Missouri Pharmacist Q3 2016

July | Aug. 2016 Volume 90, Issue III

Relax &

Rewind

AT LAKE OF THE OZARKS pa ge 15

PROVIDER

STATUS

What does it mean?

pa ge 20

Making the right choices through diabetes patient education.

M

ACT NOW, SCHOLARSHIP GRANT MONEY IS AVAILABLE FOR A LIMITED TIME. Living with diabetes is never easy, but knowing how to manage this disease can make a big difference.

YOU HAVE THE POWER TO EDUCATE AND CHANGE THE LIVES OF PEOPLE WITH DIABETES. Diabetes Self-Management Education (DSME) site accreditation grant money is available.

Be the first to apply.

Scholarship grants are available July 2016 – June 2017 with a limited quantity of grants available.

All Diabetes Accreditation Standards-Practical 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 and potentially other commercial payers and Missouri Medicaid for diabetes patient education.

Visit MoRX.com/pse now to learn

more and to submit a DSME scholarship grant application.

This grant opportunity is in partnership with the Missouri Department of Health and Senior Services and MPA. Living with diabetes is never easy, but quality education from a local Missouri pharmacist can make a big difference in someone’s life.

Pharmacist Service Expansion Project

Missouri Pharmacist Magazine, Volume 90, Issue III

THE TABLE OF

CONTENTS

Relax &

Rewind

Departments

MPA Staff

From the President pg. 2

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. 3 Member News pg. 5 Tech Corner pg 6 Expert Insight pg. 8 Law & Finance pg 12 Conference Overview pg 15 Legislative Review pg 20 Education News pg 25 Need To Know pg 27 Technology Tune-Up pg 30 Now & Then pg 32

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 Mizzou Pharmacy, Columbia Member at Large - LISA UMFLEET, RPh, CDE, 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.

To advertise or for advertising rate information email 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 III, Summer 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

Rewind, And Plan Your Future

by JUSTIN MAY, PharmD

Justin May, PharmD, Red Cross Pharmacy, Sedalia, Mo. is President of Missouri Pharmacy Association.

F

or many, summer is a time of rest and relaxation. For the Missouri Pharmacy Association, summer means hard work, planning and preparation! It's when we finalize plans for the annual meeting in September, prepare for our board retreat in August, touch base with our legislators and, new in 2016, hold our first MPA Young Leadership Retreat.

This year the Missouri Pharmacy Association (MPA) will come together again at TanTar-A Resort in Osage Beach September 8-11.

In years past, the annual meetings at Tan-Tar-A drew our highest attendance. Many Missouri pharmacists have fond memories of relaxing with colleagues and friends at Tan-Tar-A and there are more than a few who spent childhood vacations at MPA Annual. Although times have changed since the early MPA meetings at Tan-Tar-A, it's certain that those who attended faced significant challenges and came up with workable solutions. Today is no different. The

As you know, the MPA serves as the legislative voice of Missouri pharmacists. In order to serve as that voice the MPA must be known to both State and Federal legislators. Ron Fitzwater (CEO MPA), Christian Tadrus (MPA Past President), and I attended National Community Pharmacist Association Congressional Pharmacy Summit May 24-25 in Washington D.C. to discuss current pharmacy issues such as PBM transparency and pharmacist provider status with our legislators. It is the relationships MPA members have with their legislators at home that allows MPA representatives to have quality, substantive conversations with legislators on Capitol Hill.

Through the hard work of the MPA and its members, Missouri pharmacy had a fantastic 2016 legislative season! A few highlights of bills that passed are MAC Pricing/PBM Legislation (Senate Bill 865), Biosimilars (Senate Bill 875), Naloxone (House Bill 1568), Step Therapy (House Bill 2029), and the Budget, which has

“We gather to share ideas in order to provide superior care to the patients we serve.” challenges are different, but the reasons we find solutions are the same: we gather to share ideas in order to provide superior care to the patients we serve.

In recent years, developing young leadership has been a top priority for the MPA board, and this year the first annual MPA Young Leadership Retreat was held July 8-10. A small group of pharmacists identified by their peers as young leaders gathered for training to help further develop leadership skills. It is the young pharmacists, the new practitioners, who will be our new leaders, who will carry the torch of our profession and face the challenges of the future.

Our goal is to bring these individuals into the MPA and help them lead us.

2 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

significant pharmacy reimbursement implications due to Medicaid budget and Federal Reimbursement Allowance (FRA). A complete list of pharmacy related bills that passed can be found on the MPA website. Legislative advances to the profession of pharmacy cannot be accomplished without an active MPA membership. Thank you for all of your hard work!

Please join the MPA this September for a relaxing weekend with colleagues and friends.

Invite a young pharmacist to attend. Take in the continuing education and enjoy networking and brainstorming at our social events. Gather at Tan-Tar-A to “Rewind” and plan your future.

I look forward to seeing you there!

CEO UPDATE

"Little Man"

by RON FITZWATER, CAE, MBA

A

s I talk to pharmacists around the state of Missouri, I hear differing opinions on the state of the health care industry; specifically, the practice of pharmacy within that industry. Big business and corporate players are extending their reach into health care. Many of the changes they are making are not translating into better care for patients, better outcomes, or a decrease in health care costs as they promised. Conversely, their changes have often resulted in less care, narrowly structured networks and pharmacy formularies, and a continued escalation of costs.

all had an impact on pharmacists, and more importantly, on the patients you serve. Some of the most onerous are the companies who participate in the Medicare Part D program.

We have been working to both understand and develop a way to educate pharmacists on how to prepare for one of their growing programs – DIR (direct/indirect remuneration) fees. These one-sided fees are a mechanism being used to leverage pharmacist reimbursement and impact your ability to manage the health care of your patients. Many of the effects will be hardest felt in the rural areas and smaller towns around our state.

As I was growing up, most of the music that was played in our house was country music.

I became a lifelong fan of it and have acquired

Ron Fitzwater, MBA, CAE, is the CEO of Missouri Pharmacy Association.

“Big business and corporate players are extending their reach into health care. Many of the changes they are making are not translating into better care for patients, better outcomes, or a decrease in health care costs as they promised.”

From a professional perspective, it would be hard to argue that there has ever been a better time to be a pharmacist. New and enhanced educational training and opportunities have broadly expanded the practice of pharmacy to include not only dispensing services, but hands-on patient care services such as MTM, immunizations, diabetes management and more. These services place pharmacists in a pivotal spot in the new health care marketplace.

But there are a number of challenges, too.

Even though there has been a broad expansion in patient services, reimbursement opportunities for many of these pharmacist-provided services have been slow to follow the new health care paradigm, compounded by serious changes to the reimbursement model for dispensing drugs. PBMs and other third parties have implemented new reimbursement processes to “manage” or “contain” health care costs. Changes like mandatory mail order, artificially narrowed networks, and copay manipulation have

new favorite bands and singers over the years.

One of them is Alan Jackson. A number of years ago he had a hit song “Little Man." The song tells the story of the damage that some big corporations and corporate mergers can have on small businesses and towns and cities all across our state and country. The pharmacy profession has definitely felt those effects.

Here is our challenge: how do we continue to respond to those changes and opportunities as we move forward in this transition from a volume-based health care system to one that rewards value?

The Board of the Missouri Pharmacy Association has been diligently working to do just that. From the creation of the Missouri Pharmacist Care Network (MO PCN) to educational programming to an aggressive presence in the State Capitol, we are working every day to represent the interests of patients and pharmacists.

WE NEED YOUR ASSISTANCE.

How can you help? One, be a strong participant with the Missouri Pharmacy Association. We are the only organization in Missouri addressing issues that impact pharmacists every day. No one else is looking out for your profession. In fact, they are working to negatively impact your profession. Two, support our Pharmacist PAC. We are working to develop a relationship with legislators who understand our message and will work to help us address our challenges. And three, become active in the political process this election year. It matters who you send to Jefferson City and Washington, DC to represent you and vote on the critical issues. Please be an active participant in the process by building a relationship with your elected officials. It matters.

Thank you for supporting MPA. It is an honor to work side by side with you as we work to capitalize on the new opportunities that are available. New administrations next year in Jefferson City and Washington will keep things interesting.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 3

RED LETTER DATES August 18-20

January 2017

MPA Board Retreat

Legislative Session Opens

September 8-11

February 2017

Vail, CO

MPA Rewind: Annual Conference & Expo Tan-Tar-A Resort – Lake of the Ozarks

Jefferson City, MO

MPA Board of Directors Jefferson City, MO

March 2017

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.

APhA Annual Convention

More Info & Registration: MoRx.com

March 29, 2017

March 28, 2017

MPA Board of Directors Meeting Jefferson City, MO

September 22

Legislative Day

The 9th annual Falls Prevention Awareness Day (FPAD) will be observed on September 22, 2016— the first day of fall. The event raises awareness about how to prevent fall-related injuries among older adults. The theme of this year's event is Ready, Steady, Balance: Prevent Falls in 2016.

