ARRX 2nd Issue 2021

Second Issue 2021 Award-Winning Quarterly Publication of the Arkansas Pharmacists Association

Great Chances in the Midst of Change 2021 Legislative Session Recap

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Congratulations 2021 Scholarship Winners Pharmacists Mutual is proud to support students who are interested in serving in an independent or small chain community pharmacy or an underserved geographic or cultural community.

Each student listed received a $2,500 scholarship.

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Ganiat Asuni Philadelphia College

Matthew Brock Medical University of South Carolina

of Osteopathic Medicine

Megan Breier Ohio Northern University

Hayden Wooldridge University of Mississippi

Marlee Clements Mercer University

Hassan Khatib Wayne State University

Megan Hardy South Dakota State University

Kristian Tan Keck Graduate Institute

Morgan Rambo Samford University

Kayla Lucas Virginia Commonwealth University

Sarah Erlingheuser University of Connecticut

Kensey Hunt St. Louis College of Pharmacy

Steven Kramer St. Louis College of Pharmacy

Kinsey McClure University of South Carolina

Sarah Lankford Presbyterian College

ACCEPTING APPLICATIONS FOR 2022 SCHOLARSHIPS October 1, 2021 - December 1, 2021 • phmic.com/scholarship/ 808 Highway 18 W | PO Box 370 | Algona, Iowa 50511 | P. 800.247.5930 | F. 515.295.9306 | E. info@phmic.com | phmic.com

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APA Staff John Vinson, Pharm.D. Executive Vice President & CEO John@arrx.org

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Nicki Hilliard, Pharm.D. Director of Professional Affairs Nicki@arrx.org Jordan Foster Director of Communications Jordan@arrx.org Susannah Fuquay Director of Membership & Meetings Susannah@arrx.org Celeste Reid Director of Administrative Services Celeste@arrx.org Debra Wolfe Director of Government Affairs Debra@arrx.org Office E-mail Address Staff@arrx.org Publisher: John Vinson Editor: Jordan Foster Arkansas Pharmacists Association PO Box 3798 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 93. © 2021 Arkansas Pharmacists Association.

POSTMASTER: Send address changes to AR•Rx The Arkansas Pharmacist PO Box 3798 Little Rock, AR 72201-2923 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: If You Wait for Perfect

Conditions, You'll Never Get Anything Done

22 Legislator Profile: Rep Brian Evans 23 2020 Bowl of Hygeia Award Recipients

5 From the President: A Historic Term

24 AAHP: A Serving Heart

7 Member Spotlight:

25 Consulting Academy: Medication

8 FEATURE: Great Chances in the Midst

26 Compounding Academy: PCCA Gives

Emily Holton, Pharm.D. of Change

13 Safety Nets: Student Spotlights

Discrepancies

Detailed Response to FDA Warning Letter

15 New Drugs: FDA Springs Forward in

2021

16 Feature: Deja Vu All Over Again 18 UAMS: Foundation for Many Successes

of the Class of 2021

19 UAMS College of Pharmacy 2021

Graduates

20 Harding: Class of 2021 - Resiliency,

Poise, and Compassion

21 Harding University College of

ADVERTISERS 2 Pharmacists Mutual 6 Retail Designs, Incorporated 6 Arkansas Pharmacy Support Group 12 Pharmacy Quality Commitment 14 UAMS College of Pharmacy 14 EPIC 22 UAMS College of Pharmacy 26 Law Offices of Darren O'Quinn 27 Biotech Pharmacal, Inc. Back Cover: PPA/CPA

Pharmacy 2021 Graduates

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Cover photo courtesy of Arkansas Secretary of State

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APA Board of Directors

INSIDE APA

2021 - 2022 Officers President – Max Caldwell, P.D., Wynne President-Elect - Dylan Jones, Pharm.D., Fayetteville Vice President – James Bethea, Pharm.D., Stuttgart Past President – Kristen Riddle, Pharm.D., Greenbrier

Regional Representatives

John Vinson, Pharm.D. APA Executive Vice President & CEO

If You Wait for Perfect Conditions, You'll Never Get Anything Done

Region 1 Representatives - Kevin Barton, Pharm.D., Bentonville - John Hall, Pharm.D., Fort Smith - Spencer Mabry, Pharm.D., Berryville

“One who watches the wind will not sow and one who looks at the clouds will not harvest.” Ecclesiastes 11:4, The Bible

Region 2 Representatives - Erin Beth Hays, Pharm.D., Pleasant Plains - Jett Jones, Pharm.D., Jonesboro

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Region 3 Representatives - Brandon Achor, Pharm.D., Sherwood - Brittany Sanders, Pharm.D., Little Rock - Lanita White, Pharm.D., Little Rock Region 4 Representative - Betsy Tuberville, Pharm.D., Camden Region 5 Representative - Lelan Stice, Pharm.D., Pine Bluff At Large Representatives - Stacy Boeckmann, Pharm.D., Wynne - Rick Pennington, P.D., Lonoke Arkansas Association of Health-System Pharmacists HyeJin Son, Pharm.D., Little Rock Academy of Compounding Pharmacists Greg Turner, Pharm.D., Searcy Academy of Consultant Pharmacists Emily Holton, Pharm.D., Bentonville

Ex-Officio APA Executive Vice President & CEO John Vinson, Pharm.D., Benton AR State Board of Pharmacy Representative John Kirtley, Pharm.D., Little Rock Board of Health Member Marsha Boss, P.D., Little Rock UAMS College of Pharmacy (Dean) Cindy Stowe, Pharm.D., Little Rock Harding College of Pharmacy (Dean) Jeff Mercer, Pharm.D., Searcy General Counsel Nate Steel, J.D., Little Rock Treasurer Richard Hanry, P.D., El Dorado UAMS COP Student Lindsey Worthington, Little Rock Harding COP Student 4 Ferguson, Searcy Hannah ARRX 2nd Quarter 2021.indd 4

any of our members have embraced these words of wisdom in both their spiritual lives and in their professional lives, especially in recent years. You have had to in order to survive. The last few years have been tough but also very rewarding. In the professional realm, our first responders, pharmacists, and other healthcare professionals have faced a perfect storm of attacks and adversity. At the same time, the success of working collaboratively as a healthcare team to dramatically slow down the pandemic and save lives has been enormously satisfying at both a personal and professional level. Our pharmacy profession has been taking action and creating new opportunities for growth and professional satisfaction for those willing to adapt in today’s healthcare system. Collectively, we are seeing advances both “on the bench” and clinically in the real world in real time, but also in the policy world for the future.

The 2021 Arkansas state legislative session and policy changes made in our state law may go down as one of the best in recent memory for Arkansas pharmacists. On paper, it looks to be very positive for the profession and for our patients. Time will tell if the potential of the new laws and changes lives up to reality of what it means to each of you. I expect that you will read the APA articles about these changes, attend our continuing education sessions and network with your colleagues through our events to share best practices. It is only through application and sharing that it will be meaningful in all 75 counties.

"Don't wait for the stars to align.

Reach up, rearrange them the way you want them to be. Create your own constellation." Pharrell Williams

Your state association, the Arkansas Pharmacists Association, worked extremely hard this year with both our members and our elected officials, to advocate for many of the 2021 state law policy changes. We still had a pandemic to navigate and a burned building that physically hampered our efforts, but just like each of you, our members in the community and our hospitals, we do not have time to wait on perfect conditions to achieve success and progress in improving the opportunities for our profession.

Our advocacy and advancement of the profession is not possible without our members and your relationships with elected officials, your engagement with the association in sharing your successes and challenges, and your financial support to the Arkansas Pharmacists Political Action Committee (PAC).

The state legislature is currently in recess and will come back this fall to engage in additional state government business. Their top agenda item will be to finalize redistricting lines for political representation in statewide elections.

This happens every ten years. Practically for our efforts in advocacy, this means that all 135 state legislative seats will be up for re-election in 2022 with a much higher percentage of those being contested than normal years. It also will coincide with an election for a new Governor, Lieutenant Governor, Attorney General, Treasurer, and others who have executive level influence over areas of state policy and government.

