Jan. | Mar. 2016 Volume 90, Issue I
Building A Stronger Voice MPA unveils new membership model
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Missouri Pharmacist Magazine, Volume 90, Issue I
THE TABLE OF
CONTENTS Departments
Missouri Association Pharmacy Staff
From the President pg. 4
Missouri Pharmacy Association Staff RON FITZWATER, MBA, CAE, Chief Executive Officer ROBYN SILVEY, Chief Operating Officer CHERYL HOFFER, Vice President Pharmacist Program Initiatives TRAVIS FITZWATER, Director of Strategic Initiatives DREW OESTREICH, Pharmacy Provider Relations ERICA GILLILAN, Administrative and Meetings Coordinator SARA WALSH, Member Services Coordinator LAUREN BROWN, Membership Coordinator
CEO Update pg. 5 Member News pg. 6 Pharmacy Tidbits pg 8 Legislative Feature pg 10 The Value of an MPA Membership pg. 18 Tech Corner pg 20 Law and Finance pg 22 Education News pg 26 Red Letter Dates pg 28 Then & Now pg 30
Board of Directors President - JUSTIN MAY, PharmD Red Cross Pharmacy, Sedalia President-Elect - MARTY MICHEL, RPh, MBA, CDE Key Drugs, Poplar Bluff Treasurer - MELODY SAVLEY, BS ALPS Pharmacy, Springfield Secretary - CHRIS GERONSIN, RPh Beverly Hills Pharmacy, St. Louis Immediate Past President - ERICA HOPKINS, PharmD Stadium Pharmacy, Independence Member at Large - LISA UMFLEET, RPh, CGP Parkland Health Mart Pharmacy, Desloge Member at Large - Joni Forbus, PharmD Family Pharmacy, Joplin Member at Large - DANIEL GOOD, MS, RPh Mercy Health, Springfield Member at Large - CURT WOOD, PharmD Elder Care Pharmacy Consultants LLC, New London Ex-Officio Member - RUSSEL MELCHERT, PhD, RPh UMKC School of Pharmacy, Kansas City Ex-Officio Member - JOHN PIEPER, PharmD, FCCP St. Louis College of Pharmacy, St. Louis
MISSOURI PHARMACY ASSOCIATION | 211 EAST CAPITOL AVENUE | JEFFERSON CITY, MO 65101 PH: (573) 636-7522 FAX: (573) 636-7485 MORX.COM MISSOURI PHARMACY ASSOCIATION MISSION: The Missouri Pharmacy Association promotes and protects the role of pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team. Missouri Pharmacist is mailed to MPA members, non-member pharmacists, pharmacy educators, pharmacy technicians and pharmacy students in the state of Missouri. All views and opinions expressed in articles are those of the writer and are not necessarily the official position of the Missouri Pharmacy Association. For advertising rates or editorial inquiries, contact Robyn Silvey at Robyn@MoRx.com or call (573) 636-7522. Missouri Pharmacist, Vol 90, Issue 1, Winter 2016 is owned and published quarterly by the Missouri Pharmacy Association, 211 East Capitol Avenue, Jefferson City, MO 65101. Postage paid at Fulton, MO and additional mailing offices. Postmaster: send address changes to Missouri Pharmacist, 211 E. Capitol Avenue, Jefferson City, MO 65101-3001
FROM THE PRESIDENT
Welcome To The First 2016 Edition Of Missouri Pharmacist! by JUSTIN MAY, PharmD
Justin May, PharmD, Red Cross Pharmacy, Sedalia, Mo. is President of Missouri Pharmacy Association.
Y
ou have received this publication because you are a licensed pharmacist in the State of Missouri, regardless of your current membership status in the Missouri Pharmacy Association (MPA). Many of you are familiar with the MPA; for those of you that are not as familiar with the MPA I will provide a brief introduction to the Association before highlighting our exciting 2016 agenda. In short, the MPA protects and promotes the pharmacist’s role as the medication expert in patient care relationships in all practice settings. This is such a high priority for the MPA that it is an integral part of our mission statement which can be found on the contents page of this edition of Missouri Pharmacist. In fact, protecting and promoting the profession has been our reason for existence for over 136 years. A couple easyto-see examples of the MPA’s efforts include pharmacist administered immunizations (with a recent expansion in 2014 of the number and types of immunizations given by protocol) and medication therapy services (MTS) protocols that allow pharmacists to collaborate with physicians in managing patient medications.
• Biosimilar Drugs (HB1366, HB1878) • Dispensing of Contraceptives (HB1679) • Requirement to Fill Valid Prescriptions (HB1907) • Prescription Abuse Registry/PDMP (HB1922) • Medication Synchronization • Opioid Antagonist Dispensing by Pharmacist And Technicians • Epinephrine Auto-Injectors for Emergency Use • Maximum Allowable Cost (MAC) Pricing • Medical Marijuana • Pharmacy Budget/FRA Program • Expansion of MCO Coverage Area in the MO Healthnet Program
* A complete list and background information can be found on page 12 or check out the MPA Legislative Action Center on our website.
Any or all of these introduced bills, if passed, can affect your practice as a pharmacist whether you work for a hospital, a large chain pharmacy, a single store independent or own your own pharmacy business. Keep in mind that very few of these bills were introduced by the MPA; however, the MPA monitors the bill’s progress and evaluates how they will affect the
“All it takes is a vote and our profession can change.” Advancing the clinical pursuits of pharmacists is the fun part of our job and falls under the “promoting” portion of our mission statement. The real challenge, and what is not so easily seen, is the “protecting” part of our work. Every year there is legislation introduced that may be harmful to the practice of pharmacy in Missouri (regardless of practice setting) and every year the MPA stands up for pharmacists to protect the profession. As you know, the practice of pharmacy in Missouri is defined by our state legislature. All it takes is a vote and our profession can change. We have an extensive legislative agenda for 2016. An abbreviated list* of legislative topics we are monitoring include:
4 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
profession of pharmacy as a whole. The MPA then helps its members interpret the impact of proposed legislation and acts as the member pharmacist’s voice to legislators. As with any representative association, the MPA needs members. The larger the portion of the pharmacists in the state we represent, the louder the voice we have at the capitol. We have now made it easier and more cost effective than ever to be a member of the MPA. I encourage you to read about our new membership model on page 18 and then promptly join the MPA! If you are not a current MPA member, please consider joining and doing your part to help promote and protect the profession of pharmacy in Missouri. If you are a current MPA member, thank you for your service!
CEO UPDATE
Pioneers by RON FITZWATER, MBA, CAE
T
he Missouri Pharmacy Association has been in existence for over 136 years representing pharmacists in our great state. Over that time, we have seen many exciting changes in health care – especially relating to pharmacy. As you know, there have been some extremely exciting expansions to your practice over the past ten years. And if we continue our diligent efforts, there are some additional exciting expansions that lay ahead of us. How did those positive changes come about though? What happened to cause the expansion of opportunities for pharmacists here in Missouri? The simple answer is that they did not just happen. They were orchestrated by a group of highly dedicated individuals in MPA that saw the remarkable talent and training of pharmacists and began to help create opportunities in the health care system to allow pharmacists to use your expanded medication
The MPA Board of Directors recognized both this challenge and more importantly potential ways to address it. They worked for approximately one and a half years to try to develop a solution. One of the clear needs was to get back to the collective collegiality of the past so that the profession is working in unison again on the key issues that are limiting your ability to fully practice your profession. And more importantly, to be able to get paid for your services in the new “pay for performance” marketplace that is being developed in the entire health care system. The health care world is changing, and it is incumbent that we create a new practice environment where you can practice your profession. To that end, the MPA Board is looking to a new pioneer spirit to address these challenges. The dictionary defines a pioneer as someone who “begins or helps develop something new and prepares the way for others to follow. Someone who is first or among the earliest in a field of enterprise or progress.” And that is just what is happening at MPA. That “pioneer spirit” has hit again. At the 2015 MPA Annual Convention,
“The health care world is changing, and it is incumbent that we create a new practice environment where you can practice your profession.” knowledge and patient skills to expand your role within the health care industry. These leaders and individuals had the good fortune of working within the pharmacy profession when there was more of a sense of community – a time when most pharmacists joined together within MPA to collectively address these issues and expand opportunities. But today as the entire health care marketplace continues to grow and specialize, it is much more difficult to collectively address the key problems and issues as they arise. And now with so many health care issues moved to the Federal level, it provides an even greater challenge to make sure that the needs of our pharmacist members are addressed in this new fast-paced, decentralized environment.