May 2017

Falls Awareness Day

October 15-19

NCPA Annual Convention Join more than 3,000 community pharmacists from across the country at the premier convention for independent community pharmacy. ncpanet.org/meetings/annual-convention New Orleans, LA

December

Legislative Bill Filing Opens Jefferson City, MO

MPA Board of Directors Meeting Jefferson City, MO

Jefferson City, MO

Legislative Session Closes Jefferson City, MO

NCPA Legislative Conference Washington, DC

July 2017

MPA Young Leadership Retreat

August 2017

MPA Board Retreat

September 7-10, 2017

IPhA, MPA Joint Annual Conference & Trade Show St. Louis, MO

MEMBER NEWS

Three Rivers Endowment Trust Elects New Chairman

MARTY MICHEL, RPh, MBA, CDE

T

he Three Rivers Endowment Trust has elected its new chairman for the coming year. Dr. Marty Michel, a pharmacist, was elected as the new chairman at the annual meeting held in June.

His term began on July 1. Michel and his wife, Julita, own and operate Key Drugs in Poplar Bluff and Dexter.

“This is an exciting time for the Three Rivers Endowment Trust,” Michel said. “With the culmination of a successful major gifts campaign, it’s rewarding to see the completion of the Three Rivers - Sikeston building, the completion of the new classroom building on the Poplar Bluff campus, and the start of the construction of the Libla Family Sports Complex and work to pursue other initiatives to support Three Rivers College.”

Michel graduated from the University of Mississippi Pharmacy School with honors. He continued his education with William Woods University and received a Master’s in Business Administration. Michel has served on many local, state, and national boards, including the Missouri Board of Pharmacy, the Missouri Pharmacy Association, the Butler County Health Department Board of Trustees and the Ozark Foothills Healthcare Consortium.

Michel also received the Citizen of the Year award presented by the Poplar Bluff Police Department in 1994. Currently he is an Adjunct Clinical Instructor in Pharmacy Practice with St. Louis College of Pharmacy,

University of Missouri Kansas City School of Pharmacy and the University of Mississippi School of Pharmacy.

“I’m looking forward to working with Marty as our Chairman,” Michelle Reynolds, executive director of the Endowment Trust and Director of Development at Three Rivers College, said. “He has served a vital role since the inception of the organization, and I’m confident the Trust will continue to thrive under his leadership.”

The Three Rivers Endowment Trust formed in 2010 as a not-profit organization, designated by Three Rivers College to receive and manage gifts on behalf of the college. It acts as a trustee for donations to assure that gifts are distributed in the manner specified by the donor.

Natalie Riley, an attorney at the Holden Law Office in Dexter, preceded Michel as chairman.

In addition to accepting annual gifts, pledges, and planned gifts, the Three Rivers Endowment Trust is involved in several activities, including a Trivia Night, Day at the Ballpark with the St. Louis Cardinals, an annual golf tournament, a benefit run among other activities.

The organization awards thousands of dollars in scholarships annually.

For more information, check www.trcc. edu regularly for event updates or by calling the Three Rivers Endowment Trust at (573) 840-9077. Reprinted courtesy of KFVS12.

M

About Marty

and received a Masters degree in Business Administration in 2001 from William Woods University. He and his wife Julita currently own the pharmacies; Key Drugs, Key Drugs at Northwest in Poplar Bluff, and Key Drugs at Dexter.

Also A Member Of

• SEMO Pharmacy Association • NABP (National Association of Boards of Pharmacy) • Member of the American Association of Diabetic Educators • Past member of Poplar Bluff Healthfest Committee • Past chairman of Poplar Bluff Drug Commission • Past members of Red-Flag Drug Committee • Past member of the Ozark Foothills Healthcare Consortium • Past member of the Missouri State Board of Pharmacy for 8 years (President of the Board of Pharmacy for 5 years) • Past County elected member of the Butler County Health Department Board of Trustees for 8 years (President of the Health Department Board for 5 years) • Current President Elect of Missouri Pharmacy Association

arty Michel graduated with honors from the University of Mississippi with a B.S. in pharmacy in 1983. Michel continued his education by graduating from the Southeast Missouri Law Enforcement Academy in 1993

• Current President of Three Rivers College Endowment Trust board • Current Board Member of Compliant Pharmacy Alliance Buying Group

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 5

TECH CORNER

You Ask. We Answer.

TECHNICIAN CE REQUIREMENTS We are receiving a number of questions on changes in CE requirements, so here's a refresher on what you need to know.

Your Question: What do I need to know about PTCB’s ‘technician-specific’ (T-specific) CE requirement?

PTCB’s Answer: All recertification and

reinstatement candidates eligible to renew in 2015 and beyond are required to submit pharmacy technician-specific CE for hours earned on or after January 1, 2015. For recertification, 20 hours of technician-specific CE must be completed, including 1 hour in pharmacy law and 1 in patient safety. For reinstatement, 20 hours of technician-specific CE is required, including 2 hours in pharmacy law and 1 in patient safety. PTCB has determined that all CE programs offered by Accreditation Council for Pharmacy Education (ACPE)-accredited providers with the target audience designator ‘T’ satisfy the requirement for technician-specific subject matter. PTCB will not

accept any CE hours earned after January 1, 2015 with the target audience designation ‘P’

(pharmacist-specific). If you have

already earned CE that is P-specific, PTCB recommends checking with your CE provider to see if they offer an equivalent course with a ‘T’ designation. (Please note that PTCB will accept CE programs from non-accredited providers if PTCB determines the program’s objectives are technician-specific and assess or sustain the competency critical to pharmacy technician practice as stated in PTCB’s Pharmacy Technician Certification Examination Blueprint.)

Your Question: What else do I need to know about CE requirement changes?

PTCB’s Answer: PTCB has made the

following changes in two other requirements: 1) In-Service Hours: Beginning in 2015, the maximum number of CE hours that can be earned through certain in-service projects and training has been reduced from 10 to 5. Recertification applications submitted in 2015 and later may only include 5 CE hours earned through in-service projects and training, even if the in-service hours

6 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

were earned before January 1, 2015. Note that in-service hours are optional, not mandatory. Credit will only be granted for the completion of in-service training that is outside of regular work responsibilities; specific requirements are outlined in the Universal Continuing Education Form found on PTCB’s website.

2) College Credits: Beginning in 2016, the maximum number of CE hours that can be earned through college credits has be reduced from 15 to 10. Recertification applications submitted in 2016 and beyond will be limited to inclusion of 10 CE hours earned through college credits, even if the college credits were earned prior to January 1, 2016. Please note that college credits are optional, not mandatory.

Previously published in PTCB’s CPhT Connection newsletter.

MEMBER NEWS

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pharmacists, managers, technicians, pharmacy owners, educators, students and every MPA member in Missouri.

Delivering to over 6,500 professionals, we have the Missouri Pharmacy Industry covered.

To advertise or for advertising rate information email advertising@MoRx.com or call (573) 644-2258.

First Annual Young Leadership Weekend Retreat A Success

by ROBYN SILVEY

M

issouri Pharmacy Association hosted its first Young Leadership Retreat July 8-10 at Old Kinderhook Resort in Camdenton, Missouri. Twelve young pharmacists from across the state were handpicked by MPA’s Board of Directors and invited to participate in this program.

The weekend began with introductions and discussing the topic of leadership. "What is leadership? What makes an effective or ineffective leader? What do I want to get from this retreat?" These questions and more were asked, discussed and shared. A dinner cruise on the Lake of the Ozarks was the perfect backdrop for an evening of getting to know each other.

The remainder of the weekend consisted of various leadership tools such as taking the Myers-Briggs test, valuing and leveraging differences, unconscious bias training, effectively implementing change, and creating an action plan. The Myers-Briggs Type Indicator (MBTI) is an introspective self-report questionnaire designed to indicate psychological preferences in how people perceive the world and make decisions. Pharmacists encounter a wide variety of individuals on a daily basis from physicians and patients to colleagues and family. Part of our networking throughout the retreat allowed us to learn more about our unique personalities and triggers in order to effectively communicate and work with those around us. We came away with valuable tools to manage some of the stumbling blocks we encounter in our day-to-day work environment, as well as, our personal lives.

The retreat wrapped up at noon on Sunday, tying it all together discussing contemporary issues in pharmacy and leadership opportunities in Missouri. We walked away with some very valuable resources along with newly gained friendships.

More in-depth details of this program can be found in the next issue of Missouri Pharmacist. We look forward to continuing to host a Young Leadership Retreat each year to provide pharmacists the resources in becoming an effective leader.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 7

EXPERT INSIGHT

Implementing Team-Based Care Into A Pharmacy Practice

by SANDRA BOLLINGER

PharmD, FASCP, CGP, CDE, CPT, CFts, MCMP-II Health Priorities, Inc., Cape Girardeau, MO

Team-based care has been defined as “the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient— to accomplish shared goals within and across settings to achieve coordinated, high-quality care.1"

T

he team-based care concept originated in the late 1990s with the chronic care model and is extending the team beyond the traditional four walls of a clinic and its staff to include pharmacists, community health workers, public health nurses in schools, dieticians, social workers and others performing their work remotely from within the community or patient’s home.

Much has been written about effective team-based care in both the acute and primary care practice settings where pharmacists have been integrated as a member of the interdisciplinary team, but little is found regarding team-based care within a pharmacy practice setting.3-9 Specialized teams exist for hospital rapid response, disaster response, chronic care, hospice and home-based care, but other specialty areas, including pharmacy, are still in need. When a pharmacist participates as a member of an interdisciplinary team from a remote location that is removed from a traditional clinic setting, the pharmacist needs to stand not as a single tree, but to surround him/herself with well-trained support staff, including technicians, to create a forest that can withstand the elements.

