PA Pharmacist September/October 2016

Pennsylvania

PERMIT NO. 533

PAID

HARRISBURG PA

PRSRT STD

U.S. POSTAGE

September/October 2016 z Volume 97 z Issue 4

The official publication of the Pennsylvania Pharmacists Association

CONTENTS Our Vision

6 On the Cover AMERICAN PHARMACISTS MONTH October is the month we celebrate and promote pharmacists as medication experts

Pennsylvania pharmacists will be recognized, engaged, and fairly compensated as healthcare providers.

Our Mission 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.

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DEPARTMENTS President’s message, events, advertisers index, and new members

INDUSTRY news Preserving your pharmacy license part II, financial forum, pharmacogenomics, certificates of insurance

8 features Spotlight, profiles, rotation, provider status, medical assistance enrollment, 28 association news Foundation report, member news, GRASP graduate list, BOD leadership retreat, conference schedule at a glance, call for 2017 grant applications 8

PPA Board of Directors PPA Officers President: Eric Pusey, RPh President Elect: Nicholas Leon, PharmD, BCPS, BCACP Vice President: Lauren Simko, PharmD Immediate Past President: Donna Hazel, RPh Regional Directors Central Region: Robert Killoran, RPh Northeast Region: Thomas Franko, PharmD, BCACP Northwest Region: Nickolas Kernich, PharmD Southeast Region: Mark Lawson, PharmD, MBA Southwest Region: Cory Krebs, RPh Practice Directors Academia: Roshni Patel, PharmD Community-Independent/LTC: Stephanie Smith Cooney, PharmD Community Independent/LTC: Chuck Kray, RPh Chain Pharmacists: Stephen Pfeiffer PharmD, MBA Health System Pharmacists: Richard Demers, RPh, MS, FASHP Managed Care/Government/Industry and Other: Julene Vidic, RPh Associates: Greg Drew, RPh

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Student Directors East: Rachel Von Vital West: Marissa Badzik PPA Office Staff CEO: Patricia A. Epple, CAE pepple@papharmacists.com | Ext. 3 Program Manager: Sara Powers spowers@papharmacists.com | Ext. 2 Government Relations Manager: Donald L. Smith, III dsmith@papharmacists.com | Ext. 6 Communications Coordinator: Danielle Adams dadams@papharmacists.com | Ext. 1 Membership Coordinator: Ashley Robbins arobbins@papharmacists.com | Ext. 5 Bookkeeper: Michele Dibble mdibble@papharmacists.com | Ext. 4 PPCN Executive Manager: Mindy Kozminski, PharmD, BCACP mkozminski@papharmacists.com PPCN Trainer: Brandon Antinopoulos, PharmD ppcntrainer@papharmacists.com

Pennsylvania Pharmacists Association (PPA) 508 North Third Street, Harrisburg, PA 17101 (717) 234-6151 Fax: (717) 236-1618 www.papharmacists.com | ppa@papharmacists.com 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 Olufunmilola Abraham, PhD, MS, BPharm Hershey S. Bell, MD, MS, FAAFP Kim Coley , FCCP, PharmD, RPh Bernard Graham, PhD Stephanie Smith Cooney, PharmD Associate Editor: Danielle Adams Editor/Manager: Pat Epple

Pennsylvania MAGAZINE

papharmacists.com | ppa@papharmacists.com |

Designed and Published

by Graphtech Sarah DiCello, Publications Manager (717) 238-5751 x118 sarah@thinkgraphtech.com For Advertising Information: Alexis Kierce, Account Manager (717) 238-5751 x119 alexis@thinkgraphtech.com Pharmacist State Board of Pharmacy Members Institutional: Gayle Cotchen, BSPharm., PharmD., MBA Independent Community: Rob Frankil, RPh Chain Community: Janet Hart, RPh Chain Community: Theresa M. Talbott, RPh Independent Community: Mark J. Zilner, RPh Board of Pharmacy Meeting Dates: September 20, 2016 October 18, 2016 November 15, 2016 December 13, 2016

PRESIDENT’S MESSAGE

Pharmacy is sometimes misperceived in our role as dispensers of opiods, as being part of the problem. Our goal has always been to serve the legitimate and necessary needs of our patients while trying to stop the overuse and diversion of opiates in our community.

pharmacists are on the front line of the opiod epidemic The opiod and heroin problem in the state of Pennsylvania and the nation is truly an epidemic.

The over use, over prescribing and misuse of prescription narcotics and analgesics has no barriers.

The opiod and heroin problem in the state of Pennsylvania and the nation is truly an epidemic. The overuse, over prescribing and misuse of prescription narcotics and analgesics has no barriers.

Pharmacists in every practice setting have a critical role to play. The Pennsylvania Pharmacy Association has established our own Addressing Opioid Awareness and Addiction Task Force to develop and implement policies and education initiatives. In addition we are working in collaboration with the PA Medical Society, the PA Dental Association, and the PA District Attorneys as they are working on similar initiatives. Pharmacy is sometimes misperceived in our role as dispensers of opioids, as being part of the problem.

Our goal has always been to serve the legitimate and necessary needs of our patients while trying to stop the overuse and diversion of opiates in our community.

Pharmacy needs to not only be at the table for discussion but be at the forefront of educating patients and physicians. As part of this initiative PPA developed our Opioid

4 • Pennsylvania Pharmacist • September/October 2016

Dispensing Guidelines for Pennsylvania in conjunction with the Pennsylvania Department of Health, Commonwealth of Pennsylvania. The guidelines can be found on the PPA website through this link http://www.papharmacists. com/?page=Drug_Resource_Center or by tagging the Resource tab and then Drug Diversion.

A passage from the guidelines states; “These guidelines are focused on several key areas that can impact pharmacists of any practice setting. Focal points include assessing the appropriateness of opioid pain medication at the point of dispensing, recognition of “red flags” on prescriptions as well as high risk medication combinations, available resources for those with a substance use disorder, and methods to prevent diversion from the emergency department. The purpose of these guidelines are to aid pharmacists in ensuring that dispensed opioid pain medication is both safe and appropriate for each patient. This is only to act as a

supplement to and not replacement for the clinical and professional judgment of a pharmacist.”

The PDMP (Prescription Drug Monitoring Program), officially called ABC-MAP in Pennsylvania, will be an additional tool for pharmacists and prescribers to help monitor and control this misuse of opioids in our state. Pharmacists have been entrusted with the responsibility of providing quality care for our patients and also helping our communities deal with drug abuse, dependency and medication assisted therapies. Pharmacy is up for the challenge!  Eric M. Pusey, R.Ph, CDE PPA President 2016–2017

CALENDAR OF EVENTS | ADVERTISERS INDEX

SEPTEMBER

noveMBER

22

4–6

PPA’s Annual Golf Outing Limerick, PA

22–25 Annual Conference King of Prussia, PA

PRS Lattanzio Consulting Group – 2

deceMBER

25

PPA Board of Directors Meeting King of Prussia, PA

ASCP Annual Meeting Dallas, TX

1

PPA Board of Directors Meeting Harrisburg, PA

4–8

ASHP Mid Year Clinical Meeting Las Vegas, NV

OCTOBER

JANUARy

3–6

26–29 Mid-Year Conference 2017 Lancaster, PA

15–19 NCPA Annual Conference New Orleans, LA

PA Pharmacists Care Network – 5 Value Drug Company – 7 “Interpreting Your Blood Work” by Dr. Daniel T. Wagner – 10 Hayslip & Zost – 10 Thomas Jefferson University — Jefferson College of Pharmacy – 11 PPA Educational Foundation– 17

25–27 ACCP Annual Meeting Bethesda, MD

AMCP Educational Conference National Harbor, MD

ADVERTISERS INDEX

29

PPA Board of Directors Meeting Lancaster, PA

Rx Health Mart Pharmacy – 17 RDC – 19 R.J. Hedges & Associates – 21 APSC – 26 PA Opiod Dispensing Guidelines – 26 H.D. Smith – 27 We Have One Shot! – 27 S & L Solutions LLC – 29 Independent Pharmacy Buying Group – 33 PPA’s 2016 Annual Conference Schedule – 34 Buy-Sellapharmacy – 36 Cardinal Health – 37 Keystone Pharmacy Purchasing Alliance – 41 Who Is PPA? – 43 Pharmacists Mutual – 47

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

QS/1 – Back Cover 

The Pennsylvania Pharmacists Association, through the Comprehensive Medication Management Collaborative, is providing toolkits to help all pharmacists implement successful patient care programs. The toolkits contain a variety of samples, ideas, steps, and links to help you in your development of a program at your pharmacy!

Visit: http://www.papharmacists.com/page/Toolkitshome to view these toolkits!

www.papharmacists.com • 5

WELCOME! NEW MEMBERS

PPA Welcomes the following New Members who joined the association on May 23, 2016 — July 21, 2016. Please make these new members feel welcome and part of Pennsylvania pharmacy!

Pharmacists Daniel Iseminger, Bedford, Fulton County Medical Center Maegan Kochasic, Harrison City Tyler Ruby, Everett, Everett Pharmacy Rowland Tibbott, Ebensburg, Value Drug Co. Scott Bolesta, Shavertown, Wilkes University – Nesbitt School of Pharmacy Bonnie Voss, McKean Debra Gangemi, Brockie Michael Shope, Brockie Kayla Bitler, Brockie Brianna Polito, Williams Apothecary Casey Inman, McKeesport, Rite Aid Vincent Canzanese, Burman’s Community Pharmacy Christianna Martynowski, Towanda William Bedwick, Kingston, Pocono Medical Center Karen Iseminger, Everett, Everett Pharmacy Sandip Patel, Ashland, Bracey Pharmacy Laura Schmidt, Sewickley, Lincoln Pharmacy

Susan Skledar, Monroeville, University of Pittsburgh School of Pharmacy Frank Piotrowski, Forest City, Wayne Health Pharmacy Lori Daukas, Doylestown, Contract Pharmacy Services William Faust, Sandy Ridge, Community Pharmacy Francis Straub, Saint Marys, St. Marys Pharmacy, Inc Christopher Leon, Easton, West End Services Lauren Posteraro, Wexford, Giant Eagle Tom Silvonic, First National Pharmacy Jignesh Patel, NuWay Pharmacy Prasad Ravipati, Savemart Pharmacy Mina Antonius, Highmark BCBS PGY1 Managed Care Pharmacy Residency Program Janetta Geronian, Highmark BCBS PGY1 Managed Care Pharmacy Residency Program Katelyn Simmons, Pittsburgh, Duquesne University – Mylan School of Pharmacy Hannah Renner, Pittsburgh, University of Pittsburgh School of Pharmacy

Pharmacy Technicians Maria Castro, Cherry Hill, Walgreens Rumana Alam, Wallingford Students Duquesne University – Mylan School of Pharmacy Anna Zuschnitt, Bristol Jefferson School of Pharmacy Jennifer Kmetich, Philadelphia Gianna Girone, Cherry Hill LECOM School of Pharmacy Heidi Frynkewicz, Erie Rebecca Goetz, Lake View Tyler Liebegott, Erie Philadelphia College of Pharmacy Insung Hwang, Horsham Caitlyn Crawford, Philadelphia Lauren Chun, Yardley

American Pharmacists Month is celebrated annually in October and serves to promote pharmacists as medication experts, an integral member of the health care team, and directly involved in patient care. APhM aims to educate the public, policy makers and other health care professionals about the role pharmacists play in the reduction of overall health care costs and the safe and effective management of medications. Pharmacists have a significant role in assessing patients’ medication management in patients and referring them to physicians.

Let PPA know how you’re celebrating American Pharmacists Month at ppa@papharmacists.com!

