North Carolina Pharmacist Volume 102 Number 1 by North Carolina Association of Pharmacists

North Carolina Pharmacist Volume 102 Number 1 Winter 2021

Advancing Pharmacy. Improving Health.

Official Journal of the North Carolina Association of Pharmacists ncpharmacists.org

Official Journal of the North Carolina Association of Pharmacists 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649

www.ncpharmacists.org EDITOR-IN-CHIEF Tina Thornhill

North Carolina Pharmacist Volume 102 Number 1

Winter 2021

Inside

LAYOUT/DESIGN Rhonda Horner-Davis

• From the President .....................................................................................3

EDITORIAL BOARD MEMBERS

• From the Executive Director ...................................................................................4

Anna Armstrong Jamie Brown Lisa Dinkins Jean Douglas Brock Harris Amy Holmes John Kessler Angela Livingood Bill Taylor

• Mark Your Calendars ..............................................................................................8 • Call for Posters ......................................................................................................9 • New Drug Monograph ..........................................................................................13 • Member Spotlight ................................................................................................17

BOARD OF DIRECTORS

• A message from PAAS ..........................................................................................20

EXECUTIVE DIRECTOR Penny Shelton

• Why should a Pharmacy Technician get PTCB Certified? ...................................23

PRESIDENT Beth Mills PRESIDENT-ELECT Matthew Kelm PAST PRESIDENT Dave Phillips TREASURER Ryan Mills

• I Choose Membership .......................................................................................25

Click Here to Keep in Touch North Carolina Pharmacist is supported in part by:

SECRETARY Paige Brown

• Mutual Drug ........................................................................................10

Anita Yang, Chair, SPF Brianna Berish, Chair, NPF Anna Armstrong, Chair, Community Angela Livingood, Chair, Health-System Janine Bailey, Chair, Chronic Care Irene Ulrich, Chair, Ambulatory Ouita Gatton, At-Large Vinay Patel, At-Large Riley Bowers, At-Large

• Alliance for Patient Medication Safety .............................................15

North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

• EPIC Pharmacies Inc .........................................................................12 • Pharmacists Mutual Companies .......................................................16 • Pharmacy Quality Commitment .......................................................19 • Pharmacy Technician Certification Board .......................................21 • NCAP Career Center ..........................................................................24 • Your Community Health Plan ............................................................28 • VUCA ...................................................................................................30 CORRECTIONS AND ADVERTISING For rates and deadline information, please contact Rhonda Horner-Davis at rhonda@ncpharmacists.org

•From the President • Dr. Beth Mills, PharmD, CPP, BCACP, CDE

Spring into action!

Spring arrives in March and with it comes warmer days, brighter sunshine, and blooming flowers. This year, it also brings a sense of hope for safer gatherings with friends and family and a return to the life we had pre-pandemic. This hope we are feeling is largely due to the quick dissemination and administration of COVID vaccines and the declining numbers of positive cases, hospitalizations, and deaths caused by the COVID-19 virus.

Pharmacy professionals are crucial public health partners and play a vital role in this fight against COVID-19. Pharmacists, pharmacy technicians and student pharmacists are working tirelessly to get the COVID vaccine into people’s arms. We are making a difference in the lives of our patients. We are advocating for their health and well-being. Advocacy is an important part of being a pharmacy professional and brings about positive change for patients and the profession. When pharmacists are awarded their degrees, we take the Oath of the Pharmacist and vow to “embrace and advocate changes that improve patient care.” I recently spoke to student pharmacists from all four pharmacy schools in

North Carolina about the important role they play in advocacy efforts and how to be an agent of change. We discussed strategies for advocating for policy change, patients, and our profession as a whole.

One strategy is to raise public awareness of the value of pharmacy services. Each time you interact with a patient, ensure they know who you are. For example, “Hi, my name is Beth Mills. I am a pharmacist and I am here to give your COVID vaccine today.” We must continue to prove our profession, knowledge and interventions lead to improved therapeutic outcomes and quality of life for our patients. Every time we provide evidence-based recommendations or counsel a patient on their prescriptions, we are showing the value of pharmacy. We must believe in and support services pharmacy has to offer or is working to offer. Join and be active in your state pharmacy organization! Stay up to date on political issues by visiting NCAP’s advocacy page. Here you will find the most current information pertaining to bill language and legislative updates for issues such as PBM reform, collaborative practice, medication administration and pay parity. It is important to be well-versed on the policy changPage 3

es currently underway so we can teach others about them and garnish their support. Use what you learn to educate policymakers in our state. Contact elected officials through emails and letters. Call them or invite them to your practice site. Become a resource for pharmacy issues!

