2024 Fall Arizona Journal of Pharmacy

Arizona Journal of Pharmacy O F F I C I A L

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Jacob Schwarz, PharmD, MBA, BCIDP, BCCCP, BCPS, FAzPA AzPA President 2024-2025

In This Edition: AzPA Health-Systems SIG Update

Precepting for Growth: How Mindset Theory Enhances Experiential Education Audit Risks: Medication Home Delivery

Contents Board of Directors 2024-2025 OFFICERS President Jacob Schwarz President Elect Jaime von Glahn Past President Kimberly Langley Treasurer Ryan Gries Secretary Brandy DeChellis Director/CEO Vacant

COVER STORY page 4

DIRECTORS AT LARGE Community Brianne Spaeth Health System Mary Manning Technician Melinda Browning Misty Brannon Reasol Chino Danielle Gilliam Joseph Pelleriot Yousef Toma LIASIONS University of Arizona Student Chapter Nguyen Pham Dean's Designated Representative Nancy Alvarez Midwestern University Student Chapter Cheleen An Dean's Designated Representative Michael Dietrich Creighton University Student Chapter Sahar Toluee Dean's Designated Representative Jane Stein Legal Counsel Roger Morris

AzPA Staff Chief Executive Officer Vacant Education & Professional Development Dawn Gerber Interim CEO/Events & Strategic Partnerships Cindy Esquer Membership & Volunteer Services Vacant Strategic Programs Kristin Calabro Administrative Services Melina Esquer Editor Cindy Esquer Melina Esquer Creative Coordinator Tricia Dewey

The interactive digital version of the Arizona Journal of Pharmacy is available for members only online in your member portal.

(480) 838-3385 | admin@azpharmacy.org Editor's Note: Any personal opinions expressed in this magazine are not necessarily those held by the Arizona Pharmacy Association. "Arizona Journal of Pharmacy" (ISSN 1949-0941) is published quarterly by the Arizona Pharmacy Association at: 1845 E. Southern Avenue, Tempe, AZ 85282-5831

President’s Message 4 AzPA News Welcome New Members 5 University & Alumni News 17 Editorial AzPA Health Systems SIG Update 6 Preceptors Corner 8 Audit Risks: Medication Home Delivery 15 APPE Reflections 12 Advocacy Legislative Review 24

UPCOMING EVENTS February 15, 2025 Creighton University Phoenix, AZ

June 12, 2025 Tucson, AZ

June 12-15, 2025 Tucson, AZ

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EDITORIAL PRESIDENT'S MESSAGE

Dear AzPA Members, As I am writing this letter to you, I think back to when I wrote my first President’s Message to the AzPA members four years ago in the middle of the pandemic. It is amazing to see how much has changed and how we have grown as an organization; yet there is still so much work to do to improve the profession of pharmacy here in Arizona while simultaneously improving the lives of our patients and community.

This summer at the AzPA Annual Convention I talked about the Olympic rings and how each ring represented a part of AzPA: past successes, current endeavors, adversity to the profession, the unknown, and our future successes to attain a Gold Medal.

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.

As we reflect on AzPA’s accomplishments, there are so many amazing things that we should be proud of. From the time during the pandemic when AzPA helped support the Arizona community through the pandemic and beyond by certifying hundreds of pharmacists and technicians in being able to provide the COVID-19 vaccinations. To the 2023 Annual Convention which celebrated the 100-year anniversary of the very first Arizona pharmacy meeting. Our most current success and major initiative comes from AzPA being awarded a one-million-dollar grant by Maricopa County to reduce overdose deaths as part of the Stop Overdose Deaths Arizona (SODAz) program.

While it is great to celebrate our successes, there are many adversities and unknowns for which we must address as both an organization and the profession as a whole. Two of the biggest issues I see that we must work together on are workplace conditions in our pharmacies and PBM reform. Too many times we have seen news articles discussing the workforce shortage in the community pharmacy setting, and at the same time we have seen our colleagues on social media telling stories and describing unsafe workplace conditions being forced upon pharmacy professionals. When it comes to PBMs and potential reform, how many times have we heard from our colleagues that pharmacies are unable to keep the doors open because they are not being reimbursed the cost of a medication from the PBM. It became such an issue that last year the U.S. Supreme Court ruled in favor of an Arkansas law to regulate PBMs and how they conduct business within the State of Arkansas.

Most recently, with the stepping down of our now past-CEO, Kelly Fine, who served the AzPA in this role for 13 years, your leaders of the AzPA continue to work to help the AzPA through these times. Not only is your AzPA Board of Directors continuing to search for our new CEO who will help take us in new directions, but the Board and volunteers continue to work to support the AzPA and pharmacy profession here in the State of Arizona by continuing to provide the services you have become accustomed to.

Given our current challenges, how can we individually and collectively achieve a Gold Medal?

How can our organization continue to grow in ways that effectively support pharmacy professionals in Arizona? The answer to these questions is quite simple, the answer is you.

