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Fall 2013 Award Winning Quarterly Publication of the Arkansas Pharmacists Association

Arkansas Continues to Lead National Pharmacy New MAC Law an Important Weapon


Contents

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Inside APA: It's Complicated

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From the President: Contributing Through Our Strengths to Enhance the Profession

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COVER: Arkansas Continues to Lead National Pharmacy

Mark S. Riley, Pharm.D. Executive Vice President and CEO Mark@arrx.org

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FEATURE: Q and A with APA’s Mark Riley, New NCPA President

Scott Pace, Pharm.D., J.D. Chief Operating Officer Scott@arrx.org

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FEATURE: New MAC Law an Important Weapon

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Legislator Profile: Rep. John Burris (R-Harrison)

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RX and the Law: Workers Compensation

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Safety Nets: Coumadin® (warfarin sodium)

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Quality Notes from AFMC: Improving Care for Medicare-Medicaid Patients

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Member Spotlight: Carol Long, EPIC Mercy Hospital

Celeste Reid Director of Administrative Services Celeste@arrx.org

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Pharmacist Immunization Program: Time is a Common Barrier to Doing Immunizations

Debra Wolfe Director of Government Affairs Debra@arrx.org

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APA Calendar of Events

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UAMS Report: New Students, ACPE Accreditation Site Visit

Office E-mail Address Support@arrx.org

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Harding Report: New Beginnings: Harding President and Facilities, Rho Chi Chapter

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Arkansas Association of Health-System Pharmacists: AAHP Celebrates Fall Seminar and Progressive Pharmacy Practice

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APA Compounding Academy: Compounding Legislation Moving in Congress

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APA District Meetings in Pictures

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Member Classifieds

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USPS Statement of Ownership

Directory of Advertisers

26 Cover photo: Arkansas State Highway & Transportation Department

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Pace Alliance Bell UAMS Alumni Association EPIC Pharmacies Arkansas Pharmacy Support Group Retail Designs Law Offices of Darren O’Quinn, PLLC First Financial Bank CPE in Paradise Pharmacy Quality Commitment Pharmacists Mutual Life Insurance APA Honors Cardinal Health

THE ARKANSAS PHARMACIST

APA Staff

Eileen E. Denne, APR Senior Director of Communications Eileen@arrx.org Eric Crumbaugh, Pharm.D. Immunization Grant Coordinator Eric@arrx.org Matt Merrigan, MSOD Director of Membership and Meetings Matt@arrx.org

Publisher: Mark Riley Editor: Eileen Denne Art & 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 01993763) 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). Nonmembers subscription rate is $30.00 annually. Periodical rate postage paid at Little Rock, AR 72201. Current edition issue number 64. © 2013 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

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APA Board of Directors

INSIDE APA

2013-2014 Officers

INSIDE APA

President - Dana Woods, P.D., Mountain View President-Elect - Brandon Cooper, Pharm.D., Jonesboro Vice President - John Vinson, Pharm.D., Fort Smith Past President - Dennis Moore, Pharm.D., Batesville

Area Representatives Area I (Northwest) Michael Butler, Pharm.D., Hot Springs Village Area II (Northeast) Brent Panneck, Pharm.D., Lake City Area III (Central) Eddie Glover, P.D., Conway Area IV (Southwest/Southeast) Lynn Crouse, Pharm.D., Eudora

District Presidents District 1 - Clint Boone, Pharm.D., Little Rock District 2 - Kristy Reed, Pharm.D., Jonesboro District 3 - Chris Allbritton, Pharm.D., Springdale District 4 - Lise Liles, Pharm.D., Texarkana District 5 - Dean Watts, P.D., DeWitt District 6 - Stephen Carroll, Pharm.D., MBA, Arkadelphia District 7 - C.A. Kuykendall, P.D., Ozark District 8 - Casey McLeod, Pharm.D., Searcy

Academy of Consultant Pharmacists Larry McGinnis, Pharm.D., FASCP, Searcy

Academy of Compounding Pharmacists Warren Lee, Pharm.D., Fort Smith

Arkansas Association of Health-System Pharmacists

Lanita S. White, Pharm.D., Little Rock

Ex-Officio APA Executive Vice President: Mark Riley, Pharm.D., Little Rock Board of Health Member: John Page, P.D., Fayetteville AR State Board of Pharmacy Representative: John Clay Kirtley, Pharm.D., Little Rock UAMS College of Pharmacy Representative (Dean): Stephanie Gardner, Pharm.D., Ed.D., Little Rock Harding College of Pharmacy Representative (Dean): Julie Hixson-Wallace, Pharm.D., Searcy Legal Counsel: Harold Simpson, J.D., Little Rock Treasurer: Richard Hanry, P.D., El Dorado UAMS College of Pharmacy Student Representative: Dylan Jones, Fayetteville Harding College of Pharmacy Student Representative: Mark Egbuka, Searcy

Mark Riley, Pharm.D. Executive Vice President & CEO

Drug Supply Shortage, Compounding and Generic Price Increases: It's Complicated

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o many of the issues (challenges and opportunities) we face in pharmacy are related, so single issues cannot always be dealt with in a silo. Never has this been more evident than right now. We had great discussions in the Open Door Forum part of our District Meetings surrounding several subjects that are inherently connected. The most common themes included ‘Drug Supply Shortages’ which makes ‘Compounding’ of needed medicines a critical issue for hospitals and others. The shortages also lead, in part, to supply and demand driven ‘Generic Price Increases.’ The inability or unwillingness of the PBMs to update drug prices in accordance with the increases in a timely manner creates ‘Insufficient and Inaccurate Maximum Allowable Cost (MAC) prices’ paid to community pharmacies leading to the need for enforcement of our ‘MAC Legislation’ to give those pharmacies fair and equitable relief from underpayments. Complicated? Yes. Challenging? Yes. Solvable? The answer has to be yes or patients, pharmacists and the health care system in general will suffer dire consequences. These issues will require input from providers, payers, and patients along with common sense enforcement by government leaders. We have to identify causes and solutions in an open and honest fashion and expose the problems that are creating chaos in the system. As I said in the District Meetings, I sure don’t have all of the answers. But, answers cannot come

without questions being asked and we are trying to do that both at the state and national level. The working of market forces isn’t always simple or fair but we need to ferret out those, if any, who are purposely causing some of these problems for their own gain.

One of my goals as president of National Community Pharmacists Association (NCPA) is to create a meaningful dialogue among the involved parties relating to these critical issues and how they can be addressed in the short term as well as long term.

Hospitals desperately need a reliable, affordable, and steady supply of lifesaving drugs. Payers need to have stability in costs and projections of costs, and pharmacists need fair payment for the products and services they are supplying. And, of course, patients need the system to work so they don’t get caught in the middle and become the real losers. We have to be thoughtful as we attempt to solve these problems. I am convinced that as health care reform initiatives meant to save money and increase quality occur, the self-protective reactions to those initiatives sometimes trigger problems. For instance, because of recent

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F ROM TH E P R E S I D E N T

experience, when a rumored shortage or price increase of yet another drug surfaces, what happens? Those pharmacists that hear first add additional inventory as a protective measure, therefore, causing a more pronounced shortage very quickly. No one can blame a pharmacist for his/her action, but the results can be problematic for the supply chain and for those who do not have ample supplies at a reasonable price. The point of all of this is that these problems cannot be solved in a vacuum. As we come up with solutions for one, other problems should begin to be resolved also. One of my goals as president of National Community Pharmacists Association (NCPA) is to create a meaningful dialogue among the involved parties relating to these critical

FROM THE PRESIDENT

issues and how they can be addressed in the short term as well as long term. We particularly need corrective action for MAC prices that are not representative of the marketplace. I have already begun this process. I want to express my appreciation first to the Board of Directors and to each and every APA member for your support as I start my year as NCPA president. I hope to give as much as I get back and I am confident the experience will help me to contribute to Arkansas pharmacy as well as community pharmacies everywhere. I will be spending additional time out of the office but rest assured our able staff will be here ready to answer your questions or help in any way they can. §

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Contributing Through Our Strengths to Enhance the Profession

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embers of the APA board of directors spent some time this past August identifying their individual strengths. What are yours? They described themselves as: experienced, committed, motivated, willing to try new things, vocal, entrepreneurial, innovative, friendly, flexible, idea generators, multi-taskers and community volunteers. At the Annual Board Retreat in Little Rock, the question asked was, “What communication and leadership strengths do you bring to your role as a board member?” The exercise was intended to help us appreciate one another’s talents and to better understand our commitment to Arkansas pharmacy. The board’s feedback is especially meaningful as we support our own Executive Vice President and CEO, Mark Riley, as he leads the National Community Pharmacists Association in 2013-2014. Without the strong backing and support of APA members, Mark would not have been able to embark on the leadership journey at NCPA, and we would not have enabled the starring role that Arkansas pharmacy will play as he travels across the country in the coming year. As the board noted at the Retreat, we can serve pharmacy and each other more effectively when we are unified and connected. Following the exercise, board members said they were surprised by three things: 1) the common thoughts expressed during the Board Strengths exercise; 2) the diversity of the overall APA membership; and, 3) while there was lots of discussion about reimbursement, there was just as much focus on the profession.

