Pennsylvania Pharmacist July/August 2014

July/August 2014 z Volume 95 z Issue 4

The official publication of the Pennsylvania Pharmacists Association

Take a trip to MARS for

“Pharmacy’s Future is in the Stars”

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PPA’s 2014 Annual Conference, September 18–21

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PPA Board of Directors PPA Officers: President: Eric R. Esterbrook, RPh President-Elect: Donna Hazel, RPh First Vice President: Eric Pusey, RPh, CDE Second Vice President: Nicholas Leon, PharmD, BCPS, BCACP Immediate Past President: J. Scott Miskovsky, RPh

Our Vision

Pennsylvania pharmacists will be recognized, engaged, and fairly compensated as health-care providers.

PPA Office Staff: CEO: Patricia A. Epple, CAE pepple@papharmacists.com Communications Coordinator: Erica Brandt ebrandt@papharmacists.com Membership Coordinator: Courtney Box cbox@papharmacists.com Program Coordinator: Sara Powers spowers@papharmacists.com Government Relations Manager: Donald L. Smith, III dsmith@papharmacists.com

Ext. 3 Ext. 2 Ext. 1 Ext. 4 Ext. 6

Pennsylvania Pharmacists Association (PPA) 508 North Third Street, Harrisburg, PA 17101 (717) 234-6151 Fax: (717) 236-1618 www.papharmacists.com ppa@papharmacists.com www.facebook.com/PAPharmacy www.twitter.com/papharmacists Pennsylvania Pharmacist (ISSN 0031-4633) is the official publication of the Pennsylvania Pharmaceutical Association d/b/a Pennsylvania Pharmacists Association and is published every other month, six times per year. Annual subscription is $100 for non-members; for members it is included in the annual dues. Editorial information should be addressed to the PPA address listed above. Peer reviewed articles accepted according to the stated guidelines available from PPA. Editorial Board: Tara L. Pummer, PharmD, Chairman Hershey S. Bell, M.D., M.S., FAAFP Stephanie Smith Cooney, PharmDPP Bernard Graham, PhD Brian S. Plager, RPh, MBA Associate Editor: Erica Brandt Editor/Manager: Pat Epple

The Pennsylvania Pharmacists Association, as the leading voice of pharmacy, promotes the profession through advocacy, education, and communication to enhance patient care and public health.

Pennsylvania

Regional Directors: Central: Ellen Nastase, BS Pharmacy, MS Pharmacy Northeast: Thomas Franko, PharmD, BCACP Northwest: Elliott Cook, PharmD Southeast: Vacant to be filled by the Board of Directors Southwest: Lauren Simko, PharmD Academy Directors: Academy of Alternative Pharmacy Practice: Jamie McConaha, PharmD, CGP, BCACP Academy of Chain Pharmacists: Stephen Pfeiffer, PharmD, MBA, RPh Academy of Community Pharmacists: Martin J. Kendra, RPh Academy of Health System Pharmacists: Richard Demers, RPh, MS, FASHP Academy of Long Term Care and Consultant Pharmacists: Brant Gahr, RPh Academy of Pharmacy Industry Associates: Todd Eury Academy of Pharmacy Technicians: Vacant to be filled by the Board of Directors Academy of Student Pharmacists: Benjamin Andrick

Our Mission

MAGAZINE

Departments

President’s Message..................................................................................... 5 Calendar of Events....................................................................................... 7 Campus Checkup........................................................................................ 13 Member News.............................................................................................. 27 New Members.............................................................................................. 50

Features PPA Foundation Grant Report, Sarah Krahe Dombrowski, PharmD ............. 8 Pennsylvania Pharmacists Association Member Profile, Nicholas Leon, PharmD, BCPS, BCACP.................................................. 15 Rx and the Law, Are You Ready for the Unexpected? .................................. 33 Tracking Systems for Pseudoephedrine Sales .............................................. 37 Profiles in Pharmacy Innovation: Diane Boomsma, PharmD ......................... 43

Association News Congratulations to the 2014 Recipients of the PPA Outstanding Student Award ............................................................. 28 True Life I’m a New Practitioner Recap......................................................... 30 Pharmacy Technician Corner........................................................................ 31 Meet the 2014–2015 Board of Directors....................................................... 35 Proposed Changes to PPA’s Constitution and Bylaws................................... 36 Congratulations, 2014 PPA Graduates!......................................................... 41 PharmPAC Working for You!......................................................................... 44 My Rotation Experience with PPA................................................................. 46 Student SIG Grants Available........................................................................ 47 Call for 2015 PPA Educational Foundation Grant Applications...................... 48 PPA 2014 Annual Conference Schedule at a Glance — “Pharmacy’s Future is in the Stars”........................................................... 49

Industry News

Published by: Graphtech Sarah DiCello, Publications Manager (717) 238-5751 sarah@thinkgraphtech.com

Co-Payment Coupons: The Good, The Bad, and The Ugly .......................... 6 NASPA Finds State-level Provider Status is Widespread, But Not Necessarily Linked to Payment................................................................. 20 Small Doses................................................................................................. 24

For Advertising Information: Alexis Kierce, Account Manager (717) 238-5751 alexis@thinkgraphtech.com

Journal

Designed by: Graphtech Pharmacist State Board of Pharmacy Members: Gayle A. Cotchen, PharmD, MBA – Institutional” Janet Hart, RPh – Community Chain Pauline Montgomery, RPh – Community Independent Theresa M. Talbott, RPh – Community Chain Mark J. Zilner, RPh – Community Independent 2014 Board of Pharmacy Meeting Dates: July 8, 2014

August 12, 2014 September 16, 2014 October 21, 2014 November 12, 2014 December 9, 2014 On the Cover: Photographs of Mars, Pennsylvania, courtesy of the Butler County Tourism & Convention Bureau.

The Unintended Consequences of Pennsylvania’s Department of Public Welfare Six Prescription Drug Limit Executive Summary ................ 18 ADVERTISERS INDEX American Pharmacy Services Corporation 12 Buy-Sellapharmacy.com 7 Cardinal Health 4 Hayslip & Zost 34 Independent Pharmacy Buying Group 42 Jefferson School of Pharmacy 26 The Keystone Pharmacy Purchasing Alliance 40 Lake Erie College of Osteopathic Medicine 22

Pharmacists Mutual Insurance Company 52 PPA Educational Foundation 39 PRS Pharmacy Services 2 PTCB 17 R.J. Hedges & Associates 25 Rochester Drug Company 51 University of Pittsburgh School of Pharmacy 10 Value Drug Company 16

DISCLAIMER — The opinions of the authors reflected in this publication do not reflect PPA’s position in any way.

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© 2013 Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. Lit. No. 1RI12495 (09/2013)

Departments

Eric Esterbrook, RPh PPA President 2014–2015

Message from the President A s PPA enters its 137th year it is my honor and privilege to serve as President. Thank you to Scott Miskovsky for leading our organization through another successful year. During my term as President, I will act as a Steward to our Association by upholding its traditions and values.

Star ratings, PQA measures, PDC, ACOs and HRMs are all terms I heard little or nothing about a year ago. Now they matter. Now community pharmacists need to pay attention to these terms as they will have an impact in the near future. Where did I become informed about these terms?

Through my involvement with PPA. I got involved with PPA a number of years ago at a training for the administering of injectable medications. It was here that I was first learned about pharmacies getting reimbursed for something other than dispensing prescriptions. Not long after this training came MTM, another example of reimbursement other than dispensing. Two of my goals as President this year are to pursue recognition as providers and to continue the development of the MTM network.

I am excited and see opportunity in our future. I feel this way by staying informed and gaining knowledge and networking with other pharmacists at various events held by PPA. Now is the time to get involved!

Consider joining a committee or attending a conference to meet other members.

As an independent pharmacy owner I have always felt that action, not talking or complaining, is what gets results. PBM transparency , fair audits and the expansion of pharmacists’ scope of immunizations are actions being taken by PPA and its Legislative efforts.

I am excited and see opportunity in our future. I feel this way by staying informed and gaining knowledge and networking with other pharmacists at various events held by PPA. Now is the time to get involved!

Consider joining a committee or attending a conference to meet other members.

Please join me for PPA’s 2014

Annual Conference, “Pharmacy’s Future is in the Stars” in September. We will honor those who have served the profession and look to our new leaders in pharmacy.

I look forward to serving as your President,

Eric Esterbrook, RPh PPA President 2014–2015 z

Pennsylvania Pharmacist I July/August 2014 I 5

Industry News

$

Co-Payment Coupons

The good, The bad, and The ugly Author: Danielle Clare, PharmD Candidate 2014 from Virginia Commonwealth University

T

he affordability of healthcare and prescription drugs continues to be an issue for many Americans. Research published on medication adherence cited onethird of patients reported difficulty paying for their medications and 22% of patients reported “trying to save money” as a reason for nonadherence.1 Nonadherence accounts for up to $300 billion a year in additional U.S. health care spending by leading to increased hospital admissions, and worse health outcomes.2 Manufacturers of pharmaceuticals have employed copayment (copay) coupons as a strategy to help patients afford prescriptions and increase adherence. In 2010, drug manufactures subsidized copayments for approximately 11–13% of all brand prescriptions dispensed.3 The Good: Patients can use copay coupons to help reduce outof-pocket costs for medications.

Cost reduction ideally helps to eliminate the financial barrier that prevents access and adherence to these expensive brand-name 6 I Pennsylvania Pharmacist I July/August 2014

medications. The coupons can be obtained from physician office visits and pharmacies, distributed directly to patients, or accessed via manufacturer websites.

The Bad: A report from the Congressional Budget Office found that Medicare pays an additional $76 every time a senior chooses a brand drug over a generic drug, leading to increased healthcare costs and wasted tax dollars when safe and effective generic alternatives are available.4 Insurers use tiered copay structures to incentivize patients to choose more cost-effective options.

Coupons bypass cost-sharing incentives, leaving the payer with increased utilization of higher cost brand medications.

Of note, federal law prohibits copay coupon use by Medicare and Medicaid insured patients.

Manipulation of the “true out of pocket costs” by pushing a Medicare beneficiary through the coverage gap or keeping them in the coverage gap is considered fraud.5 Fraudulent activities, including circumventing Medicare insurance and using a cash price for a beneficiary, may be picked up by plan sponsors or Centers for

Medicaid and Medicare Services during an audit and could result in recoupments of reimbursement and fines to the pharmacy.5 The Ugly: Copayment coupon cards can only be used for a limited time. Patient outcomes post-coupon expiration have not been studied in the literature.

However, when copayment coupon coverage ends, patients may be faced with a predicament of prescription affordability which may lead to nonadherence, gaps in care, and/or the need to switch to a different, more affordable medication.

Some pharmacy benefit managers (PBM’s) and insurers have taken action against drug manufactures with formal policy changes within their companies.

CVS Caremark, Express Scripts, and as of July 1st, United Healthcare reject prescription claims that used copayment coupons. Patients using mail order may also be unable to use drug coupons, as they are not always accepted.

A patient-centered, team-based approach to healthcare should Continued on page 39

Departments Thank You to Our Corporate Partners These companies support PPA activities throughout the year.

DIAMOND LEVEL

Calendar of Events July

26–30

AACP Annual Meeting — Grapevine, TX

August

PLATINUM LEVEL

23–26

NACDS Total Store Expo — Boston, MA

24

NASPA Annual Meeting — Boston, MA

September

14–16

ACCP Annual Meeting — Atlanta, GA

18–21

PPA Annual Conference — Mars, PA

October

GOLD LEVEL

8–10

AMCP Educational Conference — oston, MA

18–22

NCPA Annual Conference — ustin, TX

November

SILVER LEVEL

ASCP Annual Meeting — Orlando, FL

December

BRONZE LEVEL

5–7 7–11

ASHP Mid-Year Clinical Meeting — Anaheim, CA

For additional events and PPA committee meetings, be sure to see our Calendar of Events on the PPA website!

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Features

PPA Foundation Grant Report Each year, the PPA Educational Foundation awards several grants to explore innovation in pharmacy practice.

All awardees are required to submit a report of their work. Below is the report from one of the 2013 awardees, Sarah Krahe Dombrowski. Reports are also retained on the website under the Educational Foundation section.

