North Carolina Pharmacist Volume 105 Number 3 by North Carolina Association of Pharmacists

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

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

LAYOUT/DESIGN

Rhonda Horner-Davis

EDITORIAL BOARD MEMBERS

Anna Armstrong

Jamie Brown

Lisa Dinkins

Jean Douglas

Brock Harris

Amy Holmes

John Kessler

Angela Livingood

Bill Taylor

BOARD OF DIRECTORS

EXECUTIVE DIRECTOR

Penny Shelton

PRESIDENT Bob Granko

PRESIDENT-ELECT

Tom D’Andrea

PAST PRESIDENT

Ouita Gatton

TREASURER

Ryan Mills

SECRETARY

Beth Caveness

Cassey Zendarski, Chair, SPF

Micaela Hayes, Chair, NPF

Lisa Dinkins, Chair, Community

Tyler Vest, Chair, Health-System

Kimberly Hayashi, Chair, Chronic Care

Mackie King, Chair, Ambulatory

Angela Livingood, At-Large

Elizabeth Locklear, At-Large

Macary Weck Marciniak, At-Large

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.

North Carolina Pharmacist

A Few Things Inside

Welcome to my third installment for the North Carolina Association of Pharmacists. Continuing with my theme of being “Of Service,” I present two evergreen pharmacy service topics: Fostering Collaboration and Strengthening Others. Fostering collaboration within the practice of pharmacy is essential for enhancing patient care and optimizing health outcomes. By integrating pharmacists into multidisciplinary healthcare teams, we can leverage their expertise in medication management and therapy optimization. Open communication channels ensure that pharmacists’ and pharmacy technicians’ insights are incorporated into patient care plans, ultimately improving patient safety and enhancing the overall efficiency and effectiveness of healthcare delivery. Kind of why we are in the business, don’t you think?

At the center of collaboration is the concept of Trust. Trust is built through consistent, transparent, and reliable actions over time, fostering strong relationships and mutual respect. It requires an ongoing commitment to integrity and accountability, ensuring trust is maintained even in challenging situations. Ultimately, sustainable

Robert P. Granko, BS Pharm, PharmD, MBA, FASHP, FNCAP

Embracing the Future: A Vision of Trust and Confidence

trust enhances collaboration and works to ensure our long-term success. After all, pharmacists are ranked as the third most trusted medical professionals among various occupations in Gallup’s 2023 Annual Rating of Honesty and Ethics survey, where 58% of Americans ranked pharmacists as having high honest and ethical standards—something I know I am proud of and hope you are as well.

As we foster collaborations within our team, building off the centerpiece of trust, we must enable others to act. We can do this in many ways, but one way I’d like to highlight is developing their capabilities, their skills, and their abilities—yes, I mean their competence. Building someone’s competence (and maybe their confidence) involves providing them with the necessary training, resources, and support to develop their skills and knowledge. Regular feedback and opportunities for hands-on experience help reinforce learning and boost confidence. Encouraging continuous professional development and setting achievable goals further enhances their competence and performance. A focus on continuous professional development is paramount for advancing our profession, especially given the

rise and intersection of Artificial Intelligence and its budding role in our beloved profession. By working together and empowering each team member, we can achieve superior patient outcomes and drive continuous improvement. Allow me to make a request? Can you work towards a commitment to deploying these principles, with a goal of building a stronger, more cohesive, and inclusive practice setting? Next time we cross paths, I’d love to hear your success story!

P.S. Don’t forget to join us at the 2024 NCAP’s 26th Annual Anti-Infective Conference, Friday, October 25th.

2530 Professional Road Suite 200 North Chesterfield, Virginia 23235

Toll Free: (866) 365-7472

www.medicationsafety.org

As I write this, yesterday was the first day of fall, and our nation is in the final rounds of the 2024 “Battle Royale” known as the presidential general election. It does not matter whether you are a first-time or seasoned voter. It does not matter whether you identify as Democrat, Republican, Independent, Libertarian, Green, or other party member. One thing is for sure, everyone has grown tired of political ads and polls. Sadly, over the past few decades, our nation and its politics have become increasingly divisive and vitriolic. It has been said that the divisiveness of our nation’s political process has taken the “united” out of the United States of America. Although my column comes at election time, it is not focused on the state of American politics. Instead, I’m using the backdrop of this election to illuminate the importance of and the potential fragility of “unity” among our profession as we continue to fight for important pharmacy legislation here in North Carolina.

The North Carolina Association of Pharmacists was founded on the very premise that unification produces strength. We are truly “stronger together.” These two

Penny S. Shelton, PharmD, FASCP, FNCAP

Stronger Together

words are never truer, and the proof of their meaning is never more evident than in our Association’s legislative efforts. The statement is more than just words on paper, it is the very principle upon which we operate. The 2023-2024 legislative session has been very challenging. The Jones’ Street politics within the General Assembly have taken us on quite the rollercoaster ride, with the highs of victories like expanded immunization authority and the lows of losses like a committee killing the payment for pharmacist-provided healthcare services provision. Then there has been the ongoing battle to pass the PBM reform bill. No other bill has produced the level of grassroots activism among pharmacy professionals as we have seen with H246. Of late, media outlets have been running stories on this bill. The media coverage is important to help educate the public about what H246 is really about; otherwise, the residents of North Carolina only see and hear the negative social media posts planted by the opposition.

Setting expectations for pharmacists and others is important. Passing legislation is no easy feat. When it comes to the General Assembly, any victory of any size is a huge victory. Although H246 has not passed, we have gleaned extraordinarily important insight

into the strategy and tactics necessary to get PBM reform legislation signed into law. It is easy to become frustrated and to retreat. NCAP promises to continue to fight for the profession and the patients we serve. We ask that you, too, turn your frustration into steadfastness and remain committed to the ongoing work alongside us. As a profession, we must remain vigilant and unified. In the face of frustration, factions can form, and unity can become fragile. Mahatma Gandhi once said, “Unity to be real must stand the severest strain without breaking,” and Henry Ford stated that “if everyone is moving forward together, then success takes care of itself.” There is an abundance of common sense steeped within these two quotes. Strong advice for our profession right now! As we continue to find a way to succeed in passing important pharmacy legislation, one message looms louder and rings truer than any other, and that is: our patients cannot afford for our profession to be divided. We stand zero chance of success if we attempt to stand divided.

Twenty-five years ago, our profession saw great value in unifying. Unification does not mean we will never disagree, but we agree to work together to achieve a common goal for the profession. Joe Echevarria, the previous CEO of

Deloitte and current CEO & Acting President of the University of Miami, is credited with saying, “The best way to predict the future is to create it together.” We know the future we want for the profession and the future needs of our patients and communities. Together, we can achieve that future. How can you help instill unity and togetherness in this fight for what is right for the profession and patients?

First, if you hear pharmacists or technicians expressing their frustration over the PBM reform bill or any other piece of legislation:

1. Share the difficulty of passing any legislation and explain that we are not giving up.

2. Ask if they are members of and follow the news from the North Carolina Association of Pharmacists.

3. Ask if they have a relationship with their state senator and/ or representative. If not, share the importance of establishing a personal relationship.

