Spring 2011 Minnesota Pharmacist by MPhA Minnesota Pharmacists Association

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MPhA Board of Directors Executive/Finance Committee: President: Brent Thompson Past-President: Bruce Thompson President-Elect: Scott Setzepfandt Secretary-Treasurer: Bill Diers Speaker: Meghan Kelly Executive Vice President: Julie K. Johnson Rural Board Members: Ted Beatty Mark Trumm Metro Board Members: Cheng Lo James Marttila

Spring 2011 Volume 65. Number 2, ISSN 0026-5616

At-Large Board Members: Tiffany Elton Randy Seifert Eric Slindee Jill Strykowski Jason Varin

President’s Desk Many Organizations, One Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Student Representation: Duluth MPSA Liaison: Alicia Mattson Minneapolis MPSA Liaison: Brittany Alms

Executive’s Report Pharmacists and Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Ex-Officio: Rod Carter, COP Julie K. Johnson, MPhA MSHP Representative

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: Julie K. Johnson Managing Editor, Design and Production: Anna Wrisky

The Minnesota Pharmacist (ISSN # 0026-5616) journal is published quarterly by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469. Phone: 651-697-1771 or 1-800-4518349, 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 the editor at the above address or email julie@ mpha.org. 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.

in this issue

featureS What’s in it for Me? Why Buy from You? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 AWARxE Campaign: What’s in the Pitcher?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MTM Marketing Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Developing MTM Marketing Strategies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 pharmacy and the law You’ve Been Served!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Feature Speak to Be Remembered and Repeated: 7 Rules to Remember . . . . . . . . . . . . . . . 17 Financial Forum Take Advantage of the Saving Years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 featureS MPCA Revisiting Rules for Pharmaceutical Reverse Distribution. . . . . . . . . . . . . . 19 Bariatric Surgery Meets Pharmaceutical Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Emergency Preparedness: Lessons Learned and Future Direction Pharmacists’ Role in Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Association Presidential Candidates. . . . . . . . . . . . . . . . . . 26 Student Perspective Student Pharmacists Join the Battle Against Cancer: Duluth Becomes “Where Leukemia Meets its Match” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 MPhA 127th Annual Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Join the Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Advertisers

Dakota Drug Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 McKesson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Outcomes Pharmaceutical Health Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 21 PACE Alliance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Pharmacists Mutual Companies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Pharmacy Quality Commitment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Acceptance of advertisement does not indicate endorsement. Minnesota Pharmacist Spring 2011 n

Pharmacy Time Capsules

Upcoming Events Visit www.mpha.org for more information and to register

Technician Conference MSHP/MPhA Event, July 21, 2011 Crowne Plaza, Plymouth 127th Annual Meeting, June 10-12, 2011 Madden’s Resort, Brainerd

Moved, graduated, or have a name change? Update your profile through your online MPhA Member Portal page.

2011 (Second Quarter) By: Dennis B. Worthen, Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH

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

1986—Twenty-five years ago:

Reye’s Syndrome warning required to be added to all aspirin labels.

The American Association of Pharmaceutical Scientists (AAPS) was formed with almost 3,000 charter members.

Human Genome Project launched with the object to understand the human genome and therefore provide the continuing progress of medicine. 1961—Fifty Years Ago:

President Kennedy signed Public Law 87-319 designating the third week in March as National Poison Prevention Week. 1936—Seventy-five Years Ago:

MPhA Office 1000 Westgate Drive Suite 252 St. Paul, MN 55114 phone: 651-697-1771 fax: 651-290-2266 Visit us online at www.mpha.org!

Minnesota Pharmacist Spring 2011 n

The use of radiopharmaceuticals began when John Lawrence administered a radioactive isotope of phosphorus-32 to treat chronic leukemia. 1911—One hundred Years Ago:

The US Supreme Court ruled against Dr. Miles Medical Co., which had sued a distributor for selling its products at cut rate prices. 1886—One hundred twenty-five years ago:

The University at Buffalo School of Pharmacy and Pharmaceutical Sciences opened.

Many Organizations

One vision

by Brent Thompson, Pharm.D., MPhA President

Minnesota really is a special place to be. Living here makes me (ACPE), the American Association of Colleges of Pharmacy extremely proud; yet, I’m a bit embarrassed to be smiling while (AACP), the American College of Clinical Pharmacy (ACCP), looking at piles of snow on April 1. There’s somethe American Society of Consultant Pharmacists thing to be said for the strength and endurance of We will someday carry (ASCP), and the National Community Minnesotans and how that is reflected to the rest Pharmacists Association (NCPA). There are one voice, united as of the world. People say we are nuts. People wonnearly as many at the local level in each state. der how we do it. But, people are always quick to I’m a member of several. I believe the missions a profession with the of every one of them are good, solid, heartfelt point out the good folks that live here. and necessary. What concerns me most is the single goal of serving We just got home from the APhA Annual meetperception that we don’t agree as a profession. ing in Seattle and it truly was a celebration of our patients better. I worry that policymakers, other healthcare colgood folks in Minnesota. We had many of our leagues, and our patients might see that we are amazing Minnesota pharmacists receive awards at divided and work only to serve ourselves. A few the meeting, which you will see in this journal. These recipients years back, I heard Bob Osterhaus say something in his Melendy are long-standing, committed, and very appreciated members of Lecture that struck hard at the core of my vision. He said “We MPhA. I want to congratulate and thank one of these incredible should all be able to agree, if it ain’t right for our patients, it ain’t people for once again representing Minnesota pharmacy in a speright for the profession.” It’s really that simple. If there are difcial way. Julie Johnson, executive director of MPhA, received the fering opinions in the profession, we should ask ourselves which Gloria Niemeyer Francke Leadership Mentor Award. This award best serves our patients and have a united voice as a profession. was established to recognize an individual who has promoted and encouraged pharmacists to attain leadership positions through This will likely not be my last opportunity to share with you, but example, acting as a role model and mentor. This is certainly will be my last commentary in Minnesota Pharmacist as president reflective of why myself and many many others in MPhA have of MPhA. The year has been filled with exciting opportunities and sought certain accomplishments in the pharmacy profession. I’m changes for MPhA. From moving offices and expanding the assopersonally very grateful for her gentle guidance and encourageciation’s operational ability, squeezing some “Pharmacy Nights” ment. As always, it felt good to be a Minnesota pharmacist at our into morning events so our messages would get to all corners of the national association meeting. state in a timely manner, to development of an entirely new strategic plan this summer, with health care reform in the spotlight. I’m Back to the message I promised you throughout the year — prohonored to have been asked to serve you as president of MPhA. fessional involvement. Hopefully, my ramblings have been useful I’m appreciative of all those who have chosen to be involved and for some and no one has tired of the message. Pharmacy is a comgive their time, and pleased to know MPhA continues to remain mitment to a life of service to our families, our friends, the public, strong in serving Minnesota pharmacists to advance patient care. the profession and our patients. I’ve shared with you ways to get involved, how being too humble might stop you from taking an active role in advancing the profession, and how even the easy little commitments can play a huge role in our involvement. Dr. Brent Thompson I haven’t shared with you in these pages as yet what I believe MPhA President deserves some time — is my personal vision for the profession: Please remember this: “We will someday carry one voice, united as a profession with the single goal of serving our patients better.” Currently, I rec“Every man owes a part of his time and money to the business or ognize about nine major national pharmacy organizations and industry in which he is engaged. No man has a moral right to withI’m sure there are several I’m missing: the American Pharmacists hold his support from an organization that is striving to improve Association (APhA), the National Alliance of State Pharmacy conditions within his sphere.” Pres. T. Roosevelt - 1908 Associations (NASPA), the American Society of Health-System Pharmacists (ASHP), the Academy of Managed Care Pharmacy (AMCP), the Accreditation Council for Pharmacy Education Minnesota Pharmacist Spring 2011 n

executive’s report

Pharmacists and Public Health by Julie K. Johnson, Pharm.D., MPhA Executive Vice President/CEO

Pharmacists’ contributions to patient health and the health care system are not new to any of us. But we continue to demonstrate ways to provide examples of our value to others in the system. In another article, I talked about how it’s not about us but rather what we can do to better the health of our patients. In other words, in what ways can we contribute to the total health of the patients we serve? In the Fall Minnesota Pharmacist, the contents of my “perspective” article proved to be useful information for MPhA as we were asked by the Minnesota Department of Health to join them in an MDH/Pharmacists Engagement Collaborative. The project and efforts culminated as a program to prepare and engage pharmacists to support community emergency preparedness efforts by participating in Minnesota’s Medical Reserve Corps or other established, event-responder groups. Kevin Sell engaged the MPhA leadership to set the effort in motion by expressing interest from the MDH to reach out to pharmacists because of the growth of pharmacist-delivered immunizations. The goals of the initiative include: assessment of current participation by pharmacists and other community providers in emergency response, review of state and national responses to the 2010 H1N1 threat, identification of strengths and improvements necessary to coordinate effective efforts between pharmacists and public health to meet needs of future events, to educate pharmacists and other community providers on the roles, opportunities and capabilities necessary to respond to public health needs relating to immediate and anticipated health threats — and most importantly, to engage pharmacists and other community providers in the preparation necessary to respond to future public health threats by enlisting them in ongoing networks so that they have the tools to respond when called. A summary of the information presented is included in this issue on page 25 by Alison Knutson, Pharm.D., a University of Minnesota Leadership Resident who worked with MPhA during her time with our organization to develop the program content. By the time this issue is printed, six of these programs were presented during the Spring Pharmacy Night events and will be offered again during the MPhA Annual Meeting at Madden’s in Brainerd on Friday, June 10 and the MPhA/MSHP Technician Conference on July 21. Webinars of this presentation (including continuing education credits for pharmacists and nurses) will soon become available on the MPhA Web site at mpha.org. And thanks to the support of MDH, this journal is provided to

all pharmacists in Minnesota in the hope that more pharmacists become aware of the opportunities and continued need for their involvement in public health initiatives.

Julie K. Johnson, Pharm.D. MPhA Executive Vice President/CEO

127th

Annual Meeting

of the Minnesota Pharmacists Association

Learn, Relax, Enjoy in Northern Minnesota with MPhA!

See page 32 for details.

Visit www.mpha.org to register online!

Minnesota Pharmacist Spring 2011 n

viewpoint

What’s in it for Me?

Why Buy from You? by Lowell J. Anderson, D.Sc., FAPhA

Does it matter what our profession’s brand is? What your practice’s brand is? What your personal brand is? Does it really matter what people think of us as a profession and you as a member of the profession? I think it matters greatly. Our brand contributes to our status in the health delivery system, product reimbursement and service compensation, our inclusion in developing delivery concepts and ultimately the long-term viability and success of our practices.

other consumer goods that people forget to buy at the grocery or the dollar store. These are important, but they are all product related! At one time the Value Proposition for many pharmacists was “Quick, Cheap and Accurate.” That is now expected and no longer resonates with the consumers of our services. In hospitals, medicines magically appear just–in-time and the patient never sees the dispensing pharmacist – much less interact with him or her. Still product related!

For the medical profession, being known as a “doctor” or “physician” defines a person who takes care of people’s health, and, of course, has reserved parking spaces at the hospital!

The core “value proposition” that seems to be missing is that pharmacists “take care of people’s health by managing their medication therapy.” Unfortunately it is not part of our brand.

