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Professional Liability
measure up?
Coverage Benefits Our Professional Liability Policy is specifically designed as excess coverage, yet it can become your first line of defense when no other coverage is available.
Apply Online!
Go to www.phmic.com, and choose the Pharmacist Liability Application under the Online Services tab.
• 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.
For more information, please contact your local representative:
• Risk management assistance that may reduce pharmacy professional exposure.
Lee Ann Sonnenschein, LTCP 800.247.5930 ext. 7148 605.372.3277
Tom Nilsson , CIC, LTCP 800.247.5930 ext. 7115 952.949.0617
Endorsed by*:
Sheila Welle , CIC, LUTCF, LTCP 800.247.5930 ext. 7110 218.483.4338
2
Minnesota Pharmacist March-April 2013 n
*Compensated Endorsement Not licensed to sell all products in all states. Form No. PM PhL 196
INSIDE
March-April 2013
Volume 67. Number 2, ISSN 0026-5616
Upfront Views and News President’s Desk: Springing Forward . . . . . . . . . . . . . . . . . . . . . . . . 5
Clinical Issues Pharmacy and the Law: Do I Have to Fill this Prescription? . . . . . . . . . . 9 Collaborative-Practice Agreements: Wave of the Future?. . . . . . . . . . 20 Electronic Tools for Ambulatory Care . . . . . . . . . . . . . . . . . . . . . . . . . 22 Define or Be Defined: Duluth Area Pharmacists Engage in Modernization of the Pharmacy Practice Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Report of Drug Insert Labeling Revisions . . . . . . . . . . . . . . . . . . . . . . 27 Pronunciation of Active Ingredient Names. . . . . . . . . . . . . . . . . . . . . . 28
Industry News APhA Advances Provider Status Initiative. . . . . . . . . . . . . . . . . . . . . . 10 Pharmacy Time Capsules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Health Insurance Exchanges: What Pharmacists Need to Know. . . . . 18
On the Cover
Collaborative Practice Agreements: Wave of the Future? page 20
Need to Know
Minnesota News
MPhA Annual Meeting: Information & Registration
MPhA Annual Meeting: Details and Registration. . . . . . . . . . . . . . . . . . 15
page 15
Report from the State Capitol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
MPhA News Member Profile: Daniel Miller, PharmD. . . . . . . . . . . . . . . . . . . . . . . . . . . 6 MPhA Candidates for President-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Organization Member Profile: Fairview Pharmacy Services. . . . . . . . . . 8 AWARxE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Resource Directory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Must-read
Health Insurance Exchanges: What Pharmacists Need to Know page 18
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MPhA Board of Directors Executive/Finance Committee: President: Martin Erickson Past-President: Scott Setzepfandt President-Elect: Jill Strykowski Secretary-Treasurer: Bill Diers Speaker: Meghan Kelly Executive Vice President: Vacant Rural Board Members: Eric Slindee Jeff Lindoo Metro Board Members: Cheng Lo Brittany Symonds At-Large Board Members: Tiffany Elton Tim Cernohous Keri Hager Amy Sapola Jason Varin
Upcoming Events Visit www.mpha.org for more information and registration 2013 MPhA Annual Conference May 17-18, 2013 | Marriott Minneapolis Northwest, Twin Cities See pages 15-17 for more information and a registration form!
Not Your Mother’s MPhA 2013 MPhA Annual Conference
Student Representation: Duluth MPSA Liaison: Brittany Novak Minneapolis MPSA Liaison: Amy Herbranson Ex-Officio: Bruce Benson, COP MPhA Executive Vice President (vacant) MSHP Representative
May 17-18, 2013
Marriott Minneapolis Northwest
Pharmacy Technician Representative: Barb Stodola
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: Anna Wrisky 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). 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. 4 Minnesota Pharmacist March-April 2013 n
MPhA Mission: Call for Articles The Minnesota Pharmacist accepts articles for publication from its members and from nonmembers. 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.
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.
Moved, graduated, or have 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
Springing Forward by Martin A. Erickson, III, RPh, Director of Professional Services and Regulatory Affairs, Fagron
In the January-February issue, I promised to share details of your executive board’s search for our next executive vice president. The application period closed February 22. The search committee, composed of your executive committee, scheduled first interviews with potential candidates from the pool of applicants. Following the first interviews, the search committee reviewed the results and conducted in-person interviews with the candidates showing the greatest potential to be our next EVP. From these second interviews, the committee has chosen two finalists who will be presented to the full MPhA Board of Directors and comments will be solicited. The final candidate will be presented to the board for affirmation in late March. The goal is to ask the successful candidate to begin his or her duties before the Annual Meeting in May. As in life, all of the foregoing is based upon the expectation that “nothing will go wrong…” So, please be patient. Our new EVP and all of us, the members, will embark upon a new adventure, a new chapter in the saga of Minnesota pharmacy, a chapter of special importance because the pharmacy practice act changes will be presented and debated in the Legislature during the 2014 session. Our consultants and lobbyists from Ewald Consulting and our new EVP will need assistance from all of us
as the bill wends its way through the legislative process. Please consider how you might be of unique assistance in this effort. For foundational material, please be aware of the legislative updates from our lobbyists, the first of which appears in this edition of the Minnesota Pharmacist. In another, related area, I think you will find Rita Tonkinson’s article on health insurance exchanges in Minnesota helpful as you speak with patients and legislators. I have pondered this new chapter; I at once am honored and experience some trepidation, sitting in the president’s position as our story unfolds. I am confident that the broad support of pharmacists in all areas of practice that we have seen developing in the past few years indicates resurgent growth and interest in advancing our profession to a statewide audience as well as to our individual patients. Why am I confident? Minnesota pharmacy has been a leader nationally — for starters, look at the positions held by Minnesotans, most recently APhA President Steve Simenson. And we have been in the forefront of change for the good of our patients. Students are continuing this tradition: Zach Merk’s discussion of collaborative practice is an excellent example. After all, our professional business is about making sure each person we encounter — colleague, patient, supplier, etc. — receives the full benefit of our professional expertise and our personal care and integrity. The business
We do take care of our patients, we are imaginative, energetic leaders in our profession. side will thrive, paradoxically, when we let go of buying, selling, bottom-lining and make our profession our business. As I learned from my parents and grandparents: take care of the patients and the patients will take care of your business. Our annual meeting theme this year is “Not Your Mother’s MPhA:” the traditions taught by our professional mothers (and fathers) produced remarkable changes in practice and the Association; growth and development brought us here and will carry us into the future. Hence my confidence about pharmacy in Minnesota: we do take care of our patients, we are imaginative, energetic leaders in our profession, we live out our care and concern for humanity in one-on-one encounters at the consulting desk, in patients’ room, and in the halls of the Legislature. Our next leader, our EVP, will bring a mix of all of these qualities, undergirded by professional oath and excellent education and experience. It’s going to be fun — yes, fun — to participate in the serious business of practicing professional pharmacy in the next chapter of the MPhA story.
Minnesota Pharmacist March-April 2013 n
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Member Profile: Daniel Miller, PharmD Walgreens, Minneapolis “While I love pharmacy and all that it offers professionally, I have a second love,” said Daniel Miller, PharmD. “In my small amount of free time, I make stained-glass art. I have sold my small panels and ornaments at the Midtown Farmers Market in Minneapolis. Being a pharmacist helps, I often need lots of bandages, but I enjoy creating bright and colorful pieces that brighten people spaces as well as pharmacies.” “I began my career in pharmacy as a pharmacy technician at a Walgreens in Coralville, Iowa in January 2003,” Daniel said. As president of his high school’s science club, he invited a pharmacist to talk to the club about careers. Later, he said, when he took inventory of his life goals and where he wanted to be, he realized that he loved chemistry and life-sciences as well as working with people as an educator. That interaction with the pharmacist drove his first steps toward a degree in pharmacy, he said.
Daniel studied pharmacy and earned his PharmD from the University of Iowa, College of Pharmacy in June, 2008. Currently, his job title is Health-Systems Pharmacy Manager, Market HIV Pharmacist. He works at Walgreens Health-Systems Pharmacy at Uptown Row in Minneapolis. When asked about what is most meaningful in his day-to-day pharmacy work he said, “My favorite part of being a pharmacist is having deep, meaningful conversations with patients regarding their pharmaceutical care. Engaging and retaining patients is very fulfilling and, occasionally, I get to walk away after advocating for the patient, knowing that I have made a big difference and my help was appreciated.“ “I admit I’m very focused on the HIV community! I just saw How to Survive a Plague and it was deeply moving.” The greatest challenge in his career, Daniel said, is balancing time. “To balance outreach into the HIV community, while managing the business and clinical aspects of the pharmacy, is sometimes difficult. Also, empowering six other Walgreens HIV Centers of Excellence, mentoring first-year
MPhA Members:
students and precepting fourth-year students is also challenging.” Daniel said that keeping a rigid and thorough calendar and depending on his technicians and students, who are so much of why his pharmacy works, is how he survives. “I would like to see the Minnesota Pharmacist provide articles on specialty pharmacies. While specialty pharmacies may care for specific populations, their work is extremely important to the patients they serve.” With regard to being a member of MPhA, Daniel said, “I feel strongly that pharmacists need to be represented in the legislative process. Our voices and concerns need to be expressed through the presence of professionals at the Capitol so that we can have a say in how our own profession is governed.” Aside from being a leisure-time artist, Daniel said, “Something else that you wouldn’t guess about me is that I also appreciate tattoo artistry. I have 10 of them, discreetly hidden while I perform professional duties.”
