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Second Quarter 2018 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

Arkansas Pharmacists Make History

NEW PBM LAW

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APA Staff Scott Pace, Pharm.D., J.D. Executive Vice President and CEO Scott@arrx.org

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John Vinson, Pharm.D. Vice President of Practice Innovation John@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Elisabeth Mathews, Pharm.D. Executive Fellow Elisabeth@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Support@arrx.org Publisher: Scott Pace Editor: Jordan Foster Design: Gwen Canfield - Creative Instinct Arkansas Pharmacists Association 417 South Victory Street Little Rock, AR 72201-2923 Phone 501-372-5250 Fax 501-372-0546 AR•Rx The Arkansas Pharmacist © (ISSN 0199-3763) is published quarterly by the Arkansas Pharmacists Association, Inc. It is distributed to members as a regular service paid for through allocation of membership dues ($5.00). Non-members subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 83. © 2018 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist 417 South Victory Little Rock, AR 72201 Opinions and statements made by contributors, cartoonists or columnists do not necessarily reflect the attitude of the Association, nor is it responsible for them. All advertisements placed in this publication are subject to the approval of the APA Executive Committee. Visit us on the web at www.arrx.org.

CONTENTS 4 Inside APA: The World Turned Upside

Down

5 From the President: Better Than We

Found It

7 Member Spotlight: Chad Vance

Pharm.D., Cornerstone Pharmacy at Greers Ferry

8 FEATURE: CDC Reccommends

New Shingles Vaccine

12 Rx and the Law: Death with Dignity 13 Safety Nets: Staying Alert Saves Lives 14 New Drugs: Will 2018 Be Another

Banner Year for the FDA?

16 FEATURE: From There to Here 21 2018 APA Convention Insert 28 UAMS: Leaders Recognize the Value of

People

30 Harding University: Harding's Center

for Health Sciences Offers Many Opportunities

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32 AAHP: Advocacy! Advocacy! Advocacy! 33 Legislator Profile: Representative

Matthew Shepherd

34 Compounding Academy: FDA’s New

Guidance Documents Overshadowed by Reimbursement Crisis

35 2018 Calendar of Events 36 Compliance Corner: A View from the

Board Meeting: Patient Counseling

38 2018 APA Golf Tournament ADVERTISERS 2 Pharmacists Mutual 6 Retail Designs, Incorporated 6 Arkansas Pharmacy Support Group 12 Law Offices of Darren O'Quinn 15 Pace Alliance 20 EPN 37 APA Congratulates Nicki Hilliard 37 EPIC Pharmacies 41 Save the Date: 2018 APA Convention 42 2017 Bowl of Hygeia Award Recipients 43 Pharmacy Quality Commitment Back Cover: Smith Drug

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APA Board of Directors

INSIDE APA

2017 - 2018 Officers President - Lynn Crouse, Pharm.D., Lake Village President-Elect – Stephen Carroll, Pharm.D., Benton Vice President – Dean Watts, P.D., DeWitt Past President – Eddie Glover, P.D., Conway

Regional Representatives Region 1 Representatives - Dylan Jones, Pharm.D., Fayetteville - Spencer Mabry, Pharm.D., Berryville - Lacey Parker, Pharm.D., Centerton Region 2 Representatives - Max Caldwell, P.D., Wynne - Darla York, P.D., Salem Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Clint Boone, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representatives - Betsy Tuberville, Pharm.D., Camden Region 5 Representatives - James Bethea, Pharm.D., Stuttgart At Large Representatives - Amber Bynum, Pharm.D., Little Rock - Yanci Walker, Pharm.D., Russellville Academy of Compounding Pharmacists Becca Mitchell, Pharm.D., Greenbrier Arkansas Association of Health-System Pharmacists Brandy Owen, Pharm.D., Conway

Ex-Officio APA Executive Vice President & CEO Scott Pace, Pharm.D., J.D., Little Rock Board of Health Member Gary Bass, Pharm.D., Little Rock AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean) Keith Olsen, Pharm.D., Little Rock Harding College of Pharmacy Representative (Dean) Jeff Mercer, Pharm.D., Searcy Legal Counsel Harold Simpson, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Meghan Petersen Harding COP Student Chithien Le 4

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The World Turned Upside Down Scott Pace, Pharm.D., J.D. Executive Vice President & CEO

H

ave you seen the amazing play Hamilton? The award-winning play depicts the founding of America and the struggle that the Colonial Americans faced against British oppression. After being relentlessly taxed by the British, the Colonial Americans decided enough was enough and fought back against the injustice of taxation without representation in the British parliament. This ultimately led to the Revolutionary War where the Colonial Americans battled injustice by fighting for their independence from the British. The war culminated with the Battle of Yorktown where the Colonial Americans and their allies, the French, surrounded the British troops led by General Cornwallis. After the British surrendered at Yorktown, the world had literally been turned upside down by a group of Colonial Americans who were ‘young, scrappy and hungry’ and were willing to fight for what was right for the promise of a new day. The first three months of this year have felt like the world has been turned upside down in healthcare, as the pharmacists of Arkansas and their patients revolted against the injustice of the pharmacy benefits managers (PBMs) as their severe reimbursement cuts at the first of the year jeopardized patients and providers all around our state. The pharmacists and patients decided to rise up against these cuts to expose the hidden practices that the PBMs unleashed. Pharmacists first rose up at the special Health Insurance Marketplace Subcommittee in January that highlighted the spread pricing that was being used by the plans in the marketplace. Then you rose up at a press conference held in February that demonstrated the difference in the prices CVS paid itself compared to local Arkansas pharmacies. Finally, you rose up through the political

activism displayed by pharmacists and patients all throughout the state by calling and asking your legislators to help place appropriate oversight over the practices of PBMs in Arkansas. Arkansas’s elected leaders heard the voices of their constituents and they too rose up to support legislation that placed the Insurance Commissioner on the playing field to ensure that a neutral referee was overseeing how pharmacy benefits are administered in Arkansas. Your activism and efforts have turned the pharmacy world upside down and have created a new day for patients, a new day for tax payers and a new day for pharmacists throughout Arkansas. I want to express my sincere thanks to each and everyone one of you. This has been a hard battle and rest assured, there will be much more to do as we move towards the rule making process. But we will continue to rise up and fight each step of the way. A special thanks to APA’s staff who has done an amazing job this year: Susannah Fuquay, Jordan Foster, Elisabeth Mathews, Celeste Reid, John Vinson and Debra Wolfe. Finally, the members of the Arkansas General Assembly deserve a huge thank you for hearing the voices of their constituents and taking action to ensure that there was a level playing field. Special thanks goes to Gov. Asa Hutchinson and his staff for thoroughly hearing the issues, calling a special session of the Arkansas General Assembly and for signing the bill into law; to Lt. Gov. Tim Griffin for lending his voice to this issue and taking a public role in supporting patients and pharmacists; and to our legislative champions, Sens. Ron Caldwell, Jason Rapert, and Bruce Maloch, and Reps.

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THE WORLD TURNED UPSIDE DOWN

Michelle Gray, Jeff Wardlaw, Reginald Murdock and Jimmy Gazaway who spent countless hours in meetings helping to draft and edit the bill to make sure it was the best it could possibly be.

The eyes of the rest of the country have fallen on our efforts. Good work Arkansas pharmacists. You’ve turned the pharmacy world upside down. §

FROM THE PRESIDENT

Better Than We Found It

A

t every stage of your life, the level of participation in your endeavors proportionately dictates your level of success. A successful school PTA usually has good parents involved. Conversely, a weak PTA may have good parents not involved. The analogies are endless. Success may be measured in many different ways, but the most valuable measure of success possesses an attribute of fulfillment and purpose. It maintains a sense of belonging, comfort, meaning, and pride. Belonging to the Arkansas Pharmacists Association reliably gives Arkansas Pharmacists these advantages daily. Make no mistake, as a member of APA, you still have the struggles of any job. The multi-directional challenges and road blocks are still to be experienced. However, members enjoy belonging to a diligent group of minds committed to the same effort. The magnitude and duration of our daily trials are somewhat lessened when we are aware that others like us are experiencing the same dilemmas. We find comfort in knowing that together we are more apt to overcome and survive. So much of what we do as pharmacists daily has nothing to do with legislative jockeying and political maneuvering. The welfare of patients in our communities is our primary focus. Seeing them feel better and get well as a result of our handiwork and dedication is our most valued compliment. Seeing the people whose lives we affect do well as a result gives us the fulfillment and sense of purpose to be better. And as we get better so do our communities. Many times in pharmacy, we struggle with the meaning of our performance. Are we doing the best possible? Are we making a difference? Can we do better if...? Many times, people float from job to job, not because of salary but because of happiness in their workplace. A feeling of making a difference and pride in "who I am" ensures an identifiable improvement in success and personal fulfillment. What I am telling you is that the APA can and does do these things for pharmacists all the time, not just in a legislative session. Your membership in APA strengthens all parties involved. We do not want you just for your dues. We want you for your minds. We want you for the sharing of information and ideas. We want you to help advance our profession in this state so that when you are no longer a practicing pharmacist, WWW.ARRX.ORG