The Arkansas Pharmacists Association will need your help raising $100,000 this cycle so that we can continue to financially support elected officials who listen to us and help pharmacists provide care in our communities. This means we need at least 100 pharmacy owners, pharmacists, pharmacy businesses, or other VIP friends of Arkansas pharmacists to donate at least $500 or $1000, with a maximum of $5000, plus the usual equally AR•Rx

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important contributions of $50, $100 or $250 that help us reach our financial goals. Student pharmacists should also join in and consider a $50 contribution. A “PAC” contribution of at least $50 or $100 will actually make student pharmacists or pharmacists eligible for a $50 tax credit (or up to $100 for married couples) on your state income taxes in Arkansas.

Arkansas is one of only a few states that have this incentive to become financially involved in the political process. Take advantage of it and invest in the process. I am encouraging you to make this investment as soon as possible so that APA can continue to financially support political friends of our profession. It is vital to our success. Financial support of our

political friends does not directly influence policy, but it does continue to help us remain politically relevant with a voice at the table in our political system. Arkansas pharmacists have had a prominent voice in recent years at the table both at the state and nationally in pharmacy policy discussions.

Let’s keep it that way! § Mail PAC physical checks to: Arkansas Pharmacists PAC PO Box 3798 Little Rock, AR 72203

PAC Online Giving Website: www.arrx.org/pac

FROM THE PRESIDENT

A Historic Term

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hat an exciting year we have had in Arkansas pharmacy! will provide clinical opportunities for It has truly been a blessing to be the 2020-2021 our pharmacists to practice at the president of the Arkansas Pharmacist Association. I have top of their licenses with prescriptive Kristen Riddle, Pharm.D. been honored to serve through this historic year! A lot has authority for CLIA waived tests via APA Past President happened this year for us as well…a Supreme Court victory, protocol, OTC prescribing, and a successful COVID vaccine rollout, and a tremendous 2021 therapeutic substitution. As well as Legislative Session. Even during a world laws allowing prescriptive authority for pandemic, Arkansas pharmacy rose to birth control and immunization for adults the top. Through all manner of trials and and children over 3 years of age. We tribulations the pharmacists of our state have increasing opportunities in medical have continued to serve our patients as billing as well as collaboration with other well as our profession. This year we were medical professionals as providers. Our blessed to not only have the Rutledge vs communities and our patients need us to continue to provide medication PCMA case heard at the highest court synchronization, adherence programs, in the land, but we also received a 8-0, and medication therapy management. unanimous ruling in our favor! Arkansas stepped up and lead the COVID vaccine We are and we will continue to be at the center of the healthcare team serving our rollout, vaccinating thousands of patients patients and communities. Now we have in our communities across Arkansas. the opportunity to join together and build

Our APA Board and APA Staff worked a legacy as APA rebuilds our building. hard this year. Throughout the pandemic In this new building we can furnish the our APA Board continued to meet via hopes and dreams of the APA, catering Zoom, sometimes even having 5-hour APA CEO John Vinson, APA 2020-2021 to the needs of pharmacists and patients remote meetings. APA is blessed to President Kristen Riddle, and APA 2021-2022 across the great state of Arkansas. The have a dedicated board and staff who, President Max Caldwell new location for the APA headquarters regardless of a building burned and our will be located directly across from the offices lost, our staff worked through all capitol building. This location will offer a of these setbacks to continue achieving and working towards central location for all of Arkansas, as well as a direct link to building a better future for the APA. I am thankful for the great the lawmakers who continue to guide the direction of state examples of strong leadership that went before me and very policy. excited about the strong APA leadership coming behind me.

APA has been and will continue to be a national leader in our Combining the knowledge of past leaders, the fresh ideas profession. I am proud to an Arkansas pharmacist! of the current APA members, and the goals of the future

of Arkansas pharmacy, we are rocketing towards a better Looking forward, there are countless opportunities for the tomorrow. A tomorrow that I, in the utmost confidence, believe pharmacist of Arkansas. Our 2021 legislative session has will continue to be built upon. You have to be willing to plant opened numerous doors for the pharmacists in our state. a tree under whose shade you will never sit, and I believe that Again, our hard-working staff at APA accomplished a great the APA is planting trees all across our beautiful and proud many goals and had huge wins for our profession. Many state. Thank you for my time as president of this board, I look forward to continue working with the leadership of the APA. § pharmacists are expanding their clinical services offered in their pharmacies for our patients. It is my opinion that Act 503 WWW.ARRX.ORG

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MEMBER SPOTLIGHT

Emily Holton Pharm.D. Long-Term Care Pharmacy Consultant

Pharmacy School & Graduation Year: UAMS, 2014 Years in business: Seven years Favorite part of the job and why: My favorite parts of

my current consulting practice include the flexibility it provides (life-work balance is very important, especially when raising kids), being part of a healthcare team (working with nurses and other providers to ensure the best resident care) and the unexpected relationships I form with residents when visiting facilities (especially during COVID when many were not able to have visitation).

Least favorite part of the job and why: I do a lot of

my work from home, by myself. That’s been the hardest transition coming from the retail setting where I was around people all day long. When I began working from home, the break from the general public was at first, welcomed. But as time goes on, I have realized I miss some of the interactions.

What do you think will be the biggest challenges for pharmacists in the next 5 years? Continuing to

establish our role as providers by offering additional direct-care patient services that we are able to bill and be reimbursed for at fair rates. Rising drug costs and below cost reimbursement continue to be a challenges as well.

Oddest request from a patient/customer: When working

retail, I provided an over-the-counter consult regarding lice for an adult. The patient had a known exposure, but said she did not have anyone she could ask to look through her hair. She asked if I could look through it to see if I could identify any nits or active lice. I gloved up and started searching with the disclaimer of “I’ve never done this before!”. She was new to the area and super appreciative of me obliging her request.

Recent reads: Hidden Valley Road by Robert Kolker Favorite activities/hobbies: Living in Northwest

Arkansas you can find me out on Beaver Lake, exploring the biking trails and parks, or visiting all the locally owned restaurants and micro-breweries.

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Ideal dinner guests: I have family spread throughout the nation, and since COVID, I have not got to see many of them. I would love a big family dinner with everyone!

If not a pharmacist: a teacher! I feel like a lot of pharmacy

does involve education—counseling patients, teaching nurses, and sharing new practices/guidelines/medications with providers. In a way, I still get to be a teacher, but if not in pharmacy related topics, then probably secondary education as a math or science teacher.

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

Being an active member of APA can be rewarding in many ways—you’re able to develop relationships with other pharmacists and leaders across the state who you can rely on for answering questions, providing referrals and recommendations, and collaborating with on issues important in your practice. Especially since starting my consulting business, I have had to work harder to keep up with pharmacy law and appreciate all the CE and meetings that APA offers to keep me updated. §

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2021 LEGISLATIVE SESSION UPDATE

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uring the 2021 legislative session, the efforts of the Arkansas Pharmacists Association (APA) were unwavering as they advocated for the profession on a wide range of issues from refining administrative processes to expanding pharmacist authority. This diligence on behalf of the APA resulted in significant triumphs for Arkansas pharmacists. While some changes to state law were minor, there were also multiple changes considered to be substantial, offering pharmacists the opportunity to further demonstrate their capability to provide quality patient care as the most accessible healthcare providers.

The Process Before summarizing these momentous updates, it may first be beneficial to provide a brief overview of the administrative process.

APA provides legislative sponsors with draft of legislation

Draft sent to "bill drafting" by the sponsor, who then "files the bill"

House HB#### Sent to committee, desk, or calendar

Senate SB#### Sent to committee, desk, or calendar

Committee action / inaction Hearings / Markup

Committee action / inaction Hearings / Markup

Floor activity / debate / votes

Floor activity / debate / votes

Bill approved by each side, goes to the Governor for signature, and becomes law

Regulatory activity It is essential to remember that this is a process. Therefore, the bill that returns from bill drafting may differ from that originally requested by the APA. As a result, readers may see a draft on the Arkansas Legislative website (www.arkleg. state.ar.us/) that is distinct from the initial draft.