Pharmacists may forget about the existing team within their own pharmacy practice site—their staff. The pharmacist will be able to work more efficiently if team-based care is implemented within their practice by drawing on the skills, strengths and dependability of their staff. Utilizing the work that has been done by the specialized teams, as well as what has been reported as a result of research in the acute and primary care settings, pharmacy is well situated to adapt the results of those studies into their own practice settings in order to develop a highly effective pharmacy team-based care model.

8 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

“Work should be matched to each staff member's licensure, experience and abilities2”. This is a critical piece for pharmacists to embrace in order to free up the time that is necessary for them to engage in a clinical role.

With the proper training, direction and oversight, pharmacy support staff, especially pharmacy technicians, should be able to perform most, if not all, of the duties that do not require the clinical judgment or expertise of the pharmacist. These responsibilities could include: scheduling appointments, preparing a patient chart, assisting the patient with completing health questionnaires, calling patients with refill reminders, billing, etc. The pharmacist should ask him/herself, “Does this task require the clinical expertise of a pharmacist?” If not, determine who on the team is qualified to perform the task and delegate the responsibility away from the pharmacist. Both precepting pharmacy students and sponsoring a residency program provide opportunities to bring more expertise to the team and help lighten the load of the pharmacist.

In a pharmacy, work flow is of particular importance regardless if a prescription is being filled, a customer is checking out at the register, a prescription is being dropped off, an order is being checked in or if someone rings the bell at the drive-through window. There is a process, or flow for everything that goes on in a pharmacy. Sometimes the flow runs smoothly but sometimes it seems chaotic. Why is this? Each member of the pharmacy team relies upon information and actions that are taken by other members of the team. When there is not a clearly articulated process (or goal) in place, or when communication breaks down, things begin to lose that flow and tasks may be lost from the process.

The same holds true for pharmacy team-based care. No matter whether the pharmacist is helping a patient with self-management goal setting, preparing action plans, performing medication reconciliation, providing Medication Therapy Management (MTM), working on ways to improve chronic care management, providing preventive screenings or seeing a patient for a follow up, clear roles for each team member are

EXPERT INSIGHT critical. Each member needs to know what they are responsible and accountable for when assisting the pharmacist with the specified task.

This will optimize the efficiency of the team.2 The team members who are available at each workplace will vary.

Individualize the team with the assets (staff) that are currently employed at the pharmacy. Analyze the employees. Evaluate their strengths and weaknesses. Once team members are identified, responsibilities can be assigned. Good communication is key at all times. As the team-based care model develops, a considerable amount will be learned from the process. When team members have concerns or observe things not flowing as expected, they should make notes and share those notes with the pharmacist/manager. Track the information that is learned, analyze the findings and make adjustments.

Managers/pharmacists will depend on good information from co-workers to address concerns. This is known as debriefing. Debriefing allows team members to take a step back and ask what has gone well, what hasn’t and what could be done differently. This information will help gain a better picture of how the team is functioning, and ultimately be used as guide for quality improvement opportunities.11 In summary, pharmacists who want to assume more clinical roles in health care will have to abandon the solo approach to care and embrace the team- based care model within the pharmacy practice setting. Use the five core Principles of Team-Based Health Care as a roadmap for building an efficient and highly effective team-based care model in the pharmacy. Measure both the processes and the outcomes of team-based care, and use those findings to identify potential barriers so strategies can be developed to overcome them.

1 Naylor MD, Coburn KD, Kurtzman ET, et al. Inter-professional team-based primary care for chronically ill adults: State of the science. Unpublished white paper presented at the ABIM Foundation meeting to Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia, PA; March 24-25, 2010.

2 Mitchell, P., M. Wynia, R. Golden, B. McNellis, S. Okun, C.E. Webb, V. Rohrbach, and I. Von Kohorn. 2012. Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine, Washington, DC. www.iom.edu/tbc.

3 Grumbach K, Bodenheimer T. Can health care teams improve primary care practice? JAMA. Mar 10 2004;291(10):1246-1251.

4 American Academy of Family Physicians (AAoP), American College of Physicians, American Osteopathic Association. Joint principles of the patient-centered medical home. Washington, DC; February 2007.

5 Bodenheimer T. Lessons from the trenches—a high-functioning primary care clinic. N Engl J Med. Jul 7 2011;365(1):5-8.

6 Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. Sep-Oct 2007;5(5):457-461.

7 Mui AC. The Program of All-Inclusive Care for the Elderly (PACE): An innovative long-term care model in the United States. Journal of Aging & Social Policy.

2001;13(2-3):53-67.

8 Naylor MD. Transitional care for older adults: A cost-effective model. LDI Issue Brief. Apr-May 2004;9(6):1-4.

9 Porter ME, Teisberg EO. How physicians can change the future of health care.

JAMA. Mar 14 2007;297(10):1103-1111 10 Institute of Medicine (US); Olsen LA, Saunders RS, McGinnis JM, editors. Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. Washington (DC): National Academies Press (US); 2011. 8, Team-Based Care and the Learning Culture. Available from: http://www.ncbi.nlm. nih.gov/books/NBK92080/ 11 Williams RG, Silverman R, Schwind C, et al. Surgeon information transfer and communication: factors affecting quality and efficiency of inpatient care. Ann Surg. Feb 2007;245(2):159-169.

Principles of Team-Based Health Care The Institute of Medicine published a paper in 2012 entitled, “Core Principles & Values of Ef fective Team-based Health Care.”

The report described five core principles of team-based healthcare2:

1. Shared Goals

The team—including the patient and, where appropriate, family members or other support persons—works to establish shared goals that reflect patient and family priorities and that can be clearly articulated, understood and supported by all team members.

2. Clear Roles There are clear expectations for each team member's functions, responsibilities and accountabilities, which optimize the team's efficiency and often make it possible for the team to take advantage of division of labor, thereby accomplishing more than the sum of its parts.

3. Mutual Trust Team members earn each other's trust, creating strong norms of reciprocity and greater opportunities for shared achievement.

4. Effective Communication The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings.

5. Measurable Processes and Outcomes The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team's goals. These are used to track and improve performance immediately and over time.

These are basic fundamentals that can be learned, measured, compared and replicated. Implementing these principles builds strong and effective teams. An entire team actively embracing a clear set of shared goals for both the patient’s care and the team providing the care establishes the foundation of a successful and effective team-based health care model. If all staff members are allowed to work to the highest level of their expertise and ability, the workload for all team members will be lightened.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 9

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10 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

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SPRING 2015 13

LAW & FINANCE

Comprehensive Financial Planning: What It Is, Why It Matters

by Pat Reding & Bo Schnurr

J

ust what is “comprehensive financial planning?” As you invest and save for retirement, you will no doubt hear or read about it, but what does that phrase really mean? Just what does comprehensive financial planning entail, and why do knowledgeable investors request this kind of approach? While the phrase may seem ambiguous to some, it can be simply defined.

Comprehensive financial planning is about building wealth through a process, not a product.

Financial products are everywhere, and simply putting money into an investment is not a gateway to getting rich, nor a solution to your financial issues.

Comprehensive financial planning is holistic. It is about more than “money.” A comprehensive financial plan is not only built around your goals, but also around your core values.

What matters most to you in life? How does your wealth relate to that? What should your wealth help you accomplish? What could it accomplish for others?

Comprehensive financial planning considers the entirety of your financial life. Your assets, your liabilities, your taxes, your income, your business – these aspects of your financial life are never isolated from each other. Occasionally or frequently, they interrelate. Comprehensive financial planning recognizes this interrelation and takes a systematic, integrated approach toward improving your financial situation.

Comprehensive financial planning is longrange. It presents a strategy for the accumulation, maintenance and eventual distribution of your wealth, in a written plan to be implemented and fine-tuned over time.

What makes this kind of planning so necessary? If you aim to build and preserve wealth, you must play defense as well as offense. Too many people see building wealth only in terms of investing – you invest, you make money, and that is how you become rich. That is only a small part of the story. The rich carefully plan to minimize their taxes and debts, and adjust their wealth accumulation and wealth preservation tactics in accordance with their personal risk tolerance and changing market climates.

Basing decisions on a plan prevents destructive behaviors when markets turn unstable.

Impulsive decision-making is what leads many investors to buy high and sell low. Buying and selling in reaction to short-term volatility is a day trading mentality. On the whole, investors lose ground by buying and selling too actively.

The Boston-based investment research firm Dalbar found that from 1994-2013, the average retail investor earned 5 percent a year compared to the 9 percent average return for U.S. equities – and chasing the return would be a major reason for that difference. A comprehensive financial plan – and its long-range vision – helps to discourage this sort of behavior. At the

12 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

same time, the plan – and the financial professional(s) who helped create it – can encourage the investor to stay the course.1 A comprehensive financial plan is a collaboration that results in an ongoing relationship.

Since the plan is goal-based and values-rooted, both the investor and the financial professional involved have spent considerable time on its articulation. There are shared responsibilities between them. Trust strengthens as they live up to and follow through on those responsibilities.

That continuing engagement promotes commitment and a view of success.

Think of a comprehensive financial plan as your compass. Accordingly, the financial professional who works with you to craft and refine the plan can serve as your navigator on the journey toward your goals. The plan provides not only direction, but also an integrated strategy to try and better your overall financial life over time.