6 • Pennsylvania Pharmacist • September/October 2016

ING C U OD R T IN

Value Health Center Telemedicine

The Value Health Center Telemedicine Program is an alternative setting to traditional healthcare. The Telemedicine Program is provided through American Well’s Web-based platform, Amwell™. It enables patients to consult with a U.S.-trained, board certified physician using a secure, private, online video connection from their laptop, tablet, smartphone or via an American Well telehealth kiosk.

• Specialty Pharmacy Services • NEW! CP Specialty Pharmacy ServicesTM • VSP Care Site

It’s easy to explain why our cooperative, Value Drug Company (VDC), has been committed to serving Independent Community Pharmacy for over 80 years. We do what we do because we care.

• NEW! Monthly Projected Dividend Payment

Specialty Services

• NEW! Monthly Generic Specials

CP Specialty Pharmacy Services™ enables a community pharmacy to utilize specialty pharmacy service options when receiving referrals from your local physicians and specialists, often allowing you to dispense them.

Value Specialty Pharmacy (VSP) Opened in 2011, by VDC, in order to provide an option to fill specialty prescriptions for independent pharmacy patients without utilizing traditional mail order. Visit www.vsprx.com for more information.

Value Drug Company is a cooperative operating as a full line wholesale distributor providing pharmaceuticals and health-related products. VDC services retail, long term care, specialty pharmacy and 340B covered entities to both stockholders and non-stockholders.

To find out more about Value Drug Company, contact Romi Madia, Director of Sales at 412-596-7256 or rmadia@valuedrugco.com.

Visit www.valuedrugco.com for additional programs and services we provide our members.

• NEW! Generic Rewards Program • 340B Authorized Distributor • Dedicated Onstaff Resource • Immunization Program w/ Protocol Physicians

A full line wholesaler that works for you!

contact: Romi Madia at 412-596-7256 or rmadia@valuedrugco.com for more information

195 Theater Drive, Duncansville, PA 16635 | phone: 1-800-252-3786

FEATURE ARTICLE

Stauffer’s Drug Store, It Stays in the Family By: Shaina Kulp, PharmD, Williams Apothecary This article was contributed while Shaina was on rotation with PPA. Stauffer’s Drug Store, located in New Holland, Lancaster County, is by every definition a family owned and operated pharmacy.

The Stauffer family bought the pharmacy in 1896 and despite the many changes and events that have happened in the world, the pharmacy has remained in the family since.

This summer the fifth generation of Stauffer pharmacists, Joshua Stauffer, will officially take over the pharmacy when his father, Jeffrey Stauffer, retires. Josh graduated from the Philadelphia College of Pharmacy in 2005 and is preceded in owning the pharmacy by: William, Wilford, Gilbert, and Jeff Stauffer, all of whom graduated from the Philadelphia College of Pharmacy. Not only has the pharmacy been passed down from generation to generation, but the Stauffer family also kept the tradition of each generation of pharmacists paying for the next generation’s pharmacy education.

8 • Pennsylvania Pharmacist • September/October 2016

In addition to Jeff and Josh Stauffer, Stauffer’s Drug Store has three additional pharmacists on staff; Eric and Michele Pavelik and Sonja Zeek. The pharmacy also employs a nurse, a number of pharmacy technicians, delivery drivers, and office personnel, some of which are members of or related to the Stauffer family. And for those employees that are not related, they all state that they feel like they are a member of the Stauffer family.

On the surface, Stauffer’s Drug Store may seem like a typical independent pharmacy, but they are anything but ordinary. They offer a large number of services that are unique to their pharmacy and the surrounding area. In addition to being an independent community pharmacy, they also operate a long-term care pharmacy that supplies prescriptions and consultant pharmacist services to many of the long-term care facilities in and

around New Holland. They also help in transitioning patients from the inpatient care setting to home care by reconciling patient’s medications and providing a pre-packaged medication program.

Due to Stauffer’s location in Lancaster County, they service a large population of Amish and Mennonite patients. The majority of these patients do not have insurance because of their religious beliefs and Stauffer’s offers them their discount program, Stauffer Care, so that they do not have to pay full price for all of their medications. In addition, they also offer prescription mail services, which are highly utilized by the Amish and elderly patients who cannot easily get to the pharmacy. Delivery options are available for the patients that live in the independent living communities at the long-term care facilities.

A medication synchronization program is also

available for all patients of Stauffer’s Drug Store as well as some MTM services.

Although Stauffer’s Drug Store has been around for a long time, there are still a number of challenges that they face. One of the most prevalent challenges that Josh sees every day is the competition with large pharmacies and insurance companies. He stated that it is becoming increasingly harder to just focus on the patient and their needs within the pharmacy. However, Josh believes that being an independent pharmacy gives them more flexibility and allows them to quickly adapt to the ever-changing world of pharmacy to best meet the needs of their patients. It also permits them the ability to focus their pharmacy on what they enjoy doing and perfecting those skills. As Josh put it, “you have to find an area you like and enjoy doing every day and for me, community and long-term care pharmacy together is the best of both worlds!”

Stauffer’s Drug Store is known in the community for providing quality care and building long lasting relationships with their patients. In addition to building connections with their patients, they have also established longstanding relationships with local physicians and healthcare providers to better serve their patients.

Stauffer’s Drug Store is known in the community for providing quality care and building long lasting relationships with their patients. In addition to building connections with their patients, they have also established longstanding relationships with local physicians and healthcare providers to better serve their patients. Building these relationships with local healthcare providers and other pharmacies in the area is something that Josh identifies as being very important in helping a pharmacy grow and expand.

Furthermore, he believes that it is essential to partner with people who are like-minded and have a similar business model to your own, as well as going through pharmacy organizations to meet other pharmacists. He considers organizations like PPA essential for helping pharmacists to come together and stay up-todate on important issues and give pharmacists a voice.

There is no doubt that the reason that Stauffer’s Drug Store has been around for 115 years is because they believe in the value of family and doing everything in their power to care for their patients. This family operated pharmacy that makes their employees and patients alike feel like family while providing the highest quality care, is truly a family affair. 

www.papharmacists.com • 9

FEATURE ARTICLE

MEMBER PROFILE • Kathryn Grandizio-Stephens Contributed By: Christine Trusky, PharmD, PGY1 Resident at the Lebanon Valley Medical Center This Member Profile was completed while Christine was on rotation with PPA. What is a unique experience you have had as a pharmacist? The most special moment during my pharmacy career was when Danville Pharmacy was presented with the Key to Danville by Representative Kurt Masser and Mayor Bernie Swank. It was an exciting moment for myself and my staff in which we realized how much we mean to the community and how much they appreciate us. It was such an honor and a humbling experience!

Pharmacy Owner and Pharmacist in Charge of Danville Pharmacy Philadelphia College of Pharmacy (PCP)

What do you enjoy most about being a pharmacist? I love patient care, and find it to be the most rewarding aspect of my job. I feel best when I am behind the counter at the pharmacy. Helping a patient and making a difference in their day or in their quality of life is what makes being a pharmacist worth it. We develop close relationships with our patients. We know them by name and know their families and their children. When you have relationships like that with patients it makes them more comfortable opening up about their problems and medical conditions. I am very blessed to be a pharmacist with a great team who truly cares about the patients they serve.

What advice would you give to newly licensed pharmacists? Never forget that being a pharmacist means taking care of the patient and putting them first. Don’t ever lose sight of that being your number one goal. Focus and concentrate on how you helped someone each day, and learn something new every day. Always have a thirst for knowledge, because you can never know everything there is to know about pharmacy. It’s when you think you know everything and have all the answers that mistakes happen.

What advancements would you like to see in the pharmacy profession in the next 5–10 years? I would like to see more pharmacist interaction/

integration in physicians’ offices and outpatient clinics. Pharmacists need to move from behind the counter out into the community to help with patients’ drug therapy and disease state management issues. We need to start utilizing our degrees and training as pharmacists to our maximum ability. 

ELEMENTS

of Success Re

Reputation: Year after year, JCP students excel in national student pharmacy competitions.

Cn Connections: JCP students learn side by side with peers in a wide range of healthcare professions.

explore.Jefferson.edu/Pharmacy

Af Affiliation: JCP is part of one of the nation’s most successful and leading-edge healthcare learning environments.

Lo Location: JCP’s Center City location is in the heart of one of the nation’s most culturally diverse and historic cities.

FEATURE ARTICLE

RESIDENCY PROFILES Meet Pennsylvania’se 2016–2017 Residents!

Kalyn Marie Acker, PharmD Allegheny General Hospital, PGY2 Graduate of: The University of Texas, 2015

Aiman Bandali, PharmD, Hahnemann University Hospital, PGY1 Graduate of: Rutgers, 2016

Daniel Brust, PharmD Erie VA Medical Center, PGY1 Graduate of: Duquesne University, 2016

Jessica Anderson, PharmD UPMC Presbyterian/ Shadyside, PGY2 Graduate of: Presbyterian College School of Pharmacy, 2015

Sheava K. Blackman, PharmD, UPMC Shadyside, PGY1 Graduate of: Nova Southeastern University, 2016

Carley Buchanan, PharmD Allegheny General Hospital, PGY2 Graduate of: Duquesne University, 2015

Sarah Marie Anderson, PharmD Duquesne University, PGY1 Graduate of: Cedarville University School of Pharmacy, 2016

Anna Bondar, PharmD UPMC St. Margaret, PGY2 Graduate of: University of Pittsburgh, 2015

Kelcymarie Bye, PharmD Lebanon VA Medical Center, PGY1 Graduate of: University of Maryland, Baltimore, 2016

Mina Antonius, PharmD Highmark, PGY1 Graduate of: Virginia Commonwealth University, 2016

Megan Bookser, PharmD Magee-Womens Hospital of UPMC, PGY1 Graduate of: Ohio Northern University, Raabe College of Pharmacy, 2016

Megan Carr, PharmD UPMC St. Margaret, PGY1 Graduate of: University of Kansas School of Pharmacy, 2016

Gina Ayers, PharmD UPMC St. Margaret, PGY1 Graduate of: Shenandoah University, 2016

Gregory Bresin, PharmD CVS Caremark, PGY1 Graduate of: University of Pittsburgh, 2016

Sophia Chhay, PharmD Erie VA Medical Center, PGY1 Graduate of: University of Findlay, 2016

12 • Pennsylvania Pharmacist • September/October 2016

NO PICTURE AVAILABLE

Jacqueline Chirico, PharmD Pennsylvania Hospital, PGY1 Graduate of: St. John’s University, 2016

Chelsea Jayne Cunningham Evry, PharmD Lancaster General Health – Penn Medicine, PGY1; Graduate of: University of the Science – Philadelphia College of Pharmacy, 2016

Vincent Ekenga, PharmD Duquesne University, PGY2 Graduate of: Xavier University of Louisiana, 2012

Catherine Chun, PharmD Thomas Jefferson University Hospital, PGY2 Graduate of: Temple University School of Pharmacy, 2015

Julia Marie Veronica Dawson, PharmD Children’s Hospital of Pittsburgh of UPMC, PGY1 Graduate of: Duquesne University Mylan School of Pharmacy, 2016

Emily Fargo, PharmD UPMC St. Margaret, PGY1 Graduate of: University of Pittsburgh School of Pharmacy, 2016

Brooklyn Cobb, PharmD USciences in conjunction with Cooper University Hospital, PGY2, Pharmacotherapy Graduate of: Hampton University, 2015

Angela DiPaola, PharmD ACME Sav-on Pharmacy, PGY1 Graduate of: Philadelphia College of Pharmacy, 2016

Corinn Floyd, PharmD Duquesne University/ Giant Eagle Pharmacy, PGY1; Graduate of: LECOM School of Pharmacy, 2016

Katlyn Combs, PharmD Lancaster General Health, PGY1 Graduate of: Notre Dame of Maryland School of Pharmacy, 2016

Ta-Seti M. Donald, PharmD Pennsylvania Hospital, PGY1 Graduate of: Temple University School of Pharmacy, 2016

