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• Additional protection for you above that provided by your employer. • Covered 24 hours a day anywhere in the United States, its territories and possessions, Canada or Puerto Rico. • Covers compounding and immunizations (if legal in your state). • On-staff pharmacist-attorneys are available to counsel policyholders.
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*Compensated Endorsement Not licensed to sell all products in all states. Form No. PM PhL 196
INSIDE
July-August 2013
Volume 67. Number 4, ISSN 0026-56
Upfront Views and News
President’s Desk: New Beginnings . . . . . . . . . . . . . . . . . . . . . . . . . 5 Elizabeth Cinqueonce Returns to MPhA . . . . . . . . . . . . . . . . . . . . . . . . 6 Viewpoint: Do You Consider Yourself “Qualified?”. . . . . . . . . . . . . 12
Clinical Issues
Oral Chemotherapy: A Pharmacist’s Perspective. . . . . . . . . . . . . . . . 17 Report of Drug Insert Labeling Revisions . . . . . . . . . . . . . . . . . . . . . . 20 Pronunciation of Active Ingredient Names. . . . . . . . . . . . . . . . . . . . . . 21
Industry News
Practice-Based Research Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
On the Cover Liz and Jill
President’s Desk: New Beginnings page 5 Elizabeth Cinqueonce Returns to MPhA page 6
Minnesota News
Statute 151: Filling a Prescription for Change. . . . . . . . . . . . . . . . . . . . 9 Legislative Wrap-Up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
MPhA News
Member Profile: Kendra Metz with Thrifty White Pharmacy. . . . . . . . . 8 In Memoriam: Lester Hackner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 MPhA Award Winners and Annual Conference Photos . . . . . . . . . . . 22
Find us on Facebook... Minnesota Pharmacists Association You’ll find quick updates about what is happening at MPhA and more photos from our events! 3
Minnesota Pharmacist July-August 2013 n
MPhA Board of Directors
Executive/Finance Committee: President: Jill Strykowski Past-President: Martin Erickson President-Elect: Randall Seifert Secretary-Treasurer: Doug Lobdell Speaker: Kandace Schuft Executive Vice President: Liz Cinqueonce Rural Board Members: Eric Slindee Jeff Lindoo Metro Board Members: Melissa Katzenberger Brittany Symonds
Upcoming Events
For all event information go to www.mpha.org!
October Pharmacy Nights –
Alexandria, Metro Area, Duluth, Rochester
At-Large Board Members: Tiffany Elton Craig Else Keri Hager Allyson Schlichte Student Representation: Duluth MPSA Liaison: Sheila Martin Minneapolis MPSA Liaison: Jennifer Dobbe Ex-Officio: Bruce Benson, COP Liz Cinqueonce, MPhA MSHP Representative Pharmacy Technician Representative: Barb Stodola
MPhA MTM Symposium 2013: “Pharmacy Practice - Evolving Locally & Nationally” November 15, 2013, Bloomington, MN Registration Open Date: August 19, 2013
Event Highlights: • Industry Professional Speakers • Networking with MTM Pharmacist Colleagues • Interacting with Exhibitors & Sponsoring Companies • Roundtable Discussions • 100+ Attendees
MINNESOTA PHARMACIST
Official publication of the Minnesota Pharmacists Association. MPhA is an affiliate of the American Pharmacists Association, the American Society of Consultant Pharmacists, the Academy of Managed Care Pharmacy, and the National Community Pharmacists Association.
Editor: Laurie Pumper, CAE Managing Editor, Design and Production: Jazzy McCroskey The Minnesota Pharmacist (ISSN # 00265616) journal is published six times per year by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 551141469. Phone: 651-697-1771 or 1-800-451-8349, 651-290-2266 fax, info@mpha.org. Periodicals postage paid at St. Paul, MN (USPS-352040).
MPhA Mission:
Serving Minnesota pharmacists to advance patient care. The Minnesota Pharmacists Association is a state professional association, whose membership is made up of pharmacists, pharmacy students, pharmacy technicians, and those with a business interest in pharmacy. MPhA will be the place where pharmacists go first for education, information and resources to become empowered to provide optimal patient care. MPhA will be the recognized and respected voice of pharmacy with legislators, regulators, payors, media and the public.
Postmaster: Send address changes to Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469. Article Submission/advertising: For writer’s guidelines, article submission, or advertising opportunities, contact Laurie Pumper at the above address or email lauriep@ewald.com.
Copyright 2013. Bylined articles express the opinion of the contributors and do not necessarily reflect the position of the Minnesota Pharmacists Association. Articles printed in this publication may not be reproduced in any manner, either in whole or in part, without specific written permission of the publisher.
Acceptance of advertisement does not indicate endorsement.
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Have you moved? Have you graduated? Have you had a name change? Update your profile through your online MPhA Member Portal page to continue receiving important association updates.
Upfront Views and News
President’s Desk
New Beginnings By Jill Strykowski I am humbled and privileged to write my first column as President of the Minnesota Pharmacists Association (MPhA). I embrace the challenge to represent our practice with a promise to all of you to let our mission drive our work: “Serving Minnesota pharmacists to advance patient care.” We are in the midst of radical change and new beginnings for MPhA and the practice of Pharmacy; our mission will be our collective guiding light. So… what are these new beginnings for the association? The first of our new beginnings comes with an announcement: your Board of Directors has chosen a new Executive Vice President, Liz Cinqueonce. Many of you remember Liz as Liz Carpenter, having formerly worked for MPhA for 12 years as Vice President of Public Affairs. Under Liz’s leadership, many important legislative initiatives were advanced for the practice. Among the distinguished accomplishments during her tenure: recognition of pharmacists as providers in payment for medication therapy management, expansion of pharmacists’ scope of practice for both collaborative drug therapy management and vaccine administration, and advancement of “Justin’s Bill” addressing illicit online pharmacies. Since leaving MPhA in 2008, Liz has worked for the Minnesota Department of Health (MDH) and the Department of Human Services (DHS) with a primary focus in leading e-health initiatives. With her long-standing relationship at MPhA, the Legislature, and work with MDH and DHS, we are delighted to welcome Liz back to MPhA as the new executive vice president. Liz began 5
Minnesota Pharmacist July-August 2013 n
her new role with MPhA on June 10 and offices at the Ewald Consulting location. We look forward to introducing and re-introducing Liz to all of you as we begin the next new leadership beginning for the association. The Pharmacy Practice Act change brings our second new beginning. We are all aware that the practice of pharmacy has changed substantially since the 1937 act. Although the current act has been amended over the last threequarters of a century, the foundation of the act is still focused on product supply and distribution rather than clinical services that pharmacists also carry out today. The Center for Leading Healthcare Change at the College of Pharmacy brought together a working group to draft proposed language to a new Pharmacy Practice Act to be brought before the state legislature in the 2014 session. The guiding principles of the working group were to consider broad engagement and feedback from the Minnesota pharmacist community. We are the collective pharmacy community and as such — this is the time to let your voice be heard. Under the leadership of Michelle Aytay at MPhA, the practice act is being systematically reviewed by membership from across the state. The time is now for you to provide your input. With implementation of the Affordable Care Act on the near horizon in 2014, we must be ready within our profession to respond to the demands that the market and society are driving for us. A new beginning is indeed needed. We welcome and encourage your partici-
pation in the review and invite you to read about the changes in this edition of the journal. A subsequent chapter will be the recognition of pharmacists as providers and we anxiously await the developments of our California colleagues in this regard … but first — please engage in the dialogue for our Minnesota Practice Act. Our final new beginning (and there will be so many more!) relates to the theme of our Annual meeting “Not your Mother’s MPhA”. The patients we serve expect — and deserve — that as a practice we are a cohesive, integrated group that is working
I embrace the challenge to represent our practice with a promise to all of you to let our mission drive our work. together on their behalf. Additionally, our payers have incentives in place and expect that we bridge the gaps that have existed between retail, hospital, pharmacy benefit management, clinic and other pharmacy practice settings. Developing processes and tools to work together at the interfaces of care in an intraprofessional manner is our pharmacy community’s imperative. In addition, the annual meeting presented this imperative through patient example and demonstration of unique practice settings. Certainly a new beginning in intraprofessionalism to be embraced.