In this edition of the North Carolina Journal, Penny Shelton, Executive Director, provides a brief review of NCAP’s advocacy agenda. She is calling on you to take action - a “call to duty”. All pharmacy professionals need to be unified in their efforts to continue the momentum we are seeing. NCAP’s lobbyist, Tony Solari, recently told me “Beth, without a unified voice and grassroots support on important issues, legislators won’t take us seriously”. Independent pharmacists, health-system pharmacists, chain pharmacists, and long-term care pharmacists all have differing agendas and goals. NCAP serves to help unify our profession, but we must all come together and support pharmacy as one profession. As we look to the year ahead, we have hope for positive changes for our profession but we need you to “spring into action” for pharmacy advocacy! Beth Mills, PharmD

•From the Executive Director• Penny Shelton, PharmD, BCGP, FASCP

Indelible Marks of COVID-19

I really did not want my first column of 2021 to mention the words pandemic, unprecedented, COVID-19 or coronavirus, but this virus has permeated nearly every aspect of our lives, and is nearly impossible to elude. With the exceptions of my family and education, the virus is perhaps the most transformative event to occur during my life. It has changed how we work, play, learn, worship, shop and interact. For those we have lost, we grieve; and for survivors, well, we do not know what the long-lasting effects will be. The vaccine has brought much needed hope, and while we move toward a day when all are fully immunized, the desire to ‘return to a pre-COVID normal’ is a questionable goal at best. The goal posts have moved, and it is more likely, that it is a ‘new norm’ that awaits us. Sure, we eagerly await the ability to safely gather with friends and family, sans masks. We look forward to attending full capacity sporting events or concerts, and grabbing a meal or drink with colleagues after work at a local bar or restaurant. We want to hop on a flight for vacation, and our children want to invite

friends over and go to school again. The loosening of restrictions is slowly moving us in this direction. Yet, the adaptations made during the pandemic have most likely changed society forever.

As an example, telehealth took a leap forward during the pandemic. The virus was the catalyst for a greatly needed, and more flexible healthcare option. Associations, like NCAP, had to secure new technology and figure out how to provide greater online continuing education options for member, as well as facilitate new ways for members to interact. Online technologies previously used to facilitate business meetings opened new ways for families to spend time together remotely. So much of the impact of the pandemic has left indelible marks of painful loss, the loss of: lives, businesses, housing, food security, and more. Yet, the above examples of pandemic-driven, technology-supported changes are examples of indelible marks for gains that will remain in place long after the crisis passes. For the profession of pharmacy, a silver lining amidst the devastating consequences of COVID-19, is that the pandemic opened the eyes of policymakers and others to the important role that pharPage 4

macists have in the care of patients. More decision makers are beginning to see pharmacists as an underutilized resource. The pandemic illuminated gaps for which pharmacists are a natural, and dare I say logical, healthcare professional educated and trained to fill these gaps in care. The crisis, somehow made it okay for pharmacists to provide remote services, help with COVID testing, give CDC approved vaccinations to children, and administer COVID vaccines. NCAP like many other state associations, will in 2021, attempt to run legislation that builds off of the expanded scope permitted during the COVID crisis. It is extremely important for our profession to capitalize on this opportunity, now. This is one of the reasons why we will be running multiple bills this year. All of our profession needs to come together to support our issues. Pharmacists, pharmacy technicians and student pharmacists should turn to NCAP to learn more about the issues, and to find ways that you can help. Please review ‘Our Path Forward’ on pages 6-7 for a brief overview of our 2021 advocacy agenda. It is time for pharmacy to leave an indelible mark, by working together, to pass each of our bills, during this legislative session.

This year is perhaps the most important year in the history of the profession; therefore, I’m going to end my column with an ‘ask’ or a ‘call to duty’. Recruit a group of people at your place of employment that are willing to place a call or write a brief notecard to a legislator. Have them ready and waiting in the wings for when we put out ‘alerts’ to notify legislators about one of our bills. NCAP will provide you with everything you and they need to craft their message, but we need your help to recruit individuals to be ready. If you are willing to do this, please email me at penny@ ncpharmacists.org and provide your name, cell # and place of employment where you will be soliciting recruits to help. Pharmacy Proud,

Pharmacists as Advocates

• Click here to view the NCAP Legislative Newsletters • Click here to donate to the NCAP Advocacy Fund

Penny Shelton, Executive Director

Page 5

THE PATH FORWARD The NCAP 2021 Advocacy Agenda

NCAP Pushes For Major Change B Y P E N NY S H EL T ON , E X E C U T I VE D IR E C T OR The 2021 Legislative Session is out of the gate, and off and running! NCAP will be running multiple bills designed to tackle five (5) major issues; and if successful, will expand patient care and advance the practice of pharmacy in our state. Regardless of the grassroots strategies and tactics--needed for each of our bills-the one true path forward is 'unity'. We need a united front on behalf of all pharmacists, technicians and student pharmacists in order to succeed. Our message to legislators must be consistent and address the benefits for patients, our state's health rankings, as well as illuminate the local economic benefits for expanded authority and existing services. We know we will have some key battles in moving our legislation forward. Depending on the bill, our opposition will vary from large corporate entities, such as PBMs and health plans, to other healthcare-related associations. Pharmacy cannot afford to remain complacent. NCAP is doing what is in the best interest of our profession, our members, and the patients we serve. Over the years, pharmacy has, at times, been its own worst enemy. We can no longer silo ourselves into factions. We are all pharmacists, first, irrespective of practice settings or additional credentials. You wonder why pharmacists in other states can do things we cannot do here in NC, well now is our chance to change things. To change things, together! To walk this path, together! Please share this message and our advocacy agenda with other pharmacists and pharmacy staff.

