Jacob Schwarz, PharmD, MBA, BCIDP , BCCCP , BCPS, FAzPA
Jacob Schwarz graduated from the University of Arizona-College of Pharmacy in 2010 and then went on to complete a PGY-1 Pharmacy Residency in Lakeland, FL. Jake returned back to Phoenix and practiced at Phoenix Children’s Hospital prior to taking a clinical pharmacist position at Yuma Regional Medical Center, where he worked for over 9 years in various positions including serving as the PGY-1 Residency Program Director and Pharmacy Clinical Coordinator for over 7 at Yuma Regional Medical Center for over 7 years before recently accepting a position as an ICU Pharmacist at Mayo Clinic Hospital in Phoenix, AZ. Along the way Jake has attained board certifications in Pharmacotherapy, Critical Care, and Infectious Diseases. Jake also graduated with a Master of Business Administration with healthcare administration focus from the University of Massachusetts in Spring of 2021. Along with constantly learning for himself, Jake has also been active in the education of healthcare professionals throughout his career. He has been an IPPE and APPE preceptor multiple Colleges of Pharmacy, including UofA, Midwestern, Purdue, and Drake University. Jake has also taught his pharmacy residents on clinical rotations, as well as provided didactic lectures to the medical and nursing staff at Yuma Regional to help improve patient care at the institution. In Spring 2022, the University of Arizona named Jake their Preceptor of the Year for his dedication to teaching and excellence. Jake has also been an active member of the Arizona Pharmacy Association having served on the AzPA Board of Directors since 2016 and is currently serving as the President-Elect Pro Tempore. Jake has also been active in AzPA in the education of pharmacy professionals by presenting at several different AzPA Conferences, and in 2021 was named a Fellow of the Arizona Pharmacy Association.
Dear Fellow AzPA Members,
As my year of serving as your President comes to its conclusion, I wanted to reflect over the past 12 months and how the profession of pharmacy and how the Arizona Pharmacy Association are both moving into a new Era.
Last year at the Annual Convention I spoke to you about going for the gold medal, not only individually in our professional careers, but also as an organization. So where did AzPA reach for the gold medal this past year and where can we continue to strive for that level? Well to start things off AzPA continued to provide successful high-quality continuing education at our Fall Conference Rapid Renewal, our ASHP-affiliated Spring Clinical Conference, and our Annual Convention down in Tucson.
We also had a number of successful social and networking events throughout the past year. We had a fun night at the Phoenix Suns basketball game, a relaxing afternoon at the Chicago Cubs Spring Training, as well as the pickleball tournament in conjunction with the Arizona Pharmacy Foundation where our student members took home the gold.
But this year also presented its challenges as AzPA transitioned in a new direction and a new Era. It was last summer that our CEO Kelly Fine stepped down from her position for different opportunities. Not only did the Arizona Pharmacy Association need to find our new CEO, but under their leadership and of the officers’ help determine the direction our organization to ensure that AzPA is successful in its goals of supporting the profession of pharmacy here in Arizona. And while it may not make the journey any easier or without uncertainty, we know both change and progress are inevitable for AzPA to be successful, and I truly believe that under our new CEO Garet Turner we truly can grow and be successful as an organization. I hope that we take the theme from our new President Dr Jaime von Glahn at this year’s Annual Conference, FEARLESS: Inspiring New Horizons in Pharmacy’s Next Era, and as an organization work towards, while still holding onto the things and traditions that make AzPA what is it today.
Before I close and say good-bye as your President, I do want to acknowledge certain groups and individuals. To all my Committee Chairs, thank you for giving your time and energy to AzPA as I know we could not have succeeded without you. In thank Mark Boesen for all his efforts not just in the Legislative Committee, but for all his support to the pharmacy community and supporting local pharmacies both on a local and national level. To the AzPA staff, none of this could be done without you, especially to Cindy Esquer. You stepped up to help fill the leadership void and helped to ensure that AzPA met its mission while we searched for our new CEO
My Board of Directors, I thank you for your leadership and support during this past year as we have begun our transition to the future. Lastly, to my fellow AzPA Officers, Kim Langley, Jaime von Glahn, Ryan Gries, and Brandy DeChellis, you have always been there to help support and help me drive this organization forward into our new Era…I couldn’t have done it without your friendship
Thank you again AzPA for the honor of serving as your President a second time. I hope to see you again in-person at a future event soon.
Sincerely,
PharmPAC, the political action committee of AzPA, is fighting to ensure pharmacy professionals, businesses, and the patients we serve are protected, empowered, and prioritized.
We are calling on our allies in the pharmacy industry to stand with us by:
This is more than a donation -- it's a declaration that you BELIEVE in the future of pharmacy and want to help shape it. Making individual donations of $150 or more
• Or helping us collect $1,000 PAC-to-PAC contributions
NALOXONE SUCCESS STORIES
Andrew Heglin, PharmD | Associate Director of Community Pharmacy, Genoa Healthcare #20324
Here at Genoa within Southwest Network, Estrella Vista, the Naloxone Pharmacy Distribution Program has become a vital part of the clinic. Being able to distribute naloxone easily to patients, providers, and caregivers easily and efficiently is breaking down walls and saving lives. This program has opened up important conversations about overdosing signs/symptoms and the significance of having naloxone available to as many people as possible. Rather than speaking with a psychiatrist, people feel more comfortable walking up and speaking with pharmacy staff about these kits, and being able to offer it to them easily and free of charge has proven to be a successful tactic
We have also been able to utilize this program to fight the stigma behind asking for naloxone. A hurdle that we face is the judgement people perceive to be there when they ask for naloxone. This program gives people a safe, comfortable, and judgement-free zone to ask questions about naloxone whether it’s for them, a client, a friend, a family member, or a stranger. Here at our clinic, due to the ease of dispensing, we have already saved multiple lives on site with the kits that have been passed out to the clinic staff. Many of our members have overdosed right outside our doors, and if our staff did not have the naloxone on hand, provided by the pharmacy, then those members wouldn’t be with us continuing their treatment today.
