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A Peer-Reviewed Journal | Vol. LXXIII, No. 1 | JAN.FEB.MAR 2017

CELEBRATING A LEGACY OF LEADERSHIP Thomas R. Temple Leadership Endowment Completion Celebrates Tom’s Vision & Legacy for Pharmacy Leadership Development

INSIDE: Board of Trustees Election Naloxone Dispensing 2017 Legislative Priorities

TABLE OF CONTENTS 8515 Douglas Avenue, Suite 16, Des Moines, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: |

PUBLICATION STAFF David Schaaf, Managing Editor Kate Gainer, PharmD Anthony Pudlo, PharmD, MBA, BCACP Laura Miller Sarah Derr, PharmD

COVER STORY Celebrating a Legacy of Leadership pg. 42

Completion of the Thomas R. Temple Leadership Endowment ensures Tom’s vision of building pharmacy leaders continues into perpetuity.

OFFICERS CHAIRMAN Bob Greenwood, RPh, Waterloo PRESIDENT Rick Knudson, PharmD, BCPS, MS, MBA, Clear Lake PRESIDENT-ELECT Craig Logemann, RPh, BCACP, CDE, Ankeny TREASURER Sue Purcell, RPh, Dubuque SPEAKER OF THE HOUSE Susan Vos, PharmD, FAPhA, Iowa City VICE SPEAKER OF THE HOUSE Steven Martens, PharmD, Grundy Center

TRUSTEES REGION 1 Christopher Clayton, PharmD, MBA, Manchester REGION 2 Ryan Jacobsen, PharmD, BCPS, Iowa City REGION 3 Rachel Digmann, PharmD, BCPS, Ankeny REGION 4 Jerod Work, PharmD, Sioux Center AT LARGE Jessica Frank, PharmD, Winterset Nora Stelter, PharmD, CHWC, Urbandale Brett Barker, PharmD, Nevada Stevie Veach, PharmD, BCACP, Tiffin HONORARY PRESIDENT Jane DeWitt, RPh, Iowa City PHARMACY TECHNICIAN Meg Finn, CPhT, North Liberty STUDENT PHARMACISTS Nick Vollmer, Drake University Casey O’Connell, The University of Iowa The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see “The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) publishes 4 issues per year: January/ February/March issue; April/May/June issue; July/August/ September issue; and October/November/December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices. POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly, The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by ColorFx; Graphic design done by the Iowa Pharmacy Association.

Making an Impact with IPPAC See how and why IPA uses this important advocacy tool. pg. 32

2017-2018 Board of Trustees Election Preview the candidates before you cast your ballot. pg. 7


IPA Board of Trustees Election . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Feature: How Pharmacists Can Impact the Quality Payment Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Midwest Pharmacy Expo Preview . . . . . . . . . . . . . . . . . . . . . . . 12 Naloxone Dispensing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 IPA Committee Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Deans’ Columns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Make an Impact with IPPAC . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Celebrating A Legacy of Leadership . . . . . . . . . . . . . . . . . . . . . 42


President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 IPA Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. JAN.FEB.MAR 2017 |



MISSION, VISION & VALUES Rick Knudson, PharmD, MS, MBA, BCPS Clear Lake, Iowa IPA President


ave you looked at IPA’s new strategic plan for 2016-19? I think that it is important that each of us as pharmacy professionals be aware of the core aspects for which our association stands. This year I have been talking with you about moving from gaining provider status to being patient care providers. I think it is only fitting that we take a look at IPA’s mission and vision statements as well as the association’s core values to see how IPA supports our provider status efforts. In addition, each of us can better see how we can help support IPA.

IPA’s Mission Statement:

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. Well, you can’t get much more patient and outcome centered than that! As pharmacy professionals it is our job to make sure that we support all aspects of the patients we serve. This, of course, includes medication therapy but also includes many other aspects of patient care. That is why the new strategic plan speaks to health outcomes rather than just a narrower focus on medication outcomes.

IPA’s Vision Statement:

The Iowa Pharmacy Association is an influential voice representing pharmacy professionals in Iowa. We provide essential services and information, advance the profession, and improve patient care and health


| The Journal of the Iowa Pharmacy Association

outcomes through advocacy, leadership, collaboration, education, and innovation. These items are the core components of what our association provides to and for us. If you think about the programs and services in which IPA invests time and resources you will find that each of them, in one way or another, fit under at least one of these core areas. We, as IPA members, should be thinking about what actions we should take (both formal and informal) to support this mission. I want to explore each of IPA’s values statements a little more in-depth. Maybe that will inspire each of us to live those values a little more fully. Collaboration: Seek opportunities to partner with key stakeholders to achieve common goals and tackle healthcare challenges. Collaboration comes in many forms: collaboration with other pharmacists, other providers, civic groups, organizations, and the list goes on. It is often through collaborative efforts when we truly show the value and benefit that pharmacist can bring to the table. I think about IPA helping to catalyze the Community Pharmacy Enhanced Service Network (CPESN) here in Iowa. I think about collaborative efforts in areas such as the pioneer ACO collaborative. How have you collaborated to drive pharmacy practice forward? Advocacy: Promote the value of the pharmacy profession to payers, policy makers and patients and enable our members to do the same. One of the most important aspects of IPA’s purpose is to advocate for the profession. One major way in which this occurs is through grass roots

legislative advocacy activities with the state legislature. It is often said that “health care is local” and never is that truer than in the oversight of health care – driven by our state legislators. Do you have a personal relationship with your elected officials? Do they know who you are? If you communicate our professional issues to them, will they listen? It is important to build those relationships now so that you can help IPA advocate on behalf of all pharmacists. Innovation: Strive for excellence by actively pursuing “what’s next” for pharmacy practice. Innovation is key to the success of any endeavor. What we have done in the past is certainly not the recipe for success in the future. IPA works to foster innovation. The Outcomes Innovative Pharmacy Grant program which is sponsored by the IPA Foundation is but one example of IPA’s dedication to innovation in pharmacy practice. How have you been innovative in your own practice or how have you utilized IPA to assist in that process? Education: Provide high quality educational resources and opportunities to equip an engaged and innovative membership. Lifelong learning is essential in the practice of pharmacy. IPA takes great pride in providing some of the highest quality educational opportunities of any pharmacy association out there. The Midwest Pharmacy Expo, of which IPA was the founding organization, is but one example. Have you taken advantage of IPA’s offerings? Engagement: Cultivate a culture that drives members to be actively engaged

PRESIDENT’S PAGE within their profession and provide them with opportunities to make an impactful contribution. Engagement of pharmacists across the state in IPA is essential. It is essential for the health and vibrancy of IPA but even more importantly it is essential to the success of pharmacy practice in the state of Iowa. There are a multitude of ways that you can become engaged: committees, education sessions, face-toface meetings, or simply renewing your membership. These are key ways that all pharmacists can and should be engaged in IPA’s mission. Leadership: Invest in the future of the pharmacy profession by nurturing leaders and innovators who inspire others to transform the profession.


Leadership is a key component of both our association but also of our profession as a whole. Leaders create an environment where all of the other values that we have already spoken about can thrive and grow. Leaders dedicate their time and talents in any number of ways. Remember, not all leaders start with a capital “L”… sometimes the most influential leaders are those with the little “l”. Have you been a leader in our association? Positive Patient Outcomes: The health and safety of the patient is at the core of everything that the profession and this association does, guided by the principle of “if it’s good for the patient, it’s good for pharmacy.”

became pharmacy professionals and members of IPA. The patient. We must always put the patient and their welfare first. When we do that we can always rest assured that we are moving in a positive direction. This is why a focus on patients is a key aspect of IPA’s new strategic plan. As you can see, IPA’s strategic plan is a very focused effort to crystalize the association’s purpose. It gives guidance to IPA’s staff and officers as well as to each of you, its members. I encourage all of you to be familiar with the strategic plan and use it as a barometer of both the association’s progress and movement as well as your own! ■

Finally, we must never forget the central and most important reason that we all

June 16-17, 2017 Coralville Marriott Hotel & Conference Center Join your pharmacy colleagues from across the state to participate in the policy adoption process in the House of Delegates, Annual Award Presentations, quality speakers, and GREAT networking with pharmacy leaders!

JAN.FEB.MAR 2017 |



BOARD OF TRUSTEES ELECTION ELECTRONIC BALLOTS WILL BE SENT THURSDAY FEBRUARY. 3, 2017. Each candidate’s personal statement and bio will be available online with the electronic ballots. All IPA Pharmacist members vote for all elections. Ballots will close Tuesday, February 14 at 12:00 midnight.

To request a paper ballot, contact the IPA office at 515-270-0713.


Craig graduated with his Bachelor Degree in Pharmacy from the University of Iowa. Following his pharmacy practice residency at the University of Iowa Hospitals and Clinics, he was a hospital pharmacist in St Paul for six years. During that time, he received his Doctor of Pharmacy degree from the University of Minnesota. In 1995, he returned to Iowa and was family medicine faculty with the University of Iowa and Iowa Lutheran Hospital Family Practice Residency. Since 2004, he has provided clinical pharmacist services at various family medicine clinics with UnityPoint Clinics (currently at Urbandale and Ankeny). He has provided leadership in advancing medication therapy services within UnityPoint Health. He is an adjunct professor with colleges of pharmacy at The University of Iowa and Drake University. Craig has served on various committees with the Iowa Pharmacy Association over the past 18 years, including the Professional Affairs and Public Affairs Committees. He served as Vice Speaker and Speaker of the House of Delegates from 2008-2010. He has also been a speaker at many of the IPA continuing education programs. In 2005, he received the Innovative Pharmacist Award from the association. Craig is a member of American College of Clinical Pharmacy, American Diabetes Association, American Association of Diabetes Educators and Christian Pharmacists Fellowship International. He is Board Certified in Ambulatory Care Pharmacy, Certified Insulin Pump Educator and a Certified Diabetes Educator.


Cheryl Clarke, BS Pharm, RPh, FAPhA, is assistant dean for clinical affairs and associate professor of pharmacy pactice at the Drake University College of Pharmacy and Health Sciences. She administers the experiential education programs for the Doctor of Pharmacy, Occupational Therapy Doctorate, and undergraduate health sciences programs. Prior to joining Drake, Clarke served in a variety of roles at the Iowa Pharmacy Association (IPA) including senior vice president of professional and public affairs. During her tenure at IPA, she administered the IPA policy process, directed the drug utilization review programs for clients such as Iowa Medicaid, and supported the development and implementation of patient care payment models including the Iowa Medicaid Pharmaceutical Case Management program. Clarke is a 1986 graduate of the Drake University College of Pharmacy and is currently completing the Doctor of Education Leadership program at Drake University. Clarke is an active member of a variety of professional associations including IPA where she has served on the board of trustees, policy committee chair, house delegate, and numerous committees. She was co-chair of the IPA/Iowa Board of Pharmacy Patient Safety Task Force and a former member of the State of Iowa Pharmacy and Therapeutics Committee. Clarke is past president of the Iowa Rural Health Association and recipient of its Jerry Karbeling Award. Clarke is an APhA-APPM Fellow of the American Pharmacists Association and has served on various APhA policy committees and as a house delegate.

CoraLynn Trewet, MS, PharmD, BCPS, CDE Ankeny

CoraLynn B. Trewet attended Drake University graduating with her Doctor of Pharmacy degree and then completed a Practice Management Residency where she also obtained her Masters in Pharmacy Administration from the University of Kansas. Currently, she is a medical science liaison with Sanofi specializing in diabetes. Prior to this, she enjoyed several years as an Associate Clinical Professor of Family Medicine for The University of Iowa. Dr. Trewet is a Board Certified Pharmacy Therapy Specialist (BCPS) and a Certified Diabetes Educator (CDE). She was named Iowa’s Distinguished Young Pharmacist of the Year in 2011 and is a fellow of the National Lipid Association and American Pharmacists Association. She has been an active volunteer with state and national associations working to advance the profession of pharmacy. She was called upon for her clinical expertise as she represented the American Pharmacists Association (APhA) as a member of a NHLBI/NIH committee for approval and dissemination of the most recent cardiovascular guidelines. She has been a speaker at various regional and national meetings in various clinical and adult learning topics. She has a passion for making things better.

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William Baker, BS Pharm Iowa City

William Baker received his BS Pharmacy Degree from The University of Iowa College of Pharmacy in 1979. In 2007 Bill completed Executive Certificate Programs at Wharton School for Business in Marketing and Executive Management for Pharmacy Leaders. After graduation in 1979, Bill worked as a staff pharmacist for two pharmacies in eastern Iowa and as a pharmacy manager for 20 years for Osco Drug in the Iowa City area. He is a Certified Diabetes Educator and was the regional coordinator for the Osco Drug Diabetes Care Program from 1997 – 2001. In 1998 Bill received the American Stores - President’s Excellence Award for his work in Patient Care Programs. In 2000, he took a full time position as manager of clinical programs for Osco Drug, responsible for developing and implementing various programs across the enterprise. In 2003 Bill moved in to a marketing role supporting the pharmacy initiatives and in 2008 began a position in human resources as a manager of regional recruiting and college relations for the parent company Supervalu. Bill began his current role as district pharmacy Supervisor for CVS/Health in 2011, overseeing the retail pharmacy operations for 26 pharmacies operating in four states (IA, IL, ND and MN).


Carol Anderson, PharmD Mason City

Carol earned her BS in Pharmacy from NDSU and Pharm D from the University of Iowa. She works as a clinical pharmacist at Mercy Medical Center- North Iowa in Mason City, where her responsibilities include serving as a scientific member of IRB, writer/editor of P&T’s monthly newsletter, and liaison to P&T regarding anticoagulation management from a systems and safety standpoint. Her clinical duties range from rounding with the Hospitalist service, Cardiology team or ICU team to serving as a Cancer Center pharmacist. Her participation at IPA includes service on the Health System Liaison Board and has served for several years in the House of Delegates. She has also twice served as President of North Iowa Pharmacy, Inc. She is a long-time member of IPA, North Iowa Pharmacy, Inc, and ASHP.

Bill has continued a strong relationship with The University of Iowa College of Pharmacy as an adjunct professor as well as a clinical instructor from 1990 – 1994. He has also served on several boards and committees at the college, including the Diversity Committee, Curriculum Committee and Alumni Board. Bill has served on various IPA committees and the IPA Board of Trustees and a delegate.