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The following is a status update regarding considerable changes that took place in the 2021 legislative session:

Improving Patient Outcomes and Access to Care Act 758 (HB1781) | Arkansas Medicaid Slot Expansion Historically, Arkansas Medicaid beneficiaries have been restricted to receive a maximum of 3 Medicaid-paid prescriptions per calendar month without an extension of benefits (EOB), which allows up to 6 prescriptions per calendar month. Under previous law, all filled prescriptions would count toward the monthly limit with the exception of select categories. These categories include family planning items, prescriptions for Medicaid-eligible long-term care facility residents, prescriptions for Medicaid-eligible beneficiaries under 21 years in the Child Health Services/Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, prescriptions for opioid use disorder treatment according to Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines, and prescriptions for tobacco cessation products. This restriction was removed during the spring legislative session, eliminating the extension of benefits requirement to allow 6 prescriptions per month for adult patients in the program. Exemption categories were also expanded to include common medications for chronic disease state management including those used for anticoagulation, asthma, chronic obstructive pulmonary disease, diabetes, hypercholesterolemia, and hypertension. In addition, the restriction for prescription expiration at 6 months was removed and now aligns with federal and state regulations requiring a 12-month expiration date for routine prescriptions and a 6-month expiration for controlled substances.

While this bill was signed into law on April 19th and will go into effect on August 1st, the Department of Human Services is in the process of making the necessary changes for implementation, which are due on or before January 1, 2022. Indeed, there still some time until this act is fully put into practice, although we as pharmacists understand the implications this great change will have for patients in Arkansas and eagerly await its adoption.

Medication and Vaccine Administration Act 406 (HB1135) | Pharmacist Authority to Prescribe, Administer, Deliver, or Dispense Vaccines, Immunizations, and Medications to Treat Adverse Reactions to Administered Vaccines After the national emergency declaration on March 13, 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, a significant drop in childhood immunizations was observed. To counter this conundrum in the midst of the pandemic, the US Department of Health & Human Services allowed pharmacists in all states to administer vaccines to children as young as 3 years of age. Prior to this change in August 2020, vaccine and immunization administration by Arkansas pharmacists were restricted to individuals 7 years of age and older under a general written protocol. For medication administration aside from vaccines or immunizations, pharmacists were previously AR•Rx

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2021 Legislative Session Update

Great Chances in the Midst of Change

By Madisyn Strain, Pharm.D., BCPS & Nicki Hilliard, Pharm.D., BCNP

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2021 LEGISLATIVE SESSION UPDATE

required to have a patient-specific order or prescription from a physician.

As outlined in Act 406, pharmacists will now have the opportunity to prescribe, administer, deliver, distribute, or dispense vaccines, immunizations, or medications that treat adverse reactions associated with their administration to patients 3 years of age or older. However, additional requirements exist for pharmacists who wish to prescribe and administer a vaccine or immunization other than for influenza or COVID-19 to an individual who is 3 to 6 years of age which include: • Participate in the federal Vaccines for Children Program; and • Inform the adult caregivers accompanying the person who is 3 years of age to 6 years of age of the importance of a well-child visit with a pediatrician or other licensed primary care provider and recommend a well-child visit at least yearly.

The language within the bill was developed in collaboration with the Arkansas Chapter of the American Academy of Pediatrics to both promote team-based care and ensure continuity of care.

Act 407 (HB1135) | Pharmacy Technician Authority to Administer Vaccines

• Complete 3-hour online program developed with peer review and Accreditation Council for Pharmacy Education (ACPE) approval.

• Complete Basic Life Support (BLS) training for healthcare professional, bloodborne pathogen training, and Occupational Safety and Health Administration (OSHA) training for avoiding needle stick injuries

Act 408 (HB1069) | Pharmacist Authority to Initiate and Dispense Oral Contraceptive Therapy Following the 2021 legislative session, Arkansas became 1 of 15 US jurisdictions with statues or regulations that allow pharmacists to prescribe oral contraceptives without

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Similar to Act 406, the bill encourages a team-based approach by requiring the pharmacist to inquire about visits to the patient’s primary care or women’s health provider, providing the patient with a referral for local provider and a limited supply of oral contraceptives.

Before assuming this new role, pharmacists must first complete a training program approved by the Arkansas State Board of Pharmacy (BOP). Also, it is important to note that it is not currently legal for pharmacists to initiate and dispense these types of medication despite the current changes in the law as the BOP regulations have not been updated at this time. However, the BOP and APA are actively working to finalize this regulation and intend to notify pharmacists within the state once the process is complete.

The House of Representatives meets during the COVID pandemic. (Photo Courtesy Arkansas Secretary of State)

Along with the role of the pharmacist, the role of the pharmacy technician is expanding to ensure they are able to practice at the top of their license. Act 407 allows pharmacy technicians to do just that as they will now be able to participate in the technical component of administering immunizations to patients under the supervision of a licensed pharmacist. See training requirements below:

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a collaborative practice agreement. The new law adds oral contraceptives to the list of medications that Arkansas pharmacists are able to initiate under a statewide protocol for a patient who is 18 years of age or older in conjunction with existing agents, including naloxone and nicotine replacement therapy.

Act 503 (HB1246) | Pharmacist Authority to Treat Certain Health Conditions and Modify Physician Dispensing

While pharmacists in Arkansas have been authorized to test and screen for health conditions that the Centers for Medicare and Medicaid services has determined qualify for a waiver under the federal Clinical Laboratory Improvement Amendments (CLIA) of 1988, the act goes one step further to amend current Arkansas Code § 17-92-101 regarding the “practice of pharmacy” definition as follows: • •

(a) Providing pharmacy care. (b) A pharmacist may treat the following conditions within the framework of a statewide written protocol: (1) Influenza; (2) Pharyngitis caused by group A Streptococcus; or (3) Other health conditions that can be screened utilizing the waived test under CLIA of 1988, that may be adopted by rule of the Arkansas State BOP, in consultation with and upon approval of the Arkansas State Medical Board.”

The Arkansas State BOP and Medical Board will collaborate to develop a formulary of medications that pharmacists are able to prescribe for the conditions noted above as well as a statewide protocol. In addition, the act is among the first in the nation to permit pharmacists to make therapeutic substitutions for drug classes approved by the Arkansas BOP (unless otherwise indicated by the prescriber). It also

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GREAT CHANCES IN THE MIDST OF GREAT CHANGE

allows physicians to dispense acute care medications (14day supply) and medications for the management of chronic health conditions, limited to diabetes, hypertension, and hypercholesterolemia (one-time 30-day supply). The same legality circumstances apply as listed above in Act 408 with an implementation date of January 1, 2022.

Pharmacy Benefits Manager Act 665 (HB1804) | Arkansas Pharmacy Audit Bill of Rights and Arkansas Pharmacy Benefits Manager Licensure Act The Arkansas Pharmacy Benefits Manager (PBM) Licensure Act (Act 900) passed in the 2018 Special Session placed comprehensive licensure and oversight over PBMs in Arkansas by permitting the Arkansas Insurance Department and Arkansas Insurance Commissioner to serve as PBM regulators. This purpose of this bill was to synchronize the definition of “health benefit plan” as defined in Act 900, which was unanimously upheld with an 8-0 decision at the US Supreme Court in December 2020. In addition, the bill shifts the oversight of the audit laws from the Arkansas BOP to the Arkansas Insurance department, consistent with Act 900.

Act 922 (HB1852) | Standards for Prescription Delivery

Act 1104 (HB1709) | Guidelines for Rebates Offered

by Pharmaceutical Manufacturers that Sell Insulin Act 1104 requires that all manufacturer discounts, coupons, payments, or rebates be provided directly to the patient at the pharmacy counter versus PBMs to allow greater flexibility for the free market in order to determine the optimal method for delivering discounts from manufacturers at the point of sell to consumer. The implementation date is set for January 1, 2022, offering plan sponsors, manufacturers, PBMs, and other stakeholders time to transition before the law takes full effect.

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The highlights of Act 1053 include the prohibition of data mining and misuse of patient medical records, clinic notes, and health claims data to solicit pharmacy services for a patients who has not requested to receive these services.

The bill clearly defines outlawed practices for seeking new prescriptions, refill authorization of existing prescriptions or transfer of existing prescriptions from prescribers or other pharmacies without a proper pharmacist-patient relationship.

Moving Forward with Change

Senator Kim Hammer presents a bill to the Arkansas Senate. (Photo Courtesy Arkansas Secretary of State)

When given the choice to receive prescriptions via home delivery, this option may afford many advantages to patients. However, requiring this service by an insurance provider or PBM can pose potential problems for patients who wish to continue receiving care at the pharmacy and discourage patientcentered care. Thankfully, this bill prohibits mandatory home delivery for prescription medications and allows the Arkansas State BOP the ability to promulgate rules for delivery standards to promote safe procedures and offer patient protection.

