PA Pharmacist March-April Issue

pennsylvania

PHARMACIST March/April 2020 • Volume 101 • Issue 2

PPA working for

YOU!

THE OFFICIAL PUBLICATION OF THE

CONTENTS 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

ON THE COVER: Whether advocating for Medicaid Reform with the Auditor General, presenting valuable continuing professional development programs at our conferences, or working with students and new practitioners …

PPA is working for You, your patients, and the future of pharmacy and patient care.

DEPARTMENTS

INDUSTRY NEWS 34 Rx and the Law: Controlled Substances

5

President’s Message

PPA OFFICE STAFF CEO: Patricia A. Epple, CAE pepple@papharmacists.com | Ext. 3 Government Relations Manager: Angela Zaydon, JD azaydon@papharmacists.com | Ext. 6 Communications Manager: Victoria Madonna, CPhT vmadonna@papharmacists.com | Ext. 5 Conference and Membership Manager: Katie Hoster khoster@papharmacist.com | Ext. 1 PPCN and Special Program Manager: Holly Spence hspence@papharmacists.com | Ext. 7 Bookkeeper: Michele Dibble mdibble@papharmacists.com | Ext. 4 PPCN Executive Director of Network Operations: Stephanie McGrath, PharmD smcgrath@papharmacists.com

7

Calendar of Events

8

Welcome! New Members

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

16 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.

25 Legislative Profiles

EDITORIAL BOARD Kim Coley, FCCP, PharmD, RPh, Chair Michael Gionfriddo, PharmD, PhD Elizabeth Harris, PharmD, BCACP Yardlee Kauffman, PharmD, MPH, BCACP Jinsun Paek, PharmD, BCPS

10 Affiliated Member News 11

14 Campus Checkup

FEATURES 16 Student Member Profiles 26 Pharmacy Spotlight 28 Retaining Your Customers: Using Customer Journey Mapping to Keep Your Customers

ASSOCIATION NEWS 9

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: Vacant Independent Community: Rob Frankil, RPh Chain Community: Janet Hart, RPh Chain Community: Theresa M. Talbott, RPh Board of Pharmacy Meeting Dates: March 17, 2020 May 5, 2020 June 16, 2020 July 21,2020

Member News

9

Auditor General Continues the Fight for PBM Accountability of Taxpayer Dollars in Medicaid Recorded CE Webinars

12 PPCN Update 18 Legislative Day Save the Date 30 Call for Nominations 21 PPA Educational Foundation 2019 Annual Report

38 Financial Forum: Why Do You Need A Will?

JOURNAL 35 DOAC and Forget-It? Evaluating the Necessity of Ambulatory Direct Oral Anticoagulant Monitoring Services

RESEARCH 36 Quality Improvement Projects

OUR VISION

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

OUR MISSION

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

26 Call for Nominations 32 Foundation 2020 Grant Recipients Announced

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President’s Message As spring is now upon us, the term “Spring Forward” is meaningful to us in Pharmacy--especially today. We are poised to have our profession move forward, but it will take the energy and commitment of all of us. The time for action is now and our path forward is clear. We must move to have our legislators enact appropriate laws for us to practice at the top of our license. Our patients need us.

Over the past months there have been multiple publications that speak to this issue; in the January issue of the Harvard Business Review, an article titled “Managing the Most Expensive Patients” cites the role of the Pharmacist as of key value in improving care for the sickest and most complex patients at Permanente Health.

In addition, later that month an article in the New York Times titled “How Chaos at Chain Pharmacies Is Putting Patients at Risk” reports on the dangers to patients when Pharmacists are forced to work in organizations that have their primary focus on the transaction rather than the patient.

At the recent PPA Mid-Year Meeting, which had strong attendance, there were impressive presentations displaying the work of PPCN in their continued growth and their workshops on “Flip the Pharmacy.” Additionally, the ever-growing membership of Primary Care Pharmacists met to plan their structure for growth and knowledge exchange. These vital groups show the evergrowing ways in which Pharmacists as part of PPA are improving patient outcomes through their expertise and clinical work.

Medications are and will be the most important therapy for patient care, this is implicit. Our profession is best suited to improve patients’ use of medications. The statistics that are available on patient compliance and failures continue to be a problem in this country. According to the CDC, approximately 50% of medications are taken incorrectly and direct health care costs associated with non-adherence exceed $100 billion annually. We now need to make this clear to our legislators. There is no question that the lobbyists who are supported by publicly traded companies have their primary interest based on their shareholders, not the individual patient who needs our support.

I make this plea to all of our membership: please come out and join PPA on Legislative day on April 8, 2020. We need a strong turnout to move ahead with crucial pieces of legislation. In addition, please take the time to find your local legislator and engage them in these conversations.

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

“There is no question that the lobbyists who are supported by publicly traded companies have their primary interest based on their shareholders, not the individual patient who needs our support.

I make this plea to all of our membership: please come out and join PPA on Legislative day on April 8, 2020. We need a strong turnout to move ahead with crucial pieces of legislation.

In addition, please take the time to find your local legislator and engage them in these conversations. ” — Richard Demers www.papharmacists.com 5

Calendar of Events March

April

May

10–11

8

4–6

19

21–24

17–18

NACDS Rx Impact — Washington, DC CE Webinar: Feedback to Feed Forward: Assessing Learner Performance Through Feedback — 12PM

19–20

National Alliance of State Pharmacy Associations — National Harbor, MD

20–23

Pharmacy Legislative Day — Harrisburg, PA Academy of Managed Care — Houston, TX

22–23

NCPDP Annual Conference, Scottsdale, AZ NASPA – PMI Leadership Conference, San Antonio, TX

NCPA Congressional Fly In, Washignton, DC

July

25–28

13–14

NACDS Annual Meeting, Scottsdale, AZ

PPA Boards of Directors Retreat — State College, PA

APhA Annual Meeting — National Harbor, MD (Washington, DC area)

21

Pennsylvania Reception at APhA — National Harbor, MD

Advertisers Index

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

2 AAP 4 PRS 6

Duquesne University School of Pharmacy 19

IPBG

Value Drug Company

The Partnership for Safe Medicines 17

Keystone

27

20

29 31

R.J. Hedges McKesson Epic

32

Pharmacists Mutual

40

Pharmacy Technician Corner Match the generic name to the brand and identify the schedule for each of the following controlled substances:

Generic

Brand

1. Acetaminophen with codeine

A. Adipex-P®

2. Dexmethylphenidate

B. Androgel®

3. Hydrocodone with acetaminophen

C. Ativan®

4. Lisdexamphetamine

D. Focalin®

5. Lorazepam

E. Lyrica®

6. Oxycodone with acetaminophen

F. Norco®

7. Phentermine

G. Percocet®

8. Pregabalin

H. Phenergan with codeine®

9. Promethazine with codeine

I. Tylenol #3®

10. Testosterone

J. Vyvanse®

Schedule

See answers on page 26.

www.papharmacists.com 7

Welcome! New Members PPA Welcomes the following New Members who joined the association from December 2, 2019–January 31, 2020.

Please make these new members feel welcome and part of Pennsylvania pharmacy!

ASSOCIATES Jim Bernitt, Rochester, NY, RDC Brian Dunleavy, Chalfont, PMC Pharmacy Chris Masseth, Rochester, NY, RDC

PHARMACISTS Dina Attalla, Audubon, Rite Aid Nisarg Bhojak, Reading, Reading Discount Pharmacy

Francis Rubino, Philadelphia, Friendship Pharmacy

Northeast Ohio Medical University Brianna Bailey, North Lima, OH

Mario Sellecchia, Philadelphia, Medical Tower Pharmacy

Temple University School of Pharmacy

Leon Shusterman, Philadelphia, New Care Pharmacy

Shashank Gidipally, Philadelphia

Tesfahun Angasso, Philadelphia

Douglas Smith, Philadelphia, TMT Pharmaceutical Management

Yesh Patel, Bensalem Shruti Shah, Whitehall

Hoang Thanh, Philadelphia, Arch Pharmacy

Daniel Thai, Philadelphia

Natalie Capozzolo, Pittsburgh, University of Pittsburgh School of Pharmacy

Taira Vollmer, Saint Marys, St. Mary’s Pharmacy, Inc.