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Overall board strengths, as articulated by our leaders, included: • Political and professional activism; • Leadership and national recognition among other pharmacists; • Collegiality and furtherance towards a common purpose; • The academy model which works well in Arkansas with different interests under a single umbrella; • And, the unselfish nature of the pharmacists of Arkansas.

Dana Woods, P.D. President

As the board noted at the Retreat, we can serve pharmacy and each other more effectively when we are unified and connected.

How will you embark on your leadership journey? What are your strengths in your community and for your profession? Have you considered how to continue to keep a fresh perspective on pharmacy and to help sort out the many thorny issues we face? You have started with active membership in APA. Why not consider running for the APA board? Why not get involved in one of the national pharmacy associations? While I encourage one and all to step into a leadership role, any organization is bigger than one person. With all of us playing to our strengths and stepping up, we’ll be able to continue to enhance the profession. §

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By Eileen E. Denne 1954-1955 Dr. G.H. Eisele NARD President

1961-1976 Dr. Willard Simmons NARD Executive Secretary

1984-1996 Dr. Charles West NARD Executive Secretary

Arkansas Continues to Lead National Pharmacy By Eileen E. Denne, APR

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uring the next 12 months, Arkansas is positioned to lead the national discourse on pharmacy as it has many times during the past fifty years. On October 16, APA’s Executive Vice President and CEO Mark Riley was installed as president of the 23,000-member National Community Pharmacists Association (NCPA). “There is a strong Arkansas leadership legacy that’s contributed to the national pharmacy organization,” said NCPA CEO Douglas Hoey, RPh., MBA. “NCPA is a collection of microcosms. Arkansas has one of the strongest state pharmacy associations in the country. What Mark does in Arkansas is a laboratory of innovation that can be used on a national scale. His experience on the state side is really valuable.” Hoey pointed out that NCPA, which changed its name from the National Association of Retail Druggists (NARD) to NCPA in 1998, has a long history of Arkansas leaders: • 1954 to 1955- G.H. Eisele (deceased) of Hot Springs was president of NARD. • 1961 to 1976- Willard Simmons (deceased) from Texarkana was NARD executive secretary immediately following a term as chairman of the Executive Committee. • 1984 to 1996- Charles West of Little Rock was named NARD’s executive secretary after serving as chairman of the Executive Committee. • 1994 to 1995- Gene Graves of Little Rock was NARD president.

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1994-1995 Dr. Gene Graves NARD President

“Arkansas has one of the strongest state pharmacy associations in the country” - Douglas Hoey, NCPA CEO.

Prestige and influential contacts for Arkansas

Graves, West and Hoey had only positive things to say about Riley’s new role as NCPA President. According to Graves, “It is very prestigious to be president of NCPA representing independent retail pharmacies all over the country. It is very prestigious and shows how Dr. Mark S. Riley strong pharmacy is in Arkansas. It NCPA President is amazing, but lots of states really 2013-2014 look at Arkansas and have a very high degree of respect for Arkansas pharmacists. It is a real accolade to pharmacists in the state to stand up and lead and Mark has done that.” Graves served as NARD president when President Bill Clinton was in the White House. “Clinton was advocating Medicare coverage for prescription drugs and actually got it passed,” Graves said. Graves’ agenda as president included ensuring adequate compensation for retail pharmacists was in the Medicare bill, although after the legislation passed, Congress overturned it. Graves also started the National Home Infusion Association, for which he served as president, during his NARD presidency. Riley is in a unique position to serve because of his retail background and experience as APA executive director, Graves said.

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“Mark stands above most pharmacists because he has the retail background and also has tremendous experience dealing with legislators, regulators, Medicaid, Medicare, and PBMs. So there isn’t another person in country more grounded or who better understands pharmacy than Mark. The last guy who had that set of experiences was Charlie West.”

to look at things from the other person’s perspective. In pharmacy we have to convey complex issues and we use lots of industry lingo. Mark is able to take complex ideas and translate them into concepts that anyone can understand which is vitally important as we talk to people outside our profession like legislators, payers, patients, etc.

When he served as the chief staff executive, West said the biggest surprise or lesson learned by presidents during their year was how welcome the NCPA president was made to feel everywhere he or she went. “I suppose the lesson learned was more of an affirmation that pharmacists everywhere really deserve their ranking in the Gallup poll,” he said. [The annual Gallup Honesty and Ethics Survey ranks pharmacists among the top in honesty and ethical standards.]

“One of his strengths is that he is competitive. He wants to win. He’s a good sport, he will play fair, but he wants to win so his drive fits perfectly and is a great inspiration for us at NCPA,” Hoey added.

Asked what Riley’s position will mean for Arkansas, West said “Arkansas will benefit because Mark will meet people from all walks of the pharmacy profession and the pharmaceutical industry. He’ll have contacts that will serve Arkansas pharmacy well into the future as many of the contacts are at the highest level and very influential. Arkansas benefits because another Arkansas citizen has reached the apex of his profession and thus brings honor to the state.”

Personality and experience well-suited to the role

West suggested that the NCPA president needs to really know the issues, be a good public speaker, be a good representative of the association and the profession and be a good listener. “I have known and admired Mark for many, many years, probably since he was a pharmacy student. Early on I was impressed with his leadership abilities and his commitment to the pharmacy profession and his willingness to do the tough jobs. He served as an APA district president when he was very young and during his tenure we had to deal with a tough pharmacy crime issue. He handled his responsibility with great tact and presence of mind.” NCPA’s Hoey described Riley as an All-Star baseball catcher in the way he leads – not the most flamboyant or getting the most attention, but leading by example and contributing to the team. “Mark is very pragmatic and practical. He tries

Riley’s wife Brenda says one of his best qualities is his ability to listen to all sides. “He’s a devil’s advocate; he looks at all angles and makes decisions that are the best for pharmacists. He’s honest, so anything he says, that’s what he’ll do.” She added, “At every meeting I hear nothing but good things about Mark and that has to reflect well on Arkansas. Doug Hoey said if every state association had someone like Mark, he wouldn’t have a job. Mark brings attention to our state. Being president, he’ll go to more state conventions and will get recognition for Arkansas as well as NCPA.”

Other national leaders from Arkansas

Riley’s leadership position is just one of many held by Arkansans currently. The following individuals are also currently serving important roles for national pharmacy organizations: • Nicki Hilliard, Pharm.D., BCNP President, American Pharmacists Association (APhA) Academy of Pharmacy Practice and Management; professor of pharmacy practice at UAMS College of Pharmacy. • Stephanie Gardner, Pharm.D., Ed.D.,Vice President, Accreditation Council for Pharmacy Education (ACPE), Dean, UAMS College of Pharmacy. • Tery Baskin, Pharm.D. Treasurer, American Pharmacists Association (APhA), president, RX Results • Brandi Hamilton, President of American Pharmacists Association Academy of Student Pharmacists (APhAASP), P-4 student, UAMS College of Pharmacy. §

Arkansas will benefit because Mark will meet people from all walks of the pharmacy profession and the pharmaceutical industry. He'll have contacts that will serve Arkansas pharmacy well into the future...

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A R K A N S A S C O N T I N U E S TO L E A D N A T I O N A L P H A RM A C Y

Q&A

with APA Executive Vice President and CEO Mark Riley

How long have you served in a leadership position at NCPA?

I became one of the vice presidents in 2005. I’ve been a member since 1979 but I had never been real active. When I took the APA job (July 1, 2003), I started going to NCPA meetings, and then within the first year, I did talks for NCPA on Pharmacy Benefit Managers (PBM)s. I became the PBM guy pretty quickly. NCPA asked me in fall 2004 if I would consider coming on Board. I came in as fourth Vice President then immediately moved up to second Vice President and then accelerated to Treasurer. It usually takes 14 years to become NCPA president; it will be nine for me. Charlie West promoted me from behind the scenes when he chaired the NCPA Foundation.

What encouraged you to volunteer for the board and then an officer position at NCPA?