Key Factors Associated with Successful Integration of Patient Care Services into Dispensing Workflow: A Traditional Community Chain Pharmacy eEaluation Sarah Krahe Dombrowski, PharmD; Stephanie Harriman McGrath, PharmD; Jennifer L. Bacci, PharmD; Brian Bobby, PharmD; Kim C. Coley, PharmD; Melissa Somma McGivney, PharmD, FCCP, FAPhA

Research Objective The objective of this study was to identify workflow, leadership, and organizational factors enabling provision of patient care services in highperforming chain community pharmacy practices through workflow observation and key informant interviews.

Research Study Outcomes – Results and Conclusions One hundred twenty-one pharmacies in Western PA were evaluated for successful integration of patient care services into dispensing workflow.

Of the pharmacies located in the geographic area, 57 pharmacies had an OutcomesMTMTM composite rating ≥ 3 out of 4 and 36 pharmacies had high immunization rates. Upon crossing these lists together, 18 pharmacies appeared on both lists qualifying them for the study. Of the 18 qualified pharmacies, 1 pharmacy did not have an assigned pharmacy manager at the time of selection and two pharmacy managers declined participation of their pharmacies in the study. This left 15 pharmacies enrolled in the study.

Demographic information was collected for each of these pharmacies by surveying the pharmacy managers. (Table 1) The pharmacies filled an average of 1200 prescriptions per week (range 533-2400). Pharmacies offered a variety of clinical services to patients with all of the pharmacies offering immunizations, performing targeted interventions, and adherence programs. Additionally, the pharmacies varied in structure including some having a patient care room, drive thru, robot dispensing system, “Wellness store” model, etc. The pharmacists represented all levels of degree and varied in years of experience in community pharmacy. On average, the

8 I Pennsylvania Pharmacist I July/August 2014

Table 1: Pharmacy Demographics Clinical Services Offered

n=15

Immunizations

15 (100%)

Targeted Interventions

15 (100%)

Adherence initiatives

15 (100%)

CMR/MTM

10 (67%)

Diabetes

3 (20%)

Pharmacy Structure

n=15

Patient Care Room

7 (47%)

“Wellness Store” model

4 (27%)

Clinical Pharmacist onsite

4 (27%)

Employs interns

10 (67%)

Precepts student pharmacists 10 (67%) Pharmacist Demographics

n=33

Pharmacists with PharmD

18 (64%)

Pharmacist MTM Training

n=15

Rite Aid training

15 (100%)

MTM Program training

15 (100%)

Pharmacy School Curriculum 6 (40%) Residency training

1 (7%)

State training program

2 (13%)

National training program

2 (13%)

Features pharmacists in these practices were 12.5 years out of pharmacy school (range) and 18 pharmacists (64%) had a Doctor of Pharmacy (PharmD) degree.

A total of 29 interviews were conducted from January 2013 to May 2013. Specifically, 15 pharmacists and 14 ancillary staff members were interviewed. Of the 14 ancillary staff interviews, 10 were pharmacy technicians, 3 were pharmacy interns, and 1 was a Wellness Ambassador. A total of 14 workflow observations were completed (one pharmacy manager declined observation).

All interviewees were staff at one of the qualified pharmacies.

Our study focused on the workflow, organizational structure, and leadership within each of the pharmacies contributing to the successful integration of patient care services into dispensing workflow.

The qualitative analysis of the key informant interviews revealed three dominant themes and three subthemes: I. Personal relationship with patients and genuine care II. Attitude of the pharmacist and pharmacy team III. Patient care is a total team effort

i. Workflow compliance and innovation

ii. Well-trained staff facilitate provision of clinical services

iii. Information transparency and open communication

Theme I: Personal relationship with patients and genuine care: Pharmacists and ancillary staff both reported that their implementation of patient care services was facilitated by their personal knowledge of their patients. Additionally, they felt close with the patients and reported that they genuinely care about them. Below are some responses illustrating this theme: “I think it’s genuine caring by our pharmacists, and I think it’s community outreach, and I think that everybody just does their job and works as hard as they can to get the job done” (Pharmacist) “You have to have the core desire to improve their health. I think once you develop a personal relationship with your patients… it makes your interactions more meaningful.” (Pharmacy Intern) Theme 2: Attitude of the pharmacist and pharmacy team: Another key factor in implementation of clinical services is the attitude of the pharmacist.

They go above and beyond to care for their patients. A number of pharmacists were early adopters of clinical programs. They cite a drive to move the profession forward and embrace change. Additionally, the staff feel similarly to their pharmacists and were engaged in provision of advance patient care services. The following quotes illustrate this message: “Don’t try to resist [patient care].

Embrace it, and make it work.

If you embrace it, you get the right attitude for it, and you can

do it…once you get going with it, it’s not that difficult…It’s just taking that first step to do it.”

(Pharmacist) “Pharmacy is always an evolving field, so if something’s new don’t hesitate to take it on.

It might be a little bit extra work in the beginning, but eventually, once you adapt a program for your specific site, you can make it fit in, and it can be as successful as you want to make it.” (Pharmacy Intern) Theme 3: Patient care is a total team effort: Nearly every pharmacist and ancillary staff member interviewed cited how important having everyone on the same page was to the success of their pharmacy’s ability to provide for its patients. Moreover, a number of key informants discussed engagement of the front end staff as a key to their pharmacies’ success.

“I think everybody helps. Even the front managers will try to help, try to encourage people to come back and talk to us about over-the-counter medications, immunizations, or any kind of a consult.” (Pharmacist) “Everyone has to be made to feel that they have a vital role in your pharmacy.” (Technician) “If implemented correctly, I don’t think [patient care] has to affect the workload at all…I’ve noticed the most success is when there is either a tech or an intern that gets involved with it.” (Pharmacy Intern) Continued on page 11

Pennsylvania Pharmacist I July/August 2014 I 9

University of Pittsburgh Pittsburgh University of School of Pharmacy

Features PPA Foundation Grant Report

Continued from page 9

Subtheme 3.1: Workflow compliance: Upon being asked how the pharmacists maintain their workflow, many discussed that they are compliant with company prescribed workflow, running it the way it is supposed to be run. They utilize specific roles for all staff members and ensure that everyone follows proper procedure. By running workflow to its max, these pharmacists are able to provide additional care to their patients. These pharmacists have made an effort to customize workflow to their pharmacies and the staff. They made adjustments to optimize the delivery of patient care.

The reason their immunization programs have gone so well is that they are well-prepared.

“We do the workflow the way it’s supposed to be, and so we’re never really behind. So we can kind of take the time to do the consults when we need to.” (Pharmacist) “We’ve set goals ... and we try and work towards that goal.”

(Technician) “I notice that the pharmacists like to pull up the patient history profile, even if that’s not necessary to verify prescriptions ... see what their refill percentage is.”

(Pharmacy Intern)

Subtheme 3.2: Well trained staff utilized in delivery of patient care: When asked about key factors enabling them to implement patient care services in their pharmacies, the majority of the pharmacists referenced the importance of a well-trained technician. Their comments describe personal investment in the technicians and interns and an expectation that ancillary staff know what the pharmacists and patients need. There was also reference to these technicians and interns being well trained so that they can assist with delivery of patient care services.

“I try to give whatever I can, that my hands can do to my staff” (Pharmacist) “We’re able to do a lot of things that free up time for the pharmacists…It’s a chance for them to get to know our patients as well.” (Technician) “I honestly think that our staff here is very strong,… and I think that’s made us be able to adapt to greater responsibilities being added on.” (Pharmacy Intern) Subtheme 3.3: Information transparency and open communication: Pharmacists and ancillary staff both discussed open communication within the pharmacy. Moreover, the pharmacists make a distinct effort to pass on information to ancillary staff and pharmacist partners. In addition to the sharing of information,

pharmacy staff discussed opportunities for continuous quality improvement. They felt engaged in the pharmacy and that improvements in the system were direct results of their input.

“I let [the tech] know everything that I know basically. Anything that I learn along the way, I pass on to her. Same thing with my partner…and I expect them to do the same thing…”

(Pharmacist) “The leadership’s great….If someone makes a mistake, it’s more of a learning opportunity and not more of a scolding. So it’s, it’s a great learning environment in that we’re all able to ask questions.” (Technician) Workflow observations Workflow observations were coded and patterns tabulated. A total of 14 workflow observations were conducted; one pharmacy managed declined participation in workflow observation following interview. Information gathered from workflow observations includes interactions between staff members with each other as well as with patients. The observations yielded information regarding the pattern of the interactions with patients. As seen in Table 2, distribution of workflow activities was fairly consistent across the observed pharmacies. Observers noted that the technician was primarily responsible for the data entry 91% of the time, counting 91% of the time, and taking the

Pennsylvania Pharmacist I July/August 2014 I 11

Features PPA Foundation Grant Report

continued from page 11

Table 2: Distribution of Dispensing Tasks Tasks

Pharmacist Non-Pharmacist

Drop-off

2 10%

18 90%

Data Entry

2

21 91%

Counting

2 9%

9%

20 91%

prescription from the patient at drop off 90% of the time.

An example of the workflow can be seen to the right. This sample includes details about primary responsibilities of interactions.

pharmacy. Specifically, we need a unified definition of patient care, consistent training program which incorporates ancillary staff, and a strategy to overcome barriers identified. This data will be presented to Rite Aid Corporation in a report and as a manuscript to disseminate the results to others in community pharmacy.

Conclusion The findings of this study contain information to improve implementation of advanced patient services in community

Acknowledgements: Janice Pringle, PhD; Jesse McCullough, PharmD; Alexa Benner, PharmD; Timothy Sheerer, PharmD; Nicole Pezzino, PharmD candidate; Julie Cusatis, PharmD candidate; Grant support from the PPA Education Foundation and APhA Foundation.

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Departments

Campus Checkup LECOM School of Pharmacy Chosen for Top Awards in ‘Script Your Future’ Challenge The Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy was chosen for two prestigious awards in the 2014 National Consumers League (NCL) Script Your Future (SYF) Medication Adherence Team Challenge.

For helping patients in Erie and in Bradenton, Fla., understand why they should take medications as prescribed, LECOM students received the National Team Award and were just one of two pharmacy schools nationally to earn that honor this year. The competition involved nearly 50 schools of pharmacy and other health professions.

In addition to this, LECOM won the Creative Inter-professional Team Event Award for promotions

that fostered collaboration between pharmacy students and dental and medical Ashley Ramp, a second-year pharmacy student, Hershey students. The award Bell, MD, Dean of the LECOM School of Pharmacy, also recognizes the Matthew Palilonis, a second-year medical student, and Justin Scholl, PharmD, Assistant Professor announced schools and colleges LECOM’s national awards in the Script Your Future of pharmacy that Medication Adherence Challenge. were most effective in raising awareness For both awards, the LECOM of the importance of School of Pharmacy will receive medication adherence, defined as funds to be used for future taking medications as prescribed, community outreach related to and promoting adherence in medication adherence. In the three an “original or inventive way.” years of the competition, LECOM The NCL noted that LECOM now has won two national awards students, as part of their outreach, and an honorable mention award. spoke to local nursing students z about adherence and how to use interventions to increase communication with patients.

LECOM Donates to PharmPAC! Thank you to LECOM who generously donated $500.00 to PharmPAC as a result of their White Coat Fundraiser! They exceeded the goal of selling over 100 coats.

An announcement about the White Coat Fundraiser was originally made during APhAASP meetings and the fundraiser was promoted on Facebook. In addition to this, the fundraiser was marketed through promotional emails to all pharmacy students.

Although the students receive a

white coat from LECOM during the fall White Coat Ceremony, having a few extras on hand for presentations, health fairs, labs and rotations is always useful.

Students were able to order the coats through Survey Monkey, and all coats were custom embroidered with the name and logo of LECOM and provided an option for students to customize their name for the pocket.

LECOM’s Keystone Club Contribution came from the

APhA-ASP/SPPA chapter and was organized by Christopher Sedgwick, APhA-ASP Chapter President, Beth Miller, Director of the LECOM SPPA Chapter, Taylor Warmbrodt, LECOM SPPA Alternate who assisted with the P1 class and Elaina Farah.

Thank you to all who contributed! z Continued on page 14

Pennsylvania Pharmacist I July/August 2014 I 13

Departments Campus Checkup

explaining yourself, it is also acting upon one’s actions.

