Illinois Pharmacist Jul/Aug/Sep 2015

> > > IN THIS ISSUE Columns 4 The President’s Perspective 10 Executive Director’s Viewpoint 12 Board of Pharmacy Update 14 From the Editor 16 New Product Review 18 Clinical Review 24 Rx & The Law

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26 Campus News Resources 13 Pharmacy Advocacy Fund 21 Top 10 Reasons to Join IPhA

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30 IPhA Foundation 31 IPPAC 31 IPhA Bookstore

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Featured This Issue 6 IPhA Annual Conference 11 IPhA Foundation Fundraiser: Cubs vs Brewers 20 Lombard Pharmacy Named IPC’s 2015 Most Valuable Pharmacy (MVP) Award Winner 22 Opioid Addiction and Abuse Symposium: Training Health Care Professionals 25 Appealing Health Carrier Decisions 29 Pharmacists Mutual Releases Second Quarter Financial Results

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pg 20 Advertiser’s Index 3 IPhA Online Career Center 5 National Association of Chain Drug Stores 15 HD Smith

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

23 Pharmacists Mutual Companies 28 Pharmacy Technician Certification Board 32 Pharmacy Quality Committment

SUPPORTING PHARMACISTS ADVANCING CAREERS Find the best jobs and highly qualified pharmacists Illinois has to offer.

ONLINE CAREER CENTER

www.ipha.org

IPhA Executive Committee

IPhA Staff

Chairman of the Board Mickie Brunner, PharmD MickieRX@aol.com

Executive Director Garth Reynolds, RPh greynolds@ipha.org

President Cindy Mende Russell, RPh caamende@yahoo.com

Accounting Manager Erica Burris ericab@ipha.org

President Elect Eric Bandy, RPh eric@bandys.biz Vice President Ben Calcaterra, RPh ky_bjc@yahoo.com Secretary Jessica Kerr, PharmD, CDE jekerr@siue.edu Treasurer David Mikus, RPh davetravel1@aol.com

Member Services Manager Kimberly Condon kimc@ipha.org Administrative Assistant Sandra Dial sandrad@ipha.org Director of Government Affairs J Michael Patton mpatton@ipha.org Director of Clinical Programs Starlin Haydon-Greatting, RPh starlin@ipha.org Clinical Program Assistant Denise MacKenzie, PharmD denisem@ipha.org

Illinois Pharmacist | 204 W Cook Street | Springfield, IL 62704 Phone: (217) 522-7300 | Fax: (217) 522-7349 Email: ipha@ipha.org | Website: www.ipha.org

MISSION STATEMENT: The Illinois Pharmacists Association is dedicated to enhancing the professional competency of pharmacists, advancing the standards of pharmacy practice, improving pharmacists’ effectiveness in assuring rational drug use in society, and leading in the resolution of public policy issues affecting pharmacists.

VOLUME 77, NUMBER 3 (Jul/Aug/Sep 2015): The Illinois Pharmacist (ISSN 0195-2099) is published quarterly by the Illinois Pharmacists Association located at 204 W Cook, Springfield, IL 62704. Subscriptions are $200 per year. Periodical postage paid at Pontiac, IL and additional mailing offices. Postmaster: Send address changes to Illinois Pharmacist, 204 W Cook, Springfield, IL 62704 * Phone: (217) 522-7300 * Fax: (217) 522-7349. All contents ©2014 Illinois Pharmacists Association.

STATEMENT OF PURPOSE: The Illinois Pharmacist is a forum for debate and new ideas regarding pharmacy in the State of Illinois. Its goals are to keep members informed on legislative and regulatory developments and pharmacy practice issues, to help members improve job performance by providing practical information and to inform members about Association activities.

The opinions and positions expressed in articles contained in the Illinois Pharmacist are those of the authors and do not necessarily reflect the opinions and positions of the membership, officers, directors or staff of the Illinois Pharmacists Association. Illinois Pharmacist reserves the right to reject any advertising considered by management to be objectionable. Illinois Pharmacist also reserves the right to place the word “advertisement” on any ad it believes to resemble editorial material.

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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President’s Perspective SUMMER!

IPhA President Cindy Russell, RPh Summer! I have spent the last couple weeks moving into a new place. I am finally downsizing. It is not as easy as it sounds going through years of stuff and deciding what is important and what I can pitch. One of the things in my room is all of my nametags from the IPhA Annual Meetings. September is my favorite months. I love the weather and then at the end of September is IPhA’s Annual Meeting . I love going to the Annual Meeting. I never miss them now, but, I have to admit, earlier in my career, I was never involved in my pharmacy associations and I never went to a meeting. Boy, I didn’t know what I was missing!

I think, for me, my favorite part of going to the meeting is the social aspect of it all. In the last 10 years, I have met so many pharmacists from all corners of Illinois. I have met and talked to pharmacists and technicians in all the different practice settings.

I have made friends that I would have never had if it weren’t for IPhA and the Annual Meeting. I have met students who I have seen through school and graduation and now are practicing pharmacists. So, for me, membership in the Association is priceless.

Of course, you can also get most of your CPE that you need for the year at the Annual Meeting. I pretty much get all of my CPE from the IPhA Annual Meeting. There is always a good variety of topics relevant to what is going on in pharmacy today. Last year, one of the topics was on E-cigarettes and I think it was one of my favorite CPE’s last year. Although, if you haven’t been to Conference and you haven’t participated in Pharmacy Jeopardy, you don’t know what you are missing. It is probably the most fun you could ever have getting CPE in your life!

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And lastly, the House of Delegates. The Annual Meeting is where the Illinois House of Delegates meet to discuss and pass policies.

It is the foundation of who we are and what we believe and where we want the profession of pharmacy to go in Illinois. So, if this is something you want to be involved in, come and see what the House of Delegates is all about!!

This years meeting is at the Westin Lombard on September 2427. For those that go every year, I am looking forward to seeing you there! For anyone who has never been or hasn’t been in a while, I would encourage you to go. You will not regret it.

If you can’t make if for the whole conference, come for a day or two. Meet your fellow colleages, attend a couple CPE’s (or all of them). See what Pharmacy Jeopardy is all about! Meet your Association Board members, they represent you and your profession. Tell us what you want for the Association and the profession of Pharmacy in Illinois. Have fun. Recharge! Fire Up For Pharmacy!

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

A common purpose unites us... ...they are better off for it.

NACDS salutes the IPhA, and values our partnership.

Our work together on policy issues is an extension of our commitment behind the counter. When we speak as one, we protect and advance the role of community pharmacy in healthcare.

We are proud to stand with you, as we stand up for those we serve.

NATIONAL ASSOCIATION OF

CHAIN DRUG STORES Pharmacies. The face of neighborhood healthcare.

The 2015 Illinois Pharmacists Annual Conference - “Fire Up for Pharmacy” - brings together colleagues from varying specialties of pharmacy and provides opportunities for pharmacists, technicians and other industry leaders to delve into issues currently confronting today’s pharmacy professional. No matter the scope of practice, the conference is poised to show how today’s pharmacy professionals can overcome the challenges, become increasingly aware of current compliance requirements, and advance patient care while focusing on medication adherence.

Join us this year at the Westin Lombard Yorktown Center, 70 Yorktown Shopping Center, Lombard, Illinois on Thursday, September 24 through Sunday, September 27 and gather together not only to learn the latest updates in pharmacy but also to engage in professional networking.

At the conclusion of the event, pharmacists and pharmacy technicians will be able to: 1. Discuss the new innovations and practice standards affecting current pharmacy practice.

2. Discuss and analyze opportunities for pharmacists to expand their practice settings and engage their patients through pharmacist provided care.

3. Discuss emerging trends in disease management.

OTHER PRE-CONFERENCE EVENTS IPhA Foundation Fundraiser – Cubs vs Brewers (see page 11 for details) Opioid Addiction and Abuse Symposium: Training Health Care Professionals (see page 22 for details) Delivering Medication Therapy Management Services – A Certificate Program Visit www.pharmacist.com/delivering-medication-management-services for details and registration.

Quick-Glance Conference Schedule THURSDAY - SEPTEMBER 24, 2015 5:30 - 7:30 pm Registration

SATURDAY - SEPTEMBER 26, 2015 7:00 - 8:30 am

Hosted Breakfast - Teva Pharmaceuticals

8:30 - 9:30 am

Asthma Update

Antimicrobial Activity of Oral Anit-Infectives & their Application to Common Ambulatory Infections

9:45 - 10:45 am

Critical Updates in the Management of Chronic Heart Failure

7:30 - 9:30 pm Opening Reception FRIDAY - SEPTEMBER 25, 2015 7:00 - 8:30 am

Breakfast

8:30 - 9:30 am

Prediabetes: You Can Help Your Patients Exit the Express Lane to Diabetes

The Pharmacists Role in the Management of Chronic Kidney Disease

How to Make Pain Management Less Painful: Tips for the Outpatient Pharmacist

Compounding

Oral Emergency Contraceptives: A Mechanism of Action and Efficacy Update

11:00 - 12:45 pm

GENERAL SESSION

12:45 - 2:50 pm

Lunch/Exhibits/Networking/PharmAuction/Poster Presentations

3:00 - 4:30 pm

CPE--Jeopardy!

