Pennsylvania Pharmacist November/December 2018

pennsylvania

PHARMACIST November/December 2018 • Volume 99 • Issue 6

KEEPING COMMUNITY PHARMACIES

IN THE GAME Auditor General DePasquale covers all the bases of questionable business practices of PBMs

THE OFFICIAL PUBLICATION OF THE

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CONTENTS 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

ON THE COVER: KEEPING COMMUNITY PHARMACIES IN THE GAME The Auditor General is the fiscal watchdog for the State. He is responsible for using audits to ensure that all state money is spent legally and properly..

DEPARTMENTS

ASSOCIATION NEWS

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

5

Calendar of Events

7

President’s Message

9

Welcome! New Members

24 Heart and Home of PA Pharmacy — Check out our building renovation progress

Pennsylvania Pharmacists Association (PPA) 508 North Third Street, Harrisburg, PA 17101 (717) 234-6151 Fax: (717) 236-1618 www.papharmacists.com | ppa@papharmacists.com

14 Student Member Profile

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.

18 Legislative Profiles

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

10 Member News 12 Affiliated Member News 34 Campus Checkup

FEATURES 16 Member Profile 20 Pharmacy Spotlight 21 Top Tier 2018–2019 Residents 22 DPP and Community Pharmacy:

Twelve Pharmacy Sites Added in PA to Deliver Preventive

Diabetes Services!

26 Keeping Community Pharmacists in the Game — Auditor General DePasquale requires a level playing field!

28 Celebrating 140th Anniversary 32 PPCN Update

INDUSTRY NEWS 38 Pharmacy and the Law: Marijuana Development 40 Financial Forum: Are Too Many Baby Boomers Too Indebted?

JOURNAL 41 How Can Health Kiosks Facilitate Patient Engagement?

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: Kristen Bergmaier, Account Manager (717) 238-5751 x124 kristen@thinkgraphtech.com

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

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 Independent Community: Mark J. Zilner, RPh Board of Pharmacy Meeting Dates: January 8, 2019 March 5, 2019 April 16, 2019 June 4, 2019

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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Calendar of Events November 1-4

Advertisers Index Smith Drug Company 2 RDC 4

American Society of Consultant Pharmacists Annual Meeting – National Harbor, MD

IPBG 6

December

MedSafe 13

2–6

EPIC 15

American Society of HealthSystem Pharmacists Mid-Year Clinical Meeting — Anaheim, CA

12

PPA Board of Directors — PPA Office, Harrisburg, PA

13

Value Drug Company 8

Hayslip & Zost 16 R.J. Hedges & Associates 19 EPIC 31

PPAEF Board of Directors Meeting — Conference Call

Jefferson College of Pharmacy 36

January

PTCB 39

16–19

APMS 42

International Association of Compounding Pharmacists — Fort Lauderdale, FL

24–27

International Association of Compounding Pharmacists Educational Conference — Fort Lauderdale, FL

25–27

2019 Mid-Year Conference — Gettysburg, PA

25

PPAEF Board of Directors Meeting — Gettysburg, PA

26

PPCN Board of Directors Meeting — Gettysburg, PA

27

PPA Board of Directors Meeting — Gettysburg, PA

February 3–5

Regional Chain Conference – Palm Beach, FL

March 5–6

RxImpact — Washington, DC

22–25

American Pharmacists Association — Seattle, WA

23

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

PRS 37

Keystone 43 Pharmacists Mutual Back Cover

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President’s Message A cool swab of mud, water, or leaves placed on the body were early forms of treatment. Before the profession of pharmacy existed, there were crude ways to treat ailments. From these beginnings stemmed our profession. Clay tablets began to house early prescriptions and directions for compounding for illnesses.

Many herbs, barks, and roots began to be used for conditions through a trial and error process of determining what worked best. Throughout various countries and cities, pharmacy slowly molded itself into what it is today. Pharmacy was often combined with religion, medicine, and various forms of healing over the years.

Today, we trace our roots back to Babylon, Chinese emperor Shen Nung, and “Papyrus Ebers” from 1500 BC that contained 800 prescriptions.

Reading about the history of apothecaries, healers, pharmacists, and medicine throughout history is fascinating. To imagine the profession went from mud, water, and leaves into the advanced healthcare delivery organization it is today is a lot to comprehend.

In just 18 years since I have graduated pharmacy school, I have seen computer systems advance, immunizations able to be given at the pharmacy by trained pharmacists, electronic prescribing, and the development of integrated systems to track potential abuse.

How have we grown and evolved as a profession? Educated apothecaries and pharmacists throughout history advanced our profession into the abilities we have today as pharmacists.

However, we still have a long way to go and much to accomplish.

We continue to fight for fair reimbursement, expansions of immunization rights, and overall greater roles in the health of our patients. History has been led by those that fought for pharmacy, and in our modern-day era, we must continue that fight.

Lauren Simko, PharmD PPA President 2018–2019

“We continue to fight for fair reimbursement, expansions of immunization rights, and overall greater roles in the health of our

Legislative Day will be returning this spring, and I encourage you to watch for announcements and plan to attend. PPA will prepare and guide you through the process – no need to feel unprepared!

We must continue to educate those outside of our profession just as our predecessors have done.

patients. History has been

I hope you enjoyed the programming, networking, and social gatherings at our Annual Conference, “Growing our Future: 140 Years and Counting”. I want to thank everyone for their well wishes and kind words throughout the weekend. Our conferences continue to be a special time for education and learning but have also turned into amazing weekends spent with colleagues. A special thank you for family and friends who have supported me throughout my Presidency and will continue to do so as my term quickly goes by, and a thank you to Pat Epple and PPA staff for another amazing effort at this year’s conference.

modern-day era, we must

led by those that fought for pharmacy, and in our continue that fight.”

— Lauren Simko

I also hope that all of you are planning to attend our Mid-Year Conference held January 24–27, 2019 in Gettysburg, PA. Just as Gettysburg played an important role in the history of our country, I hope you find that PPA and our conferences play an important role in the history of your career. PPA offers much to us as pharmacists, and in turn, we must continue to advance our profession for the health of our patients and betterment of our country’s health.

www.papharmacists.com 7

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Welcome! New Members PPA Welcomes the following New Members who joined the association on August 3, 2018 – October 5, 2018. Please make these new members feel welcome and part of Pennsylvania pharmacy!

PHARMACISTS Jessica Adams, Philadelphia, Philadelphia College of Pharmacy Adeboye Adejare, Philadelphia, Philadelphia College of Pharmacy Danielle Alm, Philadelphia, Philadelphia College of Pharmacy Sulema Barron, Scranton, Moses Taylor Hospital

Islam Ghazi, Philadelphia, Philadelphia College of Pharmacy

Robert Mueller, Philadelphia, Philadelphia College of Pharmacy

Henry Gialanella, Chambersburg, Chambers Apothecary

Branden Nemecek, Pittsburgh, Duquesne University School of Pharmacy

Pardeep Gupta, Philadelphia, Philadelphia College of Pharmacy Diane Hadley, Philadelphia, Philadelphia College of Pharmacy Jason Hall, York, Minnich’s Pharmacy

Angela Bingham, Philadelphia, Philadelphia College of Pharmacy

Beverly Harrell, Philadelphia, Philadelphia College of Pharmacy

Lodge Bliznesky, Pittsburgh, Duquesne University School of Pharmacy

Peter Harvison, Philadelphia, Philadelphia College of Pharmacy

Jane Bowen, Philadelphia, Philadelphia College of Pharmacy

William Huy, Owigsburg, Valley Discount Pharmacy

Joseph Notte, Pittsburgh, Allegheny General Hospital Diane Rhodes, Pittsburgh, Duquesne University School of Pharmacy Elizabeth Robinson, Mechanicsburg, Minnich’s Pharmacy Kristen Roche, Mechanicsburg, Minnich’s Pharmacy Kristina Rosus, Hermitage, UPMC Tori Rudy, Saltsburg, Giant Eagle