Janetta Geronian, PharmD Highmark Blue CrossBlue Shield, PGY1 Graduate of: University of Pittsburgh School of Pharmacy, 2016

Ardis Copenhaver, MS, PharmD UPMC St. Margaret, PGY1 Graduate of: Medical University of South Carolina, 2016

Shane Donnelly, PharmD Delta Care Rx/ Duquesne University, PGY2 Graduate of: Duquesne University Mylan School of Pharmacy, 2015

Nicholas Giruzzi, PharmD Lawrenceville Family Health Center/UPMC St. Margaret, PGY2 Graduate of: Albany College of Pharmacy and Health Sciences, 2015

NO PICTURE AVAILABLE

www.papharmacists.com • 13

FEATURE ARTICLE

RESIDENCY PROFILES continued Aubrey Goertel, PharmD Lehigh Valley Health Network-Cedar Crest, PGY1 Graduate of: Duquesne University, 2016

Teresina C. Imbrogno, PharmD Duquesne University/ St. Barnabas Long-Term Care, PGY1 Graduate of: Duquesne University Mylan School of Pharmacy, 2016

Chelsea Konopka, PharmD Allegheny General Hospital, PGY2 Graduate of: Duquesne University, 2015

Breana Goscicki, PharmD Lehigh Valley Health Network, PGY1 Graduate of: Northeastern University, 2016

Anastasia Ipatova, PharmD Walgreens Specialty Pharmacy with Duquesne University Mylan School of Pharmacy, PGY1 Graduate of: Duquesne University Mylan School of Pharmacy, 2016

Nathan Lamberton, PharmD UPMC St. Margaret – Bloomfield-Garfield Family Health Center, PGY2 Graduate of: Albany College of Pharmacy and Health Sciences, 2015

Alana Grabigel, PharmD UPMC Shadyside, PGY1 Graduate of: Duquesne University, 2016

Nellie Jafari, PharmD Allegheny General Hospital, PGY2 Graduate of: Virginia Commonwealth University, 2015

Victoria LaMonaca, PharmD Allegheny General Hospital, PGY2 Graduate of: Duquesne University Year: 2015

Matthew Hadginske, PharmD Geisinger Wyoming Valley Medical Center, PGY1 Graduate of: Wilkes University, 2016

Haley Kavelak, PharmD University of the Sciences, PGY1 Graduate of: University of the Sciences, 2015

Bradley E. Lauver, PharmD Geisinger Medical Center, PGY1 Graduate of: Philadelphia College of Pharmacy, University of the Sciences, 2016

Gregory Hood, PharmD Moses Taylor Hospital, PGY1 Graduate of: Wilkes University, 2016

Jeffrey Kinney, PharmD UPMC Health Plan, PGY1 Graduate of: Wilkes University, 2016

Rosanna Li, PharmD Thomas Jefferson University Hospital, PGY2 Graduate of: University of Connecticut School of Pharmacy, 2015

14 • Pennsylvania Pharmacist • September/October 2016

NO PICTURE AVAILABLE

Tristan Maiers, PharmD Geisinger Medical Center, PGY2 Graduate of: Ohio Northern University, 2015

Morgan R. Peterman, PharmD Lebanon VA Medical Center, PGY1 Graduate of: Wilkes University, 2015

Ami Shah, PharmD Thomas Jefferson University Hospital, PGY2 Graduate of: Rutgers University, Ernest Mario School of Pharmacy, 2015

Joel Musser, PharmD Lancaster General Health – Penn Medicine, PGY1 Graduate of: Temple University, 2016

Chelsea Reed, PharmD Lebanon VA Medical Center, PGY1 Graduate of: University of Wisconsion-Madison School of Pharmacy, 2016

Megha Shah, PharmD Hahnemann University Hospital, PGY1 Graduate of: Philadelphia College of Pharmacy, 2016

Mandana Naderi, PharmD Geisinger Wyoming Valley Medical Center, PGY1 Graduate of: Washington State University College of Pharmacy, 2016

Brittany Rosenfeld, PharmD Allegheny General Hospital, PGY2 Graduate of: Duquesne University, 2015

Sydney P. Springer, PharmD UPMC St. Margaret, PGY2 Graduate of: University of Rohde Island College of Pharmacy, 2015

Diana Pak, PharmD Moses Taylor Hospital, PGY1 Graduate of: Temple University, 2016

Sandra Rumyantsev, PharmD Reading Hospital, PGY1 Graduate of: MCPHS, 2016

Kyle Strnad, PharmD UPMC Presbyterian, PGY2 Graduate of: Thomas Jefferson University School of Pharmacy, 2015

Katelyn Simmons, PharmD Duquesne University and Preferred Primary Care Physicians, PGY2 Graduate of: Ohio Northern University, 2015

Nissa Tasnim, PharmD Reading Hospital and Medical Center, PGY1 Graduate of: Temple University, 2016

Lauren Para, PharmD Geisinger Medical Center, PGY1 Graduate of: Wilkes University, 2016

NO PICTURE AVAILABLE

www.papharmacists.com • 15

FEATURE ARTICLE

RESIDENCY PROFILES continued Khushbu P. Thaker, PharmD UPMC PresbyterianShadyside, PGY2 Graduate of: MCPHS University, 2015

Neil J. Turco, PharmD UPMC St. Margaret, PGY1 Graduate of: University of Pittsburgh School of Pharmacy, 2016

Shari N. Williams, PharmD St. Luke’s University Health Network, PGY1 Graduate of: Mercer University College of Pharmacy, 2016

Christine Trusky, PharmD Lebanon VAMC, PGY1 Graduate of: Wilkes University, 2016

Jessah Villamor, PharmD St. Luke’s University Health Network, PGY1 Graduate of: Rutgers University, 2016

Cheryl Wisseh, PharmD Duquesne University Mylan School of Pharmacy/Center for Pharmacy Care, PGY1 Graduate of: UNC Eshelman School of Pharmacy, 2016

Our residents are achieving great things and we are proud to feature them in our magazine!

We wish them the best of luck in their residency! You can view the full version of the residency profiles on our website at: http://www.papharmacists.com/page/Residency

16 • Pennsylvania Pharmacist • September/October 2016

Educational Foundation Advancing Patient Care

My Profession...My Practice...My Philanthropy “I have seen the Foundation grow over the past 5 years of my pharmacy career, as a student and practitioner. This growth leads to the advancement of practice in Pennsylvania and development of future generation pharmacists. Early evidence of this comes from the development of the Pennsylvania Pharmacists Care Network and expanded interest in student educational events. For example, this year 58 students, from Pitt alone, are putting together 25 posters for the upcoming Midyear meeting - outstanding growth!

My contribution, and hopefully yours, is going to a great cause - one that we can all stand for. Regardless of your practice, the advancement of the practice should be of utmost importance. Through the Educational Foundation the groundwork is being laid for pharmacy's future in Pennsylvania.

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.”

Kyle McCormick, PharmD, Community Practice Resident, Gatti Pharmacy and the University of Pittsburgh School of Pharmacy, PPA Educational Foundation Board member and contributor For more information on how you can make a difference, http://www.papharmacists.com/?page=FoundationInfo

Educational Foundation

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My Profession...My Practice...My Philanthropy

“I have seen the Foundation grow over the years of my pharmacy career, as a student AREpast YOU5 READY? and practitioner. This growth leads to the advancement of practice in Pennsylvania and deVisit healthmart.com/townhalls velopment of future generation pharmacists. Early evidence of this comes from the developto see dates and times in your area, get ment of the Pennsylvania Pharmacists Care Network and expanded interest in student educamore information, and register today. All tional events. For example, this year 58 students, from Pitt alone, are putting together 25 independent pharmacy posters for the upcoming Midyear meeting - outstanding growth! owners, pharmacists

Maintaining Profitability in a and techs are invited. You need not be a Changing Industry My contribution, and hopefully yours, is Health going toMart a great - one that we can all stand tocause attend.

for. Regardless of your practice, the advancement of the practice should be of utmost importance. Through the Educational Foundation the groundwork is being laid for pharmacy's Commit.

Change.

Succeed. future in Pennsylvania.

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.”

Kyle McCormick, PharmD, Community Practice Resident, Gatti Pharmacy and the University of Pittsburgh School of Pharmacy, PPA Educational Foundation Board member and contributor

Health Mart is proud to be a member of the McKesson family, sharing in the collective industry knowledge and experience residing within all of the McKesson corporate affiliates. Learn more at mckesson.com. ©2016 Health Mart Systems, Inc. All rights reserved. HM-08871-B-01-16

For more information on how you can make a difference, http://www.papharmacists.com/?page=FoundationInfo

FEATURE ARTICLE

STUDENT MEMBER PROFILES Michael J Dovidio, Jr. How did you initially become involved in PPA?

Michael J. Dovidio, Jr. Duquesne University, 2016

I have always had a passion for independent business. In fact, I basically grew up in a restaurant.

My parents are in their 25th year and 4th location with their restaurant, Chat-N-Chew Cafe. So when the opportunity to partake in an entrepreneurial concentration arose on campus, I immediately signed up. Through this concentration, I worked to develop my own personal business plan. It was during my first ever presentation of this plan that the student president of NCPA, Sydney Kehr, approached me about partaking in a business plan competition.

Sydney and I went on to compete in both NCPA and PPA, which was the start of my involvement in PPA. What benefits have you gotten from being involved with PPA and other professional pharmacy organizations?

Sherri Nye University of The Sciences, 2017

Growing my network has been the single-handed greatest part of being involved with PPA. Attending the PPA conference last year was one of my most proud weekends while in school. I had the chance to meet independent business owners, experience a showcase focusing on advancing pharmacy, play in a round of golf, and represent Duquesne in the business plan competition. From my involvement in PPA, I have an experience that only one other person in my class has had. It is important to be able to define yourself from the other pharmacy students, and PPA has helped me to distinguish myself. This distinction allowed me to project a more professional image to my preceptors; not just as another pharmacy student, but as a pharmacy student with self-developed business experience.

What piece of advice would you give to a younger version of yourself if you could?

I have always felt myself a strong leader, but one who abstains from those opportunities. So I would tell my younger self to become involved with pharmacy organizations sooner, network stronger, showcase your leadership talent, and don’t let the fear of failing (or being wrong) hold you back.

Outside of pharmacy, what do you do to relax in your free time?

I try to exercise in my free time, both as a hobby and for health benefits, which is becoming easier to do as the weather is getting nicer. Aside from that, I just try to stay well informed with current things going on in the country and around the world.

18 • Pennsylvania Pharmacist • September/October 2016

Sherri Nye What rotations and experiences are you most excited for next year?

I have several rotations at Pinnacle Health in Harrisburg, PA. One of them is a renal transplant rotation, which I am really excited about due to my interest in immunology and solid organ transplant.

I am also completing my hospital and community pharmacy rotations there. I’ve never worked in a community pharmacy located in a hospital so I’m looking forward to the experience.

What is a unique opportunity that you were able to have through your PPA membership?

I’ve attended several PPA networking events on my campus, and I’ve had the opportunity to speak with alumni about their careers. These events illustrated the many career opportunities available to me, and they helped me decide what I want to do when I graduate.

If you could choose another career besides pharmacy what would it be?

I love science and medicine so I would still be in the medical profession. I love psychiatrics and mental health so I would probably be a psychiatrist.

When you are not working in the pharmacy, what activity are you most likely doing?

I love reading and music. I own a beautiful Di Zhao flute which I play regularly. When I’m not playing, the radio is on. I am also part of a woodwind ensemble here on campus and at the end of every semester, we have a concert featuring all of the instrumental ensembles. All of the musicians are part of a campus organization called The Kingsessing Players. I am actually the student government representative for our organization this year. When I have the chance, I play with my best friend who is also a flutist. 