Our brand is not that concise. There is no similar perception of what pharmacy is, or what a pharmacist does. Actually our brand is pretty schizoid. Who we are is determined by where we practice. We are known as a chain, community, hospital, clinical and consultant pharmacist, or whatever. Each has a different value to the public that is determined in part by the consumer’s opinion of the facility that we use to define ourselves. And, in fact, we encourage that perception because we label ourselves that way, even though we talk among ourselves as health-care professionals. Our allied health professionals also see each “modifier-pharmacist” as a different type of professional with different competencies.

Professionals skilled in marketing also talk about “emotional benefit.” Emotional benefits are the feelings that consumers have when they make a purchasing choice. As examples, think about the good feeling you get about a new car or the purchase of ice cream. Emotional benefits are beyond the functional benefits because of their psychological nature.

Unfortunately, there is also a consumer perception of different levels of competence that comes with these workplace definitions, which I believe is largely related to accessibility of the practitioner. The more accessible a pharmacist is to the consumer of services, the more competent he or she is judged to be. Spending your time behind the dispensing counter barrier does not lead to accessibility and a heightened perception of competence. Marketing professionals talk in terms of “value proposition” – the functional benefit of a brand that relates directly to the service. Consider FedEx dependability – “We Deliver.” Or, Jiffy Lube with a “30 minute oil change.” What is the functional benefit of going to a pharmacy and talking with a pharmacist? Is there an overarching consumer image of pharmacists and pharmacist services that is independent of the setting where we work? We can certainly say that part of our value proposition is that you can get a prescription accurately filled at a licensed pharmacy. Community pharmacies are a good place to get over-the-counter medicines, greeting cards, toothpaste and 8

Minnesota Pharmacist Spring 2011 n

Although we can get warm fuzzies over our new car or the prospect of an ice cream cone on a summer day, I think it is probably very difficult for a consumer to have a similar emotional reaction to the pretty pink pills in a prescription package — covered with warning labels. The emotional benefit comes when there is a social interaction: in our case, between the consumer and the pharmacist. Quite simply, each of us who practices in a patient-care setting is the “face of pharmacy.” Each of us contributes to the brand of a caring profession and the value proposition of our profession. The pharmacist who spends time with consumers beyond the transactional demands or the requirements of the board of pharmacy contributes to the emotional benefit that in combination with our value proposition creates our brand. Conversely, the practitioners who do not interact at a personal level also create an emotional benefit and value proposition judgment in the minds of consumers. Unfortunately. Those judgments all too often are negative: “If all I am getting is a prescription, it doesn’t make any difference where I get it.” Consumers not only want to know “What’s in it for me?” but “Why buy from you?” Why Buy From You? continued on page 9

COMMITMENT TO EXCELLENCE and TPL Sales Leader

Awarded to Sheila Welle Pharmacists Mutual Companies awarded Sheila Welle the 2010 Commitment to Excellence Award. This award recognizes the field representative who has displayed dedication to excellence in service to customers based on several areas of measurement. She also earned the 2010 Pharmacists Life Insurance Company Sales Leader Award. Welle earned this award by having the highest Pharmacists Life production of the most life insurance policies sold last year.

Sheila Welle, CIC, LUTCF, LTCP is a field representative for North Dakota and Northern Minnesota. Before joining Pharmacists Mutual in 1996, Welle was employed at Pioneer Mutual in Fargo, No. Dak. She is originally from Emerado, No. Dak., attended Larimore High, and graduated from Wahpeton College. Welle and her husband, Steve, currently reside in Hawley, Minn. Welle has one son, Casey, and two stepsons, Ray and Chris.

Welle was recognized at the 2011 Annual Sales and Marketing Meeting in Las Vegas, Nev.

Why Buy From You? continued from page 8 As pharmacist practitioners, we are busy professionals. Each one of us has many reasons to not leave the security of the hospital or community-pharmacy dispensing counter. Some reasons are valid. But we need to realize that not a lot of care occurs when there is a spatula in one hand and an Abbott Counting Tray in the other! It does take a conscious effort to put a face on your practice and your profession. I think that independent pharmacists are pretty good at this. It is just the nature of independent practice: the CEO is the practice, a member of the community and sees the results daily in a very personal way.

Lowell J. Anderson, D.Sc., FAPhA, practiced in community pharmacy for most of his career. He is a former president of MPhA, MN Board of Pharmacy and APhA. In addition he has held positions in the Accrediting Council on Pharmacy Education, National Association of Board of Pharmacy and the United States Pharmacopeia. Currently he is co-director of the Center for Leading Healthcare Change, University of Minnesota and co-editor of the International Pharmacy Journal. He is a Remington Medalist.

The Minnesota Pharmacists Foundation works to create a strong future for pharmacy by investing in pharmacists of tomorrow. The Foundation backs this commitment by providing annual scholarships to pharmacy students attending the University of Minnesota campuses in Duluth and Minneapolis. Visit our page on Facebook or the MPhA site to learn more about how you can help us achieve our goals!

Minnesota Pharmacist Spring 2011 n

Student Perspective

What’s in the Pitcher? By Heather Dekan, University of Minnesota Pharmacy Student

Are you aware of the decisions kids face today when it comes to prescription drugs? More than three in five teens say that prescription drugs are easy to get their hands on. Well, as student pharmacists, we weren’t aware of the wide availability of these drugs until we partnered with AWARxE, a national program with the purpose of educating people on the dangers of abusing and misusing prescription and OTC drugs. AWARxE has specific, ongoing efforts in the state of Minnesota that have been designed with middle school students in mind. Currently, student pharmacists give an AWARxE presentation in a small classroom setting. The message presented to the students is that drugs aren’t bad, but the misuse and abuse of drugs is. As University of Minnesota pharmacy students, we feel compelled to do our part in educating middle school students on medication misuse and abuse. Our goal is to leave students with the ability to make the right decisions when it comes to prescription drug use, especially in a social situation.

understand the analogy and how it can be related to drugs: Don’t consume handfuls of unknown drugs! We have found that humor and raw factual truth are integral to appeal to this age group. Teenagers can be a tough audience, but not unreachable. Candor relates well with the teens and allows for a connection to be made during presentations. So, are these presentations successful? Yes. The students are engaged, eager to volunteer, entertained, and interactive. Does the message stick? Yes. Jim, a health teacher, stated, “I was standing in the back of the room and one of my students who talks every day in class was sitting there with her eyes glued to the presentation. She came up to me afterwards and said ‘You know what I learned today? Drugs aren’t bad; it is bad to abuse them.’” If you are interested in an AWARxE presentation at your school, please contact Julie Johnson at Julie@mpha.org.

Student pharmacists didn’t know a whole lot when it comes to teaching 7th and 8th graders, so we looked for help. An 8th grade health teacher and the school district’s prevention specialist were able to provide the following tips: 1. Keep it casual — presenters wear jeans and a nice shirt. 2. Sit with the kids — presenters sit on desks to show that they are talking with the kids, not at them. 3. Make the presentation funny and interactive. It is common knowledge that sometime in the past teens have been told drugs are bad. The presenter’s first question for the students is: “Are drugs bad?” Most students answer “yes,” some say “no.” However, the best answer is, “it depends.” The presenters start a discussion by reinforcing that prescription drugs are not bad, it is the abuse and misuse of drugs that is dangerous to their immediate and long-term health. Then, to verbally and visually explain the dangers of mixing a variety of medications — what typically happens at a “Skittles party” — the presenters conduct an engaging demonstration for the students. A middle school student volunteer is asked to drink or eat individual healthy items, such as juice, milk, water, crackers, oatmeal, and cheese. The presenters then unveil a cocktail of all the contents combined in a pitcher and ask who would put this in their body. Not only does this combination look disgusting, but who would have any idea what was in the pitcher. The kids

Minnesota Pharmacist Spring 2011 n

Pictured are Heather Dekan, AWARxE Coordinator, Marilyn Eelkema, Minnesota Pharmacists Foundation President, and Zach Wyman, also an AWARxE Coordinator

4 Fraud and Abu se Training 4 Pseudoephed rine Log 4 OSHA Requ irements 4 HIPAA Priva

Policies an cy and Security d Procedur es Quality As Program surance (QA)

Is a QA Program Missing From Your Checklist? Pharmacy Quality Commitment™ (PQC™) is what you need! Reduction of medication errors and implementation of a QA program are no longer options. A growing number of pharmacy network contracts require a process in place and no matter what it is called, QA, CQI, safe medication practices, or medication error identification and reduction program – PQC™ is the answer.

• • • • • •

The PQC™ Program: Legally protects reported data through a federally listed Patient Safety Organization (PSO) Helps increase efficiency and improve patient safety through a continuous quality improvement (CQI) process Provides easy-to-use tools to collect and analyze medication near miss and error data Presents a turnkey program to help you meet obligations for QA and CQI requirements Includes simple method to verify compliance Offers excellent training, customer service and ongoing support

Not all programs are the same, make sure your pharmacy and your data is protected. Pharmacies that license PQC™ and report patient safety events are provided federal legal protection to information that is reported through the Alliance for Patient Medication Safety (APMS) – a federally listed PSO. To learn more about PSOs, visit www.pso.ahrq-gov/psos/fastfacts.htm.

Call toll free (866) 365-7472 or go to www.pqc.net for more information. PQC is brought to you by your state pharmacy association. Minnesota Pharmacist Spring 2011 n

Developing MTM Marketing Strategies

MTM Marketing Research: Lessons Learned from Focus Groups in Minnesota Community Pharmacies by Nate Chandler, Classs of 2011, University of Minnesota Duluth College of Pharmacy What do we need to do in order to effectively market our skills as MTM providers? How can we relay the concept of MTM to patients and practitioners in Minnesota? Why do patients tend to not participate in the service? Can we gain insight from the patient perspective to help improve our efforts? On March 15, 2011, the University of Minnesota hosted an event that focused the spotlight directly on these and other questions. The answers have been a long-standing source of mystery, and perhaps frustration, for those practitioners who are delivering or attempting to deliver MTM services to patients. When trying to build the base for a widespread acceptance of MTM services in any practice setting, understanding the perspectives of patients can give some useful insights for improvement opportunities. That was the goal of some recent research completed around the state by a marketing specialty company. Mark It!, a Rochester, Minn.-based marketing firm, conducted six focus groups consisting of MTM-eligible patients in retail pharmacy settings. The focus group participants were identified, deemed eligible for MTM service coverage, and then recruited by each individual site. Sessions were about two hours in length and included a short educational video shown about halfway through the encounter to explain MTM more clearly. Focus groups were designed to gather the patients’ opinions, expectations and insights on their pharmaceutical and medical care. Patients were asked to explain their current views on the roles held by their pharmacist, their physician, and any issues or concerns they had with their current medication regimen. Next, participants were asked about MTM and asked to explain the extent of their previous awareness. After watching the video explaining the major concepts of the MTM service, participants also shared their reactions. Here are some key pre-video perceptions raised by patients: 1. Pharmacists are commonly viewed as the coach or advisor on medications. 2. Pharmacists are viewed as more available than the physicians, and often spend more time than the physicians. 3. Physicians and pharmacists are both viewed as part of the care team, though people said the pharmacist probably lacked the intimate knowledge that is possessed by physicians. 4. Physicians are viewed by many patients as the medication experts in educating, checking interactions and follow-up. 12

