PA Pharmacist September/October 2019

pennsylvania

PHARMACIST

PRSRT STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 533

September/October 2019 • Volume 100 • Issue 5

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CONTENTS ON THE COVER: PPA BOARD OF DIRECTORS PPA OFFICERS President: Richard Demers, MS, RPh, FASHP President Elect: Chuck Kray, RPh Vice President: Thomas Franko, PharmD, BCACP Immediate Past President: Lauren Simko, PharmD REGIONAL DIRECTORS Central Region: Deron Shultz, RPh Northeast Region: Vick Shah, PharmD, BCPS Northwest Region: Brandon Antinopoulos, PharmD Southeast Region: Karleen Melody, 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: Elizabeth Leonard 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: Vacant Bookkeeper: Michele Dibble mdibble@papharmacists.com | Ext. 4 PPCN Executive Manager: Stephanie McGrath, PharmD smcgrath@papharmacists.com Pennsylvania Pharmacists Association (PPA) 508 North Third Street, Harrisburg, PA 17101 (717) 234-6151 Fax: (717) 236-1618 www.papharmacists.com | ppa@papharmacists.com Pennsylvania Pharmacist (ISSN 0031-4633) is the official publication of the Pennsylvania Pharmaceutical Association d/b/a Pennsylvania Pharmacists Association and is published every other month, six times per year. Annual subscription is $100 for non-members; for members it is included in the annual dues. Editorial information should be addressed to the PPA address listed above. Peer reviewed articles accepted according to the stated guidelines available from PPA.

EDITORIAL BOARD Hershey S. Bell, M.D.,M.S.,FAAFP Kim Coley, FCCP, PharmD, RPh, Chair Michael Gionfriddo, PharmD, PhD Yardlee Kauffman, PharmD, MPH, BCACP Jinsun Paek, PharmD, BCPS Associate Editor: Victoria Madonna Editor/Manager: Pat Epple PUBLISHED BY GRAPHTECH Alexis Kierce, Publications Manager (717) 238-5751 x119 alexis@thinkgraphtech.com For Advertising Information: Jen Smith, Account Manager (717) 238-5751 x124 jen@thinkgraphtech.com DESIGNED BY GRAPHTECH PHARMACIST STATE BOARD OF PHARMACY MEMBERS Institutional: Gayle Cotchen, BSPharm., PharmD., MBA Independent Community: Rob Frankil, RPh Chain Community: Janet Hart, RPh Chain Community: Theresa M. Talbott, RPh Board of Pharmacy Meeting Dates: August 27, 2019 October 22, 2019 December 10, 2019 January 28, 2020

MEDICAID: Our #1 Priority this Fall PPA brings representatives from the House and Senate, Standing Committees, Department of Human Services and the governor’s office together in one room with pharmacists to discuss Medicaid issues, including PBMs, PSAO’s, appeals, payment and the necessary fixes needed moving forward.

DEPARTMENTS 5

President’s Message

7

Calendar of Events

8

Member News

10 Affiliated Member News 12 Welcome! New Members

FEATURES 13 Student Member Profile 14 Legislative Profiles 15 Member Profile 16 Pharmacy Spotlight 18 Medicaid Issues Top PPAs Summer and Fall Advocacy Agenda 23 Debunking 3 Independent Pharmacy Marketing Myths 30 Community Pharmacist-Provided Smoking Cessation Services: Partnering with STRAND

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

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

ASSOCIATION NEWS 20 PPCN Update 22 Congratulations to the recipients of the 2018 Educational Foundation Student Scholarships!

26 PPA 2018-2019 Annual Report 32 GRASP Graduate List

RESEARCH 24 Using the FINER Criteria to Evaluate Your Research Question www.papharmacists.com 3

Give Immunizations a Shot

Value Drug Company can help you launch a year-round immunization program that helps turn your pharmacy into a healthcare destination within your community.

The market for vaccinations is expected to reach $49.3 billion by 2022, representing a 7.5% compound annual growth rate from $32.3 billion in 20161. Combined with the fact that 93% of Americans live within five miles of a pharmacy2, vaccines provide an opportunity for independent pharmacists to boost revenue and broaden their customer base.

It’s been estimated that a vaccination rate of 20% can result in a 6% increase in frontend sales3. With an average profit of $23 per vaccination, you really have nothing to lose but money.

Offering immunizations has been a great way to grow [our] business. It was a good opportunity to help bring on new patients and keep existing patients from going to the competition. We just started in the fall of 2018 and have completed over 100 flu shots. Value Drug Company was extremely helpful in helping us set up the program. They streamlined our process and were always available to answer our questions.”

Richard Pipek | Pharmacist Brown’s Drugs Boardman, OH

Learn more about our immunization program and the many benefits of Value Drug membership.

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195 Theater Drive, Duncansville, PA 16635 | phone: 1-800-252-3786 | www.valuedrugco.com Marotta, R. (2018, August 20). Let’s get down to business: The value of pharmacy immunization.

Retrieved from https://www.pharmacytimes.com/publications/issue/2018/august2018/lets-get-down-to-business-the-value-of-pharmacy-immunization 1

2,3

Dudzinski, R. (2017, August 29). Immunizations: shot in the arm for retail pharmacy. Chain Drug Review. Retrieved from https://www.chaindrugreview.com/immunizations-shot-in-the-arm-for-retail-pharmacy/?rel=0

President’s Message Our members are the backbone of PPA and I can’t thank you enough for giving me the opportunity to serve and lead the organization in this role. I believe PPA is in a great position to continue to have our voices heard and make an important impact in ongoing changes and challenges within healthcare.

PPA continues to focus on a number of areas of opportunity; ongoing professional practice advancement, networking and communications, and advocacy and government affairs. In each of these areas we have efforts in place to make significant progress.

For example, in the area of advocacy, PPA is working with the Department of Human Services (DHS) on a weekly basis on several issues. It is important to note that we bring every complaint we receive from our members to the attention of the Department immediately. We have the ability to let the Department know how the implementation of their contracts and rules are working in reality. Many issues with Medicaid, MCO’s and PBMs are unknown until PPA alerts them.

We are also working with all stakeholders on agreeable language to our Medicaid Transparency Package of legislation so that the legislation won’t face as many challenges and can move swiftly through the legislative process in both the House and the Senate, along with new rules for mandatory 90-day fills issue.

I would challenge all who are members of PPA to take an active role in our organization. Many ask me about the benefits they get from PPA, and I tell them we get out at least twice what we put in once we start to get involved.

The future of Pharmacy is to become vital part of healthcare.

Pharmacists are now being recognized as an important resource to help patients succeed with their medication therapies. PPA will continue to play a crucial role in the effort to advance Pharmacists’ practice. The Pennsylvania Pharmacists Care Network, a program that leads the nation in patient support, is just one example. We will all need to continue to support this important program through the next year and years to come. We will also need to provide a balance of education, professional networking and advocacy that is important to our continued success in the upcoming years.