Even outside our clinic, this site specifically services a variety of sobriety homes, intensive outpatient programs, and group homes that very commonly deal with addiction and substance abuse. Being able to offer these kits to all the members in these facilities has saved countless lives. Having this program in the pharmacy that services these homes allows us to have that conversation right when a client is admitted to the facility.
The Naloxone Pharmacy Distribution Program has had a huge impact on our clinic and the members that we serve, and I look forward to working with this program moving forward so that we may continue to break down walls, fight the stigma, and ultimately save lives!"
NALOXONE SUCCESS STORIES
Last week, I was talking with a nurse at the pharmacy window, and a guy came in and said that his friend was overdosing back behind our building.
I quickly handed the nurse a Narcan kit and told her to go find him and I would follow her out there. I went out there with an additional kit and we found the man. He was unconscious in a corner behind our building. Our nurse gave him the first dose, tried to check him out a little and after no response, gave a second dose. We waited a couple more minutes and he started coughing and coming to. We were able to get him sitting up, talking, and moved him to a shady area and gave him some water. He unfortunately left on his bicycle before the paramedics showed up to check him out but our office assistant did see him later that afternoon riding his bike still so he was ok.
I also had a patient tell me that she gave the kit that she got from us to her son who runs a group home for troubled youth. He had to use the Narcan on a kid at the home and was able to reverse the overdose and have the kid taken to the hospital for observation."
These are just a couple of stories of how the program has helped in our community."
Amber Schwarz, PharmD | Site Manager, Genoa Healthcare
MariamFarag,RN(left) AmberSchwarz,PharmD(right)
Jason
Rick Patel
WELCOME
NEW AZPA MEMBERS!
Pharmacist
Aimee Sullivan
Rodriguez
Thomas Burkey
Technician
Resident
Emily Evans
Samantha Sutton
Wilbur Yebuah
Michael Erstad
Student Pharmacist
Cheleen An
Edgar Leon Kiana Arab
Mary Manning, PharmD, MBA, BCPS AzPABoardofDirectors-HealthSystem
AzPA HEALTH SYSTEM SPECIAL INTEREST GROUP (AZ-ASHP)
This year’s annual convention marked the conclusion of my term on the AzPA Board of Directors. Serving in this capacity has been a rewarding experience, offering numerous opportunities to develop strong relationships, gain an understanding of an organization dedicated to supporting pharmacists, technicians and patients across Arizona, and lead the state affiliate chapter of ASHP
While I am no longer serving in a leadership role, I remain committed to staying actively involved with AzPA and the Health System Special Interest Group (SIG) as well as serving as one of the three Arizona delegates to ASHP. I would strongly encourage you, as a fellow professional, to consider engaging with these groups as well
AzPA plays a critical role in advocating for the interests of all pharmacists in Arizona, including those working in health systems. However, health systems pharmacists often face unique challenges due to their lower visibility compared to community pharmacists. This lack of visibility can lead to misunderstandings by regulators and the public Furthermore, our representation within the AzPA and on the Board of Pharmacy remains limited. Addressing this disparity is essential, and your involvement can make a significant difference. By participating in AzPA and the Health System SIG, you can help shape advocacy, education, research, and networking efforts to better meet the needs of health systems pharmacists in Arizona.
As I hand over the reins to Sarah Stephens, I am excited to continue collaborating with AzPA in the years to come. I look forward to connecting with many of you during future HS SIG calls, at the AzPA Spring Clinical meeting, and during Annual Conventions. Together, we can continue to advance our profession and reinforce the vital role of health systems pharmacists in the healthcare landscape
Thank you for your continued dedication and commitment to pharmacy. Your active participation is invaluable to the success of AzPA and its mission.
Mary Manning, PharmD, MBA, BCPS 2024-25 AzPA Board of Directors-Health System
Through the Looking Glass:
Frameworks to Expand Insights and Action for Personal Development
While the joys of “passing the baton” to the newest members of our profession are pronounced and undeniable, the diverse challenges faced by pharmacy preceptors lead many on a never-ending pursuit of navigation tools, no matter how far along the journey. Any web search for personal and professional development resources will result in an overwhelming list of quizzes, blogs, books, videos, and podcasts to optimize our approaches to daily life
The following discussion seeks to highlight examples of self-assessment frameworks that can enhance our precepting skills by helping us find joy in our work, identify our strengths, understand reciprocity styles, manage our emotion, harness our creativity, or define our leadership style. Not intended as comprehensive descriptions, these brief summaries may inspire a new perspective worth exploring.
Finding Joy in Our Work
Understanding the components of our work that either build us up or drain us of energy and joy can clarify our responses to our work environment and create opportunities to maximize satisfaction and prevent burnout.
The 6 Types of Working Genius
Referred to as a “personality and productivity” assessment by author Patrick Lencioni, this tool is structured upon six stages of typical project workflow: wonder, invention, discernment, galvanizing, enablement, and tenacity. For example, wonder describes the stage of identifying an overarching opportunity or challenge, while tenacity represents the steps to finalize project completion.
Authors
Erin Raney
Lindsay Davis
EDITORIAL
PRECEPTOR CORNER
While each of us has likely developed skills in each, we all favor certain stages in which we either thrive (our “geniuses”) or languish (our “frustrations”). An online assessment generates a profile of our two “geniuses”, two “competencies” and two “frustrations” to inform both individual planning and improve team functioning and collaboration.¹
Example:John, a hospital-based pharmacist and preceptor, finds himself procrastinating on finalizing the syllabus and calendar for upcoming pharmacy student rotations for his institution’s precepting team. His “Working Genius” profile indicates geniuses of invention and discernment and frustrations of galvanizingand tenacity. He is a prolific contributor to new ideas for rotation activities during brainstorming sessions but dreads organizing specific learning plans and calendars. Offering to split up responsibilities, Elizabeth steps in with complementary geniuses of tenacity and enablement and finalize and communicate the rotation materials to the preceptors to learners.