University of Pittsburgh School of Pharmacy

Jacqueline Deiley, Pittsburgh

Lauren White, Eagleville

Robin Donahue, Hatboro, Willits Pharmacy Services

Laura Wilson, McKees Rocks, Boehringer Ingelheim

Joshua Dover, New Castle

Catherine Wisniewski, Ephrata, Anderson Pharmacy

Catelin Fulghum, Exton, Penn State Health St. Joseph

TECHNICIANS

Danielle DiGiorgio, Indiana Austin Douglass, Pittsburgh Sydney Dyne, Kane Meghan Jones, Export Amanda Kan, Conshohocken Maia Klimatcheva, Webster, NY Thomas Le, Lansdale

Mumesh Gabrehana, Philadelphia, Lancaster Pharmacy

Amira Boswell Hampton, Philadelphia, Solace Pharmacy and Wellness Shop

Jacquelyn Heisler, Yardley, Express Scripts, Inc.

Lilian Diaz, Schnecksville

Kevin Mahar, Pittsburgh

Erin Hunsicker, Coaldale, Shipman’s Pharmacy

Jamaal Garnett, Philadelphia, Solace Pharmacy and Wellness Shop

Michael Mast, Pittsburgh

Safa Kagani, Pittsburgh

Loretta Williams, Chester

Roshni Pattabiraman, Allentown

STUDENTS

Deanna Schnitzer, Edison, NJ

Duquesne University School of Pharmacy

Nina Tao, Pittsburgh

Danielle Lapes, Lititz, Lebanon VA Medical Center Alex Long, Philadelphia, Patient Care Pharmacy

Katie DeBiasio, Oakdale

Alex Luong, Philadelphia, 8th Street Pharmacy

Julia Fadul, Painted Post, NY

Prasad Mattupalli, Harrisburg, Uptown Discount Pharmacy

John Harris, Pittsburgh

Garrett McLaughlin, Belle Vernon, UPMC Presbyterian Hospital

Abigail Hopple, Chamberburg

Sharon Miller, Irwin, UPMC Hillman Cancer Center

Connor Och, Pittsburgh

Susan Miller, Elizabethtown Charlotte Moss, Benton, Vine Pharmacy James Neels, Newtown, UPMC Hillman Cancer Center Chuck Obeid, Pittston, Sheehans Pharmacy Jayanth Panyam, Philadelphia, Temple University School of Pharmacy

Tyler Herman, McKees Rocks Kelsee Lazor, Painted Post, NY Kimberly Pacy, Sherman, NY Bhuneshwari Patel, Pittsburgh Alaina Pericoloso, Mount Laurel, NJ Corey Perrotte, Pittsburgh Allison Tempo, Greensburg Adam Thompson, South Park John Wheeler, Pittsburgh

Jay Patel, Bridgeport, Bridgeport Family Pharmacy

Jefferson College of Pharmacy

Sam Patel, Philadelphia, West Girard Health Pharmacy

Fiona Mai, Lancaster

Rana Elmekadem, Haddonfield, NJ Ngan Nguyen, Philadelphia

Marcus Patterson, Philadelphia, Solace Pharmacy and Wellness Shop

LECOM School of Pharmacy

Carolyn Perez, Downingtown

Jessica Campbell, Erie

Theresa Phlan, Philadelphia, Lan Apothecary

8 Pennsylvania Pharmacist — Mar/Apr 2020

Becky McCracken, Brookville Amanda White, Erie

John Leventopoulos, North Huntingdon

Julianne Mercer, Pittsburgh

Alyssa Vogel, Clairton Aarti Zaver, Carlisle Jennifer Zheng, Pittsburgh Alecia Zika, Valencia Philadelphia College of Pharmacy Kaitlyn Gaynor, Berlin, NJ Dong Lee, Warrington Naomi Lee, Glenside Ayush Sood, Philadelphia Toobah Wali, Philadelphia Kaleb Zhang, Philadelphia Wilkes University Nesbitt School of Pharmacy Daniel Maldonado, Bloomsburg Himani Patel, Scranton Mariam Sey, Hummelstown Shaiva Shah, Scranton

Auditor General Continues the Fight for PBM Accountability of Taxpayer Dollars in Medicaid The auditor general continues shed light on the questionable business practices of Pharmacy Benefit Managers (PBMs), the middle men between drug manufacturers and pharmacies especially in the Medicaid arena. Auditor General DePasquale called on the Pennsylvania Senate to act on PPAs legislation and bill package (HB 941, HB 942, HB 943, HB 944 and HB 945) designed to help rein in the Medicaid prescription costs and pay pharmacies fairly and adequately. “There’s too little transparency around the billions of dollars that state taxpayers pay PBMs for services provided to Medicaid enrollees. It’s time for the Senate to act on a package of bills approved by the House last fall and send them to the governor for his signature.”

The Auditor General produced two special reports over the last year examining the growing role of PBMs and outlined solutions, which are included in our legislation.

PPAs President Elect Chuck Kray, owner of Hershey Pharmacy and Darrin Silbaugh, PPA member and owner of Harrisburg Pharmacy joined the Auditor General at the press conference to discuss how PBM business practices are negatively impacting independent pharmacies and

the patients they serve in the community. DePasquale reinforced the importance of independent pharmacies by stating that in many communities, independent pharmacies are the front door of health care. “When small pharmacies close, it can create a real hardship on residents and make it more difficult for them to quickly access the medications and medical information they need.”

On-Demand webinars are available in the following topic areas: • Patient Safety

• Hepatitis C

• Immunization

• Medical Marijuana

• Laws & Regulations • Tobacco Cessation

To assist pharmacists and pharmacy technicians on-the-go, PPA has a diverse library of ondemand webinars available for viewing at your convenience. On-demand webinars are available for free to PPA members.

• Pain Management

• Oncology

• Substance Abuse

• Pharmacy Management

• Diabetes

• CEs for Pharmacy Technicians

• Anticoagulants

• Miscellaneous

• Precepting • Geriatrics Visit papharmacists.com/Recorded_CE_Webinars for more information.

www.papharmacists.com 9

Affiliated Member News Allegheny County Pharmacists Association (ACPA) Update ACPA had an active start to 2020!

We were so happy to see many pharmacist and student pharmacist members at the Mid-Year meeting learning how to advance our patient care practices. We enjoyed the many educational programs led by our own collection of experts including updates on vaccine error reporting, e-care plan navigation, and veterinary medicine. We are very lucky to have such a knowledgeable group to lead our profession forward.

Congratulations to the Duquesne University team on winning the OTC Jeopardy competition and many thanks to the game show host, our own John DeJames! ACPA also offered support with competition judge, Karen Pater and scorekeepers Ashley Firm and Katie Sulkowski.

ACPA also hosted our annual business meeting on February 6th on the campus of Duquesne University allowing our local and student members to observe and participate in a board meeting. The evening started with a Q & A with several of our members representing a variety of practice settings including managed care, industry, independent pharmacy, and ambulatory care.

Afterwards, a business meeting was conducted including officer and committee reports to show our student members the inner workings of our county association.

Lancaster County Pharmacists Association (LCPA) Update In January, LCPA held their general meeting at the Greenfield Inn, hosted by Novo Nordisk. The topic of the evening Rybelsus: The first oral semaglutide. In February, LCPA also held a meeting at John J. Jeffries hosted by Janssen Pharmaceuticals on the topic Xarelto and the results from the EINSTEIN Trials in Venous Thromboembolism and the COMPASS Trial in Chronic CAD/PAD. Thank you to all who attended and a big thank you to all the presenters!

Also, please join us on Tuesday, March 10th at the Penn State Health Milton S. Hershey Medical Center for our March CE & Joint Meeting with CAPA as welcome PPA CEO Patricia Epple as the presenter for the evening!

Please check our website www.lancasterpharmacists.com for all upcoming events! We hope to see you at a future meeting!