Thane Kading, RPh Iowa City

Thane Kading, RPh has been active in pharmacy practice for over two decades. She received her BSPharm from The University of Iowa in 1995. After graduation, she worked as a hospital clinical pharmacist in Illinois for two years. As a hospital pharmacist she was able to help implement new pharmacy driven programs (pharmacokinetic dosing, renal adjustment dosing, IV to PO conversion, and decentral pharmacist rounding on ICU/CCU) with support from the P&T committee and her pharmacy director. After relocating to Iowa City, she joined the Hy-Vee team in 1997 as a staff pharmacist. Shortly after, in 1999 she started Hy-Vee’s first Immunizing Pharmacy. In 2005, she was promoted to the first Clinical Pharmacist & Residency Coordinator for Hy-Vee, Inc. Kading also works at the Community Health Free Clinic in Cedar Rapids, running their Diabetes Management Program. She received her Certified Diabetes Educator (CDE) Certificate in 2010. Kading currently works on developing and implementing clinical programs for Hy-Vee, Inc. including but not limited to: expanding travel health services, implementing state wide protocols for naloxone, coordinating smoking cessation programs for Hy-Vee employees, and designing best practice models for MTM. Kading provides local travel consultation services to patients in collaboration with a medical practice and became the first Iowa Pharmacy to carry Yellow Fever Vaccine in 2013. She is currently adjunct faculty member with the University Of Iowa College Of Pharmacy, precepting students and residents at her practice site. Kading currently serves on the IPA Legislative Committee.


| The Journal of the Iowa Pharmacy Association

Megan Snyder, PharmD Breda

Megan Snyder received her Doctor of Pharmacy degree from Drake University in 2010. Megan has been employed as a pharmacist at Stewart Memorial Community Hospital (SMCH)/Community Pharmacy in Lake City, IA for the past 4.5 years. Her current job responsibilities include medication reconciliation, patient education, medication therapy management, and medication adherence counseling. She also serves as the vaccination coordinator for the community pharmacies, presents at community outreach programs, and is a member of the State Innovation Model (SIM) care coordination team and Patient Family Advisory Committee at SMCH. She is an IPPE and APPE preceptor for Drake University and South Dakota State University. She also volunteers her time as a pharmacist in Nicaragua for 1 week intervals– this coming spring will be her 3rd mission trip to Nicaragua. Megan is an active member of the IPA and has served on a policy committee (1 term) and on the Health-System Liaison Board (3 terms). She is also a past participant of the Leadership Pharmacy Conference (2012).


Nancy Bell, PharmD West Des Moines

Nancy Bell is a medical outcomes specialist for Pfizer in Iowa and Nebraska. She works with payers and large health care delivery systems to improve the quality of healthcare. Nancy has been active in several public health issues including a recent task force on opioid and heroine abuse. She has worked with various advocacy groups on smoking cessation policies and efforts in the state and served for a number of years on the State of Iowa Task Force for Antibiotic Resistance, for which she received the Director’s Award of Merit from the Iowa Department of Public Health. Prior to Pfizer, Nancy worked for the clinical services division of IPA, working most notably with the Iowa Medicaid drug utilization review and prior authorization programs. She has also worked as part of a team delivering quality care to patients in a staff model HMO setting with John Deere Health Care and has 5 years’ experience as a community pharmacist. Nancy graduated from Drake University with a Bachelor of Science in Pharmacy in 1990 and received her Doctor of Pharmacy at the University of Kansas in 2004. Nancy has served in various capacities with IPA and is a past participant of Leadership Pharmacy. She has been very involved at Drake supporting the Curriculum Committee, the National Advisory Board to the College of Pharmacy, student interviews, student shadowing. Nancy was honored by the Pharmaceutical Manufacturers of America in 2016 with the We Work for Health Award for going beyond her role with Pfizer for her activities with IPA, Drake, and various public health initiatives.

Heather Ourth, PharmD, BCPS, CGP Ackworth

Heather Ourth is the pharmacy benefits management national program manager for clinical pharmacy practice program and outcomes assessment with the Department of Veterans Affairs. In this role, Dr. Ourth’s work has an emphasis on program development, implementation and outcomes/impact assessments designed to evaluate the impact of clinical pharmacy services on the costs and quality of patient care. She also works to identify proven, innovative roles for pharmacists, lead clinical pharmacy health services research and quality improvement projects, author numerous publications, and apply pharmacoeconomic principles to support VA initiatives in this area. In 2015, Heather was appointed to the IDPH Medication Safety Steering Committee. Heather received her BS in Pharmacy from Ferris State University in 1995 and her Doctor of Pharmacy Degree from the University of Florida in 2007. Dr. Ourth was a past recipient of the VA Under Secretary for Health Pharmacy Benefits Management Innovation Award, the National Alliance of State Pharmacy Associations’ (NASPA) Excellence in Innovation Award and the Michigan Distinguished Young Pharmacist Award. Dr. Ourth is a long-standing member of IPA and other professional associations including ASHP, ACCP, and APhA. Heather has served IPA as a member of the Policy Committee on Professional Affairs for 4 years and is providing leadership as the Chair this year. She has also served on the Education Advisory Committee for three years, the Membership Task Force and is a past participant in the IPA Leadership Pharmacy Conference.


John Hamiel, PharmD Waterloo

John Hamiel is the regional director of pharmacy for the Wheaton Franciscan Healthcare facilities in Iowa. He is based out of Covenant Medical Center in Waterloo, Iowa. Dr. Hamiel oversees the pharmacy operations of three hospitals and three retail stores in the WaterlooCedar Falls area. He received his PharmD degree from The University of Iowa in 1997 where he also served as a member of Rho Chi, the College of Pharmacy’s Curriculum Planning Committee, and was an inaugural member of Dr. Henri Manasse’s PSAP program to encourage cooperation between the students of the various Colleges of Healthcare. Dr. Hamiel is a past recipient of The University Of Iowa College Of Pharmacy’s Hospital Preceptor of the Year award. He has also served as a member of ISMP’s nation-wide Forum on ADU Safe Practices. John Hamiel is currently involved with establishing a 340B program, CPOE, PGY1 Residency Program, Smart Pumps, and inventory management systems in his current location. His interests include antibiotic stewardship, using technology to promote patient safety and workplace efficiency, increasing technician roles, and strengthening pharmacy education at all levels.

Deanna McDanel, PharmD, BCPS, BCACP Coralville

Deanna McDanel is a clinical pharmacy specialist in ambulatory care at the University of Iowa Hospitals and Clinics (UIHC) and a clinical associate professor with the University of Iowa College of Pharmacy (UICOP). She obtained this position after graduating with her PharmD degree from the UICOP in 2001. Deanna subsequently completed a Specialized Residency in Primary Care at the UIHC in 2002. Over the past 15 years, she has served as a clinician in the Anticoagulation and Allergy/Immunology Clinics, and has worked in geriatrics and internal medicine. In 2007, Deanna became the UIHC PGY2 Ambulatory Care Residency Program Director and Coordinator of the PGY1 Pharmacy Residency with a focus in Ambulatory Care. She obtained her BCPS in 2004 and BCACP in 2012. As a clinical professor, she has actively taught and precepted hundreds of students. Deanna and her ambulatory care colleagues were recognized as Faculty Preceptors of the Year in 2008. She was honored with the 2015 National Master Preceptor of the year award from AACP and the UICOP Teacher of the Year award for 2nd year professional students in 2012 and 2016. She recently received the Genesis Alumni Award from the UICOP in 2016. IPA has been a part of her career since 2001. She has served as a Policy Committee member for 7 years, including vice-chair and chair of the Policy Committee on Public Affairs in 2013 and 2014, respectively. She has served as an IPA House delegate for 7 years and was selected as a participant of the 2004 Leadership Pharmacy Conference. She maintains active membership within numerous other pharmacy organizations and has had multiple leadership roles. JAN.FEB.MAR 2017 |



HOW PHARMACISTS CAN IMPACT THE QUALITY PAYMENT PROGRAM Katy Brown, PharmD Clinical Pharmacy Specialist QIN-QIO Multi-State Task Lead Medication Safety and Adverse Drug Event Prevention Telligen

Lyndsay Fluharty, MA Senior Marketing and Communications Consultant Telligen

Below is a follow up article to last quarter’s Journal cover story “The Medicare Quality Payment Program: Who, What, When, Why & How”


n the last issue of the Journal of the Iowa Pharmacy Association (Vol. LXXII No. 4), Telligen Quality Innovation Network - Quality Improvement Organization (QIN-QIO) provided an overview of the Centers for Medicare and Medicaid Services’ (CMS) Quality Payment Program (QPP) that begins January 2017. The purpose of the QPP is to give clinicians the tools and resources they need to serve the more than 55 million Americans who receive healthcare through Medicare. The QPP is a shift to high-value, patient-centered care over volume. The program is designed to reimburse physicians and other eligible clinicians participating in Medicare Part B and provide them with the opportunity to earn payment incentives based on evidence-based and practice-specific quality data. Both clinicians and pharmacists will benefit from understanding the details of the QPP, but even more importantly, the patients will benefit by receiving better quality healthcare due to reporting of a new performance category, Improvement Activities*, introduced by CMS. These activities reward eligible clinicians for


| The Journal of the Iowa Pharmacy Association

care focused on care coordination, beneficiary engagement, and patient safety. By aligning the Improvement Activities with the quality measures, clinicians should see better patient outcomes more rapidly. Although the QPP is intended for clinicians, Telligen recognizes there are opportunities for pharmacists to assist in these quality measures and Improvement Activities. Through collaborate efforts, pharmacists and clinicians can work together to help their patients manage diseases and help prevent medicationrelated adverse events. This article will identify a few examples specific to quality measures in which pharmacists can actively contribute. By understanding the quality measures and Improvement Activities*, pharmacists can work more closely with physicians and become an integral part of patient care. The following quality measure summaries are examples in which pharmacists can assist clinicians in meeting their reporting quality goals. • Anti-depressant Medication Management: Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. • Controlling High Blood Pressure: Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period. • Hemoglobin A1c Poor Control (Diabetes): Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. • Medication Reconciliation Post-Discharge: The percentage of discharges from any inpatient

facility for patients 18 years and older of age seen within 30 days following discharge for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record. • Opioid Therapy Follow-up Evaluation: All patients 18 and older prescribed opiates for longer than six weeks duration who had a follow-up evaluation conducted at least every three months during Opioid Therapy documented in the medical record. • Use of Appropriate Medications for People with Asthma: The percentage of patients 5-64 years of age who were identified as having persistent asthma and were dispensed appropriate medications that they remained on for at least 75% of their treatment period. • Use of High Risk Medications in the Elderly: Percentage of patients 66 years of age and older who were ordered high-risk medications. The shift towards patient-centered care, which is a key element of the QPP, allows pharmacists to bring needed skills and knowledge to a patient’s care by assisting with medication management. As part of the QIN-QIO program**, Telligen supports these efforts through medication safety and an antibiotic stewardship program. Please contact the authors if you have any additional questions. If you have questions about QPP, visit Telligen’s website www. or CMS’s QPP home page at If you would like to learn more about the work Telligen is doing in Iowa, please visit *more information found at ** more information found at http://


Trump Appoints the Next HHS Secretary President Donald Trump has selected Representative Tom Price as the next Health and Human Services Secretary. Rep. Price is an orthopedic surgeon who has served as a Republican Congressman for six terms. He has introduced bills offering detailed and comprehensive replacement plan for the Affordable Care Act in every Congress since 2009. Many of Rep. Price’s ideas have been included in the “Better Way” agenda that was issued in the House of Representatives months ago.

Updated Statin Recommendation from USPSTF The US Prevention Services Task Force (USPSTF) has released statin recommendations that expand upon the ACC/AHA recommendations released in 2013. The USPSTF suggests consideration of statins therapy for all patients between ages 40 and 75 with a calculated 10-year risk of cardiovascular event of 10% or greater and at least one of the following risk factors: high cholesterol, high blood pressure, diabetes, or a history of smoking. These recommendations also note that those with lower risk may benefit from taking a daily statin. The evidence review also found “no increase in risk” for side effects including “muscle pain, liver problems, memory issues, or diabetes.”

Substance Addiction Common and Undertreated The U.S. Surgeon General issued a report titled Facing Addiction in America: The Surgeon General’s Repot on Alcohol, Drugs and Health in November. This is the first report issued by a surgeon general on substance abuse. The report states that one in seven Americans will face substance addiction in their lifetime. Unfortunately, only 10% of those who

are now addicted receive treatment. The report addresses alcohol, illicit drugs, and prescription drug misuse and dedicates sections to neurobiology, prevention, treatment, recovery, health system integration and recommendations for the future.

President Obama Signs Innovation in Research and Drug Development Legislation On December 14, 2016, President Obama signed the bipartisan 21st Century Cures Act into law. The $6.3 billion bill aims to increase funding for medical research (including cancer, drug addiction and mental health), speeds the development and approval of experimental treatments and renovates the federal policy on mental health care.

20 States Accuse Generic Drug Companies of Price Fixing Twenty state attorney generals, including Iowa, filed an antitrust lawsuit on December 15, 2016, accusing six drug makers of generic drug price fixing. The lawsuit named manufacturers Teva, Mylan, Aurobindo Pharma, Citron Pharma and Mayne Pharma and focused on two medications, doxycycline hyclate and glyburide. The lawsuit stems from an investigation in Connecticut in July 2014 which uncovered evidence of a longrunning series of schemes to fix prices on a number of generic pharmaceuticals in the United States.

FDA Updates ‘Do Not Compound’ List of Drugs

Abuse-Deterrent Formulation Effectiveness Unproven An investigation by the Associated Press and the Center for Public Integrity has revealed that drug manufacturers are seeing billions in sales of abuse-deterrent formulations (ADFs). The report states that little evidence exists that prove ADFs prevent overdose or death. The CDC is taking a careful approach – promoting the promise of ADFs while acknowledging the limited effectiveness data. Meanwhile manufacturers are taking advantage of the opportunity afforded by the newlypatented, higher-priced formulations.

Ebola Vaccine Shows 100% Effectiveness Rate Trials of an experimental Ebola vaccine from Merck are showing 100% effectiveness against the virus. The vaccine rVSV-ZEBOV (Merck Sharp & Dohme) is a recombinant replication competent vesicular stomatitis virus-based vaccine that expresses a surface glycoprotein of the Zaire strain of Ebola virus. In tests in Guinea and Sierra Leone, researchers gave a single intramuscular dose to people who had been in contact with a newly diagnosed Ebola patient. Over 2,100 people were vaccinated with no cases of Ebola occurring 10 days or more after randomization. Though the vaccine has yet to be approved by the FDA or other agency, an emergency stockpile of 300,000 doses have been created in case of another outbreak. ■

The FDA posted a final rule that updates the list of drug products that may not be compounded because they have been withdrawn or removed from the market for safety or effectiveness reasons. The list applies to drugs compounded for human use and many items on the list have limitations.

JAN.FEB.MAR 2017 |


FEBRUARY 17-19, 2017 The Midwest Pharmacy Expo brings together pharmacists, pharmacy technicians and student pharmacists from across the Midwest for the region’s premier live CE event.


FEATURING: • Ambulatory Care Advancement Conference (Friday, February 17) • Saturday Keynote by Robert M. Chiusano, MBA

The weekend features high quality live continuing education, engaging networking opportunities, and inspiring keynote speakers in a professional and relaxed Midwest atmosphere.