My leadership was tested What it Means to be a when I was the coordinator of a Leader by Terry Pak, medication safety presentation GRASP Participant called, Katy’s Kids. Katy’s Kids is an hour long presentation I first heard of the word explaining the importance of not “leader” in kindergarten. In my confusing candy with medicine. kindergarten class This presentation was we had assigned jobs developed for students such as paper passer, in kindergarten lunchroom helper, through second and line LEADER. I grade at Cornerstone always got excited Christian Academy when it was my turn in West Philadelphia. to be the line leader.

Some challenges I In my young mind, I had to overcome were was easily amused by liability insurance the concept no matter and developing an Photo from the Katy’s Kids how fast I walked the effective presentation presentation as described rest of my class had to that was engaging

by Terry Pak. follow or if I stopped and educational. walking, everyone else stopped However, arranging, meeting, walking. For a while I associated and teaching the other student being a leader only meant having pharmacists who would be doing followers. Since I became a the presentation was the most member of the Pennsylvania challenging task. I had to clearly Pharmacists Association a leader is communicate my vision of the more than just leading a group of project since a presentation like people. this had never been done before.

A leader is a magnet of In the end, we did three successful inspiration. They motivate others presentations, which consisted to achieve and create high of six students who spent 30 standards for themselves and the minutes explaining the dangers of organization. Leadership does improper medication use, health not come naturally but instead initiatives and the different fields it is a never-ending process of of pharmacy. At each presentation self-study and experiences. A the Philadelphia College of core fundamental of leadership Pharmacy students communicated is communication. If a leader is effectively and engaged the young not able to effectively explain and students with personal stories and implement their vision, then the questions. The active involvement results of the group are subpar. of the young students filled the This misunderstanding can lead to classroom with excitement to learn. animosity and frustration, which is As I continue to be a member counterproductive. Communication of PPA, my definition of a leader is more than just effectively Continued from page 13

14 I Pennsylvania Pharmacist I July/August 2014

will continue to change. While my definition might change, I hope to continue my enthusiasm for pharmacy and be a magnet of inspiration. z

Duquesne Students Raise Poison Prevention Awareness Eight student members of the Duquesne University chapter of APhA-ASP partnered with the Allegheny County Pharmacists Association to stuff packets of poison prevention information to distribute to local pharmacies and children’s startup programs throughout Allegheny County. The packets included Mr. Yuk stickers, checklists of common household items that are poisonous and other information about poison prevention. Over 350 packets were made to distribute to families throughout the county. This was in preparation of National Poison Prevention Week, which is the third week of March, annually. Student pharmacists and pharmacists have been instrument in providing information to help reduce the risk of childhood poisonings. z

Front row (L to R): Simon George, Ashley Adams, Alicia Sacco Back row: Jordan Moore, Stan Jonas, Alicia Lanni. The students are members of the class of 2015. Stan Jonas, PharmBS, MPH, is a pharmacist with the Allegheny County Health Department.

Features Pennsylvania Pharmacists Association Member Profile

Nicholas Leon, PharmD, BCPS, BCACP Pharmacy/Practice Site: The Penn Center for Primary Care at Penn – Presbyterian Medical Center in Philadelphia; Assistant Professor at Jefferson School of Pharmacy Education: USP PharmD Graduate, ’07; PGY-1 in pharmacy practice at the Veteran Affairs Medical Center in Albuquerque, NM; PGY-2 in ambulatory care at the University of Maryland – School of Pharmacy in Baltimore, MD

What made you choose the profession of pharmacy?

I was fortunate enough to take pharmacology as an elective course during my time at Central High School in Philadelphia. It was there that I was first exposed to the concepts of pharmacodynamics/pharmacokinetics and I fell in love with it.

How did your Pharmacy experiences shape your career?

During my first pre-professional year, I was looking for a job and decided to answer a hand written job posting for an independent pharmacy in Roxborough. After going to the interview in ripped jeans, and a rock n’roll tee shirt, miraculously I was hired (by a pharmacist who went to Woodstock, mind you). This is where I was first exposed to how the science of pharmacy blends with the “art” of pharmacy practice. I learned the value of building relationships, having good communication skills and that a pharmacist could make a difference. It was also because of this job that I was fortunate enough to meet my wife. These

two experiences have helped to cement my passion for the profession which I have used as a springboard to help others ever since.

What was the most memorable experience of your career?

I was on an APPE rotation site at a community pharmacy with Bruce Sigman, Past President of PPA. Bruce convinced me to go to my first Legislative Day where he had me set up appointments with local legislators. We needed to prepare something to talk about, so I created a spreadsheet to show how poor our reimbursements were. I also found a study which showed the cost of dispensing the prescriptions. The experience of presenting this information to legislators exposed me to how I can make a difference. Feeling empowered to affect change, motivated me to become more involved in PPA.

What do you like most about being a pharmacist?

talking about medications. The one who can say if the medications are helping you or hurting you; and to answer the question, is this the right medication, at the right dose, for the right reason, for the right person.

How has being a PPA member helped you professionally?

The Association has helped me in many different ways. PPA has a very solid infrastructure that easily enables pharmacists to become involved through a variety of different ways. They can put you in a position to network with and learn from other experienced professionals. They have also done an excellent job of advocating for our profession within the state.

During your career, what do you believe to be the single most significant advancement in pharmacy?

Collaborative practice agreements are a great advancement. Pharmacists have flourished with that kind of responsibility and that’s one of the things that allow us to fight for provider status.

Continued on page 17

I enjoy being the person that has the luxury of thinking and

Pennsylvania Pharmacist I July/August 2014 I 15

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continued from page 15

What is the most important piece of advice you would give a newly licensed pharmacist on their first day of work or residency?

You have to know how to work as a team with other people from all types of disciplines and backgrounds. It is important to be the person people want to work with.

Where would you like to see the profession go in 10 years?

Healthcare provider status.

I would like to see more community pharmacists engaged in collaborative practice agreements with direct patient care responsibilities and more chronic disease management.

What is a memorable quote you have?

I find this quote so fitting because I would like to see my vision for pharmacy turn into reality.

When you are not working, where can you be found?

On the golf course- trying improve my game!

Compiled By: Courtney B. Graham, PharmD Candidate 2014 Wilkes University

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Journal

The Unintended Consequences of Pennsylvania’s Department of Public Welfare Six Prescription Drug Limit A White Paper, created by a Work Group of PPA’s Health Policy Committee, examining the unintended consequences of the Department of Public Welfare’s (DPW) six prescription per month drug limit and offering alternatives involving pharmacists’ care. Below is an excerpt from the Executive Summary of the white paper created by a Work Group of the Health Policy Committee of the Pennsylvania Pharmacists Association (PPA).

To view the full Executive Summary and/or the complete white paper, please visit www.papharmacists.com.

Excerpt from the Executive Summary On January 3, 2012, Pennsylvania’s Department of Public Welfare (DPW) implemented a six prescription per month policy for categorically needy adult Medical Assistance (MA) recipients, 21 years of age and older. The policy was intended as a cost saving method when the 2011–2012 Pennsylvania State Budget required severe cuts within DPW, which targeted a $14.8 million reduction through reduced dental and pharmacy benefits. The decision by DPW to implement the six-drug limit was made under the premise that the majority of MA recipients would not be impacted.

The purpose of the white paper is to share the unintended consequences of DPW’s six prescription policy and the

18 I Pennsylvania Pharmacist I July/August 2014

burdens placed on providers and patients navigating DPW procedures. These burdens often cause delays in patients receiving medications and adversely affect prescribed treatment as witnessed in clinical practice and suggested by studies evaluating similar policies. Examples from across the country showcase the success that occurs when states collaborate and partner with the medical community to provide quality, cost effective healthcare for their Medicaid populations are also highlighted in the paper.

Under this limiting policy, physicians and pharmacists are in the unenviable position of deciding which medications to discontinue if the patient is denied an exemption by DPW. An increase in health service utilization could suggest this policy caused harm to those beneficiaries

denied the seventh prescription.

Overall costs, health and safety outcomes of this policy have not been critically evaluated. All factors need to be considered in order to justify implementation of this prescription limit policy as a costsaving strategy that does not cause harm.

A collaborative approach to health care, which includes pharmacists, has been shown in several studies to improve patient outcomes, and reduce costs for the patient, the insurer and the health care system. Several states have successfully reduced inappropriate prescribing by allowing pharmacists to perform Medication Therapy Management (MTM). In 2006, the Center for Medicare and Medicaid Services (CMS) began the implementation of MTM Services to Medicare D participants. MTM is designed to

Journal help the patient get the most out of their medication and improve their health outcomes. Although MTM services have been slowly evolving under Medicare D over the last seven years, several studies have been published in medical literature showing the benefit of pharmacist provided MTM services for improving the patient’s quality of life and overall reduction of healthcare costs. Recent changes in 2013 require all Medicare D patients to receive MTM services annually.

Polices limiting drug therapy are not new or innovative and have never been proven to be an effective strategy in truly reducing costs or improving patient care.

However, Pennsylvania, like many other states, pursues them in place of meaningful and viable alternatives. This white paper is not intended to place blame and the Pennsylvania Pharmacists Association is sensitive to the pressure policy makers face in controlling costs in the Commonwealth. Rather, its purpose is to demonstrate that through professional collaboration with the medical and pharmacy community, there are successful alternatives for saving healthcare dollars.

Executive Summary Conclusion Polices such as these are not new or innovative and have never been proven to be an effective strategy to reduce costs or improve patient care. However, Pennsylvania, like many other

states, pursues them in place of meaningful and viable alternatives.

This white paper is not intended to show blame, and is sensitive to the pressure policy makers are up against in controlling costs for our state. However this paper was written to show that with professional collaboration there are successful alternatives for saving healthcare dollars.

This document provides examples from across the country

Polices limiting drug therapy are not new or innovative and have never been proven to be an effective strategy in truly reducing costs or improving patient care.

However, Pennsylvania, like many other states, pursues them in place of meaningful and viable alternatives. to showcase the success that occurs when states are willing to collaborate and partner with the medical community to provide quality, cost effective healthcare for their Medicaid populations.

Pharmacists, physicians, nurses, insurance providers, and many others in the health care field together provide a wealth of knowledge and opportunity to construct these types of combined programs. Empowering pharmacists to provide patient care services such as comprehensive and targeted medication reviews and treatment recommendations has been proven to reduce costs

and improve patient care. It is estimated that about 75% of patient care occurs after diagnosis and initiation of treatment. It is during this part of patient care that pharmacists have proven to make a tremendous impact on adherence to treatment plans, identifying and resolving medication related problems, adverse effects, and drug interactions; addressing cost issues; and making follow up calls, all of which directly or indirectly contribute to success of the treatment. Successful treatment reduces costs by avoiding medication errors, emergency room visits, and hospital admissions. Allowing pharmacists greater opportunity to collaborate with patients, physicians, and other healthcare providers will help ensure patient safety and patient care. Pennsylvania has the opportunity to begin a new path toward ensuring all citizens have access to and benefit from the best healthcare available, while reducing overall costs. All this is possible without risking patient safety or patient care. z

Pennsylvania Pharmacist I July/August 2014 I 19

Industry News

NASPA finds state-level provider status is widespread, but not necessarily linked to payment Krystalyn Weaver, PharmD, Director of Policy and State Relations, National Alliance of State Pharmacy Associations, Richmond, VA

T

hirty-four states recognized pharmacists as providers or practitioners in at least one section of their state statute or in their state Medicaid program, according to a recent analysis conducted by the National Alliance of State Pharmacy Associations (NASPA). But little correlation existed between the recognition of pharmacists as providers within state law or the Medicaid program, and payment for pharmacists’ patient care services.

The actual framework and positioning of the language in state law varied greatly from state to state, as did the payment implications of having provider status.

“The large number of states who already have recognized pharmacists as providers or practitioners is both exciting and sobering news,” Rebecca P. Snead, BSPharm, NASPA Executive Vice

20 I Pennsylvania Pharmacist I July/August 2014

providing. The analysis included President and CEO, told Pharmacy the collection of information on Today. “It’s exciting because it payment for pharmacists’ patient shows us that there are fewer care services from Medicaid, state statutory barriers to payment for pharmacists’ patient care The large number of states who already services, have recognized pharmacists as providers but also is a is … exciting because it shows us that there reminder that there is much are fewer statutory barriers to payment for work to be pharmacists’ patient care services, but also done beyond is a reminder that there is much work to be legislative done beyond legislative advocacy. advocacy.”