Nobel laureate John Nash once said, “the best for the group comes when everyone in the group does what's best for himself AND the group.” So, I ask each of you to do your part in helping to do what is best for you AND for our profession. If you are unsure of how you can help support the AzPA, let me give you a few examples: Join one of the AzPA Committees, which are always seeking active and engaged members to help achieve our strategic goals. ◦ Advocate for our profession by engaging with members of the Arizona Legislature on bills and initiatives that are important to the pharmacy profession. ◦

I believe the most important thing you can do to support the AzPA, is to become engaged with your professional colleagues to join and support the AzPA in its initiatives. Only with our strength in numbers can we truly make the impact we so desire.

While this past year our organization and profession has celebrated many successes, I believe there is still much work to be done before we reach the top of the podium to get our Gold Medal. I ask you to join me and to help yourselves and the AzPA become the organization we all want and need to support the profession of pharmacy here in Arizona.

Jacob Schwarz, PharmD, MBA, BCIDP, BCCCP, BCPS, FAzPA AzPA President 2024-2025

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WELCOME NEW MEMBERS! 1st Year Practitioner Maya Patel Jacquelin Pierre

2nd Year Practitioner Daisy Arellano

Pharmacist Nadine Faulkner Matthew McCulloch Stefanie Reeves Amy Reinmann Rhonda Seeley Marla Trepanier Richard Trepanier Carolanne Wartman Christopher White Jason Williamson Christine Yarbrough Jamie Brown Sean Burton John Cao

Resident Aniqa Azad Shannyn Gilchirst-Oates Quinten Murphy Alexis Smith

Technician Kirsty Badilla Almetta Bagley Brian Lowe

Premium Pharmacist Tyler Debban Matthew Montes De Oca Robert Sulzbach

Associate Ann Bolar Megan Davis Jerry Gomez Neal Patel Berenice Sanchez Courtney Sullivan

Student Pharmacist Cheyenne Acosta Jalesa Adams Biane Alkhasib Savannah Anderson Louis Arcieri Samuel Azizian Brooke Bratovich Samantha Brodsky Stephen Carlson Anna Chapin Juan Chong Chiedoziem Chukwu Robert Colica Taylor Cova Adrian Delgado Alanis Dilic Sean Do Zachary Dunford Cedou Dyemo Aidan Fisher Haley Fraser Lauren Gasiewicz Ahmad Ghannam Maria Gonzalez Chandranae Green Alexander Hames

AZPA NEWS Leigh Horne Austin Hwa Mark Isom Caleb Jackson Redha Jafar Kristina Jasso-Lopez Mariam Khan Brian Khuong Sabrina Kizy Alma Kllobocishta David Kyle Steven Lam Lam Kent Layton Emilia Le Cheyenne Lemieux Byrdie Lopez Ryan Lukasik-Drescher Isabele Mai Maria Marin Tomasz Maslanka Tearah McRae-Kee Natasha Mebius Sophia Moghimi Mina Mohammed Amy Morales Matthew Nam Jason Nguyen Sarah Oaida Nicole Octaviano Francisca Okoro Anabella Olenik Peter Osiecki Jason Pham Nguyen Anna Karen Pineda Jennifer Plummer Kyrstin Ponce Marleah Rezvani Brittney Shirley Soroush Shockrany Michael Siongco Healie Situ Sonya Song Kevin Tate Lauren Toma Alina Torres Christopher Tu Hayden Turley Alexandra Tzoumakis Carsyn Vanblarcum Johnathan Vo Andrianna Walsh Tyler Watson Nayeli Zamora

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EDITORIAL HEALTH SYSTEMS

AzPA Health Systems SIG Update "...health systems pharmacists are less visible than our colleagues in the community, and as such, less understood by regulators and the public. If these topics are of interest to you, I’d like to encourage you to get involved in the AzPA Legislative Committee and/or join the AzPA Health System Special Interest Group (SIG)."

AUTHORS/CONTRIBUTORS Mary Manning, PharmD, MBA, BCPS Director at Large – Health Systems DISCLOSURE The author(s) declare no real or potential conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honorarium.

FUNDING No funding was provided.

ACKNOWLEDGEMENT The author gratefully acknowledges all pharmacy practice preceptors dedicated to providing high quality learning experiences.

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CONT. HEALTH SYSTEMS I hope you are all enjoying our cooler temperatures as it was a long hot summer! As we roll into the Fall/Winter, there is a lot of legislative action at both the state and local level. In this edition of the AzPA Health System SIG article, I’d like to update you on five legislative items that ASHP will be taking to Capitol Hill during ASHP Legislative Day.

Ensure patients access to pharmacists’ services (Equitable Community Access to Pharmacist Service Act – H.R. 1770, S. 2477). As states are expanding coverage of pharmacist service under Medicaid and private insurance, Medicare coverage is not keeping pace with advances in the states, leaving senior behind.

Protect the 340B drug pricing program (Protect 340B Act – H.R. 2534 & The 340B PATIENTS Act – H.R. 7635). Safety net hospitals rely on the 340B program to provide healthcare services. The 340B program expands access to medications for uninsured and underinsured patients. Actions being taken by drug manufacturers and PBMs under mind the program and jeopardize patient services.

Issue: Reject site-neutral payments for lower standards of care.