Independent owners are members of APA. NCPA gave me a chance to be on the front lines representing those folks. I was already an NCPA member so it was a natural progression. They thought and I thought that I had something to offer. I’ve never been able to stand on the sidelines. I had pretty extensive discussions with our board about it and they thought it was a good thing. I think we get a great return to Arkansas for my investment of time in NCPA.  

What leadership qualities do you feel the president needs to effectively manage NCPA?

The president is the face of the organization. He or she needs to be able to articulate major issues; speak publicly about issues and about NCPA; and be able to attend as many public meetings as can fit into your schedule. The president represents the organization in several high level meetings with AR•Rx

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other organizations that impact the association and the industry.

What are the issues you think you’ll be devoting the most time to during the coming year?

“My [NCPA] presidency puts us in a position of having a leading voice. Arkansas pharmacists will have someone they know sitting in meetings deciding on the national direction of independent pharmacy.”

Provider status and health care reform. In general, we’ll address having pharmacists positioned to be involved in the changes in health care in terms of patient care and using our knowledge base to improve the health care system as well as to represent the business interests of independent pharmacists in general.

What are the changes that have taken place in pharmacy since you began with NCPA?

The business climate has gone from private to almost totally third party paid. We have created managed care which involves PBMs and insurance companies versus a one-onone relationship where the patient pays for medicine. We need to help members navigate the pitfalls involved in the third party arena, particularly with the position that PBMs hold. We fight for fairness and advocacy and an equal playing field so that pharmacists can be free to take care of their patients.

How about politically?

Since I have been in leadership, political involvement in NCPA has grown considerably due to members recognizing the importance of Political Action Committees (PACs) and getting involved. NCPA moved from 946th in national PACs 9


Q & A W I TH M A R K R I L E Y

to the top 40. Arkansas has also ramped up politically. It is evident that independent pharmacists are become more politically involved. As I always like to say, in politics you’re either at the table or on the plate. We appreciate pharmacists both nationally and at the state level supporting candidates who support pharmacy.

How will pharmacists in Arkansas benefit from your service as NCPA president?

My presidency puts us in a position of having a leading voice. Arkansas pharmacists will have someone they know sitting in meetings deciding on the national direction of independent pharmacy. As the late Guy Newcomb said to Larry Wamble about board service, “If there are 10-12 people sitting around in a room making decisions affecting your future, don’t you want to be one of them?”

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What do you hope to gain from visiting pharmacists in other states?

Nobody has built a perfect mousetrap. We all have good ideas and sometimes we get to steal them and bounce things off them. Other states steal things we’ve done. What happens federally affects us all so we have to work in concert. No state is an island.

What changes do you see coming up for independent pharmacists in the next 5 years?

There will be further growth in pharmacists getting involved in patient care. Pharmacists as medication experts have the knowledge base that will be utilized more effectively in total patient care. From a business standpoint, their entrepreneurial nature will lead the way in coming up with new ideas. 2004- Mark Riley received the NCPA Charles M. West Freedom Award and was a Phi Lambda Sigma Inductee.

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Timeline of

Q & A W I TH M A R K R I L E Y

1971-72

Served as delivery boy for Lester Hosto and Jerry Stephens.

1974-76 Worked for Lester and Jerry as a student. 1976

Mark Riley’s

Pharmacy Career

Graduated with degree in pharmacy from University of Arkansas for Medical Sciences (UAMS) College of Pharmacy.

1976-1983 Served as manager and pharmacist at Landmark Pharmacy. 1978

Joined APA Board of Directors.

1983

Opened East End Pharmacy in Little Rock and served as pharmacist-incharge until 2003.

1984

Recipient of Leadership Award, National Association of Retail Drugstores (now NCPA).

1984-1985

Served as President of APA.

1988

Awarded APA “Pharmacist of the Year.”

1990

UAMS COP Preceptor of the Year.

1997

Received Pharm.D. from UAMS.

NARD President Jim Vincent presents Mark with the Leadership Award in 1984.

1999-2003 Served on Arkansas State Board of Pharmacy. 2003

Joined APA as Executive Vice President and Rho Chi Inductee.

2004 Recipient of NCPA Charles M. West Freedom Award and Phi Lambda Sigma Inductee. 2004 Daughter-in-law Lana (married to Mark and Brenda’s oldest son Clay) graduated from UAMS College of Pharmacy. 2005

Mark is recognized as the outgoing APA President by incoming President Tery Baskin in 1984.

Became NCPA Board member.

2008 Daughter-in-law Stacy (married to Mark and Brenda’s youngest son Chad) graduated from UAMS College of Pharmacy. 2009

Son Chad graduated from UAMS College of Pharmacy.

2011-2012

Served as NCPA Chairman.

2011 Harding University College of Pharmacy honored Riley by renaming its NCPA student chapter the Dr. Mark S. Riley Chapter. 2013

Became President of NCPA. §

Mark and Brenda Riley at their pharmacy in East End, Arkansas. AR•Rx

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M A X I MUM A L L O W A B L E C O S T L A W

APA’s New Maximum Allowable Cost Law an Important Weapon Ins and outs of taking advantage of the new law By Scott Pace, Pharm.D., J.D.

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n community pharmacies across Arkansas and the U.S., a pharmacist or technician may look at the onscreen remittance and say, “We just got paid below our cost.” This has become a common occurrence in the last year. Often, the major cause of the underpayment is a dramatic increase in the cost of the generic medication, while the pharmacy benefit managers (PBMs) have yet to adjust their maximum allowable costs (MACs) to reflect the new market price for the medication.

are making an adjustment to their MAC pricing. If they make an adjustment, you have the right to reverse and resubmit the claim at the new price. If they deny an adjustment, then they are required to provide you with the NDC number of a product that is available in Arkansas from one of the major wholesalers. If a PBM provides you with the NDC information, as required by law, it is advisable to report this information to your wholesale business partner to assist them in their negotiations with vendors.

These dramatic price increases are occurring with some of the most commonly prescribed and, formerly, inexpensive generic medications on the market. We have seen increases among Keep in mind several basic but important issues before you file most of the topical corticosteroid a MAC challenge with a PBM. First, preparations, oral prednisone, make sure you submitted the claim levothyroxine, doxycycline, divalproex correctly…check your day supply and These new waves of dramatic ER, enalapril, fluconazole…the list check your quantity billed compared price increases make APA’s seems truly limitless. While price to the package size. Also, check the new MAC law (Act 1194) an pricing that you submit to the PBM, if increases in the past have certainly even more important weapon caused pharmacies to lose small your computer system has your usual amounts of money on a prescription and customary price set incorrectly, in pharmacists’ arsenal to fight from time to time, the dramatic nature then this could also be a source of a for fair reimbursement. pricing issue. Finally, don’t be afraid of the current price increases in the to call your friendly competitors who market are causing hundreds of dollars of loss on some prescriptions. As an trade from different wholesalers to see example, a 500-count bottle of generic doxycycline tablets if they are able to acquire the drug at a less expensive price. If they are, then you know that your MAC challenge will likely went up overnight from approximately $30 a bottle to $2,000 be denied and you can address a potential pricing issue with a bottle! That’s a 6500% increase in price. your wholesale business partner. These new waves of dramatic price increases make APA’s Unfortunately, this is one of the realities of the generic world new MAC law (Act 1194) an even more important weapon in pharmacists’ arsenal to fight for fair reimbursement. So what we live in. The bright side is that APA’s MAC bill gives a are your rights under the law and what do you have to do to clearly defined mechanism to challenge these prices and take advantage of it? First, the law does not require PBMs it provides the ability for the attorney general to challenge to make any changes to their pricing. the PBMs if they are not following the law. Many PBMs are following the law as it is intended and we have received The law provides you with certain protections that require a numerous success stories of prices being adjusted. Likewise, PBM to respond to your MAC inquiry within a certain period we have heard of a number of cases where the law was not of time. For instance, you as a pharmacist should report followed. APA will continue to reach out to the PBMs to any MAC pricing issues to the PBM within three days of ensure that they understand the intent of the bill and how to operationalize it in their companies. filling the prescription. Keep in mind if you use a Pharmacy Services Administrative Organization (PSAO) to contract In the meantime, please keep submitting your pricing issues on your behalf, then the PSAO will need to file the pricing to APA at our website, www.arrx.org. § challenge on your behalf. Once the challenge has been filled, the PBM has seven business days to respond to you to say whether or not they 12

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Q & A W I TH M A R K R I L E Y

Legislator Profile

Rep. John Burris District: 98

Legislature an education and understanding of policy, a

Represents: Parts of Boone and Carroll Counties Years in Office: 2009 – present Occupation: Political Consultant Your pharmacist: N/A (I don’t really have one. I’m the young, healthy guy that helps keep costs low.)