Lindsey Jachim, Canonsburg, Allegheny General Hospital

Alice Scaletta, Philadelphia, Philadelphia College of Pharmacy

Patrice Carmichael, Drexel Hill

Jean-Francois Jasmin, Philadelphia, Philadelphia College of Pharmacy

Sondra Schultz, Philadelphia, Philadelphia College of Pharmacy

Raymond Carter, Richmond, VA, Federal Bureau of Prisions

Kamal Jonnalagadda, Philadelphia, Philadelphia College of Pharmacy

Gary Sloskey, Philadelphia, Philadelphia College of Pharmacy

Lisa Charneski, Philadelphia, Philadelphia College of Pharmacy

Khalid Kamal, Pittsburgh, Duquesne University School of Pharmacy

Jennifer Smith, Philadelphia, Philadelphia College of Pharmacy

Angela Chen, Philadelphia, Rite Aid

Sojeet Kaur, Alburtis

Bin Chen, Philadelphia, Philadelphia College of Pharmacy

Raed Khashan, Philadelphia, Philadelphia College of Pharmacy

Benjamin Stonesifer, Chambersburg, McDonald’s Pharmacy

Jennifer Clawges, Morgantown, WV, CVS Health

Madeline King, Philadelphia, Philadelphia College of Pharmacy

Jesse Swartz, Philadelphia, Philadelphia College of Pharmacy

Brooklyn Cobb, Philadelphia, Philadelphia College of Pharmacy

Sarah Kleinfeld, Philadelphia, Philadelphia College of Pharmacy

Yen Ta, Philadelphia, Philadelphia College of Pharmacy

Michelle Cochran, Atglen, Yoder’s Pharmacy

Robert Laux, Pittsburgh, Duquesne University School of Pharmacy

Ruy Tchao, Philadelphia, Philadelphia College of Pharmacy

Brian Colfer, Philadelphia, Philadelphia College of Pharmacy

Kaitlyn Lech, Rockaway, NJ, Rutgers Pharmaceutical Industry Fellowship

Shanaz Tejani-Butt, Philadelphia, Philadelphia College of Pharmacy

Ryan D’Angelo, Philadelphia, Philadelphia College of Pharmacy

Wichitah Leng, Philadelphia, Delaware Valley ACO

Tyan Thomas, Philadelphia, Philadelphia College of Pharmacy

Danny Dao, Northampton

Zhiyu Li, Philadelphia, Philadelphia College of Pharmacy

Michael Thomson, Philadelphia, Philadelphia College of Pharmacy

Pasquale Longhi, Hollidaysburg, Thompson Pharmacy

Karen Tietze, Philadelphia, Philadelphia College of Pharmacy

Frederick Lucado, Philadelphia, Philadelphia College of Pharmacy

John Tomko, Pittsburgh, Duquesne University School of Pharmacy

Hilary Mandler, Philadelphia, Philadelphia College of Pharmacy

Jacqueline Uffner, Pennsburg, Healthsouth Reading

Marsha McFalls, McDonald, Duquesne University School of Pharmacy

Harry Vargo, Philadelphia, Philadelphia College of Pharmacy

Suzanne Carbonaro, Philadelphia, Philadelphia College of Pharmacy

Christopher Darling, Clarendon, Darling Apothecary LLC Viha Dave, Philadelphia, Penn Presbyterian Medical Center Justin Delic, Philadelphia, Philadelphia College of Pharmacy Barbara Diemer, Philadelphia, Philadelphia College of Pharmacy Anil D’ Mello, Philadelphia, Philadelphia College of Pharmacy Shane Donnelly, Pittsburgh, Delta Care Rx James Drennen, Pittsburgh, Duquesne University School of Pharmacy Karen Fancher, Sewickley, Duquesne University School of Pharmacy Lori Feldman, Wayne

David McGain, Philadelphia, University of Pennsylvania Thaddeus McGiness, Philadelphia, Philadelphia College of Pharmacy Amy McLaughlin, Philadelphia, Philadelphia College of Pharmacy Meghan McNelly, Mechanicsburg, PA Health & Wellness

Edward Finn, Mars, Phinn Pharma

Carolyn McWilliams, Downingtown, Camilla Hall Pharmacy

Daniel Fitzgerald, Pittsburgh, University of Pittsburgh School of Pharmacy

Justine Meadows, Uniontown, Moses Taylor Hospital

Kimberly Stripp, Pittsburgh

Laura Waite, Philadelphia, Philadelphia College of Pharmacy Erica Waldorf, Philadelphia, Philadelphia College of Pharmacy Jason Wallach, Philadelphia, Philadelphia College of Pharmacy Brittany Whiteman, Mechanicsburg, CVS Pharmacy Timothy Wirth, Williamsport, UPMC Susquehanna Kurt Wolfgang, Williamsport, UPMC Susquehanna Kara Zakin, Philadelphia, Philadelphia College of Pharmacy

Andrew Gaiser, Worthington, Xcenda

Isabelle Mercier, Philadelphia, Philadelphia College of Pharmacy

Robert Gallagher, Pittsburgh, Duquesne University School of Pharmacy

Richard Minoff, Philadelphia, Philadelphia College of Pharmacy

David Zimmerman, Pittsburgh, Duquesne University School of Pharmacy

Jeffrey Moore, Philadelphia, Philadelphia College of Pharmacy

Jason Zupec, Philadelphia, Philadelphia College of Pharmacy

Valerie Ganetsky, Philadelphia, Philadelphia College of Pharmacy

ASSOCIATES Kiersten Ambrose, Pittsburgh, Burstin, Frantz & Hicks Ronald Sucre, Pittsburgh, Burstin, Frantz & Hicks Monique Zelin, Collegeville, Amas Pharmaceuticals STUDENTS Creighton University Victoria Collier, Tacoma, WA Lori Collins, Saint Thomas Duquesne University School of Pharmacy Lalah Ali, Pittsburgh Deena Awadalla, Warren, OH Miranda Burgman, Pittsburgh Ich Hiep Chieu, Munhall Caroline Crossey, Munhall Bryce Grohol, Pittsburgh Kaitlyn Janusey, Venetia Joanne Lutman, Pittsburgh Kyra Murphy, Canonsburg Patrick Ollinger, Hollidaysburg Crystal Onwu, Pittsburgh Cassandra Patterson, New Castle Saverio Santell, Sharpsville Joseph Simpson, Pittsburgh Jennifer Yannuzzi, Shavertown Jefferson College of Pharmacy Chigozie Amugo, Williamstown, NJ Brianna Brown, Conshohocken Mikaela Buntz, Moosic Pallavi Chary, Philadelphia Michelle Culbert, Brookhaven Jessica Cunningham, Philadelphia Andrew Dae Orazio, Southampton Emily Farina, Philadelphia Jennifer Gerhart, Philadelphia Julia Kopec, Wilmington, DE Yi Lok Lai, Philadelphia Ellen Ly, Philadelphia Chandni Patel, Philadelphia Cat-Trinh Phan, Monmouth Junction, NJ Dana Reigner, Havertown Inga Rekhtman, Philadelphia Timothy Smith, Philadelphia Umut Turkdogan, Philadelphia LECOM School of Pharmacy Oluwayomi Adeniyi, Bronx, NY Abillo Fon, Erie Rukia Hashmy, Erie BaileyAnne Low, Warrington Lauren McConell, Cresson Fidelis Nchocho, Erie Darrin Weinzierl, Nicktown Philadelphia College of Pharmacy Samantha Scheib, Philadelphia Wilkes University Nesbitt School of Pharmacy Landon Bordner, Williamstown Deanna Fox, Freeland Brittany Gurreri, Kingston Sohaib Khaliq, Apalachin, NY Melissa Kilvitis, Scranton Rachel Lazevnick, Pittston Marissa Lewis, Dalton Jonathan Little, Watsonton Jamey Mikovich, Nesquehoning Stephanie Ostir, Clifford Township Brianna Price, Clifford Township Brandon Rinehimer, Clifford Township Megan Sokol, Bloomsburg Nash Wenner, Lehighton Kiersten Wiedwald, Kingston

www.papharmacists.com 9

Member News In White House meeting, NCPA stresses DIR remedies NCPA representatives met this week at the White House with Trump Administration advisors from the Domestic Policy Council to urge elimination of pharmacy DIR fees as a part of the president’s drug pricing strategy. It was NCPA’s highest-level meeting yet on the issue. Pharmacy owner and NCPA member Rob Frankil of Sellersville, Pa., and NCPA Advocacy Center staffers Karry La Violette and Ronna Hauser attended the meeting. They stressed that DIR fees are the most pressing issue facing community pharmacists and urged the administration to address remedies in its drug pricing blueprint. They also discussed a proposed Part D rule for 2020, which is currently awaiting clearance by the Office of Management and Budget.

Podgurski recognized for more than four decades of service to pharmacy, industry The National Association of Chain Drug Store (NACDS) presented the Harold W. Pratt Award — its highest honor commemorating service to pharmacy — to Mike Podgurski, Rite Aid Corporation’s vice president, pharmacy services.

The award was presented during the Business Program of the NACDS Total Store Expo.

Value Drug Company has been named one of the Best Places to Work in PA for 2018 The awards program, created in 2000, is one of the first statewide programs of its kind in the country.

The program is a public/private partnership between Team Pennsylvania Foundation, the Pennsylvania Department of Community and Economic Development, the Pennsylvania State Council of the Society for Human Resource Management, and the Central Penn Business Journal.

FOLLOW US ON SOCIAL MEDIA @PAPHARMACISTS

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

10 Pennsylvania Pharmacist — Nov/Dec 2018

Congratulations to Assistant Dean of Student Services Dr. Janet Astle!

Janet Astle, BS Pharm, EdD, Assistant Professor and Assistant Dean of Student Services was recognized for 25 years of service at Duquesne University School of Pharmacy. The service recognition was given during the Annual Faculty Reception and Awards Ceremony where the University community gathers to celebrate faculty members and their accomplishments.

Wilkes University on The Today Show For the past couple of years, Wilkes University pharmacy students have been going to New York City to represent our profession. Below are photos of Wilkes Students with host’s Al Roaker and Hoda Kotb. The students brought along signs and posters to promote October as American Pharmacist Month.

Congratulations to the PPA Couple!

Anthony Fanucci, PharmD and Allie Grudeski, Wilkes University PharmD Candidate 2019 were married in September 2018.

A Future Pharmacist has been born!

PPA Board Member Nicole Pezzino and her husband welcomed a baby boy, Carson, in June 2018.

Congratulations to Nicole and her family!

We can’t wait to see Carson as a future PPA member!

www.papharmacists.com 11

Affiliated Member News BMPA Update On Wednesday, September 12, BucksMont board director Jan Kitzen and BucksMont president Steve Pfeiffer staffed an information table at a reception following the annual White Coat Ceremony at the Student Faculty Center on Temple’s Health Science Center campus. Our table was attractively displayed with our new stand-alone banner, new descriptive brochures and a generous supply of beach towels to offer the PY1 students. Well over 40 students visited our table and we provided them with information regarding student membership in our association. This was a very exciting day for the students and we are delighted that we were invited to be a part of this important event. We are confident that many of the students will eventually become student members of our association.

ACPA Update ACPA hosted its annual picnic at Schenley Park on Wednesday, September 12th. ACPA members and their guests gathered at the park for a fun evening to talk with other pharmacists and student pharmacists, dine on delicious food from Dave’s Country Meats, and play a great game of kickball.

Officers and committee chairs met with members to discuss activities for the upcoming year.

On September 25th, ACPA was honored to have Dr. David Schwartz, OB-GYN, present an educational program regarding endometriosis and its treatment. The program was hosted by Abbvie Womens Health. Pharmacists, pharmacy technicians, and student pharmacists met at The Capital Grille to learn more about this disease state and new treatment approaches.

12 Pennsylvania Pharmacist — Nov/Dec 2018

LCPA Update This past summer, the Lancaster County Pharmacists Association held its annual Student Scholarship interviews and awarded 7 scholarships to pharmacy students from Lancaster County. These scholarships are awarded based on financial need, academic achievement, and overall character. Interviews are conducted by LCPA members, and after the interviews are over, students are welcome to stay and network with each other and with our members.

Overall, it’s a great experience for everyone involved. Congratulations to the 2018 scholarship recipients!