Go online to to mpha.org to vote for your 2014-2015 MPhA President-Elect and all other open Board seats!
Voting began on March 15 and will close on Tuesday, April 9. Be sure to cast your ballot! 6
Minnesota Pharmacist March-April 2013 n
President-Elect Candidates 2014-2015 Board of Directors
Randall Seifert, PharmD
Senior Associate Dean and Professor, Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth, Minn.
Randall Seifert is the Senior Associate Dean and Professor at the University of Minnesota College of Pharmacy on the Duluth Campus. He earned a Bachelor of Science degree in pharmacy at North Dakota State University (NDSU) in 1975. After a short time practicing community pharmacy in Manchester, N.H., he entered the University of Minnesota Doctor of Pharmacy program, graduating in 1978. He then completed a research fellowship in cardiology at the university. Dr. Seifert joined the NDSU clinical faculty in 1979 and became the Director of Clinical programs in 1983. He left NDSU in 1987 and entered private practice in Santa Barbara, Calif., where he practiced as a long-term care consultant and pharmacy manager, clinical trials director at California Clinical Trials, and VP of Pharmacy, Clinical Research and Disease Management at Santa Barbara Medical Foundation Clinic. He started Seifert and Associates, a managed care pharmacy consulting company, in 1997. He returned to academics at the University of Minnesota in 2005. Seifert has extensive experience in pharmacy benefit design, managed care, medical group management and pharmacy services management. He acquired pharmacy benefit management experience in several settings, including an HMO, medical provider groups, and consulting for employer groups. He serves as a consultant to a large multispecialty and IPA medical group in Southern California. He has been extensively involved in developing medication therapy management benefits for the City of Duluth, City of Superior, St. Louis County, Dakota County and the University of Minnesota U Plan MTM benefit program. He lectures frequently on pharmacy benefit design and medication therapy management. His research development interests are in the areas of benefit design, marketing of pharmaceutical care services and use of technology to improve access to pharmaceutical care in various settings, including employer operations and rural communities. Randall says, “It is an honor to be asked to run for president-elect of the association. In the next couple of years we have much work to do in order to secure our professional place within the rapidly changing health care delivery system. “We start from a good place. I am excited about the efforts that have been made on the part of the association, the Center for Leading Healthcare Change and grassroots members to make substantial and positive changes in our professional practice act.”
Eric N. Slindee, BSPharm
Sterling Drug Pharmacy 27, Harmony, Minn.
Eric Slindee is a respected Community Pharmacist with a strong history of professional service. Since graduating from the University of Minnesota’s College of Pharmacy in 1978, Slindee has worked in several retail pharmacy settings in the Twin Cities and in southeastern Minnesota. While in college, Eric interned at Target Pharmacy #3. His first full-time job was in Austin at Osco Drugs. He relocated to work at the Kmart Pharmacy in West St. Paul for another two years. A small-town guy at heart, Eric and his wife, Lori, moved to Harmony, Minn., in 1982. They successfully managed and owned their own pharmacy for 27 years. For many years, Slindee also served as the pharmacist at the Harmony Community Hospital. In 2009, Slindee sold the pharmacy to a group now owned by Sterling Drug. Eric continues to be the pharmacist in Harmony, where he now has provided professional service to four generations. Slindee brings his strengths to the leadership of MPhA. Through years of business ownership and management, he has a solid working knowledge of budgets, financial statements, advertising, and personnel. In pharmacy practice, Eric says, “I most enjoy patient consultation so that together we can arrive at a plan to improve their therapeutic outcomes so they can live a healthier, happier life.” Slindee has been an MPhA member since 1980, and has served on the MPhA Board of Directors since 2005. He has represented MPhA at the State Capitol by meeting with legislators on legislative day. He has represented pharmacists in meetings with Blue Cross Blue Shield of MN and Prime Therapeutics at the Attorney General’s office. At the community level, Eric has been involved in many leadership roles. He worked on development of the Harmony-Preston Valley bike trail during a multi-year planning process. Slindee is a 30-year member of the Harmony Lions. He’s been a leader in many community events, promotions and festivals. In his church, He has served multiple terms on the church council, call committees and sings in the choir. Slindee grew up in the northern Minnesota community of Blackduck. He attended Concordia College in Moorhead, Minn., for two years before being accepted into the University of Minnesota’s College of Pharmacy in Minneapolis. Eric says, “I am committed to and strive to serve Minnesota pharmacists in all practice settings to advance patient care. I would be humbled and honored to serve you as your president of the Minnesota Pharmacists Association.” Minnesota Pharmacist March-April 2013 n
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Organization Member Profile: Fairview Pharmacy Services Contact name: Bob Beacher, RPh Your job title: President, Fairview Pharmacy Services Locations/number of pharmacies in your organization:
estimated 44,000 polystyrene coolers from reaching landfills in 2013. Why it’s important to your organization to support MPhA:
Fairview Pharmacy Services (FPS) operates 46 pharmacies with 1,113 employees in the 11-county metro area. Practice sites include retail pharmacy, inpatient pharmacy, home infusion therapy, mail order pharmacy, a central compounding pharmacy, specialty pharmacy, long-term care, outpatient infusion centers, multiple Medication Therapy Management sites, and a pharmacy benefits management company.
FPS has always had a number of individual pharmacists and technicians who are members of MPhA, many playing an active role in the organization. We recognize the value — and indeed the necessity — for the profession to have a strong professional organization to serve as an advocate for advancing pharmacy’s interests to government, regulators, and a variety of third-party interest groups. MPhA plays this role and it is vital for organizations like Fairview to support this effort.
Brief history of your organization; what makes it unique?
What is the biggest benefit of MPhA membership to your employees?
Fairview Pharmacy Services is part of Fairview Health Services, a non-profit health care system that includes both community hospitals and the University of Minnesota Medical Center. The first Fairview Pharmacy was opened in 1990 adjacent to Fairview Southdale Hospital and was opened to fill discharge prescriptions at Fairview Southdale Hospital as well as provide home infusion therapy services to Fairview in partnership with Fairview Home Care and Hospice. During the past 23 years, Fairview Pharmacy has evolved into an organization that provides comprehensive pharmacy distribution and medication management services to all of Fairview’s patients, no matter what the treatment setting.
This is a dynamic time within health care. Health care is changing, and with that the practice of pharmacy is changing as well. Pharmacists and technicians need a vehicle to actively engage with other health care professionals to shape pharmacy’s role on the health care team. It will take a concerted effort to shepherd the profession through the dramatic changes the health care system will undergo in the next few years. MPhA can be the conduit of awareness through its variety of effective communications, committees and opportunities for involvement.
Recently, in the interest of environmental stewardship, we introduced the use of biodegradable coolers for temperature-controlled shipping of medications. Use of this eco-friendly packing material will prevent an 8
Minnesota Pharmacist March-April 2013 n
will have for your employees? By providing MPhA membership to all Fairview pharmacists and technicians through the corporate membership option, it is our hope that many will become actively involved in the work of shaping the future of our profession. In essence, we are saying to our staff, “we will assist you by providing membership in a professional organization that can help position pharmacy for successful and rewarding inclusion in the new world of health care. But it is up to you to roll up your sleeves and actively contribute to the effort. Don’t wait for someone else to do it on your behalf.” Fairview Pharmacy Services thanks MPhA for giving corporations the opportunity to provide a cost-effective way to encourage their professional staff to become involved in their profession. We recognize the benefits of expanding the base of membership and providing opportunities for motivated individuals to become advocates for change. We are pleased to have Fairview and its employees play a role in shaping pharmacy’s future.
What kind of impact do you hope MPhA
The recently remodeled Fairview-Riverside pharmacy. Minnesota Pharmacist March-April 2013 n
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Pharmacy and the Law
Do I Have to Fill this Prescription? By Don R. McGuire Jr., RPh, JD This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.
Many pharmacists have asked the question, “I have some doubts about this prescription; do I have to fill it?” We will deal with this question in terms of therapeutics and patient health. We will reserve the topic of conscientious objection for a different time. When I was a young pharmacist, a more experienced colleague at the hospital received a phone order for IV propranolol, but at an oral dosage. The other pharmacist refused to dispense it, even in the face of verbal threats from the prescriber. In the end, the order wasn’t filled and any potential harm to the patient was avoided. What should you do if faced with a prescription that you believe is harmful to the patient? This harm may come from serious side effects, drug interactions, or possible addiction to controlled substances. Some states deal directly with this question in their regulations. For example, California states that pharmacists can refuse to fill prescriptions that would be against the law or that
could potentially have a harmful effect on a patient’s health.1 Indiana states that the pharmacist can refuse to fill a prescription that is contrary to law, that is against the best interests of the patient, that would aid or abet an addiction or habit, or that is contrary to the health and safety of the patient.2 Two general rules can be formulated from these examples. 1. Prescriptions that are illegal or invalid can’t be filled. This is one of the most difficult scenarios for a pharmacist when it comes to controlled substances. The DEA takes the position that to be valid, a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The DEA believes that the law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. It is difficult for a pharmacist to know when the line has been crossed from legitimate
treatment to addiction. I think it is safe to say that if the current prescription presented to you is causing you to ask the question, then the line is very close or perhaps already crossed. 2. Prescriptions that could harm the patient shouldn’t be dispensed. This seems obvious, but is not always easy to apply in the real world. The dosage is on the high side of normal, the patient has had penicillin before, the drug interacts with a previous prescription, or any other scenario that you can imagine where the prescriber directs you to go ahead and fill the prescription. However, if you think there is a high probability that the patient will be harmed, no one can order you to dispense the prescription. While California and Indiana spell out the responsibility of the pharmacist in these two situations, I believe that the same responsibility exists even in jurisdictions that don’t explicitly cite it.
