Apr. | June 2016
7
Volume 90, Issue II
KNOWLEDGE
IN NUMBERS pa ge 14
SPRING 2015 13
Missouri Pharmacist Magazine, Volume 90, Issue II
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 Red Letter Dates pg 6 Member News pg. 7
Board of Directors
Legislative Day 2016 pg 10 Knowledge In Numbers pg. 14 Tech Corner pg 22 Law and Finance pg 24 Market Review pg 25 Education News pg 26 Expert Insight pg 29 Now & Then pg 30
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, FASHP Mercy Health, Springfield Member at Large - CURT WOOD, RPh, CGP, FASCP Elder Care Pharmacy Consultants LLC, New London Ex-Officio Member - RUSSELL 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 contact Jason Jett at advertising@MoRx.com or call (573) 644-2258. For editorial inquiries, contact Robyn Silvey at Robyn@MoRx.com or call (573) 636-7522. Missouri Pharmacist, Vol 90, Issue II, Spring 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
Change Is In The Air
by JUSTIN MAY, PharmD
S
pring in Missouri is rapidly approaching. We’ve already tasted a few bluesky days in the mid-60’s and the grass is rapidly turning green. Turkeys are
Justin May, PharmD, Red Cross Pharmacy, Sedalia, Mo. is President of Missouri Pharmacy Association.
gobbling, spring peepers are singing and dogwood and redbud trees are showing their colors. Change is in the air! Like a beautiful Missouri spring, the profession of pharmacy is also changing; and I believe the profession is experiencing its own spring. A few short years ago, Missouri pharmacists gained the opportunity to enter into immunization protocols with physicians. A couple years later, we added to our protocol options with Medication Therapy Services (MTS). This year there is a potential for pharmacists to add the prescribing and dispensing of hormonal contraceptive patches and self-administered oral hormonal contraceptives, Missouri House Bill 1679 (HB 1679), to the list. Like many of you may be thinking… my first reaction to this bill was: “I’m not sure I want to do that!” Quickly I realized that I am not the only pharmacist in the State and, like immunizations and MTS, not all pharmacists will prescribe hormonal contraceptives. However, all phar-
In this month’s Missouri Pharmacist, you will find pharmacy law and financial updates, an article on Long Term Care pharmacy, updates from pharmacy schools, and various tools… to name a few. Most importantly, the Missouri Pharmacy Association is here to advance the profession by helping pharmacists support legislation like HB 1679. Legislative Day is a great example of how the Missouri Pharmacy Association helps pharmacists by organizing events for members of our profession to interact with our legislators with a unified voice. The MPA is an important association in Missouri pharmacy, however, it pales in comparison to the significance that YOU have to the practice of pharmacy in the State of Missouri. The Missouri Pharmacy Association cannot exist without YOU. The practice of pharmacy will not advance without YOU. Like a beautiful Missouri spring, change begins slowly. First it’s a few spring peepers singing, then a single dogwood bloom, and a
“Like a beautiful Missouri spring, the profession of pharmacy is also changing; and I believe the profession is experiencing its own spring.” macists should be able to enjoy the opportunity to advance their practice with immunizations, MTS, and hormonal contraceptive prescribing if they so choose. The Missouri Pharmacy Association (MPA) provides you with tools and resources to help you take advantage of new opportunities. The MPA provides various live training and certification courses throughout the year… ranging from immunization training to MTS certification and Diabetes Accreditation Standards - Practical Applications (DASPA) certification. Web based continuing education (CE) courses are available throughout the year and the MPA Annual Conference provides a wide variety of CE topics and certification courses.
4 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
redbud tree here and there. Suddenly spring is in full bloom! Unlike nature’s seasonal occurrence, pharmacists can push along our own spring through events like Pharmacist of the Day, Legislative Day, or by just being a member of the Missouri Pharmacy Association. The signs of Pharmacy spring are already here: immunization protocol, MTS, and an introduced bill for hormonal contraceptive prescribing. With your help, in no time we will look around and say “Wow! What a beautiful spring in Missouri Pharmacy!”
CEO UPDATE
Everest by RON FITZWATER, MBA, CAE
T
he movie, Everest, was popular last year. It was based on a true story relating to a failed attempt to get a group of climbers to the summit. Sometimes work in the Capitol, especially in Washington, DC, is like climbing a mountain. And sometimes the outcome is much different than what was anticipated. As I watched the movie, I began to compare the similarities of climbing a mountain with the process of passing legislation or regulatory changes. I acknowledge upfront that the risk/rewards of climbing peaks such as Everest are much more dramatic.
• Success also often depends on teamwork. Just like navigating a treacherous climb, success at the Capitol depends on building relationships with like-minded legislators and other health care groups that understand your issue and help to deflect criticism from opponents. We spend a lot of time building those relationships. Your assistance back home in building relationships with your legislators is critical to our success in Jefferson City. • It is mandatory to persevere over adversity. Situations don’t always go the way you want them to go. It is important to have a long-term vision and to find ways to slowly move forward and to find ways around formidable obstacles.
“My experience is that the hard work of the climb is worth it.” But there are similarities: • You need a vision and a plan. The old adage, “if you don’t know where you are going, any road will get you there” certainly comes into play at the Capitol. You have to know where you want to go with the legislation and what impact it will have on all parties if it is passed. The MPA Board, through work and consultation with the Legislative Committee, spends a lot of time assessing the future for pharmacy and then creating legislative proposals to move the critical issues forward. In addition, they work closely with the national associations to help address pharmacy-friendly legislation in DC. As you know, there are a lot of very powerful forces working to make some dramatic changes in the health care marketplace. Your Board works extremely hard to make sure that pharmacists are represented everywhere that pharmacy is being discussed.
• Success also requires the right environment. As in the movie where adverse climate conditions were deadly to some of the climbers, adverse conditions in the Capitol at the time you are trying to move your issue sometimes stalls progress. We don’t always have “weather reports” in the Capitol that allows us to read the environment. So you have to be able to pick up on the signs (verbal and non-verbal) to find the right environment to move your issue. • Success improves if there is a path or trail. In the Capitol that often relates to having previously worked with the sponsoring legislator, to get other bills approved. The trust and working knowledge you build in those situations will be beneficial down the road as we work to pass our legislation.
Ron Fitzwater, MBA, CAE, is the CEO of Missouri Pharmacy Association.
MISSOURI PHARMACY ASSOCIATION
pacts on our members if they are not addressed appropriately. We are getting plenty of opportunities to do some “mountain climbing.” But my experience in climbing is that the hard work of the climb is worth it. Once you reach the summit, the reward is unbelievable and many times indescribable to someone who is not there. We are looking forward to ‘mountain-top experiences” in the Missouri and Washington, DC Capitols this year. I hope you will join us for the climb.