Overview of results To determine which states have designated pharmacists as providers or practitioners, NASPA staff looked at state statutes, specifically the insurance code, the business and professional codes, and the pharmacy practice act; looked at the Medicaid provider manuals; and surveyed the state pharmacy association executives.

NASPA staff also collected information on states where pharmacists are being paid for the patient care services they are

employee benefits, and network contracts with private payers; instances of network contracting opportunities were captured from a survey of state pharmacy association executives. The analysis didn’t include contracts between a single payer and a single provider, incident-to billing, and facility fee billing.

Of the 34 states that recognized pharmacists as providers or practitioners, the majority do so through state statute, but a handful also recognize pharmacists within their state Medicaid provider

Industry News

Pharmacists designated as providers Pharmacists not designated as providers Pharmacists paid for targeted services*

manuals. In a couple of cases, pharmacists are recognized in their Medicaid provider manual but not within state law.

In at least 28 states, pharmacists’ patient care services (other than immunization administration) are covered by either the state or private payers. Included in the 28 were 15 states where pharmacists can be paid for services by their Medicaid program for at least one specified service, and 6 states with a state employee MTM benefit.

In at least six states, pharmacists are not formally recognized as providers in the state’s statute or Medicaid provider manual, but

are compensated for providing targeted patient care services.

One of the reasons for the lack of correlation between payment and a state’s designation of pharmacists as providers or practitioners is likely due to pharmacists not being federally recognized as providers. Because Medicaid and private payers often follow precedents set by Medicare, federal provider status for pharmacists within the Social Security Act would likely make coverage for pharmacists’ patient care services easier and more widespread.

State pathways to provider status A state can take various pathways to designate pharmacists as providers.

Insurance code. The insurance code is one of the most common places within state statutes for pharmacists to be formally recognized as providers. The insurance code is the set of laws with which insurance companies in the state must comply. But because state insurance laws do not apply to publicly funded programs (Medicare, Medicaid, Continued on page 23

Pennsylvania Pharmacist I July/August 2014 I 21

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Industry News as health care providers in their business, professional, or occupation codes. A handful of state employee plans) or to plans states, such as Minnesota and for self-funded employers, the Michigan, recognize pharmacists insurance code affects only a small in their public health provisions; portion of the insurance market— Minnesota also recognizes so changes to these laws may have pharmacists as providers in the less impact. insurance code.

Although some states have seen Recognition by Medicaid. positive effects from recognizing At least nine states recognize pharmacists as providers under pharmacists as providers in the the insurance code, others have state Medicaid provider manual, including two states where The NASPA analysis showed that legislative pharmacists are changes are not the only way—and never not recognized the final step—to effect chanage in the in statute. pharmacy practice model. Practicing Although pharmacists collectively lcan make a huge recognition impact on the national and state level as providers provider status initiatives by doing what they in Medicaid doesn’t always do best: taking care of their patients. result in payment for the seen little change. For example, provision of patient care services, pharmacists in Virginia have been it does help to remove a barrier to recognized as practitioners in the implementing new programs that insurance code for more than a include pharmacists. decade but have not seen scalable Recognition by private payment from private insurers for payers. Because the end goal their services. of achieving provider status is to Other sections in state codes. provide patients with access to In a handful of states, pharmacists coverage for pharmacists’ patient are recognized as providers in care services, another approach the pharmacy practice act. With is to work directly with private this approach, the statute may payers. This approach has been include in the definition of the used in states such as New word “pharmacist” a provider Mexico, where pharmacists are designation. Such is the case with recognized by many of the health Connecticut and Tennessee, which maintenance organizations and also both recognize pharmacists health plans, and in Tennessee, as health care providers in the where pharmacists are recognized insurance code. and being paid as providers of Some states, such as California patient care services through a and Nevada, define pharmacists program developed by the Blue NASPA

Continued from page 21

Cross Health Foundation and the Tennessee Pharmacists Research and Education Foundation.

Every pharmacist can make an impact. The NASPA analysis showed that legislative changes are not the only way—and never the final step—to effect change in the pharmacy practice model.

Practicing pharmacists collectively can make a huge impact on the national and state level provider status initiatives by doing what they do best: taking care of their patients. Pharmacists need to share their impact on patients’ health outcomes and costs. As public demand increases for pharmacists’ patient care services, there will be more pressure on payers to cover them. Pharmacists should continue to support APhA and other national and pharmacy associations to ensure the success of provider status initiatives. z CALL TO ACTION

Please note that it was not possible for the National Alliance of State Pharmacy Associations (NASPA) to do a comprehensive analysis of all potential contracts between pharmacists and payers for the provision of patient care services. If you are a pharmacist who is currently participating in such a contract, APhA and NASPA want to hear about it! Please send information about your program to Michael Ghobrial, PharmD, JD, APhA Associate Director of Health Policy, at mghobrial@aphanet.org.

Continued on page 24

Pennsylvania Pharmacist I July/August 2014 I 23

Industry News

Small Doses eSSENTIAL Accessibility Welcomes Merck to Coalition to Better Serve People with Disabilities eSSENTIAL Accessibility is pleased to announce that Merck, a global healthcare leader, is now a member of the MarketAbility Coalition-a group of leading global brands and organizations that have come together with a shared purpose-to better reach, serve and empower people with disabilities.

As part of the partnership, Merck offers a free assistive app on merck.com and merckengage.com.

The app gives people who have trouble typing, moving a mouse or reading, the tools they need to better access the internet.

The eSSENTIAL Accessibility app™ provides a suite of keyboard and mouse replacement solutions, among other tools, designed to help people with physical, reading and agerelated disabilities get online. The app is free of charge to the enduser and can be downloaded by clicking the blue wheelchair and keyboard symbol located on merck.com and merckengage.com.

Once downloaded, the app can be used on any website.

Visitors who click on the icon are directed to a special Merck landing page (http:// essentialaccessibility.com/merck/).

Here, they can download the app, access MerckEngage for online resources for healthy living, view job opportunities within the company, learn about Merck’s global diversity and inclusion practices, as well as Merck’s Workplace EnABLEment program, and access the Merck Manual for Pet Health, which offers readers information on animal-assisted 24 I Pennsylvania Pharmacist I July/August 2014

therapy, service animals for people who are differently abled and the health benefits of pet ownership.

“We are pleased to join this important coalition of organizations that are working together to empower people with different abilities by making inclusivity the norm,” says David L. Gonzales, chief diversity officer, Merck.

“Merck has recognized, from the get-go, the importance of being a diverse and inclusive organization,” says Simon Dermer, Managing Director of eSSENTIAL Accessibil-

ity. “From developing products that serve people with disabilities, to offering their employees with disabilities the outstanding Workplace EnABLEment program, to their community giving efforts and their partnerships with organizations that promote thought leadership on diversity, Merck truly sets the bar. We are proud to have them join the MarketAbility Coalition and we look forward to working together to help take their inclusivity efforts to the next level.” z

PQA Announces Release of a Commissioned Study on ValueBased Incentive Models for Community Pharmacy An independent report co-commissioned by the Pharmacy Quality Alliance that describes various value-based incentive programs was unveiled during the PQA’s 9th Annual Meeting and Best Practice Forum. “Perspectives: Applying Value-Based Financial Incentive Models Within Community Pharmacy Practice” was presented by lead investigator author Janice L. Pringle, PhD, Director of the Program Evaluation Research Unit (PERU) at the University of Pittsburgh, School of Pharmacy.

Commissioned by PQA and the Jewish Healthcare Foundation in 2013, this report was developed through the input of an Advisory Committee representing pharmacy providers, other healthcare providers, payers, purchasers, economists, professional organizations and other policy makers. Elements of value-

based incentive programs and information on how community pharmacies can become involved and integrated with these programs are contained in the paper, along with tools and suggestions for implementing these programs in pharmacy practice, and examples of current value-based incentive programs being implemented.

“PQA appreciates the efforts of Dr. Pringle and the members of the Advisory Committee in their dedication to produce this impactful paper. It is our hope that this paper will foster an increased dialogue, and serve as a call to action for those working in and with community pharmacies to take proactive steps toward valuebased incentive models,” said Laura Cranston, PQA’s Executive Director. The value-based incentives paper will be available at www.PQAalliance.org. z

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Member News Congratulations to William Thompson Jr., RPh, Chief Executive Officer of Thompson Pharmacy, with earning the Lifetime Achievement Award for Business Excellence from The Blair County Chamber of Commerce.

This award is presented to an individual who is a strong advocate for business in Blair County and is professionally and personally excellent.

LECOM Institute for Advanced Wound Treatment & Hyperbaric Medicine at Millcreek Community Hospital, a member of the Healogics network, participated in the first Healogics National Wound Care Awareness Week from June 2 to June 6. LECOM Institute for Advanced Wound Treatment & Hyperbaric Medicine offers advanced therapies to patients suffering from chronic wounds.

Program directors across the nation will dedicate the entire week to visiting local physician offices to provide education to help staff identify patients that may benefit from advanced wound care.

Congratulations to Dr. Patricia Kroboth, PhD for receiving the American College of Clinical Pharmacology, Bristol-Myers Squibb Mentorship in Clinical Pharmacology Award.

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Pennsylvania Pharmacist I July/August 2014 I 27

Association News

Congratulations to the 2014 Recipients of the PPA Outstanding Student Award This award honors and recognizes one graduating student at each school of pharmacy in Pennsylvania who has been most active in pharmacy organizations during his/her academic year.

Duquesne University Mylan School of Pharmacy: Haley Wochner

of pharmacy; it is truly an inspiration!

PPA has blessed me with memorable events and forever friends that allowed me to grow personally and professionally, and I am complimented that an organization that gave so much to me felt that I deserved recognition with an Outstanding Student Award for the Class of 2014! I have moved to Minneapolis, Minnesota to work for CVS/ Pharmacy. Thanks to my great experiences through PPA, I plan on being involved with the Minnesota Pharmacists Association and bring what I have learned to a new group of pharmacists. Thank you all for your support and hard work to enhance the profession

Jefferson University School of Pharmacy: Yuliya Baratt

28 I Pennsylvania Pharmacist I July/August 2014

The Pennsylvania Pharmacists Association has provided me with many opportunities during my time at Jefferson. My participation with this organization has helped me grow as a person and a student pharmacist. I have had the pleasure of presenting multiple posters at PPA meetings over the years but the achievement I am most proud of was the opportunity to give a continuing education presentation on insulin dosing at the latest PPA annual meeting.

Now having finished pharmacy school I am extremely grateful for everything that participation

in PPA has afforded me. It has been a huge part of my pharmacy career thus far and I anticipate that it will continue to be so in the future. I have met many great people during my time with PPA and I look forward to working with them in the future. Receiving this award from an organization I have been so proud to be a part of was a great honor for me. It was unbelievably humbling to have my work recognized by people I admire so much.

LECOM School of Pharmacy: Katherine Trexler I feel honored to have won PPA’s Outstanding Student Award. My pharmacy school experience was greatly enhanced through my involvement with PPA. My

Association News first experience with PPA was GRASP, where I was introduced to PPA and to pharmacy advocacy.

After that, I served as the PPA delegate for my school, LECOM. Some of the activities our chapter participated in were starting the Katy’s Kids program in our community, visiting our local representative and holding a white coat sale fundraiser for PharmPAC. I enjoyed PPA events during my time as a student, including Legislative Day, the Mid-Year Conference and Annual Conference. I am excited to begin a PGY1 residency at the Coatesville VA Medical Center and continue my involvement in PPA! Philadelphia College of Pharmacy: Lydia Watkin Thank you, it is an honor to have been named Philadelphia College of Pharmacy’s PPA Outstanding Student of the Year and have my academic achievement recognized.

I am beginning a PGY1 pharmacy residency at the Hershey Medical Center to further my clinical knowledge and experience. I plan to remain an active member in PPA and continue to support the development of our profession.