Minnesota Pharmacist Spring 2011 n

5. Patient awareness of MTM — both the concept as well as availability — is very low. Patients also revealed concerns about their current drug regimens such as: 1. Timing and administration techniques, 2. Overdosing risks, 3. Mail-order pharmaceuticals taking away personal relationships, and 4. Notifications when dosages or formulations change. In the middle of the session, the video describing MTM was shown. The patients were then re-surveyed after viewing the video. Some of the key points from patients after the video were: 1. Patients reacted very positively to the concept of MTM, and wanted pharmacists to be a part of their healthcare team. 2. The main perceived benefits from the patient perspective resulting from an MTM visit included optimizing medication use, improving treatment outcomes, and improving quality of life. 3. In general, patients felt that any medication management visits should be covered by insurance. 4. The name medication therapy management is not a clear enough title for most patients to grasp. A suggestion that was mentioned multiple times was to simply drop the “therapy” and just call it “medication management.” 5. Another universal theme highlighted by patients was collaboration. The entire team must subscribe to the concept for it to work — from the physician to the pharmacist to the patient. Patients showed more willingness to attend an MTM visit if their physician was the driving force behind the encounter and provided endorsement of the service. In conclusion, the marketing team provided a few recommendations as we move forward into an ever-evolving landscape of healthcare in the United States. First, patients need to clearly understand the difference between MTM and counseling on prescriptions. Second, focus your marketing efforts towards the top three benefits patients mentioned: optimizing safe and effective medication use, improving treatment outcomes and improving quality of life. These are key messages and may help increase the uptake and utilization MTM Marketing Research continued on page 14

Developing MTM Marketing Strategies

Creating a Sustainable Competitive Advantage:

Developing MTM Marketing Strategies by Gina Rozinka, Classs of 2011, University of Minnesota Duluth College of Pharmacy What is a sustainable competitive advantage (SCA)? How does SCA relate to marketing medication therapy management (MTM)? I had the opportunity to attend the “Marketing MTM Strategies” seminar sponsored by the UPlan to discuss past, present and future marketing strategies to expand the practice of MTM. Dr. Rajiv Vaidyanathan, professor of Marketing from the Labovitz School of Business and Economics, University of Minnesota Duluth, presented basic marketing concepts to current MTM practitioners. He provided definitions, raised thought provoking questions and discussed segmentation, targeting and positioning to develop a sustainable competitive advantage. Market segmentation is a principle that helps us to more accurately identify our patient base. It is roughly defined as a group of consumers with similar needs that utilize services for similar reasons. Consumers can be broadly categorized based on geographic location and demographic information. Market segmentation allows MTM practitioners to evaluate who our patients are and who we want as our patients. This concept also requires us to evaluate our resources, objectives and current marketing strategies to determine if we are meeting the needs of our patient base and if not, how we can improve it. Defining a market segment will help you find new patients and serve a need not currently being met, as well as more effectively use marketing resources and develop a niche for your service.

ly to purchase (or utilize) your service if they can find emotional value in your services. So when you combine the concepts of segmentation, targeting and positioning, you arrive at the concept of sustainable competitive advantage. Sustainable competitive advantage asks the question: What can you do better than your competitors that they cannot copy and that customers care about? This concept allows you to uniquely identify yourself as an MTM practitioner, providing cognitive pharmacy services to ensure the safety and efficacy of all your patient’s medications. By evaluating your market segment, your target audience and how you plan to position yourself in the market, then you have successfully created a foundation for marketing MTM services!

Dr. Rajiv Vaidyanathan’s Overview of the STP Process

Following is a list of questions each MTM provider was given during the UPlan Marketing MTM Strategies workshop. Each provider was encouraged to take these questions back to their pharmacy, health system or office to develop and refine their current MTM marketing plan. 1. Define market segments. 2. Assess and evaluate segments (size, growth, attractiveness).

Targeting a specific patient population allows practitioners the opportunity to offer a distinctive and beneficial product, identify competitors, as well as match the needs of those individuals identified in segment population. The key to targeting is to highlight the “benefits” of your service and not focus on the “features.” Provide potential patients with concrete benefits, for example, evaluate all drug therapies to ensure safety and efficacy, help patients receive maximum benefit while minimizing financial output, improve patient understanding and education on medication therapy and collaboration with the patient’s physician to provide tailored and optimal treatment options.

3. Evaluate your pharmacy’s/facility’s resources and objectives.

To understand the concept of positioning, ask yourself the question: How do your potential patients view and perceive your service? For individuals who decide to utilize MTM, they need to clearly perceive the tangible benefit provided by your service. One key step to developing your position is determining your potential patient’s perceptions and preferences. Positioning allows you to create an identity in the market that is congruent with what your target audience would like. A key point Dr. Rajiv emphasized was ensuring that your service appeals to your patient’s emotions. Consumers have a tendency to find greater value and are more like-

3. Determining your own and your competitors’ positions (how does each competitor compare on the key benefits?),

4. Select most appropriate segment(s) as target market(s). 5. Develop marketing and positioning strategy for each target market. 6. Develop marketing mix (tactics) for each target market. Implementation Steps for Positioning: 1. Identifying competitors, 2. Assessing customer perceptions of self and competitors (what benefits are important to customers?),

4. Analyzing customer preferences (determine segments and the requirements of each segment), 5. Selecting a positioning strategy for the target market (where do consumer values match benefits offered?), and 6. Monitoring the positioning strategy (must know if positioning is successful, customer needs changing, etc.). Minnesota Pharmacist Spring 2011 n

Developing MTM Marketing Strategies

Pharmacy Students Provide a Look at MTM: What’s Happening Now and What Happens Next by Rita Tonkinson

The articles, “MTM Marketing Research: Lessons Learned from Focus Groups in Minnesota Community Pharmacies” and “Creating a Sustainable Competitive Advantage: Developing MTM Marketing Strategies”, underscore the need for dialogue among perscribers, pharmacists and patients. When patients agreed to participate in focus groups held at the University of Minnesota, they had little knowledge of medication therapy management (MTM); they didn’t understand what the service provided; and they were not aware of value to their personal medication regimen. Nate Chandler, author of the article covering patient perceptions, made it clear that once patients understood how this service could improve their personal medication outcomes, they were very enthusiastic regarding the possibilities of having pharmacists more involved in their healthcare team -- if the service is physician driven.

Pharmacists’ task at hand is to become marketing experts; defining your market is not as easy as it sounds. “The need for continued support for pharmacists to make these important services available to their patients is clear,” said Julie Johnson, Pharm.D., executive vice president and CEO, MPhA. “Much work is yet to be done in educating legislators, prescribers, patients, and last but not least, in supporting an environment where pharmacists create medication management services their patients will demand.”

Rita Tonkinson is a contracted staff writer for the association, who provides insightful looks into the field of pharmacy for our readers.

Pharmacists’ task at hand is to educate prescribers and patients about MTM; changing perceptions is not as easy as it sounds. Gina Rozinka attended the seminar sponsored by UPlan, as mentioned in her article. This seminar covered the how to aspect of building an MTM practice. She emphasized that the first step is to identify the market segment, and then develop market strategies for each segment in your population. Rozinka learned that the MTM service you provide must appeal to the patient’s emotions. In her conclusion, Rozinka urges pharmacists to begin talking to patients and their physicians about MTM.

MTM Marketing Research continued from page 12 of the MTM concept from the patients. Finally, the creation of a visible, open collaborative relationship with the physicians is essential. Physicians are generally viewed as the leaders of the healthcare team, and having their endorsement appears to be an important piece to building a successful practice. While the ultimate structure of healthcare in the U.S. is more unclear than ever, it appears that MTM may indeed be a part of its future. Legislation is moving through the state and national level, which is an attempt to increase eligibility. Healthcare homes may provide a new and reliable market for MTM services. Even the private sector is beginning to slowly expand into providing MTM as a benefit of their prescription drug plans, with a bit of focused marketing and simply talking to patients, we can keep the ball rolling in the right direction. We have a great start. And with a bit more exposure, the word-of-mouth advertising will likely be more pow14

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erful than anyone expected. In the meantime, build a marketing plan, talk to your patients and their physicians, and get out there and do what you know as the medication experts: Manage medications and improve your patients’ lives!

Mark It! Contact Info: http://www.yourmarkit.com 507-529-9000

Run with the bulls. Don’t be content to watch from the sidelines. Pace Alliance offers you the chance to make your pharmacy a prosperous business, one that stays ahead of the game. We know what it takes to survive. After all, we have been running ahead of the bulls for 22 years. Plus, teaming up with Pace benefits the Minnesota Pharmacists Association. So stop watching from the sidelines. Join the group of your peers who want to control the destiny of their businesses in order to prosper. This is your chance to take the bull by the horns. Contact Pace Alliance today.

1-888-200-0998 • www.pacealliance.com Minnesota Pharmacist Spring 2011 n

PHARMACY MARKETING GROUP, INC. • PHARMACY and the law

YOU’VE BEEN SERVED! by Don McGuire, R.Ph., J.D. The day that you had hoped would never come has come. The sheriff makes his way through the store, with papers in his hand, heading towards the prescription counter. The sheriff says, “Chris, I’ve got something for you.” The sheriff hands you the summons and complaint and walks out of the store. A summons is the notice that a suit has been filed against you. A complaint is the actual lawsuit. Now what do you do? The most important thing is to not ignore it. This event, service of process, is the start of a procedure that is very time-sensitive. Unfortunately, some defendants read through the complaint and conclude that it is either a bogus case or just a ploy to extract money from them. The worst thing you can do is to toss it aside or throw it in a drawer and forget about it. This is not something that is going to go away. Ignoring it will only cause you more problems. In fact, the clock started when the sheriff handed Chris the summons. Court rules prescribe the time frame within which some sort of response to the summons must be made. Depending on the jurisdiction, this is typically 20 or 30 days, although there are some other limitations out there. If nothing is filed with the court before this time expires, the plaintiff may be able to file for a default judgment. A default judgment essentially says, “You failed to respond, you lose.” If the plaintiff gains a default judgment, they can then begin to try to collect the money from you. The worst thing about a default judgment is that there is no deliberation on the facts or the issues of the case. You might end up paying on that bogus case that you tossed into the desk drawer. The most typical response to a summons and complaint is to file an answer. The answer addresses all of the allegations made by the plaintiff. The response is usually one of three possibilities: admission, denial, or not enough information. With an admission, you admit that the allegation is true. With a denial, you deny that the allegation is true. The third response is used when you don’t know enough about the allegation to admit or deny it. For litigation purposes, this is treated as a denial. A response needs to be made for each and every allegation in the complaint. The answer is also the place where affirmative defenses are raised. These are legal defenses that counteract the allegations against you. For example, raising truth as a defense to slander or libel. However, there are circumstances when other filings are made instead of an answer. These are generally motions that raise a 16

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particular issue to the court. The purpose of these motions is to contest certain issues prior to actually working on the substance of the case via the answer. If you are successful on these issues, many times the case is thrown out and there is no need to work on the substance of the case. The issues contested can include a lack of jurisdiction by the court, the case was filed in the incorrect venue, the summons and complaint were improperly served, the case failed to name the proper parties, or the case is a duplicate of a previously filed case in another court. It takes time to evaluate the allegations, decide whether to file an answer and/or a motion and to decide what allegations need to be admitted or denied. Timeliness is your most valuable asset. Don’t be an ostrich when you are served. Sticking your head in the sand won’t make it go away and ignoring it could result in some serious negative ramifications for you. Call your attorney and/or insurance company as soon as possible. The more time they have to work on your response, the better it will be.