There are a lot of issues bombarding pharmacy right now – on both the state level as well as the federal level. Many of them are very complicated and could have far-reaching im-
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 5
RED LETTER DATES May 7
St. Louis College of Pharmacy Graduation St. Louis, MO
May 13
Legislative Session Closes 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 Tan-Tar-A Resort – Lake of the Ozarks
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. More Info & Registration: www.MoRx.com
Remember the good ol' days when the annual conference was a time of rest and relaxation with friends, family and business affiliates? Add in some networking and continuing education and take a MPA Rewind. Pharmacy has come a long way over the years and by no means do we want to take a step backwards, but let’s take a moment to rewind and come together with your pharmacy family to network and share ideas. This year the Missouri Pharmacy Association (MPA) will come together again at TanTar-A Resort in beautiful Osage Beach, Missouri September 8-11, 2016. This is a great way to create connections and build relationships with individuals in the pharmacy community. The weekend is full of professional development opportunities such as, applicable continuing education and updates on legislative matters. Exhibitors and Sponsors will have the opportunity to showcase their message, products and updates to pharmacy professionals in all practice settings. Join us for a relaxing weekend and bring your family along too! Educational sessions tentatively planned: Long Term Care Immunization Update Board of Pharmacy Update USP 800 Precepting Star Ratings Medical Marijuana Legislative Pharmacy Security/Robberies Provider Status Addictive Behavior Pharm to Farm Student Breakouts Technician Breakouts
MEMBER NEWS
LONG-TERM CARE
The Impact of Proposed CMS Guidelines
by MARIO CORONADO
PharmD Candidate 2016, St. Louis College of Pharmacy
L
ong term care (LTC) services have been evolving consistently over the past decade. As the U.S. population has aged, these services have become more and more prevalent, and changes have been made to further encourage the best care possible for patients. Along these lines, pharmacists’ services within LTC facilities have expanded beyond the role of dispensing. The Centers for Medicare and Medicaid Services (CMS) have long recognized the role pharmacists can play in ensuring the responsible use of medications within LTC facilities, and newly proposed guidelines seek to expand this role. Long term care is a broad category. In Missouri, this includes residential care facilities, assisted living facilities, intermediate care facilities, and skilled nursing facilities.1 In general; it is any facility with the purpose of providing “health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition.”2 Naturally, such a patient population requires pharmacy services such as dispensing and consultation. But, while this is not a community setting, LTC facilities also vary greatly from a hospital setting. With relation to dispensing services, LTC facilities require both traditional dispensing and, often, the organization of a patient’s medication regimen. They must have a Missouri Class C license with procedures in place for the “accurate acquiring, receiving, dispensing, and administration of all drugs” to “meet the needs of each resident.”3 Pharmacies can take a variety of forms, from a facility-owned, in-house pharmacy to a contracted, off-site pharmacy. Services from these pharmacies can go on to include United States Pharmacopeia (USP) compliant medication
packaging solutions to ensure patient adherence to their regimen. Along with dispensing pharmacy services, CMS and Missouri regulations require the facility to have a licensed pharmacist who provides consultation and assists in the development of policies and procedures related to pharmacy services.1,3 These regulations go on to acknowledge the impact that clinical pharmacy services have on improving patient care by requiring consultant pharmacy services. A key part of these required services is a monthly medication regimen review for each patient that must be performed by a pharmacist, per CMS guidelines. In facilities under only Missouri jurisdiction, this monthly medication review is only required every two months and can also be performed by a nurse.1 The goal of this review is to proactively address any medication-related problems, errors, or irregularities, leading to positive outcomes and minimizing adverse events.3 Pharmacists then work with a variety of medical and nursing staff to provide long term care to a variety of patients. While both dispensing and consulting pharmacy have often been performed by the same entity, it is now common for long term care facilities to contract out consulting pharmacy services to a separate company that specializes in it. Under pressure to cut costs, dispensing pharmacy services have been moving toward large-scale operations with less emphasis on consulting services; this creates an opportunity in-which it makes sense to carve out consulting into a separate, contracted pharmacy service.4 This has helped spur the industry of consultant pharmacists, “medication therapy experts who provide advice on the use of medications by older adults, whether they live in the community or in long term care facilities.”5 A key responsibility of a consultant pharmacist is meeting the CMS requirement of a monthly medication regimen review. But, where a pharmacist once performed these reviews in an office away from the patients, they are now practicing at the full extent of their training and licensing alongside nurses and physicians, face to face with patients.5 LTC facilities have realized the value that pharmacists offer. Additional responsibilities of pharmacists in
Missouri include assisting in the development of written policies and procedures regarding pharmaceutical services in these facilities, checking emergency medication supplies monthly, and reviewing physician orders prior to medication administration. Facilities are also required to have regular in-services and continuing education specific to long term care, and pharmacists can play a key role in taking these opportunities to educate other health-care professionals.1 Whether it is prearranging a patient’s medication regimen to save the nursing staff time or making evidence-based recommendations to the physicians, the role of a pharmacist in LTC surpasses traditional boundaries. The proposed 2015 CMS guidelines for LTC facilities that wish to participate in the Medicare and Medicaid programs acknowledge the impact pharmacists have on patient care by continuing to expand pharmacist responsibilities.7 In addition to the monthly drug regimen review, the proposed rules ask pharmacists to perform a full medical chart review of patients either every six months or under the following circumstances: when a patient is new to the facility, the patient transfers to or from the facility, or monthly if the patient is receiving a psychotropic, an antibiotic, or another medication that the facility deems requires this increased supervision. By reviewing a patient’s medical chart, the consultant pharmacist is more able to make sure the patient is treated holistically and not just for an indication. Moreover, if an irregularity is found within a drug regimen review or chart review, instead of just reporting this to the attending physician, the pharmacist may be required to report this to the attending, the medical director, and the nursing director; and the attending must then document a review and rationale for action taken as a result. Antipsychotic use in nursing homes is an important issue that CMS has been trying to address for years, and these new guidelines will expand pharmacists’ impact within this area as well. It has been over ten years since the FDA notified health-care professionals of the risk of increased mortality associated with atypical antipsychotic use for dementia-related psychosis.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 7
MEMBER NEWS Since then, the FDA has expanded on this to require a black-box warning for all antipsychotics, warning of increased mortality in elderly patients with dementia related psychosis.8 A CMS initiative, the National Partnership to Improve Dementia Care, has met its goal of decreasing off-label antipsychotic use by 15% since March, 2012, and is now working towards a 30% decrease by the end of 2016.9,10 From March 2011 to March 2013, off-label antipsychotic medication use in Missouri has decreased by 9% of baseline. However, the state is still ranked 45 out of 50 with a prevalence of off-label antipsychotic use in 23.75% of “long-stay” residents.10 Current CMS guidelines strictly state that no antipsychotic may be used without a specific diagnosis in the chart, and that if used, the patient should receive cognitive-behavioral therapy and gradual dose reductions if possible. The proposed updates build upon these restrictions to further minimize the risk of inappropriate use. First, CMS is proposing to change restrictions from just antipsychotics to the broader category of psychotropic drugs, or, “any medication that affects brain activities associated with mental processes and behavior.”7 This broadens the category to include anxiolytics and hypnotics, such as benzodiazepines, another known high-risk medication class in the elderly, along with opioids and even antidepressants. Looking at this all-encompassing definition of psychotropic drugs applied to the broader chart review regulations discussed above, it is
8 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
clear that pharmacists are going to have significantly increased responsibilities when it comes to ensuring patients are on appropriate medical therapy. Also, as-needed antipsychotic orders can currently be active for extended periods of time. This carries the risk of inappropriate use long after resolution of the initial indication. New guidelines further propose that as-needed orders for psychotropic drugs be limited to 48 hours and require a review with rationale before renewing the order. With respect to psychotropic drugs, these guidelines increase the breadth and volume of services consulting pharmacists may perform, from assessing appropriate indications to helping manage dose titrations. Due to the high risks associated with these medications, it is clear that increased pharmacist involvement is warranted and will benefit the patients. Antibiotic stewardship and infection control have long been concerns in long term care facilities, but there are no requirements for pharmacist involvement in this service. As many as 380,000 patients in LTC facilities die of infection every year,11 and the incidence of antibiotic resistant infections is on the rise. Therefore, there is a clear opportunity for pharmacist involvement to ensure appropriate antibiotic use in LTC facilities similar to as in a hospital. Hence, in addition to requiring a monthly medical chart review by a pharmacist for all patients on antibiotics as discussed above, facilities must now establish an infection prevention and control pro-
gram (IPCP) that includes an antibiotic stewardship program with protocols for appropriate use and monitoring parameters. Facilities must also offer influenza and pneumococcal vaccines to all patients. The pharmacy profession is well suited to lead facilities in these efforts. Along with overseeing antibiotic use in individual patients, consultant pharmacists can make a facility-wide impact as they use their expertise to bring policies up to these newest standards. Consulting services, particularly in long term care, are a continually evolving area of pharmacy practice, and one in which a pharmacist can practice at the full scope of their training. The proposed CMS guidelines for long term care facilities reflect the growing emphasis on clinical pharmacy services within healthcare. With increased pharmacist involvement in psychotropic drug use and antibiotic stewardship, medication therapy will continue to improve within the LTC patient population. REFERENCES:
1
Licensure Regulations Manual. Section for Long-Term Care Regulation. Division of Regulation and Licensure. Missouri Department of Health and Senior Services. March 30, 2005. Accessed March 7, 2015.