Name

Amanda Gingrich

Brianna Brown

Allison Kachel

Fiona Mai

Ashley Sargent

Dylan Fox

Molly Stott

Year P4 P4 P3 P4 P2 P3 P2

School Wilkes Jefferson Duquesne Jefferson Jefferson Wilkes Rhode Island

Scholarship Awarded The Search Family Award Royer Pharmacy Award Wiley’s Pharmacy Award David J. Ference Award The Ortmann Family Award Charles Bonadio Award Donald DeLong Award

Special Thanks to Those Who Make These Awards Possible: Gerald and Suzanne Ganse Family Foundation Bob and Coleen Kayden The Royer’s Families Mrs. Donald Delong Mary Clayre Ortmann Ted Search and family The Wiley’s Families All LCPA Members P.J. Ortmann and Family

Check out our website for upcoming LCPA events at www.lancasterpharmacists.com!

Student Member Profiles

Wilkes University PharmD Candidate 2019

find 2 or 3 organizations to be involved with (PPA being one, of course!) and dedicate my time to those organizations. I was one of those P1 students that got involved with EVERY club and spread myself too thin to the point where I couldn’t actually enjoy being a part of the organization. Listen to what the upper classmen have to say about each club and make an educated decision on which ones to get involved with from there on out.

How did you hear about PPA?

Why did you choose to become involved in PPA?

I first heard of PPA my freshman year of college.

Our Pharmacy Senate teams up with our PrePharmacy Club to put on a round table event where pre-pharmacy students can get more information about organizations before entering pharmacy school.

Jennie Smith was a HUGE advocate for PPA and made sure to give us all a good idea as to what PPA was all about. Ever since then, I had it on my radar that as soon as I started pharmacy school, PPA would be the very first club I would join!

During my sophomore year, PPA was working closely with legislators to lower the age in which pharmacists could immunize individuals receiving the flu vaccine.

I saw how hard the Wilkes University PPA chapter worked at calling, mailing, and emailing their legislators to lower the age.

All the hard work paid off and the bill successfully passed allowing pharma­ cists to immunize those nine and older for the flu vaccine. I was already very interested in PPA, but this certainly sealed the deal into me joining the following year.

Allie Fanucci

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

If I could have given myself any advice during my first year of pharmacy school, I would have told myself to

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

Dr. Nicole Pezzino has really influenced me to become a community pharmacist. She’s taught me that being a community pharmacist is so much more than just checking prescriptions

14 Pennsylvania Pharmacist — Nov/Dec 2018

and counseling patients.

She is a big advocate that the biggest thing you can do as a community pharmacist is give back to the community. She gets involved with the local senior center doing different presentations, blood pressure screenings, etc. It’s important that you have a presence in your community, both in and out of the pharmacy.

She also stresses that as a community pharmacist you must be a lifelong learner and constantly stay up to date. Your patients will continuously ask you questions about things they’ve heard on TV, in the newspaper, etc. and it’s crucial to be right with your patients, learning about new things, and educating them.

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

In the next five years, I hope to be a community pharmacist or a pharmacy district manager. I hope to be serving my community in some way – whether that’s as a pharmacist behind the bench or a pharmacist managing other pharmacists to help their patients to their best ability.

Favorite food you have eaten on campus?

I’m not one to really eat on campus – but I did utilize our little convenience store outside the room we always had class in. My go-to snacks were always Smartfood White Cheddar popcorn and peanut butter M&Ms.

Lauren Stabler Philadelphia College of Pharmacy PharmD Candidate 2019 How did you hear about PPA? One of the PCP alumni sponsored the Student Pennsylvania Pharmacists Association memberships for all of the Pennsylvania residents in the P1 class.

Favorite drug name to pronounce My favorite drug class to pronounce is the Thiazolidinediones.

Flashback to your first year of pharmacy school; what advice would you give yourself knowing what you know now?

I would encourage myself to become involved with pharmacy advocacy and exploring career paths sooner than I did. I underestimated how fast my years in pharmacy school would fly.

Why did you choose to become involved in PPA? A friend of mine was serving as the membership ambassador for our

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Student Member Profiles continued school’s PPA organization when I attended Legislative Day as a P1. She explained how important it was to advocate for our profession and how PPA provides students as well as pharmacists the opportunity to do this.

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

Elizabeth Harris and Dr. Karleen Melody are both wonderful mentors that have encouraged my involvement with PPA and my enthusiasm for patient care since my first professional year at PCP. Where do you think you’ll be in five years?

I see myself thriving in a community setting in 5 years, engaging in face-to-face patient care and making a direct impact on their health outcomes by being easily accessible and reliable.

Favorite food you have eaten on campus?

Sausage and eggs over rice from Linda’s Cart. www.papharmacists.com 15

Member Profile involved with PPA whom I have met and some who I hopefully will get the chance to meet soon.

Name the number 1 reason why you became a pharmacist?

Wichitah Leng, PharmD

Wilkes University, Nesbitt School of Pharmacy 2006

MBA

Temple University, Fox School of Business anticipated 2019 Director of Population Health Pharmacy Strategies Delaware Valley Accountable Care Organization (DVACO) What is the most important piece of advice you would give a newly licensed pharmacist on their first day of work?

Ask a lot of questions. No one expects you to know everything. It’s important to understand that everyone more senior than you has had a “first day” in their careers. A good colleague will always welcome the opportunity to help you get your feet under you.

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

PPA provides insights into the practice and legislative issues that impact the future viability of our profession. There is also a rich network of colleagues

What initially drew me in was the desire to positively impact the quality of life for our patients and to do so by leveraging my sense of curiosity and creativity.

What keeps me excited is my belief that pharmacists are positioned to be among the most dynamic contributors to healthcare in a value-based care delivery model.

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

There have been so many who have influenced me throughout my career and they continue to do so.

But if not for the sincere advice I received very early on in my career, I would not be where I am today.

There are two people I want to acknowledge.

First, Brian Vukovich was my pharmacy preceptor during my internship with CVS/pharmacy in Lebanon, PA. He offered so much mentorship on how to be a great pharmacist and a community leader.

Additionally, Rich Paoletti, who extended me an opportunity to work in the pharmacy department at what was then Lancaster General Hospital upon graduation and then recommended that I turn it down. Rich took the brief

16 Pennsylvania Pharmacist — Nov/Dec 2018

time we had during my interview to understand my career drivers and helped steer me onto the right trajectory.

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?

The US is ripe for innovation, so I would want to stay here. But, if I had to relocate, I would consider

for an organization like the United Nations. Although I would not have to live in another country, I could practice pharmacy with a global reach.

Best thing you ever ate?

This is likely the hardest question I’ll ever have to answer. I’m a foodie at heart and love great barbeque, but I have a real soft spot for good oldfashioned Cambodian beef lok lak.

Legislative Profiles Sen. Lisa Baker What are the key issues you would like to see addressed this session?

I would like to examine the role and impact of Pharmacy Benefit Managers in Pennsylvania to see if there is a need to enact legislation that addresses the amounts PBMs can charge patients and the amounts they reimburse pharmacies. I also believe we need to address the crisis being faced by rural hospitals and see if we can Senator Lisa Baker we create a payment model R-20 that allows those hospitals to continue to operate and to offer quality services. Other critical health care related issues are presumptive eligibility for seniors to receive home and community based services rather than nursing home care, reviewing the impact of recent changes to the Medical Assistance Transportation Program on rural counties, and continuing our work to address issues related to opioid abuse.

Tell our members a little about your background and why you are a legislator.

My father fostered in me a love of government and an understanding of the role it can play in improving people’s lives. I’ve had a passion for public service since high school. My civics teacher Jerry Stinson was very inspiring and instrumental in my participation in a Washington Workshop seminar at a Congressional Youth Leadership Conference. After that, I majored in government at Shippensburg University. I worked for nearly 30 years in both the legislative and executive branches before running for office myself.

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

Pharmacies must be able to continue to provide the critical health care services that they do today. This means they must receive fair prices for the drugs they prescribe and should be given the freedom to offer services and products that their customers need. I also see pharmacies as the front line in the fight against waste and fraud and against opioid misuse and dependency.

Advice for pharmacists about the political process?

Don’t assume that legislators know your issues or understand the ways to solve the problems you face. The ideas we get come primarily from you. You must engage

18 Pennsylvania Pharmacist — Nov/Dec 2018

your legislator and let him or her know what your concerns are. Help your legislator to come up with solutions. Do not just identify problems.

What do you do for relaxation or enjoyment?

Reading, gardening, cooking, walking my dog Finley, riding my mountain bike.

Rep. Kathy Rapp What are the key issues you would like to see addressed this session?

The 2019-2020 session should prove to be a busy session for the Health Committee of the Pennsylvania House. The Committee will continue to examine the Opioid Epidemic and its impact on families and children, our medical community, first responders and the mental health system as well as the financial burden on the State and communities across Pennsylvania.

Representative Kathy Rapp R-65

The cost of pharmaceuticals and pharmacy benefit managers has been raised this session leading to an audit by the Auditor General. Once the audit is finalized, the Chair and others will be meeting with the Auditor General to examine and draft legislation for the next session. The cost of pharmaceuticals in general is also an issue the Trump administration is addressing that we will follow closely in Pennsylvania.

The committee will also advance pro-life legislation, tackle the Lyme Disease insurance coverage if not passed and signed this session. I also hope to advance more insurance coverage and medical assistance coverage for dental care for constituents.

The education awareness for parents regarding vaccines has been an issue that members of the committee have addressed to me. There are, as always, issues regarding welfare reform, medical assistance re-imbursement, licensing issues and many other issues that will come before the committee.

Tell our members a little about your background and why you are a legislator.

I never planned my life goal to be a legislator. After being a military family, moving back to Warren, PA and being a stay-at-home mom until my children were in

Legislative Profiles continued school, I became involved in advocacy for people with disabilities. My involvement led to helping many parents at the local and regional level and then to the state level.

I became employed by the parent training center in PA under the Individuals with Disabilities Education Act as the Transition Coordinator for the State. In this capacity, I worked with professionals from the Departments of Education, Welfare and Office of Vocational Education.