Identifying Personal Strengths
Several decades ago, the positive psychology movement popularized the concept that awareness and development of individual strengths leads to improved satisfaction with relationships in personal and professional environments. When applied to a clinical learning environment, developing our personal precepting style based upon our strengths is a win-win for both the preceptor and learner. While many strengths-based assessments are available, two commonly recognized instruments are described below
CliftonStrengths
Based upon the findings of Dr. Don Clifton, creator of the foundational principles of the positive psychology movement, this tool is built upon 34 character strength themes researched by the Gallup organization. An online assessment identifies our individual top five strength themes.
These are further categorized within four strength domains of executing,influencing,relationshipbuilding, and strategicthinking Individualized recommendations for embracing the strengths we can most efficiently optimize are provided.²
VIA Survey
Drs. Christopher Peterson and Martin Seligman, positive psychology researchers, identified 24 character strengths possessed by all individuals, but to varying degrees. The Values in Action (VIA) Inventory of Strengths provides a personalized ranking of our strengths, which are categorized in the following six domains: wisdom,courage,humanity,justice,temperance,andtranscendence As with other strengths-models, it outlines strategies towards lifelong development of our top strengths.³
Example:As a new preceptor within 5 years of graduating from pharmacy school, Joel is noticing that their precepting style seems to differ from other pharmacists within the same community pharmacy setting. While attempting to define their philosophy of precepting, Joel notices several patterns within their strengths assessments. Their CliftonStrengths model indicates top strengths in relationship building, including relator,positivity,and empathy Their VIA profile indicates three of their top five strengths in the domain of transcendence: hope,gratitude, and humor. Joel reflects that their precepting style prioritizes these attributes and feels energized to build upon what feels most natural, empowering their learners through this lens.
Managing Emotion
Awareness of emotional tendencies illuminates our internal insights and our interactions with others. Emotions are core to relationships within all healthcare settings with patients, colleagues, and learners. Whether it involves managing our own emotions while supporting a learner or understanding the experiences of the learner themselves, assessments of our emotional tendencies are highly intertwined within precepting strategies.
Emotional Intelligence
2.0
Emotional intelligence broadly refers to our awareness of emotion in ourselves and others and our ability to manage it in our personal and professional lives. There are many tools to objectively measure emotional intelligence, commonly referred to as EI or EQ. The online assessment, developed by Drs. Travis Bradberry and Jean Greaves,
provides an overall E.I. score, as well as scores in four separate domains: self-awareness,self-management,socialawareness, relationshipmanagement. The accompanying individualized reports provide structured steps for development.⁴
Emotional Agility
Psychologist Dr. Susan David describes emotional agility as “a process that allows you to be in the moment, changing or maintaining your behaviors to live in ways that align with your intentions and values.” The Emotional Agility Quiz provides personalized strategies for emotional regulation. The report is divided into our propensity for four “movements” in the process of gaining emotional agility: showingup,steppingout,walkingyour why, and movingon⁵
Example:Courtney, a pharmacy residency preceptor, is surprised that resident self-reflection and feedback received this year during midpoint and final evaluations doesn’t match her assessments of areas of challenge and opportunity. Her overall E.I. score is 78, with the greatest potential for growth in socialawarenessand relationshipbuilding, scores of 72 and 68, respectively. The Emotional Agility Quiz suggests a focus in movingon, specifically “choosing courage over comfort” when developing relationships. Consideration of this information allows Courtney to develop a plan for engaging with the residents to understand their perspectives and seek resources for navigating difficult feedback conversations.
Understanding Reciprocity Styles
Understanding reciprocity styles is key to navigating relationships with more awareness, effectiveness, and lasting impact. Reciprocity, in this context, refers to how individuals give and receive help, favors, or support. There are three primary categories: givers, takers, and matchers. Giverstend to offer help freely, often without expecting anything in return. Takersfocus on maximizing personal gain, which can sometimes be at the expense of others. Matchers strive to maintain a balance by pro/reactively reciprocating help anticipated or received.
Give and Take
Organizational psychologist Dr. Adam Grant’s research “has inspired people to rethink fundamental assumptions about motivation, generosity and creativity.” He urges us to recognize that life isn't a zero-sum game and that over the course of one's training and career,
PRECEPTOR CORNER
people who choose giving as their reciprocity style end up more successful and happier than those who lean towards matching or taking. He also debunks the misguided notion that givers sacrifice their own accomplishment potential when placing intentional effort on serving others. Dr. Grant coins the term “otherish giving” as the pinnacle where personal achievement and caring for others is synergized and burnout is mitigated.⁶
Example:Jackie serves as a supervisor of pharmacists and trainees (including residents and students) in her department. Additionally, she serves on the committees involved with hiring pharmacist and pharmacy technician staff and participating in the rank selection process for pharmacy residents within the institution. Inevitably in such discussions concepts such as candidate personality traits including agreeableness, teamwork, resilience, and willingness to serve others arise Recently burnout and difficulties with overcoming setbacks have been a major issue for the department resulting in resignations. Jackie recently read the book “Give and Take” by Adam Grant and is planning to share her learnings with her team as they prepare for the next round of interviews and encourage them to take the online quiz to learn their own styles.
Most insightful to her was learning that agreeableness is a personality trait linked to genetics while reciprocity style is more closely linked to character traits and personal values and motives. Often people tend to stereotype agreeable people as givers and disagreeable people as takers, when these two traits present independently of one another. Disagreeable givers may be the most undervalued team members, while agreeable takers can be among the most toxic to workplace culture. Of particular interest was learning that resilience may be fortified among those who lean into a giving reciprocity style, and especially so for those who are “otherish givers.” Jackie wants to use this new knowledge to inform the interview process and serve institutional outcomes related to department culture, teamwork, and associate tenure
PRECEPTOR CORNER
Harnessing
Creativity
Problem solving is fundamental to a positive learning environment within demanding and often unstable healthcare settings. While creativity is not often an area of focus within the profession, identifying a personal approach to building resilience and adaptability is beneficial to us and our learners.