Do I Have to Fill this Prescription? continues on page 12
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.
Minnesota Pharmacist March-April 2013 n
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Industry News
APhA Advances Provider Status Initiative
APhA has announced a major effort to obtain recognition of pharmacists as providers in the health care system. A major component of that recognition is the listing of pharmacists as providers in the Social Security Act. Provider listing in the Social Security Act is an important component in the ultimate goal of providing consumers and other health care providers with access to our services. For patients to achieve the full benefit of their medications, pharmacists must be part of the team. The American Society of Health‐ System Pharmacists (ASHP) released a similar statement from its CEO on January 2, following on the heels of an American College of Clinical Pharmacy (ACCP) board action last November and an Academy of Managed Care Pharmacy (AMCP) position statement approved by its board last June. Other national pharmacy organizations have also expressed interest in participating in provider status efforts. People on all medications, particularly those with complex medical conditions, benefit from pharmacists’ clinical services, APhA will tell Congress. “It’s the smart spend that pays” will be the tagline advocated by APhA, which will cite published literature and practice-based experience showing that when pharmacists get involved, overall health care costs go down and quality and patient safety improve.
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“It is time for pharmacists to be recognized for the value they bring to improved patient outcomes,” said Steven T. Simenson, APhA President-Elect. “Pharmacist advocacy in legislative and private payer arenas is a critical component” so that pharmacists are paid for their expertise.
To optimize our health care spending, Medicare must include pharmacists’ clinical services that are provided in collaboration with physicians and other providers on the health care team. Recognition of pharmacists’ clinical services in the nonphysician part of Medicare Part B would help to improve patient outcomes and assist physicians and other providers in meeting complex health care needs of patients. Medicare Part B is not the only important user of the Social Security Act provider list, as accountable care organizations, state Medicaid programs, and other payers usually rely on the Social Security Act provider list to determine payment policies and services covered.
“It is time for pharmacists to be recognized for the value they bring to improved patient outcomes,” said Steven T. Simenson, BSPharm, FAPhA, FACA, FACVP, APhA President and Chair of APhA’s Provider Status Task Force. “Pharmacist advocacy in legislative and private payer arenas is a critical component to achieve pharmacists being paid, as are all other providers, for their clinical decision making. This should apply to all of pharmacy practice, regardless of practice site.” “We are pleased to see so many national and state organizations rising up to support provider status, and we will
work diligently to marshal our collective strength into one set of principles that all our organizations can support,” said APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA. A statement for the pharmacy, medical, and legislative communities was posted on the homepage of pharmacist.com. The APhA Board of Trustees has allocated significant financial and human resources to work on this issue. Although changing the law would literally take an act of Congress, the initiative isn’t just about a legislative fix. The profession is exploring all avenues, including working with the private sector and states. For the past two years, APhA has been in dialogue with stakeholders within and outside of pharmacy regarding ways to advance recognition of pharmacists’ patient care services. Recent discussions among the health care reform pharmacy stakeholders have APhA continues on page 11
APhA continued from page 10 been taking place to come up with a comprehensive and cohesive plan for the profession. Beyond the national pharmacy organizations, advocacy for provider status has included the U.S. Public Health Service pharmacy report to the Surgeon General a year ago; the Change.org petition started by Sandra Leal, PharmD, CDE, of El Rio Health Center in Tucson, Ariz., on November 15, 2011; and more recently, a White House “We the People” petition, started by student pharmacist Steve Soman of St. John’s University College of Pharmacy and Health Sciences in Queens, N.Y. If the White House petition amasses 25,000 signatures by January 26, 2013, then the White House must issue an official response. These are examples of the types of advocacy needed by a critical mass of the profession in order to attain the desired recognition. Calling provider status a “top- priority strategic issue,” ASHP CEO Paul W. Abramowitz, PharmD, FASHP, explained ASHP’s involvement in the profession-wide push for provider status in his From the CEO column in ASHP InterSections, released January 2. “Achieving provider status under section 1861 of the Social Security Act is important for the profession. It is essential to recognize pharmacists for the patient care providers that they already are,” Abramowitz wrote. “Achieving provider status will not be easy. It will take a massive grassroots effort by individual pharmacy practitioners and affiliated state societies leading state‐based coalitions. … Achieving provider status will also require a strong and cohesive national coalition of pharmacy organizations, consumer groups, and other health care organizations that understand the
value pharmacists bring to the care of the American people.” In November 2012, the ACCP Board of Regents authorized a new initiative to seek provider status for clinical pharmacists working in all practice settings. Its action is focused more narrowly than that of other national groups. “‘Qualified clinical pharmacists’ will possess credential(s) beyond entry level that are commensurate with the scope of services being proposed for coverage and that assure the clinical pharmacist’s ability to contribute to team‐based, patient‐centered care,” according to the December 2012 ACCP Report article on the initiative. The Academy of Managed Care Pharmacy (AMCP) issued a position statement on Non‐Physician Provider Status for Pharmacists that was approved by the AMCP Board of Directors in June 2012. Provider status would “allow pharmacists to be reimbursed directly from Medicare Part B for providing cognitive services to patients covered under the program,” according to the position statement. “Although current Medicare Part D law reimburses pharmacies for pharmacists providing some cognitive services, including medication therapy management (MTM) to a select subset of patients, the program is restrictive and encompasses only a small set of the services pharmacists are capable of undertaking.”
Pharmacy Time Capsules By: Dennis B. Worthen, Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH
1988—Twenty-five years ago: • Medicare Catastrophic Health Care Act passed by Congress but repealed immediately after a groundswell of negative reaction. • Board of Pharmacy Specialties (BPS) recognizes Pharmacotherapy and Nutritional Support as pharmacy practice specialties
1963—Fifty years ago: • The first measles vaccine was licensed for use in the U.S. John Enders developed the vaccine from a strain of measles isolated by Thomas Peebles. • Valium (diazepam) marketed by Hoffman-LaRoche.
1938—Seventy-five years ago: • The Federal Food, Drug, and Cosmetic Act was passed in response to deaths from the use of Massengill’s Elixir of Sulfanilamide. • Albert Hofmann of Sandoz Laboratories in Switzerland synthesized LSD (lysergic acid diethylamide).
1913—One hundred years ago: • Alaska passed territorial practice act.
1888—One hundred twenty-five years ago: • First class of pharmacy students enrolled in the South Dakota State College (then the State Agricultural College) in Brookings, SD. One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America’s history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org
Do I Have to Fill this Prescription? continued from page 9 If not, then why bother to require that drug utilization reviews be performed? And if the pharmacist is powerless to act when something is detected, again, why require them? We all know that there are some risks associated with every drug and every treatment. What we are talking about here are the large, severe risks. In the propranolol example given earlier, the pharmacist was convinced that the patient would die if he dispensed that order as prescribed. If the prescriber can overrule the pharmacist’s professional judgment in this situation, then the chances of an irreversible, negative outcome increase. But you can’t make these decisions in a vacuum. Discussion with the prescriber will probably be necessary. Perhaps discussions with the patient also will be necessary. Use the information from these discussions in conjunction with your professional knowledge, experience and judgment.
As I tell pharmacists in these situations, it is much easier to defend a case where the pharmacist refuses to fill a questionable prescription than it is to defend a case where the pharmacist has doubts about what was dispensed. You don’t want your answer to the deposition question, “And what did you do when you became aware of this potential danger?” to be, “Nothing.” We can’t ensure 100% safety, but we want to avoid high probabilities of serious harm. Pharmacists owe patients their highest efforts to treat their health problems and try to protect them from avoidable harm. The pharmacist’s duty to a patient does not require the pharmacist to do anything illegal. However, I do believe that it requires pharmacists to use their professional judgment for the patient’s benefit. That may mean refusing to dispense a particular prescription. And that situation
may require some intestinal fortitude on the part of the pharmacist. Citations: 1 California Code of Regulations, Division 17, Title 16, Article 2, Section 1707.6 2 Indiana Code 25-26-13-16
© Don R. McGuire Jr., RPh, JD, is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.
What’s the best way to let pharmacists and technicians know about my new product or service? Advertise in the newly redesigned Minnesota Pharmacist, the official journal of MPhA. For the first time, all pharmacists throughout Minnesota receive a copy of Minnesota Pharmacist. The Minnesota Pharmacist is the leading pharmacy publication in our state: Circulation – sent to all 9,000+ pharmacists 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
This is the publication you should advertise in because… The Minnesota Pharmacist is the only publication in the hands of every Minnesota pharmacist. • Gain exposure • Build brand awareness
Sign up online at www.mpha.org or contact Paul Hanscom at 651-290-6274 or paulh@ewald.com. 12
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Minnesota Pharmacist March-April 2013 n
MPhA ANNUAL MEETING: May 17 – 18, 2013
Marriott Minneapolis Northwest Not Your Mother’s MPhA
The Annual Conference takes place May 17-18, 2013 at the Marriott Minneapolis Northwest, and includes two days of educational sessions in pharmacy practice and disease-state topics. Additionally, MPhA will host Minnesota’s “Pharmacy Leaders” and recognize them for service to field of pharmacy.
Top reasons to attend Learn
Network
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This conference features more than 20 industry professionals, speaking to the ins and outs of pharmacy.
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This event is the premier gathering of Minnesota pharmacists in the industry.