Ron Fitzwater, MBA, CAE, is the CEO of Missouri Pharmacy Association.
MISSOURI PHARMACY ASSOCIATION
MPA members unanimously approved creating an additional membership category to assist in re-building the foundation of MPA and create a new expanded opportunity for all pharmacists and technicians in Missouri to participate in the association. This new Business Model reduces the cost of membership while broadening the base. Please watch for additional information re: how you can participate in this exciting new opportunity. We look forward to working with you in 2016. It’s going to be an incredible year. I hope you will join our pioneers as we chart new directions and opportunities for Missouri Pharmacists. It is going to be an exciting “ride.”
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 5
MEMBER NEWS
2015 Award Recipients:
MPA Highlights Achievements at Annual Conference & Expo
Traveler of the Year– Greg Trachsel, Novo Nordisk
Greg Trachsel is a Diabetes Care Specialist for Novo Nordisk Pharmaceuticals and has worked for them since 2012. He assists physician clinics, hospitals and pharmacies in Middle and Northeast Missouri in the education and treatment of patients with diabetes. He has been in the health care industry since 1997, working for Capital Region Medical Center in Jefferson City, Option Care Home Infusion, and Sanofi Pharmaceuticals prior to joining Novo Nordisk. Greg is proud to be able to partner with health care professionals, especially pharmacists, in helping find solutions for patients, whether it be in how to educate patients about their disease state, more readily access appropriate therapies or how to better utilize currently employed therapies.
Terry Mungle Excellence in Sales Award–Jason Hamilton, Cardinal Health
Jason Hamilton is a sales manager for Cardinal Health. He has been with Cardinal Health for nine years. Currently Jason is responsible for pharmaceutical distribution sales to retail independent pharmacies throughout all of Kansas and Oklahoma, the western third of Missouri and Northwest Arkansas. Jason’s team includes five sales consultants, a pharmacy operations consultant and three merchandising consultants. The things that Jason enjoys most about his career with Cardinal Health is that he has the opportunity to work on the front lines with his Retail Independent pharmacy customers. He enjoys getting to know his customers and
works with them to ensure their sustainability in an ever changing market.
MPA Distinguished Young Pharmacist–Clark Kebodeaux, PharmD, BCACP
Clark Kebodeaux is an assistant professor of pharmacy practice at the St. Louis College of Pharmacy and has a shared faculty position with Walgreens Pharmacy. He graduated from the University of Kansas School of Pharmacy and completed a PGY1 community pharmacy residency at the University of Kentucky College of Pharmacy.
2015 award winners at MPA’s Conference and Expo.
Innovative Pharmacist Award– Sara Nicolaus, PharmD
A 2009 graduate of the University of Missouri – Kansas City School of Pharmacy and residency trained through the University of Iowa PGY1 residency at Mercy Family Pharmacy/Mercy Hospital in Dubuque, Iowa, Sara Nicolaus, PharmD, joined Red Cross Pharmacy as a Clinical Pharmacist in 2010. Dr. Nicolaus has since filled the roles of Long Term Care pharmacist and Nursing Home consultant pharmacist, compounding specialist, wellness coach, Clinical Specialty Pharmacist, and MTM pharmacist. Dr. Nicolaus firmly believes pharmacists’ hold a clinical role in patient care and works toward this role in her daily practice. With her guidance, Red Cross Pharmacy’s adherence program now manages the lives of nearly 9,000 patients each month providing enhanced patient engagement and care opportunities.
6 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
Additionally, Dr. Nicolaus takes multiple APPE students each year and works closely with UMKC’s Community Pharmacy Residency program at Red Cross Pharmacy.
Technician of the Year– Carol George, CPhT
Those of you that own your own Pharmacy realize how great employees are the “life blood” of the business. This Technician has worked for this particular pharmacy since 1979 so she has a lot of ability to stick with her job. Way beyond this she has been a valuable, versatile, and creative asset to our business by bringing her amazing personality and ability to work through problems while being very customer oriented as well as endearing to all those who have been lucky enough to work with her. She has endured six remodels, 9 computer systems, and of course a Pharmacy market place that looks nothing like it did in the 1970’s when she started. She has been trained in at least 6 different areas and even though she started with us having only an electric type writer, she has become well versed in computers, a certified pharmacy tech, trained in long term care pharmacy as well as retail, sterile compounding, hospice care, and occasionally has taken her extra time to deliver needed medicine to patients after hours or on weekend at her expense.
Faculty Member of the Year UMKC School of Pharmacy–Andrew Bzowyckyj, PharmD, BCPS, CDE
Dr. Bzowyckyj graduated from the University of Connecticut School of Pharmacy with a Doctorate of Pharmacy (PharmD) and subsequently completed a 2-year Pharmaceutical Care Leadership Residency at the University of Minnesota College of Pharmacy specializing in ambulatory care/family medicine practice, academia, health care policy, and general philosophies regarding leading change. He is currently a Clinical Assistant Professor at the University of Missouri – Kansas City School of Pharmacy in the Division of Pharmacy Practice and Administration. In this capacity, he has a clinical practice site in The Diabetes Center at Truman Medical
MEMBER NEWS Centers - Hospital Hill (TMC-HH) where he provides direct patient care approximately 3 days per week, which serves as an experiential learning setting for student pharmacists (IPPE and APPE) and residents. Since joining the team at TMC-HH, he has been providing Diabetes Self-Management Education (DSME) to outpatients enrolled in the ADA-accredited program (individual and group education) in addition to conducting individual medication management visits with complex patients with diabetes and numerous other comorbidities. He is a Certified Diabetes Educator and Board Certified Pharmacotherapy Specialist.
across the country in improving patient care and measurable pharmacy quality. Dr. Logan tirelessly pours himself in to his work. Many long days at the pharmacy were put in to get to the stage of integration in to the community. Many of his patients have his cell number and will call him for emergency fills of medications. Even after closing he will re-open the pharmacy day or night for a patient in need.
Faculty Member of the Year STLCOP– Matthew Pitlick, PharmD, BCPS Dr. Pitlick graduated from Drake University in 2008. He then completed a PGY-1 Pharmacy Practice residency with the VA St. Louis Healthcare System. Dr. Pitlick joined the faculty at St. Louis College of Pharmacy in 2009. His practice site is at the VA St. Louis Healthcare System in ambulatory care. He currently teaches several introductory courses and dermatology therapeutics. His research interest includes student and faculty development. He enjoys spending time with his wife (also a faculty member at St. Louis College of Pharmacy) and three children, playing/watching sports, or completing home improvement projects.
Bowl of Hygeia–2015 Bowl of Hygeia Richard Logan, PharmD
Dr. Richard Logan has been the proud owner of L&S Pharmacy, a community based pharmacy located in Charleston Missouri since 1976. In 1978 he purchased a second location in Sikeston, Missouri, and recently in 2014 opened a third location in New Madrid, MO. In 2006, Dr. Logan also developed a community pharmacy driven medication adherence program that was studied by Pfizer Outcomes, to show improvements in patient adherence across multiple therapeutic categories. That adherence program evolved into MedHere Today, a national medication adherence and performance consulting firm that assists pharmacies
serves as a preceptor for experiential rotations for UMKC, STLCOP, and Creighton. She has served as Member-at-Large, Treasurer, Secretary, President-Elect and currently President of the Missouri Pharmacy Association Board of Directors. In 2009 she received the MPA Distinguished Young Pharmacist Award and received the MPA Board Appreciation Award in 2012-2013. Her passion is Medication Therapy Management (MTM), with an emphasis in diabetes education and management. She participated in the Diabetes Accreditation Standards Program (DASPA) in 2010 and is the program coordinator for D&H Drugstore’s accredited Diabetes and Healthy Living DSME program. In addition to serving on the MPA Board, Erica is also a member of AADE, APhA, NCPA and Phi Lambda Sigma.
McKesson Plaque Appreciation Award NCPA Leadership Plaque– Justin R. May, PharmD
As a 1974 graduate of UMKC School of Pharmacy, Bill has worked for Harry S. Truman VA Hospital for over 30 years, with the past 15 years as the pharmacy supervisor. He has been dedicated to providing cost-effective evidence based care for many years and was actively involved in providing advanced practice care for anticoagulation patients long before this was done in the community, providing specialized care to patients. Bill is always willing to do what it takes to treat the patient and provide the best care to our Veterans.