• Four CE Tracks • Current Headlines • Clinical Pearls • Management • Technician • Sunday Favorites including Gamechangers & New Drug Update

15.5 hrs of CPE for Pharmacists & 10 hrs for Technicians including Patient Safety & Federal Law


Holiday Inn Des Moines-Airport & Conference Center 6111 Fleur Dr, Des Moines, IA 50321

Eat, sleep, park and enjoy Expo all in the same location!

Learn, Connect & Be Inspired with Your Colleagues from Across the Midwest! 12

| The Journal of the Iowa Pharmacy Association

EXPO SCHEDULE Friday, February 17, 2017

Ambulatory Care Advancement Conference 7:30-8:45 am 8:45–9:00 am 9:00–10:00 am 10:00–10:45 am 11:00–11:45 am 11:45 am–1:00 pm 1:00–2:30 pm 2:45–4:15 pm 4:15–4:30 pm 5:30-7:30 pm

Registration Welcome Keynote: “Navigating the Future: Advancing Ambulatory Care Pharmacy Practice” Quality Measures: How Pharmacists Can Make an Impact P Population Management P Lunch & Networking (lunch provided) Transitioning into Transitional Care P Best Practices for Documentation and Communication P Wrap-up and Adjourn Expo Welcome Reception

Saturday, February 18, 2017 Midwest Pharmacy Expo 6:30–8:30 am 7:00–8:15 am 8:30–9:00 am 9:00–10:00 am

Registration Industry Symposium Breakfasts Welcome Keynote: “Mediocrity is Not an Option” by Bob Chiusano P/T

10:15–11:15 am Session 1 What Lies Below the Surface: Unseen Risk in Your Ambulatory Patient on Chronic Opioid Therapy P/T Clinical Pearls: Diabetes P USP 800: What You Need to Know P 10 Habits of Highly Effective Pharmacy Technicians T 11:30 am–12:30 pm Session 2 Novel Oral Anticoagulant Reversal P Clinical Pearls: OTC Medications P Informatics: What is it and Where is it Going? P/T Clinical Pearls for Technicians: Diabetes T

12:30–2:00 pm

Lunch and Exhibit Hall

2:00–3:00 pm Session 3 Electronic Cigarettes: Clearing the Air P/T Clinical Pearls: Oncology P Mentoring vs. Managing P Time Management is really LIFE Management T 3:15–4:15 pm Session 4 Pharmacogenomics P/T Clinical Pearls: Pulmonary Medicine P Pharmacy Training: Bridging the Gap Between Student and Independent Practitioner P Clinical Pearls for Technicians: OTC Medications T 4:30–5:30 pm Session 5 Use and Misuse of Antibiotics: A Focus on Antibiotic Stewardship P Clinical Pearls: Mental Health P There Seems to be a Mistake with My Prescription P/T The Evolving Role of the Pharmacy Technician T 5:45–7:00 pm

Political Leadership Reception**

Sunday, February 19, 2017 Midwest Pharmacy Expo 6:30–8:00 am 7:00–8:00 am 8:00–9:30 am 9:45–10:45 am 11:00 am–12:30 pm

Registration Industry Symposium Breakfasts New Drug Update P/T How to Cut Your Compliance Risk in Half: The Top 10 Pharmacy Compliance Issues P/T Gamechangers in Pharmacy: 2016 P/T

P - accredited for pharmacists T - accredited for pharmacy technicians **Additional ticket purchase required

JAN.FEB.MAR 2017 |



BOP Podcast Now Accredited for Pharmacy Law CPE

IPA’s “BOP: What, Why & How” podcast is now accredited for pharmacy law CPE credit. Each of the six podcasts coming in 2017 qualifies for 0.025 CEU/0.25 hours. The CPE is available for free for IPA members as part of the CEI library included with their membership. Nonmembers may purchase the credit through CEI for a nominal fee (the podcast itself is free to listen to). For information on obtaining CPE and to listen or subscribe to the podcast, go to

First Part D Enhanced MTM Pilot Begins in Iowa

The Part D Enhanced Medication Therapy Management (MTM) model will conduct a 5-year pilot project to test whether providing Part D sponsors with additional payment incentives promotes enhancements in the MTM program and lead to improved therapeutic outcomes while reducing Medicare expenditures. OutcomesMTM has partnered with Humana, who is one of the five Part D payers participating in the Enhanced MTM program in Iowa, to provide eligibility for several new and enhanced MTM services via the OutcomesMTM Connect Platform. Services available on this platform include medication reconciliation, medication assessment for volatile medications (such as warfarin or insulin), comprehensive medication review (CMR), OTC Therapies (such as aspirin), inappropriate administration/ technique, and adherence monitoring.


| The Journal of the Iowa Pharmacy Association

At this point, IPA is only aware of this Enhanced MTM program utilizing the expertise of local pharmacists in 2017. Over the course of the five years, IPA would expect that the other Part D plans engaged in this pilot program will release details on their Enhanced MTM program.

advocacy and the medical society to continue the discussion around med sync and discuss how we can partner to obtain reimbursement for pharmacies who provide med sync services.

IPA Hosts Medication Synchronization Summit

IPA has created a workgroup to assist the Health-System Liaison Board in advancing the ASHP/ASHP Foundation Practice Advancement Initiative (PAI). The PAI is a nationwide effort to advance practice in hospitals and health-systems with a focus on ambulatory care services.

IPA gathered key stakeholders to discuss medication synchronization (med sync) in Iowa. Attendees at this statewide discussion included: patient advocacy groups, community pharmacists, industry partners, the Iowa Department of Public Health, and the Iowa Medical Society. This group had a lively discussion which focused on the current landscape of med sync in Iowa, the benefits, barriers and opportunities that exist with med synch, and next steps for IPA to consider in expanding med sync services. IPA plans to follow up with payers, patient

Practice Advancement Initiative Workgroup Formed

Part of the workgroup’s charge working with outpatient pharmacies and practitioners in Iowa to complete a self-assessment survey to establish a baseline and identify gaps in ambulatory care services compared to the recommendations from the ASHP Ambulatory Care Summit.

Iowa Reception at the APhA Annual Meeting

Join IPA, Drake University College of Pharmacy and Health Science and The University of Iowa College of Pharmacy and the rest of the Iowa pharmacy family at the Iowa Reception at this year’s APhA Annual Meeting at Exposition.

March 26, 2017 5:30-7:00 p.m. Hilton San Francisco Continental Ballroom 7/8/9 333 O’Farrell St, San Francisco, CA 94102 Join us to reconnect with colleagues and make new connections within the extended Iowa pharmacy family!


Information gathered from this survey will guide the workgroup in creating and implementing programs and services tailored to best serve Iowa practices with ambulatory care services.

Pill Dude 2.0 Now Available

NALOXONE DISPENSING BY STATEWIDE STANDING ORDER During the 2016 legislative session, IPA advocated for legislation to allow pharmacists to dispense the opioid antagonist naloxone. Following the passing of this law, the Iowa Board of Pharmacy and the Iowa Department of Public Health (IDPH) wrote rules to allow pharmacists to dispense naloxone under a statewide standing order issued by Dr. Patty Quinlisk, the medical director of IDPH. At the November 2, 2016 Iowa Board of Pharmacy meeting, the board passed these rules with emergency adoption to allow pharmacists to dispense the opioid antagonist naloxone following completion of pharmacist-specific training. The rules are effective immediately and allow pharmacists to dispense naloxone to emergency medical services and law enforcement as well as patients, caregivers, and persons in a position to assist. An assessment form must be completed with each request for naloxone, and a completed assessment form must be faxed to IDPH within seven (7) days.

Pill Dude, the mascot for the Iowa TakeAway program, has received a much-needed update. Two new costumes are now available for pharmacies participating in the TakeAway program for use in community outreach, health fairs, etc. Pill Dude was designed to draw attention to the TakeAway program and promote proper medication disposal. To rent a Pill Dude costume for an outreach event, contact IPA at 515-2700713 or ■

To participate, pharmacists must sign the statewide standing order and complete at least one hour of continuing education specific to naloxone. The Collaborative Education Institute (CEI) has created a free CE module based on Iowa’s naloxone rules which is available at or IPA has also created resources to assist pharmacists and pharmacies in implementing this rule and dispensing naloxone. Resources include: sample policy and procedures, payment guide, patient education brochures, and marketing materials. Additionally, IPA has recorded a short podcast and 2/2/2 with additional information. To access these resources, go to Other resources to educate pharmacists on these rules can be found on the Board of Pharmacy and IDPH websites.

Ready, Set, GO!

Resources are now available at that will help you...

Get Ready... • Board of Pharmacy Rules & FAQ • IDPH’s Statewide Standing order • IPA’s 2/2/2 Webinar & Podcast

Get Set... • Policy & Procedures Template • CEI’s Naloxone Training • Pharmacy Marketing Tools (including draft letter to the editor and flyers)

& Go • Payment Determination Flowchart • Patient/Caregiver Education JAN.FEB.MAR 2017 |



Advisory Committee on Medicaid & Pharmacy Benefits Programs

IPA Advisory Committee Reviews Wellmark ValueBased Pharmacy Program; Medicaid Managed Care On September 21, 2016, the committee met to discuss updates from Wellmark, Iowa Medicaid, the PCMA lawsuit, DIR fees, and other issues of concern. Matt Hosford, director of pharmacy at Wellmark, attended the meeting to discuss updates planned for Wellmark in 2017, including a new value-based formulary and medication synchronization. The Committee spent much of its time reviewing issues related to Medicaid managed care, and offered extensive feedback to IPA on means for improvement. A presentation was made by the Iowa CPESN luminaries about the current status of the pharmacist-led enhanced services network.


Recommendations of this Committee: • Collaborate with Wellmark to maintain ongoing implementation of their value-based pharmacy program • Advocate for appropriate compensation to pharmacies and coverage for patients for naloxone when administered under the statewide standing order • Encourage IPA members to continue to submit issues of concern regarding Medicaid managed care through the IPA online survey form • Educate IPA members on the need to continue to submit PBM complaints to the Iowa Insurance Division

IPA advisory committees provide guidance to the Board of Trustees and staff regarding specific practice areas. Committees meet at least once a year at IPA headquarters in Des Moines, and may be asked to provide feedback by email or conference call throughout the year. The following pages feature recaps from this year’s committee meetings include topics discussed and recommendations given.

Serving on a Committee

Serving on an IPA committee gives you the opportunity to influence the direction of the association and the advancement of pharmacy practice across the state. Each year, IPA’s president selects pharmacists, residents, pharmacy technicians and student pharmacists from a variety practice settings and areas of the state to serve on committees. See the list of committees at: IPA committees are formed in the late summer months. If you are interested in serving on a committee, contact Anthony Pudlo at or 515-270-0713.


| The Journal of the Iowa Pharmacy Association

Committee Members Kim Spading* Randy McDonough** Nash Albadarin Nancy Bell Connor Dierks Tom Donnor Jessica Frank Ryan Frerichs Mike Fuller Ryan Hannan Terry Jacobsen Mercy Macharia Dani Markus Chris Parker

Wes Pilkington Emily Prinz Mark Richards Heather Rickertsen Marshall Sanders Sarah Schmidt Jess Smith Jenny Tuttle Rochelle Yang


Health System Liaison Board

Education Advisory Committee

Hospital Practitioners Move Forward on PAI Strategies

Education Committee Meets Via Conference Call; Plans for Live Meeting after Expo

The IPA Health System Liaison Board (HSLB) convened on October 26, 2016, to discuss issues affecting the profession at a national level, the Iowa Board of Pharmacy, and statewide practice advancement initiatives. Among the many topics discussed were rising cost of medications, provider status, USP <800> and compounding practice, technician product verification (or Tech-Check-Tech), and hospital practice and ambulatory care self-assessment surveys. The Committee reviewed the efforts of HSLB sub-groups focused on expanding tools for antibiotic stewardship programs; developing critical access hospital residency programs; and addressing gaps in medication reconciliation procedures.

Newly formed in 2014, the 2016-2017 IPA Education Committee conducted its initial meeting on October 11, 2016 via conference call to discuss new ideas to address the educational needs of IPA members. The Committee spent much time discussing lessons learned from partnering with ASHP to offer BPS recertification sessions at the 2016 Midwest Pharmacy Expo. Due to a lack of interest from national associations to partner with IPA for future BPS recertification programming, the Committee sought to develop a survey to better understand the needs of BPS-certified pharmacists and the opportunity for IPA to offer study groups for the BPS initial or recertification exams. The Committee will reconvene after evaluations are collected from the 2017 Midwest Pharmacy Expo to discuss the format and educational programs needed for the 2018 Expo event.

Recommendations of this Committee: • Educate members on the tools and resources available to promote pharmacists as leaders in antimicrobial stewardship • Finalize a toolkit for development of critical access hospital residency programs • Pursue the ASHP Foundation state affiliate Practice Advancement Initiative (PAI) grant

Recommendations of this Committee: • Develop a survey that will be sent to members and other BPS-certified pharmacists to guide the development of a proposal to the IPA Board of Trustees for BPS study groups

• Collaborate with patient advocacy groups and other stakeholder groups to address concerns of the rising cost of medications • Engage the IPA grassroots advocacy network to garner Congressional support for federal provider status in 2017 • Collaborate with the Board of Pharmacy to educate members on inspection checklists regarding USP compounding standards

Committee Members Candy Jordan* Shane Madsen** Max Anderegg Brianne Bakken Amanda Bushman Matt Farley Angie Fouts Grace Fenner Derek Grimm Kari Heitzman Jeff Houseman Sue Keller Lisa Lambi Mary Lacy

Monika Makowiecki Jasmine Mangrum Alex Mersch Jessica Nesheim Anh Ngo Kate Pape Traci Peters Zach Pollock Holly Randleman Tyler Sandahl Mark Sorenson Annie Stella Jonathan Wilson

Committee Members Emily Beckett* Chris Parker** Elisha Andreas Sharon Cashman Connie Connolly Geena Hopwood Ryan Jacobsen June Johnson Carrie Koenigsfeld John L’Estrange Nic Lehman Marie Ljosenvoor Craig Logemann Cindy Marek

Heather Ourth Chayla Stanton-Robinson Stevie Veach Nicholas Vollmer Nancee Waterbury Sara Wiedenfeld Claire Weidman

* - Chair ** - Vice Chair

JAN.FEB.MAR 2017 |


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Long Term Care and Senior Care Advisory Committee

Pharmacy Technician Advisory Committee

LTC Committee Discuss Statewide Initiatives

Technicians Collaborate for Advanced Practice Roles in Iowa

The IPA Long Term Care & Senior Advisory Committee convened on Thursday, November 10, 2016 to address practice issues related to LTC pharmacy in Iowa and provide recommendations to the IPA Board of Trustees. Several initiatives that are being driven at the state level were reviewed by the Committee, including: antibiotic stewardship, falls prevention, and inappropriate antipsychotic medication use. The Committee evaluated current state regulations in order to provide formal recommendations to the Board of Pharmacy (BOP) and the Department of Inspections and Appeals (DIA). The Committee plans to reconvene via conference call to reconnect on regulatory recommendations and to learn more about programs offered by SafeNetRx. Recommendations of this Committee: • Discuss the role of consultant pharmacists and best practices with key infectious disease pharmacists engaged in IPA’s Health-System Liaison Board • Explore opportunities with the Iowa Physical Therapy Association and/or Iowa Occupational Therapy Association on falls prevention strategies in LTC settings • Develop education to address gaps in discharge orders and after hour deliveries for controlled substances with patients in LTC • Address lack of OTC coverage in LTC facilities with the Iowa Medicaid and DHS and other stakeholders