Creative Types Shape the Future
This personality-based online quiz by Adobe explores our orientation to thinking, problem-solving, and collaborating. There are 8 creative type categories: strategist,regenerator,luminary, catalyst,gardener,guide,alchemist,and architect. Each description outlines creative strengths, aspirations, and growth opportunities.⁷
Example:Mark is a hospital pharmacy preceptor faced with upcoming changes in the electronic medical record which will impact the orientation and training of students and residents. Mark is particularly excited about developing the training program and offers multiple perspectives on incorporating learners, while other pharmacists have little interest in brainstorming. Mark’s “Creative Type” is notably an architect, which is excited about challenges and thrives on building new and new ideas. Through this awareness, Mark recognizes that his colleagues may not share this creative approach, and he gains confidence in embracing the leading role for program development while showing sensitivity to the approaches of others.
Defining a Leadership Style
Leadership skills are essential to clinical and administrative tasks within pharmacy. Identifying and honing our authentic leadership style also has application in the precepting role when serving as a role model in a learner’s educational path. Numerous leadership development resources are available, focusing on various theories and techniques.
Communication techniques are instrumental to leading others and vary based upon our interpersonal skills and priorities. This online assessment characterizes our leadership styles through a communication lens by labeling five types: nurturer, creative, guardian, connector, and pioneer. Individuals are provided with a “foundational, secondary, and tertiary” voice, as well as the “blind spot,” and “nemesis” voice. Guidance for maximizing the impact of our voice as well as interacting and engaging those with differing voices is a key focus of the model ⁸
Example: A team of preceptors at an academic health sciences center is led by Mary. The team is frustrated that new department productivity metrics will require them to precept more learners on each rotation. Mary’s “5 Voices” profile reveals that her “foundational voice” is nurturer, while her “nemesis voice” is pioneer. She understands that while the focus on metrics aligns with her “nemesis voice,” she can lean into her natural leadership disposition as nurturer and employ a people-focused strategy to guide conversations with department administrators, creating an optimal solution for the team.
Action Plan and Next Steps
The self-assessment frameworks described above represent only a sampling of those available for exploration. While these tools enhance our awareness of our personality traits and behaviors, real change requires purposeful and actionable strategies. Would you like to add to your precepting toolkit? Start by engaging with one assessment that speaks to you, and reflect on these questions:
- What new information/perspectives have I learned about myself or my situation?
- What is one way I can apply this to my precepting responsibilities?
Consider the applicability of these assessments not only for ourselves as preceptors or our precepting colleagues, but also for our learners. Incorporating a model on strengths, creativity, emotion, or leadership into our students’ or residents’ learning experiences heightens their insight into behaviors and emphasizes selfreflection. Sharing the experience with our learners not only displays continuous professional development but provides a common language for the mutual growth that takes place between preceptor and learner. With these additional tools, what a mindful journey it can be!
Rath T Strengths Finder 2 0 Gallup Press; 2007 (access code for basic online assessment included with book purchase)
https://mycreativetype.com
https://www susandavid com/quiz/
David S. Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life Avery; 2016
https://www.talentsmarteq.com/test/
Bradberry T, Greaves J Emotional Intelligence 2.0. Talentsmart; 2009. (access code for basic online assessment included with book purchase)
https://adamgrant net/quizzes/giveand-take-quiz/
Give and Take Quiz
Grant AM. Give and Take: The Hidden Social Dynamics of Success Penguin Books; 2013
https://www workinggenius com/about/ assessment
Six Types of Working Genius
Lencioni P The 6 Types of Working Genius: A Better Way to Understand Your Gifts, Your Frustrations, and Your Team. Matt Holt Books; 2022 (access code for online assessment not included with book purchase) $25 Website and Associated Publication Fee
assessment (with book code) $14.99
assessments $24 99 – 59 99
fee for online assessment
The 5 Voices
References
VIA Survey
https://5voices.com/
Kubicek J, Cockram S. The 5 Voices: How to Communicate Effectively with Everyone You Lead. John Wiley & Sons, Inc.; 2016. (access code for online assessment not included with book purchase)
https://www viacharacter org/acco unt/register
https://www.viacharacter.org/chara cter-strengths
No fee for basic assessment
Comprehensive report $49
No fee for basic assessment
Comprehensive reports from $15 to $49
1. Lencioni P . The 6 Types of Working Genius: A Better Way to Understand Your Gifts, Your Frustrations, and Your Team. Matt Holt Books; 2022.
2. Rath T. Strengths Finder 2.0. Gallup Press; 2007.
3. VIA Survey. Available at https://www.viacharacter.org/character-strengths. Accessed May 26, 2025
4. Bradberry T, Greaves J. Emotional Intelligence 2.0. Talentsmart; 2009
5. David S. Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life. Avery; 2016
6. Grant AM. Give and Take: The Hidden Social Dynamics of Success. Penguin Books; 2013
7. Creative Types by Adobe. Available at: https://mycreativetype.com/. Accessed May 26, 2025
8. Kubicek J, Cockram S. The 5 Voices: How to Communicate Effectively with Everyone You Lead. John Wiley & Sons, Inc.; 2016
Filling Prescriptions with Two NDCs: What You Need to Consider
We’ve all been in the sticky situation of having a few straggling pills left associated with one NDC that would be ideal to get off the shelf and free up some space. Maybe this NDC used to be the preferred product and now it has changed, or the manufacturer was bought out by another company. What is the proper way to bill and dispense two different NDCs on the same fill? It’s important to take both physical dispensing and claim processing into consideration to avoid the additional risk of this situation.
It should be clear to the patient that they are receiving two NDCs when dispensing. Some pharmacies prefer to place both products in the same vial (separated with clean cotton) and include an auxiliary sticker that notifies the patient that ‘Thisisthesamemedication youhavebeengetting.Color,size,orshapemayappeardifferent’. Note that dispensing two products in one vial could lead to misbranding the product dispensed, as there is likely only going to be only one NDC with the manufacturer and item description listed on the label
To avoid unintended allergic responses, do not use recycled cotton from manufacturer stock bottles (e.g., sulfasalazine, penicillin, etc.). Pharmacies may want to consider using two separate vials, each labeled with the correct NDC, manufacturer, and item description accurately reflecting its contents. While this method does not require cotton, it should still include an auxiliary sticker to inform the patient.