Justin May received his Doctor of Pharmacy degree from UMKC in 2001 and has experience in government, national chain, regional chain, and locally owned pharmacies. He is Director of Pharmacy for Red Cross Pharmacy, a northwest-central Missouri regional chain of 12 retail and 3 long-term care pharmacies. He facilitates design, implementation, and management of clinical and patient care services. Since coming onboard with Red Cross Pharmacy in 2007, May has helped develop and grow a pharmacy-based patient centered care model that coordinates patient care in a retail setting. He is a certified immunizing pharmacist and has implemented a company wide immunization program as well as organized and conducted multiple on-site immunization clinics.
Generation Rx– Erica M. Hopkins, PharmD
President’s Award– Lisa K. Umfleet, RPh CGP
Pharmacist Making a Difference– William Dickinson, RPh
Erica Hopkins received her PharmD in 2007 from UMKC School of Pharmacy. While in school she was a member of the MPA, ASP, NCPA and Rho Chi. Currently, Hopkins is the Pharmacist-in-Charge at D&H Drugstore, an independent pharmacy in Columbia and also
Honorary President’s Award– Steve Hartwig, RPh Past President’s Pin and Award– Erica M. Hopkins, PharmD
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 7
PHARMACY TIDBITS
Pharmacy Provider Status:
Pharmacists must claim their position as providers
W by KENNA MARX, PharmD Candidate 2016, UMKC School of Pharmacy at Mizzou
Introduction
Why should the government recognize pharmacists as providers when we frequently don’t recognize ourselves in this way? The fact is, pharmacists are currently not recognized as healthcare providers eligible for Medicare Part B reimbursement under the Social Security Act (SSA) section 1861 which limits the full range of services a pharmacist is capable of providing to their patient(s), other than dispensing. “Every patient seen in any practice setting represents an opportunity to demonstrate the value of pharmacy beyond the stereotype of a dispensing pharmacist.”1 The policy makers in charge of paving the way for our future are stuck in the traditional image of a pharmacist standing behind a counter providing medications and occasional counseling. We are not commonly seen as doctors of our trade and little is understood about the range of clinical services pharmacists can provide and the potential for solving current problems within the healthcare system. However, before we can shape the country’s view of pharmacy practice, we must first step up and claim our position as providers.
Social Security Act
The Social Security Act appropriates what professions are considered providers: physician assistants, nurse practitioners, certified nurse midwives, clinical social workers, clinical psychologists, and registered dietitians/ nutrition professionals. All of these provide a different area of expertise and provide some
level of primary care and patient care services. Although pharmacists provide expertise in their field and perform a wide range of patient care activities from counseling and adherence programs to comprehensive medication and disease management, they are not included on this important piece of legislation. Currently pharmacists are allowed to receive some reimbursement for Medication Therapy Management (MTM) services through Medicare Part D. This was designed by the Centers for Medicaid and Medicare Services (CMS) to help improve medication use and reduce the risk of drug related adverse events. However, there are limitations which prevent patient participation within this program.2 As of now, only elderly, disabled, and low income patients are eligible for MTM services through Part D. Patients must also be eligible for Medicare Part D and pay the required monthly premiums. In 2006, only 10% of Medicare Part D enrollees qualified for these services with only a slight increase in more recent years.2 Eligibility restrictions, restrictions and fiscal considerations limit the applicability of MTM Part D programs from becoming a primary source of compensation for practicing pharmacists. This is another reason why it is important that pharmacists be recognized as providers so that they can provide these and many other services to patients with proper incentive and compensation.
Follow the legislation
There are two bills making their way through the senate and House of Representatives named S.314 and HR.592 respectively, introduced in January of 2015. Collectively they are entitled the Pharmacy and Medically Underserved Areas Enhancement Act. These bills give Medicare beneficiaries access to pharmacist provided services under Medicare Part B by amending section 1861 of the Social Security Act (SSA). Pharmacists would be reimbursed at 85% of a physician’s fee schedule for their provided services unless operating under the direct supervision of the physician, in which case they may receive 100% reimbursement.
8 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
The bill concerns state licensed pharmacists with a B.S. Pharm or a PharmD. The services available for reimbursement would be authorized under state pharmacy scope of practice laws and would require pharmacist specific codes to be developed by the Secretary of Health and Human Services. There are 435 total representatives in the House and 100 senators, two from each state. To date there are 185 cosponsors from the House of Representatives and 28 within the Senate who support the new bills depicted above.4,5
Why we care
Medications are involved in 80 percent of all treatments in any healthcare setting. “Each year there are more than 1.5 million preventable medication-related adverse events in the United States.”4 Nearly 300 billion dollars are spent annually to treat avoidable adverse events from improper medication use. A 2011 report to the Surgeon General provided compelling discussion to support health reform through the delivery of expanded patient care services from pharmacists.2 In this report it described pharmacists as an already integrated member of primary care as a health care provider and defined the services that registered pharmacists are prepared to provide. The second and third focus points stated that for patients to continue to improve patient outcomes, they must be recognized by healthcare providers and be compensated adequately to the level of services provided. The fourth point focused on the overwhelming amount of evidence that integrating pharmacists into patient care results in more favorable outcomes and across all healthcare settings.
What we can do as pharmacists?
The pharmacy practice started with a focus on the distribution of medications. As drug therapies have grown in complexity, pharmacists have evolved to provide expert knowledge and medication management. Pharmacy education has also changed over the years from apprenticeships to six year medical programs which result in a doctorate of pharmacy. Pharmacist moved out of the pharmacy and into
PHARMACY TIDBITS patient units with the beginning of hospital pharmacy which lead the way for the emergence of clinical pharmacy. Collaborative practice agreements have given pharmacists the power to initiate, modify, and discontinue drug therapies based on preset protocols determined with the collaborating physician. Pharmacists have been proven to improve the quality of care, improve outcomes, reduce adverse drug events, reduce patient’s length of hospitalization and readmission rate, and reduce total healthcare costs. Pharmacists have the education and the capability to perform patient assessments, perform disease management, order, interpret and monitor laboratory tests, perform clinical assessments and develop therapeutic plans, provide care coordination and counseling for wellness and disease prevention, and develop patient relationships for follow-up care.2
What is standing in our way?
Opposition comes from different directions. Physicians seem to interpret an advance in pharmacy as a threat to their authority in the health field. The truth of the matter is that there is a mutual relationship between pharmacists and physicians which capitalize on each other’s strengths.5 Large populations within the United States still live in medically underserved areas where there are limited numbers of physicians to see to their medical needs. By sharing patient care responsibilities, pharmacists can help cover the gaps in patient care and free physician time for diagnosis and attendance to more critically ill patients, improve patient provider satisfaction, and focus more time on complicated matters not within the scope of pharmacy education. As physicians and patients begin to accept pharmacists as primary care providers, reimbursement still remains a huge barrier. Congress and Legislators are refusing to increase healthcare spending to include pharmacy reimbursement. There is national discontent with the current healthcare system and payers are hesitant to continue putting money into a system that they perceive as ‘broken.’ The
healthcare system is moving away from fee for service and heading towards payments based on outcome measures.
Get Involved
we are and pave the way for what pharmacy could potentially be. The future of pharmacy practice is dependent on our “willingness to exert ourselves to achieve our full potential as pharmacists.”6 It is time that legislation reflects the change that is occurring within pharmacy practice. Quality assurance models and data continue to support the value of pharmacists to healthcare in terms of patient satisfaction, improved outcomes, and cost savings.