Like most about office: Arkansas is a small state. It’s easy to have an impact on our future. Like least about office: It can be frustrating. There are typically

two kinds of people at the Capitol: those who want to take someone else’s money and use it for their good idea, and those who want to leverage the power of government to their benefit but to the harm of their competitor. Very few lobby – in a general use of the word – for free and fair. We need more free and fair but less status quo. We are moving in the right direction. It just takes time.

Upcoming election: I do not plan to seek another office. I plan to help elect Tom Cotton to the United States Senate.

Most admired politicians: Winston Churchill and David

Sanders. Churchill’s wit and command of language allowed him to out-debate any opponent, even in the rare instance that he was wrong. It’s a talent that is priceless in politics. David Sanders is a state senator from West Little Rock. He has combination of talents that make him the MVP of the

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work ethic to fully commit to the job despite its low rewards, and the ethical compass to not be affected by those trying to affect him. Advice for pharmacists about the political process and working with the AR Legislature: Don’t get frustrated. Termlimits make for a difficult environment. No Legislator is an expert at all things. Pharmacy is a very unique field, with very unique issues. It is difficult for Legislators to understand the ins-and-outs of any trade or vocation, and that is especially so with pharmacy. Be patient and make your case succinctly.

Your fantasy political gathering would include: The 89th General Assembly of the State of Arkansas. They’re all very good people who try to do the right thing.

Toughest issue of the past Session: Reducing the state’s

income tax was the most difficult issue to negotiate and pass. For a variety of reasons, politicians tend to favor special interest or sector-specific tax reductions. I favor reductions of our income tax. It benefits the average Arkansan and makes Arkansas more competitive in our region. I hope we can continue down the path of restructuring and reducing this tax.

What do you do for fun: I like to play golf and ultimate Frisbee.

If you can find a hole-in-the-wall restaurant, count me in for that as well. §

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Workers Compensation 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.

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orkers Compensation laws currently exist in all 50 states and the District of Columbia. They are important to both pharmacy owners and pharmacy employees. But do we understand what these laws provide and how they came to be? In most cases, these questions aren’t confronted until a claim occurs. It is much better to become educated prior to a claim for a number of reasons. For the owner, it is important to know your responsibilities prior to the claim to make sure that you have met them. For employees, it is important to know what to do when an injury occurs and what benefits you will be eligible to receive. In most situations involving personal injury, the laws of negligence apply. These laws are a mixture of statutory law and Common Law principles. Prior to Workers Compensation laws, employee injuries were handled as negligence cases. However, this presented many hurdles to the employee. The cases were difficult to win because the employer had good defenses available to them. If the employee contributed to the injury, or some other employee was the cause of the injury, then the employer was not liable. The employer could also assert that the employee knew the job was dangerous when they took it and assumed the risk. These cases were also difficult for the employee financially because they were not working and they didn’t have the resources available to them that the employer did. Employers were afraid of these claims because if the employee were successful, there were no limits on the amounts they could recover. In 1910, the state of New York created the first Workers Compensation program in the United States1. These statutes create trade-offs between the employer and the employees. Workers Compensation is a statutory creation, so there are no Common Law principles involved in it. As a practical result, Workers Compensation is state-defined and differs in detail from state to state. Therefore, this article can only discuss this topic at a high level. You will need to explore on your own for the details of your state’s program. The trade-offs are these. The employee is entitled to compensation and/or benefits for job-related injuries or diseases without the necessity of proving fault on the part of the employer. It is a no-fault system. These benefits are outlined in the statute and remove the specter of a run-away jury verdict for the employer. Workers Compensation becomes the exclusive remedy for the employee, so they no longer have the right to sue their employer for their injury. The intent was to provide a system that was fair to both sides and that provided benefits to the employee in a timely manner. In effect, the system was designed to be easier, cheaper, and more efficient than courts.

Generally, Workers Compensation provides benefits to the employee only in certain circumstances. The cause of their injury must be related to their employment and the occurrence must have taken place while engaged in work-related activities. While this looks simple on the surface, there have been many disputes over causation and over what is a work-related activity. As a result, there is more litigation that occurs in Workers Compensation claims than was originally foreseen. However, it takes place in front of an Administrative Law Judge instead of in a court. Many times this is still faster and less expensive than the regular court system. As an employer, it is very important to know when you are required to provide Workers Compensation benefits to your employees. In most states, this is done by setting a threshold of a minimum number of employees that trigger the responsibility. Failure to provide the benefits can result in fines and penalties being assessed against the owner. Providing the benefits doesn’t always mean going out and buying Workers Compensation insurance. Many states allow the employer to self-insure, while a few states require that the employer buy the coverage from a state-run plan. It is incumbent upon the owner to know what the requirements are and follow them. As an employee, it is important to know whether you are included in the Workers Compensation plan (some states exempt certain types of workers) and what you should do if you are injured on the job. Most states require a First Report of Injury be made as soon as possible. Sometimes this might even be required within 24 to 48 hours. Failure to report injuries timely could jeopardize the coverage. It is crucial that all injuries be reported at the time that they occur. Occasionally the employee thinks that the situation is very minor and doesn’t report it to the employer. The problem is that if the injury worsens and becomes significant days later, it may be difficult to prove that the injury was job related or that it occurred while on the job. Workers Compensation as it exists today may not be a perfect system. But it is a fact of modern life. Employers and employees should familiarize themselves with the responsibilities and benefits that they may have under their state’s program. § _______________________________________________________ © 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.

1 Commercial Insurance, 2nd Edition, A. Flitner & J. Trupin, 2007, page 12-3.

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UUNNI IVVEERRSSI ITTY Y OOFF AARRKKAAN R M E D I C A L S C I E NC CE ES C CO OLL LL E EG GE E O O FF PP H HA A RM R MAACCYY NSSAASS FF O OR

Coumadin® Welcome to another issue of Safety Nets. This column illustrates the potential hazards associated with illegible prescriber handwriting. Thank you for your continued support of this column.

A patient presented the original prescription illustrated in Figure One to a pharmacy technician.

and appropriate medical intervention are available. It could not be safely taken as a “home” dose.

Figure One

The second issue is the dose itself. Thirty and more years ago we had 25 mg warfarin tablets for “rapid induction” of effect. The authors of Safety Nets cannot recall ever having seen a daily dose of warfarin in excess of 40 mg, even then. It is outside the range of loading warfarin doses that would be ordered today.

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he technician entered the prescription information into the computer as Coumadin® (warfarin sodium) 10 mg Tablets, quantity four, with directions to the patient of “take two tablets by mouth twice daily today”. The same technician filled the order and placed it in line for pharmacist verification and patient counseling. While examining the prescription for accuracy, the pharmacist became concerned about the warfarin dose and dosing interval. In his experience, he had never encountered an order that directed a patient to administer 40 mg of warfarin sodium in a single day. The pharmacist asked the patient if the prescriber had told him to expect to receive a large dose of a “blood thinner”. The startled patient responded “my doctor said I had bronchitis – why would he give me a blood thinner?” At this point, the pharmacist called the prescriber for clarification. After listening to the explanation, the prescriber stated he intended to treat the patient’s bronchitis with prednisone 20 mg tablets to be administered twice daily for two days. The prescriber went on to thank the pharmacist for his concern and his telephone call. The pharmacist filled the new prescription for prednisone – deactivated the Coumadin® prescription – and provided the appropriate patient counseling. Thanks to the efforts of the pharmacist in this case, a potentially harmful medication error was prevented from reaching this patient. Fortunately, this pharmacist worked in a pharmacy environment that allowed him to treat the prescription as a unique entity, rather than simply filling the order in a rushed, uncaring, methodical, robotic fashion. His working environment allowed him to take the time to uncover the potential problem and take the necessary steps to resolve it. This prescription provides an example of a drug order that could never be handled as a matter of routine. The sole reason for such a dose of warfarin would be to induce anticoagulation. It is a dose that could only reasonably be administered safely in a controlled environment, where immediate laboratory results