2
Nursing Facilities. Medicaid.gov. The Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/institutional-care/nursing-facilities-nf.html. Accessed March 2, 2015.
3 Appendix PP – Guidance to Surveyors for Long Term Care Facilities. State Operations Manual. Rev. 26, August 17, 2007. The Centers for Medicare and Medicaid Services. Accessed March 2, 2015.
4
Why Choose an Independent Consulting Pharmacy Firm?. Eldercare Pharmacy Consultants. February 10, 2008. http://www. eldercarerx.com/IndependentConsultPharmAll.aspx. Accessed March 3, 2015.
5 What is a… Consultant Pharmacist?. American Society of Con-
sultant Pharmacists. https://www.ascp.com/articles/what-consultant-pharmacist. October 10, 2013. Accessed March 2, 2015.
6 Long Term Care and Consultant Pharmacy. American Society
of Consultant Pharmacists. Accessed March 2, 2015.
7
Medicare and Medicaid Programs; Reform of requirements for Long Term Care Facilities. The Centers for Medicare and Medicaid Services. Department of Health and Human Services. July 16, 2015. Accessed February 29, 2015
8
Information for Healthcare Professionals: Conventional Antipsychotics. Drugs. U.S. Food and Drug Administration. June 16, 2008. Updated August 15, 2013. http://www.fda.gov/Drugs/ DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm. Accessed March 4, 2016.
9 Antipsychotic Use in Nursing Facility Residents. American Society of Consultant Pharmacists. https://www.ascp.com/articles/antipsychotic-medication-use-nursing-facility-residents. Accessed March 4, 2016.
10 National Partnership to Improve Dementia Care in Nursing
Homes. CMS.Gov. The Centers for Medicare and Medicaid Services. Updated January 7, 2016. https://www.cms.gov/Medicare/ Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes.html. Accessed March 4, 2016.
11 Nursing Homes and Assisted Living (Long-Term Café Facilities
[LTCFs]). Centers for Disease Control and Prevention. Updated September 15, 2015. http://www.cdc.gov/longtermcare/. Accessed March 4, 2016.
Awards
MEMBER NEWS
Bowl of Hygeia Award
Technician of the Year Award
ously received this award. The recipient is not currently serving, nor has he/she served within the immediate past two years on the Association’s awards committee or as an officer of the MPA in other than ex officio capacity; and has compiled an outstanding record of community service that reflects well on the pharmacy profession.
must be a member of Missouri Pharmacy Association; must be a pharmacy technician currently working in a Missouri pharmacy; must demonstrate outstanding skills as a technician that helps the pharmacist and pharmacy provide better pharmacy care and more efficient service to the patient/customer; and must show an interest and concern for the community by participating in some activities outside of work.
Presented for outstanding community Presented to recognize the service. Award Criteria: The recipient must be a contributions that pharmacy member of the Missouri Pharmacy Association; must be technicians make in the daily activity of the pharmacy. Award Criteria: The recipient a licensed pharmacist in Missouri and has not previ-
Faculty Member of the Year Award
Presented to one faculty member at each campus for their contributions to the practice of pharmacy. Award Criteria: The
recipient must be a member of Missouri Pharmacy Association; must have worked for UMKC or STLCOP for at least 3 years; and must not have previously won this award.
Generation Rx Award of Excellence
Award Criteria: The recipient must have demonstrated a commitment to the mission of substance abuse education in his/her community; and must have raised awareness of the dangers of prescription drug abuse among the general public and among the pharmacy community.
Innovative Pharmacy Practice Award
Presented to an outstanding innovative pharmacy. Award Criteria: The recipient must have demonstrated a rare, unique, and/or an innovative style of pharmacy practice resulting in improved patient care; must be licensed in Missouri and must practice in Missouri; and must be a member of Missouri Pharmacy Association.
Pharmacist Making a Difference Award
Presented to a pharmacist who makes a difference in the quality of life in his or her patients. Award Criteria: The recipient should have shown a desire to “go beyond the call of duty” to provide quality pharmacy care; must be licensed in Missouri and must practice in Missouri; and must be a member of the Missouri Pharmacy Association.
Terry Mungle Excellence in Sales Award
Presented in recognition of excellence in pharmaceutical sales. Award Criteria: The recipient must demonstrate a passion for offering outstanding service to pharmacy customers; must be interested and knowledgeable of pharmacy needs and concerns; and must have shown interest in and support the Missouri Pharmacy Association activities and mission.
Traveler of the Year Award
Presented to a sales representative who calls on Missouri pharmacies.
Award Criteria: The recipient should have shown a willingness and initiative to help pharmacists better serve their patients and the community; should have shown support and interest in the Missouri Pharmacy Association, through support of programs, exhibits and/or attendance at district and/or state meetings.
Young Pharmacist Award
Presented to an outstanding young pharmacist. Award Criteria:
The recipient must be a member of Missouri Pharmacy Association; must be a pharmacist licensed in Missouri; must have received his/her entry degree in pharmacy no more than nine years ago; must be actively practicing in retail, hospital or consulting pharmacy; and must participate in pharmacy associations, professional programs and/or community service.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 9
MISSOURI PHARMACY ASSOCIATION HOSTS LEGISLATIVE DAY 2016 Members of the Missouri Pharmacy Association, which represents pharmacists throughout the state, converged on Jefferson City, Wednesday, March 30th, for MPA’s Legislative Day 2016. Members include pharmacists, pharmacy technicians, and pharmacy students.