Insurance companies are seeking to reduce hospital payments for drug administration to match levels at physician offices or ambulatory infusion centers. This overlooks the higher levels of care offered by hospitals that are often needed by patients.

Address the underlying causes of drug shortages. Severe drug shortages are a significant threat to patient care. Shortages are driven by extreme price competition among generic manufacturers.

Solutions should focus on quality and supply chain resiliency and larger marketplace trends. ASHP’s drug shortage recommendations include improving transparency into manufacturer quality, encourage long-term, guaranteed volume contracts, and finance private sector buffer supplies.

Safeguard funding for pharmacy residency programs. CMS is denying health systems Residency Medicare Pass-Thru funding and refusing to provide guidance to help hospitals that are part of health systems or academic medical centers comply with audit requirements. ASHP is asking Congress to pass legislation clarifying how multihospital systems can comply.

Pharmacy practice is predominantly regulated at the state level, and AzPA is the organization that ensures all pharmacists in Arizona have a voice in this process. This includes health systems pharmacists. Unfortunately, health systems pharmacists are less visible than our colleagues in the community, and as such, less understood by regulators and the public. If these topics are of interest to you, I’d like to encourage you to get involved in the AzPA Legislative Committee and/or join the AzPA Health System Special Interest Group (SIG).

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EDITORIAL PRECEPTOR CORNER

"With persistence and effort, someone can nurture and develop the qualities they seek to develop, regardless of any inherent talents they were born with."

Precepting for Growth: How Mindset Theory Enhances Experiential Education AUTHORS/CONTRIBUTORS Janet Cooley, PharmD, BCACP Director of Experiential Education, Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, University of Arizona

Suzanne Larson, PharmD, Director of Experiential Education, Department of Pharmacy Practice, Midwestern University College of Pharmacy DISCLOSURE The author(s) declare no real or potential conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honorarium.

FUNDING No funding was provided.

ACKNOWLEDGEMENT The author gratefully acknowledges all pharmacy practice preceptors dedicated to providing high quality learning experiences.

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CONT. PRECEPTOR CORNER Introduction What are mindsets? And what do they have to do with precepting?

Mindset theory was pioneered by Carol Dweck, PhD, a psychology researcher at Stanford University.1 Dweck posits that mindsets are implicit theories we adopt that govern our actions, behaviors and thoughts.1 In other words, mindsets are our internal coding, running in the background of our consciousness, shaping our personality, affecting our actions, behaviors and thoughts and influencing how we show up in the world.1 Dweck’s work describes two mindsets – the fixed mindset and the growth mindset.

Cultivating a growth mindset in preceptors Barbara Blackburn, an author and speaker about learning, shared that “Reinforcing a growth mindset with your students requires that you have a growth mindset.”2 Before preceptors can consider cultivating a growth mindset in learners, a mindset self-assessment a good place to start.

A fixed mindset, also known as entity theory, is characterized by a belief that an individual’s qualities or attributes, such as intelligence, talent, and aptitude are fixed from birth.1 A growth mindset, also known as incremental theory, is described as a belief that individuals have the capacity grow, change, and adapt.1 With persistence and effort, someone can nurture and develop the qualities they seek to develop, regardless of any inherent talents they were born with.

As pharmacy preceptors, it is likely that we will encounter learners, coworkers, and patients with both fixed and growth mindsets. How might this impact our work as pharmacists and preceptors? In individuals expressing a fixed mindset, we may notice diminished resilience when responding to setbacks. They may make excuses and blame others for their shortcomings. With a fixed mindset, setbacks can signal low ability or intelligence, and can be devastating. A learner with a fixed mindset may sacrifice learning opportunities to avoid the potential embarrassment of showing deficiencies or perceived shortcomings. When given corrective feedback, these individuals may get discouraged and defensive and are more likely to consider lying and cheating. Individuals in a fixed mindset may cling to a specific identity (“I am smart”, “I am good at math”) that may feel threatened by challenging learning situations, feedback, or mistakes.

Exploring the results of the mindset self-assessment, it is helpful to consider that individuals rarely display highly fixed or highly growth mindsets. Instead, individuals are more likely to score in the middle with a blend of both fixed and growth mindsets. There may be some areas where a fixed mindset is more apparent, perhaps in sports or music, and other areas where a growth mindset might be more prominent, such as with learning and education. Also, depending on the time of day or week, our health, or a variety of external and internal factors, mindsets can be influenced and may skew one way or the other. Think of mindsets as being on a spectrum, as evidence has shown that mindsets are changeable and easily influenced. 1,4,5 Because mindsets are so easily influenced, preceptors can do much to influence the mindset of their learners.

When encountering individuals with a growth mindset, we may observe resilience and the embracing of uncomfortable learning experiences that are designed to grow the learner’s capacities. A learner with a growth mindset recognizes that learning is difficult and messy but understands that this process is necessary for growth. This person welcomes challenges and only competes with themselves, striving to become better than they were before. A learner with a growth mindset is hungry for feedback, and when given, the suggestions are quickly and eagerly implemented. Individuals with a growth mindset can differentiate their identity from their ability, so that when they make a mistake or face a challenging situation, while still difficult, it doesn’t make them question who they are.