On October 13, 2016, the IPA Technician Advisory Committee met to review the issues and trends related to pharmacy technicians in Iowa. The Committee was provided a presentation by Deeb Eib of the Pharmacy Technician Certification Board (PTCB) to review PTCB’s program, advancing roles of technicians, upcoming changes to their examination, and new initiatives of PTCB. He encouraged the Committee to submit comments for consideration at 2017 consensus conference on pharmacy technicians. The Committee discussed developing further advanced practice opportunities for technicians in Iowa due to the growth seen through medication reconciliation, telepharmacy, and technician product verification (or Tech-Check-Tech). Recommendations of this Committee: • Encourage IPA to offer comments to PTCB for their 2017 Consensus Conference • Recommends creation of a policy statement on professionalism of pharmacy technicians • Encourage technician involvement on the Practice Advancement Initiative (PAI) Workgroup of the HealthSystem Liaison Board. • Recommend evaluation of the opportunity for pharmacy technicians to serve on the Iowa Board of Pharmacy

• Increase dialogue with DIA to address issues with collaborative practice agreements • Utilize a committee subgroup to review BOP regulations related to LTC practice, and provide recommended improvements to these areas of BOP regulations

Committee Members Mark McMullen* Becky Kehoe** Rocky Anderson David Brothersen Alyssa Cosnek Brittany Doughtery Anisa Fornoff Christie Hart Mackenzie Leal Micaela Maeyaert Marcia McNulty

Kristin Meyer Dick Michael Kristen Peterson Jake Powers Justin Rash Jeff Reist Marie Sirek Leslie Tierney Amy Wadstrom Michael Williams Jr Pamela Wiltfang

Committee Members Lori Foster* Jean Gallogly** Jessica Burge Breann Bowe Meg Finn Anna Fishel Sonya Jones Judy Mentzer Angie Miller Kaye Moeller Shawnae Morey

Morgan Reynolds Tammy Sharp-Becker Jill Shoopman Alyce Steig Julia Strause Christina Ulrey Amanda West

* - Chair ** - Vice Chair

JAN.FEB.MAR 2017 |



FIRST YEAR REFLECTIONS Renae Chesnut, RPh, EdD, MBA Dean Drake University College of Pharmacy & Health Sciences


s I reflect on my first year as Dean, I am humbled by and appreciative of the support that I have received as I stepped into my new role. Even more, my appreciation has grown for the components that make the pharmacy environment in the state of Iowa and at Drake University special: • A pharmacy family within the state that supports one another and strives to make the profession of pharmacy a better place for patient care. Becoming educated as a pharmacist in the state of Iowa is a selling point for our student applicants. We feel fortunate to have so many outstanding preceptors that support our program. We also enjoy national recognition for our initiatives which will be furthered at the 2017 APhA Annual Meeting when the New Practice Model is highlighted as Mike Andreski presents his research. • CPHS faculty and staff that continually raise the bar for what it means to be excellent. The talent of our faculty and their commitment to our students, the consistent support of our staff,


| The Journal of the Iowa Pharmacy Association

and the vision and energy of our leadership team is a constant reminder of why I am so proud to be a part of Drake’s program. A testament of that leadership and engagement are the recent awards received by our faculty:

Grandview University, Mercy College of Health Sciences, and Des Moines Area Community College has created learning experiences and activities that will make a difference in the future of health care.

• Geoff Wall - named the ParataPharmacy Times HealthSystem Pharmacist of the Year.

• Alumni and friends who have supported the college through scholarships, white coat sponsorships, capital campaign donations, mentorships, and many other examples of generosity. It was wonderful to have so many return to campus for various events including the second All-Pharmacy Reunion, held in April 2016.

• Kristin Meyer – selected as the Armon Neal Senior Care Pharmacist by the American Society of Consultant Pharmacy. • Erik Maki - named the IPA Health-System Pharmacist of the Year. • John Rovers – received the Principal Financial Group Global Citizenship Award for his work to build a global learning environment on campus. • Outstanding learners who have a quest for knowledge and new experiences. The future of our profession is in good hands when I see learners striving for excellence and becoming engaged in the profession. • Collaborative partnerships in the Des Moines area that have led to combined degree programs and team-based inter-professional learning experiences. Creating the Des Moines Area Inter-professional Education Collaborative with Des Moines University,

I continue to be inspired by the support for our college and am confident that the components above will help us deal with future challenges to create opportunities. Thank you for your continued support of our College, faculty and staff, and students. I look forward to many successes in future years! ■




uring the past decade our College, like the profession itself, has been immersed in dramatic change. Among our many achievements, we have instituted a new organizational structure that strategically coalesces our resources and strives to champion excellence in all that we do; established a systematically layered approach to mentoring both students and faculty; developed an avant-garde curriculum that embraces student-centric leaning and promotes critical thinking and discovery; hired a new generation of highly talented faculty whose potential as scholars is already bearing extraordinary results; established a culture of philanthropy to provide much-needed financial support for our students and faculty; created a robust outreach program to facilitate greater alumni engagement; built a new business platform to promote alternative revenue sources; and, began construction on a new, state-of-the-art College facility. While each of these accomplishments (and many others that could have been noted) deserves special mention, I believe it important to focus some special attention on the latter - our ‘new home’. To the casual observer our need for a new facility, given the antiquity and inadequacies of our existing home, are readily evident. In fact, I have adopted (and promoted publicly) the mantra “From worst to first!” as a way of underscoring just how bad our needs for new digs are at present. However, what is less evident are two special features that will help distinguish our new College facility from all others in the nation and, indeed, the world. First, is the concept of ‘Universal Design’….think American Disabilities

Act (ADA) on steroids! New structures must always be ADA compliant but we have decided to go well beyond ADA compliance. At present, deep shafts are being drilled to reach bedrock and cement pylons are being installed as the first steps toward laying a solid foundation. Metaphorically speaking, it is important to note that our facility will be the first health sciences education and research facility designed and constructed in the world that has chosen to embrace the concepts of Universal Design since its inception - thereby laying the foundation for an entirely new dimension of cultural diversity. Students from all walks of life are welcome to apply to our program provided they have met the academic pre-requisites and have demonstrated the intellectual capacity and professional drive to pursue a program as rigorous as ours. However, for applicants with a physical disability, it is fair to say that our current facility, despite being ADA compliant, would pose a number of challenges. On the other hand, our new home will serve as a model for others to emulate when it comes to accommodating the needs of students with disabilities. We believe that embracing such principles is not only the right thing to do but it helps to promote entirely new opportunities for our students to study side-by-side with fellow students whose physical challenges will, unto themselves, serve as a wonderful reminder of the countless needs of those we, as pharmacists, are called upon to serve. And secondly, the College has operated a drug manufacturing facility for almost five decades. Focused primarily on production of clinical supply chain items that

Donald Letendre, PharmD Dean The University of Iowa College of Pharmacy

are used in early phase research, the College, under the banner of UI Pharmaceuticals, has developed a solid reputation for the quality and integrity of the products it has produced. The sterile products segment of the business is located in the oldest wing of the current facility which is slated for demolition. The easy thing to do would be to discontinue operations. However, recognizing the growing need for specialized sterile product production, especially in an emerging era of pharmacogenetically-driven designer drug therapy, coupled with the untenable reality of declining State resources for higher education, we have decided to ‘double-down’. At present we operate one sterile products production line. In the new facility we will house two production lines in a first-class, state-of-theart sterile products facility that will be on par with the most advanced production facilities of its kind in the world. This unique dimension of our enterprise requires a finished floor-to-ceiling height of 24 feet and a technological investment that will be the most sophisticated of its kind in any pharmacy educational facility worldwide. Since this highly complex operation will be housed in the lower level of the facility, our new home will require a foundation unlike any other. ■

JAN.FEB.MAR 2017 |



CPESN Continues to Evolve

During their Annual Convention in October, the National Community Pharmacists Association (NCPA) announced a partnership with Community Care of North Carolina (CCNC) to form a new national company known as CPESN USA. CPESN USA stems from a grant that CCNC received from the Center for Medicare & Medicaid Innovation (CMMI) in 2014 to establish the Community Pharmacy Enhanced Services Network (CPESN) in North Carolina. The CMMI grant was expanded to assist CCNC in the expansion of the CPESN to other states in the US. With multiple states in the beginning stages of forming a CPESN, NCPA and CCNC saw a need to establish a national organization to assist the state level CPESNs. CPESN

USA is designed to encourage local networks of pharmacies to provide enhanced services.

the optimal integration with partnering organizations (IPA, CPESN USA, Drake and Iowa).

Iowa has been hard at work for the last year establishing the Iowa CPESN which will be under the CPESN USA umbrella. With nearly 90 pharmacies in the network, the luminaries (Ryan Frerichs, Bob Greenwood, Randy McDonough, Matt Osterhaus, and Cheri Schmit) have met regularly to discuss the structure and other core aspects of the CPESN. The luminaries are exploring revenue sources for the network, applying for grants, meeting with potential clients and exploring a dues structure for member pharmacies. An initial meeting with an attorney to discuss forming a legal entity was held in December. The luminary group will meet in January to develop a business plan for the network, including

CPESN Iowa will continue to address the areas of practice development, quality assurance/improvement and marketing the services of the network in conjunction with the work groups and all members of the network. On Friday, February 17, in conjunction with the Midwest Pharmacy Expo, the Iowa CPESN will meet to discuss next steps and the luminaries will share current progress in Iowa. CPESN members mark your calendars and plan to attend this event. More information will be made available to pharmacies in the CPESN as the event approaches. ■


June 15, 2017 Coralville Marriott Hotel & Conference Center This year’s Forum will once again be held the day before IPA’s Annual Meeting at the same location. Watch for additional communications for the full Practice Advancement Forum agenda and registration!

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September 8-9, 2017 Deadline to Apply – May 1, 2017

Application Deadline – March 1

The Eggleston Executive Internship in Association Management is a 12-week program held each year during the summer months in the IPA offices in Des Moines. The Bill Burke Student Pharmacist Leadership Conference is scheduled for September 8-9, 2017, in Des Moines, Iowa. The conference will be held in conjunction with the IPA Foundation’s Eggleston-Granberg Golf Classic to provide additional opportunities for networking and learning. The Bill Burke Student Leadership Conference aims to: • Instill quality organizational leadership skills • Increase awareness of issues impacting the profession of pharmacy • Encourage development of leadership skills and involvement in professional and community activities • Recognize pharmacy students who have displayed leadership potential • Improve communication and teamwork skills

To Apply

Current P1 through P3 student pharmacists from Drake University and The University of Iowa can go to for more information or to complete an application before May 1, 2017. “I can count pills, pour liquids, and compound medications but this is just a small part of a being a pharmacist. Being a consultant to my patients – that’s where I’ve used my education and where I have been of greatest service.” -Bill Burke

During the internship experience, the intern will receive educational instruction in each of the Association’s division as follows: • Public Affairs and Business Development • Professional and Educational Affairs • Organizational and Administrative Affairs The ideal candidate is an IPA student pharmacist member currently in their second year of pharmacy school.

To Apply

Applicants should submit their online application at along with a current resume and writing sample to Anthony Pudlo at by March 1, 2017. For more information, please review the IPA website or contact IPA at 515-270-0713.

JAN.FEB.MAR 2017 |





Frank Caligiuri, PharmD, Drake University

Objectives To identify the understanding, attitudes, and perceived needs of pharmacists practicing in Iowa’s Medically Underserved Areas (MUAs) if the Pharmacy and Medically Underserved Areas Enhancement Act were to pass.

Zachary Pape, PharmD, Drake University Scott Morrett, PharmD, Drake University Grant Stimes, PharmD Candidate, Drake University The corresponding author for the manuscript is: Erin Ulrich, PhD Fitch Hall 113 2507 University Ave Des Moines, IA 50311-4505 Phone: (515) 450-6006 Fax: (515) 271-1867 Email: No conflicts of interests were identified by the authors. No funding was required for this project. There have been no prior presentation of this work

Methods Multi-step thematic analyses was conducted on pharmacists’ answers to four open-ended questions from a onetime anonymous online questionnaire. Participating pharmacists were practicing in MUAs throughout the state of Iowa, as defined by the US Department of Health and Human Services, in Summer 2015. A total of 535 pharmacists were contacted via email to complete a one-time online questionnaire. Key Findings Overall, the responding majority of pharmacists identified as practicing in a community setting and had been practicing pharmacy for around 20 years. Thematic analyses of 139 responses illustrated that there are six themes that fall into two categories, 1) overall health care industry (access to care, benefit to the profession, and uncertainty) and 2) individual pharmacies (training, workflow, and inter-professional relations).


| The Journal of the Iowa Pharmacy Association

Conclusion Pharmacists would like to implement more billable clinical services into their practice; however, many questions and concerns still remain. Effective and timely implementation of newly billable clinical services may be expedited with the help of resources provided by state and national pharmacy associations and boards of pharmacy in addition to training by schools of pharmacy. Keywords Health Policy, Management, Qualitative Research



Enactment of the “Pharmacy and Medically Underserved Areas Enhancement Act,” commonly referred to as “Provider Status,” would allow pharmacists in select areas to bill Medicare Part B for clinical services provided. The term clinical services cover a variety of different functions of which the full extent is not yet fully realized. These services would be defined by the scope of practice for pharmacists in each state. In summary, the bill will cover clinical services that a pharmacist is legally able to willing to provide in their specific state, that would otherwise be billed to Medicare Part B by another authorized healthcare provider. Common examples include providing health and wellness testing, managing chronic diseases and medications, and administering immunizations.2 Although there are several ways in which a pharmacist might reach and impact their patients, performance of medication therapy management (MTM) services is most commonly referred to when discussing additional billable services. MTM is billable through many state Medicaid programs and Medicare Part D plans but not through Medicare Part B. Unfortunately, not every patient is covered by Medicaid or is enrolled in a Part D program which covers these activities. As of now, these are the clinical services which are seemingly the most billable for the average pharmacist due to the established Current Procedural Terminology (CPT) codes and the ability to bill directly to Medicaid and certain Medicare Part D plans. Furthermore, there exists other services which are billable, but require an avenue through a physician. Services like chronic disease state management appointments, like diabetes and hypertension, medication reconciliation in care transitions, hypertension screenings, and many other activities cannot currently be billed directly through CMS. Although CPT codes exist (Appendix A)3, they must be billed for by a physician or other recognized practitioner as if that person performed the activities themselves. This

hinders pharmacists in outpatient settings from realistically being able to set up a process which allows for services to be billed in this setting. A newly proposed bill would make drastic changes in access to healthcare. In January 2015, two companion bills, H.R. 592 and S. 314, both titled the “Pharmacy and Medically Underserved Areas Enhancement Act”, were introduced in the United States House of Representatives and Senate respectively. Passage of these bills would amend title XVIII of the Social Securities Act and would label pharmacists as providers and allow pharmacists in MUAs to bill for reimbursement of services through Medicare Part B.4,5 With the Pharmacy and Medically Underserved Areas Enhancement Act proposing to involve pharmacists as a member of the health care team, expected results include increased rates of patient satisfaction and reduced health care costs.6,7


The objective of this study was to identify the understanding, attitudes, and perceived needs of pharmacists practicing in Iowa’s MUAs if the Pharmacy and Medically Underserved Areas Enhancement Act (PMUAEA) were to pass as federal legislation (i.e. H.R. 592 and S. 314.). Additionally, the study describes pharmacists’ perceived needs to be able to provide services that would be billable under the PMUAEA.