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Make sure that you are up to date on your CEs. MPhA is offering 9.5 contact hours (4 Friday, 5.5 Saturday) at this conference. Saturday’s sessions are approved for both Pharmacists and Technicians! This isn’t something you want to miss!
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Network with the who’s who of Minnesota pharmacists across all practice settings.
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Meet industry reps.
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Meet new graduates and students entering the field.
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Share your experiences with others while learning more about the changes in the industry.
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Sessions will be covering timely information that you’ll need to stay up to date in the pharmacy world and all of the changes going on.
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A total of 6 total breakout sessions (made up from 2 tracks each afternoon) representing 2 tracks each day will provide conference attendees with the opportunity to select specific topics of interest. Sessions are available for all levels of experience. Whether you are new to the industry or a seasoned professional, there is something for everyone! • • • • • • •
Trends in Health Systems Setting Trends in the Community Setting Anti-Microbial Stewardship Program Compounding Pharmacy Transitions of Care Practice Update Wellness Program
Testimonial: “Outstanding educ ational sessions – timely and very strong mat erials to assist phar macy & pharmacist practic e.” – 2012 Pharmacist Attendee
Not Your Mother’s MPhA •
We live in a dynamic world. Things that were true in pharmacy even 5 years ago have changed dramatically. This conference will help keep you in the know as you learn about things affecting all pharmacists in the state of Minnesota.
Take part in this event – held in the Twin Cities for the first time in more than 15 years! You don’t want to miss this celebration of your colleagues and friends in the industry – now more convenient to attend.
Registration and full details available at mpha.org
Minnesota Pharmacist March-April 2013 n
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MPhA Brings Industry Leaders to Annual Meeting MPhA Keynote Speaker
Agenda
LOYD V. ALLEN, Jr., PhD
FRIDAY, MAY 17, 2013
MPhA is proud to welcome a worldrenowned educator, author and researcher as our keynote speaker at the 2013 Annual Meeting! Loyd V. Allen, PhD, is Editor-in-Chief of the International Journal of Pharmaceutical Compounding, CEO of the Midwest Institute of Research and Technology and Professor Emeritus of the University of Oklahoma College of Pharmacy. He obtained his BS and MS in Pharmacy from the University of Oklahoma College of Pharmacy, respectively.
MPhA Key Speakers Mark M. Zipper, PhD, Director of Clinical Operations, Allina Mental Health, Allina Health
8:00-8:30am Registration 8:30-10:00am Keynote Speaker: Compounding Pharmacy 10:00-10:30am Break 10:30-11:30am General Session: Anti-Microbial Stewardship Program 11:30am Lunch & Exhibit Hall 12:30-1:00pm General Session: Introduction to New Models Program 1:00-2:00pm Breakouts Track 1: Health Systems Track: New Models: Trends in the Health Systems Setting Track 2: Community Pharmacy Track: New Models: Trends in the Community Setting 2:00-3:00pm General Session: Transitions of Care 3:00-3:15pm Break/Exhibits 3:15-4:45pm General Session House of Delegates 4:45-6:00pm Exhibitor Reception 6:00-8:00pm President's Banquet
SATURDAY, MAY 18, 2013
Ruth Lynfield, State Epidemiologist and Medical Director, Minnesota Department of Health
and Registration full details line n o e l b a l i a v a at mpha.org! g the form n i s u r e t s i g (Or re .) pposite page o e h t n o 16 Minnesota Pharmacist March-April 2013 n
7:30am Registration 8:00-9:00am Breakfast in Exhibit Hall 9:00-10:00am Keynote Speaker: Wellness Program 10:00-10:30am Break 10:30am General Session: Practice Update -12:00pm 12:00-1:00pm Honors Lunch & Awards 1:00-2:00pm Breakouts Track 1: General Track: Pain Competition - Part 1 Track 2: Technician Track: Board of Pharmacy Detailed Update Track 3:AWARxE Training 2:00-3:00pm Breakouts Track 1:General Track: Pain Competition - Part 2 Track 2: Technician Track:Institutional Drug Diversion: Risk and Prevention 3:00 - 3:15pm Break 3:15 - 4:15pm General Session: Career Roundtables 4:15pm Adjourn
MPhA rEGIsTrATION
2013 annual meeting/conference • May 17-18, 2013 Name Organization Address City Phone:
home
work
State ZIP
cell email (required for event confirmation)
Full Weekend: Friday & Saturday
Saturday only: CE, Keynote & Awards
MPhA Member $325 Non member $425 Pharmacy Student Member $225
MPhA Member $180 Non member $280 Pharmacy Student Member $145
Friday only: CE, Keynote & President’s Banquet MPhA Member $200 Non member $300 Pharmacy Student Member $145
Late Registration: All registrations received after April 19, 2013 will be charged a $25 late fee.
I am a first time attendee.
I plan to attend the Welcome Reception on Thursday night from 7:00 – 9:00pm. I plan to attend the President’s Banquet on Friday night from 6:00 – 8:00pm.
If you have special dietary needs, please list here: _____________________________________________
additional guest(s)
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$45 x ____ = $_________
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MPF student education fund Your 100% tax deductible donation to the Minnesota Pharmacists Foundation will reimburse student registration and housing costs, supporting our future pharmacists and leaders. Full ($215)
Day ($105)
Other ____
Enclosed is an additional check payable to the Minnesota Pharmacists Foundation.
Session handouts will be available electronically on the MPhA website. Attendees will be notified one week before the conference of their availability. If you prefer a printed set of handouts to be provided for your use at the conference, please check the box below: I am requesting printed handouts for an additional charge of $25
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Mail or fax form back to MPhA:
1000 Westgate Drive, Suite 252 • St. Paul, MN 55114
651-290-2266 fax • www.mpha.org • Questions? 651-697-1771 • 800-451-8349 Please do not email credit card information. Fax or mail your registration form to protect this information.
Printed Handouts = $__________
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Minnesota Pharmacist March-April 2013 n
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Industry News
Health Insurance Exchanges: What Pharmacists Need to Know By Rita Tonkinson The Affordable Care Act ushered in a new health care paradigm. To most busy pharmacists, it’s all very confusing. Without a doubt, it is complex, dynamic and a source of many questions. However, the most important take-away is that pharmacists have excellent opportunities to become significant contributors to the success of new primary care teams. There’s enough information online to fill this journal and all journals for the remainder of the year! This article will touch on the basics: • Patient Protection and Affordable Care Act of 2010, also referred to as the Affordable Care Act (ACA) • Essential Health Benefits under Federal Law • Accountable Health Care Organizations/Medical Homes • The Role of the Pharmacist on the Primary Care Health Team The Affordable Care Act “In July 2012, the Center for Medicare and Medicaid Innovation released a competitive funding opportunity for states to test innovative payment and service delivery models that have the potential to lower costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while maintaining or improving quality of care for program beneficiaries.” This statement is part of the executive summary of “The Minnesota Accountable Health Model,” published in September 2012 18
Minnesota Pharmacist March-April 2013 n
by the Department of Human Services (DHS), Health Reform Minnesota. According to this source, Minnesota submitted a Model Testing proposal for the state’s model on September 24, 2012. In November 2012, Gov. Dayton sent a letter and application to HHS Secretary Sebelius formally submitting Minnesota’s intent to operate a statebased health insurance exchange (minnpost.com, Dayton administration commits to state-run health exchange, November 16, 2012). A task force appointed by the governor provided its recommendations to the governor and to the legislature on December 13, 2012 (minnpost.com, Minnesota task force finalizes plan for implementing federal health care reform, December 14, 2012). Improved health, improved care and lower costs through changes in health care delivery are being referred to as the Triple Aim; the structure to achieve significant goals in a teambased setting is the Accountable Care Organization (ACO). While all states are working to address the current fragmentation and to integrate services to achieve the Triple Aim, not all models will look alike. According to a background paper prepared by Alyssa Ferrie, PharmD candidate 2013, for the Minnesota Pharmacists Association, there are three exchange models: • Market Organizer: This exchange will serve as an information source on health plans and enable consumers to make informed decisions.
