Pennsylvania Pharmacist May/June 2019 Issue

pennsylvania

PHARMACIST May/June 2019 • Volume 100 • Issue 3

Legislative Day 2019 By the Numbers

255 Informational packets provided to legislators & others 94 Pharmacists 207 Students from all 7 schools 3 Special meetings with agencies 101 House meetings 42 Senate meetings 1 Well attended Rally!

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CONTENTS ON THE COVER: PPA BOARD OF DIRECTORS PPA OFFICERS President: Lauren Simko, PharmD President Elect: Richard Demers, MS, RPh, FASHP Vice President: Chuck Kray, RPh Immediate Past President: Nicholas Leon, PharmD, BCPS, BCACP REGIONAL DIRECTORS Central Region: Deron Shultz, RPh Northeast Region: Vick Shah, PharmD, BCPS Northwest Region: Nickolas Kernich, PharmD Southeast Region: David Stone, PharmD Southwest Region: Brian Sidone, PharmD PRACTICE DIRECTORS Academia: Nicole Pezzino, PharmD, BCACP, CDE Chain Pharmacists: Renee Richardson, PharmD Community Independent: Shawn Nairn, RPh Community Independent: Christopher Antypas, PharmD Health System Pharmacists: Darryle Tillman Jr., RPh MCO/Industry/Government/Other: John Barrett, MBA, RPh Associates: Pat Lavella, RPh STUDENT DIRECTORS Student Director East: Dylan Fox Student Director West: Shannon Ye PPA OFFICE STAFF CEO: Patricia A. Epple, CAE pepple@papharmacists.com | Ext. 3 Conference and CE Manager: Linsley Gentile lgentile@papharmacists.com | Ext. 2 Government Relations Manager: Angela Zaydon azaydon@papharmacists.com | Ext. 6 Membership and Marketing Coordinator: Victoria Madonna vmadonna@papharmacists.com | Ext. 5 Membership and Program Coordinator: Rachel Stall rstall@paharmacists.com | Ext. 1 Bookkeeper: Michele Dibble mdibble@papharmacists.com | Ext. 4 PPCN Executive Manager: Stephanie McGrath, PharmD smcgrath@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 Hershey S. Bell, M.D.,M.S.,FAAFP Kim Coley, FCCP, PharmD, RPh, Chair Michael Gionfriddo, PharmD, PhD Yardlee Kauffman, PharmD, MPH, BCACP Jinsun Paek, PharmD, BCPS Associate Editor: Victoria Madonna Editor/Manager: Pat Epple PUBLISHED BY GRAPHTECH Alexis Kierce, Publications Manager (717) 238-5751 x119 alexis@thinkgraphtech.com For Advertising Information: Jen Smith, Account Manager (717) 238-5751 x124 jen@thinkgraphtech.com DESIGNED BY GRAPHTECH 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 Board of Pharmacy Meeting Dates: June 4, 2019 July 16, 2019 August 27, 2019 October 22, 2019

YOUR HEALTH. YOUR PHARAMCIST. On April 9, more than 300 pharmacists and pharmacy students from all across Pennsylvania converged on the Capitol in Harrisburg to advocate on behalf of the profession and show how pharmacists are fighting for fair reimbursement, and transparency in Medicaid. Auditor General Eugene DePasquale kicked off the rally!

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

DEPARTMENTS 5

President’s Message

7

Calendar of Events

9

Welcome! New Members

10 Member News 11

Affiliated Member News

12 Campus Checkup

FEATURES 14 Student Member Profile 16 Member Profile 17 Legislative Profiles 19 Pharmacy Spotlight

ASSOCIATION NEWS 20 PPCN Update 21 PPCN Annual Report 25 2019 PPA Graduating Students 26 Pennsylvania Pharmacy Legislative Day 29 APhA Update

INDUSTRY NEWS 30 Pharmacy and the Law: Partial Fills 31 Financial Forum: Traditional vs.

Roth IRAs

RESEARCH 33 Professional Development for the Practicing Pharmacist: Developing a Research Question www.papharmacists.com 3

President’s Message We are each given the gift of 365 days in a year, and in some special years, we are given 366. I am certain you will all agree with me that those 365 days often seem to go by in the blink of an eye. In my mind, the past 365 days have graced me with the title of President of Pennsylvania Pharmacists Association, and I will forever be thankful for this honor.

As we move forward to our next President, I want to thank Immediate Past-President Nick Leon for his support and advice, send along my best wishes to incoming President Rick Demers, and thank CEO Pat Epple for her guidance and leadership. The staff at PPA has been nothing short of wonderful, and my friend Donna Hazel has left her impression on me by getting me involved with PPA many moons ago. Past Presidents Eric Esterbrook, Eric Pusey, and many, many more have also provided their support over the years, for which I am very grateful.

I also want to thank my two wonderful children, Kealie & Layne, my mother Marlene, and my boyfriend, Mike. Without their love and support this past year, I never would have been able to fulfill my duties.

As we progress to a new President, a new Board of Directors, and hopefully some legislative wins to advance pharmacy in our Commonwealth of Pennsylvania, let’s take a minute to reflect how we utilize those 365 that we receive every year. While a lot of that time is spent working, there is also a significant amount of time spent with family and friends. In those remaining extra minutes or hours that come your way, have you spent even a small part of that time giving back to your profession? “Time is what we want most, but what we use worst.” — William Penn.

Our 2019 Annual Conference will be held this year at Seven Springs Resort in Champion, Pennsylvania, not far from my hometown of Pittsburgh. Join us for our Achieving Independence Competition, diverse and educational CEs, and our Leadership & Awards Dinner. It is an amazing weekend that pulls pharmacy together and provides professional and personal accomplishments.

If you haven’t yet done so, I encourage all of you to visit our website, www.papharmacists.com. Here you can find information on our Board of Directors, conferences, available continuing education, and our advocacy efforts. Take the time to navigate through and utilize PPA to better yourself and your pharmacy.

Lastly, as we move forward and continue 2019 and move into 2020, I encourage all of you to take a few minutes to reflect on your goals and your accomplishments this past year. We have all positively impacted our patients, our families, and our communities, and we should all congratulate ourselves for these accomplishments. Also take a few minutes to reflect, what all can get done in any given year? Can you attend a conference? Legislative Day? Write and visit your local representative? Think about the gift of time and how you can be a better pharmacist throughout all 365 days!

Lauren Simko, PharmD PPA President 2018–2019

“I encourage all of you to take a few minutes to reflect on your goals and your accomplishments this past year. We have all positively impacted our patients, our families, and our communities, and we should all congratulate ourselves for these accomplishments.”

— Lauren Simko

www.papharmacists.com 5

Calendar of Events

Advertisers Index 2

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May 16–18

Pharmacists Mutual

National Association of Boards of Pharmacy — Minneapolis, MN

22

CE Webinar: Branching Out: Recent ACIP Immunization Recommendations and Adjuvanted Vaccines — 12PM

PRS

4

6

Smith Drug Company EPIC

10

Jefferson College of Pharmacy Value Drug Company

June

8 13

15

18 AmerisourceBergen 28 R.J. Hedges 32 McKesson 34 IPBG 35 RDC Back Cover S&L Solutions LLC

20–21

PPCN Planning Session – Harrisburg, PA

21–22

Value Merchandise Expo — Altoona, PA

26

CE Webinar: Fighting the Good Fight: How to Convert Opioids Just Right! — 12PM

July 11

CE Webinar: The Art of War: Strategies to Control Pain in the Older Adult — 12PM

8&9

PPA, PPAEF, and affiliated counties Leadership Retreat — State College, PA

13–17

American Association of Colleges of Pharmacy — Chicago, IL

August

12

CE Webinar: The (Hopefully) Bloodless Battle for Safe Use of DOACs — 9:30AM

September 19–22

2019 Annual Conference — Seven Springs, PA For additional events including webinars, CE opportunities, and PPA committee meetings, be sure to see our Calendar of Events on the PPA website!