Subject Selection: In Iowa, patient access to providers is sparse with 72 of Iowa’s 99 counties labeled as “Medically Underserved Areas” as defined by the US Department of Health and Human Services.8 A listing of all Iowa pharmacies, including pharmacy manager email addresses, was obtained from the Iowa Board of Pharmacy (BOP). This list was cross referenced with the US Department of Health and Human Services (HHS) website in order to identify which pharmacies would be covered by the Pharmacy and Medically Underserved Areas Enhancement Act. According to the

bills, affected areas included pharmacies operating in MUAs or in a Health Professional Shortage Area in addition to pharmacies serving medically underserved populations (all of which, from now on, will be collectively referred to as MUAs). Surveys were sent via email to pharmacists working in eligible pharmacies. Data Collection: A total of 535 eligible pharmacists were asked to participate via email based on inclusion criteria, registered with the BOP and employed in an HHS-designated MUA, and received an initial invite to participate which included the URL to the online questionnaire. Within this invitation, it was made clear that they were selected because their pharmacy was located within an MUA. Two identical follow-up reminder emails were sent, two and four weeks after the initial email. Informed consent was conducted electronically. This study utilized an anonymous, onetime, online Qualtrics questionnaire. This questionnaire was intentionally made anonymous to encourage pharmacists to participate, to decrease social desirability of responses and to offer more in-depth responses to sensitive open-ended questions. Data collection occurred between July 1, 2015 and August 15, 2015. The insitutional review board approved this study in Spring of 2015. Question Development: The openended questions, based on the goals of the study, were administered to investigate pharmacists’ attitudes and perceived needs to enhance practice if the Pharmacy and Medically Underserved Areas Enhancement Act were to pass. A social and administrative pharmacy researcher, a pharmacist, and a student pharmacist evaluated questions for face validity. The final open-ended questions included: 1) Perceived impacts of the Pharmacy and Medically Underserved Areas Enhancement Act on their pharmacy, 2) If the Pharmacy and Medically Underserved Areas Enhancement Act were to pass, how they plan to increase the amount or types of services offered, 3) Perceived potential downfalls and negative impacts on their pharmacy, and 4) Additional comments JAN.FEB.MAR 2017 |



or concerns of pharmacy needs. Analyses: Frequencies and descriptive statistics were conducted on all pharmacy characteristics questions asked in the online questionnaire prior to the open-ended questions. A multi-step process of thematic analysis was used to identify the core themes that represent the perceptions of pharmacists about their attitudes and perceived barriers to providing services if the Pharmacy and Medically Underserved Areas Enhancement Act were to pass. The analysis team was made up of a social and administrative pharmacy researcher, a pharmacist, and a student pharmacist. To develop a preliminary codebook, each team member read a sample of transcripts and assigned descriptive codes to segments of text. Team members met to reach consensus on codes and one team member applied these codes to all subject responses. A second coding step entailed members of the research team interactively reading through survey answers. Members of the research team developed discipline specific coding schemes and then met to reach consensus on overarching categories that would capture individual differences and allow for generalizability to the perceptions of all. Subject responses were then grouped into six primary themes.


Of the 535 email invitations to participate with a URL link to an online survey, 36 email accounts were undeliverable and 11 stated that they were out-of-the-office during the data collection period. For thematic analyses to have 80% power to detect two instances of a theme with 10% prevalence would require 29 participants.9 Therefore, having 139 responses adds power and robustness to the findings. The calculated response rate is 25.9%. The majority of responding pharmacists identified as practicing in a community setting (36% Independent, 14.4% Chain, and 8.6% Grocery Store Chain) with 20.9% of pharmacists identifying as practicing outside of community pharmacy, such as long-term care centers and hospital practice (Table 1). There was almost level distribution between the


| The Journal of the Iowa Pharmacy Association

six weekly dispensing load categories; however, about 20% of respondents reported filling between 400-799 prescriptions per week. Approximately 60% of respondents reported having between 1-4 days of the week with little or no time to provide clinical services (Table 1). Of the 139 respondents, only 63 (45.3%) reported currently offering services that are billable. Thematic analysis of the free text responses revealed six themes and suggests that pharmacists have willingness to change their scope of practice but have uncertainty and some concerns over proper implementation of this change. These six themes fall into two categories—overall health care industry (access to care, benefit to the profession, and uncertainty) and individual pharmacies (training, workflow, and inter-professional relations). Overall Health Care Industry There were three themes that addressed respondents understanding of the legislation, attitudes, and concerns at the macro-level of the health care industry; access to care, benefit to the profession, and uncertainty. Access to care. There were a number of ways pharmacists recognized the impact this legislation would have on patient care. Some examples of ways pharmacists may impact their patients could be through the successful incorporation of MTM services or diabetes/hypertension management programs: I feel being compensated for providing more clinical services would allow me and my pharmacy staff to better serve our community and improve patient outcomes. In some cases, pharmacists linked this legislation to an increase in patient access: It could help us reach out to patients that need these services, that can’t afford them now. I think this legislation will open up the opportunity to provide these services to more patients.

Benefit to the Profession. There was a strong understanding among pharmacists that this legislation would be a great benefit to the profession. In the majority of cases, respondents stated that this would offer overall financial stability for the pharmacy profession by providing reimbursement for services they already perform such as; diabetes education, comprehensive medication reviews (CMRs), cardiovascular risk management, point-of-care testing, and smoking cessation education. Actual reimbursement is estimated to be between $34 to $148 depending on service and CPT code.10 One pharmacist reflected on the current services offered: We have acceptance by patients and health professionals of the clinical services related to medication management, synchronization, immunization, etc. already. I think this legislation will only solidify what we are already doing and open up the opportunity to provide these services to more patients. In other cases, respondents made a connection between the passing of this legislation and improved perception of pharmacists and optimizing pharmacists’ skills: “I think the opportunity to help patients would hopefully improve the public’s perception of what a pharmacist can do for their patients.” “I think it would greatly enhance the services we are able to provide and better utilize our pharmacist capabilities.” Uncertainty. There were two levels of uncertainty that were common within this theme. The first is uncertainty of how the legislation would impact their pharmacy, if at all. The second type of uncertainty revolves around reimbursement levels. Some respondents communicated that they did understand the proposed legislation and had general uncertainty of how this legislation would potential impact their practice:


Respondents’ comments on pharmacy technicians focused on training to schedule patient appointments:

Table1: Overall Pharmacy Characteristics n(%) Type of Pharmacy (n=111) Chain

20 (18.0)

Grocery Store Chain

12 (10.8)


50 (45.0)


29 (26.2)

I would train more technicians to help reach out to eligible patients and make appointments. Train staff to help with scheduling and finding patients that would benefit from this service.

Number of Rx filled/week (n=108) 0-399

17 (15.7)


23 (21.3)


22 (20.4)


14 (13.0)


12 (11.1)


20 (18.5)

How many days per week would you consider that your pharmacy staff has little to no time to perform clinical services due to the high level of prescriptions filled at your pharmacy? (n=101) 0 days

9 (9.0)

1-2 days

35 (34.7)

3-4 days

38 (37.6)

5-6 days

13 (12.9)

7 days

6 (6.0) Mean (SD)


Number of pharmacists working an average week day (n=139)

1.88 (1.37)


Number of technicians working an average week day (n=139)

3.19 (3.17)


Number of students/interns working during an average weekday (n=139)

0.26 (.55)


Number of years practicing (n=139)

19.61 (12.39)


Number of years as manager in Current place of employment (n=139)

10.23 (10.14)


I don’t know enough about this legislation to comment on this at all. I am not sure if it includes hospital patients and how it would be billed in Critical Access hospitals. Essentially, I don’t really know that it will affect me at all for a while. However, the majority of responses mentioned that the success of implementing change depends on reimbursement levels: Depending on reimbursement, this could make or break independent pharmacy. I find that many times the benefit of MTM lies with patient care

and satisfaction, not reimbursement. Reimbursement would have to warrant the high hourly wage of a pharmacist. The level of reimbursement must be high enough to support the activity. I’m not optimistic about that.” Individual Pharmacies The remaining three themes addressed needs and barriers at the pharmacy level; training, workflow, and interprofessional relations. Training. Training surrounded two major needs; 1) Training of the pharmacists (development of procedures and policies that align with this legislation), and 2) training of pharmacy technicians.

It was clear that pharmacists did not have policies and procedures in place for the services they are performing informally that, if this legislation were to pass, would easily be altered to allow for proper reimbursement. In some cases, respondents were concerned with making sure policies and procedures would guarantee maximum efficiency on identifying eligible patients and reimbursement: We would need to establish procedures to be certain eligible patients/ opportunities do not fall through the cracks. Depending on how the criteria are defined for covered services, we will need to establish policies and procedures so that Medicare knows what we do and we would need to add these activities to our quality improvement program. In another case, the respondent desired additional education on how to implement services successfully from workflow changes to how to advertise: I think pharmacists need help with billing for these services and educating the local clinics regarding the benefits of these services. Most pharmacists are very capable of providing the actual clinical service; it’s getting the service incorporated into the daily work flow and marketing the services that can become problematic. Workflow. Workflow responses were those that mentioned perceived changes to the pharmacy staff or infrastructure to allow for effective and efficient workflow. These statements were phrased in a manner that emphasized individual pharmacies could handle these changes JAN.FEB.MAR 2017 |



themselves and do not require external assistance from the state pharmacy board or state institutes of higher education. In some cases, respondents emphasized that physical changes to the pharmacies would be of priority in order for a successful transition that aligns with this legislation: By doing some remodeling for the space for patient consultation in a more private setting. We would definitely have to look into increasing auto-fill, as well as greater space to provide the services. In other cases, respondents commented that current tasks by pharmacists would need to be transferred to technicians: Delegate more pharmacy duties to the technician and devote more pharmacist time to patient education and clinical services. Some of the pharmacists led services such as med sync will need to be transferred to technicians. In the majority of workflow responses, pharmacists stated additional hiring of staff would need to occur to allow for pharmacists to take on additional reimbursable clinical services: Either increasing technical staff or hiring another pharmacist. Hopefully we could add some part-time pharmacist hours and some technician hours specifically for that purpose. Inter-professional Relations. There were positive and negative responses surrounding the impact this legislation would have on their inter-professional relationships. Some pharmacists report a concern about other health care providers’ attitudes about pharmacists’ new scope of practice and how negative perceptions of this change would impact relationships they hope to build with the providers: Potential for turf battles because prescribers may see this as pharmacists infringing on their


| The Journal of the Iowa Pharmacy Association

practice and patients, when it could be an excellent opportunity to enhance collaborative practice and enhance patient care. I think pharmacists will need to be cautious with certain medical providers that may feel that we are stepping on their toes.” In other cases, pharmacists provided positive responses about the ways this legislation could have on interprofessional relationships and the impact of this improved inter-professional relationships on patient care. Our ability to collaborate with practitioners and our local hospitals would improve. I feel that I would be able to better support the medical staff with more medication monitoring responsibility and clinical pharmacy programs, possible inpatient medication reconciliation and inpatient ordering for admitted patients.


Access to Care Our results show that pharmacists generally believe there would be an overall increase in access to care. Particularly, some pharmacists believed legislation would increase access to services, which would then increase the overall access to care. Pharmacists are educated and trained to provide clinical services, and they are legally able to do so within their scope of practice.7,11 Pharmacists feel that implementation of additional services will lead to higher rates of patient satisfaction and reduced healthcare costs which could influence accessibility in a positive way.7,12 Benefit to the Profession The majority of respondents believed that this legislation would benefit the profession of pharmacy through financial stability from reimbursement of services already being performed. Several respondents noted the potential enhanced perception/recognition of pharmacists and of the services that they have been

trained to provide. Pharmacists have been shown to be one of the most widely trusted professionals according to Gallup Polls in recent years.9 Some pharmacists claim they are struggling to turn profits from prescription sales alone due to lack of proper reimbursement. Additional billable clinical services may benefit the profession financially by providing additional revenue. Due to the perceived benefits of this bill to patient care and the profession, many national and state pharmacy organizations have advocated for this legislation. Organizations such as the American Pharmacists Association (APhA) and the American Society of Health-Systems Pharmacists (ASHP) have set up avenues for practitioners to become more involved. For example, APhA’s “Pharmacist Provide Care” campaign sent over 16,500 communications to members of Congress in just four months after the bill’s introduction.13 The legislation, as of November 2016, has 293 and 51 cosponsors in the House and Senate, respectively. Although the proposed changes are clearly influential in the practice of pharmacy and may result in creation of new ways for pharmacists to impact their patients and receive adequate payment for the establishment of the aforementioned clinical services, it is clear that many practicing pharmacists may not be aware of the scale these changes may have on improving patient care. If there is hesitation and confusion within the profession, it is likely there will be public hesitation and confusion as to the importance of these changes being enacted. This may account for a lower chance of passing the bills despite the support. Uncertainty Uncertainty was a common theme among pharmacists—specifically about potential reimbursement levels of services provided. The majority of responses were uncertain of how successful the implementation of the legislation would be, citing that it was dependent upon reimbursement levels and means for collecting payment for the services.

Student loan refinancing for IPA members SoFi saves pharmacist borrowers an average of $448 a month1

Apply through to get a $100 welcome bonus2 when you refinance your student loans. Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. See for a complete list of terms and conditions. Current as of 10.1.16. SoFi loans are originated by SoFi Lending Corp (dba SoFi) California Finance Lender #6054612. NMLS #1121636. 1Monthly savings calculation is based on all SoFi members with a pharmacist degree who refinanced their student loans between 7/1/15 and 6/30/16. The calculation is derived by averaging the monthly savings of SoFi members with a pharmacist degree, which is calculated by taking the monthly student loan payments prior to refinancing minus the monthly student loan payments after refinancing with SoFi. SoFi’s monthly savings methodology for student loan refinancing assumes 1) members’ interest rates do not change over time (projections for variable rates are static at the time of the refinancing and do not reflect actual movement of rates in the future) 2) members make all payments on time. SoFi’s monthly savings methodology for student loan refinancing excludes refinancings in which 1) members elect a SoFi loan with a shorter term than their prior student loan term(s) 2) the term length of the SoFi member’s prior student loan(s) was shorter than 5 years or longer than 25 years 3) the SoFi member did not provide correct or complete information regarding his or her outstanding balance, loan type, APR, or current monthly payment. SoFi excludes the above refinancings in an effort to maximize transparency on how we calculate our monthly savings amount and to minimize the risk of member data error skewing the monthly savings amount. 2Payment will be issued electronically once you become a SoFi borrower; you have submitted a completed application with documents and your loan has been disbursed. Offer good for new customers only.