HTTPS://NCAPPOLICYADVOCACY.WIXSITE.COM/MYSITE Page 6

Our Bills PBM Licensure & Protections Administer Injectable Drugs

Modernize & Expand Collaborative Practice Limited Prescriptive Authority for Public Health Needs

Payment Parity Under Medical Benefit for Patient Care Services

NCAP is committed to serving as your guide along this important journey. There is a link to our government affairs webpages provided in the footer of this article. In addition to posting updates, providing talking points, and other grassroots materials for each of our bills on this site, we will be using our advocacy newsletter to share news about the progress of each of our bills. We will also use our member emails, and online academy & forum discussion boards, to solicit support, as well as to put out 'call-to-action' alerts as needed during this long session.

2021 BILLS: KEY INTENT Pharmacy Benefit Managers Bill: The intent is to require PBMs doing business in North Carolina to be register with the Department of Insurance. The bill grants audit and rule-making authority to DOI to enforce greater transparency. The bill also addresses a number of consumer and pharmacy protections such as anti-steering. Drug Administration Bill: The intent is to expand pharmacists' scope of practice to include ability to administer injectable drugs.

"If you want to go far, go together." - A FR I CA N P R OVERB

Wisdom behind a 'unified' Association -

Collaborative Practice Bill: The intent is to modernize and remove unnecessary barriers to collaborative practice, which will better enable the use of CPAs in all practice settings. Provisions address any licensed pharmacist/physician, uses more holistic language for care, and adds physician assistants and nurse practitioners. Public Health Bill: The intent is to grant limited prescriptive authority per statewide protocols to allow pharmacists to provide drugs from a select list, including tobacco cessation, hormonal contraceptives, and HIV post-exposure prophylaxis. The bill also allows for test and treat for common non-chronic conditions, such as the flu. Payment Parity Bill: The intent is to require equal pay for patient care services, provided by pharmacists, under medical benefit of health plans, if the service would have been covered had it been provided by another healthcare provider, and the care is within the pharmacist's scope of practice.

HTTPS://NCAPPOLICYADVOCACY.WIXSITE.COM/MYSITE THE CROSS ROAD Page 7

P AGE 02

Mark your Calendars July 18

March 21

Your NCAP staff is excited to bring you lots of opportuNCAP 2021 Advocacy Agenda: nities to learn, expand your What Every Pharmacy Professional Should Know scope of practice and rack up Speaker: Dr. Penny Shelton, NCAP those very important conExecutive Director tinuing education hours. We have lots of amazing proApril 18 gramming planned for you this year. In addition to our Resiliency in Challenging and Turbulent Times monthly webinar series, we Speaker: Robert Granko, PharmD have our virtual Convention, student programming, ResMay 2 idency Conference and so much more. Keep checking A Care Transition Model Speaker: Mary-Haston Vest, the Events section on our PharmD website, www.ncpharmacists. org, for details and to regJune 6 – 9 ister for events. Mark your calendar for the following NCAP’s 2021 Virtual Convention dates!

Diabetes Care Initiative Speaker: Tara Baran, PharmD August 15

Pharmacy Law Topic Speaker: Geoffrey Mospan, PharmD September 19

New Drug Updates Part I Speaker: Lakeshea Love, PharmD October 17

New Drug Updates Part II Speaker: Lakeshea Love, PharmD

Stay tuned! More events to come.

NCAP is looking for Speakers

If you’re “in the know” when it comes to the latest updates, have ex-

pert advice or exciting research to share, NCAP is looking for YOU! Your presentation skills are needed for Convention, Webinars, Certificate Programs, etc. We want your name on our list! Interested? Contact Angie Broughton at angie@ncpharmacists.org. Page 8

NCAP Annual Meeting to Hold its 6th Annual Poster Session The NCAP 2021 Annual Convention will be presented in a virtual format June 6 – 9 and will host its 6th annual poster session. Presenting a poster at NCAP is an excellent opportunity to share your research with pharmacy practitioners all around the state! Selected abstracts will be published in the North Carolina Pharmacist: The Official Journal of the North Carolina Association of Pharmacists. Submissions by practitioners, students, and residents are welcome! Details of when and how the poster session will be presented will be advised to all authors of the posters chosen for presentation when they are notified their work has been selected. Categories:

Please submit your name, your credentials, and your abstract to Mindy Parman mgparman@gmail. com. Deadline: April 12, 2021. Status of submissions will be communicated to authors by April 30, 2021. Abstracts will be printed as submitted in the North Carolina Pharmacist: The Official Journal of the North Carolina Association of Pharmacists. Edits to abstracts cannot be made after submission. NOTE: Poster presenters MUST register for the Convention for the day of presentations. There will be no discounted registration, honorarium or speaker fee.

Original Research: Clinical or educational research appealing to an audience of pharmacy professionals in North Carolina. May include health services, pharmacotherapy, medication safety, or patient outcomes. Abstract Headings: Objective, methods, results, conclusions

Quality Improvement Evaluations: Assessments of quality improvement measures such as medication use evaluations or process improvements. May include ideas and practices new to system, or practice setting. Abstract Headings: Objective, methods, results, conclusions

Case Report or Series: Description of a unique patient case or series. May include novel indication, dose or administration of a medication. Abstract Headings: Introduction, case (s), discussion Word Count: 300 words (excluding author names and title)

Abstracts describing ongoing research will be considered with partially completed data. Descriptions of planned research without any data will not be accepted. Abstracts will be evaluated based on readability and organization, relevance, and potential impact to pharmacy practice.