© Don McGuire, R.Ph., J.D., is General Counsel 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 the policies and procedures of their employers and insurance companies, and act accordingly. 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.

feature

Speak To Be Remembered and Repeated

7 Rules to Remember By THE Executive Speech Coach Patricia Fripp, CSP, CPAE

“Speak to be remembered and repeated” is the advice I give my executive speech-coaching clients. Isn’t that the goal of every executive, professional speaker and sales professional — to be remembered and repeated? However, it’s easier said than done. Here are some tips. 1. Speak in short sentences or phrases. Edit your sentences to a nub. Jerry Seinfeld said, “I will spend an hour taking an eight word sentence and editing it down to five.” In comedy, the fewer the words between the set-up and the punch word, the bigger the laugh. In business communications, change the punch word or phrase to impact phrase. 2. Don’t step on your punch word. It should be the final word or idea in the sentence. (Yes, this works for Jerry Seinfeld and his comedian brethren, and it also works for business communicators.) The otherwise-powerful word “today” can also be the biggest impact-diluting word in business communications if you use it wrong. For example, in the sentence, “You have to make an important decision today,” your punch word should be “decision.” So switch it around and change the noun “decision” to the active verb “decide.” “Today, you have to DECIDE!” 3. Perfect your pause. Deliver your punch word and then pause ... and pause ... and pause. Give your listeners time to digest what you’ve just said. Get comfortable with silence, and don’t be tempted to rush on or fill it with “um’s.” 4. Repeat your key ideas more than once. Do not be afraid of being redundant. Instead, worry that tomorrow your audience members will not remember your key ideas. 5. Never read your speech. Remember, the audience wants to hear from you. If someone is simply going to read a script or the titles off a PowerPoint slide presentation, you could have stayed home. (PowerPoint is a magnificent visual aid, but not a scripting aid.) 6. Use stories. Help your listeners to “see” your words. Statistics and facts are fine, but sell your message and make yourself unforgettable by getting listeners to make the movie in their heads. For

example, you might say, “Drunk driving is a bad idea. Let me share with you some statistics on the loss of control drivers experience after even one beer.” Instead say, “Never, never, never drive drunk! Not even after one beer. I know. My friend Eliot Kramer was absolutely positive that two drinks couldn’t affect his timing and judgment.” (Hold up a single shoe, dangling from its shoelaces.) “Six months ago, he died.” Farther on, add some statistics and then conclude with a reference to your powerful story. 7. Say something memorable. Presidents have gifted speech writers to coin ringing phrases for the history books. You can be just as memorable in your field when you think about what you want to say and why. Here’s an example from the memorial for 60 Minutes’ Ed Bradley. Fellow reporter Steve Kroft said, “I learned a lot from Ed Bradley, and not just about journalism. I learned a lot about friendship, manners, clothes, wine, freshly cut flowers (which he had delivered to his office every week) and the importance of stopping and smelling them every once in awhile.” Another example, from Mike Powell when he was a senior scientist at Genentech, giving a speech to the Continental Breakfast Club: “Being a scientist is like doing a jigsaw puzzle, in a snow storm, at night, when you don’t have all the pieces, or the picture you are trying to create.” Remember to try out these seven key ideas as you prepare your next presentation so your words will be remembered and repeated. Why else would you go to all that effort?

About the Author Patricia Fripp is an executive speech coach, sales presentation trainer, and keynote speaker on sales, customer service, promoting business, and communication skills. She works with companies large and small, and individuals from the C-Suite to the work floor. She builds leaders, transforms sales teams and delights audiences. She is the author of Get What You Want!, Make It, So You Don’t Have to Fake It!, and is a past-president of the National Speakers Association. To learn more about having Patricia do her magic for you, contact her at www.Fripp. com, (415) 753-6556, or PFripp@Fripp.com.

Minnesota Pharmacist Spring 2011 n

PHARMACY MARKETING GROUP, INC. • FINANCIAL FORUM

TAKE ADVANTAGE OF THE

SAVING YEARS Preparing for retirement requires a plan, and that plan should consist of two important phases: the saving years and the retirement years. To achieve the goal of a financially secure retirement, you will have to make wise decisions during the saving phase of your plan.

efit (i.e. tax deduction) of a traditional IRA contribution? If she chooses to invest the money she would otherwise pay in taxes, her savings could get an additional boost. But if she chooses to spend it elsewhere, the deduction a traditional IRA offers may not help in building her retirement assets.

For starters, if you plan to use IRAs to help you save, you need to decide what type of IRA you’re going to use. Traditional and Roth IRAs have different eligibility requirements, and each has its own advantages. More than likely, your unique financial needs will make one kind of IRA better-suited for you than the other, so it’s a good idea to evaluate your options.

Kim also needs to ask herself how soon she will need to access her retirement savings. Any traditional IRA withdrawals before age 59½ will be taxed as ordinary income and may also incur a 10% IRS penalty. So if she expects to need access to her retirement savings before age 59½, tax- and penalty-free access to Roth IRA contributions would probably prove valuable.

The main difference between traditional and Roth IRAs is the way their earnings are treated for tax purposes, so it’s important you understand the concepts of tax-deferred and tax advantaged accumulation. With tax deferral, you only owe taxes when you withdraw money from the account. A traditional IRA lets you make contributions and pay taxes when you take withdrawals. Withdrawals prior to age 59½ may be subject to a 1070 IRS penalty.

Additionally, Kim needs to think about whether her tax bracket during retirement will be higher or lower than what it is currently. This could provide valuable insight as to which account would be better suited for her, given the taxation of traditional IRA withdrawals versus the tax-free withdrawals from a Roth IRA.

On the other side of the coin, tax-free growth means you don’t have to pay federal taxes on your earnings. A Roth IRA offers the potential for tax-free growth on the after-tax dollars you invest, as long as you meet a few specific requirements. To avoid paying taxes on your Roth IRA earnings, you must have held the IRA for five years and you must be age 59½ or older at the time of withdrawal. Nonqualified withdrawals may be subject to income taxes and a 10% IRS penalty. In addition to the difference in how earnings are taxed, another important consideration is the tax deduction possibilities of a traditional IRA. As long as you meet certain conditions, you may be able to claim a deduction on your income taxes based on the amount of your IRA contributions.* To help illustrate our objective, let’s consider an example. Suppose Kim, age 30, is thinking about investing for her future retirement security. Even before considering her IRA options, her first smart move would be to invest in her employer’s 401(k) plan. Assuming she’s already done that, let’s think about her IRA options. With a modified adjusted gross income (MAGI) of $30,000, she is eligible for either a tax-deductible contribution to a traditional IRA or a nondeductible contribution to a Roth IRA. To help her decide, she should think about her answers to a few key questions. For one thing, how would she handle the immediate tax ben18

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Like our example, it’s important for you to think about retirement savings well before you approach the time when you’ll actually need the funds. Take steps now to get your savings started, and make the most of the years you have to add to that savings. *This example is for illustrative purposes only and does not reflect the performance of any particular investment.

Provided by courtesy of Pat Reding, CFPTM of Pro Advantage Services Inc., in Algona, Iowa. For more information, please call Pat Reding at 1-800-288-6669. Registered representative of and securities offered through Berthel Fisher & Company Financial Services, Inc. Member NASD & SIPC. Pro Advantage Services, Inc./Pharmacists Mutual is independent of Berthel Fisher & Company Financial Services Inc. Berthel Fisher & Company Financial Services, Inc. does not provide legal or tax advice. Before taking any action that would have tax consequences, consult with your tax and legal professionals. This article is for informational purposes only. It is not meant to be a recommendation or solicitation of any securities or market strategy. This series, Financial Forum, is presented by Pro Advantage Services, Inc., a subsidiary of 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.

Feature

MPCA Revisiting Rules for

Pharmaceutical Reverse Distribution by Rita Tonkinson

The Minnesota Pollution Control Agency (MPCA) has revised its regulatory approach to reverse distribution of unusable undispensed pharmaceuticals. “Minnesota has one of the most aggressive programs of enforcement with health care providers in the nation,” said Jeff Lindoo, executive vice president of Longterm Care Services at Thrifty White Pharmacies. “Hospitals have been under scrutiny for the past several years. Particularly, hospital pharmacies have been following waste regulations rigorously. Although technically full enforcement began for all health care facilities on October 1, 2010, there are still pharmacies, long-term care facilities, and clinics working to understand the rules and come into full compliance.” Pharmacies that are licensed as hazardous waste generators and are attempting to follow the hazardous waste rules remain unclear about what can be sent to a reverse distributor. “The Environmental Protection Agency (EPA) has adopted a position that if a product has value or potential value, it is not waste,” Lindoo said. So federally, outdated pharmaceuticals may be sent to a reverse distributor because if there is a potential for credit to be received they are still considered products. The Minnesota Hazardous Waste Rules are different than the federal position. In Minnesota, once a product can no longer be used for its intended purpose (dispensed to a patient), even if it has or may have value, it is waste. That makes an expired pharmaceutical a waste in Minnesota. According to Brandon Finke, a hazardous waste inspector with the MPCA, the hazardous waste rules start with the assumption that all pharmaceutical waste generated by businesses is hazardous waste unless documentation (product inserts, MSDS sheets, etc.) shows that it is not listed (P- or U-list) and does not possess a hazardous chemical characteristic (ignitable, oxidizer, corrosive, reactive, toxic, or lethal). Unless evaluated and shown to be non-hazardous, pharmaceutical waste is subject to all applicable hazardous waste requirements. There are three options for a business to dispose of hazardous waste (including unevaluated) pharmaceuticals:

1. Have it picked up by licensed hazardous waste transporter, 2. Drop it off at a Very Small Quantity Generator Collection Program, or 3. Pour it down the drain to a sanitary sewer with prior approval from the local wastewater treatment authority. The MPCA’s new decision represents a limited alternative to the full hazardous waste requirements. It allows a pharmaceutical in a closed, original manufacturer or dispensing container that will not be used for its intended purpose and has not yet been dispensed to continue to be managed through reverse distribution. In order to use this alternative and manage pharmaceutical waste through reverse distribution a pharmacy must: 1. Document agreement with the reverse distributor that waste received from the pharmacy will be managed appropriately, 2. Maintain a plan including the names and locations of facilities used by reverse distributor to dispose of waste received from the pharmacy, and 3. Retain disposal records provided by the reverse distributor for three years. The new requirements have been worked out through the cooperation of the Minnesota Pollution Control Agency and the MPhA Public Affairs Committee. Although the hazardous waste laws have been on the books since the late 1970s, until recently they have not been enforced with regard to waste pharmaceuticals in community pharmacies in Minnesota. Additional assistance with understanding the rules as well as leniency with regard to usable in-date pharmaceuticals and legitimately useable expired pharmaceuticals would be helpful. How is this new decision by the MPCA different from the Minnesota Hazardous Waste Rules? 1. Reverse distributed pharmaceuticals may be excluded from the determination of hazardous waste generator size. However, a pharmacist who does not generate any other fully regulated hazardous waste must maintain an active status Hazardous Waste Identification Number by subReverse Distribution continued on page 23 Minnesota Pharmacist Spring 2011 n

Get Paid For What You Know! Medication Therapy Management Services

Getting Started is easy! 1. GeT COnTraCTed To participate, complete an Outcomes MTM Network Participation Agreement by clicking on “Pharmacy Contracting.”