Richard Demers, RPh, MS, FASHP PPA President 2019–2020

“Healthcare is at a cross roads and is in the cross hairs of our government” — Richard Demers

Healthcare is at a cross roads and is in the cross hairs of our government. There is no question that it is poised to undergo substantial change in the future. These changes will provide both risks and opportunities for the practice of pharmacy. If we can all work together as a unified profession, we stand well positioned to create opportunities for us to best serve our patients. Again, I thank everyone for their support and look forward to working with you all over the next year.

www.papharmacists.com 5

Calendar of Events September 19–22

2019 PPA Annual Conference – Seven Springs, PA

20

Advertisers Index RDC 2 Value Drug Company 4 PRS 6

PPCN Board of Directors Meeting

Jefferson 9

20

EPIC 21

PPAEF Board of Directors Meeting

22

PPA Board of Directors Meeting

R.J. Hedges 25 APMS 33 Amerisource Bergen 33

October

IPBG 35

15

CE Webinar: Medication Synchronization with a (Helical) Twist: Incorporating Medication Management in to a Medication Synchronization Program – 12PM

Pharmacists Mutual 36

26–29 National Community Pharmacists Association Annual Conference – San Diego, CA

26–29 American College of Clinical Pharmacy Annual Conference – New York, NY

December 5

PPA Board of Directors Meeting – Harrisburg, PA

8–12

American Society of Health System Pharmacists Mid-Year Clinical Meeting – Las Vegas, NV

January

“On behalf of the Editorial Board,

23–26

2020 PPA Mid-Year Conference - Harrisburg, PA

24

PPCN Board of Directors Meeting

24

we appreciate the contributions by our members to showcase their clinical, teaching, and research experiences. Sharing your work inspires

PPAEF Board of Directors Meeting

24

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

FOLLOW US ON SOCIAL MEDIA @PAPHARMACISTS

others to innovate in their own professional settings and creates new opportunities for collaborative work.

Thank you for your support!”

-Yardlee Kauffman, PharmD Editorial Review Board Member

www.papharmacists.com 7

Member News Exciting Things on the Docket for PPCN PPCN Board Members and Luminaries met for a 1.5 day strategic planning session at the PPA office. The initiative developed some exciting and aggressive strategies for keeping our PPCN pharmacies relevant in the marketplace. Watch for more announcements!

Congratulations to Wilkes University Graduate, Allie Fanucci, a 2019 Recipient of the PPA Outstanding Student Award!

“I am humbled and honored to have received the Outstanding Pharmacy Student Award for Wilkes University. I attribute my involvement with PPA to so much of my leadership development as well as overall want to do more for our profession. Upon graduation, I will be working as a pharmacist with CVS Health and cannot wait to make a difference in the neighborhood I will be serving. It is my plan to continue to advocate for our profession through PPA, especially for community pharmacists. We are the future of our profession and we are the ones who will be making a difference!”

Pictured Left to right, top row: Rob Maher, Ron McDermott, Rick Demers, Stephanie Thomas, Nick Leon and front row, Stephanie Smith Cooney, Chris Antypas, Stephanie McGrath, Melissa McGivney, and Kristen Hartzell

Congratulations to Yardlee Kaufman!

Congratulations to Yardlee Kauffman, PPA Editorial Review Board member on her recent marriage. Yardlee and her husband tied the knot in Asheville, NC in May 2019. Congratulations to Yardlee!

Share Your News With Us! Share your news with us — send all snippets of achievements and honor to PPA’s Membership and Marketing Coordinator — Victoria Madonna at vmadonna@papharmacists.com.

8 Pennsylvania Pharmacist — Sept/Oct 2019

Jefferson College of Pharmacy D O C T O R O F P H A R M AC Y M S P O P U L AT I O N H E A LT H P H A R M AC Y Learn more at Jefferson.edu/Pharmacy

www.papharmacists.com 9

Affiliated Member News Lancaster County Pharmacists Association (LCPA) Update In June, LCPA held their annual scholarship interviews for pharmacy students who reside in Lancaster County.

The scholarships are awarded based on academics, financial need, and overall character. This year, LCPA awarded scholarships to six impressive individuals. Thank you to the following who make these scholarships possible: Gerald and Suzanne Ganse Family Foundation

Bob and Coleen Kayden

Ted Search and Family

Werner and Mary Clayre Ortmann

P.J. Ortmann and Family

Mrs. Donald DeLong

Richard H. Williams

All LCPA members

The Wiley Families

The Royer Families

Save the date of Sunday, October 20th! LCPA will hold a scholarship fundraiser at Issac’s at Granite Run in Manheim. The scholarship fund will gain 25% from in house sales and 15% from gift card sales. Keep an eye out for the flyer!

LCPA will be back with regular meetings starting in the fall. Please check www.lancasterpharmacists.com for the meeting schedule and information on upcoming events.

BucksMont Pharmacists Association (BMPA) Update Spring Social Event/CE Program Offered at Recent BMPA Meeting The BucksMont Pharmacists Association sponsored a social event and CE program on June 6 at P.J. Whelihan’s Pub in Blue Bell, PA. About 30 members and guests attended the event. After an hour of socializing, networking and enjoying delicious hors d’ouevres, attendees assembled for the CE portion of the program. BMPA president-elect and PA State Board of Pharmacy member Rob Frankil presented a one hour CE program on “A Review of Pennsylvania’s Standing Naloxone Order.” Rob’s presentation was lively, energetic and interactive, as many attendees became actively engaged during the presentation. Rob covered a broad area related to naloxone itself as well as the specifics of the standing order including how to identify a person suspected of overdose, available dosage forms to administer, refills and answered many questions from the audience. It is recommended that in order to be best prepared to administer naloxone, pharmacists should enroll in a training program available from the PA Department of Health.

Immediately following the CE program BMPA president Steve Pfeiffer called to order an open business meeting. Event manager Ashley Robold discussed our upcoming plans for an outing to the Reading Phillies on Sunday, August 18, 2019. BMPA is hosting a buffet from 1:00-3:30 and game time is 2:15.

The cost is free for BMPA members and $28 for family and friends and nonmembers. Deadline to register is July 18. Registration notices will be sent out as e-mails and posted on the BMPA FB page. Finally, Ashley mentioned that the fall meeting is tentatively scheduled for Nov 7th.

10 Pennsylvania Pharmacist — Sept/Oct 2019

Rob Frankil and Frank Konzelman at BMPA June meeting

Allegheny County Pharmacists Association (ACPA) Update ACPA had a very busy summer celebrating the accomplishments of our previous officers and kicking off the New Year with a brainstorming session of incoming officers and board members to plan out events for the coming year.

All of ACPA would like to send our messages of thanks and gratitude to our outgoing president, AJ Greco, for all his leadership over the last year. Thank you AJ! Incoming president, Amy Woods, led the kickoff meeting focusing on planning for the upcoming year and our goals for the organization and profession within the county!

A few of the events focused on at the kickoff were the annual back to school picnic hosted in early September recruiting new committee members and welcoming the students back for another academic year and planning for PPA annual meeting at Seven Springs Mountain Resort. We are excited to continue to plan for a year full of events and collaboration.

ACPA would also like to congratulate several members receiving recognition for their accomplishments within the profession. Amy Haver was featured in APhA’s Pharmacy Today highlighting her and her team’s work on medication management in the elderly population. Karen Hoang received the Grand Council Deputy Outstanding Achievement Award from Kappa Psi Pharmaceutical Fraternity for her commitment to leading and mentoring students at the University of Pittsburgh, School of Pharmacy.

Many congratulations for your outstanding achievements and recognition- we are so proud!

Karen Hoang and her award

AJ Greco receives his plaque of appreciation from Kyle McCormick

Amy Woods receives her incoming Presidential gavel

www.papharmacists.com 11

Welcome! New Members PPA Welcomes the following New Members who joined the association on March 30, 2019 – July 26, 2019. Please make these new members feel welcome and part of Pennsylvania pharmacy!