I received a Commission from Governor Schweiker to serve on the Rehabilitation Council of PA. The positions led me to advocate issues with my local, state and federal government officials. I also joined my local political party. I was also employed at a local Skilled Nursing Facility for about two years as the Marketing, Admissions Administrator. My predecessor decided to retire, and I decided to run for the office.

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

Pharmacy is playing a significant role in healthcare today.

The door has been opened for consumers to not only receive their prescriptions from their pharmacy, but many vaccines.

Advice for pharmacists about the political process?

Pharmacists and pharmacies can work together for the benefit of the consumer in controlling cost for the Ameri­can people and the people of Pennsylvania. The Government Relations Offices can work closely with legislators regarding pharmaceuticals, vaccines, costs and other issues to present their view of legislation affect­ing the legislator’s constituents and the people of Pennsylvania. Local pharmacists should always feel comfortable in approaching their local legislators regarding issues affecting them. They are important to the legislative process in addressing health issues of the people they serve.

What do you do for relaxation or enjoyment?

Being a legislator is a rewarding position. It is also time consuming. I live four hours from the Pennsylvania Capitol and I have the fourth largest district geographically. I represent the 65th district which consists of all of Warren County, the western half of Forest County and Titusville and seven townships in Crawford County. The district is a rural district in Northwestern PA. I enjoy spending any free time I have with my children and grandchildren. I reside on a small farm. I enjoy horseback riding and the outdoors. www.papharmacists.com 19

Pharmacy Spotlight Meet Asti’s Pharmacy Meet Dan Asti After graduating from Duquesne University School of Pharmacy in 1995 and working for the chain industry for most of his career, his passion for giving personalized care for his patients led him and his wife, Jennifer, to open Asti’s South Hills Pharmacy in 2005. Approximately 15 minutes south of Pittsburgh in Mt. Lebanon, Asti’s is dedicated to deliver exceptional service and has a desire to build relationships with both patients and providers. To present day, the pharmacy has grown to include an accredited compounding lab, a long-term care pharmacy, and an accredited specialty pharmacy.

Meet Chris Antypas After Dan wanted to assemble more experts in pharmaceutical care, Chris joined the team in 2012 as an owner and Chief Operating Officer. After graduating from University of Pittsburgh School of Pharmacy in 2009, Chris worked exclusively for independent pharmacies across multiple states where his unique and valuable experience has made him an innovator in the field.

Together with 13 pharmacists and over 30 technicians and interns, and 4 delivery drivers between their compounding team, long term care pharmacy, and community pharmacy, Asti’s operates as a high volume community pharmacy.

Each group of technicians and pharmacists has unique responsibilities and roles throughout the team and provide value in their own way. From coordinating patient access to prescriptions, to conducting medication reviews and collaborating with physicians in a family practice office, our pharmacy team prides itself in innovation while maintaining the connection of a hometown pharmacy.

What We Offer Asti’s is unique in its pursuit of innovation in pharmacy practice, and the services offered reflect that approach.

Each service offered by Asti’s Pharmacy is driven by the value that it brings to a patient or provider, and some of those services are listed below:

c. Immunization Clinics (including travel vaccines) d. Diabetes Prevention Program (DPP) e. Diabetes Self-Management Education (DSME) f. Smoking Cessation Services g. Point of Care Testing (with mobile permit) h. Monthly Disease State Education Classes i. Medication Therapy Management/Complete Medication Reviews 3. Collaboration with Providers a. Hospital Discharge Program/Transitions of Care b. Collaborative Practice Agreement for In-Office Billable Services

1. Improving Access to Medications and Care a. Free home delivery b. In-home RPh consults c. Prior-authorization support and financial assistance d. Community heath-fair screenings e. Naloxone Dispensing Program f. Medicare Plan Review and Benefit Gap Reviews (for underinsured patients) g. Medication Compounding

Asti’s South Hills Pharmacy strives to be recognized as an “Outcomes Based Pharmacy” that helps patients to achieve a desired health outcome. Aside from what they off their patients, Asti’s participates in several community outreach programs, including Narcan dispensing and education, vaccination clinics and brown bag events, and off-site education classes are just some of the ways they stay involved in the community.

2. Improving Patient Outcomes a. Medication Synchronization b. Adherence Packaging

“The most challenging part of owning a pharmacy is facing factors that are out of your control”, said Antypas.

Ambiguous fees, lack of transparency, and reimbursement Continued on next page

20 Pennsylvania Pharmacist — Nov/Dec 2018

Facing Adversity

TopTier 2018–2019 Residents

Name and Credentials

Name and Credentials

Name and Credentials

Name and Credentials

Practice Site ACME Sav-on Pharmacy

Practice Site ACME Sav-On Pharmacy

Practice Site Giant Eagle Pharmacy

Practice Site Asti’s South Hills Pharmacy

University Affiliation University of Pittsburgh School of Pharmacy

Residency Program University of Pittsburgh School of Pharmacy

Phuong Hoang, BS, PharmD

Linh Y. Huynh, PharmD

University Affiliation University Affiliation Temple University School of University of the Sciences Pharmacy Philadelphia College of Pharmacy PharmD Degree

Amber D. Lapping, PharmD, CTTS

Pharmacy Degree Pharmacy Degree Duquesne University Temple University School of School of Pharmacy 2018 Pharmacy 2018 Research Question Research Question Grocery store customer Research Question What implementation choice of community Prescriber perceptions of strategies have pharma­cists pharmacy and awareness of pharmacist-administered employed to pharmacy care in a grocery long acting injectable success­fully engage chain that offers clinical antipsychotic program patients in Diabetes services in Pennsylvania in community pharmacy Prevention Programs chain: a national surveyacross Pennsylvania? based study University of Pittsburgh School of Pharmacy 2019

Catherine B. Phi, PharmD

Pharmacy Degree MCPHS University 2018 Research Question How does a medication adherence packaging service provided by an independent community pharmacy impact patientcentered outcomes?

Pharmacy Spotlight Meet Anti’s Pharmacy continued issues are often damaging to pharmacies and can be difficult to combat as an owner. Being forced to sign payer contracts with companies that are also competing pharmacies adds to these challenges – especially due to the lack government/regulatory oversight on these contracts. “Our strongest asset to compete in this tough market is to demonstrate our ability to improve patient outcomes – which is why Asti’s is focusing so strongly on those areas of pharmacy practice”.

Taking Care of Our Patients Owning this pharmacy gives our team freedom to take care of our patients needs to benefit them and the business. As

an owner, you have the flexibility and room to find creative ways to provide value to patients and your business. “You can be a pioneer in innovation and can control your own destiny, this includes choosing how to staff your pharmacy and what services your pharmacy provides to best meet the needs of your patient population”.

Our Mission To think that this all started with one man striving to build stronger interactions with patients proves our dedication.

Creating lifelong relationships by bettering the lives of all we touch is what we practice every day and will continue to in our advancing future. www.papharmacists.com 21

DPP and Community Pharmacy: Twelve Pharmacy Sites Added in PA to Deliver Preventive Diabetes Services!

The Centers for Disease Control (CDC) has stated community pharmacies represent an untapped resource for diabetes prevention and delay. Pharmacists are uniquely positioned to help screen, raise awareness, and make an intervention impact. Pharmacists, already often called upon to counsel their patients with diabetes, may now be poised to counsel their patients in these manualized and evidence-based behavior change approaches especially when it comes to diabetes prevention.

The Centers for Disease Control National Diabetes Prevention Program (NDPP) (Diabetes Care, 2017) also showed that over 14,000 persons with obesity and elevated glucose who participated in an evidence-based, one-year DPP (attending 14 sessions on average) lost 4% of their initial body weight and just under half increased their physical activity to at least 150 minutes/week.

For this reason, the Pennsylvania Pharmacists Association (PPA) partnered with the PA Department of Health (DOH) in 2018 to launch the DPP program in a number of pharmacies. This new initiative between PPA and DOH was launched with getting pharmacists in a number of pharmacies to launch and then maintain the program. At this time, PPA has successfully had 13 pharmacies launch the program and efforts are underway to get up to 9 more established in the coming year. The CDC is very excited about pharmacy involvement recognizing the impact pharmacists can have in their community.

According to Pat Epple, PPA CEO, “The DPP program is an amazing opportunity for community pharmacies. It is another way for pharmacies to expand their business and further develop clinical and patient care services. We were pleased to partner with PA Department of Health to get twelve sites accredited. We had hoped for 20 but the 12 is still an important benchmark for the state and I have to say that the CDC is watching what our pharmacies are doing!”

The Diabetes Prevention Program (DPP) clinical trial showed that a behavioral lifestyle intervention focused on healthy, balanced diet, physical activity (150-minutes weekly) and modest weight loss (7%) for overweight persons with impaired glucose tolerance or “pre-diabetes” was significantly more effective in reducing cumulative risk for diabetes than a drug or placebo intervention over 2.8 years. The incidence of diabetes was 58% lower with lifestyle and 31 percent lower with the drug metformin.

“I just held my first class and actually had 10 people show up! Such a wonderful group of individuals!

Thank you for your help and they

Learn more about DPP by visiting the CDC website for NDPP: https://www.cdc.gov/diabetes/prevention/ index.html

The grant money covered the pharmacist’s attendance at the Innovative Wellness Solutions “Group Lifestyle Balance” (GLB) training session, one of the approved CDC programs or taking the online training. GLB is a series of coaching programs about lifestyle changes. Additionally $6,000 was provided to help the pharmacies market and launch their first initiative. An equivalent of about $600 for 10 patients, although some had more and some had less. Per CDC requirements, classes must have 5 or more participants to launch. Sessions # 1-16 are delivered in the first six months of launch and then 6 more monthly sessions are delivered in the second six months (#17 to #22). The CDC will ask you to collect and report basic data for each participant (sessions attended, weight at each session, activity minutes). To advance your recognition status, participants must show an average 5% weight loss from baseline.

The pharmacies, who have received or are in the process of completing their first round of patient sessions for pending recognition status and being able to begin appropriate billing for this service include:

(and I) are VERY excited about this

• Asti’s South Hills Pharmacy

program!”