• Selective Contracting Model: The state will play an active role and will contract with a limited number of health plans and may require that plans meet certain cost/quality metrics. • Active Purchaser Model: The state will actually purchase health insurance on behalf of consumers. Under the ACA, states have the option to expand Medicaid eligibility to nearly all individuals under age 65 whose incomes fall below 138% of the federal poverty level. The plans must cover all Essential Health Benefits (EHBs) in the Medicaid program. Please refer to the Federal Register listing of the 10 Essential Health Benefits on page 25. “Minnesota has made significant progress toward the Triple Aim of improved health, improved care, and lower costs through dramatic transformations in health care delivery, led by home grown innovations among our integrated health care systems and payer partners,” states the Executive Summary of the Minnesota Accountable Health Model. The document further sums up the challenges yet to be faced: “However, millions of Minnesotans continue to experience fragmented, uncoordinated care. This fragmentation is even more pronounced when individuals have complex health issues and need multiple types of care, such as mental health, substance abuse and long-term supports and services. The lack of coordination between services
results in poorer health and higher costs for families and the state. While these challenges exist statewide, providers that are small, independent, serve as the health care safety net, or are in rural areas face unique barriers to improved care coordination across systems.” To better understand the scope of changes to take place over the next few years, following is some information from various resources. Essential Health Benefits On November 20, 2012, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule entitled “Patient Protection and Affordable Care Act: Standards Related to Essential Health Benefits, Actuarial Value and Accreditation.” A summary communication from the National Community Pharmacists Association (NCPA) provides a clear, concise overview of the elements of the Act that are moving forward in Minnesota as well as throughout the nation. It states, the “rules will implement standards for health insurance issuers in the small group and individual market to insurance reforms, standards for states relative to the establishment of Exchanges and standards for issue of Qualified Health Plans (QHPs).” The U.S. Department of Health and Human Services (HHS) has issued two sets of regulations that set the parameters for the state exchanges. One set outlines how exchanges will be run, while the other defines qualified health plans and essential health benefits. A qualified health plan (QHP) must: be certified or recognized by each exchange, Consumer Oriented and Operated Plan (CO-OP) program or multi-state exchange in which the plan is offered; provide an essential health benefits package; and be offered by an insurer. HHS has decided to allow each state to choose from a set of four plans to serve as the benchmark plan for the state. States can choose a benchmark plan that is: 1) one of
Improved health, improved care and the three largest small group plans in the state; lower costs through changes in health 2) one of the three larg- care delivery are being referred to as the est state employee health plans; 3) one of Triple Aim; the structure to achieve signifthe three largest federal icant goals in a team-based setting is the employee health plan Accountable Care Organization (ACO) options; or 4) the largWhile all states are working to address est HMO plan offered in the state’s commercial fragmentation and to integrate services... market. These plans not all models will look alike. must cover 10 benefit categories. HHS plans to select classification system as a common the small group plan with the largest organizational tool for plans to report enrollment in the state as the default drug coverage and is requesting combenchmark for states that choose not ments on this proposal. This approach to select a benchmark plan. States to prescription drug coverage is a sigwere required to select their bench- nificant departure from the Medicare mark plan on or before September Part D drug plans that are required to 30, 2012; otherwise, HHS will select cover “substantially all” drugs in the folthe default benchmark plan. As of lowing protected classes of drugs: antiOctober 2, 2012, 25 states, including cancer; anti-psychotic, anti-convulsant; the District of Columbia, have selected anti-depressants; immunosuppressant; a benchmark plan. Some states have and HIV and AIDS drugs. asked for further clarification from HHS Accountable Care Homes/ before determining their benchmark Medical Homes plan. A fact sheet developed in November A summary provided by NCPA in 2012 and provided by MPhA considers November 2012 reported that with how individual states may establish regard to prescription drug coverage: exchanges. Several questions were “Under the proposed rule, plans may answered: have limitations on coverage that differ from the EHB-benchmark plan, but Should the state establish an exchange covered benefits, limitations on cover- or let the federal government step in? age (including limits on the amount, As of November 15, 2012, 17 states duration, and scope of covered ben- and the District of Columbia have efits), and prescription drug benefits established a state-based exchange. must remain substantially equal to Tennessee, Pennsylvania, Idaho, New those covered by the EHB-benchmark Jersey, Arizona and Wisconsin were plan. Under the proposed rule, a plan still undecided as to whether to create must cover the greater of 1) drugs in a state run exchange. The remaining every USP category and class; or 2) states have indicated that they will the same number of drugs in each partner with the federal government to category and class as the EHB bench- run the exchange or will allow the federal government to run the exchange in mark plan.” their state. On November 15, 2012, the There is also a provision that “would administration announced an extenrequire health plans to establish a sion of the deadline to submit letters procedure that would allow an enrollee of intent to build state-run exchanges to request clinically appropriate drugs to December 14. The original deadline not covered by the health plan.” The was November 16, 2012. NCPA report states that HHS also indicates that it is considering using the most recent version of the USP Exchanges continues on page 23 Minnesota Pharmacist March-April 2013 n
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Collaborative Practice Agreements: Wave of the Future?
By Zach Merk, PharmD Candidate demographics within Minnesota; participants were representatives of Fairview Health Services, Park Nicollet, Hennepin County Medical Center, Indian Health Services, Minnesota Veterans Affairs, Genoa Health Care, Goodrich Pharmacy, and University of Minnesota Physicians.
Introduction Collaborative practice agreements (CPA) allow pharmacists to practice under the prescriptive authority of other health care providers. CPAs can allow pharmacists to assume professional responsibility of performing patient assessments; ordering drug therapy-related laboratory tests; administering drugs; and selecting, initiating, monitoring, continuing, and adjusting drug regimens. There have been many papers written that show positive patient outcomes and financial benefits when pharmacists participate in CPAs, and CPAs really allow us to practice at the level of our ability as pharmacists. An interview was completed by ten pharmacists and one physician who were all recommended by their peers as CPA experts to explore the makeup of a successful CPA. They comprised a wide variety of health care systems and 20
Minnesota Pharmacist March-April 2013 n
Interview Results All interviews were completed by individuals with significant experience developing CPAs, and as several participants stated, “don’t reinvent the wheel.” These experiences can be drawn upon for pharmacists in Minnesota who are interested in initiating a CPA. Here is a summary of their suggestions: When initiating a CPA, one should begin by fully assessing the situation. Try to identify the needs of the practice, the needs of physicians, and the needs of the patients. You may be able to get your CPA off the ground by identifying a task that the physician does not have time to do. Once needs are identified, develop relationships with physicians and ask someone who you work
with well to promote your services to other providers. There were many recommendations about where to start — hyperlipidemia, asthma, smoking cessation, and hypertension to name a few — but almost all pharmacists interviewed agreed that it is important to start with one or two disease states. As you begin your CPA, re-evaluate your practice and ensure you are compliant with all state and federal laws. It is important to document! Document everything you do in the electronic medical record and document outcomes so that you can prove the value of your CPA to
employers and physicians in the future. Explaining to physicians how you make decisions about medications is important for continued success. Finally, remember that this is an ongoing process. A CPA should be reviewed formally at least annually for ongoing appropriateness of communication techniques, documentation, and scope of practice. A very robust CPA can eventually be developed using this process. Qualities of Successful Collaborative Practice Agreements In reviewing common themes throughout the interviews, three qualities appear to be critical to successful CPAs. The first is communication. It is especially critical before a CPA is agreed upon and when a CPA is initiated. Additionally, good communication beyond initial creation of the CPA was also one of the most highly reported suggestions for continued success. Second, developing a CPA needs to be a gradual process. It should begin with relationship building and learning the physicians’ needs. Then, you can slowly add on additional agreements as the physician becomes more familiar with you. Most of the pharmacists interviewed that had robust CPAs started out with a CPA that covered one disease state or one class of medication. The third necessary quality is credibility. Many participants stated that as a pharmacist, you should inform physicians how and why you make decisions. There was also support for becoming credentialed, completing additional certification, or completing a trial period. Documentation showing outcomes is also a great way to establish credibility.
Additional Resources A great deal of useful information is available on MPhA’s Medication T h e r a p y Management Resources page, including cost of service calculators, a list of different documentation systems available, sample presentations and business plans, and several sample CPAs. I hope that this article encourages you to initiate a CPA in your practice! CPA Guidance Documents: Jump-start your CPA by searching the web for these items: CDC – Partnering with Pharmacists in the Prevention and Control of Chronic Diseases NACPB – Model State Pharmacy Act ACCP – Collaborative Drug Therapy Management Zach Merk is a fourth-year pharmacy student at the College of Pharmacy University of Minnesota where he is completing the Leadership Emphasis Area. He is an active participant in the Pharmacy Practice Act Revision process and an HIV educator for the Minnesota AIDS project. Merk is currently seeking a residency in the Twin Cities area and hopes to work in ambulatory care and academia settings.
It is very important to document! Document everything you do in the electronic health record and document outcomes so that you can prove the value of your CPA to employers and physicians in the future. Minnesota Pharmacist March-April 2013 n
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Clinical Issues
by Ann Brigl
Electronic Tools for Ambulatory Care
A survey published by APhA in 2011 identified several barriers to the implementation of medication therapy management (MTM) services. Some of these barriers were technology, billing, and documentation. During my ambulatory care Advanced Pharmacy Practice Experience (APPE) rotation at several locations of Genoa Healthcare, I learned about some resources to help overcome such barriers. These resources were identified by my preceptor, Julie Gambaiani, a board certified ambulatory care pharmacist. She has started two MTM practices over her career, one in a retail setting and also at Genoa Healthcare. Minnesota Information Immunization Connection (MIIC) MIIC is a free service provided by the state of Minnesota to health care providers to track the immunization history of patients. When registered with this program, pharmacists can determine what immunizations are still recommended and are able to document immunizations that have been administered. By using this program, pharmacists can identify any vaccines that are missing from the patient’s immunization profile. To register for this program, contact the Regional Coordinator for your area. Website: https://miic.health.state.mn.us/ Minnesota E-Connect E-Connect is another free online ser-
vice that was granted state funds to promote the use of electronic claims processing in Minnesota. This service allows any provider with an NPI number to file electronic medical claims using current procedural terminology (CPT) codes. By using CPT codes, the pharmacist can charge for MTM services and vaccinations based on what was provided to the patient. Minnesota E-connect will set up accounts on your behalf with many of the major payers (the E-connect website lists all payers they contract with) to receive and transmit electronic bills. Health care providers must set up their own contracts to help ensure reimbursement. Registration for this program can be conducted on the website. Website: http://www.mneconnect.org/ Assurance Systems Assurance is a fee-for-service software system that has specifically been designed to bill for MTM services. Assurance Systems bases its billing structure on the Minnesota Medicaid levels of reimbursement for MTM. The system provides a step-by-step process to ensure the requirements for an MTM billing are fulfilled. It also submits claims for adjudication to designated payers. A unique feature of Assurance is that it provides data to support the use of MTM services. Examples of such data include: outpatient office visits avoided, long-term care visits avoided, lab services avoided, number of medications the patient has discon-
tinued, and costs incurred for MTM services. This type of data measurement can be calculated similar to return-oninvestment or cost-saved-per-person calculations. To register for Assurance Systems, visit their website. Website: http://www.medsmanagement.com/index.html The above resources are just a select few that can help a MTM pharmacist create an effective practice. While there are barriers to the implementation of MTM services in mainstream health care, there are many helpful tools available for health care providers. To effectively utilize these tools, pharmacists must be made aware of the services. MTM practitioners also need to communicate with one another to make these tools easier to implement and utilize. Citation: American Pharmacists Association. Medication therapy management digest: perspectives on MTM service implementation. Accessed in November 2012 at http:// www.pharmacist.com/sites/default/files/ files/mtm_2011_digest.pdf Ann Brigl is a fourth-year pharmacy student at the College of Pharmacy University of Minnesota, Twin Cities campus.