PHARMACISTS Carina Antypas, McDonald, Allegheny Health Network Jennifer Asti, Venetia, Asti’s South Hills Pharmacy/C&G Health Solutions Kennedy Austin, Pittsburgh, Duquesne University School of Pharmacy Molly Bettridge, Freeland, MD Carrie Corboy, Lambertville, NE, Janssen Pharmaceuticals Michael DePaz, Bethel Park, Valeda Rx Leslie Gingo, Pittsburgh, UPMC Magee Women’s Hospital Christopher Goncalo, Philadelphia, Hospital of the University of Pennsylvania Bonnie Gray, McKean Nicole Gye, Wyomissing, Reading Hospital

Garrett Lambert, Coraopolis, Duquesne University School of Pharmacy Alania Leber, York, The Medicine Shoppe Gina Lee, Pittsburgh, Veterans Affairs Pittsburgh Healthcare System Marissa Levito, Pittsburgh, UPMC Presbyterian Bridgette McCauley, Johnstown, Conemaugh Health System Michelle Murphy, Moorestown, NJ, AmeriHealth Caritas Alex Novgorodov, Brentwood, TN, LifePoint Health Alyssa Romaine, Erie, Erie VA Medical Center Nolan Schmitz, Pittsburgh, UPMC St. Margaret Kianna Sebrell, Limerick, Anuva Health

Shannon Haar, Cherry Hill, NJ, University of the Sciences

Amanda Shaver, Pittsburgh, Duquesne University School of Pharmacy

Tyler Halfhill, York, Minnich’s Pharmacy

Dylan Smith, Glen Rocks, Stauffer’s Drug Store

Stephen Harper, Uniontown, Hixenbaugh’s Drug Store

Justina Szakal, Rostraver Township, Nickman’s Drug Inc.

Theresa Horn

Linda Trout, Lansdale

Lakyn Husinka, Pittsburgh, Duquesne University School of Pharmacy Pargol Jones, King of Prussia, PerformRx – AmeriHealth Caritas Family of Companies Emma Kim, Mount Holly, NJ, Penn Presbyterian Medical Center

Evan Turco, Pittsburgh, University of Pittsburgh School of Pharmacy Olivia Vanscoy, Farmdale, OH, Merck & Co., Inc. Bretton Walberg, Greenville, Walberg Family Pharmacies Erica Whyte, New Freeport, Rite Aid

Eric Kinney, Pittsburgh, Duquesne University School of Pharmacy

Amanda Williams, Tabernacle, NJ, PerformRx – AmeriHealth Caritas Family of Companies

Hanna Korda, Beaverfalls, Duquesne University School of Pharmacy

Abbey Yannerella, Canfield, OH, CVS Health

Erin Kozlow, Geneva, IL, Penn State Health Milton S Hershey Medical Center

Eric Zwick, Macungie

12 Pennsylvania Pharmacist — Sept/Oct 2019

ASSOCIATES Mike Bindert, Farmington, CT, McKesson TECHNICIANS Kellie Leonard, Harrisburg, Capital BlueCross STUDENTS Duquesne University School of Pharmacy Andrew Christensen, Bethany, CT Destiny Fisher, Shickshinny Cheyenne Ware, Rockwood Jefferson College of Pharmacy Mercedes Bellam, Philadelphia Serena Mang, Perkasie Ashley Sargent, Manheim LECOM School of Pharmacy Nathalie El Hadi, Erie Tyler Hochman, Irwin University of Pittsburgh School of Pharmacy Garrett Day, Wexford Niti Patel, Bensalem University of the Sciences/PCP Christine Le, Philadelphia Katherine Sesuca, Cheltenham, AL Wilkes University Nesbitt School of Pharmacy Madison Trauger, Perkasie

Student Member Profiles the way including but not limited to: Dr. Shah, Dr. Ronner, Dr. Scott, Dr. Alugupalli, Dr. Bhushan, Dr. Patel, Dr. Thomson, and Dr. Knorr.

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

Working in the pharmaceutical industry in either marketing, market access, or regulatory affairs.

Julian De La Calzada Easton, PA 2020 PharmD Candidate Jefferson College of Pharmacy How did you hear about PPA? Fellow classmates.

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

Learn how to prioritize your time and use a daily planner!

Also, get involved with professional organizations as much as you can.

Why did you choose to become involved in PPA? I wanted to get involved with Pharmacy Legislative Day in Harrisburg. I believe pharmacists can do so much more clinically than we are currently allowed to do in PA. So advocating for provider status and our patients are very important.

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

Many professors and preceptors have inspired me and helped me along

Favorite food you have eaten on campus?

BrWhenever the school hosted events like the Spring Carnival they always had these awesome potato chips there. I don’t know if the culinary staff made them, but they were good.

Sara Skoritowski Scranton, PA Philadelphia College of Pharmacy, 2020 How did you hear about PPA? I heard about PPA during my P1 year. PPA was providing free memberships to Pennsylvania students at the white coat ceremony.

Favorite drug name to pronounce Opdivo!

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

I would tell myself to be patient because the interesting material and topics of pharmacy school are on the way.

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

Yes, numerous professors have influenced my throughout my didactic years at PCP. One of the most influential professors I had was Dr. Michael Cawley. I was introduced to him during my first semester of therapeutics.

He would constantly provide support and motivation despite the difficulty of the course.

He passion for pharmacy showed in each and every one of his lectures. He inspired me to pursue an area of pharmacy that will make me display that same passion.

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

In 5 years, I envision myself conducting research within the pharmaceutical industry.

Favorite food you have eaten on campus?

Gluten free tuna sandwiches at Wilson Express.

Why did you choose to become involved in PPA? I chose to get involved in PPA because I wanted to become involved in a smaller “niche” pharmacy organization on campus.

PPA on my campus was just that fit!

If you, someone you know or a pharmacy would like to be featured in a future issue of the magazine, please contact Victoria Madonna, Membership and Marketing Coordinator at vmadonna@papharmacists.com www.papharmacists.com 13

Legislative Profiles Rep. Aaron Bernstine R-10 What are the key issues you would like to see addressed this session (2019–2020)?

Since I ran for office, my top priority has been bringing jobs to the 10th Legislative District and beyond. I believe that means we need to be focused on enacting fiscally responsible policies that remove the obstacles our job creators face, so they can grow jobs and reinvest in our communities.

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

Prior to running for state representative, I worked for ADP in the field of human capital management, ran several small businesses, and a 107-acre farm in New Galilee, Pennsylvania. From my viewpoint in western Pennsylvania, I saw too many career politicians in Harrisburg making the wrong decisions for our economy, our businesses and our families. I decided to “be the change” as they say and ran for state representative in 2016. I remain committed to fighting government overspending, reforming Harrisburg, eliminating burdensome taxes, and improving the 10th district’s businesses climate.

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

As the health care industry evolves and integrated health care giants dominate, it’s becoming more difficult for patients to gain quick and convenient access to knowledgeable health care professionals. Our pharmacies are a great, convenient resource for seniors and individuals of all ages seeking a one-stop shop for medical care and counsel. Family pharmacies can provide excellent comprehensive clinical services, and we need to take a look at what we can do at the state level to make it easier for them to provide these services.

What do you do for relaxation or enjoyment?

When I’m not working on legislation or running my small businesses, I enjoy working on my farm and spending time with my four-year-old son, Dierks. It’s a constant goal of mine to foster a strong work ethic and appreciation for entrepreneurship in the next generation.