FOLLOW US ON SOCIAL MEDIA @PAPHARMACISTS

For 100 volumes The Pennsylvania Pharmacist has been a resource for practicing pharmacists across Pennsylvania. As an editorial board we aim to continue this tradition over the next 100 issues. In that spirit, beginning with this, the 100th volume we are beginning a series of professional development articles written by the editorial board and PPA members. It is our sincere hope that these articles will be a go-to reference for students and practitioners alike.”

— Michael Gionfriddo, PharmD, PhD Assistant Professor, Center for Pharmacy Innovation and Outcomes, Geisinger Editorial Review Board Member www.papharmacists.com 7

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Welcome! New Members PPA Welcomes the following New Members who joined the association on February 1, 2019– March 29, 2019. Please make these new members feel welcome and part of Pennsylvania pharmacy!

Nathan Lieb, Hastings

Jibin Johnykutty, Philadelphia

Paul Ament, Latrobe, Excela Health

Appalachian College of Pharmacy

Vivian Munakwa-Njah, Erie

Halil Kasimoglu, Warminster

Amanda Benninger, Mars, Highmark

Lindsey Ratliff, Hershey

Minh Nguyen, Erie

Steven Lee, Philadelphia

Jasmine Oro, Erie

Long Lieu, Philadelphia

Lama Ozeir, Erie

Chandni Malani, Hatboro

Aaron Green, Derry

Hang Pham, Reading

Maliha Malik, Glenolden

Alexa Haddon, West Middlesex

Theron Richardson, Erie

Ngoc Nguyen, Philadelphia

Kendall Haney, Leonardtown, MD

Yousif Shamoon, Erie

Jamie Nguyen, Philadelphia

Nathan Lowery, Port Allegany

Angela Song, Erie

lien nguyen, Philadelphia

Lauren Phoenix, Allison Park

Whitnie Sullivan, Erie

Khue Nguyen, Philadelphia

Rachel Roper, Johnstown

Augustine Tafor, Erie

Varshita Parmar, Philadelphia

Zacheus Stager, Bellefonte

Noah Vasil, Erie

Deep Patel, Chalfont

Isabel Tonti, Pittsburgh

Gaoseng Yang, Erie

Brandon Pham, Philadelphia

Heather Winter, Morgantown, WV

Lipscomb University School of Pharmacy

PHARMACISTS

Sarah Ferry Deborah Hauser, Lewisberry, Rite Aid Jaymie Lako, Denver, Gateway Health Trisha McIntyre, Waterford, Rite Aid Melinda Moran, Pittsburgh, UPMC Western Psychiatric Hospital David Morcos, Orefield, PerformRx Jessica Nichols James Parmiter, Bensalem, PerformRx Binal Patel, Avondale, PerformRx Sweta Patel, Hospital of the University of Pennsylvania —Perelman Roman Reznick, Feasterville, PerformRx Carrie Rosnick Pamela Rutter, Gibsonia, Varian Medical Systems Margaret Shepherd, Cinnaminson, NJ, PerformRx Christine Sosa, Lyndhurst, NJ, CVS Alyssa Stewart, Latrobe, Walmart Pharmacy Om Talreja, Rego Park, NY, Allegheny General Hospital Devon Trumbower, Garnet Valley, PerformRx Calla Vodoor, Philadelphia, PerformRx

ASSOCIATES Jeffrey Gutkind, Doylestown, Temptime Corporation

TECHNICIANS Dawnna Sileo, Archbald, Penn Foster Career School

STUDENTS

Duquesne University School of Pharmacy

Jefferson College of Pharmacy

Steven Pham, Philadelphia Samuel Saitie, Upper Darby

Brian Dugan, Canonsburg

Natalie Tambon, Norwood

MCPHS University — Boston

Jessica Tran, Philadelphia

Billy Spear, Hazleton

Ahreum Yoo, Philadelphia

Temple University School of Pharmacy

University of Cincinnati School of Pharmacy

Nour Aboushaar, Cedar Grove, NJ

William Steele, Oakdale

Daniel Afari, Humble, TX

David Adewunmi, Bowie, MD

Marwah Alfatlawi, Erie

Neelesh Agarwal, North Potomac, MD

University of Maryland School of Pharmacy

Oyi Amasiani, Erie

Sarina Ahmed, Upper Darby

Lois Anti, Erie

Abdullah Ajibade, Philadelphia

Rania Bashi, Erie

Junine Aristilde, Jamaica, NY

Emily Bauman, Erie

Jaswitha Basu, Philadelphia

Selena Bouapha, Erie

Michael Belperio, Philadelphia

Reide Cooper, Erie

Julia Bold, Bethlehem

Tuan Doan, Erie

Timothy Choi, Marlton, NJ

Francis Essel, Erie

Brady Cotler, Philadelphia

Getty Eyong, Erie

Nour Elsayed, Drexel Hill

Taghrid Hassoun, Erie

Jasvir Gill, Florence, NJ

Philadelphia College of Pharmacy

Emily Humes, Erie

Justin Gronauer, Mullica Hill, NJ

Christopher Cardace, Philadelphia

Gloria Jones, Fallston, MD

Endonita Hajzeraj, Whitehall

Wiktor Pac, Philadelphia

Stephen Kazmer, Erie

Miranda Holt, Oreland

Khoa Pham, Hummelstown

Kiana King, Erie

Gwang-Wen Hu, Philadelphia

Elizabeth Sauers, Holland

Sun Kyung Kwon, Erie

Lisa Huang, Philadelphia

Roy Kim, Philadelphia Monica Woloshin, Yardley LECOM School of Pharmacy Aisha Acha, Erie Oluwafunmilayo Adeyinka, Randallstown, MD

Have you updated your profile lately?

Taylor Kaminsky, Baltimore, MD University of Pittsburgh School of Pharmacy Juan Cervantes, Carnegie Jennifer Dolphin, Wallingford Sneha Gaitonde, Pittsburgh Helen Hill, Pittsburgh Shawn Meehl, Erie Nicholas Sturniolo, Pittsburgh

PPA wants to make sure you are receiving the latest news concerning CE’s, Advocacy, and the latest industry trends. Please take the time to update your mailing address, email, place of employment and any other information that as changed. Don’t remember how to login? Call Victoria, Membership and Marketing Coordinator @ 717-234-6151 Ext. 5.

www.papharmacists.com 9

Member News In Memoriam Congratulations to Suzanne Higginbotham and Janet Astle!

Dr. Suzanne Higginbotham and Dr. Janet Astle recently received a $97,500 grant from the AmerisourceBergen Foundation to support the implementation of a Substance Use Disorder Certificate Program aimed to train working professionals and students in the health sciences, medicine, public administration, biological sciences, social work, sociology, and other related disciplines in advanced knowledge in substance use disorders, treatment modalities and care coordination.

10 Pennsylvania Pharmacist — May/Jun 2019

PPA was saddened to hear of the passing of member

John P. Forlenza owner of Forlenza’s Pharmacy of Luzerne County.

Our thoughts are with his family, friends and colleagues.

Pharmacy Memorabilia For Sale Do you collect pharmacy memorabilia?

Ralph Progar of Gibsonia, is moving and has some items to sell. If interested in receiving a list call 1-412-860-5458.