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Act 1053 (SB617) | Written Consent to Transfer Prescriptions, Disclosures of Ownership Interest or Conflicts of Interest, and Data Mining of Patient Information

Surprisingly, the updates within this article are limited as additional legislation was passed during the 2021 session to advance the profession of pharmacy. However, it is evident to see that groundbreaking change is underway that will ultimately broaden Arkansas pharmacist scope of practice and encourage transparency in the administrative realm. For Winston Churchill once said, “A pessimist sees difficulty in every opportunity, an optimist sees opportunity in every difficulty.” Therefore, let us be optimists, embrace change, and grasp at the opportunity to take the lead and improve the lives of Arkansans.

Special Thanks to the Sponsors of 2021 Pharmacy Legislation Sen. Cecile Bledsoe Rep. Justin Boyd Rep. Joshua Bryant Sen. Ron Caldwell Sen. Linda Chesterfield Sen. Breanne Davis Rep. Brian Evans Sen. Trent Garner Sen. Ben Gilmore Rep. Justin Gonzalez Rep. Michelle Gray

Sen. Bart Hester Rep. Lee Johnson Rep. Robin Lundstrum Rep. Steve Magie Rep. John Payton Rep. Clint Penzo Rep. Aaron Pilkington Sen. Jason Rapert Sen. Dan Sullivan Sen. Dave Wallace

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UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES COLLEGE OF PHARMACY

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

Student Spotlights This issue of Safety Nets illustrates the potential hazards associated with poorly handwritten prescriptions. Thank you for your continued support of this column.

The first Student Spotlight was published in the 2018 Spring issue of The Arkansas Pharmacist. Since that time, our Student Spotlight feature has been published quarterly in conjunction with

Safety Nets. The response from our UAMS student pharmacists has been so overwhelmingly positive, this issue of Safety Nets is solely dedicated to Student Spotlights. §

STUDENT SPOTLIGHT

STUDENT SPOTLIGHT

Point of Care Testing: The Impact on Patient Care

ALS: A Daughter's Perspective - Lindsey Worthington

- Hannah Howard

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ue to the development in technology and healthcare, the role of the pharmacist continues to evolve. From dispensing medications to educating and immunizing patients, pharmacists play a significant role in a patient’s care. Point-of-care testing is an innovative practice that more pharmacies should implement.

POCT is defined as laboratory testing conducted near the point of patient care. Whether you are wanting to test for influenza, strep, or blood glucose, POCT will allow you to administer and read the tests efficiently and effectively.

POCT in the pharmacy has become a popular topic in healthcare over the past decade and will continue to grow as the dynamic of our healthcare system changes.

Despite its growth, many still have hesitations regarding POCT. As an intern working in a community pharmacy that recently introduced POCT into our workflow, I’ve had the opportunity to see firsthand the benefits this service offers to patients. In addition, POCT offers pharmacists an opportunity to adopt a greater role in patient care and further their knowledge about medications, medication therapies, and disease prevention. In addition, POCT improves rapport between patients and pharmacists and encourages patients to take control of their health to ultimately achieve better outcomes.

Though it is easy to fall into the familiarity of our routines, it is important pharmacists stay up to date with developments in healthcare to ensure patients receive exceptional care. POCT is easy to implement into the workflow of the pharmacy and ultimately gives the patients better experiences and quality of care.

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n unexplainable limp was my Dad’s first sign of ALS, a terminal illness that completely paralyzes your body, stealing your ability to move, talk, and eventually breathe. In the following six years, my family was thrown into the pain and uncertainty this disease brings.

Dad slowly progressed to a wheelchair and breathing machine. I learned how to put on his breathing mask, prop his feet up to prevent swelling, and operate the wheelchair lift. From helping him eat dinner to putting on his shoes, I took pride in helping my Dad. He never complained about his pain or prognosis and fully invested himself into each of his relationships. When people came to support Dad, they left feeling encouraged within their own lives. I want to honor my Dad’s legacy by bringing that same dedication into uplifting my profession. Even when not dispensing medications, pharmacists can still be impactful.

Our family’s pharmacist went that extra mile by getting to know us personally and establishing a bond to ease our anxiety. I will be forever grateful to that pharmacy.

Creating a meaningful relationship with a patient and their family can be challenging in today’s community pharmacy settings. Pharmacists must not lose site of the fact that the patient is our first priority. We must strive to treat each patient as a unique individual rather than “the next person in line.”

The support our pharmacist gave Dad motivates me to give that kind of care to others. I encourage all pharmacists to get to know their patients beyond a superficial level. Getting to know them – and their life circumstances – can inspire you to advocate for a working environment that will allow you to create more impactful patient-pharmacist relationships.

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CONGRATS

CLASS OF 2021

UAMS College of Pharmacy. YOUR SUPPORT SETS US APART. Dean’s Society • Professorship & Chairs • 30+ Endowed Scholarships

UAMS.Info/PharmacyGiving

Helping independent pharmacies compete since 1982.

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Now with more services to thrive in today's pharmacy landscape.

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CM

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• Group volume purchasing • Profits distributed to members at year-end • EPIC Pharmacy Network – third party contracting • – claims reconciliation and automated reimbursements below cost system • – regulatory and compliance management

CY

CMY

K

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

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1

FDA Springs Forward in 2021 With contributions from Kelsey Hansen, PharmD and Mallory Williams, PharmD

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lthough COVID vaccination efforts have proven to be the primary focus in medicine, drug research and development is keeping the FDA quite busy! Fifteen novel medications have been approved by the FDA in the first quarter of 2021, with many additional labeling, new dosage forms, and efficacy supplemental applications also being submitted. As 2021 continues, the promise of a healthier and happier future is encouraging.

Oncology: Four kinase inhibitors have been approved in early 2021. CoselaTM (trilaciclib) is indicated to reduce the occurrence of chemotherapy-induced myelosuppression. Tepmetko® (tepotinib) received accelerated approval based on overall response rate and duration of response in treatment of metastatic non-small cell lung cancer. In addition, UkoniqTM (umbralisib) received accelerated approval for use in marginal zone lymphoma and follicular lymphoma.

Fotivda® (tivozanib) is indicated for the treatment of relapsed or refractory advanced renal cell carcinoma. Pepaxto® (melphalan flufenamide) is an alkylating drug that obtained accelerated approval for treatment of relapse or refractory multiple myeloma.

Infectious Disease: CabenuvaTM (cabotegravir/rilpivirine) is a combination integrase strand transfer inhibitor and non-nucleoside transferase inhibitor injectable used as a complete regimen to treat HIV-1 infection.

Pediatric: AzstarysTM (serdexmethylphenidate/dexmethylphenidate) is a combination of serdexmethylphenidate, KemPharm’s prodrug of dexmethylphenidate, that is co-formulated with immediate-release dexmethylphenidate. It is approved for the treatment of ADHD in patients six years and older. QelbreeTM (viloxazine) is a selective norepinephrine reuptake inhibitor indicated for the treatment of

ADHD in patients ages 6-17 years. Zegalogue® (dasiglucagon) is an antihypoglycemic agent indicated for the treatment of severe hypoglycemia in patients with diabetes ages 6 years and older.

NulibryTM (fosdenopterin) is a cyclic pyranopterin monophosphate for patients with Molybdenum cofactor deficiency (MoCD) Type A. This medicine replaces the critical component a child with MoCD Type A needs to make molybdenum cofactor because of their inability to synthesize it.

Chronic Care: VerquvoTM (vericiguat) is a soluble guanylate cyclase stimulator that was approved to reduce the risk of cardiovascular death and heart failure hospitalization following a recent heart failure hospitalization or need for outpatient intravenous diuretics in symptomatic chronic heart failure and ejection fraction less than 45%. LupkynisTM (voclosporin) is a novel structurally modified calcineurin inhibitor with a dual mechanism of action: promotes podocyte stability leading to increased integrity in the glomeruli and acts as an immunosuppressant through inhibition of T-cell activation and cytokine production. This is a prescription medicine used with other medicines to treat adults with active lupus nephritis. Amondys 45TM (casimersen) is an antisense oligonucleotide indicated for the treatment of Duchenne muscular dystrophy in patients with a confirmed mutation amenable to exon 45 skipping. PonvoryTM (ponesimod) is a sphingosine 1-phosphate receptor modulator indicated for the treatment of relapsing forms of multiple sclerosis.