4. Ask if they participate in calls to action on state pharmacy bills.

Second, it is essential that our profession have a strong political

action committee (PAC). A PAC allows us to “unite” our fundraising to support election campaigns for pharmacy-friendly legislators. Individual contributions have more power when we combine our giving through a PAC. NCAP recently assumed the management of the North Carolina Pharmacy PAC “Pill PAC.” We have been told that based on the number of pharmacists and pharmacy technicians in the state, if everyone gave to the PAC, pharmacy would have one of the most powerful PACs in the state. We have created a new “Rise Up. Join the Fight for Pharmacy” campaign, and now is the time for us to work together to rebuild the PAC. I hope you will join us by giving whatever amount you can afford to give. Go to https://pillpacnc.org or text the word “Pills” to (704) 396-5553. Please share this PAC information and encourage your colleagues to give, too. Every dollar helps, for we are stronger together!

Pharmacy Proud,

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All NCAP members can unlock the best life has to offer with exclusive savings on: Theme Parks, Attractions and Shows; Hotels, Flights and Rental Cars; Concerts, Sports and Live Events; Movie Tickets; Electronics and much more. Visit the Membership Benefits tab at ncpharmacists.org to find out more!

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Penny

Get To Know The NCAP Lobbyists

An Amazingly Effective Team

In late 2019, the NCAP Board of Directors made a decision to change lobbyists to help better position the Association to achieve success with our ever-increasing legislative agenda. We knew that in the next long session, 2021-2022, our agenda would include multiple bills. After putting out a request for lobbyist applicants and conducting interviews, the Board chose to contract with Solari Government Solutions. Anthony “Tony” Solari began working with NCAP in January 2020, focusing that year on grass-root and grasstop preparations for what would end up being the most successful legislative year for North Carolina pharmacy.

Tony Solari earned his M.A. and Ph.D. in Political Science from Duke University. He has a long-standing career in government affairs, including serving as a policy analyst for the State Treasurer’s Office, as the lead lobbyist for NC Smart Start, and as the lobbyist for NC Sustainable Energy Solutions. Solari was named one of the most effective lobbyists by the NC Center for Nonprofits. He also teaches in the Department of Political Science at NC State University.

In 2021, while working with NCAP, Solari made the decision to team up with former Representative Debra Conrad. Conrad served four terms, 2013-2020,

in the NC General Assembly, representing House District 74. She earned degrees in chemistry and microbiology, and after college, she worked at Wake Forest University School of Medicine. Over the years, while living in Winston-Salem, raising a family, and running a business, she became more and more involved in her community. During this time, she began building both an interest and a successful service record in local politics. She was very involved in the Winston-Salem Chamber of Commerce. She served on the Board of Trustees for Novant Health and the Triad Film Commission. In 2013, she was elected to her first term in the NC House. Today, she runs Conrad CapitoLink, LLC.

Solari and Conrad’s collective political experience and connections create an amazingly successful and synergistic lobbying team for NCAP. They work tirelessly for NCAP, providing a number of valuable services in addition to lobbying in Raleigh. They were instrumental in helping enact S.257, the “Medication Cost Transparency Act,” as well as H.96/S.575, “Allow Pharmacists to Administer Injectable Drugs,” and “Pharmacists Improve Public Health Needs.” They worked on various pieces of legislation regarding COVID-19-related pharmacy/ patient issues and helped pass legislation requiring PBMs oper-

ating in the state to be licensed by the Department of Insurance.

In the 2023-2024 legislative session, their work helped ensure that S.206 passed, granting pharmacists greater immunizing

Anthony Solari Solari Government Solutions

Debra Conrad Conrad CapitoLink

authority and securing qualified technicians’ ability to continue immunizing once the federal PREP Act provisions expired.

Solari and Conrad worked diligently to get both “payment for pharmacist-provided health care services” and “modernizing collaborative practice” provisions into H.125, which was successfully passed by the Senate and then sent back to the House. The bill was referred to a Conference Committee to reach an agreement on a final version to put before both chambers. Unfortunately, the committee removed both provisions prior to a late-night vote by the Senate and House.

At the time of this article, H.246 is technically still alive, but there is little hope that the Senate will pass some version of this bill when they return to Raleigh following the general elections in early November. However, Solari and Conrad are still hard at work on this bill, helping to build a coalition of allies. They have been working with NCAP leadership to

meet with county commissioners, chambers of commerce, and patient advocacy groups. These relationships are important because if we have to start over in 2025 with a PBM reform bill, our experience with the NC Senate in the 2023-2024 session has taught us that it will take more than pharmacy advocating for PBM reform to pass this type of legislation successfully.

They worked with members of both the House and Senate to introduce a Test and Treat bill during the session. The experience with this bill helped us to identify legislative allies and champions for a future attempt at successfully running this type of legislation.

Solari and Conrad worked primarily on H.246, the PBM Reform Bill, in 2023 and 2024. The Bill was passed unanimously in the House in April 2023; however, it was prevented from being heard in the Senate Health Committee. Nearly two years of work went into educating Senate members and Senate Lead-

ership about the importance of and need for PBM reform in North Carolina.

The vast majority of contract lobbyists and lobbying firms only provide limited services to non-profit organizations like NCAP. But Solari and Conrad are highly effective, full-service providers. In addition to the numerous hours spent in the legislative buildings in Raleigh, they also support the Association’s advocacy work by assisting with webinars and workshops and providing regular updates for our news. They meet every other week with the NCAP Policy & Advocacy Committee, and they meet at least weekly with the NCAP Executive Director. Solari and Conrad help organize Pharmacy Legislative Day and assist with getting legislators to speak at NCAP-hosted events. They also write letters and emails of support to the media and stakeholders on both state and federal pharmacy issues.

Rest assured, your NCAP lobbyists are effectively representing our profession.

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Poster Abstracts

Category: Original Research –Poster 2

Title: Impact of Change in HbA1c after initiation of Continuous Glucose Monitor (CGM)

Authors: Eberwein, A; Blum, A; Patel, R; Gaines, D

Institution: Eastern Carolina Medical Center

Objective: One key aspect of treating Diabetes is accurately monitoring blood glucose levels. As CGM technology continues to improve and more insurance plans cover these devices for patients, it is important to see how continuous glucose monitor (CGM) use impacts disease management. The primary purpose of this study is to investigate the change in hemoglobin A1C (HbA1C) 3 months

The scientific posters session is an excellent opportunity for practitioners, students, and residents to share research with pharmacy practitioners all around the state! Selected abstracts are published below.

after starting either a Dexcom™ or Freestyle Libre™ CGM to monitor blood glucose. The secondary objective is to see if there was a difference in HbA1C change between patients who use insulin and patients who do not use insulin.

Methods: This is a retrospective observation study in a rural clinical medical practice. The data was reviewed from 119 patients who received either a Dexcom™ or Freestyle Libre™ CGM between January 1, 2018 to December 31, 2023. Those excluded are patients who have not been seen by a provider since July 1, 2023, patients with Type 1 diabetes, patients using a closed loop pump with CGM integration, and patients who did not have a HbA1C drawn within one year of CGM initiation.

Results: A total of 31 patients with a mean age of 63.4 years

and a mean starting HbA1C of 8.1% were included and analyzed. Data collected included change in HbA1C after CGM initiation, time to next HbA1C after CGM initiation, and enrollment status in Diabetes Self-Management Education and Support Services (DSMES). The average change in HbA1C from the 31 patients assessed, reviewed, and analyzed was –1.2% (p value 0.000005) and follow up A1C average was 4.2 months. A total of 29 out of 31 patients were seen for DSMES.