A simple, free, online mindset assessment is available on the Mindset Works website.3 We recommend investing a few minutes to take this assessment to gain insight into your own mindset.

Mindsets in literature Dweck and colleagues contributed numerous examples to illustrate the effect of mindset on learning. One early example study was conducted in 1998 with 128 fifth graders.4 These students were provided with a set of easy problems, then divided into three groups, each given a different prompt to induce either a fixed or growth mindset and a control group: “You must be smart;" “You must have worked hard," or no feedback. 4

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CONT. PRECEPTOR CORNER Then, all three groups were given a set of difficult problems. The students who were told that they were smart, or given the trait-based praise, showed less persistence with the difficult problems and showed less enjoyment with the process, thus having induced a fixed mindset.4 The students who were told that they must have worked hard, or given effort-based praise, were more concerned about their learning than their performance.4 They showed increased persistence and more enjoyment as they were solving the difficult 4 problems and had been induced into a growth mindset. While this example is in elementary aged children, it exemplifies the importance of how feedback can shift a learner’s mindset.

Other studies have shown a positive effect on adult learners as well.

In 2008, Nussbaum and Dweck took a sample of 29 undergraduate students and induced a fixed mindset or a growth mindset by having the students read one of two short essays.5 The growth mindsetinducing essay discussed the challenges and obstacles that were faced by individuals that later experienced high degrees of success.5 The fixed mindset-inducing essay described how prominent individuals5considered geniuses were intelligent from early childhood. Following the reading of the essays, the students were given a reading comprehension test, followed by a 4-minute speed reading task, followed by more comprehension questions.5 Each student was told that they scored in the 37th percentile.5 These students were then given the opportunity to view the strategies of5 either higher performing students or lower performing students. In this study, students that were induced to a fixed mindset preferred to view strategies of those that had performed more poorly than them; students with an induced growth mindset preferred to view strategies of those that had performed better than them.5 This example from adult learners highlights how critical mindset can be in helping learners to learn from their experiences and the impact of mindset on ego.

In both of these studies, we can appreciate how easy it is to influence mindsets with simple learning interventions.

Promoting a Growth Mindset Personally, an individual can work to change their mindset by developing self-awareness about their mindset. This includes taking the self-assessment described above and sharing with others.

Similarly, a preceptor can help induce a growth mindset in their learners by directly teach their learners about this concept, including sharing this and other mindset articles or viewing Carol Dweck’s TED Talk. 6

Another important strategy for promoting a growth mindset is to pay attention to our chosen words, both as internal self-talk and externally communicated with learners. Words matter to us and our learners. Are there opportunities to promote a growth mindset with carefully chosen phrases? Use ample growth mindset phrases and encouragement with your learner, such as “You practiced and improved!” or “I know you don’t feel like you are there yet, but your work in this area has really improved.”

Another important way to promote a growth mindset is to seek out feedback, embrace challenges and try learning something new. When precepting, feedback is critical, however preceptors may inadvertently promote a fixed mindset when attributes are praised, when little or no feedback is given, or when a preceptor focuses solely on results instead of also looking at student growth and the process used. Fixed mindset phrases like “You are really good at this!” or “This really isn’t your forte” can induce a fixed mindset. A preceptor that regularly provides formative feedback can help a learner maintain a growth mindset. Preceptors can also encourage learners to find challenges and difficult learning experiences in a supportive environment. A preceptor can also induce a growth mindset by using teaching strategies such as Socratic questioning, which use probing questions as guides for students to connect past knowledge with future applications. 7 Also, a pre- and post-test at the beginning and end of each rotation can showcase a learner’s growth and development over the rotation block, promoting a growth mindset.

It is also important that an individual acknowledges failures and mistakes and uses them as lessons. As preceptors, learner mistakes and missteps are a key opportunity to help learners learn. Preceptors can also help learners think about their learning and work as being “works in progress” with room for growth by encouraging that projects have multiple drafts submitted, with learners responding to feedback with each iteration. This can demonstrate that it takes multiple attempts to produce a polished finished product. When preceptors share stories of their current and past challenges, learners can appreciate that even experienced pharmacists are still a “work in progress.”

Finally, preceptors and learners can both seek to be surrounded by like-minded individuals who are also seeking a growth mindset.

Preceptors can share these concepts with learners and spend the rotation block as “accountability buddies” to listen for signs of a fixed mindsets from each other.

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CONT. PRECEPTOR CORNER It is particularly inspiring to consider that preceptors and learners are on a parallel journey of growth together. Students rely on preceptors and sites to provide authentic pharmacy practice opportunities for them to apply their didactic knowledge; preceptors rely on learners to provide opportunities for them to refine and hone their teaching, mentoring, and education skills.

Preceptors and students can progress together.

Summary In summary, mindsets are intangible factors that influence how we think, act, and respond. They are not static and can be modified with effort and persistence. Individuals with a growth mindset embrace learning opportunities, individuals with a fixed mindset resist learning opportunities. Most importantly, preceptors can do much to promote a growth mindset in their students.