Biologic: EvkeezaTM (ievinacumab-dgnb) is an injectable prescription medicine used along with other low-density lipoprotein lowering medicines in people older than 12 years of age with homozygous familial hypercholesterolemia. §

Drug

Indication

Route

Dosing

Amondys 45™️ (casimersen)

Duchenne muscular dystrophy

IV

Weekly

Azstarys™️ (serdexmethylphenidate/dexmethylphenidate)

ADHD

PO

Daily

Cabenuva™️ (cabotegravir/rilpivirine)

HIV

IM

Monthly

Cosela™️ (trilaciclib)

chemotherapy-induced myelosuppression

IV

Within 4 hours of chemotherapy initiation

Evkeeza™️ (evinacumab-dgnb)

homozygous familiar hypercholesterolemia

IV

Monthly

Fotivda® (tivozanib)

renal cell carcinoma

PO

Day 1-21 of each 28-day treatment cycle

Lupkynis™️ (voclosporin)

lupus nephritis

PO

BID

Nulibry™️ (fosdenopterin)

molybdenum cofactor deficiency Type A

IV

Daily

Pepaxto® (melphalan flufenamide)

relapsed or refractory multiple myeloma

IV

Day 1 of each 28-day treatment cycle

Tepmetko (tepotinib)

non-small cell lung cancer

PO

Daily

®

Ukoniq™️ (umbralisib)

marginal zone lymphoma & follicular lymphoma

PO

Daily

Verquvo™️ (vericiguat)

chronic heart failure

PO

Daily

Qelbree™️ (viloxazine)

ADHD

PO

Daily

Zegalogue (dasiglucagon)

severe hypoglycemia

SQ

PRN

Ponvory™️ (ponesimod)

relapsing forms of multiple sclerosis

PO

Daily

®

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8/30/21 12:42 PM

Pharmacist Kelsey Gocke administers a COVID vaccine to pharmacist Sarah Mitchell at Mitchell's Park Street Pharmacy in Calico Rock.

Deja Vu All Over Again

By Jordan Foster Director of Communications

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fter almost a year and a half of quarantines, masks, hospitalizations, deaths, and vaccines, Arkansans saw the radiant light at the end of the COVID-19 tunnel begin to steadily dim and fade away, replaced with the sobering realization that we had not yet made it through the storm - we were merely in the eye of the hurricane. Pharmacies that once had waiting lists with hundreds or thousands of people clawing for the COVID vaccine are now seeing days or even weeks between vaccination appointments. And with every passing day, the count of new COVID cases steadily rises while vaccines sit on freezer shelves with rapidly approaching expiration dates. So you be asking, “what can we do” or even “what can I do?” When it comes to changing the minds of the unvaccinated, the key to making a lasting impact is twofold: who and how.

Four Kinds of People As vaccination rates began to decrease nationwide in late Spring, countless studies were conducted to paint a picture of The Unvaccinated American. People were asked how likely they would be to get the COVID vaccine along with demographic information such as race, sex, age, political affiliation, geographical location, etc. However, this approach had a key flaw – it told researchers who was not getting vaccinated but not why. In an opinion article in the New York Times titled “Meet the Four Kinds of People Holding Us Back from Full Vaccination,” 1 Sema K. Sgaier, CEO of Surgo Ventures, a nonprofit organization focused on using data to address health problems, detailed Surgo’s recent national survey2 of U.S. adults that allowed the organization to group respondents into distinct profiles based on their shared beliefs and common barriers for vaccination:

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• The COVID Skeptics • The Cost-Anxious • The System Distrusters • The Watchful The researchers found that the people in each group shared some beliefs and barriers about COVID-19 vaccination.

Additionally, the research showed that the profiles were not purely demographically homogenous; each profile had respondents that were spread (sometimes unevenly) across the spectrum of race, age, political affiliation, socioeconomic class, etc., providing health officials with a better look at not just who to approach with vaccine information but how to do it.

COVID Skeptics - Covid Skeptics are the most adamant in their refusal to get vaccinated. Unfortunately, the research found that this group is the most common in Arkansas. Primarily, the group’s low vaccine confidence is due to their deep-seated beliefs about how they think vaccines work and their own opinions about what's best for them and their families. The primary barriers researchers found with members of this group come from the members’ universal belief in at least one specific conspiracy theory (such as microchips in the vaccines, the government’s exploitation of COVID-19 to control people, or the idea that the pandemic was created by an international ring of highly powerful people who secretly manipulate world events.

Cost-Anxious – The Cost-Anxious group is dominant in states like Mississippi that have high poverty rates and low Medicaid coverage. This group worries about the potential expense of getting vaccinated, whether it’s an investment of time or money.

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

DEJA VU ALL OVER AGAIN

System Distrusters – According to the survey, members of the System Distruster group are predominantly people of color who believe that the health care system doesn’t treat them fairly. High rates of this group are found in Washington, D.C., Maryland, and Georgia. Researchers found that people in this group tend to have low expectations that other members of their communities will get vaccinated.

Watchful – Members of the Watchful group, most dominant in Delaware, Hawaii, and Rhode Island, could be the easiest to convince to be vaccinated as they are also the most likely to wear masks. However, in order to be convinced they require a resource that is working against vaccination efforts: time. This group is holding out to see what happens to the people they know who have chosen to get vaccinated before deciding for themselves.

grocery stores, bars, restaurants, and local businesses.

System Distrusters – With System Distrusters, the hesitation to be vaccinated comes less from a direct distrust of the current vaccine and more from a distrust of the healthcare system due to their belief that it does not treat them fairly. “It will be important for public health officials to hold conversations — formal or informal — with trusted members of their own communities to air concerns and be transparent about efforts to vaccinate underserved communities. People in this group have low expectations that other members of their communities will get vaccinated, so making vaccinations of people they know as visible as possible will be important. Tracking and illuminating efforts to ensure the vaccine rollout is equitable and sharing that with the community is key.”

Watchful – Members of the Watchful group are doing just that: watching. They’re watching their friends, family, Knowing the distinct profiles and neighbors to see what kind of the people with the lowest of vaccine experience they have vaccine confidence, the study before making a commitment then takes a deeper dive into the to be vaccinated. Behavioral characteristics of the groups to science researchers realize that determine the unique approaches a strong way to persuade people healthcare leaders should use to (especially ones in this group) to effectively reach these groups.

Lynn Wilson of Rison Pharmacy administers the COVID-19 accept a product is by establishing vaccine. visible norms. Encouraging people COVID Skeptics – According who are already vaccinated to to the survey, an overwhelming proudly display and discuss their 84% of this group believe the vaccination status could give Watchful people the nudge they government is attempting to control people by exploiting the need to make a move.

COVID-19 pandemic. Because of their high distrust of elected officials, a strong response to this group would be the use Conclusion of nonpolitical figures to share the message of vaccination.

About 50 percent of COVID skeptics trust doctors compared Although vaccination numbers in Arkansas have drastically to just 32 percent who trust scientists. Religious leaders who decreased over the Summer, the strong presence of the Delta support vaccination could also be a potential key advocate variant in the state has slowly begun to spark some interest in since 9 percent of this group say the vaccine goes against the minds of unvaccinated Arkansans. As COVID case numbers their religious beliefs. “The key to engaging this group will be to continue to increase at levels we haven’t seen in more than six avoid trying to debunk what they believe; rather, experts need to months, now is the time for all healthcare officials to do whatever listen, acknowledge how they feel and then share the facts. Our they can both professionally and personally to help move the research finds that emphasizing that vaccination is their own, needle on vaccination rates in the Natural State. personal choice — one that can help them protect friends and family members — can also work.”