Conclusion: In patients with uncontrolled type 2 diabetes seen at Eastern Carolina Medical Center, initiation of a CGM enhances glycemic control and lowers HbA1C.

Category: Original Research –Poster 3

Title: Promoting Health Literacy: Efficacy of an Obesity Focused Educational Intervention

for Undergraduates

Authors: Cameron Carter, PharmD Candidate, Maggie Nobles, PharmD Candidate, Nicholas Castellucci, PharmD Candidate, Matthew McCall, PharmD Candidate, Fatma alDhefery, PharmD Candidate, and *Amie J. Dirks-Naylor, M.S., Ph.D.

*Corresponding author

Institution: Wingate University School of Pharmacy, Wingate NC

Objectives: Obesity is a progressive issue that affects 1 in 3 adults in the United States. Research shows that educational interventions can positively impact community knowledge levels and implementation of anti-obesity lifestyle habits. The objective of this study was to determine the impact of an obesity-focused educational intervention on undergraduate students’ knowledge of the disease state. Correlation between personal exercise habits and health literacy levels were also investigated.

Methods: An interactive educational lyceum was held at Wingate University. Study participants were undergraduate students at Wingate University aged 18 years and older. Participants were recruited via flyers, campus wide emails, and a university managed lyceum calendar. Pre- and post-surveys were used to collect information on demographics, personal habits,

and knowledge of obesity and obesity related topics. Participant engagement involved three interactive activities within the educational session.

Results: 97 and 96 participants completed the pre- and post-surveys, respectively. Results showed that the intervention improved knowledge of general obesity information and related topics of sleep, exercise, and nutrition. The number of knowledge-based questions answered correctly increased from 49% to 71% following the intervention. Every knowledge-based question showed improvement from pre- to post-intervention. There was no correlation between participants’ baseline personal habits and knowledge levels.

Conclusion: The results suggest that the intervention was able to significantly improve undergraduate students’ knowledge of obesity and obesity related topics including sleep, exercise, and nutrition, better preparing them to live an obesity-free lifestyle. This research highlights the valuable role of targeted educational interventions in fostering health literacy and promoting healthy lifestyle choices among college students.

Keywords: Obesity, Health Literacy, Health Education, Health Promotion, University, College Education, Undergraduate Students

Category: Original Research –Poster 4

Title: Clearing the Air: A Pharmacy Student-Led Health Education Initiative to Com -

bat Adolescent Tobacco Use

Authors: Dakota Chavis, Aveeda Thavichith, Dalia Chamma, Vanessa White, Jasmine Jones, Bienfaiteur Mugisha, and Amie J. Dirks-Naylor MS, PhD

Institution: Wingate University School of Pharmacy, Wingate NC

Objectives: Tobacco use among adolescents is a growing problem that yields many negative side effects including cancer, lung disease, heart disease, and even death. Lowering the use of tobacco among the adult population starts with the prevention of tobacco use initiation. Thus, the objective of this study is to investigate the efficacy of an interactive educational session conducted by pharmacy students to enhance tobacco knowledge among fourth-grade students.

Methods: The study involved educating 4th-grade students from two local elementary schools. Pharmacy students delivered educational sessions to five classes, focusing on the complications and negative health effects associated with tobacco use, as well as the importance of avoiding initiation. Each educational session consisted of a short slideshow followed by an interactive activity. The efficacy of the intervention was assessed through a pre-and post-assessment to measure knowledge gained.

Results: Out of a total of 112 fourth-grade students, 108 completed the pre- and post-assessment. The results confirmed that the intervention increased the participants’

knowledge about tobacco use and its harmful effects, with a 13% score improvement from pre- to post-assessment. Student feedback indicated high satisfaction; with 68.5% reporting they learned more about tobacco from the educational session.

Conclusions: The results suggest that an interactive educational session presented by student pharmacists was able to improve knowledge regarding tobacco use and its harmful effects. Through this research, it is evident that health science students are a vital resource for providing education to children regarding tobacco and its harmful effects.

North Carolina (NC) and whether accessibility differs by pharmacy type (chain pharmacies vs. independent pharmacies). The relationship between availability of EC and factors such as cost, location, and ID requirements were also analyzed.

ing identification than chain pharmacies (7.4%).

Category: Original Research –Poster 5

Title: Assessing the Accessibility of Emergency Contraception at Local Pharmacies in Underserved Communities of North Carolina

Authors: Daniela T Lopez, PharmD Candidate 1, Mollie Scott, PharmD, BCACP, CPP, FASHP, FNCAP, 1,2 Delesha Carpenter, PhD, MSPH, 1,3

Institution: UNC Eshelman School of Pharmacy 1,2,3 , UNC School of Medicine 2, MAHEC 2

Introduction: EC can prevent pregnancy for up to five days after intercourse, making its immediate access an important factor to assess. This study aimed to determine the accessibility of EC at pharmacies in the most underserved areas of

Methods: A cross-sectional secret shopper study of 140 NC pharmacies stratified by pharmacy type within Tier 1 counties was conducted from January 2024 to February 2024. A trained secret shopper called pharmacies, enacted a standardized script, and recorded whether EC was available, its cost, location within the pharmacy and ID requirements. We examined the relationship between pharmacy type and county with EC availability, cost, location and ID requirements for purchase.

Results: Among the sample pharmacies, 55.7% had EC available at the time of the call, 6.4% could order EC within 48 hours, and 27.1% did not have EC available or could order it within 48 hours. Overall, 77.1% of chain pharmacies had EC available immediately or within 48 hours vs. 47.2% of independent pharmacies (p<0.05). Independent pharmacies offered EC at lower cost than chain pharmacies (p<0.001). In terms of location, 75.9% of chain pharmacies kept EC on the shelf; whereas, 87.9% of the independent pharmacies stored EC behind the counter (p<0.05). Most pharmacies (85%) did not require identification for purchase, but independent pharmacies (27.3%) had a higher proportion of locations requir-

Conclusions: Chain pharmacies had a higher availability of EC, more easy access via on-theshelf placement, and generally did not require identification for purchase. However, independent pharmacies offered EC at lower prices.

Category: Literature Review –Poster 6

Title: Tianeptine: Unveiling the Dangers of “Street Heroin” Disguised as a Dietary Supplement

Authors: Elizabeth K. Gonzalez B.S. 1, Samir A. Kouzi, B.Sc. Pharm., Ph.D. 1

Institution: Wingate University School of Pharmacy, Wingate NC 1

Objective: The primary goal of this study is to investigate the pharmacological profile of tianeptine, it’s opioid-like effects, associated toxicological risks, and how pharmacists play a critical role in advocating against the purchase and use of tianeptine.

Methods: A comprehensive review of literature was conducted to analyze the pharmacology and toxicology of tianeptine. Case reports of 2 fatalities due to tianeptine intoxication were evaluated to understand the cause of death. FDA advisories and regulatory alerts were reviewed to understand official warnings and restrictions.

Results: Although tianeptine is a prescription antidepressant

approved in other continents such as Europe, Asia, and South America, it is not approved by the FDA in the U.S. Tianeptine is associated with multiple side effects at high doses along with toxicity, dependence, withdrawal symptoms, respiratory depression, and even mortality. The ease of access of this drug in places such as gas stations, online websites, as well as vitamin shops increases the chance of buyers unknowingly exposing themselves to the potential harmful toxicities associated with this drug. The FDA has issued warnings regarding its misuse, prompting companies to issue a voluntary recall of its products. In the U.S, there have been at least 162 cases of tianeptine exposure reported to the Poison Control Centers, with 151 cases being from 2020 alone.