SHARE YOUR NEWS WITH US Share your news with us — send all snippets of achievements and honor to PPA’s Membership and Marketing Coordinator — Victoria Madonna at vmadonna@papharmacists.com

Affiliated Member News BMPA Winter Meeting The BucksMont Pharmacists necessary to start over again, Association held its 2019 winter should the delay between doses exceed 6 months. In meeting at the Buck hotel in clinical trials, Shingrix® was Feasterville, PA on March 7 and shown to be 91% effective was attended by approximately in patients ≥ 70 years, a 25 BMPA members and population known to have a guests. We would like to decreased immune function. thank GlaxoSmithKline Other representatives from pharmaceuticals for GSK were also present and sponsoring our meeting and were very helpful in answering presenting: “An Educational the numerous questions from Overview of Shingrix.” Tom the audience.

Dumas, PharmD, a medical science liaison with GSK After the GSK presentation, Vaccines delivered an BMPA president Steve Pfeiffer interesting and informative led an open business meeting. presentation. Dr. Dumas A major topic of discussion explained that the primary was devoted to developing reason for the shortage of this new approaches to attract new vaccine is that healthcare new members. Several good professionals are vaccinating ideas were raised and will be at a rate many times that of discussed further. We also prior years. There is also very discussed ways to increase high demand based on ACIP the number of applicants for BMPA event manager Ashley Robold with President Steve recommendations. In an effort Pfeiffer our annual scholarship by to increase the manufacture improving our communications of new batches, GSK has with local pharmacy schools. purchased a manufacturing facility in France that will All were encouraged to attend Legislative day on April be devoted to manufacturing vaccine exclusively for 9 and social event with a full 1.0 hour CE program on the USA. Dr. Dumas also indicated, according to the Narcan/Opioids. The date and location of this contact CDC, that for those patients who received the first their local legislators if unable to attend. Finally, BMPA dose and are still waiting for the second, it will not be is planning to sponsor a spring event will follow.

LCPA Update In February, LCPA met at Gibraltar located in Lancaster for a presentation provided by Teva Pharmaceuticals on the complex process of manufacturing and obtaining FDA approvals for biosimilar medications. The presentation also touched on the differences between the number of biosimilars used in the US vs the EU. Pharmacists can expect to see the use of biosimilars increase over the next few years.

March’s presentation was also provided by Teva Pharmaceuticals on their new product for migraine headaches, Ajovy. Neurologist Dr. D. Gary Kolva

discussed the patient group most likely to benefit from this new therapy as well as the mechanism of action and pathophysiology of migraine headaches. Teva representative Roy McMullen discussed insurance coverage and the patient copay cards available through Teva.

We will continue to have events through the month of May and then take a break for the summer. Regular meetings will resume in September. Please continue to visit our website for upcoming events at www. lancasterpharmacists.com.

www.papharmacists.com 11

Campus Checkup LECOM School of Pharmacy Contributed by: Maria Peluso, Communication Ambassador A lot has been happening here at LECOM Erie!

Throughout the past couple of months, we have hosted a number of Script Your Future events including the health fair we had with APhA at the Erie Bayhawks basketball game on February 23rd. We also had two health fairs with Rite Aid Pharmacies in Erie on March 2nd and 6th.

We were able to educate the public on chronic health conditions such as heart health and diabetes. Our members who volunteered were happy to be a part of an important effort to promote health in the community. At the Mid-Year conference in January, LECOM competed and won second place at the OTC competition, which was a huge achievement for us and we were glad to have been a part of it. To round off the academic school year, we are beginning to elect new members into office. We are excited for what PPA at LECOM Erie has in store for the next school year!

Ohio Northern University Raabe College of Pharmacy Contributed by: Morgan Augustine, Communication Ambassador The PPA chapter at Ohio Northern University is getting ready to have a meeting to show our P2 members how to apply for their pharmacy intern license as well as a general meeting before spring semester comes to a close. We just got back from spring break last week and only have about a month and half left in the semester.

Our government relations ambassador continues to give updates on Pennsylvania legislation as well as promoting GRASP. We as a chapter at Ohio Northern University will also be doing elections to get new officers soon for the coming fall semester.

Philadelphia College of Pharmacy Contributed by: Kayla Askey, Communication Ambassador For the Philadelphia College of Pharmacy student PPA chapter, 2018–2019 was another very successful school year. From our programs engaging the West Philadelphia community to our advocacy efforts with our on-campus GRASP events, we were very busy. In April, we sent many members and students to Harrisburg to advocate at Legislative Day. A number of students came 12 Pennsylvania Pharmacist — May/Jun 2019

out to promote pharmacy through policy educational engagement with their state representatives. Our Philadelphia College of Pharmacy student chapter offered blood glucose screenings to representatives and staff at the capitol. Students were able to advocate for their profession while having fun. Now that this busy semester has come to an end, we would like to thank all of our members and students who came out to our events. We could not have been successful without you! We look forward to another great semester next year. Finally, the Philadelphia College of Pharmacy student PPA chapter would like to congratulate all the graduating students. We wish you the best of luck in your future endeavors!

University of Pittsburgh School of Pharmacy Contributed by: Emily Dell, Communication Ambassador We have finally made it to the end of the school year! Students from the Pitt Chapter of PPA recently attended Legislative Day at the beginning of April, one of the biggest events for our organization. We were excited to take a large number of students from the P2 class and students from other classes to Harrisburg on Tuesday, April 9th. Students from Pitt met with legislators from their home towns. It is our hope that Pitt students enjoyed this trip, saw the impact we can have on the pharmacy profession and are thinking about becoming more involved with PPA in the future.

We are looking forward to having some volunteering opportunities in the future with the Allegheny County Pharmacists Association (ACPA). This group works with different organizations in the Pittsburgh area to hold volunteering events at the Greater Pittsburgh Community Food Bank and at Global Links, a medical relief and development organization dedicated to supporting health improvement initiatives.

The Pitt Chapter of PPA went to the Boys and Girls Club in Shadyside in Pittsburgh, PA to work with children from the area to educate them about healthy food choices and medication safety as a part of our Katy’s Kids program. The kids were challenged to tell the difference between pseudoephedrine tablets and Red Hot candies, enforcing the importance of being safe with medications. Within this experience, we were also teaching them about what pharmacists do and the importance of what we do. We are proud of everything that students from Pitt have been doing, and we look forward to continuing our efforts over the summer and into the next school.

Mirna Rezkalla Student Pharmacist Class of 2019

Jefferson College of Pharmacy “Jefferson College of Pharmacy (JCP) students prepare to become healthcare team players

through education and activities, such as the Health Mentors Program, where students learn firsthand from a patient about things that really matter to patients living with chronic health conditions.

”

Advantages of being a Jefferson pharmacy student include: • Interprofessional learning at the beginning and throughout the curriculum • Interaction with practicing pharmacists of Jefferson Health to maximize learning and skill development • JCP is a recognized leader in the provision of interprofessional education (IPE) Entering pharmacy students identify the focus on IPE as a strong reason to select Jefferson.

100 percent of JCP 2018 graduates passed the North American Pharmacist Licensure Exam (NAPLEX) on their first attempt. The national average for the first time takers was 89 percent.

Learn more at Jefferson.edu/PharmDOutcomes.

Student Member Profiles the answer because that is how you will learn best.

advocate for pharmacy and advance our profession.

With the different confer­ ences and meetings that PPA holds throughout the year, membership also offers valuable networking opportunities to get to know others within the profession.

Jeffrey Ward Greensburg, PA 2019 PharmD Candidate, Duquesne University School of Pharmacy How did you hear about PPA? I heard about PPA through some of their meetings that have been held at Duquesne as well as from friends who are PPA members.