FEATURE ARTICLE

APPE Rotation with PPA: A Unique and Valuable Experience By: Christine Trusky, PharmD, PGY1 Resident at the Lebanon VA Medical Center

IF YOU HAVE ANY INTEREST IN LEARNING MORE ABOUT PPA AND THE WAY THE Government IMPACTS THE PHARMACY PROFESSION, I ENCOURAGE YOU TO BECOME A MEMBER OF PPA

When people would ask me where I was spending my final

pharmacy rotation, and I responded “PPA”, the next questions were always “What is that?” “Where is that?” “What will you do there?” I didn’t exactly know how to answer all of those questions, or what to expect before my rotation at the Pennsylvania Pharmacists Association. I chose it as a rotation because I was a PPA member, and I thought it would give me a better understanding of what PPA did and how the government affects the profession of pharmacy. During my rotation I certainly learned a great deal about both of those areas, plus a lot more!

One of the things that makes PPA a particularly unique pharmacy rotation is that you are not directly caring for patients like you would be at a typical rotation site in a hospital or community pharmacy. Instead, you get to learn about the many important legislative aspects of pharmacy. This rotation allowed me to work closely with all of the staff members of PPA, and enabled me to see behind the scenes of what goes into running a pharmacy organization. I had the opportunity to assist with writing articles for the magazine, creating a CE activity for pharmacists, reviewing legislative bills, mailing information to members, and preparing for Legislative Day. I was also able to attend many meetings which helped me learn more about the current initiatives PPA was working on, as well as, current legislature that was coming up for a vote in the House of Representatives and the Senate.

Added bonus — I was able to walk by the beautiful Capitol building each morning on my way to rotation!

I had always heard during school that it was important to be an advocate for your profession, but it never really sank in until my experience at PPA. Being here has shown me first-hand how critical, and rewarding it is to be involved with pharmacy organizations, particularly PPA, as both a student and pharmacist. I attended my first Legislative Day, which was an exciting and inspiring experience! I was surprised how willing the Senators and Representatives were to talk with pharmacists and students about the current pharmacy issues. Afterwards, I even received a personal thank you from my Senator for coming in to speak with him. Knowing that you can make a difference by advocating for your profession in an empowering feeling! I would encourage all pharmacy students to attend Legislative Day. Speaking with pharmacists who are members of PPA also allowed me to learn about independent pharmacy, and the challenges they face today with the competition of larger chains. It is important that we overcome those challenges in order to ensure that independent pharmacies are always available to patients, because the services they offer are irreplaceable.

My rotation at PPA was a unique and valuable experience that I would not have been able to get at any other rotation site. It opened my eyes to aspects of pharmacy I never would have known about! If you have any interest in learning more about PPA and the way the government impacts the pharmacy profession, I encourage you to become a member of PPA and take this rotation. 

20 • Pennsylvania Pharmacist • September/October 2016

FEATURE ARTICLE

PROVIDER STATUS

22 • Pennsylvania Pharmacist • September/October 2016

Across practice settings, provider status is seen as the answer for the future of pharmacy. So let’s start by defining the term: What is provider status, and why do we need it?

That’s a great place to start. The term “provider status” really refers back to the fact that federally — specifically in Part B of the Social Security Act where health care providers and their services are identified for Medicare coverage — pharmacists are not included. So in this case, the exclusion of pharmacists on a list of providers means Medicare beneficiaries aren’t able to access pharmacists’ patient care services such as diabetes management, smoking cessation assistance, and others through their Medicare benefits.

Hence our goal of attaining federal “provider status.” A pending step in that direction would be passage of the Pharmacy and Medically Underserved Areas Enhancement Act, aka H.R. 592 or S.314. This legislation would allow Medicare to pay for pharmacists’ services in medically-underserved areas. Believe it or not, this includes most of Pennsylvania.

But if you dig into the “why” of that objective, it’s more than just about pharmacists. It’s about the fact that patients benefit from the valuable services pharmacists can provide. We know that when pharmacists are on the healthcare team, outcomes improve and costs go down.

The goal is to ensure that patients’ have access to pharmacists’ brains — not just the products we dispense.

Back to the term provider status.

Medicare access is a major step, but it’s only the first step. The reality is that we need to approach ensuring patient access to pharmacists’ services from more than one angle. Though Medicare patients make up a huge population of those who would benefit from pharmacists knowledge and skills, there are many other patients who do not have Medicare coverage. Thus, when we attempt any

effort to get patients access to these services, we tend to use the label “provider status” on it—even though the meaning of that term is more specific to the federal example. In fact, most states, including Pennsylvania, already may consider pharmacists as providers in at least one area of state law. But that doesn’t mean we already have ensured patient access to pharmacists’ patient care services in those states.

So “provider status” is broader. It encompasses any effort to get patients access to these services, which makes the meaning of that term somewhat complicated.

Doesn’t everyone support increased access? To broader Services?

Well, not every pharmacist wants to provide these services. Often when I’m talking about integrating more patient-care services into our practices I get the inevitable comment: “I’m too busy in the pharmacy as it is. There is no way I can add even more activities to my day-to-day operations and still get prescriptions filled.”

As a practicing community pharmacist myself — although it’s only moonlighting — I can relate. Any pharmacist or consumer for that matter knows how busy a community pharmacy can be. It is, in fact, difficult to add to that workload in the world we live in now.

Do we truly understand the pharmacy profession’s goal of “provider status” and what will be the results? In honor of the upcoming Pharmacist Month, PPA CEO Pat Epple visited with Krystalyn, Weaver, PharmD of NASPA for the Pennsylvania Pharmacist Magazine, based on a previous interview done with the Georgia Pharmacy Association. We wanted to focus on why federal provider status is important and what will it mean for pharmacists in Pennsylvania.

But that’s the key phrase: in the world we live in now. It doesn’t have to be this way.

I challenge my peers not to think of the current practice environment.

When we’re talking about broadening pharmacists’ services, think of the future. Remember that the reason we aren’t already doing this is because our payment system is broken — it doesn’t recognize the full value that pharmacists are capable of providing. A core premise of the provider status push is that we have to change our business model. We need to change the practice environment

www.papharmacists.com • 23

FEATURE ARTICLE

H.R. 592 legislation

and make it feasible for our services to be delivered effectively.

We are talking about overhauling our workflow so patient-care services become a focus, not an add-on. And yes, we’re talking about new streams of revenue.

I would also argue that considering the ever increasing pressures to decrease what Americans pay for prescription drugs, that a change in our business model is likely essential for pharmacies to survive. Every pharmacy owner can attest to the fact that margins are decreasing. In order to keep pharmacist jobs viable, we need to leverage our most valuable asset: our ability to optimize medication regimens, assist patients with disease management and prevention, and decrease overall health care costs — not just get the right drug to the right patient at the right time (although that will always be important).

If the case is so strong, what’s keeping Congress?

That’s a great question, but it assumes that policy decisions are always made with 100 percent reliance on facts and data. The reality is that national policy is influenced by political pressures. And one of the biggest political pressures we’re facing today is our national debt and the ever ballooning costs of entitlement programs. Adding pharmacists services to Medicare benefits will come at an added cost to the program, at least initially.

So rather than reflecting on why it hasn’t happened yet, I like to focus on why now is a good time. There has never before been more of an awareness on health policy in the larger policy environment. Policy makers are realizing that saving money is more than simply cutting costs — it’s also critical to get the most value.

Pharmacists are pros at keeping people healthy and maximizing the utility of a critical healthcare resource: medications.

We have plenty of data to show that. More people are realizing this, so not only do we have unprecedented collaboration among pharmacy associations, wholesalers, and national pharmacy chains, we are now seeing support from many outside organizations such as the Centers for Disease Control and Prevention, the National Governors Association, the Office of the Surgeon General, and others.

that would allow

Medicare to pay for

pharmacists’ services in medically-underserved areas

PHARMACISTS CAN GET THEMSELVES AHEAD OF THE GAME BY INCORPORATING SERVICES INTO THEIR CURRENT BUSINESS MODEL NOW. AMONG THE MOST IMPORTANT NEXT STEP, BE INVOLVED WITH PPA. SUPPORT THE ASSOCIATION’S EFFORTS! If Congress is so concerned about the price tag, hasn’t research demonstrated that the long-term savings from compensating pharmacists as providers is greater than the short-term costs? Won’t healthier patients and reduced hospital admissions save Medicaid and Medicare significant money.

Absolutely, there are plenty of data to show that pharmacists can save payers on the overall cost of healthcare in both the short and long term. There are hard data showing that within one year, simply paying pharmacists to provide modest MTM services for Medicaid patients delivered a 4 to 1 return on investment. And data for the long term is even stronger — an average ROI as high as 12 to 1.

Unfortunately, the way new federal bills are analyzed don’t usually account for these savings. The Congressional Budget Office assigns a “score” to bills that estimates the cost of the bill to the federal budget over the next 10 years. But that score doesn’t take into account cost savings — which doesn’t help our cause one bit. We’ve heard that this process may be loosening a bit but the

24 • Pennsylvania Pharmacist • September/October 2016

score of the federal bill will continue to be a challenge, especially in an election year.

You’ve mentioned that Congress needs to enact provider status and we support this. We also want pharmacists to be added to the Medicare list of providers.

We want pharmacists to have the same payment “status“ as the other providers.

But that’s at the federal level, what about at the state level? Status is not the issue.

In Pennsylvania, our focus is on increasing access and coverage for the patient’s we serve. We are trying to make that happen through our PPCN but it is a slow go.

There is no benefit to asking the legislature to grant pharmacists provider status. So, what would state efforts look like?

Absolutely. There is a lot states can do to ensure patients access to and coverage for pharmacists’ patient care services. The state environment is different than the federal one. At the federal level, a somewhat simple change of definition in law results in a massive change in the payment structure for MANY patients across the country. At the state level this almost always isn’t the case.

There are often several places in state law and regulation where the term “provider” is defined, each with a different degree of impact on patient access to pharmacists’ services. They may be important in their own way but are very unlikely to be the broader solution that a federal change would be.

Additionally, it’s at the state level where scope of practice is defined, and that’s an essential factor in pharmacists’ ability to provide the care they want to provide. In recent years states have made improvements to laws regulating pharmacists: broadening immunization and collaborative practice agreements, allowing pharmacists to prescribe travel medication, and promoting access to public health services through pharmacies, such as smoking cessation products and hormonal contraceptives.

Finally, states can influence local payers including Medicaid managed care plans, state employee plans, and private payers by simply working with those payers directly and sharing the business case with them.

So are we talking about expanding the role of pharmacists? Providing services under collaborative practice agreements with physicians? Or simply providing services that pharmacists can already do but currently aren’t being compensated for?

All of the above. As we discussed before, state efforts often include work to align

pharmacists’ scope of practice with their clinical ability — so patients aren’t missing out on pharmacists’ care because of outdated laws. Collaborative practice agreements can allow for increased collaboration and efficiencies in care delivery — unless the state laws and regulations are so restrictive that entering into an agreement becomes a burden. I understand that PPA has made considerable progress in advancing your practice act in recent years.

And finally there are services that pharmacists can already do and already are doing that they aren’t being compensated for. It won’t be as easy as just submitting a quick claim for services; we’ll need to comply with the rules and regulations other providers comply with now — including credentialing, documentation, quality assurance, etc.

How do you think physicians will react to that? Does it change the physician– pharmacist relationship?

The examples we currently have of physician-pharmacist collaborations show that great creativity is required to make the relationship financially viable. But when we are able to find sustainable revenue streams to take the strain off of the system, physicians often report favorably on working closely with pharmacists. I think physicians and other providers will embrace the presence of pharmacists on the health care team. Let’s face it — drugs are complicated and there are plenty of other things doctors, nurses, physician assistants, and nurse practitioners have to focus on. Having a medication expert on their side will make their job that much easier and allow them to provide care to more patients.