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The pharmacist who spotted this tragedy in the making did not only demonstrate appropriate vigilance in patient care. This colleague demonstrated the baseline competence that is implied when the law speaks of the “learned intermediary”. All patients have a right to expect anyone holding a license to practice pharmacy will note that a dose such as this is extraordinary. The universal principle was here upheld by the single pharmacist in the case of a single drug order for a single person. Everyone who taught this pharmacist, from early childhood through to preceptors in the experiential education courses, has a right to feel genuine pride. Along the way this pharmacist became learned in the science of pharmacy, and also became an exemplar of the values that pharmacy represents. Pharmacy owners and managers – including pharmacy corporate directors - must provide working environments conducive to patient safety. This begins with adequate staffing of pharmacists and support personnel. Inadequate staffing can result in a working environment characterized by disorganization, distractions, interruptions and ultimately chaos. Pharmacists working in these locations become frustrated and often feel anger and resentment. Prescription volume will continue to increase as “baby boomers” require more and more medications. Pharmacists will be expected to fill the increased volume of prescriptions in a timely fashion and also provide Board of Pharmacy required patient counseling. Pharmacists will also be expected to prevent drug-drug and drug-disease interactions from reaching patients. Managing this increased workload will be very difficult, even with adequate staffing. Pharmacists must consistently address staffing concerns with each supervisor in terms relating to patient safety. Pharmacists whose concerns are ignored should explore other pharmacy employment opportunities. §

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Improving Care for Medicare-Medicaid Patients Recent changes in the health care system have prompted a paradigm shift in payment models for health care providers. The payment models have departed from the traditional feefor-service model and have moved to a pay-for-performance model – incentivizing health care providers to attain certain pre-defined quality and safety metrics. Due to provisions in the Patient Protection and Affordable Care Act of 2010, many providers are concentrating these quality improvement efforts on enhancing care coordination and patient transitions in order to reduce unnecessary re-hospitalizations. As a result, the Centers for Medicare & Medicaid Services (CMS) recently reported that the national Medicare 30-day readmission rate has dropped to a five-year low of 17.8 percent in the final quarter of 2012. This drop translates to the prevention of more than 70,000 Medicare readmissions that year.1

Dual Eligible Patients

While these achievements are significant in the Medicare population alone, attention is now being given to other coverage types as well. Specifically, the dual eligible population has recently garnered national attention as the target of future health care improvement efforts. Dual eligible beneficiaries are those low-income elderly and disabled patients enrolled in both the Medicare and Medicaid health insurance programs. In 2008, there were approximately nine million dual eligible enrollees nationwide, with over 118,000 of these living in Arkansas. These patients are some of the most chronically ill, vulnerable and diverse individuals among both coverage programs. Therefore, they have higher rates of health care consumption and are almost twice as likely to experience two or more hospitalizations compared to Medicare-only beneficiaries.2 However, despite these known statistics, the majority of dual eligible beneficiaries are excluded from the evidence-base of nationally recognized interventions to improve care transitions and reduce readmission rates. This presents a unique opportunity to address the fragmented care coordination, inefficiencies and high expenditures associated with the dual eligible population.

CMS Special Innovation Project

In 2012, CMS awarded the Arkansas Foundation for Medical Care (AFMC), the Medicare Quality Improvement Organization for Arkansas, with a special innovation contract to reduce hospital readmissions and improve care transitions for dual eligible beneficiaries. This contract, one of only two in the nation, charged AFMC with assisting providers in evaluating, AR•Rx

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monitoring and improving the health care of their dual eligible population. To achieve the overall goal of the project, an intervention must be developed or modified specifically for implementation within the dual eligible population. This intervention will then be disseminated nationwide for utilization. In partnership with the Greater Delta Alliance for Health, Inc., AFMC is currently implementing this project in the following counties: Arkansas, Ashley, Bradley, Chicot, Desha, Drew and Lincoln. AFMC formed the Arkansas Care Transitions (ACT) Delta community coalition, comprised of health care providers, civic leaders and other stakeholders dedicated to improving care transitions, to facilitate the implementation of this project. Additionally, an extensive, multifaceted root cause analysis was performed to identify the underlying causes of dual eligible readmissions and found poor interprovider communication and lack of community resource referrals to be the key readmitting drivers in this population. Therefore, providers in the area are preparing to implement an intervention consisting of improved communication tools and region-specific community resource guides.

How Can Pharmacists Get Involved?

Pharmacists can play a key role in this project to improve the overall coordination of care for the dual eligible population. Practicing pharmacists in the aforementioned project area should be proactive in joining the ACT Delta coalition. Those practicing outside this area should consider joining or developing similar initiatives in their health care setting and/or community. § Pharmacists interested in learning more about this project can contact Dr. Christi Quarles Smith at csmith@afmc.org. REFERENCES 1. Jonathan Blum, Acting Principal Deputy Administrator and Director of the Centers for Medicare & Medicaid Services. Senate Finance Committee. February 28, 2013. 2. Jacobson G, Neuman T, et al. Medicare’s role for dual eligible beneficiaries. Kaiser Family Foundation Program on Medicare Policy. April 2012. Christi Quarles Smith, Pharm.D., is a pharmacy specialist at the Arkansas Foundation for Medical Care (AFMC), and is the team lead for AFMC's reducing adverse drug events and care transitions projects. She is a graduate of the University of Arkansas for Medical Sciences (UAMS) and completed a Pharmacy Practice residency at UAMS. She can be reached at csmith@afmc.org. AFMC is the state's health care Quality Improvement Organization and contracts with the Centers for Medicare & Medicaid Services to give technical assistance to health care providers. AFMC's mission is to promote excellence in health and health care through education and evaluation.

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DENNIS MOORE VIEWS PHARMACY FROM 5,000 FEET

Member Spotlight

Carol Long EPIC-GENSIS TEAM MERCY HOSPITAL

Pharmacy practice: My practice is in the area of informatics. Mercy has implemented an electronic health record (EHR) across all our facilities, and I work on implementation and optimization of the Pharmacy and Oncology modules.

Graduate pharmacy school and year: BS Pharm in 1991 and

non-traditional PharmD in 2008.

Years in profession: I did a residency in Hospital Pharmacy

the tiny critical access to the huge medical center, and trying to get all those people to play nice in the same sand box.

Oddest request from a patient/customer: This isn't really a

request.. but one of those times where you think "Did she REALLY just do that?" I was working with an older, not-socomputer-savvy staff member in training for the EHR and I told her to use her mouse and click on a certain button. She picked up the mouse and put it up to the computer screen, pointed to the button and clicked!

at the VA in 1991-1992. Then I worked at Washington Regional Medical Center in Fayetteville in various capacities (staff pharmacist, clinical pharmacist, assistant director, informatics) for a total of 14 years. I took a brief detour through home infusion and closed-door institutional pharmacy in the middle of my time at Washington Regional. I moved to Mercy in 2006 at the beginning of our project to implement the EHR.

Fun activities: Watching football, especially the Razorbacks; boating, snorkeling/scuba.

Favorite part of the job: I have two favorites. Number one

Ideal dinner guests: Both sets of my grandparents. My

is definitely the people I work with. The Pharmacy Team is spread out across 4 states, but we are like extended family. Being in the trenches together in the crucible of a go-live and working those long hours and resolving problems together is a very bonding experience. Number two is the opportunity to understand pharmacy operations across the full spectrum of hospital types and sizes from a tiny 6-bed critical access hospital to a huge 1000-bed medical center.

Recent reads: The Meaning of Marriage by Tim Keller, Prayers for Sale by Sandra Dallas.

grandmothers because they died when I was still young and there's so much I would like to ask them now, and my grandfathers because they both died before I was born.

If not a pharmacist then… Probably some kind of research. I worked in an immunology research lab before I went to pharmacy school, and I loved it. §

Least favorite part of the job: Trying to figure out how to

configure an EHR that will work for all those hospitals from

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and CEO Mark

Pharmacist Immunization Program

Time is a Common Barrier to Doing Immunizations By Eric Crumbaugh, Pharm.D. Remedy Drug pharmacist Laura Lumsden provides immunization to Leah Cyphers.

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rkansas pharmacists have been authorized to administer medications since 1998; however, only about half of all pharmacies across the state currently offer these services. The Pharmacist Immunization Program’s goal has been to identify and address any barriers to establishing and conducting these programs. Throughout this initiative, pharmacists have reported the main reason and/or challenge is that there is not enough time in a pharmacy to conduct these services, or that the services would be disruptive to the daily workflow. In March 2013, a phone survey of every independent community pharmacy in the state found that over a third of the pharmacies do not offer immunizations in their stores because they are too busy. Also, 69 percent of immunizing pharmacies reported they encountered time as a challenge.2 Time is the most precious commodity in a retail pharmacy. Pharmacists are presented with a multitude of tasks each day requiring the highest degree of attention to detail and accuracy. Pharmacists may feel that they scarcely have time to fulfill these basic duties in the pharmacy, much less establish or grow additional clinical programs including immunization services. The survey also asked pharmacies to report the average number of prescriptions their stores fill per week and how many pharmacists worked at their store. Pharmacies that offer immunization services fill on average approximately 1,200

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prescriptions per week and employ an average of three pharmacists. Pharmacies that do not offer immunizations fill on average approximately 880 prescriptions per week and employ an average of two pharmacists.1, 2

Surveys have found that pharmacists believe lack of time is one of the most common barriers to conducting immunization programs in their stores. To overcome this challenge, pharmacists have delegated some of the non-professional tasks to other pharmacy employees and utilized student pharmacists to screen patients and administer medications.