As the years go by, this approach may do more than make money for you – it may help you to build and retain lifelong wealth.

1 fool.com/investing/general/2015/03/22/3-common-mistakes-that-cost-investors-dearly.aspx [3/22/15]

LAW & FINANCE

by

DON. R. MCGUIRE JR., R.Ph., J.D.

U

And The Law

ses 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.

We are entering another period of change in the pharmacy profession. We experienced such a period during the 1990s when collaborative practice and pharmacist-administered immunizations were new topics of conversation.

Now we are seeing an enhancement of pharmacist-provided, patient-centered services. And these changes are dovetailing with the drive for provider status for pharmacists. I remember performing kinetic dosing for aminoglycosides at our hospital in the 1990s. We were very proud of how progressive and advanced we were. Our results were improving our patients’ outcomes.

It was only later that we discovered that collaborative practice wasn’t yet authorized by our state practice act.

At the opposite end of the spectrum from those who blindly race ahead are those who resist such changes. These are pharmacists who are comfortable in their existing practices and are worried about the extra liability and exposure when performing new patient care services. These extra liability concerns have been discussed in previous articles. Change and progress are necessary to stay relevant and useful in the modern world. The key to managing change is preparation.

Ohio enacted a law at the end of 2015 that enhanced the ability of pharmacists and physicians to enter into collaborative practice agreements. Among the authorities granted to pharmacists are ordering blood and urine tests, analyzing those results, modifying drug regimens (including ordering new drugs), and authorizing a refill of critical medications. Oregon has a new law going into effect in 2016 which authorizes pharmacists to prescribe self-administered oral or transdermal birth control. California has also passed a law similar to Oregon’s. Typically these statutes authorize pharmacists to expand their practices, but they do not require them to do so. So how do you prepare to expand your (and your patients’) horizons?

Examine the new practices open to you in your state. Which of them are you currently competent to perform? Which can you obtain addition training relatively quickly and become competent? Which ones best serve the needs of your patients? Once you know that, you can assess your liability exposure in performing those services. This is done by reviewing your legal duties to your patients. What duties are

required for you to provide the service? What possible ways could those duties be breached?

What possible injuries that could result from that breach? In this way, you can evaluate your exposure for providing any new service.

Once you have decided to move ahead, the next step in preparation is to examine your insurance coverage. You can’t just assume that new practices are covered. Individual insurance companies can determine what they do and do not want to cover in a policy, regardless of what constitutes the scope of practice in your state. It is never safe to assume that you have coverage for something without first asking and validating that with your insurance carrier. For example, there are policies available in the marketplace that exclude damages resulting from patient counseling – whether or not the counseling is required by law. While we are talking about optional activities and services here, your insurance policy should certainly cover the activities that you are required to perform. To avoid problems later, it is a good practice to read your insurance policy to make sure that it provides the coverage that you need.

Once you have assessed your possible exposure and verified your insurance coverage, you are ready to begin providing advanced services like those authorized in Oregon, Ohio, California and other states. You are part of the next wave of change in pharmacy practice. The profession of pharmacy has come a long way in a relatively short period of time. In the 1950s, it was unethical to tell a patient the name of their prescribed medication. Now pharmacist are engaging in extensive collaborative practices, providing MTM and immunizations; even prescribing medications whose names they weren’t allowed to disclose a few years ago. It is an exciting time to be a pharmacist! © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 13

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Not licensed to sell all products in all states.

14 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

phmic.com

Relax &

Rewind

AT MPA's ANNUAL CONFERENCE & EXPO SEPTEMBER 8TH-11TH | TAN-TAR-A RESORT | LAKE OF THE OZARKS

CONFERENCE ARTWORK PLUS START OF ARTICLE

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 15

RELAX AND REWIND AT MPA's ANNUAL CONFERENCE & EXPO

Relax &

Rewind

AT MPA's ANNUAL CONFERENCE & EXPO SEPTEMBER 8TH-11TH | TAN-TAR-A RESORT | LAKE OF THE OZARKS

Remember the good old days when the annual conference was a time of rest and relaxation with friends, family and business affiliates?

Let's take an MPA Rewind back to those days! Add in some networking, continuing education and a great trade show, and it's the perfect place to rewind and relax with your pharmacy family and share ideas ... and to bring your family along too!

7 Reasons to Attend a Professional Conference In case you're on the fence about coming to the Lake for the MPA Conference & Expo, here are some thought-starters: 1. Share the energy of like-minded individuals – energy that you won't find in on-line learning.

2. “Sharpen the Saw”– Stephen Covey's suggestion that sometimes you have to take a break from the “work” of your work to sharpen your skills.

3. Network. There will be lots of chances to mix and mingle, to reconnect with people you know and to meet new ones.

4. Find out what's new. Take advantage of the Expo to learn about new tools or apps or processes that can improve your business.

5. Learn in a new space. A change of environment can help get a fresh perspective. Remember Robin Williams in “Dead Poet's Society?”

6. Get out of your comfort zone. If you're used to learning from journals, blogs and on-line articles, a live conference may be the way to get out of a business rut and learn some fresh ideas.

7. Meet experts face-to-face. It's a chance to discuss a thought-provoking article with the author, or ask questions of someone in person. It's a different perspective from reading emails!

PLAN TO ATTEND, SIGN UP TODAY! Savor the food... remember the view.

SEPTEMBER 8TH-11TH | LAKE OF THE OZARKS

Golf Tournament Registration Form**

Register Online!

Go to www.MORx.com

September 8, 2016 | 11:00 AM - 12:00 PM Registration & Lunch | 12:00 PM Shotgun start Oaks Golf Course | 1524 State Road KK, Osage Beach, MO | (573) 348-8535

Individual Player ($125)

One individual player, green fees, golf cart, lunch & shirt

Where the locals meet!

4 Player Team ($500)

Four individual players, green fees, golf cart & lunch

NOTE: Please include the names of the person(s) on your team in the section below.

Individual Name: Contact Phone:

AUTHENTIC AMERICAN RESTAURANT WITH A GREAT BAR... that’s the idea behind Baxter’s. We’re perfect for just about anydining occasion or gathering that calls for great food, warm, personal service and an inviting, casual atmosphere.

Contact Email:

2124 Bagnell Dam Boulevard • Lake Ozark, MO 65049 T (573) 365.2669 F (573) 365.2686 www.BaxtersLakesideGrille.com

Address: State:

City: Shirt size:

Zip:

I cannot play in the tournament, but enclosed is my donation of $125 as an Individual Sponsor.

Please provide the names of the person(s) on your team or on the team you are sponsoring.

1. _______________________________________________________________________________________________ 2. _______________________________________________________________________________________________ 3. _______________________________________________________________________________________________ 4. _______________________________________________________________________________________________

Be a Sponsor

Sponsor a Hole - $300 • •

Recognition at hole Recognition in program materials

Sponsorship Information Primary Contact:

Company Name: Contact Phone:

Contact Email:

Donations I will donate the following items for golf tournament participation prizes (i.e. golf towels, tees, caps, ball markers, prizes, etc.):

Mail to: Missouri Pharmacy Association | 211 East Capitol Avenue, Jefferson City, MO 65101 Phone: 573.636.7522 | Fax: 573.636.7485

**Permission to Use Photograph: I grant to the Missouri Pharmacy Association (MPA), its representatives and employees the right to take photographs of me and my property in connection with MPA’s 2016 Annual Conference & Expo. I authorize MPA, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that MPA may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. By registering for this event, I agree that I have read and understand the above.

REGISTER ON-LINE AT WWW.MoRx.COM

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THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 17

Agenda Wednesday, September 7th

4-7 p.m.

Missouri Pharmacy Association Board of Director’s Meeting (for board members only) Location: Redbud

Thursday, September 8th GOLF 11 a.m.

12 p.m.

Lunch Shotgun Start Location: Oaks Golf Course

CERTIFICATION

8 a.m.-6 p.m. APhA’s Pharmacy-Based Immunization Delivery Speakers: Garth K. Reynolds, RPh and Miranda Wihelm, PharmD Location: Parasol 11

RECEPTION

5:30-7 p.m.

Welcome Reception Location: Windgate Plaza (if rain, will be located in Parasol I) 9 p.m-12 a.m. Hospitality Suites Open

Location: Room 1603

AT MPA's ANNUAL CONFERENCE & EXPO SEPTEMBER 8TH-11TH | TAN-TAR-A RESORT | LAKE OF THE OZARKS

Friday, September 9th

7:30-8:30 a.m. Registration 7:30-8 a.m. Missouri Pharmacy Services Corp.

Board Meeting (for board members only) Location: Room 61 (Level 6) 7:30-8:30 a.m. Breakfast Redwood Financial Group (Gabe Hulsey) Location: Salon A 8:30-9 a.m. Welcome/Awards Location: Salon C 9-10 a.m.

Missouri Board of Pharmacy Update and Q&A Speaker: Kimberly A. Grinston, J.D. Location: Salon C 10-11 a.m.

Direct Care Pro Speaker: Sandra Bollinger, PharmD., FASCP, CGP, CDE, CPT, CFts Location: Salon C 11 a.m.-Noon Provider Status Speaker: Andrew Bzowyckyj, PharmD, BCPS, CDE Location: Salon C Noon-1 p.m. Lunch: Central Investment Advisors State Of The Market (15 minute) Location: Parasol 1&2 1-2:15 p.m.