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you left this wonderful profession better than when you found it. We do not always agree, all the time, Lynn Crouse, Pharm.D. on everything. We strive daily to President advance the practice of pharmacy to the benefit of our patients. We evolve new modalities of practice to improve patient outcomes. We look ahead for our shortcomings and signs of change. We endeavor to improve the delivery of pharmacist knowledge and expertise to our patients. In short, we try to be better. When pharmacists decide not to be members of APA, we are left to work with less or what could have been. We need each other to thrive and thereby we have the APA. We need the APA and the APA needs us for the best possible outcome for our patients. It is a powerful conduit for me to help you and for you to help me. It is our duty and responsibility as professionals to advocate for the advancement of the practice of our profession, to disseminate the knowledge of our innovations for those that come after us, and to improve the health of our communities. As the glory of the most recent events fade, new issues always emerge to challenge our abilities to help our patients. We will be ready. How ready greatly depends on you and your participation in the Arkansas Pharmacists Association. The greater the membership the greater the association. It’s as simple as that. If you are a member, may I say "Thank you for helping me" and please continue to help. I know it will make each of us better at what we do. If you are a pharmacist in Arkansas, please know and appreciate the tireless job that Scott, John, and the entire staff at the APA office perform to advocate for your continued existence and success. I am proud to be an Arkansan and proud to be a pharmacist. I, like you, are part of a historical lineage of trusted professionals within our state. I do believe if our predecessors had not formed the APA, we would enjoy nothing close to what we have today. For a chance at a better tomorrow, remember to renew your membership in the Arkansas Pharmacists Association every year. Thank you for allowing me to be a part of this profession and for serving as President of the Arkansas Pharmacists Association. It is truly an honor. §

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MEMBER SPOTLIGHT

Chad Vance, Pharm.D. Cornerstone Pharmacy at Greers Ferry

Pharmacy practice:

Cornerstone Pharmacy at Greers Ferry

Pharmacy school and graduation year: UAMS 2011

Years in business:

Store opened in 2006, I have been here since 2011

Favorite part of the job and why:

Interacting with the patients/customers and explaining things in a way that helps them feel confident about why they are taking the medications. The majority of our customers are my grandparents age and our goal is for them to feel comfortable asking questions and fully understand everything before they leave.

Least favorite part of the job and why:

Losing those same customers that you see so often that become friends and part of your life at work. There is always something different about each customer that you are reminded of periodically and I miss those things as time goes on.

What do you think will be the biggest challenges for pharmacists in the next 5 years? Proving our value as healthcare providers

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Oddest request from a patient/customer:

“Put your hands up!” (pause)…. ”I’m being serious!” (another pause)

Recent reads: Five Little Monkeys Jumping on the Bed Be Prepared: A Practical Handbook for New Dads Fun activities/hobbies:

Hunting, fishing, golf, Razorback sporting events, snowskiing

Ideal dinner guests:

Family, friends, Sherlock Holmes

If not a pharmacist then…:

A local repairman, somebody that can fix just about anything just like my dad.

Why should a pharmacist in Arkansas be a member of the Arkansas Pharmacists Association?

The reasons to join the APA would take more space than I am allowed. Instead I would ask “Why not join APA?” There is not a pharmacist working today that doesn’t worry about the future of pharmacy as we know it. However, as a member of APA, I am confident in the individuals that are working very hard every day to protect our profession while we are all busy helping patients. The APA is a vital watchdog for pharmacy in Arkansas and currently they are leading the nation. §

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CDC RECOMMENDS

New Shingles Vaccine By John Vinson, PharmD and Sarah Smith, PharmD Candidate

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aricella zoster virus is a virus that infects nearly 99% of adults aged 50 and older. The virus is usually primarily acquired through having the chickenpox early in life. While the virus usually remains latent in the cranial nerves and dorsal root ganglia of most people, one in three people will have the virus reactivated at some point in their life to go on and cause herpes zoster, also known as shingles. The rash caused by shingles can be extremely painful itself, but shingles can also cause long-term, lingering complications such as postherpetic neuralgia. Shingles and its complications are especially detrimental to the older population due to a natural age-related decline in immune function that causes more intense manifestations of the disease. Since 2006, the mainstay for prevention of shingles in older adults has been Zostavax, a live attenuated vaccine from Merck that is administered subcutaneously to adults over the age of 50. The live vaccine showed about a 20-70% reduction in shingles risk in clinical trials, depending on

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age. While the vaccine is approved by the Food and Drug Administration (FDA) for patients aged 50 and older, it is currently only recommended for patients over the age of 60 by the Advisory Committee on Immunization Practices (ACIP). Also, since the vaccine is live, immunocompromised patients and pregnant patients are ineligible to receive it. The limitations of Zostavax as well as concerns over decline of efficacy long-term presented a need for a more powerful and effective protection against herpes zoster. Enter Shingrix. In October 2017, the FDA approved GlaxoSmithKline’s new recombinant, adjuvant zoster vaccine Shingrix. The two-dose intramuscular injection boasts high efficacy, with over 90% efficacy in all age groups over 50. Because of these high efficacy rates, ACIP is now recommending Shingrix as the preferred vaccine for shingles prevention over Zostavax for patients aged 50 and older. Additionally, ACIP also recommends that patients who have previously received Zostavax should receive Shingrix. With

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NEW SHINGLES VACCINE

a greater range of ages covered as well as the lack of live vaccine administration restrictions, Shingrix will be able provide shingles prevention coverage to more patients under ACIP recommendations. The Shingrix vaccine contains recombinant varicella zoster virus glycoprotein E subunit antigen. Glycoprotein E is one of the most abundant glycoproteins expressed in cells infected by the varicella zoster virus and is involved in the cell-to-cell spread of the virus. By introducing a recombinant, or genetically engineered, antigen of this glycoprotein to a patient, both humoral and cell-mediated immune responses are elicited to provide immunologic memory against varicella zoster virus in the case of reactivation.

Shingrix, however, is supplied as a vial containing the adjuvant component as a suspension that is added to the second vial containing the glycoprotein E component when reconstituting. Finally, while Zostavax is administered subcutaneously in the triceps region of the arm, Shingrix is given as an intramuscular injection in the deltoid muscle of the arm.

Despite the promising results that Shingrix provides, there are a few things working against the vaccine’s favor that could prevent widespread uptake of the vaccine by the patient population at large. For one, Shingrix is a two-dose immunization series, with the second injection given twosix months after the first. Currently, no studies have been done to assess the efficacy of a single dose of Shingrix, so adherence to the entire series should be In addition to recombinant glycoprotein E, enforced. This will provide both a challenge and opportunity for pharmacists to ensure Shingrix also contains an adjuvant called Overall, Shingrix is a AS01B. An adjuvant is a substance added adherence through patient outreach and major step forward for to a vaccine to boost the immune response reminders. Pharmacists across the state shingles prevention. to the antigen contained in the vaccine. already have action plans on how to tackle An adjuvant is particularly advantageous adherence—from calendars completely With pharmacists’ help, in this vaccine because the target devoted to Shingrix to reminder notes on more people than patient population, adults over the age the patient’s profile. Arkansas pharmacist ever before can be of 50, have a natural age-related decline Tyler Staten said, “We put the second dose protected from varicella in the refill queue for two months out from in immunity and, in turn, a reduction in the first dose, and then we call the patient the functionality of immune cells that zoster reactivation. when the refill pops up. Shingrix also has prevent varicella zoster reactivation. The great reminder cards with a sticky back so adjuvant contained in Shingrix allows for a potentially more efficacious and longerthat patients can add them to their own lasting protection against shingles. calendars.” It is also extremely important for pharmacists and other vaccination providers to document doses of The evidence of this age-related waning in immune function Shingrix given in the Arkansas Department of Health WebIZ immunization information system (IIS). WebIZ is a statewide is evident in Zostavax efficacy rates. While the live vaccine shows around 70% efficacy in the 50-59 age group, that electronic registry that makes is efficient for health care efficacy is diminished to around 18% in patients over the age providers to share immunization medical history with one of 80. The overall long-term efficacy of Zostavax has also another to facilitate higher immunization rates, coordinated been questioned for this same reason, with studies showing care and less waste by avoiding giving the vaccine multiple times when the patient is unable to provide accurate history. overall decline in efficacy over time. Shingrix, on the other hand, was able to establish over 90% efficacy in all age groups WebIZ can be manually populated with data or better yet over 50. Additionally, while Shingrix is not FDA-approved for can easily be electronically interfaced to share data. Script the prevention of postherpetic neuralgia, it showed a 90% Management Partners, Prescribe Wellness, Immslink, and reduction in postherpetic neuralgia risk in clinical trials. Even Arkansas SHARE HIE are examples of available interfaces in Arkansas that can tie WebIZ to common pharmacy software more promising, another study showed that the overall efficacy of Shingrix remained around 90% in patients over the age of like QS1, Rx30, Pioneer, Computer-Rx, RxMaster, Liberty, 70 after a mean follow-up time of 3.7 years. and others. Another way that Shingrix differs from Zostavax is in the storage, preparation, and administration of the vaccine. While Zostavax has to be kept in the freezer (between -50°C and -15°C) and must be administered within 30 minutes following reconstitution, Shingrix is kept in the refrigerator (between 2°C and 8°C) and can be administered within 6 hours of reconstitution as long as the reconstituted vaccine is kept under refrigeration. Both vaccines come in the form of two vials prior to reconstitution. Zostavax is supplied as a single-dose vial containing the vaccine and a vial containing the diluent.