President’s Desk Continued on page 13
Elizabeth Cinqueonce Returns to MPhA Elizabeth “Liz” Cinqueonce has been chosen as the new executive vice president of the Minnesota Pharmacists Association. Liz is returning to the MPhA after more than four years of work in state agencies, where she focused on health care reform and health information technology. Most recently, Liz served as deputy director of the Health Economics Program at the Minnesota Department of Health (MDH). She was recruited to provide strategic and operational management, and was responsible for fiscal and budgetary analysis, contract and grant management, and coordination of special projects that involved staff across multiple sections of the agency. She served on the inter-agency leadership team responsible for implementation of a $45 million State Innovation Model grant to test the Minnesota Accountable Health Model. She also represented MDH as a content advisor to the Minnesota health insurance exchange (MNSure) in the development of a module to display Statewide Quality Reporting and Measurement System (SQRMS) data on Minnesota clinics and hospitals. Liz worked for the Minnesota Department of Human Services (DHS) as manager of E-health and Data Projects. She managed the oversight and expansion of the managed care encounter data quality program, focused on ensuring that data collected from managed care organizations was complete, timely and accurate. She also implemented and man6
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aged the Minnesota Electronic Health Record (EHR) Incentive Program. This involved obtaining CMS authorization to implement and pay an estimated $96.5 million in incentive payments to Minnesota providers during the first two years of the program; she also secured $2.2 million to support program administration. Under her guidance, program registration opened two months ahead of schedule — and disbursement of payments began within two weeks of the first provider attestation. This work followed three years of service at the Minnesota Department of Health as the deputy director for the Office of Health Information Technology, where she led work to expand the adoption and use of electronic health records and health information exchange. In her time at MPhA (1997 to 2008), Liz rose through the ranks from membership assistant to special interest group coordinator to director of pharmacy and legislative affairs, and finally to vice president of public affairs. In her role as vice president, Liz served as the primary lobbyist for influencing legislative and regulatory action for the association. A few of the legislative successes achieved during that time include “Justin’s Bill,” addressing illicit online pharmacies; expansions in pharmacists’ scope of practice to include collaborative drug therapy management and authority to administer vaccines; as well as mitigation of proposals to reduce pharmacists’ reimbursement under Medicaid. She also participated in the executive management team overseeing general associ-
ation operations. Liz was the recipient of the Minnesota Friend of Pharmacy Award in 2007. Liz earned her bachelor’s degree in political science from the University of St. Thomas. She has participated in professional development activities for association management as well as legislative, fiscal analysis, and ethics training. Liz resides in Hugo, Minn., with husband Carmelo and daughters Allison, Jayna and Gabriela. The family enjoys exploring state parks, spending time on Minnesota lakes, cooking together, and spending time with their large extended family.
Call for Articles The Minnesota Pharmacist accepts articles for publication from its members and from non-members. All content is subject to review by the MPhA Editorial Advisory Committee and MPhA Staff, who will determine whether material is of interest to our readers. To submit an article or an idea/ abstract, please send an email to Communication Director Laurie Pumper at lauriep@ewald.com.
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Member Profile: Kendra Metz, PharmD
“You’ve heard the fairytale about the hunter marrying the farmer’s daughter? Well, it’s a true story,” said Kendra Metz, pharmacist at Thrifty White Pharmacy in Moose Lake, Minn. She grew up in Saskatchewan, Canada and “fell for a Minnesota man who was hunting in Saskatchewan.” But this is only part of her story.
cussing vaccinations, I value prevention and I believe knowledge is power.”
pharmacists to better care for our patients,” she said.
Her first job in pharmacy was as a pharmacy technician in 2005 for Drugstore Pharmacy located in a grocery store in Saskatoon, Saskatchewan. Her fiancé from Minnesota was overseas for one year; she needed a job so a friend assisted her in obtaining a job at a local pharmacy. “I knew nothing about pharmacy at the time, but there were two great pharmacists who encouraged me; they were my reasons for pursuing pharmacy and I’m still in contact with these influential pharmacists.
Metz believes that because of growing up in a very close family with both sets of grandparents residing in her hometown, she has strong values and a commitment to helping others. Realizing that every patient is valuable and deserving of her professional
“Whether it is counseling about a new prescription, presenting at respiratory or diabetes support groups, conducting MTM appointments, or discussing vaccinations, I value prevention and I believe knowledge is power.”
“I grew up with Ukrainian foods such as perogies, natchinka (a cornbread casserole) and wheat boiled with sugar. These foods were present at every wedding and most holidays as were local dance favorites such as the polka, seven step and the butterfly. My heritage is important to who I am,” she said.
Metz is a graduate of the University of Minnesota, Duluth campus and graduated in 2012. She said that the Duluth campus was perfect for her because of the availability of outdoor activities she enjoys, access to a “top” pharmacy education, and a variety of community outreach activities that she pursues. Definitely, she said, that the favorite part of her job is interacting with patients. Patient education in any form is challenging yet fulfilling for her, she said. “Whether it is counseling about a new prescription, presenting at respiratory or diabetes support groups, conducting MTM appointments, or dis8
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knowledge and her compassion to serve, she advises her patients in the same way she would advise those close to her. While studying in Duluth, she became involved with MPhA through MPSA, which is very active in community health fairs and other health initiatives. Mainly, she chose organizing events where she presented to children about medication safety. She strongly believes that as a pharmacist, it is important to continue to support MPhA. “It is a voice for our profession and provides various opportunities for
Believe it or not – the last movie she saw was the “The Princess and the Frog” and the last book she read was “If You Give a Pig a Pancake.” That’s because her two-year-old daughter asks for these favorites. The last adult books she read were the complete series, “The Hunger Games.” “You may not expect that my favorite sport is curling; I have been curling since I was four years old. Hiking with my husband and daughter is a favorite time together. And, when I have more leisure time, I’d like to knit just like my Granny taught me.”