Pharmacists reported being cautious about this aspect of the legislation because of past issues with reimbursement levels and delayed payments from other government programs. According to some pharmacists, extreme levels of audits and lack of payment for medical supplies/transplantation medications have been what has steered pharmacies away from government funded programs. If pharmacies are going to adopt billing for clinical services, they must be reimbursed at a reasonable rate within a reasonable window of time. Associations and governing bodies within pharmacy must be willing to advocate for and ensure that pharmacists are being compensated and treated fairly within the law, so small independent community pharmacies, as well as large chains, can offer clinical services in MUAs. Training There are multiple areas of training that would be beneficial for pharmacists. Examples include understanding billing procedures, explaining types of clinical services that would be covered, and education on how to formulate policy and procedures that would increase efficiency, maximize financial benefit, and define training requirements for support staff, like technicians. Implementation of new legislation always comes with the need for adaptation by the profession. Because of the overarching goal of the proposed bills, significant changes will need to be made regarding the role of a pharmacist. Changes in job description may result in a need for additional training through extra certifications by pharmacists, through organizations such as APhA or the American Association of Diabetes Educators. This bill is unique and original thus new policies and procedures may need to be put in place within each pharmacy practicing in MUAs. The implementation of policies and procedures by the owners and managers of these pharmacies will be key in efficiently creating new services. For pharmacies already offering these services, their practice may need to be adjusted to fit new legal requirements and goals.


| The Journal of the Iowa Pharmacy Association

Workflow Concerns with workflow center around the inclusion of more pharmacy staff to help take on additional duties required by pharmacist in an MUA. It should also be noted that pharmacists cited infrastructural changes and delegation of various duties to technicians as necessities in order to successfully implement changes and provide additional clinical services to their patient population. Pharmacists noted that it was likely they could implement new clinical services but would have to take a closer look at their workflow or business models. Corporations and independent pharmacies alike may need to prepare themselves for newly incurred staffing costs if they are to implement these newly billable services. Ideally, the increased revenue will cover the costs of more staff and marketing for these services.. While pharmacists could undoubtedly find a solution, guidance from a state or national association would help expedite the process. Inter-professional Relations Pharmacist responses varied from positive comments regarding increased inclusion as a part of a healthcare team and the ability to assist overworked physicians in MUAs to negative comments concerned with starting â&#x20AC;&#x153;turf-warsâ&#x20AC;? between professions which may also be qualified to perform some of the services mentioned. Because of the stark differences in types of responses, this concept is likely affected on a community-to-community basis depending on the personalities and types of healthcare practices already present in the community. Many times, the pharmacist is the only healthcare worker in the immediate area of an MUA, and they are currently unable to bill Medicare Part B for the clinical services they may already provide.6 Current physicians and other health care providers will need to be aware that the proposed bills are meant to improve patient care. Current pharmacies should look to cooperate with prescribers in the area as to form inter-professional

connections that may allow for pharmacists to assist with a prescriberâ&#x20AC;&#x2122;s workload. Inter-professional relationships may vary based on individual community factors, yet it is important to note that pharmacists should make efforts to join the health care team respectfully. Next Steps There are many potential ideas to support pharmacists during this change. One idea brought forward was to request IPA to nominate a spokesperson to be the point of contact for this issue. Other pharmacists and research faculty have mentioned that a website would good for pharmacists who are impacted by this bill to network and share resources. IPA and institutes of higher education should also be asking pharmacists who will be impacted by this bill their input on how to advocate for this change.


Pharmacists who answered the questionnaire may feel more strongly about the Pharmacy and Medically Underserved Areas Enhancement Act in either direction, causing a pull to each extreme. Non-response bias also may have been encountered in an attempt to keep the questionnaire anonymous and elicit more accurate and honest responses. Additionally, the list of pharmacies obtained through the board of pharmacy contained only email addresses of pharmacists. Several situations arose where the contact on file would not necessarily be the person in charge of making these types of decisions for their pharmacy.


Despite many positive thoughts with respect to the implications of the Pharmacy and Medically Underserved Areas Enhancement Act, pharmacists have many unanswered questions and concerns. Boards of pharmacy, pharmacy associations, and schools of pharmacy still have time to develop realistic plans to help pharmacists transition successfully into their new role. These themes can be used as a starting point to develop resources for pharmacists.



1. American Society of Health-System Pharmacists. Pharmacy and Medically Underserved Areas Enhancement Act. Advocacy/ProviderStatus/Pharmacy-and-MedicallyUnderserved-Areas-Enhancement-Act. Accessed July 7, 2016. 2. American Pharmacists Association. H.R. 592/S. 314 The Pharmacy and Medically Underserved Areas Enhancement Act. http://www. HR592-S314Overview.pdf. Accessed July 7, 2016. 3. Avalere Health LLC. Developing Trends in Delivery and Reimbursement of Pharmacist Services. uploads/2015/11/103015_Avalere_NACDS_ WhitePaper_LP_Final.pdf. Accessed September 11, 2016.

Appendix A: Medication Therapy Management CPT Codes 99605

Medication therapy management service(s) (MTM) provided by a pharmacist, individual, face to face with patient, with assessment and intervention if provided; initial 15 minutes, new patient


Medication therapy management service(s) (MTM) provided by a pharmacist, individual, face to face with patient, with assessment and intervention if provided; initial 15 minutes, established patient


Medication therapy management service(s) (MTM) provided by a pharmacist, individual, face to face with patient, with assessment and intervention if provided; each additional 15 minutes (List separately in addition to code for primary service)

CPT Codes for “Incident to” billing 99211

Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified healthcare professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.


Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused history; A problem focused examination; Straightforward medical decision-making. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face to face with the patient and/or family.


Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision-making of low complexity. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face to face with the patient and/or family.


Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision-making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face to face with the patient and/or family.


Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision-making of high complexity. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies is provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face to face with the patient and/or family.


Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements: • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient • Chronic conditions place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline • Comprehensive care plan established, implemented, revised, or monitored


Transitional care management services with the following required elements: • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge • Medical decision-making of at least moderate complexity during the service period • Face-to-face visit, within 14 calendar days of discharge


Transitional care management services with the following required elements: • Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge • Medical decision-making of high complexity during the service period •Face-to-face visit, within 7 calendar days of discharge

4. Pharmacy and Medically Underserved Areas Enhancement Act. Title XVIII. H.R. 592 (2015) 5. Pharmacy and Medically Underserved Areas Enhancement Act. Title XVIII. S. 314. (2015) 6. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48:923–933. 7. Giberson S, Yoder S, Lee MP. Improving patient and health system outcomes through advanced pharmacy practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011. 8. US. Department of Health and Human Services. Medically underserved areas/populations: guidelines for MUA and MUP designation. http://www.hrsa. gov/shortage/mua/index.html. Accessed December 23, 2015. 9. Simone A. Pharmacists among most widely trusted professionals Gallup Poll finds. Pharmacy Times. December, 2013. Accessed December 23, 2015. 10. Drug Topics. Pharmacy reimbursement: Make the most of MTM. http://drugtopics.,1). Accessed September 11, 2016. 11. Avalere Health LLC. Exploring pharmacists’ role in a changing healthcare environment. May 2014. insights/exploring-pharmacists-role-in-a-changinghealthcare-environment. Accessed December 23, 2015. 12. Fugard AJ, Potts HW. Supporting thinking on sample size for thematic analyses: a quantitative tool. Int J Soc Res Meth. 2015;18(6): 669-684 10.1080/13645579.2015.1005453 13. American Pharmacists Association. Provider status advocacy results in more cosponsors for H.R. 592, S. 314. April 6, 2015. https://www.pharmacist. com/provider-status-advocacy-results-morecosponsors-hr-592-s-314. Accessed: July 7 ,2016

JAN.FEB.MAR 2017 |




The Iowa Pharmacy Political Action Committee (IPPAC) is an important tool in sustaining IPA’s legislative involvement. Contributions from individual pharmacy professionals are used strategically to strengthen relationships with key legislators and keep pharmacy’s presence highly visible.

Rep. Guy Vander Linden (r) and Jane Nicholson (l) of Mahaska Drug

Whenever possible, an IPPAC donor will hand deliver the check to a candidate or legislator to build a personal connection. Here are a few stories and photos from those deliveries from this past year.

“Met [Sen. Amanda Ragan] at the Community Kitchen in Mason City... She was appreciative and understands pharmacy issues on the state level. A real friend!” - Tim Becker Brian Benson (l) with Sen. Matt McCoy (r) Rep. Peter Cownie (center right) and Helen Eddy (r)

“I explained the frustration of the patient, physician and pharmacist when we knew the patient was doing well on a certain medication and was forced to jump through the hoops...”

“We had a great conversation regarding Medicaid dispensing fees and PBM’s in general. He mentioned how much he enjoyed working with the [Iowa] Pharmacy Association.” - Helen Eddy Kristin Meyer (l) with Rep. Mark Smith (2nd from left)

Why is Contributing to IPPAC Important? 32

| The Journal of the Iowa Pharmacy Association

The IPPAC is used to unify and amplify the voice of Iowa pharmacy professionals on a consistent basis. Even though many members are engaged in advocacy, gaps exist where a pharmacy-friendly legislator may not have an established relationship with a member. IPPAC contributions to legislators and candidates fill those support gaps

- Ann Moon with Rep. Joel Fry

and provide opportunities to educate these leaders on the importance of pharmacy in the health and wellbeing of Iowans. To keep Iowa pharmacy a viable, strong and active participant in the legislative process, consider making a contribution to the IPPAC at www.



Thank you to all who contributed to the IPPAC or LDF in 2016!


2016 Iowa Pharmacy Political Action Committee Donors Bruce Alexander Carol Anderson Kenneth Anderson Brett Barker Tony Beraldi L.Gene Carlson Carl Chalstrom Renae Chesnut Cheryl Clarke Jon Clingman Connie Connolly Kyra Corbett Bernie Cremers Neal Daley John Daniel Jane DeWitt Ashley Dohrn Steve Firman John Forbes Ryan Frerichs

Kate Gainer Brandon Gerleman Robert Greenwood Betty Grinde Colleen Haglan-Lynch John Hamiel Jacqueline Harms Richard Hartig Greg Hoyman Hy-Vee Employee PAC Harold Jackson June Johnson Dennis Jorgensen Mike LaGrange Erik Maki Gary Maly Kristin Meyer Robert Nichols John Nicholson Robert Osterhaus

Wes Pilkington Lisa Ploehn Dan Pomeroy Anthony Pudlo Susan Purcell Doug Schara Jim Scott Denise Soltis Toni Sumpter Tom Taiber Farah Towfic Stevie Veach Dustin Villhauer James Wallace Ryan Weber Michael Wolnerman

The Iowa Pharmacy Political Action Committee (IPPAC) is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. The IPPAC is funded by contributions from individual pharmacists, pharmacy technicians, or student pharmacists, as well as member PACs of other organizations. Your contributions to the IPPAC aid in advocating for practice advancement, PBM regulation and other important issues facing our profession.

2016 Legislative Defense Fund Donors Aaron Stangel Anderson Pharmacy Kenneth Anderson Carson Klug Coon Rapids Pharmacy - Dan Pomeroy Denver Drug - Brett Hansen Drilling Morningside Pharmacy William Drilling Fontanelle Drug - Kaye Bax Kevin McClimon Koerner Whipple Pharmacies Todd Wragge Kwik-Rx Pharmacy - Tom Fox

Michele Cooper NCPA & APhA University of Iowa Chapters Parkview Pharmacy - Peter Bilden Reinbeck Pharmacy - Brent Bovy Robert Greenwood Sumpter Pharmacy & Wellness Toni Sumpter The Prescription Shoppe Linda Nightingale Timothy Wright Valley Drug Store - Linda Grimm Widner Drug Store - Bob Sack

IPA’s Legislative Defense Fund (LDF) consists of donations from corporate sponsors. Since corporations are prohibited from contributing to candidates (and therefore, the IPPAC), these funds are used to pay for advocacy activities, which include IPA’s Legislative Day and Capitol Screenings, contracted lobbyists and external consultants, and IPPAC administration and fundraising costs.

Learn more or donate online at JAN.FEB.MAR 2017 |



BOARD OF PHARMACY PREPARES FOR 2017 Meeting with IPA & College of Pharmacy Leadership

On November 1, 2016, representatives from the Board of Pharmacy, IPA, and the Colleges of Pharmacy met at the Board of Pharmacy offices to discuss current and upcoming pharmacy issues and initiatives to help build consensus moving into the 2017 legislative session. The discussion focused on advancing roles of pharmacy technicians, valuebased and enhanced pharmacy services networks, and prescription drug abuse. With the many issues impacting the role of pharmacy technicians, there was active dialogue on the desire to have technician representation on the Board of Pharmacy. This topic was recommended for the IPA House of Delegates to debate in 2017.

Telepharmacy Proposed Regulations

During their November 2, 2016 meeting, the Board of Pharmacy approved their initial proposed regulations on telepharmacy. These proposed regulations brought about additional comments and suggestions to the Board of Pharmacy, including specific recommendations from the Governor’s Office. During their January 5, 2017 meeting, the Board of Pharmacy declined to approve a second round of proposed regulations on telepharmacy. Therefore, issues related to telepharmacy practice will likely be addressed by state legislators during the 2017 legislative session.

Waiver Requests Approved

The Board of Pharmacy continues to work with hospital-based pharmacies to approve waivers to delay enforcement


| The Journal of the Iowa Pharmacy Association

of sterile compounding regulations while the pharmacy undergoes necessary construction to adhere to USP compounding standards. Throughout 2016 and into 2017, pharmacies have sought waivers to delay the implementation of IAC 657 Chapter 20, which took effect on November 18, 2015.

In 2017, two Board members (Jim Miller and LaDonna Gracious) will seek reappointment to their positions. In addition, pharmacist Board member Ed Maier will finish the final year of his third term on the Board of Pharmacy, therefore a new pharmacist Board member will be appointed this summer.

The Board may grant a waiver of or a variance from all of part of a current rule. No waiver or variance may be granted from a requirement that is required by statute or law. The decision on whether the circumstances identified in a pharmacy’s petition justify granting of a waiver or variance is made at the discretion of the Board upon consideration of all relevant factors. The complete procedures for waiver or variance requests can be found in Board of Pharmacy rules, 657 IAC Chapter 34.