For pharmacists to be recognized as providers, we can no longer be content being labeled as “pill pushers” or dispensers. By promoting pharmacists in the community who are working as providers in managed care settings or Veterans Affairs Systems, we can gain public 1 O’Brien JM. How Nurse Practitioners Obtained Provider Status: Lessons for Pharmacists. American Journal of Health Systems Pharmacy. 2003; awareness of what pharmacists bring to the table 60(22). 2Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to as providers. Initiation of dialog in the public the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.3American Pharmacists Association. Provider is crucial so that we can emphasize the value of Status: What pharmacists need to know now. Accessed August 24th, 2015 at http://www.pharmacist.com/provider-status-what-pharmacistspharmacists in increasing patient access, quality need-know-now#_edn44Congress.gov. H.R.592-Pharmacy and Medically Underserved Areas Enhancement Act. Accessed August 20th, 2015 at care, and decreasing healthcare costs. https://www.congress.gov/bill/114th-congress/house-bill/592 5Congress. gov. S.314-Pharmacy and Medically Underserved Areas Enhancement Act. Reaching out to your elected officials will Accessed August 20th, 2015 at https://www.congress.gov/bill/114th-congress/senate-bill/314 6Dole E. Is Prescribing the Next Step in the Evolution of Pharmacy? ASHP Intersections. Accessed August 24th, 2015 at http:// bring attention and support to the provider stawww.ashpintersections.org/2012/05/is-prescribing-the-next-step-in-theevolution-of-pharmacy/ 7Abramowitz PW. The evolution and metamortus campaign. There are many groups looking phosis of the pharmacy practice model. AM J Health-Syst Pharm. 2009; 66: 1437-1446. for passionate pharmacists and supporters for this movement. The American Pharmacists Association (APhA), American Society of Hospital Pharmacists (ASHP), or our local Missouri Pharmacy Association (MPA) are great places to get involved. Attending upcoming events and staying up to date on our progress is a great way to help our profession reach CALL (573) 636-7522 provider status. There are links on APhA’s website (http://www.pharmacist. com/providerstatusrecognition) where you can search Missouri Pharmacist is the only for and contact your elected magazine that delivers to all officials to urge them to suppharmacists, managers, technicians, port the bills now circulating pharmacy owners, educators, students through the House and Senand every MPA member in Missouri. ate. By doing this, supporters can spread awareness Delivering to over 6,500 professionals, concerning the pharmacy we have the Missouri Pharmacy Industry covered. potential and demand the deserved recognition of For advertising rates and sizes contact Robyn Silvey at pharmacists as providers. Robyn@MoRx.com or call (573) 636-7522.
ADVERTISE TODAY
Conclusion
We need to stand up and be recognized for what
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 9
MAKE
10 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
AN IMPACT MPA
works diligently to ensure the rights of pharmacists and technicians are represented in the state legislature. by Ron Fitzwater, MBA, CAE
T
he MPA Legislative Committee and Board of Directors continuously monitor this legislation and other newly filed legislation to assess its impact on pharmacists and your patients. Please watch CEO Update and check the MPA website (www.MoRx.com) for up-to-the-minute updates and additional information. Use the following chart as a preliminary list of pharmacy-related legislation that has been filed in the Missouri House and Senate for the 2016 Legislative Session. The list also indicates the current position that the Missouri Pharmacy Association has taken on each piece of legislation. Please plan to join us in Jefferson City on Wednesday, March 30 for the 2016 MPA Legislative Day to help us push this legislation through the Legislature.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 11
House Bills HB 1366
Changes the laws regarding the substitution by a pharmacist of an interchangeable biological product for a prescribed product
Hubrecht, Tila (151)
Support
HB 1579
Establishes the Missouri health information exchange commission
Jones, Caleb (050)
Support
HB 1679
Changes the laws regarding the dispensing of contraceptives
Solon, Sheila (031)
Support
HB 1878
Changes the laws regarding the substitution by a pharmacist of an interchangeable biological product for a prescribed product
Solon, Sheila (031)
Support
HB 1892
Establishes the narcotics control act
Rehder, Holly (148)
Support
HB 1905
Establishes programs and services to increase preventative health care services in the state
Newman, Stacey (087)
Oppose
HB 1907
Requires a pharmacy to fill a valid and lawful prescription for any fda-approved drug or device to prevent pregnancy including emergency contraceptives without delay
Newman, Stacey (087)
Oppose
HB 1922
Establishes a prescription abuse registry
Barnes, Jay (060)
Neutral
HB 2045
Prohibits a health carrier or health benefit plan from denying coverage for dispensing drugs prescribed for the treatment of chronic illnesses to synchronize the refilling of prescriptions
Morris, Lynn (140)
Support
HB 2316
Delineates procedures to be used by pharmacy benefits managers with regards to maximum allowable cost lists
Morris, Lynn (140)
Support
HB 2406
Allows pharmacists to exercise professional judgment in dispensing varying quantities of medication per fill when filling prescriptions for maintenance medication
Jones, Caleb (050)
Support
BILL NUMBER
DESCRIPTION
BILL SPONSOR
MPA’S POSITION
12 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
Senate Bills SB 677
Establishes requirements for authorized entities to stock epinephrine (epi) auto-injectors for use in emergencies
Sater, David (29)
Support
SB 768
Establishes a prescription drug monitoring act
Schaaf, Rob (34)
Oppose
SB 794
Creates a sales tax exemption for parts and accessories of certain types of medical equipment
Wallingford, Wayne (27)
Support
SB 813
Allows pharmacists and pharmacy technicians to sell and dispense opioid antagonists
Brown, Dan (16)
TBD
SB 843
Modifies provisions relating to covered prescription benefits
Schaaf, Rob (34)
TBD
SB 864
Provides that only a licensed pharmacist can determine to dispense an emergency supply of medication without the prescribers authorization
Sater, David (29)
Support
SB 865
Provides that all licensees regulated by the Board of Pharmacy shall report disciplinary actions taken by another licensing jurisdiction against such person or entity’s license
Sater, David (29)
TBD
SB 866
Modifies laws regarding the renewal licenses issue by the Board of Pharmacy
Sater, David (29)
TBD
SB 868
Extends a sunset provision for coverage of early refills of prescription eye drops
Wasson, Jay (20)
Support
SB 875
Allows a pharmacist to select an interchangeable biological product when filling a biological product prescription
Schaefer, Kurt (19)
Support
SB 908
Delineates procedures to be used by pharmacy benefit managers with regards to maximum allowable cost lists
Sater, David (29)
Support
SB 910
Requires health carriers or managed care plans to offer medication synchronization services
Sater, David (29)
Support
SB 973
Provides that a pharmacist may dispense varying quantities of maintenance medication
Wasson, Jay (20)
Support
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THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 13
2016 LEGISLATIVE DAY
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Join us March 30th for the Missouri Pharmacy Association’s Legislative Day. This annual event showcases key pharmacy legislation, updates, C Pricing O MO HealthNet O Federal Issues O Pharmacy Practice guest speakers Board and of Pharmacy Update O Legislative Process O PDMP 2 hours of30,continuing March for the Missouri Pharmacy Association’s Legislative Day. Join us on Legislative Day 2016 for MAC Pricing, al event showcases key pharmacy legislation, updates, guest speakers, education approved Mo HealthNet, Federal Issues, Pharmacy Practices, rs of continuing approved by the Missouri Board of Pharmacy. by theeducation Missouri Board of Pharmacy Updates, Board of Pharmacy. Legislative Process, PDMP, and more.
/(*,6/$7,9( '$<
e t i Paint it Wh SPONSORED BY:
AGENDA
7:30-8:15 a.m. - Check-in & Breakfast
MPA 2016 Legislative Day Agenda
8:15 a.m.-12:15 p.m. - Legislative Updates 7:30-8:15am
Check-In and Breakfast, Capitol Plaza Hotel
8:15am-12:15pm Legislative 11:30 a.m.-12:15 p.m. - Updates Lunch
11:30am-12:15pm Lunch, Capitol Plaza Hotel and Convention Center 12:15pm WEAR YOUR WHITE COATS! Transition to Missouri State Capitol 12:15 p.m. Group 12:25pm Photo on North Capitol Steps (facing Missouri River) Transition towith MO State Capitol 1:00pm Visit Legislators 2:30pm Dessert Social, 3rd Floor Capitol Rotunda 4:30pm Pharmacy Political Action Committee Fundraiser, Capitol Plaza Hotel – Lincoln Room 12:25 p.m. Capitol Plaza Hotel is located at 415 W. McCarty St. in Jefferson City, Mo.
Group Photo on Capitol Steps
Visit 14 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
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Mark your calendar for March 30th as we paint the “Missouri Capitol White” for Missouri Pharmacy Association’s Legislative Day. Be sure to attend, and when you do dress for success. Wear your white lab coat. We’ll make an impact visually, and verbally, as we visit with the legislative body and discuss the current needs within the health care and the pharmacy profession. Away from the State Capitol, we’ll gather at Capitol Plaza Hotel and Convention Center to listen to guest speakers, network with colleagues, and gain valuable continued education approved by the Missouri Board of Pharmacy. Together we’ll advocate for the growth of the pharmacy profession and strengthen the voice of the Missouri Pharmacist.
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Adapt to
o Thrive
ADAPT TO THRIVE
ADAPT TO THRIVE by REP. TRAVIS FITZWATER
JOIN MPA TODAY, VISIT MORX.COM/JOIN OR CALL US AT (573) 636-7522
THERE IS STRENGTH IN NUMBERS
MPA’s new membership model is built to attract increased participation throughout Missouri’s pharmacy profession. Join today and receive this beautiful pill sticker to proudly display on your store front window.