10 Pennsylvania Pharmacist — Mar/Apr 2020

Member News A Future Pharmacist Has Been Born!

A PPA Member was featured in NCPA’s America’s Pharmacist!

Congratulations to Gale Garmong, PharmD, PPA Educational Foundation Board Member, on the recent birth of his child. Gale and his wife, Katy, welcomed Wesley Daniel, born October 16, 2019, at 6lbs 15oz and 20in. Congratulations to Gale and his family!

How Many PPA Members Have Released a Music CD? Well we know one has. Dr. Hershey Bell, Dean of LECOM School of Pharmacy released his new EP “San Ysidro” Individual mp3 can be purchased at http://www.nimbitmusic.com/hersheybell (If necessary, search “Hershey Bell” and go to my “Store”) and Physical CDs can also be purchased at https://lecom.edu/alumni/ fundraising-activities/san-ysidro/ ALL PROFITS support the LECOM Scholarship Fund.

Kristen Hartzell, PharmD and Vice President and clinical pharmacist of Hartzell’s Pharmacy and PPCN Luminary, was profiled in the January 2020 issue. Hartzell was also featured in the December 2019 issue her efforts towards the Diabetes Prevention Program (DPP) in her community.

Congratulations to Kristen and Hartzell’s Pharmacy!

Our Pharmacists are the Winners!

Pennsylvania won 5th place in the State Challenge competition based on the amount of subscribers for the APhA Well-Being Index assessment. Even though the State Challenge has concluded, the Well-being Index has not. It remains a tool you can use to assess burnout and stress. Take the quiz by visiting www.mywellbeingindex. org/signup. Use the code: APhA.

SHARE YOUR NEWS WITH US Send all snippets of achievements and honor to PPA’s Communications Manager — Victoria Madonna vmadonna@papharmacists.com

Affiliated Member News continued BucksMont Pharmacists Association (BMPA) The BucksMont Pharmacists Association was well represented at the PPA Mid-Year Conference in Harrisburg. In addition to attending the PPA County Association Meeting, a Board meeting, followed by a dinner for all BMPA attendees, took place at Bricco Restaurant in downtown Harrisburg.

BMPA in conjunction with the Bucks and Montgomery County chapters of Pennsylvania Society of Health System Pharmacists (PSHP) sponsored a presentation and dinner event on Multiple Myeloma: A Discussion of the Disease State, REMS Program and Treatment, on March 12th at the William Penn Inn. BMPA will be offering an educational session with a dinner on April 2nd at Maggiano’s Little Italy in King of Prussia. The topic “Overview of Polycystic Kidney Disease” will be presented by Kelly Reed, PhD from Otsuka Pharmaceuticals.

Pictured above at the BMPA Board and Dinner were: left: Frank Konzelman, Vice President. John Gatto , Montgomery County Director, Rosellen Gatto, John Barrett, Melissa Barrett, Rob Frankil, President, Dave Cunninghan, Treasurer, Bob Schreiber, Eileen Frankil, Scott Himler, Anthony Trivino, Mike Brown, Bucks County Director, Jason Vizirov, Oleg Zvenigorodsky. www.papharmacists.com 11

PPCN Update PPA Mid-Year Recap From January 24–26, more than 90 PPCN pharmacists and technicians attended the PPA Mid-Year conference in Harrisburg! We welcomed colleagues from CPESN Maryland and CPESN South Carolina who joined to participate in numerous Flip the Pharmacy sessions. Friday morning kicked off with simultaneous sessions: Delivering Enhanced Care Part 2 and a Skills Based Flip the Pharmacy Workshop. During the skills workshop, participants learned about blood pressure and glucose monitoring in the community. All 40 Flip the Pharmacy enrolled pharmacies also went home with a full set of blood pressure cuffs and stethoscopes, provided in partnership with the PA Department of Health.

In the afternoon, participants enjoyed a Documentation Bootcamp, sponsored by our Flip the Pharmacy partners OmniSYS, PioneerRx, Prescribe Wellness, and QS/1.

Pharmacists and techs engaged with these eCare plan vendors to learn more about how to document their interventions electronically and capped off the day with a Mix and Mingle networking reception. Documenting

Nick Leon, PharmD and Danielle Mayer, PharmD, Jefferson College of Pharmacy faculty and Flip the Pharmacy coaches, present the Flip the Pharmacy Skills Assessment Workshop.

12 Pennsylvania Pharmacist — Mar/Apr 2020

patient care interventions is critical to working with other care providers, following up and monitoring patients, and is required to bill for services. Four months into the Flip the Pharmacy initiative, the Pennsylvania Practice Transformation Team ranks 3rd nationally in the number of eCare plans submitted and 1st for the number of blood pressures documented nationally! Practice transformation is working, and Pennsylvania is leading the way.

Additionally, we held our inaugural Flip the Pharmacy Payer Advisory Group meeting in conjunction with the PPA Mid-Year conference. Representatives from four different health plans, the PA Department of Health and the PA Department of Human Services met with our PPCN team to discuss how pharmacists can work with payers on sustainable models of care delivery. Collaboration, outcomes and eCare plan data transmission were all common themes and therefore areas of focus as we move forward in numerous partnerships.

Continued on next page

Flip the Pharmacy program partners Ashley Keller, OmniSYS, Robyn Amberg, Prescribe Wellness, and Josh Howland, PharmD, PionerRx sponsor the Mix and Mingle reception. (not pictured, Zach Princell and Ed Vess from QS/1).

Flip the Pharmacy Team “We Care” gathers at the Mix and Mingle Networking reception.

PPA Mid-Year Recap continued

Keep a Compelling Scoreboard “People and teams play differently when they are keeping score, and the right kind of scoreboards motivate the players to win.”- Our PPCN team was inspired by The Four Principles of Execution® and launched the Flip the Pharmacy Performance Dashboards at the PPA Mid-Year conference. Through a partnership with PPA and the PA Department of Health, all 40 of our Flip the Pharmacy locations went home with a “compelling scoreboard” to post in the pharmacy and engage the entire pharmacy team in setting and meeting goals.

Priorities for 2020

Gale Garmong, PharmD and Stephanie Smith Cooney, PharmD discuss proper blood pressure monitoring technique at the Skills Assessment Workshop.

Payers, payers, payers! Our PPCN team is working persistently to engage payers and stakeholders in partnerships. It’s critical that our pharmacies are ready to maximize the partnerships we bring to them. Keep up with the Flip the Pharmacy Change Packages, and tune in to our regular Coffee and Conversation webinars to stay engaged and get ready!

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

Stephanie McGrath, PharmD, Brandon Antinopoulos, PharmD and Sophia Cothrel, PharmD, Flip the Pharmacy PA Practice Transformation Team, show off the Flip the Pharmacy Performance Dashboards.

Child Abuse RECOGNITION AND REPORTING FOR PHARMACISTS

Training

Becky McCracken, technician, Means Lauf Pharmacy and Amanda Johns, PharmD, RxExpress Health Mart Pharmacy, practice blood pressure assessment at the Skills Assessment Workshop.

This 2-hour online training is available on-demand, and can be completed in a single sitting or watched in pieces. The best part: this training is completely free for PPA members! Meeting Act 31 renewal requirements has never been easier!

Go to www.papharmacists.com/ChildAbuse for more information. www.papharmacists.com 13

Campus Checkup

Duquesne University School of Pharmacy Contributed by: Dakota Miller, Communications Ambassador Duquesne has had a great start to 2020! We finished a toy drive for THEISS Health Center in mid-December and ended up with many donations. The campus OTC competition had a great turnout with 16 teams participating.

Duquesne also had a strong representation with the number of students that went to the mid-year conference, with Duquesne winning the OTC competition! During the upcoming semester, we have a few volunteer events planned in the community and are all looking forward to legislative day in April.