Page 9

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New Drug

By Shaniqua Williams

Vibegron (Gemtesa®)

Distribution Vibegron is 50% protein bound and has a volume of distribution of 6304 liters.

Generic Name: Vibegron Brand Name: Gemtesa® Similar Agent: Mirabegron Classification1: β3-adrenoceptor agonist Manufacturer: Urovant Sciences, Inc. FDA Approval: December 23, 2020

Metabolism Vibegron is metabolized by the CYP3A4 hepatic enzyme.

Elimination Vibegron has a half-life of ~31 hours across all populations. It is excreted 59% (54% unchanged) in the feces and 20% (19% unchanged) in the urine.

Indication Treatment of overactive bladder (OAB) in adults with symptoms of urge urinary incontinence, urgency, and urinary frequency in adults. 1

Pharmacology1 Through the activation of beta-3 adrenergic receptors, vibegron increases bladder capacity by relaxing the detrusor smooth muscle during bladder filling.

Pharmacokinetics1 Absorption Vibegron reaches maximum concentration in the serum between 1-3 hours. Vibegron can be crushed and administered with a tablespoon of applesauce, as this does not affect the absorption when compared to taking a 75mg intact tablet. There are also no clinically significant differences in absorption upon taking vibegron with a high fat meal.

Clinical Efficacy2,3 The first phase III study to evaluate the efficacy of vibegron was a multi-center, 12-week, double-blind, randomized controlled trial that included 1232 Japanese patients with OAB. The primary endpoint of the study was to determine the change from baseline in the average daily number of micturition’s at week 12. Imidafenacin, an anticholinergic drug used in Asia, was used as an active control. Patients with OAB symptoms for ≥ 6 months who met the eligibility criteria entered a 2-week, placebo run-in phase. During this phase, patients received 2 tablets of vibegron placebo and 1 tablet of imidafenacin placebo in the morning and 1 tablet of imidafenacin placebo in the evening. Once eligibility was confirmed at the end of the run-in phase, patients were randomly assigned in a 3.3:3.3:3.3:1

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ratio to one of the following four treatment groups: vibegron (50 mg or 100 mg once daily), placebo, or imidafenacin (0.1 mg twice daily). Treatment with vibegron 50 mg and 100 mg significantly improved the primary and secondary efficacy variables, compared with placebo. Change in the number of micturitions per day at week 12 from baseline was -2.08 (-2.27,-1.89 CI; p <0.001) in the vibegron 50 mg group, -2.03 (-2.22,-1.84; p <0.001) in the vibegron 100 mg group, and -1.21 (-1.40,-1.03) in the placebo group. The most common adverse drug events reported with vibegron were nasopharyngitis, dry mouth, and constipation. This shorter 12week trial was limited by its inclusion of an entirely Japanese population.

been enough time to potentially evaluate safety data.

Dosing1,4 The recommended dosing for vibegron is 75mg orally once daily with or without food. Patients may also crush vibegron tablets and mix with a tablespoon of applesauce immediately followed by a glass of water. In patients with mild-to-moderate hepatic impairment (Child-Pugh A and B), no dosage adjustment is needed. However, in patients with severe hepatic impairment (Child-Pugh C), use is not recommended as vibegron has not been studied in this population. In patients with an estimated glomerular filtration rate (eGFR) of 15 mL/ minute/1.73 m2 or more, no dosage adjustment is needed. In patients with an eGFR less 15 mL/minute/1.73 m2 use is not recommended as vibegron has not been studied in these patients.

EMPOWUR was a phase III study that evaluated the efficacy of vibegron. It was a 12-week, double-blind, randomized control trial which aimed to assess the efficacy, safety, and tolerability of vibegron in 1518 patients with OAB. The co-primary Storage1 outcomes were the change from baseline to week Vibegron should be stored at 20°C to 25°C (68°F to 12 in the average daily number of micturitions and 77°F); however, excursions of 15°C to 30°C (59°F to change from baseline to week 12 in the average dai- 86°F) are permitted. ly number of urge urinary incontinence episodes for patients with wet OAB (frequency and urgency Availability and Cost1 accompanied by urge incontinence). Patients were Vibegron will be available in April of 2021 as a included if they were at least 18 years of age with a 75mg light green oval film-coated tablet in quantihistory of OAB, and were diagnosed by a physician ties of either 30 or 90. The cost for vibegron is not 3 or more months before screening. Adult patients currently available. with OAB with eight or more micturitions per day were randomized 5:5:4 to 75 mg vibegron, placebo, Summary/Use in Clinical Practice5,6 or extended-release 4 mg extended-release toltero- Current guideline therapies for the treatment of OAB include behavioral therapy as a first-line apdine. At 12 weeks, the least-squares mean change proach followed by the use of oral antimuscarinics from baseline in micturition frequency among 492 or oral β3-adrenoceptor agonists as second-line patients in the vibegron group was -1.8 episodes therapy. per day, compared with -1.3 episodes in the placebo group, with a least-squares mean difference of When compared to the established β3-adrenore-0.05 (95% CI -0.8, -0.2; p <0.001) . At 12 weeks, ceptor used for OAB, mirabegron, there are some the least-squares mean change from baseline in UI episode frequency among 383 patients in the vibe- similarities, but important differences do exist between the two agents. While both medications are gron group was -2.0 episodes per day, compared administered orally once daily, vibegron is available with -1.4 in the placebo group. The adverse events in an immediate-release tablet that can be crushed that were seen with vibegron with an incidence and mixed with applesauce. This provides a distinct of 2.0% and higher than placebo were headache advantage over mirabegron in populations, espe(4.0% vs 2.4%), nasopharyngitis (2.8% vs 1.7%), cially geriatric patients, who may have difficulty diarrhea (2.2% vs 1.1%), and nausea (2.2% vs swallowing. While long-term safety data are still 1.1%). A strength of this study is that it included a lacking, the data currently availably indicate that larger sample size. A limitation to this study was vibegron may provide a generally safer treatment the trial length of 12 weeks, which may not have Page 14