10 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
2016 LEGISLATIVE DAY
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 11
12 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
2016 LEGISLATIVE DAY
T
he day began with a legislative briefing at Capitol Plaza Hotel, where attendees heard from speakers including Congressman Jason Smith (MO-8), Missouri Attorney General Chris Koster, and State Representatives Travis Fitzwater (Holts Summit, District 49) and Holly Rehder (Sikeston, District 148). At 12:15pm the group transitioned to the Missouri State Capitol and visited members of the Missouri Legislature. Ron Fitzwater, CEO of the Missouri Pharmacy Association, said, “The key issue that we discussed at the 2016 Legislative Day was the development of a Prescription Drug Monitoring Program (PDMP) for Missouri. Missouri is the only state in the nation that has not yet adopted a PDMP. This critical legislation would save lives and protect Missouri families and communities from the dangers of prescription drug abuse by enacting a secure database to assist physicians and pharmacists.” The Legislation has already passed in the Missouri House. “The Missouri Pharmacy Association and pharmacists throughout Missouri have been ardent supporters of a PDMP in our state for a number of years” said Ron Fitzwater, CEO, “and we will be working with members of the Missouri Senate to push for passage of a PDMP in the 2016 Legislative Session,” he said. HB 1892 has already passed the Missouri House.
Opposite page (L-R): Representative Holly Rehder of District 148, Missouri Attorney General Chris Koster, and Speaker of the House Todd Richardson of District 152 address the MPA Legislative Day audience from the podium at Capitol Plaza Hotel.
This page: Congressman Jason
Smith, U.S. Representative of the 8th District of Missouri, discusses federal healthcare issues with pharmacists and students at Missouri Pharmacy Association Legislative Day.
“The Missouri Pharmacy Association and pharmacists throughout Missouri have been ardent supporters of a PDMP in our state for a number of years.” – Ron Fitzwater, CEO
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 13
KNOWLEDGE IN NUMBERS Understanding the State of Missouri’s Health Care
Pharmacy calculations, measurements and conversions form the basis of a pharmaceutical professional. The system of pharmaceutical measurements includes calculations and conversions, as well as an understanding of the ingredients and components of a medication dosage. There are three measurement systems in pharmacy calculations, which a pharmaceutical professional must learn to carry out the critical functions used in the pharmacy: the Metric system, the Apothecary system, and the Avoirdupois system. The numbers are important, and as pharmacist role in the patient/doctor equation, it is critical they have a general knowledge of the patient base.
14 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
The following pages show how Missouri stacks up against other regions of the country, including; wage and compensation comparisons, rankings of Missouri’s population as it relates to infectious diseases, health insurance coverage, as well as a general knowledge of the key health and socio-economic issues facing residents of the state of Missouri. Use the knowledge compiled here to maximize your effectiveness as a member of the health care provider team.
36 OVERALL HEALTH RANKING of missouri
Behaviors
Obesity 30.2% of adult population
Ranked 29th
Smoking 20.6% of adult population
th
out of 50 states
Ranked 38th
Excessive Drinking 16.1% of adult population
Ranked 14th
Drug Deaths 16.4% of deaths per 100,000 population
Ranked 37th
Physical Inactivity 25.0% of adult population
Ranked 36th
Strengths
• Low percentage of children in poverty • Low prevalence of excessive drinking • High rate of high school graduation
Challenges
• Low immunization coverage among adolescents • Low per capita public health funding • Limited availability of dentists
High School Graduation 85.7% of students
Ranked 13th
Outcomes
Poor Mental Health Days Poor Physical Health Days Cardiovascular Deaths Premature Death (years lost)
22nd 39th 41st 39th
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 15
how much is the average pharmacist salary in missouri?
ON AVERAGE AMERICANS SP
St. Joseph
$110,455
Kansas City
$119,945
Columbia &
St. Louis
$109,203 $118,952
Jefferson City
Joplin
$95,281
Springfield
$110,196
74.2 million
TOTAL number of RETAIL PRESCRIPTION DRUGS FILLED AT MISSOURI PHARMACIES in 2015 16 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
$8
TOTAL RETAIL SALES FOR PRESCRIPTION DRUGS FILLED AT MISSOURI PHARMACIES in 2015
$5.1 BILLION
PENT
8,713
per person ON HEALTHCARE IN 2013
About 12% of it goes to pharmaceuticals.
more than any other country.
IN 2015, EACH MISSOURI RESIDENT ON AVERAGE HAD OVER 12 PRESCRIPTION DRUGS FILLED AT PHARMACIES
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 17
34, 270
LUNG & BRONCHUS
CANCER
NEW CASES EXPECTED IN MISSOURI in 2016
12, 970
top 5 diagnosed
Despite current efforts, nationally Missouri ranks 40th in cancer deaths with 206.3 deaths per 100,000 population. The number one state had 146.1 deaths per 100,000 population.
PROSTATE LUNG & BRONCHUS LIVER & BILE DUCT
PANCREAS
top 5 KILLERS COLORECTUM
For the Missouri areas listed below, each individual represents an additional 1% increase over the national median for adults with diabetes
BREAST (FEMALE)
DIABETES
Kirksville St. Joseph KANSAS CITY Central Mo St. Louis Joplin Springfield West Plains Cape Girardeau Poplar Bluff
18 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
MELANOMA OF THE SKIN
COLORECTUM
DEATHS EXPECTED IN MISSOURI in 2016
Improvement Needed
BREAST (FEMALE)
+18% +18%
+21%
+24% +25%
+25% +23%
+31%
HIGHLIGHTS & INDICATORS • In the past year, diabetes increased 16% from 9.6% to 11.1% of adults in Missouri
% of Population Smoking & Eating
Missourians have replaced the tobacco with el snacko.
25% 20% smoking 15% 1990
• In the past year, disparity in health status by education level increased 40% from 20.5% to 28.7% • In the past two years, smoking decreased 14% from 23.9% to 20.6% of adults • In the past five years, children in poverty decreased 40% from 23.8% to 14.2% of children
COMMUNITY & ENVIRONMENT Infectious Disease
25% 20% 15%
30th
Chlamydia (cases per 100,000 population)
25th
Pertussis (cases per 100,000 population)
26th
2000
2005
Nation
2010
2015
obesity Policy
453.8
27th
(combined values)
1995
Missouri
Immunizations of percentage of children aged 19 to 35 months is 70%, ranking Missouri at 34th. Percentage of immunizations given to adolescents (combined value of HPV, MCV4 and Tdap ranks as 43rd.
9.3
Missouri ranks 48th in the immunization of HPV males aged 13 to 17 years old at 11.3%.
Salmonella (cases per 100,000 population) 14.1
How We Rank Nationally
Almost Bottom
Can Annual Household Income Determine Diabetes?
18.6% 13.2% 12.7% 12.2% +35%
Our modern day poor live off the dollar menu leaving nutrition out of the picture. The chart to the left highlights the percentage of Missourians with diabetes based on household income.
7.3%
+36% less than $15k
$15k-$24,999
$25k-$34,999
$35k-$49,999
$50k+
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 19
NEED TO KNOW
Ready To Renew? 2016
Printed with permission by the Missouri Board of Pharmacy.
20 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
MEMBER SPOTLIGHT
Joni Forbus Pharmacist, Family Pharmacy Inc.