Temple University School of Pharmacy: Parth Bhatt I am greatly humbled and honored to be receiving this award. I would

like to express my sincerest gratitude to the Pennsylvania Pharmacists Association for recognizing me with the Outstanding Student of the Year Award. I thank PPA for giving me opportunities to explore and learn about different facets of the profession. I plan to work in a chain pharmacy and serve the community and make a positive impact as a community pharmacist. Seeing how PPA influenced me, I would like to stay involved with PPA and other state pharmacy organizations to contribute in making our profession more advanced. I urge all aspirant pharmacy students to not only join the PPA but take full advantage of all that they offer.

University of Pittsburgh School of Pharmacy: Brandon Antinopoulos On top of the excitement of graduating from pharmacy school, I was thrilled to learn that I had been awarded the PPA 2014 Outstanding Student Award. I absolutely love this organization and am grateful for all the memories and opportunities it has provided me.

This award will help jumpstart my continued involvement in PPA and my commitment to advancing the role of the pharmacist in the Commonwealth of Pennsylvania.

Thank you PPA for this amazing award.

Wilkes University Nesbitt College of Pharmacy: Courtney Graham I am honored to be the recipient of the PPA 2014 Outstanding Student Award from Wilkes University.

PPA and Wilkes University have helped me develop my skills to advocate for the profession of pharmacy. I will begin my career as a pharmacist at Weis Pharmacy in central Pennsylvania. I am excited to educate my patients on a day to day basis as an integrated part of their healthcare. I have enjoyed the opportunities I received from being an active student member in PPA and I look forward to my continued involvement. Thank you for selecting me for this most prestigious award! z

Pennsylvania Pharmacist I July/August 2014 I 29

Association News

“True Life: I’m a New Practitioner … Now What?”

N

ow what? It’s amazing how two simple words can combine to create such a loaded question. There is comfort in knowing that there are many successful graduates who have had to confront this same question.

They say hindsight is 20/20 and the “True Life: I’m a New Practitioner…Now What?” forum provided by PPA’s New Practitioner Advisory Board and ACPA in the spring of 2014 gave students the opportunity to ask new practitioners what they wish they had known as recent graduates and how to make the professional and personal transition from student to pharmacist. Jennifer Bacci, PharmD, New Practitioner Advisory Board Chair, along with other members of the New Practitioner Advisory Board, developed the idea as a way to engage local student chapters and demonstrate one of the many benefits of being a new practitioner member. The event was a team effort between Bacci, Chelsea Harrison, PharmD, Karen Pater, PharmD (ACPA President), Kyle McGrath, 2015 PharmD Candidate, who coordinated the event held at the University of Pittsburgh and Jamie McConaha, PharmD, CGP, BCACP, who helped coordinate the room at Duquesne University.

The following new practitioners participated as panel members for the events: Sarah Deutsch,

30 I Pennsylvania Pharmacist I July/August 2014

They say hindsight is 20/20 and the “True Life: I’m a New Practitioner…Now What?” forum gave students the opportunity to ask new practitioners what they wish they had known as recent graduates and how to make the professional and personal transition from student to pharmacist.

PharmD, Amanda George, PharmD, AJ Greco, PharmD, Ellen Deutsch, PharmD, Lauren Long, PharmD, Kate Naper, PharmD, Kristin Franks, PharmD, and Claire Schum, PharmD. The invited panel members all practice in varying settings (community, hospital, managed care, academia, ambulatory care, etc.) and have all taken different paths to get to their current positions. Panel members were excited to help students and have a positive impact on

students. There were five panel members at the Duquesne event and four panel members at the University of Pittsburgh event with 15–20 students in attendance at each occurrence. Students felt comfortable asking questions related to how to manage financial obligations, what it is like to be a new professional and how to feel safe as a new pharmacist. The forum attracted both members and non-members. z

Association News

Pharmacy Technician Corner PPA Pharmacy Technician Profile: Tom Lindeman, CPhT What made you want to be a pharmacy technician?

Pharmacy tech became an “encore career” after I completed a thirty-five year career in public education as a teacher, therapist, facilitator, principal and supervisor of special education with the Carbon Lehigh Intermediate Unit. I have always admired the pharmacy profession and the positive impact it has on peoples’ health and well-being. I saw pharmacy tech as a viable way to help people, educate and mentor other techs and use my business marketing skills and experience.

As a lifelong educator/learner, I recognized the importance and value of professional credentials and pursued study and achieved the CPhT certification.

What piece of advice would you give to a new pharmacy technician on their first day?

Practice Patience: one cannot learn it all in one day; perseverance is key! Actively Listen: one can learn much from the pharmacist and other experienced techs. Ask Questions: this promotes learning and facilitates success. And finally, seek continuing education: take advantage of the ample opportunities to gain knowledge

in the profession – online, attending conferences, webinars – NEVER STOP LEARNING!

What is your view of the future of the pharmacy technician profession?

As the “baby boomers” age and seniors become a major demographic component of American society, there will be an ever-increasing need for pharmacists and techs to provide MTM to patients, while creating an awareness of the dangers of polypharmacy. The pharmacist will primarily undertake this role, which should provide added responsibilities, duties, and opportunities for techs in other areas of the pharmacy.

Possessing a CPhT designation will be the value-added component for technicians to provide outstanding service to patients. Pharmacy Technicians must endeavor to influence the Pennsylvania State Board of Pharmacy to recognize the CPhT designation in order to achieve professional status, as Pennsylvania is currently one of only five states that do not regulate pharmacy technicians.

Professional status will enhance respect, improved compensation

and ongoing professional development for technicians: resulting in better care and service to patients. z Continued on page 32

Pennsylvania Pharmacist I July/August 2014 I 31

Association News Pharmacy Technician Corner

continued from page 31

Why PPA Pharmacy Technicians Love What They Do! Donna M. Foster, CPhT

Melissa Keebler, CPhT

Tom Lindeman, CPhT

For me, it’s all about knowing that what I do can make a difference, albeit indirectly. It’s about helping patients recover from illness or surgery, & getting the medications to the floors on time so that the nurses can provide the best possible care!

I love being a pharmacy technician because I do not have the stomach to be a nurse like my mom, but I love the medical field.

I enjoy the patient interaction and the feeling that I am an important part in their cancer treatment at Lancaster Cancer Center. Although they are going through this hard time dealing with this disease many of them still have such a positive outlook on everything and most are always smiling. I am blessed to be a part of their care and treatment. It’s all about the patients!

My passion as a pharmacy technician is enabled by the fantastic opportunity I have to serve patients, educate other techs and market a new community pharmacy on a daily basis!

Sharon Massen, PhD, CPhT

I think being a pharmacy technician is special because it Being a pharmacy technician is a caring position in which the in a level one trauma center is patients come in looking for a always exciting! There are very kind heart and a helping hand; few “routine” days. It could be a the technician is there to do both simple car vs. buggy accident or a of these and to help the patients gang related shooting with patients on the road to recovery as he or needing emergency she sends the patients But of all the practice areas in the pharmacy intravenous fluids that on their way with their takes precedence over medications. field, being a pharmacy technician program everything else. The instructor is by far the most rewarding. You get Iris Apple, CPhT old adage “expect the to use your creativity and, sometimes, ingenuity I love my career as best, but prepare for the to teach difficult subjects to students. a pharmacy technician worst” applies in the because it gives me the hospital practice setting.

— Pamela Good, CPhT ability to gain different But of all the practice experiences by working areas in the pharmacy Tina Gulick, CPhT in various settings and I am able field, being a pharmacy technician to learn something new on a daily I love my job, every day I get program instructor is by far the basis. I can be in the background up and think about the challenging most rewarding. You get to use helping people live better lives, issues that come across my desk your creativity and, sometimes, while learning about different daily, whether it be a resident/ ingenuity to teach difficult subjects diseases and conditions and how patient that needs a medication to students. Seeing the “light they are treated. z ASAP because they are dying, bulb go off” for a student who is how to obtain a medication struggling is the most rewarding for a resident that may not be part of the job. Having a student able to afford it, to assisting my return, several years later, to co-workers with a mathematical inform you of their success, is question, two days are NEVER priceless! alike.

Pamela Good, CPhT

32 I Pennsylvania Pharmacist I July/August 2014

Features

and the Law

By Don. R. McGuire Jr., RPh, J.D. This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

ARE YOU READY FOR THE UNEXPECTED?

T

he phone call occurred that no one wants to get. Joe Plum, the owner of Plum’s Pharmacy, had passed away during the night.

It was unexpected and the staff at the pharmacy was very upset to hear the news. Their grief and sorrow turned into anxiety over the next few days when they learned that Joe had died without a will. What did the future hold for Plum’s Pharmacy?

Like most pharmacy owners, Joe had planned and was prepared for contingencies that would affect his business; changes in prescribing habits, changing in reimbursement rates, and the addition of more patient-centered services. But he failed to plan for what would happen if he wasn’t there. When you don’t plan, the state does it for you through laws called intestate succession. These laws vary by state and may distribute your estate in a completely different manner than you would. Here are a couple of examples:

Delaware1 § 502 Share of spouse.

The intestate share of the surviving spouse is: (1) If there is no surviving issue or parents of the decedent, the entire intestate estate; (2) If there is no surviving issue but the decedent is survived by a parent or parents, the first $50,000 of the intestate personal estate, plus one half of the balance of the intestate personal estate, plus a life estate in the intestate real estate; (3) If there are surviving issue all of whom are issue of the surviving spouse also, the first $50,000 of the intestate personal estate, plus one half of the balance of the intestate personal estate, plus a life estate in the intestate real estate; (4) If there are surviving issue, one or more of whom are not issue of the surviving spouse, one half of the intestate personal estate, plus a life estate in the intestate real estate. § 503 Share of heirs other than surviving spouse.

The part of the intestate estate not passing to the surviving spouse under § 502 of this title, or the entire intestate estate if there is no surviving spouse, passes as follows: (1) To the issue of the decedent, per stirpes; (2) If there is no surviving issue, to the decedent’s parent or parents equally; (3) If there is no surviving issue or parent, to the brothers and sisters and the issue of each deceased brother or sister, per stirpes;

(4) If there is no surviving issue, parent or issue of a parent, then to the next of kin of the decedent, and to the issue of a deceased next of kin, per stirpes; (5) Any property passing under this section to 2 or more persons passes to such persons as tenants in common.

Idaho2 15-2-102. Share of the spouse. The intestate share of the surviving spouse is as follows: (a) As to separate property: (1) If there is no surviving issue or parent of the decedent, the entire intestate estate; (2) If there is no surviving issue but the decedent is survived by a parent or parents, one-half (1/2) of the intestate estate; (3) If there are surviving issue of the deceased spouse, one-half (1/2) of the intestate estate. (b) As to community property: (1) The one-half (1/2) of community property which belongs to the decedent passes to the surviving spouse.

15-2-103. Share of heirs other than surviving spouse. The part of the intestate estate not passing to the surviving spouse under section 15-2-102 of this part, or the entire intestate estate if there is no surviving spouse, passes as follows: (a) To the issue of the decedent; if they are all of the same degree of kinship to the decedent they take equally, but if of unequal degree, then those of more remote degree take by representation; (b) If there is no surviving issue, to his parent or parents equally; (c) If there is no surviving issue or parent, to the issue of the parents or either of them by representation; Continued on page 34

Pennsylvania Pharmacist I July/August 2014 I 33

Features (d) If there is no surviving issue, parent or issue of a parent, but the decedent is survived by one (1) or more grandparents or issue of grandparents, half of the estate passes to the paternal grandparents if both survive, or to the surviving paternal grandparent, or to the issue of the paternal grandparents if both are deceased, the issue taking equally if they are all of the same degree of kinship to the decedent, but if of unequal degree those of more remote degree take by representation; and the other half passes to the maternal relatives in the same manner; but if there be no surviving grandparent or issue of grandparents on either the paternal or the maternal side, the entire estate passes to the relatives on the other side in the same manner as the half.

Overlooking some of the legalese, you can see that this situation becomes complicated very quickly and the results can differ by states and by family situation. The reason for the staff’s anxiety is readily apparent. Who will end up owning the pharmacy – Joe’s spouse, his children or maybe even his parents? Are any of these possibilities what Joe wanted?

Many people are reluctant to do estate planning. They are uncomfortable talking about death.

But not talking about it and not planning passes the problem on to those left behind. Planning is more likely to leave the business that you worked so hard to build in a more viable condition to continue.