Sen. Patrick Stefano R-32 What are the key issues you would like to see addressed this session (2019-2020)?

Making Pennsylvania a competitive state to do business in is always my number one priority. It really does address every other problem we face. Too many times in Harrisburg the way to get more tax revenue is thought to be raising taxes. I see the answer to the need for tax revenue as needing more small businesses paying those taxes not more taxes on the same small businesses. In order to make Pennsylvania that kind of state we need to restrain spending, reduce regulations and keep the government out of the way of growth.

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

I am the third generation of my family’s printing company in Fayette County. My father instilled in me the idea that community involvement was essential for a business like ours to succeed so I became involved in a number of community groups. Two of those, the Chamber of Commerce and the National Federation of Independent Businesses, saw me interact with my local state legislators. I would send them emails about an issue that was important to small business and get form letters back. It became clear to me that my elected officials weren’t listening to me and so when this opportunity presented itself in 2014 I saw it as a way to give back to community and ensure that the voices of small business were represented.

Advice for pharmacists about the political process?

Stay in touch with your legislators on issues impacting your important industry. Plan regular meetings, phone calls or emails and give them updates about what pending legislation could mean for your customers and the future of the industry. Legislators deal with a variety of subjects daily, and we rely on the experts in the field to help us make informed decisions that impact our constituency and their businesses.

14 Pennsylvania Pharmacist — Sept/Oct 2019

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

Pharmacists are on the front lines of health care delivery.

As we rely more and more on medications for treatment it’s important we have experts in medications accessible and available to answer patients’ questions on those medications. In rural communities pharmacists are too often the only medical professional in town making them Continued on next page

Member Profile Joining has made me realize the importance of grassroots advocacy for the profession of pharmacy. Everyone has the opportunity to shape our profession, even at the local level, and can influence national policy.

Name the number one reason why you became a pharmacist?

Lauren Megargell, PharmD Director, Clinical Services PerformRx, Philadelphia, PA

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

Pharmacy school provides a solid foundational knowledge. It is now your responsibility to continue the lifelong learning process. Educating yourself is not only helpful for your career trajectory, but ensures you are providing the most up-to-date relevant healthcare information for the patients we serve.

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

I recently joined PPA at a recommendation of a coworker.

Stephen Starr and Jose Garces that have developed our vibrant restaurant scene. One restaurant in particular, Tinto, offers an amazing tapas tasting menu. While all offerings in the tasting menu are delicious, the duck confit toast with Serrano ham & black cherry paired with a glass of Tempranillo wine is by far my favorite.

Pharmacists serve as accessible healthcare providers that empower patients to make informed decisions about their health.

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

The most influential person would have been my grandfather. He demonstrated to me at a very young age the value of an education.

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

I would love the opportunity to work in England. It would enable me to learn how a country with universal health coverage system functions.

Best thing you ever ate?

We are fortunate in Philadelphia to have chefs including Marc Vetri,

Legislative Profiles continued even more essential to the medical team. I see all of those facts becoming more true in the future as healthcare continues its evolution in the digital age.

Advice for pharmacists about the political process?

Be engaged! As discussions take place in the medical policy it is important that pharmacist voices are not lost amidst the major players in the healthcare industry. It’s part of the reason why I enjoy the yearly visits that the PA Pharmacists Association coordinate in our Harrisburg offices. Hearing directly from those impacted by the decisions that we make in Harrisburg can make a huge difference in how I view an issue. Don’t be intimidated! Remember that in your field you are the expert and your legislators have a

lot to learn from you. Legislators can’t learn about your industry without your engagement. I probably get a few hundred pieces of literature from groups on the bills that we consider. Sometimes the information sticks sometimes it doesn’t, but when I hear directly from a constituent about how something affects them it really makes a lasting impression.

What do you do for relaxation or enjoyment?

I enjoy following Pittsburgh sports teams and watching movies with my family. My son and I enjoy flying model airplanes. My local community also has several community theatres that do terrific productions. In the winter months I also enjoy skiing. www.papharmacists.com 15

Pharmacy Spotlight My Journey of Practicing “Integrative Pharmacy” and How It Exceeded all Expectations By: Dr. Daniel T. Wagner Reflecting on my last 2 decades of operating a completely natural pharmacy (called Nutrifarmacy) is a journey that had engendered a fascinating aspect of our chosen profession. It has defined “patient” service and “patient” consultation to a new level. In addition to the most important aspect of patient/customer service the endeavor has also been financially rewarding. It was free from the restraints of drug companies, insurance companies and their many different prescription contracts, PBMs, and other third party contactors and payers. In addition to not being tied to a prescription business it has afforded me time to travel the rainforests of South and Central America pursuing my passion for better understanding medicinal plants. I practiced what I call “ethnopharmacy,” (not ethnobotany) to a level that few pharmacists have ever encountered. Working closely with indigenous shamans, midwives, herbalists, and bushmasters has educated me to fully understand the importance of preserving the few remaining rainforests (truly the world’s greatest pharmacy).

These simple people still have much to teach us about how modern pharmaceutical companies can still harvest new drugs from natural sources (which still comprise nearly 20 percent of all the Rx drugs on the market) that could still be the cure for many diseases still plaguing modern man.

As a young pharmacist, my dream was to have a practice where I was able to see patients “by appointment” and provide meaningful consultations. I opened my own professional pharmacy (MED-PHARM ) in 1980.

For 17 years MED-PHARM was a huge success. In time I became disconcerted dispensing drugs to people I would not necessarily take myself. My store was so busy that I barely had time to consult with my patients. My intent on setting up a health practice where I could see patients for private consultation manifested perfectly when I opened NutriFarmacy- in 1997. It was Western PA’s first and only ‘natural’ pharmacy.

NutriFarmacy was a retail business selling quality vitamins, herbs, homeopathy, nutritional formulas, essential oils, and other “dietary supplements” that were never 16 Pennsylvania Pharmacist — Sept/Oct 2019

meant to replace drug therapy. My intent was to better “integrate” these products with allopathic medicine (e.g., drugs, surgery, psychotherapy). Myriads of people who question how their prescription medicine regimen can or cannot mix with vitamins or herbals or may deplete needed nutrients. They inquired if there may be elicit dangerous side effects. They are frustrated and perplexed why their trusted health professional (mainly the pharmacist) has little knowledge in this area. They could end up getting poor advice from the many “charlatan” selling unregulated, dietary supplements in America. They go to the internet where any wild and frequently unprofessional advice is possible. These problems rarely if ever occurred for me. I had thousands of appointments over the years and these questions were always answered (right away or via research) to the satisfaction of the patient.

Over time I have engaged private natural & allopathic consultations many times and many free of charge. But a majority of the customers paid a fee without a complaint.

The average consultation time ranged from 60 minutes to 120 minutes. There was always concomitant sales of vitamins or other dietary supplements that went along with the consultation. In a few short years, I had a steady and loyal clientele that came to see me on a regular basis and bought all their supplements from me. The competition was non-existent and the referrals were steady. I can truly say, without reservation, that I loved my “job.”

In a different light, the freedom of my practice has also enabled me to further expand the “clinical” importance of the pharmacy profession. I have traveled to Nigeria, West Africa sixteen times in the last twenty years along with a small, voluntary medical team of pharmacists, physicians, nurses and naturopaths, to conduct large-scale clinics in diabetes screening and education at 15 hospitals in six states across the vast country. I initiated an NGO called The World Health Vision in 2006 and in addition to diabetes work our teams have also worked with thousands of people to better recognized and treat hypertension, cataracts, and help prevent blindness (vitamin A program).