One could hypothesize that the immunizing stores fill more prescriptions per week because the immunizations they give are counted in that number. On the other hand, perhaps the pharmacies that offer immunizations fill more prescriptions because they offer this additional clinical service. Our analysis of the surveys has proven neither of the above theories; however, these surveys have found that pharmacists believe lack of time is one of the most common barriers to conducting immunization programs in their stores.

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P H A RM A C I S T I MMU N I Z A T I O N P ROGR A M

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To overcome this challenge, pharmacists have delegated some of the non-professional tasks to other pharmacy employees and utilized student pharmacists to screen patients and administer medications. The practice promoted by the Pharmacist Immunization Program is to handle each immunization exactly like a new prescription. When a patient presents to the pharmacy requesting an immunization, the technician gives the patient a consent form and vaccine information sheet and inputs the immunization in the computer. Then a technician “fills” the vaccination by pulling it from the fridge or freezer and putting the consent form with it. Next the immunization and consent form are placed in line with the other prescriptions to be verified by the pharmacist. If there are several prescriptions waiting to be checked, the immunization is treated just like another prescription. Most of the time patients do not mind having to wait a few minutes to receive their immunization.

from the patient, then the pharmacist can review the VIS with the patient and administer the immunization. Most of the time reviewing the VIS and administering the immunization will take the same amount of time as counseling a patient on a new prescription.

Once the pharmacist has “checked” the vaccine and the patient’s consent form, the clerk or technician can get payment

1 Barriers to Pharmacist Administered Vaccination Services April 2013 2 Pharmacist-Administered Adult Immunization Services March 2013

Pharmacies with successful immunization programs have been able to address the challenges by including their pharmacy staff in the process of filling a prescription for vaccinations, utilizing pharmacy students in the screening and administration of immunizations, and most importantly incorporating these services into the daily workflow of the pharmacy. Please feel free to contact Dr. Eric Crumbaugh, Immunization Grant Coordinator with the Pharmacist Immunization Program, for innovative ways your pharmacy can overcome the challenges of creating a successful immunization program. §

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2013-2014 Calendar of Events OCTOBER

October 24 APA Golden CPE Little Rock, AR

NOVEMBER

November 7-9 American Society of Consultant Pharmacists Annual Meeting and Exhibition National Harbor, MD

DECEMBER

December 8-12 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exhibition Seattle, WA December 7-8 APA Committee Forum and Board Meeting Crowne Plaza Hotel Little Rock, AR

2014 MARCH

March 9 APA Board Meeting Little Rock, AR March 28-31 American Pharmacists Association Annual Meeting and Exposition Orlando, FL

APRIL

April 10 Arkansas Pharmacy Foundation Golf Tournament Location TBD

JUNE

June 12-14 APA 132nd Annual Convention The Chancellor Hotel Fayetteville, AR

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C O L L E G E S O F P H A RM A C Y

UAMS

New Students, ACPE Accreditation Site Visit Stephanie Gardner Pharm.D., Ed.D. Dean

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e’re off to another great start this fall at the UAMS College of Pharmacy with 121 first-year students making it official Aug. 23rd at our annual White Coat Ceremony. A special “thanks” goes to Mark Riley, Pharm.D., Executive Vice President of the Arkansas Pharmacists Association, for joining us to help welcome the new students as they begin their journey within the profession. The new class is highly competitive with a grade point average of 3.51 and an average PCAT score of 71. Seventy-four students have undergraduate degrees, three have Master’s degrees and one student holds a doctoral degree. Of On Aug. 1, I was the 121 first-year students, appointed associate 105 are from Arkansas provost for society and and the other 16 are from health, in addition to K e n t u c k y, Maryland, continuing my role as Missouri and Texas.

dean. This gives me the opportunity to work on campus-level projects that I'm passionate about, including interprofessional education and health prevention and promotion.

Accreditation Site Visit

Adding to the bustle during the busiest time of the academic year, we also have been working diligently to complete our Self Study for an upcoming Accreditation Council for Pharmacy Education (ACPE) accreditation site team visit, which is Oct. 15-18. A special debt of gratitude to Kat Neill, Pharm.D., Assistant Dean for experiential education, and Cindy Stowe, Pharm.D., Associate Dean for administrative and academic affairs, for working around the clock to put the finishing touches on this sizable effort in the last few weeks to complete the project. Our faculty approved our Self Study, and the last year of work by many faculty members, staff, students and alumni has come together to provide us with a terrific summary of our strengths and opportunities for further growth. The completion of this project is the reflection of a true team effort.

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COP Drug Approved by FDA

While student activities and classes were ramping up, it also was a great couple of weeks in the research arena. Peter Crooks, Ph.D., chair of the Department of Pharmaceutical Sciences, was notified that one of his drug discoveries, Valchlor, was approved by the Federal Drug Administration (FDA). Ceptaris, the company Dr. Crooks founded to develop Valchlor, recently was purchased by the Swiss company, Actelion. Valchlor was developed for the treatment of early-stage cutaneous T-cell lymphoma. I am consistently in awe of the genius behind Dr. Crooks and the energy he brings to the college every day. We also were notified that Martin Hauer-Jensen, M.D., Ph.D., chair of the Division of Radiation Health, has been elected vice president of the Radiation Research Society and will become its president in 2015. This appointment is a great honor and recognizes his significant scientific accomplishments.

ACE Fellowship Complete

On a more personal note, I have completed my Fellowship with the American Council on Education. I was able to learn under the mentorship of President Ray Greenberg at the Medical University of South Carolina during three, one-month experiences on the Charleston campus. I feel very fortunate to continue to have the support of UAMS Chancellor Dan Rahn, M.D. On Aug. 1, I was appointed associate provost for society and health, in addition to continuing my role as dean. This gives me the opportunity to work on campus-level projects that I'm passionate about, including interprofessional education and health prevention and promotion. It also signifies the important and expanding role that pharmacy plays on the UAMS campus. I am looking forward to new challenges and greatly appreciate all the kind emails and notes that I’ve received from alumni and friends over the past few weeks. §

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C O L L E G E S O F P H A RM A C Y

HARDING UNIVERSITY

Julie Hixson-Wallace Pharm.D., BCPS Dean

New Beginnings: Harding President and Facilities, Rho Chi Chapter

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t's that time of year when summer vacations end and many of us settle back into the routine of work and school. But this year with the routine come many new beginnings for us at Harding. For a brand new class of 62 first professional year students, orientation started on August 12 followed by classes on August 19. This year's incoming class hails from 17 states and five foreign countries, with the majority (40 percent) coming from Arkansas. For a brand new class of graduates, the class of 2013, graduation day came on May 11, 2013 as 54 individuals embarked on their new beginning on a path toward becoming licensed, practicing pharmacists.

New President: Dr. Bruce McLarty

A most momentous new beginning at Harding is that of the university's fifth president in its 90-year history, Dr. Bruce McLarty. Dr. McLarty assumed his role as president on June 1, 2013 and was inaugurated on September 20, 2013 to much pomp and circumstance. Delegates from over 110 other universities and professional organizations were on hand along with many other state and national dignitaries for this important occasion. Adjacent and connecting via a skywalk to the Farrar building that houses the College of Pharmacy and Physician Assistant Program on the Harding campus is a new 45,000 square foot additional Center for Health Sciences building. This facility includes a speech clinic that offers clinical services at no charge to the community as well as four differently appointed clinical laboratory spaces for training of nursing as well as other health sciences students. The facility houses the Communication Sciences and Disorders program at Harding which offers both bachelors and Masters level degrees as well as the Carr College of Nursing. The bachelor of nursing degree has been offered for over 30 years at Harding and a new family nurse practitioner program is anticipated to enroll students for the fall of 2014.