E
ver since Joni Forbus was in junior high school she knew she wanted to become a pharmacist. Forbus is currently the pharmacy manager at Family Pharmacy in Joplin. “I wanted to work in the health care industry, but I don’t do well with the sight of blood, so pharmacy seemed like a good fit,” Forbus said. Forbus received her first pharmaceutical job after high school in Nevada and loved it from day one. The pharmacists she trained under in Nevada had a way with people and took extra time with their patients, which is something Forbus has never forgotten. “There is a special way a good pharmacist will interact with people,” she said. “I felt by being a pharmacist I could combine my love of health care with my love of people. I never once changed majors or questioned my decision to become a pharmacist. It’s a career where every day is different and the people I interact with are what keeps me motivated to be better.” The patients are by far Forbus’ most rewarding part of her job. The pharmacy is usually the last stop for patients before they head home from the hospital or from the doctor’s office. Typically patients walk into the pharmacy totally confused or overwhelmed on what medications to take or the side effects of what
Fun Facts Joni Forbus helps teach Vacation Bible School at First Baptist Church in Seneca, MO. She also gives her time to Faithful Friends Animal Advocates and helps with the monthly animal adoption day.
may have just been prescribed to them. “I feel like part of my job is to fill in the missing pieces of the puzzle,” Forbus said. She
only person in the room.” She said the second piece of advice had more to do with being an astute student of the law and the government.
“...if you are going to be involved with pharmacy, you better like politics. There is a law for everything. If you don’t get involved in how the laws are written, then the practice of pharmacy will be written by the lawmakers instead of the pharmacists.” knows taking the extra time with every patient is key and sees the reward when a patient thanks her, especially when they come in scared or completely confused. She feels if she can help just one person get through something difficult and come out with a smile, then her day is made, and that is where the real reward lies. “To send patients away happy will always be memorable for me,” Forbus said. For budding pharmacists Forbus has two pieces of advice: one she received before she entered school and one she received while she was a student. “No. 1 is always take it one patient at a time,” she said. “Give each patient your utmost attention. Don’t be overwhelmed by the waiting line. Make each patient feel like they are the
“No. 2 would be if you are going to be involved with pharmacy, you better like politics. There is a law for everything. If you don’t get involved in how the laws are written, then the practice of pharmacy will be written by the lawmakers instead of the pharmacists. Being involved in the Missouri Pharmacy Association is one of the best things pharmacists can do when it comes to staying involved politically.” Forbus earned her associate’s degree in science from Cottey College in 2002, and her Doctorate of Pharmacy from the University of Missouri-Kansas City in 2007. Printed with permission by the Joplin Regional Business Journal.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 21
TECH CORNER
What is
Active PTCB Certified Pharmacy Technicians
CONTINUING EDUCATION?
Map Key as of December 31, 2015
States that regulate pharmacy technicians and include national certification in their regulations.
A
According to the Accreditation Council for Pharmacy Education (ACPE), continuing pharmacy education, “is a structured educational activity designed or intended to support the continuing development of pharmacists and/ or pharmacy technicians to maintain and enhance their competence. Continuing pharmacy education should promote problem-solving and critical thinking and be applicable to the safe practice of pharmacy.”
Continuing Education Requirements
Certificants must complete a minimum of twenty (20) hours of continuing education (CE) during each two (2) year recertification cycle. Any CE hours earned after January 1, 2015 must be in pharmacy technician-specific subject matter. For recertification candidates, one (1) hour of the twenty (20) hours must be in the subject of pharmacy law and one (1) hour must be in the subject of patient safety (refer to the ACPE definition of patient safety in the ACPE Policy and Procedures Manual, topic designation 05). For reinstatement candidates, two (2) of the twenty (20) hours must be in the subject of
States that do not regulate pharmacy technicians
States that regulate pharmacy technicians
Since 1995, the Pharmacy Technician Certification Board has granted 587,536 certifications. This map represents the 275,864* PTCB certified pharmacy technicians (CPhTs) who were active at the end of 2015. All 50 states and DC accept PTCB Certification. 45 states and DC regulate pharmacy technicians; 23 states and DC include national certification in their regulations. • Total also includes active CPhTs in Canada and the Virgin Islands. •• Key source: 2015 National Association of Boards of Pharmacy Survey of Pharmacy Law and independent research.
pharmacy law and one (1) hour must be in the subject of patient safety. A maximum of ten (10) hours of the twenty (20) hours may be earned by completing a relevant college course with a grade of “C” or better. A maximum of five (5) hours may be earned by completing in-service projects. CPhTs must complete all CE hours within the two (2) year recertification cycle (on or before the expiration date). No CE hours completed before certification is granted may be used to satisfy recertification requirements. CE hours can only be applied to the recertification cycle in which they are completed, and cannot be carried over and applied to future cycles.
Pharmacy Technician-Specific Subject Matter
Certificants must satisfy CE requirements in pharmacy technician-specific subject matter. In order to qualify as pharmacy technician-specific, a CE program’s objectives must assess or sustain the competency critical to pharmacy technician practice stated in PTCB’s Pharmacy Technician Certification Examination Blueprint.
22 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
Approved Activities
PTCB has determined that all CE programs offered by ACPE-accredited providers with the target audience designation “T” satisfy the requirement of pertaining to pharmacy technician-specific subject matter. Other CE programs will be accepted if PTCB determines that the program’s objectives assess or sustain the competency critical to pharmacy technician practice stated in PTCB’s Pharmacy Technician Certification Examination Blueprint. Any CE hours earned after January 1, 2015 with the target audience designation “P” (pharmacist-specific) will not be accepted. For more information please refer to the Recertification Policy. CPhTs who are unsure about whether or not PTCB will accept a CE activity may submit the Continuing Education Pre-Approval Request Form for CE pre-approval to PTCB, during the following months: January, May, and September. Requests must include sufficient information to demonstrate that the CE activity pertains to pharmacy technician-specific subject matter. Pre-approval requests received outside of these months will not be reviewed.
TECH CORNER
PTCB'S NATIONAL CERTIFICATION PROGRAM
Continuing Education Documentation
CPhTs must maintain their own records of CE hours earned during each recertification period. They are also responsible for maintaining these records for at least one (1) year after the certification cycle ends. Acceptable documentation of participation in a college course may be either a transcript or a grade report. For in-service projects or other CEs for which a certificate of participation is not available, the supervising pharmacist or instructor must complete the Universal Continuing Education Form.
Information provided by Pharmacy Technician Certification Board (PTCB). PTCB develops, maintains, promotes, and administers a nationally accredited certification and recertification program for pharmacy technicians to enable the most effective support of pharmacists to advance patient safety. For more information visit www.ptcb.org
Pharmacist Service Expansion Project ATTENTION DASPA TRAINED PHARMACISTS DIABETES SELF-MANAGEMENT EDUCATION (DSME) SITE ACCREDITATION GRANT $ AVAILABLE All Diabetes Accreditation StandardsPractical Applications (DASPA) trained Missouri pharmacists are encouraged to apply for the PSE DSME scholarship grant. DASPA training, along with site accreditation, allows you to bill Medicare Part B for diabetes patient education, as well as potentially other commercial payers and Missouri Medicaid.
To apply within the current PSE contract year, you must complete the site accreditation process by June 30, 2016. Additional DSME scholarship grants will be available in the new PSE contract year, July 2016-June 2017. Visit MoRX.com/pse-project--dsme to learn more and to submit a DSME Scholarship Grant Application. A grant opportunity in partnership with the Missouri Department of Health and Senior Services and MPA.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 23
LAW AND FINANCE
Payment Solutions for Your Pharmacy by EMILY KAMPETER
Government Accounts Officer, Central Bank
T
he way we pay for things is changing. You can tap your phone to buy a cup of coffee and send a gift card to your friend in seconds. The same type of efficiency is available to your pharmacy. Plus, the industry is making it more secure, so you can have peace of mind and convenience wrapped into one.