Processing the claim appropriately can be a complex endeavor. The data logged in the pharmacy dispensing software and submitted to the third-party payors has important downstream purposes. Incorrect data reflecting the claim can cause problems with FDA recalls and PBM audits.
Filling Prescriptions with Two NDCs: What You Need to Consider
Let’s consider an example where the pharmacy is dispensing #30 atorvastatin 20 mg tablets and only has #20 tablets of old manufacturer NDC ‘A’ and needs #10 tablets of new manufacturer NDC ‘B’ to complete the fill. Many pharmacies would process a single claim transaction with only one of the NDCs being filled. In this example, NDC ‘A’ would likely be billed as this NDC represents most of the fill. This can cause many problems including the following:
• The claim may be considered in violation of PBM contracts – identification and enforcement by PBMs may be difficult
If there is ever an FDA recall on NDC ‘B’ that requires a claim utilization report for the pharmacy to find impacted patients, you may not be able to find this claim. Recalls may be rare, but patient safety can be at risk.
• The pharmacy may have an inventory shortage on a future PBM invoice audit
The best practice to avoid these issues would be to process two separate claim transactions. This way each NDC is appropriately accounted for in your pharmacy software and adjudicated to the PBM. This may require the utilization of the Submission Clarification Code (SCC) value of 62. In Section 3.1.12 Submission Clarification Code (SCC) of the NCPDP Telecommunication FAQ document¹ defines this value as being,
This will tie the claims together to help align with the plan benefit parameters. When using this override on a plan that recognizes the code, the pharmacy should receive Approved Message Code (548-6F) value 023, “Proratedcopaymentappliedbasedondayssupply. Planhasproratedthecopaymentbasedondayssupply,” according to the NCPDP Telecommunication FAQ document linked above PAAS Tips:
• Pharmacies may need to contact PBM helpdesks if they do not recognize SCC-62 to resolve an early refill and/or duplicate copays.
•
• Pharmacies will need to assess their own risk tolerance and practicality of using SCC62.
The Bachelor of Science in Medical Pharmacology and Toxicology degree will prepare students to join a workforce that addresses the needs of an aging population, face the challenges posed by climate change and work in emerging areas of research and discovery across STEM fields. The program directly supports ABOR’s AZ Healthy Tomorrow initiative, to rapidly grow the health care workforce in Arizona.
“We are pleased to announce the launch of our second undergraduate major, the Bachelor of Science in Medical Pharmacology and Toxicology,” said Rick G. Schnellmann, PhD, dean of the Coit College of Pharmacy and the Howard J Schaeffer Endowed Chair in Pharmaceutical Sciences. “This innovative program explores the effects of chemicals on the human body, covering both beneficial medications and harmful toxicants. While it remains an excellent pathway to our Doctor of Pharmacy degree, it also offers a solid foundation for careers in research and other health care professions.”
The program delves into the world of medical pharmacology and toxicology, where students will explore the effects of venoms, poisons, drugs and everyday chemicals on the human body and environment. Pharmacology and toxicology are complementary and interdisciplinary biomedical sciences that draw upon cell biology, systems physiology, biochemistry, molecular biology and genetics. Pharmacology and toxicology students will also receive hands-on learning and health sciences research opportunities at the Coit College of Pharmacy's Arizona Poison and Drug Information Center
“We are thankful that the Arizona Board of Regents is supporting the R. Ken Coit College of Pharmacy with the approval of the Bachelor of Science in Medical Pharmacology
and Toxicology, which aligns with ABOR’s AZ Healthy Tomorrow initiative,” said Michael D. Dake, MD, senior vice president for the University of Arizona Health Sciences.
“This new degree will complement the educational programs we currently offer through our two accredited medical schools and our colleges of nursing, pharmacy, public health and health sciences. The health care professionals who graduate with this degree will play an important part in meeting the needs of Arizona residents and alleviating health disparities throughout the state.”
Pharmacology and toxicology graduates will be prepared for jobs in fields such as poison control information specialists and technicians, medical courier and tissue processing technicians, blood and plasma processors, and sanitization compliance technicians, all of which the U.S. Bureau of Labor Statistics projects to grow between 2022 and 2032.
“With the growing demand for skilled health care professionals, we are committed to giving our graduates a competitive edge, and we believe this degree will provide just that,” Schnellmann said.
The Medical Pharmacology and Toxicology degree program is already enrolling students for the 2025-26 academic year
Rick
July 2025 Update
Midwestern University College of Pharmacy
Mitchell R. Emerson, PhD Dean, Midwestern University College of Pharmacy
Greetings from the College of Pharmacy at Midwestern University. The Summer is always bittersweet as we welcome the Class of 2028 and say goodbye to the Class of 2025. With the tuning of the season we are reminded of the many accomplishments of our faculty, staff, students, alumni, and friends. As always, we want to highlight and celebrate all our milestones, and we look forward to achieving even more in the coming months.
Congratulations to the Class of 2025! On June 3rd, we celebrated this outstanding class of professionals as they move off into residency, further education, and into their careers as pharmacists. The Class of 2025 has the distinction of having the highest percentage of members going on to post graduate training (residency/fellowship) and a match rate of 91%! We welcome them as alumni and look forward to staying in touch as their careers evolve
At the same time, we were saying goodbye, we welcomed a dynamic and eager group of students to the Class of 2028 While their journey has just begun, we know that they will develop into scholars, leaders, and outstanding pharmacists in their three short years at Midwestern.
Thank you to everyone that joined us in Tucson for the Pharm to Table networking reception, hosted in conjunction with AZPA 2025. It was great to connect and reconnect with so many of you at the gorgeous Westin La Paloma.