Wills, however, are not the only way to do estate planning. There are other options for both your business life and your family life.

Consult your local attorney to find out what options are right for you and your family. While this may not be the most pleasant way to

34 I Pennsylvania Pharmacist I July/August 2014

spend an afternoon, the result will be well worth it. The legacy you leave behind will be the one that you choose. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

References: 1 – For the entire intestate succession provisions, see Delaware Code Title 12 Sections 501 to 512.

2 – For the entire intestate succession provisions, see Title 15 Idaho Probate Code 15-2-101 to 15-2-114.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly. z

Tony Hayslip, ABR/AREP 713-829-7570 Tony@RxBrokerage.com

Ernie Zost, RPH 727-415-3659 Ernie@RxBrokerage.com

Association News

Meet the 2014-2015 Board of Directors Officers:

President, Eric Esterbrook, RPh

President-Elect, Donna Hazel, RPh*

First Vice President, Eric Pusey, RPh, CDE*

Second Vice President, Nicholas Leon, PharmD, BCPS, BCACP*

Immediate Past President, J. Scott Miskovsky, RPh

Director–Academy of Chain Pharmacists, Stephen Pfeiffer, PharmD, MBA, RPh*

Director–Academy of Community Pharmacists, Martin Kendra, RPh*

Director–Academy of Health System Pharmacists, Richard Demers, RPh, MS, FASHP

Director–Academy of Long Term Care and Consultant Pharmacists, Brant Gahr, RPh

Director–Academy of Student Pharmacists, Benjamin Andrick*

Director–Central Region, Ellen Nastase, BS Pharmacy, MS Pharmacy*

Director–Northeast Region, Thomas Franko, PharmD, BCACP*

Directors:

Director–Academy of Alternative Pharmacy Practice, Jamie McConaha, PharmD, CGP, BCACP

Vacant ... to be filled by the Board of Directors

Director–Academy of Pharmacy Industry Associates, Todd Eury

Director–Academy of Pharmacy Technicians

Elections for the 2014 PPA Board of Directors were held in the spring of 2014, and new Officers and Directors will assume their position on July 1, 2014. Officers and Directors will be installed during the Annual Business Meeting on Saturday, September 20th at the 2014 Annual Conference. To read the biographies for each Board member please visit www.papharmacists.com.

Vacant ... to be filled by the Board of Directors

Director–Northwest Region, Elliott Cook, PharmD

Director–Southeast Region

Director–Southwest Region, Lauren Simko, PharmD*

*Newly-elected leaders

Pennsylvania Pharmacist I July/August 2014 I 35

Association News

All members are invited to attend the

PPA Annual Business Meeting Saturday, September 20, 2014 The Annual Meeting of the corporation, as required by law, will be held during the Annual Conference and will consider proposed changes to PPA’s Constitution and Bylaws.

In accordance with the requirements to amend PPA’s Constitution and Bylaws, PPA is providing this notification of the intention to consider these changes at the PPA Annual Meeting to be held on: Saturday, September 20, 2014 in conjunction with the PPA Annual Conference at the Four Points by Sheraton Pittsburgh North, Mars, PA. The proposed changes to both the Constitution and the Bylaws are available for the advance review of all members at: https:// papharmacists.com/Policy.

Members may attend only the Annual Business Meeting at no charge, which is tentatively slated for 8 a.m. For those wishing to also attend the breakfast before the meeting or any part of the conference, you must be a registered attendee for all or part of the conference or purchase a breakfast only ticket. Please see full registration information at www. papharmacists.com/annualconference.

36 I Pennsylvania Pharmacist I July/August 2014

Features

Tracking Systems for Pseudoephedrine Sales

W

hen meth labs seizures (PMP). The next method is a was to electronically track the started to explode around tracking system with a block sales. This would allow us to the country, it became obvious sale. This is where once a person easily gather the information on something had to be done. People purchases the legal maximum each purchase and purchaser of working in this area looked at amount of pseudoephedrine the pseudoephedrine. This allows what chemicals and items were system will block the sale. The law enforcement to identify used in the process of making third basic method of tracking is those who purchase excessive meth and which of those could a straight tracking system. This amounts. Then it was thought if be regulated or controlled to help system collects the information a block sale program was added attack the meth lab problem. The on the person purchasing the this would make the system even one consistent drug better. The intent was was pseudoephedrine. to prevent someone There are three basic methods of Whether a meth from purchasing over “cook” (a person the legal amount of tracking the sales of pseudoephedrine. who illegally makes pseudoephedrine. Two First is prescription only for the sale of methamphetamine) used states and several cities pseudoephedrine and tracking the sales the red phosphorous and counties around the through the state prescription monitoring or anhydrous ammonia country have decided to program (PMP). The next method is a method, they need really restrict the sales tracking system with a block sale.

This is pseudoephedrine. and have made it a where once a person purchases the legal So pseudoephedrine prescription only drug. became the ingredient to This requires a person maximum amount of pseudoephedrine be tracked. It also was go and get a prescription the system will block the sale. The third easiest to track these from a doctor or other basic method of tracking is a straight sales because of the qualified person. These tracking system. This system collects the federal Combat Meth Act, purchases can be information on the person purchasing the which requires certain tracked under the state’s pseudoephedrine without any interference. information has to be prescription monitoring, collected by the seller. if the state has one.

The next question was When looking at how does law enforcement set pseudoephedrine without any which option is the best for an up a system to track the sales of interference. When looking at area, you have to determine pseudoephedrine to help work on which system is best, we must what you want the system to reducing meth labs? look at what is the intent of the do for you. If your goal is to There are three basic system. Each system has strengths make the most impact on the methods of tracking the sales and weaknesses based on the diversion of pseudoephedrine of pseudoephedrine. First is intent of the user. to methamphetamine labs then prescription only for the sale of When tracking pseudoephedrine making pseudoephedrine a pseudoephedrine and tracking sales was first started as a way prescription only drug is what you the sales through the state to attacking this problem, it was want. This would require the prescription monitoring program determined the best method Continued on page 38

Pennsylvania Pharmacist I July/August 2014 I 37

Features Tracking Systems

continued from page 37

buyer to go to a doctor or other qualified person to determine if the pseudoephedrine is the proper drug for them.

If the goal is to reduce the sales of pseudoephedrine which is being diverted to meth labs without the impact or inconvenience of prescription then blocked sales system appears to be the system to use. Unfortunately for many reasons this system does not work as designed.

“Smurfers” (people who buy/ collect pseudoephedrine for illegal use) have found numerous ways to get around this system. Some of the ways used are the use of false identification, working together in groups, hiring others to purchase pseudoephedrine and going to stores not involved in a blocked sales program. Also if a Smurfer just purchases right under the legal amount they will not be identified as someone who is diverting their purchases of pseudoephedrine to making meth.

The last system is a tracking system used to track the sales of pseudoephedrine. This system is a good investigation tool for making of criminal cases against “Smurfers”. This system will collect the data on the sales of pseudoephedrine by people especially those who are purchasing above the legal amount, be it state or federal levels. This system can be done in real time or the purchase information can be sent on a regular basis, such as once a week.

With a real time reporting system

38 I Pennsylvania Pharmacist I July/August 2014

law enforcement will immediately be notified and they can target a “Smurfer” at the store. This does create more work at the time of sale because the information has to be entered immediately.

If the sales information is sent on regular schedule then law enforcement can use it to make historical cases (after the crime has been committed). While this system does not attempt to prevent the illegal purchase of

While no system is perfect, we need to decide what our goals are when dealing with the sale of pseudoephedrine. ... No matter which way we go, it is absolutely necessary for law enforcement and pharmacists to work together on this ever growing problem. pseudoephedrine it does provide the most accurate data on the diversion of pseudoephedrine. It allows law enforcement to better identify “Smurfers” and for use to attempt to determine the true problem of “smurfing”.

While no system is perfect, we need to decide what our goals are when dealing with the sale of pseudoephedrine. If we are looking at impacting the illegal diversion then prescription sales is the best method. If allowing law enforcement to have the most accurate information on purchase by “Smurfers” then the

tracking system without blocked sales system is the desired system.

No matter which way we go, it is absolutely necessary for law enforcement and pharmacists to work together on this ever growing problem.

Author Brian Sallee Brian Sallee has 33 years of law enforcement experience with over 25 years as a narcotics detective. Brian is currently assigned to the Meth Unit with the Albuquerque Police Department. Brian is also the President of BBS Narcotics Enforcement Training & Consulting, LLC. He is cross-commissioned with the New Mexico Board of Pharmacy as an investigator. Brian was instrumental with the implementation and operation of the New Mexico Methamphetamine Special Information System (NMMSIS), which electronically tracks the sale of pseudoephedrine. He provides training for various pharmacy associations and teaches classes for the University of New Mexico; College of Pharmacy. Brian has a Masters Degree in Criminal Justice from New Mexico State University. Brian is co-author of the books: Narcotics Investigation: Working and Surviving and The Methamphetamine Handbook: What You Need to Know. z

For more information on how you can make a difference, www.papharmacists.com/foundation.

Educational Foundation Advancing Patient Care

My Profession...My Practice...My Philanthropy “The Foundation presents a wonderful opportunity for pharmacists in all practice settings to work collaboratively towards practice advancement. I firmly believe in its mission and its focus on Advancing Patient Care so I am walking the walk through my contribution.

The monthly credit card deduction is a simple, convenient way to support our professional future. For the cost of a cup of fancy coffee or a lunch out, my contribution is added to my monthly bill. At the end of the year, I get a charitable contribution statement for my total contribution for use in preparing my tax return deductions. It’s easy but it does a lot.

Through the Foundation, I am supporting grants, student programs, and fostering the future of our profession. This is MY way of making a difference—join us and support your profession and your philanthropy– the PPA Educational Foundation.”

Melissa McGivney, PharmD, FCCP, Associate Professor & Director, Community Practice Residencies, University of Pittsburgh and Foundation contributor For more information on how you can make a difference, www.papharmacists.com/foundation.

Co-Payment Coupons

continued from page 6

be mindful of several factors when choosing drug therapy in addition to price, including safety, tolerability, effectiveness, and simplicity. The use of copay coupons may be appropriate in certain situations to help patients find appropriate resources so they can afford necessary prescription drugs. Relying on copayment coupons should not be the primary message delivered to patients. However, if safe and effective generic options exist, the choice of a cheaper drug may be the best choice for patients and

insurers alike in keeping down the overall costs of healthcare and maintaining consistent, affordable access to medications, long term.

For those who cannot afford the cost of prescription drugs, patient assistance programs may help cover the cost for those who qualify for such programs. z References: (1) Langer Research Associates of New York, NY. Medication Adherence in America: A National Report Card. June 2013. National Community Pharmacists Association. http://www.ncpanet.org/pdf/ reportcard/AdherenceReportCard_Full.pdf (2) PhRMA. Improving prescription adherence is key to better health care: Taking medicines as prescribed can lower costs and improve health outcomes.

January 2011. http://www.phrma.org/sites/ default/files/pdf/PhRMA_Improving%20 Medication%20Adherence_Issue%20Brief. pdf (3) Cahn, L. How to Combat Pharma’s Costly Coupon Programs. Managed care, 2012. Managed Care Magazine Online website. http://www.managedcaremag. com/archives/1205/1205.coupons/html.

(4) Schultz, D. Drug Coupons: A good deal for the patient, but not the insurer. Kaiser Health News, 2012. Kaiser Health News website. http://www.kaiserhealthnews.org/ Stories/2012/October/02/drug-coupons. aspx?p=1 (5) Pharmacist’Letter. Medicare Part D: Controlling Fraud, Waste, & Abuse 2012: Training Course. http://pharmacistsletter. therapeuticresearch.com/ce/ceCourse. aspx?cs=&s=PL&pv=1&pc=12-904&quiz=& AspxAutoDetectCookieSupport=1

Pennsylvania Pharmacist I July/August 2014 I 39

Over $8.5 Million disbursed to participating members in 2013

Association News

Congratulations, 2014 PPA Graduates!