option when compared to mirabegron. Importantly, vibegron was not associated with elevations in blood pressure and, unlike mirabegron, it is not recommended for patients to have periodic blood pressure checks. In terms of drug-drug interactions, vibegron is a substrate for CYP3A4, but no CYP2D6 involvement is noted. Unlike mirabegron, a substrate for CYP3A4 and moderate CYP2D6 inhibitor, fewer drug-drug interactions are expected. Vibegron appears to be an effective and safe option for the treatment of OAB. There has been an extension study to the EMPOWUR trial to evaluate the safety/effectiveness in patients with patients with symptoms of OAB. The trial has been completed and results are pending. Shaniqua Williams is a PharmD Candidate (Class of 2021) at Campbell University College of Pharmacy & Health Sciences. slwilliams1217@email. campbell.edu References

1. Gemtesa [package insert]. Urovant Sciences Inc, Irvine, CA; Revised December 2020. https://dailymed.nlm.nih. gov/dailymed/fda/fdaDrugXsl.cfm?setid=25f21d2514f8-4fda-91f6-7aa8b68aa1c8&type=display. Accessed January 07, 2021. 2. Yoshida M, Takeda M, Gotoh M, Nagai S, Kurose T. Vibegron, a Novel Potent and Selective β3-Adrenoreceptor Agonist, for the Treatment of Patients with Overactive Bladder: A Randomized, Double-blind, Placebo-controlled Phase 3 Study. Eur Urol. 2018 May;73(5):783-790. doi: 10.1016/j.eururo.2017.12.022. 3. Staskin D, Frankel J, Varano S, Shortino D, Jankowich R, Mudd PN Jr. International Phase III, Randomized, Double-Blind, Placebo and Active Controlled Study to Evaluate the Safety and Efficacy of Vibegron in Patients with Symptoms of Overactive Bladder: EMPOWUR. J Urol. 2020 Aug;204(2):316-324. doi: 10.1097/ JU.0000000000000807. 4. Gemtesa. In: Clinical Pharmacology [database online]. Tampa, FL: Elsevier. https://www.clinicalkey.com/pharmacology/monograph/5301?sec=monindi&n=GEMTESA. Accessed January 07, 2021. 5. Drug Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: https://fco.factsandcomparisons.com/lco/action/sbs. Accessed January 29, 2021. 6. Myrbetriq [package insert]. Astellas Pharma US, Inc, Northbrook, Illinois; Revised April 2018. https:// dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl. cfm?setid=ba9e9e15-e666-4c56-9271-2e24739cfa2d&type=display. Accessed January 29, 2021.

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Member Spotlight The NCAP Ambulatory Care Academy is proud to introduce one of its newest members, Dr. Geena Eglin. Geena earned her Doctorate in Pharmacy from MCPHS University in Boston, Massachusetts in May of 2018. Geena completed a PGY1 Community-Based Pharmacy residency program at Baystate Medical Center in Springfield, Massachusetts. There she spent her longitudinal learning experiences in various patient care settings including several pharmacist-led pharmacotherapy clinics, specialty pharmacy and transitions of care. She then completed her PGY2 Ambulatory Care Pharmacy residency program at New Hanover Regional Medical Center (NHRMC) in Wilmington, North Carolina. Geena was a stellar resident and was recognized with two of the three annual residency awards given at NHRMC. For

her outstanding clinical, teaching and interpersonal skills, Geena was the recipient of both the NHRMC Resident Practice Award and the Resident Teaching Award. Geena currently works at Novant Health New Hanover Regional Medical Center (NHNHRMC) as an ambulatory care clinical pharmacist in the area of specialty disease state management. This position is the first of its kind, where Geena has been tasked to expand outpatient pharmacy services beyond those established in primary care practices into specialty clinics at NHNHRMC. To implement this new specialty pharmacist service line, Geena has pulled from her vast range of past pharmacy experience noting the benefits of her residency programs. “I couldn’t have ended up where I am Page 17