Philadelphia College of Pharmacy Contributed by: Julia James, Communications Ambassador PCP has been busy preparing students for their respective competitions or research presentations at PPA Mid-Year! We had 6 students compete and six students present their research! A highlight of the conference was when our P4 student Kayla Askey presented her research as a CE with Dr. Daniel Ventricelli MPH, PharmD! They focused on the attitude and behavior of pharmacists when prescribing buprenorphine. As the semester progresses, PCP plans to prepare students for Legislative Day, as well as hold a naloxone training on campus!

14 Pennsylvania Pharmacist — Mar/Apr 2020

University of Pittsburgh School of Pharmacy Contributed by: Emily Dell, Communications Ambassador We hope that everyone had a great time at the Mid-Year conference in January! We were proud to have three of our Pitt PPA members compete in the OTC competition at the conference: Mara Cubellis (P3), Arianna Sprando (P3) and Julianne Mercer (P2), and we all had a great time cheering them on.

We also had two of our P3 students compete in the Know Pain Know Gain Competition, Sejla Jukic and David Katz. We are very proud

of our students for competing, and we hope to participate in the competitions again next year. One last student spotlight goes to our own Amanda Cremeans (P2) for her talk about OTC Hearing Aids during the student programming.

She gave a talk about work she is doing to increase pharmacists’ knowledge of OTC hearing aids, which will become available in community pharmacies all over some time in 2020. Many other Pitt

students represented our school in the poster presentation as well. At the beginning of our semester, we held a Policy and Pints Trivia Night on our campus for students to join, socialize and play trivia, all while learning about the importance of advocacy for the pharmacy professions. We plan to hold more events like these as we approach Legislative Day in April!

Wilkes University Nesbitt School of Pharmacy Contributed by: Stephanie Ostir, Communications Ambassador The Wilkes PPA members enjoyed their winter breaks, but are happy to be back on campus to start the spring semester! In December, Wilkes PPA and APhA-ASP chapters concluded the semester with a joined club social to a Wilkes-Barre/Scranton Penguins Hockey game. Fun was had by everyone!

To start the new semester, Wilkes PPA’s first event was a trip to Harrisburg for the Mid-Year Conference.

All members enjoyed networking, competing, and learning more about advocating for the profession throughout the weekend. Three of Wilkes’ members, Zach Schmidt, Liam Bartko, and Cody Morcom, competed in the OTC competition at the conference.

In the upcoming weeks, Wilkes PPA has an umbrella sale, Legislative Week, Katy’s Kids events, social media promotion giveaways, and guest speakers to look forward to.

FOLLOW US ON SOCIAL MEDIA @PAPHARMACISTS

www.papharmacists.com 15

Student Member Profiles How did you hear about PPA? I found out about PPA through the emails about organizations at Duquesne.

Favorite drug name to pronounce Remicade

Michael Chieu Oakland, CA 2020 PharmD Candidate Duquesne University School of Pharmacy

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

Studying is important but, remember to carve time out for your kids.

Why did you choose to become involved in PPA? I chose to become involved

in PPA because they helped me to recognize the importance of advocating for our profession. Many of the changes I wish to see in health care such as increasing health care literacy in all populations and gaining recognition as a provider can be achieved through us advocating for it.

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

It’s interesting to learn about their backgrounds and how they got where they are.

It’s also captivating to

see them outside of the academic environment working in their respective pharmacy fields.

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

In five years I am hoping that I will have matched with an administrative residency and be close to gaining financial independence.

Favorite food you have eaten on campus?

Being a foodie I love all food ... but my all-time favorite has to be ice cream.

Member Profile guilt you in to checking a script you aren’t comfortable with — you will get faster, and speed is not as important as patient safety.

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

Megan Dunlop, PharmD, CTTS Clinical Pharmacist Rx Partners UPMC Community Provider Services in Altoona, PA and part-time floater pharmacist for Mainline Pharmacy University of Pittsburgh PharmD Class of 2017

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

Take your time and never let someone rush you or

As someone that does not closely follow politics, PPA allows we to keep up to date on legislature that is important to the world of pharmacy and easily contact my representatives. PPA conferences are a great place to get CE, network, and catch up with old friends. I always look forward to the next PPA meeting!

Name the number 1 reason why you became a pharmacist?

Because science and medicine are cool, but touching blood and guts

is icky! In reality, I have wanted to be a pharmacist since my High School Anatomy and Physiology class, where my teacher would tie in disease states and possible medications to fix them as we learned about different parts of the body. It was in this class that I discovered I loved learning about medicine, but I did not like dissecting the cats and pigs we kept in the classroom closet for the whole semester (yuck). When my teacher suggested I look into pharmacy school, I knew I had found my calling.

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

I really look up to my PGY1 residency director, Brian Sidone. Not only did he know everything about medications, but he also

has an incredible sense of business and how to make pharmacist clinical services work in the real world.

When solving problems at work, I often find myself thinking “what would Brian do?”

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 am not sure I know enough about pharmacy in other countries to make an informed decision, but I do have a minor in German and have always wanted to live in Germany, so that’s what I’ll pick.

Best thing you ever ate?

Oryx steak while on a safari in Namibia.

If you, someone you know or a pharmacy would like to be featured in a future issue of the magazine, please contact Victoria Madonna, Communications Manager at vmadonna@papharmacists.com 16 Pennsylvania Pharmacist — Mar/Apr 2020

Continue Your Education.

Substance Use Disorder:

Identification & Referral Certificate Program Taught by expert faculty, this innovative certificate program is designed to assist pharmacists in: • identifying substance use issues • conducting assessments • making referrals This program is offered in partnership with Duquesne University, Pennsylvania Pharmacists Association, and is supported by a grant through the Amerisource Bergen Foundation.

Program Requirements: • Self-study Activities (10 hours) • Live Interactive Seminar (7 hours) • Post-Seminar Assessment Pricing: $59 – PPA Members $79 – Non-PPA Members Upcoming Training Dates: • • • •

Friday-Saturday, March 27-28, 2020 – Pittsburgh* Saturday, May 2, 2020 – Wilkes-Barre Friday, May 8, 2020 – Pittsburgh TBA – Philadelphia

To learn more or to register visit: duq.edu/sud *Duquesne University Continuing Education Springfest registrants may add on the Substance Use Disorder Certificate Program for a discounted price. Visit duq.edu/springfest for more information.

The Pennsylvania Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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Legislative Profiles Sen. Joe Pittman, R-14

Rep. Jeff Pyle, R-60

What are the key issues you would like to see addressed this session (2020)?

What are the key issues you would like to see addressed this session (2020)?

School property tax elimination is critical and I hope it is addressed in the upcoming session. I am a strong supporter of SB76 and I continue to advocate for its passage. I would also like to see drug pricing transparency enacted.

Drug manufacturers continue to raise their prices with little to no explanation as to why. Pharmaceutical companies should have to justify their prices before others are required to pay them and Pharmacy Benefit Managers should show more transparency in their operations as it relates to drug pricing.

1. Holding the line on Governor Wolf’s never-ending call for higher taxes

Tell our members a little about your background and why you became a legislator?

I was raised in Hillsdale, Pennsylvania and have been a lifelong resident of the 41st Senatorial district. As a husband and a father, I am invested in making western Pennsylvania a better place to live, work, and raise a family. I served as Senator White’s chief of staff for over 18 years, and when he decided to retire in February of 2018, I wanted to continue his legacy of fighting for smaller government, economic development and the protection of family sustaining jobs in our thriving energy and manufacturing economy.

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

Particularly in rural communities, I believe pharmacy is becoming an increasingly significant first line of care for many. I see the role of pharmacy continuing to evolve in providing necessary counsel and care well beyond the filling of prescriptions.

Advice for pharmacists about the political process?

“Compromise” is not a dirty word. I have always been impressed by the Pennsylvania Pharmacists’ grassroots and advocacy efforts in Harrisburg. Pharmacists have many issues that are brought before the General Assembly each session. Patience and a willingness to compromise is how to get those things done.

What do you do for relaxation or enjoyment?

I enjoy spending time with my wife and four children (two boys and two girls). I am also an avid outdoorsman. I enjoy hunting, fishing, and sharing all the wonderful outdoor opportunities of western Pennsylvania with my children.