4:45 - 5:45 pm

#CustomizeYourCareer

4:45 - 5:45 pm

Insulin Cases: Inpatient and Outpatient

To Disclose or Not to Disclose (Medication Errors)....That is the question?

5:50 - 7:00 pm

House of Delegates

7:30 - 10:00 pm

President’s Banquet & Awards

10:00 pm

President’s Reception

9:45 - 10:45 am Management of Lipids Beyond Statin Therapy

Needle Facts: Immunization Update 2015

11:00 - 12:15 pm General Session 12:30 - 1:50 pm Lunch 2:00 - 3:00 pm

Am Care Panel (Part 1)

Caring for Veterinary Patients in the Community Pharmacy

3:10 - 4:10 pm

Am Care Panel (Part 2)

Incretin Therapies: Clinical Updates for Type 2 Diabetes

3:30 - 6:00 pm

Patient Counseling Competition/ Business Plan Competition

4:15 - 5:15 pm

House of Delegates - Roundtables

4:30 - 7:00 pm

Exhibits and Networking

7:00 - 8:15 pm

Alumni Receptions

8:15 - 10:30 pm IPhA Foundation Trivia Night Fundraiser (Doors Open @ 7:30)

SUNDAY - SEPTEMBER 27, 2015 7:30 - 8:45 am

IPPAC Breakfast

9:00 - 11:00 am

GENERAL SESSION - Law Review

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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General Conference Information CONTINUING PHARMACY EDUCATION

HOTEL ACCOMODATIONS Overnight rooms are provided to Illinois Pharmacists Annual Conference Attendees at a special rate of $139 per night , plus tax. This rate is only available through August 25, 2015. CALL (888) 627-9031 and ask for the IPhA Conference guestroom rate. Or, for online reservations, visit www.ipha.org and click on the Hotel Information link to make reservations online.

HANDOUTS - ONLINE ONLY Attendees will be responsible for printing their own copies of handouts this year. Handouts will be available online at www.ipha.org after September 17, and will remain online for at least 60 days following the Conference. If you are unable to access the handouts and would like copies provided, please notify the IPhA office at 217-5227300 or by email to kimc@ipha.org. We appreciate your consideration of cost savings to the Association as well as avoiding waste with overprinting. There will be a $50 fee for a print handout packet.

FACULTY DISCLOSURE To ensure independence, objectivity, and adherence to commonly accepted standard practices, all faculty are required to disclose to all participants any significant relationship with a commercial company whose products, devices or services may be mentioned in faculty presentations or with commercial supporter of these continuing pharmacy education programs. Any disclosures will be included in the final conference program and announced during the appropriate course.

POLICY ON INDUSTRY SUPPORT IPhA adheres to the U.S. Food & Drug Administration’s policy on industry supported educational activities. IPhA policy requires, among other things, that we conduct the educational program supported by any corporate educational grants independently and without control by the grantor of the program’s planning, content or execution. Furthermore, the programs must be free of commercial bias for or against any product.

MEETING DRESS CODE Meeting room temperatures may vary so please dress in layers and remember to bring a jacket or sweater.

Business casual attire is recommended.

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Registrants at the 2015 Illinois Pharmacists Annual Conference may earn up to 13 contact hours (1.3 CEUs) of continuing pharmacy education. In order to receive continuing pharmacy education credit, all meeting attendees must complete and submit an activity evaluation form online for each course attended, along with the overall meeting evaluation form. Codes for each session will be provided during individual sessions only.

These codes must be correctly entered at the beginning of the appropriate evaluation in order to validate your attendance. Links to evaluation forms will be emailed to attendees on the Monday following conference.

Evaluations must be completed online no later than Wednesday, October 14, 2015, to receive CPE credit for programs. Complete educational program descriptions will be posted in the conference materials received onsite and will also be available online prior to the conference.

STATEMENTS OF CREDIT As of January 1, 2013, all Illinois Pharmacists Association proof of credit is available on your CPE Monitor transcript located at www.nabp. net. Paper statements of credit will no longer be issued. Confirmation of attendance for the various sessions will be sent by Illinois Pharmacists Association to NABP through the CPE Monitor system. Participants should have included their CPE Monitor information when registering for the meeting. Credit will be uploaded 45-60 days after the date of the event.

ACCREDITATION STATEMENT Illinois Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Click the conference banner

at www.ipha.org for latest conference updates and/or to register online!

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

The IPhA Foundation is holding a Fundraiser at this year’s Illinois Pharmacists Annual Conference.

Join us for

Brush up on that “useless” knowledge and join us for a fun-filled night of food, friends, and trivia! Trivia Night is included in the price of conference.

Mark your calendar for Friday, September 25th at 7:30 p.m!

We will also have a

WOW

WALL OF WINE!

Wall of Wine will allow you to purchase a cork for $20 that can be traded in for a surprise bottle of wine that could be worth $100 or more.

This event cannot take place without your help. Please contact Erica at 217-522-7300 or ericab@ipha.org if you will be bringing your favorite bottle of wine to contribute to this event!

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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Executive Director’s Viewpoint

Ignite Your PASSION!

IPhA Executive Director Garth Reynolds, RPh “Enthusiasm is one of the most powerful engines of success. When you do a thing, do it with all your might. Put your whole soul into it. Stamp it with your own personality. Be active, be energetic and faithful, and you will accomplish your object. Nothing great was ever achieved without enthusiasm.”

Ralph Waldo Emerson

2015 Illinois Pharmacists Annual Conference I encourage each of you to get Fired Up for Pharmacy and attend this year’s Annual Conference, in Lombard, September 24-27. This year, we are offering a new pre-conference program on Opioid Addiction and Abuse Symposium on Thursday afternoon prior to the start of Conference. As you will see in the pages of this issue, your Conference and Education Committee has worked very hard to bring a great lineup of continuing pharmacy education (CPE) programming and keynote sessions. Our Friday Keynote Session will focus on two essential topics. The Illinois Department of Public Health will be discussing the importance of I-CARE (Illinois Immunization Registry) and how to register. Jennifer Baumgartner, ACPE Assistant Director, CPE Provider Accreditation Program, will be speaking about Continuing Pharmacy Development (CPD) and how pharmacists should approach lifelong learning. On Saturday, we are pleased to PAGE 10

have Matt Osterhaus, APhA Immediate Past President and co-owner of Osterhaus Pharmacy, who will address the implementation of pharmacists care services in your practice. Annual Conference & Pre-Conference Programming are great opportunities to obtain up to 16.0 contact hours of CPE and up to 9.0 contact hours for pharmacy technician CPE, including pharmacy law and patient safety sessions. The IPhA Foundation will also be offering two fundraising events. Come to Wrigley Field on Wednesday, September 23rd to see the Cubs battle Central Division rivals, the Milwaukee Brewers, in one of the remaining vital games of the season. On Friday evening, bring your thinking caps and team up to compete in our IPhA Foundation Trivia Night. So, Register Today at ipha.org and Fire Up For Pharmacy to join us September 2427 in Lombard!

Provider Status The Federal Provider Status bills (S.314 & H.R.592) continuing to gain support in Congress and with our Illinois Delegation. Senator Durbin has added his sponsor to S.314, which Senator Kirk has a chief co-sponsor. 14 of our 17 (current) Representatives have signed on to support H.R.592. Please contact Representatives Luis Gutierrez (202/2258203), Randy Hultgren (202/225-2976), and Peter Roskam (202/225-4561) to ask for their support and to co-sponsor H.R.592 to advance patient care through access to pharmacists. This is a key moment in pharmacy policy. Pharmacist Provider Status is essential for our profession to take and maintain the next evolutionary steps in pharmacist provided patient-centered care. Be a part of the movement to improve your practice and your profession.

State Reimbursement Issues As we have discussed previously, many pharmacies throughout Illinois ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

continue to be impacted by negative and improper reimbursements not just from the Managed Medicaid Plans but also the State Employee Plans. IPhA has established a Medication Price Reporting Form so you can share your examples of the reimbursement that you are experiencing. The form is voluntary and allows IPhA to show lawmakers and Department officials the reality of the decisions being made and the damage to pharmacies, regardless of practice size or setting. The General Assembly is still negotiating with the Governor’s office of the FY2016 Budget and IPhA is working closely with legislators, administration officials, and pharmacy stakeholders to minimize budget actions that would further decrease dispensing fees and cause increased strain on pharmacies to the quality and access to patient care that each of you provide. I urge you to please keep sending in examples of improper and negative reimbursements and reach out to your legislators and the Governor’s office to inform them of how these state plans are impacting your practice.