• Bechtel’s Pharmacy

— Nicole Pezzino, PharmD, Wilkes University and Weis Markets Pharmacy

• Community Pharmacy • Gateway Pharmacy • Gatti Pharmacy

22 Pennsylvania Pharmacist — Nov/Dec 2018

• Giant Eagle Pharmacy • Hartzell’s Pharmacy

“Thank you for your ongoing support.

• Hilltop Pharmacy

PPA has been very instrumental to

• Mainline Pharmacy

getting our clinical programs up and

• The Medicine Shoppe — Somerset

going. I utilize your webinars and

• Patton Pharmacy

feedback from all the pharmacists

• Weis Markets

to keep pushing forward.”

Many of these community pharmacies are also PPCN pharmacies; however, that was not an absolute requirement to participate.

We commend these pharmacies for taking the initiative!

You are leaders in the state and country!

— Rebecca Swintek, PharmD, Director of Clinical Services, Community Pharmacy

Another Launch in 2018–2019 PPA is working with another small group of pharmacies to do the same in 2018 through 2019 and may even have another group after that. The program is involved and needs some real attention up-front but once you get your system established, you can really feel you are bringing a worthwhile program to your community and getting fairly paid, especially when done to scale.

THE NCPA CONFERENCE

held in Boston on October 6-9 was a big year for Pennsylvania. We congratulate PPA Past President David Smith on his year as NCPA President. We also congratulate Stephanie Smith Cooney on being nominated as a finalist for CPESN USA Luminary of the Year. Far right are also from left to right Kelsey Dutka – Duquesne University, Jake Gambo – Philadelphia College of Pharmacy, Shannon Ye – University of Pittsburgh, and Sophia Cothrel – University of Pittsburgh who received the SIG Grant based on their application entry and interest in community pharmacy to attend the conference.

www.papharmacists.com 23

Heart and Home of PA Pharmacy Check out our building renovation progress.

PPA is in the process of an important capital campaign to raise funds to support a total renovation of its headquarters, which is ideally situated right across the street from the Capitol Building in Harrisburg.

Over recent years, the building, which we have owned since 1948, has suffered multiple episodes of insufficient heat, air conditioning, plumbing issues, water damage, among others. Throughout each of these episodes, Pat and her staff have been true professionals, consistently persevering through 90 degree temperatures, 30 degree freeze outs, water leaks, and plumbing that is “inconsistent.” They do this because they are dedicated to OUR state pharmacy association. The last time our building underwent major renovation was in the late 1980s. We cannot delay any longer in making desperately needed renovations.

I think you’ll agree that OUR building is more than a collection of office space.

• It is a symbol. It shows legislators, health professions groups, and other stakeholders that we are a legitimate and strong organization that must be heard and respected.

• It is functional. PPA staff are busy! They need to work in a building that promotes productivity and enhances morale. We need to be able to continue to recruit top talent — we need an environment they want to work in.

• It is our history. Our building houses artifacts, records, and PPA’s legacy. From antique apothecary scales, to old volumes of key text, to digital records showcasing how PPA has enhanced the practice of pharmacy across the Commonwealth. Our building is who we are.

• It is our future. Our future leaders, staff, students, and stakeholders will need to occupy a space that inspires and facilitates the next 10, 20, 30 years’ worth of innovations, practice advancements, legislative initiatives, etc.

We look forward to working with you in our newly renovated space as we continue to advance OUR profession forward. Please feel free to reach out to Pat Epple or any of the PPA Staff if you have questions, 717-234-6151, or ppa@papharmacists.com As a valued and important member of our organization, we are asking for your support in fundraising to renovate our building. We established a minimum goal of $140,000 in conjunction with our 140th anniversary celebration. Through our leadership contributions of our Boards, we have already raised almost $65,000 towards this goal. I urge all of our members to help not

BEFORE & IN PROGRESS PICTURES

LOWER LEVEL

24 Pennsylvania Pharmacist — Nov/Dec 2018

MID LEVEL

We look forward to working with you in our newly renovated space as we continue to advance OUR profession

TIME TO START HOLIDAY SHOPPING WITH

forward. just meet the minimum, but to work with us to exceed expectations!

The PPA Board has done its due diligence and considered a number of options. We considered moving to another space, but concluded that this was not a viable or sound option since it would cost at least as much for a less convenient location that would abandon our history.

We looked at graduated renovations but given the magnitude of the need, and what our association staff have already persevered through, this did not make logistical or financial sense. While we are not creating a “Taj Mahal,” our total expense in renovating three floors, doing complete systems replacement, asbestos abatement, and becoming ADA compliant, is in the realm of $725,000. So please know the Board debated long and hard about this but ended up feeling it made sense to renovate this building and that the work is needed and needed now.

Go to http://www.papharmacists.com/?page=Buildsupport and the link options are at the bottom of the page.

Did you know that Amazon donates 0.5% of the price of your eligible AmazonSmile purchases to the PPA Educational Foundation?

This contribution supports the grant program, student poster presentations, the LEAD program, pain competition, and much more!

All you need to do is:

STEP ONE

Go to Smile.Amazon.com.

STEP TWO

Choose PPA Educational Foundation as your charity.

STEP THREE

Whenever you are shopping, start at Smile.Amazon.com!

Take advantage of this easy way to do your holiday shopping and help your Foundation!

SECOND FLOOR

You can help PPA’s Educational Foundation just by buying the stuff you need every day, using Smile.Amazon.com. www.papharmacists.com 25

Keeping Community Pharmacists in the Game Auditor General DePasquale requires a level playing field!

The PA Pharmacists Association, in collaboration with Value Drug, PARD and Keystone Purchasing Alliance, first brought the issue of the questionable business practices of Pharmacy Benefit Managers (PBMs) to the Auditor General last winter. While the questionable business practices of PBMs has been going on for quite some time now, the debacle that happened in late fall with CVS/Caremark reimbursing pharmacy’s under cost was the icing on the cake.

The Auditor General is the fiscal watchdog for the State. He is responsible for using audits to ensure that all state money is spent legally and properly. In this instance, Auditor General Eugene DePasquale has oversight over taxpayer dollars in the area of Medicaid and State employee’s health care. Both of these programs utilize taxpayer dollars, including the contracts with PBMs. While this is a complex issue in general, with more acronyms and formulas used to calculate one cost, the Auditor General took the issue on full force. He started with a press conference alerting all interested parties as to his intentions, how he was going to go about his investigation, and the information he expected to receive throughout the process in order to move forward with his review, analysis and final recommendations.

There were five hearings set up by the Auditor General’s office held around the state including Bethlehem, Delaware County, Beaver County, Erie and Harrisburg. There was also a special meeting in York set up by Deron Shultz of Minnich’s Pharmacy, which was heavily attended by pharmacists.

Many of our members testified as to the original purpose of PBMs, how they grew over the years into an unregulated conglomerate, and how they are manipulating the system to the detriment of community pharmacies and Pennsylvania taxpayers. Moreover, our pharmacists were able to provide specific examples of discrepancies between the over inflated price 26 Pennsylvania Pharmacist — Nov/Dec 2018

billed to the MCO by the PBM and the drastically lower payment paid to the pharmacies. There was an overall theme in every hearing that showed examples of the ongoing and sometimes egregious business practices of PBMs. In every example of price spread there was one question that was continually left unanswered. Where’s the taxpayer’s money?

The other theme that was brought forth throughout all of the hearings by the Auditor General was that he requires a fair and level playing field.

As someone who played many sports and is a sports enthusiast, he used a lot of sports analogies to put this issue into perspective. He stated many times that there is a reason Penn State, a Division I football team, with undergraduate enrollment of 46,000 doesn’t play Shippensburg University,

a Division II football team with an undergraduate enrollment of 5,900.

Its just not fair! He has also stated that there is a difference between an unfair playing field and simply ‘doing it better.’ If one business has a better business model and sells more product than another business on the same level playing field, then kudos to that business for doing it better. But he believes, after the testimony that has been presented as well as looking at the issue nationwide, that there is no level playing field with PMBs and community pharmacies. With ‘take-itor-leave-it contracts, price spreading, under-cost reimbursements, manipulation of rebates, unknown audit procedures, an appeal process that reaps few changes, and an overall lack of transparency, it appears that Penn State is playing against the fourth-grade pee-wee football team.

So where do we go from here?

The Auditor General will complete his investigation and publish the findings in the Review. This Review will have recommendations for the Commonwealth, as well as several agencies. From there, PPA will review the recommendations, see which of those, if any, have been implemented, and then gear up to introduce legislation where needed.

This is where every PPA member should suit up and get ready for the game. We will be calling on you to talk with your legislator, attend legislative day, and help with the grass roots efforts to move the legislation towards the goal line. This is an important issue that needs addressed now so that you can continue to help patients in your community. In addition, it is an important issue for every Pennsylvanian so that they know where and how their tax dollars are being spent. The requirement that PBMs play fairly with transparency as the main driver, is a good start and a win-win for everyone!

Special thanks to: Value Drug, Keystone, RDC, and IPBG for promoting the hearings and working with us and to all of the pharmacists who came out to the hearings and specifically testified at the risk of their business.

And a very special thanks to John Pavis, Vince Hartzell, Ed Melber and Ed Bechtel for testifying at the Bethlehem hearing.

A very special thanks to Mel Brodsky, Melinda Williams, Dan Hussar, and Steve Shaeffer for testifying at the Delaware County hearing.

on the first panel and pharmacists Andrew Mubbala, Dave Cippel, and John McClellan who testified at the Harrisburg hearing.

A very special thanks to Pat Lavella, Ron McDermott, Shawn Narin, Chris Antypas, and Emanuel Panos for testifying at the Beaver County hearing.

A huge shout out to all the pharmacists, pharmacy technicians and students who were the cheerleaders attending these hearings, providing support for their colleagues and packing the hearing rooms showing support for the Auditor General in his quest for gathering information. You made a huge impact, so much so that the news media attended these hearings and we are gaining more and more attention on this issue.

A very special thanks to Robert Kasisky, Christine Kasisky, and Brian Sidone who testified at the Erie County hearing.