2. Extending access with better consumer pricing (liquor control chairman) 3. Protecting our constitutional rights for an increasingly aggressive Left Tell our members a little about your background and why you became a legislator?

I was a school teacher who had a bad experience with local government and the only way to fix it was to win the office. I had some success as mayor and my legislative predecessor recruited me and…here we are!

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

Pharmacy’s future role will expand accordingly with the research and development of new products. As our population increases, the need for pharmacy services will become more vital.

Advice for pharmacists about the political process?

Don’t be afraid to call your legislator if an issue arises affecting you. I’m very fortunate that a boyhood friend is a highly respected pharmacist and he’s not shy about calling.

It has been very helpful on the issues.

What do you do for relaxation or enjoyment?

I’ve got two kids and take care of my mother so there isn’t a lot of free time but when I can, I like to go to the shooting range and also work on my family’s properties.

“Pharmacy’s future role will expand accordingly with the research and development of new products. As our population increases, the need for pharmacy services will become more vital.”

— Jeff Pyle www.papharmacists.com 25

Pharmacy* Spotlight: Over the last several years medical cannabis has become a trending therapy option for patients with qualifying conditions including, but not limited to Anxiety, Cancer, Autism and Opioid Use Disorder. Medical cannabis dispensaries have been opening up across the United States (“US”) at a rapid rate over the past few years, and Columbia Care Inc. (“Columbia Care” or “the Company”), one of the largest, fully integrated operators in the global medical cannabis industry has been at the forefront of that growth. Founded in 2012, Columbia Care holds licenses across the US and European Union and upon the closing of the Company’s recently announced acquisition of The Green Solution, Colorado’s largest and most efficient operator, will have 96 facilities located across 16 US jurisdictions. Columbia Care operates three medical cannabis dispensaries in the Commonwealth of Pennsylvania, located in Allentown, Scranton and Wilkes Barre. As part of the medical cannabis program in the Commonwealth, Columbia Care provides education and a variety of products for registered patients.

Pharmacists on staff at each dispensary play an integral role teaching, providing guidance and dispensing to the medical cannabis patients they serve. Joseph Shipula, PharmD and Jenna Carmichael, PharmD do just that at Columbia Care’s Wilkes Barre location.

Shipula, a 2012 graduate of Wilkes University Nesbitt School of Pharmacy, previously worked in the chain and independent practice industries. “Working in the medical cannabis industry has allowed me to spend more time working directly with patients to help them address their healthcare needs, which was one of the main reasons I became interested in pharmacy to begin with,” said Mr. Shipula.

“I went to pharmacy school to help people,” added Ms. Carmichael, a 2011 graduate of University of Arizona College of Pharmacy. “I originally thought that was going to be through clinical pharmacy in a clinic or hospital however I have found that I prefer a more holistic approach and am happy to be working at Columbia Care, educating patients and the public on the benefits of medical cannabis”.

Improving overall health and wellness through medical cannabis is not the only way the Company serves patients in the community. Columbia Care, both locally and nationally, is committed to providing educational seminars as well as donations to national advocacy groups and various local organizations that provide financial and emotional support to residents of the community, including the NEPA Epilepsy Foundation, Challenger League, Cancer Society, and numerous other organizations.

Along with educating and improving her patient’s health and wellness journey, Carmichael is also interested in the value that professional organizations such as PPA can offer to this emerging industry. “In this new area of pharmacy, being part of a professional organization is very helpful for support in obtaining CE.” Carmichael stated. “Now more than ever, there are numerous opportunities to educate other practitioners on the positive role that cannabis can have in overall wellness while furthering research on its effectiveness in the treatment of multiple conditions”.

Patients are the central focus of every pharmacist and the most important part of their oath to the community and Columbia Care is proud to have pharmacists like Mr. Shipula and Ms. Carmichael on staff in order to bring quality, expertise and trust to cannabis patients seeking to live a healthier lifestyle. For more information on Columbia Care, please visit www.col-care.com. *Columbia Care is a medical cannabis dispensary, not a pharmacy.

Pharmacy Technician Corner continued Answers to questions on page 7:

Generic

Brand

1. Acetaminophen with codeine 2. Dexmethylphenidate 3. Hydrocodone with acetaminophen 4. Lisdexamphetamine 5. Lorazepam 6. Oxycodone with acetaminophen 7. Phentermine 8. Pregabalin 9. Promethazine with codeine 10. Testosterone

I. Tylenol #3® D. Focalin® F. Norco® J. Vyvanse® C. Ativan® G. Percocet® A. Adipex-P® E. Lyrica® H. Phenergan with codeine® B. Androgel®

26 Pennsylvania Pharmacist — Mar/Apr 2020

Schedule 3 2 2 2 4 2 4 5 5 3

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Operating for over 25 years with Honesty, Integrity, and Transparency

Retaining Your Customers Using Customer Journey Mapping to Keep Your Customers

By Paul Zabroske

To grow a business you need to: 1) Acquire customers 2) Retain them 3) Increase your share of their wallet

1

Filling a prescription — Make sure you experience yourself all the ways your customer can order a prescription, online, by phone, via a mobile app or in person. Are they all easy, positive and quick experiences?

Perhaps counter-intuitively the next “intentional marketing” article is going to focus first on #2: Retaining Your Customers. Why? Because if you do not have a customer experience that retains — the right product, services and customer service that exceeds their expectations — it is not worth spending a dime on #1: Acquiring Customers.

2

Walking up to your Store — This your store’s billboard. It tells the existing and new customers who you are and what is important to you. Old faded signs, outdated papers taped to the door, or dirty windows reflect on you, your store and the healthcare service you provide.

The only thing worse than NOT bringing in customers is bringing them into a bad experience (so they do not come back, nor do their friends who hear about the experience).

3

Where to start?...with the customer of course. Customer journey mapping is an excellent way of carefully looking at what your customer goes through and what can be done to improve that experience. This can be an involved process, but a simple mapping exercise can have a significant impact on making sure you are “retention ready” Picture one of your most valuable customers. Now imagine their experience with your pharmacy as they go through the following “touchpoints”. For each point write down the strengths and weaknesses of that experience as well as what changes you could make to improve it. To make it easy go to this link and download a worksheet to use: https://bit.ly/2Sio2Zn

Walking through the store — What message does your product selection send? Are the products displayed neatly? Counter surfaces should be clutter-free and only one easel per counter. Do your signs look like they belong together …or do they have messages and designs that do not work together? As your customer looks around the store, everything they see is sending them a message about you, your attention to detail, and your professionalism.

4 5

28 Pennsylvania Pharmacist — Mar/Apr 2020

Greeted warmly — Is every customer welcomed as they walk in with a smile and a “How can I help you?”

Picking up my prescription — is it obvious where I pick up my prescriptions (NOTE: for those who answer “Well my store is so small it is easy to figure it out.”

If the customer has to “figure it out” they have had to invest energy that is unnecessary and will negatively impact their impression…especially their first impression.)

6 7

Getting answers — is it obvious how I can get my questions answered?

“Thank you” — does every customer know they are appreciated before they leave the store?

Once you have mapped out all the key “points of contact” the customer has with you, your team and your store (and there are probably more than the above list) and the “strengths”, “weaknesses” and most importantly, the “changes” are all written out, take action! Make sure each step of your customer’s journey is one that encourages them to continue to do business with you and to bring their friends.

Then and only then should you consider spending your hard-earned marketing dollars to acquire new customers ... but that is the next intentional marketing article.

Paul Zabroske is president of Zabroske HealthCare Marketing Consultants LLC where he uses 20 years of pharmacy marketing experience to “help those who help others”. He can be reached at paul. zabroske@gmail.com.

Call for Award Nominations PPA’s Awards Committee is seeking nominations for several prestigious association awards that are presented annually during the Association’s Annual Conference which will be held October 1–4 at the Kalahari Resort in the Poconos. Many pharmacists currently practicing in Pennsylvania are excellent candidates for these awards; individuals whose contributions have made pharmacy a better profession for all of us. Below is a list of the awards and criteria for selection of the award recipient for each.