Pharmacists need to continue to come together to voice their opinion on how government decisions and PBM practices are damaging the quality and access to patient care in Illinois. Pharmacists must be able to work with other health care providers to ensure that the patients receive the treatment and care services that the health care team has decided is the best course. Patient care can never be decided by an algorithm or limited access to care to meet a fiscal goal.

Patient care is personal and pharmacists and other health care provider must be allowed to treat the patient, not treat the insurance policy or government regulation that restricts open access to providers and treatment options. Voice your opinion, Protect your practice, and Support IPhA in our continued efforts to improve patient care and pharmacy practice in Illinois.

Illinois Pharmacists Association Foundation Fundraiser Wednesday, September 23rd, 2015 @ 7:05 PM Join us for a Cubs vs. Brewers Baseball game at Wrigley Field on the Wednesday prior to conference. Please come to support the Illinois Pharmacists Association Foundation as they HIT their goals out of the PARK!

The IPhA Foundation provides support in the form of grants, scholarships, and professional expertise for pharmacist delivered patient care initiatives designed to optimize patient health outcomes, student participation in IPhA activities, and the preservation and promotion of the history of pharmacy in Illinois.

vs Only 50 tickets are available...

Please visit www.ipha.org to register today!

Board of Pharmacy Update Illinois State Board of Pharmacy Chairman Yagnesh (Yash) V Patel, RPh

directed and supervised by the pharmacist, shall counsel the patient or patient’s agent using his or her professional judgment.

Board of Pharmacy update:

Summer is here at last and I hope yours is going well!

Since the last article, the Department of Professional Regulation has achieved a major milestone, passing of the new pharmacy practice rules. There are several new changes and I encourage you to visit this link for details: http://www.ilga.gov/commission/jcar/ admincode/068/06801330sections.html One of the new additions to the rules is: Section 1330.800 Pharmacy Self-Inspection

Every licensed pharmacy shall conduct an annual self-inspection using forms provided by the Division.

The annual self-inspection shall be conducted during the same month, annually, as determined by the pharmacy. Documentation of the selfinspection shall be maintained at the pharmacy for 5 years. The primary objective of the self-inspection is to create an opportunity for a pharmacy to identify and correct areas of noncompliance with State and federal law. This includes, but is not limited to, recordkeeping, inventory, labeling and sanitation requirements.

(Source: Added at 39 Ill. Reg. 6267, effective April 23, 2015) Link to the self-inspection form is: http://www.idfpr.com/Forms/PDFs/ PharmacySelfInspectionReport.pdf PAGE 12

We have new Board members recently appointed by the Governor. Please join me in welcoming them to the team: Lemrey Al Carter Pharm.D. (Chicago) Despina Kotis Pharm.D. (Chicago) Richard Mazzotti R.Ph. (Taylorville) Continuing our discussion from the previous article on patient centric pharmacy practice, one of the cornerstones is patient counseling. 25 years ago, the Federal government passed Omnibus Budget Reconciliation Act of 1990 (OBRA’90) to offer patient counseling. The Pharmacist plays an integral role in optimizing drug therapy by directly communicating to the patient or patient’s care giver information about the prescription drug or device. Patient counseling is an individualized approach that promotes better outcomes and addresses several common nonadherence related problems.

This important piece of patient health is further reinforced in our Pharmacy Practice Act. Below are some excerpts from Section 1330.700 Patient Counseling: •

Upon receipt of a new or refill prescription, a prospective drug regimen review or drug utilization evaluation shall be performed. An offer to counsel shall be made on all prescriptions. If the offer to counsel is accepted, the pharmacist or the student pharmacist, as

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

•

If, in the pharmacist’s professional judgment, oral counseling is not practicable for the patient or patient’s agent, the pharmacist shall use alternative forms of patient information. When used in place of oral counseling, alternative forms of patient information shall advise the patient or agent that the pharmacist may be contacted for consultation in person at the pharmacy or by tollfree or collect telephone service.

•

Patient identifiable information obtained by the pharmacist or the pharmacist’s designee for the purpose of patient record maintenance, prospective drug review, drug utilization review and patient counseling shall be considered protected health information, as defined in Section 3(cc) of the Act. A pharmacist shall provide counseling related to protected health information in a discreet, supportive and informative manner.

For entire section languages please refer to: http://www.ilga. gov/commission/jcar/admincode /068/068013300G07000R.html I encourage all registrants to actively offer and provide patient counseling.

I wish you all a healthy and safe summer.

IPhA needs your financial support to continue monitoring legislation and advocating for pharmacy. Please consider contributing today!

Thank you to these pharmacy advocacy fund contributors (January 1 - July 31, 2015) ÎÎ ÎÎ ÎÎ ÎÎ ÎÎ

Byron Berry Ben & Katie Calcaterra Joyce Fogleman Linda Gehrt Donald Gronewold

ÎÎ ÎÎ ÎÎ ÎÎ ÎÎ

ÎÎ ÎÎ ÎÎ ÎÎ

Steve Karagiannis Timothy Lehan Michael Minesinger William Powers Alan Reed

Pamela Reynolds Terry Traster John Velk Bruce Wood

I am proud to support the Illinois Pharmacy Advocacy Fund!

Name:

(as you wish name to appear in the acknowledgement of your contribution) Address: Phone: Email:

 If needed, I am willing to contact my state legislator to be an advocate for pharmacy in Illinois!

..............................................................................................................................................

Pledge Information:  Enclosed is my contribution of:  $2,000

 $1,000

 $500

 Other $__________

 I would like to contribute $_______ on a monthly basis until I notify IPhA to discontinue.  Please charge my credit card $_______ on the 15th of each month for one year.

.................................................................................................................................

Payment Information:  Check payable to Illinois Pharmacists Association enclosed  Please charge my credit card:  Visa

 MasterCard

Card #: _____________________________________

CVV: _____________

 American Express

Exp Date: ____________________________

Signature: _____________________________________________________

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Please mail or fax this page with your payment to: Illinois Pharmacists Association  204 West Cook St  Springfield IL 62704-2526  Fax 217-522-7349

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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From the Editor Random RANTS those expensive computers the PBM’s existence depends upon, and program it to find the Group number from the ID if it is so necessary for the PBM to know it.

IPhA Editor Jefftry Ellis, RPh If Marijuana is a medication, why are Drug Companies not manufacturing it and Pharmacies not distributing it? It seems we are constructing a new method of medication manufacturing and delivery that already has one in place. Why are we (society) not using the existing system? The answer, of course, is it is classified as a “C 1” drug (no medicinal use), so federally it is not allowed to be even tested for medicinal use. Therefore, we get no testing, proof of safety and efficacy, and a weirdly odd delivery system. This is a phase society apparently has to go through to get the position that marijuana is like alcohol and is actually a recreational drug. This I have no problem with except when they cloak it in “medical” terms. Then I am professionally offended.

Also: Still illegal federally. Be very careful if you depend upon a license to practice your profession. It is the current administration’s choice not to prosecute, and administrations do not last forever.

Insurance Cards: 1. Why do we have to enter anything other than the ID? What is the function of the group number? It has to be for the convenience of the PBM. But don’t try to convince me it is necessary for me to enter it.

When I call the PBM, they are perfectly capable of telling me the Group number from the ID. So, use PAGE 14

2. And this message is for you, Illinois Blue Cross.

If you insert three letters in front of the ID, IT BECOMES PART OF THE ID! Don’t tell me to “just” leave those letters out. Rather than, say, approximately 500,000 pharmacy workers having to know “just” to leave those letters out, try programing your 1 (one) computer “just” to ignore those letters if inserted into the ID field! It is not that hard! (To their credit, I believe they do ignore the group field altogether). You may be able to detect that I hate the work “just” when spoken to me by PBM’s. Or Doctors. Or Techs. Or Patients.

Anyone apparently.

3. When the state of Illinois issues pharmacist licenses, they prefix the ID number with “051.“.

I assume that means “pharmacist” in bureaucratspeak. Get it PBMs? Assign each PBM a number (letter, symbol-don’t care) and make them prefix the number to the beginning of the ID. See? No BIN, PCN, Groups, etc. All unnecessary. One field in the insurance screen. IT’S NOT THAT HARD! Why do I have to hand-write the address of the patient, the phone number and DEA number of the Doctor on each controlled prescription? It is 1.) on the sticker on the back of the prescription or 2.) in my computer where the image is stored. What function does having the address/DEA number serve? If it is not on the prescription, how do I find it? I look it up in the computer! Which is where the image is stored! I have better things to do (which is anything). It really does seem like I spend the majority of my time performing tasks which do nothing to improve or protect the patient. I contend it is only in the law so PBM’s can justify payment pullbacks.

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

I CHOOSE A

TRANSPARENT WHOLESALER hdsmith.com | 217.529.0211

Helping You Care For Your Community

NPR

New Product Review

Tanzeum (albiglutide)

Company: GlaxoSmithKline1

Preparing for Injection1

Approval/Release Date: April 20141

•

Open needle and push it on the end of the pen until it clicks.