Report from the State Capitol By Patrick Lobejko, MPhA Lobbyist
Minnesota News
Statute 151: Filling a Prescription for Change By Rita Tonkinson
There are likely a very few pharmacists practicing today who were alive in 1937. Ask any 76 year old to describe the changes in technology, in the sciences, in medicine, in everyday life — chances are he or she could not begin to list more than just the obvious few. That’s why pharmacists throughout Minnesota know that their Practice Act, Statute 151, does not begin to allow the practice of their profession to be all that it should be, all that it’s capable of, and all that its collective professional expertise can add to the health care delivery system today and tomorrow.
up to date. This committee took into account the time and effort expended just to get amendments introduced into the Legislature and to get amendments passed. They expressed frustration with the piece-meal approach and looked for an avenue to tackle a complete revision. The committee approached the Center for Leading Healthcare Change at the College of Pharmacy, University of Minnesota as a conduit to assemble a group of pharmacists who would be willing to identify the issues, assemble the evidence, and articulate the need for change in order to push for significant reform.
The original Pharmacy Practice Act is very restrictive, some language is not relevant, the few amendments that have been made were helpful but inadequate — it’s time to bring Statute 151 into the 21st century.
In November 2010, the Center for Leading Healthcare Change called together a working group at the college and began the arduous task of modernizing the language in Minnesota Statutes, Chapter 151. Subdivision by subdivision, definition by definition, amendment by amendment, the working group painstakingly developed recommendations as a starting point for real reform.
“It’s been nearly 80 years since the practice act was developed and there has not been a full-scale review and update completed since then,” said Todd Sorensen, professor and associate department head, Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota. During the 2009-2010 working sessions of the Minnesota Pharmacists Association’s (MPhA) Public Affairs and Policy Committee, members of the committee began to formulate a long-range plan to initiate a complete overhaul of the Pharmacy Practice Act in statute. Although many changes have been made to the practice act as issues arose and the practice changed, no group has looked at the act from beginning to end to bring it 9
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In the group’s report, “Enabling Pharmacists to Respond to the Health Needs of Minnesota Communities,” it was pointed out that “the current law restricts the pharmacist practitioner to practice in a manner not that different from the manner anticipated in the 1937 Act.” Their stated goal then was to establish a Pharmacy Practice Act that would “free the pharmacist practitioner to be responsive in delivering services while still protecting the public health.” The original working group consisted
of twelve pharmacists and a chairman. Although there are many pharmacists who would contribute significantly to this work, in the interest of expediency, members of this group were included because of their practice specialty and their understanding of the needs of Minnesotans in the emerging health reform initiatives. There are, of course, sections and definitions that do not directly affect the practice of pharmacy and the working group did not include those in its review. This group made several recommendations with regard to language updates; however, continued work was designed to be passed on to a steering committee that will deal with writing language that accurately reflects pharmacy practice today and what is anticipated for the profession’s future. At MPhA’s House of Delegates meeting in 2012, the Public Affairs and Policy Committee submitted a resolution that was adopted: “MPhA recognizes the work of the Center for Leading Healthcare Change Working Group in their endeavors to reform the Pharmacy Practice Act, evaluate the recommendations put forth, provide input and feedback, and work toward the enactment of the changes in the Pharmacy Practice Act.” “MPhA has tasked a group representing a broad mix of practice settings to review our current Pharmacy Practice Act and suggest changes that help it better reflect our role in the health care Statute 151 Continued on page 10
Statute 151 Continued from page 9 team and position us for expanded roles in the future. Lowell Anderson and the Center for Leading Healthcare Change have led the way with this work and it is our job to build on that great work. In order for our work to be successful, we need broad input and support from Minnesota pharmacists and pharmacy technicians,” said Craig Else, hospitalist program director for Fairview Medical Group, Fairview Ridges Hospital.
When it comes time to draft the language, the steering committee will continue to accept input from interested parties as well as the Board of Pharmacy and MPhA’s lobbyists.
Recommendations were forwarded to MPhA’s steering committee to be reviewed by a broader number of pharmacists and pharmacy-related members. The steering committee’s first task was to develop a mission statement to keep meetings focused. The mission is as follows: “To ensure that pharmacists are able to fully apply their knowledge and skills to improve patient health.” The committee then obtained preliminary consensus on the following definitions: “practice of pharmacy;” “pharmacy;” “drug” and “medicine.” (Please see page 11.) “Much of the current Practice Act focuses on a pharmacist’s responsibility with interpreting orders and the process of controlling and dispensing medications,” Sorensen added. “An overall focus of this group is developing language that creates the legislative foundation for the regulatory changes necessary to oversee the direct patient care functions of pharmacists.”
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The steering committee has been and continues to be open to all pharmacists who wish to provide feedback. Members from the original working group continue to contribute to the process as well. Stakeholders represented on the steering committee are the College of Pharmacy, National Association of Chain Drug Stores (NACDS), Minnesota Retailers Association (MNRA), Minnesota Medical Association (MMA), hospital pharmacists, community pharmacists (both chain and independent), pharmacists who are members of Minnesota Society of Hospital Pharmacists (MSHP); student pharmacists, and pharmacy residents. The steering committee has also asked for and received input from the Board of Pharmacy. Other associations and related health care groups are invited to attend steering committee meetings as the steering committee completes its initial structural process. For instance, the Minnesota Nurses Association (MNA) and similar health care groups will be invited to respond in the coming months. “The steering committee is looking for feedback from all pharmacists in the state. Now is the time to provide input and engage in the dialogue — the future of the profession is being shaped today and your voice needs to be heard,” said Jill Strykowsky, M.S., R.Ph., pharmacy director, Mercy and Unity hospitals, and MPhA president. Individuals are encouraged to participate in person or via conference call and webinar. Work will continue throughout the summer. The committee members will seek support from the MMA and the MNA, and continue to work with the Board of Pharmacy. A detailed communication plan has been drafted to maintain contact with all stakeholders. “Collaborative processes are not always the fastest, but in the case of
looking at changes to Minnesota’s pharmacy laws, the Pharmacy Practice Act Steering Committee is producing an excellent result via just such a process. Clearly bringing together Minnesota’s pharmacy stakeholders is the right way to create a vision for the future for pharmacy, and have that vision reflected in law,” said Bruce Nustad, MNRA president. When the time comes to draft the language, the steering committee will continue to accept input from interested parties as well as the Board of Pharmacy and MPhA’s lobbyists. The steering committee has also looked at what other states are doing as they update their respective pharmacy practice acts. In addition, the steering committee has looked at model language provided by the National Association of Boards of Pharmacy (NABP). In the fall of 2013, MPhA will seek authors for the bill. A primary spokesperson will be identified. That person will likely be MPhA’s executive vice president. While the intended time frame suggests that the revised pharmacy act bill will be introduced in the 2014 Legislature, there are some concerns with the aggressive timeline. Those concerns were expressed by Cody Wiberg, executive director of the Board of Pharmacy, at a recent Public Affairs and Policy Committee meeting, because the board promulgates rules that interpret day-to-day application of any new language in Statute 151. The concerns deal with time and staff constraints at the board. While it was reported that the board’s requested appropriations have been approved by the Legislature, new hires, who are greatly needed to support the board’s work on this issue, will likely not be hired until June or July 2013. This may delay the expected timeline for introduction at the Legislature. Statute 151 Continued on page 19