Missouri Pharmacy Association revises it’s membership structure to create a more inclusive model.
few years ago, the Missouri Pharmacy Association Board of Directors had the foresight to see the incoming struggle with membership, not only for the MPA, but also for associations across Missouri and the country. It was realized with most certainty that without a significant change in the membership structure, we as an association of pharmacists and technicians, could lose our voice in an ever changing economic, political, and social environment. Our schools were growing and professors became more disconnected with the organization. Independent pharmacies across the state battle with third parties and insurance companies while building their entrepreneurial interests and focus on their local communities. Hospitals struggle through clinical issues and how to provide patient care to a broad spectrum of patients. And, pharmacists as professionals try to find the careers they’re meant for while battling to ensure they can provide the best patient care possible in a setting that they’re passionate about. Among many other struggles, pharmacists are always voted by patients as
YOUR LIVELIHOOD
MPA represents you by continuing to expand the pharmacy profession and securing financial reimbursements for your benefit. We’ve got your back at every table discussing pharmacy matters – private industry, Medicare & Medicaid and national organizations.
one of the most trusted health care providers year after year. With all of this knowledge, our Board understood that as health care is adapting to a new, innovative, and evolving world, so must the association. The MPA isn’t tasked with answering all of the health care problems, but indeed to be an advocate to a larger number of pharmacists, technicians, pharmacy schools, and pharmacy businesses.
Membership class. The business membership is tailored to every pharmacy business category in the state. The Board has thought for the pharmacy schools, independents, hospitals, chains, as well as individual members. The most important consideration in the decision making process for this new membership class was making it easier for pharmacists and technicians to be involved while making it more affordable for a broader base of businesses and individuals.
“The business membership is tailored to every pharmacy business category in the state.” Therefore, the MPA Board of Directors have revolutionized how we advocate for pharmacy by creating a whole new level of membership with the organization. Beginning in 2016, the MPA has launched it’s brand new Business
18 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
At the start of 2016, the new Business Membership class will be offered to any individual pharmacy location for $360 and allow all pharmacists and technicians at that location to be a member of the association and enjoy
ADAPT TO THRIVE the benefits that come along with that. Not only does the pharmacist and technician join as adjunct members, but also the membership offers the business a membership level that will help us think towards, educate, and advocate for the business side of pharmacy for a more substantial number of stores around Missouri. So, for instance, if you’re currently an individual member and you own a pharmacy in Missouri, for $80 more per year you will be a member, any pharmacist and/or technician on staff at that location is a member, and your store will receive member benefits. That’s $360 per site that you own, and all of the pharmacists and technicians plus the store receive member benefits (If you have 3 sites, that’s $360 per site times 3, or $1,080 for the year for all 3 stores, pharmacists, and technicians to receive membership). If you have two pharmacists at your location, you’re saving $200 per year on the individual member cost if you join as a business member instead of paying for individual memberships for each of the two staff pharmacists. The same costs savings are being offered to hospitals (Within a certain staff size), the schools of pharmacy (A flat fee from the school provides all faculty membership to the MPA), chains, and other pharmacy organizations. The new MPA Business Membership class is already revolutionizing our member structure. In our soft launch from late October until the end of the year in December, we’ve already converted 200+ pharmacists, technicians, and businesses into a member of the MPA through this program. We are so excited to be unveiling this new class of membership with the MPA to all pharmacists, pharmacies, pharmacy businesses, and technicians across the state. We hope you’ll see the great value to joining the MPA, especially now that we have a model that makes it much more inclusive to pharmacy stakeholders around our great state of Missouri.
If you’re interested in joining the MPA, contact us and we’ll set up your new class of membership. Call (573) 636-7522 today or join online at www.MoRx.com/join.
THERE IS STRENGTH IN NUMBERS Join Missouri Pharmacy Association. MPA advocates for you. What have we accomplished? • Securing financial reimbursements for pharmacists. MPA worked with the legislature and other health care professions to push opportunities to enhance the role of the pharmacist by expanding the pharmacy practice act. Pharmacists now have the opportunity to develop a collaborative practice agreement with physicians to independently provide immunizations and other health care services to Missouri patients. • Solidifying pharmacist reimbursement. By working with the legislature MPA helped create programs that expand services to patients while at the same time providing creative new funding sources for Missouri. As a result, patients, taxpayers and pharmacists are all winners.
MPA keeps you in the know on issues that matter. What issues? • Health care is a hot topic and issues touch pharmacists. The Affordable Care Act forces new reimbursement models and will require pharmacists to be recognized as health care providers in order to participate and be reimbursed for services. MPA is tracking every change impacting pharmacists and provides alerts on current status. • MPA supports practice-based research initiatives and innovative pharmacy practice activities. MPA members will be up-to-date on grants and programs supported by MPA that foster activity on topics like pharmacist administered immunizations, medication therapy management and practice advancement programs. • We listen to member needs, take the MPA voice to every table where pharmacy services are discussed, and keep members informed on trends and activities impacting Missouri pharmacists.
What are MPA financial benefits? • Insurance policy discounts are offered by a company started by pharmacists for pharmacists. The company understands the practice of pharmacy and key areas of exposure. The company’s board of directors consists of pharmacists who have the unique ability to anticipate changes in the pharmacy profession and develop insurance products to cover those risks. • Members receive special pricing on quality improvement programs offered by Pharmacist Quality Commitment designed to help pharmacists comply with quality assurance requirements found in network contracts. Medicare Part D, and state regulations. MPA is a grassroots organization. We listen to our members and act on what we hear. Become a member, reap the benefits and for those interested in helping shape the future of the pharmacy profession there is opportunity to be involved in committee work, programs and events, and board positions.
Join now and strengthen the voice of pharmacists. THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 19
TECH CORNER by HEATHER LYONS-BURNEY,
PharmD Clinical Assistant Professor
Pharmacists and technicians are caring generous people that are often pillars in their communities. Those of us that volunteer our time and resources understand the benefits we receive personally, but did you know that volunteering can actually be ... good for you?
V
Volunteers are happier and healthier and volunteering can be more beneficial to your health than exercising and eating well. In fact, studies show that older people who volunteer remain physically active longer, have more robust psychological well-being, and live longer. Fulfill your sense of purpose by volunteering. The very nature of volunteering is choosing to wok without being paid for it. Often this means choosing a cause you feel strongly about and spending your time making a difference in your community. Dr. Thomas Gilovich, a psychology professor at Cornell University, as well as other researchers have found that experiences deliver more-lasting happiness than things. Experiences – what we’ve seen, things we’ve done and places we’ve been – become a part of our identity. By finding your purpose, you work alongside people who feel as strongly as you do about a cause, allowing the development of new friendships and social connections. In addition to strengthening your social network, volunteering with family members strengthens family bonds and values. Children who volunteer with their parents are more likely to become adults who volunteer. A local volunteer in Springfield, Rebekah Rose, CPhT and Operations Manager, has volunteered since the age of 13, “as a candy-striper for Mercy (then St. John’s) Hospital”. “My favorite
Live longer,
Volunteer!