How do you see these efforts impacting the quality of patient care?

It’s been said many times before but I’ll say it again: When pharmacists are on the team, health outcomes improve and costs go down. I think it’s a given that pharmacists’ services can improve quality. The impact pharmacists are already making, even in our broken system, is probably underappreciated.

But I think if we align the incentives appropriately — and build an infrastructure that allows pharmacists to access the patient health data they need — the system can be fixed to maximize pharmacists’ skills and improve patient care.

4TO1

INVESTMENT RETURN

BY PAYING

PHARMACISTS TO PROVIDE

MODEST MTM SERVICES FOR MEDICAID PATIENTS

Let’s talk about compensation. If, as providers, pharmacists could be compensated for a broader range of their services, what does that look like? What are the mechanics of it?

I don’t want it to sound like an easy, quick transition. We’ll need to adjust workflows, reimagine how we use pharmacy technicians, implement infrastructure changes to allow pharmacists to plug into the information systems hospitals and doctors use, and learn how to do medical billing. And medical billing is VERY different than prescription billing, which is quick, automated and immediately tells you if a claim is covered.

In medical billing, a claim is submitted but the provider may not know for weeks if it will be paid by the insurer. Copays have to be collected at the time of service but are only estimates of what the patient’s cost share is — meaning you have to bill the patient after the fact as well. And if a claim isn’t covered, the dispute process can be lengthy and arduous. Obviously all of these challenges have been overcome by our colleagues in other health professions so they’re not insurmountable, but they will be big changes for pharmacy.

Sounds like this is an issue pharmacists need to anticipate, so that when it’s enacted, our members are ready to take advantage of it on day one. So, as a last question, what should Pennsylvania pharmacists be doing now to prepare themselves, their practices, and their patients for these potential changes?

Pharmacists can get themselves ahead of the game by incorporating services into their current business model now. Start small. Consider incorporating medication synchronization into your pharmacy.

Incorporate other adherence interventions.

Make sure to fulfill all of the Medicare Part D MTM opportunities that come your way.

This will help you to get your workflow to a better place and start to change patient perceptions about the level of care pharmacists are capable of providing.

Build relationships in the community. Reach out to local physicians’ offices, get to know the care managers in the local hospital and see if you can find a way to help them with medication reconciliation at discharge.

Building relationships will also build a referral network. Yes, this will mean business when we are able to bill Medicare for medical services but it will also mean increased business now. If your local providers see you as the go-to pharmacy for optimal medication management, they will send their patients to you.

Try to understand the quality measurement landscape — and beyond Star Ratings.

Physicians, ACOs, medical homes, and hospitals are all held to different quality metrics. Learn what they are, learn what the pressure points are and think of how pharmacists can help to achieve those metrics. Also get to know the billing codes that may be available to us through Medicare. These include CPT codes, chronic care management codes, G-Codes and more.

The Medicare Learning Network is a great resource. Sign up for their email list and get information sent to you regularly.

And among the most important next step, be involved with PPA. Support the Association’s efforts!

Thank you, Pat, for this opportunity to share my thoughts with pharmacists in Pennsylvania.

Thank you, Krystal. Excellent information.

Clearly, there are many changes to come and those able to adapt will survive and flourish Special note: PPA has been working vigorously to both look at legislative and practice advocacy when it comes to advancing changes in pharmacist provided patient care. In recent years, we have been successful in advancing and protecting our practice act in numerous ways as well as our creation of the Comprehensive Medication Management Collaborative (CMMC), the Pennsylvania Pharmacists Care Network (PPCN), and developing various tools and services for our members to utilize. Please see the Pharmacists Care Network tab on our website for more information. 

www.papharmacists.com • 25

FEATURE ARTICLE

IMPORTANT MESSAGE • Ordering, Referring and Prescribing Providers Must Enroll in Medical Assistance Effective September 25, 2016, the Pennsylvania Department of Human Services (Department) will deny payment on claims for services that are ordered, referred or prescribed by health care providers who are not enrolled in the Medical Assistance (MA) program. If a provider who is not enrolled in the Medical Assistance program orders, refers, or prescribes a service for a MA Fee for Service beneficiary, the claim submitted by the rendering or billing provider will not be paid, even though the rendering or billing provider is enrolled in the MA program.

Examples of services that require a prescription, an order, or a referral are: qll medications; medical supplies, medical equipment, orthotics, and prosthetics; lab tests; home health services; radiologic imaging services; hospital admissions; and procedures done in a hospital short procedure unit (SPU), an ambulatory surgical center, or a treatment room.

This requirement, that a provider that orders, refers, or prescribes items or services for a MA beneficiary be enrolled in a state’s Medicaid program, is contained in the Affordable Care Act (ACA). The ACA and implementing regulations require that physicians and other providers, who order, prescribe and refer items or services for Medicaid beneficiaries must enroll in the state’s Medicaid program, even if

those providers do not submit claims to the state Medicaid program for Medicaid-covered services rendered to Medicaid beneficiaries.

Beginning April 1, 2016, the Department has been sending informational messages to some billing providers when the ordering, referring or prescribing provider identified on the claim is not enrolled in the MA program. The billing provider may want to inform the MA beneficiary and the ordering, referring or prescribing provider of the requirement to enroll in the MA program in order to avoid any interruption in therapy or a course of treatment. Providers,who order, refer or prescribe items or services for MA beneficiaries, should access the Department’s website at www.dhs.pa.gov for information on how to complete and submit a MA enrollment application.

The Department created a tool called the “Medical Assistance Enrolled Provider Portal Lookup” for enrolled MA providers to verify if practitioners who are ordering, referring and prescribing items and services for MA beneficiaries are enrolled in MA program. Enrolled providers may access the tool by logging into the PROMISe™ Internet provider portal at the following Department website link: https:// promise.dpw.state.pa.us. 

http://www.papharmacists.com/Drug_Resource_Center

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ASSOCIATION NEWS

PPA FOUNDATION GRANT • Final Report Contributed by: Gale E. Garmong, PharmD; Jennifer L. Bacci, PharmD, BCACP, MPH; Lucas A. Berenbrok, PharmD; Stephanie Harriman McGrath, PharmD; Kristine L. Ossman, PharmD; Olufunmilola Abraham, PhD, BPharm; Brittney A. Knass, PharmD Candidate, 2016; Melissa Somma McGivney, PharmD, FCCP, FAPhA1 This study and report was made possible in part through a grant provided by the PPA Educational Foundation grant in 2015. This report was not submitted through the peer review process and is presented a report only. The full report may be found under the Foundation section Grants – 2015 Grants http:// www.papharmacists. com/page/FBOD_ Grants15

REFERENCES 1 Author not named in grant

Acknowledgements Rite Aid Corporation: Donna Hazel, RPh; John Toth, RPh; Jesse McCullough, PharmD; Mike Mills, PharmD; JT Leatherwood, RPh; Jermaine Smith, RPh. University of Pittsburgh: Brandon Antinopoulos, PharmD; Christine Jordan, PharmD; Kyle McCormick, PharmD.

Research Objective To evaluate the impact of a community pharmacist coaching program on (1) targeted medication review (TMR) completion rates and (2) pharmacy revenue from TMRs; and (3) to describe pharmacy staff perceptions of the coaching program.

Research Methods An adaptive pharmacist coaching program was developed drawing from principles of social network theory, motivational interviewing, high-performing clinical team formation, preceptorship, and social cognitive theory. The coaching program was designed to increase pharmacists’ comfort in providing patient care and to help pharmacists address barriers to providing patient care within workflow.

Participating pharmacies were recruited from a traditional chain community pharmacy within the greater Pittsburgh, PA, area. To be included in this study, at least one pharmacist at each pharmacy location had to have access to both studied medication therapy management (MTM) platforms.

Forty-two pharmacies met the inclusion criteria.

These pharmacies were then stratified into low, intermediate, and high performance groups by baseline TMR completion rates.

Three pharmacies from each performance group were randomly selected as intervention pharmacies, and their pharmacy managers were invited to participate in the study. A pharmacist from each participating site was identified to serve as the pharmacist clinical champion (PCC), with preference given to pharmacists with prior training on MTM and access to studied MTM platforms. As is common in implementation science, the PCC represented the pharmacy in interactions with the coach and led implementation efforts on site between coaching visits. Each intervention pharmacy was matched to a control pharmacy based on their performance group, prescription volume, and pharmacist/technician hours. Intervention pharmacies received the coaching program, and both intervention and control pharmacies received written reference materials on MTM platforms.

The coach completed a total of 4 coaching inter­ actions with the PCC from each intervention pharm­ acy. During the first interaction, the coach visited the pharmacy, discussed the PCC’s perceptions of current performance and barriers to MTM com­ple­tion, completed a proficiency checklist to identify additional barriers, and developed a plan collaboratively with

28 • Pennsylvania Pharmacist • September/October 2016

the PCC to address barriers and increase completion.

A 1 week follow-up call and 1 and 2 month follow-up visits were conducted to assess the pharmacy team’s progress and troubleshoot additional barriers.

TMR completion rates and revenue were calculated for both control and intervention pharmacies using MTM platform reports. The pre-intervention period was November 2014 to January 2015, and the post-intervention period was February to April 2015. Median changes in TMR completion rates and revenue were compared between intervention and control pharmacies.

Eight pharmacists opted to participate in audio-recorded, semi-structured key informant interviews to elicit their perceptions of the coaching program, with one additional pharmacist agreeing to participate but declining to be audio-recorded. All pharmacists completed a demographic survey prior to the interview.

Interviews were transcribed, coded inductively, and subjected to a general thematic analysis

Preliminary Findings Comparison of changes in TMR completion and revenue between intervention and control pharmacies showed no significant trends, likely due to our small sample size. The key informant interviews provided insight on aspects of coaching that pharmacists valued, as well as pharmacist preferences for future coaching programs. Pharmacists emphasized the importance of hands-on, individualized training with feedback and follow-up. Pharmacist acceptance of coaching may be increased by emphasizing coaching’s relation to professional expectations, appealing to pharmacists’ desire to improve, and allowing flexible scheduling of coaching times. Pharmacists are also willing to accept coaching from new practitioners.

Future coaching programs should seek to further address incorporation of patient care within workflow and engaging the pharmacy team.

Conclusion Coaching may represent a strategy for increasing provision of patient care by community pharmacists.

This study provides insight into pharmacy staff perceptions of coaching and could serve as a guide for other community pharmacies developing coaching programs as a way to support implementation of patient care services. 

BOARD OF DIRECTORS LEADERSHIP RETREAT On Tuesday, July 12th and Wednesday, July 13th the PPA Board of Directors and Student Advisory Board met in State College for their annual orientation and leadership retreat. This two-day retreat included a student orientation session, a new PPA Board member orientation, a Board meeting and a planning session focused on boosting membership numbers! 

Pictured at left Front Row: Olivia Marchionda, Nicolette Diehl, Rachel von Vital, Rachel Richter, Jennifer Fever, Marissa Badzik, Rebecca Wytiaz. Second Row: Lauren Stabler, Olivia Erickson, Kayla Bardzel, Felicia Snyder, Jamie Celento.

Third Row: Brandon Barry, Kaitlin Bova, Ali Shabaz, Anthony Fanucci, Colleen D’Amico

View our Video on S&L’s “Results Driven Assessment” at www.sandlsolutions.com

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Call 888.273.0325 or visit www.sandlsolutions.com to learn more.

www.papharmacists.com • 29

ASSOCIATION NEWS

Free Ways To Give To PPA’s Educational Foundation In this era or rising costs, there is much competition for charitable giving, and there are now several options we can consider to “give for free” or to make our dollars go further. These options are an important way to raise funds, and they take very little effort to do so.

giving for free

Amazon announced its new charitable program, Amazon Smile, in 2014, where individuals can sign up, select a charity to support, and have 0.5% of eligible sales go the selected charity. There is no cost to the individuals using the program. To sign up for the for this simple way to give for free, go to www.smile.amazon.com and type the name of your nonprofit and click search, then click select when the your nonprofit’s name appears on your screen.

