville mallory.megee@uky.edu

University of Kentucky Student Representative

Jeff Mills, Louisville jeff.mills@nortonhealthcare.org

Scott Sisco, MA Director of Communications & Continuing Education ssisco@kphanet.org

Chris Palutis, Lexington chris@candcrx.com Christian Polen cpolen7392@my.sullivan.edu

Robert McFalls, M.Div. Executive Director rmcfalls@kphanet.org

Sullivan University Student Representative

Richard Slone, Hindman richardkslone@msn.com Mary Thacker, Louisville mary.thacker@att.net Sam Willett, Mayfield duncancenter@bellsouth.net

Angela Gibson Director of Membership & Administrative Services agibson@kphanet.org Leah Tolliver, PharmD Director of Pharmacy Emergency Preparedness ltolliver@kphanet.org Elizabeth Ramey Receptionist/Office Assistant eramey@kphanet.org

* At-Large Member to Executive Committee

KPhA sends email announcements weekly. If you arenâ&#x20AC;&#x2122;t receiving: eNews, Legislative Updates, Grassroots Alerts and other important announcements, send your email address to ssisco@kphanet.org to get on the list. 38

THE KENTUCKY PHARMACIST

50 Years Ago/Frequently Called and Contacted

January 2015

50 Years Ago at KPhA AROUND THE STATE WITH DISTRICT MEETINGS The Jefferson County Academy of Pharmacy had their dinner dance and installation of officers January 24th. Joe T. Elmes, R.Ph., is the new President, succeeding William R. Walker, R.Ph. The First District had their installation of officers at a dinner dance January 28th. The new President is Howard Ralston, R.Ph., of Paducah, who succeeds Walter M. Boyett R.Ph., of Mayfield. The Second District had their annual party in February with James Lee Gaddis, R.Ph., presiding. The Fourth District met on January 7th in Russelville for a social hour and dinner. Attending the meeting were several pre-pharmacy students from Western State College. Dr. William Rowlett, Bowling Green, was the guest speaker and presented a humorous talk concerning the psychology of medicine from the time the patient enters the doctorâ&#x20AC;&#x2122;s office until he receives the prescription. The group plans to meet in Bowling Green in March. The Northern Kentucky Pharmacists Association met in January as they do every month but we do not have the information as we go to press. Christian County is expecting to have a meeting in Hopkinsville in March in which nearby counties will be invited to attend. The purpose of the meeting is to organize the counties in the surrounding areas into a new district where travel will not be so great. - From The Kentucky Pharmacist, February 1965, Volume XXVIII, Number 2.

Frequently Called and Contacted Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org

Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org info@kshp.org American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 info@ncpanet.org Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222

THE KENTUCKY PHARMACIST

January 2015

THE

Kentucky PHARMACIST 1228 US 127 South Frankfort, KY 40601

Save the Date 137th KPhA Annual Meeting & Convention Show your Pharmacist Pride with a KPhA Roamey Window Cling!

June 25-28, 2015 Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

$5 â&#x20AC;&#x201D; All proceeds benefit the KPhA Building Fund Available at the KPhA Online Store www.kphanet.org, click on About Tab, Online Store

For more upcoming events, visit www.kphanet.org. 40

THE KENTUCKY PHARMACIST