Star Ratings Speakers: Tripp Logan, PharmD, Justin May, PharmD, and Lisa Umfleet, RPh, CDE, CGP Location: Salon C 2:15-2:30 p.m. Break Location: Salon C 2:30-4:30 p.m. Immunization Updates: Speaker: Goldie Peters, PharmD, BCPS Location: Salon C 4:30-5:30 p.m. Hep C Speaker: TBD Location: Salon C

Pharm to Farm Speaker: Kelly Cochran, PharmD, BCPS Location: Parasol II 7-9 p.m.

Pharmacy Agent Corporation (for board members only) 7-10 p.m.

(PAC) Meeting/Dinner Location: JB Hooks

Exhibitor Set-up Location: Windgate Hall 9 p.m-12 a.m. Hospitality Suite Opens Location: Room 1603

Relax &

Rewind

18 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

Saturday, September 10th

7:30 a.m.

Registration 7:30-8:30 a.m. Past President’s Breakfast (Invite Only) Location: Room 64 (Level 6) General Breakfast (All Attendees) Location: Salon C 8-9:45 a.m. Exhibitor Set-up Location: Windgate Hall 8:30-9 a.m. Awards Location: Salon C 9-10 a.m.

MBOP Sterile Compounding Update Speaker: Katie DeBold, PharmD Location: Salon C 10-11 a.m.

Transitions of Care Speakers: Allison Patton, PharmD, Stephanie Paul, PharmD, and Heather Taylor, PharmD Location: Salon C 11 a.m-2 p.m. Trade Show & Lunch Location: Wingate Hall 12-1 p.m.

Lunch Location: Windgate Hall 2-3 p.m.

Precepting Speaker: Diane McClaskey, RPh, BCPS Location: Parasol I

Chronic Pain/Addictive Behavior Speaker: Maureen Knell, PharmD, BCPS Location: Parasol II 3-4 p.m.

Security/Pharmacy Robberies Speaker: Marc Gonzalez Location: Parasol I

Oral Contraceptives Speaker: Stephanie Schauner, PharmD Location: Parasol II 4-4:15 p.m. Break Location: Salon C 4:15-5:15 p.m. Medical Marijuana Speaker: Kari Franson, PharmD, PhD, BCPP Location: Salon C 6-7 p.m.

Reception Location: Salon B 7 p.m.

Missouri Pharmacy Association Gala Location: Salon B 9 p.m-12 a.m. Hospitality Suite Opens Location: Room 1603

Sunday, September 11 7:30-8 a.m.

Missouri Pharmacy Foundation Board Meeting (for board members only) Location: Room 64 (Level 6) 8-9 a.m.

Breakfast with Legislative Update Speaker: Jorgen Schlemeier Location: Parasol 1&2 9-10 a.m.

EPA Drug Disposal Location: Redbud 10-11 a.m.

Beers Criteria Speaker: Curt Wood, RPh, CGP, FASCP Location: Redbud 11 a.m.-12 p.m Antibiotic Stewardship Speaker: Kelli Musick, PharmD, CGP Location: Redbud

DEPARTMENT CONFERENCETAG

PLAN TO ATTEND, SIGN UP TODAY! SEPTEMBER 8TH-11TH | TAN-TAR-A RESORT | LAKE OF THE OZARKS

Friday, September 9th Additional Breakout Sessions Student Sessions 2:30-4:30 p.m.

(30 minutes each) Location: Parasol I

Leadership:

Tim Mitchell, RPh

Management:

REGISTER ON-LINE AT WWW.MoRx.COM

Registration Form

2016 MPA Conference & Expo September 8 - 11, 2016 Osage Beach, MO

Online Registration available at www.MORx.com

I am a new attendee.

Name

Credentials

Preferred Name for name badge, include credentials

Spouse/Guest(s) name (if attending)

Company Name

Address

Heather Burney, PharmD

Starting a Pharmacy: Heather Burney, PharmD

Financial Planning:

Central Investment Services

Tech Sessions

2:30-4:30 p.m.

(30 minutes each) Location: Parasol II

MTMs the Techs Roll Natalie Hoffelmeyer

Adherence

Natalie Hoffelmeyer

Clinical Services

Natalie Hoffelmeyer

Customer Service

Erica Hopkins, PharmD

Immunization Screening for Techs Christa Goforth

Saturday, September 10th Additional Breakout Sessions Student Sessions 9:30-11 a.m.

(30 minutes each) Location: Parasol I

CV Development & Letter of Intent Workshop Tech Sessions

9:30-11 a.m.

(45 minutes each) Location: Parasol II

Insurance Calculations/Compounding

City, State, Zip Phone

DOB (MM/DD)

Email

NABP Number

School

To register multiple guests and/or students, please register online at www.morx.com or call MPA at 573.636.7522.

Pricing/Registration Options:

Full conference and day registrations include all breakfast, lunch and dinner meals, with the exception of the Gala dinner Saturday night.

A meal ticket must be purchased separately if you plan to attend the Gala.

Registration does not include golf. Registration for those events is below. To register for certain meals only, please use the Add On section below.

Member: Full Conference Friday Sunday Saturday $335 $180 $150 $75 Pharmacist/Associate

Technician Student

$190 $75

$130 $50

Full Conference Non-Member: $435 Pharmacist/Associate $290 Technician $100 Student

Spouse/Guest:

Must be a non-pharmacist $195 Full Conference $115 Friday Only $55 Saturday Only Sunday Only $25

Friday

$250

$110 $50

$50

Saturday

Sunday

$220

$180 $75

Gala 10, 2016 GalaTickets: Tickets:Saturday, Saturday,September Sept. 12, 2015 #

Gala tickets (Adult $75; Child *$30)

*Child rates are for 12 & under

Payment Information Check to the Missouri Pharmacy Association is enclosed.

MPA’s Tax Identification number is 44-0357135.

Total: $___________ Visa

Discover

MasterCard

Amex

Billing Address City, State, Zip Card No.

**Signature:

#

Circle all that apply

Conference Expo Luncheon (Adult $30; Child *$15)

We understand that circumstances arise that require you to cancel or send a substitute. Refunds are granted in full up to 60 days and half up to 30 days prior to the event. After that, no refunds will be issued, unless extenuating circumstances arise.

Please notify the MPA of any changes prior to the event to help facilitate the check-in process.

HOTEL ACCOMMODATIONS:

You are responsible for making your own hotel reservations at the following hotel: Tan-Tar-A Resort 494 Tan Tar A Drive Osage Beach, MO 65065 (573) 348-3131 or 800-Tan-Tar-A Mention: Missouri Pharmacy Association Reservation cut-off date is August 17, 2016 Room Rates begin at $129 plus tax per night

Name on card

Exp. Date

Add Ons: Friday, Saturday, Sunday Breakfasts ($25 each)

Cancellation Policy:

Shirt size: ___________

*Please complete the Golf Tournament registration form (seperate, additional form).

Credit Card

#

Special Needs Please let us know if you have special physical or dietary needs:

Golf Tournament*: Thursday, Sept. 8 | 12:00 PM $125 $500

Welcome Reception (Thurs., Sept. 8th 5:30-7 p.m.)

Conference Expo - lunch included (Sat. Sept. 10th 11 a.m. - 2 p.m.)

$145 $100 $40

$160 $75

Special Events: Individual Foursome

$15

Please select which events you plan on attending:

INCLUDED in the full & daily registration fees

Security Code Date:

Mail to: Missouri Pharmacy Association 211 East Capitol Avenue, Jefferson City, MO 65101 Phone: 573.636.7522 | Fax: 573.636.7485

**Permission to Use Photograph: I grant to the Missouri Pharmacy Association (MPA), its representatives and employees the right to take photographs of me and my property in connection with MPA’s 2016 Annual Conference & Expo. I authorize MPA, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that MPA may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. By registering for this event, I agree that I have read and understand the above.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 19

PROVIDER

STATUS BY

KRYSTALYN WEAVER

We talk a lot about the idea of pharmacists having PROVIDER

STATUS

But what exactly does that mean?

Krystalyn Weaver, PharmD, the vice president of policy and operations for the National Alliance of State Pharmacy Associations, talks to us about that phrase—why provider status is important and why we’re working so hard to achieve it here and nationwide.

Across practice settings, provider status is seen as the great brass ring for pharmacists. So let’s start by defining the term: What is provider status, and why do we need it?

Today the federal government does not recognize pharmacists as medical “providers”— specifically in Part B of the Social Security Act. That means Medicare beneficiaries aren’t able to access pharmacists’ patient-care services such as diabetes management, smoking cessation assistance, and even simple wellness visits through their Medicare benefits.

Hence our goal of attaining federal “provider status." (A major step of that would be passage of the Pharmacy and Medically Underserved Areas Enhancement Act, aka H.R. 592 or S.314. It would allow Medicare to pay for pharmacists' services in medically-underserved areas.

But if you dig into the why of that objective, it's more than just about pharmacists.

It's about the fact that patients benefit from the valuable services pharmacists can provide. We know that when pharmacists are on the healthcare team, outcomes improve and costs go down.

To sum it up, the goal is to ensure that patients have access to pharmacists’ brains— not just the products we dispense.