•

With needle in place, gently tap the clear cartridge 2 to 3 times to bring large air bubbles to the top. Presence of small air bubbles is acceptable.

•

To release large air bubbles, hold the pen with tip upright and twist the clear cartridge in the direction of the arrow (clockwise) until the number 3 appears in the viewing window and a click is heard. The injection button at the bottom of the pen body will pop out with the completion of this step.

•

Carefully remove outer and inner needle cap exposing needle.

Pharmacological Class: Glucagon-

like peptide 1 agonist1

Indication: Type 2 diabetes mellitus

1

Supplied: Single use 30 mg pen; single use 50 mg pen1 Dosage:

30 mg subcutaneously once weekly; may increase to 50 mg once weekly if adequate glycemic response is not achieved. Administer on the same day every week. Day of the week may be switched as long as the last dose was administered ≥4 days before. No adjustment for renal or hepatic impairment is required.1 Reconstitution and Administration:

Description of Pen

1

Pen has a body with three compartments attached.

Compartments are labeled as “1”, “2”, and “3” on the device. Water and the medication in powder form are contained separately in compartments 1 and 2. The device has a viewing window in which the number 1 will initially be present.

Reconstitution1 •

•

•

Hold the pen vertically by the pen body with one hand and twist the clear cartridge in the direction of the arrow (clockwise) the until pen clicks using the other hand; now the number 2 will appear in the viewing window.

Gently rock the pen back and forth 5 times to mix the drug and water together. It is important not to shake the pen hard to avoid foaming.

Place the pen in an upright position with cartridge pointing up to allow the medication to dissolve.

Manufacturer suggests placing the pen in a clean, empty cup. Keep pen in this position to allow medication to dissolve for at least 15 minutes for the 30 mg pen or 30 min for the 50 mg pen.

•

Pen must be used within 8 hours after reconstituting the medication.

•

After the appropriate amount of time, gently rock the pen back and forth 5 times again. Medication is now dissolved and should appear clear, yellow and be free of solid particles.

PAGE 16

Administration1 •

Insert the needle into a cleaned area of skin and slowly push the injection button to inject the medication.

Pushing the button slowly will allow for less pressure to be felt. Pen can be injected subcutaneously into the upper arm, thigh, or abdomen. Rotate the ejection site on a weekly basis.

•

After pressing the button, a click will sound. Keep the pen in this position with thumb pressed on the button for 5 seconds to deliver the full dose.

•

Remove needle from skin.

•

Dispose of pen in sharps container.

•

To view this process, refer to: http://www.tanzeum. com/how-to-use.html.

Storage:

Before dispensing, refrigerate pens at 36ºF to 46ºF. Patients can refrigerate the pen or store at room temperature not to exceed 86ºF for up to 4 weeks. Discard if it becomes frozen at any point.1 Contraindications:

Any hypersensitivity to albiglutide or any inactive components of the medication, personal or family history of medullary thyroid carcinoma, or multiple endocrine neoplasia syndrome type1, 2 Warnings/Precautions:

Serious hypersensitivity reactions (pruritus, rash, and dyspnea) and acute pancreatitis have been reported.

Discontinue use in either setting. Thyroid tumors have

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

developed in animal studies (see Black Box Warning). Use is not recommended in preexisting severe gastrointestinal disease. Acute renal failure and chronic renal failure exacerbation cases have been reported. Caution should be used in patients with history of renal dysfunction especially upon initiation or escalation of dose.2 Black Box Warning:

GLP-1 receptor agonist use has been associated with thyroid C-cell tumors in rodent studies. It is unknown whether albiglutide can cause thyroid tumors and is contraindicated in patients with a personal or family history of medullary thyroid carcinoma.2 Drug Interactions:

Absorption of orally administered medications was unaffected by albiglutide in clinical trials, but it can cause a delay in gastric emptying. Because of the delay in gastric emptying time, albiglutide has the potential to alter the absorption of oral medications when administered together.

Caution should be used when given with orally administered medications. Â Androgens, insulin, and sulfonylureas may enhance hypoglycemic effect. Corticosteroids (inhaled/ systemic) and thiazides may diminish the hypoglycemic effects of diabetes medications.2 Adverse Reactions:

Hypoglycemia (combination therapy 3%-17%), diarrhea (13%), nausea (11%), local injection site reaction (11%18%), Upper respiratory tract infection (14%), back pain (7%), arthralgia (7%), influenza (5%), atrial fibrillation (1%)2

Michael Ranzini Pharm.D. Candidate Class of 2015 Midwestern University Chicago College of Pharmacy Courtney Linhart~ Pharm.D. Candidate Class of 2015 Midwestern University Chicago College of Pharmacy Jennifer Mazan, Pharm.D. Assistant Professor of Pharmacy Practice Midwestern University Chicago College of Pharmacy jmazan@midwestern.edu The authors do not have any disclosures or conflicts of interest.

studied in the Harmony program that consists of eight phase 3 clinical trials. The Harmony 3 trial was a doubleblind, parallel-group, placebo- and active-controlled trial assessing the efficacy of once weekly albiglutide compared to sitagliptin, glimepiride, and placebo in 1,012 patients with type 2 diabetes mellitus who were receiving metformin but were not adequately controlled. At the conclusion of the 104 week trial, albiglutide significantly reduced HbA1c compared to placebo (-0.9%, p<0.0001), sitagliptin (-0.4%, p=0.0001), and glimepiride (-0.3%, p=0.0033).4 Place in Therapy:

Not recommended as first line therapy. After initiation of metformin therapy, if glycemic goals are not achieved, a GLP-1 receptor agonist or basal insulin can be added on to therapy. If metformin use is contraindicated, a GLP-1 receptor agonist can be initiated first.5

Pregnancy Category: C2

References:

Monitoring:

1. Tanzeum [package insert]. Wilmington, DE: GlaxoSmithKline LLC; 2014.

Monitoring includes HbA1c, plasma glucose, renal function, and signs or symptoms of pancreatitis. Patients should also be monitored for thyroid nodules, elevated serum calcitonin levels, and abnormalities present in thyroid ultrasounds; these signs merit a referral to an endocrinologist.2 Clinical Trials:

A randomized, double-blind, placebo-controlled, parallelgroup, 13-month long study determined the efficacy, safety and tolerability of various doses of albiglutide in three different dosing regimens in patients with uncontrolled diabetes. The statistically significant study groups included albiglutide 30 mg weekly, albiglutide 50 mg every 2 weeks, and albiglutide 100mg monthly. At the conclusion of the trial, albiglutide 30 mg proved to be the optimal dosing option with an A1c lowering of -0.63% (p<0.003) with the most common adverse events being nausea and vomiting occurring in 29.0% of patients.3 Albiglutide was further

2. Albiglutide. Drug monograph. Lexi-Drugs. http://www.lexi.com (accessed 11 Oct 2014) 3. Rosenstock J, Reusch J, Bush M, Yang F, Stewart M. Potential of albiglutide, a long-acting GLP-1 receptor agonist, in type 2 diabetes: a randomized controlled trial exploring weekly, biweekly, and monthly dosing. Diabetes Care2009;32:1880-6.

4. Ahren B, Johnson SL, Stewart M, et al. HARMONY 3: 104-week randomized, double-blind, placebo- and active-controlled trial assessing the efficacy and safety of albiglutide compared with placebo, sitagliptin, and glimepiride in patients with type 2 diabetes taking metformin. Diabetes Care. 2014 Aug3;37(8):2141-2148.

5. Inzucchi SE, Bergenstal RM, Buse JB, et al; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EAS). Diabetes Care 2012;35:1364-1279.

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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CR

Clinical Review The Community Pharmacistâ&#x20AC;&#x2122;s Role in Transitions of Care

Improving transitions of care for patients has become a national focus for health care providers. According to The Joint Commission, medication reconciliation should be done to reduce the medication errors.1 Pharmacists can play an essential role in implementation of new patient-centered programs and coordinating care, as each patient transitions from one health care setting to another. Typically, transitions of care is thought of as a patientâ&#x20AC;&#x2122;s transition from inpatient care back to the community or ambulatory care setting; however, transitions of care can also be considered on a wider scale to include any time a patient transitions from one health care setting or level of care to another. A more comprehensive view of transitions of care can include the transition from primary care to the community pharmacy or community pharmacy to long-term care. Additionally, transitions of care are typically assumed to be limited to the time frame associated with the change in care. However, time frames can be dependent on the relationship between health care settings. For example, the relationship between primary care and community pharmacy is often on-going as the patient progresses through chronic conditions. This is especially true as patients transition through life stages, such as childhood to adulthood or adulthood to elderly. Pharmacists can play an active and vital role on the healthcare team, providing education about medication adverse effects and reducing hospitalizations. Providing these services can generate revenue as pharmacists are able to bill for some services they provide. Despite that, the role of pharmacists in the transition of care process continues to grow, pharmacists are still faced with several challenges and limitations.