Favorite drug name to pronounce Eszopiclone Flashback to your first year of pharmacy school; what advice would you give yourself knowing what you know now?

Stay on top of studying and schoolwork because once you fall behind, it’s difficult to catch back up.

Have any professors influenced you since you have started down this career path?

Most of my professors at Duquesne have been influential as I have been preparing to become a licensed pharmacist.

Professors who make learning enjoyable and engaging, such as Dr. Nemecek, Dr. Wolfgang, and Dr. Zimmerman, have especially influenced me to become a pharmacist who truly cares for the patients I’ll see.

Where do you think you’ll be in five years?

In five years, I plan on practicing as a licensed pharmacist helping as many patients as possible live better lives.

Favorite food you have eaten on campus?

Chick Fil-A.

Why did you choose to become involved in PPA? I wanted to become involved with PPA to incorporate myself more in professional organizations.

As a student pharmacist in Pennsylvania, I see PPA as a great network of pharmacists, students, and pharmacy technicians to 14 Pennsylvania Pharmacist — May/Jun 2019

Why did you choose to become involved in PPA?

Heather Winter Patton, Pennsylvania 2019 PharmD Candidate, Duquesne University School of Pharmacy How did you hear about PPA? The first time that I heard about PPA was through the student PPA group at Duquesne. They advertised for meetings and fundraisers frequently.

Favorite drug name to pronounce Ocrevus (ocrelizumab) Flashback to your first year of pharmacy school; what advice would you give yourself knowing what you know now?

I would forewarn myself that it is going to get worse before it gets better, to embrace the topics that you are the least comfortable with, and to not be scared to not know

PPA provides a lot of opportunities for students and pharmacists to get involved in professional progression. Additionally, I chose to do an APPE rotation with PPA allowing me to get more experience with the amazing organization.

Have any professors influenced you since you have starting down this career path?

I am thankful to have such great professors and mentors, although they weren’t always so supportive of my choice to pursue pharmaceutical industry.

Where do you think you’ll be in five years?

I hope that in five years my pharmaceutical fellowship has lead me to the beginning of an enjoyable, rewarding, and successful career.

Favorite food you have eaten on campus?

All of the mac & cheeses at the Red Ring Bar and Grille are absolutely amazing!

If you, someone you know or a pharmacy would like to be featured in a future issue of the magazine, please contact Victoria Madonna, Membership and Marketing Coordinator at vmadonna@papharmacists.com

Member Profile finding new ones to get excited about! I’ve learned more about different pharmacy practices from our statewide experts, and I’ve gotten to be part of some committees that have pushed me to learn more and more. I love being part of the PPCN &b CMMC, the PPA Education Committee, and the Marijuana Task Force. Each of these has made me a better pharmacist.

Name the number one reason why you became a pharmacist?

Rebecca Miller Wise

I wanted to be in health care but I wanted to teach. Pharmacy is the perfect mash-up of those because every pharmacist teaches — their patients, other practitioners, students, etc. about health and wellness. It’s the perfect career.

Clinical Administrator and Pharmacy Services Specialist; Associate Professor and Director of Admissions LECOM School of Pharmacy

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

Is there anyone in your professional career that helped shape you into the Pharmacist you are today?

Absolutely. There were two people who I admired the most and made me who I am as a pharmacist today: Mr. Michael Allgeier from Waterford Pharmacy in Waterford, PA. I interned and then worked for him after I got my license. He is the classic small-town pharmacist. He knows everyone’s name and their families, and really cares for each person in the town as an individual. Secondly was one of my professors in pharmacy

I’d tell him that being nervous is natural, but you know more than you think — trust yourself. This is what you’ve worked toward all these years — enjoy this day because you’ll remember it forever!

How has becoming a member of PPA made you grow professionally?

So many ways! When I joined PPA, I didn’t know all the opportunities I’d be afforded, and now I’m still

CE WEBINAR

school who is now a colleague — Dr. Janene Madras. She showed me the importance of treating each patient as a unique case while also adhering to evidence based treatments and guidelines. She showed me the value of the pharmacist as the place where science and care intersect.

Out of anywhere in the world, if you had to choose a different place to live and practice pharmacy where would it be and why?

I would not want to be anywhere else.

I love NW PA and all it has to offer.

I live and work 30 minutes from the beach and 30 minutes from the ski slopes. I work with the most dedicated team of people I’ve ever known, and I have the support of an administration that values me for my individual strengths. My patients trust me and are loyal to me, which is the best a pharmacist can ask for. No, I’d never want to be anywhere different. I am in my own version of paradise.

Best thing you ever ate?

This made me laugh because I wasn’t expecting this question! I was visiting San Francisco and went to a restaurant recommended to me by the LECOM School of Pharmacy Dean, Dr. Hershey Bell, called Scoma’s. It is down on the wharf with a pretty spectacular view of The Bay. I had the best scallops ever!

Fighting the Good Fight: How to Convert Opioids Just Right!

July 11, 2019 • 12 PM • 1 Contact Hour Presented by: Tanya J. Uritsky, PharmD, BCPS, CPE Clinical Pharmacy Specialist Pain Medication Stewardship, Hospital of the University of Pennsylvania In this interactive case-based session, the audience will learn the intricacies of converting between different opioids, including between routes and different agents. Considerations about agent selection, dosing, as well as nuances of clinical practice will be discussed. Case-based learning will be used to illustrate conversion concepts and will offer many opportunities to practice!

16 Pennsylvania Pharmacist — May/Jun 2019

Legislative Profiles Rep. Seth Grove What are the key issues you would like to see addressed this session (2019–2020)?

a relationship with your elected officials, you can help them understand the importance of pharmacology and ensure that it is an issue that comes across their desk, and that they are comfortable asking you about the effect on your profession.

I have been appointed the Chairman of the new House Government Oversight Committee. My first priority this session is to get this committee operational.

Creating a new committee, especially one which sole function is investigations of the executive branch, is a daunting task. While this work is being done, I plan on being legislatively active on many fronts from working on reducing the skills gap to integrating physical health and behavioral health under Medicaid, I will also be focusing on bringing more transparency and oversight to PBM’s in the Commonwealth. We have tremendous bipartisan tailwind in the legislature right now to do some really good work on this front and much of it deserves credit to the PA Pharmacists for advocating and talking with their elected leaders about the struggles you are facing! Another bill I am morning on is to expand the different immunizations pharmacists can administer to children in order to increase immunization rates.

What do you do for relaxation or enjoyment?

Tell our members a little about your back ground and why you are legislator?

The budget currently on the table is a hide-andseek approach with a lot of shifting that is not easy to understand for lawmakers, let alone taxpayers. I’m working on bringing more accountability to taxpayer dollars collected in Harrisburg so everyone can understand how their money is spent.

I am in my 6th term as a State Representative and am married to a Duquesne University Pharmacy School graduate, who is a retail pharmacist. We have three children, two boys and a precious, warrior-queen (if you can’t tell she has dad wrapped around her finger).

I became a legislator because I saw a need for policy leadership and the need to drive a positive-pro growth economic agenda in Harrisburg. I am not a fan of the status quo and have also taken on tough issues.

How do you see pharmacy and its role in health care evolving in the future?

Pharmacists are the front line in the health care industry.

They have more interactions with patients on a regular basis than any other medical practitioner. Pharmacists role in health care will continue to expand, especially around service delivery and prescription monitoring.

Advice for pharmacists about the political process?

Simply build a relationship with your elected leaders. They don’t know what they don’t know, and many may not understand what pharmacists do on a daily basis or what a pharmacist’s role is in the health care industry. By building

I have two very athletic boys, so I spend many enjoyable hours taking them between games and practices. We also enjoy fishing and legendary Nerf gun battles.