EMV Chip Cards and Terminals Get ready to dip your chip! Not a potato chip, but your credit or debit card. If you haven’t already, you will be inserting (dipping) your card into a reader rather than swiping it at the counter. Your cards will start having EMV chips and your card machines will need to read them. EMV stands for EuroPay, MasterCard and Visa, and the chips were created to protect against counterfeit cards. EMV transactions create unique transaction data that cannot be used for other transactions. For added security, card machines can be configured to prompt for a PIN, which is the most secure EMV transaction, or they can require a signature.
Chip Cards
When you receive your chip cards, they will still include a magnetic stripe. So regardless of what card machine a merchant has, you will be able to use your card. Here are some rules of thumb when using your chip card: • Chip-enabled card machine: Insert your card and follow the prompts • Without chip card machine: Swipe your card and proceed as normal • Phone or online: Provide your card info the way you always have
Chip Terminals
If you accept cards at the point of sale, you’ll want to update your card machine. Effective October 2015, a liability shift took place in the United States for all point of sale transactions. The merchant who does not support the more secure processing capability may assume liability for transactions completed with counterfeit cards. Previously, this liability was taken by the card issuer. The shift is designed to protect all parties and encourage the use of EMV chip-enabled transactions, but it’s not a mandate. However, merchants not using EMV terminals could see an increase in card-present chargebacks if not using EMV processing. Be sure to talk with your merchant services provider about your options and risks. Being responsible for even one fraudulent transaction could be devastating to your business. 24 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
Digital Wallets
Before long, some of us won’t be carrying plastic at all. Digital wallets, such as Apple Pay, reside on mobile phones and will take the place of credit cards, bank accounts and loyalty cards. We’re still in the early stages of digital wallets, so keep accepting credit cards, checks and other forms of payment. You’ll just want to talk to your customers about their expectations for digital wallet acceptance. Talk to your current merchant provider about what hardware and software you’ll need to accept payment and the costs associated with the new technology.
Virtual Card Payments
Point-of-sale card transactions are becoming more secure and so our vendor payment methods, only without all the plastic. Virtual card payments are replacing checks and automated clearing house (ACH) payments to reduce the risk of check fraud, improve payment and reporting time and produce a revenue stream for organizations.
The Process
When you can pay your vendors with a virtual credit card, a non-plastic, one-time card number is securely transmitted with a limit that matches your invoice exactly. Then, the supplier runs the credit card to receive funds. Here is how the process works: • Buyer approves invoice within accounting system • Buyer exports and uploads payment file from accounting system • Bank debits buyer’s account to match payment file • Supplier receives remittance and virtual card number for payment via email • Buyer receives reconciliation reports on status of payments • Bank pays monthly revenue share to customer
The Revenue
The last step in the process is important - your accounts payable system is now a revenue generator. Because you’re paying expenses using a virtual credit card, you’re earning a rebate just like you did at the counter. To maximize your rebate, you also can pair your corporate purchasing card spend with your virtual card payments. From chip cards to virtual payments, the world of accepting and sending payments is changing rapidly. If you embrace these changes, you may have some more time on your hands and money in the bank account.
U
LAW & FINANCE
DISCLOSURES OF PHI by
DON. R. MCGUIRE JR., R.Ph., J.D.
Uses and disclosures of Protected Health Information (PHI) are allowed under the Health Insurance Portability and Accountability Act (HIPAA) as needed to perform transactions for treatment, payment, or healthcare operations (TPO). This is well known to pharmacists, but not always by patients. Patients are aware of HIPAA and some of them think that HIPAA prohibits all use and disclosure of PHI. Patients have reported claims alleging that the pharmacists violated HIPAA by contacting the prescriber to clarify a prescription. Pharmacists know that they can disclose PHI to another treating health professional under TPO. Pharmacists may be less aware of other uses and disclosures permitted under HIPAA that are not included under TPO. These can be found in the Code of Federal Regulations at 45 CFR 164.512. These uses and disclosures are not absolute. Many have conditions that must be met prior to the use or disclosure being made. The length of this article won’t allow a complete listing of all the conditions for each. The regulations may also restrict the parties to whom the disclosure may be made. The first permitted use and disclosure is for public health activities. This allows disclosures to public health authorities, FDA and other persons in certain circumstances. One of these is an agency authorized to receive reports of child abuse or neglect. This connects to a second permitted disclosure about victims of abuse, neglect, or domestic violence. There is some overlap in these permitted uses, so caution is needed to make sure your situation fits into the parameters. There are three related disclosures that involve law enforcement. The first allows disclosures to law enforcement officials about victims of crime or about criminal conduct. Disclosure is also permitted to avert serious threats to health or safety, either to a person or to the public. This could even include disclosing PHI that would help police identify or apprehend escapees. The third permitted use here is disclosures to a coroner or medical examiner to help identify a person or help determine the cause of death. Regulations also permit disclosures for cadaveric organ, eye or tissue donations; or for research purposes. There are a number of specific conditions regarding disclosures for research purposes. There are two exceptions involving the legal and regulatory system. The regulation provides for disclosures to a health oversight agency if the agency is performing their oversight activities. This would include audits, inspections, investigations or disciplinary actions. These are not audits conducted by third party payers. There is also an exception for court orders and subpoenas. There are conditions to be met for the subpoena exception to be valid, so use caution when responding to a subpoena. The last two exceptions are in specialized areas. The first is for specialized government functions. These include uses and disclosures for military and veterans activities, national security activities, protective services for
the President, correctional institutions or to the National Instant Criminal Background Check System. The last exception is the disclosure of PHI to workers compensation programs as required by law. Workers compensation is a statutorily-created system that regulates the care of injured workers. The lesson for pharmacists is that there are many situations other than TPO where use or disclosure of PHI is permitted without the patient’s authorization. All of the exceptions are subject to conditions and are not absolute. Also, the pharmacist should remember that they are only allowed to disclose the minimum amount of information necessary to fulfill the purpose of the disclosure. These exceptions are not authorizations to disclose all PHI concerning an individual. When presented with a request for PHI, the pharmacist should investigate if the request is permissible under TPO or some other exception. If the request is permissible, the pharmacist should verify that all conditions have been met. The Department of Health and Human Services has a useful page on its website to help the pharmacist navigate rules and conditions. It can be found at: http://www.hhs.gov/hipaa/for-professionals/faq. As always, the pharmacist should reach out to their local attorney if they need assistance in navigating the HIPAA waters. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.
Are Your Patients’
Personal Information Safe? Last year over
112 million medical
records were compromised due to data breaches. The cost per medical record averaged $400.
If you had a data breach, could you afford the financial and reputational cost?