The role of pharmacists in the continuity of care for patients is expanding. Within the community pharmacy setting, pharmacists are now involved with activities such as patient education, delivery of medications to patient homes or bedside, blood pressure screenings, blood glucose screenings, human immunodeficiency virus testing, genetic testing, medication education, medical device education such as insulin pens or glucometers, and general health screenings.2-3 Community pharmacists provide disease state education classes for a variety of disease states, including diabetes, smoking cessation, asthma, and chronic obstructive pulmonary disease (COPD).

The goals of these services are to educate the patient, reduce medication errors, and increase patient adherence to therapy plans. Community pharmacists have a unique opportunity to serve as an intermediate between inpatient and outpatient settings. Upon admission, communication between inpatient and outpatient pharmacists can help to reduce medication errors.4 Community pharmacists can provide valuable information when patients are admitted to the hospital including a current list of prescription medications, refill history and allergies to medications. Upon discharge, community pharmacists can provide medication therapy management services to PAGE 18

identify discrepancies and therapeutic duplications between pre and post discharge medication regimens.5 Furthermore, community pharmacists can enhance communication between health care providers by contacting primary care physicians with therapeutic recommendations and need for additional medical supplies such as insulin syringes, glucose testing strips, lancets or a blood pressure cuff. Community pharmacists are best positioned to optimize therapy because they are able to provide recommendations based on third party provider covered medications.5 Additionally, pharmacists can identify and discontinue automatic refill programs to prevent patients from continuing to receive discontinued medications. Community based clinical service programs allow patients better access to the health care team leading to reduction in medication errors, increased adherence and reduced hospital readmissions.

Medication errors associated with transitions of care can lead to increased readmission rates. One study found, upon discharge from the hospital, one in five patients had an adverse event with one-third of those events being preventable.6 Another study found that for every 25 patients that are seen for transition of care visits, one patient will benefit with resolution of a medication error.7 Although not all of these medication errors lead to hospital readmission, it remains important to patientsâ&#x20AC;&#x2122; long-term health goals to avoid medication errors. Community pharmacists can take an active role in reducing readmission rates by partnering with hospital systems to provide transition of care services including medication management sessions.

These services can include bedside delivery of post-discharge medications and follow-up phone calls to assess adherence and patient understanding of the new medication therapies.8 Studies have found a decreased readmission rate in patients who receive these services.7 Furthermore, patients should receive an updated list of their medications in order to help reduce confusion and medication errors.1,7 Pharmacists can help patients better understand changes made to their medication list by highlighting which medications have been changed postdischarge to indicate which medications have been started and which medications need to be discontinued. Additionally, it is important for pharmacists to educate patients on the rationale for changes to their medications. By billing for medication management sessions, pharmacists not only aid in patient care, but are able to generate revenue for the pharmacy.

The financial implications of adding clinical services in a community setting have been documented.7,9-10 Study results indicate services such as providing vaccinations, medication therapy management, blister packing, compounding and disease state management education classes can contribute to profits within the community setting.9 Typically a fee-for-service model is used to bill for these services currently.10 However, partnering

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

with an accountable care organization, which are paid based on performance measures, could be a potential avenue as these models of care expand. Using marketing techniques such as brochures, to educate patients and providers of available services can help generate interest in these services. Not only can community pharmacies generate income through clinical services, but there is potential for community pharmacies to aid in reducing health care costs of readmissions. One study found medication reconciliation post-discharge resulted in a cost savings of about $35,000 per 100 patients.7 Despite evidence for growing revenue in community pharmacy related to transition of care programs, pharmacists still face several challenges when implementing these initiatives.

Challenges pharmacists face when implementing transition of care programs include recruitment of patients into program services, obtaining accurate contact information for patients and gaining access to necessary medical records.2 Recruitment of patients into transition of care programs continues to be an area for improvement. Health care providers lack knowledge that pharmacy services are available, while patients lack understanding of how they might benefit from these services.

Improved recruitment initiatives can include partnering with insurance providers, assisting with discharge planning before patients leave the inpatient setting and providing patient incentives. Maintaining accurate contact information for patients can also be difficult. Pharmacist can take an active role in collecting contact information by asking for multiple sources including a home address, phone number and emergency contact information. Additionally, pharmacists can work with insurance providers and hospital systems to establish collaborative relationships in order to gain access to patient medical records.

Access to records can aid pharmacists in making more accurate and comprehensive recommendations to providers. Additionally, access to medical records can help pharmacists target patients who can most benefit from services offered. It has been shown that not all patients benefit from clinical pharmacy services postdischarge.11 Therefore, transition of care programs should target those patients at highest risk and acuity. Patients at highest risk can be identified through demographics including patients taking â&#x2030;Ľ 5 medications, limited health literacy, older adults and children with special needs, patients with cognitive impairment and those with low income. Another approach to target patients includes assessing the number times a patient presents for a primary care or specialist visit.5 For example, one pharmacy targeted their efforts to coordinate care toward Medicaid patients who visit their physician at least 4 times per year and have at least 9 outpatient specialist visits per year.12 The transition from one health care setting to anther can cause confusion for patients and without proper communication among health care providers patients are at risk for medication errors and the potential for hospital readmission. Pharmacists can provide medication therapy management services, reduce errors, as well as provide a source of revenue. Although these services are growing, there are still areas for pharmacists to improve.

Author: Anne Misher, PharmD Midwestern University Chicago College of Pharmacy PGY1 Pharmacist Practice Resident amishe@midwestern.edu Author has no conflicts of interest.

References 1. The Joint Commission. Ambulatory Health Care National Patient Safety Goals Effective January 1, 2014. Available from: http:// www.jointcommission.org/assets/1/6/AHC_NPSG_Chapter_2014. pdf (Assessed November 1, 2014).

2. Sen S, Bowen JF, Ganetsky VS, Hadley D, Melody K, Otsuka S, Vanmali R, Thomas T. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings.

Pharm Pract (Granada). 2014;12:439.

3. Oâ&#x20AC;&#x2122;Connor SK, Ferreri SP, Michaels NM, et al. Exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. Pharmacogenomics. 2012;13:955-62.

4. Pourrat X, Corneau H, Floch S, et al. Communication between community and hospital pharmacists: impact on medication reconciliation at admission. Int J Clin Pharm. 2013;35:656-63.

5. American College of Clinical Pharmacy, Hume AL, Kirwin J, Bieber HL, et al. Improving care transitions: current practice and future opportunities for pharmacists. Pharmacotherapy. 2012;32:e326-37.

6. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-7.

7. Kilcup M, Schultz D, Carlson J, et al. Postdischarge pharmacist medication reconciliation: impact on readmission rates and financial savings. J Am Pharm Assoc (2003). 2013;53:78-84.

8. Kirkham HS, Clark BL, Paynter J, et al. The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission. Am J Health Syst Pharm. 2014;71:739-45.

9. Doucette WR, McDonough RP, Mormann MM, et al. Three-year financial analysis of pharmacy services at an independent community pharmacy. J Am Pharm Assoc (2003). 2012;52:181-7.

10. Norwood GJ, Sleath BL, Caiola SM, et al. Costs of implementing pharmaceutical care in community pharmacies. J Am Pharm Assoc.

1998;38:755-61.

11. Farris KB, Carter BL, Xu Y, et al. Effect of a care transition intervention by pharmacists: an RCT. BMC Health Serv Res. 2014;14:406.

12. Moose J, Branham A. Pharmacists as influencers of patient adherence. Directions in Pharmacy. 2014;1(5). Available from: http:// www.pharmacytimes.com/publications/directions-in-pharmacy (Accessed November 12, 2014).

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

PAGE 19

Lombard Pharmacy Named IPC’s

2015 Most Valuable Pharmacy (MVP) Award Winner Independent Pharmacy Cooperative (IPC) is honored to announce Lombard Pharmacy and owner Craig Kueltzo as its 2015 Most Valuable Pharmacy (MVP). Kueltzo, his family and the pharmacy staff received IPC’s MVP Award at last Friday’s IPC Annual Business Meeting held during McKesson ideaShare 2015 in San Diego, California.

“It’s my pleasure to highlight the amazing work done by owner Craig Kueltzo and his pharmacy’s staff by awarding them IPC’s Most Valuable Pharmacy for 2015,” IPC President and CEO Don Anderson said. “Lombard Pharmacy represents an essential business in the heart of its loyal community, relishes the importance of community leadership and promotes a business culture that always strives for excellence in customer service.”

IPC’s MVP Award recognizes a pharmacy that realizes the value of its extensive engagement within its cooperative.

Lombard Pharmacy actively participates in various IPC initiatives and takes full advantage of the variety of IPC programs and services available to them, realizing the critical impact they have on the pharmacy’s operations.

“IPC’s allegiance is to independent pharmacy and promoting the future of independent pharmacy,” said Kueltzo, who has also served on IPC’s Advisory Board. “I wouldn’t be without them, and our IPC membership has meant a lot to us over the years.”