Back to the term provider status. Medicare access is a major step, but it's only the first step. The reality is that we need to approach ensuring patient access to pharmacists’ services from more than one angle. Though Medicare patients make up a huge population of those who would benefit from pharmacists' knowledge and skills, there are many other patients who do not have Medicare coverage.

So provider status is broader. It encompasses any effort to get patients access to these services, which makes the meaning of that term somewhat complicated.

KRYSTALYN WEAVER, PharmD Add to that the fact that not every pharmacist wants to provide those services. Often when I'm talking about integrating more patient-care services into our practices I get the inevitable comment: “I’m too busy in the pharmacy as it is. There is no way I can add even more activities to my day-to-day operations and still get prescriptions filled.”

As a practicing community pharmacist myself (although it’s only moonlighting), I can relate. Any pharmacist (or consumer for that matter) knows how busy a community pharmacy can be. It is, in fact, difficult to add to that workload in the world we live in now.

But that's the key phrase: in the world we live in now. It doesn't have to be this way.

I challenge my peers not to think of the current practice environment. When we're talking about broadening pharmacists' services, think of the future.

Remember that the reason we aren’t already doing this is because our payment system is broken—it doesn’t recognize the value pharmacists are capable of providing. A core premise of the provider status push is that we have to change our business model. We need to change the practice environment and make it feasible for our services to be delivered effectively.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 21

LEGISLATIVE REVIEW

WHEN PHARMACISTS ARE ON THE HEALTHCARE TEAM, OUTCOMES IMPROVE AND COSTS GO DOWN.

We are talking about overhauling our workflow so patient-care services become a focus, not an add-on. And yes, we're talking about new streams of revenue.

I would also argue that considering the ever increasing pressures to decrease what Americans pay for prescription drugs, that a change in our business model is likely essential for pharmacies to survive. Any pharmacy owner can attest to the fact that margins are decreasing. In order to keep pharmacist jobs viable, we need to leverage our most valuable asset: our ability to optimize medication regimens, assist patients with disease management and prevention, and decrease overall health care costs—not just get the right drug to the right patient at the right time (although that will always be important).

If the case is so strong, what's keeping Congress?

That’s a great question, but it assumes that policy decisions are always made with 100 percent reliance on facts and data. The reality is that national policy is influenced by political pressures. And one of the biggest political pressures we're facing today is our national debt and the ever-ballooning costs of entitlement programs. Adding pharmacists' services to Medicare benefits will come at an added cost to the program, at least initially.

So rather than reflecting on why it hasn’t happened yet, I like to focus on why now is a good time. There has never before been more of an awareness on health policy in the larger policy environment. Policy makers are realizing that saving money is more than simply cutting costs—it's also critical to get the most value.

Pharmacists are pros at keeping people healthy and maximizing the utility of a critical healthcare resource: medications. We have plenty of data to show that. More people are realizing this, so not only do we have unprecedented collaboration among pharmacy associations, wholesalers, and national pharmacy chains, we are now seeing support from many outside organizations such as the Centers for Disease Control and Prevention, the National Governors Association, the Office of the Surgeon General, and others.

22 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

Okay, so Congress is concerned about the price tag.

Isn’t there research, though, to demonstrate that the longterm savings from compensating pharmacists as providers is greater than the short-term costs? I can imagine healthier patients and reduced hospital admissions could save Medicaid and Medicare some real money.

Absolutely, there is plenty of data to show that pharmacists can save payers on the overall cost of healthcare in both the short and long term. There is hard data showing that within one year, simply paying pharmacists to provide modest MTM services for Medicaid patients delivered a 4 to 1 return on investment. And data for the long term is even stronger—an average ROI as high as 12 to 1.

Unfortunately, the way new federal bills are analyzed doesn’t account for these savings. The Congressional Budget Office assigns a score to bills that estimates the cost of the bill to the federal budget over the next 10 years. But that score doesn’t take into account cost savings—which doesn’t help our cause one bit. We've heard that this process may be loosening a bit but the score of the federal bill will continue to be a challenge, especially in an election year.

You’ve mentioned that Congress would need to enact provider status at the federal level. But what about at the state level? What would state provider status look like?

Absolutely, there is a lot states can do to ensure patients access to and coverage for pharmacists’ patient care services (which is really what we mean by provider status, remember). Unfortunately, it isn’t as simple as a state legislature granting provider status. The state environment is different than the federal one. At the federal level, a somewhat simple change of definition in law results in a massive change in the payment structure for MANY patients across the country. At the state level this almost always isn’t the case.

There are often several places in state law and regulation where the term provider status is defined, each with a different degree of impact on patient access to pharmacists’ services. They may be important in their own way but are very unlikely to be the broader solution that a federal change would be.

Additionally, it's at the state level where scope of practice is defined, and that's an essential factor in pharmacists’ ability to provide the care they want to provide. In recent years states have made improvements to laws regulating pharmacists: broadening immunization and collaborative practice agreements, allowing pharmacists to prescribe travel medication, and promoting access to public health services through pharmacies, such as smoking cessation products and hormonal contraceptives.

Finally, states can influence local payers including Medicaid, state employee plans, and private payers through legislative or regulatory action, or by simply working with those payers directly and sharing the business case with them.

LEGISLATIVE REVIEW

PROVIDER STATUS So are we talking about expanding pharmacists’ scope of practice?

Providing services under collaborative practice agreements with physicians? Or simply doing stuff pharmacists can already do but currently can’t be compensated for?

All of the above. As we discussed before, state provider status efforts often include work to align pharmacists’ scope of practice with their clinical ability—so patients aren’t missing out on pharmacists’ care because of outdated laws. Collaborative practice agreements can allow for increased collaboration and efficiencies in care delivery—unless the state laws and regulations are so restrictive that entering into an agreement becomes a burden.

And finally there are things pharmacists can do and already are doing that they aren't being compensated for. It won’t be as easy as just submitting a quick claim for services; we'll need to comply with the rules and regulations other providers comply with now—including credentialing, documentation, quality assurance, etc.

How do you think physicians will react to that? Does it change the physician– pharmacist relationship?

The examples we currently have of physician-pharmacist collaborations are relatively few and far between because it requires great creativity to make the relationship financially viable. But when we are able to find sustainable revenue streams to take the strain off of the system, physicians often report favorably on working closely with pharmacists. I think physicians and other providers will embrace the presence of pharmacists on the health care team. Let’s face it—drugs are complicated and there are plenty of other things doctors, nurses, physician assistants, and nurse practitioners have to focus on. Having a medication expert on their side will make their job that much easier and allow them to provide care to more patients.

How do you see this new paradigm impacting the quality of patient care?

It’s been said many times before but I’ll say it again: When pharmacists are on the team, health outcomes improve and costs go down.

I think it's a given that pharmacists’ services can improve quality. The impact pharmacists are already making, even in our broken system, is probably underappreciated. But I think if we align the incentives appropriately—and build an infrastructure that allows pharmacists to access the patient health data they need—the system can be fixed to maximize pharmacists' skills and improve patient care.

Let’s talk about compensation.

If, as providers, pharmacists could be compensated for a broader range of their services, what does that look like? What are the mechanics of it?

I don’t want it to sound like an easy, quick transition. We'll need to adjust workflows, reimagine how we use pharmacy technicians, implement infrastructure changes to allow pharmacists to plug into the information systems hospitals and doctors use, and learn how to do medical billing. And medical billing is VERY different than prescription billing, which is quick, automated and immediately tells you if a claim is covered.

In medical billing, a claim is submitted but the provider may not know for weeks if it will be paid by the insurer. Copays have to be collected at the time of service but are only estimates of what the patient’s cost share is—meaning you have to bill the patient after the fact as well.

And if a claim isn’t covered, the dispute process can be lengthy and arduous. Obviously all of these challenges have been overcome by our colleagues in other health professions so they're not insurmountable, but they will be big changes for pharmacy.

Sounds like this is an issue pharmacists need to anticipate, so that when it’s enacted, our members are ready to take advantage of it on day one. What can pharmacists be doing now to prepare themselves, their practices, and their patients for provider status?

Pharmacists can get themselves ahead of the game by incorporating services into their current business model now. Start small. Consider incorporating medication synchronization into your pharmacy. Incorporate other adherence interventions. Make sure to fulfill all of the Medicare Part D MTM opportunities that come your way. This will help you to get your workflow to a better place and start to change patient perceptions about the level of care pharmacists are capable of providing.

Build relationships in the community.

Reach out to local physicians' offices, get to know the care managers in the local hospital and see if you can find a way to help them with medication reconciliation at discharge.

Building relationships will also build a referral network. Yes, this will mean business when we are able to bill Medicare for medical services but it will also mean increased business now. If your local providers see you as the go-to pharmacy for optimal medication management, they will send their patients to you.

Try to understand the quality measurement landscape—and beyond Star Ratings.

Physicians, ACOs, medical homes, and hospitals are all held to different quality metrics.

Learn what they are, learn what the pressure points are and think of how pharmacists can help to achieve those metrics. Also get to know the billing codes that may be available to us through Medicare. These include CPT codes, chronic care management codes, G-Codes and more. The Medicare Learning Network is a great resource. Sign up for their email list and get information sent to you regularly.

Interview first appeared in Georgia Pharmacy magazine.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 23

THE PLACE FOR PEOPLE

GOING PLACES For more than 125 years, the UMKC School of Pharmacy has trained some of Missouri’s best health-care professionals.