MPhA Steering Committee Suggested Practice Act Definition Changes: Before
After
“Practice of pharmacy” means:
“Practice of pharmacy” means the practice in
(1) interpretation and evaluation of prescription drug orders;
which a pharmacist accepts responsibility for
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a manu-
a consumer’s medicines-related needs, which
facturer or packager of nonprescription drugs or commercially packaged legend drugs and
may include but are not limited to:
devices); (3) participation in clinical interpretations and monitoring of drug therapy for assurance of safe
1. The management of medication-related con-
and effective use of drugs;
sumer needs, which may include
(4) participation in drug and therapeutic device selection; drug administration for first dosage and medical emergencies; drug regimen reviews; and drug or drug-related research;
a. Modifying, initiating, and discontinuing
(5) participation in administration of influenza vaccines to all eligible individuals ten years of
medications
age and older and all other vaccines to patients 18 years of age and older under standing orders from a physician licensed under chapter 147 or by written protocol with a physician
b. Ordering and collecting information to
provided that:
inform medication management
(i) the pharmacist is trained in a program approved by the American Council of c. Documenting appropriately
Pharmaceutical Education for the administration of immunizations or graduated from a college of pharmacy in 2001 or thereafter; and (ii) the pharmacist reports the administration of the immunization to the patient’s primary phy-
2. The control, dispensing, preparation, and
sician or clinic;
compounding of drugs or medicines
(6) participation in the practice of managing drug therapy and modifying drug therapy, according to section 151.21, subdivision 1, according to a written protocol between the specific
3. Collaboration with other practitioners in the
pharmacist and the individual dentist, optometrist, physician, podiatrist, or veterinarian who is
management of the care of a consumer or
responsible for the patient’s care and authorized to independently prescribe drugs. Any sig-
patient
nificant changes in drug therapy must be reported by the pharmacist to the patient’s medical 4. Administration of drugs or medicines
record; (7) participation in the storage of drugs and the maintenance of records; (8) responsibility for participation in patient counseling on therapeutic values, content, hazards, and uses of drugs and devices; and (9) offering or performing those acts, services, operations, or transactions necessary in the conduct, operation, management, and control of a pharmacy. “Pharmacy” means an established place of business in which prescriptions, drugs, medicines,
“Pharmacy” means an established place of
chemicals, and poisons are prepared, compounded, dispensed, vended, or sold to or for the
business in which medications are prepared,
use of patients and from which related clinical pharmacy services are delivered.
compounded, or dispensed, but does not restrict all services of a pharmacist to its location.
Subd. 5.Drug. The term “drug” means all medicinal substances and preparations recognized
The terms “drug” and “medicine” means articles
by the United States Pharmacopoeia and National Formulary, or any revision thereof, and all
recognized as Drugs or Medicines by the
substances and preparations intended for external and internal use in the diagnosis, cure,
United States Pharmacopoeia, or any other
mitigation, treatment, or prevention of disease in humans or other animals, and all substanc-
official compendium, or supplement, for use in
es and preparations, other than food, intended to affect the structure or any function of the
the diagnosis, cure, mitigation, treatment, or
bodies of humans or other animals.
prevention of disease in humans or other animals; articles intended for use in the diagnosis,
Subd. 6.Medicine. The term “medicine” means any remedial agent that has the property of
cure, mitigation, treatment, or prevention of
curing, preventing, treating, or mitigating diseases, or that is used for that purpose.
disease in humans or other animals; articles (other than food) intended to affect the struc-
Subd. 7.Poisons. The term “poisons” means any substance which, when introduced into
ture or any function of the body of humans or
the system, directly or by absorption, produces violent, morbid, or fatal changes, or which
other animals; and articles intended for use as
destroys living tissue with which it comes in contact.
a component of any articles specified in clause above in this definition.
Subd. 8.Chemical. The term “chemical” means all medicinal or industrial substances, whether simple or compound, or obtained through the process of the science and art of chemistry,
Recommendation to strike both subd. 7 & 8
whether of organic or inorganic origin.
since they are no longer used in the definition of pharmacy.
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Viewpoint
Do You Consider Yourself “Qualified?” By Lowell J. Anderson, D.Sc., FAPhA Saturday, May 12 was commencement day for the College of Pharmacy. One hundred sixty graduates had the remaining hurdle of the board exams before they would officially be pharmacists. I was touched by this year’s commencement. In part because it was a well-done event — nice music, medieval academic regalia, and excited participants. In part because I know, like, and respect many of the graduates. In part because I was thinking about my son who is graduating from high school this year, and projecting ahead four years to his college graduation. And, in part because of the commencement speaker’s message. The speaker, Susan Winckler, is a friend, pharmacist, and attorney. She previously worked at APhA and as chief of staff at the FDA — now, senior advisor at Leavitt Partners. After congratulating the class on their accomplishment and noting the pride radiating from the families in the audience, Susan talked about titles. “Each of you is earning a new title today, a title with great opportunity, and responsibility. You have earned the title of ‘Doctor’ as the University conveys your PharmD or PhD degree. We know that life is full of titles. Each of you will earn additional titles through your life—I am certain that someone in this class will earn a title, such as mayor or representative, through a popular election; another will earn an administrative title, such as dean, through academic advancement, and many of you have earned, or will earn, titles of great import 12
Minnesota Pharmacist July-August 2013 n
through family events…mother, father, aunt, uncle, grandmother, grandfather. Savor those titles, and the accompanying responsibility.”
I think the class of 2013 is one whose members will gain titles such as mayor, representative or dean. This is a class that has studied leadership. It is also a class that has demonstrated leadership — in the college and in their communities. They accept responsibility as members of a profession and a community. Winckler described how they were entering the profession at a great time because: “Health care is changing, and
pharmacy practice will change with it. We are moving from an era where compassion was key . . . to an era where economics will matter more, and there simply will not be enough resources for everyone to receive everything the health care system has to offer. “We are moving to a system that rewards outcomes — where the value of an intervention is based not on the incremental cost or billing opportunity but on the contribution of the intervention to the health of the patient . . . and look at the longer term value of medication therapy.”
The challenge for these graduates, who will practice in an environment of constant change over their entire career, will be to secure a place for the profession and themselves in the changing system. It should not be accepted as a given that pharmacists will be equal participants in the evolving systems of accountable-care organizations or health homes.
“The battle over ‘who does what’, stimulated by a focus on fee-generating activity, is being replaced with the collective effort of an integrated interdisciplinary team… where each member of the team plays their position. The physician pitcher, the nurse catcher, the pharmacist first baseman (or perhaps we would rather be a shortstop?) play well as individuals—and excel as a team. And patient, and population, health improve.”