Conclusion: Tianeptine masquerades as an antidepressant while behaving equivalent to opioids. This emphasizes the critical need for public awareness and regulatory intervention. By heading FDA advisories, abstaining from use, as well as educating others, individuals can safeguard themselves against the potentially hazardous outcomes from its usage, promoting health and well-being in communities.

Category: Original Research –Poster 7

Title: Pharmacist-Enhanced Access To Contraception In North Carolina (PEACE-NC): Characterizing Early Patient And Pharmacy Adopters Of Contraception Services

Authors: Jessica Hudak, PharmD Candidate 1, Mollie Ashe Scott, PharmD, BCACP, CPP, FASHP, FNCAP 1,2,3 , Amanda Savage, PharmD 1, Roshni Pattabiraman, PharmD 3

Institution: UNC Eshelman School of Pharmacy, Chapel Hill, NC; UNC School of Medicine, Chapel Hill, NC; MAHEC Department of Pharmacotherapy, Asheville, NC

Objective: In March 2022, standing orders were enacted that allowed contraception-trained North Carolina (NC) immunizing pharmacists to initiate hormonal contraceptives (HCs). This study evaluated where pharmacist-provided contraception services were offered in NC within the first year of implementation, who the patients were that sought this service, and the outcomes of the contraception consultations.

Methods: Participants were NC Association of Pharmacists (NCAP) contraceptive trained pharmacists who provided contraception consultation services between April 1, 2022 and December 31, 2023. Demographic data about the pharmacies was collected via a Qualtrics survey and de-identified patient information was collected from individual NC Department of Health and Human Services (DHHS) Patient Questionnaire and Provider Communication forms NCDHHS forms were deidentified and uploaded to a secure SharePoint site, and data was extracted entered into Excel for analysis using descriptive statistics.

Results: Seventeen pharmacies

were consented for participation and completed a pharmacy demographic survey; to-date, four have uploaded patient visit documentation. Of the 17 consented pharmacies, 70.6% were independent, with 47.1% residing in a rural NC county. From the uploaded NCDHHS forms, the majority age range of patients was 12-18 years (29.4%), 50% had commercial insurance, 52.9% were established with a primary care provider, and 73.9% had previously used a HC method. Pharmacists most frequently prescribed a combined oral contraceptive (53.8%), with only one documented physician referral due to hypertension.

Conclusion: Preliminary data indicates that early adopting pharmacies were primarily independent, and almost half of the study participants were in rural communities. Pharmacies are serving minors despite the requirement for parent or guardian consent, the most frequent contraceptive prescribed was a combined hormonal contraception, and the most common reason for referral was hypertension. Documentation of encounters was frequently incomplete, suggesting additional training for pharmacists is warranted.

Category: Original Research –Poster 8

Title: Safety and Efficacy of Abbreviated DOAC Loading Durations after Initial Parenteral Anticoagulation for Treatment of VTE in Patients with Morbid Obesity

Authors: Kieran O’Reilly, PharmD Candidate 1,2, Grace Pryor, PharmD Candidate 1,3 , Deardra Lewis, PharmD Candidate 1,4, Xyrish Pino, PharmD Candidate 1,4, Payal Mehta, PharmD Candidate 1,4, Alexandra Mihm, PharmD, BCPS 1,3 , Sarah Nisly, PharmD, MEd, BCPS, FCCP 1,5

Institutions: 1Atrium Health Wake Forest Baptist, Winston-Salem, NC, 2University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, 3Wingate University School of Pharmacy, Wingate, NC, 4High Point University Fred Wilson School of Pharmacy, High Point, NC, 5Clinical Education Alliance, Reston, VA

Objective: This study evaluates the safety and efficacy of abbreviated loading dose (LD) durations of direct oral anticoagulants (DOACs) in morbidly obese patients receiving initial parental anticoagulation for venous thromboembolism (VTE) treatment.

Methods: This is a retrospective cohort study of morbidly obese patients hospitalized with radiographically confirmed VTE and a BMI > 40 kg/m2 between January 1, 2021, and December 31, 2022. Patients received at least 48 hours of parenteral anticoagulation before transitioning to apixaban or rivaroxaban. Patients were evaluated based on receiving an abbreviated LD (< 7 days of apixaban or < 21 days for rivaroxaban) versus a full LD. The primary outcome was VTE recurrence within six months. Secondary outcomes

include International Society of Thrombosis and Haemostasias (ISTH) defined bleeding events, VTE mortality, and all-cause mortality. Primary and secondary endpoints were analyzed using chi-squared (SPSS v29).

Results: Forty-three morbidly obese patients, with an average BMI of 46.2 kg/m2, were diagnosed with VTE (n=9 [20.9%] DVT, n=22 [51.2%] PE, n=12 [27.9%] PE and DVT) during the study period. Heparin (90.1%), enoxaparin (34.9%), and argatroban (7%) were the initial parenteral anticoagulants administered for at least 48 hours before DOAC transition. Twelve (27.9%) patients were included in the abbreviated LD group (n=9 [75%] apixaban, n=3 [25%] rivaroxaban) and 31 (72.1%) patients were included in the full LD group (apixaban n=26 [83.9%], rivaroxaban n=5 [16.1%]). There was no significant difference in the primary outcome of VTE recurrence between the abbreviated and full LD groups (n=0 [0%] vs. n=2 [6.4%], p=0.37). Additionally, no significant differences in secondary outcomes were observed.

Conclusion: In morbidly obese patients receiving at least 48 hours of initial parenteral anticoagulation for VTE treatment, an abbreviated LD of apixaban or rivaroxaban may be appropriate, although results of this study are limited by the small sample size and low event rates.

Category: Original Research –Poster 9

Title: Survey of North Caro -

lina Community-based and Ambulatory Care Pharmacists

Regarding Pharmacist Administration of Long-Acting Injectable Medications

Authors: Mina E. Wolfe, PharmD, Laura A. Rhodes, PharmD, BCACP, Macary W. Marciniak, PharmD, BCACP, BCPS, FAPhA, Ouita D. Gatton, RPh, FNCAP, Laura Russell, PharmD

Institution: UNC Eshelman School of Pharmacy

Objective: Effective October 1, 2021, immunizing pharmacists in North Carolina (NC) are authorized to administer long-acting injectables (LAIs) to patients aged 18+ years with a prescription. While some pharmacists in NC have begun providing LAIs, much remains unknown regarding their experience administering LAIs. The objective of this study was to evaluate the opinions of NC pharmacists regarding administering, counseling, monitoring, and barriers to providing LAIs.

Methods: This cross-sectional, survey-based study was conducted online via Qualtrics. The 25-item survey was distributed electronically via a listserv to NC pharmacists. Individuals were eligible for inclusion if they held a valid NC pharmacist license, worked in a community-based pharmacy or ambulatory care pharmacy, and had begun administering LAIs. Respondents could select multiple answers for types of LAIs administered and barriers to implementing LAI services and questions could be skipped.