Having an Effect

Cost-Anxious – Because the Cost-Anxious group have worries about time and expense to getting vaccinated, their vaccination needs to be as effortless as possible by taking the vaccines to them. Three methods that will be critical to targeting this group: stressing that the vaccine is completely free encouraging employers to provide paid time off for both vaccine doses holding vaccination clinics in non-healthcare locations that people frequent such as workplaces, churches, daycares,

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1 - Sgaier, Sema. "Meet the Four Kinds of People Who Are Holding Us Back from Full Vaccination." New York Times, May 18, 2021, www.shorturl.at/dlCF1 2 - Surgo Ventures. "A Large-Scale Facebook Survey of U.S. Adults: Leveraging Precision Health to Increase COVID-19 Vaccine Uptake." May 2021, www.shorturl.at/rvSV1

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UAMS SCHOOL OF PHARMACY

Foundation for Many Successes of the Class of 2021 Cindy Stowe, Pharm.D. Dean and Professor UAMS College of Pharmacy

“After all, the purpose of learning isn’t to affirm our beliefs; it’s to evolve our beliefs.” – Adam Grant

R

emaining adaptable and open to change the Class of 2021 has had a crash course in flexibility and resilience.

The pandemic experience has sent us all scrambling to rethink our situations and our paths forward. As this academic year draws to a close I’m reminded of a graduation speech I heard in 2016 by James Ryan then Dean of the Harvard University Graduate School of Education. The focus of his talk was asking questions and remaining curious. The situations over the last year have led to many questions both rhetorical and authentic in asking us to rethink and evolve. I think Dr. Ryan’s speech is timeless as you embark on your careers in a time of uncertainty and complexity. He referenced five questions to keep in mind and I am sharing them here: 1) “Wait, what?”

2) “I wonder why/if…?”

3) “Couldn’t we at least…?”

4) “How can I help?

5) “What truly matters?”

The complexity of the world and the pace of change means we need to be thinking and rethinking in equal measure – perhaps more rethinking. Be courageous and willing to change your mind – update your thinking or test your hypothesis. Question one and two offer the encouragement to slow down, seek clarity, remain curious, and consider how each of us can improve the world around us in big and small ways. Question three is the golden ticket to find a compromise to moving beyond disagreement – be courageous.

Question four is the basis of all great relationships and is at the heart of caring with humility. Leading the question with ‘how’ acknowledges that each of us are the experts of our own lives. Question five helps us get to the heart of life, and is the amalgam of all that makes us up (personal and professional) – the whole thing – one. Dr. Ryan encourages that we ask ourselves these questions regularly to remain flexible and adaptable and ultimately satisfied with a life well lived.

These questions are great reminders for all of us to consider during this particular time of year as we welcome the Class of 2021 into full membership of a profession that we dearly love. My hope for each member of the Class of 2021 is that the chosen career as a pharmacist is far more than a job or simply a career. You might ask how a profession can be more than a career? I believe it is a career with deep, deep meaning – a CALLING. The meaningfulness of your work will help you thrive in the intrinsic fulfillment of the work by bringing your best self to the work. The intrinsic rewards of being a pharmacist are many. Over the months as the COVID-19 vaccines have become available there is one that

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I hear come up over and over, gratitude. The gratitude expressed by recipients of the vaccines…I don’t need to tell you about this as you have experienced this…patients are so thankful that you are here in their communities caring for each of them. The energy created by serving your communities is the energy necessary to do this meaningful work.

There is curiosity too in these patients in seeing pharmacists in a new broader light as an accessible healthcare provider with much to give to enhance the health and well-being of our communities.

So, Class of 2021 make Dr. Ryan’s five questions a checklist in your mind as you think and rethink during the days and years ahead – engage in your journey. I challenge you to use your career as your stage for the ultimate form of selfexpression. You will continue to improve, learn, and grow embrace this uncomfortableness to stretch your understanding. Question your beliefs more than looking for signs that you are right. Finally, use your work to spend more time in your values and create new adventures that make more moments that matter to you and for those you serve…your patients, your staff, your colleagues, and the profession.

Live your CALLING. Oh I almost forgot, Dr. Ryan had a bonus question (from Raymond Carver’s poem Late Fragment) that I hope you will all ‘get’ when the time comes, “And did you get what you wanted from this life, even so?”

References Ryan, JE. Wait, What? And Life’s Other Essential Questions. HarperCollins Copyright 2017 New York, NY ISBN 9780062664570.

James Ryan’s 2016 Commencement Speech https://www. youtube.com/watch?v=XBvyBn6crLE&list=RDCMUC1Up4 TuDvGZraQUj9vxUaxQ&index=2 (Accessed April 23, 2021) Grant, A. Think Again: The Power of Knowing What You Don’t Know. Penguin Random House LLC Copyright 2021 New York, NY ISBN 9781984878106 Meier JD. Do you have a job, career, or calling? Meaningful work matters. https://sourcesofinsight.com/jobs-careersand-callings/ (Accessed April 23, 2021) Carver, R. Late Fragment https://www.americanpoems. com/poets/carver/late-fragment/ (Accessed April 23, 2021)

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

Ryan Anglin

Kathryn Barfield

University of Arkansas for Medical Sciences College of Pharmacy Class of 2021 Senior Class 2020-2021

Justin Beeks

Samuel Bell

Rima Bhakta

Lindsey Betts

Taylor Bitely

Hannah Black

Laura Bolt

Samuel Bonney

Brittany Butterfield

Matthew Calhoun

Katelynn Callaway

Caylin Carson

Peyton Cashion

Corinna Celoso

Trenton Cheek

Sarah Covert

Trung Dang

Patrick Dietz

Jacqueline Dodwell

Kim Duong

Nichole Edwards

Sarah Emison

Jason Engstrom

Domonick Esparza

Ember Fenton

Jack Finney

Kendl Fischer

Allyson Flaherty

Kera Flippo

Morgan Gillum

Halley Green

Cade Gurley

Patrick Gurley

Cate Halloran

Dana Hamilton

Jessica Hardage

Shannon Hardage

Hayley Harrington

Hayley Hervey

Son Ho

Cassidy Holt

Alexis Ingram

Natalie Irvin

Anna James

Marlee James

CJ Jarboe

Byron Johnson

Shakeena Johnson

Marissa Johnston

Allison Jolley

Sarah Kuhn

Crystal Lavey

Amanda Lawson

Austin Lovelady

Kristen Lovelady

Joshua Lowery

Whitney Lumpkin

Elizabeth Mace

Ryan Marks

Nohora Mcginty

Skyler Mckissock

Ian Mcvinney

Nicole Moix

Jennifer Moore

James Murphy

Nancy Murphy

Gabriella Madeline Nepomuceno Neubauer

Mary Nguyen

Alyssa Outhay

Alexander Phan

Uyen Phan

Jessica Regalado

Elizabeth Reichard

Kennedy Richard

Abby Richards

Joanna Rish

Haodi Ruan

Ryan Sage

Kayla Schapp

Austin Sewell

Arthur Shaw

Gray Stanton

Evan Stoll

Aliyah Strong

Marina Swanson

Colton Taylor

Tyler Tollett

Tyler Towers

Zach Vaughn

Paul Ward

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Wade Weaver

Kaylee Wilcox

Seth Wilson

Tiffany Withrow

Mollie Wolfe

Maddison Schuller

Not Pictured: Stacey Grandison Catherine Jensen Anh Le Javier Ortiz silva Bhumi Patel

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8/30/21 12:42 PM

HARDING UNIVERSITY REPORT

Class of 2021 - Resiliency, Poise, and Compassion

E

ach morning as I walk to had the opportunity for required experience hours. The new my office, I pass a line of reality facing our students were graduation standards that still composite class photos of our applied to learners amid a practice world that was uncertain Harding University College of about hosting students.