On Tuesday, August 26th at 5pm, all alumni are invited back to campus for an evening of sweet treats and mentoring/connecting with current students. We’d love for you to share your story and answer questions from the current students and enjoy Rita’s frozen treats. Look for more details soon and a link to RSVP soon.
For those of you planning to attend ASHP/Midwinter in December in Las Vegas, we look forward to catching up with you there. We’re planning an Alumni and Friends reception at LaLibertine! In the Mandalay Bay Hotel on Sunday, December 7th. More details to come
We are looking forward to catching up with all of you and connecting at a future event. If you’re in the Glendale area, please reach out and stop by the campus. So much has changed, but still remains the same welcoming place
Did you know we have a Midwestern University Job Board? If you’re looking to hire or looking for a new opportunity, please click here for more information https://www.midwestern.edu/alumni/alumni-jobfinder
If you’ve recently moved or relocated, please ensure we have your updated contact information. Please email updates to your Manager of Alumni Relations, Kimberly Hastings, at KHastings@midwestern.edu
To follow us and learn more about our events and wins, join the MWU Pharmacy social media community:
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Midwestern University College of Pharmacy
Creighton University College of Pharmacy
Amy F. Wilson, PharmD Dean, Creighton University College of Pharmacy
Creighton Graduates First Phoenix Pharmacy Students During 2025 Commencement
by:MollyGarriott
Congratulations to the 2025 graduates of Creighton University’s School of Pharmacy and Health Professions pharmacy program. For the first time since establishing the Phoenix campus, the University has conferred Doctor of Pharmacy degrees to students in Phoenix. These students join their Omaha counterparts to bring competence and compassion to the pharmacy field.
In a program that blends practical instruction with professional experience in keeping with the Jesuit value of curapersonalis(care for the whole person), Creighton is proud to form leaders in the field of pharmacy who provide care with confidence
Creighton-educated pharmacists are well-equipped to lead in numerous settings, from hospitals and clinics to academic and researching institutions, and from government agencies and military units to businesses and private practice. As patient-centered practitioners and cutting-edge researchers, they work on the front lines of disease state management, disease prevention and patient outcomes.
Thank you to our dedicated faculty who are integral to our mission of educating the next generation of healthcare leaders. They are changing the world, one student, one pharmacy professional at a time. Because of their commitment and expertise, this year's graduates will continue Creighton's long history of providing compassionate, ground-breaking healthcare
And now with Creighton's presence in Phoenix, which draws students from across Arizona, pharmacies and their patients in the Southwest will directly benefit.
Students like ...
Phoenix native Sharon Ruditser, PharmD’25, who is looking forward to applying the knowledge and skills she acquired at Creighton as a new minted Doctor of Pharmacy. She is slated to begin a postdoctoral fellowship in research and development:
“Through my Creighton education, content experts in the classroom equipped me with the clinical knowledge and critical thinking skills necessary to practice as a competent pharmacist,” she says. “Outside of the classroom, Creighton’s partnerships with a wide range of pharmacy practices across the country allowed me to gain experience in diverse fields and work with a variety of patient populations, helping me develop a well-rounded and adaptable approach to my future practice.”
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Creighton University College of Pharmacy
Ruditser believes Creighton’s emphasis on early exposure to patients in both the clinical setting and through service learning helped develop her technical and communication skills alongside empathy and compassion, all necessary qualities of a healthcare professional.
One of her favorite Creighton memories was volunteering in the St. Vincent de Paul Clinic. She had the opportunity to work in an interprofessional setting with licensed professionals and fellow students: “It allowed me to build connections with classmates and faculty outside the classroom while gaining valuable experience caring for patients and supporting underserved members of the community.”
Boosting Immunity: Exploring the Role of Granulocyte-Colony Stimulating Factors in Managing Febrile Neutropenia
Authors:
AnnaMerauta,PharmD NicoleTinta,PharmD,BCPS
1.0 Introduction
Febrile neutropenia (FN) is an oncologic emergency that is often encountered in immunocompromised patients undergoing chemotherapy. FN occurs when a patient develops a fever, defined as a sustained oral temperature greater than or equal to 1004ºF for one hour or a single reading greater than or equal to 101ºF , while simultaneously being neutropenic ¹ Severe neutropenia is defined as an absolute neutrophil count (ANC) less than 500 cells/mm3 ¹ The lack of circulating neutrophils, which innately defend the host, results in impaired phagocytosis and the killing of pathogens, subsequently predisposing the patient to developing febrile neutropenia.¹
The spectrum of bloodstream isolates has fluctuated over the past decades and gram-positive organisms have become increasingly more common, along with the concern for a rise in drugresistant gram-negative bacterial infections, like carbapenemase-producing and extendedspectrum beta-lactamase species.¹
Typical organisms found in febrile neutropenia include gram-positive bacteria, such as coagulasenegative staphylococci and Staphylococcus aureus, including methicillin-resistant strains (MRSA). As well as gram-negative bacteria, such as Escherichiacoliand Pseudomonas aeruginosa, and various fungi, like Candida¹
The prevalence of FN varies depending on patient-specific factors and the type or intensity of the chemotherapy regimen. In the United States, the annual incidence of FN is roughly 8 per 1,000 patients with cancer ² FN mortality rate increases based on a patient’s underlying characteristics, such as older age, presence of comorbidities, and type of cancer ² Although advancements for the treatment of FN have been made, a multifaceted approach involving early intervention and collaboration among healthcare professionals,
such as oncologists, infectious disease specialists, and pharmacy, is essential for optimal patient care. The purpose of this paper is to examine the controversy surrounding the use of granulocyte-colony stimulating factors (G-CSFs) in the treatment of FN and explore guidelines and literature related to their use
2.0 Granulocyte-Colony Stimulating Factors
G-CSF is a hormone our body produces to stimulate and regulate neutrophil production from the bone marrow to get them into the body’s circulation.³ Increasing the ANC can help the host better defend itself and naturally boost their immunity. G-CSFs in FN prophylaxis are routinely used and have long been studied for the prevention of FN episodes, however, there is currently a lack of consensus on their role in patients with FN. Another consideration is whether a patient should receive G-CSF if they develop FN and already received a prophylactic G-CSF . The long-acting G-CSF (pegfilgrastim) contains a polyethylene glycol (PEG) moiety that allows it to remain under the neutrophil mechanisms of degradation instead of being renally excreted like the short-acting G-CSFs. This allows it to have a prolonged duration of action in the body. Table one below compares the different G-CSFs and their unique characteristics.