A very special thanks to Matt Magner from NCPA, Angela Zaydon, PPA and Pat Epple, PPA, who testified

www.papharmacists.com 27

Association News

2000–2018 — Start of a New Decade — Look How Far We have Come!

The growing PBM threat…

In early 2000, the biggest concern of many independent pharmacy was the growth of mail order and the move towards a mandate for it by many insurers along with the move to managed care. In the late 90s, many community pharmacies in the southeast portion of the state would close their doors under the low reimbursements instituted through managed care. While the big 4 PBMs,

PRESIDENTS DURING THIS PERIOD: Lauren Simko . . . . . . . . . . . . . . 2018-2019 Nicholas Leon . . . . . . . . . . . . . . 2017-2018 Eric Pusey . . . . . . . . . . . . . . . . . . 2016-2017 Donna Hazel . . . . . . . . . . . . . . . 2015-2016 Eric Esterbrook . . . . . . . . . . . . 2014-2015 Joseph Scott Miskovsky . . . 2013-2014 Rob Frankil . . . . . . . . . . . . . . . . . 2012-2013 Adam Welch . . . . . . . . . . . . . . . . 2011-2012 Mark Rabinowitz . . . . . . . . . . . 2010-2011 Sherri Lee . . . . . . . . . . . . . . . . . 2009-2010 Gregory Shaeffer . . . . . . . . 2008-2009 Sharon Abayasekara . . . . . . 2007-2008 Michele C. Musheno . . . . . . 2006-2007 George Haynes . . . . . . . . . . 2005-2006 Bruce Sigman . . . . . . . . . . . . 2004-2005 Scott Himler . . . . . . . . . . . . . . 2003-2004 Coleen M. Kayden . . . . . . . 2002-2003 David M. Smith . . . . . . . . . . . . 2001-2002 Robert W. Piavis . . . . . . . . . . 2000-2001 David W. Leach . . . . . . . . . . . 1999-2000

28 Pennsylvania Pharmacist — Nov/Dec 2018

at that time were Express Scripts, Merck-Medco, Caremark, and PCS, others were also growing and soon there would be additional mergers and changes. The influence of PBMs on all aspects of prescription benefits would expend throughout the next twenty years despite efforts nationally and by PPA in Pennsylvania to curb this influence, beginning with several efforts to prevent mandatory mail order through legislation.

Changing of the guard…

In 2001, long-time PPA Executive Director Carmen DiCello announced his planned retirement and the Association embarked on a yearlong national search finally hiring Patricia Epple as his replacement on June 1, 2002. The association’s finance were at a critical point that year and shortly thereafter all but one other staff member was laid off and plans for a major Capital Campaign were announced. For the next two years, efforts to raise about $200,000 ensued which allowed the association to get out of its debt and back on its feet.

The Association also began a serious outreach to engage the six schools of pharmacy by traveling to the schools and holding meetings on campus. As online resources continued to expand so did the association’s efforts in this regard. A new database system, online communications, a new website and more were announced.

Conferences were altered for more focus on CEs and a shorter timeframe, along with adding student programs.

IMPORTANT EVENTS 2001 2001 2003 2004

The 9/11 attacks The iPod is introduced Gulf War II is started Google starts defining internet searches 2005 Hurricane Katrina devastates New Orleans 2005 YouTube and blogging start challenging traditional media 2006 Medicare Part D begins 2006 Social networking starts defining connections 2008 America experiences & 2009 its worst depression since the Great One 2010 The ACA is signed into law 2011 Navy SEALS take down Osama Bin Laden 2012 Washington and Colorado legalize marijuana 2015 US Supreme Court allows same-sex marriage 2015 Over 2/3 of Americans own Smartphones 2016 NFL announces $100 Million concussion initiative 2017 The polarization of & 2018 American politics continue to rise.

Part D — boom or bust?

By 2006, Medicare Part D was kicking off and the Association hosted four large events across the state in cooperation with the schools to help pharmacists understand and prepare for this benefit. For many pharmacists, Part D was either a mixed blessing or even possibly a curse depending on the time and place. Navigating through all of the rules and programs was a challenge and patients were equally stressed. But the years have rolled by and it is now a fact of life for seniors.

And then there were seven…

Beginning in 2000, colleges of pharmacy were required to only award the PharmD degree, which initially sparked some controversy and objection to change, along with sparking a reduction in the workforce, exasperated by the coming of Part D which then caused a significant growth in the applications to open pharmacy schools. Today, the Doctor of Pharmacy degree is the accepted norm and the curriculum pathway including IPPE and APPE fully standardized. In all of this, Pennsylvania saw the coming of a seventh school of pharmacy, the Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy, and its offering of an accelerated post graduate three year path.

Professional practice moves forward…

This period also marked some important legislative successes when it came to practice changes. In 2002, after great debate, an act was passed allowing pharmacists to provide vaccinations for those over the age of 18 and permitting collaborative agreements in the institutional setting only. It took over six years for these to become a reality. This was followed up by permitting collaborative agreements in all practice settings and then expanding to the flu vaccine for nine years of age and up. Regulations are still pending for student interns to immunize but they are coming. PPA continues to push for increased vaccination permissions.

On a national level, a cohort of national pharmacy organizations have joined forces to change federal legislation which would recognize pharmacists as providers in Medicare and Medicaid and that initiative continues to make progress. Many more challenges and opportunities lie ahead for practice advancement and PPA intends to work on introducing legislation allowing the prescribing by pharmacists of tobacco cessation medication.

Efforts to keep community pharmacy alive and well….

Throughout this period though the business issues facing community pharmacy have been at the forefront

DID YOU KNOW? One of Pennsylvania’s Capitol building’s most noteworthy features is the colorful Moravian tiles that cover the first floor of the Rotunda and its adjacent corridors. Designed and manufactured by Henry Chapman Mercer (1856-1930) of Doylestown, the floor is interspersed with close to 400 tile mosaics illustrating the state’s history, animals, industries, occupations and modes of transportation. The tiles are thought to be some of the finest examples of Pennsylvania German folk art. Pharmacy can boast its own Mortar tile marking the profession!

of PPA activities and recent years have seen some successes and some disappointments. Despite enacting anti-mandatory mail order legislation, PBM registration, fair audits, generic and MAC transparency, and more, the limitations of enforcement claimed by the Insurance Department for federal programs, Medicaid, and for ERISA exempted plans have handcuffed our ability to have significant impact. Still PPA and our members plug away at meaningful PBM reforms.

Continued on next page

ANNUAL MEETINGS 2018 Lancaster, PA, Lancaster DoubleTree 2017 Pocono Manor, PA, Kalahari Resorts and Conventions 2016 King of Prussia, PA CrownePlaze Valley Forge 2015 Grantville, PA, Holiday Inn Harrisburg Hershey 2014 Mars, PA, Sheraton Piottsburgh North 2013 Gettysburg, PA, Wyndham Gettysburg 2012 Scranton, PA, Scranton Hilton

2011 King of Prussia, PA, Crowne Plaza Valley Forge 2010 Mars, PA Sheraton, Pittsburgh North 2009 Lancaster, PA, The Eden Resort 2008 Gettysburg, PA, Wyndham Gettysburg 2007 Allentown, PA, Holiday Inn and Conference Center 2006 King of Prussia, PA, Crowne Plaza Valley Forge 2005 Champion, PA, Seven Springs Mountain Resort

2004 Harrisburg, PA, Wyndham Harrisburg-Hershey 2003 Pocono Manor, PA, Pocono Manor Inn 2002 Hershey, PA, Hershey Lodge and Convention Center 2001 Champion, PA, Seven Springs Mountain Resort 2000 Philadelphia, PA, Adam’s Mark Hotel

www.papharmacists.com 29

2000–2018 — Start of a New Decade continued Recently this fall considerable effort, through the Auditor General Hearings and legislative discussions, is paving the way for legislative bills in next session.

networks, becoming the second largest one in the country. PPA looks for plenty more growth and opportunity for PPCN in the coming years.

Making a contribution…

Saving our pharmacy home…

PPA’s Educational Foundation also came of age in this time period. Founded in the late 90s it struggled for many years, but after getting new life through some dedicated members’ leadership, the Foundation now sponsors many student programs, provides numerous practice based grants, and is building its reserves to continue its efforts well into the future as it takes over actual ownership of the PPA Building.

A network of care….

Starting in 2010, PPA began supporting a new initiative which was created to serves a new model for community pharmacies to show their value and provide meaningful patient care. The initiative has slowly morphed into a new business arm of PPA, the Pennsylvania Pharmacists Care Network or PPCN. In 2017, PPCN launched its first payer contract and joined the Community Pharmacy Enhanced Services Network (CPESN), a network of

Finally 2018 marked a critical year for PPA has the Board determined that retaining our beautiful, but in disrepair, art deco building located across from the state Capitol building was important and committed serious funding to repair and restore it. This included embarking on another Capital Campaign to help offset the cost. When completed in the coming months, our building will continue to be the heart and home of Pennsylvania Pharmacy for years to come.

Through these years, our leaders continued to step up to the plate to help the profession navigate through sometimes rough waters; but, the Pennsylvania Pharmacists Association continues to lead the profession forward. As we celebrate 140 years, it is only fitting that we wish for another 140 years of advocating for the profession and advancing patient care!

30 Pennsylvania Pharmacist — Nov/Dec 2018

HISTORICAL PHARMACY EVENTS 2001 A Historical Marker was placed in Philadel­ phia for the American Pharmaceutical Association. This Professional society was created, Oct. 6–8, 1852, to assure quality and safe distribution of drugs. Pharmacists from eight states met in a building nearby for the founding meeting; among them was Philadelphian William Proctor, Jr., “Father of American Pharmacy.”

2005 Carl’s Drug Store celebrated its 180th anniversary as the oldest, continuously operating drug store in the United States.

To mark the celebration, a booklet chronicling the history of Carl’s Drug Store was published by Frank Ervin. In addition, an old-fashioned, hand-held church fan, featuring the image of a glass slide that was used as an advertisement for the drug store in the local Greencastle theater, was produced. Both the booklet and fan were given away as mementos of the 180th anniversary.