A profession united will need to fight for positions on the team. Many of the class of 2013 understand this and have the talent and will to prevail. I hope that those who might think that due to their education and degree, they are entitled to a position on the team are few. Those who see themselves as entitled will certainly be disappointed. “Practicing at the top of your education — and to the top of the expectations of your new title — requires confidence, as well as competence. So each of you must carry your new title confidently, regardless of your career steps. Your title has no qualifiers … you are a pharmacist. No matter where you practice, or choose to exercise your expertise, you are a pharmacist.”
She is correct: In the minds of consumers, patients and legislators, pharmacists don’t have qualifiers. Qualifiers only exist in our own minds. In the battle for position in these new delivery systems we cannot have a family food fight over who are the “real” pharmacists.
Viewpoint Continued on page 13
Viewpoint continued from page 12 At the national level, professional associations generally work well together. It is at the state level where we sometimes see the food fights. Hospital, independent, and chain organizations — each sees its “qualifier” as more important than the object — pharmacist! Each uses the superiority of his or her own “qualifier” to justify not joining forces in the advancement of the profession. The dogma of organizational separatism at the state level was never a good idea, and if continued will diminish the significance of the entire profession as it seeks a place in the new systems. This class, as evidenced in the Minnesota Pharmacist Student Alliance (MPSA), a student organization with representation from all other student organizations, showed that they can put the “qualifiers” aside and work together to common cause. It takes work — but it is doable. It is my hope
The AWARxE campaign was founded by the Minnesota Pharmacists Foundation in 2009, in order to educate communities and individuals on the dangers of abuse or misuse of prescription medications. VISIT MPHA.ORG FOR MORE INFORMATION.
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Minnesota Pharmacist July-August 2013 n
that these graduates bring their inclusive organizational skills to the profession from the get-go. We need them — now. Ninety percent of 2013 graduates had a college degree before they came to pharmacy. Fifty percent will continue their education in a one-year or twoyear residency program. This is eight to ten years of education! Over the four years of pharmacy education, each student invested more than $100,000 in tuition and expenses. And, on average, leaves school with significant student loans. Lots of time and dollars add up to both a commitment and investment: A very good reason to make this profession the best it can be. To the Class of 2013: You made a grand investment in becoming pharmacists. If we never hear from you again, it will be a shame and a waste. You have the power to make a difference
in the profession and in the manner in which we address the health needs of our communities. The cynics will ask: Will you? The optimists will ask: When will you? The leaders will ask: How will you? Lowell J. Anderson, D.Sc., FAPhA, FFIP, practiced in community pharmacy for most of his career. He is a former president of MPhA, Minnesota Board of Pharmacy and APhA. In addition he has held positions in the Accrediting Council on Pharmacy Education, National Association of Board of Pharmacy and the United States Pharmacopeia. Currently he is Senior Fellow and Co-director of the Center for Leading Healthcare Change, University of Minnesota and co-editor of the International Pharmacy Journal. He is a Remington Medalist.
President’s Desk continued from page 5 Through the new beginning leadership of our Executive Vice President, Liz Cinqueonce, the call for your engagement in our Pharmacy Practice Act and the urgency of developing a higher standard for intraprofessional practice, we are standing at the brink of an opportunity to advance pharmacy practice. Our patients, the public and our payers trust that we work together. Our work this year will be to nurture the new beginnings and season our mission to: “Serve Minnesota pharmacists to advance patient care.” I am grateful for the opportunity to work with all of you and invite you to the table.
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Industry News
Practice-Based Research Network
By Jon Schommer, Ph.D., Professor and Associate Department Head, Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy A Practice-Based Research Network (PBRN) is “a group of ambulatory practices devoted principally to the primary care of patients, affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community based practice.”1 PBRNs first were formed in primary care practices in the late 1970s 2-3 and involved community-based clinicians and their staffs in activities designed to help understand and improve primary care.1 The goal was to link relevant practice questions with rigorous research methods in community settings to provide information that was reliable, valid, and transferable into everyday practice.
“A person’s regular interaction with medications is not only a frequently and consistently occurring health care event, it also interfaces with almost all other aspects of his or her health care.” Thought leaders within pharmacy have begun developing and implementing Pharmacy Practice-Based Research Networks.4 The advantages of such networks to patient care and to society are rooted in the use of medications by almost all members of society during their lifetime and the accessibility that pharmacies provide to the public. The use of medications is likely to be the only treatment modality with which people interact on a daily basis. More than 500 million times a day in the United States, individuals make the 15
Minnesota Pharmacist July-August 2013 n
decision to-take or not-to-take a prescription medication.5 In addition there are approximately 6 million pharmacy visits per day.5 Arguably, these are the most frequently occurring health care events, far outpacing such things as the number of physician office visits (2.6 million per day),6 hospital inpatient procedures (123,287 per day),7 and hospital discharges (108,041 per day).7 Eighty percent of the way chronic diseases are prevented and managed is with medications.8 In any given week, 81% of U.S. adults take at least one medication, and nearly one-third take five or more different medications.9-10 Over a lifetime, it is estimated that a typical person will take 14,000 pills.11 When one considers that a 60-year span of adulthood is about 22,000 days, the frequency with which individuals interact with medications is astounding. A person’s regular interaction with medications is not only a frequently and consistently occurring health care event, it also interfaces with almost all other aspects of his or her health care. For example, according to the World Health Organization, adherence to medication therapies is the primary determinant of treatment success and the consequences of poor adherence are poor health outcomes and increased health-care costs.12 When transitions in care, such as hospitalization, are experienced by individuals, they become especially vulnerable for medical errors as a result of incomplete or inaccurate communication about medication therapies. After hospital and intensive care unit discharges, individuals are at high risk for unintentional discontinuation of medications with proven efficacy for treating
chronic diseases.13 Avoidable hospital readmissions are directly related to medication-related events about onethird of the time.14 Developing capacity for research in networks of community pharmacies could help fill gaps in our understanding of the medication use process by focusing upon 1) questions encountered by pharmacist practitioners in their practices, 2) issues that are relevant to members of diverse communities served by these practices, and 3) research that can be shared quickly with pharmacy practice and the broader healthcare community. The advantagess of such an approach are clear. In the U.S. there are more than 70,000 pharmacies in all types of health care facilities including more than 56,000 community pharmacies. The geographic locations of pharmacies are based upon community members’ preferences for convenience and access, making them a logical site though which care can be studied and enhanced.15 Pharmacists are central to the medication use process and are the most frequently encountered health professionals for many patients. In addition to access and convenience, studies in community pharmacy settings afford the opportunity to observe self-care behaviors that overlay prescribed therapies including over-thecounter drugs and nutritional supplements.16 For patients under the care of multiple prescribers, the pharmacy serves as an “ideal place for studying and improving the continuity and coordination of care across settings.”16 Since many patients visit pharmacies PBRNetwork Continued on page 19
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Clinical Issues
Oral Chemotherapy: A Pharmacist’s Perspective By Kara Kent, Pharm.D.