Board of Pharmacy staff member, Debbie Jorgensen, retired at end of 2016. This position will be filled in 2017.

Online License Renewal & Database Update

The Board of Pharmacy has diligently worked through the processes set by the State of Iowa to finalize the components for a Request for Proposal (RFP) on a new database for license registration and renewal. The RFP will be released in early 2017; allowing for the implementation of the new database and license renewals in 2018.

Changes with Board of Pharmacy Members & Staff

Kay Jensen, public member on the Board of Pharmacy, resigned from her position. This position will remain open until a new individual is appointed by the Governor.

Compliance officer Jennifer Tiffany will be assuming new responsibilities to oversee the Prescription Drug Monitoring Program (PDMP) and administer the medication disposal program for controlled substances offered by the Board. Compliance officer Jennifer O’Toole will be assuming new responsibilities to oversee the Iowa Monitoring Program for Pharmacy Professionals (IMP3). With these changes to compliance officer responsibilities, the Board of Pharmacy plans to hire to a new compliance officer in 2017. ■


HISTORIC ELECTION PLACES TWO PHARMACISTS IN IOWA LEGISLATURE For the first time in history, a pharmacist will be serving in each chamber of the Iowa legislature following the November 8, 2016, election. Rep. John Forbes (D-40) of Urbandale was reelected to a third term in the Iowa House of Representatives. Rep. Forbes owns a Medicap Pharmacy in Urbandale and is a past president of IPA, serving 1999-2000. He is a 1980 graduate of the Drake University College of Pharmacy and Health Sciences.

Sen. Tom Greene from West Burlington was elected to the Iowa Senate. Tom is pharmacist at Heritage Park Pharmacy in West Burlington and is a 1973 graduate of the Drake University College of Pharmacy and Health Sciences. Rep. Forbes and Sen. Greene will begin their terms when the 87th Iowa General Assembly begins its 2017 legislative session on January 9, 2017.

Resolving Your Medicaid MCO Issues

IPA has been collecting member’s specific concerns regarding the transition of Medicaid to an MCO model since June. Thank you to all who have submitted concerns, issues and questions to IPA. Most pharmacies who submit a concern have called the MCO helpline and worked with their pharmacy liaison. When a resolution is not found via this path, the pharmacy submits their concern via a survey on the IPA website and IPA works with the MCOs to resolve these concerns. In the last couple of months IPA has been able to obtain answers and resolve multiple concerns. For example, one pharmacy was having difficulty with coverage for meloxicam in a patient with rheumatoid arthritis who was previously on naproxen. When the pharmacy ran the claim, they received a notification that a prior authorization (PA) was needed; however, when they informed the physician’s office of this, the nurse told them that she had spoken with the insurance and they did not need a PA. The pharmacy contacted IPA who worked with the MCOs to resolve this issue and the patient was able to pick up the medication before running out of their current supply. Another member contacted IPA as they were unable to obtain the fee schedule for incontinence products such as disposable bed pads. IPA worked with the MCO to obtain this information for the pharmacy to share with their patients.

SENATOR GRASSLEY VISITS IPA Senator Chuck Grassley visited IPA headquarters on October 10th to discuss pharmacy and key issues related to pharmacy with several IPA members. The group had a lively discussion about provider status, which Senator Grassley has been supportive of in the past, and the need for a new bill number to reintroduce

this effort in the next legislative session. The senator was receptive to the discussion regarding PBM transparency and DIR fees. IPA is thankful for the opportunity to host Senator Grassley and discuss pharmacy issues affecting Iowa pharmacists.

Finally, a member was receiving claim rejections for an unknown reason. IPA worked with the MCO and uncovered that the pharmacist was not entered into the system as a provider and therefore the claims were rejecting. This was resolved and the pharmacy was able to obtain payment. If you or your pharmacy has concern or question about processing claims or receiving payment from the MCOs please fill out the “Send feedback to IPA” located under the Iowa Medicaid Info box on at

JAN.FEB.MAR 2017 |


Embassy Suites, Des Moines • Iowa State Capitol

AGENDA IPA’s annual Legislative Day is the cornerstone of the association’s legislative and public policy efforts. Each year pharmacists, pharmacy technicians and student pharmacists engage in face-toface grassroots advocacy with Iowa legislators; attracting nearly 200 members of our profession to the Iowa State Capitol! NEW THIS YEAR! The afternoon will feature opportunities for both patient safety AND pharmacy law CPE.

8:00–9:00 a.m.

Registration at Embassy Suites 9:00–10:00 a.m.

Welcome & Legislative Briefing IPA’s legislative counsel will provide an overview on the issues that IPA members should discuss with their legislators at the Capitol.

10:00–10:20 a.m.

IPA’s Good Government Award Presentation

New in 2017, IPA will award an Iowa legislator who has worked strongly on behalf of pharmacy and healthcare issues its annual ‘Good Government Award.’

10:30 a.m.–1:00 p.m.

Student pharmacist and first time attendees will have the opportunity to pair up with pharmacist mentors and visit the Capitol in small groups.

Capitol Visits & Lunch

Contact Laura Miller at to serve as a one‑day mentor or to be placed in a group with other IPA members.

**All attendees are encouraged to contact their legislators in advance to schedule a meeting and/or lunch during this time block. Pharmacist mentors will be introduced to form small groups prior to departing.

Pharmacist and student pharmacist attendees will group together, pairing up in advance of Capitol Hill visits. Attendees will travel by bus to the Iowa state capital to meet with their state senator and state representative. Box lunches available in capitol rotunda.

1:15 p.m.

IPA Group Photo

Meet at the stairs of the capitol rotunda for a group picture. Photo taken at 1:15 sharp – please arrive five minutes early. White coats encouraged.

1:45–2:45 p.m. - PATIENT SAFETY CPE

Prescription Drug Abuse – Statewide Solutions to a National Epidemic

Panel: Representatives from BOP, ODCP & IMS Tackling the opioid epidemic requires an all-hands-on-deck approach. Here from a


| The Journal of the Iowa Pharmacy Association

panel of state organizations bringing unique strategies and collaborating to find solutions to a complex health and societal issue.

3:00–4:30 p.m. PHARMACY LAW CPE

Pharmacy Law Update: 2017 IPA Legislative Day Perspective from Iowa’s Executive Branch (30 min)

Nic Pottebaum, Health Policy Advisory, Governor Terry Branstad (invited) From Iowa’s managed care program in Medicaid to combating the prescription drug abuse epidemic, Mr. Pottebaum will provide insight from the Governor’s office related to important health care issues and the role pharmacists can serve to continue providing care to Iowans.

Pharmacist Legislator Panel (30 min)

Rep. John Forbes (D-40) and Sen. Tom Greene (R-44) For the first time in IPA’s history, pharmacists are serving in both legislative chambers, and both political parties. Hear their perspectives on the 87th Iowa General Assembly and the state’s priorities.

Pharmacy: What impact does the new Administration and Congress have on our profession? (30 min)

Michael Tomberlin, vice president, government affairs at the National Community Pharmacists Association (NCPA) Following November’s election, and the inauguration of a new U.S. President and Congress, hear from industry experts inside the beltway how the shake up already has, or could, impact the profession of pharmacy and several key initiatives from provider status to PBM regulation to drug approval and prescription importation.

Register at


2017 LEGISLATIVE PRIORITIES IPA’s Legislative Advisory Committee and Board of Trustees have established the following legislative and regulatory priorities for 2017.

counseling and treatment; dispensing travel medications or hormonal contraceptives; furnishing naloxone for opioid overdose; and point of care testing and treatment.

State Legislative Priorites

Prescription Drug Abuse IPA supports expanding the prescription drug monitoring program (PDMP) to interconnect with the other 49 state PDMPs; to allow unsolicited reports to pharmacists and prescribers related to controlled substance prescriptions; and to require all pharmacists and prescribers register to use the Iowa PDMP. IPA also supports legislation that would require prescribers and pharmacies to use e-prescribing for all controlled substance prescriptions in Iowa.

Technician Product Verification IPA supports expanding the New Practice Model initiative to provide greater time for pharmacists’ involvement in patient care activities by allowing certified pharmacy technicians, with additional training, to perform the final verification of prescriptions. Technician product verification, currently defined as ‘tech-check-tech’ has been in the Pharmacy Practice Act since 2008 as a practice exclusively allowed in institutional pharmacy settings. IPA’s New Practice Model initiative has piloted technician product verification in the community pharmacy setting, demonstrating increased patient safety through 1) fewer dispensing errors and 2) greater patient care services provided in pilot sites. Expansion of technician product verification in Iowa’s community and hospital pharmacies will elevate pharmacist and pharmacy technician roles to the top of their training and improve patients’ pharmaceutical care. Pharmacist Statewide Protocols IPA supports the creation of an advisory council of prescribers, public health stakeholders and pharmacists to develop statewide protocols that allow pharmacists to deliver care under a standardized protocol to address public health needs. Statewide protocols create the opportunity for pharmacists to provide additional care with prescription medications to positively impact public health. Examples of statewide protocols include: administering immunizations; smoking cessation

The Iowa Board of Pharmacy currently administers the Iowa PDMP. IPA works closely with the Board of Pharmacy, along with other stakeholders to address the current opioid abuse epidemic and provide strategies and solutions to policymakers and legislators. One other state has mandated EPCS (electronic prescribing of controlled substances) providing a 1-year implementation timeline for prescribers and pharmacies to achieve compliance.

State Regulatory Priorities Collaborative Practice – Iowa Board Of Pharmacy IPA supports a review and revision of Board of Pharmacy rules related to Collaborative Practice Agreements. Since 2006, the Iowa Board of Pharmacy and Board of Medicine have had joint rules governing collaborative practice agreements between pharmacists and physicians in the state of Iowa. IPA believes the opportunity to increase the public health impact of services that can be delegated to a pharmacist by other healthcare providers can be achieved

through updating the current BOP rules related to Collaborative Practice Agreements. IA Health Link – Medicaid Managed Care – Department Of Human Services IPA is committed to working with DHS, the Iowa Medicaid Enterprise (IME), the Governor’s office and the three Managed Care Organizations that have contracted with the state of Iowa. Medicaid modernization ‘IA Health Link’ has the opportunity to lower healthcare costs to the state by managing and maximizing provider services to Medicaid beneficiaries. IPA believes oversight of the MCO’s will be critical to ensure provider services (such as pharmacist services including MTM) are not reduced, but rather optimized; and that prescription drug reimbursement remain at the statutorily set rate of AAC + $10.12, as determined by a provider survey.

State Legislative & Regulatory Policy Positions Interchangable Biosimilars IPA will monitor and work with stakeholder groups that may introduce biosimilar legislation in the state of Iowa. The FDA is currently developing the approval pathway for interchangeable biosimilars in the United States. While none of the currently approved biosimilar products have achieved interchangeable status, legislative changes are needed to allow for future substitution of interchangeable biosimilars as well as explicitly prohibit the substitution of biosimilar products that are not deemed interchangeable by the FDA. Eighteen states have seen legislation introduced to address substitution of biosimilar products. ■

JAN.FEB.MAR 2017 |



TECH TIDBITS Highlights from IPA’s monthly e-newsletter specifically for pharmacy technician members. Opioid Abuse Epidemic & AbuseDeterrent Formulations (ADF)

Opioids are medications used to treat moderate-to-severe pain. Prescription opioids are commonly prescribed following surgery, traumatic injury, or for painful health conditions such as cancer. In recent years, the uses of opioids have become increasingly acceptable and are now often prescribe to treat chronic pain, other than cancer, despite serious risks. The abuse potential of opioids is very high. Chronic use of opioids leads to brain abnormalities that result in intense cravings, compulsive use, and addiction. Taking too many prescription opioids can stop a person’s breathing and lead to death. The most common opioids involved in overdose deaths include methadone, oxycodone and hydrocodone. Understanding the Epidemic On March 14, 2016, the CDC released a statement regarding the opioid epidemic, stating, “More people died from drug overdoses in 2014 than in any year on record.” More than half of these deaths involved an opioid. To put it into perspective they announced that, “From 2000 to 2014 nearly half a million people died from drug overdose. 78 Americans die every day from an opioid overdose.” This includes those with prescriptions for opioids. In the last 15 years, both prescriptions sold for opioids in the US nearly quadrupled and the number of deaths from prescription opioids quadrupled as well. What is interesting is that the overall change in the amount of pain Americans report has remained unchanged. Efforts to Prevent Abuse and Overdose • Work to improve opioid prescribing -- Prescribe only for moderatesevere pain -- Try non-opioids as first-line -- Prescribe abuse-deterrent formulations when possible • Expand access to treatment


| The Journal of the Iowa Pharmacy Association

• Expand access to the use of naloxone • Pharmacies must promote the use of state prescription drug monitoring programs Abuse-Deterrent Formulations (ADF) Opioid products are often manipulated for abuse by different routes of administrating (injected, snorted, etc…). Opioids with abuse-deterrent formulations (ADF) have been developed to make abuse of the manipulated product less attractive or less rewarding. Unfortunately, the technologies developed thus far do not deter the most common form of abuse, swallowing a large number of intact capsules or tablets. On March 25, 2016, the FDA issued draft guidelines for generic abuse-deterrent opioids. The aim of this guidance was to support the development of generic versions of opioids with ADF.

U-100, U-200, U-300, and U-500: Ensuring Patient Safety with Concentrated Insulin

New and existing insulin products are available, which are more concentrated than the standard U-100 insulin. As the condition of diabetes progresses, a patient’s body become more resistant to insulin and they need higher doses. Therefore, concentrated insulins have been developed to decrease the volume of insulin injected and to allow for longer duration of action. Toujeo® (insulin glargine U-300), Tresiba® (insulin degludec U-100 and U-200), and Humulin® R (regular insulin U-500) are a few examples of concentrated insulin products. Insulin is a high-risk medication due to the serious patient safety concerns if errors are made in dosing or dispensing of the product. With new concentrated insulins, patients need to clearly understand these new concentrations so they do not incorrectly give themselves too much insulin and experience low blood sugars. Dispensing errors can also lead to patient safety problems.