2013 Historical Marker was placed at the former Tassell Pharmacy in Latrobe where the first documented Banana Split was created by apprentice pharmacist David Strickler.

PPCN Gains National Recognition!

This fall brought national attention to PPCN’s tremendous growth and leadership. As one of the largest local CPESN USA networks, PPCN now has a seat at the CPESN Board of Managers. CPESN USA is directed by a Board of Managers who are elected by the local networks. CPESN USA now has almost 1,800 pharmacies in 45 local networks nationwide. PPCN is one of the 14 networks to have over 40 members and is therefore able to elect a member to represent PPCN on the Board of Managers. PPCN is pleased to announce that Gatti Pharmacy Owner, Stephanie Smith Cooney, PharmD will be representing PPCN! Stephanie is a long-standing, active member of PPA. Early on, Stephanie heard of the idea of highperforming pharmacies networking together and didn’t hesitate to join.

Knowing she had to be a part of this significant change within the pharmacy industry, she was of the first to join both PPCN and CPESN USA.

She is ecstatic to be networked together with so many innovative pharmacists to help patients thrive.

Thanks, in no small part, to Stephanie, PPCN is one of the largest CPESN networks in America and has several active payer engagements. Her efforts have been recognized by her fellow pharmacists both in Pennsyl­ vania and across America, as she was one of three finalists for the 2018 CPESN Luminary-of-the-Year Award.

Stephanie is encouraged to see growth in and development of so many local networks, especially PPCN, as they undergo positive changes from joining CPESN USA. So, what’s next for Stephanie and PPCN? Stephanie says that PPCN is working tirelessly to engage more payer opportunities, expand the network, and ensure care delivery is “top-notch.” Always open to learning, Stephanie is eager to take on the challenges Gatti Pharmacy, PPCN and CPESN USA have in front of them.

Strategic Planning Underway

Find a Pharmacy!

PPCN held a productive strategic planning session in September during which PPA and PPCN Board members joined with PPCN Luminaries to evaluate the current state of PPCN and plan for the future.

It was clear during that session that Pennsylvania is one of the leading CPESN networks, and that our infrastructure, support from PPA, and expertise of our members has enabled great success. 2018 has been a year of growth in membership and engagement with payers, and 2019 will bring continued success!

This fall PPCN was pleased to announce the official launch of the PPCN Pharmacy Locator website! All PPCN pharmacies are “findable” on this site, and can be searched by geographic location or by services provided (adherence packaging, home delivery, etc).

PPCN is actively and frequently marketing this locator to health plan partners, providers, care managers and other stakeholders so that they can refer patients to our pharmacies for the enhanced services that their patients or members need.

Want to find a PPCN Pharmacy? Visit this site, or simply scan the QR code on your smartphone! www.papharmacists.com/locate If you would like to learn more about PPCN, visit http:// papharmacistsnetwork.com/ or email PPCN Executive Manager Stephanie McGrath, PharmD at smcgrath@papharmacists.com PPCN wishes you all a healthy holiday season!

32 Pennsylvania Pharmacist — Nov/Dec 2018

Campus Checkup

LECOM School of Pharmacy Jefferson College of Pharmacy Contributed by: Nicole Leshko, Communication Ambassador This June, members of PPA and APhA-ASP joined together to run Jefferson College of Pharmacy’s first ever Healthy Heart 5K and Health Fair.

During this event, we hosted a 5K at FDR Park in Philadelphia, PA. This event was open to the public where participants were able to attend our student-run health fair and receive blood pressure screenings, diabetes education, healthy habit education and smoking cessation counseling in addition to running a 5K! Jefferson’s PPA and APhA-ASP members had so much fun at this event and it was such a success—we plan to continue this 5K and Health Fair this coming year!

Contributed by: Maria Peluso, Communication Ambassador The last couple of months at LECOM Erie have been very busy! We had our first membership drive the week of 9/10, and are working diligently to get students to either join or renew their current memberships. We hope to assist many of these students to be future activists in PA pharmacy. To further support our school PPA board, we have elected several P1’s as co-chairs to develop the skills needed to take on board positions in the next school year.

Kirk Guidotti will be our Membership Ambassador CoChair, Oluwayomi Adeniyi will be our Communications Ambassador Co-Chair, and Rukia Hashmy will be our Government Relations Ambassador Co-Chair. Our Alternate Director will be Cody Staebler. We are so happy to have them on our board and spread the word about PPA. We are looking forward to our events planned for the near future which consist of blood pressure clinics and advocacy events!

Ohio Northern University Raabe College of Pharmacy Contributed by: Morgan Augustine, Communication Ambassador Classes have started, and our members are excited for the start of a new year. Being a fairly new pharmacy organization on campus, we at the ONU chapter of PPA is still establishing its role in the college. We had a successful membership drive, gaining interest from several of the Pennsylvania residents in the Raabe College of Pharmacy. In addition, we are making plans to collaborate with other organizations at the university, including APhA-ASP, to create more opportunities for outreach, personal development, and networking for our members.

We are also looking forward to sending representatives from our chapter to the annual PPA conference. As we continue to grow as an organization, we look forward to having a stronger presence on our campus and at future conferences!

Philadelphia College of Pharmacy Contributed by: Kayla Askey, Communication Ambassador The Philadelphia College of Pharmacy student PPA chapter was very active this semester! The semester started quickly with a well-attended general interest meeting and a local competition for the brand-new Diabetes Competition. In October, students from our student chapter of PPA teamed up with other pharmacy 34 Pennsylvania Pharmacist — Nov/Dec 2018

organizations to participate in a Collaborative Health Fair, held at a local church in West Philadelphia. There, students measured community members’ body mass index (BMI) and discussed healthy living strategies. Additionally, we wrapped up the semester with a local OTC Competition to determine who would represent our student chapter at the Mid-Year Conference competition in January.

Throughout the semester, we fundraised by selling “Herbie

the Hedgehog” stuffed animals to students, faculty, and staff across campus to donate to children at the Children’s Hospital of Pennsylvania. Furthermore, we held events to introduce students to the GRASP program and a letter writing campaign that was brought to every event. Overall, the Philadelphia College of Pharmacy student PPA chapter led a busy and fulfilling semester, and has many plans for the semester to come!

Temple University School of Pharmacy Contributed by: JJ Lapin, Communication Ambassador After returning to campus after a restful summer, the Temple Pharmacy chapter of PPA got down to business right away, recruiting new members at a school-wide welcome back barbeque! At this event, we set up a table where we spoke with new PY1 students about what PPA was all about, what we have planned for the upcoming semester, and how they could get involved. We also had our first community outreach event, where students ran a flu clinic as part of a wellness fair at a local church. At this event, students helped educate the public on the importance of immunizations and assisted the pharmacist in enrolling 20 people to get their annual flu shot! We are the final stages in planning both a blood pressure screening event and a Katy’s Kids outreach event at a local elementary school, so we are very excited for a productive year at Temple!

University of Pittsburgh School of Pharmacy Contributed by: Emily Dell, Communication Ambassador The University of Pittsburgh Chapter of PPA has a lot planned for the upcoming semester. Every school year, the different pharmacy organizations represented in our school work together to advocate for the “Dean’s Theme,” a broad theme around which we base projects and events. These topics stem from the ones focused on by APhA-ASP. This year, our theme is Operation Heart, which focuses on how pharmacists can play a role in the heart-health of their patients. Some of our chapter members attended the Annual Picnic held by the Allegheny County Pharmacists Association (ACPA) in Schenley Park near the University of Pittsburgh’s campus. During this event, we had the opportunity to network with pharmacists and other pharmacy students from the area. This year, the University of Pittsburgh is launching the Primerx Program which exposes pharmacy students to career opportunities that will be available to them after graduation. Pitt PPA hopes to incorporate something with financial literacy into the program, but more is yet to come!

Board members that attended the Allegheny County Pharmacists Association (ACPA) Picnic on Wednesday, September 12th in Schenley Park. From left to right: Emily Dell (P2), Hailey Mook (P2), Mara Cubellis (P2), Abby Kois (P3), Divya Patel (P3)

www.papharmacists.com 35

Campus Checkup continued Wilkes University: Nesbitt School of Pharmacy Contributed by: Rachel Wood, Communication Ambassador The fall semester at Wilkes has been off to a great start! We had a lot of fun surprising our new P1 class with pharmacy vials filled with treats and membership forms from PPA taped under their seats in class. In addition, we welcomed many new and returning pharmacy students at our club mixer and welcome back breakfast.

Our Katy’s Kids events have been going great. We have had the opportunity to attend 2 daycares and a health fair to teach the importance of candy vs. medicine. We are super excited for the Katy’s Kids events we have set up for the remainder of the semester as well!

In addition to Katy’s Kids, we are looking forward to our blood pressure screenings, teaming up with APhA for our opioid epidemic committee, our club social, and the upcoming conference!

Jefferson College of Pharmacy my first year, I teamed up with students from “During other healthcare professions in several interprofessional activities. I am confident that wherever I practice, I will have a great understanding of how to collaborate with a team to provide patient-centered care.

”

Advantages of being a Jefferson pharmacy student include: • Interprofessional learning at the beginning and throughout the curriculum

Mirna Rezkalla Student Pharmacist Class of 2019

• JCP is a recognized leader in the provision of inter­ professional education (IPE) Entering pharmacy students identify the focus on IPE as a strong reason to select Jefferson.

View our pharmacy licensing exam scores, postgraduate match rates and more: Jefferson.edu/PharmDOutcomes

Pharmacy and the Law: Marijuana Development

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.

Back in 2014, this series explored the legality of marijuana, medical and otherwise, as state laws diverged from Federal law. This divergence started with California in 1996. Two concepts discussed in that article have not changed; the Supremacy Clause and Enforcement Discretion.