The use of oral chemotherapy agents is increasing rapidly due to the greater number of novel oral agents available.1 In 2012 the FDA approved nine oral chemotherapy agents for various cancer indications.2 These agents present several advantages to the more traditional parenteral chemotherapy.2,3 One is patient convenience; many patients prefer oral chemotherapy because this allows administration of the medication at home and often less frequent visits to the infusion center. While these therapies are convenient, they present unique challenges and good patient education is imperative for safe and efficacious use. The purpose of the study was to evaluate current counseling practices in regard to oral chemotherapy agents and to gain a pharmacist’s perspective on how pharmacists are receiving education on oral chemotherapy and how they would prefer to be educated on these agents. Methods A survey was created and distributed through email. The survey was available electronically through Survey MonkeyŽ from March 14 to April 24, 2013 and consisted of 23 multiple choice and multiple answer questions. Subjects could skip questions if they felt it was necessary. The survey was available to actively practicing licensed pharmacists in the United States. All respondents had to answer yes to being actively practicing and licensed pharmacists to take the survey. Exempt status was granted to the proj17
Minnesota Pharmacist July-August 2013 n
ect by the Allina Health Investigational Review Board (IRB) and the University of Minnesota IRB. Results A total of 510 United States licensed practicing pharmacists completed the survey. Of those who completed the survey, 75.3% (439) were female, 82% (474) had obtained a doctor of pharmacy degree, 125 were board certified pharmacotherapy specialists and 25 were board certified oncology pharmacists. The most common practice settings of respondents were hospital and retail pharmacy. A total number of 362 pharmacists dispensed oral chemotherapy agents. Of those pharmacists who dispensed oral chemotherapy, 74.9% (204) doublecheck the dose of the oral chemotherapy agent at the point of verification, and 66.4% (215) provide counseling to patients. Half of the pharmacists who dispense oral chemotherapy felt very confident (10.5% [48]) or somewhat confident (32.5% [148]) counseling patients on these agents. The most common method of counseling was at the point of medication pick up from the pharmacy (84.5% [204]). Other methods for counseling included counseling at hospital discharge, counseling with a phone call, or a scheduled appointment with a pharmacist. The reported barriers to counseling included lack of time and lack of knowledge about the medications. Among all pharmacists who answered the survey, 10.5% (48) felt very confi-
dent, 32.5% (148) felt somewhat confident counseling on oral chemotherapy and 56.9% (260) felt unsure (16.2% [74]), not really confident (28.9% [132]) or not at all confident (11.8% [54]) counseling on oral chemotherapy. Only 49.4% (224) of pharmacists had received education on these agents. The most common method for pharmacist education was a drug database, pharmacy curriculum, formal continuing education and primary literature. Roughly half of pharmacists (44.9% [201]) do not think their pharmacy education provided them with the necessary tools to counsel on oral chemotherapy medications. The preferred method to receive education on these agents was formal continuing education and through a drug database.
Most pharmacists, irrespective of their practice setting, will need to have baseline knowledge about these agents. Discussion With the rapid growth of oral chemotherapy, it is expected pharmacists will see more prescriptions for these agents. Many of these agents are part of complex regimens with specific administration directions and narrow therapeutic indices and a high rate of adverse events. Thorough patient education is important to ensure safe and efficacious use.3 Chemotherapy Continued on page 18
Chemotherapy continued from page 17
Most pharmacists, irrespective of their practice setting, will need to have baseline knowledge about these agents. In the survey, pharmacists who dispensed oral chemotherapy were in the retail, hospital, ambulatory care or specialty pharmacy settings. The need for pharmacist education on oral chemotherapy agents is necessary in all areas of pharmacy. Of pharmacists who completed the survey, only about 50% had received education on these agents and only half of those felt confident counseling patients. Education is needed to increase pharmacists’ level of confidence to appropriately dispense and counsel on these agents. In a study conducted by Charpentier M, et al., after a live one-hour continuing education session on oral chemotherapy,
pharmacists’ confidence significantly improved from no confidence to some confidence (p<0.001).4 Continuing education was the preferred method of education reported by the pharmacists in the survey. Several continuing education opportunities are available through various organizations. PharmCon, Inc and PharmQD offer continuing education on oral chemotherapy on the Internet for no or a small fee.5,6 Another good resource on the role of oral chemotherapy in the treatment of cancer is the National Comprehensive Cancer Network (NCCN). Resources for counseling can be found on drug databases (UpToDate®, Micromedex®), NCCN and manufacturers’ websites.
Comparison of pharmacy practice settings Retail
(n=272)
Dispense oral
Hospital (n=196)
Am Care (n=61)
Any site dispensing oral chemotherapy (n=362)*
61.5% #(155)
77.3% #(150)
50% #(30)
100%
Counsel – yes
62.3% (144)
39.7% (71)
51.7% (31)
66.4% #(215)
Verify dose – yes
65.1% #(97)
85.2% (115)
75.9% (22)
74.8% (246)
Confidence coun-
33.2% #(68)
51.5% #(84)
47.3% v(26)
49.2% #(145)
Education on oral 49.2% #(96) chemo – yes
n=195
44.2% #(72)
62.5% #(35)
48.6% #(142)
Preference for
CE #(164)
CE #(130)
CE #(45)
CE #(239)
chemotherapy – yes
seling**
education
n=252
n=231
n=149
n=199
n=182
n=194
n=179
n=135
n=163
n=163
n=160
n=60
n=60
n=29
n=55
n=56
n=55
n=324
n=329
n=295
n=292
n=287
*any site answering yes to dispensing oral chemotherapy **includes those pharmacists who felt very confident and somewhat confident counseling on oral chemotherapy 18
Minnesota Pharmacist July-August 2013 n
Conclusion Pharmacists are dispensing chemotherapy drugs in a variety of settings. Education is important for safe use and in order to provide counseling to patients on these agents. Continuing education addressing oral chemotherapy is available through several sources and organizations. Pharmacists should seek out education on these agents as the use of oral chemotherapy continues to evolve and more patients are receiving complex medications where patient education is paramount for safe and effective use. References 1. Bartel SB. Safe practices and financial considerations in using oral chemotherapeutic agents. American Journal of Health-System Pharmacy. 2007;64(9 Supplement 5):S8-S14. 2. FDA approved drugs. Center Watch website. http:// www.centerwatch.com/drug-information/fda-approvals/. Updated 2013. Accessed April 20, 2013. 3. Weingart S, Brown E, Bach P, et al. NCCN task force report: Oral chemotherapy. National Comprehensive Cancer Network. JNCCN. 2008;6. http://www.nccn.org/JNCCN/PDF/JNSU3_combined_ Oral_Chemo_2008.pdf. Accessed April 15, 2013. 4. Charpentier M, Kelly Orr K, Taveira T. Improving pharmacist knowledge of oral chemotherapy in the community. Ann. Pharmacother. 2012;46:1205. 5. Milkiewicz K. Oral chemotherapy and the pharmacist’s role: Providing pharmaceutical care for cancer patients. FreeCE.com Pharmaceutical Education Consultants website. http://www.freece.com/freece/ Cal_Details.aspx?ID=e59e03fa-d336-472c-9a16b9dd71479f49. Updated 2013. Accessed April 30, 2013. 6. Pick A. Home care of the oncology patient: The Pharmacist’s role in the patient management and safe handling of oral chemotherapy. PharmQD website. http://www.pharmqd.com/continuingeducation/homecare-oncology-patient-pharmacist%E2%80%99s-rolepatient-management-and-safe-handlin. Updated 2012. Accessed April 29, 2013.