As a provider of Outcomes MTMS, you will: • Promote effective medication use • Enhance professional satisfaction • Generate new revenue for your pharmacy • Build patient loyalty • Demonstrate the value of community pharmacists

Over 2.5 MilliOn paTienTS naTiOnwide have received Outcomes MTM coverage, a number that will continue to grow.

2. GeT Trained To be eligible to provide MTM services and receive professional fees, complete the Outcomes Personal Pharmacist training program by selecting “Pharmacist Training.” 3. GeT paid To get paid for MTM services, view your pharmacy’s list of eligible patients and begin documenting and billing MTM claims.

getoutcomes.com Or

877.237.0050

Minnesota Pharmacist Spring 2011 n

Outcomes Pharmaceutical Health Care® Minnesota Territory Manager Report March 2011 Eligible Patients Contracted and Trained Pharmacies Participating Pharmacies (year-to-date) Missed Revenue (2010)

61,930 735 254 $828,200

Top Performing Pharmacies: Walgreens 10500 –Duluth, MN Coborn’s Pharmacy 2006 –Little Falls, MN Bloomington Drug –Bloomington, MN 1,600

Guidepoint Pharmacy 101 –Brainerd, MN Mayo Clinic Pharmacy –Rochester, MN Goodrich Pharmacy –Anoka, MN

1,455

1,400 1,200 1,000

735

800

595 551

600 400

254 243

168

200 0

Current Goal

40% 35%

35% 30%

30% 25%

25%

26%

20%

2010 Goal

15% 10% 5% 0% TIP Response %

TIP Success %

Minnesota Pharmacist Spring 2011 n

Feature

Bariatric Surgery Meets

Pharmaceutical Care Andrew Bzowyckyj, Pharm.D., Assistant Professor Endocrinology UMKC College of Pharmacy

According to the American Society of Bariatric and Metabolic Surgery, about 220,000 people with morbid obesity in the United States underwent bariatric surgery in 2008.1 This number has been increasing annually at an increasingly rapid rate (up from about 16,000 in the early 1990s and 103,000 in 2003).2 Because the prevalence of this class of procedures continues to increase, it is essential for pharmacists to serve as pharmacotherapy resources for patients interested in undergoing or having undergone any of these procedures. The purpose of this article is to provide some of the key details regarding how a pharmacist can assist patients through this process. The Procedures

The three most common types of bariatric surgery are the adjustable gastric band (commonly referred to as “the lap band”), the Roux-en-Y gastric bypass (“gastric bypass”), and the vertical sleeve gastrectomy (“the sleeve”). Regardless of the type of bariatric surgery performed, the resultant anatomical alterations will undoubtedly impact a patient’s pharmacokinetic and/or pharmacodynamic response to his or her medication regimen. The specific changes to the gastrointestinal anatomy depend on the procedure performed: 1. Gastric Band: an adjustable band is placed around the top of the stomach to create a small pouch making the patient feel satisfied faster and longer. This is a solely restrictive procedure. 2. Roux-en-Y: reduces the patient’s stomach to a small pouch in addition to changing the route of the intestines (bypassing the stomach and duodenum which still remain intact). This is a restrictive and malabsorptive procedure. 3. Sleeve Gastrectomy: a patient’s stomach is stapled along its vertical curvature with about 80 percent of the stomach removed. This is a solely restrictive procedure.

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Formulation Considerations

The easiest way to help your patients prepare for medication administration after surgery is to have them practice taking medications in split, crushed, or liquid forms beforehand. Although it is hard to predict exactly what a patient will continue taking after surgery (since many medications “fall off” due to improving metabolic conditions), the best way to be prepared is to assume that all of them will be continued post-operatively. In order to assist your patients, offer to scan their medication lists for capsules, extended/delayed release formulations, large tablets, and anything that requires acidity for dissolution/absorption, just to name a few. Tablets that are larger than the size of a pencil eraser (or too large to fit through a drinking straw) will not be able to pass through the restricted spaces resulting from the surgery and should be split or crushed if possible. Conversely, for extended/delayed release formulations or capsules, assess for other formulations of the same product available (e.g. fluoxetine capsules to tablets, venlafaxine extended release daily to immediate release three times daily), other medications in the same or similar class (i.e. pregabalin capsules to gabapentin tablets), or a pre-manufactured liquid of the same medication. Compounded suspensions also prove beneficial, although premanufactured solutions are preferred since there is no need to break down any of the medication particles. Whenever altering formulations, remember to assess for differences in bioavailability between formulations and the impact that food has on absorption since dose adjustments may be necessary. It is also advisable to avoid liquid products with high sugar and/or alcohol content if possible due to their high osmolarity which could lead to dumping syndrome. For capsules that have the recommendation “do not open,” often times a phone call to the manufacturer can be helpful in making a more “evidence-based” recommendation regarding dosage form manipulation since they frequently have unpublished stability studies of extemporaneous compounds or may be able to provide other recommendations. Medications of Concern

With the decreased surface area of the stomach lining comes an increased risk of gastrointestinal bleeding. Because of this, medications with a high baseline incidence of gastrointestinal bleeding such as antiplatelets (e.g. clopidogrel, prasugrel), NSAIDs (e.g. ibuprofen, naproxen, nabumetone, aspirin), and chronic oral steroids (e.g. prednisone, dexamethasone) should not be continued after surgery if possible. Other medications should be assessed Bariatric Surgery continued on page 23

Feature Reverse Distribution continued from page 19 mitting a Hazardous Waste License Application every three years. The Metropolitan counties (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington) each have independent authority to determine hazardous waste licensing requirements and fees within their respective jurisdictions. 2. The closed original manufacturer or dispensing container holding the pharmaceutical may itself be stored in an open container labeled with the words “reverse distribution”, “pharmaceuticals for reverse distribution”, or “expired pharmaceuticals” in place of a closed container labeled with the words “Hazardous Waste” and a description that clearly identifies its contents to employees and emergency personnel. 3. The undispensed discarded pharmaceutical may be transported, without the use of a licensed hazardous waste transporter or Uniform Hazardous Waste Manifest, by a common carrier, pharmaceutical wholesaler, or pharmaceutical manufacturer. All pharmacies need to obtain a hazardous waste generator identification number from the MPCA and apply for a hazardous waste generator license either through the MPCA or appropriate Metro county according to the amount and type of waste produced. In addition, a pharmacy, long-term care facility, or clinic may generate other types of waste like electronics (anything with a picture tube, LCD display, or LED lights), batteries, fluorescent lamps, and PCB ballasts and capacitors that may not be placed in the trash. The MPCA is in the process of developing a factsheet that will explain exactly how this new decision will affect current reverse distribution practices. For more information about managing pharmaceuticals and other types of waste, visit this Web site created by the MPCA and the Minnesota Technical Assistance Program (MnTAP) at the University of Minnesota: http://www. mntap.umn.edu/healthcarehw/Pharmacies/Index.html

Bariatric Surgery continued from page 22 individually within the context of your specific patient for their risk of complicating conditions post-operatively while keeping in mind the patient’s perceptions and expectations. What About Supplements?

After each of these procedures, the risk for nutritional deficiencies is very high although the extent varies depending on the procedure. The majority of supplements that are continued indefinitely after surgery are those that are heavily dependent on dietary intake or the acidic pH of the average stomach for metabolism/absorption (e.g. cyanocobalamin, iron, calcium, multivitamin – especially thiamine). Because of the decreased GI acidity, the calcium citrate formulation is essential for absorption. With the malabsorptive Roux-en-Y procedure, daily multivitamin supplements will help ensure that all of the fat soluble vitamins are more likely to be maintained at adequate levels, especially vitamin D. The role of pharmaceutical care

Even though the impact of a pharmacist in this area is assumed to be based solely in knowledge regarding pharmacokinetics and commercially available dosage forms, the provision of pharmaceutical care can still play a tremendous role to benefit these patients. An in-depth discussion with your patient regarding their medication experience (including an accurate medication history) will help guide your decision making process for how much flexibility there is to change medication therapy and what possible recommendations for adjustments would be, if needed. As always, each medication should still be assessed for indication, efficacy, safety and convenience before considering manipulations/alternatives in order to find ways to optimize and streamline therapy. Only by looking at a patient’s entire medication regimen can the most efficient therapy be accomplished. After all, what is the purpose of assisting a patient in administering a medication if it is not even indicated in the first place? Sources

1. http://www.asbs.org/Newsite07/media/asmbs_fs_surgery.pdf 2. http://win.niddk.nih.gov/publications/labs.htm#howmany

Rita Tonkinson is a contracted staff writer for the association, who provides insightful looks into the field of pharmacy for our readers. Andrew Bzowyckyj is a second-year Pharmaceutical Care Leadership Resident with the University of Minnesota College of Pharmacy Ambulatory Care Residency Program. His current practice site is in the Bariatric Surgery Center at Unity Hospital in Fridley, Minn.

Minnesota Pharmacist Spring 2011 n

Bowl of Hygeia finds new home at APhA by Joe Sheffer, Pharmacy Tradition Secured The Bowl of Hygeia (replica) has a new home on the National Mall with the recent transfer of this prestigious award from the National Alliance of State Pharmacy Associations (NASPA) and Pfizer to APhA for placement in the Association’s Awards Gallery. Earlier in 2010, Pfizer transferred all rights and responsibilities of the award program to NASPA, including possession of the Bowl of Hygeia replica that was housed at the corporate headquarters of the sponsoring company. The original Bowl of Hygeia award is housed in the A.H. Robins family collection. APhA is gratified to maintain stewardship of the Bowl replica on NASPA’s behalf. For more than 50 years, the Bowl of Hygeia has recognized pharmacists who are committed to making important contributions to their communities. Each year, pharmacists in all 50 states, the District of

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Columbia, and Puerto Rico are eligible for the prestigious award. The award itself depicts the traditional symbol of healing through medicine — a symbol that has been associated with pharmacy for thousands of years. In Greek mythology, Hygeia was the goddess of health and the daughter of Aesculapius, the Greek god of medicine.