Define or Be Defined
Clinical Issues
Duluth Area Pharmacists Engage in Modernization of the Pharmacy Practice Act By Laura Palombi, PharmD, MAT; Maggie Kading, PharmD; Keri Hager, PharmD The Duluth Area Pharmacists (DAP) is a grassroots group encompassing all interested pharmacists, pharmacy technicians, pharmacy students and other colleague health care providers that convenes monthly. The group has goals of improving patient health outcomes and advancing the practice of pharmacy. The DAP group, comprised of persons from northern Minnesota, gathers to engage in discussion of proposed amendments to modernize the Minnesota Statutes governing the practice of pharmacy. The amendments were proposed by a Working Group, which was brought together under the leadership of the Center for Leading Healthcare Change at the University of Minnesota College of Pharmacy. The group consisted of a chairperson and 12 members from various pharmacy backgrounds and was responsible for producing the document, “Enabling Pharmacists to Respond to the Health Needs of Minnesota Communities: Recommendations for the Modernization of MN Statutes, Chapter 151.” After becoming aware of the recommendations set forth by the Working Group, and the critical importance of legislation that would free Minnesota pharmacists to fully participate in new health care delivery systems and not be limited by the language of the 1937 Act, the DAP gathered to engage in discussion. This dialogue, led by ambulatory care pharmacy residents and attended by one of the members of the original Working Group, was entitled “Define or Be Defined.”
The lively and fruitful discussion that occurred at the first “Define or Be Defined” meeting stretched into three consecutive meetings as local pharmacists debated the language and proposed changes of the Working Group and the implications that this language could potentially have on pharmacy practice. In working through the Practice Act and the proposed changes section by section, pharmacists and technicians from settings that included health system pharmacy, academic pharmacy, independent retail pharmacy, long-term care pharmacy and large chain retail pharmacy weighed in and offered their feedback. Some of the more contentious issues included the details of how a pharmacy should be defined so as to not limit a pharmacy to merely a dispensing location, as well as the critical topic of how to define a pharmacist and address concerns that the “practice of pharmacy” could be taken over by those outside of the profession. Much discussion ensued about who is responsible for the actions of pharmacy technicians, if technician ratios need to be adjusted, and if so, who should set the technician ratios. The question of whether issues such as pricing and reimbursement even have a place in a practice act was discussed at length. Key issues including the current and future scope of practice and the expanding role of pharmacists in collaborative practice were debated. Lastly, DAP members weighed in on the very timely topic of drug quality as addressed in Minnesota statute, especially as it pertains to products from compounding facilities, and what
measures Minnesota pharmacists might take to help ensure their patients receive only products meeting standards of strength, quality, and purity. DAP members’ overall consensus on statutory change is to move pharmacy practice forward to meet the health care needs of patients, and to have a statute flexible enough to keep up with dynamic health care delivery models and the evolving role of pharmacists in patient care. This discussion and feedback was captured and will be forwarded to state pharmacy organizations, the College of Pharmacy, the Board of Pharmacy, and other health professionals as this proposed legislation is shaped. DAP members plan to remain involved with this iterative process moving forward and hope other pharmacists, pharmacy students, and pharmacy technicians will engage, discuss, and unite on this very important issue … our practice. Editor’s Note: MPhA is also dedicated to addressing the proposed changes to the Minnesota Pharmacy Practice Act and has a steering committee that meets monthly. Their aim is “to ensure that future pharmacists are able to fully apply their knowledge and skills to improve patient health.” The meetings are open to all members, and we encourage you to attend or call in to help define your Practice Act.
Minnesota Pharmacist March-April 2013 n
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Exchanges continued from page 19 What will the governance structure of the exchange be? States are deciding whether to run their exchanges partnering with or creating a new state agency, as an independent public entity or as a nonprofit. A state agency run exchange can leverage established administrative systems and procedures, while a quasi-governmental or nonprofit exchange could be less influenced from politics because it is isolated from government and interest groups. Law requires exchanges that are established independently from a state government to be governed by a board that is overseen by the state. What will be the rules regarding carrier participation? Health insurance plans that want to be offered through the exchange must provide one of four levels of coverage for essential benefits or provide catastrophic coverage for those under 30. The four levels are platinum, gold, silver or bronze. These four levels are defined by the actuarial value coverage. How will the exchange mesh with the existing commercial market? In order for a health insurance plan to be offered in the state exchange it must meet the minimum standards that are offered in the essential benefits health plan. How will the exchange eligibility processes interface with Medicaid/CHIP? The Supreme Court ruling on June 28, 2012 upheld the ACA’s Medicaid expansion, but the authority of the Secretary of Health and Human Services to enforce Medicaid expansion was limited by establishing that the secretary cannot reduce current Medicaid funding if a state decides to not expand Medicaid. The ACA expands eligibility, beginning January 2014, to all persons under the age of 65 with incomes at or below 138% of the federal poverty level (FPL). In January 1, 2012, this would be an individual
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Minnesota Pharmacist March-April 2013 n
who earned a maximum of $15,415. The ACA also expands Medicaid for children ages 6-18 in households with an income of up to 138% FPS. The Supreme Court’s decision does not affect this expansion. States are currently required to cover children who live in households with an income of up to 100% FPL, and the ACA will expand this to 138% FPL, in 2012. The ACA also requires states to maintain current eligibility standards, methodologies and procedures for Medicaid under the state’s current plan or waiver. Secretary Kathleen Sebelius stated in a letter of July 2012 that the only provisions affected by the Supreme Court’s decision regard the expansion of Medicaid eligibility for adults with an income up to 138% FPL. The Role of the Pharmacist on the Primary Care Health Team This is an opportunity for pharmacists to “get in on the ground floor!” An article, “Affordable Health Care Act: It’s Here to Stay so Buckle in,” written by Julie K. Johnson, PharmD, (Minnesota Pharmacist, Vol. 66, No. 3, Fall 2012) indicates that there are and will be opportunities for pharmacists to expand their practices. Among the important statistics cited, it was noted that 3.7 billion prescriptions were filled at retail pharmacies in 2010 and that number is expected to rise as states have the option of expanding Medicaid eligibility. She also noted that with the expansion of Medicaid under ACA, pharmacists will be “required to participate in direct patient care to positively impact quality measures.” She also urged pharmacists to discover how to become integral to the success of accountable care organizations (ACOs) and medical homes. In an issue brief prepared by MPhA, the expansion opportunities include: • Providing medication therapy management (MTM) services
for prescription and over-thecounter medications; • Reducing the risk of adverse events by screening for drug interactions, identifying unnecessary or suboptimal medications and suggesting additional or alternative drug therapy; • Becoming a drug therapy resource providing evidencebased recommendations on the safest, most effective treatments; • Enhancing patient outcomes with decreased overall health care cost. “The pharmacist is the best health care provider to manage drug complexities,” said Dean Marilyn Speedie, PhD, College of Pharmacy, University of Minnesota. In a presentation to the Minnesota Health Care Task Force Work Group in Summer 2012 (and shared on the American Pharmacists Association website), Speedie stated that the time has come for finding opportunities in the emerging health care scene: “Pharmacists are not being fully utilized to the extent of their education.” Over the past 20 years, drug therapy has become more complex, she said. “Modern pharmacists are prepared to provide medication management to optimize health outcomes as part of the health care team.” In her presentation, Dean Speedie provided the following workforce strategies and recommendations: • Include a pharmacist as an integral component of the medical/health home team. • Include pharmacists as accountable providers in ACOs, compensate for role in improving health outcomes. Exchanges continues on page 24
Exchanges continued from page 23 • Utilize pharmacy technicians as a cost effective way to distribute product. • Incentivize pharmacists to seek advanced clinical skill development. • Educate more pharmacists who have a population health orientation to guide ACOs in the use of medications and pharmacist provided care. • Incentivize more pharmacists and physicians to participate in collaborative practice agreements.
Three ACOs driven by Walgreens were among the 106 new ACOs announced by CMS on January 10, 2013. The first pharmacy to create any ACO, Walgreens approached the affiliated physicians’ group in New Jersey, Florida and Texas. These innovations are clearly indications that ACA is opening doors — doors not yet imagined by some. “By offering more services, more affordable services, and with the convenience of pharmacy locations, pharmacists are serving more than just the community as they are working closely with a growing number of hospitals and health systems on coordinated care programs like ACOs, with pharmacists serving as an integral part of patient care teams — and helping to improve patient care and satisfaction, while also lowering health care costs,”
said Michelle Aytay, RPh, CDE, Market 21 Clinical Services, Walgreens, and chair of the MPhA Public Affairs and Policy Committee. “Pharmacists are playing an important role in health care today, and as the most accessible health care providers in communities throughout the country, they are uniquely positioned to help bridge critical gaps in care.” Rita Tonkinson is the Communication Director (retired) of the Minnesota Pharmacists Association.