References

1. Dweck CS. Mindset: The New Psychology of Success. New York: Ballantine Books; 2008.

2. Applying a growth mindset in the classroom. Education Week. https://www.edweek.org/teaching-learning/opinion-responseapplying-a-growth-mindset-in-the-classroom/2015/12. Published December 2015. Accessed August 30, 2024.

3. Mindset Works. What is my mindset? Mindset Blog. https://blog.mindsetworks.com/what-is-my-mindset. Published 2015. Accessed August 30, 2024.

4. Mueller CM, Dweck CS. Praise for intelligence can undermine children's motivation and performance. J Pers Soc Psychol.

1998;75(1):33-52.

5. Nussbaum AD, Dweck CS. Defensiveness versus remediation: self-theories and modes of self-esteem maintenance. Pers Soc Psychol Bull. 2008;34(5):599-612.

6. Carol Dweck - A Study on Praise and Mindsets. YouTube. https://www.youtube.com/watch?v=hiiEeMN7vbQ. Accessed August 30, 2024.

7. The Thinker's Guide to Socratic Questioning. Critical Thinking. https://www.criticalthinking.org/store/products/the-thinkers-guide-tosocratic-questioning/231. Accessed August 30, 2024.

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EDITORIAL APPE REFLECTIONS

APPE Rotations: Reflections from AzPA APPE Students "Overall, my involvement at AzPA was both enriching and rewarding, contributing significantly to my professional development" - Praise Setodji

Finding My Voice in Pharmacy: Reflections from My Time as an Advanced Pharmacy Practice Experience (APPE) Student with the Arizona Pharmacy Association (AzPA) Alexandra Paden, Midwestern University College of PharmacyGlendale, Class of 2025 Dawn Gerber, Midwestern University College of Pharmacy-Glendale, Associate Professor

Initially, I approached this Advanced Pharmacy Practice Experience (APPE) rotation with the Arizona Pharmacy Association (AzPA) with some trepidation, as I didn’t think I would find the administrative aspects particularly engaging. However, I learned so much and appreciated the experience. It has opened my eyes to new perspectives and possibilities in pharmacy.

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CONT. APPE REFLECTIONS I had the opportunity to engage in a diverse range of experiences. I supported the 2024 AzPA Fall Conference by providing peer-review feedback for various continuing education (CE) programs’ slides and post-learning assessment questions. I assisted in the update and revision of the pharmacy technician immunization administration certificate program by refining slides and assessment questions. I was able to write an editorial article for the Arizona Journal of Pharmacy regarding how stress can affect the body while providing resources that are available to pharmacy professionals in Arizona. I learned that numerous elements are involved in organizing a conference and developing continuing education programs. Lastly, I learned about the 4Ms of geriatrics by participating in the weekly geriatric patient case discussions with geriatric medical fellows and medical residents completing their geriatric rotation.

I learned that what I originally thought I wanted to do as my future career, may not be what I want. In discussing with Dr. Gerber, I discovered that maybe my future goals involve me working in a more administrative role, rather than in face-to-face patient communication. I also learned during rounding that to be successful, having a process in finding information is crucial.

Observing an AzPA Board of Directors meeting provided me with valuable insights into the many facets of the organization that students may not fully appreciate.

This rotation provided me with insights into a different aspect of pharmacy that is often not covered in academic settings. I am pleased to say that I genuinely appreciated nearly every aspect of the experience. It has also reinforced my desire to actively participate in my state’s pharmacy organization once I become a registered pharmacist, whether here in Arizona or in another location.

From Student to Contributor: My Transformative Experience with the Arizona Pharmacy Association Praise Setodji, Midwestern University College of Pharmacy-Glendale, Class of 2025 Dawn Gerber, Midwestern University College of Pharmacy-Glendale, Associate Professor

I started my APPE rotation with the Arizona Pharmacy Association (AzPA) and Dr. Dawn Gerber with the uncertainty of not knowing exactly what to expect, but with the willingness to learn everything that came my way. The biggest surprise was the opportunity to meet amazing people with diverse skills, both pharmacists and non-pharmacists. I chose medicine largely because of the influence my mom had on me growing up, and my overall goal has always been to live a meaningful life by doing what I witnessed as a child: caring for others. Little did I know the path would be far more challenging than I had anticipated. From moving to the US and restarting my education, starting in pharmacy, I have no regrets — not the slightest.

During the AzPA Leadership Orientation day, I connected with pharmacists with various expertise, some of whom graduated years ago but remain active within the organization. I had the privilege of speaking with many of them, particularly Dr. Langley, whose knowledge and accomplishments truly impressed me.

During the Leadership Orientation, I gained deeper insights into the various committees, particularly the Education Committee and the Mentor Connection Program (MCP) steering committee, both of which piqued my interest.

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CONT. APPE REFLECTIONS The MCP is a great way to empower future pharmacists like myself and guide them in becoming impactful healthcare leaders. It’s also an opportunity to lead by example and give back. The Education Committee has played a big part in my APPE, mainly due to the various projects I worked on. I’m truly grateful for the chance to peer-review the contents of the Technician Immunization Administration Certificate Program, as this experience also allowed me to refresh my knowledge of immunization practices.