Pharmacy (HUCOP) graduates. It’s a fitting routine that sets my mood and frames my mind on True to their reputation, the class of 2021 met the pandemic challenges directly. They adapted to the augmented the important work that we do at Harding, and it reminds me of our most treasured resource— classroom learning environment, our students. This year, we will completed their didactic studies on time, and managed a P4-year add a 10th composite frame to True to their reputation, the class of the hallway—the class of 2021! As filled with sometimes planned and 2021 met the pandemic challenges they are honored at graduation and more often re-arranged advanced directly... Students demonstrated prepare to enter the professional pharmacy practice experiences. world of pharmacy, I have been Students demonstrated their their learning in community and thinking about this remarkable learning in community and institutional settings as required and group of students. institutional settings as required did so at a critical time when the world and did so at a critical time when As a founding member of our the world needed every abledneeded every abled-professional to program, I am exceedingly proud professional to support the support the vaccination effort. of our students. You might say that vaccination effort. it comes with the territory, given my role as dean. Still, I believe that While it’s admirable that our anyone who spends any measurable time around our students students persisted to graduation, the way they persevered will grow to love them. They are fiercely loyal to one another— and continued to serve others during a difficult time is what in work and play—and are serious about their education. Each truly defines the heart of this class. The HUCOP Class of student cohort carries its own personality—and thinking on 2021—consisting of a mere 46 students—completed more the class of 2021, I recall an extraordinary group of individuals than 5,400 hours of community service health and wellness who showed incredible resiliency and met challenges with activities, including countless hours in COVID-19 vaccination admirable poise and compassion for others. efforts. Collectively, this class served as frontline healthcare providers throughout Arkansas and other states and assisted These students began their pharmacy education at Harding in with thousands of vaccine doses. Knowing this class as I 2017 with no way of knowing what the future would hold. With do, it didn’t come as a surprise, but it’s fitting to know that eagerness and anticipation, they launched into their studies, the most-lasting legacy of this class will be their example of navigating the usual exams and assessments of our curriculum compassion, servant leadership, and persistence through together. The College went through a comprehensive personal and collective challenges. accreditation site visit that year, and among the highlights of This year, as we hang the composite class photo of our that visit was this bright and ambitious class of 2021. What tenth class of pharmacy graduates, we will do so with great was evident then still holds true today – this class of students is special, and together they have achieved great success admiration and appreciation for the accomplishments of despite the most challenging times in our history.

Harding University College of Pharmacy class of 2021. This wonderful cohort of students will forever be known for their The world changed in the spring of 2020 as the pandemic resilience, tenacity, and compassion as they continued to lead, fundamentally altered the way of life for everyone. All students contribute, and serve others against unparalleled challenges were threatened by these changes, but our class of 2021 was on their way to becoming pharmacists. They have certainly the most at-risk for a delay in academic progression. Traditional gained our respect and will no doubt be one of my favorite face-to-face classroom instruction was suddenly impossible memories as I pass their photos each morning on my way to work. and their plans for advanced pharmacy practice experiences were no longer certain. As Harding turned to a blend of virtual and on-campus learning for our classroom studies, the college Congratulations to all of the new graduates – both Harding worked with willing practice sites and many of our wonderful and UAMS! § preceptors throughout the region to assure that students

Jeff Mercer, Pharm.D. Dean and Professor Harding College of Pharmacy

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

Denise Avila

Kaitlin Ballek

Brooke Boston

Malorey Brannon

Aaron Bright

Jedediah Burghout

Karlee Carney

Jeremy Ramos President

Tomi O. Chavez

Corrina Riggs Secretary/Treasurer

Emily Bass Chappell

Rachel Coursey

Patrick LaBorde Vice President

Harding University College of Pharmacy LE

Kelsey Hansen

Alan Jacobs

Brandi Berryman Keely

TY

HA

R

D

Grace Goslee

IN

SI

Kassandra Fetz

Y

COL

AC

Madison T. Everett

O F P HA R

M

GE

G UNIVE

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Class of 2021 Katherine Hood

Rachel Huggins

James Jackson

Stephen Jackson

Zachariah Lester

Jerri D. Mathis

Molly McCurley

Jessica McNair

Katherine McSpadden

Janet Chelagat Moti

Kennedy Neal

Elizabeth Nguyen

Drake Palazzi

Brittany Petty

Daniela Silva

Candyce Simmons

Samantha Kay Smith

Megan Spence

Sarah Steely

Natalie Stirrup

Jordan Stubblefield

Shadi Tehrani

Brandon Van

Vanessa Wells

Parker White

Mallory Williams

Alexis Woodard

Zareen Khera Zeller

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8/30/21 12:42 PM

LEGISLATOR PROFILE

Representative Brian Evans Cabot

District: 43 Represents (Counties): Lonoke County Years in Office: Currently in second term Occupation: President & CEO of L&L Freight Services, Inc. Your Hometown Pharmacist: Heartland Pharmacy (Roxanne Wetzler)

Most admired politician: President Ronald Reagan

What do you like most about being a legislator? In serving

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

my district and state, I have the opportunity to find solutions for those that otherwise may not be able to help themselves, essentially changing someone's life for the better.

What do you like least about being a legislator? I have always strived to be a people pleaser and often on critical votes, I know before I cast my vote that even though I am making one side of the issue happy, I could be disappointing someone else.

Most important lesson learned as a legislator: Legislative

success depends on your ability to navigate through three things: politics, personalities and policies.

communication is vital. Build a relationship with your legislators and be willing to be a voice for your association.

Your fantasy political gathering would be: George

Washington, John Quincy Adams, Theodore Roosevelt, Herbert Hoover, Dwight D. Eisenhower, Martin Luther King Jr. and Ronald Reagan

Hobbies: Enjoying all of the outdoor beauty and opportunities of the Natural State §

AAHP Board

Arkansas State Board of Pharmacy

Executive Director.............Susan Newton, Pharm.D., Russellville President...............................Hye Jin Son, Pharm.D., Little Rock President-Elect................ Kevin Robertson, Pharm.D., Little Rock Past President.................Kimberly Young, Pharm.D., Little Rock Treasurer.................................Andrea Boland, Pharm.D., Hector Secretary..................................Melissa Shipp, Pharm.D., Searcy Board Member at Large.............Gavin Jones, Pharm.D., Benton Board Member at Large.......Amber Powell, Pharm.D., Little Rock Board Member at Large........Ashley Wilson, Pharm.D., Little Rock

President................................Lenora Newsome, P.D., Smackover Vice President/Secretary....Rebecca Mitchell, Pharm.D., Greenbrier Past President...............................Debbie Mack, P.D., Bentonville Member................................Rodney Richmond, Pharm.D., Searcy Member.................................Lynn Crouse, Pharm.D., Lake Village Member.............................................Brian Jolly, Pharm.D., Beebe Public Member...........................................Carol Rader, Fort Smith Public Member..............................................Amy Fore, Fort Smith

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

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

2020 Recipients of the “Bowl of Hygeia” Award

Barry Rich Alabama

Robert Kronenberg Arizona

Mike Smets Arkansas

Robert Scheidtmann California

Debra Devereaux Colorado

Mark Petruzzi Connecticut

Hooshang Shanehsaz Delaware

Humberto Martinez Florida

Drew Miller Georgia

Wendy Iwasaki Hawaii

David Mikus Illinois

Tom DeVille Indiana

Peter Fay Iowa

Mike Bellesine Kansas

Bob Oakley Kentucky

Stephen Hill Louisiana

Kevin Holland Maine

Carol Stevenson Maryland

Todd Brown Massachusetts

Carrie Germain Michigan

Kendra Metz Minnesota

Ann Franklin Mississippi

Marty Michel Missouri

Howard Beall Montana

Christopher Shaffer Nebraska

Daniel Heller Nevada

Thomas Algozzine New Hampshire

Ed Rucki New Jersey

Chris Woodul New Mexico

Amina Abubakar North Carolina

David Sandberg North Dakota

Troy Gahm Ohio

Linda Howrey Oregon

Gerard O'Hare Pennsylvania

Tracey Taveira Rhode Island

Tenny Moss South Carolina

Doug Johnson South Dakota

Roger Davis Tennessee

Takova Wallace-Gay Texas

Paige Patterick Utah

Rob Carpenter Vermont

Mark Vaughan Virginia

Don Downing Washington

Jose Diaz-Luna Washington DC

The “Bowl of Hygeia”

Photo Not Available

Roger Paganelli New York

Ron Mabie Wisconsin

Antoinette Brown 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.

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8/30/21 12:42 PM

ARKANSAS ACADEMY OF HEALTH-SYSTEM PHARMACISTS

A Serving Heart

A

s we continue to remind ourselves of The Oath of a Pharmacist, the first oath states “I will consider the welfare of humanity and relief of suffering my primary concerns.” This statement makes me think about ways we can give back to our communities. Of course the nature of pharmacy is caring for those in our community and we give back to them each and every day we go to work. But what I think of when I read this line is reaching and serving our patients where they are.

Kim Young, Pharm.D. AAHP 2020-2021 President

Community service should be convenient for the ones we are serving. Service is defined as voluntary work intended to help people in a particular area. I know there are many avenues of community service we could serve in: food kitchens, church activities, trash pick up, etc, but I want to highlight the charitable medical clinics across the state of Arkansas.