PPA wishes the 2014 PPA graduating students all of the best as they embark on their pharmacy careers! Remember to remain a committed member of our state pharmacy association no matter where you reside. For those remaining in Pennsylvania, we invite and encourage you to update your membership to pharmacist as either a resident or New Practitioner. This can be done online or by contacting Courtney Box at cbox@papharmacists. com PPA membership is an investment in your future livelihood, professional happiness and the well-being of your patients. Best wishes with your future endeavors! z Duquesne University — Mylan School of Pharmacy Michael Ballow Elizabeth Chartier Alyssa Clark Megan Cockroft Anne Countway Jordan Cunningham Logan Gamelier Julia Green Matthew Lee Hershberger Janelle Hestin Lindsey Hilton Paul Huffman Brandon Hunt Ashley Rose Kearney Nathan Kiernan Kennedy Min Kyung Kim Ian Kish Rachel Klaphake Katherine McCaffrey Jessica McLaughlin Jacob Moore Heather Opal Aaron Pellicciotti Michael M Piskuric Ilana Portman Rachael Renee Ross Michael Schontz Stephen Shadid Joseph Sneeringer Rachel Strauss William Trombatt Andrew Uhlmann Kallyn Westfall Haley Ann Wochner Lauren Elizabeth Wolfe Megan Zielke Jefferson University, School of Pharmacy Yuliya Baratt Ian Cook Sarah Mahon Rupali Patel Almamy Sesay William Truong LECOM School of Pharmacy Cassandra R Camp Cassie Marie Groner Brandon Richard Hetzell Maegan Lorraine Kochasic Bryan Koronowski Sumita Markana Jessica Carol Norris Angela Shick Kyle Spaniol Karrisa Lynn Tocyloski

Katherine Trexler Wondoson Hailu Yimamu Gina Marie Zappia Philadelphia College of Pharmacy at USP Sun Woo Ahn Frantz Benjamin Brittany Blood Joshua Allen Campbell Jung Yoon Chae Francesca Chieffallo Allison Conte Robert DeSantis Alyson Destefano Nabil Dharsi Heather Edwards William Fine Daniel Flannery Adam Gockley Joseph Guan Paul Hanna Alexandra Hauser Scott Hershey Mitchell Hughes Monica Huon Zhimeng Jin Laney Jones Ann Joy Hany Karara Jessica Kim Rachel Kim Soo Yun Kim Marianna Koerner Derek Krajek Sarah Kraus Julia Kravitz Michelle Kwon Annette Lista Yuqian Liu Angela Lye Andriy Lykhatskyy Robert McNeill John J Minchak Lisa Mitchell John Mondin Deana Musaka Sophia Ng Jinsun Paek Richard Parente Jin Hyung Park Judy Juyoung Park Judy Park Jigna Patel Mitesh Patel Christina Persaud Anita Ann Pothen Kaitlin Pruskowski Katrin Samy Jennifer Santamala Hansneet Sarang

Masato Sugeno Robin Thomas Kara Underhill Jennifer Vidal Leonard Vinciguerra Laura Walter Lydia Watkin Danny Yang Catherine Yi Ashley Zielen Temple University School of Pharmacy Richard Ababio Sarah Ahmed Jaclyn Beckett Parth V Bhatt Grace Bian Rachel Bogdanoff Brittany Cael Eris Cani Kevin Capps Hyeyoon Choi Nayoon Choi Brittany Conahan Duc Do Leon Do Nina Dziopa Theresa Ebinger Michael Edleman Chrisjon Ayen Fabian Cori Fraser Tracey Gaines David Gajdosik Ryan Gordon Daniel Green Patrick Haar Kelly Ann Hawthorne Angela Huynh Eri Jibowo Rashida Jones Jordanis Joy Nur Kazzaz Eugenia Khoo Robert J Klepacki Ashley Knipe Thanh J. La Bo Lee Mina Lee Michael Lehr Caitlin Lozorak Valerie Lu Elise Lyver Jonida Miraka Erika Monacelli Lauren Navarre Christy Newman An Nguyen Hang Nguyen Justin Robert Nixon Mercy Nyamweya

Ezinne Okwuego Steven Orlando Nauramy Osefo Kavita Patel Khushboo Patel Nidhi Patel Punit Patel Alex Peck Quynh-Anh Pham Vicky Qin Leda Ramoz Kelsey Sands Sung Hee So Hannah E Spinner Maximilian Straka Kemeisha Taylor Ali Tejani Selamawit Teklu Emily C. Terak Brittany Towler Kayla Tran Tung Troung Nhat Vu Lance Wetzel Karina Yedwabnik University of Pittsburgh School of Pharmacy Caitlyn Anderson Brandon Antinopoulos Samantha Becker Jonathan David Bodrog Paul Bowers Michelle Bucci Vantonile Vien Bui Frank Cintineo Elizabeth Ciuchta Julie Cusatis Melanie Rose Darrigo Stefanie Lauren Drahsuchak Cristina Elgin Lindsay M Fakete Joseph Fiore Ashley Firm Felix Y Fisher William L Ginsberg Emily P Graham Daniel Richard Green Joshua Daniel Greenberger Lorin Grieve Cory Hale Samantha Frances Holliday Cayla Jones Christine Ann Jordan Matthew Joseph Ho-Sik Kim Jessa Koch Anthony Richard Kostka Pamela Jane Lyons Emily Mallit Andrew Menard

James Michael Montgomery Cody Alan Moore Jose P Nery Ravi Patel James Thomas Payne Nicole Pezzino Natalie Pratte Lindsay Anne Rosso Deanna Marie Rowe Danielle Theresa Schneider Kinley Sepkovic Allison Sherman Brahim Shettima John Andrew Stapf Allison Elizabeth Supko Gregory Trietley Sarah Ward Evan Williams Tamiko Yamatani Wilkes University Nesbitt College of Pharmacy Sara Bellanco Megan Blusius Jefferson G Bohan Nicole Caffiero Brian Michael Cebulko Eliza Sadie Daubert William Eggleston Sarah Elias Amanda Evanich Colleen Herman Christopher Joseph Jankowski Michael Anthony Kachmarsky Edward S. Martinko Matthew Montville Rebecca Sue MorrisonMattiioli Jeremy Nolt Sheena Patel Tricia Quay Matthew Reichart Alyson Marie Stambaugh Trey Lee Tietz Meagan Williams Long Island University Rong Zheng Notre Dame of Maryland University Lindsey Glucksnis Ohio Northern University Kelly Marie Dye Marqui Eileen Milford West Virginia University Jeanine Elizabeth Hardy

Pennsylvania Pharmacist I July/August 2014 I 41

Independent Pharmacy Buying Group Giving independent pharmacy the ability to grow their business and bottom line thru innovative and forward thinking programs.

Founded by pharmacists who still work in their own stores.

Special pricing from AmerisourceBergen exclusive to IPBG members Members average $10,000 a year in “first to shelf” generics.

Up to $1,200 for attending AmerisourceBergen’s Expo PPA, NCPA, PAAS, and DEALookUp 100% paid dues for compliant members.

Members kept informed on all important issues from (i.e.) HIPAA, EQuIPP, CMS, OIG, ACO, NHIC, etc.

Member of Federation of Pharmacy Networks— 100% of rebates from FPN paid to you. $100 Lifetime processing fee—no other charges.

Learn about us—Visit our website today www.IPBGRx.com Call 877-971-IPBG (4174) Independent Pharmacy Buying Group 39 S. Morton Avenue, Suite 1 Morton, PA 19070

Features

Profiles in Pharmacy Innovation: Diane Boomsma, PharmD Brought to you by the PPA Educational Foundation.

Pharmacists … Advancing patient care!

The Foundation regularly showcases profiles of pharmacists who are involved in innovative patient care or pharmacy practice.

Education: Duquesne University Mylan School of Pharmacy, B.S. in Pharmacy; Shenandoah University Bernard J Dunn Pharmacy School, PharmD. Practice Site: Custom Prescriptions of Lancaster, PA. Description: Custom Prescriptions specializes in pharmaceutical compounding to enable the patient and health care provider to customize medications according to the patient’s medical needs, allergies, and additional preferences. They truly are “your friendly, neighborhood corner pharmacy with a high tech twist.”

Innovative Services Provided: Dr. Diane Boomsma opened Custom Prescriptions in 2007 with the purpose of providing patients with an integrative health and wellness approach targeted at addressing their individual needs.

She and her dedicated staff have successfully blended state-of-theart technologies with traditional methods of compounding to guarantee quality care for your whole family–and they mean it–they also provide veterinary compounding! They have the versatility to tailor therapy in order

to meet a diverse spectrum of physician and patient and ensures needs. that patients only receive the They have a fully integrated highest quality of care. operating system that utilizes Why Independent Pharmacy: barcode scanning and links to Early in her career Dr. Boomsma the scales to reduce human error. worked briefly for a small chain They also use a Resident Acoustic pharmacy before finding her Mixer (i.e. RAM) which removes calling in pharmacy compounding. the trituration process from She enjoys the camaraderie found compounding and has enabled among independent pharmacists them to standardize the way they and she has enjoyed getting to compound formulas ensuring the know her other colleagues and uniformity and quality of their communicating with them; she is products and enhancing Quality involved in several professional Assurance. organizations in addition to PPA Dr. Boomsma provides private such as APhA, IACP and NCPA; consultations to talk with patients Continued on page 45 about their health and overall wellness and discuss if they are achieving outcomes and if not, find out why. She adheres to the “Triad of Care” principle which promotes collaborative health practices and patient education and involves the pharmacist, Technician working in a powder containment hood

Pennsylvania Pharmacist I July/August 2014 I 43

Association News

PharmPAC – Working for You! As a PPA member, you enjoy the benefits from a multitude of programs. One of the primary benefits offered by PPA, and a big goal of the Association, is the representation of pharmacy within the legislative and regulatory processes of the Commonwealth.

These advocacy efforts depend on financial support through our members’ direct contributions through the Pennsylvania Pharmacists Association Political Action Committee, or PharmPAC. Often times, the success of PharmPAC and its day-to-day actions goes unnoticed by PPA members. However, PharmPAC has a proven history of successful legislative representation and influence. Because let’s face it, in the political arena, most victories and defeats are not clear-cut decisions, but rather compromises between many involved parties.

Contributing to PharmPAC provides: • Pharmacists who share the same political objectives a united means to use their resources to increase the impact of their contributions to candidates • An extension of the right of all pharmacists to participate in the political process and support candidates who share the same objectives • A vehicle for a unified voice: while an individual contributor is powerful, PharmPAC is the voice for the entire pharmacy profession and is heard loud and clear • PPA with a means to be more proactive politically • Increased visibility for pharmacy with legislators and candidates in the political arena

Delaware County pharmacists converse with local legislators during their annual Legislative Breakfast.

• Assistance in meeting legislative goals and other government relations efforts • A seat at the table to ensure legislators listen and learn about pharmacy and your interests • Relationship building with legislators whom PPA can call on when introducing legislation, attempting to block detrimental legislation, or fighting for amendments Because PPA members have realized these many benefits of PharmPAC, over the past few years PharmPAC has maintained a steady increase in contributions and contributors. In 2013, PharmPAC raised over $58,000 – its most EVER! With a record breaking year in the books, PPA’s Board of Directors set a very aggressive, but reachable, fundraising goal of $60,000 in 2014. With your help, we have the opportunity to reach this goal and even significantly surpass it.

PharmPAC’s efforts must encompass the combined voice and support of all PPA members.

We fight against opponents who continuously record multi-billion dollar profits and settle lawsuits in the tens of millions of dollars without hesitation. Only with support of its members will PharmPAC be successful. It is vital that PPA has a strong financial and political presence in order to win our legislative battles. PharmPAC is the outlet that can provide the financial backbone for legislative advocacy success.

Continued on page 45

44 I Pennsylvania Pharmacist I July/August 2014

Association News continued from page 44

papharmacists.com/pharmpac or contact Don Smith at (717) 234-6151, ext. 102. z

Making a PharmPAC contribution is accessible by visiting www.papharmacists.com/pharmpac. You can contribute online, download a form to make a onetime contribution or sign-up to become a monthly or quarterly contributor (recommended!).

We are almost half-way through the year and still have a long way to reach our 2014 fundraising goal.

We have raised just over $25,000 – but we aren’t done yet. Now is the time to get involved and make an investment in your profession.

The success of PharmPAC relies on YOU. It is important to become active in the political process and understand that decisions that are made by legislators directly affect your profession.

If you already contribute to PharmPAC, THANK YOU! If you would like to make a donation or sign-up to become a monthly contributor, please visit www.