organization that I volunteered with in college was Special Olympics, where I helped the area director with office work and even coached an all deaf bowling team and a gymnastics team.” Rebekah’s sense of volunteerism led her to join the coalition leading the Springfield area’s Medication Take Back events for the past 3 years in order to provide a safe way for her pharmacy customers to dispose of unwanted medication. During the past six Take Back Events, the Springfield community has taken back 8,074 pounds of medications. How many of us volunteer our time? According to the Bureau of Labor Statistics, the volunteer rate was about 25.3 percent in 2014, and about 62.8 million people volunteered through or for an organization at least once that year. Overall in Missouri in 2014, 30.2% of our state’s residents volunteer, ranking us 17th among the 50 states and Washington, DC. That
20 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
amounts to 1.3 million volunteers and 146.1 million hours of service. For our non-profit and social organizations, that amounted to a $3.4 billion service contribution. Most of these organizations depend upon volunteers to accomplish their mission and are only successful by maintaining a strong volunteer workforce. By volunteering you are doing something good for society, filling in the gaps where government programs leave off, and meeting the needs of people from all walks of life. Help fill the gap in your community and find your purpose by volunteering! If you aren’t currently volunteering, there are many organizations to help you get started – check with your local churches or Chamber of Commerce. REFERENCES/RESOURCES:
“Reasons why you should volunteer”, Psychology Today, March 12, 2014 “Volunteering at a Free Clinic”, Drug Topics, June 23, 2014 “What Inspires Me”, Bradberry, Travis, TalentSmart, January 2016 Bureau of Labor Statistics, February 25, 2015 www.volunteeringinamerica.gov
GRANT FUNDS
APPLY NOW BY REGISTERING AT MORX.COM
GRANT FUNDS AVAILABLE PHARMACY SERVICE EXPANSION PROJECT
M
PA has begun year two of the Pharmacist Service Expansion (PSE) grant project with the Department of Health and Senior Services (DHSS), in conjunction with the Centers for Disease Control and Prevention (CDC). The PSE contract for year two runs from June 30, 2015 through June 29, 2016. The PSE Project allows pharmacists to apply for a scholarship grant* to cover program participation costs for Medication Therapy Services (MTS), Diabetes Accreditation Standards – Practical Ap-
plications (DASPA) certification, and disease-specific programming (supporting MTS certified pharmacist certification renewal). Additionally, scholarship grant funds are available for Diabetes Self-Management Education (DSME) site accreditation. Participants pay the program costs upfront. Then, if your grant application is accepted and all certification requirements are completed, you receive reimbursement. *MTS scholarship grants are limited to pharmacists licensed and practicing in the state of Missouri. DASPA scholarship grants are limited to pharmacists licensed in the state of Missouri and 6th or 7th year (depending on pharmacy school) pharmacy students intending to practice in Missouri.
PARTICIPATE IN THE PSE PROJECT TO APPLY, VISIT MORX.COM AND REGISTER
3. Receive program cost reimbursement upon completion of all requirements The PSE Project is for all pharmacists, whether you hold your BS Pharm or PharmD degree.
UMKC School of Pharmacy, UMKC Health Sciences Building 2464 Charlotte Street Kansas City, MO 64108 CEU: 1.025; Contact Hours: 10.25; $895 Cost (onsite) (In addition: $345 Cost for online AADE training) (PSE scholarship funds reimburse your program cost: $895+$345=$1,240)
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2. Register to attend a PSE program
Thursday, March 31 - Friday, April 1, 2016
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To find out, call Redwood Financial Group for a free consultation to learn how to protect your business and clients’ personal information with a Cyber Liability Policy. Gabriel W. Hulsey, CLCS 573–298–6480 ghulsey@redwoodfg.com Data from “tre: Data Breach Report: 12/31/15”
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THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 21
LAW AND FINANCE
Delivering the Prescription
The importance of thinking through patient hand-off protocol. by DON R. MCGUIRE JR., RPh, JD
A
lot has been written about quality processes in the dispensing function and many good ideas are out there; the Two Dosage Unit rule, shelf talkers, NDC checks, etc. But one thing that isn’t often talked about is getting the right prescription to the right patient. All of the safety and quality processes go for naught if the prescription is given to the incorrect patient. Consider these two examples. Tom Smith comes into Anytown Pharmacy to pick up his wife’s prescription. In the will-call bin with her prescription was also one for Ron Smith. The technician thought Tom had said Ron and assumed that the second prescription was his. She gave Tom both prescriptions. The error was discovered when Tom returned home. Paul was making a delivery for City Pharmacy one afternoon and pulled into a driveway shared by 101 and 103 Main Street. Mary was standing in the driveway. “You got here just in time; I’m headed out for my doctor’s appointment.” Paul ignored his normal protocol at the insistence of the patient. He gave the prescriptions to Mary who left for her appointment. Paul discovered later that the prescriptions were for a patient who lived at 103, but Mary lived at 101. Many times pharmacists don’t think about the actual hand-off to patients. They would be surprised to learn what happens at the delivery point. For example; patients step forward when someone else’s name is called, patients or staff hear names incorrectly, patients with the same or similar names appear at the pharmacy at the same time, or patients in the same extended family with the same name utilize the same pharmacy. Unfortunately, claims history tells us that these patients are very likely to take the medications that they go home with or get delivered to them. This occurs even when their name isn’t on the label, they have never heard of the drug or their own doctor’s name is not on the prescription. Also unfortunately, juries are less inclined to place blame on the patient for these sorts of mishaps. Fair or not, the responsibility falls on the pharmacy to get the right medication to the right patient. A number of solutions are available. Patient counseling is an effective tool to discover errors at the time of delivery, but patient counseling is not always needed or required, so we need other tools. Asking the patient to produce identification and requiring the staff to review prior to handing over the medications is one method. Others have asked the patient for a second identifier to
22 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
“Fair or not, the responsibility falls on the pharmacy to get the right medication to the right patient.” differentiate patients with similar names; address, phone number or social security number. This has to be done as discreetly as possible to protect the patient’s privacy. It is also helpful to ask additional questions of persons picking up others’ prescriptions; what is their relationship to the patient or ask some of the secondary identifiers above. Delivery drivers should verify the address and identity of the patient when delivering medications. Date, time and to whom the medications were delivered should all be documented. Ignoring proper delivery protocol in the dispensing process creates a weak point in the pharmacy’s overall quality initiative. History shows us that patients will take whatever medication is given to them. It is essential that this final step in the dispensing process gets the same attention as other steps in the process. Once the medication is in the wrong hands, it is impossible to predict the outcome. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.
LAW AND FINANCE
Proactive Narcotic Abuse Screening by EDWARD R. KING, Pharmacy Student, Intern
C
ase: An independent pharmacy filling high doses of narcotic CNS depressants for a middle-aged man receives notice of a claim. The patient was found unresponsive by his wife, and pronounced dead at the scene. Toxicology reports indicate supratherapeutic concentrations of hydrocodone, oxycodone, and alprazolam. Additionally, multiple tablets of Oxycontin® are found in the patient’s stomach upon autopsy. Looking through the patient’s record, it is noted that the patient paid cash on multiple ‘vacation-supply’ and ‘lost-supply’. The prescriptions were written by a variety of physicians in different practices, and no effort was made to confirm their knowledge of the other’s care. Additionally, records revealed prescriptions were also filled at other pharmacies in the area.
Result: The filling pharmacist was found liable, resulting in over $200,000 paid out in liability and litigation fees. The Centers for Disease Control and Prevention (CDC) has declared prescription drug abuse an epidemic, with prescription opioid overdose deaths outnumbering heroin and cocaine overdose deaths combined. In 2011, 16,917 drug-poisoning deaths involved an opioid analgesic, which has more than quadrupled from 1992. According to the National Survey on Drug Use and Health, over 14 million individuals aged 12 or older used prescription drugs non-medically in the past 12 months. The increased incidence of prescription drug abuse and related overdose is both alarming and actionable. Healthcare providers are the gatekeepers of patient access to prescription drugs. When a patient’s addiction takes hold, those gatekeepers must intervene. Community pharmacists are optimally positioned to ensure the appropriate use of controlled substances. When a patient presents to the pharmacy a prescription for a controlled substance, the text column at right provides the questions that should be addressed. Prescription Drug Monitoring Programs (PDMPs) are an excellent resource that should be utilized to ensure appropriate drug therapy. Currently, 49 of 50 states (all except Missouri) have PDMPs, while some are not fully operational. Further information regarding the PDMP in your state can be found on the National Association of State Controlled Substance Authorities’. Checking the PDMP, contacting the prescribing physician(s), and determining the drug’s indication are prudent. All information regarding the appropriateness of therapy should always be documented. Instating proactive measures to ensure appropriate drug therapy in regards to controlled substances is of utmost importance given the breadth of the problem. This will in turn reduce potential claims of liability and improve your pharmacy practice. Most importantly, it will further enable pharmacists to advocate for their most vulnerable patients.
“Currently, 49 of 50 states (all except Missouri) have Prescription Drug Monitoring Programs (PDMPs).”
Answering ‘no’ to any one of the questions below warrants further investigation into the prescription’s legitimacy.
Has the patient filled here before? Does it logistically make sense for the patient to be filling their medication here? (i.e. How far away is their home address and/ or doctor’s office from the pharmacy?) Is the patient filling this prescription through insurance? If a patient’s medication history is available, is there only one physician/ practice prescribing controlled substances for this patient? Is this prescription being filled on the date of or after the fill date on the script?
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 23
THE PTCB
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SPRING 2015 3
MARKET REVIEW
2015: A Time For Patience DON’T LET THE MARKET’S JUMPS RATTLE YOUR COMMITMENT TO STAYING INVESTED.