Essential Health Benefits Required by ACA The Affordable Health Care Act (ACA) directs that the essential health benefits (EHB) reflect the scope of benefits covered by a typical employer plan and cover at least the following 10 general categories of items and services: 1) ambulatory patient services; 2) emergency services; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance use disorder services, including behavioral health treatment; 6) prescription drugs; 7) rehabilitative and habilitative services and devices; 8) laboratory services; 9) preventative and wellness services and chronic disease management; and 10) pediatric services including oral and vision care. EHB will promote predictability for consumers who purchase coverage in these markets, facilitate comparison across health plans and ensure that individual and small group subscribers have the same access to the same scope of benefits provided under a typical employer. Section 2707 of the Public Health Service Act, as added by section 1201 of the Affordable Care Act, directs that, for plan years beginning on or after January 1, 2014, health insurance issuers offering non-grandfathered plans in the individual or small group market ensure such coverage includes EHB as described in
section 1302(a) of the Affordable Care Act, Section 1302, to be defined by the Secretary. The law also directs that EHB reflect the scope of benefits covered by a typical employer plan and cover at least the 10 general categories of items and services previously listed. Section 1302(b) (4) of the Affordable Care Act Further established that the Secretary define EHB such that it: • Sets an appropriate balance among the 10 general categories; • Does not discriminate based on age, disability, or expected length of life; • Takes into account the health care needs of diverse segments of the population; and • Does not allow denials of essential benefits based on age, life expectancy, disability, or degree of medical dependency and quality of life. Section 1302(b)(4) of the Affordable Care Act further directs the Secretary to consider the provision of emergency services
and dental benefits when determining whether a particular health plan covers the EHB. Finally, sections 1302(b)(4)(G) and (H) of the Affordable Care Act direct the Secretary to periodically review the EHB, report the findings of the review to the Congress and to the public, and update the EHB as needed.
Source: Federal Register/Vol. 77, No. 140/ Friday, July 20, 2012/ Rules and Regulations
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Minnesota Pharmacist March-April 2013 n
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Report from the State Capitol
MPhA News
by Patrick Lobejko, MPhA Lobbyist
The 2013 Minnesota legislative session has begun and is off to a relatively quiet beginning. The item that has kept the attention of most legislators is Governor Dayton’s budget recommendations for the next two years. The proposed revenue increase totals $732 million in order to solve the $1.1 billion budget deficit the state is facing. Some key provisions include a new Fourth Tier income tax rate on the top 2% of income earners, increasing the tax on tobacco by $.94 per pack (to match the tax in Wisconsin), and extending the state sales tax to internet purchases (the so-called “Amazon tax”). The governor’s budget has a couple of items relating to pharmacies. Under the health and human services budget, there is a recommendation to expand SMAC pricing to cover drugs administered in a clinical setting. Governor Dayton also recommends making changes to drug reimbursement rates for providers enrolled as 340B covered entities with the Department of Human
Services to create a more consistent reimbursement methodology. The lone piece of legislation that has moved rather rapidly is the bill implementing Minnesota’s health exchange. The exchange, a key part of the federal Affordable Care Act, will create an insurance marketplace for consumers and small businesses to compare and purchase health insurance. This would work much like an online travel site such as Expedia and Kayak. Questions remain on a number of provisions of the bill, including who will be tasked with administering the exchange. The current language calls for a new state agency instead of the Commerce Department which currently oversees health insurance. The cost of the implementation and data privacy concerns are also being discussed. Opponents of the bill worry that trying to push the bill through this session simply because a deadline is in place is a poor way to pass such a largescale reform in state health care delivery. Under federal law, the state must put an exchange bill into law by March 31. The exchange must be operational by the beginning of 2014.
On the House side, the bill has passed through a variety of committees and was passed by the full House in early March. The Senate also approved its version of the bill; because the Senate version was different from the House bill, a Conference Committee was assigned to work out the differences. A vote on the Conference Committee bill will take place while this issue of the Minnesota Pharmacist is in production. It is likely that the governor will sign it well in advance of the March 31 deadline. The Legislature is holding hearings on the governor’s proposed budget. The February budget forecast showed continued improvement in the state’s tax receipts since the previous forecast in November. Gov. Dayton released a revised budget proposal in March reflecting the improved forecast. The House and Senate leaders will likely find it easier to come to a consensus on the legislative budget proposal with the February budget forecast numbers in hand. If you have questions about MPhA’s legislative platform, please contact Patrick Lobejko at patrickl@ewald.com or 651290-7473.
For a full list of all Minnesota legislators
and their contact information, visit the MPhA website at www.mpha.org
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Minnesota Pharmacist March-April 2013 n
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. The entries chosen for inclusion are the majority, but not all, efficacy supplements. It is also important to note that the short descriptions of the changes provided in the Table may not provide all information associated with the revision. Additional supporting changes may also be in the revised labeling (for example, new safety information). Readers should consult the new labeling when the changes cited are important to their specific need.
Table of Efficacy Supplements, November and December, 2012 PROPRIETARY NAME
ACTIVE INGREDIENT(S)
NEW INFORMATION
DATE
Tamiflu
o s e l t a m i v i r Indications: Expand the patient population Dec. 21 phosphate to include patients 2 weeks to one year of age for treatment of influenza. [Note: Not prevention]
Kineret
anakinra
New Indication: Use of anakinra in the Dec. 21 treatment of Neonatal Onset Multisystem Inflammatory Disease (NOMID).
Alvesco
ciclesonide
Labeling now states efficacy in children 6 Dec. 17 months to 4 years of age.
Zytiga
a b i r a t e r o n e New Indication: In combination with predni- Dec. 10 acetate sone for the treatment of patients with metastatic castration-resistant prostate cancer.
Promacta
e l t r o m b o p a g New Indication: Treatment of thrombocy- Nov. 16 olamine topenia in patients with chronic hepatitis C to allow the initiation and maintenance of interferon-based therapy.
Viramune XR
nevirapine
New Indication: For the treatment of HIV-1 Nov. 8 infection in pediatric patients 6 to less than 18 years of age.
Xarelto
rivaroxaban
New Indication: Provide for the treatment Nov. 2 of deep vein thrombosis, the treatment of pulmonary embolism, the reduction in risk for deep vein thrombosis, and the reduction in risk for pulmonary embolism.
Different presentations and extent of restating the revised information are noted in this report. Variation comes about by extent of the change and ease of understanding the changes in different presentations, or the wording used in the FDA approval letter. It is anticipated that format and description of the changes will be refined in future reports. Consult the FDA website to obtain or review FDA’s approval letter and/or revised insert labeling: 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 Minnesota Pharmacist March-April 2013 n
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Pronunciation of Active Ingredient Names Of Recently Approved Drug Products By Kent T. Johnson, MSPharm
PROPRIETARY NAME
This column provides a guide to pronunciation of the nonproprietary name of active ingredients 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. Also, there is some editorial privilege exercised to not include selected products in this list because the product may not have great impact upon traditional pharmacy services, e.g., a new radiopharmaceutical, or for other reasons. The pronunciation guide comes from: 2012 USP Dictionary of USAN and International Drug Names. Additional information on how pronunciation is established will be seen in future editions of the Minnesota Pharmacist.
NONPROPRIETARY NAME OF ACTIVE
PRONUNCIATION
INGREDIENT(S)
DATE
APPROVED
Fulyzaq
crofelemer
kroe fel’ e mer
Dec. 31
Sirturo
bedaquiline
bed ak’ wi leen
Dec. 28
Eliquis
apixaban
a pix’ a ban
Dec. 28
Juxtapid
lomitapide mesylate
loe mi’ ta pide
Dec. 21
Gattex
teduglutide
te” due gloo’ tide
Dec. 21
Iclusig
ponatinib
poe na’ ti nib
Dec. 14
Signifor
pasireotide diaspartate
pas” i ree’ oh tide
Dec. 14
Cometriq
cabozantinib s-malate
ka” boe zan’ ti nib
Nov. 29
Xeljanz
tofacitinib citrate
toe” fa sye’ ti nib
Nov. 6
FURTHERING PHARMACY
ADVANCING
CAREERS Find the best jobs and highly qualified pharmacists Minnesota has to offer.