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Secondly, due to the adjuvant in Shingrix, the immune response is much more pronounced in patients than with Zostavax. Unfortunately, this means more adverse events for patients. In clinical trials, 9.4% of patients receiving Shingrix reported Grade 3 or higher injection-site reactions, whereas 0-4% of Zostavax recipients reported Grade 3 or higher injectionsite reactions. However, the incidence of serious adverse events did not differ between Shingrix and placebo groups. So, while the adverse effects may be unpleasant for patients, the vaccine is indeed safe. Patients should be counseled on these

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NEW SHINGLES VACCINE

potential adverse effects before receiving each dose of the vaccine. Studies have shown that an adverse reaction to the first dose of the vaccine does not mean a reaction will occur again on the second dose and vice versa. Arkansas pharmacist Lisa Johnson has received the Shingrix vaccine herself and experienced these adverse reactions firsthand. “I have never had any reaction to a vaccine before, but I had every side effect possible with Shingrix,” she said. “My arm was very, very sore and red. I was feverish and had flu-like and stomach symptoms. All lasted around 72 hours. I will get the second dose, though. I hope it goes better.” Other questions that pharmacists might get about Shingrix are concerning the co-administration of other vaccines. Currently, there have only been completed studies on coadministration of Shingrix with Fluarix Quadrivalent, but according to the Center for Disease Control’s general best practice guidelines regarding immunizations, recombinant and adjuvanted vaccines can be concomitantly administered with other adult vaccines. Regarding patients who have already received Zostavax, Shingrix is recommended for these patients and should be given no less than two months after receiving the Zostavax vaccine. Overall, Shingrix is a major step forward for shingles prevention. With pharmacists’ help, more people than ever before can be protected from varicella zoster reactivation. §

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NEW SHINGLES VACCINE

https://www.gsksource.com/pharma/content/gsk/source/us/en/brands/shingrix/pi/home.html https://www.merckvaccines.com/Products/Zostavax https://www.gskmedicalinformation.com https://gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Shingrix/pdf/SHINGRIX.PDF https://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm http://jvi.asm.org/content/74/23/11377.full https://www.cdc.gov/vaccines/acip/recs/grade/herpes-zoster.html#modalIdString_CDCTable_4 https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf#page=6

AAHP Board

Arkansas State Board of Pharmacy

Executive Director............Susan Newton, Pharm.D., Russellville

President.......................................Tom Warmack, P.D., Sheridan

President................................Brandy Owen, Pharm.D., Conway

Vice President/Secretary..................Steve Bryant, P.D., Batesville

President-Elect.....................David Fortner, Pharm.D., Sherwood

Member..........................................Debbie Mack, P.D., Bentonville

Past President...................Kendrea Jones, Pharm.D., Little Rock

Member...................................Lenora Newsome, P.D., Smackover

Treasurer...........................Kendrea Jones, Pharm.D., Little Rock

Member...........................Rebecca Mitchell, Pharm.D., Greenbrier

Secretary..................................Melissa Shipp, Pharm.D., Searcy

Member....................................Ken Lancaster, P.D., Arkadelphia

Member-at-Large........Erin Beth Hays, Pharm.D., Pleasant Plains

Public Member........................................Carol Rader, Fort Smith

Member-at-Large.....................Joy Brock, Pharm.D., Little Rock

Public Member............................................Amy Fore, Fort Smith

Technician Representative.....BeeLinda Temple, CPhT, Pine Bluff

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Death with Dignity This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and the Arkansas Pharmacists Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

D

eath with Dignity. Physician-assisted Suicide. Aid in Dying. Nomenclature has evolved in the twenty years since Oregon passed the first Physician-assisted Suicide legislation in the United States. There are now a total of six states plus the District of Columbia that allow the practice. Three of those six states passed their legislation during the last two years. That’s not much data on which to base a trend, but it does raise questions for pharmacists participating in the practice. Each state is different in detail, but the high level procedures are similar. The patient must make a request for medication with which to end their life. This request may be oral and sometimes requires a second request following a mandatory waiting period. Eventually this request is documented on a state-created form and the patient’s signature is witnessed by at least one disinterested witness. Typically the patient

must have been diagnosed with a terminal illness and facing death within a relatively short time, such as six months. The attending physician then has to certify a number of items in order to be compliant with the law. These include the terminal nature of the patient’s condition, an assessment of their mental state, that there doesn’t appear to be any coercive force being exerted on the patient and that the patient has been counseled on risks, benefits and alternatives. This completed form is then forwarded to the appropriate state agency, many times the Department of Health. Once the attending physician has certified the patient meets the criteria of the law, many times the patient is required to meet with a second, consulting physician. This physician then documents their assessment of the patient’s condition on the state form. Finally, the form must be submitted to the state, either directly and/or through the attending physician. Either the attending or consulting physician can refer the patient for a psychiatric/psychological examination. This exam is also documented on a state form and submitted as above. If the patient has successfully passed these hurdles and waited for the requisite waiting periods, their physician is ready to dispense the needed medications(s) or write prescriptions for them. Now it is time for the pharmacist to get involved. The first decision by a pharmacist may not be a legal one, but a moral one. How does the pharmacist feel personally about dispensing these medication(s)? Does it feel wrong or run counter to what their career goal has been? These are not questions that can be answered by anyone but the pharmacist involved. One thing to consider is that by the time the patient gets to this point in the process, it is as a result of careful consideration. § _______________________________________________________________ © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

Melanie Reinhardt, Pharm.D. Eddie Dunn, Pharm.D.

Staying Alert Saves Lives This issue of Safety Nets once again examines the potential hazards associated with electronic prescriptions. Thank you for your continued support of this column.

T

he electronic prescription illustrated in Figure One was transmitted from a prescriber's officer to a community pharmacy in Eastern Arkansas. The pharmacy technician entered the patient directions as "Take one tablet on Monday, Wednesday, and Friday and two and one-half tablets on Tuesday, Thursday, Saturday, and Sunday." This information - along with the prescription image - was transmitted from the input queue to the pharmacist verification queue of the computer. The pharmacist initially verified the technician had correctly entered the directions, but after further reflection, began to question the appropriateness of a 12.5 mg warfarin dose four days a week (i.e. two and one-half warfarin 5 mg tablets per dose for a total of 12.5 mg). The pharmacist decided to call the prescriber for clarification. After listening to the pharmacist's concerns, the prescriber stated the patient was to receive warfarin 5 mg on Monday, Wednesday, and Friday, and warfarin 2.5 mg on Tuesday, Thursday, Saturday, and Sunday. The prescriber remarked "I can see how the directions we sent are confusing. I really appreciate you calling." After this, the prescription was correctly filled, and the patient was instructed to take "one tablet (5 mg) daily on Monday, Wednesday, and Friday, and one-half tablet (2.5 mg) daily on Tuesday, Thursday, Saturday, and Sunday.

Figure 1

The use of electronic prescriptions continues to increase. Unfortunately, their use does not automatically translate into improved patient safety. The electronic prescription in this case is particularly dangerous. The patient directions contained in this order are unclear and can be interpreted several ways: • Take one tablet (5 mg) on Monday, Wednesday, and Friday and two and one-half tablets (12.5 mg) the rest • Take one tablet (5 mg) on Monday, Wednesday, and Friday, and a 2.5 mg tablet the rest • Take one tablet (5 mg) on Monday, Wednesday, and Friday, and one-half tablet (2.5 mg) the rest (the intended directions) These electronic patient directions are completely unacceptable. They become dangerous and potentially life-threatening when they are used in conjunction with a narrow therapeutic index medication such as warfarin. If the patient in this case had ingested 5 mg of warfarin three days a week, and 12.5 mg four days a week - for a weekly total of 65 mg - the result could have been catastrophic. WWW.ARRX.ORG

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Fortunately for the patient in this case, an alert pharmacist questioned these dangerous directions which had already been entered into the computer by the technician. If this pharmacist had been working in a robotic fashion, she could have quickly glanced at the electronic Sig. and verified the technician's interpretation as being correct. It is important for all pharmacists to treat every prescription as a unique entity. Granted, this can be difficult in a busy, understaffed pharmacy. Pharmacists' who believe their work environment is not conducive to patient safety should bring their concerns to the pharmacy owner or manager. If their concerns are ignored, other employment options should be considered. Pharmacists must be allowed to practice in working conditions that promote patient safety - not jeopardize it. § STUDENT SPOTLIGHT

Being Diabetic - Caemeron Bitzer I am a Type 1 diabetic student pharmacist. Of course I would rather not have diabetes, but my condition has given me the ability to empathize with diabetic patients in a pharmacy setting. Many chronic diseases require lifelong treatment, however, diabetes is one that without medication will ultimately result in death or lifelong complications for those with the disease. Unfortunately, it has been my experience that every time I go the pharmacy no one asks me questions about my condition. I buy OTC insulin and take care of myself due to the expense of pharmacy school, prescriber's visits, and medications. I do not visit a prescriber on a regular basis because I cannot afford it. I do, however, live a healthy lifestyle and monitor my blood glucose very carefully. From my experience, pharmacists must do a better job interacting with their diabetic patients. I realize many patients do not want to interact with a pharmacist, and many pharmacists believe they are too busy to interact with their patients on a one-to-one basis. However, I believe even some pharmacist-patient interaction would improve the lives of patients with diabetes. Before enrolling in the College of Pharmacy, I was a practicing nurse. I have seen numerous patients with diabetes discharged from the hospital with little, if any, instruction on how to administer insulin injections. Obviously, it is critical for these patients to interact with a pharmacist. The next time one of your patients with diabetes enters your pharmacy, please take a few moments and talk to them. Simple questions such as, "How are you doing?", "Is your blood sugar under control?", "Are you having any problems with your insulin injections?", "Have you checked your A1C lately?" can make a big difference in their overall quality of life.

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Will 2018 Be Another Banner Year for the FDA? By David Gerick, PharmD Candidate, Harding University College of Pharmacy This column, presented by the Harding University College of Pharmacy, aims to briefly highlight information on new molecular or biological entities, new indications, or significant new dosage forms recently approved by the FDA.