W
hat the market does today, it may not do tomorrow. That may seem elementary, but there are days, weeks, months, and even years when that investing lesson is ignored. Wall Street started 2015 with pronounced volatility, and in the opening six weeks of the year, investors were again reminded why patience is so important. What did investors do in January? Sell. The S&P 500 lost 3.10%. Discouraging news items bred pessimism: deflation was coming to Europe, world demand for oil had peaked and prices would never come near $100 again, the slowdown in Europe and Asia would soon unravel America’s economic comeback. An old market belief dictates that the opening month of a year sets the tone for the rest of the year. Clear implication: 2015 equals bad market year. Sell, sell before it is too late.1 What did investors do at the start of February? Buy. The S&P 500 gained 3.03% in the first trading week of the month (and it had advanced 2.64% in the 30 days ending February 6). Encouraging news items bred optimism: the European Central Bank unveiled an asset-purchase program extending into 2016 to fight deflation with a scope matching QE3, oil prices began to rebound sharply, assorted earnings pleased Wall Street. Clear implication: 2015 might not be so bad. Buy the dip.2,3 What’s the takeaway here? Don’t panic. Don’t let a down January lead you to put off your annual IRA contribution or trim your per-paycheck retirement plan deferrals. What ground stocks lose, they may quickly regain. For the record, 2014 provided the same lesson in patience. January 2014 saw the S&P 500 fall 3.56%. February 2014 brought a 4.31% gain. The S&P went on to go +11.39% for the year. Perhaps its 2015 performance will mimic this.1,3 History is no barometer of future stock market performance, but it can be illuminating with regard to how stocks have overcome the “January effect” – a bad January does not necessarily lead to a lousy year. In fact, here is the real eye-opener: during 1989-2014, the S&P finished up for the year 75% of the time after a loss of 2% or greater in January, with an average annual gain of nearly 8% in those market years. In fact, only twice in the past quarter-century has a bad January presaged a bad year for the index (2000, 2008). In 2009, it lost 8.57% in January and went +35.02% for the rest of the year. In 2003, it gave up 2.74% for January, then went +29.94% across the next 11 months. This illustrates that on Wall Street, anything can happen – and that includes good things.4 Stay patient & stay invested. The last couple of years have been notably placid for U.S. stocks. Entering February, the S&P had gone more than 1,200 days without a correction. That lulled some investors into a comfort zone, to the point where they overreacted to significant (but in no way aberrant) stock market fluctuations.5 Patience is a virtue for the long-term investor trying to build wealth for retirement and other future objectives. Already, this stock market year has highlighted its value. The Federal Reserve may elect to raise interest rates and the strong dollar may persist for some time, but those factors may not hold back the bulls in 2015 any more than many others have since 2009. 1ycharts.com/indicators/sp_500_monthly_return [2/9/15] 2markets.on.nytimes.com/research/markets/usmarkets/usmarkets.asp [2/6/15] CITATIONS. 3 4
online.wsj.com/mdc/public/page/2_3022-quarterly_gblstkidx.html [12/31/14] investing.com/analysis/75-of-the-time,-%27down%27-january-good-for-s-p500%27s-yearly-close-240337 [1/31/15] 5tinyurl.com/kw8ue3b [1/31/15]
Pat Reding and Bo Schnurr are registered representatives of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary. Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note - investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 25
EDUCATION NEWS
FOUNDERS DAY AT ST. LOUIS COLLEGE OF PHARMACY Another entry in the more than 150-year history of St. Louis College of Pharmacy was written today as spades turned over dirt on what is soon to become a massive construction site. In just over a year, the northeast corner of campus will be home to a seven-story, 193,000-square-foot, Recreation and Student Center (RAS). “It’s an exciting time at St. Louis College of Pharmacy, full of energy, promise, and innovation,” said John A. Pieper, PharmD, president of St. Louis College of Pharmacy, to the assembled crowd of students, faculty, staff, alumni, and elected officials at the groundbreaking. The ceremony took place steps from the College’s new Academic and Research Building and Library (ARB). The award-winning, student education and research facility, library, and learning center officially opened in August. Following the groundbreaking ceremony, the assembled crowd entered the ARB auditorium for a special speaker. Bill DeWitt III, president of the St. Louis Cardinals, talked about the importance of investing in the future, commitment to the city and region, and being strong leaders in the community. “It surprised me to learn that St. Louis College of Pharmacy was founded in 1864,” DeWitt said. “That’s even earlier than the Cardinals.” Groundbreaking of Recreation and Student Center. This was the College’s second Founders Day celebration, marking the day when a group of luminaries including Eugene Massot and Henry Shaw approved a charter, constitution, and bylaws to establish the first college of pharmacy west of the Mississippi. The RAS is scheduled to open in the spring of 2017. The first floor of the building will consist of a large dining hall and kitchen, reception area, and a competition gymnasium. The second floor will have meeting rooms and an intramural gymnasium. A recreation center
Ground-breaking ceremony for the 193,000-square-foot Recreation and Student Center at St. Louis College of Pharmacy.
with a 200-meter, three-lane indoor track will be the main feature on the third floor. The student center, including a success center and student support offices, will be on the fourth floor. The College’s second residence hall with room for 220 beds will be on the fifth through seventh floors, nearly doubling the College’s on-campus housing space.
UMKC SCHOOL OF PHARMACY AT MIZZOU CELEBRATES 10TH ANNIVERSARY UMKC School of Pharmacy at Mizzou celebrated its 10th anniversary in 2015. The original intent in opening a satellite location in Columbia, Mo. was to help cure the rural pharmacy shortage. Although the rural pharmacy shortage continues to be an issue, it is clear that the site is attracting rural students each year who might not otherwise find their way to Kansas City and a pharmacy. The first two graduating classes from the
26 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
Columbia site, graduates of 2010 and 2011, the majority have filled positions in central and southern Missouri. These are areas of the state that tend to suffer more acutely from the pharmacy shortage. When the Columbia site opened, UMKC, which remains the only public school of pharmacy in the state, was turning away five out of six applicants. The satellite site has helped the school expand the number of students it can admit and increase its annual graduating class by 30 each year.
MISSOURI PHARMACY ASSOCIATION OFFERS DISTANCE LEARNING MPA has partnered with leading pharmacy associations across the country to bring members convenient access to the most relevant topics and best speakers within the industry. With multiple live webinars a month and more than 100 CPE self-study courses available, MPA’s Learning Center allows you to easily train staff, increase your knowledge,
EDUCATION NEWS
© St. Louis College of Pharmacy
and most importantly, earn CEUs from the comfort of your home or office. Visit https:// education.MoRx.com today to browse through and register for courses! The Missouri Pharmacy Association is the source for pharmacists’ continuing education and professional development opportunities. MPA members can access online the latest webinars on subjects important to your career development. With Missouri Pharmacy Association online learning component you can:
• Register online for any program • Earn credit 24/7 at your convenience • Access your purchased programs and reprint certificates • Live Webinars from your home or office • CE On-Demand offered 24/7
UPDATE: NEW RULES FOR CPE MONITOR REPORTING ACPE-accredited providers of continuing pharmacy education announce new rules re-
garding reporting of CEUs to the NABP eProfile ID/CPE Monitor data base. Effective May 1, 2014 all ACPE-accredited providers have 60 days post the CPE activity participation date to upload the participant credit into CPE Monitor. The provider must upload the participant information 60 days from the date the participant completed the CPE activity. This applies to all CPE activities: live, internet-based, and home-study articles. What this means for you as the participant of any CE activity, make sure you give correct information regarding birthdates and NABP eProfile #’s on all form fields when registering for a CE activity. It is the responsibility of every CE participant to give the provider the correct information or CE credits will not be recorded on your NABP eProfile. For more information, visit MPA’s Learning Center at www.MoRx.com.
you can print and complete on the go. Also included are live and on demand webinars in the area of pharmacy law and patient safety.
HOW DO I ACCESS MY BUCKET FOR THE FIRST TIME? 1. Log on to www.GoToCEI.org, click on the white “Partner” bucket 2. Locate and click on the Missouri Pharmacy Association logo 3. Enter your association’s code (receive code by being an MPA member) in the field provided and click “Apply” 4. You will be prompted to login or if you are new to CEI, begin by clicking “Login” and create an account 5. Click “Confirm” at the bottom of the page
HOW DO I SUBMIT MY CPE?