2.1 Filgrastim Versus Pegfilgrastim
Filgrastim is usually given by intravenous or subcutaneous route at a dose of 5 mcg/kg daily for prevention of chemotherapy-induced neutropenia and can be increased in 5 mcg/kg increments with chemotherapy cycles as warranted based on the patient’s severity of neutropenia.⁴
It is typically continued until ANC reaches 10,000 cells/mm3 after expected nadir ⁴ On the other hand, pegfilgrastim is only given by subcutaneous route at a dose of 6 mg once per chemotherapy cycle ⁵
This is advantageous as it prevents the need for daily administration. However, doses of 6 mg are not appropriate for those weighing less than 45 kg. Pediatric patients less than 10 kg should receive a 0 1 mg/kg dose, 10 to 20 kg require a dose of 1.5 mg, 21 to 30 kg require 2.5 mg, and 31 to 44.9 kg require 4 mg.⁵
Table One: G-CSF Dosing Regimens and Pharmacokinetics
3 0 Clinical Practice Guidelines
G-CSFs are routinely used in chemotherapy patients for FN prophylaxis. G-CSF use in patients with acute febrile neutropenia remains controversial and recommendations vary by society. The National Comprehensive Cancer Network (NCCN) clinical practice guidelines have specific recommendations when G-CSFs would be appropriate to use in patients presenting with FN ⁷ However, the Infectious Diseases Society of America (IDSA) guidelines state that these agents are not recommended for treatment of established fever and neutropenia.¹ The limited evidence supporting the use of G-CSFs in patients with confirmed FN warrants further investigation.
3 1 National Comprehensive Cancer Network
The 2021 NCCN hematopoietic growth factor guidelines stratify individuals by their potential risk for developing FN and this determines whether G-CSFs should be used prophylactically. This risk is determined by patient age, goals of treatment, comorbidities, type of cancer, and chemotherapy regimen. In patients with a low risk (< 10%) for FN, it is not routinely recommended to receive G-CSFs. In those with intermediate risk (10-20%) of developing FN, use should be considered in patients with one or more risk factors. These risk factors include prior chemotherapy, persistent neutropenia, bone marrow tumor involvement, recent surgery, open wounds, liver or renal dysfunction, and age over 65 years receiving full chemotherapy dose intensity. Patients at high risk have more than a 20% chance of developing FN and G-CSFs should be initiated with the first chemotherapy cycle ⁷
NCCN guidelines dictate G-CSF use in those with acute FN based on prior G-CSF administration history. Additional G-CSFs are not recommended if the patient already received long-acting prophylactic pegfilgrastim. If the patient is receiving daily prophylactic filgrastim or tbo-filgrastim it may be continued. Patients that did not receive prophylactic G-CSFs and have no risk factors for an infection-associated complication should not receive therapeutic myeloid growth factors (MGFs) in acute FN. Therapeutic MGFs can be considered if risk factors are present. These risk factors include age over 65 years, ANC < 100 cells/mm³, neutropenia duration expected to be > 10 days, hospitalization at the time of fever, prior FN episode, or any confirmed infection. MGFs include our G-CSFs and granulocyte-macrophage colony stimulating factors (GM-CSFs), sargramostim and molgramostim, that stimulate the production and regulation of macrophages as well ⁷
3.2 Infectious Diseases Society of America
The 2010 IDSA clinical practice guidelines for the use of antimicrobial agents in neutropenic patients with cancer also recommend the prophylactic use of G-CSFs if the patient’s anticipated risk of FN is greater than or equal to 20%, especially if the patient is older, has poor nutritional status, extensive comorbid medical conditions, or no antibiotic prophylaxis. The IDSA advocates against their use in patients with acute FN as adjuncts to antibiotics. The society acknowledges that there is reduced incidence of FN, infection-related mortality, as well as all-cause mortality with their prophylactic use. However, they recommend against G-CSF use in FN due to the lack of survival or clinical benefit seen. IDSA’s stance is that G-CSF cost and adverse effects outweigh the benefit in acute FN ¹
4.0 Granulocyte-Colony Stimulating Factors in Acute Febrile Neutropenia
A 2014 Cochrane review evaluated the safety and efficacy of adding colony stimulating factors (CSFs) to antibiotics compared to antibiotics alone when treating chemotherapy-induced FN. They included fourteen randomized controlled trials (RCTs), comprising roughly 1500 patients. Most studies looked at the G-CSF filgrastim, however some reviewed the GM-CSF sargramostim. The use of CSFs plus antibiotics compared to antibiotics alone showed similar overall and infection-related mortality rates. A non-statistically
significant decrease in overall mortality was seen in the CSF group (hazard ratio (HR) 0 74, 95% confidence interval (CI) 047-1.16).⁸ Similarly, there was also a non-significant decrease in infection-related mortality (HR 0 75, 95% CI 047-1.20). Patients receiving CSF plus antibiotics had a statistically significant shorter duration of antibiotic use (standardized mean difference -1.5 days (95% CI -2.83 to -0 18), and less likely to be hospitalized for more than 10 days (risk ratio (RR) 0 65 (95% CI 044 to 0 95)⁸. Additionally, patients receiving CSF experienced faster neutrophil recovery (RR 0 52 (95% CI 0 34 to 0 81) defined as ANC < 1000/mm³ for more than 5 to 10 days.⁸ A strength of this study is the large study population, expanding its generalizability. A major limitation of this review is the diversity of antimicrobial and CSF regimens and durations. Adding CSF to antibiotics for treatment of chemotherapy-induced FN did not show any mortality benefit, however, it may have other clinical benefits.