At a special ceremony, Kuetlzo was surprised at pharmacy on June 11, 2015 with a special acknowledgement ceremony involving a visit from IPC Director of Sales Operations Mindy Herrmann.

“It’s truly humbling to receive this great award in front of my peers, family and staff,” Kueltzo said. “It recognizes the wonderful work done by everyone here at Lombard Pharmacy, and it means a lot to me.”

IPC’s previous MVPs were: 2014: Tieton Village Drugs of Yakima, Washington; 2013: Beemon Drugs of Jackson, Mississippi; 2012: Yost Pharmacy of Mason, Ohio; 2011: Neuhauser Pharmacy of Madison, Wisconsin; 2010: Windham Pharmacy of Windham, New York.

Dating back to 1983, IPC has grown to be the nation’s largest group purchasing organization, representing over 2,500 members. With locations in Sun Prairie, Wisconsin and Phoenix, Arizona, IPC prides itself on providing access to the most effective programs and services to put profit back into the independent pharmacy.

For more information about IPC, go to www.ipcrx.com.

PAGE 20

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

10 TOP

5. Proclaim Your Professionalism

REASONS TO JOIN

Adding your name to the ranks of your colleagues who currently are members declares your pride in the profession you have chosen. Support IPhA’s advocacy efforts as we work with policy makers to implement health care reform legislation and as we continue to advocate for legislation and regulations that positively impact the profession. Join us in efforts to promote the important role of pharmacists on the health care team.

IPhA

6. See It All

1. Strengthen Your Career IPhA members enjoy educational opportunities designed to increase knowledge and keep up with the latest information. Members also receive a discount on titles available in the IPhA Bookstore, as well as access to the Online Career Center.

IPhA is the only statewide pharmacy organization that represents all pharmacists in all practice settings – you can learn about all the opportunities available within pharmacy and gain insights from pharmacists representing a variety of practice settings.

2. Advance Patient Care

7. Reach Out to Your Community

The more you learn about drug and treatment updates through our publication, Illinois Pharmacists, as well as electronically through the EIE (E-Info Exchange), the better equipped you are to help your patients. IPhA is also a licensed partner to provide the following certificate programs:

IPhA recognizes an array of local and cultural organizations that provide an opportunity for you to network within your own community.

•

Delivering Medication Therapy Management Services

•

Pharmacy-Based Cardiovascular Disease Risk Management

•

Pharmacy-Based Immunization Delivery

•

The Pharmacist and Patient-Centered Diabetes Care

•

As well as the advanced pharmacy training program: Pharmacy-Based Travel Health Services

3. Network with Others in Your Field IPhA members are invited to join their colleagues at the IPhA Annual Meeting. Meet members with similar professional interests online through IPhA’s networking sites on Twitter, Facebook, and www.ipha.org. Members are encouraged to join e-Communities and Special Interest Groups.

Pharmacy professionals can also meet and engage with other professionals by attending Local Pharmacy Association Events.

8. Develop Your Leadership Skills Participate as an active leader in a variety of workshops, training series, and volunteer leadership positions that will develop your skills as you give back to your profession.

9. Receive Scholarships and Awards IPhA has a distinguished awards and scholarship program recognizing members for involvement in the Association, for leadership, academic success and grassroots advocacy. The IPhA Foundation supports members through awards and scholarship programs. In 2015, IPhA is adding two new awards: IPhA Educator of the Year and Generation-Rx, sponsored by Cardinal.

10. Gain the Competitive Edge 4. Advocate for Your Profession By joining IPhA, you are supporting the only organization the represents the unified voice of all pharmacists. During the past year, IPhA’s work on health care legislation and regulation increased policy makers’ awareness of the pharmacist’s role in combating the medication use crisis. IPhA continues to work to affect policy on your behalf. The Legislative Report keeps you up-to-date with current bills that IPhA is tracking that have potential to affect your practice!

IPhA gives you exclusive access to unique experiences, career information, and resources designed to meet your needs and provide support as you advance in your career.

JOIN TODAY www.ipha.org

Opioid Addiction and Abuse Symposium: Training Health Care Professionals Thursday, September 24 - 1:00-5:30 pm Westin Lombard Yorktown Center Just before the IPhA Annual Conference!

Join us for an afternoon program that discusses opioid addiction and abuse covering the following topics: Addiction as a Disease, Opioid Overdose and Reversal Agents, and Mechanisms for Pharmacy Personnel to Engage in Reducing Prescription Drug Abuse.

At the Completion of this program, the pharmacist will be able to: 1. Describe the epidemiology of current use of prescription and illicit opioid agents.

2. Discuss the neurochemical mechanisms of substance use disorder.

3. Describe the neurobiological aspect of opioid dependence.

4. Explain treatment approaches to addiction revolving opioid dependence.

5. Recognize warning signs of patients with possible opioid addiction risk factors or behaviors.

6. Recognize pertinent signs and symptoms of opioid overdose.

7. Identify the mechanisms of action and appropriate uses of opioid reversal agents.

8. Demonstrate how to use commercially available products of opioid reversal 9. Identify the role of pharmacy personnel in opioid overdose management.

10. Identify ways pharmacy personnel can contribute to the reduction of prescription drug abuse, misuse and diversion.

11. Describe how pharmacists may utilize prescription drug monitoring programs to screen for potential safety concerns.

12. Explain critical pharmacy personnel roles in collaborative and outreach efforts to reduce prescription drug misuse, abuse and diversion.

PAGE 22

At the completion of this program, the technician should be able to: 1.

Describe the epidemiology of current use of prescription and illicit opioid agents.

The Illinois Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Universal Program Number:

2. Discuss the neurochemical mechanisms of substance use disorder.

0135-0000-15-016-L04-P 0135-0000-15-016-L04-T

3. Describe the neurobiological aspect of opioid dependence.

Contact hours: 4.5 hours

4. Recognize warning signs of patients with possible opioid addiction risk factors or behaviors.

Initial Release Date: 09/16/2015

5. Recognize pertinent signs and symptoms of opioid overdose.

6. Identify the mechanisms of action and appropriate uses of opioid reversal agents.

7. Identify the role of pharmacy personnel in opioid overdose management.

8. Identify ways pharmacy personnel can contribute to the reduction of prescription drug abuse, misuse and diversion.

9. Explain critical pharmacy personnel roles in collaborative and outreach efforts to reduce prescription drug misuse, abuse and diversion.

Faculty: Kelly Gable, PharmD, BCPP, Associate Professor, Department of Pharmacy Practice, SIUE School of Pharmacy Jessica L Kerr, PharmD, CDE, Assistant Chair, Department of Pharmacy Practice, Associate Professor, Department of Pharmacy Practice, SIUE School of Pharmacy Tina Messenger, PharmD Candidate 2016, SIUE School of Pharmacy Khyati Patel, PharmD, BCPS, Assistant Professor, Rosalind Franklin University of Medicine and Science (RFUMS); Primary Care Pharmacy Provider, Aurora Medical Center Kenosha (AMCK) Family Practice Clinic Michael Shuman, PharmD, BCPP, Assistant Professor, Pharmacy Practice, Rosalind Franklin University of Medicine and Science (RFUMS)

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

Expiration Date: 09/16/2018 Target Audience: Pharmacists and Pharmacy Technicians Agenda: 12:30 pm............................... Registration 1:00 â&#x20AC;&#x201C; 5:30 pm....................Programming Registration For additional information, or to register, visit www.ipha.org.

Registration required by 9/17/15.

Registration Fees: Pharmacist Member:.......................... $49 Pharmacist Non-member: ............... $249 * Technician Member:.......................... $34 Technician Non-member:................... $66 * Student Member:................................ $24 Student Non-Member:....................... $40 * *(Non member pricing includes discounted 1 year Membership)

Endorsed* by:

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ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

* Compensated endorsement.

Not licensed to sell all products in all PAGE 23states.

PHARMACY MARKETING GROUP, INC

&THE LAW

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

That’s Not My State

By Phillip J. Schieffer, PharmD/J.D. - Dual-Degree Candidate, Drake University

Often you find yourself flipping through pharmacy news and see recent court decisions that affect the practice of pharmacy in a different state. You might think, “Well it’s not in my state, so who cares?”

Even though that decision may not pertain to your practice now, it could later. The extent to which it does stems from its persuasive authority. Persuasive authority is the characteristic of a judicial opinion that courts in other jurisdictions can rely on in deciding a case. But, this authority is neither absolute nor guaranteed.

Of course there are the judicial opinions issued in your state that directly affect your practice of pharmacy. These are said to have mandatory authority. Once an opinion is rendered based on a particular set of facts, it becomes the rule of law that all lower courts in that jurisdiction (including the court it came out of) must follow from then on. There is no discretion over whether to follow this rule.

The process of following decisions with mandatory authority is called stare decisis, meaning “let the decision stand.” Mandatory authority derived from stare decisis serves the purpose of continuity (so people know what the law is and how to act), as well as efficiency in not having to consider policy arguments every time the same issue is raised.