today without first completing a Community-Based PGY1 as it exposed me to the varied roles of pharmacists in the world of ambulatory care” she states. Geena followed by saying “from there, an ambulatory care PGY2 at NHRMC was a no-brainer!” Those of us in residency training know if is always rewarding to keep one of your graduates on board as a colleague. So it is no surprise that, the pharmacists at NHNHRMC have been excited to have Geena’s engaging personality and enduring work ethic as part of the team since July of 2020. Her most recent accomplishments include becoming both a Board-Certified Ambulatory Care Pharmacist (BCACP) as well as a Clinical Pharmacist Practitioner (CPP) in the state of North Carolina in November of 2020. In addition to Geena’s

patient care services, she is also a preceptor and mentor to PGY1 and PGY2 Pharmacy residents as well as student pharmacists at NHNHRMC. Geena’s commitment to her patients stretch far past the walls of the clinic, as she is continuously involved in community outreach services, from flu clinics to medication take back events and everything in between. Geena has also been a continuous volunteer in the COVID-19 vaccination clinics hosted by NHNHRMC since late December. The pharmacy team, with Geena’s assistance, has enabled the health system to deliver over 30,000 vaccinations to the patients within Southeastern North Carolina. When she is not at work or volunteering, you can find her somewhere outside, whether it’s on the beach or hiking, spending time with her friends and family. Geena is excited to become more involved in the Ambulatory Care Academy to make connections to other practitioners across the state, especially in the area of specialty pharmacy. Geena has a passion for expanding pharmacy services to underserved populations and reducing barriers to care for all patients.

Please help the Executive Board of the NCAP Ambulatory Care Academy in welcoming Geena!

Geena Eglin, PharmD, BCACP, CPP

Written by: Michelle Rager, PharmD, BCPS, CDCES, CPP Page 18

Pharmacy Audit A Message From PAAS National Clinical Note Best Practices Pharmacy Audit Assistance Services PAAS National® has recently seen audit results from a MedImpact/ SCIO Health Analytics virtual audit where prescriptions were flagged for full recoupment due to the discrepancy 4D (Unauthorized Changed/Altered Prescription). Each prescription was clarified with the prescriber’s office; however, the date of the annotations was missing. Enforcement does not appear to be widespread, so this could be the result of an auditor error.

• Some pharmacies have created customized ink stamps to facilitate, and promote, consistent process for staff

PAAS suggests that pharmacies implement standardized clinical note practices that include four (4) elements:

By Trenton Thiede, PharmD, MBA, President at PAAS National®, expert third party audit advice and FWA/HIPAA compliance.

• Notes such as “per MD” or “per RN” have been insufficient for item #3 in some audits • Verbal clarifications with prescribers do NOT change the origin code of the prescription

PAAS National® is committed to serving community While PAAS strongly objects to this type of aggressive pharmacies and helping keep hard-earned money auditing practice, we want to share this experience as a where it belongs. Contact us today at (608) 873-1342 reminder to encourage best practices to protect against or info@paasnational.com to see why membership cut-throat auditors in the future. might be right for you.

1. Date of the annotation 2. Specific information being clarified 3. Name and title of the person providing the information 4. Pharmacy staff name/initials

PAAS Tips: • Electronic annotations in pharmacy dispensing software may have electronic date/user stamps that automate items #1 and #4

paasnational.com Page 20

Call for Articles North Carolina Pharmacist (NCP) is currently accepting articles for publication consideration. We accept a diverse scope of articles, including but not limited to: original research, quality improvement, medication safety, case reports/case series, reviews, clinical pearls, unique business models, technology, and opinions. NCP is a peer-reviewed publication intended to inform, educate, and motivate pharmacists, from students to seasoned practitioners, and pharmacy technicians in all areas of pharmacy. Articles written by students, residents, and new practitioners are welcome. Mentors and preceptors – please consider advising your mentees and students to submit their appropriate written work to NCP for publication. Don’t miss this opportunity to share your knowledge and experience with the North Carolina pharmacy community by publishing an article in NCP. Click on Guidelines for Authors for information on formatting and article types accepted for review. For questions, please contact Tina Thornhill, PharmD, FASCP, BCGP, Editor, at tina.h.thornhill@ gmail.com.

North Carolina Pharmacist is the Official Journal of the North Carolina Association of Pharmacists Located at: 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649 www.ncpharmacists.org Page 22

Why should a pharmacy technician get PTCB certified? Ted Spader, R.Ph B.S. Over the past 3 years, I have seen many people take my Pharmacy Technician Certification Board (PTCB) review course with high hopes of passing the pharmacy technician certification exam. I always ask why they came to the class and more importantly, why they want to get certified. Here are some of the answers: Pharmacy technicians want to increase their salaries and if PTCB certification gives them the opportunity to “climb the ladder”, why not take the PTCB test. Certification is the next step that states will be taking in relation to improving the quality of pharmacy. Certified techs will be an integral part in the pharmacy team and in order to stay on the cutting edge, techs need to prepare and take the test. In some states, PTCB certification is mandatory in order to be a pharmacy technician. There are some companies that also require their techs to be certified. The job market opens up for those qualified techs, while others may be left in the cold. Some techs want the respect that comes along with a certificate on the wall stating that he/