Learning how to be a peer reviewer is an important skill that I’m thankful to have gained, and I applied in preparing for the AzPA 2024 Fall Conference. I was also empowered to take on the role of a moderator and I embraced the opportunity. Moving forward, I hope to volunteer for similar experiences and even provide a continuing education (CE) presentation.

I’m truly grateful for Dr. Gerber’s trust in me and my classmate, allowing us to work independently while always being available to help.

REGISTRATION IS NOW OPEN!

I also appreciate how much she values our input in the various committees and meetings she’s involved with.

She consistently gives us feedback on areas for improvement, even when it can be uncomfortable, which shows how much she cares about our growth.

It’s clear she has our best interests at heart, and I am grateful for that. I hope to continue working with her even after my APPE rotation at AzPA. Lastly, I want to express my appreciation to everyone at AzPA for their kindness and willingness to help and teach us, especially Cindy Esquer, AzPA Interim CEO, and Melina Esquer, Administrative Coordinator.

I thoroughly enjoyed my time at AzPA. The experience provided me with valuable insights into the field of pharmacy, enhanced my professional network, and allowed me to engage with dedicated pharmacy professionals. Overall, my involvement at AzPA was both enriching and rewarding, contributing significantly to my professional development.

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EDITORIAL PAAS NATIONAL

Audit Risks: Medication Home Delivery Many independent pharmacies offer unique services to their patients, such as house charge accounts and medication delivery, to provide a better customer experience. While these are convenient services to offer patients, they do bring audit risks if they are implemented without appropriate safeguards.

PAAS National® analyst have seen numerous PBM audit recoupments for insufficient deliveries and discrepancies linked to insufficient evidence of refill request, copay collection, or delivery. Additionally, we have seen audits where the prescriptions were billed for deceased patients.

Review the tips below to ensure that your pharmacy doesn’t incur unnecessary audit risks.

PAAS Tips: • Home Delivery Tips • Require a dated signature from patient/caregiver at every delivery (pre-printed dates on delivery manifests are insufficient).

• Avoid leaving medications in the mailbox or at the door without evidence of delivery (geotagged photos from pharmacy staff are typically insufficient).

• Avoid “automatic refills” and instead implement a “medication synchronization” program that includes a telephone check-in prior to medication billing and delivery to ensure that patient is still alive, living at same address, has not been hospitalized since last delivery (or had medication therapy changes), and to confirm the needed medications prior to scheduled delivery date.

• Collect payment at the time of delivery, or implement a robust accounts receivable (“house charge”) process.

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EDITORIAL PAAS NATIONAL • Facility Delivery Tips • Coordinate with LTC facilities to understand if Medicare

patients are in a “Part A” versus a “Private Pay” status as this will dictate whether pharmacy is to bill the facility (if Part A) or Medicare Part D (if private pay).

• Develop written agreements in place that require facility cooperation with retroactive billing changes such as when claims are accidentally billed to Medicare Part D and then subsequently adjusted due to Part A status.

• Pre-printed dates on delivery manifests are insufficient, receiving individuals should handwrite the date received.

For additional insight on house charge accounts and copay collection, contact PAAS (608) 873-1342.

By Trenton Thiede, PharmD, MBA, President at PAAS National®, expert third party audit Assistance and FWA/HIPAA compliance.

Copyright © 2024 PAAS National, LLC. Unauthorized use or distribution prohibited. All use subject to terms at https://paasnational.com/terms-of-use/.

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EDITORIAL UNIVERSITY & ALUMNI

Rick G. Schnellmann, PhD Dean, University of Arizona College of Pharmacy

AZ REACH Marks One-Year Anniversary With Nearly 6,000 Rural Patient Transfers

Celebrating its one-year anniversary, the Arizona Resource Equity and Access Coordination Hub (AZ REACH) is marking the occasion with nearly 6,000 patient transfer requests, dramatically improving access to care for hospitalized Arizonans and easing the administrative burden on providers, particularly in rural areas.

The Arizona Poison and Drug Information Center at the R. Ken Coit College of Pharmacy partnered with the Arizona Department of Health Services and Blackbox Healthcare Solutions in December 2022 to launch AZ REACH, a statewide program aimed at enhancing equitable access to care for rural communities. The program has helped improve health care access for thousands of Arizona patients.

As a nurse, I know that the AZ REACH program helps save practitioners time and patients’ lives,” said Representative Willoughby. “With the introduction of AZ STEP, we are taking a monumental step towards improving patient care, throughput, and access to specialty services, particularly in our smaller rural hospitals.

AZ REACH emerged from the transformative experiences of the Arizona Surge Line, a centralized transfer center that played a pivotal role in load-leveling hospitals and facilitating patient transfers during the COVID-19 pandemic. Throughout the pandemic, 85% of transfer requests originated from Rural, Indian Health Services, Tribally Operated PL-638, and Critical Access Hospitals, revealing a significant disparity in access to care for rural Arizonans. In response to this need, state and federal grants were utilized to establish AZ REACH.

In its first year, AZ REACH: • Transferred 5,298 patients — 91 percent of the 5,804 requests received.