Our secret? Teamwork.

Fewer than 20 schools in the country have schools of medicine, dentistry, nursing and health studies. UMKC is one of them. Our students work on one campus toward one goal – making sure Missouri gets the very best in health care.

Interprofessional education is just one of the great things about UMKC. Discover the rest at pharmacy.umkc.edu.

Tiffany Stewart School of Pharmacy Class of 2017

EDUCATION NEWS Following the Commencement address, the graduates were presented for the formal conferring of degrees by President Pieper.

One by one, each student crossed the stage to receive their diploma and doctoral hood in recognition of the completion of the Doctor of Pharmacy.

COMMENCEMENT BY THE NUMBERS

UMKC School of Pharmacy 2016 Commencement.

UMKC SCHOOL OF PHARMACY COMMENCEMENT HONORS THE CLASS OF 2016 The School of Pharmacy Graduation and Commencement ceremony was held Friday, May 13, in Swinney Recreation Center on the UMKC campus. The ceremony included recognition of all UMKC Pharmacy graduates, both PharmD. and Ph.D. The ceremony included an address from the Provost and a keynote speaker. Academic honors were announced. Each pharmacy graduate was recognized individually as they crossed the stage and degrees were conferred. A “Welcome to the Alumni” address was offered by a pharmacy alumnus.

COMMENCEMENT BY THE NUMBERS • 120 graduates • 24 graduates awarded honors • 12 Cum Laude (with honors) • 6 Magna Cum Laude (with high honors) • 6 Summa Cum Laude (with highest honors)

ST. LOUIS COLLEGE OF PHARMACY COMMENCEMENT HONORS THE CLASS OF 2016 Saturday, May 7, marked St. Louis College of Pharmacy’s 148th Annual Commencement.

Held at the Peabody Opera House in downtown St. Louis, the ceremony honored the 215 members of the class of 2016 – the largest graduating class in the College’s history. Faculty, staff and members of the College administration joined the families and friends of the graduates to recognize the newest group of College alumni.

Following a processional led by the John Ford Highland Pipe Band and Faculty Marshal Evelyn Becker-Meyer ’83/’93, PharmD., Joseph Fleishaker, Ph.D., chair of the Board of Trustees, called the ceremony to order. John A. Pieper, PharmD., FCCP, president of the College, presided over the ceremony and delivered opening remarks. Melissa Green delivered remarks on behalf of the class of 2016.

• 215 graduates • 50 transfer students • 101 graduates awarded honors • 55 Cum Laude (with honors) • 23 Magna Cum Laude (with high honors) • 23 Summa Cum Laude (with highest honors) • 16 states represented • 2 countries represented

St. Louis College of Pharmacy 2016 Commencement. © St. Louis College of Pharmacy

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 25

Join the force. Impact your profession.

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Cannabinoid Medicine in Missouri A Brief Introduction

A

s more states approve medical marijuana or use of extracted cannabinoids, pharmacists are increasingly affected by this legalization. States such as Connecticut and Michigan require active participation of a licensed pharmacist; in all states, pharmacists are beginning to see more patients who are open about their medicinal cannabis use, legal or illegal. In a recent pilot survey of Kansas City Metro Area pharmacy personnel, 69 percent believed it was very

by CYDNEY McQUEEN, PharmD

important to be more knowledgeable about medical marijuana and cannabinoid medicine therapy, while a survey of 212 pharmacy students found that 94 percent believe more information on cannabis medicine should be integrated into pharmacy school curricula.1, 2 Cannabinoids are not found only in cannabis; humans possess at least three cannabinoid receptors (CB1, CB2, and GPR55), and produce at least three cannabinoids acting on these receptors (anandamide, 2-arachidonoylglycerol,

and palmitoyl-ethanolamide), as well as closely related analogues. This endocannabinoid system is involved in a wide range of activities, including pain sensation, gastrointestinal function and appetite, learning, memory, and immune responses. CB1 occurs throughout the nervous system and many other tissues, while CB2 is limited to the immune system (white blood cells, spleen, tonsils). The most wellknown component is tetrahydrocannabinol (THC), the psychoactive compound responsible

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 27

NEED TO KNOW

FOR HEMP OIL APPLICATION VISIT HEALTH.MO.GOV/ABOUT/PROPOSEDRULES/HEMPEXTRACT.PHP

for the “high,” but cannabis contains over 85 different cannabinoids plus terpenes and other constituents. Terpenes give cannabis its characteristic odors and many exhibit CB1 and/or CB2 receptor binding and modulating activity, as well as other pharmacologic activities contributing to medicinal effects. The second most prominent cannabinoid is cannabidiol (CBD). It has no psychoactive effects and attenuates many negative effects of pure THC. Major cannabinoids are listed in Table 1.

In summer 2014, Missouri House Bill 2238 became law, which allowed production and use of CBD oil in patients with severe refractory epilepsy unresponsive to standard treatments. The CBD oil, called “hemp oil,” must be prepared from plant material containing at least 5% CBD and less than 0.3% THC. Patients or caregivers must register with Missouri and receive a hemp extract registration card. Obtaining the card requires certification from a neurologist who 1) attests that a minimum of three prescription treatments have been tried and failed and 2) agrees to monitor and evaluate use and provide that information to the state. At last count, at least 62 hemp extract registration cards have been issued; only a few neurologists have been willing to certify patients, which can be a barrier to care. However, it is estimated that the number of patients using CBD oil obtained from out of state sources, and without monitoring from a healthcare provider, is likely to be upwards of 1,000.

At this time, two non-profits, Noah’s Arc Foundation of Missouri (NAFMO) and BeLeaf, are licensed to grow the hemp plants, extract and process the CBD oil, and provide the oil through “oil care centers.” Oil must be purchased in person, which may present logistical issues for patients because of limited oil care centers. BeLeaf, located in Earth City, is currently serving 20 patients, and works with pediatric neurologists at Cardinal Glennon Children’s Hospital. It offers a 15 mg/ml oil.

NAFMO centers are confirmed in Kansas City, St. Louis and Springfield, and will receive their first shipments of a 40 mg/ml oil in mid-August 2016.

So once a patient obtains CBD oil, what is the likelihood of effectiveness for seizure treatment? According to many proponents, and as shown on the CNN documentary, “Weed,” CBD oil works miracles. The reality is a little different; some patients do obtain a great deal of benefit from CBD, but research and experience have demonstrated that CBD is like most drug therapies – very helpful for some patients, moderately helpful for others, and not helpful or even harmful for the rest. In clinical trials for epilepsy, patients with Lennox-Gastaut syndrome or Dravet syndrome are the most likely to have some beneficial response. Based on the small

number of studies performed in epilepsy of all types with either CBD or CBD/THC preparations, a loose generalization regarding expectations could be formed as follows: 20 percent of patients may experience a significant reduction in the number of seizures (a 75-100 percent reduction); 40 percent may experience a small to moderate reduction; 20 percent will have no response; and 20 percent may experience a worsening of seizures.

Additional clinical trials are underway, so more complete information will become available over the next few years. ritish GW Pharmaceuticals has an investigational new drug application with the FDA for EpidiolexTM, a purified CBD liquid. Under an expanded access program, over 400 children have been treated in the US; after 12 weeks, 47 percent of all patients experienced a ≥50 percent reduction in seizure frequency, with a median overall reduction of seizure frequency of 45.1 percent.3 Seizure freedom was achieved in 9 percent of all patients. Dravet syndrome patients had a better response rate, with a 62.7 percent median reduction in seizure frequency and 13 percent achieving seizure freedom.

Epidiolex has Orphan Drug Status and Fast Track Status with the FDA, so some experts are predicting approval within the next two years.

Adverse events do occur with CBD; most commonly, somnolence and/or fatigue and gastrointestinal issues. Additionally, drug interactions are possible. THC and CBD are both metabolized by cytochrome P450 3A4; THC is also a 2C9 substrate and CBD a 2C19 substrate. CBD is a rather powerful 3A4 inhibitor while THC induces 1A2 to a lesser extent.

Other cannabinoids affect different enzymes or additional metabolic processes. The drug interaction potential is not yet well-researched, which makes solid recommendations for avoiding or managing drug interactions difficult.

Most studies in epileptic patients have utilized CBD as an adjunctive therapy without noting adverse interactions with antiepileptic agents.

A bill to allow use of hemp oil for conditions other than epilepsy is in committee with the Missouri legislature at present. House Bill 2213 to allow medical marijuana was defeated in April 2016, but the advocacy group, New Approach Missouri, collected more than 260,000 signatures petitioning for a legalization measure on the November 2016 ballot.4, 5 For now, Missouri pharmacist involvement with patients using CBD oil for epilepsy is limited to providing cautions regarding potential drug interactions and possibly providing patients or caregivers with information on the hemp oil registration process (see Resources below). In the not-so-distant future, we may be dispensing CBD products by pre-

B

According to many proponents, and as shown on the CNN documentary,“Weed,” CBD oil works miracles. The reality is a little different; some patients do obtain a great deal of benefit from CBD, but research and experience have demonstrated that CBD is like most drug therapies – very helpful for some patients, moderately helpful for others, and not helpful or even harmful for the rest.

28 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

NEED TO KNOW

CANNABINOID MEDICINE IN MISSOURI scription, while further down the road, Missouri pharmacists may have the opportunity to be involved in the decision-making and dispensing process for medical marijuana.