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ver the past decade the FDA approved an average of 31 novel drugs annually. After giving the nod to only 22 new drugs in 2016, only one approval shy of tying the decade-low, in 2017 the FDA cleared the way for more new molecular entities and biological products than any other year during this same timeframe. What’s more is that ⅓ of these drugs were first-in-class, pointing to the potential for a strong positive impact on Americans health. It will be interesting to see what the FDA and the drug industry have in store for 2018. Here’s what we have so far:

Chronic Care: Two topical solutions approved to reduce

intraocular pressure in patients with open-angle glaucoma or ocular hypertension include Rhopressa® (netarsudil), a first-in-class Rho-associated protein kinase inhibitor, and also Vyzulta™ (latanoprostene bunod). Several diabetic products were approved. Steglatro™ (ertugliflozin) was added as a single-agent to the growing class of SGLT2 inhibitors, and as fixed-dose combination products including Steglujan™ (ertugliflozin/sitagliptin) and Segluromet™ (ertugliflozin/metformin). dermaPACE System was reviewed through the de novo premarket review pathway as the first acoustic shock wave device (similar to lithotripsy technology) to treat chronic full-thickness diabetic foot ulcers.

Infectious Disease: Receiving approval for use in the

acute-care arena was Giapreza™ (angiotensin II), a first-in-class synthetic peptide of human angiotensin II for treating septic shock through priority review. Chronic-care products included Trogarzo™ (ibalizumab-uiyk), receiving fast-track priority review with breakthrough therapy and orphan drug designations as the first HIV-1 inhibitor and long-acting monoclonal antibody for multidrug-resistant HIV-1. Biktarvy® (bictegravir/emtricitabine/tenofovir alafenamide), another HIV-1 treatment, received priority review as a complete once-daily treatment.

prostate cancer. Lynparza® (olaparib), a targeted PARP inhibitor, became the first drug indicated specifically for BRCA-mutated breast cancer. Lutathera® (lutetium Lu 177 dotatate) received priority review with orphan status as the first radiopharmaceutical for the treatment of gastroenteropancreatic neuroendocrine tumors. Other new drugs approved include Macrilen™ (macimorelin) which was granted orphan designation as a first-in-class oral growth hormone secretagogue receptor agonist for adult growth hormone deficiency. And finally, Symdeko™ (tezacaftor/ivacaftor) received priority review as an orphan drug for the treatment of cystic fibrosis patients aged >12 years who have certain genetic mutations.

Drug Withdrawals: Reports of inflammatory brain disorders in Europe lead to the voluntary withdrawal of Zinbryta® (daclizumab) from the world-wide market, a monoclonal antibody previously used for relapsing forms of MS.

New Dosage Forms: Significant new dosage forms approved

this quarter include: Clorotekal® (chloroprocaine, intrathecal) for local spinal anesthesia; Dexycu™ (dexamethasone, intraocular injectable suspension) for cataract surgery; Firvanq™ (vancomycin, powder for oral suspension) for C. difficile-associated diarrhea and enterocolitis due to S. aureus-associated (including MRSA); Goprelto (cocaine, intranasal) as local anesthesia for nasal procedures; Osmolex ER™ (amantadine, extendedrelease tablet) for Parkinson’s disease; Prexxartan® (valsartan, oral solution) for hypertension and heart failure; Siklos® (hydroxyurea, tablet) for sickle cell anemia; and Sinuva™ (mometasone, sinus implant) for nasal polyps. §

Oncology: Three anticancer products received a nod this quarter. Erleada™ (apalutamide) is an androgen receptor inhibitor that received priority review as the first treatment approved for non-metastatic castration-resistant

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From to By Jordan Foster

THERE

HERE

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hat a difference three months can make. Pharmacists across the state opened their doors on the first day of 2018 looking forward to a new year but were quickly snapped back to reality when dramatic reimbursement cuts started flooding in. APA received frantic calls and faxes from pharmacists worried about these lower reimbursements and the effects it would have on their patients and their stores. Determined to find a solution, APA CEO Scott Pace and staff worked for the next three months to negotiate with industry leaders, educate the public, and craft legislation that would save pharmacies from closure and protect patient choice. What began as a reimbursement cut to Arkansas community pharmacies grew into a story that continues to make national headlines. Now, pharmacists across the country are looking to Arkansas as a beacon in the fight against unfair practices by PBMs.

January 1

Arkansas BCBS and CVS Caremark unexpectedly and drastically cut reimbursements to the pharmacies by negatively manipulating maximum allowable cost prices after contracts were already signed.

January 25

APA leadership again meets with Governor Asa Hutchinson and his aides to discuss new cuts by BCBS and CVS Caremark to all private commercial self-insured and fully insured plans.

2018 January 10-11

APA leadership has initial meetings with Governor Asa Hutchinson and BCBS CEO Curtis Barnett to discuss the crisis Arkansas pharmacists are facing after reimbursement cuts.

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January 24

Arkansas BCBS and CVS Caremark drastically cut reimbursement in all lines of private commercial selfinsured and fully insured populations.

January 26

APA begins campaign to engage the general public on the issue, including one-page handouts that describe what a PBM is, scripts for patients to call their local representative or health insurance company and demand action, and letters to the editor distributed throughout the state.

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January 2018

Independent pharmacies in Arkansas receive letters from CVS Pharmacy offering to buy them out during hard times with declining reimbursement.

January 31

A record breaking crowd of pharmacists pack the MAC building at the state capitol complex during an Arkansas Health Insurance Marketplace committee meeting. Representatives from Arkansas BCBS testified that they knew that QualChoice/ OptumRx and Ambetter/CVS Caremark were intentionally paying pharmacies below their cost and that they made a calculated decision to do the same thing to level the playing field for themselves in the market.

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February 2018

Local media begin to cover the story of PBMs in Arkansas, including all four local tv stations and numerous statewide radio stations and newspapers.

February 8

Scott Pace meets with John Ryan, CEO of Ambetter Arkansas to review cuts. Arkansas Attorney General launches investigation regarding complaints about reimbursement rates between pharmacy benefits manager, CVS Caremark, and Arkansas pharmacies.

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February 12

Scott meets with leaders from Arkansas Blue Cross Blue Shield, including CEO Curtis Barnett.

February 14

Scott again meets with Ambetter Arkansas CEO John Ryan.

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February 19

Governor Asa Hutchinson calls a press conference to announce that he intends to call for a special legislative session to address the pharmacy crisis in Arkansas.

February 21

APA hosts a press conference to show the ways CVS/ Caremark has been breaking the law by reimbursing their own CVS stores at a higher rate than independent pharmacies for the same drug, and by reporting a reimbursement rate to patients that was higher than the actual reimbursement amount. The press conference is streamed live online with hundreds of viewers from across the country tuning in.

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February 23

The Log Cabin Democrat publishes an op-ed written by Conway pharmacists David Smith about the dangers of PBMs titled “The Monster in the Closet.” The piece gets national attention when it is picked up by several newspapers outside Arkansas.

March 12

The Arkansas Legislative Special Session begins with bills filed in the House and Senate that would require PBMs to be licensed by the Insurance Department in order to do business in Arkansas. To be licensed, PBMs must not be breaking any Arkansas laws.

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March 15

After overwhelming support in both the House and Senate led by APA champions Sens. Ron Caldwell, Jason Rapert, and Bruce Maloch, and Reps. Michelle Gray, Jeff Wardlaw, Reginald Murdock and Jimmy Gazaway, Governor Asa Hutchinson officially signs the PBM Licensure Act into law. §

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136 th APA Annual Convention June 7-9, 2018 The Arkansas Pharmacists Association’s (APA) 136th Annual Convention will be held at Embassy Suites Northwest Arkansas in Rogers from June 7-9, 2018. The conference theme, Making Your Way in the World Today, reflects the struggles and triumphs the pharmacy community has seen in the past year and the renewed passion those challenges bring for the future. Pharmacists can stay up-to-date and informed with the continuing pharmacy education sessions and networking opportunities planned at the convention. This annual conference will welcome up to 350 pharmacists, students, pharmacy technicians, exhibitors, and special guests. ______________________________________________________

Why Attend

____________________________________________________

Continuing Pharmacy Education: APA will offer continuing pharmacy education credit hours with highly-regarded instructors on topics ranging from medical marijuana to point of care testing.

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Comprehensive Exhibition: Exhibitors including pharmacy wholesalers, manufacturers, insurers, colleges of pharmacy, and software vendors will be on hand to discuss their newest products and services that will benefit the practice of pharmacy in Arkansas. Be sure to visit with these 22 professionals to learn about their innovative products.

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Social and Networking Events: Join old and new friends at the convention social events. In addition to the always popular Opening Reception at the Exhibit Hall, attendees can spend an evening at the world-renowned Crystal Bridges Museum enjoying some of the most beautiful works of art by local and classical artists. __________________________________________________

Accommodations

__________________________________________________

The host hotel for the 136th APA Annual Convention is The Embassy Suites Northwest Arkansas at 3303 S Pinnacle Hills Pkwy in Rogers. Check-in is at 3:00 PM and check-out is 12:00 PM. For reservations, call 479845-3271 or visit www.arrx.org/convention-hotel. Room rate is $145.00 plus tax while they last. Mention Arkansas Pharmacists Association for group rate.