For all future shopping visits to Amazon, go to www.smile.amazon.com to shop. You’ll have the entire Amazon site available to you from that link, so all you have to do is shop as you normally do from that link.

It may seem like pennies, but if you shop often, and many others shop often, those pennies can add up to make a difference over time.

ebates is a cash-back free shopping portal that leverages their ability to bring shoppers to retail sites, which then pay eBates a rebate, and eBates shares that rebate with shoppers. More than 1,700 retailers, hotel chains, and sites participate.

To sign up, provide some basic information (name, address, other items like email address). There are three options regarding your payment preferences. The third one is “send my Big Fat Check to Someone Else.” In that field, type you can type your nonprofit’s name, and provide the address information for your nonprofit. When shopping, log into eBates, search for the retailer name, then click on the retailer and shop. For computers with newer browsers, a user can install the eBates Cash Back Button, which automatically earns the rebate when shopping on the site of any eBates retailer without the need for logging in and searching. There is also an eBates app for iPhones and iPads.

iGive is an online shopping mall where a portion of each purchase is donated to the cause of the user’s choice at no cost to the user. Like eBates, iGive harnesses the power of its many users with the retailers on their site. iGive is compensated for bringing users and retailers together, and they share that compensation with their users’ charities. More than 1,500 stores are part of the iGive site, and users do not have to enter any codes to earn donations. To join, go to www.igive.com, and fill in the form (name, email address, zip code). Then click on Choose Cause. You can search for your organization by name and select them as your charity. Like eBates, there is an iGive button for installation on computers with newer browsers and there is an iPad and iPhone app. To shop on iGive, go to www.igive.com and log in (or open the app). Then type in the store name, and click on that store name to shop and earn a donation for your organization.

Bookmark the site so you remember to shop amazon through the www.smile.amazon.com link!

Shop during shopping days like Black Friday and Cyber Monday to earn very high cash back percentages. You can earn extra bonuses for the organization by having people join through my tell-a-friend link: http://www.ebates.com/ rf.do?referrerid=lQ95LISEklZG44Wn9xjuiQ%3D %3D&eeid=26471. Whenever I encourage people in my organization to join, I ask them to join through my link.

Make sure cookies are enabled when using the iGive button. It’s necessary to ensure that the donations process properly.

30 • Pennsylvania Pharmacist • September/October 2016

MEMBER NEWS Andrew Brown’s Drug Store and Home Health Care Center ... in Scranton was voted the best place to work in NEPA in the small company category!

Theresa Talbott Appointed to New Post

free bucks

Theresa Talbott, RPh was recently appointed to the National Association of Boards of Pharmacy (NABP) Advisory Committee on Examinations.

Pharmacists Mutual Companies ... was named to the 2016 Ward’s 50 Benchmark Group of top-performing insurance companies in the United States. Being named to this group recognizes Pharmacist Mutual for achieving results in areas of safety, consistency, and performance over a five year period (2011–2015).

Corporate Matching Gift Programs One often overlooked

ways to make your money more valuable to charitable organizations is through corporate matching gift programs. These programs often match donations made by the individual working for (or retired from) the company or by their spouse/partner.

Matching gift programs usually require some notification the company, notifying them of the donation. The employee generally provides the information of the organization receiving the donation, and the recipient organization must usually confirm the donation. This website allows users to search for the names of companies participating in a Matching Gift program. http://www.matchinggifts.com/search/rit Please note that it’s possible to have a gift matched more than once, if both spouses/ partners work for matching gift companies.

Creativity Rewarded Justin Saver, University of Pittsburgh PharmD Candidate 2018, was announced as a PQA-CVS Health Foundation Scholar. This new initiative is designed to foster student interest in performance measurement and quality improvement. Saver submitted a concept for a unique project that he will develop throughout the academic year, and then present during the PQA Annual Meeting in May 2017.

Sellersville Pharmacy ... at Penn Foundation, owned by Rob Frankil, was visited by Governor Wolf. The Penn Foundation, a community based non-profit with complete mental health and addiction services, was awarded a Top 20 addiction center in Pennsylvania by Governor Wolf to help with the opioid epidemic. 

If you or your spouse/partner work for a matching gift company, bookmark the site related to processing your corporate match. 

www.papharmacists.com • 31

ASSOCIATION NEWS

Government Relations Advocacy for Student Pharmacists (GRASP) Graduate List The Pennsylvania Pharmacists Association would like to recognize and congratulate all students who have successfully completed the GRASP program September 1, 2015 to June 13, 2016.

Duquesne University — Mylan School of Pharmacy

Philadelphia College of Pharmacy

Temple University School of Pharmacy

Colleen D’Amico

Hamad Juboori

Daniel Brust

Justin George

Oxana Placinta

Jamie Celento

Shaina Kulp

Courteny Hager

Swana Thomas

Mary Kimmel Valerie Magda

Wilkes University — Nesbitt School of Pharmacy

Kelly Mazzei

University of Pittsburgh School of Pharmacy

Kayla Bardzel

Raymond Snyder

Dylan Atkinson

Katie Bressler

Alvina Tran

Marissa Badzik

Keri Diehl

Brandon Barry

Anthony Fanucci

Jefferson School of Pharmacy

Mariah Brown

Sarah Fillman

Nicolette Diehl

Christian Giovanni

Richard LaCoursiere

Douglas Drab

Alexandra Grudeski

Ashley Maister

Jennifer Fever

Rebekah Harris

Mary Grace Fitzmaurice

Jayden Hensley

Jillian Grapsy

Emily Jones

Lindsay Jablonski

Kristen Lopatofsky

Mason Jaynes

Taylor Moyer

Heather Johnson

Ashley Robold

Philipp Kappes

Jennifer Smith

Dilafruz Khakimova

Felicia Snyder

Olivia Marchionda

Nicholas Stauffer

Sierra Milton

Letitia Warunek

Karen Quach

Samantha Weiksner 

Lake Erie College of Osteopathic Medicine School of Pharmacy Sara DiLascio Kaitlin Fairlamb Dalton Fishel Ashley Freeman Abby Gallagher Sally Habusta Olivia Hines Chelsey Hughes Mason Koehle Victoria Matteson Shivam Patel

Mara Rubin Justin Saver Elyse Tomaszewski Xinyan Ye

Emily Petrak Jamie Shepard James Shoemaker Erik Whyne

32 • Pennsylvania Pharmacist • September/October 2016

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Schedule At A Glance: Thursday

FRIDAY:

PPA’s Annual Golf Outing benefiting PPA’s Educational Foundation and PharmPAC at Turtle Creek Golf Course

Professional Development: Special Medical Marijuana Briefing and Education Session CE: Assessing the Revolution of your Heart's Constitution CE: Digital Health 103: Resources for Pharmacists CE: Lehigh Valley Pain Management Alliance Experience

Open Meetings:

Social Events:

PPA Business Meeting

New Practitioner Reception

Independent Owners Forum Health System Forum

Past Presidents Reception Welcome Reception & Dinner in Exhibit Hall

STUDENT PROGRAMMING: Residency – Preparing yourself for a residency showcase

Professional Development – Building a successful career Naloxone Residency Showcase Achieving Independence Competition

General Session: Pennsylvania’s Prescription Opioid and Heroin Crisis – Developing Partnerships for Solutions!

SATURDAY:

Presented by: Dr. Rachel Levine, PA Physician General, & Gary Tennis, Secretary of PA's Department of Drug and Alcohol Programs

Professional Development: CE: Spirometry: An Innovative Value-Added Service for Pharmacists CE: Healthcare Trends and Changes – Creating Connectedness and Leveraging Medication Synchronization to Influence Patient Behavior and Drive Adherence Panel Discussion: Community Pharmacy Role in Accountable Care Organizations & Patient Centered Medical Home Panel Discussion: Transitions of Care & Medication Reconciliation Substance Abuse Programming Open Meetings:

Social Events:

PPA Business Meeting

Breakfast Buffet

Independent Owners Forum Health System Forum

Lunch in Exhibit Hall Leadership & Awards Reception and Dinner

SUNDAY: Professional Development: Are You Smarter Than a Fifth Year Pharmacy Student?

CE: The Star Spangled Revolution: How Community Pharmacies can Affect their Quality Measures CE: Deprescribing: The New Way to Guide Medication Reviews Social Events: Breakfast Buffet

WWW.PAPHARMACISTS.COM/ANNUAL2016

ASSOCIATION NEWS

Call for 2017 PPA Educational Foundation Grant Applications Information about Grant Opportunities, the 2017 Grant Announcement, and the Grant Application can be found on the PPA website under Foundation, Grant Programs.

The PPA Educational Foundation will award up to four grants in 2017 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.

For 2017: 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.

The Foundation has available on its website a short recorded webinar (about 15 minutes) on the Foundation, the grant program, its goals and objectives, and the application and decision process.

Watching the webinar is not required but may be helpful in providing any applicant with a greater chance of success by a full understanding of the process and expectations. Participation will also not be considered in the grant evaluation process and therefore is not a requirement or guarantee of success. 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.

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! 

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INDUSTRY NEWS

PRESERVING YOUR PHARMACY LICENSE • Part II By: Steven E. Grubb, Esq., Goldberg Katzman P.C. WHAT IS A FORMAL DISCIPLINARY ACTION LIKE? If you previously decided to go it alone in the investigatory phase, now is the time to consult an attorney since not only has a preliminary determination been made that the charges against you are serious, there is also a formal procedure that will now be followed that can be difficult to navigate without legal counsel.

Part I of this Article examined the general disciplinary procedures up through the investigation phase of a complaint against you or your pharmacy.

Many disciplinary proceedings end there.

The second part of this article examines those proceedings that go beyond the investigation and into the formal disciplinary phase.

The case begins by the prosecuting attorney preparing, filing and serving upon you an Order to Show Cause. The Order to Show Cause sets forth the allegations against you and will also detail the potential punishment that could be accorded, such as a reprimand, license suspension or revocation and civil monetary penalties. The identification of potential penalties is general in nature. It should not be construed as the likely outcome or even what the prosecuting attorney will seek in terms of discipline.

You will have thirty (30) days to file a written response.

Your response will contain your response to the facts stated against you and raise additional facts you feel are relevant and which you wish to be made known in your defense. Keep in mind that this is now a formal proceeding. It does you no good to contact the investigator you met with to convince them this was a big misunderstanding. At this point, it is better to meet with your lawyer and prepare your defense to the charges.

CAN I SETTLE? In matters of professional licensure, “settlements” occur through a document called a Consent Agreement and Order. They are often more akin to a “plea agreement” in a criminal proceeding, than a “compromise” in a civil litigation context. It is extremely rare that a Consent Agreement will result in a settlement where you are completely exonerated.

The compromise aspect of the Consent Agreement usually means that you are agreeing to some form of discipline and admitting to an agreed upon statement of facts that your attorney negotiates with the prosecuting attorney.

If you engage in the Consent Agreement process, just because you are undertaking this in the context of “settlement,” does not mean the discipline is any less severe or important. For example, if you agree to a suspension or revocation of your license, that fact is still going to be published in a newspaper of general circulation in your home county, no different than if this was your punishment following a full hearing.

Consent decrees are also part of your permanent record.

38 • Pennsylvania Pharmacist • September/October 2016

The utility in exploring a Consent Agreement is that it enables you some control over the type of penalty to be imposed. In addition, it saves you the expense and anxiety associated with proceeding to a full administrative hearing.