MPhA News
In Memoriam: Lester Charles Hackner July 14, 1927 – May 8, 2013 Lester Hackner worked for 37 years as a pharmacist at Gray’s Drug, where he was a co-owner since 1976. Gray’s Campus Drug under Lester was an institution in Dinkytown with its pharmacy and grill serving as home to thousands including Bob Dylan (who lived upstairs). Lester attended Johnson High School, and served in the U.S. Army during World War II. He graduated from the University of Minnesota in 1951. Lester was a life member of the Minnesota Pharmacists Association and Past President of the Minnesota Pharmacy Alumni Society.
Lester served 4 years as a member of the Minnesota Board of Pharmacy including serving as Vice President. He was a member of the Century Mortar Club, serving on the Board of Directors and a member of the National Association of Retail Druggists, a member of the American Pharmaceutical Association, Phi Delta Chi, Jewish War Veterans and a Member of Temple of Aaron Synagogue. Lester was preceded in death by parents, Leah and Israel Hackner, sister Carrol and brother-in-law, Sonny
Practice-Based Research Network continued from page 15
Statute 151 Continued from page 10 The other caveat discussed by Wiberg is that it is extremely important for consensus among the many stakeholders before the bill is presented to the Legislature. If there is still significant division among stakeholders, there will likely be “push back” from the supportive bill authors and legislative committees hearing the bill. However, the steering committee, pulled together and supported by MPhA, will continue its work based on the original timeline. The steering committee is committed to addressing each hurdle as it appears and will
remain strong in its resolve. There is consensus, however, that it is important for pharmacy and pharmacy-related organization to keep on task and produce a Pharmacy Practice Act that will support and enhance pharmacists’ professional activities for the future.
Rita Tonkinson was the managing editor of the Minnesota Pharmacist for 10 years and has been writing for the journal for 17 years.
Managed Care Academy The MPhA Managed Care Academy and Minnesota Academy of Managed Care Pharmacy (AMCP) members will host their next networking session on Thursday, October 3, 2013 in Bloomington, from 7:30 a.m. to 9 a.m. A keynote speaker from HealthLeaders InterStudy will be speaking on Health Reform & the Exchanges. More details to follow. Please contact Denise Wolff, PharmD, with any questions at: denise. wolff@emdserono.com.
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Minnesota Pharmacist July-August 2013 n
Zukerman, brother Irwin, nephew Marc Polikoff and grandniece, Amy Harer. He is survived by his nieces Nancy Polikoff, Ilene (Jay) Goldberg, Bennett (Mona) Hackner, Gayle Hackner, Leah (John) Nemzeh and Ira (Denise) Hackner, and grand-nieces and grandnephews, as well as great-nieces and great-nephews.
at frequent and regular intervals it is an ideal place to examine the quality, safety, efficiency, and effectiveness of many prescribed treatments for chronic care.16 Such access to patients at the point of procuring most of the medications utilized in the U.S. presents a unique opportunity for pharmacists and pharmacies to help contribute to an understanding of the medication use process. Pharmacy-Based PBRNs can focus on collecting information in real-world settings (pharmacies) to help address societal, community, or professional questions that relate to medication use. Such a focus would expand upon existing work and begin to collect information for the purpose of addressing societal and community questions related to the medication use process. In this domain, pharmacy PBRNs can serve as natural laboratories in the field setting to address a variety of questions. Read the full www.mpha.org.
report
online
at
Clinical Issues
Report of Drug Insert Labeling Revisions Based Upon New Efficacy Information By Kent T. Johnson, MSPharm Recent revisions to drug product insert labeling that might be of interest and importance to pharmacists are noted in the accompanying Table. The entries are selected from the many supplements to approved drug applications approved each month by FDA for marketed drugs and biologics. Specifically, entries to this Table are largely based upon supplements categorized: “Efficacy supplement with clinical data to support”, “New or modified indication”, or “Patient
Population Altered”. These would typically be the type to provide new or revised: Indications and Usage and/or Dosage and Administration changes in the professional labeling. Readers should consult the new package insert labeling when the changes cited are important to their specific need.
http://www.accessdata.fda.gov/ scripts/cder/drugsatfda/index. cfm?fuseaction=Reports.ReportsMenu If you have questions about this article, please contact the author at kenttjohnson@usfamily.net
Consult the FDA website to obtain or review FDA’s approval letter and/or revised insert labeling:
DRUG NAME
NEW INDICATIONS OR DOSAGE INFORMATION IN LABELING
Actemra (tocilizumab) Vyvanse (lisdexamfetamine dimesylate) Amitiza (lubiprostone) Doryx (doxycycline hyclate)
Provides for the treatment of active polyarticular juvenile arthritis in patients Apr. 29 2 years of age and older. Provides for the treatment of ADHD in children and adolescents ages 6-17 Apr. 26 years. Provides for treatment of opioid-induced constipation (OIC) in adults with Apr. 19 chronic, non-cancer pain. Alternate dosage regimen for the treatment of uncomplicated urethral or Apr. 11 endocervical infection caused by Chlamydia trachomatis.
What’s the best way to let pharmacists and technicians know about my new product or service? Advertise in the Minnesota Pharmacist, the official MPhA journal:
Circulation – sent to approximately 9,000 pharmacists, technicians, and students in Minnesota Value – best cost-per-thousand among state pharmacy publications Quality – professional, four-color printing on coated paper Informative – strong editorial topics drive each issue Reader-friendly – new organized layout helps readers find what they want Strong Voice – covering topics of greatest importance to the Minnesota pharmacy community Sign up online at www.mpha.org or contact Paul Hanscom at 651-290-6274 or paulh@mpha.org.
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Minnesota Pharmacist July-August 2013 n
Clinical Issues
Pronunciation of Active Ingredient Names Of Recently Approved Drug Products By Kent T. Johnson, MSPharm This column provides a guide to pronunciation of the nonproprietary name of active ingredients (or active moiety) in drug products recently approved by FDA under a new drug application (NDA) or a biologics license application (BLA). The list is not exhaustive for every recent approval. For example, some newly approved drug products have active ingredients found in previously approved products. The pronunciation guide comes from: 2012 USP Dictionary of USAN and International Drug Names.
