INTERVIEW
Serving pharmacists and patients Sarah Derr, PharmD Minnesota Pharmacists Association Please tell us about the history of the Minnesota Pharmacists Association (MPhA).
Prescriptive authority for non-diagnosable conditions is an issue for the MPhA. What can you tell us about this?
MPhA—formerly known as the Minnesota State Pharmaceutical Association (MSPhA)—was founded in 1883. Meeting in St. Paul that year, a group of 12 influential druggists made plans and preparations to organize a state pharmaceutical association. MSPhA later produced the other institutions of pharmacy in Minnesota: the state Board of Pharmacy, established in 1885, and the University of Minnesota’s College of Pharmacy (CoP), established in 1892. Over the last 137 years, MPhA has served all pharmacists, student pharmacists, and pharmacy technicians. MPhA continues to be the organization that represents all pharmacists in the state of Minnesota. (See DiGangi, Frank E., A Century of Service and Leadership. 2003.)
The other organization that is well known in Minnesota is the Minnesota Society of Health System Pharmacists (MSHP). This organization’s members are mostly comprised of pharmacists from health systems and in administrative positions within hospitals. Another smaller organization is the Minnesota College of Clinical Pharmacy (MCCP), which has members serving in clinical roles, such as those working in the clinic and those working in specialties such as renal failure, hematology, and oncology. The other major player in Minnesota pharmacy is the CoP, which not only graduates PharmD students, but also plays a large role in keeping alumni connected and serving in large leadership roles in the profession. About a decade ago, the Practice Act Task Force was created, now known as the Minnesota Pharmacy Alliance. This brings together MPhA, MSHP, MCCP, and the CoP to discuss how we can best serve Minnesota pharmacists. The Alliance works closely together, especially on legislative issues, to ensure that we are one voice. This group works on several issues throughout the year.
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APRIL 2020 MINNESOTA PHYSICIAN
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There are other associations of pharmacists in Minnesota. What can you tell us about them and how you all work together?
MPhA has been pursuing prescriptive authority during the 2020 legislative session. We are pursuing conditions that do not require a diagnosis, such as nicotine replacement for smoking cessation, emergency opioid antagonists such as naloxone, and self-administered hormonal contraceptives. We are pursuing these three areas because they all are medications that a patient can have dispensed at the pharmacy. Pharmacists are the most accessible health care professionals, and they see patients, on average, 25 times a year. When a patient is ready to quit smoking, it is best that they get the medication and counseling that they need at that point in time, before they change their mind.
Prior Authorization is an issue that impacts most physicians in many ways. How does it impact pharmacists and what are some potential solutions to these problems?
Prior Authorization can be a challenge for all health care professionals. Pharmacists are impacted when a patient brings a script to the pharmacy that requires a prior authorization that the prescriber was not aware of. In these cases, the pharmacist has to contact the clinic to get a prior authorization. This can cause a delay in the patient getting their medication. Additionally, plans change their formularies at least once a month, if not more often. This can cause the need for a new prior authorization mid-year, which then can lead to further delay in patients getting their medication. Potential solutions are to stop health plans from changing their formulary mid-year. In addition, once a patient has had a prior authorization for a medication, we could eliminate the need to renew prior authorization each year.
Medication administration by pharmacists is another important issue. Can you explain your work in this area?
Pharmacists are well trained to counsel and teach patients how to administer their medications. Many patients are not comfortable administering injectable medications on their own. Pharmacists are well equipped to administer these medications. In the 2019 legislative session, the Minnesota Pharmacy Alliance passed legislation to allow pharmacists to administer long-acting injectables for mental health and substance use disorders. In 2020, the Minnesota Pharmacy Alliance has efforts underway to expand this to all injectable medications so that patients have the access to the medications that they need. Additionally, pharmacists are the most accessible providers and are often closer to the patient’s home than to the clinic. Several states have recently passed legislation around PBM transparency. These bills are now being challenged on the Supreme Court level as ERISA violations. Please explain why the legislation was necessary and why it is being challenged.
In the 2019 legislative session, the Minnesota Pharmacy Alliance passed legislation to regulate the PBMs through the Commerce Department. This is extremely important, as the PBMs are not well