Sen. Kristen Phillips-Hill What are the key issues you would like to see addressed this session (2019-2020)?

Several issues, including much needed school property tax relief, improving access to high-speed internet in underserved areas, removing unnecessary regulations and burdens on businesses and local governmental entities, including school districts, and workforce development rise to the top.

Tell our members a little about your back ground and why you are legislator?

My passion started with education issues. I originally served on the school board and owned a small business. As a school director, I saw the challenges and opportunities to be a good fiscal steward of taxpayer dollars while at the same time, ensuring a strong, quality public education system for students. I ran for the state House in 2014 and after two terms, I ran for the state Senate in 2018. I believe in leading by example, which is why I do not accept the legislative health care plan nor do I accept the public pension offered to lawmakers.

How do you see pharmacy and its role in health care evolving in the future?

Pharmacies are a critical access point for patients all across the commonwealth. With much of our state’s Medicaid Continued on next page www.papharmacists.com 17

Legislative Profiles continued budget paying for prescription care for many Pennsylvanians, especially our seniors, pharmacists can be a vocal advocate in how we can best serve our population while looking out for taxpayer dollars. I’m looking at reforms that would allow pharmacists to steer patients to less expensive medication alternatives, but because of archaic agreements with pharmacy benefit managers, they cannot.

I also think pharmacists can and should be the eyes and ears in the opioid epidemic battle.

Advice for pharmacists about the political process?

The legislative process can be very daunting, but it really starts with a conversation and a relationship with your local senator and representative. The conversation is important to keep us up-to-speed on what is happening in your respective industry. We rely on the input of local residents, and that includes pharmacists. Send an email, call the local office, or request a meeting with the senator. Meetings in the local office with constituents are very rewarding and

18 Pennsylvania Pharmacist — May/Jun 2019

educational for me. We are most effective when we are educated on the respective issues.

What do you do for relaxation or enjoyment?

I enjoy reading, genealogy research and kayaking in beautiful York County. My husband and I are “foodies” so we enjoy looking for great places to eat or try something new.

Before elected office, I was involved in the antiques market, so I enjoy antiquing and finding “hidden treasures.”

But most of all, I thoroughly enjoy serving in elected office.

It’s incredibly challenging but also very rewarding.

However, I would say the greatest enjoyment is taking a local resident’s concern or problem and resolving that issue through a new state law, or working through the bureaucracy to help resolve their concern.

Pharmacy Spotlight Community Pharmacy By: Jeffrey Ward, Doctor of Pharmacy Candidate 2019, Duquesne University School of Pharmacy This article was contributed while Jeff was on rotation with PPA.

Small enough to know you, large enough to fulfill your pharmacy needs.

Community Pharmacy also offers additional services ranging beyond diabetes prevention/care. These clinical services include Medication Therapy Management and This is how Rebecca Swintek, Director of Clinical Services Immunizations. They have also partnered with their local for Community Pharmacy, describes the independent hospital, Tyrone Regional Health Network, to provide pharmacy working to improve patient care in Tyrone, collaborative care to patients in the community. This Pennsylvania. Rebecca was destined for a career in collaboration allows Community Pharmacy to assist in pharmacy from a young age due to the fact that her dad providing wellness visits, chronic care management, was a pharmacist for transition of care Kopp Drug. “I loved services, and bedside how he would interact delivery. Not only with patients and does providing these providers and always services result in felt that would be better patient care for where I ended up.” the community; it also While she grew up helps the pharmacy around community remain profitable with pharmacy, Swintek the ever-reducing was torn between reimbursement inpatient clinical rates associated pharmacy and with dispensing community pharmacy medications in upon graduating an independent from the University pharmacy. Swintek of Pittsburgh School explains, “We are of Pharmacy in 2012. willing to make the As the first pharmacy investment of time resident at UPMC and money to further “Pharmacists have the education and the opportunity to provide McKeesport, she our pharmacy and completed her our profession.” As direct patient care and be paid for those services.”

PGY1 residency and such, Community — Rebecca Swintek began working as an Pharmacy sees inpatient clinical pharmacist. five years later, she joined Bill patients four days per week, eight hours per day for their Faust, co-owner of Community Pharmacy, and became the Medicare annual wellness visits. The pharmacy also offers a pharmacy’s Director of Clinical Services.

CCM program where they call patients on a monthly basis to work on health goals as well as the barriers they may face “Pharmacy is clearly moving from the dispensing model in reaching these goals. Swintek believes that both of these and transitioning to providing patient care,” Swintek clinical initiatives have been very rewarding in helping explains. As such, she joined a pharmacy with a dedicated patients. From her experiences thus far, she sees the focus on direct patient care, something not commonly profession moving in a direction in which more pharmacists seen in the everyday retail pharmacy. In addition to will be able to fill gaps in care, explaining “pharmacists dispensing medications, Community Pharmacy provides have the education and the opportunity to provide direct a large array of clinical services as well as compounding patient care and be paid for those services”. services. One key focus of the pharmacy is on diabetes care. Community Pharmacy is accredited to provide Diabetes Self-Management Education through AADE and is currently going through the accreditation process for the CDC’s Diabetes Prevention Program. As a DPP Group Lifestyle Balance coach through the University of Pittsburgh, Swintek has seen vast successes to the point where the CDC is featuring Community Pharmacy in a National DPP marketing campaign to capture the success and passion associated with the program’s implementation in Tyrone, Pennsylvania.

While there seem to be more and more challenges to sustaining as a successful independent pharmacy, Rebecca Swintek and Community Pharmacy have addressed patient care in ways that extend far beyond what is typically seen in a community pharmacy. This practice environment allows Swintek to practice how she wants to practice and work with other professionals who share in her same vision of pharmacy.

www.papharmacists.com 19

PPCN Update PPCN Pharmacists Demonstrate Their Value After six months of an active contract with a Pennsylvania Medicaid MCO, PPCN pharmacists engaged over 1,600 patients in comprehensive medication management- and were paid to do so! Our network pharmacists have demonstrated their ability to improve adherence to chronic medication, assist patients in quitting smoking, transition patients from opioids to more effective and safer pain management alternatives, and connect patients to health plan resources to meet their nonmedication related needs. Care management teams from multiple health plans are using our PPCN Pharmacy Finder to refer patients to the valuable services that network pharmacies offer! Want to find a PPCN Pharmacy? Check out our Pharmacy Finder here: www. papharmacists.com/locate

Payer Engagement The PPCN leadership team and luminaries are actively and frequently meeting with a variety of payers and stakeholders to foster synergistic partnerships to improve health care outcomes and provide opportunities for our network pharmacies to expand their business. A growing body of evidence nationwide shows that when community pharmacists provide local care with a focus on outcomes, the cost of care is reduced.

Despite this, payers and stakeholders in PA want to see what OUR local pharmacists are capable of. Thanks to the pharmacy engagement in a payer contract that we have with a Medicaid MCO, we are able to share the impact of care that our pharmacists have had on health plan members. Care provision is grounded in the standardized approach of the Pharmacist’s Patient Care Process, but individualized to meet the needs of each patient, in his or her local community. Documentation of care 20 Pennsylvania Pharmacist — May/Jun 2019

provided is absolutely critical- “if you didn’t document it, it didn’t happen” and our partnership with STRAND Clinical Technologies has allowed us to evaluate the positive impact our pharmacists are having on their patients. Stay tuned for more developments!

they serve. Want to learn more?

Reach out to Stephanie McGrath, PharmD, Executive Director of Network Operations at smcgrath@ papharmacists.com. Want to hear it from a colleague? Reach out and we will connect with one of our talented and innovative luminaries!