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”
redwoodfg.com
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 25
EDUCATION NEWS
HARRIS-STOWE STATE UNIVERSITY AND ST. LOUIS COLLEGE OF PHARMACY LAUNCH NEW DUAL DEGREE PROGRAM Harris-Stowe State University (HSSU) and St. Louis College of Pharmacy (the College) recently announced the formation of a new program to provide educational opportunities for students in the field of pharmacy. The dual degree program will allow students to pursue a Doctor of Pharmacy degree in a 3+4 format. Students will complete three years of study in the Biology/Pre-Pharmacy track at Harris-Stowe and in their fourth year, they will begin work on their Doctor of Pharmacy at the College. The institutions celebrated the agreement in a formal signing ceremony today in the new Academic and Research Building on the St. Louis College of Pharmacy campus. “This partnership with St. Louis College of Pharmacy will allow our students the chance to enter an exciting health care career with tremendous employment potential,” said Dr. Dwaun J. Warmack, president, Harris-Stowe State University. “Today’s students realize that pharmacists work alongside physicians on health care teams and play a vital role in improving their patients’ overall health and well-being.” Over the next decade, more Americans are expected to seek health services due to the aging population, and the Bureau of Labor Statistics projects employment in health care occupations is projected to grow 19 percent between 2014 and 2024. In the recently released report: “African Americans: College Majors and Earnings,” African Americans who chose pharmacy careers with a bachelor’s level degree saw the highest median annual earnings, at around $84,000. Earning potential is even higher with a Doctor of Pharmacy degree: according to the
Dwaun J. Warmack, president of Harris-Stowe State University and John A. Pieper, president at St. Louis College of Pharmacy, flanked by faculty, staff and students affiliated with the program, gather to celebrate the signing of a formal agreement on February 17. The agreement will create a dual degree doctor of pharmacy program for HSSU.
Bureau of Labor Statistics, the 2014 median salary for pharmacists was $120,950. Dr. Dwaun Warmack, president of Harris-Stowe and Dr. John A. Pieper, president, St. Louis College of Pharmacy signed the agreement surrounded by faculty, staff and Harris-Stowe students interested in the program. Representing HSSU were Dr. Dwyane Smith, provost and vice president for academic affairs, Dr. Michelle McClure, associate provost, Dr. Jon Corbett, chair for the Department of Math-
students must complete all prerequisite courses by the end of their junior year. The student must also hold a cumulative GPA of at least 2.7, hold no individual course grades below a C- in prerequisite courses, successfully complete an in-person interview and writing assessment, and taken the Pharmacy College Admission Test. These requirements are the same as any student applying to transfer into the College’s professional program. Students who successfully complete four years of study in the dual-de-
“This partnership with St. Louis College of Pharmacy will allow our students the chance to enter an exciting health care career with tremendous employment potential” ematics and Natural Science, Dr. Jana Marcette, assistant professor of biology, Dr. Sandra Leal, assistant professor of biology, and Dr. Tommie Turner, director of the Math and Science Academy. Also representing the College was Dr. Bruce Canaday, dean of the School of Pharmacy, and Dr. Brenda Gleason, associate dean for academic affairs. To be eligible to enter the first professional year of the Doctor of Pharmacy program, HSSU
26 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
gree program will earn a Bachelor of Science in Biology with a Pre-Pharmacy minor from HSSU. They will earn a Doctor of Pharmacy degree from the College after completing the remaining professional program coursework and progression requirements. HSSU students will be eligible to enter the program as early as this fall.
EDUCATION NEWS Kendall Guthrie Dr. Bill Gutheil
Sarah Billings
Š St. Louis College of Pharmacy
UMKC RECEIVES CONTINUATION OF ACCREDITATION STATUS University of Missouri-Kansas City School of Pharmacy’s Doctor of Pharmacy recently received accreditation status through 2024. As with all accredited pharmacy programs, the accreditation process identifies areas of improvement in addition to listing many compliments, including: the strength of the student body in terms of maturity, professionalism, and leadership; the commitment of faculty to make students feel welcome; the Experiential Education Office and involvement of preceptors and support of students and the Office of Student Affairs including areas the University has improved student success. The UMKC program is accredited by: The Accreditation Council for Pharmacy Education 135 South LaSalle Street, Suite 4100 Chicago, IL 60603 www.acpe-accredit.org
GRANT AWARDED
NEW HIRES AT UMKC
Dr. Bill Gutheil, Associate Professor at UMKC, recently secured a major new research grant awarded by the National Institutes of Health to (over $600,000 over two years) to further develop his technology aimed at multiplexed antibacterial library screening. Dr. Gutheil received his B.S. in Biochemistry in 1983 from Cal Poly San Louis Obispo CA, and his Ph.D. in Chemistry in 1989 from the University of Southern California. After graduation, he did Postdoctoral Research first at Harvard University in the CBBSM (Center for Biochemical & Biophysical Sciences & Medicine) under the direction of Professors Barton Holmquist and Bert Vallee, where he received training in the areas of Analytical Metallobiochemistry, Protein Biochemistry, and Molecular Biology, and was awarded an NIH Postdoctoral Fellowship. He then received additional Postdoctoral training in the Laboratory of Professor William Bachovchin at Tufts University Medical School where he received training in the areas of Bio-organic chemistry, NMR spectroscopy, and Immunochemistry.
Kendall Guthrie, based in Kansas City, joined the staff of UMKC as Assistant Clinical Professor in November 2015 and Sarah Billings, PharmD, became Assistant Clinical Professor and is based in Springfield. UMKC is now actively recruiting five more pharmacy practice faculty positions with one in Columbia, two in Kansas City, and two new positions in Springfield! In addition, we are currently recruiting two basic science faculty positions in our Division of Pharmacology and Toxicology here in Kansas City.
UMKC ACADEMY OF STUDENT PHARMACISTS REC The Academy of Student Pharmacists (ASP) at UMKC received the Division AA National Chapter Achievement Award, the National Second Runner-up Operation Heart Award, and the Region VI Operation Diabetes Award. Two student pharmacists, Elizabeth Rodman and T. J. Pham, served as Missouri Delegates to the APhA House of Delegates. The APhA-ASP Chapter officers include; presidents Elizabeth Rodman and Andrew Fennewald, and faculty advisors, Drs. Angela Brownfield, Andrew Bzowyckyj, Lisa Cillessen, Kelly Cochran, Cameron Lindsey, Valerie Ruehter, and Heather Taylor.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 27
A Buying group for independent retAil phArmAcies
...owned by 19 state pharmacy organizations ...a leader negotiating on behalf of independents ...saving pharmacies money for more than 25 years ...financially supports the state pharmacy organizations ...serving pharmacies nationwide 1-888-200-0998 | www.pacealliance.com
SPRING 2015 7
EXPERT INSIGHT
For the DASPA Graduate
DASPA For Both The Novice And The Trained by SANDRA BOLLINGER
PharmD, FASCP, CGP, CDE, CPT, CFts Health Priorities, Inc., Sikeston, MO
Y
ou’ve probably heard of DASPA but still don’t understand what all the hoop-la is about. If that’s the case, here’s the lowdown. Diabetes Accreditation Standards-Practical Applications (DASPA) is a diabetes training program that equips pharmacists with the tools and knowledge necessary to establish an accredited diabetes education program through a community pharmacy. Why is affiliation with an accredited diabetes education program important? It’s important because being affiliated with an accredited diabetes education program is the key to being eligible for payment by the Centers for Medicare & Medicaid Services (CMS). Yes, you read correctly, DASPA offers community pharmacists the training and tools needed to help them expand their clinical role into diabetes self-management education/training (DSME/T), which is reimbursable by CMS for providing the service. The DASPA program consists of two separate components, one of which is completed online and the other via live participation. The program provides you with hands-on experience and expert advice on billing, program set-up, successful operations, patient outreach plus more.