The survey was open for 30 days (reminder on day 15). Ten $50 gift cards were used as an incentive. Descriptive statistics were used to analyze results.

Results: 127 responses were received from pharmacists administering LAIs. Most reported being a staff pharmacist (n=35, 28%), pharmacist manager (n=28, 22%), or clinical pharmacist (n=25, 20%) who served a general population (n=80, 63%). Pharmacists reported confidence in administration (n=102/104, 98%), counseling on side effects (n=99/103, 96%), counseling on monitoring (n=96/104, 92%), and ability to seek additional resources (n=100/104, 96%). Antipsychotics were the most frequently administered LAI type (n=56/188, 30%), followed by Vitamin B12 (n=54/188, 29%) and testosterone (n=37/188, 20%). The most cited barriers were billing or reimbursement (n=65/238, 27%) and time constraints (n=58/238, 24%).

Conclusion: Community-based and ambulatory care pharmacists are an access point for medication administration, with one-third of LAI administration including antipsychotics. Nearly all pharmacists felt confident in their counseling skills, knowledge, and administration technique. Barriers to LAI uptake include compensation for service and time constraints.

Category: Original Research –Poster 10

Title: Impact of Student Pharmacist-Provided Education on Stress and Anxiety for College Undergraduate and Graduate

Students

Authors: Brittney Griffin, Hannah Derby, Skyler Bennett, Rachel Bostic, Isaac Lagarde Jr., Natalie Williams, Lisa Dinkins PharmD, BCACP

Objective: The purpose of this study was to measure the impact of student pharmacist-provided education on the signs and symptoms of stress/ anxiety and resources for self-management and professional support.

Methods: Participants included students at a private university. A 5-minute educational encounter and handout on interventions for stress and anxiety were provided. After the encounter, a Qualtrics survey utilizing the GAD7 screening questions was administered to students and a theoretical GAD7 score was calculated by researchers. Data regarding the use of self-maintenance therapies and professional campus-based mental health services prior to education versus after were also collected.

Results: A total of 103 students participated in the study. The survey revealed that 82.5% of participants reported some degree of anxiety; 41.7% mild, 19.4% moderate, and 21.4% severe. The survey showed that 88% of participants previously utilized self-maintenance either alone or with other methods, which decreased to 63% after the educational intervention. Expected utilization of off-campus professional resources increased from 16% to 28%. Expected utilization of on-campus

resources increased from 13% to 20%. Expected utilization of on-campus counseling center resources increased from 15% to 54%. Expected utilization of other resources not listed decreased from 7% to 6%.

Conclusions: This study suggests that a significant number of the student body is affected by stress and/or anxiety. Following education on available resources, there was an increase in willingness to seek professional assistance for the management of stress and anxiety. Study participants appear to have demonstrated a high level of self-awareness, given the significant increase in the expected utilization of professional resources and subsequent decrease of self-maintenance.

Category: Original Research –Poster 11

Title: CARE-HP: Counseling Approaches for Reducing Hypertension in the Underserved Population

Authors: Eugene Jones Jr. BS; William Mossman, AS; Anna Crowell Gambrell, BS; Michael Anderson BS, Callie Walker; Rebecca Sarpong, BS; Corresponding Author: Dr. Jennifer Wood, PharmD, BCPS

Objectives: The study’s objectives were to assess the effectiveness of one-on-one individual counseling on the reduction of blood pressure in individuals in an underserved population. The primary objective was to assess the change in systolic blood pressure (SBP) in par-

ticipants over the course of the intervention. The secondary objective was to evaluate participants willingness to enact certain lifestyle changes such as salt restricted diets, increasing weekly exercise, and nicotine cessation.

Methods: This was a single site intervention involving participants at an addiction ministry in Union County, NC, Ground 40, between September 2023 and January 2024. The study assessed SBP, nicotine use, current levels of exercise, and diet of participants at monthly intervals. Participants were offered personalized one on one counseling on areas where therapeutic lifestyle changes could be implemented based on participant willingness. Then, each month following implementation, participants were later screened for willingness to follow recommendations and reduction in blood pressure.

Results: The initial study population consisted of thirteen participants, the eight that returned for a one-month follow-up were included in the final analysis. After implementing counseling on lifestyle interventions in eight participants of the select patient population an overall reduction in systolic blood pressure of 9.3 mmHg was seen. Additionally, multiple participants saw a reduction in systolic blood pressure of greater than 20 mmHg. The interventions implemented were exercise, smoking cessation, and diet changes. Willingness to implement lifestyle changes was also assessed and the

majority of participants demonstrated an increased willingness to implement changes.

Conclusion: Findings suggest that one on one intervention produced promising results in the management of hypertension. Future studies are needed with a larger population to produce statistically significant results; however, this study brings promise to the future of influential strategies that can effectively manage hypertension in underserved populations.

Category: Original Research –Poster 12

Title: Effect of Parent Education on Willingness to Enforce Screen Time Limitations on Children to Increase Physical Activity and Combat Childhood Obesity

Authors: Alyssa Bland, PharmD Candidate; Jasmine Gibson, PharmD Candidate; Alexis Howard, PharmD Candidate; Rylee Williams, PharmD Candidate; Charlie Yang, PharmD Candidate; Lisa Dinkins, PharmD

Objective: This study aimed to assess the change in willingness of parents/guardians to alter their children(s) physical activity or monitor screen time following a brief educational encounter.

Methods: This study included parents/guardians of children ages 5-13 years. It was conducted in various locations across Union County, North Carolina, targeting areas such as health fairs, parks/playgrounds, local

children’s museums, and neighborhoods. Participants were given introductory information followed by a 3–5-minute education session and educational pamphlet. Educational material included information on obesity prevalence in children, along with recommendations on physical activity and screen time. Participants completed a 4-question Likert scale survey after receiving educational material, which asked them to compare their willingness to monitor screen time or alter their child(ren)’s physical activity before and after the educational encounter.

Results: There were 28 participants in the study. Prior to the educational encounter, the majority of parents were “likely” (32.1%) or “very likely” (28.6%) to monitor their child’s physical activity which increased to 46.4% and 32.1%, respectively, after the educational intervention. For screen time, prior to education, 39.2% of parents were “likely” to monitor screen time which increased to 60.7% of parents being “very likely” after the educational intervention.

Conclusions: Parents/guardians were more willing to monitor their child(ren)’s screen time and alter their physical activity following a brief educational encounter. Future studies could increase the number of community partners, such as parent teacher association meetings and collaboration with local organizations for a wider outreach.

Category: Original Research –

Poster 13

Title: Blood Pressure Changes After Treatment With Low-Sodium Oxybate in Oxybate-Naive Patients With Narcolepsy or Idiopathic Hypersomnia: A Post Hoc Analysis

Authors: Shawn Candler, MD1; Douglas S. Fuller, MS1; Thomas J. Measey, PhD1; William B. White, MD2

Affiliation: 1Jazz Pharmaceuticals, Philadelphia, PA, USA; 2Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA

Objective: Excess sodium intake is associated with increased blood pressure (BP) and cardiovascular risk. Low-sodium oxybate (LXB; Xywav®), an FDA-approved treatment for excessive daytime sleepiness or cataplexy in patients aged ≥7 years with narcolepsy and for idiopathic hypersomnia in adults, contains the same active moiety as high-sodium oxybates (Xyrem® and Lumryz™) but 92% less sodium. This post hoc analysis evaluated BP changes during 2 phase 3 trials of LXB (NCT03030599 [narcolepsy]; NCT03533114 [idiopathic hypersomnia]).