PROPRIETARY NAME
NONPROPRIETARY NAME OF ACTIVE INGREDIENT(S)
PRONUNCIATION
DATE APPROVED
Invokana
canagliflozin
kan” a gli floe’ zin
Mar. 29
Tefidera
dimethyl fumarate
dye meth’ il fue’ ma rate
Mar. 27
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Not Your Motherâ&#x20AC;&#x2122;s MPhA Annual Conference May 17-18
MPhA Award Winners Bowl of Hygeia
Harvey Buchholz
Distinguished Young Pharmacist Award Nick Giller
Excellence in Innovation Award
First Light Health System Pharmacy Team Harold R. Popp Award Bruce Thompson
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MPhA News
MPhA News
Legislative Wrap-Up By Patrick Lobejko, MPhA Lobbyist
This was a relatively quiet year at the Capitol for pharmacists. The main focus at the Legislature was on licensure. Next year, however, will be a busy and important year for MPhA and its members. As we head into the summer and fall, MPhA will gear up to get ready for 2014. HHS Omnibus Finance Bill (HF 1233) After back-and-forth by the Governor and Legislature, the final agreement decreased HHS spending by $50 million. Considering both the House and Senate initially had a budget target decrease of $150 million, the HHS Conference Committee had an extra $100 million to work with. Other provisions in the conference committee report include: • $12.8 million investment in Medical Education Research Costs (MERC) that had been reduced during the 2011 legislative session. • $39.8 million surcharge on health plans. • $36.6 million to realign hospital surcharges. • 5% rate increase for nursing facilities. • 2% rate increase for home and community-based services providers.
not passed as its own bill, the language was included in the HHS Omnibus Finance Bill. Changes in pharmacy licensure requirements include: • Out-of-state pharmacies that dispense drugs to Minnesota residents must comply with federal law. • Out-of-state pharmacies must provide proof of licensure or registration by the state where they are physically located. • A separate license is required for each pharmacy at which any portion of the dispensing process occurs for drugs dispensed in Minnesota. • No license will be issued unless the pharmacy passes an inspection. For out-of-state pharmacies, a report issued by the regulatory authority of the state where the pharmacy is located satisfies the requirement. Changes for drug manufacturers included: • Manufacturers that are required to be registered under federal law must be registered before they can be licensed. • Out-of-state manufacturers must be licensed by the state where they are physically located.
Board of Pharmacy Bill (HF 1136/SF 1081)
• A separate license is required for each facility where manufacturing occurs.
A bill that changes licensing requirements for pharmacies, drug manufacturers, and wholesale drug distributors was introduced this past year. Although
• Prohibits issuing a license unless the manufacturer passes an inspection.
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Minnesota Pharmacist July-August 2013 n
Changes for drug distributors included:
• Makes it unlawful for a wholesale distributor to sell drugs to anyone located in the state or to receive drugs in reverse distribution from anyone located within the state. • A separate license is required for each wholesale distribution facility from which drugs are shipped into the state.
Prescription Monitoring Program (HF 1208/SF 1081) A part of the prescription monitoring program legislation was included in the final HHS Omnibus Finance bill. The provision includes language that allows pharmacies to dispense drugs in bona fide research studies that are conducted pursuant to an investigational new drug application. The measure also states that dispensing and distribution of research drugs by pharmacies isn’t considered compounding, manufacturing, or wholesaling. Licensed Dietician or Nutritionist Allowed to Adhere to a Practice Guideline for a Legend Drug Prescribed by a Physician (HF 195/SF 431) This bill allows licensed dietitians and licensed nutritionists to enter into a protocol with a licensed practitioner so that the dietitian or nutritionist can administer or prescribe legend drugs to specified patients. It was passed by both houses and signed into law by the governor.
MPhA Member Benefits Not a member? Visit mpha.org and join today!
Pharmacy as a profession is undergoing profound and rapid change. The Minnesota Pharmacists Association is here to help pharmacists in all settings to navigate change successfully. MPhA is sending our Minnesota Pharmacist journal to all pharmacists in the state of Minnesota in order to make you aware of current issues — and to encourage you to join us as a member. The benefits of belonging to MPhA far outweigh your dues investment. Many of our benefits can be accessed easily through our website. From online dues renewal, conference registration and member searches, we strive to not only make membership valuable, but easy to use and navigate. Not able to find what you are looking for? Contact our office and we can help point you in the right direction. MEMBERSHIP DUES: Check with your employer to see if your corporation is part of MPhA’s Organizational Membership; if so, you are already an MPhA member and are entitled to partake in all member benefits. If your employer is not an MPhA Organizational Member, check to see if they will cover a portion of your MPhA individual membership dues. ADVOCACY: MPhA provides members with a “voice” for pharmacy in policy development at the state and national levels. The association puts a “face on pharmacy” through media and outreach to health care entities that rely on MPhA for information and resources related to pharmacy services. Through legislative representation, policy planning, and lobbying, the association ensures that issues pertaining to pharmacy are not overlooked or undercut. We fight for the rights of pharmacists and pharmacy professionals to provide the highest level of care to the patients they serve. MPhA encourages members to become involved in this process by being active in grassroots actions and events. As a member, you will have access to important updates and resources made possible by your support. PROFESSIONAL DEVELOPMENT AND EDUCATION MPhA provides a variety of events throughout the year to keep members involved in pharmacy issues while offering continuing education, networking opportunities and fun! Events are listed on the MPhA website and are open to all. Members receive a discount on event programming, such as Annual Meeting and Fall Clinical Symposium. PRODUCTS AND SERVICES Members benefit from discounted rates and prices on both professional and business related services. Products • Pharmacists Letter • Pharmacy Quality Commitment Program • PAAS • Fraud, Wast and Abuse Compliance Program
Professional Services • Pharmacists Mutual Insurance • Technician Manuals Business Services • Coupon Redemption Program • PAAS 3rd-Party Audit Services • Credit Card Processing Services COMMUNICATION Communication is our cornerstone of keeping you informed of association, state and national news and action. Minnesota Pharmacist The Minnesota Pharmacist is the association’s journal that contains articles and features on today’s pharmacy topics. It mails to all pharmacists in Minnesota, with a total circulation reaching approximately 9,000 pharmacists, technicians, and students. The journal is published six times per year. Small Doses Our Small Doses email newsletter goes out to all subscribed members. This weekly e-news vehicle shares upcoming events, business topics, important legislative or regulatory updates, and other news. Pharmacy News Flash Once a week, Pharmacy News Flash is delivered by email to members. These updates include news about national issues affecting pharmacists, along with local headlines and job openings. CAREER CENTER Tailored to both our job seekers and employers, our Career Center allows you to browse openings or post opportunities at your convenience. Search for Minnesota locations, or broaden your search to outside states. The center holds a variety of options to tailor results to your needs. RESOURCES Members receive special online access to pharmacy resources. From MTM templates and brochures to information on immunizations, we save you valuable time by having these resources readily available to you for use in your practice.
Call today or visit the MPhA website to join this leading pharmacy association! 651-697-1771 or 800-451-8349 www.mpha.org