Does Your Pharmacy Have What it Takes?

If you would like to learn more about PPCN, visit http:// papharmacistsnetwork.com/ or email PPCN Executive Director of Network Operations Stephanie McGrath, PharmD at smcgrath@papharmacists. com. Follow us on Twitter @ PPCN_CPESN and Instagram papharmacistsnetwork

PPCN is actively recruiting pharmacies who provide individualized, high quality care to patients in their communities.

Pharmacies must be able to meet minimum requirements and have the ability to transmit an eCare plan as documentation on patients

FOLLOW PPCN ON SOCIAL MEDIA! PPCN launched the #ShareYourCare campaign to highlight the great care that PPCN pharmacists are providing in their communities. PPCN is on Twitter and Instagram! Follow us on Twitter @PPCN_CPESN and Instagram papharmacistsnetwork to hear about the great work of our pharmacists!

Save the Date

2019 Annual Conference September 19-22, 2019 Seven Springs Mountain Resort Seven Springs, PA

Congratulations to the 2019 PPA Graduating Students!

PPA wishes the 2019 PPA graduating students all of the best as they embark on their pharmacy careers! Remember to remain a committed member of our state pharmacy association, no matter where you reside! For those staying in Pennsylvania, we invite and encourage you to update your membership as a New Practitioner! This can be done online or by contacting Victoria Madonna, vmadonna@papharmacists.com.

Duquesne University School of Pharmacy Taylor Akers Rachel Anderson Adrian Carella Jamie Celento Patrick Creisher Kayla Dunhoff Kelsey Dutka Olivia Erickson Erin Grover Thomas Handerhan Irene Jankowski Kathryn Kerr Johnathan Kloss Benjamin Lackner Valerie Magda Nisha Mallya Stephanie Matesic Kelly Mazzei Nicole Mirguet Maddison Morrell Cheyanne Novich Patrick Ollinger Lauren Phoenix Christianna Riley Rachel Roper Brandon Ross William Roth Danielle Taciuch Tyler Thomas Alexis Treaster Jeffrey Ward Heather Winter Jennifer Yannuzzi Jefferson College of Pharmacy Brooke Barlow Ashley Barlow Brianna Brown Pallavi Chary Denise Fournier Hannah Kafisheh Dustin Lee Ustina Mikhiel Patrick Pauls Nancy Tang Umut Turkdogan Andres Varilias Rebecca Warrington LECOM School of Pharmacy Michael Coulter Joseph Cristello

Jordan Frederick Shannon Haberman Jessica Lipp Christina Schuler Emma Wysocki Lipscomb University Brian Dugan Notre Dame Of Maryland University Robert Gootz Ohio Northern University Raabe School of Pharmacy Nicholas Bileck Samantha Blake Danielle Johnson Alexandria Lacombe Joseph Muscarella Temple University School of Pharmacy Adeline Cruz Carly Harsha Soon Kwon Jojo Baidn Ali Shahbaz Sara Groome Phu Tran Besar Elezi Jefin George Arjun Chauhan University of Charleston Jessica Ferris University of Cinncinnati William Steele University of Pittsburgh School of Pharmacy Olivia Berger Kaitlyn Burkett Meghan Cahalane Kristel Chatellier Amanda Colangelo Sophia Cothrel Abigail Elmes Madison Freehling Carly Gabriel Alexis Giles Barbara Grden Andrea Groves Kelsey Hake

Katherine Halza Hannah Hoseyni Sarah Hunt Kara Ioannou Ashley Kamp Victoria Lauver Kathryn Muzzio David Nesmith Layne Reihart Mikhaila Rice Amanda Schwenk Angela Sutt Megan Sybeldon Thomas Szeltner Michael Udovich Marissa Waterloo Lauren Xu Xinyan Ye Rui Zhang Sarah Zielinski Philadelphia College of Pharmacy Sean Ahern Simone Avratiner Nicole Ayers Brittany Bair Hannah Bittner Morgan Carroll Richie Chan Stephen Cho Reena Concepcion Andria Dang Branden Duong Bethina Escala Joseph Falbo Anika Fanlo John Farrell Jacob Gambo Angela Garipov Tommy Giang Rachel Hatch Michelina Hesse Eric Hsiao Daniel Huang Ashley Jackson Stephy Johnson Zoya Kakar Kathryn Kalman Geena Kludjian Celine Kuan Jeffrey Laov Jessica Lapczynski Ron Lodise

Vincent Louanphom Christopher Makosiej Pamela Marmur Rian Maurer Austin McCray Maureen McGarry Kelly Mitchell Matthew Moyer Ina Pajo Dhaval Patel Karan Patel Janki Patel Kim Peng Charissa Pham Natalie Rodriguez Samantha Scheib Brittany Serna Ami Shah Ada Shehu Brittany Souryavong Lauren Stabler Matthew Stathis Marc Storb Kasey Stragand Angela Teberio Jalpa Thaker Edgard Trott Jared Waxman Melissa Weingartner Wilkes University Nesbitt School of Pharmacy Nikko Bonavoglia Amanda Boyer Kendra Croker Cadean Daugherty Lorena DiGuiseppe Alexandra Fanucci Eileen Friery Brittany Gurreri Taylor Hodle Emily Kneeream Aaron Knopp Laura Misiewicz Abigail Nemeth Alex Ponce Leslie Shumlas Sierra Smith Abby Stevens Jacob Weaver Erika Zarfoss

www.papharmacists.com 25

Pennsylvania Pharmacy Legislative Day Your Health. Your Pharmacist.

On April 9, more than 330 pharmacists, pharmacy students, and pharmacy technicians from all across Pennsylvania converged on the Capitol in Harrisburg to advocate on behalf of the profession and show how vital pharmacists are to patient’s health. Attendees held over 150 meetings with legislators and staff, armed with the message to require transparency in PBM contracts in Medicaid and oppose cuts to pharmacy reimbursement in Medicaid programs. Additionally, pharmacists asked their legislators to support expanding pharmacistprovided immunization opportunities, medication synchronization, and pharmacy technician registration.

The day began with a continental breakfast in the East Wing of the Capitol that also included screenings, displays, and information provided by Pennsylvania’s schools of pharmacy.

Students offered guidance on overall wellness and better medication management while providing free health screenings to legislators, staffers, and the public:

• Wilkes University Nesbitt College of Pharmacy: Smoking Cessation In addition to meetings with legislators or staff, several special meetings were scheduled for small groups of attendees at the PPA office.

These informal meetings included presentations and discussions with: Leesa Allen, Deputy Secretary of the Department of Human Services, who spoke about the current status of the program, anticipated enhancements, and other initiatives.

Eugene DePasquale, Auditor General, who addressed our concerns with PBM business practices in Medicaid and questionable reimbursement practices.

Later in the day, attendees filled the grand staircase in the Main

• University of Pittsburgh School of Pharmacy: Medication Adherence and Immunizations

Rotunda for the “Your Health Your Pharmacist” rally and press conference. The rally was kicked off by Auditor General Eugene DePasquale, who had three main discussion topics in support of a bill package being introduced: First, he stated — if you believe we need to find out what’s happened to billions of your taxpayer dollars, then support this package. Second, competition at the retail level is a must to make sure that our community pharmacists can do their job in a way that their patients need. And third, the front line of health care is prescription drugs and the current system is pricing people out of being able to afford the medicines that they need.

This package of legislation will help that and keep our independent pharmacists in business.