If the bill introduced by Senator

The Supremacy Clause is a provision in the United States Constitution and it states that Federal law is supreme to state law.1 Generally, states may enact laws that are more stringent than Federal laws, but not more lenient. For example, a state can move a Schedule III up to a Schedule II or move a non-controlled drug into Schedule IV within their borders. But a state is unable to move a Schedule II down to Schedule III. This is a basic tenet in the relationship between Federal and state laws. However, this tenet seems to have been forgotten as states moved to legalize marijuana and associated products within their borders.

conversation on marijuana in the United

One reason that this has occurred is another concept known as Enforcement Discretion. This occurs when an agency responsible for the enforcement of a law decides to not enforce that law. An earlier example of this concept was the importation of prescription drugs from Canada.

The Food & Drug Administration (FDA) stated that all importation was illegal, but they exercised their discretion and would not prosecute those bringing in these drugs for their own use. In essence, the activity is still illegal, but the agency chooses to do nothing about it. The Drug Enforcement Administration (DEA) has been following this course since at least the publication of the Ogden memo in 2009.

gets in the way, it may be the additional

The caveat here is that the agencies always have the ability to change their minds.

Two recent developments have the potential to radically change the marijuana discussion. The first is the publica­ tion of a DEA internal directive on May 22, 2018.2 The clarification provided in this directive is that products and materials made from the parts of the marijuana plant that are not included in the definition of marijuana under the Controlled Substances Act (CSA) are not themselves controlled under the CSA. The directive goes on to say, “the mere presence of cannabinoids is not itself dispositive as to whether a substance is within the scope of the CSA ... ” This is a reversal from the position taken by DEA in a news release in 2001 that stated that any product that causes THC to enter the human body is a Schedule I substance.

Essentially they were saying at that time was that any product that has any THC in it is a controlled substance.

What this change in direction might mean for future enforcement actions by DEA is uncertain at this time.

38 Pennsylvania Pharmacist — Nov/Dec 2018

Charles Schumer on June 28, 2018 passed, it would completely change the States. There has been a huge shift in public opinion on this issue, especially in the last 20 years or so. It is too early to tell if the bill has enough support in Congress to get passed. If anything requirements and studies that are created in the bill. Each of them comes with their own appropriations, so the fight may come down to the budget. Stay alert for new developments — there will almost assuredly be more coming!

The second recent development was the introduction of a bill by Senator Charles Schumer of New York on June 28, 2018.3 This bill may render the previous discussions moot.

The main objective of the bill is the removal of marijuana and THC from Schedule I of the CSA. The bill also amends a number of U. S. Code sections to remove marijuana and THC from them. Examples of these include removing them from the definition of felony drug offense and from the mandatory sentencing guidelines. If marijuana and THC are no longer Schedule I substances, there is no longer any disconnect between state and Federal law. The states would clearly be free to regulate marijuana as they see fit.

The law also creates some other related funds and requirements. First, the bill creates a fund to provide small business loans to women and socially and economically disadvantaged people who want to operate a marijuana business. It also directs the National Highway Traffic Safety Administration to study the impact of driving under

the influence of THC on highway safety. The bill goes on to direct the Secretary of Health and Human Services to conduct research on various health issues involving marijuana, such as the effects of THC on the brain, efficacy of marijuana as treatment for specific conditions, and the identification of additional medical uses for marijuana. The bill would also restrict advertising of marijuana products if needed for the protection of the public health, especially for individuals who are 18 years old or younger. Lastly, the bill would provide funds for grants to states to allow them to set up programs to expunge previous marijuana convictions.

If passed, this bill would completely change the conversa­ tion on marijuana in the United States. There has been a huge shift in public opinion on this issue, especially in the last 20 years or so. It is too early to tell if the bill has enough support in Congress to get passed. If anything gets in the way, it may be the additional requirements and studies that are created in the bill. Each of them comes with their own appropriations, so the fight may come down to the budget.

Stay alert for new developments — there will almost assuredly be more coming!

CITATIONS 1 Montana’s authority is based on a decision by the Montana Supreme Article 6 - This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.

2 https://www.deadiversion.usdoj.gov/schedules/marijuana/dea_ internal_directive_cannabinoids_05222018.html 3 Marijuana Freedom and Opportunity Act - https://www.congress.gov/ bill/115th-congress/senate-bill/3174/text?q=%7B%22search%22%3A% 5B%22schumer+marijuana%22%5D%7D&r=1 © 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.

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Your patients.

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www.papharmacists.com 39

Financial Forum: Are Too Many Baby Boomers Too Indebted?

Financial burdens could alter their retirement prospects.

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.

Imagine retiring with $50,000 of debt. Some new retirees owe more than that. Outstanding home loans, education debt, small business loans, and lingering credit card balances threaten to compromise their retirement plans.

How serious is the problem? A study from the University of Michigan’s Retirement Research Center illustrates how bad it has become. Back in 1998, 37% of Americans aged 56-61 shouldered recurring debt; the average such household owed $3,634 each month (in 2012 dollars).

Today, 42% of such households do – and the mean debt load is now $17,623.1 Are increased mortgage costs to blame? Partly, but not fully. Quite a few homeowners do trade up or refinance after age 50. The Consumer Financial Protection Bureau notes that between 2001-2011, the percentage of homeowners 65 and older carrying a mortgage went from 22% to 30%. The data for homeowners 75 and older was more alarming. While 8.4% of this demographic had outstanding home loans in 2001, 21.2% did by 2011.2 Education debt is weighing on boomer households.

According to the Motley Fool, the average recent college graduate has $30,000–$35,000 in outstanding student loans. It would take monthly payments of $300–$400 over a decade to eradicate that kind of debt.3 As good debts have risen, bad debts have also grown.

MagnifyMoney, a financial analytics website, pored over the most recent round of UMRRC data and determined that 32% of older consumers now contend with revolving debt each month. The average recurring non-mortgage debt for these seniors: $12,490, of which $4,786 is attributed to credit cards. A staggering 22% of older Americans have more than $10,000 in revolving credit card debt – pretty painful when you consider that the average credit card carries 14% interest.1 One school of thought says that retiring with a mortgage is okay. Interest rates on home loans are rising, but they are still not far from historic lows, and homeowners who have bought or refinanced recently could be carrying loans at less than 4% interest. While carrying mortgage debt into retirement may be bearable, owning a home free and clear is better.

How about you? Can you retire debt-free? It may seem improbable, but if small steps are taken, that goal may come within reach. Every year you delay retirement is another year you have full financial power to attack debt.

Working longer may not be ideal, but it can give you 40 Pennsylvania Pharmacist — Nov/Dec 2018

How about you? Can you retire debtfree? It may seem improbable, but if small steps are taken, that goal may come within reach. Every year you delay retirement is another year you have full financial power to attack debt. the potential to start retirement owing less. Cutting off financial support for young adult children can also free up money to pay down debt. They have many more years to pay off what they owe than you do. You could also think about moving to a cheaper home, driving a cheaper car, or living in a cheaper state; any linked short-term financial expenses might pale in comparison to the potential savings. Whether you pay off your smallest debts first or your highest-interest ones, you are subtracting burdens from your financial life. The fewer financial burdens you have in retirement, the better.

CITATIONS 1 forbes.com/sites/nextavenue/2017/09/20/how-debt-is-threateningretirement-dreams/ [9/20/17] 2 cbsnews.com/news/mortgage-tips-for-retirees-and-near-retirees/ [10/20/17] 3 tinyurl.com/ybgvt7po [9/29/17] 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

How Can Health Kiosks Facilitate Patient Engagement?

Corresponding Author: Sophia Cothrel, PharmD Candidate Class of 2019, University of Pittsburgh School of Pharmacy Author: Olufunmilola Abraham, PhD, MS, BPharm, University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics This is an original manuscript and we have no conflicts of interest to disclose.

Key Words

The value of using health kiosks to

Kiosk • Patient care • Health education • Health information

facilitate effective communication

Abstract

between patients and healthcare

The purpose of this manuscript is to describe how health kiosks have evolved to increase access to health information and patient engagement. Health kiosks were first introduced to promote public health by providing easy access to educational resources to individuals with difficulty acquiring health information. Health kiosks now offer a range of features beyond disseminating health information in both clinical and non-clinical settings. The acceptance of health kiosks by users within the general public is a key factor in predicting their use. Numerous studies have found that health kiosks are typically easy to use and useful, but the user-interface of kiosks needs to be better designed to facilitate learning of health information. One benefit of kiosk use is increased user knowledge on information presented by kiosks such as condition-related health information, and another is self-reported positive behavior change in diet and exercise. An additional potential benefit of using kiosks is increased communication between patients and healthcare professionals. The value of using health kiosks to facilitate effective communication between patients and healthcare professionals has been significantly understudied. Since health kiosks are useful for facilitating patient-provider communication, they could be a critical approach to improving patient engagement and health outcomes. Emerging uses of health kiosks could provide users with greater incentives to use kiosks because they allow patients to more directly engage in managing their own health. More research is needed to elucidate how user demographics, kiosk settings, and acceptability of kiosks may influence health outcomes.

Introduction Health kiosks are interactive computer terminals with screens that provide access to health information or otherwise engage users in their healthcare. The purpose of this manuscript is to describe how health kiosks have been used, their benefits, and how they continue to evolve to increase access to health information and patient engagement. The development and implementation of health kiosks for community use to improve public health first began in the early 1990s.1 A primary reason

professionals has been significantly understudied. Since health kiosks are useful for facilitating patient-provider communication, they could be a critical approach to improving patient engagement and health outcomes.

for introducing health kiosks with modules and internet access into public settings was to increase access to health information.1-3 Prior to kiosk implementation, there was insufficient access to specific health information tailored to patients’ preferences and needs. Health information provided by kiosks varies widely; examples of health information include but are not limited to specific information on conditions such as obesity or high blood pressure as well as general tips on health and safety. Health kiosks make it easier for patients with limited access to healthcare providers or the internet to seek and receive health information.1-6 In more recent years the role of health kiosks has expanded, and it is evolving continuously as technology and health information advance. Kiosks now offer a range of features beyond disseminating health information, which include measuring patient health parameters such as weight and obtaining patient medical information in clinical and non-clinical settings. As the design of health kiosks evolves, this health information technology has the potential to facilitate and increase patient engagement in healthcare.

For the full article, please visit http://www.papharmacists.com/?page=Articles.

www.papharmacists.com 41

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