We appreciate the support of our Wholesale Business Partners!* AmerisourceBergen Cardinal Health McKesson Morris & Dickson Company, LLC Smith Drug Company * These organizations did not provide any financial support for continuing education activities. AR•Rx

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Schedule of Events ____________________________________________________

Wednesday, June 6, 2018

2:00 - 5:30 PM

AFTERNOON CPE BLOCK • Arkansas Pharmacy Law Update • Utilizing Enhanced Patient Care Services to Improve Patient Adherence • Point of Care Testing

4:30 - 5:30 PM

Arkansas Pharmacists Foundation Board Meeting

5:30 - 6:00 PM

President’s Reception- Honoring Past Presidents

6:00 - 8:00 PM

Opening Reception / Student Poster Session in Exhibit Hall

____________________________________________________ 9:00 AM - 12:00 PM

APA Board of Directors Meeting

1:00 PM

Golf Tournament Lost Springs Golf Club Rogers, AR ____________________________________________________

Thursday, June 7, 2018

____________________________________________________

2016-2017 APA President Eddie Glover presents the 2017 Pharmacist of the Year Award to Laura Lumsden

7:00 AM - 4:30 PM

Registration

7:30 - 8:45 AM

Breakfast Honoring 2018 APhA President Nicki Hilliard

8:45 AM - 11:45 PM

MORNING CPE BLOCK • Pharmacists’ Documentation of Patient Care Services • 2018 New Drugs

12:00 - 1:45 PM

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Luncheon & Awards Ceremony featuring AP-PAC Guest Speaker Governor Asa Hutchinson

______________________________________________________

Friday, June 8, 2018

____________________________________________________ 7:00 AM - 4:30 PM

Registration

7:30 - 8:45 AM

Breakfast

9:00 AM - 12:00 PM

MORNING CPE BLOCK • Legislative Panel • State of the Association Address • Pharmacists as Providers: Recognition by Health Plans

10:00 AM - 12:30 PM

Arkansas Association of Health-System Pharmacists (AAHP) Board Meeting

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136 th APA Annual Convention • June 7-9, 2018 ______________________________________________________

Saturday, June 9, 2018

Spouse Trip

10:00 AM - 1:00 PM

_____________________________________________________

Spouse Trip Walmart Museum (lunch provided)

The Walmart Museum is as much a part of Walmart’s history as the exhibits and artifacts that it houses. The creation of the Walmart Museum was, as Sam Walton put it, “a labor of love” for many associates. And so, today, The Walmart Museum carries on the mission it always has: to educate, engage, and inspire visitors about the heritage of Walmart. 12:00 - 2:00 PM

Lunch in Exhibit Hall

2:00 - 5:15 PM

AFTERNOON CPE BLOCK • Medical Cannabis - Operational Issues • Mental Health Matters - How Pharmacists Can Help

Crystal Bridges

7:00 - 10:00 AM

Registration

7:30 - 8:45 AM

Continental Breakfast

9:00 AM - 12:30 PM

MORNING CPE BLOCK • Make Immunization Practices Great Again - Updating and Expanding Pharmacy-Based Immunization Services • Pharmacist Role in Continuous Glucose Monitoring

12:30 PM

Convention Adjourns

2018 Annual Convention

CPE Schedule

______________________________________________________

Thursday Morning

_____________________________________________________ PHARMACISTS’ DOCUMENTATION OF PATIENT CARE SERVICES Randy McDonough, Pharm.D., M.S., CGP, BCPS, FAPhA,, Towncrest and Towncrest Compounding Pharmacies, Iowa CPE Objectives: • Discuss the key components of appropriate patient care documentation • Develop clinical recommendations to communicate to other healthcare providers • Describe the elements of the e-Care plan • Discuss how to engage prescribers __________________________________________________

A Night at Crystal Bridges Museum of American Art Crystal Bridges takes its name from a nearby natural spring and the bridge construction incorporated in the building, designed by world-renowned architect Moshe Safdie. A series of pavilions nestled around two spring-fed ponds house galleries, meeting and classroom spaces, and a large, glassenclosed gathering hall. Guest amenities include a restaurant on a glass-enclosed bridge overlooking the ponds, a Museum Store designed by architect Marlon Blackwell, and a library featuring more than 50,000 volumes of art reference material. Sculpture and walking trails link the Museum’s 120-acre park to downtown Bentonville, Arkansas. APA guests will enjoy full access to the mueum, including the featured Georgia O’Keefe exhibit. 4 24

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2018 NEW DRUGS Jill T. Johnson, Pharm.D., BCPS, UAMS College of Pharmacy CPE Objectives: • Identify new drug additions for 2018 • Summarize the current literature for the new drugs • Reflect on the place in therapy of the new drugs for 2018 • Differentiate clinical and surrogate endpoints for the new drugs • Examine beneficial and novel new drugs that have emerged to market

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Embassy Suites Northwest Arkansas • Rogers, Arkansas _____________________________________________________

Thursday Afternoon

___________________________________________________

CPE Sessions

ARKANSAS PHARMACY LAW UPDATE John Kirtley, Pharm.D., Arkansas State Board of Pharmacy CPE Objectives: • Analyze recent changes in pharmacy regulations in Arkansas • Discuss the reasoning behind changes to pharmacy regulations • Describe recent pharmacy regulatory changes and challenges • Identify three practice changes to protect your controlled substance inventory

__________________________________________________

UTILIZING ENHANCED PATIENT CARE SERVICES TO IMPROVE PATIENT ADHERENCE Brenna Neumann, Pharm.D., Collier Drug Stores CPE Objectives: • Describe how enhanced patient care services can be applied to improve medication adherence • Summarize the steps necessary to ensure compliance with the Arkansas Board of Pharmacy rules with regards to delivery of enhanced services such as multidose packaging and medication administration • Formulate a policy and procedures outline for delivery of each enhanced patient care service aimed at medication adherence • Determine how to utilize support staff in the delivery of medication adherence strategies • Specify ways in which to engage with other healthcare providers to facilitate delivery of pharmacy services aimed at improving medication adherence __________________________________________________ POINT OF CARE TESTING Lindsey Watford, Pharm.D., Teasley Drug; Megan G. Smith, Pharm.D., BCACP, UAMS College of Pharmacy; Brandon Achor, Pharm.D., Lackie Drug CPE Objectives: • Define point of care testing • Develop a point of care program in your pharmacy • Identify benefits and drawbacks of testing in your pharmacy • Identify ways to make a point of care program successful

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_____________________________________________________

Friday Morning

___________________________________________________ LEGISLATIVE PANEL Moderated By Representative Justin Boyd CPE Objectives: • Describe the role pharmacists can take in local and state government • Reflect on the 2018 Special Session and the legislation that was passed • Identify ways to create a working, professional relationship with your local legislators __________________________________________________ PHARMACISTS AS PROVIDERS: RECOGNITION BY HEALTH PLANS Jenny Arnold, Pharm.D., BCPS, Washington State Pharmacy Association CPE Objectives: • Explain Washington State efforts for health insurance coverage of pharmacist provided services • Describe the enrollment process for health plan provider networks • Explain the differences between billing a pharmacy claim and a medical claim ___________________________________________________

Friday Afternoon

___________________________________________________ MEDICAL CANNABIS - OPERATIONAL ISSUES Rhonda Beck, Pharm.D., Nathan Grifford, Pharm.D., Sara Parsley, BBA, M.Ed.IT - Trinity Herbal Compliance CPE Objectives: • Importance of training and continual education of dispensary agents, patients, caregivers, and the general public

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136 th APA Annual Convention • June 7-9, 2018

Vaccines for Children Program • Apply current Advisory Committee on Immunization Practices (ACIP) recommendations to adolescent and adult patients regarding specific immunizations • Identify the appropriate routine immunizations indicated for an adult patient based on age and medical conditions according to the evidence-based recommendations by the Centers for Disease Control and Prevention • Examine recent outbreaks of vaccine-preventable disease and apply recommendations to patients during times of outbreaks • Evaluate strategies to identify patients at increased risk for vaccine-preventable disease ___________________________________________________ • Understand medical cannabis dispensary rules and regulations and how to prepare for audits • Partner with pharmacist to initiate and follow standard operational procedures for inventory control, destruction process, recall procedures, documentation practices, and patient care guidelines • Recognize potential drug interactions and signs of abuse and addiction • Explain quality and potency testing requirements and how to interpret results __________________________________________________ MENTAL HEALTH MATTERS – HOW PHARMACISTS CAN HELP Jake Galdo, Pharm.D., M.B.A., BCPS, BCGP, Pharmacy Quality Alliance

CPE Objectives: • Describe the current landscape of mental healthcare in the United States • Customize patient care with pharmacotherapy updates • Understand role of quality metrics in mental healthcare • Implement pharmacist-led mental health services • Discuss Arkansas Medicaid changes, including PASSE ___________________________________________________

Saturday Morning

___________________________________________________ MAKE IMMUNIZATION PRACTICES GREAT AGAIN— UPDATING AND EXPANDING PHARMACY-BASED IMMUNIZATION SERVICES Eric Crumbaugh, Pharm.D., ExpressRx

PHARMACIST ROLE IN CONTINUOUS GLUCOSE MONITORING Gabriella Douglass, Pharm.D., BCACP, AAHIVP, Harding University COP and ARcare CPE Objectives: • Recognize the role of pharmacists in communicating about Continuous Glucose Monitoring (CGM) and providing patient education to improve CGM device selection and optimize adherence • Describe opportunities for pharmacists to perform diabetes management activities utilizing CGM • Explain how pharmacists can collaborate with interdisciplinary healthcare teams to optimize the care of patients with diabetes • Discuss potential outcomes of diabetes management activities provided by pharmacists

The University of Arkansas for Medical Sciences (UAMS) College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of Continuing Pharmacy Education. These programs are open to all pharmacists. To receive credit, the pharmacy participant must complete all online post-tests/program evaluation forms. If the attendance documentation is illegible then no credit can be issued. Partial credit will not be given for a session; you must attend each session in full to receive credit for that particular session. Credit will be uploaded to CPE Monitor within 60 business days of completion of the program. Participants will be notified via email when credit has been uploaded to the CPE monitor database. You may check the status of your CPE credit anytime by logging on to your CPE Monitor account at www.mycpemonitor.net.