Charitable Christian Medical Clinic of Hope in Hope, Arkansas 114 South Main Street, Hope, AR 71801 (870) 826-7060 Christian Community Care Clinic in Benton, Arkansas 220 W South St, Benton, AR 72015 (501) 776-1703 Cooperative Christian Ministries and Clinic in Hot Springs, Arkansas 133 Arbor St, Hot Springs, AR 71901 (501) 318-1153 E.C.H.O. (Eureka Christian Health Outreach) in Eureka Springs, Arkansas 4004 E Van Buren, Eureka Springs, AR 72632 (479) 253-5888 Harmony Health Clinic in Little Rock, Arkansas 201 E Roosevelt Rd, Little Rock, AR 72206 (501) 375-4400 Mountain Home Christian Clinic in Mountain Home, Arkansas 421 W Wade Ave, Mountain Home, AR 72653 (870) 424-2433

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River City Medical Clinic in North Little Rock, Arkansas 4614 John F Kennedy Blvd, North Little Rock, AR 72116 (501) 791-2200 Shepard’s Hope Neighborhood Health Center in Little Rock, Arkansas 2404 S Tyler St, Little Rock, AR 72204 (501) 614-9523 Westside Free Medical Clinic in Little Rock, Arkansas 2415 N Tyler St, Little Rock, AR 72207 (501) 664-0340 Please do not consider this an all inclusive list of clinics, and I apologize if I have omitted a clinic you may serve at right now. The clinics provide medical services to the citizens of our state who otherwise would not be able to access healthcare. From my personal experience the patients at the clinics truly appreciate the volunteers time and expertise. I know we all are extremely busy and our time is very precious but we volunteer not necessarily because we have the time, but because we have the heart.

The Westside Free Medical Clinic is the oldest free clinic in Arkansas and was founded in 1970. Like many other free clinics across the state, the clinic has evolved over the years to include not just medical but other services as well: pharmacy, dental, mental health, dermatology, physical therapy, etc. There are several clinics listed above that have translators available for the patients or have a clinic dedicated to Spanish speaking patients. I would encourage you to reach out to a clinic and see how you can serve (see the lists including phone numbers listed above).

I have witnessed pharmacists across our great state over the last few months giving back unconditionally to our communities. Pharmacists have worked tirelessly in order to vaccinate as many people as they can with COVID-19 vaccinations. Our pharmacists have worked longer hours and extra days to get it done as quickly and efficiently as possible. I wish I could thank each pharmacist personally for all their hard work.

THANK YOU! THANK YOU! THANK YOU! Pharmacists have answered the call and stepped up to the plate in unprecedented fashion! Another reason I am honored to be an Arkansas Pharmacist. §

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THE ARKANSAS PHARMACIST

8/30/21 12:42 PM

CONSULTING ACADEMY REPORT

Medication Discrepancies Denise Robertson, P.D. Consulting Academy 2020-2021 President

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s consultants, we are responsible for medication accuracy in the facilities that we service. Continuum of care upon return from a hospital stay is of particular importance.

Preventing hospital readmission, medication errors and adverse events is our primary goal. The riskiest time for a resident is when transitioning from a hospital stay back to the nursing home.

Studies from 2009 show that medication discrepancies affected as many as 41% of patients discharged from hospitals.1 Since that time period, much has been done in an attempt to reduce such discrepancies. However, recent studies show little improvement, with reported discrepancies reaching 40 percent.2

Most often, the extended-release product is ordered but the immediate-release product is transcribed to the physician’s orders. Loading doses of amiodarone are frequently given in the hospital and then tapered. Errors occur most often in dose and dosing frequency once at the facility when tapering is not completed before transfer. Warfarin most often has staggered dosing, alternating doses and days given. The more complicated the regimen, the more chance for error.

Occasionally, even a PT/INR schedule will not be specified.

Vitamin D doses are often transcribed as 50,000 Units QD instead of 5,000 Units QD. Fentanyl patches are often applied after surgery and continued upon discharge.

Particular attention should be given to monitoring directives and stop dates. And always I believe the key to avoiding such review the resident allergy list discrepancies is communication again. New allergies may have and reconciliation...If the healthcare been added or new medications team is aware of the high potential added that the resident is allergic to. for errors during transition, it will

Reading these articles sparked me to pay closer attention to how often residents in the facilities that I consult were readmitted from the hospital and experienced medication discrepancies. I was shocked to see how many help to better protect our residents. of them had some type of I believe the key to avoiding such discrepancy! The most common discrepancies is communication were dosing frequency errors, and reconciliation. A clear, medications continued beyond established stop dates, concise medication discharge summary should always be prepared that has been reviewed by a nurse, pharmacist, medications that were not continued but were supposed or other qualified professional at the hospital. In turn, the to be, and extended-release medication transcribed as medication discharge summary should always be reviewed immediate-release. by the facility’s qualified professional and the consultant pharmacist. It should then be compared to the new To be clear, these were errors that were missed upon return from the hospital and transcribed to the current physician physician’s order sheet. If the healthcare team is aware of the high potential for errors during transition, it will help to order sheet at the nursing facility. The percentage, although better protect our residents. § unknown, would certainly be higher if we totaled the ones caught and corrected before transcribing.

Warfarin, insulin, opioids, and cardiovascular medications top the list of drugs most frequently involved in harmful errors during transitions.3 During my drug reconciliations, I find discrepancies most often with the same few medications and those available in multiple formulations. Diltiazem, metoprolol, isosorbide and venlafaxine all come in both extended-release and immediate-release formulations.

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References J Gen Intern Med. 2009 May; 24(5): 630–635 Drugs - Real World Outcomes (2020) 7:53–62 https://doi. org/10.1007/s40801-019-00176-5 3 Pharmacy and Therapeutics, PT 2016 Apr;41(4): 204-205 1 2

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COMPOUNDING ACADEMY REPORT

PCCA Gives Detailed Response to FDA Warning Letter Brooks Rogers, Pharm.D. 2020 - 2021 Compounding Academy President

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n my last article, I wrote about a warning letter the FDA sent Professional Compounding Centers of America (PCCA).

PCCA has since given a more detailed response to each of the findings from the letter. Initially, the FDA made three main conclusions from a visit to the PCCA Houston facility in October 2019. You may recall, the three main discoveries were: 1. PCCA received drug ingredients from at least one API supplier whose drugs had been placed on “import alert” at the time they were imported by PCCA. 2. PCCA failed to ensure that the glycerin API it repackages corresponds to appropriate quality standards causing the glycerin API to be impure and misbranded.

3. FDA requested that PCCA publicly disclose their manufacturers.

PCCA’s more detailed response to each of these findings: 1. The FDA noted there were 23 listed suppliers on Import Alert. PCCA states that they never imported or distributed product from these suppliers while they were on Import Alert.

PCCA also claims they had no interaction with 20 of the 23 manufacturers. The remaining three were investigated and consistent with the PCCA SOP in effect at the time. PCCA also refutes the claim the FDA raised about their supply chain, based on PCCA ever importing an API from a manufacturer, rather than the time frame the API was actually sourced from the manufacturer.

2. PCCA states that it does not repackage or distribute glycerin products for use as API, as the letter states, but they only repackage and redistribute for use as an excipient intended for mixing into other products. Based on additional testing, PCCA states that their glycerin excipient is not contaminated. Nevertheless, PCCA has implemented testing practices resulting in all glycerin excipient samples will undergo three rounds of diethylene glycol and ethylene glycol identity testing (US based manufacturer, US based supplier, and 3rd party) before the product is distributed to customers.

3. The FDA warning letter relates to a drug product, which is drugs in a final dosage form. PCCA standpoint is they do not repackage a finished dosage form; thus, the labeling regulation does not apply, and that PCCA products are not ‘misbranded.’ However, PCCA will comply with the FDA’s request for their labels to say that PCCA is the repackager of the product. They also note, their labels have been as such for 40 years and this has never been an issue.

After reviewing the response from PCCA, it seems that they did not agree with much, if any, of the warning they were given but are making changes to comply with all requests.

PCCA stands firm in their commitment with the FDA to keep patients safe and supply only quality products.

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THE ARKANSAS PHARMACIST

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