Methods: This analysis included 79 oxybate-naive participants (aged 18–70 years) with narcolepsy with cataplexy and 108 oxybate-naive participants (aged 19–75 years) with idiopathic hypersomnia. Participants received LXB during a 12-week (narcolepsy) or 10- to 14-week (idiopathic hyper-

somnia), open-label, optimized treatment and titration period, followed by a 2-week stable-dose period (SDP). Seated BP measurements were recorded at all study visits. Changes from baseline in mean systolic BP (SBP) were analyzed using linear mixed models.

Results: Mean (SD) participant age was 36.8 (12.3) years (narcolepsy) and 40.7 (13.7) years (idiopathic hypersomnia); 69.6% (narcolepsy) and 72.2% (idiopathic hypersomnia) of participants were female. Baseline mean (SD) SBP (mmHg) was 122.1 (12.8) (narcolepsy) and 122.8 (13.8) (idiopathic hypersomnia). Least squares mean (95% CI) changes from baseline in SBP (mmHg) for the narcolepsy group at weeks 4, 8, 12, and end of SDP were −0.2 (−2.6, 2.2), −1.6 (−3.9, 0.7), 0.2 (−2.1, 2.5), and 0.3 (−2.1, 2.6), respectively, and for the idiopathic hypersomnia group at weeks 1, 4, 8, and end of SDP were 1.0 (−0.6, 2.6), 0.6 (−1.3, 2.4), 1.1 (−0.8, 2.9), and −0.8 (−2.9, 1.3), respectively.

Conclusion: No increases in SBP were found in patients treated with open-label LXB. While this was an exploratory, post hoc analysis of studies that were not designed to examine BP changes, the data suggest that LXB treatment does not meaningfully impact BP.

Disclosures:

S Candler, DS Fuller, and TJ Measey are full-time employees of Jazz Pharmaceuticals who, in the course of this employment, have received stock options exercisable for, and other stock

awards of, ordinary shares of Jazz Pharmaceuticals, plc.

WB White is a cardiovascular safety consultant to Jazz Pharmaceuticals, plc.

Category: Original Research –Poster 14

Title: Comparison of VTE Event Rates Between Neurosurgery Practices for VTE Prophylaxis in the Spinal Surgery Population

Authors: Sophia Jacome Singletary1,2, Keyla Thompson1,3, Marisa Rinehart, PharmD, BCPS1

Institution: Atrium Health

Wake Forest Baptist, Winston Salem NC; Wingate University School of Pharmacy, Wingate NC; High Point University Fred Wilson School of Pharmacy, High Point NC

Background: To date, the practice of using thromboprophylaxis following spine surgery has not been standardized. The modality of thromboprophylaxis in the neurosurgical practice has historically been based on surgeon preference. Though optimal timing and agent selection remain controversial, several prospective reviews have identified that the incidence of postoperative VTE in neurosurgical patients may be lower when using prophylaxis.

Objective: The purpose of this study was to compare the rates of VTE events within 30 days post-surgical intervention in the spinal surgery population that used different prophylaxis strategies.

Methods: A retrospective study of hospitalized patients who received VTE prophylaxis after spinal surgery was conducted. Patient data was collected regarding timing of prophylaxis, agent selection and VTE events. The primary endpoint was the rate of VTE events associated with initiation of VTE prophylaxis. Secondary endpoints included rates of individual prophylaxis agents utilized and their respective doses, rate of VTE event relative to timing of VTE prophylaxis initiation, rate of safety events including major bleeding events and clinically relevant nonmajor bleeding (CRNMB), the average CAPRINI scores, and the rates of various CAPRINI score components.

Results: A total of 266 patients were included in the analysis. Most patients received heparin, followed by enoxaparin 30 mg daily, enoxaparin 30 mg BID, enoxaparin 40 mg daily, and weight-based dosing enoxaparin. VTE events occurred in one patient with no statistically significant differences between the groups. Secondary outcomes demonstrated no statistically significant differences between no VTE prophylaxis or any regimen of VTE prophylaxis.

Conclusion: The use of VTE prophylaxis does not statistically increase risk of bleeding post spine surgery, however, the lack of VTE prophylaxis does not statistically increase risk of a VTE event. A larger randomized controlled trial is needed to determine the optimal use of VTE prophylaxis in this patient population.

The Power to Choose

Why Relexxii?

References: 1. RELEXXII® (methylphenidate hydrochloride extended-release tablets) package insert. Vertical Pharmaceuticals, LLC; 2023. 2. Data on ﬁle, Osmotica Pharmaceuticals.

*Co-pay assistance is applicable to prescription coverage for eligible commercially insured patients. O er void where prohibited. No income restrictions apply. Other restrictions may apply. O er e ective 04/2024. Alora Pharmaceuticals, LLC reserves the right to rescind, revoke, or amend this o er without notice. For full terms and conditions visit relexxii.com/savings.

The individuals depicted are models used for illustrative purposes only.

INDICATION & IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

RELEXXII is a central nervous system (CNS) stimulant indicated for the treatment of attention deﬁcit hyperactivity disorder (ADHD) in adults (up to the age of 65 years) and pediatric patients 6 years of age and older.

WARNING: ABUSE, MISUSE, AND ADDICTION

See full prescribing information for complete boxed warning.

RELEXXII has a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Misuse and abuse of CNS stimulants, including RELEXXII, can result in overdose and death.

• Before prescribing RELEXXII, assess each patient’s risk for abuse, misuse, and addiction.

• Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug.

• Throughout treatment, reassess each patient’s risk and frequently monitor for signs and symptoms of abuse, misuse, and addiction.

Please see Important Safety Information on reverse side and Full Prescribing Information, including Boxed Warning at relexxii.com/pi or scan here

INDICATION

WARNING: ABUSE, MISUSE, AND ADDICTION

See full prescribing information for complete boxed warning.

• Before prescribing RELEXXII, assess each patient’s risk for abuse, misuse, and addiction.

• Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug.

• Throughout treatment, reassess each patient’s risk and frequently monitor for signs and symptoms of abuse, misuse, and addiction.

• RELEXXII is contraindicated in patients with known hypersensitivity to methylphenidate or other components of RELEXXII.

• RELEXXII is contraindicated in patients with concurrent treatment of monoamine oxidase inhibitor (MAOI) or using MAOI within the preceding 14 days.

• Risks to Patients with Serious Cardiac Disease: Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmias, coronary artery disease, or serious cardiac disease.

• Increased Blood Pressure and Heart Rate: Monitor blood pressure and pulse. Monitor all RELEXXII-treated patients for hypertension and tachycardia.

• Psychiatric Adverse Reactions: Prior to initiating RELEXXII, screen patients for risk factors for developing a manic episode. If new psychotic or manic symptoms occur, consider discontinuing RELEXXII.

• Priapism: If abnormally sustained or frequent and painful erections occur, patients should seek immediate medical attention.

• Peripheral Vasculopathy, including Raynaud’s Phenomenon: Careful observation for digital changes is necessary during RELEXXII treatment. Further clinical evaluation (e.g., rheumatology referral) may be appropriate for patients who develop signs or symptoms of peripheral vasculopathy.