2010 Recipients of the “Bowl of Hygeia” Award

James Walker Alabama

Robert Johnson Arizona

Ronald Norris Arkansas

Horace Williams California

Tim Mead Colorado

Jacqueline M. Murphy Connecticut

Kim Robbins Delaware

Eric Alvarez Florida

Flynn Warren Georgia

Elwin Goo Hawaii

Carl Hudson Jr. Illinois

Jeanne VanTyle Indiana

John Forbes Iowa

Steven Charles Kansas

Kimberly Croley Kentucky

John O. LeTard Louisiana

Douglas Kay Maine

David Fulton Jr. Maryland

Donna Horn Massachusetts

Michael Sanborn Michigan

Gregory W. Trumm Minnesota

William Wells Mississippi

Robert Piepho Missouri

Ernest Ratzburg Montana

Charles Moore Nebraska

Kathryn Craven Nevada

Robert Gooch New Hampshire

Richard Weiss New Jersey

L. Kirk Irby New Mexico

Stephen Giroux New York

Albert Lockamy Jr. North Carolina

Terry Kristensen North Dakota

Jeffrey Allison Ohio

Charles Braden Oklahoma

John Block Oregon

Michele Musheno Pennsylvania

Marisel Menchaca Puerto Rico

Kimberly McDonough Rhode Island

Lynn Connelly South Carolina

Mark Dady South Dakota

Sherry Hill Tennessee

Douglas Parker Texas

Derek Christensen Utah

Randy Pratico Vermont

Brenda Smith Virginia

The “Bowl of Hygeia”

Holly Henry Washington

Betsy Elswick West Virginia

Susan Sutter Wisconsin

Linda Martin Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community which richly deserves both congratulations and our thanks for their high example. Over the years a number of companies have supported the continuation of this worthwhile program, including Wyeth and Pfizer. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility from Pfizer for continuing this prestigious recognition program. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Minnesota Pharmacist Spring 2011 n

Presidential Candidates • 2011-2012 Board of Directors

Martin Erickson

James Martilla

I have more than four decades of experience in a variety of pharmacy practice settings, including ownership and management of a community pharmacy, hospital pharmacy, consulting pharmacist for long-term care and hospital environs. As a third generation Minnesota pharmacist, I learned my appreciation for the important work of the Minnesota Pharmacists Association on a daily basis from my grandfather, Edward Holland, and my mother, Jeanne Erickson, a 1943 graduate of the University of Minnesota College of Pharmacy and owner and operator of the family pharmacy, Warroad Heritage Pharmacy.

I joined the Minnesota State Pharmaceutical Association (now Minnesota Pharmacists Association) soon after I graduated from pharmacy school. I joined because I was told that one should join his professional organization to support his profession. That advice is as good now as it was when my father said that to me 40 years ago. While the practice of pharmacy has evolved greatly since those days, the challenges seem the same. Belonging to your professional organization is crucial to the support of guiding the practice of pharmacy through these turbulent times.

I received my Bachelor of Arts in microbiology from the University of Minnesota in 1970; my second bachelor degree in pharmacy from the University in 1973, and attended the University of North Dakota Law School in the early 1980s. In 2009, I earned a Master of Divinity degree from the United Theological Seminary of the Twin Cities. Currently, I serve as director of Professional Services and Regulatory Affairs/Quality Assurance for pharmaceutical manufacturing. I am also a columnist for Pharmacy Times, having written the “Compounding Hotline” for the past two decades.

I graduated with a Bachelor of Science in pharmacy in 1971 and a Doctor of Pharmacy in 1973 from the University of Minnesota College of Pharmacy. In 1984, I received a Master in Business from the College of St. Thomas. I am a recipient of awards from the American Pharmacists Association, the Veterans Health Administration and the Mayo Clinic, in addition to authoring numerous papers on pharmacy practice.

I believe that a vital part of MPhA’s mission is to ensure not only the future of the profession, but to secure that future by instilling professional ethical practice in our current students – setting examples and modeling practice excellence. Having been a preceptor of both Minnesota and North Dakota pharmacy students for many years, I see an important role of the association as an educator. In the legislative arena, we must ensure regulations are equitable and reasonable and especially that legislation is not passed that adds further stressors to all areas of pharmacy practice, pharmacists, and technicians. We must work to ensure that our profession continues to uphold its proud tradition of professionalism and integrity in all areas of practice, from MTM to dispensing, using best practices in consultation and judgment when serving our patients and clients. Further, through dialog with our state and federal legislators, we must work untiringly and with resolve to protect our profession from the avarice presented by formulary caprices of third-party payors. We must work at the state and federal government levels to advocate against random passage and/or enforcement of nonexistent, nonsensical, anti-business, and anti-patient rules by state and, especially, federal agencies. I believe our strength as an association lies in recognizing those sources of inspiration, knowledge, and insight, including our visionary leaders, that can assist our individual spiritual, intellectual, and physical growth, and by extension as an association, so that we provide a strong legacy for subsequent generations of pharmacists. I am humbled by my nomination to be considered for the position of MPhA president, and would be honored to have an opportunity to serve.

Minnesota Pharmacist Spring 2011 n

Currently, I serve as the director of the Pharmaceutical Contracting and Formulary Management area at Mayo Clinic where I have been in various pharmaceutical managerial positions for 24 years. Previously, I spent more than 15 years working in academia, longterm care and managed-care consulting, in addition to pharmacy ownership in clinic and retail pharmacy. I have served several terms on the Board of Directors of MPhA, in addition to serving on the Academy of Managed Care Pharmacy Leadership Group as a committee chair. Other committee involvement over the years includes the American Pharmacists Association, the Academy of Managed Care Pharmacy, the Minnesota Society of Managed Care Pharmacy, and MPhA, in addition to being a Fellow in the American Apothecaries and American Society of Consultant Pharmacists. We face great challenges as the delivery of health care, including pharmacy, goes through the greatest changes since the inception of Medicare in 1965. A strong association with strong membership is needed now as much as any time in our history. Our professional organization is dedicated to ensuring that pharmacy remains a viable and prominent component of health care. There is much work to be done at both the state and federal levels. The fact that I am considered a candidate for president of this organization is a great honor and a tremendous opportunity to continue the legacy of this 128-year-old organization.

Feature

Emergency Preparedness: Lessons Learned and Future Direction Pharmacists’ Role in Public Health by Alison R. Knutson, Pharm.D., Pharmaceutical Care Leadership Resident

Pharmacists possess a unique skill set and perspective that make them vital to many aspects of public health — including delivering vaccinations, providing patient education, and promoting safe and effective medication use. One of the most under-recognized areas for contribution to public health is emergency preparedness. The American Public Health Association (APHA) passed a policy in 2006 titled “The Role of the Pharmacist in Public Health.”1 This included provisions regarding emergency preparedness efforts, stating, “Pharmacists should be prepared to quickly assess and respond to critical situations and have been a welcomed addition to the collaborative emergency team.” The responsibilities pharmacists hold to our patients and overall public health are echoed in the first line of the Oath of the Pharmacist, which states that we will consider the welfare of humanity and relief of suffering our primary concerns. The potential of pharmacists’ contributions has been seen through examples such as Hurricane Katrina, the 35W Bridge Collapse and the H1N1 Pandemic. However, there is also astounding room for growth in emergency preparedness efforts by pharmacists both state and nationwide. Hurricane Katrina

In 2005, Hurricane Katrina caused significant damage across the Gulf coast stretching from central Florida to Texas. The most devastating damage occurred in New Orleans, La., where 80% of the city was flooded from the storm. Due to the damage, most residents of the city were immediately evacuated and sent to other large metropolitan areas. With the complete overturn of thousands of lives, several issues arose regarding medications. Many people were injured or acutely ill, requiring medical attention and, often, immediate medication therapy. Along with destroyed homes were destroyed possessions, including medications for chronic conditions. The loss of photo albums and heirlooms is devastating, but the loss of insulin and nitroglycerin can be life-threatening. When the decision was made to transport evacuees to Houston, Texas, the Houston Astrodome was quickly organized to house an expected 25,000 evacuees. Around 11,000 evacuees were “admitted” to the makeshift clinic set up in the Astrodome for treatment of injuries and chronic conditions. Pharmacists were responsible for ensuring that each patient received the necessary lifesaving medications.2

The pharmacy staff at a hospital in Houston immediately took over all prescription filling responsibilities. The prescriptions were filled at the hospital, then brought to the Astrodome to be dispensed by pharmacists. More than 2,000 prescriptions were filled in the first week.2 CVS, with its own crew of volunteer pharmacists and its high-volume filling capacities, took over the operation after the first week. They reported that more than 20,000 prescriptions were filled in the two weeks that followed. In addition to the dispensing role, pharmacists were also called on frequently for dosing recommendations and infectious disease consults, since many of the volunteer physicians were trained in orthopedics, cardiology, and many specialties other than emergency medicine. When disasters or emergencies occur, such as Hurricane Katrina, pharmacists are asked to step outside of their day-to-day practice and pull from all of the education and training they have received. 35W Bridge Collapse

On August 1, 2007, the 35W bridge over the Mississippi River collapsed during the evening rush hour. This warranted an immediate large-scale emergency response from area hospitals to help those injured in the collapse. The main and closest hospitals accessed were Hennepin County Medical (HCMC) and the University of Minnesota Medical Center (UMMC)-Fairview. Just months earlier, in May of 2007, the Minnesota Department of Health (MDH) organized a citywide drill simulating an emergency bioterrorism event. This allowed pharmacists to practice emergency procedures, including request of stock from the federal Strategic National Stockpile, coordinating communications among healthcare teams in multiple locations, and proper reporting. As a result of the drill, the HCMC pharmacy department updated its emergency preparedness protocol to include a list of “orange alert” drugs. This list included medications that may be in short supply in the case of a large-scale emergency. This “orange list” provided significant guidance during the 35W bridge collapse, to ensure vital medications were readily available. At UMMCFairview, pharmacists were stationed in the ER to assess medication needs, and technicians traveled between the ER and pharmacy delivering these medications. In this case, the medications needed and used most frequently were morphine, cefazolin, lactated Ringer’s injection, and tetanus toxoids. The pharmacies at both HCMC and UMMC-Fairview worked diligently to provide these needed medications as efficiently as possible. Emergency Preparedness continued on page 28 Minnesota Pharmacist Spring 2011 n

Emergency Preparedness continued from page 27 H1N1 Pandemic

In March 2009, the first two cases of Novel H1N1 influenza were confirmed in Mexico and the United States. Less than one month later, on April 21, the Centers for Disease Control and Prevention (CDC) prepared an alert for healthcare providers informing them of the growing population of patients confirmed to be infected with the Novel H1N1 influenza. On June 11, 2009, the World Health Organization declared an H1N1 pandemic. Pharmacist involvement was essential with regards to vaccination campaigns and medication use and distribution for the prevention and treatment of the Novel H1N1 influenza. The large vaccination campaigns to encourage everyone to receive the H1N1 vaccine nationwide were greatly supported by the readily available locations for vaccination, including community pharmacies. There were also mass immunization clinics that utilized pharmacists as immunizers. Many questions arose from other healthcare providers regarding appropriate use of antiviral medications, and pharmacists were and are the most accessible resource to clarify these issues. ASTHO Survey

One important aspect of emergency preparedness is recognizing the need to learn from previous experiences. Following the H1N1 pandemic, the Association of State and Territorial Health Officials (ASTHO) was charged by the CDC to evaluate the response of the healthcare system to this pandemic. The ASTHO survey was distributed on April 2, 2010, to state health officers, senior deputies, agency-assigned public health lawyers, directors of public health preparedness, and immunization managers. Included among those surveyed were pharmacists involved in efforts during the pandemic.3 Based on this survey, many strengths were identified. The survey responders noted that new relationships were established between pharmacies and public health departments in many states throughout the U.S. Another strength identified was that “[State] personnel were dedicated to contacting every pharmacy in the state weekly to ascertain current stock levels and projected supply replenishment.” This ensured that every region of the state contained an adequate and appropriate stock of vaccine and medication, given population size and current number of confirmed cases. From this strength, ASTHO identified a recommendation for the future. The suggestion was made to create a federal-level system for monitoring stock levels of a specific set of pharmaceuticals, either using national pharmacy corporate chains or coordinating with each state individually. Also, the vaccination campaigns were identified as an area for growth; suggestions included expanding the scope of healthcare providers, such as pharmacists, the ability to deliver immunizations.4 Vaccination