CPE Objectives: • Discuss recently updated recommendations regarding shingles vaccination • Discuss the process to establish a pharmacy-based

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APA 2018 Annual Convention REGISTRATION FORM Register online at www.arrx.org First Name: _________________________________________ Last Name: _________________________________________ Designation: P.D. Pharm.D. Technician Student Other Nickname (for badge): _______________________________ Home Address: _____________________________________ City: _________________ State: ___ Zip: _______________ Cell Phone:_____________ Work Phone: ________________ Email: ______________________________________________ Employer: __________________________________________ Pharmacist License # (e.g. PD01234): _________________ NABP E-Profile #:____________________________________

PHARMACIST FULL REGISTRATION PACKAGE

Includes: All CPE sessions, receptions, exhibit hall admission, prize drawings, breaks, and social event tickets for Thursday, Friday, and Saturday. APA MEMBER

NON MEMBER

Full Registration

$329

$424

Full Registration

$449

$544

& Spouse/Guest

Embassy Suites Northwest Arkansas • Rogers, Arkansas

TECHNICIAN REGISTRATION PACKAGE APA MEMBER

NON MEMBER

Full Registration

$175

$195

Thursday Only Registration

$120

$140

Friday Only Registration

$120

$140

Saturday Only Registration

$120

$140

STUDENT PHARMACIST SPONSORSHIP Student Pharmacist Sponsorship - $85

Sponsor a student pharmacist to provide the opportunity for a UAMS or Harding College of Pharmacy student to attend the APA convention for free.

# of Students to Sponsor _____ @ $85 each = __________

ADDITIONAL CONVENTION ACTIVITIES Wednesday, June 6 Convention Golf Tournament, Lost Springs Golf and Athletic Club, Rogers, AR - $65 # of Golfers ______ at $65 per player = ________________ Name(s) of Golfers ________________ _________________ ________________ _________________ Friday, June 8 Spouse Trip to Walmart Museum - $40 Name of Attendee: _________________________________

SOCIAL EVENT TICKETS - Friday, June 9 Social Event Tickets are included in the Full Registration Package.

PHARMACIST DAILY REGISTRATION PACKAGE

Includes: All CPE sessions, receptions, exhibit hall admission, prize drawings, breaks and social events for the day of registration. APA MEMBER NON MEMBER Thursday Only Registration

$219

$269

Thursday Only Registration and Spouse/Guest

$289

$339

Friday Only Registration

$219

$269

Friday Only Registration and Spouse/Guest

$289

$339

Saturday Only Registration

$169

$219

Saturday Only Registration and Spouse/Guest

$219

$269

A Night at Crystal Bridges # of Additional Tickets: ________ @ $15 each = _________

RESERVATIONS Please let us know the number of attendees for each event you plan on attending. (Include yourself plus any guests) ____ Thursday, June 7- Breakfast ____ Thursday, June 7- Awards Luncheon and Ceremony ____ Thursday, June 7- Opening Exhibitor Reception ____ Friday, June 8- Breakfast ____ Friday, June 8- Exhibitor Lunch ____ Friday, June 8- A Night at Crystal Bridges ____ Saturday, June 9- Breakfast

PAYMENT Total Amount: ______________________________________ Pymt. Type: __Visa __AmEx __MC __Discover __Check Card# ______________________________________________ Exp____________________ Sec Code___________________ Please make checks payable to: Arkansas Pharmacists Association, 417 S. Victory St., Little Rock, AR 72201 Fax to: 501-372-0546. Or register at: www.arrx.org/2018_convention

Refund Policy By May 25, 2018, 50 percent refund will be issued. After May 25, 2018, no refund will be issued. All refund/cancellation W W W . A Rmust RX.O requests beR Gsubmitted to APA in writing. Registrations are non-transferrable.

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UAMS SCHOOL OF PHARMACY

Leaders Recognize the Value of People Keith Olsen Pharm.D., FCCP, FCCM Dean and Professor

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ne of the enjoyable facets of my position is that I have the opportunity to visit with many different folks; most in some capacity of leadership. What seems common is that leaders beget leaders, leaders hang out with leaders, leaders seek out leaders, and leaders practice leadership. Most of all, leaders recognize the value of people, and want to continue giving back. At UAMS, our students’ work in their community service projects and all they achieve outside of daily coursework creates a stimulating environment. Our faculty, advisors and alumni are energized by the discipline of influencing others through lifelong learning and mentoring. Leadership possibilities are all around for the taking. We have observed great examples of this over the past three months. At UAMS College of Pharmacy, we are a culture of leadership. Every P1 student is introduced to numerous organizational opportunities during orientation the first week of school. Encouraging participation in organizations fosters more opportunity for leadership, provides exposure to professional advocacy, and helps students gain confidence in how to work with people. For the past several years all students take Gallup’s Strengthsfinder® evaluation to discover how their unique talents impact leadership. Through cultural patterns, beliefs, practices and behaviors, we have set the bar high for the expectation of leadership within the college.

Teaching her Pharmacy students that “half of life is what you know and the other half is who you know”, Dr. Hilliard encourages each one to find their voice and to be active.

In the nation, the percentage of leaders emerging from our relatively small state of Arkansas creates an impressive legacy. By providing great leadership in their communities, serving on state and national committees and boards, providing preceptorship or charting new political territory, these frontrunners are willing to write history. These leaders are well-connected with people of influence, and have propelled their careers one achievement at a time as they have engaged in serving, chairing, directing, and repeating leadership behaviors. One of these UAMS leaders is Dr. Nicki Hilliard.

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Dr. Hilliard is currently serving as President of the American Pharmacist Association, the largest membership voice in the nation for pharmacy advocacy. Her philosophy on leadership is “the more you give away, the more you get back”. Nicki credits her parents for influencing her through their giving of their time toward community and church efforts, and her husband, Joe, for his participation in volunteer service. Leadership involvement is part of her self-code of expectation. Showing up and being responsible is her commonsense approach to knowing the issues, gaining recognition, and growing confidence in how to work with people. Currently she is reading The Charisma Myth: How Anyone Can Master the Art and Science of Personal Magnetism by Olivia Fox Cabane. She believes anyone can develop leadership skills, and can “bloom where you are planted” by being a leader wherever they are. Teaching her Pharmacy students that “half of life is what you know and the other half is who you know”, Dr. Hilliard encourages each one to find their voice and to be active. With all of the available social media platforms, getting recognized by getting your name out there is something she professes. Leaders seek out ways to establish credibility and speak up for their profession. She believes that people need to practice mindfulness in stretching and developing leadership and communication skills, and to take the time to nominate others for recognition. When you are seen as a leader, you should live up to it. Leadership, though simple in concept, can be challenging. At UAMS, we take the responsibility of developing leaders seriously. We want to continue the cycle of generating new leaders, be energized by hanging out with leaders, be inspired by inviting and sitting under notable leadership, and respect that all people have the capacity to be leaders. We want to continue the practice of giving back. Arkansas pharmacy has a legacy of leaders. §

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HARDING UNIVERSITY REPORT

Harding's Center for Health Sciences Offers Many Opportunities Jeff Mercer, Pharm.D. Dean

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ccasionally when I speak about Harding University, professionals. Experiential simulations are utilized to place some find it surprising that the College of Pharmacy students in IPE situations that demand a level of cooperation is actually part of a larger Center for Health Sciences (CHS) and teamwork necessary to demonstrate optimal care for that incorporates multiple programs housed within the patients in a safe and controlled environment. Example Colleges of Pharmacy, Nursing, and Allied Health. Harding’s simulations include an annual university-wide disaster drill nursing program has a prestigious history that spans over that incorporates students from all of Harding’s health 40 years and was recently ranked as the #1 nursing program science programs and a 3-hour advanced cardiac life support in Arkansas.* Our College of Allied Health encompasses code simulation for upper-level pharmacy, nursing, and PA undergraduate degrees in communication sciences and students. Other pharmacy practice experiences offer the disorders and exercise and sports science, as well as graduate opportunity to work with various healthcare providers and degrees in physician assistant (PA) students to deliver optimum patient studies, speech language pathology, care in a number of community and and physical therapy (PT). In other institutional practice settings. In addition to the required related degree programs, Harding didactic and experiential has students studying mental health In addition to the required didactic and IPE activities, Harding has counseling, medical humanities, and experiential IPE activities, Harding has dietetics. Each of these fields of study developed a number of co-curricular developed a number of cocontributes to the strong investment activities that are interprofessional curricular activities that are that Harding has made in promoting in nature. One signature activity interprofessional in nature. is known as the “Night and the health sciences in Arkansas and offers opportunities for students to Round Tables” and was designed by learn collaboratively in a team-based Harding’s Interprofessional Steering approach to patient care. Committee as an interdepartmental collaboration to challenge students from a variety of healthHaving numerous health science programs at Harding is related fields to work through a patient case as a team. especially beneficial to pharmacy students as we design This once per semester event began in 2013 with the interprofessional (IPE) teaching and practice opportunities simple idea of helping students gain an understanding of throughout the doctor of pharmacy curriculum. Didactically, the important roles that each member of the group brings pharmacy students learn alongside students from other to total patient care. Even though the events are voluntary health science programs in courses of study that include for most students, attendance and participation has far human anatomy and physiology, pharmacotherapy, and outweighed expectations and continues to grow. Future IPE Christian bioethics. Students not only learn together in the events are being designed to include student physicians classroom but also participate in hands-on discovery and from associated medical schools in order to expand the team training through laboratory activities, including a shared to include primary care prescribers. cadaver dissection in the gross anatomy lab with PT students and faculty. Objective Structured Clinical Examinations Whether you already aware of Harding’s Center for Health (OSCEs) are embedded in the second and third professional Sciences or not, I would invite you to learn more about our year pharmacotherapy courses for pharmacy students to interprofessional programs by reviewing our new health present a patient case to an actively practicing healthcare sciences magazine entitled Outcomes: An Interprofessional provider (e.g. PA, physician, nurse practitioner, etc.) who also Approach to Healthcare available at http://www.harding.edu/ grades their performance. In total, the longitudinal integration outcomes. You may also find out more about Harding and our health science programs by visiting www.harding.edu. § of various types of health science learners and teachers enables students to gain an appreciation and respect for *https://www.registerednursing.org/state/ other healthcare professionals as they learn with, from, and arkansas/#rankings about each other. While classroom learning forms the important foundation of interprofessional education, pharmacy practice experiences further enhance student learning with other health 30 30