Let’s look at Bobay v. Walgreens.1 In 2007, Pansey and Dennis Bobay filed a complaint against Walgreens alleging that the pharmacy owed Ms. Bobay a duty to warn her about potential adverse injuries that could result from taking cyclosporine, gemfibrozil, and Vytorin. The Bobays were trying to prove negligence and in order to do that needed to show Walgreens had a duty to warn Ms. Bobay about drug interactions.

However, the rule of law was already established that pharmacists had no such duty unless directed by the prescribing physician. That rule came from a case previously decided by the Indiana Court of Appeals.2

PAGE 24

Since the federal judge in the United States District Court for the Northern District of Indiana was deciding on an issue in which Indiana state law governed, he was forced to apply the rule, thus favoring defendant Walgreen. As a result, that claim was dismissed from court on a motion for summary judgment. The Bobays could not recover from Walgreen on that claim because the facts were similar enough to a case that had previously been decided within their jurisdiction.

The court was bound by mandatory authority.

But what about judicial opinions from courts that have no jurisdiction where you practice pharmacy? They’re not your laws, right? Right. Your courts aren’t bound by them, right? Right. So we can totally disregard them, right? I wouldn’t. If the issue has yet to be decided in your courts, that outside opinion could play a big part in shaping your professional landscape.

Persuasive authority comes into play when a court is looking at an issue for the first time. It has no previous decisions in their own jurisdiction, so they aren’t bound by any rule of law. It has to make the rule of law and apply it to the case at hand. This process is not to be taken lightly, so persuasive authority is used for guidance in creating mandatory authority.

Exactly how persuasive a decision is, though, relies on a host of considerations. The more similar the facts are, the more persuasive it is. Reasoning behind an opinion, the person that wrote it, and the court from which the decision came all matter, too. Whether a court shares a specific doctrine on the matter is also important. Even demographic and geographic comparisons are made. It’s difficult to tell with any certainty how persuasive an “outside” decision may be.

So here we go again. Let’s get back to a pharmacist’s duty to warn a patient about adverse effects. The State of Washington looked at this issue for the very first time in McKee v. American Home Products Corporation.3 Here,

ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

Appealing Health Carrier Decisions

Helping your patients/clients appeal a denied service or treatment The Illinois Department of Insurance is reminding consumers, health care providers, and patient advocates about consumers’ rights for an independent external review when their health insurance carrier denies a claim or request based upon medical necessity (including health care setting, level of care or effectiveness), experimental/ investigational, a pre-existing condition, or rescission of the policy.

This law applies to pre-service, concurrent stay and post service adverse determinations. If the situation is urgent (the time frame for a standard appeal or review could seriously jeopardize the life or health of the covered person), then an expedited internal appeal and/ or expedited independent external review may be requested. For all other requests, the internal appeals process through insurance carrier must be exhausted prior to requesting an external independent review.

Requests for independent external reviews are filed with the Department of Insurance by fax, on-line or by U.S. mail. An independent review organization (“IRO”) registered with the Department is randomly assigned to the review, which must be conducted by a clinical reviewer who is a physician or other appropriate health care provider with: (1) expertise in the treatment of the covered person’s medical condition that is the subject of the review, (2) knowledge about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar condition of the patient, (3) holds a non-restricted license in the United States, and for physicians, a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the external review; and (4) has no history of disciplinary actions.

For standard reviews, the consumer and/or their authorized representative are notified by the Department of the

Elaine McKee alleged that the defendant pharmacists were negligent and should have warned her about the addictive effects of Plegeline for appetite suppression, that its therapeutic effect diminishes after a few weeks, and that it is not a drug to be used for long-term duration.

Since this was an issue of first impression the court looked outside the State of Washington for help. The court was persuaded particularly by factually similar cases that arose out of the Florida District Court of Appeals and Michigan Court of Appeals. There, they held that pharmacists had no such duty to warn of potential adverse effects, but only a duty to properly fill a prescription. Also, since Washington followed the “learned intermediary” doctrine they looked at decisions from other states that followed the same doctrine.4 Those states found no duty to warn on the part of the pharmacist because they did not know the nuances of a patient’s health. Even though the court wasn’t bound by those prior decisions, it chose to follow their rulings anyway.

Maybe you might want to skim through that article after all. You can anticipate what the argument for or against an

IRO assigned to the review and are invited to submit any documentation applicable to the request. The carrier is required to send all medical records related to the request to the assigned IRO. Standard reviews are generally finalized within 4-6 weeks and the decision is final, but may be appealed through the court system.

Fully insured Illinois policies are subject to the Illinois law and it generally applies to most major medical polices, including those purchased under the Affordable Care Act (ACA). However, the Department’s Office of Consumer Health Insurance assists consumers by trying to ascertain the type of plan involved, applicable appeal procedures and appropriate avenues for the appeal.

For more information regarding independent external reviews in Illinois, contact the Office of Consumer Health Insurance at (877) 850-4740 or visit the Department’s website at http://insurance. illinois.gov/ExternalReview/default.asp.

issue will be when it’s raised. Making yourself aware of what’s going on in other states helps to keep you aware of your own professional responsibilities and their evolution. © Phillip J. Schieffer, PharmD/J.D. is a Dual-Degree Candidate at Drake University.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

1. Bobay v. Walgreen Co., 2009 WL 1940727, (N.D. Ind. June 30, 2009).

2. Ingram v. Hook’s Drugs, Inc., 476 N.E. 3. McKee v. American Home Products Corp., 782 P.2d 1045 (Wash. 1989) 2d 881, 887 (Ind. Ct. App. 1985) 4. Learned intermediary doctrine applied here means that it is the physician that has the duty to warn, because not only are they educated on drug therapy, but they also have comprehensive knowledge of a patient’s medical history, unlike the pharmacist.

ILLINOIS PHARMACISTS ASSOCIATION * WWW.IPHA.ORG

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The SIUE School of Pharmacy students and faculty have had a very successful spring semester. Of the many awards received, the School’s student chapter of APhA Academy of Student Pharmacists (ASP) received an award for “Best Implementation of Generation Rx activities for Region 4 at the annual APhA meeting in March 2015.”

The Generation Rx Initiative is an educational program that increases public awareness of prescription medication abuse and encourages health care providers, community leaders, parents, teens, and college students to actively work to prevent abuse. Our students excelled in the ASHP resident “match” program with a 72% match rate. One of our student-athletes, Haley Ilcewicz, made history by completing four years of NCAA Division I eligibility and also being inducted into Rho Chi, the national pharmacy honor society.

Our first-year professional pharmacy students promoted healthy habits and literacy to nearly 9,000 area children this spring. For the ninth consecutive year, 80 SIUE students participated in the community service event.

Among the faculty successes, Dr. Kelly Gable received the SIUE Teaching Excellence Award. This is the highest university-wide award for teaching.

Dr. Scott Bergman is collaborating with the Illinois Department of Public Health on a new statewide initiative to promote appropriate use of antibiotics in outpatient health care settings, and Dr. Lisa Lubsch has been appointed

SIUE School of Pharmacy students encourage healthy habits and literacy among children.

president-elect of the Pediatric Pharmacy Advocacy Group (PPAG). In research news, Dr. Ken Witt received a $2.65 million 5 year R01 grant from the National Institute on Aging for the project entitled: Lead optimization of somatostatin-based therapeutic for Alzheimer’s Disease.

In community service projects, students and faculty traveled to businesses in Edwardsville and Glen Carbon Friday offering blood pressure checks to employees. The group, comprised of 12 faculty members and 32 students, conducted screenings on 426 individuals during the four-hour community service event.

Blood Pressure Screening Event: Robert Plumber, owner of RP Lumber, recieves a blood pressure screening from SIUE School of Pharmacy student Kassandra Moore.

Follow IPhA on Twitter at http://twitter.com/ILPharmacists.

View contact information for Local Associations at www.ipha.org > Contacts > Local Assns!

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ILLINOIS PHARMACIST (JUL/AUG/SEP 2015 - VOL. 77-NO. 3)

New Construction at St. Louis College of Pharmacy Phase II Building Announcement

St. Louis College of Pharmacy continues to improve the educational landscape of St. Louis by announcing plans for a seven-story student center, residence hall and recreation facility on the northeast corner of campus.

The building is tentatively scheduled to open December 2016. Initial building renderings may be found at www.stlcop.edu/construction.

“This is the second phase of our transformational campus construction project at St. Louis College of Pharmacy,” says College President John A. Pieper, Pharm.D. “This new building and our soon-to-open academic and research building and library will provide resources to help prepare our student pharmacists for their changing role in the health care system, and transform the College into a global leader in health care and pharmacy education.”

As it is currently planned, the first floor of the new 190,000-square-foot building will consist of a large dining hall and kitchen, reception area, and a competition gymnasium. The second floor will have additional seating for the dining hall, meeting rooms, and an intramural gymnasium.