All Consent Agreements must be approved by the Board of Pharmacy to be effective. If you are able to agree to the terms of the Consent Agreement, the matter will be considered at an upcoming Board of Pharmacy meeting. You have the opportunity to have your counsel present at the Board meeting to answer any questions the Board may have. If the Board accepts the Consent Agreement, an Order will be entered adopting the Consent Agreement and the proposed disciplinary penalty. If the Board rejects the Consent Agreement, you will have the opportunity to attempt to negotiate a different Consent Agreement or to proceed with the administrative hearing.

THE ADMINISTRATIVE HEARING Once you have filed your answer to the Order to Show cause and requested a hearing , your matter will be scheduled for an administrative hearing1. The Pharmacy Act provides that hearings, appeals and rulings are done in accordance with Pennsylvania’s Administrative Agency Law. This law and the associated regulations provide general procedures that are used by a wide variety of administrative agencies. It is not the point of this article to describe the many intricacies of the Administrative Agency Law and Regulations contained in the Pennsylvania Code, but there are many things that can happen in your proceeding aside from the hearing, such as pre-hearing conferences, pre-hearing motions and stipulations of uncontested facts. Most of these matters will be handled by your attorney who will be equipped to maneuver through these occasionally complicated procedures. This further explains the importance of having competent counsel by your side as you go through this process.

The Pharmacy Board typically delegates the conduct of the disciplinary hearing to a hearing examiner.

These individuals are attorneys who preside over the hearing much like a judge does in court. The hearing officer listens to the live testimony, makes credibility determinations and rules on the admissibility of evidence. These hearings are much like trials in a courtroom. Testimony is under oath and transcribed and subpoenas, issued by the Pharmacy Board, can be used to compel witness testimony and production of documents.

If you previously decided to go it alone in the investigatory phase, now is the time to consult an attorney since not only has a preliminary determination been made that the charges against you are serious, there is also a formal procedure that will now be followed that can be difficult to navigate without legal counsel.

The BPOA has the burden of proving a violation and, therefore, will go first. The BPOA may present documents, witness testimony and, potentially, expert witness testimony. The length of the BPOA’s case will depend on the complexity of the case and the facts which are contested. For example, many times the issue in a hearing is not whether something happened, but the severity of the penalty that the prosecuting attorney is seeking. In this case, the hearing might be relatively short with your real emphasis on convincing the hearing examiner as to a just remedy. If there are issues over whether you actually did something or differences of opinion over whether you did something correctly, the hearing will be longer.

After the Commonwealth rests, you will have the opportunity to introduce evidence on your own behalf to defend yourself. Your evidence will consist of facts used to support your position, as well as facts demonstrating your worth as a pharmacist and in the community. The latter type of evidence may not absolve you of discipline, but could assist you in reducing the level of any discipline imposed.

Following the conclusion of the administrative hearing, both parties will usually have the opportunity to file a post-hearing brief. This is a written document which presents your position on the facts and how the hearing officer should rule on the final outcome.

Following the submission of the post-hearing briefs, the record will be closed and taken under consideration by the hearing examiner. The hearing

examiner will then issue a Proposed Adjudication and Order setting forth findings of fact and conclusions of law, as well as a narrative and proposed Order which may or may not impose a disciplinary penalty against you.

From here, if either you, or the prosecuting attorney (and sometimes both), do not like the Proposed Adjudication and Order, either party may take exception by filing a brief within 30 days of the filing of the Proposed Adjudication and Order. The purpose of exceptions is to identify errors the hearing examiner may have made in the proceeding and to challenge the hearing examiner’s findings of fact and conclusions of law. The exceptions will be heard by the Pharmacy Board. The Pharmacy Board has the power to review the record, including evidence presented and a transcript of the hearing. The Board can uphold, modify or reverse the decision of the hearing examiner.

If no exceptions are filed, the Pharmacy Board will usually confirm the Proposed Adjudication and Order, although the Pharmacy Board can still review the Proposed Adjudication and Order on its own, without exceptions being taken. If you have not filed exceptions and later want to appeal the Board’s ultimate decision, your position may be unclear. Thus, even if you doubt your exceptions will be productive, it is best to preserve them.

Continued on page 40

www.papharmacists.com • 39

INDUSTRY NEWS IF I AM DISSATISFIED WITH THE OUTCOME. . .

If the Board has ruled against you, the possibility of discipline becomes more likely, but you still have options. First, you can ask the Board for reconsideration within fifteen days of the final order. Second, you can appeal the final order to the Commonwealth Court within thirty (30) days. A third option is to do both due to the overlap in the timing.

For example, if a final order is rendered by the Board on March 1, you will have to file your application for reconsideration by March 16 and your appeal by March 31. Ideally, the Board would rule on your application for reconsideration by March 31, but if it does not, you need to make sure your appeal right is preserved by filing your petition for review before March 31.

If the Commonwealth Court rules against you, there is a right to seek appeal to the Supreme Court of Pennsylvania. The Supreme Court, however, can elect not to hear your appeal. If it does hear your appeal, it will, generally, apply the same standards of review as the Commonwealth Court did.

HOW LONG IS THIS GOING TO TAKE? From the time the Board initiates an investigation, or a Complaint is filed to the time a final disposition is reached either by the Board or on Appeal can take a year or two. The BPOA’s web site reports that the investigation phase of a Complaint, before there is even a decision on whether to issue a Show Cause Order, can take months.

Reconsideration

CAN I PRACTICE WHILE ALL OF THIS GOING ON?

So you have stated your case to the hearing examiner, filed exceptions which the Board did not agree with and the Board has entered a final order against you?

Why file for reconsideration? Having an application for reconsideration granted can be difficult. In fact, the prosecuting attorney is not even required to answer the application and the Board may not even rule on your application (it is deemed denied in thirty days if the Board does not rule). So why do it? Perhaps there was a change in the law. Perhaps there was a glaring fact that the Board ignored. Perhaps the Board adopted a finding that was clearly wrong and not supportable by facts of record. Whether to ask for reconsideration is a strategic move where your lawyer’s advice and experience will be most critical.

Even if the Board grants the motion, all it is agreeing to do is reconsider its ruling. It may reconsider the ruling and still rule against you. But if the Board reverses course and rules in your favor it can be the most efficient way to your desired result.

It is likely that you can practice, however, there is an exception in the Pharmacy Act if the Board believes you pose an immediate and clear danger to the public health and safety. In this case, the Board can temporarily suspend your license without a hearing.

The Board is required to convene a hearing within thirty days of the suspension to determine whether there is a “prima facie” case against you. This means that the Board will decide whether there is evidence to support that you pose a danger. It is not a final determination. If a prima facie case exists, your license will remain suspended until the Board vacates the suspension, or a final decision is rendered, but in no event longer than one hundred eighty days. While this is going on, a formal action to suspend, revoke or restrict your license will be commenced.

Petition for Review (or appeal) You have the right to have the final order reviewed by the Commonwealth Court of Pennsylvania. You will raise to the Commonwealth Court those errors you believe were committed by the hearing examiner and/ or Board in reaching its decision.

A few things to remember when you appeal: 1) It is not a hearing where new evidence is introduced.

The Commonwealth Court is reviewing the record of the proceeding before the hearing examiner and/ or Board which emphasizes the need to present all of your evidence in the underlying proceedings. 2) The Commonwealth Court generally does not disturb discretionary actions of administrative bodies such as the Board of Pharmacy, absent a manifest abuse of discretion or an arbitrary execution of the Board’s duties. Suspending or revoking a license to practice is the role of the Board. The Commonwealth Court will likely not disturb the Board’s ruling unless the Board’s ruling was arbitrary or unsupportable, or the Board ruled incorrectly on the law.

40 • Pennsylvania Pharmacist • September/October 2016

CONCLUSION The foregoing gives you a flavor of the process that would be employed in the event you are subject to discipline by the Board of Pharmacy. In the law, there are always exceptions and nuances to every rule, and procedural maneuvers that are not discussed in this article. The charges against you, and the procedures leading to an ultimate decision should be taken seriously and not ignored. Any discipline by the Board is public and could have long-lasting implications on your future practice. It is essential that you devote the time necessary to defend yourself and enlist the services of a competent attorney to help.

REFERENCE 1 Although the Board recognizes your right to a hearing, they may not automatically schedule it. You should request a hearing in your Answer. 

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INDUSTRY FINANCIAL NEWS FORUM Many people plan their estates diligently, with input from legal, tax, and financial professionals.

Others plan earnestly, but make mistakes that can potentially affect both the transfer and destiny of family wealth.

Here are some common and notso-common errors to avoid.

This series, Financial Forum, is presented by PRISM Wealth Advisors, LLC and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@berthelrep. com. Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc.

HOW TO AVOID ESTATE PLANNING MISTAKES Too many wealthy households commit these common blunders.

Doing it all yourself. While you could write your own will or create a will or trust from a template, it can be risky to do so. Sometimes simplicity has a price. Look at the example of Warren Burger. The former Chief Justice of the United States wrote his own will, and it was just 176 words long. It proved flawed — after he died in 1995, his heirs wound up paying over $450,000 in estate taxes and other fees, costs that likely could have been avoided with a lengthier and less informal will containing appropriate language.1 Failing to update your will or trust after a life event. Relatively few estate plans are reviewed over time. Any life event should prompt you to review your will, trust, or other estate planning documents. So should a life event affecting one of your beneficiaries.

Appointing a co-trustee. Trust admin­ istration is not for everyone. Some people lack the interest, the time, or the understanding it requires, and others balk at the responsibility and potential liability involved. A co-trustee also introduces the potential for conflict.

Being too vague with your heirs about your estate plan. While you may not want to explicitly reveal who will get what prior to your passing, your heirs should have an understanding of the purpose and intentions at the heart of your estate planning. If you want to distribute more of your wealth to one child than another, write a letter to be presented after your death that explains your reasoning. Make a list of which heirs will receive particular collectibles or heirlooms. If your family has some issues, this may go a long way toward reducing squabbles and the possibility of legal costs eating up some of this or that heir’s inheritance.

Failing to consider what will happen if you & your partner are unmarried.

The “marriage penalty” affecting joint filers aside, married couples receive distinct federal tax breaks in this country ­— estate tax breaks among them. This year, the lifetime gift and estate tax exclusion amount is $5.45 million for an individual, but $10.9 million for a married couple.1,2 If you live together and you are not married, it is worth considering how your unmarried status might affect your estate planning with regard to federal and state taxes. As Forbes mentioned last year, federal and state taxes claimed more than $15 million of the $35 million estate of Oscar-winning actor Phillip Seymour Hoffman. He left 100% of

42 • Pennsylvania Pharmacist • September/October 2016

his estate to his longtime partner, and since they had never married, she could not qualify for the marriage exemption on inherited assets. While the individual lifetime gift and estate tax exclusion protected a relatively small portion of Hoffman’s estate from death taxes, the much larger remainder was taxed at rates of up to 40% rather than being passed tax-free. Hoffman also lived in New York, a state which levies a 16% estate tax for non-spouses once estates exceed $1 million.1 Leaving a trust unfunded (or underfunded). Through a simple, onesentence title change, a married couple can fund a revocable trust with their primary residence. As an example, if a couple retitles their home from “Heather and Michael Smith, Joint Tenants with Rights of Survivorship” to “Heather and Michael Smith, Trustees of the Smith Revocable Trust dated (month)(day), (year)”. They are free to retitle myriad other assets in the trust’s name.1 Ignoring a caregiver with ulterior motives. Very few people consider this possibility when creating a will or trust, but it does happen. A caregiver harboring a hidden agenda may exploit a loved one to the point where he or she revises estate planning documents for the caregiver’s financial benefit. The best estate plans are clear in their language, clear in their intentions, and updated as life events demand.

They are overseen through the years with care and scrutiny, reflecting the magnitude of the transfer of significant wealth.

This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note — investing involves risk, and past performance is no guarantee of future results.