she has successfully passed the PTCB exam for certification. They can prove that they have mastered the skill necessary to be a good technician. Many techs feel a sense of accomplishment when they pass the test and are now part of a professional team. They try harder, they read more about their profession, and they even have more meaningful responsibilities. Some techs take the exam in preparation for pharmacy school. The PTCB website’s practice exam is a rigorous insight into the knowledge needed, not only to pass the PTCB exam, but also in the day-to-day activities in the pharmacy. I think that many of the people taking the exam are fearful of being passed over in their position if they don’t improve their skills and become certified. Mandatory certification is not just in the future; it is in the near future. Many state requirements are paving the way for pharmacy technician certification. Tech registration with the Board of Pharmacy is the first step toward regulating the technician Page 23

field. The legislation allowing an increase in the ratio of pharmacists to technicians with a certified technician shows the future need for these techs. The demands that are increasing on pharmacists will ultimately require more activities and responsibilities be put on the shoulders of technicians with legislation backing them. Ultimately, the pharmacist-technician bond will not only strengthen but also augment each other in their daily activities. We pharmacists should not only support our techs toward certification, we should promote their interest in becoming certified. It is their future that will make the profession of pharmacy brighter. To learn more about the available learning modules click on the EduPharmTech logo below. Use the discount code NCAP for 10% off.

The Value of Membership When you join the Association, your membership dues are put to work immediately supporting our noble profession. NCAP is the essential and sole organization representing and fostering the advancement of pharmacy in North Carolina. Your membership helps to build awareness, create value, and generate a voice for pharmacists, pharmacy technicians and student pharmacists. While you are taking care of your patients and practices, the Association’s role is to take care of you, by protecting and advancing our profession. Every dollar of your membership dues goes to support: the development of resources and educational programming; the work of our Board, practice academies, forums, and special interest groups; our advocacy agenda; practice advancement initiatives; committees and general operations. Membership Benefits

“accept the lifelong obligation to improve (your) professional Legislative and Regulatory Moni- knowledge and competence”. NCAP provides diverse LIVE and toring and Representation ON-DEMAND continuing educaWhile you are hard at work tion programs throughout the taking care of your patients, practices, and businesses, NCAP year. We provide flexibility to is serving to represent your voice your learning needs, and enable on legislative, regulatory and oth- you, to not only enhance your er policy-related issues which im- knowledge and skills, but to also meet your annual license renewal pact the profession. NCAP is the requirements. We also provide sole organization that provides a number certificate programs a collective voice for pharmacy. NCAP works with a lobbyist to designed to provide in depth skill enhancement. Our professional carry out our advocacy agenda. development programs are open to pharmacists, pharmacy techProfessional Development nicians and student pharmacists. Many of our live and on-demand When a pharmacist takes the programs are free to members, Oath of a Pharmacist at the time of graduation, you vow to and for those that do require Page 25

payment, the price is discounted for members. Event Discounts

NCAP host an annual convention each year that includes continuing education, networking, roundtables, scientific posters and residency showcase. The annual convention is relevant to all areas of practice. Beginning in 2021, the annual convention will be held in the June/July timeframe. NCAP hosts a Health-System Leaders’ Summit, twice annually, to bring together leaders from our state’s hospitals. Likewise, the Association facilitates town hall style meetings for our Independent Pharmacy Net-

work. NCAP also hosts focused workshops to help pharmacists and technicians develop specific skills. Members receive significant discounts off registration for NCAP hosted events. Individual Credit for CME-Accredited Continuing Education

NCAP will co-accredit continuing medical education programs that pharmacists attend. Individuals must submit a form, along with requested documents, in order for NCAP to review, and make a decision on issuing an NC-CE number that can be used for renewal of your NC pharmacist license. This service is FREE for NCAP members and $20/credit hour for non-members. Practice Tools and Resources

NCAP provides a number of innovative and helpful practice tools and resources for our members. Examples of available resources include, a COVID-19 Testing Toolkit, an Immunization Toolkit, and an Establishing Clinical Services Toolkit. Our toolkits are designed to provide the nuts and bolts of what is needed to carry out a specific clinical-related need in your practice. Other types of resources available include grant participation opportunities for our members. NCAP grants are related to cutting-edge practice. Our members are the first to be provided with opportunities to participate. Virtual Networking Communities

NCAP supports a variety of online groups, to help support the special interest of our members. As examples, we have an online community for new members, one for Independent Pharmacy pharmacists and technicians, student pharmacists, new practitioners and others. Our association management system has the ability to provide an online community for any special interest group to help facilitate the networking needs of our members. Keeping You Informed

Staying current with what is happening in our profession is one of the hardest things to do. NCAP keeps members informed through a number of different types of media. Members receive access to two monthly newsletters: 1) general association and industry-related news (E-news), and 2) our Legislative & Policy Update. In addition, members receive access to our quarterly journal. NCAP also helps keep members informed through online posts and emailed ‘alerts’ and ‘calls to action’. Practice Academies

NCAP has four practice academies for members to choose from: Ambulatory Care, Chronic Care, Community Care and Health-System. The academies are excellent for networking with colleagues who do similar work to you. Members for each academy elect their leadership team members. The chairperson for each academy serves on the Board of Directors, this helps ensure that your voice and practice perspective is represented in the Page 26

governance of our Association. As a part of your regular NCAP membership dues, pharmacists, pharmacy technicians and student pharmacists can select to be a member of one or more practice academies. New Practitioner Opportunities