A recreation center with a 200-meter, three-lane indoor track will be the main feature on the third floor. The student center, including a success center and student support offices, will be on the fourth floor. The College’s second residence hall with room for 220 beds will be on the fifth through seventh floors, nearly doubling the College’s on-campus housing space.

The College chose Forum Studio, a St. Louis-based company, as its

architectural firm. PARIC Corporation will serve as general contractor.

Demolition of Whelpley Hall will begin shortly to make way for the new building. The College plans to fund this second phase in a similar way to Phase I—through donor contributions and a bond issue.

“Through our campus master planning process, we’ve committed to build for the future to provide outstanding facilities for the campus community,” Pieper says. “We remain on firm financial footing thanks to our careful planning and the generosity of our alumni and donors.”

and become leaders in the profession and their communities. Beginning in the fall of 2014, the curriculum expanded to three undergraduate years and four years of the professional program. Graduates will earn a Bachelor of Science degree after four years, and a Doctor of Pharmacy (Pharm.D.) at the completion of their studies. The College admits students directly from high school and accepts transfer students and graduates from other colleges and universities. More than 1,300 students are currently enrolled from 28 states and several countries, including Canada, China, Korea, Saudi Arabia, Slovenia, and Vietnam. College alumni practice throughout the nation and in 13 different countries, providing a strong network to assist students with their goals. Additional information is available at www.stlcop.edu.

When complete, the College will have added more than 400,000-squarefeet of usable space on the eight-acre campus. A camera is streaming images of the College’s ongoing construction at www.stlcop.edu/construction.

About St. Louis College of Pharmacy: Founded in 1864, St. Louis College of Pharmacy is the region’s only independent college of pharmacy. The College is the third oldest continuously operating and 10th largest college of pharmacy in America. Founded by luminaries such as Henry Shaw, St. Louis College of Pharmacy has been partnering with other recognized leaders to care for the health of our region’s citizens for 150 years. Located in the heart of one of the world’s finest biomedical research and patient-care centers, the College provides innovative education, research, and career opportunities for students. The College is viewed by leaders of other premier academic and health care organizations as a critical component needed to deliver high quality patient-centered care. The curriculum integrates the liberal arts and sciences alongside introductory and advanced practice experiences where students can develop expertise

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A million Chicagoens have no corner drugstore

Million Dollar Gift Lays Groundwork for New Lab Space A $1 million donation to the College of Pharmacy will turn its old compounding laboratory into something new.

The Foglia Family Foundation provided the gift to renovate the college’s aging laboratory, where students learn how to develop and test combinations of active pharmaceuticals and delivery systems for new formulations so that the ingredients are effective, stable, easy to use and acceptable to patients. And the new space promises to launch a new era for the College, its faculty and students.

“This lab will place a big focus on modern formulations and where pharmacy is going,” Dean Jerry Bauman says.

The new laboratory will feature compounding stations for 40 students and modular elements to encourage greater collaboration among students and faculty.

“This should give everyone more elbow room and result in greater student-faculty interaction,” says Associate Professor of Biopharmaceutical Sciences, Paul Pluta.

IV solutions, chemotherapy drugs and hazardous drugs, as well as non-sterile dosage forms such as capsules, liquids and semisolids.

It will also feature new technology, such as IT capabilities for students to quickly access reference information and video technology for teaching applications and monitoring student techniques. In addition, it will enable comprehensive attention to both sterile dosage forms, such as

The new multi-functional laboratory will better prepare all College of Pharmacy students for the industry’s current realities and help them become more aware of critical real-world pharmacy practice details.

Construction is expected to begin in summer 2016.

Rosalind Franklin University Graduates Its Inaugural Class!

Rosalind Franklin University of Medicine and Science (RFU) graduated its first College of Pharmacy class on Friday, June 5 at the University’s 101st commencement ceremony. The celebration was shortly followed by another milestone when the Accreditation Council for Pharmacy Education awarded the college full accreditation status at its June meeting.

Graduation took place at the University of Illinois Chicago Pavilion, where 58 PharmD graduates walked alongside nearly 600 Rosalind Franklin University MD, DPM, DPT, PhD and MS degree recipients. The ceremony celebrated the RFU culture of interprofessionalism, which was the subject of remarks by President and CEO K. Michael Welch, MB, FACP. “During your years of graduate study at RFU,” Dr. Welch said, “you have engaged in an intentional interprofessional learning experience which makes you poised to be leaders in collaborative, interprofessional healthcare teams.”

The commencement address was delivered by William E. Evans, PharmD, past president and CEO of St. Jude Children’s Research Hospital in Memphis, who was awarded an honorary Doctor of Humane Letters.

Dr. Evans emphasized the diversity in career paths afforded by a PharmD degree as he reflected on his own career in research, academia and management.

“This great education is the foundation for what you are commencing in your personal and professional life,” Dr. Evans said. “You need to know you are very well prepared for these challenges and don’t be worried. Be open to receiving and being a part of that change.”

In keeping with RFU tradition, graduates were given the opportunity to invite a faculty mentor, family member from the profession, or RFU alumni to accompany them as they received their diploma. Two Pharmacy faculty members accompanied three of the College’s graduates across the stage. Douglas Anderson, MD, alumnus of RFU’s Chicago Medical School and professor at Loyola Medical Center in Maywood, was also given this honor by his daughter in-law and now fellow RFU alumni, Morgan Anderson, PharmD. Visit www.rosalindfranklin.edu/cop for additional information about RFU’s accreditation staus and to learn more about the commencement and the exciting accomplishments of the Class of 2015.

Caption: Members of the College of Pharmacy Class of 2015 celebrate at the Rosalind Franklin University of Medicine and Science commencement.

Pharmacists Mutual Releases Second Quarter Financial Results For the quarter ending June 30, 2015, Pharmacists Mutual Insurance Company reports increased premiums written, net income, and surplus as of June 30, 2015. These results have been filed with the Iowa Insurance Division.

A summary of Pharmacists Mutual’s second quarter financial results is shown below: (in millions)

Direct Written Premium Net Earned Premium Net Underwriting Income Net Investment Income Net Income Surplus Change Surplus

Quarter Ending June 31 2015 2014 $28.7 22.6 (.2) 1.6 1.4 .5 99.5

$27.5 21.5 .6 1.3 1.7 2.0 93.1

Treasurer and CFO Kevin Banwart commented “Pharmacists Mutual realized growth in both premiums and

policies insured during the quarter. Despite significant weather events in April, the Company has strong earnings and growth in surplus for the year. In addition, the Company implemented a new claims administration system on April 27th. This system is integrated with our new policy administration system and will allow our claims staff to process claims more effectively.”

According to Ed Yorty, President and CEO, the company has now resolved the claims related to New England Compounding Center and related policies, and the plan has been approved by the presiding judge. Yorty commented, “While our reinsurers paid the large majority of the amount, we are happy to have a resolution to this matter for the company’s sake and for the victims.”

Please note that management believes all of the information provided to be true. However, the amounts shown have not been audited.

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PAGE 29

Thanks to the following for their generous

IPPAC

With your help, the IPhA Foundation helps pharmacists and student pharmacists be the best practitioners and leaders in healthcare.

contributions in 2015:

Hank Gould Garth Reynolds John Velk Marlin Weekley

Thanks to the following for their generous contributions in 2015: Executive Level ($1000+)

Marlin Weekley Director Level ($250 - $999)

Eric Bandy Anthony Budde Ben & Katie Calcaterra Beaux Cole

Jeff Ellis Starlin Haydon-Greatting Jason Kasiar Tim Lehan Randy Malan Garth Reynolds Tom Rickey Cindy Russell Harry Zollars

Sponsor Level ($100 - $249)

Tim Gleason Hank Gould Mary Lee Laura Licari Dennis Mensinger

Donor Level (up to $99)

James Shafer John Velk

Name/Address Pledge Form I wish to support the IPhA Foundation goal of providing support in the form of grants, scholarships, and professional expertise for pharmacist delivered patient care initiatives designed to optimize patient health outcomes, student participation in IPhA activities, and the preservation and promotion of the history of pharmacy in Illinois. q A single contribution of: $ __________ q Please charge my credit card $___________ for 1 year. q Please charge my credit card $___________ until I notify otherwise.

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Contributions to the IPhA Foundation, a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code, are deductible for computing income and estate taxes.

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Visit the bookstore at www.ipha.org!

“i’M AlWAyS WAtChing Out fOr My PAtientS, but whO’s watChiNg Out fOr Me?”

we are.

We are the Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization.

Our Pharmacy Quality Commitment (PQC) program helps you implement and maintain a continuous quality improvement program that offers strong federal protection for your patient safety data and your quality improvement work. PQC also helps you comply with quality assurance requirements found in network contracts, Medicare Part D, and state regulations. We offer flexible and powerful tools, ongoing training and support to keep your pharmacy running efficiently, and most importantly, to keep your patients safe.

LearN MOre: Call toll free (866) 365-7472 or visit www.pqc.net PQC is brought to you by your state PharmaCy assoCiation