Have you completed the DASPA training but still haven’t gotten your site accredited? Do you feel confused, overwhelmed or just don’t know where to start with the accreditation process? Need some help to get you through the accreditation process? YOU’RE NOT ALONE! There’s no doubt that the DASPA program provided you with all the information and tools necessary to get your diabetes program accredited. It also equipped you with valuable resources to help you implement your program once it’s been accredited. But if you’re like most others, the volume of information with which you were provided at the training might have seemed overwhelming. Let’s use a divide and conquer approach to determine what your biggest challenge(s) is/are with moving forward with accrediting your diabetes education program. Is it: • Too much information to digest • Don’t know where to start • Don’t have enough time • Need additional administrative staff • Don’t have anyone to lean on to help with questions • Other
If you responded with “too much information” try taking this approach:
• Locate the three ring binder that you received at the training. Look in the pocket on either the front or back cover and locate the CD that has all of the resources loaded on it. Review the content of the CD. Chances are pretty high that when you look at the CD now, the information will appear less onerous and will be more comprehendible than the first time you saw it. See if you are still feeling any apprehension regarding any of the content that you see on the CD. If so, make a list of those things, then reach out for assistance.
If you responded with “don’t know where to start”:
• Perform instructions found in (A) above. • Next, find a “champion” technician/employee that buys into what you are trying to accomplish. (Entire staff must buy in at some point.) You might offer an incentive to reward the person for the work that will be involved. This person will be charged with the responsibility of keeping the project on task and starting the accreditation application process. • Set a date of when you want the accreditation application to be complete. • Identify a customer that you will use as your patient “zero”. This will be the patient whose chart will be de-identified when you submit the AADE application. Set up an initial appointment with the patient so you can begin getting the chart put together with the necessary documents. Meeting with the patient now will allow you enough time to schedule a follow-up visit to record the necessary progress that has or has not been made.
If you answered “need additional administrative staff”, trying delegating responsibilities to other staff members so you won’t have to do it completely by yourself. If you answered “don’t have anyone to lean on to ask questions” please note that that is a perceived problem NOT a REAL one. NCPA is available to help with questions regarding the Medicare application. AADE is available to assist with the AADE application. MPA is available to assist with ANY questions and is available and willing to work one-on-one with you, or one of your staff, to help you make it through the process. Make plans to start working on the Accredited Diabetes Education Program application today. We need you to help make a difference in pharmacy. What can MPA do to help you achieve that goal? We’re just a phone call away.
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 29
Now&Then
SWAMP ROOT DOCTOR
by BOB PRIDDY
I
f you have sediment in your urine like brick dust, have a stone in the kidney or gravel in the bladder, or if you have “stinging sensations in the parts when voiding urine,” Binghampton, NY doctor S. Andral Kilmer had a swamp root concoction that would take care of you. And he still does because in this case what was then IS now.
Sylvester—that’s what the “S” is all about—studied with a prominent Allopathic doctor in Schoharie County, New York and then with an area pioneer in homeopathy in the same region. He seemed to have had a regular medical education in the 1860s and also studied Eclectic and Botanic Practice in Wisconsin. He became so popular with his vegetable remedies that he built his own laboratory building where 2,000 bottles of various remedies could be filled in an hour. He and his brother, Jonas, were producing eighteen different medicines by 1895, among them Kilmer’s Indian Cough and Consumption Cure (for “Cough, Colds, Hoarseness, Tickling in the Throat, Spasmodic Croup, Cankered Throat, Catarrh Irritation, Tightness Across the Chest, and Irritated Conditions of Throat and Chest”), Prompt Parilla Pills (for among other things bad taste in the mouth and torpid liver), his Ocean Weed Heart Remedy, his Female Remedy (“The great blood purifier and System regulator. The only herbal alternative and depurative ever discovered. Specially adapted to Female Constitutions.”), and Wild Indian Female Cancer Injection. But by far his most successful product was Dr. Kilmer’s Swamp Root Kidney, Liver and Bladder Cure. John E. Golley wrote a few years ago that his Swamp Root potion was made up of Buchu leaves, Oil of Juniper, Oil of Birch, Colombo Root, Swamp Sassafras, Balsam Copaiba, Balsam Tolu, Skullcap leaves, Venice Turpentine, Valerian Root, Rhubarb Root, Mandrake Root, Peppermint herb, Aloes, Cinnamon and sugar. All of this was mixed with about 10 ½ percent alcohol. He spent $100,000 to build a “Sanitarium and Hydrotherapium” outside of Binghampton in 1892, near a sulpho-phosphate spring. He also set up a cancertorium in Binghampton for the treatment of cancer patients, even paying their train fare if they committed to staying three to six months. Golley wrote, “He advocated a homeopathic approach to the treatment…which involved a controlled diet, treatment with the different springs as well as a secret medicine which, after a time, would cause the cancer to be expelled from the body.” No radiation of surgery was involved. He died of a cerebral hemorrhage in 1924. Much of the success of Dr. Kilmer’s remedies is credited to his nephew, Willis, who utilized every means of advertising and packaging available at the time to promote the products nationally. He was so zealous in his efforts that he founded his own newspaper in Binghampton, partly to put another newspaper out of business and partly to control patent medicine advertising and to make sure news articles condemning patent medicines never got circulated in the city. The other newspaper did fail. Willis’ newspaper still exists as the Binghampton Press & Sun-Bulletin. And so does Swamp Root. Willis’ widow sold the rights to Swamp Root after World War II to Medtech Laboratories, a Wyoming company. Want some? You can order it. Willis Kilmer made special efforts to keep any stories about the Pure Food and Drug Act out of the Binghampton Press. But today, the makers say Kilmer’s Swamp Root is made in a lab that follows the FDA Good Manufacturing Procedures. Dr. Kilmer is still there for you when you have brick dust in your urine or gravel in your bladder.
30 MissouriPHARMACIST Apr. | June 2016 Volume 90, Issue II
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.
Endorsed* by:
Should something happen to you...
is your family covered? Life insurance isn’t for you, it’s for them. Do you have life insurance? We can help.
“Pharmacists Mutual Companies is a company built on integrity, professionalism, moral ethics, and above all a gentle and caring touch that ensures your final wishes will truly come to fruition. Pharmacists Mutual is a cut above the rest and has successfully restored my faith in the value of insurance. I would gladly recommend Pharmacists Mutual to anyone without reservation and am forever thankful for their steadfast diligence and desire to make sure my loved one’s final wishes were carried out.”
Protect your family’s financial future with life insurance.
Call us today and experience the Pharmacists Mutual difference.
800.247.5930
Dr. Elizabeth Odumakinde, MD
Scott Naeger
800.247.5930 ext. 7142 636.524.1065
John Brubeck, LUTCF 800.247.5930 ext. 8040 816.223.3265
Products underwritten through The Pharmacists Life Insurance Company, a subsidiary of Pharmacists Mutual. * Compensated endorsement. Not licensed to sell all products in all states.
phmic.com
THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 31
THE PTCB
ADVANTAGE • Improved employment opportunities • Demonstrated value to the pharmacy team • Validated achievement • Future career growth options • Prestige among coworkers • Potential for higher salary
Certification by PTCB is the gold standard for pharmacy technicians. Many employers now require their employees to be PTCB-Certified Pharmacy Technicians (CPhTs). PTCB has a new website, a streamlined application process, sponsorships, and free verifications. The Pharmacy Technician Certification Exam (PTCE) reflects current knowledge areas demanded across all practice settings. PTCB’s requirements to become a CPhT include a high school diploma and a passing score on the PTCE. Learn more and apply at www.ptcb.org.
Get the
PTCB ADVANTAGE Become a
PTCB CPhT TODAY
SETTING THE STANDARD www.ptcb.org
CONNECT ONLINE:
SPRING 2015 3