• Identified the most needed medical services as cardiology, gastrointestinal, general surgery, pulmonology, and neurology – accounting for 52% of all requests.

• Completed transfer requests with a median time of 1.2 hours — equating to 6,000 hours or 250 days of time given back to hospital staff to focus on direct patient care.

"It cannot be overstated how crucial the Arizona Surge Line was in getting patients access to the lifesaving care they needed," said principal investigator Steven Dudley, PharmD, DABAT, director of the Arizona Poison and Drug Information Center. "These hospitals made it clear how desperately needed this was for all conditions, not just COVID. Thus, AZ REACH was born."

The impact of AZ REACH is evident. Hospitals are experiencing improved patient transfers, allowing clinicians to concentrate on delivering essential care at the bedside rather than dealing with administrative tasks, which are now efficiently managed by dedicated AZ REACH personnel.

Since its inception, the program has experienced continuous growth. In October, state funding from Arizona Representative Julie Willoughby expanded services to hospitals with 20 beds or fewer. This expansion, known as the Arizona Statewide Transfer Escalation Pathway (AZ STEP), broadened the program's services to an additional five smaller rural hospitals, increasing the total number of participating facilities to 28.

Sasha Reid, DO, is the medical director for the Wickenburg Community Hospital Emergency Department.

Her hospital jumped at the chance to partner with AZ REACH. “We were burdened with calling transfer centers…to secure transfer placement for a patient needing a higher level of care than we could provide in Wickenburg,” she said. “The time staff members spent on the phone took away from the time they were available to provide direct patient care.” continued on page 17

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CONT. UNIVERSITY & ALUMNI

AZ REACH provides a strong framework for swift activation during hospital admission surges caused by events like mass casualty incidents, seasonal increases or potential future pandemics. This was demonstrated when AZ REACH effectively responded to the surge in pediatric hospitalizations during the previous respiratory syncytial (RSV) and influenza season, assisting providers and patients regardless of the hospital they came from.

“The AZ REACH team has become an integral part of patient care for those needing transfer to larger facilities with more resources than we have at our critical access hospital,” Reid said. “We cannot thank them enough for all efforts so far and are looking forward to any expansion opportunities the team creates.”

The program embodies the commitment of Arizona's clinical medicine and public health communities to the concept of equity. It strives to ensure swift and equitable access to care for vulnerable populations and hospitals, embodying the true essence of compassion in health care.

“In underserved communities, health care provider shortages exacerbate the existing disparities,” said Charley Larsen, MSN-L, MBA, RN, NE-BC, chief nursing officer of Blackbox Healthcare Solutions and executive lead for AZ REACH. “Our program strives to ease administrative burdens on emergency care providers, granting them greater time and focus at the bedside to care for those in need.”

This work was supported by the Arizona Department of Health Services under award no. CTR0061468.

AZ REACH tracks numerous metrics such as patient demographics, required medical specialties, care levels and total transfer times. This provides a deeper understanding of the status of Arizona's health care system for county and state health departments and enables the early detection of brewing surges in hospitalizations. It also simplifies some of the daunting complexities of health care coordination that contribute to worse patient outcomes.

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EDITORIAL UNIVERSITY & ALUMNI

Midwestern University College of Pharmacy Mitchell R. Emerson, PhD Dean, Midwestern University College of Pharmacy

Greetings from the College of Pharmacy at Midwestern University!

As we get ready to welcome fall, 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.

We are looking forward to catching up with all of you and connecting at a future event. If you’re ever in the Glendale area, please reach out and stop by the campus. So much has changed, but still remains the same welcoming place.

Cholla Hall (home to much of the pharmacy program) received a gorgeous refresh of new paint, décor and carpet.

We welcomed the Class of 2027 to campus for orientation on May 28th and the first day of class was on June 3rd.

There was a full quarter of professional and personal development for the new students as we work with them to become exceptional pharmacists. A highlight of the first quarter is the CPG Alumni and Student Ice Cream Social that was hosted on Thursday, August 29th at 5pm.

Pharmacy students from all classes and alumni from our inaugural year to our most recent 2024 graduates joined us for an afternoon of sweet treats and time to mentor and network.

Did you know we have a Midwestern University Job Board?

The events continue as we are set to host a CPG Alumni/Student Mentoring Reception on Tuesday, October 29th at 5:30pm on campus. All current students and alumni are invited and encouraged to join us for delicious appetizers, beverages, and time to connect. This annual event takes place in the Sahuaro Courtyard and alumni are grouped by practice specialty. Students are encouraged to visit each table and learn more about the endless possibilities that exist as a CPG graduate.

Like us on Facebook: Midwestern University Follow us on Twitter: @MWUpharmacy Follow us on Instagram: @MWUpharmacy

If you’re looking to hire or looking for a new opportunity, please click here for more information.

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:

In December, we hope you will join us for ASHP 2024 in New Orleans! We’ll be hosting a CPG Alumni, Student and Friends Reception on Sunday, December 8th in the Big Easy. Look for more details in the coming months for specifics on the reception.