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ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

Advocacy! Advocacy! Advocacy! Brandy M. Owen Pharm.D., BCPS President

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f you didn’t know what that word meant before January 2018, I’ll bet you do now. Webster’s dictionary tells us it means the act or process of supporting a cause or proposal. In Arkansas (and especially for our retail brethren), it means fighting for your very livelihood, your patients, and even your community. Before last month, I had always thought of advocacy as just being overall supportive of this pharmacy profession. "Hey look at me, I’m a paying member of my professional association." And yes, while it STILL means that and is STILL very important to be a member of APA and AAHP (it’s membership renewal time, ya know!), this year has shown me how important ACTIVE advocacy can be. Through social media, email, blast fax, or whatever avenue you choose, pharmacists across the state have come together for a common cause in a way we have never seen before. It reaffirmed my belief in the basic concept of democracy, having your voice as a constituent heard, and how to be an ACTIVE advocate. Health system pharmacists can be just as involved in advocacy. ASHP is actively opposing House bill H.R. 4710, which would impose a two-year ban on new enrollment of Disproportionate Share Hospitals into the 340B Drug Pricing Program. ASHP believes this would potentially harm the nation’s most vulnerable patients. Created 25 years ago, the 340B program requires pharmaceutical manufacturers participating in the Medicaid or Medicare Part B programs to enter into a pharmaceutical pricing agreement (PPA) with the federal government. The intent was to enable these entities to stretch scarce federal resources as far as possible, reaching more eligible patients, and providing more comprehensive services. Admittedly a very complex process, this program serves tens of millions of uninsured and underinsured patients yearly. ASHP is asking us to reach out to our US Senators and Representatives and ask them to oppose 340B cuts. Another key issue for health system pharmacists on the national level is drug shortages. ASHP and their colleagues at the University of Utah continue to be the leaders providing timely information on drug shortages. They work on a daily basis with the FDA, Congress, and numerous other organizations to find solutions for all drug shortages and advocate for needed changes.

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ASHP and their colleagues at the University of Utah continue to be the leaders providing timely information on drug shortages. They recently developed a congressional call to action asking Congress to examine the following questions to address the underlying causes of shortages: • Should manufacturers be required to disclose to the medical community their manufacturing sites and the products produced in those sites, in terms of volume and percentage of product line? • Should sole-source products be allowed to be produced in a single plant? • Should there be redundancy in production of critical products? • Should be FDA identify a list of “critical medications” that would require manufacturers to develop a reasonable contingency plan in the event of a production interruption or shutdown? • What incentives could be developed for other manufacturers to increase production when drug shortages occur? • What can be done to determine the best locations of pharmaceutical plants in addition to ensuring that backup systems can quickly accommodate needs in the event of a disaster, given there are several types of natural disasters that can occur?

Please consider contacting your member of Congress through ASHP’s Call to Action on their website. Much of the above information is on the ASHP website, a fantastic tool for staying in the loop on issues that affect each and every one of us daily. Don’t leave advocacy up to others. It doesn’t just affect retail pharmacists. We all have a voice, and we should all find a way to use it. Use the website www.govtrack.us/congress/members/AR to find your representation, and let’s be ACTIVE ADVOCATES for our profession together. §

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LEGISLATOR PROFILE

Representative Matthew Shepherd EL DORADO

District: House District 6

Most admired politician: Ronald Reagan

Represents (Counties):

Advice for pharmacists about the political process and working with the AR Legislature:

Parts of Union, Columbia, and Ouachita Counties

Years in Office: Seven

Stay engaged with your local legislators and be patient with the political process.

Occupation: Attorney

Your fantasy political gathering would be:

Your hometown pharmacist: Richard Hanry

It would be amazing to have a conversation with Abraham Lincoln and Ronald Reagan.

What do you like most about being a legislator?

Hobbies:

What do you like least about being a legislator?

What do you look forward to the most about taking the role of Speaker of the House?

There are so many aspects of being a legislator that I enjoy, but I think what I like the most is being directly involved in decision-making for our state and its future.

Being away from my family, but that is just part of the job and fortunately, they are very supportive and understanding.

Most important lesson learned as a legislator:

Over my years of service I have learned a number of lessons that have helped me to improve as a legislator, but among the most important is to gather as much information as possible in order to make informed decisions.

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I enjoy watching my kids play sports, playing golf, and reading.

I look forward to so many different facets of serving as speaker, but ultimately I most look forward to helping to chart the course for the future of Arkansas, and helping my colleagues in the House to be effective. ยง

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` COMPOUNDING ACADEMY REPORT

Becca Mitchell, PharmD FIACP

FDA’s New Guidance Documents Overshadowed by Reimbursement Crisis

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he ferocity and fury with which Arkansas Pharmacists have united against unfair, anti-competitive reimbursement this year has been rightfully garnering the majority of pharmacists’ attention and focus. I have never been more proud to be a member of the Arkansas Pharmacist Association and am sincerely inspired by the impact being made as we all join together in pursuit of fair treatment and in defense of patient access. In January 2018, FDA published its 2018 Compounding Policy Priorities Plan – this may have been missed amid the reimbursement mayhem but its importance should not be overlooked.

Priority #1

Risk-Based Approach to CGMP Standards for Outsourcing Facilities

Timeline: 2018, month unknown Summary: FDA intends to update the July 2014 draft guidance on what aspects of CGMP are required for Outsourcing Facilities, with a goal for “more compounders to register” with FDA under Section 503B. The revised guidance, which some have nicknamed ‘503B Lite,’ will outline a “flexible, risk-based approach to CGMP.” It should be noted that the Outsourcing Facility Association, a trade organization representing a number of current 503B Outsourcing Facilities, opposes the creation of dual standards for drug quality in this space.

Priority #2

Defining & Restricting Compounding of “Essentially Copies” of FDA-Approved Products

Timeline: January 2018 Summary: Two final guidance documents were released in January 2018 for 503A and 503B, respectively. The 503A guidance is especially critical for 503A compounding pharmacies to read and understand. FDA defines a compound as “essentially a copy” with three key details that differ from many pharmacists’ traditional interpretation of what is allowed and what is not. 1. Combination products are considered copies if the ingredients are available separately from manufactured drug products. Example: Drug A is manufactured in a 5mg tablet and Drug B is manufactured in a 10mg tablet. A compounded capsule that is Drug A 5mg + Drug B 10mg is considered a copy and therefore prohibited. 2. Same or similar strength defined as within 10% of the approved product strength OR easily substitutable from what is available from a commercial manufacturer. Example: if a 25mg oral tablet is available, compounding a 50mg oral capsule is prohibited. 3. Same route of administration includes what is possible, not just what is in the approved labeling of the commercially 34

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manufactured drug. Example: an injection labeled for IM injection could be given as a SQ injection. Based on the criteria above, if a compound is considered “essentially a copy” then the prescriber must indicate on the prescription what clinical difference is necessary for that patient. Examples: “Liquid form, patient cannot swallow tablet” or “Dye free, patient allergy.” Finally, FDA’s new guidance for 503A pharmacies says that the need for the statement of clinical difference is expected to be rare, therefore those medications should not be compounded on a routine or pre-set schedule. FDA also says that products requiring documentation of clinical need should not be so commonly used that they are on pre-printed prescription pads.

Priority #3

Regulating Compounding from Bulk Substances

Timeline: March 2018 Summary: In response to a lawsuit filed in 2017 by Endo, FDA is revising its policies regarding compounding from bulk drug substances. Both 503A pharmacies and registered 503B outsourcing facilities alike are watching for this updated guidance with baited breath, given its potential for far-reaching impact on patient access.

Priority #4

Update the MOU Draft and Solidify Partnership with State Boards

Timeline: 2018, month unknown Summary: FDA will issue revised guidance whereby 503A pharmacies cannot distribute more than 50% of its compounds across state lines without triggering reporting requirements. Note that, according to FDA, “distribute” includes dispensing patient-specific prescriptions. It remains to be seen how the revised MOU will align – or not – with current statutory limitations pertaining to Arkansas pharmacy law and how the Board of Pharmacy can or will respond. Other priorities the publication mentions include finalizing guidance of biological products, the “definition of a facility” in section 503B, radiopharmaceuticals compounded or repackaged in state-licensed nuclear pharmacies, compounding in physician offices, and the negative list. FDA is clearly devoting resources and attention to compounding pharmacy; and 2018 appears be action-packed. We have seen with PBM reimbursement how effective grassroots lobbying efforts can be – should the need for a similar effort be needed to protect patient access to compounds, I know the Academy will be ready to engage. §

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`

2018 Calendar of Events

MAY ———————————— May 5, 2018 Harding College of Pharmacy Commencement Searcy, AR

AUGUST —————————— August * UAMS P1 White Coat Ceremony Little Rock, AR

May 19, 2018 UAMS College of Pharmacy Commencement Little Rock, AR

August 17, 2018 Harding P1 White Coat Ceremony Searcy, AR

JUNE ———————————

August 23-31, 2018 APA District Meetings Around the State

June 2-6, 2018 American society of Health-System Pharmacists Summer Meeting Denver, CO June 6, 2018 APA Board Meeting NWA Embassy Suites Rogers, AR June 7-9, 2018 APA 136th Annual Convention Embassy Suites Northwest Arkansas Rogers, AR

JULY ——————————— July 26-28, 2018* APA Board Retreat and Committee Chair Orientation TBA

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SEPTEMBER ———————— September 6-27, 2018 APA District Meetings Around the State