Criteria for all Awards A nominee must be a current member of PPA to be considered.

For all awards except those noted with an *, nominees must be a licensed Pennsylvania pharmacist.

Nominations are considered for one year only. Please note that nominations are no longer held on file and eligible for consideration for three years.

Bowl of Hygeia Award Sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations (NASPA) with support from Boehringer Ingelheim Granted to recognize and honor a Pennsylvania pharmacist who has demonstrated sustained commitment to community service, apart from his/her specific identification as a pharmacist, which reflects well on the profession of pharmacy. Specific Award Eligibility: • Nominee must not be currently serving or have served in the last two (2) years as a member of PPA awards committee, an elected PPA officer or a paid employee of PPA • Nominee must be living; awards are not presented posthumously • Nominee must not be a past recipient of the award

30 Pennsylvania Pharmacist — Mar/Apr 2020

PPA Pharmacist of the Year Award Presented to a pharmacist who has demonstrated dedication to the profession of pharmacy, contributed time and effort to the various professional organizations, furthered the profession of pharmacy through community service and embodied those qualities of attitude and leadership which exemplified the profession.

George S. Maggio Memorial Award Presented to the pharmacist who has contributed the most to pharmacy in Pennsylvania through his/her work in legislative activities and advocacy in conjunction with and for PPA.

NASPA Excellence in Innovation Award Sponsored by Upsher-Smith Laboratories, Inc. Recognizes a pharmacist who is involved in an innovative pharmacy practice resulting in improved patient care. The nomination must include a description of the innovative pharmacy practice which would qualify the recipient for this award.

George H. Searight Community Service Award* Presented to an individual who has shown outstanding devotion and service to PPA, and his/her own county or local association, and for outstanding community service which has enhanced the image of the profession of pharmacy within his/ her community. This award may be presented to a pharmacist or a nonpharmacist.

Pauline Montgomery Leadership Award Sponsored by Value Drug Company The Pauline Montgomery Leadership Award, sponsored by Value Drug Company, is presented annually to a female independent owner, manager, or employee of an independent pharmacy who is part of Value Drug Company and who demonstrates leadership in all of the following areas: pharmacy, politics/advocacy, and community. Value Drug Company provides a $1,000 check to the recipient.

Pharmacists Mutual Insurance Companies “Distinguished Young Pharmacist” Award

a preceptor for a Pennsylvania pharmacy practice site, and must be nominated by a PPA Student Member.

Recognizes new pharmacists for their dedication to and participation in PPA, commitment to the practice of pharmacy, and involvement in community activities. Minimum selection criteria:

PPA Pharmacy Technician of the Year*

• Licensed to practice for nine years or less.

• Has distinguished themselves in the field of pharmacy practice.

• Participated in national pharmacy association(s), professional programs, PPA activities and/or community service.

PPA Preceptor of the Year This award has a separate nomination form for students to use. Nominees must be PPA members, must be

Presented to an individual who has at least two years of experience working as a pharmacy technician in any pharmacy setting, who has demonstrated a professional attitude at their place of employment, and who has shown leadership in the training of their technicians in their practice settings.

J. Allen Duffield Pharmaceutical Industry Award* Presented to an individual who is associated with the pharmaceutical industry or other pharmacy associated/related business or service, who has contributed time,

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effort, commitment, and supported and participated in the activities and programs of PPA and who has, through his/her affiliation with the company and industry he/ she represents, contributed to the betterment of the profession of pharmacy.

Ten Under Ten Awards Recognizes the top ten pharmacists practicing for less than ten years that demonstrate commitment to advancing the profession, involvement in PPA and other pharmacy associations, and/or service to their community. Individuals must have graduated in 2010 and up to be considered for this award.

Nominate a deserving individual for an award and recognize them for all they do for the pharmacy profession!

Find the nomination form at http:// www.papharmacists.com/Awards

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Foundation 2020 Grant Recipients Announced The PPA Educational Foundation is pleased to announce the recipients of the 2020 Foundation grant! Grants may be used for projects which are targeted towards patient care by pharmacists and innovative activity around pharmacy practice.

• Carly Gabriel, PharmD, PGY1 Community-Based

• Sehrish Panjwani, PharmD, PGY2 Geriatric Pharmacy

Resident, Giant Eagle Pharmacy/ University of Pittsburgh: Informing the Development of a Transitions of Care Program Between an Emergency Department and Regional Supermarket Pharmacies. She received $600.

Resident, UPMC St. Margaret: Effect of a Pharmacist Driven Workflow on Successful Implementation of Transitional Care Management Program in a Geriatric Interprofessional Practice. She received $1,000.

• Evan Turco, PharmD, PGY-1 Community Pharmacy

• Amisha Mehta, PharmD, UPMC St. Margaret PGY1

Resident, /Asti’s South Hills Pharmacy: University of Pittsburgh: Effective Coaching Strategies for the “Flip the Pharmacy” Practice Transformation Initiative in Pennsylvania Community Pharmacies. He received $1,000.

Pharmacy Resident, UPMC St. Margaret: PharmacistLed Utilization of Real-World Data to Personalize Prescriber Prescription Writing Education at a Family Medicine Residency Practice. She received $1,000.

* Beginning in 2019, in addition to the Foundation’s Mini-Grant program, the Pennsylvania Pharmacists Association Educational Foundation will award one grant up to a maximum amount of $5,000. The grant may be used for projects which are targeted towards advancing patient care by pharmacists and innovative pharmacy practice. The deadline for the next submission is May 1st 2021.

Go to papharmacists.com/PracticeGrantProgram for more information.

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32 Pennsylvania Pharmacist — Mar/Apr 2020

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2019 Recipients of the “Bowl of Hygeia” Award

Anne Daniels Alabama

Catherine Worhatch Kowalski Alaska

Mark Boesen Arizona

Max Caldwell Arkansas

Thomas Branigan Colorado

Philip Hritcko Connecticut

Madeline Moses Delaware

Carmen Aceves Gordon Florida

Ira Katz Georgia

Mike Minesinger Illinois

Herb Halley Indiana

Marilyn Osterhaus Iowa

Vicki Schmidt Kansas

Catherine Hanna Kentucky

Kim Dupuy Wixson Louisiana

Frank McGrady Maine

Matthew Shimoda Maryland

Adele Pietrantoni Massachusetts

Gary Kadlec Michigan

Karen Bastianelli Minnesota

Randy Calvert Mississippi

Sandra Bollinger Missouri

Todd Koepp Montana

Charles Krobot Nebraska

Diana Quach Nevada

Gary Merchant New Hampshire

John Colaizzi, Jr. New Jersey

Dale McCleskey New Mexico

Bradley Arthur New York

Dennis Williams North Carolina

Dewey Schlittenhard North Dakota

Nnodum Iheme Ohio

John Crumly Oklahoma

Michele Belcher Oregon

Janet Astle Pennsylvania

Lucia Garcia-Carmona Puerto Rico

Anita Jacobson Rhode Island

Wayne Buff South Carolina

Donald Frank South Dakota

Doug Duncan Tennessee

Jennifer Barnett Texas

Roger Fitzpatrick Utah

Kimberly Wright Virginia

Steve Singer Washington

The “Bowl of Hygeia”

In Memoriam: Carl Franklin California

Christopher Keeys Washington DC

Craig Kimble West Virginia

John Muchka Wisconsin

Jennifer Nevins Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA History Hall located in Washington, DC.

Industry News Rx and the Law: Controlled Substances 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.

The opioid crisis has brought a lot of attention to the prescribing and dispensing of opioids. This attention has also extended to the prescribing and dispensing of all controlled substances. I recently attended a seminar which contained a number of sessions on opioids and controlled substances. One of these sessions suggested that every pharmacist should read the DEA’s Pharmacist’s Manual.1 That suggestion caused me to ask myself when was the last time I had read it. One human trait is that we tend to forget details over time and our memory becomes a little less sharp. There have been a number of times when I was sure what a contract provision said, only to go back, read the document, and find that what it stated was slightly different from my memory. This same phenomenon applies to the Pharmacist’s Manual. The manual is about 80 pages, but it is much more readable than the actual statute and regulations.