The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional.

This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment.

Citations 1 raymondjames.com/pointofview/seven_estate_planning_ mistakes_to_avoid [10/16/15] 2 fool.com/retirement/general/2015/12/11/estate-planning-in2016-heres-what-you-need-to-kno.aspx [12/11/15] 

INDUSTRY NEWS

pharmacogenomics • A Work in Progress By: David Huggar, PharmD1,2; Bryson Duhon, PharmD, BCPS1,2,3 1

Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin

2

Pharmacotherapy Education & Research Center, The University of Texas Health Science Center at San Antonio

3

Department of Inpatient Pharmacy, University Health System, San Antonio, TX

Printed with the permission of the Texas Pharmacy Association.

This article appeared in Texas Pharmacy in the Summer 2016 issue.

As healthcare continues to evolve in the 21st century, more attention has been placed on the philosophy of “individualized medicine.” In the case of treatment, it is not uncommon for two patients to exhibit opposing responses to the same medication due to various patient factors. A difference in response has the potential to augment efficacy and increase adverse effects. More than 800,000 medicationrelated adverse events are reported in the U.S. annually, with nearly 124,000 resulting in death.1 As a result, much effort has been focused on evaluating the role of genetics in how individuals respond to medications, or pharmacogenomics. More specifically, pharmacogenomics is a marriage between the studies of genomics, the practice of medicine, and pharmacology. Better understanding of the relationship shared by all three aspects has supported improvements and innovation in the treatment of diseases highly influenced by pharmacogenomics.

Early pharmacogenomics studies focused on differences in pharmacokinetics between relatives, as well as inheritance patterns of various drug effects. Findings from these studies improved our understanding of the body’s major metabolic pathway, the cytochrome P450 (CYP450) system.2 As a result, clinicians were able to manage patients more efficiently. Warfarin, a widely prescribed oral anticoagulant used for the treatment of numerous disease states, was one of the first medications to be investigated for influence of pharmacogenomics.

Researchers observed that persons with mutations in the 2C9 subset of their CYP450 system metabolized the drug more slowly and were thus at an increased risk of bleeding. Accounting for the influence of CYP450 and other influential genes, clinicians have

800,000 medication-related adverse events reported in the U.S. annually resulting in nearly

124,000 deaths

44 • Pennsylvania Pharmacist • September/October 2016

4

number of drugs that contained pharmacogenomics information on their label prior to initiation of HGP

140

number of drugs that contain pharmacogenomics information 15 years after completion of HGP

significantly reduced hospitalizations from warfarinassociated bleeding.3 The most significant advancements in the field came in 2003, when scientists sequenced the entire human genome.4 Completion of the Human Genome Project (HGP) offered a road map for the scientific community to focus their research efforts more appropriately.

The response has been evident. Prior to initiation of HGP, only four drugs contained pharmacogenomics information in their label.5 Nearly fifteen years after completion of HGP, that number has increased to 140 drugs.6 Among the drugs with pharmacogenomics information in their label is clopidogrel—an antiplatelet agent used to prevent clotting in a number of cardiovascular disorders. Originally approved in 1998, nearly a decade (2006) passed before the makers realized genetics influenced patient response.7 It was later revealed that variant forms of CYP2C19 reduced platelet inhibition by clopidogrel, lending to treatment failure.8 These variants, CYP2C19*2 and *3, were estimated to be prevalent in as much as 14% of the global population, predisposing them to higher risk of major cardiovascular events.9 In response, the FDA mandated a boxed warning be included on the labeling of clopidogrel.

Pain management was another early benefactor of pharmacogenomics research. Due to the subjective nature of interpreting pain and wide interpatient variability in response to medications, clinicians may struggle to find an appropriate balance of analgesia.

Excessive analgesia is associated with life-threatening side effects related to respiratory depression, while

inadequate analgesia leaves a person in discomfort.

Metabolism of analgesic medications is influenced mainly by the CYP450 system (2D6 and 2C9) and transport protein content. Mutations in the genes that encode either of these components will alter a patient’s response to analgesic medications.10 Better understanding the metabolism of analgesic medications has been crucial to providing more efficient pain management.

Arguably, no clinical specialty has benefited more from advancements in pharmacogenomics than oncology.

Much of the growth can be attributed to the dual influence of both germline and somatic mutations on disease progression. Historically, treatment of various cancers utilized site specific cytotoxic treatments, which was devastating to not only cancer cell lines, but other normal cell lines as well. Advancements in pharmacogenomics have paved the way for more targeted therapies, which spare non-cancerous cell lines. One example of such therapy is crizotinib.

Originally approved for treatment of non-small cell lung cancers (NSCLC), crizotinib was shown to be effective in more resistant cancers.3 Resistance was marked by the presence of the enzyme, anaplastic lymphoma kinase (ALK). Testing for ALK is now routine in NSCLC and used to guide therapy as a result.

In 2001, the cost of sequencing the human genome was $100 million per person; 15 years later, the cost is less than $1000 per person.11 Advancements in automation and sequencing technique are chief drivers in this lowered cost. Despite such a drastic decrease in the cost of sequencing a genome, the cost-effectiveness of clinical implication remains to be seen. Warfarin, for example, is one of the most widely used medications in the U.S. with known genetic variants that influence response, yet patients are still not routinely screened prior to the initiation of treatment. This underutilization stems from a belief that screening is not clinically indicated due to relatively low odds of adverse events in affected individuals.12 Additionally, as many as 9 out of 10 clinicians do not feel adequately prepared to provide genomics-driven care.8 Assessing the total cost of whole genome sequencing (WGS) has proven difficult due to a lack of outcomes data. Put plainly, savings from potential adverse events avoided must be balanced with additional diagnostic and treatment costs. In order for widespread adoption of genomics-driven care, more effort must be focused on assessing clinical outcomes.

Using validated diagnostic variants is necessary to drive WGS cost-effectiveness positively. In terms of treatment, identification of a genetic variant should create the opportunity for an actionable change (eg. increase dose or change medications).

Nearly 15 years after completion of HGP, the field of pharmacogenomics is still relatively in its infancy. Significant advancements have been made in the provision of WGS, however, the clinical implementation is limited. The disconnect can be attributed to a lack of clinical outcomes data to support the use of WGS and a lack of clinician comfort with genomics-driven care. Pharmacogenomics is still an attractive opportunity for drug development and disease state management. However, much work remains in assessing clinical viability.

REFERENCES 1. FDA.gov. FAERS reporting patient outcomes by year. http://www.fda.gov/Drugs/ GuidanceComplianceRegulatoryInformation/Surveillance/ AdverseDrugEffects/ucm070461.htm. Updated November 2015.

Accessed May 2016.

2. Gonzalez FJ, Skoda RC, Kimura S, et al. Characterization of the common genetic defect in humans deficient in debrisoquine metabolism. Nature. 1988; 331(6155):442–446.

3. Wang L, McLeod HL, Weinshilboum RM. Genomics and drug response. N Engl J Med. 2011; 364(12):1144–1153.

4. Lander ES, Linton LM, Birren B, et al. Initial sequencing and analysis of the human genome. Nature. 2001;409(6822):860-921.

5. Genome.gov. Quantitative advances since the human genome project. https://www.genome.gov/images/illustrations/hgp_ measures.pdf. Accessed May 2016.

6. Haga SB, Mills R, Moaddeb J. Pharmacogenetic information for patients on drug labels. Pharmgenomics Pers Med. 2014;7:297305.

7. Gladding P, Panattoni L, Webster M, Cho L, Ellis S. Clopidogrel pharmacogenomics: next steps: a clinical algorithm, gene-gene interactions, and an elusive outcomes trial. JACC Cardiovasc Interv. 2010;3(10):995-1000.

8. Mega JL, Close SL, Wiviott SD, et al. Cytochrome p-450 polymorphisms and response to clopidogrel.

N Engl J Med. 2009;360(4):354-362.

9. FDA.gov. Drug safety communication: reduced effectiveness of Plavix (clopidogrel) in patients who are poor metabolizers of the drug. http://www.fda.gov/Drugs/DrugSafety/ PostmarketDrugSafety InformationforPatientsandProviders/ucm203888.htm.

Updated March 2016. Accessed May 2016.

10. Ting S, Schug S. The pharmacogenomics of pain management: prospects for personalized medicine. J Pain Res. 2016;9:49-56.

11. Christensen KD, Dukhovny D, Siebert U, et al. Assessing the Costs and Cost-Effectiveness of Genomic Sequencing. J Pers Med. 2015;5(4):470-486.

12. Harper AR, Topol EJ. Pharmacogenomics in clinical practice and drug development. Nat Biotechnol. 2012;30(11):1117-1124. 

www.papharmacists.com • 45

INDUSTRY Rx AND NEWS THE LAW

CERTIFICATES OF INSURANCE 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.

Joan is leasing a new building for her expanding pharmacy practice. As part of her lease, she must provide a certificate of insurance to her landlord.

The landlord is insisting on a number of provisions that must be included on the certificate. However, her insurance company is unwilling to provide the certificate as required by the landlord. Joan is unhappy and stressed at being caught in the middle of this tug of war.

A certificate of insurance is a document issued by an insurance company that provides evidence of property and/or casualty insurance coverage. This certificate is evidence for Joan’s landlord that she has coverage on her property and on other items required under the lease. The trend has been that landlords, vendors, customers, and others who have a contractual relationship with the insured business want additional provisions included on the certificate. Examples of these provisions include longer notice periods for policy cancellation, statement that coverage can’t be voided by the insured’s actions, or statements that the policy coverage meets the requirements of the contract.

This is where the tug of war begins. The certificate is only evidence that insurance coverage exists. It is not an insurance policy. The certificate cannot change the policy or guarantee compliance with a contract.

At least 16 states have specific laws that do not allow the insurance companies to add these sorts of provisions to the certificate. Numerous other states have implemented this prohibition through issuance of bulletins by the insurance commissioner. Here are two examples.

Indiana’s law1 became effective in 2013. The law specifically states that a certificate does not amend, extend or alter the coverage provided by the policy referenced. It also states that the certificate cannot grants rights to a person that are not contained in the policy, such as an extended notice period.

Massachusetts has a very similar law2 that was passed in 2015. In addition to what Indiana’s law says, Massachusetts also says that the certificate shall not be construed as an insurance policy. Both states’ laws provide that it is a violation of the law to knowingly prepare, issue, request or require the issuance of a certificate contrary to the law. In both states, the insurance commissioner can enforce the law with a cease and desist order and the imposition of a fine (up to $500 in Massachusetts and up to $1,000 in Indiana).

In many states, the certificate of insurance is a filed form. This means that the insurance company must have the certificate form filed with and approved by the Department of Insurance prior to using it. In

46 • Pennsylvania Pharmacist • September/October 2016

these states, the insurance company is not allowed to deviate from the state-approved certificate.

These laws and regulations are what put Joan in the middle of the tug of war. The landlord or other party is trying to modify the insurance policy issued to Joan through changes on the certificate. The policies themselves are also state-approved forms and cannot be changed arbitrarily. That may be why they are attempting to make the changes via the certificate.

That is why Joan’s insurance company is reluctant to change the policy or the certificate of insurance.

In many jurisdictions, it is a violation of the law for the insurance company to do so. In the states with laws specifically addressing certificates, Joan or the landlord could also be in violation of the law and fined accordingly for asking or requiring that the changes be made. In these situations, the insurance company is not just trying to be difficult. They are trying to comply with the law. You should ask your insurance company for an explanation as to why the requested changes can’t be made. This can then be passed on to the landlord or other requesting party.

© Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management.

It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice.

Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

Citations 1 Ind. Code Section 27-1-42.

2 Mass. Gen. L. Ch. 175L. 

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Our Mission To help our customers attain peace of mind through specialized insurance products, risk management solutions, and superior personal service.

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