Members in the first seven years of their career as a pharmacist are automatically included in our New Practitioner Forum (NPF). NPF is a great way to meet individuals, just like you, who are starting out in their pharmacy career. NPF sponsors a number of emerging leadership opportunities for NPF members and residents, as well as networking events to facilitate camaraderie among newest generation of pharmacists, including our annual Residency Conference. Becoming active in NPF provides you with an opportunity to participate in activities specifically designed for new practitioners, and it has been our experience that individuals who join after graduation and are involved in our NPF, many times these are the same individuals who go on to help lead our practice academies and other Association leadership roles. Career Center

Located on our website. Members are invited to create free “job seeker” accounts, set up automated job alerts, and post resumes. Employers can post positions and feel confident in attracting the most qualified candidate pool.

Student Loans and Loan Consolidation Services Pharmacy school is an expensive investment, and many new graduates emerge with considerable student loan debt. NCAP has partnered with Laurel Road, an industry leader in student loan consolidation, to help our members find solutions to their student loan needs. In addition, NCAP recognizes that 4th year pharmacy students generally have additional unplanned costs associated with their final year in school (egs., your car needs repairs or you need help with graduation-related expenses). Our NCAP Endowment offers a limited number of small student loans to 4th year student members. Awards

Each year, NCAP recognizes individual professional excellence during our Annual Convention. Awards are presented to individuals who have been nominated, selected by the Nominations Committee, and recommended to the Board of Directors for approval. Discounts on Home, Travel and Entertainment

All members have access to exclusive savings on home-based services and shopping, movie tickets, theme parks, hotels, tours, Broadway and Vegas shows, and much more. In order to receive savings, you must be a member of NCAP and you can register online at Working Advantage.com. You will be prompted to create an account with your

email address and our company promo code NCpharm.

Our State Magazine Discount

NCAP has teamed up with Our State magazine to bring our members a discount off the annual subscription rate for the premier food, entertainment and travel magazine for all-things-North-Carolina. Whether you were born and bred here or are new to North Carolina, everyone enjoys the featured articles and photography showcasing places all across our state. Go to OurState.com and enter the NCAP promo code. Financial Services

The Gidley Group, a financial advisory practice of Ameriprise Financial Services, LLC, provides comprehensive financial planning and investment management services for individuals and families. The Gidley Group offers members of the North Carolina Association of Pharmacists a complimentary financial assessment for their financial planning needs. Whether you are just starting out in your career, contemplating retirement or somewhere in between, we know our members will find this personal service to be beneficial. The initial consultation provides an overview of financial planning concepts. You will not receive written analysis and/or recommendations.Investment advisory products and services are made available through Ameriprise Financial Services, LLC, a registered investment adviser.Ameriprise Financial Services, LLC, Member FINRA and SIPC.© 2020 Ameriprise Financial, Inc. All Page 27

rights reserved.

Pharmacists Mutual Insurance

Committed to the pharmacy profession, endorsed partner Pharmacists Mutual works closely with state and national pharmacy associations. Pharmacists Mutual can provide up to a 30% discount to members on disability insurance and offers a complete range of professional, business and personal insurance products and services. Click here for a listing of products and services offered by Pharmacists Mutual. Call 800.247.5930 or visit www. phmic.com.

Member Types Active Pharmacist -$195 Resident/Fellow- $50

1st Year Pharmacist - $50

2nd Year Pharmacist - $100 Joint Membership - $310

Out of State Pharmacist - $95 Retired Pharmacist - $95 Pharmacy Student - $10

Technician Student - $10

Pharmacy Technician - $35 Associate - $195

Join Now at ncpharmacists.org

YOUR COMMUNITY HEALTH PLAN Big Health Plan Options for Small Groups are Now Available Groups with 5+ employees, self-funding is possible with Your Community Health Plan. Big or small, Your Community Health Plan believes that all employers should have health plan options that work for both their employees and their bottom line. Access to an ERISA qualified Level Funded Health Plan is now accessible for groups between 5-100 lives.

Plan options include:

No Cost Primary Care Your employees have access

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Employers gain independent

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pricing for all your prescriptions.

consultation and evaluation, a plan

including telehealth, are covered

Giving you a personal pharmacist

appointed claims evaluator, and a

at 100% by the plan.

for guidance and advice.

named "Fiduciary". You and your employees have legal counsel in case of surprise billing issues or fraud.

All your hard work will pay off soon!

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REALTY

ELITE

What we do? VUCA Health has created the largest library of medication education videos that can integrate into websites, mobile apps, smart speakers, and pharmacy management systems. We work directly with health systems, pharmacies, and developers to equip them with a new way to deliver patient education and improve outcomes. In all 50 states, pharmacies can now offer a paperless alternative to the traditional leaflets given with every prescription.

VaccineSheets.com - Vaccine Info Statements all in one place. VaccineSheets.com was created by VUCA Health to help pharmacies and other healthcare providers provide digital access to vaccine information statements (VIS). We have created three ways you can provide your patients with a digital VIS: Provide Link Show QR Code Print VIS QR Code

@VUCAHEALTH