The speaker at the seminar explained that many pharmacists feel their duty is to make sure that a controlled substance prescription isn’t forged or altered. While that is true, the duty is much broader. For a controlled substance prescription to be valid, it must be issued for a legitimate medical purpose in the usual course of the prescriber’s professional practice. The law does not require a pharmacist to dispense a questionable prescription.

The DEA has provided some red flags that may indicate diversion. Those are discussed in 2018 decision and order.2 Corresponding Responsibility is a topic that requires its own forum so I won’t delve more deeply into it now.

The Pharmacist’s Manual contains information on a number of topics. Besides a basic introduction to the Schedules, there is a lot of practical information in the manual. There is a section on the transfer and disposal of controlled substances. This covers transfer to another pharmacy, the original manufacturer, or a reverse distributor. There are numerous reminders to use the triplicate DEA Form 222 to transfer Schedule II substances.

Another reason to refresh our memories periodically is that requirements change and if we rely only on our memories, we may not be current. The DEA recently announced the phase out of the triplicate form over the next two years.

The DEA Form 222 is also mentioned in the section of the manual on ordering of controlled substances. Topics here include how to order the Form 222, who is authorized to sign the forms, and what to do if the forms are lost or stolen. The manual also contains useful information on what to do when controlled substances are stolen or lost.

34 Pennsylvania Pharmacist — Mar/Apr 2020

The DEA must be notified, in writing, within one business day of the discovery of the theft or loss. Completion of the DEA Form 106 in this situation can be made easier by using the biennial inventory and prescription records because you can use these records to determine how much product was stolen or lost. There is also an entire section of recordkeeping requirements. While many pharmacies are using a perpetual inventory system today, that does not replace the required biennial inventories. Physical inventories are required for a new registrant (either opening a new pharmacy or taking over an existing one) and for products that are newly added to a schedule.

The manual also contains helpful information for the review and dispensing of controlled substance prescriptions.

It provides what information is required to be on the prescription itself and the information required to be on the prescription label. Partial fill situations are addressed as is the dispensing of controlled substances without a prescription. The record of over the counter sales of controlled substances is required to be kept in a bound record book. These types of sales must be made by a pharmacists and cannot be delegated to a non-pharmacist.

While the manual contains a lot of practical information, there are some uncommon provisions also. Sometimes these less common situations are problem-prone because we aren’t as familiar with the situation. Suppose one of your patients has a valid prescription for a C-IV medication and requests that you send a refill to their vacation home in Bermuda. Can you send that refill to a foreign country?

Not unless you are registered with the DEA as an exporter and have obtained the necessary permits or submitted the necessary declarations for export. The pharmacist might assume it is permissible to send the refill because there is a valid prescription on file. This is an example where a seemingly reasonable conclusion is incorrect.

The periodic review of the DEA’s Pharmacist’s Manual is a good risk management tool. During my years of practice, none of my employers recommended or required that I review it. My working knowledge of the DEA regulations was what I drew from my pharmacy law class and any updates that I may have read and retained. Given the scrutiny that is currently being given to the dispensing of controlled substances, an annual review of the Pharmacist’s Manual is an excellent risk management tool to help the pharmacist and pharmacy avoid a potential problem brought on by foggy memory of the requirements.

Continued on next page

DOAC and Forget-It? Evaluating the Necessity of Ambulatory Direct Oral Anticoagulant Monitoring Services Corresponding Author: Emily Fargo, PharmD, BCPS, Primary Care Clinical Specialist, Cleveland Clinic – Medina Hospital Authors: Gregory B. Castelli, PharmD, BCPS, BC-ADM, Director of the Duquesne University Center for Pharmacy Care (CPC), Elizabeth Bunk, PharmD, Clinical Pharmacist, Duquesne University Center for Pharmacy Care (CPC) The authors of this paper have no financial or personal conflicts of interest to disclose.

Keywords: DOAC, anticoagulant, pharmacist, family medicine, monitoring Background There is limited research evaluating the prescribing, monitoring, and patient adherence of direct oral anticoagulants (DOACs), yet it is important to identify gaps in care to promote appropriate usage and safe practices.

The purpose of this project was to identify trends in DOAC prescribing and consistency with labeled and evidencebased indications and dosing among three academicbased family health centers (FHCs).

Methods A retrospective chart review was performed on all adult patients prescribed DOACs who received care from physicians of three affiliated National Committee for Quality Assurance patient-centered medical home FHCs in Pittsburgh, PA, from September 2017 to February 2018. Primary outcomes included frequency of DOACs utilized for non-FDA-approved indications and frequency of DOACs dosed inconsistently with manufacturer recommendations. Secondary outcomes were gathered via telephonic interviews and included patient-reported adherence and side effects.

Results There were 119 patients with active DOAC prescriptions: rivaroxaban (66.4%), apixaban (31.1%), and dabigatran (2.5%). Approximately 75% of patients had FDAapproved indications (nonvalvular atrial fibrillation, venous thromboembolism treatment and prophylaxis), while the remaining were prescribed for non-FDAapproved indications (hypercoagulable state, valvular atrial fibrillation, history of ischemic stroke, and statuspost premature ventricular contractions ablation).

Overall, 9 (7.5%) prescriptions were not dosed according to manufacturer recommendations with the majority being suboptimal dosing. Sixty-two patients (52.1%) were reached for telephonic interviews. One third of patients taking rivaroxaban reported not taking the medication with a meal. Twelve patients (19.4%) reported missing at least one dose of DOAC weekly. Four patients reported side effects to rivaroxaban.

Conclusions About 8% of patients taking DOACs were not prescribed doses according to manufacturer recommendations, and approximately 20% of patients reported missing at least one dose weekly. This inappropriate use could place patients at unnecessary risk for adverse outcomes.

Because anticoagulants are high-risk medications and appropriate dosing and adherence are imperative for patient safety, DOAC monitoring services should be implemented to ensure appropriate use.

For read the full article, please visit: www.papharmacists.com/Articles.

Rx and the Law continued In addition, a review of your state statutes and regulations should also be done because your state may have more restrictive standards which you are required to follow. “how you are going to get there.”

References 1. https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_ manual.pdf

© 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.

2. https://www.deadiversion.usdoj.gov/fed_regs/actions/2018/fr0220_4. pdf#search=red%20flag%20diversion

www.papharmacists.com 35

Quality Improvement Projects Rachael M. Cardinal, PharmD, BCPS, PGY2 Ambulatory Care Pharmacy Resident, Faculty Development Fellow UPMC St. Margaret

Background When pharmacists or pharmacy residents are asked to complete projects within their organization, there is often uncertainty whether the project is research or quality improvement. Previous articles within this series have described research and the requirements for institutional review board (IRB) approval. This article’s goal is to define quality improvement and specify the differences between research and quality improvement.

Case Studies Before reading further, please review the scenarios below. After reading each scenario, please consider whether the study is research or quality improvement. After reading the article, return to these scenarios and re-evaluate your answers.

Answers can be found at the end of the article.

Scenario 1 You plan to evaluate the effectiveness of a commonly accepted science curriculum to determine the impact of active learning techniques. You intend to publish in hopes that other institutions can compare their results with yours. You will collect the following data: quiz scores and class evaluations that were completed as part of the curriculum and classroom practices.

Scenario 2 You plan to conduct a chart review to determine the health maintenance needs of patients receiving treatment through your clinic’s hepatitis C program. You will use this data to improve health maintenance metrics at your clinic. The following data will be collected: demographic data and health maintenance information.

36 Pennsylvania Pharmacist — Mar/Apr 2020

Scenario 3 You plan to investigate the safety and efficacy of direct oral anticoagulants (DOACs) in extremely obese and underweight patients compared to normal weight patients for treatment of venous thromboembolism (VTE) using retrospective chart review methods. The following data will be collected: demographics data, prescribed DOAC and dose, recurrent VTE incidence after initiation, and major bleed incidence after initiation.