• Long-Term Suppression of Growth in Pediatric Patients: Closely monitor growth (height and weight) in pediatric patients. Pediatric patients not growing or gaining weight as expected may need to have their treatment interrupted.

• Gastrointestinal Obstruction: Avoid use with preexisting GI narrowing.

• Acute Angle Closure Glaucoma: RELEXXII treated patients considered at risk for acute angle closure glaucoma (e.g.,patients with signiﬁcant hyperopia) should be evaluated by an ophthalmologist.

• Increased Intraocular Pressure (IOP) and Glaucoma: Prescribe RELEXXII to patients with open-angle glaucoma or abnormally increased IOP only if the beneﬁt of treatment is considered to outweigh the risk. Closely monitor patients with a history of increased IOP or open angle glaucoma.

• Motor and Verbal Tics, and Worsening of Tourette’s Syndrome: Before initiating RELEXXII, assess the family history and clinically evaluate patients for tics or Tourette’s syndrome. Regularly monitor patients for the emergence or worsening of tics or Tourette’s syndrome. Discontinue treatment if clinically appropriate.

DRUG

INTERACTIONS

• Concomitant use of Monoamine oxidase Inhibitor’s (MAOIs) and CNS stimulants can cause hypertensive crisis. Potential outcomes include death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure. Do not administer RELEXXII concomitantly with MAOIs or within 14 days after discontinuing MAOI treatment.

• RELEXXII may decrease the e ectiveness of drugs used to treat hypertension. Monitor blood pressure and adjust the dosage of the antihypertensive drug as needed.

• Concomitant use of halogenated anesthetics and RELEXXII may increase the risk of sudden blood pressure and heart rate increase during surgery. Avoid use of RELEXXII in patients being treated with anesthetics on the day of surgery.

• Combined use of methylphenidate with risperidone when there is a change in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS). Monitor patients on RELEXXII for signs of EPS with concomitant use of risperidone with associated changes in dosage.

You may report side e ects to Vertical Pharmaceuticals, LLC at 1-800-444-5164 or to the FDA at 1-800-FDA-1088.

Please see Full Prescribing Information, including Boxed Warning at relexxii.com/pi or scan here

A Lifetime of Dedication to Pharmacy: Celebrating Herman Medlin

90 Years Young

It is rare for someone to spend a lifetime doing what they love, yet Herman Medlin has done just that. At 90 years old, Herman is not just a practicing pharmacist; he is a testament to dedication and commitment. As he celebrates his 60th year as a pharmacist and his 90th birthday, we honor Herman’s enduring commitments to his profession and his community.

The Path to Pharmacy

Herman Medlin’s story begins in Virginia Beach, VA, where he grew up. After high school, he joined the Coast Guard in 1952 as a medic, serving his country during the Korean War. This period of service instilled in him a sense of duty and perseverance

that would later define his professional life. Following his military service, Herman followed his desire to help others by pursuing a degree in pharmacy and enrolling at the Medical College of Virginia, now known as Virginia Commonwealth University.

Herman’s pharmacy career began back in his hometown of Virginia Beach; however, it was love that eventually brought him to North Carolina. In 1966, he married Linda Williams, who was originally from Dunn, NC. Together, they had two daughters, Jeanette and Christine. The Medlin’s moved to North Carolina, where Herman initially worked for Peoples Drug Store in Little Washington and New Bern. Frequent visits to Dunn to see family fostered a deep connection to the area, leading to a pivotal decision

in 1976.

Establishing Medlin

Drugs – a community hub

In 1976, Herman and Linda purchased Butler and Carroll Pharmacy on Broad Street in Dunn. Eventually, the pharmacy became Medlin Drugs, a cornerstone of the community. Herman was the pharmacist, Linda managed the books, and their daughters helped in the store when they were old enough. For over 30 years, Medlin Drugs was more than a place to fill prescriptions; it was a community hub (with the requisite soda fountain) where Herman provided personalized care and attention to each customer. Throughout this time, Linda’s unwavering support and partnership were instrumental in raising their family and running the business successfully.

His daughter, Jeanette, fondly recalls his oft-repeated customer service philosophy, which she has relied on throughout her own professional career: “We cannot tell the customer ‘no,’ but we can give him or her a better ‘yes.’”

Lifelong Learning and Serving

Beyond his professional duties, Herman was also involved in the Dunn community. As an active member of the United Methodist Church and the Rotary Club, he demonstrated a commitment to service that extended beyond his pharmacy. Herman also forged

Herman Medlin Pictured Right

strong ties with Campbell University Pharmacy School, mentoring numerous pharmacy students over the years. His role as a preceptor allowed him to share his vast knowledge and experience, shaping the next generation of pharmacists… a role he considered to be a great responsibility and a great joy.

Despite his age, he has always maintained his licensure and keeps up with the latest developments in pharmacy through continuing education, ensuring he provides the best possible care to his patients in the ever-evolving field of pharmacy. Today, Herman works part-time at Woods Pharmacy in Benson, NC. His passion for pharmacy remains undiminished, and his interactions with coworkers and patients are marked by the same enthusiasm, care, and dedication that have defined his career for six decades.

Celebrating a Milestone

June 2024 marked not only Herman’s 90th birthday but also his 60th anniversary as a practicing pharmacist. This milestone is a testament to a career that has quietly touched countless lives and made significant contributions to the community. Herman’s unwavering dedication to his profession and community is a true embodiment of the spirit of pharmacy, and for that, we are grateful.

NCAP NCAP Advocacy Advocacy Fund Fund

Generous contributions have helped us to achieve huge success during the 2023 legislative session

ncpharmacists.org ncpharmacists.org

Back to School: How to Ace EpiPen ® Billing and Avoid an Audit

PAAS National ® has seen an increase in prescription validation requests and audits for EpiPen ® and, with back-toschool in full swing, we want all pharmacy employees to be aware of potential billing issues for this life-saving medication.

According to section 1 Indications and Usage of the FDA product labeling 1 , “EpiPen ® and EpiPen Jr ® are indicated for the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging insects (e.g., order Hymenoptera, which include bees, wasps, hornets, yellow jackets and fire ants) and biting insects (e.g., triatoma, mosquitoes), allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g., radiocontrast media) and other allergens, as well as idiopathic anaphylaxis or exercise-in -

duced anaphylaxis.”

Emergency medications are frequently audited, and EpiPens ® have their own unique set of audit issues, including:

1. Quantity billed

• EpiPen ® is billed as an “each”, so a 2-pack would be billed as “2 each”

• If multiple boxes of EpiPens ® are required at one time, it is advisable to verify with the prescriber why such a quantity is needed (e.g., one for home and one for school, one in each household, one for gym bag, school bag, and daycare, etc) and make a clinical note on the prescription

2. Mathematically calculable directions

• Directions that come over as “Use as directed” should generally be clarified with the prescriber as to whether the patient is to “use as directed per package instructions” in addition to updating the patient label directions accordingly

3. Days’ supply

• If a 2-pack is prescribed with directions indicating the patient may repeat the dose after a certain amount of time, billing a 1-day supply would be ap -

propriate

• If a 2-pack is prescribed with directions that do not indicate a repeat dose, then a 2-day supply would be appropriate

• Risk of audit recoupment for incorrect days’ supply is generally limited as PBMs have more tolerance for life-saving medications that are refilled on an as needed basis (rather than scheduled). Additionally, the submission of a 1-day supply versus a 2-day supply is unlikely to impact patient copay, pharmacy reimbursement, or an early refill.