Immunization campaigns have been a huge area of success for pharmacists. Per Minnesota state law, a pharmacist may deliver vaccine to those eligible with a standing order from a physician, given that the pharmacist is trained in a program approved by the Accreditation Council for Pharmaceutical Education (ACPE) for the administration of immunizations, or graduated from a college of pharmacy in 2001 or thereafter. This includes any vaccine for patients 18 years or older, and influenza vaccine to those 10 years 28

Minnesota Pharmacist Spring 2011 n

and older. Although the law does state that vaccines can be given to any adult who is 18 years and older, the Minnesota Vaccines for Children program covers those who are 18 years old; therefore, pharmacists cannot administer to those patients unless they are an approved provider under the MnVFC. During the H1N1 pandemic, pharmacies were provided with a stock of vaccination from the federal government. Because the costs of vaccines and supplies were federally subsidized, pharmacies were not allowed to charge a fee for the vaccine itself. However, depending on insurance coverage, pharmacies were allowed to charge for the cost of vaccine administration. Medication Distribution

One of the largest areas of confusion surrounding the H1N1 pandemic was medication distribution. Three areas are vital to understand in the wake of an emergency: The national supply of emergency pharmaceuticals; the federal laws protecting healthcare providers during an emergency; and the federal laws supporting use of necessary medication during an emergency. The CDC and Department of Homeland Security retain a Strategic National Stockpile (SNS), which is a cache of medical supplies and medications that might be needed in the event of a regional, state or national emergency. Supplies used from this cache are free of charge to anyone who needs them. The medications utilized, mainly antibiotics and antivirals, would generally be distributed through a mass distribution center. The SNS guarantees that medications required anywhere in the United States will be there within 12 hours from declaration of the emergency. Due to policy barriers identified in the wake of September 11, 2001, two specific laws were passed that support adjustment of resources if needed in an emergency. The first policy barrier was improved by the Public Readiness and Emergency Preparedness (PREP) Act. The PREP Act is a federal law that was passed in 2005 to protect those trying to assist in emergency relief efforts, specifically through drug development and distribution. This authorizes the Secretary of Health and Human Services to issue a declaration to protect those individuals and organizations involved in the development, manufacture, distribution, administration and use of countermeasures against pandemics, epidemics and diseases and health threats caused by chemical, biological, radiological, or nuclear agents of terrorism.5 On June 15, 2009, Health and Human Services Secretary Kathleen Sebelius extended the PREP Act declaration to H1N1 vaccines. The declaration was amended to add provisions that would help with H1N1 vaccination campaigns, through additional funding and advertising. This meant that manufacturers were given the ability to expedite the process of producing vaccine in order to meet the needs of the community. For example, in the case of H1N1, some of the clinical-use data was not collected in order to speed up delivery of vaccine to the community. Importantly, this also protected those administering the H1N1 vaccine in the event there was an adverse event to occur from receiving the vaccine. The second barrier surrounding medication distribution led to the creation of the United States Emergency Use Authorization (EUA). The EUA provides that a timely and practical medical treatment is Emergency Preparedness continued on page 29

Emergency Preparedness continued from page 28

ultystaff/oer/mrc/index.htm).

made available under emergency conditions. It authorizes use of the best product available for treatment or prevention, even when the relevant product has not yet been approved or approved for this specific use by the FDA (for example, off-label use). The FDA commissioner may declare an EUA for a specific device or medication if the concerning agent can cause a serious or life-threatening disease or condition.6

Consider becoming involved in emergency preparedness efforts at your workplace, institution, state or even nationally. The role in emergency preparedness continues to expand for pharmacists as welcome members of the healthcare team.4

During the H1N1 declared pandemic, three medications were given an EUA; Tamiflu (oseltamavir), Relenza (zanamivir) and peramavir. At the time, Tamiflu™ and Relenza™ were both FDA approved with specific treatment guidelines for viral infection. The EUA expanded the use of these medications beyond their FDA approvals. Tamiflu could be used in children <1 year old, and even in children < 3 months of age if the need was considered critical. Treatment guidelines do not recommend use of Tamiflu and Relenza past 48 hours of flu-like symptoms, but both were temporarily approved for use when symptoms had exceeded that 48-hour window. They were also both given extended expiration dates in order to ensure an adequate stock of antivirals was maintained. Peramavir, an IV antiviral medication that was still in Phase III clinical trials at the time, was granted an EUA7. The EUA was provided because there were no other adequate IV measures if a patient was unable to tolerate oral antiviral medication. Pharmacists were vital in promoting appropriate use of Peramavir™. Very little information was known about its recommended dosing, side effects and monitoring parameters, leaving pharmacists as the primary reference for this information. The interplay between the PREP Act and a declaration for EUA caused significant confusion. The EUA granted use of medications beyond their approval, and when used off-label there is lacking clinical data regarding these medications. The PREP Act protects health care professionals who are involved in use of countermeasures against something such as a pandemic were a negative outcome to occur such as a severe side effect (in this case, use of Peramivir for treatment of H1N1, or administration of the H1N1 vaccine). Opportunities for Involvement

It is vital to be comfortable with the resources available for both planning for emergency response as well as for use during an emergency. The Minnesota Department of Health (www.health. state.mn.us/) is the best place to turn for immediate state-specific information. The CDC and FDA continually update information such as vaccine recommendations at all times and appropriate use of countermeasures (antibiotics, antivirals, vaccines) in a declared emergency. There are many unique opportunities for pharmacists to be involved in public health efforts, especially in the area of emergency preparedness both throughout the state as well as nationwide.8 The Medical Reserve Corps (MRC) is a group of volunteers from many professions that can be called upon at any time if needed in an emergency or large public health need. These MRCs will request assistance from their pharmacist members in a time of need for any pharmaceutical products. In Minnesota there are two MRCs, the Minnesota Responds MRC (https://www.mnresponds.org/) and the University of Minnesota MRC (http://www.ahc.umn.edu/fac-

References 1. American Public Health Association. The Role of the Pharmacist in Public Health, policy statement. http://www.apha.org/advocacy/policy/ policysearch/default.htm?id=1338 . Policy Date 11/8/2006. 2. Young, D. Pharmacists play vital roles in Katrina Response: More

disaster-response participation urged. AJHP; 62, Nov 2005. DOI 10.2146/ news050025

3. Assessing policy barriers to effective public health response in the H1N1 influenza pandemic: Project report to the centers for disease control and prevention. June 2010. Association of State and Territorial Health Officials. 4. Survey of State Health Agency Staff on H1N1 Response Policy and

Legal Issues: Summary and Analysis. June 2010, Logan Circle Policy Group LLC. Association of State and Territorial Health Officials.

5. Public Readiness and Emergency Preparedness (PREP) Act. http://www.

pandemicflu.gov/professional/federal/vaccineliability.html. Last Updated July, 2010 6. Emergency Use Authorization, http://www.fda.gov/ RegulatoryInformation/Guidances/ucm125127.htm#intro 7. Gonzalex, R.; Masoomi, F.; Neff, W. Emergency use authorization of

Peramavir. AJHP. 2009; 66: 2162-3.

8. Woodard, L.; Bray, B.; Williams; Terriff, C. Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response. JAPhA. 2010; 50:158–164.

Herbie Cup Golf Invitational

The Classic Golf Course Saturday, June 11, 2011 • Madden’s Resort • Brainerd, MN

11 a.m. Registration 12:00 pm Shotgun Start

$135/Golfer Includes Green Fees, Golf Cart, Course Drink Tickets & Awards Drink Tickets.

Minnesota Pharmacist Spring 2011 n

Student Perspective

Student Pharmacists Join the Battle Against Cancer:

Duluth Becomes “Where Leukemia Meets its Match” By Laura Palombi, Class of 2012, student at the College of Pharmacy in Duluth, MPSA’s Vice-President of Community Outreach

Missing Piece Gala” on Friday, February 25, 2011. The event was hosted by Fox 21 News Anchor Nick LaFave and included a silent auction as well as presentations by cancer survivors and bone marrow donors who could attest to the significance of the students’ efforts. The Gala helped to raise more than $5,670. Mayor Don Ness, Duluth, attended the Gala and declared the first week of March to be “Duluth Bone Marrow Donor Registration Week” in recognition of the students’ efforts and the importance of their mission.

Duluth Mayor Don Ness joins Student Pharmacist Maggie Kading and CSS Student Bingshuo Li in declaring the first week of March “Duluth Bone Marrow Donor Registration Week”

Every day, thousands of patients suffering from blood cancers like leukemia search for a bone marrow donor match. Unfortunately, six out of ten patients today do not find a donor who can save their life. For the second year in a row, pharmacy students in the Duluth chapter of the Multicultural Pharmacy Student Organization (MPSO) are working to change that — with amazing results! Students from the College of Pharmacy in Duluth partnered with students from The College of St. Scholastica (CSS) to form the 2011 Twin Ports Bone Marrow Donor Registration Drive (BMDRD) Committee. Last year, more than 1,000 students registered to become potential Bone Marrow Registry Donors at the University of Minnesota Duluth (UMD) as a result of the student pharmacists’ efforts and the help of non-profit DKMS1. This year, the Committee organized three successful Bone Marrow Registry Drives that were held at UMD, The College of St. Scholastica, and the Miller Hill Mall. During the first week of March they registered 1,185 bone marrow donors! Because of the students’ efforts, three students from UMD have already provided lifesaving transplants to leukemia patients! For each new donor who registered, the cost to DKMS is $65. In an effort to defray those costs, the students organized the “Be the

Minnesota Pharmacist Spring 2011 n

The Bone Marrow Registry Drives at UMD were headed by PDIII Maggie Kading, who took the lead in initiating and organizing the events, in conjunction with the efforts of CSS student Bingshuo Li, experienced in organizing successful BMDRDs. Ruth Leathers, student services coordinator at the College of Pharmacy in Duluth and MPSO advisor, played a critical role in assisting the students with the considerable task of organizing three BMDRDs and the fundraising Gala. Student pharmacists who dedicated their time as members of the 2011 Twin Ports BMDRD include Kading (PDIII), Yohannes Woldemichael (PDIII), Akua Appiah-Num (PDIII), Steve Turner (PDIII), Lisa Herron (PDIII), Rachel Dugan (PDIII), Brandon Burk (PDIII), Laura Palombi (PDIII), Prasanna Narayanan (PDII), Sarah Shuster (PDII), Aklilu Beyene (PDII), and Souk Phaengkhouane (PDI). Thank you to everyone who volunteered, registered, donated money, or helped in any other way to make the Bone Marrow Registry Drives and the Be the Missing Piece Gala this year a success! We really appreciate your enthusiasm and support.

1DKMS (Deutsche Knochenmarkspenderdatei gGmbH) is the German Bone Marrow Donor Center established in Germany in 1991. The organization expanded to the United States in 2004 and currently 2.7 million bone marrow donors are registered.

Student Perspective Why register as a Bone Marrow Donor?

While family members are usually used as bone marrow donors, only 30 to 40% of patients needing a bone marrow transplant have a compatible donor in their family. As more people become part of the registry, the chances of saving the life of someone in need of a bone marrow transplant increase. Does it hurt?