Some have asked about my training and/or what particular expertise I have attained in order to practice as an integrative pharmacist. That is a fair question. My doctor of pharmacy is a clinical degree, my BS in pharmacy is a science degree, and my MBA is a business degree. I do not have a PhD in herbalism! I would freely admit that any expertise I have in holistic medicine is self-taught and the product of years of travel, book reading, seminar attending and personal research that has consumed much of my continuing education over twenty years. I first traveled with the American Botanical Council’s annual “pharmacy from the rainforest” expeditions back in 1996. I have made at least fifty trips back to the rainforests of the world afterwards, seventeen of them as the founder and president of the Student Rainforest Fund, a student NGO

set up to provide the means for American college students, studying the health professions, to get a chance to go to the rainforest and study first-hand with the indigenous peoples in the area of medicinal plants, botanical medicine and other natural products. Since its inception in 1997, I have lead teams of over 300 students (mostly studying pharmacy but also pre-med) to the jungles of Belize, Costa Rica, Guatemala, Ecuador and Peru for a unique ‘green’ experience in natural medicine.

In 2012, I achieved a certification in “botanical medicine” from Dr. Thomas Rau, director of the Paraselsus Clinic in Switzerland. This certification opened up a whole new world for me to specialize in botanical, homeopathic medicine- a leading source of natural and holistic medicine treatments in Europe.

Although private, professional consultations have been a mainstay on my practice just as important to me is the efforts I have put forth as an educator, writer, lecturer, mentor, group leader and a world traveler. I have published many professional and non-professional articles on natural pharmacy practice over the years. I have presented hundreds of lectures. I even published my first national book entitled “Interpreting Your Blood Work- How to Read it and Natural Ways to Improve Your Results.”

What a fortunate man I am! What a proud pharmacist I’ll always remain. Who would have believed with an RPh and a PharmD degree that one could go so far! www.papharmacists.com 17

Medicaid Issues Top PPAs Summer and Fall Advocacy Agenda By: Angela Zaydon, JD, Government Relations Manager We understand that there are still on-going issues in Medicaid. We are also aware that as one problem is fixed, another one crops up.

PPA is working with the Department of Human Services (DHS) on a weekly basis on several areas. The first is that we bring every complaint we receive to the attention of the Department. They are very responsive and have been helpful. This is good in many ways. First, some things look good on paper, but as we all know they don’t always work so good in reality, or the PBMs find a way around the rules. When we hear from you and we take these issues to the Department, they have the chance to make language changes in their contracts for next year and intervene where possible to fix an issue right away.

We have the ability to let the Department know how the implementation of their rules are working in reality. Many issues with Medicaid, MCO’s and PBMs are unknown until PPA alerts them.

We are also working on agreeable language on our Medicaid Transparency Package of legislation. While it was like pulling teeth to get all the players in one room we have set up meetings to discuss and negotiate the language with the Department of Human Services, the House and Senate Health Committee staffers, House and Senate Caucus staff, and the governors staff before the fall legislative session starts in mid-September. The goal of the meeting is to hash out any and all issues and have agreeable language so that the packages of bills can move quickly through each chamber without last minute objections.

The mandatory 90-day fill is another Medicaid issue that PPA has been dealing with on your behalf. Our CEO, Pat Epple, met with Geisinger regarding the issue and problems associated with the issue, and as a result, the following announcement was issued by Geisinger: We will be temporarily lifting the mandatory 90-day fill requirement on maintenance medications for our GHP Family members through December 1st. The request is currently in process at MedImpact and as soon as this change is effective, we will let PPA know. This will allow pharmacies to fill one month supplies of all medications through the end of November.

obtained more easily for members who need special compliance packaging or are identified as being at risk for non-compliance/waste.

• GHP will work with the pharmacists to evaluate additional medications that should be exempt from the mandatory 90-day supply requirement.

New Laws that Affect You Are you Ready for E-Prescribing?

Pennsylvania’s E-Prescribing Law takes effect on October 24, 2019. This law mandates that all Schedule II through IV controlled substances be prescribed electronically.

This law replaces the paper prescription pad method of prescribing controlled substances. However, pharmacists are not required to verify that one of the exceptions (listed below) exists if they receive a non-electronically prescribed prescription. A pharmacist is authorized to continue to dispense medication from valid written, oral or faxed prescriptions.

There are several exceptions to the law. Electronic prescribing is not required if the prescription is issued

• By a veterinarian;

• Under circumstances when an electronic prescription is not available to be issued or received due to a temporary technological or electrical failure;

• By a practitioner and dispensed by a pharmacy located outside of the Commonwealth;

• By a practitioner who or health care facility that does not have either internet access or an electronic health record system;

• By a practitioner treating a patient in an emergency department or a health care facility under circumstances when the practitioner reasonably determines that electronically prescribing a controlled substance would be impractical for the patient to obtain the controlled substance prescribed by electronic prescription or would cause an untimely delay resulting in an adverse impact on the patient’s medical condition;

• This will give the pharmacies and/or their PSAOs time to negotiate more favorable Choice90 Network rates with MedImpact.

• For a patient enrolled in a hospice program or for a patient residing in a nursing home or residential health care facility;

• GHP will also send a list of the PSAOs for the Lackawanna/Luzerne area pharmacies to MedImpact so they may reach out to discuss pricing.

• GHP will work with the pharmacies to streamline the pharmacist exception process so overrides can be

• For controlled substance compounded prescriptions and prescriptions containing certain elements required by the Food and Drug Administration (FDA) or any other governmental agency that are not able to be accomplished with electronic prescribing;

18 Pennsylvania Pharmacist — Sept/Oct 2019

• For a prescription issued pursuant to an established valid collaborative practice agreement between a practitioner and a pharmacist, a standing order or a drug research protocol;

• For a prescription issued in an emergency situation pursuant to federal or state law and regulations of the Department of Health;

• Under circumstances where the pharmacy that receives the prescription is not set up to process electronic prescriptions;

• For controlled substances that are not required to be reported to the prescription drug monitoring program system (PDMP) administered by the Department of Health; or

• Any other situation as prescribed by the Secretary of Health by regulation.

If you believe that you are unable to meet the requirements of this law by the effective date, you an apply to the Department of Health for an exemption based on economic hardship, technical limitations or exceptional circumstances. The Department of Health is in the process of establishing a form and specific information to be included in the request for an exemption. The Department can approve the exemption for up to one year from the date of approval and it may be renewed annually, subject to approval. You can contact the Department of Health at 1-877-PA-HEALTH for more information on the exemption procedures.

Medication Synchronization House Bill 195 introduced by Representative Eric Nelson was signed into law by Governor Wolf on July 2, 2019and is now Act 46 of 2019. This law goes into effect in one year, or on July 1, 2020. This law amends the Insurance Code of Pennsylvania and only applies to commercial insurance, not Medicaid or Medicare.

In order to sync a patient’s medications, that patient must be on two or more maintenance medications and it must be for the purpose of improving medication adherence. A health insurance policy must permit and apply a prorated daily cost-sharing rate to maintenance medications that are dispensed by a pharmacy as a partial supply if the pharmacist or prescriber determines the fill or refill is in the best interest of the patient. The fill or refill is limited to three times per year for each maintenance medication.