Pharmacists pose for a photo with Senator Robert Tomlinson (R-Bucks) after a round of golf at Sen. Tomlinson’s Annual Golf Outing.

PharmPAC — Working for You!

Profiles in Pharmacy Innovation

continued from page 43

to name a few. Dr. Boomsma is dedicated to addressing the needs of her community and donating to charity as well as assisting her patients in whatever way possible.

Any plans to expand? “No. God has me right where I am supposed to be.”

Advice? “Always put the patient first in your thought process and you can’t go wrong. Act in their best interest and in most cases, you can’t go wrong.”

Contact Information: 902 N Duke St, Lancaster, PA 17602 717-393-0518 diane@customscripts.us

The Welcome Counter at Custom Prescriptions of Lancaster

Compiled By: Ilana Portman, PharmD Candidate 2014 Duquesne University. z

Pennsylvania Pharmacist I July/August 2014 I 45

Association News

My Rotation Experience with PPA Ilana Portman, PharmD Candidate 2014 Duquesne University

M

y rotation with the Pennsylvania Pharmacists Association was an invaluable and gratifying experience. I have been an active student member for several years and have benefited from the many opportunities provided to student pharmacists.

As such, I had a basic knowledge of the Association’s structure and the role it plays in pharmacy, but my rotation really improved my understanding of our organization.

During the five weeks I spent with PPA I gained a greater insight into of the inner-workings of a professional association and the intricacies of managing a successful organization.

Members are essential to the existence of an association but even more crucial to the success of the organization is the ability to sustain and grow a strong membership base. As the newest PPA staff member and the Membership Coordinator, Courtney Box is a vital asset to the organization and its members. She processes new members, oversees membership renewals and ensures that PPA’s membership database is complete with up-to-date member information. She also organizes student programming, serves as the Staff Liaison to the Student Advisory Board and develops and sends out the monthly Student Voice and weekly membership reports. PPA recently held their annual MPJE Law Review programs for students and I

46 I Pennsylvania Pharmacist I July/August 2014

assisted Courtney in compiling and processing the survey results from the two sessions. I also helped to update a list of members for the database and contributed to the Student Voice.

I also enjoyed the opportunity to work with Sara Powers, the Program Coordinator, who serves the Ilana Portman Association in more ways than her title delineates. She organizes all of the Continuing Education (CE) programs and ensures they adhere to stringent ACPE standards, communicates with PPA’s affiliated county organizations and is an invaluable resource for technicians and pharmacists. She is also handles the Association’s book-keeping and financial operations. She is incredibly detail-oriented and dedicated to ensuring every CE, whether it is a home-study, webinar, or live session, is a success. I learned a great deal from Sara and I took part in committee calls, developed a CE home-study and wrote a piece on a forum held by one of the affiliated counties.

I worked closely with Erica

Brandt, the Communications Coordinator, who promotes the Association and updates members on current pharmacy issues and upcoming events through weekly email bulletins, the PPA website, and social media; she also plans the Mid-Year and Annual Conferences. She demonstrated the importance of having an attention to detail and the ability to cultivate healthy relationships with other organizations and companies; ensuring that every publication and every conference is successful.

I helped update the website, made posts to social media and wrote several articles for the Pennsylvania Pharmacist.

I have attended several conferences as well as the

Association News GRASP program, and I was really looking forward to assisting Don with his legislative efforts and advocating for pharmacy. PPA gives a voice to our profession and without Don we would sound pretty hoarse. Don Smith serves as the Government Relations and Advocacy Manager and plays a key role in providing members with legislative updates, resources to contact local legislators, information about legislation affecting pharmacy and making sure our opinion is heard. I communicated directly with legislative staff to schedule meetings to discuss SB 831-Pharmacy Audit Integrity. I also drafted Issue Briefs on SB

1180 and HB 1694 which address the implementation of a new, integrated Controlled Substance Database.

Lastly, under the directive of the Association’s CEO, Pat Epple, I acquired a comprehensive understanding of what goes into running a successful pharmacy association and I have a better understanding of just how key state pharmacy organizations are for progressing and protecting the pharmacy profession. I participated in and summarized committee calls to discuss the patient care network initiative, attended the Educational Foundation Board Meeting as well as meeting of the State Board of Pharmacy. Pat cultivates valuable

Student Grants Available to Attend NCPA Conference P PA’s SIG (Special Interest Group for Independent Pharmacy) members annually present up to four grants to deserving and interested students which cover the expenses to attend the National Community Pharmacists Association (NCPA) Annual Convention. Covered expenses include: 1 roundtrip coach airfare, up to 4 nights hotel accommodations (room and tax), the student registration fee, and up to $200 in meals and incidentals such as parking at the airport, and transfers from airport to hotel, (receipts must be submitted). In order to be eligible for consideration, students must be a 5th or 6th

year pharmacy student enrolled at a Pennsylvania School of Pharmacy or equivalent of last two professional years, a Pennsylvania resident, a PPA Student Member, have a sincere interest in community pharmacy particularly independent pharmacy ownership and may not have been a previous SIG grant recipient.

Applications are now available for the fall NCPA conference in Austin, TX directly from PPA or on the website, (go to the PPA website, www.papharmacists. com and click on About PPA and then go to the Special Interest group tab on the fly-out bar), and must be submitted by the August 1 deadline. Please also contact

relationships between other state and national organizations and is dedicated to advocating for the profession. Pat is tasked with guiding the Association in reaching its goals while keeping the organization’s mission and vision in mind.

There is so much happening behind the scenes and we are fortunate to have a staff that is so dedicated to supporting our mission. I had an incredibly edifying and rewarding experience and I look forward to a bright future in pharmacy and continuing my involvement with PPA as an active new practitioner! z

Courtney Box at PPA for more information.

Applications may be mailed to the PPA office, 508 North Third Street, Harrisburg, PA 17101, faxed to PPA at 717-236-1618, or emailed to cbox@papharmacists. com. A committee of SIG members will determine this year’s four recipients. Students will be required to write a short article about their experience for the Pennsylvania Pharmacist and/ or the Student Voice following the convention in order to receive final payment. z

Pennsylvania Pharmacist I July/August 2014 I 47

Association News

Call for 2015 PPA Educational Foundation Grant Applications T he PPA Educational Foundation will award up to four grants in 2015 with a maximum amount of $1,000 per awarded grant. Grants may be used for projects which are targeted towards patient care by pharmacists and innovative activity around pharmacy practice.

The purpose of the grants is to encourage exploration of innovative and best pharmacy practices, especially those which focus on patient-centered services or which offer some patient benefit. The Foundation will hold a pre-submission, optional webinar for interested applicants on Monday, October 6, 2014 at 1:00 p.m. The webinar will be a 20 to 25 minute presentation on the Foundation, the grant program, its goals and objectives, and the application and decision process. There will also be an opportunity for questions. The pre-submission webinar is optional but many applicants find it very helpful. If you are interested you must register in advance by sending an email to Foundation@ papharmacists.com. You will be sent specifics about login/call-in a few days in advance.

48 I Pennsylvania Pharmacist I July/August 2014

FOR 2015

The PPA Educational Foundation encourages the submission of grants that investigate, demonstrate, document, measure or otherwise explore the value of pharmacist involvement in the Patient Centered Medical Home (PCMH), Accountable Care Organizations(ACOs) or other innovative models of collaboration. Of particular interest to the Foundation, are the following aspects related to the business model of embedding a pharmacist in the PCMH/ACO: productivity, ROI, payment, and/or quality outcomes/measures. This focus does not preclude applications of another topic or project.

We encourage residents, new practitioners, seasoned practitioners, students, and academia members to apply! It can be a simple, easy way to support a new or ongoing venture of provision of patient care!

Information about Grant Opportunities, the 2015 Grant Announcement, and the Grant Application can be found on the PPA website under Foundation, Grant Programs. z

GRANTS AT A GLANCE Grants to be Awarded in 2015: 4 max Monetary Value: $1,000/grant Pre-submission Webinar (optional): Monday, October 6, 2014 1:00 p.m.

Register in advance for pre-submission Webinar: send an email to Foundation@papharmacists.com

“Pharmacy’s Future is in the Stars” September 18-21, 2014 Four Points by Sheraton Pittsburgh North, Mars, PA

Schedule at a Glance: Thursday, September 18: Pharmacy-Based Immunization Delivery MTM Training Board of Directors Meeting Pirates Game Reception

Saturday, September 20: Breakfast Sponsored by Rite Aid Pharmacy, Annual Business Meeting, Installation of the PPA Board Keynote Speaker Molly Ekstrand, RPh, AE-C, CDE Continuing Education, 9 choices available Student Programming, 4 choices available Exhibitor Meeting/Pharmacy Industry Associates Forum Lunch in the Exhibit Hall, *Expanded hours for 2014!* Residency Showcase Achieving Independence Competition & Reception Leadership & Awards Reception & Dinner

Friday, September 19: Golf Outing Community Residency Research Meeting Top TIER Continuing Education, 4 choices available Coalition of Schools of Pharmacy Meeting PPA Educational Foundation Board Meeting Health Policy Committee Meeting Student Advisory Board Meeting Past President & New Practitioner Receptions Welcome Reception and Dinner in the Exhibit Hall, *Expanded hours for 2014!*

Sunday, September 21: Breakfast Sponsored by Johnson & Johnson Diabetes Solutions Companies LifeScan & General Announcements Continuing Education, 4 choices available Student Programming, 3 choices available

Information available at www.papharmacists.com/annualconference APhA Pharmacy-Based Immunization Delivery: APhA’s Pharmacy-Based Immunization Delivery will be offered as a pre-conference program on Thursday, September 18th at 8:00AM.

Leadership & Awards Dinner: Join us for this special event as we recognize our newly elected leaders and pay a tribute to those whose work on behalf of the pharmacy profession has been exemplary.

Meet the Exhibitors: By popular demand this year’s Exhibit Hall will have EXTENDED HOURS! Join us in the Exhibit Hall as our vendors display the latest and greatest products in pharmacy!

Continuing Education and Student Programming: This year’s conference will feature 23 total hours of CE Programming!

Golf Outing: Take a swing during PPA’s Annual Golf Outing at the Pittsburgh National Golf Club to support PharmPAC and the Educational Foundation.

Information available at: www.papharmacists.com/ annualconference

Departments

Welcome! New Members PPA welcomes the following New Members who joined the association – April 4, 2014– June 3, 2014. Please make these new members feel welcome and part of Pennsylvania pharmacy!

ACTIVE PHARMACIST KarenBeth Bohan Wilkes University-Nesbitt College of Pharmacy Michael Cawley Philadelphia College of Pharmacy at USP Gladys Duenas Philadelphia College of Pharmacy at USP Evan Legenzoff LECOM School of Pharmacy Adebayo Adeniran Clayton, NJ Daniel McConnell Hughesville Matthew D. Newton Pottsville

NEW PRACTITIONER Michael Bianco Cheswick Cory Hobson Dorneyville Pharmacy Whitehall

TECHNICIAN Susan Bowers Malvern Josh Hartman Northampton

Melissa Keebler Ephrata

Vivian Tang Pittsburgh

Rachel Russell Safeway Littlestown

Anh Vu Aurora, CO

Diane Sanchez Lancaster

RESIDENT Immaculata Adams Chester Springs Lauren Chambers Roxboro, NC Arnold Decano Philadelphia Jillian Dougherty West Chester Anna Drapkin Abington Memorial Hospital North Wales Kirsten Garman Johnstown Elizabeth Giunta Mt. Laurel Sarah Rindfuss Pittsburgh Nahir Rivera Thomas Jefferson Hospitals

STUDENT Duquesne University – Mylan School of Pharmacy Elizabeth Chartier Jordan Cunningham Mariah Deibert Joanna Fitzer Rachel Klaphake Hannah Straight LECOM School of Pharmacy Sumita Markana Philadelphia College of Pharmacy at USP Colleen D’Amico Justin George University of Pittsburgh School of Pharmacy Kelsey Barclay Alexandra Ellis Wilkes University — Nesbitt College of Pharmacy

A « « « « « « « «

Holland Kunkel

Christina Romeo Pittsburgh

Karen Horvath Bethlehem

50 I Pennsylvania Pharmacist I July/August 2014

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