The registration process is painless. It requires some paperwork followed by an inside-the-cheek swab. If you are asked to donate, the donation method is determined by the patient’s doctor. Most bone marrow donations can be done through a blood draw. Does it cost anything? Twin Ports BMDRD Commitee members Steve Turner and Yohannes Woldemichael at the Miller Hill Mall BMDRD.

There is no cost to you to register or donate bone marrow. Who is needed?

EVERYONE between the ages of 18 and 55. Individuals with these backgrounds are especially needed: Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, Hispanic or Latino, and mixed race. Will I be selected as a donor?

The chance that you will be asked to actually donate bone marrow depends on your tissue type. About one out of 200 registrants will donate, while only four in 10 patients will receive a donation. Twin Ports BMDRD Committee members Aklilu Beyene and Lisa Herron at the UMD BMDRD.

Where can I get more information?

DKMS Americas Web site: http://www. dkmsamericas.org. Information on the donation process: http://www.dkmsamericas.org/bonemarrow-donors/bone-marrow-donationprocess.

Minnesota Pharmacist Spring 2011 n

127th

Annual Meeting

of the Minnesota Pharmacists Association

June 10-12, 2011 at Maddens Resort 11266 Pine Beach Peninsula • Brainerd, MN 56401

Learn, Relax, Enjoy in Northern Minnesota with MPhA!

Join us in Brainerd for the

Friday CE

2011 MPhA Annual Meeting and Conference!

• Traditional and Evolving Roles of Vitamin D

We are excited to bring to you our 127th Annual Meeting! Set in the scenic Brainerd area, this year’s meeting will take place at Madden’s on Gull Lake.

• Emergency Preparedness: Lessons Learned and Future Direction

Another strong educational program! You will also find opportunities to interact with other pharmacy professionals to further develop your network connections, or reconnect with old friends. This information can also be found on our Web site, and I encourage you to visit our Annual Meeting link for additional information and resources. We can’t wait to see you in June — return your registration today!

Brent Thompson, Pharm.D. MPhA President

• Scanning the Medication Therapy Management Horizon

• Update on Laws and Rules Related to Pharmacy Practice

Saturday CE • Maximizing Your Diabetes Marketplace

• Pharmacist Role in Accountable Care Organizations

• The Minnesota Research and Practice Innovation Forum • Diabetes Management ∙∙ Self Monitoring of Blood Glucose in Patients with Diabetes ∙∙ Managing Infections in Patients with Diabetes ∙∙ Insulin Pumps and Sensors, and Continuous Glucose Monitoring & Artificial Pancreas

What to Bring Camera • Sunscreen • Bug Spray • Comfortable Shoes Dress for the conference is casual/resort casual. The evenings can be cool, and so can the session rooms, so pack a light sweater or jacket. For the President’s Banquet, many dress on a business/semi-formal level. Men may choose to wear a nice shirt and slacks or a suit. Women may want to consider a nice dress set or slacks and blouse. Please feel free to dress at your own comfort level.

Minnesota Pharmacist Spring 2011 n

Sunday CE: • Healthcare Reform: Opportunities for Pharmacy and the Importance of Advocacy

mpha registration

2011 annual meeting/conference NAMe

OrgANizAtiON

AddreSS City

StAte

PhONe:

hOMe

wOrk

ziP

Cell

eMAil (required fOr eveNt CONfirMAtiON)

Full Weekend: Friday, Saturday & Sunday Program/Non member $385 MPhA Member $285 Pharmacy Student Member $215

Saturday only: CE, Break, Meals & Banquet Program/Non member $225 MPhA Member $175 Pharmacy Student Member $135

Friday only: CE, Break, Dinner & Opening Reception Program/Non member $175 MPhA Member $125 Pharmacy Student Member $90

Sunday only: CE, Break & Honors Brunch Program/Non member $125 MPhA Member $100 Pharmacy Student Member $65

Late Registration: All registrations received after May 20, 2011 will be charged a $25 late fee.

additional gueSt(S) I will be bringing a guest(s) with me to the following events: (Do not include yourself) friday bbq 12 & Under: $20 x ___; Adult: $40 x ___; = $_________ friday Opening reception12 & Under: $10 x ___;Adult: $25 x ___;= $_________ Saturday breakfast 12 & Under: $13 x ___; Adult: $18 x ___; = $_________ Saturday lunch/exhibit hall12 & Under: $13 x ___;Adult: $25 x ___;= $_________ Saturday President’s banquet12 & Under: $20 x ___;Adult: $50 x ___;= $_________ Sunday honor’s brunch12 & Under: $15 x ___;Adult: $30 x ___; = $_________ iF you have SPecial dietary needS, PleaSe liSt here: _____________________________________ _____________________________________________________________________________________________ Session handouts will be available electronically on the MPhA website. Attendees will be notified one week before the conference of their availability.

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)

if you prefer a printed set of handouts to be provided for your use at the conference, please check the box below:

Other ____

enclosed is an additional check payable to the Minnesota Pharmacists foundation.

i am requesting printed handouts for an additional charge of $5.

MPha PayMent by: Check

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discover

If paying by credit card, all fields below are required.

additional guests = $__________ Printed handouts = $__________

CArdhOlder NAMe (PriNt) CArd NuMber

SeC COde

exP

MPha total = $_________

CArdhOlder SigNAture billiNg AddreSS (if differeNt thAN AbOve)

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

(For office use only)

initials date CK/CC amt. paid bal. due

fin.

Please do not email credit card information. fax or mail your registration form to protect this information.

Minnesota Pharmacist Spring 2011 n

MADDEN’S RESERVATION REQUEST DEADLINE: May 10, 2011 Check in time: 4:30 PM

Check out time: 11:00 AM

MN Pharmacists Assn Arrival: Friday, June 10, 2011 Departure: Sunday, June 12, 2011

#7215

YOUR TWO NIGHT, LODGING ONLY PACKAGE RATES ARE: Deluxe Hotel Rooms

Premium Units and Cabins

Luxury Golf Suites

______$390.84 Per Unit

______$464.58 Per Unit

______$562.90 Per Unit

The package rates listed above include lodging, use of 3 sand beaches, 5 swimming pools, saunas, whirlpools, fitness room, business center, service charge and 6.875% MN State Sales tax. Madden’s Golf Courses; Pine Beach East, Pine Beach West and the Social 9 are offered at a special conference rate. ROOMS: Reservation and housing requests will not be accepted or honored without payment. Any reservation requests received after April 26, 2011 will be accepted on a space available basis only. Online Reservations: Go to https://reservations.ihotelier.com/crs/g_reservation.cfm?groupID=523379&hotelID=73976 Pre/Post Stays: The Association’s contracted daily rate will be honored 3 days pre conference as well as 3 days post conference for all attendees, subject to availability. Call Madden’s to make an extended reservation.

OCCUPANT 1-

ADDITIONAL OCCUPANTS

Single occupancy_____Double_____Accessible_____ Name Mr/Ms_____________________________________________

Name Mr/Ms______________________________________________

Company ________________________________________________

Children’s names & ages____________________________________

Address ________________________________________________

________________________________________________________

City ______________________________State_______Zip________

________________________________________________________

Daytime phone___________________________________________

________________________________________________________

Email __________________________________________________

________________________________________________________

Credit card number

________________________________________________________

VISA or MASTER

____________________________________________Exp________ Amount to be debited $__________________

PAYMENT INFORMATION: Full package payment is required at time of reservation request. When a credit card is used for a reservation request, it must be valid and will be charged the required amount when the reservation is processed. We accept VISA or MASTERCARD. Checks made out to MADDEN’S ON GULL LAKE are acceptable and must accompany the reservation request form. Vouchers and Purchase orders are not accepted for payment. All guests must present a credit card at check-in. Mail This Form To: MADDEN’S ON GULL LAKE, 11266 Pine Beach Peninsula, Brainerd, MN 56401. Call Reservations at 800-642-5363 or FAX to 218-829-7698. A credit card is required for payment on all phone and fax requests.

CANCELLATION POLICY: You are responsible for your entire stay; early departures or reservation reductions are not refundable. Package payments are refundable minus a $25.00 cancellation fee if you cancel by May 10, 2011. Any cancellations made after May 10, 2011 will not receive a refund. (Replacements are gladly accepted.) Reservations made after the deadline are nonrefundable.

Reservation made by _______________________________________________Phone ________________________Date _____________________

Minnesota Pharmacist Spring 2011 n

Partnership Join the

Full Name (Mr/Ms/Dr): ________________________________________________ Address: ____________________________________________________________ City: __________________________________ State: ________ Zip: ___________

Phone: _________________________ Preferred Fax: _________________________ Preferred E-mail: ______________________________________________________ Birth Date: ___________________________

Male

Serving Minnesota pharmacists to advance patient care.

Female

College Attended: _____________________________________________________ Year Graduated: _________ Degree(s): _____________________________________ Board License Number: __________________________________________________ Please Send Mail To:

Residence

www.mpha.org

Business

Business Name: ________________________________________________________ Business Address: _______________________________________________________ City: ______________________________________ State: _______ Zip: ___________ Business Phone: ____________________________

I am applying as (choose one): With the exception of Associate Members, you must have completed pharmacist educational requirements.

Annually

Monthly

Active Pharmacist. . . . . . . . . . . . . . . . . . . . . . . $395 . . . . . $33 Retired Pharmacist. . . . . . . . . . . . . . . . . . . . . . $145 . . . $12.50 Out-of-State Member . . . . . . . . . . . . . . . . . . . $230 . . . $19.50 Associate Member (non-pharmacist) . . . . . . . . $295 . . . . . $25 2nd or 3rd Year Resident/Graduate Student . . $130 . . . . . $11 1st Year Practitioner/Resident/Grad Student. . . $25 . . . . . N/A 2nd Year Practitioner. . . . . . . . . . . . . . . . . . . . $200 . . . $16.70 Technician Associate . . . . . . . . . . . . . . . . . . . . . $55 . . . . . N/A MPSA Student. . . . . . . . . . . . . . . . . . . . . . . . . . $25 . . . . . N/A

payment:

Academies Your primary Academy is included in membership. Please select your setting: Academic Chain Management Community Hospital Independent-Owner Industry Long-Term Care/Consultant Managed Care Medication Therapy Management Technician

I am paying in full Check Credit Card I am paying by monthly debit Savings: Account #___________________________ Routing #___________________________ Checking: Attach voided check I am paying by Credit card (All credit card fields are required) Visa Mastercard Discover Card Number:________________________________________Expiration Date:________Security Code: _______ Cardholder Signature: __________________________________ Cardholder Address

Same as above

Address: ________________________________________City: ________________ State: _____ Zip: _________ (For office use only)

Mail or fax back to: Minnesota Pharmacists Association • 1000 Westgate Drive, Suite 252 • St. Paul, MN 55114 651.290.2266 fax • 800.451.8349 mn • 651-697-1771 metro

initials date CK/CC amt. paid bal. due

fin.

Every Customer counts! Dakota Drug Inc. 1101 Lund Boulevard Anoka, MN 55303 phone (763) 432-4333 fax (763) 421-0661 www.dakdrug.com

As the Midwest’s only Independent Drug Wholesaler, Dakota Drug has grown and developed by addressing the needs of you, the Community Pharmacist, and by providing assistance to ensure your success. We are committed to personal service and welcome the opportunity to assist you.

The Upper Midwest’s Independent Healthcare Distributor