Note that this law does not apply to prescription drugs that are unit-of-use packaging for which medication synchronization is not possible or controlled substances classified in Schedule II.

Call for 2020 PPA Educational Foundation Grant Applications Fostering Pharmacy’s Future!

The PPA Educational Foundation will award up to four grants in 2020 with a maximum amount of $1,000 per awarded grant. Grants may be used for projects which are targeted towards patient care by pharmacists and innovative activity around pharmacy practice. The purpose of the grants is to encourage exploration of innovative and best pharmacy practices, especially those which focus on patientcentered services or which offer some patient benefit.

The Foundation will hold a pre-submission, optional webinar for interested applicants on Tuesday, October 1, 2019 at 12 noon. The webinar will be a 20 to 25 minute presentation on the Foundation, the grant program, its goals and objectives, and the application and decision process. There will also be an opportunity for questions. The pre-submission webinar is optional but many applicants find it very helpful. If you are interested you must register in advance by finding the event on our Calendar of Events on our website, and clicking on the registration link in the details.

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

Information about Grant Opportunities, the 2020 Grant Announcement, and the Grant Application can be found on the PPA website under Foundation, Grant Programs.

In addition, dispensing fees for a partial supply or refilled prescriptions must be paid in full for each maintenance medication dispensed regardless of any prorated copay for the patient. A health insurance plan may not use payment structures incorporating prorated dispensing fees. www.papharmacists.com 19

PPCN Update PPCN in the National Spotlight Our leadership team has been busy this summer sharing the work of PPCN both nationally and locally in PA. Pennsylvania had a large presence at the AACP meeting in Chicago where Nick Leon (Jefferson College of Pharmacy) and Anisha Grover (Temple University) presented a poster on the state-wide enhanced pharmacy network patient care training program which is now offered at all seven Pennsylvania schools of pharmacy. PPCN was invited to present to the Opioid Command Center at PEMA, where Patricia Epple (PPA and PPCN) and Chuck Kray (Hershey Pharmacy) discussed the role of community pharmacists in the opioid crisis. PPCN was also invited to present to the Gateway Health care management team of over 150 care managers and supervisors. Stephanie McGrath (PPCN) and Sarah Hoover (ACORx) highlighted the value of local, community pharmacies, the patientcentered services they offer, and how to refer patients to a PPCN pharmacy for their services!

Nick Leon and Anisha Grover present PPCN poster

CPESN Launches ACT Collaborative!

At the July AACP meeting in Chicago, the University of Pittsburgh School of Pharmacy, with partners CPF, CPESN USA, and AACP launched the ACT Pharmacy Collaborative. The ACT (Academia-CPESN Transformation) Pharmacy Collaborative is an operational learning and ACTing collaborative between schools/colleges of pharmacy and clinically integrated networks of community-based pharmacies. The goal of the collaborative is to support the transformation of community-based pharmacy practice from a product-based care model to a community-based pharmacy care delivery model. The collaborative will unite schools/colleges of pharmacy and pharmacist leaders nationwide with a common focus to transform community-based pharmacy practice, mobilize stakeholders and resources to support and facilitate implementation of community-based pharmacy care and amplify the development and implementation of sustainable community-based pharmacy care delivery. If you’d like to learn more about the Collaborative, visit www.actforpharmacy.com.

20 Pennsylvania Pharmacist — Sept/Oct 2019

Nick Leon (PPCN), Troy Trygstad (CPESN USA), Melissa McGivney (PPCN), and Megan Smith (Arkansas) kick off ACT Collaborative

Welcome to new PPCN Members

Introducing Sophia Cothrel, PharmD- Fellow, Community Pharmacy Practice Development

PPCN would like to welcome Springfield Pharmacy, Cook’s Pharmacy of Kingston, The Medicine Shoppe #233, Minnich’s Pharmacy and Minnich’s Continuing Care Pharmacy. We appreciate your partnership! Want to find a PPCN Pharmacy? Check out our Pharmacy Finder here: www.papharmacists.com/locate These pharmacies are five new members that are already taking advantage of payer contract opportunities, increased visibility on our pharmacy locator and access to clinical practice development experts and tools. We are stronger together, and are actively recruiting high quality pharmacy partners. Contact Stephanie McGrath, PharmD, PPCN Executive Director of Network Operations at smcgrath@ papharmacists.com or visit http://papharmacistsnetwork. com/ for more info on how to join!

The PPCN team welcomed Sophia Cothrel in July!

Sophia graduated from the University of Pittsburgh School of Pharmacy in April 2019 and will be completing a 2-year fellowship with the University of Pittsburgh School of Pharmacy. She will be supporting the work and initiatives of PPCN thanks to the generous support of the PPA Educational Foundation. You will hear from her during meetings and webinars and get the chance to meet her in person at the PPA Annual and Midyear meetings. If you see her, please introduce yourself and tell her about your pharmacy!

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

Follow us on Twitter @PPCN_CPESN and Instagram papharmacistsnetwork

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Congratulations to the following individuals who are the recipients of the 2019 Educational Foundation Student Scholarships! All applicants were required to be PPA members, who were at least PY1 and returning to school in the fall. Applicants were required to submit a letter of recommendation and answer essay questions.

The Foundation also wants to give a big thank you to the individuals and companies who are supporting the future of pharmacy with these scholarships!

MedvisoRxs LLC Scholarship

IPBG Scholarship

Elizabeth Leonard Duquesne University PharmD Candidate 2020

Dylan Fox Wilkes University PharmD Candidate 2020

Terra Pharm/Organic Remedies Pharmacy Scholarship Erica Jackson LECOM PharmD Candidate 2020

Sa’ed Al-Olimat Duquesne University PharmD Candidate 2020

Through PPA and its affiliates a total of over $15,000 in scholarships were provided this year.

ACPA, BMPA, and LCPA all also provide student scholarships.

22 Pennsylvania Pharmacist — Sept/Oct 2019

Debunking 3 Independent Pharmacy Marketing Myths “Marketing is a black hole. You just pour money down it and never know what happens.” said a Pennsylvania Independent pharmacy owner in answer to the question: “What kind of marketing to you do?”

The fact is that all independents are doing marketing and with thought, it can make a huge difference in their bottom line.

To Start:

1. What products do you offer? How profitable are the different categories for you?

2. Who are your customers? Which ones are the most profitable?

3. H ow profitable are your best customers over 6 months? That’s how much you can spend to get more like them.

4. H ow and from where do you get your most profitable customers?

5. What services and programs (like mobile apps or med sync) do you offer to encourage your customers to become healthier (and better customers)?

6. How do you communicate with your customers, face-to-face, in-store, online, local print, radio or TV? How much business can you attribute to these communications?

I will make my case by doing some myth debunking.

Myth #1: I don’t do any marketing.

Every independent pharmacist is a marketer.

They all: Choose products. + Decide how much to charge (especially with front end items)

+ Decide how to communicate

+ Come up with a reason to buy

= marketing

But if these decisions are not made with thought & care they are “accidental” instead of “intentional marketers”?

Myth #2: Marketing is expensive, I can’t afford it.

Baloney! The fact is pharmacies cannot afford not to do marketing.

Some of the most important marketing is NOT expensive... it is just absolutely sink-or-swim important! Taking action on the answers to these questions is not costly but it will make a huge bottom-line difference.