PHARMACY TECHNICIAN EDUCATION MADE EASIER Missouri Pharmacy Association partners with CEI to offer streamlined access to Pharmacy Technician education. All the programs and credit you need to continue your Pharmacy Technician education is located in one place. As a Missouri Pharmacy Association Member and CEI Partner, you have FREE access to CEI’s CPhT Recertification Bucket. You will access these programs through our Partners page on the CEI website – www.GoToCEI.org. The CPhT Recertification Bucket includes Pharmacy Technician Recertification CPE activities in categories consistent with PTCB Domains, structured as 10, 1 hour written modules
1. Log on to www.GoToCEI.org, click on “My Profile” 2. Locate the activity title you wish to complete within your profile and click on the exam 3. Complete the exam and evaluation as prompted, click ‘Submit’ to send your information to CPE Monitor All activities will be populated into your Pending folder. Review activities within your Profile and move them to the appropriate folder to continue on to receive CPE credit. Questions? Contact Cindy Smith at csmith@gotocei.org or (515) 270-8118.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 27
RED LETTER DATES March 4-7
APhA Annual Convention Baltimore, MD
May 7
St. Louis College of Pharmacy Graduation St. Louis, MO
March 29
May 13
MPA Board of Directors Meeting
Legislative Session Closes
211 East Capitol Avenue Jefferson City, MO
March 30
2016 MPA Legislative Day: Paint It White Capitol Plaza Hotel 415 West McCarty Street Jefferson City, MO 65101
More Info & Registration: www.MoRx.com
March 31-April 1
Kansas City: DASPA Certification Program
The Missouri Pharmacy Association will be hosting a DASPA program on March 31 - April 1. This live session includes a home study portion that participants will need to complete to attend the sessions on Thursday and Friday to be eligible for the Certificate of Completion. UMKC School of Pharmacy UMKC Health Sciences Building 2464 Charlotte Street Kansas City, MO 64108 CEU: 1.025 Contact Hours: 10.25 Cost: $895 More Info & Registration: www.MoRx.com
Jefferson City, MO
May 13
UMKC School of Pharmacy Graduation Kansas City, MO
May 23-25
NCPA Legislative Conference Washington, DC
July 8-10
Young Pharmacist Leadership Weekend Camdenton, MO
August 18-20
MPA Board Retreat Vail, CO
September 8-11
MPA Rewind: Annual Conference & Exp
This is the largest MPA event of the year. The convention and trade show provides continuing education and networking opportunities to those in the pharmacy profession. In addition, members are celebrated with awards throughout the convention. A golf tournament precedes the convention and expo in addition to the planned social activities. Tan-Tar-A Resort â&#x20AC;&#x201C; Lake of the Ozarks More Info & Registration: www.MoRx.com
28 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
WHO WE ARE
Missouri Pharmacy Association
The Missouri Pharmacy Association promotes and protects the role of pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team.
Vision Statement
The unified voice for Missouri pharmacists.
Our History
On September 10, 1879, four Missouri pharmacists met in the Boone County Court House in Columbia to plan for a professional organization of Missouri pharmacists. Specifically, they wanted to unite pharmacists in efforts to repeal a new law, which placed frustrating limitations on the profession of pharmacy, but they also envisioned an organization dedicated to protecting and promoting pharmacy’s needs and interests in Missouri. Their challenge to all Missouri pharmacists to meet in Sedalia on October 29, 1879, ushered in a colorful period in Missouri pharmacy history. The 62 pharmacists who answered their call responded to the idea of a professional organization and became charter members of the Missouri Pharmaceutical Association (MPA). Efforts of the fledgling organization resulted in the repeal of the unfavorable law. In 1881 new legislation, written by the MPA, established Missouri’s first Board of Pharmacy and set standards for pharmacy practice. Through the years MPA has continued to support legislation to improve the practice of pharmacy in Missouri, and to oppose legislation that could be detrimental to the profession. Legislators rely on input from the MPA when addressing proposed laws impacting the pharmacy industry.
MISSOURI PHARMACY ASSOCIATION
Today’s Missouri Pharmacy Association
The Missouri Pharmacy Association is a committed group of professional pharmacists with high standards and goals. MPA has a rich history of involvement in pharmacy issues on state and national levels. With membership, a pharmacist joins others who support the professional ideas for which pharmacy stands. In today’s changing health care environment, it is critical that pharmacist voices are heard and pharmacy interests are protected, so both the profession and the public may have the best in pharmacy care and service. MPA is dedicated to provide for its members in many facets, including: Maintaining relationships with the Missouri Board of Pharmacy to protect pharmacy interests; interacting with the state legislature and participating in the legislative process to promote and maintain our profession in the state; Participating in educational activities with both colleges of pharmacy; Representing pharmacy with the news media and consumer groups; and Working with the necessary pharmacy organizations on the national level. All of these activities are vital to the survival of our profession in these changing times. Involvement by pharmacists all over the state assures MPA’s success. Should you have any questions, concerns, or comments about the Association, please contact any of the MPA staff or officers.
Find Out More
Connect today with Missouri Pharmacy Association online at www.MoRx.com.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 29
Now&Then
N SA–TAN–IC
by BOB PRIDDY
LAXATIVE COMPOUND
Never in a million years would you convince me that the cure for constipation is some overthe-counter concoction named for Satan, made by a company that also bottles something to pour in my car’s gas tank. But this is now. That was then. A century ago, thousands of people gurgled Sa-tan-ic because it promised to cure all kinds of ills. “It brings mental sunshine,” said one ad for the Wichita-based company that also marketed a gasoline additive that promised up to forty percent better gas mileage and a cleanser that would leave blacksmiths with clean, smooth hands after a hard day at the forge. A couple of tablespoons of this versatile laxative compound before meals or before bedtime would break loose what was backing up inside you. It also would provide “a positive relief for Stomach, Kidney and Liver complaints” and provide relief for “Dyspepsia, Asthma and shortness of breath.” It was “the greatest of blood remedies that “goes right to the cause” of cases of the blues. It “gives the liver and digestive organs a thorough toning” that would result in “improved digestion, better appetite, nourished nerves and cheerfulness.” It was even a flu-preventive that “could relieve colds, indigestion, rheumatism and most nervous troubles, and most headaches.” What made this compound so miraculous? Gentian, Wild Cherry Bark, Stillingia, Sarsaparilla, Licorice, Dandelion, Saccharin, Methyl Salicylate, Oil Sasafras [sic], Propylene Glycol, Sodium Benzoate, Caramel coloring, and water. It was 1.5% alcohol, too. Consumers could also get a three-ounce bottle of liniment that could relieve head cold symptoms if the sufferer put a drop of the stuff in boiling water and inhaled the steam. Then there was Sa-tan-ic ointment that was for “relief of cuts, burns, skin irritation and itching of piles.” Get a fingertip full of the goop and “apply…twice daily to affected parts.” Sa-tan-ic was first sold in 1914 in Oklahoma and Kansas. But when the company started peddling the stuff in Missouri, there was trouble. The federal attorney for the Western District of Missouri, acting on reports from the Secretary of Agriculture that more than four-hundred bottles of San-tan-ic had been imported to Missouri had seized them in Kansas City, Sedalia, Independence, Higginsville, and Holden. Tests found 113 were mis-branded under the Federal Food and Drugs Act. By then, company ads also promised cures for appendicitis, heart trouble, “typhoid and such diseases,” gall bladder inflammation, and blood disorders. But the investigation showed the product contained no ingredients or combination of ingredients that cured everything the company claimed to cure. The company signed a consent decree on March 19, 1921 not to market its nostrum with such expansive claims, paid the costs of proceedings, and posted an $800 bond. British author Caroline Rance, who has a webpage called “The Quack Doctor,” understands claims for such nostrums can be entertaining but says, “I don’t see the past as open to ridicule” although people often find humor in today’s responses to yesterday’s patent medicine ads. She argues that reading the claims of products such as Sa-tan-ic “can unite us with our ancestors rather than set us apart.” Her point is well-taken. Perhaps before we ridicule our ancestors for swallowing (to use an appropriate phrase) the claims of the patent medicines, soaps, and fuel-mileage boosters of the past we should remember all those late-night patent medicine and other infomercials that offer bigger this, longer that, or more satisfying whatever and consider what our descendants in another century will think about some of the labels on today’s pharmacy shelves. We’ll read another of those old labels next time.
30 MissouriPHARMACIST Jan. | Mar. 2016 Volume 90, Issue I
Bob Priddy covered Missouri politics and government for forty years as the news director of the Missourinet statewide radio network. His most recent book is The Art of the Missouri Capitol, History in Canvas, Bronze, and Stone. He’s now working on his second book about the Capitol.
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