OCTOBER ————————— October 6-10,2018 National Community Pharmacists Association Annual Convention Boston, MA October 11-12, 2018 AAHP Fall Seminar Airport Holiday Inn Little Rock, AR

October 25, 2018* APA Golden CPE Hosto Center Little Rock, AR

NOVEMBER ———————— November 1-4, 2018 American Society of Consultant Pharmacists Annual Meeting and Exhibition Gaylord National Harbor National Harbor, MD November 30, 2018* APA Committee Forum TBA November 30, 2018* APA Board Meeting TBA

DECEMBER ———————— December 2-6, 2018 American society of Health-System Pharmacists Midyear Clinical Meeting Anaheim, CA *dates subject to change

October 23, 2018 APA Board Meeting Conference Call

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A View from the Board Meeting: Patient Counseling

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his column begins a new series of Compliance Corners which will focus on issues that have been arising frequently in Board of Pharmacy disciplinary cases. The first of these is perhaps the most common basis for Board discipline: improper patient counseling. This usually—but not always—arises in the context of a medication error reported to the Board by a patient or prescriber. Often, the error could have been prevented or discovered before the prescription was dispensed to the patient if proper counseling had occurred. In that instance, the Board will often consider the failure to counsel as one of the contributing factors to the harm suffered by the patient. So what does “proper counseling” entail? A common misconception among pharmacists and technicians is that simply offering to counsel the patient is sufficient under the regulations. However, this does not meet the standard required by Board Regulation 9. The Regulation states: (1) A pharmacist shall counsel the patient or caregiver "face to face" if the patient or caregiver is in the pharmacy. If not, a pharmacist shall make a reasonable effort to counsel the patient or caregiver; (2) Alternative forms of patient information may be used to supplement, but not replace face-to-face patient counseling[.] Regulation 09-00-0001(c) (emphasis added) (available at http:// www.pharmacyboard.arkansas.gov/Websites/pharmacy/ images/rules/Regulation9.pdf). In order to be considered “effective communication” of information, counseling must include the following: (A) Name and general description of the medication dispensed, i.e. antibiotic, antihistamine, blood pressure medicine, etc. (B) Name, general description and directions for use of drug delivery devices, i.e., insulin syringes, morphine pump, etc. (C) Explanation of route of administration, dosage, times of administration, and continuity of therapy; (D) Special directions for storage as deemed necessary by the pharmacist; (E) If the drug has been determined to have a significant side effect by the Board of Pharmacy, the patient shall be properly counseled to the extent deemed necessary by the pharmacist. (F) When the prescription drug dispensed has a significant side effect, if taken with over-the-counter drugs, the pharmacist should counsel the patient about that interaction. (Example: coumadin with aspirin ) (G) If the prescription medication is significantly affected 36

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by food or diet, the pharmacist should so advise the patient. (Example: tetracycline with milk or food) (H) The pharmacist shall inform the patient or caregiver that he/she is available to answer questions about medications or general health information Regulation 09-00-0001(d)(1). Conveying this information is crucial to not only ensure that the patient understands the appropriate use of the medication but also to identify when common errors such as substituting a similarly-named drug with a very different therapeutic purposes or a change in dosage of a long-standing prescription have occurred. For example, if a technician had mistakenly input a prescription for lamotrigine as labetalol, and the pharmacist checking the prescription did not catch the error, the patient could suffer significant harm if the prescription was dispensed. In this instance, if the pharmacist on duty when the prescription was dispensed would simply state the name of the drug, its general purpose, and the dosage to be taken, the patient could identify that he or she was not supposed to receive a prescription for high blood pressure and the error would be discovered. Because the Regulation does not require counseling for refilled prescriptions, many pharmacists believe that a simple “Have you taken this before?” will suffice as counseling. However, this quick question will not identify situations where a medication error has occurred or situation where the patient has restarted a medication regimen after a period of time or where the prescriber has changed the dosage. This is particularly important when the pharmacist on duty did not personally fill the prescription and/or is unfamiliar with the patient’s medication history. For these reasons, in my experience with medication error scenarios the Board has expected more from the pharmacist, even with a refilled prescription. As a best practice, I recommend that pharmacists make it a habit to give a very quick overview of the prescription to every patient, every time. This overview can be something like: “This is labetalol for high blood pressure. Take one 100 mg pill twice a day. It may make you nauseated. Call your doctor if you have any shortness of breath or are lightheaded.” By taking this step, you will not only ensure that your patients understand the effective use of their medication but you will also be able to protect yourself from most medication errors—and an appearance before the Board. §

________________________________________________________________ Erika Gee is a partner at Wright Lindsey Jennings, a member of the firm’s Government Relations Practice and a former Chief of Staff and Chief Deputy in the Arkansas Attorney General’s Office. She focuses her practice on administrative and regulatory law, government investigations, legislative drafting and lobbying.

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APA CONGRATULATES

Nicki Hilliard AS THE 2018-2019 APhA NATIONAL PRESIDENT

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2018 APA Golf Tournament The 2018 Arkansas Pharmacists Association Golf Tournament was held at Tannenbaum Golf Course in Drasco on April 19. Seventeen teams played the beautiful 18-hole course with prizes going to the longest drive and closest to the pin. The four-player scramble golf tournament benefits the Arkansas Pharmacy Foundation and the Charles M. West Leadership Award Scholarship. The Arkansas Pharmacy Foundation promotes the profession of pharmacy in Arkansas through financial contributions and continuing education. Special thanks to our generous sponsors – Pharmacists Mutual, Smith Drug Co, Cornerstone Pharmacy – Markham, UAMS College of Pharmacy, Harding College of Pharmacy, East End Pharmacy, Marshall Medic, Caldwell Discount Drug, Smith Family Pharmacy, McCoy-Tygart Pharmacy, Community Pharmacy, Morris & Dickson, Wynne Apothecary, Collier Drug, and Harps Food Stores.

Ron Curran, Dave Bell, Don Curran, Steve Bell

Gene Boeckmann, Mick Rafferty, Ken Johnson

Clint Recktenwald, Oakley Recktenwald, Kyndall Ardoin, Henry Dannehl

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Dylan Jones, Amie Collier, Libby Primm, Gary Fancher

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Canyon Cody, Mitch Padgett, Natalie Gay, Robert Acord Chris Cooper, Ben Ramsey, Andy Roller, Ryan Harness

David Smith, John Smith, Tom Roberts, Jerry Overman Mikel McCord, Barry Talley, Tommy Johnson, Andrew Moore

Cole McRae, Brannon Hill, Josh Cummins, Jarrod King

Eric Johnson, Ty Sims, Bryan Liles, Brandon Harris

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John Vinson, Sara Massey, Randy Kassissieh, Scott Pace

Brandon Achor, Chuck Shipp, Larry Sparks, Eddie Glover

Trent Shipley, Jay Bone, Chad Vance, Chad Riley

Kevin Moore, Casey Hedden, Clyde Kirby, Michael Thilo

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John Norris, Bill Bloodworth, Mark Riley, Gary Bass

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THANK YOU

Tanner Rogers, Camdon Woodruff, Bradley Cowdrey

to all who participated in APA's 2018 Golf Tournament!

Frankie Gould, Keith Olsen, Howell Foster, Will Arnold

SAVE the

STAFF SPOTLIGHT: ELISABETH MATHEWS

DATE! JUNE 7-9, 2018

2018 APA Convention Embassy Suites Northwest Arkansas Rogers, Arkansas Join us in the rolling hills of Northwest Arkansas for the 2018 APA Annual Convention, to be held June 7-9 at the Embassy Suites Northwest Arkansas in Rogers, Arkansas. APA will offer up to 16 hours of continuing pharmacy education (CPE) relating to pharmacy practices. Members and guests will be able to learn about the latest product trends in pharmacy from more than 40 exhibitors who will showcase new products to potential customers while working to maintain and strengthen relationships with existing customers. Social events to mingle with fellow pharmacists, colleagues, and friends are planned as well as the annual golf tournament on Wednesday afternoon, June 6. Convention registration will open shortly so stay tuned for more information through InteRxActions and at www.arrx.org/annual-convention.

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2017 Recipients of the “Bowl of Hygeia” Award

Larry Presley Alabama

John McGilvray Alaska

Alan Barreuther Arizona

Sue Frank Arkansas

Pierre Del Prato California

Mary Petruzzi Connecticut

Noel Rosas Delaware

Goar Alvarez Florida

Hewitt Ted Matthews Georgia

Ed Cohen Illinois

Ahmed Abdelmageed Indiana

Tim Becker Iowa

Merlin McFarland Kansas

Melody Ryan Kentucky

Gregory Poret Louisiana

Greg Cameron Maine

Cynthia Boyle Maryland

Anita Young Massachusetts

Dennis Princing Michigan

Denise Frank Minnesota

David French Mississippi

David Farris Missouri

Matthew Bowman Montana

Gary Rihanek Nebraska

Mark Decerbo Nevada

Hubert Hein New Hampshire

Thomas F.X. Bender, Jr. New Jersey

David Lansford New Mexico

John T. McDonald III New York

Steve Caiola North Carolina

Tim Weippert North Dakota

Debra Parker Ohio

Ben Allison Oklahoma

Mercy Chipman Oregon

Jerry Musheno Pennsylvania

Marisa Carrasquillo Puerto Rico

Gary Kishfy Rhode Island

Terry Blackmon South Carolina

Tim Tucker Tennessee

Chris Alvarado Texas

Kurt Price Utah

Pat Resto Virginia

The “Bowl of Hygeia”

In Memoriam: Rob Loe South Dakota Keith Campbell Washington Daneka Lucas Washington DC

Kevin Yingling West Virginia

Thad Schumacher Wisconsin

Joe Steiner 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. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.

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