1. What products are profitable to offer and have you tried to get more?

2. What products are not profitable? Why are you still selling them?

3. Why should your customers buy the products…and why buy them from you?

4. When and where do you tell your customers about the answers to #3?

Myth #3: I don’t know enough to do any marketing Again...baloney!

Independent pharmacies can make a real marketing difference by using common sense and their knowledge of the business & their customers.

Ok, so what is the first “intentional marketing” step?

Carefully looking at what you are doing, why and how well it is working, can make a significant difference in your business and begin your transition from an “accidental” to “intentional” marketer.

Once you completed your audit, talk to some of your fellow pharmacists and see how much you have in common and what differences you have.

If you only go this far in your “intentional marketing” efforts I guarantee you will have more than a few “Why do we do that?” or “Why don’t we do that?” moments that will indicate changes to be made that do not cost an arm and a leg, but will make a difference.

Professional Development for the Practicing Pharmacist:

Using the FINER Criteria to Evaluate Your Research Question

Nevina Trunzo, PharmD Candidate 2021, Wilkes University Benjamin Andrick, PharmD, BCOP, Assistant Professor, Geisinger, Center for Pharmacy Innovations & Outcomes In a previous article, Drs. Graham & Richards outlined a process to formulate research questions. In this installment, we discuss applying the brief and descriptive acronym “FINER” criteria to appraise your proposed research question. Given the limited time and resources in our daily roles, ensuring your research question is actionable, will generate interest, and advance patient care is critical. The FINER criteria guide you through the process of creating the “elevator speech” and foundational material to justify the importance of conducting research.

Feasible

Interesting

In any pharmacy setting, every day is a busy day. Therefore, it is important to consider the project’s feasibility, both for time and available resources. Having previously described your PICO question, ask yourself “How will I collect the data and outcomes, and what skills do I need to do so?” If the information is already collected and stored electronically, it may be easy to acquire. However, if the data is handwritten, not documented electronically, stored in multiple locations, requires sample collection, or is otherwise not currently collected, you will need to consider how to acquire, collect, and store such information. This may require manual chart review, phone calls, surveys, or other prospective methods of data collection. Consider also whether you have necessary expertise or skills to conduct the research project. Often you will need collaborate with others with specialized expertise (e.g. statisticians) to complete a research project.

The research question should be interesting to the target audience and those funding the research (if applicable).

An engaged audience and support will propel the research forward.1 Your question and the potential implications of answering it should grab your audience’s attention and draw them in. To confirm whether your question is interesting, consider sharing your idea with the desired end users of the evidence and gauge their potential enthusiasm for the topic, and modify your project accordingly.

Attempting to start small, such as piloting in a single clinic or patient, will allow you to gain an accurate projection of the effort required to complete data collection and influence your decision to apply the project on a larger scale. When conducting a pilot study, be sure to note the amount of time and resources required to gauge the feasibility. Time, money, and energy are the major aspects of measuring feasibility.1 Time is especially important for pharmacy students and residents as their experiences are often fixed and limited in duration.

If you determine the project is feasible, great! If not, consider reformatting your research question or outcome to increase feasibility, such as involving the help of students or peers.1 A feasibility assessment is critical to the project’s success. If you do not have the time, resources, skills, or money necessary to complete the project, it will not get done.

24 Pennsylvania Pharmacist — Sept/Oct 2019

Novel Novel does not mean the subject of research needs to be entirely new, but rather produces unique data adding to scientific knowledge. Your project can be used to confirm or disprove previous findings.2,3 Alternatively, your project can generate new results or insights. Consider how your study is notable compared to other previously published works. Is this done in a new setting or with a new application? Does it involve a different study design or population? Consider returning to your literature search and identify gaps and opportunities (authors usually include a section on this in their discussion) if you are struggling to describe the novelty of your project.

Ethical Ensuring patients’ safety and respecting their rights is paramount in research and a key component for approval

by Institutional Review Boards (These will be covered in a future piece in this series). When designing your study, consider the risks and benefits related to the study; Do the benefits outweigh the risks? For interventional study procedures, are there safer alternatives? Consider recruitment and retention; Are your recruitment

procedures fair? Do you have adequate protection for vulnerable populations? Are any incentives commensurate to the risk and not likely to adversely affect decision making (i.e. encourage patients to take on more risk of harm than they otherwise would without the incentive)?

Consider who will have access to study data and how it will be stored; Do you have adequate protections in place to ensure the privacy and confidentiality of patients? While it is important to have a solid ethical foundation for your study, ethics and the ethical treatment of human subjects must be continuously reviewed throughout the research process, because ultimately the conduct of an investigation determines how ethical a study is.

Relevant Lastly, you need to ensure the outcomes of your research project have the potential to advance patient care either directly or indirectly. Many otherwise well-designed

studies have little relevance to day-to-day practice.

Ultimately, your research should meet the needs of the end user whether that be patients, clinicians, or other organizational stakeholders (e.g. leadership). Ask yourself “What evidence/information would I need to improve my practice?”. If your study is not designed to collect that evidence, then it is not relevant. This criterion should prompt you to consider applicability of your study; that is, considering your proposed design, to whom or how could the results of this study be applied in practice?

Conclusion The FINER criteria are a powerful prompt to help you design a study that can be ethically conducted and has the potential for real-world impact. The FINER criteria ultimately help you determine whether conducting your proposed project is possible and if it will generate interest.

Thus, this exercise helps you ensure that you start the project with the end in mind.

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Community Pharmacist-Provided Smoking Cessation Services: Partnering with STRAND Kaitlyn Burkett, PharmD Candidate 2019, University of Pittsburgh School of Pharmacy Katie Doong, PharmD, University of Pittsburgh School of Pharmacy Cigarette smoking is currently the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths each year1. The latest data from 2016 reports that 15.5% of adults aged 18 years or older currently smoke cigarettes1. This number has steadily decreased from 43% in 1964 when patrons were first warned of the negative effects associated with smoking1. Comparatively, Pennsylvania’s smoking rate of 18.0% was higher than the national average (15.5%)1,2.

Statewide, 22,000 adults die from smoking-related illnesses each year and nearly $6.4 billion dollars were spent on health care costs in 20092.

In 2015, nearly 7 of 10 adults who currently smoke cigarettes reported a desire to quit, although only 55.4% of current adult smokers in the United States stopped smoking for at least one day in a purposeful attempt to quit3. In Pennsylvania, the estimated smoking cessation rate of 51.2% from 2016 was lower than the national average (55.4%)3.

Since the approval of Zyban® (bupropion SR) in 1985 and Chantix® (varenicline) in 2006, smoking cessation rates have increased1,4,5. Patients are twice as likely to quit smoking with the support of a health care professional.

Community pharmacists are recognized as the most accessible health care professional and have the ability to provide structured smoking cessation programs.

Community pharmacist-led smoking cessation programs can reduce smoking rates, rates of disease and death from smoking-related illness and cost burden from smokingrelated illness. However, a barrier to implementation of these programs within community pharmacy practice is available reimbursement opportunities. STRAND has partnered with the Geographic Health Equity Alliance within the Community Anti-Drug Coalitions of America (CADCA) to provide community pharmacists the opportunity to participate in a pay-for-performance model for smoking cessation services.

STRAND is a web-based clinical management portal used to empower pharmacists to conduct clinical services6.