Scenario 4 You plan to review charts to determine the effectiveness of opioid and non-opioid analgesic medications for patients attending your institution’s emergency department (ED) for acute extremity pain. You plan to use this data to create an algorithm at your institution to reduce opioid usage in the ED. The following data will be collected: demographic data, type of analgesic, and pain scores.

Quality Improvement vs.

Research At first, it may seem difficult to differentiate between quality improvement and research. However, there are a few key differences.

Quality improvement is focused on advancing the processes within one’s own practice or institution.1 Quality improvement is characterized by four defining aspects: 1) examines systems/processes, 2) creates appropriate measures to determine if change improves the system/process, 3) investigates data to improve outcomes (cost, efficiency, quality), and 4) uses the results to improve quality of care within an institution.

In contrast, research: 1) creates and tests a hypothesis, 2) systematically studies a problem using a protocol, 3) collects, investigates, and interprets data, and 4) distributes the results to improve not just patient care at your institution, but any institution/ practice.

To summarize above, the most important distinction is that quality improvement is focused on improving processes within one institution whereas research is meant to develop new information to disseminate knowledge across institutions.

Again, you can think of research as improving anyone’s practice (i.e. generalizable knowledge) whereas quality improvement is changing a process within one’s institution for the better (whether it is reducing cost or optimizing a process for patient safety).2 It is important to note, that if an individual/team completed a quality improvement project that was intended to improve a process within their own institution, published it, and other practices have incorporated this new process, that does not make the original project research.3 If this occurs, the project is still considered quality improvement because of the original intent.

Other differences between research and quality improvement pertain to the study design, setting, and final data dissemination. Table 1 outlines key differences.1,4

Conclusion In summary, there are several differences between quality improvement and research.

The key point to remember is quality improvement focuses on improving your own institution’s processes whereas research can

Table 1: Major Differences Between Research and Quality Improvement.1,4 Quality Improvement

Research

Goal

Improving an institution-specific process (costefficiency, improved safety, etc.)

Finding new evidence that can be incorporated into more than one setting

Design

Does not require a stepwise process to collect data

Needs to follow a specific protocol (i.e. methods)

Setting

One location/institution

Can be one or many locations

Duration

Quicker

More extensive

Who benefits

Participants of study or institution of project

Any health care professional or institution

Outcome measurement and analysis

Does not need to include statistics; can be descriptive

Often needs to include statistical analyses (e.g. descriptive or inferential)

Outside biases/variables

Does not need to be regulated or addressed

Should be assessed/controlled to increase validity of study

Generalizable knowledge

No

Yes

Distribution

Within institution; can also attempt to publish with initial intent of quality improvement

Outside institution (publication to disseminate generalizable findings, presentations)

Oversight

Institution of project

Institution of research, IRB, funding sources

IRB approval

Uncommon

Yes

Risk of subjects

Usually none, but can also be negligible

Generally yes, but varies based on type of research conducted (exempt vs. expedited vs. full board review)

Informed consent

Not required

Generally yes, but dependent on type of research conducted (exempt vs. expedited vs. full board review)

be generalizable and incorporated into several locations. While quality improvement projects do not require IRB approval, some institutions require formal acknowledgement from the IRB that your project meets the criteria for quality improvement.

Regardless of whether your project is determined to be research or quality improvement, it is important to ensure adequate protections are in place to protect patients’ privacy and safety. If you are initiating a quality improvement project, consider reaching out to the IRB or the department responsible for quality improvement at your institution for guidance and to ensure that all relevant regulations are followed.

Acknowledgement Thank you to Anne Williams, PharmD, BCPS, for providing some example cases in the pre- and postassessment sections.

References 1. Gregory KE. Differentiating Between Research and Quality Improvement. JPNN Journal. 2015.

DOI: 10.1097/JPN.0000000000000107.

2. Quality Improvement vs. Research – Do I Need IRB Approval? VCU Office of Research and Innovation. Accessed December 28, 2019. https://research.vcu.edu/human_research/research_qi_ guidance.pdf.

3. Spraycar A, Schwarzhoff A, Engel B, et al. Quality Improvement vs. Research. Children’s Hospital of Philadelphia Research Institute. Web. 2019. Accessed December 28, 2019. https://irb.research. chop.edu/quality-improvement-vs-research.

4. Arndt JV and Netsch DS. Research Study or Quality Improvement Project? J Wound Ostomy Continence Nurs. 2012;39(4):371-375.

Answers 1. Research: The goal is to publish data so that other institutions may use the results for implementation into their own program.

2. QI: The plan is to improve a protocol within a clinic, not to expand to clinics statewide/nationwide.

3. Research: The goal is to assess the safety and efficacy of DOAC therapy in extreme body weights compared to normal weight patients (generalizable since this topic is not well studied). There is no mention that this study is institution specific to improve a process.

4. QI: Similar to #2, the plan is to create an algorithm to decrease opioid use within one institution, not all hospitals. Results may be published so that other institutions have the opportunity to use your process to improve their own systems, but this isn’t your intention. Therefore, this still satisfies the criteria for quality improvement.

www.papharmacists.com 37

Financial Forum Why Do You Need A Will?

It may not sound enticing, but creating a will puts power in your hands.

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.

According to the global analytics firm Gallup, only about 44% of Americans have created a will. This finding may not surprise you. After all, no one wants to be reminded of their mortality or dwell on what might happen upon their death, so writing a last will and testament is seldom prioritized on the to-do list of a Millennial or Gen Xer. What may surprise you, though, is the statistic cited by personal finance website The Balance: around 35% of Americans aged 65 and older lack wills.1,2 A will is an instrument of power. By creating one, you gain control over the distribution of your assets. If you die without one, the state decides what becomes of your property, with no regard to your priorities. A will is a legal document by which an individual or a couple (known as “testator�) identifies their wishes regarding the distribution of their assets after death. A will can typically be broken down into four parts: *Executors: Most wills begin by naming an executor.

Executors are responsible for carrying out the wishes outlined in a will. This involves assessing the value of the estate, gathering the assets, paying inheritance tax and other debts (if necessary), and distributing assets among beneficiaries. It is recommended that you name an alternate executor in case your first choice is unable to fulfill the obligation. Some families name multiple children as co-executors, with the intention of thwarting sibling discord, but this can introduce a logistical headache, as all the executors must act unanimously.2,3 *Guardians: A will allows you to designate a guardian for your minor children. The designated guardian you appoint must be able to assume the responsibility. For many people, this is the most important part of a will. If you die without naming a guardian, the courts will decide who takes care of your children. *Gifts: This section enables you to identify people or organizations to whom you wish to give gifts of money or specific possessions, such as jewelry or a car. You can also specify conditional gifts, such as a sum of money to a young daughter, but only when she reaches a certain age. *Estate: Your estate encompasses everything you own, including real property, financial investments, cash, and personal possessions. Once you have identified specific 38 Pennsylvania Pharmacist — Mar/Apr 2020

gifts you would like to distribute, you can apportion the rest of your estate in equal shares among your heirs, or you can split it into percentages. For example, you may decide to give 45% each to two children and the remaining 10% to your sibling.

A do-it-yourself will may be acceptable, but it may not be advisable. The law does not require a will to be drawn up by a professional, so you could create your own will, with or without using a template. If you make a mistake, however, you will not be around to correct it. When you draft a will, consider enlisting the help of a legal, tax, or financial professional who could offer you additional insight, especially if you have a large estate or a complex family situation.

Remember, a will puts power in your hands. You have worked hard to create a legacy for your loved ones. You deserve to decide how that legacy is sustained.

References 1 - https://news.gallup.com/poll/191651/majority-not.aspx [4/24/18] 2 - https://www.thebalance.com/wills-4073967 [4/24/18] 3 - https://www.nolo.com/legal-encyclopedia/naming-more-oneexecutor.html [12/3/18] Pat Reding and Bo Schnurr may be reached at 800-288-6669 or pbh@ berthelrep.com.

Registered Representative of and securities and investment advisory services offered through Berthel Fisher & Company Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & Company Financial Services Inc. This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates.

All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment

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