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Rho Chi Honor Society

Another new happening at the College of Pharmacy is the establishment of the Delta Omicron chapter of The Rho Chi Honor Society. As many of you know, The Rho Chi Honor Society is the official pharmacy honor society and only schools and colleges of pharmacy possessing full accreditation status are eligible to have Rho Chi chapters. We were pleased to induct the first 33 members to the chapter at Harding during a ceremony on April 14, 2013 presided over by Rho Chi executive board member, Dr. Andrew Smith. Among all these new beginnings, one thing remains constant and A most momentous new that is the grace of God beginning at Harding is and His call to all of us that of the university's fifth to serve our fellow man. president in its 90-year Service continues to be the essence of Harding history, Dr. Bruce McLarty. and we strive to keep this Dr. McLarty assumed his focus as we maintain our role as president on June mission of graduating 1, 2013. pharmacists who accept responsibility for improving the spiritual and physical wellness of the world. We believe we are doing this by emphasizing our core values of advancement, Christianity, collaboration, trustworthiness, innovation, outreach, nurturing, and service (ACCTIONS) and demonstrating them in the more than 2,800 hours of charitable clinic service and 3,200 hours of other pharmacy service-learning activities completed by our students each year. We believe these ACCTIONS ultimately lead to a strong sense of professionalism and we appreciate the professionalism you display as leaders of pharmacy, particularly to our students as you model excellent practice every day. Thank you for all you do for Harding and please let me know what we can do to better serve you. §

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A R K A N S A S A S S O C I A T I O N O F H E A L TH - S Y S T E M P H A RM A C I S T S

ARKANSAS ASSOCIATION OF HEALTH-SYSTEM PHARMACISTS

AAHP Celebrates Fall Seminar and Progressive Pharmacy Practice

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t is hard to believe that 2013 is almost over. As I look back and take stock of the past year, I realize just how much AAHP has accomplished. The AAHP board of directors has been able to complete several notable undertakings. We have revised and updated the constitution and by-laws of the association. These revisions have been a work in progress since 2009 and will allow us do things like have electronic as well as paper ballots for elections along with many other updated services from the APA. Completion of these tasks has been easier thanks to the leadership of the past three presidents: Willie Capers, Rayanne Story and Jason Derden. We also have a new strategic plan. This plan will guide the board’s actions for the next three years as we work to continually improve health-system pharmacy practice in Arkansas. Please be on the lookout for copies of both of these documents for your review in the coming weeks. Lanita S. White, Pharm.D. President

The board has also made a bold move with regards to the time of officer elections and installation. We currently install new officers in October of each year. While this practice coincides with the Fall Seminar, is does not coincide with our state and national organizations. Both the American Society of HealthSystem Pharmacists (ASHP) and the APA install new officers each year in June, which is several months before AAHP. Because of this, the board of directors decided to align our installation with our closest affiliate organizations and change our cycle to June as well. Starting June 2014, we will install new officers for AAHP. The 47th Annual Fall Seminar was held at the Clarion Hotel Medical Center in Little Rock October 3-4. The AAHP Fall Seminar offered over 12 hours of ACPE-accredited continuing pharmacy education for pharmacists and pharmacy technicians. We were delighted to host Mr. Doug Scheckelhoff, Vice President of Professional Development at ASHP who visited area hospitals, attended the AAHP board meeting, delivered the Fall Seminar keynote address and spent time with students and residents. This year’s seminar continued to offer technician and student specific programming, a poster

session and the Arkansas Pharmacy Residency Showcase that was co-sponsored by the Arkansas chapter of the American College of Clinical Pharmacy (AR-ACCP) and AAHP. This year we showcased 15 pharmacy residency programs including two out-of-state programs. Thanks to the residency council for a wonderful showcase. This year’s seminar was a big success and a special thanks goes to the Fall Seminar committee who worked so hard to make it again one of the best we have had. We had the largest turn out ever with over 300 registrants including pharmacists, residents, technicians and Harding and UAMS college of pharmacy students! We also presented the following awards during the meeting: • The first ever Residency Preceptor of the Year: Jennifer Stark, Veterans Health Care System of the Ozarks, Fayetteville, AR • Manager of the Year: Jon Simmons, White County Medical Center, Searcy, AR • Clinician of the Year: Andrea Cavenaugh, St. Bernards Medical Center, Jonesboro, AR • New Practitioner of the Year: Melanie Burnett, St. Bernards Medical Center, Jonesboro, AR • Technician of the Year: Audrey Burr, Baxter Regional Medical Center, Mountain Home, AR • Staff Pharmacist of the Year: Jon Ziegenbalg, White County Medical Center, Searcy, AR As we move into the next year, my goal is to work with AAHP members to continue to push progressive pharmacy practice and innovative thinking. APA past president Dr. Dennis Moore started a Provider Status Taskforce that will look at actions needed to obtain provider status for Arkansas pharmacists. We have members of AAHP working with members representing other organizations in the state to tackle this complex issue. This work is a great reflection of this year’s Fall Seminar theme – “Driving the WheeIs of Change”. The Board and I appreciate your support and all you do for the profession of pharmacy in Arkansas. §

AAHP Board Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Susan Newton, Pharm.D., Russellville President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lanita Shaverd-White, Pharm.D., Little Rock President-Elect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Marsha Crader, Pharm.D., Little Rock Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Willie Capers, Pharm.D., Jonesboro Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sharon Vire, Pharm.D., Jacksonville Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Wendy Koons, Pharm.D., Jonesboro Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Maggie Miller, Pharm.D., Batesville Member-at-Large. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Niki Carver, Pharm.D., Little Rock Member-at-Large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .James Reed, Pharm.D., Conway Technician Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Janet Liles, MS, CPht, Searcy 24

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C OM P OU N D I N G A C A D E MY

COMPOUNDING ACADEMY

Compounding Legislation Moving in Congress Warren Lee, Pharm.D. President

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n a surprise move on Thursday, September 26th, the House of Representative introduced a compromise bill (HR 3204) that combined compounding with the “Track and Trace” bill. The new bill is totally different from S. 959 and HR 3089 from Congressman Griffith’s office. The bill rapidly moved through the House and passed by voice vote on Saturday, September 28th. The new legislation, which is now awaiting action in the Senate, affects compounding in the following ways: • It creates a “voluntary” registration for a new FDAregulated entity called an “outsourcing facility”. An example of an outsourcing facility would be a business that compounds sterile medications for “office stock” without a patient-specific prescription. • It reaffirms the 1997 section 503(a) of the Food Drug & Cosmetic Act but with the removal of a clause that had not allowed for the marketing of compounds. • It has no affect on traditional compounding for patientspecific prescriptions. There are several issues with the bill that need to be resolved. • The current language in 503(a) is very ambiguous and will only propagate the conflict between federal and state laws. • The new outsourcing facility does not have to be a pharmacy. Therefore, a non-pharmacy outsourcer would have advantages over pharmacy outsourcers because they will not be subject to board of pharmacy regulations.

• Though an outsourcing facility is a “voluntary” registration, IACP has stated that there is evidence that the FDA will continue its inspections and actions against pharmacies that provide sterile office-use medications. Therefore, the so-called “voluntary” registration is probably not so voluntary after all. On Thursday, • The outsourcing facilities September 26th, the will not be able to House of Representative compound with bulk active pharmaceutical introduced a ingredients (APIs) without compromise bill (HR the express written 3204) that combined consent of the Secretary compounding with the of Health and Human “Track and Trace” bill. Services.

The new bill is totally

With the current state of different from S. 959 disarray on Capitol Hill, it is and HR 3089 from uncertain when the Senate Congressman Griffith’s will take up this bill. In the meantime there is much office. concern that special interest groups will try to “hot line” the bill for their own gain, including one possible attempt by a drug manufacturer, TherapeuticsMD, to remove compounded bio-identical hormones from the market. In the meantime, please take time to contact our Senators and make your voice heard. §

Arkansas State Board of Pharmacy President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Steve Bryant, P.D., Batesville Vice President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Justin Boyd, Pharm.D., Fort Smith Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lenora Newsome, P.D., Smacko Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Stephanie O’Neal, P.D., Wynne Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tom Warmack, P.D., Sheridan Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Robertson, Pharm.D., North Little Rock Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Larry Ross, Sherwood Public Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Joyce Palla, Arkadelphia

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2013 District Meetings

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District 5 President Dean Watts at Grand Prairie Center.

(L to R) Aaron Brown, Rick Rogers, Brooks Rogers at District 1 Meeting in Little Rock.

(L to R) Karen Watts, Brandyn England, Jacquie Charles & Gail Northcutt at District 5 meeting in Stuttgart.

(L to R) District 1 President Clint Boone and Blake Hirschceider.

(L to R) Bob Hodge, Randy Shinabery and Charles Cain at District 2 meeting in Jonesboro.

(L to R) Jacquelyn King, Bob Clark, Dwight Wallace at Little Rock District 1 Meeting.

(L to R) Phil Wilson and Stephanie Goodart-O’Neal in Jonesboro.