4. Product dispensed

• Epinephrine has many BX-rated products to EpiPen ® , and pharmacies need to obtain prescriber approval before dispensing one of these products if the prescription was written for EpiPen ®

• Conservatively, any indication on a prescription that a prescriber intended to prescribe EpiPen ® (or its AB-rated generics) should be clarified before dispensing a BX-rated generic.

• Prescriptions written generically as “Epinephrine (EpiPen)”, or with an NDC indicating EpiPen ® (or an AB-rated generic), should be interpreted as EpiPen

Common EpiPen ® /epinephrine NDCs, and their associated TE Codes, are as follows:

Product

EpiPen®

mg/0.3 mL 49502-0500-02

EpiPen® 0.3 mg/0.3 mL 49502-0500-02

Epinephrine 0.3 mg/0.3 mL 49502-0102-02

Epinephrine 0.3 mg/0.3 mL 00093-5986-27

Epinephrine

mg/0.3 mL 00115-1694-49

Mylan Specialty L.P.

Epinephrine 0.3 mg/0.3 mL 00093-5986-27 Teva Pharmaceuticals

Epinephrine 0.3 mg/0.3 mL 00115-1694-49 Amneal Pharmaceuticals

Epinephrine 0.3 mg/0.3 mL 80425-0264-01

Advanced Rx Pharmacy of Tenn

NDA Authorized Generic for EpiPen®

NDA Authorized Generic for Adrenaclick®

NDA Authorized Generic for Adrenaclick® Auvi-Q® 0.3 mg/0.3 mL 60842-0023-01 Kaleo

mL 49502-0501-02

0.15 mg/ 0.3 mL 49502-0101-02 Mylan Specialty

NDA Authorized Generic for Adrenaclick®

NDA Authorized Generic for EpiPen Jr®

Jr® Epinephrine 0.15 mg/ 0.3 mL 00093-5985-27 Teva Pharmaceuticals USA

Epinephrine 0.15 mg/ 0.3 mL 00093-5985-27 Teva Pharmaceuticals USA

0.15 mg/0.3 mL 63629-8801-01

Bryant Ranch Prepack

Epinephrine 0.15 mg/0.3 mL 63629-8801-01 Bryant Ranch Prepack

PAAS Tips:

• Clarify quantities if missing the unit of measure (each) or if the unit of measure is “unspecified”

PAAS Tips:

1. Date

References:

• Clarify directions if ambiguous or “use as directed”

• Clarify quantities if missing the unit of measure (each) or if the unit of measure is “unspecified”

• Ensure the patient label directions match any clarification with the prescriber

o Clinical notes should include four elements:

2. Name and Title of who you spoke with

• o Clinical notes should include four elements: 1.

1. Date

3. Summary of conversation

2. Name and Title of who you spoke with

3. Summary of conversation

• Clarify directions if ambiguous or “use as directed”

4. Pharmacy employee initials

https://dailymed.nlm.nih. gov/dailymed/drugInfo. cfm?setid=7560c201-9246487c-a13b-6295db04274a

4. Pharmacy employee initials

• Do not place emergency medications on auto -refill

Trenton Thiede, PharmD, MBA,

• Do not place emergency medications on auto-refill

By Trenton Thiede, PharmD, MBA, President at PAAS National ®, expert third party audit assistance , FWA/HIPAA and USP 800 compliance.

President at PAAS National ®, expert third party audit assistance , FWA/HIPAA and USP 800 compliance.

References:

• Ensure the patient label directions match any clarification with the prescriber

1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7560c201 -9246-487c-a13b-6295db04274a

Clinical notes should include four elements:

By Trenton Thiede, PharmD, MBA, President at PAAS National ® , expert third party audit assistance, FWA/HIPAA and USP 800 compliance.

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Sunday Evening Webinars

The Sunday Evening Webinar Series has presented many varied topics so far this year. Our next webinar will be on Sunday, October 20th. Pete Koval, PharmD will discuss tobacco cessation. Details will be available soon. Visit our webinar webpage to learn more and register to join us as soon as details are shared. This event will be ACPE accredited for 1 hour of live CE for pharmacists and pharmacy technicians.

2024 Anti-Infective Conference

The 26th Annual NCAP Anti-Infective Conference will be Friday, October 25 at the Greensboro Country Club. Don’t miss your chance to join us! Spaces are filling up quickly and registration will close soon. This event is a favorite for all pharmacy professionals specializing in the area of infectious diseases and for those who just want to learn more about what’s new in the field. This event is ACPE accredited for 5 hours of live CE for pharmacists and pharmacy technicians.

NC MPJE and NAPLEX Review Resources

Are you looking for preparation resources and materials to help you study for the NC MPJE and NAPLEX? Visit our resource page to find two options to help you prepare for the NC MPJE. Scroll down the same resource page for a link to a NAPLEX preparation source and tell them NCAP sent you!

Updated MPJE books and the online MPJE study course will be available October 1st.

Ambulatory Care Pharmacists Virtual Roundtable Session

Join the NCAP Ambulatory Care Academy on October 4th for NCAP Ambulatory Roundtable: Finding Joy at Work. This will be a virtual brainstorming and networking opportunity to share strategies for improving wellbeing and joy in the workplace. Visit the NCAP Events Calendar page to access the meeting by clicking the link labeled to join the meeting.

Leadership Buzz – Developmental Opportunity for New Practitioner & Student Members

The NCAP New Practitioner Forum (NPF) will be hosting their annual book club, Leadership Buzz, for new practitioners who have graduated in the past 7 years (20182024)! Student members of NCAP are invited to take part as well. Virtual sessions will be facilitated by pharmacy leaders from across the state. To learn more and register to take part in this leadership development opportunity, visit our webpage. The next book discussion will be November 14th!

Register Soon for the 2024 Residency Showcase

Residency programs and students don’t miss your opportunity to meet and make a residency connection that’s just right! This is THE event to find the perfect match for the 2025 residency year and it is happening on Saturday, November 2, 2024 at the Forsyth Novant Conference Center in Winston-Salem, NC. Find out more information and register as a student to attend or a residency program to exhibit and share more about your program by visiting our website

• Flags (American, Christian, State, College Logo, etc.)

• Clocks (Battery Operated with Logos, etc )

• Crosses with US Flag Motif Made from Recycled Wooden Shipping Pallets See Photos at TarHeel Flags on Facebook/Market Place Contact Jim Knowles, PharmD (Retired) TarHeelFlags@PinevilleDSL.net 704-835-1042 – Please Leave Message

Complete SynMed XF System including Calibrated Containers, Dell OptiPlex 7040 with monitor, Wireless Honeywell bar code scanner, Lexmark laser printer model MA810, Zebra thermal printer model TLP2824 Plus, 4 positioning tray for two sets of blister cards, complete set of calibrated covers for containers, SynMed Image Module, SynMed Assist with includes Touch screen 23" Dell Computer

This unit was bought new when starting up a pharmacy in 2020 It was never used! The unit and all are in pristine condition This would be like buying a new unit for tens of thousands less Total Cost new was over $300,000 For Sale for $190,000 Purchase price does not include shipping charges, any tax and site preparation Contact Tom D’Andrea tdandrea@cstpharmacy.com 919-629-4900