ONLINE CAREER CENTER
www.mpha.org
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Minnesota Pharmacist March-April 2013 n
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United States House & Senate/Minnesota Please note that mail delivery to Washington can be delayed by up to 10 days due to security screening. If your message is urgent, fax your letter to Washington, contact their district office, or send an email through their website. Congressman Tim Walz First Congressional District walz.house.gov Washington, DC 1034 Longworth House Office Building Washington, DC 20515202-225-2472 Rochester 1130-1/2 Seventh St NW, Room 208 Rochester, MN 55901 • 507-206-0643 Mankato 227 E. Main St., Suite 220 Mankato, MN 56001 • 507-388-2149 Congressman John Kline Second Congressional District kline.house.gov Washington, DC 2439 Rayburn House Office Building Washington, DC 20515 202-225-2271 • fax 202-225-2595 Burnsville 350 W. Burnsville Pkwy, Suite 135 Burnsville, MN 55337 952-808-1213 • Fax 952-808-1261 Congressman Eric Paulsen Third Congressional District paulsen.house.gov Washington, DC 127 Cannon House Office Building Washington, DC 20515 202-225-2871 • fax 202-225-6351 Eden Prairie 250 Prairie Center Drive, Suite 230 Eden Prairie, MN 55344 952-405-8510 • fax 952-405-8514 Congresswoman Betty McCollum Fourth Congressional District mccollum.house.gov Washington, DC 1714 Longworth House Office Building Washington, DC 20515 202-225-6631 • fax 202-225-1968 St. Paul 165 Western Ave. N., Suite 17 St. Paul, MN 55102 651-224-9191 • fax 651-224-3056 Congressman Keith Ellison Fifth Congressional District ellison.house.gov Washington, DC 1027 Longworth House Office Building
Washington, DC 20515 202-225-4755 • fax 202-225-4886 Minneapolis 2100 Plymouth Ave. N. Minneapolis, MN 55411 612-522-1212 • fax 612-522-9915 Twitter @KeithEllison Congresswoman Michele Bachmann Sixth Congressional District bachmann.house.gov Washington, DC 2417 Rayburn House Office Building Washington, DC 20515 202-225-2331 • fax 202-225-6475 Anoka 2850 Cutters Grove Ave., Suite 205 Anoka, MN 55303 763-323-8922 • fax 763-323-6585 Congressman Collin Peterson Seventh Congressional District collinpeterson.house.gov Washington, DC 2109 Rayburn House Office Building Washington, DC 20515 202-225-2165 • fax 202-225-1593 Detroit Lakes 714 Lake Ave, Suite 107 Detroit Lakes, MN 56501 218-847-5056 • fax 218-847-5109 Marshall 1420 East College Drive, SW/WC Marshall, MN 56258 507-537-2299 • fax 507-537-2298 Montevideo 100 N. First St. Montevideo, MN 56265 320-235-1061 (Willmar office) Red Lake Falls 2603 Wheat Drive Red Lake Falls, MN 56750 218-253-4356 • fax 218-253-4373 Redwood Falls 230 E Third St. Redwood Falls, MN 56283 507-637-2270 Willmar 324 Third St. SW, Suite 4 Willmar, MN 56201 320-235-1061 • fax 320-235-2651 Congressman Rick Nolan Eighth Congressional District nolan.house.gov Washington, DC 2447 Rayburn House Office Building Washington, DC 20515 • 202-225-6211 Brainerd Brainerd City Hall, 501 Laurel St. Brainerd, MN 56401 • 218-545-4078
Duluth 515 W First St., Room 235 Duluth, MN 55802 218-464-5095 • fax 218-464-5098 Senator Amy Klobuchar klobuchar.senate.gov Washington, DC 302 Hart Senate Office Building Washington, DC 20510 202-224-3244 • fax 202-228-2186 Twin Cities Metro 1200 Washington Ave. S., Room 250 Minneapolis, MN 55415 612-727-5220 • fax 612-727-5223 Southern Office 1130-1/2 Seventh St NW, Room 208 Rochester, MN 55901 507-288-5321 • fax 507-288-2922 Northwestern/Central Office 121 Fourth St S Moorhead, MN 56560 218-287-2219 • fax 218-287-2930 Northeastern Office Olcott Plaza, Room 105, 820 Ninth St N Virginia, MN 55792 218-741-9690 • fax 218-741-3692 Senator Al Franken www.franken.senate.gov Washington, DC 309 Hart Senate Office Building Washington, DC 20510 202-224-5641 Twin Cities Metro 60 East Plato Blvd, Suite 220 St. Paul, MN 55107 651-221-1016 Duluth 515 W First St., Suite 104 Duluth, MN 55802 218-722-2390 NW Mobile Office 218-230-9487 St. Cloud 916 W St. Germain St., Suite 110 St. Cloud, MN 56301 320-251-2721 St. Peter Office 208 S Minnesota Ave, Suite 6 St. Peter, MN 56082 507-931-5813
Minnesota Pharmacist March-April 2013 n
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Resource directory
Minnesota Pharmacy Resources university of minnesota College of Pharmacy, Twin Cities College of Pharmacy University of Minnesota 5-130 Weaver-Densford Hall 308 Harvard Street SE Minneapolis, MN 55455 612-624-1900 • 612-624-2974 fax www.pharmacy.umn.edu Dean Marilyn K. Speedie, PhD 612-624-1900 university of minnesota College of Pharmacy, duluth University of Minnesota College of Pharmacy, Duluth 232 Life Science Building 1110 Kirby Drive Duluth, MN 55812-3003 218-726-6000 • 218-726-6500 fax www.pharmacy.umn.edu/duluth Randall Seifert, PharmD Senior Associate Dean and Professor, Pharmacy Practice and Pharmaceutical Sciences minnesota board of pharmacy
The Minnesota Board of Pharmacy (BOP) exists to protect the public from adulterated, misbranded, and illicit drugs, and from unethical or unprofessional conduct on the part of pharmacists or other licensees, and to provide a reasonable assurance of professional competency in the practice of pharmacy by enforcing the Pharmacy Practice Act M.S. 151, State Controlled Substances Act M.S. 152 and various other statutes. The board strives to fulfill its mission through a combination of regulatory activity, technical consultation and support for pharmacy practices through the issuance of advisories on pharmacy practice issues, and through education of pharmacy practitioners. The Board of Pharmacy consists of seven 30
Minnesota Pharmacist March-April 2013 n
board members, appointed by the governor; five board members must be pharmacists, and two members must be public members. The board regulates pharmacists, pharmacies, pharmacy technicians, controlled substance researchers, drug wholesalers and drug manufacturers. The board approves licenses or registrations for these individuals or businesses, and also decides when to impose disciplinary action. Minnesota Board of Pharmacy Cody C. Wiberg, Executive Director 2829 University Ave SE, Suite 530 Minneapolis, MN 55414 651-201-2825 • 651-201-2837 fax 800-627-3529 hearing impaired www.pharmacy.state.mn.us Minnesota Board of Pharmacy Members President: Laura J. Schwartzwald Vice President: Stuart Williams (Public Member) Pharmacist Members: Karen Bergrud, Bob Goetz, Kay Hanson, Rabih Nahas Public Member: Justin Barnes minnesota department of human services The Minnesota Department of Human Services (DHS) helps provide essential services to Minnesota’s most vulnerable residents. Working with many others, including counties, tribes and non-profits, DHS help ensure that Minnesota seniors, people with disabilities, children, and others meet their basic needs and have the opportunity to reach their full potential. DHS programs include Medical Assistance (MA), MinnesotaCare, Minnesota Family Investment Program (Minnesota’s version of the federal Temporary Assistance for Needy Families program), General Assistance (GA), the Prescription Drug
Program, child protection, child support enforcement, child welfare services, and services for people who are mentally ill, chemically dependent or have physical or developmental disabilities. www.dhs.state.mn.us Drug Utilization Review board (DUR): The DUR selects specific drug entities or therapeutic classes to be targeted for provider and recipient educational interventions, and provides guidelines for their use. The DUR board is comprised of four licensed physicians, at least three licensed pharmacists and one consumer representative, with the remaining members being licensed health care professionals with clinically appropriate knowledge in prescribing, dispensing, and monitoring outpatient drugs. DUR board meetings are held four times a year. Appointing authority: Commissioner of Human Services. Compensation: $50 per member per meeting plus mileage. (Minnesota Statutes 256B.0625, subd. 13a) Drug Formulary Committee (DFC): The DFC is charged with reviewing and recommending which drugs require authorization. The DFC also reviews drugs for which coverage is optional under federal and state law. (For possible inclusion in the Medicaid fee-for-service formulary.) The DFC is comprised of four physicians, at least three pharmacists, a consumer representative, and knowledgeable health care professionals. DFC meetings are open to the public and public comments are taken for an additional 30 days following a DFC recommendation to require prior authorization for a drug. The Department of Human Services provides the DFC with information regarding the impact that placing a drug on authorization will have on the quality and cost of patient care. Appointing authority: Commissioner of Human Services. Compensation: None. (Minnesota Statutes 256B.0625, subd. 13)
MPhA Member Benefits Not a member? Visit mpha.org and join today! The Minnesota Pharmacists Association’s number one priority is its members. MPhA strives to provide services and benefits to our members that not only promote the profession of pharmacy in Minnesota, but the professional lives of our members as well. Ranging from advocacy and communication to discounted professional and business programs, we are always on the search for benefits that are valuable to you as pharmacy professionals. 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 they cover a portion of MPhA membership. Membership dues can be renewed online and a portion of your dues are tax deductible (consult your tax adviser with questions). We offer a variety of options to make payment more convenient, including a monthly debit program that will debit your credit card, checking or savings account each month (call the MPhA office to set up this feature). ADVOCACY MPhA works to provide members with a “voice” in pharmacy 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 selected event programming, such as Annual Meeting, Fall Clinical Symposium, and Midwinter Conference. PRODUCTS AND SERVICES Members benefit from discounted rates and prices on both professional and business related services. Professional Services • Pharmacists Letter • Pharmacists Mutual Insurance • Technician Manuals Business Services • Coupon Redemption Program • PAAS 3rd-Party Audit Services • Credit Card Processing Services • Pharmacists Financial Service • Discounted AAA Automotive Membership 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, reaching approximately 9,000 pharmacists, technicians, and students. The journal is published six times per year.
CAPS CAPS is our monthly faxed/emailed newsletter that keeps pharmacy professionals abreast of timely pharmacy issues and happenings. The newsletter is faxed to all pharmacies in the state, and is emailed to all MPhA members. Small Doses Our Small Doses email newsletter goes out to all subscribed members. Weekly e-news shares upcoming events, business topics, important legislative or regulatory issues, 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
Minnesota Pharmacist March-April 2013 n
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