UAMS COP Dean Stephanie Gardner addresses Little Rock District 1 Meeting. AR•Rx

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(L to R) APA’s Debra Wolfe & Mark Riley with state Rep. Andrea Lee at District 7 Meeting in Fort Smith.

District 4 President Lise Liles at the Camden meeting.

Scott Warmack presents scholarship to Ashlynne Hixon.

(L to R) Fred Barlow, Smith Drug, and Harding University COP’s Tim Howard at District 4 Meeting in Camden.

(L to R) Greg Bell, Clint Bell and UAMS' Jon Wolfe at District 6 meeting in Russellville.

(L to R) Cardinal Health’s Denise Grissom with Laura Wagner at District 6 Meeting in Hot Springs.

(L to R) Kevin Moore and Raymond Reynolds at District 6 meeting.

District 6 President Stephen Carroll kicks off meeting in Hot Springs.

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2013 District Meetings

(L to R) At Monticello District 5 Meeting, Lynn Wilson, Patricia Nicholson, Daniel Bryant (L to R) District 3 President Chris Allbritton and Kevin Caldwell at Mountain Home and Shane Dixon. Meeting.

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Dr. John Kirtley provides overview on State Board of Pharmacy.

(L to R) Heejun Woo, Dylan Jones, Carl Collier, Richard Holt, Ashley Paladino at District 3 Meeting in Rogers.

APA President Dana Moore at the District 5 Meeting in Monticello.

(L to R) Jonell Hudson, Melanie Claborn and Lois Coulter at Rogers District 3 Meeting.

(L to R) Kim Harrison and Lori Yates at the District 3 Meeting in Mountain Home.

Harding University COP Dean Julie Hixson-Wallace at District 8 Meeting in Searcy. AR•Rx

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Member Classifieds Pharmacist needed in Garland County. Pharmacist needed for PIC at an independent retail pharmacy in Garland County. Looking for self-motivated person willing to merge clinical pharmacy with independent retail. Exciting opportunity for a new approach to retail. Send inquiries to arrxjobs@gmail.com. Pharmacy Tech needed in Little Rock. Independent retail pharmacy specializing in non-sterile compounding located in Little Rock. Please call 501223-2224 or email cornerstonestacy@gmail.com for more information or to send resume. Director of Pharmacy needed at North Metro Medical Center in Jacksonville. This position is responsible for planning, organizing, directing, executing and evaluating all aspects of the pharmacy services for the hospital. Apply online at www.northmetromed.com. • Education: Bachelor Degree in Pharmacy required; PharmD degree preferred. • Licensure/Certification: Current pharmacist’s license issued by the State Board of Pharmacy required. •Experience: Two years acute care hospital e experience required. Two years of management experience preferred. (9/30/13) Pharmacy techs needed at Cantrell Drug in Little Rock. We are growing again! Cantrell Drug Company needs to fill 10 pharmacy technician positions ASAP. These positions are non-retail positions. They are fulltime with a great benefit package. The successful candidate will want to work in a lab-type environment while demonstrating attention to detail and a focus on quality. Please send your resume to dconaway@cantrelldrug.com. (9/23/13) Compounding Pharmacy Technician needed in NW Arkansas. Collier Compounding in Northwest Arkansas is looking for a full-time Compounding Technician with at least 1-2 years of experience in either sterile or non-sterile compounding. If interested please email compounding@collierdrug.com and attach resume and references. (9/12/13) PRN Pharmacist Needed: Home IV Specialists needing PRN pharmacist to help cover weekend call. Email pharmacy.homeiv@gmail.com or call 501-3368350 if interested. (8/15/13) Pharmacy for sale in Marvell. Pharmacy for sale in Marvell, Arkansas. $1.2 million in annual sales; 99 percent prescriptions. In building with nurse practitioner. Open M-F 9 am - 5 pm. Nearest competitor is 20 miles away. Contact Bob Wright: 870-816-5269 or bobwright@eastark.com. (7/29/13) Pharmacists needed in Bentonville and Springdale. Circle of Life has an immediate opening for a Contract Pharmacist to work at both our Bentonville and Springdale facilities. Should have availability to work every other weekend as needed. B.S in Pharmacy or Pharm.D. from an accredited pharmacy school, college or university. Arkansas Pharmacist license. Prior experience in a healthcare organization preferred. Please call Human Resources at 479-872-3366 or apply on-line at www.nwacircleoflife.org. (7/12/13) Need Pharmacy Technician at Little Rock Pharmacy. Experience in retail pharmacy preferred. Hours are 9 a.m. to 6 p.m. weekdays and 9 a.m. to 12:00 p.m. on Saturday. Contact jerry@pharmacylr. com. (5/7/13)

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Member Classifieds are free to APA members and $65 per issue for non-members. Contact eileen@arrx.org for more information.

Walgreens Community Pharmacists needed. Walgreens is currently seeking community pharmacists throughout Arkansas, specifically in the following cities: Bryant, Cabot, Conway, Forrest City, Fort Smith, Jonesboro, Little Rock, Magnolia, Malvern, Monticello, Mountain Hom e, North Little Rock, Paragould, Pine Bluff, Rogers, Russellville, Searcy, Sherwood, Springdale and West Memphis. Please send resume to pharmacyjobs@walgreens. com if you’re interested! (3/22/13) Full-time Pharmacy Technician needed at Conway pharmacy. Experience in retail pharmacy is preferred. Email resume to rxjrb@aol.com. (2/25/13) Full-Time Pharmacist Position in Melbourne. Staff pharmacist for LTC pharmacy located in Melbourne. No nights or weekends, but on-call rotation required. Consulting experience a plus. Send resume to AHS, P.O. Box 769, Melbourne, AR 72556 or mduncan@ alliedhc.net. (2/12/13) Northwest Arkansas Free Health Center in Fayetteville looking for pharmacy volunteers. We provide health and dental care to low income and uninsured individuals. Our pharmacy hours are Wednesday 1-3 and Thursday 6-8. Contact Monika Fischer-Massie at mfischerm@nwafhc.org or call 479-444-7548. (12/12/12) Relief Pharmacist Available. Pharmacist with compounding experience looking for relief pharmacy work in Arkansas. Please contact Buzz Garner at 479-234-1100 or drbuzz@arkansas.net. (5/8/12)

pharmacists can contact Pam Rossi at PRRossi@uams.edu or call Anne Stafford, RN Medical Manager at 501-376-6694.(2012) Experienced Relief Pharmacist Available. Experienced relief pharmacist (retail/hospital/ IV) available in Central Arkansas. Willing to travel reasonable distances. Fred Savage 501-350-1716; 501-803-4940; fred.savage@sbcglobal.net. (5/7/12) IVANRX4U, Inc., Pharmacist Relief Services, Career Placements. Relief pharmacists needed - FT or PT. Based in Springfield, MO and now in Arkansas. Staffing in Missouri, Arkansas, Eastern Kansas and Oklahoma. We provide relief pharmacists for an occasional day off, vacations, emergencies — ALL your staffing needs. Also seeking pharmacists for full or part-time situations. Please contact Christine Bommarito, Marketing and Recruiting Director, for information regarding current openings throughout Arkansas, including temporary as well as permanent placements. Let IvanRx4u help staff your pharmacy, call 417-888-5166. We welcome your email inquiries, please feel free to contact us at: ivanrx4uchristine@centurylink.net. (2011) STAFF RPH, Inc. Pharmacist and Technician Relief Services. We provide quality pharmacists and technicians that you can trust for all your staffing needs. Our current service area includes AR, TX, OK and TN. For more information call Rick Van Zandt at 501-847-5010 or email staffrph@att.net. (2011) §

Relief Pharmacist Needed. Independent pharmacy in Van Buren/Ft. Smith, AR area is seeking relief pharmacist for Saturdays. Hours on Saturday are 9 a.m. to 1 p.m. and I have excellent technicians who will be scheduled those hours. I would love to have someone work every Saturday, but need someone for at least one or two Saturdays per month. If interested please call or text 479-414-7503 or send resume or email: kbarlow@ pharmacyexpressvb.com. (2012) Charitable Clinic Needs Service Minded Pharmacists. Want to be thanked dozens of times a day? Tired of dealing with insurance? Join our team at River City Charitable Clinic in North Little Rock. We are looking for volunteer pharmacist to take an active role in the healthcare of low income, uninsured, unassisted patients. Volunteer(s) are needed specifically for a new "refill clinic". You can pick your ideal clinic time on Monday, Wednesday, or Thursday. Staff it weekly or share with a friend. Interested

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ARRx - The Arkansas Pharmacist Fall 2013  

ARRx - The Arkansas Pharmacist Fall 2013

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