• USciences/Philadelphia College of Pharmacy: Finger Sticks and Blood Glucose

The four chairmen of the Pennsyl­ vania Community Pharmacy Caucus were present to support

• Duquesne University School of Pharmacy: Carbon Monoxide and Body Composition Screenings • Jefferson University College of Pharmacy: Naloxone Administration and Overdose Management • LECOM School of Pharmacy: Hypertension Management • Temple University School of Pharmacy: Blood Pressure Screenings

26 Pennsylvania Pharmacist — May/Jun 2019

their community pharmacists.

Representative Rob Matzie had two very forceful words during the rally; “NO MORE!” He said that the community pharmacists are being squeezed out of business by the PBM’s and we say …”NO MORE!” Access to over billions of dollars to lower drug prices were given to the PBMs and instead they have abused that trust by overcharging taxpayers and driving community pharmacists out of business in order to fatten their bottom lines and we say …”NO MORE!” And lastly, that this is an issue about fairness to the patients and the taxpayers that have been ripped off and to that we say …”NO MORE!” Rep. Matzie made excellent points and had the crowd excited.

Senator Ward pointed out the hard work that PPA does on a daily basis so that pharmacists can deliver the best care possible to their patients.

Since pharmacists know their patients best and are on the front line of health care, we have to make sure that they are thriving. She went on to note that legislators recognize that without community pharmacists, their constituent’s health will suffer.

In less than eight hours, we made a huge impact in on legislators and staff.

PPA’s Legislative Day was a great success thanks to all of the students and pharmacists who participated.

PPA thanks everyone who took the time to travel to Harrisburg for Pennsylvania Pharmacy Legislative Day. We hope you will consider adding your voice to the more than 300 pharmacists and student pharmacists next year!

Continued on page 30

Duquesne University School of Pharmacy

LECOM School of Pharmacy

In less than eight hours, we made a huge impact in on legislators and staff.

PPA’s Legislative Day was a great success thanks to all of the students and pharmacists who participated.

Philadelphia College of Pharmacy

Temple University School of Pharmacy

Jefferson University College of Pharmacy

Wilkes University Nesbitt School of Pharmacy

Universitiy of Pittsburgh School of Pharmacy

Pennsylvania Pharmacy Legislative Day continued

PPA thanks everyone who took the time to travel to Harrisburg for Pennsyvlania Pharmacy Legislative Day. We hope you will consider adding your voice to the more than 300 pharmacists and student pharmacists next year!

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You need a partner that respects your independence and delivers solutions as unique as your pharmacy.

Call 610.727.7000 or email solutions@amerisourcebergen.com to see how we can build a plan that works for you—not the other way around.

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APhA Update Thank You to Our 2019 APhA Delegates!

A big thank you to Howard Cook, Richard Demers, Thomas Franko, Julie Gerhart-Rothholz, Daniel Hussar, Melissa Shiner and Melinda Williams who represented PPA at APhA in Settle at the House of Delegates this year.

Congratulations to George Downs APhA presented its Generation Rx Award of Excellence to George Downs, PharmD, of Philadelphia, PA. The award recognizes a pharmacist that has demonstrated a commitment to the mission of substance abuse education. Downs was selected in recognition of his sustained commitment and outstanding contributions to the mission of substance abuse education.

Pennsylvania Reception Approximately 250 pharmacists and students from Pennsylvania attended the Saturday evening Pennsylvania reception, where all seven schools of pharmacy and PPA joined in celebrating our alumni, pharmacy friends, and students from the Commonwealth! Plan to join us next year.

LECOM School of Pharmacy

Philadelphia College of Pharmacy

University of Pittsburgh School of Pharmacy

Wilkes University Nesbitt School of Pharmacy

Duquesne University School of Pharmacy

www.papharmacists.com 29

Pharmacy and the Law: Partial Fills

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

Partial filling of prescriptions has been going on for a long time in pharmacies. So long in fact that most pharmacists don’t think about the legalities of doing so. When you search for laws or regulations about partial filling, you get few results addressing partial filling for non-controlled substances. One of the few that is found is in West Virginia. 1 This code section allows the partial filling of any prescription if the pharmacy is unable to supply the entire amount or if the patient requests a lesser amount. Many states just don’t address partial filling for non-controlled substances in their laws or regulations.

At first glance, the issue of partially filling

Almost all states have a regulation regarding the partial filling of controlled substances, particularly Schedule II. Many of them are worded similarly to the DEA regulation on this subject.2 What is different about the DEA regulation is that it only allows partial filling in situations where the pharmacy is unable to supply the entire amount of the prescription. It doesn’t permit the patient to request a partial fill of a Schedule II substance. One of the unforeseen results of these regulations has been its potential contribution to the opioid crisis. In response to the crisis, Congress passed the Comprehensive Addiction and Recovery Act of 2016 (CARA).3 One of the many provisions of the law allows the patient or the prescriber to request a partial fill of a prescription for Schedule II controlled substances. Although the DEA hasn’t rewritten its regulations, the interpretation of the law has been that CARA supersedes the DEA regulations to allow the patient or the prescriber to request the partial fill.

On top of the treatment risks, there are also contractual issues. Partial filling may be addressed in your contracts with third party payers. These provisions may address when partial filling may occur, how it is to be documented, and how to charge for the prescription. Failure to follow the contractual requirements could result in an audit and recoupment of third party payments. It is especially important to follow the contractual requirements in cases of partial filling when the patient fails to pick up the remainder of the prescription. Failure to adjust billings in those cases could end up as cases of unjust enrichment or fraud.

For non-controlled substances, what is the legal status of partial filling in those states whose laws and regulations are silent on the issue? The answer depends on your view of how the law works. Some would say that there is nothing prohibiting it, so I can proceed to partially fill the prescription. The other view would say that there is nothing permitting it, so I can’t do it. Given the history of partial filling, I would agree with the former view. It is such an ingrained part of pharmacy practice, with little apparent risk to the public, that regulators haven’t felt the need to address it.

However, there are risks when partial filling a prescription.

There have been claims reported when the remaining portion of the prescription has been filled incorrectly.

Partial filling is a deviation from the normal workflow, so there is an increased chance of error in that situation.

Errors occur most often with look-alike, sound-alike pairs. There can also be interruptions in therapy if the remainder is overlooked or misplaced. There is also a risk that the patient will not come back to finish the course of 30 Pennsylvania Pharmacist — May/Jun 2019

a prescription seems pretty benign.

However, it does present some pitfalls for the unwary. their treatment. It is important to make sure that there is accurate documentation of what was dispensed and when.

At first glance, the issue of partially filling a prescription seems pretty benign. However, it does present some pitfalls for the unwary. The legal and/or contractual requirements may be contradictory to what is seen as good patient care. For example, the patient presents with a new prescription for an expensive medication. It may make sense to dispense a few days’ supply to make sure that the patient can tolerate the new treatment. But this can be problematic if regulations or contractual requirements do not allow partial fills. Unfortunately the world is not always rational or logical. Because of these complexities, partial filling should be addressed in your pharmacy’s policy and procedure manual.

RESOURCES 1 West Virginia Code Section 30-5-27.

2 Title 21 CFR Sections 1306.13. Section 1306.23 for Schedules III, IV, and V does not contain that limitation.

3 Public Law 114-198 © 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.

Financial Forum: Traditional vs. Roth IRAs 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.

Perhaps both traditional and Roth IRAs can play a part in your retirement plans.

Individuals who reach age 50 or older

IRAs can be an important tool in your retirement savings belt, and whichever you choose to open could have a significant impact on how those accounts might grow.

by the end of the tax year can qualify for

IRAs, or Individual Retirement Accounts, are investment vehicles used to help save money for retirement. There are two different types of IRAs: traditional and Roth.