A prospective study published in 2021 looked at the use of IV continuous infusion G-CSF as salvage treatment for patients with profound FN. This study found that G-CSFs administered via IV continuous infusion led to faster ANC recovery (> 500 cells/mm³) time The study included about a hundred patients that had a malignancy and being treated with chemotherapy, who subsequently developed FN. The median time to recovery was 25 5 hours. Positive predictive factors of shorter recovery time included lower C reactive protein, procalcitonin, and FN grade. Mortality rates were not reported.⁹ A major limitation of this study was that no comparator group existed, precluding our ability to identify an impact on clinical outcomes compared to standard treatment. Also of note, 20% of participants received prophylactic G-CSF prior to their FN episode and were still included. This introduces extraneous factors that could influence results. In both studies G-CSFs in addition to antibiotics reduced time to resolution of various measures, such as ANC recovery and length of stay, but they have not shown mortality benefit.
5 0 Cost-Analysis
Cost also plays a role in determining G-CSF use in FN. Cost-effectiveness should be determined by individual healthcare facilities and patient characteristics should be considered when weighing the benefits versus risks.¹ G-CSFs play a pivotal role in managing FN and exploring their cost-effectiveness is crucial in optimizing healthcare resource allocation. As seen in table one, doses vary due to weight and durations fluctuate based on patient-specific lab values and normalization of ANC. Therefore, the cost of these agents can accumulate rapidly to thousands of dollars. A 2014 literature review sought to provide a comprehensive estimate of the total social value delivered by these agents. More than 300,000 patients in the United States were potential candidates for prophylactic G-CSFs in 2014. Social value (SV) was defined as an umbrella of four main components: savings from reductions in FN hospitalizations, reductions in FN mortality, reductions in mortality due to the ability to deliver higher-dose chemotherapy, and reductions in antibiotic use Prophylactic G-CSF was found to have $8 5 billion in SV with 97% of this being driven by clinical outcomes. Limitations of this review include lack of available research and the ability to monetize qualitative outcomes. It is also important to note that this review is a decade old and new G-CSF biosimilars have since been approved warranting an updated cost-analysis. The results of this review cannot be directly mirrored to patients with established FN and further studies are required to evaluate G-CSF’s economical value in these patients.
6 0 Conclusion
Although G-CSFs are well understood in the setting of FN prophylaxis, the controversy over their use in patients with acute FN remains. Prior to their utilization, many patient-specific factors should be considered. Therapeutic G-CSFs should not be recommended as a means of decreasing patient mortality, but can potentially improve time to ANC recovery, decrease hospital length of stay, and reduce duration of antibiotics. There needs to be a personalized approach to G-CSF use in acute FN and should be used judiciously. Further research would be beneficial to evaluate the effect of G-CSF on chemotherapy-induced FN mortality.
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2. Boccia R, Glaspy J, Crawford J, Aapro M. Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed? Oncologist. 2022 Aug 5;27(8):625-636. doi: 10 1093/oncolo/oyac074. PMID: 35552754; PMCID: PMC9355811.
3. Theyab A, Algahtani M, Alsharif KF , Hawsawi YM, Alghamdi A, Alghamdi A, Akinwale J. New insight into the mechanism of granulocyte colony-stimulating factor (G-CSF) that induces the mobilization of neutrophils. Hematology. 2021 Dec;26(1):628-636. doi: 10 1080/16078454.2021.1965725. PMID: 34494505
7. National Comprehensive Cancer Network. Hematopoietic Growth Factors. NCCN Clinical Practice Guidelines in Oncology. Version 3.2024. Available from: [growthfactors.pdf (nccn.org)].
8. Mhaskar R, Clark OA, Lyman G, Engel Ayer Botrel T, Morganti Paladini L, Djulbegovic B. Colony-stimulating factors for chemotherapyinduced febrile neutropenia. Cochrane Database Syst Rev. 2014 Oct 30;2014(10):CD003039. doi: 10 1002/14651858.CD003039.pub2. PMID: 25356786; PMCID: PMC7141179
9. Căinap C, Cetean-Gheorghe S, Pop LA, Leucuta DC, Piciu D, Mester A, Vlad C, Ovidiu C, Gherman A, Crişan C, Bereanu A, Bălăcescu O, Constantin AM, Dicu I, Bălăcescu L, Stan A, Achimaş-Cadariu P , Căinap S. Continuous Intravenous Administration of Granulocyte-ColonyStimulating Factors-A Breakthrough in the Treatment of Cancer Patients with Febrile Neutropenia. Medicina (Kaunas). 2021 Jun 30;57(7):675. doi: 10 3390/medicina57070675. PMID: 34208815; PMCID: PMC8305666
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Dear Colleagues,
Legislative Update
On behalf of our leadership and advocacy teams, I want to extend my heartfelt thanks to each of you for your dedication, passion, and unwavering support for Senate Bill 1214—our Test & Treat initiative
Despite our best efforts, SB1214 was not even granted a hearing on the floor for a vote
This was not due to any shortcoming in our advocacy efforts nor preparation. Rather, it was the result of dysfunction within the legislature and the political maneuvering around the state budget that sidelined critical, bipartisan legislation—including ours.
This inaction doesn’t just hurt our profession. It hurts the people of Arizona. The citizens— your patients—deserve timely, accessible care, and this bill would have empowered pharmacists to deliver just that. That’s why we will not stop. We will return in the 2026 legislative session with a stronger, more refined bill, and we will continue to fight for what we know is right.
Our strength lies in our unity. Across all disciplines and practice areas, when we speak with one voice, we are powerful. We must continue to stand together, advocate together, and act together
To ensure our voice is heard loud and clear, I will continue to seek support the AzPA PAC
Our “PAC is BACK” campaign is underway, with a goal of raising $9,000 and we have raised 30% of our goal. These funds will be used strategically to amplify our message across the legislature and support candidates who champion pharmacy-focused initiatives. Every dollar helps us build the influence we need to make meaningful change
Thank you for your continued commitment to our shared mission. Together, we are shaping the future of pharmacy in Arizona—and we will prevail