The platform has different resources and tools available to pharmacies, including clinical billing, clinical interventions, clinical documentation, and marketing 6. Additionally, STRAND helps to increase access to educational resources for both pharmacists and patients. STRAND developed a four-step, six-month structured program to assist pharmacists in conducting smoking cessation counseling services. Patients prescribed Chantix® (varenicline) or nicotine replacement therapy (NRT) were contacted for 30 Pennsylvania Pharmacist — Sept/Oct 2019

interest and assessed for eligibility in the program. Patients were then enrolled into the STRAND platform, SmokeFree texting alert system, and their state-specific Quit Line.

Once enrolled, pharmacists met with patients for either group-style or one-on-one sessions. Following completion of the program, pharmacies were required to submit results.

In the initial session, pharmacists spent about 20 minutes with the patient focusing on education, enrollment in cessation resources and selection of NRT. Counseling sessions continued face-to-face or via telephone for five to ten minutes once weekly for five weeks with a comprehensive counseling at week 12. STRAND provided pharmacists with counseling topics for each session, including setting a quit date, battling cravings, dealing with side effects and slips, etc. Using the STRAND platform, patients input the number of cigarettes they smoked, holding them accountable and allowing pharmacists to provide insight and encouragement.

Pharmacies were compensated for each counseling session and those with a quit rate average greater than 35% were awarded an additional compensation per patient who remained tobacco-free. The interoperability of the platform allowed pharmacists, patients, and prescribers to easily use it. The educational materials for patients and health care professionals along with counseling guidance for pharmacists ensure high quality sessions. Using the STRAND program, several pharmacies were able to show an improvement in smoking cessation rates and illustrate a successful pay-for-performance model.

Successful Implementation in Pennsylvania Two community pharmacies in Pennsylvania participated in the smoking cessation program. Mainline Pharmacy and Asti’s South Hills Pharmacy both demonstrated a quit rate average greater than 35%. The participating pharmacies shared best practices for patient enagement and impactful patient encounters.

Mainline Pharmacy “Mainline Pharmacy has a proud history of serving our communities since 1980. We are committed to provide the highest quality of pharmacy care. Our pharmacists and staff are dedicated to meeting the needs of our patients, and helping them in all things pharmacy-related. We offer many services that go beyond filling prescriptions, such as involvement in the Pennsylvania Pharmacist

Care Network, Tobacco Cessation Services, Medication Therapy Management, and other innovative services!

These are all examples of how our pharmacy team serves our patients and improves health outcomes.”

Asti’s South Hills Pharmacy “Asti’s South Hills Pharmacy is an innovative, independent pharmacy located in the Mount Lebanon neighborhood, five miles from downtown Pittsburgh. Asti’s is home to a high-volume community pharmacy, a non-sterile compounding lab, and a licensed long-term care pharmacy all at within one location. Our services include: medication therapy management, immunization evaluation and administration, medication synchronization, adherence packaging, insurance navigation, Medicare coverage reviews, and many other complementary patient friendly services. Compounded medications include bio-identical hormone replacement, pain management, pediatric, and veterinary products.”

Best Practices:

• Pull reports within the dispensing system to identify patients that had an NRT or Chantix prescription in the past

the complex was going smoke-free soon. The patient has diabetes, COPD, and other comorbid conditions. The patient called the pharmacist after her first successful week without smoking and was so excited that she couldn’t wait to celebrate with the pharmacist. The patient told the pharmacist that she was so thankful that she had someone rooting for her to quit and how having someone follow-up with her and keep her accountable was a major help to her quitting strategy.

A female patient was in the preparation stage and got rid of all of her cigarettes, lighters, and other smokingralted objects prior to her quit date. However, she had a cigarette-rolling machine at her house that was very expensive and not something she was willing to just throw away. The pharmacist provided suggestions on storing the machine so it was not in plain sight or selling the machine to help prevent temptation. This was a barrier for the patient during this quit attempt; however, she is a regular patient at the pharmacy that the pharmacist will continue to engage in smoking cessation.

Resources

1. Centers for Disease Control and Prevention. Smoking and Tobacco Use. Current Cigarette Smoking Among Adults in the United States. https://www.cdc.gov/tobacco/data_ statistics/fact_sheets/adult_data/cig_smoking/index.htm (accessed Jan 22, 2019).

2. Centers for Disease Control and Prevention. Smoking and Tobacco Use. Extinguishing the Tobacco Epidemic in Pennsylvania. https://www.cdc.gov/tobacco/about/osh/ state-fact-sheets/pennsylvania/index.html (accessed Jan 22, 2019).

3. Centers for Disease Control and Prevention. Smoking and Tobacco Use. Quitting Smoking. https://www.cdc.gov/ tobacco/data_statistics/fact_sheets/cessation/quitting/ index.htm (accessed Jan 22, 2019).

4. Zyban® (bupropion SR) package insert. Research Triangle Park, NC: GlaxoSmithKline; 2017.

Patient Stories:

A female patient was going to be kicked out of her apartment complex if she did not quit smoking because

5. Chantix® (varenicline) package insert. New York, NY: Pfizer; 2018.

6. STRAND. Clinical Solutions. STRAND Solutions. https:// strandrx.com/solutions (accessed Feb 6, 2019).

• Flag bags at will call for patients

• Engage patients during your monthly medication review outreach with sync patients

• Ask your pharmacy team members for recommendations on approachable patients

• Utilize telephonic follow-up appointments if that is beneficial for the patients

• Utilize the Quit Line as an additional resource to support patients (patients may be eligible to receive free NRT from the Quit Line)

• Contact local businesses to refer employees or promote the program through fliers

www.papharmacists.com 31

Government Relations Advocacy for Student Pharmacists (GRASP) 2018-2019 Graduate List The Pennsylvania Pharmacists Association would like to recognize and congratulate all students who have successfully completed the GRASP program: Duquesne University – School of Pharmacy Alyssa Linden Jacquelyn Madler Jeffrey Ward Heather Winter University of Pittsburgh School of Pharmacy Julia Calandra Karlee Deibler Emily Dell Grace Erdman Kaycie Gavin Cindy Jiang Olivia Joyce Felicia Kan David Katz Michael McDermott Mackenzie Minogue Morgan Ostinowsky Catherine Pfendner Christian Rosikiewicz Lauren Xu Alex Yawny Wilkes University – Nesbitt School of Pharmacy Landon Bordner Michael Bulkley Michaela Free Kayla Hiryak Justine Seymour Megan Sokol Rachael Velehoski

32 Pennsylvania Pharmacist — Sept/Oct 2019

Lake Erie College of Osteopathic Medicine School of Pharmacy Aisha Acha Albert Addai Daniel Afari Marwah Alfatlawi Nasser Algabri Mohamed Alhashidi Oyi Amasiani Lois Anti Alicia Bartley Rania Bashi Sabrina Blake Reide Cooper Joseph DeDionisio Tuan Doan Ruaa Edani Francis Essel Christopher Evans Gertraud Eyong Erica Jackson Elyssa Johannesen Gloria Jones Stephen Kazmer Kiana King Sun Kyung Kwon Nathan Lieb Nick Miles Linh Nguyen Debra Nye Jasmine Oro Lama Ozeir Kimberly Parada Hang Pham Paul Popitan Theron Richardson Yousif Shamoon Whitnie Sullivan Augustine Tafor Noah Vasil

A continuous quality improvement program can be a lifesaver!

M AK E YO U R PAT I E N TS A N D YO UR P HAR MACY SA FE R .

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www.medicationsafety.org (866) 365-7472 The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO).

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