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EDITORIAL UNIVERSITY & ALUMNI

Creighton University College of Pharmacy Amy F. Wilson, PharmD Dean, Creighton University College of Pharmacy

Service-Learning is Integral to Creighton Healthcare Education

By their very nature, healthcare professions are servicefocused. While an interest in chemistry, biology or anatomy draws students to careers in medicine, an inherent desire to increase another’s wellbeing is foundational healthcare practice.

But at Creighton, service is not simply encouraged; it is inextricably woven into its healthcare programs, augmenting academic knowledge and skills to produce practitioners who see those they are assisting as fellow individuals and not just patients. It’s what often distinguishes Creighton graduates from their contemporaries.

“Knowing your ‘why’ will carry you through any adversity and hardship you face, and you will face a lot in this profession,” says Amy Aboalam, fourth-year pharmacy student at the Creighton University School of Pharmacy and Health Professions in Phoenix. Service, she believes, helps students discover their why.

By incorporating service into its academic programs, “Creighton has managed to ensure that the heart behind the actions of students is still beating for the right reasons,” Aboalam, a New York native and Arizona State University graduate, says.

Aboalam traveled to the Institute for Latin American Concern (ILAC), Creighton’s campus in Santiago, Dominican Republic, for its health profession immersion program. Each summer, Creighton pharmacy, dental, medical and nursing students travel to the DR to share their time and skills with local populations for whom healthcare is often prohibitive.

Jane Stein, PharmD, assistant professor, director of Pharmacy Program of ILAC and Arizona Pharmacy Association board member, first participated in the ILAC summer program as a pharmacy student on Creighton’s Omaha campus. She says it was a life-changing experience, which led her to “a life of service through Creighton University and ILAC.”

During Stein’s five years with the ILAC program, feedback from participating students has been 100% positive. When potential Creighton pharmacy students learn about service in the DR during the admissions process, their interest is piqued.

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EDITORIAL UNIVERSITY & ALUMNI As a university, Creighton is committed to promoting justice; incorporating reflection in its students, both personally and professionally; working across ethnicity, race, gender, culture and religion; and promoting cura personalis, or care for the whole person. Service is integral to all of these.

Stein believes the integration of service into the curriculum “makes the process of learning more personal.” It humanizes textbook theory. “Students take away not just interprofessional education and collaboration but relationships in the communities they serve as well.”

Of her time in the DR, Aboalam says: “It is impossible to walk away without a call to action and deeper understanding of your purpose in life, not just as a professional. You learn to face yourself and the realities you tell yourself about having to have your iced latte every morning or your afternoon bath.

You don’t. And you learn very quickly the things that really matter and the things that can never be taken away from you, such as human connection.”

Which is what good healthcare practice should be – personal, individual-focused and human.

Interested in volunteering as a preceptor for ILAC? Reach out to Jane Stein at janestein@creighton.edu.

The summer immersion program is just one service outlet at the Creighton University Health Sciences Campus – Phoenix. Healthcare students, including Aboalam, also work at the Virginia G. Piper Medical Clinic at St. Vincent de Paul, bolstering interprofessional collaboration while providing care for highly underserved communities, such as the homeless.

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Pharmacist-Directed Hormonal Contraception Training The Arizona Pharmacy Association is happy to announce that 2 years after the passage of SB1082 Arizona pharmacists can now dispense Self-Administered Hormonal Contraceptives to women 18 years and older pursuant to the newly adopted ADHS Statewide Standing Order!

Any pharmacist wishing to dispense self-administered hormonal contraceptives pursuant to this statewide Standing Order must be prepared to do the following: Complete a 3-hour Training -AzPA has created one that is compliant with ARS 32-1979.01 and AAC R4-23-407 and R4-23-408-409.

Obtain necessary equipment to measure blood pressure.

Review the Standing Order, Standard Procedures, and Self-Screening Questionnaire.

Establish SOP’s to ensure your pharmacy is compliant with all state laws.

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ADVOCACY LEGISLATIVE UPDATE

Legislative Review Fall has descended with professional baseball’s second season, the excitement of college and professional football, and the national state and federal elections. The 2024 Presidential election chaos fills the air as our country chooses a new leadership. In addition, AzPA continues the search for a new executive leader to build upon the solid foundation laid by Kelly Fine.

The AzPA Board of Directors selected Legislative Committee membership from those who completed their applications for the2025 cycle. The first Zoom meeting for the Committee will be held on Thursday, October 17, 2024. We will formulate the strategy for the 2025 State of Arizona Legislative session starting in January 2025. State elections winners will influence the upcoming legislative session!

Diane McAllister, the AzPA lobbyist, will have her work challenges depending on the election results. AzPA is fortunate to have a person of Diane’s talents working to improve the profession of pharmacy.

It may be helpful for you to acquaint yourself with the Arizona Legislature website at https://www.azleg.gov.

The site can be a useful tool during the legislative session. Also, if you have suggestions for pharmacy related bills send your thoughts to Cindy Esquer at cindyesq@azpharmacy.org. The AzPA Legislative Committee looks forward to a productive year. Finally, it is important that all of us vote in the 2024 Federal and State elections.

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