1 Buehrer H, Barton M, McQueen CE. Knowledge, beliefs, and attitudes of Kansas City metropolitan pharmacists, interns, and technicians toward cannabinoid medicines and medical marijuana (poster). ASHP Midyear Clinical Meeting, New Orleans, LA. December, 2015.

2 McQueen CE. Unpublished data. May, 2016.

3 GW Pharmaceuticals. Press release, December 7, 2015. Available at: ww.gwpharm.com/GW Pharmaceuticals Announces New Physician Reports of Epidiolex Treatment Effect in Children and Young Adults with Treatment-Resistant.aspx 4 Tenth Amendment Center. Report, April 29, 2016. Available at: http://blog.tenthamendmentcenter.com/2016/04/missouri-house-kills-medical-marijuana-billfight-moving-to-the-ballot/ 5 Payne J. New Approach Missouri blog post, May 9, 2016. Available at: http:// www.newapproachmissouri.com/we-did-it.

Definitions Medical marijuana – when the raw plant material (dried flower

clusters, the resin contained on the flowers, or a whole extract) is used, by various administration routes – oral (encapsulated or in edible form), topical, or inhalation via smoking or vaping for medicinal effects, generally under the recommendation of a healthcare provider.

Resources

Cannabinoid medicine – the use of prescription cannabinoids

(dronabinol or nabilone) or when single cannabinoid components are extracted and used separately for medicinal effects, generally under the recommendation of a healthcare provider.

Missouri website for hemp oil application

health.mo.gov/about/proposedrules/hempextract.php

Missouri Hemp Oil Suppliers

Hemp – a variety of the cannabis plant that contains high amounts of

nafmo.org beleafco.com

fiber and only traces of the psychoactive substances, THC. This is the plant cultivated in Missouri for CBD oil production.

Original House Bill

Vaping – when raw plant material is heated so the volatile cannabinoids

house.mo.gov/billtracking/bills141/biltxt/truly/HB2238T.htm

and terpenoids are vaporized, but without combustion of the plant material. This avoids creation of some of the more dangerous carcinogens associated with smoke inhalation. Extracts and oils can also be vaped.

Monitoring of Legislation mpp.org/states/missouri

Cannabinoid Examples Abbrev Known Pharmacologic Action to Date Cannabinoid CB1 agonist Δ-9- (and Δ-8)-tetrahydrocannabinol THC

Cannabidiol

CBD

CB1/CB2 indirect antagonist with mild affinity for receptors, GPR55 antagonist, 5-HT1a agonist

Cannabigerol Cannabichromene Cannabicyclol Cannabivarin Tetrahydrocannabivarin Cannabidivarin

CBG

CB1 antagonist, 5-HT1a antagonist, α2-adrenergic receptor agonist

CBC

Inhibits degradation of endocannabinoids, TRPV1 receptor stimulation

CBL

?

CBV

CB1/CB2 antagonist

THCV

CB1/CB2 antagonist

CBDV

Anticonvulsant activity through unknown mechanism

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 29

TECHNOLOGY TUNE-UP

Three Social Media Trends That Benefit Pharmacies

by REP. TRAVIS

FITZWATER

T

oday, more than ever, social media is one of the most important avenues for connecting with patients who aren’t physically in your pharmacy.

From ads on Facebook, to automation, to interaction and storytelling, social media can be a boon for your business if you use it correctly.

For some, social media is an otherworldly technology never to be considered due to the intimidation of trying to wrap your mind around software that one may or may not believe is a worthy tool for the time.

If that's you, that’s ok. Social media is intimidating for those who haven’t spent much time with these on-line technologies and have a sole focus on acute patient care. But if you’re already familiar with social media, and you’re interested in how it may help you expand your business, here are three social media trends that can benefit pharmacies.

1. AUTOMATION: On social media today you can schedule posts, automatically reply to messages, create a calendar to post at high traffic times for your on-line audience, and much more. Social media makes it easy for you to automate some of your marketing work and frees you up to focus on patient care. Below are a few of the tools (All can be found on your phone’s app store) you can use to automate your social media posting schedule: a. Facebook allows your business/fan page to schedule posts. Use it to schedule a week’s worth of posts on the weekend, and let Facebook do the posting at your appointed times during the week! You can also set it up to noti-

fy you when someone posts or asks a question on your page. b. Twitter just released Twitter Dashboard for businesses to schedule posts and track your analytics as well as follow anything that’s being said about you, your business or area of expertise on your Twitter timeline. c. Buffer is an application that uses analytics and software to automate your posting and tracks analytics over multiple platforms.

2. ADVERTISING: You want to use ads that focus on specific geographic areas around your store, or to target certain age groups or demographics, and social media can be some of the most targeted advertising you can create. For instance, if you want to target young families for your immunization offerings on Facebook, you can select an audience of only 25-45 year olds with families within a ten-mile radius of one of your stores. Instead of paying for the whole population to see this ad, only those people who fall within that range will see your ad. Never has advertising been more targeted than it is today using social media. a. HINT: Use the robust levels of analytics that are offered with social media ads to measure which ads perform better than others.

3. VIDEO: Nothing will tell the story of

your business and patient care at your pharmacy like video. This may be the most beneficial opportunity for a pharmacy in terms of marketing in a long time. Today, you can pull your phone

30 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

out of your pocket, livestream a video to your fans on multiple platforms and/or apps, and reach an audience who wants to hear how they can be healthier. The possibilities are limitless with video. Here are some video platforms worth checking out: a. Facebook livestreaming from your phone: You can open up your phone and create a video that people can watch live from their social media accounts. Amazing. b. Twitter or Instagram video: Twitter offers up to a 140 second video per tweet and Instagram gives you a minute. These are videos you can edit and post directly from your phone with little to no expertise. There’s no easier way today to create interactive content to highlight your business’ story than video. It’s FREE and it’s at your fingertips if you have a smartphone. Use it to promote the important work you do for patients. c. Livestreaming apps like Periscope are growing in popularity and provide an easy way to stream video to followers as well.

As you can see, social media is a powerful tool to show how you're providing patient care to your community. Your community will love it.

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Now&Then

T

History On A Windowsill

by BOB PRIDDY

They’re decorations now. They held the tonics that promised our ancestors health or at least relief. They’re often found at an antique auctions where a box of bottles for a buck—or two, or three—can be found.

That’s where the light blue bottle on the windowsill was found. The windowsill is an appropriate place for it.

Hundreds of years ago, in medieval Europe, pharmacies of the day displayed in their windows bottles filled with concoctions known only to the predecessors of today’s compounding pharmacists.

Only a few bottled medicines were available in the colonies during the American Revolution and it was not until 1818, or so, that William Dyott set up his own bottle-making operation in Philadelphia to make decent medicine bottles. Various shades of blue were used for bottled medicines, most of them variations of cobalt and sapphire blue. Blue bottles carried everything from beer to cosmetics and poisonous substances.

The light blue bottle on the windowsill is part of the history of America’s fourth-largest pharmaceutical company, which began when a Navy doctor in his twenties became so discouraged by the quality of medicines available during the Mexican War that he threw them overboard.

Dr. Edward R. Squibb convinced the Navy to make its own drugs and in 1851 set up a laboratory in the Brooklyn Naval Yard where he started making anesthetic ether and discovered ways to make chloroform and other preparations.

He created his own laboratory in Brooklyn in 1858 after leaving the Navy, promising his medicines would be consistently pure. One year later, he was advertising thirty-eight preparations.

He became a primary source of medicines for the Union Army during the Civil War and his Squibb pannier, a wooden chest filled with about fifty medicines, became a battlefield fixture.

A company history says it contained “ether and chloroform for use…during amputations, quinine and whiskey to treat symptoms of malaria, and herbal treatments for dysentery,” which was a problem in the unsanitary military camps.

By 1883, Squibb was producing 324 products and had world-wide sales. Nine years later, eight years before his death, Squibb brought his two sons into the company.

By then, William McLaren Bristol and John Ripley Myers had bought a failing drug manufacturing firm in Clinton, New York. They began producing a laxative mineral salt called Sal Hepatica and Ipana toothpaste, containing a disinfectant to protect against bleeding gums. They made Bristol-Meyers a profitable company for the first time in 1900.

The Squibb brothers later sold their company, which incorporated with new owners, and began using the slogan, “The priceless ingredient in every product is the honor and integrity of its maker."

Bristol-Meyers got out of the pharmaceutical business during the Depression and focused on its consumer products, adding Vitalis hair tonic and under arm deodorant Mum to its product line.

Squibb became the world’s largest producer of penicillin during World War II and a Bristol-Meyers subsidiary in Syracuse, New York also began producing large quantities of the miracle drug. Both companies became major producers of antibiotics and consumer products after the war. Bristol-Meyers bought Clairol and Squibb produced the world’s first electric toothbrush.

The companies merged in 1989 to become the second-largest pharmaceutical company in the world. Today, only Johnson & Johnson, Pfizer, and Abbott Laboratories are bigger.

The light blue bottle in the window that is part of the company’s history is not particularly old. It was designed and patented by Ferdinand Nitardy of Brooklyn, who assigned the patent to E. R. Squibb and Sons in 1932.

It is then and now on a windowsill.

32 MissouriPHARMACIST July | Sept. 2016 Volume 90, Issue III

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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