Traditional IRAs, created in 1974, are owned by roughly 35.1 million U.S. households. And Roth IRAs, created as part of the Taxpayer Relief Act in 1997, are owned by nearly 24.9 million households.1

$1,000. So, for these IRA owners, the 2019

Both kinds of IRAs share many similarities, and yet, each is quite different. Let’s take a closer look.

a part in your retirement plans. And once

Up to certain limits, traditional IRAs allow individuals to make tax-deductible contributions into the retirement account. Distributions from traditional IRAs are taxed as ordinary income, and if taken before age 59½, may be subject to a 10% federal income tax penalty. For individuals covered by a retirement plan at work, the deduction for a traditional IRA in 2019 has been phased out for incomes between $103,000 and $123,000 for married couples filing jointly and between $64,000 and $74,000 for single filers.2,3

you’ve figured out which will work better

Also, within certain limits, individuals can make contributions to a Roth IRA with after-tax dollars. To qualify for a tax-free and penalty-free withdrawal of earnings, Roth IRA distributions must meet a five-year holding requirement and occur after age 59½. Like a traditional IRA, contributions to a Roth IRA are limited based on income. For 2019, contributions to a Roth IRA are phased out between $193,000 and $203,000 for married couples filing jointly and between $122,000 and $137,000 for single filers.2,3 In addition to contribution and distribution rules, there are limits on how much can be contributed to either IRA. In fact, these limits apply to any combination of IRAs; that is, workers cannot put more than $6,000 per year into their Roth and traditional IRAs combined. So, if a worker contributed $3,500 in a given year into a traditional IRA, contributions to a Roth IRA would be limited to $2,500 in that same year.4 Individuals who reach age 50 or older by the end of the tax year can qualify for annual “catch-up” contributions of up to $1,000. So, for these IRA owners, the 2019 IRA contribution limit is $7,000.4 If you meet the income requirements, both traditional and Roth IRAs can play a part in your retirement plans. And once you’ve figured out which will work better for you, only one task remains: opening an account.

annual “catch-up” contributions of up to IRA contribution limit is $7,000.4 If you meet the income requirements, both traditional and Roth IRAs can play

for you, only one task remains: opening an account.

CITATIONS 1 https://www.ici.org/pdf/per23-10.pdf [12/17] 2 ttps://www.marketwatch.com/story/gearing-up-for-retirement-makesure-you-understand-your-tax-obligations-2018-06-14 [6/14/18] 3 https://money.usnews.com/money/retirement/articles/new-401-kand-ira-limits [11/12/18] 4 https://www.irs.gov/retirement-plans/plan-participant-employee/ retirement-topics-ira-contribution-limits [11/2/18] 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.

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.

www.papharmacists.com 31

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Professional Development for the Practicing Pharmacist:

Developing a Research Question

Jove Graham, PhD and Deshaun Richards, BS, PharmD ­— Geisinger, Danville, PA, USA Pharmacists, like other healthcare professionals, often find themselves in the position of wanting to initiate a research project, perhaps because it is a requirement of their training program or because they seek an answer to an unanswered clinical question. Regardless of the motivation behind the research, a critical first step for any project is to define (and refine) the research question being asked. This step is challenging for many, particularly if they have conducted prior research projects. The purpose of this article is to provide an overview of developing a research question.

Selecting a Research Topic In the early stages of planning, no topic is off-limits, and as a good researcher, you should feel free to brainstorm and solicit ideas and opinions from everyone around you—colleagues, mentors, other staff, patients, friends, and family. Even if you already have a general area of interest in mind (e.g., diabetes management), remember that there could be hundreds of different, specific aspects of that topic that would make an interesting project. The key is not to restrict yourself too early to one, specific idea.

When you have options to choose from, the next thing to remember is that a research topic should meet the “FINER” criteria—an acronym meaning Feasible, Interesting, Novel, Ethical and Relevant. As a researcher, you must ensure that the scope is feasible given the time and resources you have to complete it. The topic should be interesting to you (since you’ll be spending time working on it!), and you should ask whether the project and results would be considered novel. After all, you do not want to invest time in work that has already been done on a question that has been sufficiently answered. The research should also be considered ethical by your institution’s review boards and the reader. Research topics must also be relevant to the target audience because you want others to read your work. Background reading and research is important for all of the considerations above as it helps you to determine where there are gaps in the literature. It can also reveal whether the scope of your topic is too broad and needs to be narrowed. Once you have selected a research topic, the next important step is to write the topic as a well-formed research question.

Formulating the Research Question A well-formed research question has a very specific structure so that it can be carried forward throughout the life of the project, e.g., during study design, implementation, and even writing of the final research paper(s). We use another acronym, “PICO,” to guide the crafting of a good research question. PICO is composed of four distinct parts: 1) Population. This part specifies “who” or what group will be studied and can include details of the setting (“where”) and timeframe (“when”). Examples might be

workers at a hospital, or patients who were diagnosed with hypertension in the last 12 months.

2) Intervention. This part specifies “what” is being done to subjects in the study, which (despite the name) does not have to be an active ‘intervention’ but is usually a treatment or exposure of interest whose effects are being studied. Examples might be a specific surgical approach or receiving a prescription for an anticonvulsive medication.

3) Comparator. This part specifies a control or alternative treatment or group to which the intervention is being compared. Because the goal of many research projects is to determine if an intervention is “better than” some other option, this part of the structure answers the question, “better compared to what?”

4) Outcome. This final part spells out what measures will be reported for the outcomes of the study and usually specifies the timeframe over which outcomes will be measured. In a comparative study, this answers the question, “better how?” Examples may include blood pressure at 12 months, or whether or not the patient had a 90-day hospital readmission.

Altogether, a good research question that fits this model will look like the following: “Do total hip replacement (THR) patients who receive a multimodal pain regimen consume fewer opioids than patients prescribed PRN opiates in the 6 months after surgery?” Note that a project may be purely descriptive in nature, describing characteristics of a single group, or asking “how much” or “how often” something occurs (e.g., “what percentage of patient falls in a hospital occur between 1800 and 0600 hours?”).

In that case, the “C” or Comparator part of the question may be omitted, though it should be included whenever possible in to provide context for what is measured in the ‘main’ group and make the results more interpretable.

Finally, researchers may be confused about the difference between a research question and hypothesis. Simply put, a good hypothesis follows the four-part structure described above, but is phrased as a statement (instead of a question) that can be supported or refuted by the data or evidence collected.

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Professional Development continued Study Design and Beyond After developing the research question and ensuring it meets the “FINER” criteria, you are ready to decide what study design is most appropriate to answer the question.

Your four-part question should guide you in many important aspects of this design phase such as defining inclusion/ exclusion criteria, identification and assignment of patients in the intervention and comparator groups, and the collection of variables necessary to assess outcomes. The collected data and analysis will be used to support or refute the hypothesis embedded in your question and allow you to draw conclusions.

Conclusion Each step in developing your research question is important -- from selecting the research topic, to formulating a question and designing your study. The trouble many researchers encounter is writing a question that is too vague or broad.

Remembering the FINER criteria in selecting a research topic and using PICO to structure the research question will enable you to develop a well-formed research question and design your study.

Key Points • Use the FINER acronym when considering research questions o Feasible o Interesting

o Population o Intervention

o Comparator o Outcome

Further Reading Haynes BR. Forming research questions.

J Clin Epidemiol. 2006 Sep;59(9):881-6.

Freely Available: Farrugia P, Petrisor BA, Farrokhyar F, Bhandari M. Practical tips for surgical research: Research questions, hypotheses and objectives. Can J Surg.

2010;53(4):278-81.

Center for Innovation in Research and Teaching, Grand Canyon University https://cirt.gcu.edu/ research/developmentresources/tutorials/question

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• Use the PICO acronym to help you structure your research question

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