Segregating concentrated insulin products from standard U-100 insulin in the pharmacy’s refrigerator can help to prevent this error. Some pharmacies have also added the term “concentrated” to U-500 insulins in the computer system since some products (such as Humulin® R) have the same name for both U-100 and U-500 insulins. U-500 Humulin® R insulin vials require special precaution for dosing. Patients should not use regular insulin syringes since the unit marking is based on U-100 insulin. Rather, it is suggested to use tuberculin (TB) syringes which only have mL markings until U-500 syringes are developed. When converting to the concentrated insulin, the mL used for U-500 insulin should be 1/5 the mL used for the patient’s previous U-100 insulin unless a dosage change occurred. U-500 Humulin® R KwikPens® are dosed in actual insulin units. No conversion is necessary when switching from U-100 insulin to U-500 insulin pens (Remember: the volume of insulin patients will be injecting is less with U-500 insulin). The dose is dialed in 5 unit increments using the U-500 KwikPen®. Tips to ensure patient safety: • Segregate concentrated insulin products from standard U-100 insulin • Refer to U-500 insulin as “concentrated” in computer system • Use TB syringes for U-500 insulin vials • Include both units and mL in patient directions. Example: Inject 150 units (0.3 mL) subcutaneously three times daily before meals with TB syringe. • Do not label insulin pen caps in case they are interchanged with another insulin pen

Medication Reconciliation and Pharmacy Technicians

When patients are admitted into the


hospital they are often prescribed new medications and/or have alterations in their current outpatient medication regimens. Due to multiple medication changes occurring in the hospital, patients are at an increased risk for unintentional medication errors and adverse drug events during this transition. It has been reported that rates of inpatient medication errors range from 45%-76%. Most of these errors are found to occur on admission due to discrepancies in the patient’s medication history and reconciliation. To address this issue, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), also known as “Joint Commission,” designated inpatient medication reconciliation (MR) as a National Patient Safety Goal. JCAHO defines MR as, “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking.” Reconciliations are done to avoid medications errors like omissions, duplications, dosing errors,

or drug interactions. A medication reconciliation should be completed at every transition of care where new medications are prescribed to patients or existing prescriptions are rewritten. Transitions of care include situations in which there is a change in setting, service, practitioner, or level of care. Since the implementation of MR as a National Patient Safety Goal in 2005, it has been found that pharmacy-led MR processes have significantly decreased the rate of medication errors. Multiple studies have shown that pharmacists are effective at decreasing the number of medication errors; however, cost and availability are two large issues associated with these findings. Hospitals are struggling to support additional pharmacists to complete MR. Without MR, medication patient safety issues cannot be promptly identified and resolved. In Iowa, pharmacy technicians are being utilized to provide accurate MR as a

means to free up the time of a pharmacist for advanced clinical activities. Currently, there is a small body of evidence available on pharmacy techniciancentered MR (PTMR) programs directly supervised by a pharmacist. Findings thus far are showing that there is value in PTMR programs by allowing for more time in the pharmacist’s day to resolve medication errors by making clinical interventions through direct communication with providers. The Joint Commission’s 5 Steps for Completing a MR 1. Develop a list of current medications 2. Develop a list of medications to be prescribed 3. Compare the medications on the two lists 4. Make clinical decisions based on the comparison 5. Communicate the new list to appropriate caregivers and to the patient


Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Carolyn Adrian Robert Andersen Cole Anderson Elizabeth Baldwin Nicole Barrett Kayla Bown Minden Brix Scott Clark Reumina Cufurovic Mary Culpitt Merrissa DeBrackeleire Alison DeVore Tiarra Eades Riley Ehlers Rebecca Farley Trudy Fidler Beth Geater Michael Giroux Kimberly Gross Angela Grove Tamara Haake Molly Hagerman Kendra Hawk Rebeca Henrikus Nolan Herman Alexis Hotop

Katherine Carl Houston Danielle Johnson Megan Johnson Katie Jones Kimberley Judge Debra Jurgensen Amber Kai Liam Knudsen Stephanie Krois Katelyn Laraia Addison Leners Christy Lenihan Jamie Leonard Melissa Loneman Jill Long Meredith Lumberg Chantel Lytle Maureen Martin Christie Medley Victoria Medlin Angela Miller Lacey Miller Marissa Miller Debra Milligan Breanna Moore Emily Moore

Jacob Oeland Shannon O’Leary Kerry Parsons Erin Pavlis Ashley Peck Dawn Phillips-Hite Jessica Pitsch Mitchell Pope Teresa Quiroz Misty Rahlf Amber Reichert Morgan Ridout Irene Rivas Sirias Nicholas Roney Scott Root Marcus Saddler Trevor Sherping Kaylene Shore Marissa Snedeker Dylan Strait Mae Ann Swope Anna Timberlake Erica Vavricek Jose Villalobos Ryan Wenzel Taylor Zieser

Certification Excellence Since 1995, the Pharmacy Technician Certification Board (PTCB) has certified over 400,000 pharmacy technicians nationwide and is the only pharmacy technician certification program endorsed by the American Pharmacist Association, the American Society of HealthSystem Pharmacists, and the National Association of Boards of Pharmacy.

Apply to take the PTCE online at

JAN.FEB.MAR 2017 |




The Iowa Pharmacy Foundation sincerely thanks those members who make a contribution to the future of the profession by supporting the efforts of the Foundation…these contributions truly make a difference. The following list of contributors is for January 1, 2016 – December 31, 2016. Platinum Level ($1000+) Tim & Sherry Becker Ray & Sally Buser Sharon Cashman Renae & Eddie Chesnut Connie & Chris Connolly Ryan & Kate Frerichs Bob Greenwood Donald L. Letendre Lisa & Andy Ploehn Anthony Pudlo Mike Pursel Al Shepley Bernard Sorofman Bob Stessman Gold Level ($500-$999) Mark Adams Carol Anderson Quinn Bott Jay & Ann Currie Nick Dahlke Michele Evink Josh Feldmann Rick Knudson Julie Kuhle Amanda Latta Jim Miller Courtney Morris Wes Pilkington Gordon Reed Dan Ricci Doug Schara Rachel Smith Toni Sumpter Ben Urick Amy Van Gorp Rich Wenzel Tim Wright


Silver Level ($250-$499) Bill Baer Christina Baumgart Carl Chalstrom Allen Fann Steve Firman Andrew Funk Kate Gainer Sarah Grady Tom Halterman Morgan Herring Jim Hoehns Carson Klug Megan Lewis Craig Logemann Nick Lund Steven Martens Erik Maki Leman Olson Bob Osterhaus Matt & Marilyn Osterhaus Shannon Peter Chuck Phillips Dwayne Plender Sue & Kevin Purcell Holly Randleman Jacob Schnackenberg Jim Scott Mark Sorenson Angie Spannagel John & Sarah Swegle Tom Temple Farah Towfic CoraLynn Trewet Jim Wallace Sara & Terry Wiedenfeld Tanya Wilhite Bronze Level ($100-$249) Barb & Ken Anderson Rocky & Megan Anderson Mike Andreski

| The Journal of the Iowa Pharmacy Association

Brett Barker Eric Carlson Christine Catney Jonathan Clingman Ashley Dohrn Carmen Dunphy Laura Gansen Brian Gentry Tom Greene Kari Heitzman Greg Hoyman Bryce Jackman Ryan Jacobsen Sandra Johnson TJ Johnsrud Tyson Ketelsen Kayla Lalor Tim Lehan Nic Lehman Gene & Susan Lutz Shane Madsen Amanda Mathews Kristin Meyer Gary & Mary Milavetz Phyllis Olson James Oplt Tony Pape Nathan Peterson Tom Pudlo Justin Rash Jeff & Diane Reist Cheri Rockhold Schmit Andrew Riesberg Ethan Sabers Michael Schnackenberg Susan Shields Amanda Stefl Nora Stelter Joseph Thompson Marla Tonn Stevie Veach Patrick Verdun Susan Vos Michael Wolnerman

Business Partner Contributors Collaborative Education Institute Community Foundation of Greater Des Moines CVS Health Drake University College of Pharmacy Dubuque Area Pharmacy Association Kohlls Pharmacy & Homecare GRX Holdings Hartig Drug Hy-Vee Corporate Johnson County Pharmacy Association The University of Iowa College of Pharmacy Main at Locust Pharmacy McGowen, Hurst, Clark & Smith McKesson Corporation Mercy Family Pharmacy North Iowa Pharmacy Inc NuCara Pharmacy Osterhaus Pharmacy Pharmacists Mutual Companies Quad Cities Area Pharmacy Association Sanofi Towncrest Pharmacy Wasker Dorr Wimmer & Marcouiller


THOMAS R. TEMPLE LEADERSHIP THE FOUNDATION ENDOWMENT 2016: GOAL COMPLETE! INSTITUTE Thank you to those who helped grow and complete the Endowment fund in 2016. The original goal of $750,000 was divided equally among Iowa and Wisconsin and Iowa had a goal of $375,000 to endow the conference into perpetuity. (See the full story on pg. 42) Levels represent 2016 gifts only, see full campaign at LeadershipEndowment. Platinum Level ($1,000+) Ray Buser McKesson NuCara Pharmacies Anthony Pudlo Gold Level ($500-$999) Gordon Reed Toni Sumpter Stevie Veach Silver Level ($250-$499) Tom Halterman Kari Heitzman Julie Kuhle Shannon Peter

Dwayne Plender Farah Towfic Sara & Terry Wiedenfeld Bronze Level ($100-$249) Bill Baer Christina Baumgart Tyson Ketelsen Shane Madsen Phyllis Olson Mike Pursel Morgan (Sayler) Herring Nora Stelter Ben Urick Susan Vos

The Foundation Institute recognizes those donors who have committed to a sustained contribution through an automatic annual or monthly gift to the IPA Foundation. These donor leaders are recognized by various levels of their annual giving: Platinum: $1000+ Gold: $500-$999 Sliver: $250-$499

Bronze: $100-$249 Sustaining: Up to $99

If you share the Foundationâ&#x20AC;&#x2122;s vision of advancing pharmacy practice in Iowa, consider joining the Foundation Institute. Current Foundation Institute Members Bill Baer Tim & Sherry Becker Renae & Eddie Chesnut Connie Connolly Kristin Meyer Bob Stessman

JAN.FEB.MAR 2017 |



Invite to Celebration and Endowment Campaign IPA Journal, Oct/Nov/Dec 2011

CELEBRATING A LEGACY OF LEADERSHIP Completion of 5-year endowment campaign ensures Tom Temple’s vision of building pharmacy leaders continues into perpetuity.


homas R. Temple, RPh, MS, served the Iowa Pharmacy Association for 35 years, 32 of which were as the association’s executive vice president and CEO. He has long been highly respected across the country for his spirit of collaboration, forward-thinking vision and tenacity that led Iowa to the forefront of pharmacy practice. However, if you ask Tom about what he accomplished in his time at IPA, he would quickly give credit to the association’s members, leadership, staff and key partners. So, when Tom announced he would be retiring, or in his words, “transitioning,” in 2012, the association wanted to ensure Tom’s legacy and impact on the profession would be fully recognized and memorialized. The Thomas R. Temple Leadership Endowment was established through the Iowa Pharmacy Association Foundation to honor Tom’s legacy and recognize his vision that strengthened IPA and the pharmacy profession in Iowa for generations to come.


| The Journal of the Iowa Pharmacy Association

As a leader, Tom provided Iowa pharmacy with a vision of pharmacists managing patient care and being compensated to do so. To make his vision a reality, he sought to bring the right people together – skeptics and proponents alike – to find the best course of action. Under his guidance, the association and its members became strong advocates and collaborators working towards advancing patient care and became a model for other states to follow. Tom’s gift of bringing people together led to collaborations that continue to strengthen pharmacy and healthcare in Iowa and beyond. Tom had a keen ability to involve all stakeholders – pharmacists from all practice types, educators, other providers, policy makers and regulators - in each initiative the association undertook. Initiatives that began under Tom’s leadership included Drug Utilization Review and prior authorization in Iowa Medicaid; the Iowa Center for Pharmaceutical Care (ICPC)


and pharmaceutical case management, a precursor to the MTM services widely recognized today; the Iowa Pharmacist Recovery Network to assist pharmacy professionals with addiction; and pharmacist administered immunizations – with Iowa being one of the first states allow the now broadly accepted practice. Tom’s belief in the importance of high quality education and the role of the colleges in practice advancement led to a uniquely strong partnership between IPA, Drake University College of Pharmacy and Health Sciences and The University of Iowa College of Pharmacy. This partnership has led to important initiatives and involving faculty and students in the advancement of the profession. The aptly named Collaborative Education Institute, which provides continuing pharmacy education nationwide, is also a product of this relationship. From the association’s standpoint, maybe the most visible example of Tom’s ability to bring people together was the unification of the profession in Iowa under one association. Tom guided the effort to join the Iowa Pharmacists Association and the Iowa Society of Health-System into one association working to advance the profession with one vision and one voice. The Iowa Pharmacy Association, as it stands today, was formed in 1999 as the two associations merged. Many other states have tried to emulate this model, but few have succeeded. Tom’s achievements, or those of the profession under his leadership, still don’t tell the whole story of the impact his career. It can be also seen in the number of leaders – state and national, pharmacy or otherwise - that have developed from the professional culture in Iowa and IPA. Still, his full impact may be immeasurable because of the countless hours he spent mentoring and giving advice to pharmacists, student pharmacists, fellow association executives anyone who asked. Tom sought to instill a life-long passion in those entering the profession and equip each generation with the leadership skills, clinical knowledge and connections to carry the profession into the future. He had the vision to create a leadership

development program that would train young pharmacists for future leadership and engagement. This vision sparked the creation of the Leadership Pharmacy Conference in 1989. Each year, 20 pharmacists, 10 each from Iowa and Wisconsin are chosen to participate in the program which kicks off with the three-day Leadership Pharmacy Conference in the fall. Participants receive the training and tools to develop their leadership skills and prepare them for leadership roles within the pharmacy profession. That conference continues today, nurturing and building leaders for the profession. Over 300 pharmacists from Iowa have graduated from the Leadership Pharmacy Conference. These pharmacists have taken the lessons learned to lead in their communities and local governments, pharmacy practice sites and the profession on local, state and national levels. Iowa’s reputation as a leader and innovator in pharmacy practice, cultivated under Tom’s leadership, continues today not only through the leadership program he established, but through the overall culture and expectation expressed across the profession of pharmacy in Iowa to continue the legacy of leadership. Tom’s retirement from IPA was the end of a chapter of a legacy that is continuing to be written. It is that chapter that was celebrated on the evening of October 28, 2011. Over 300 pharmacists, colleagues, corporate partners, Leadership Pharmacy graduates, and friends of pharmacy in Iowa and beyond attended to recognize Tom and jumpstart the Thomas R. Temple Leadership Endowment campaign. Over the five years that followed many who shared Tom’s passion and vision of pharmacy leadership, responded generously. The endowment was completed in the fall of 2016, with over $375,000 contributed to secure the future of leadership training and Tom’s commitment to young pharmacists in Iowa. Thanks to the overwhelming generosity, Tom’s vision and legacy of leadership will continue to impact generations of pharmacists in Iowa and beyond.

BY THE NUMBERS Tom’s Leadership Pharmacy program has impacted the profession in Iowa and beyond. Here is look at the impact it has had just at IPA:


Iowa pharmacists that have graduated from Leadership Pharmacy since 1989


graduates that have served on the IPA Board of Trustees


graduates that have served as IPA President since 1999


countless graduates of served and chaired many of IPA’s advisory committees and task forces.

JAN.FEB.MAR 2017 |



THANK YOU THOMAS R. TEMPLE LEADERSHIP ENDOWMENT DONORS The Iowa Pharmacy Association Foundation shares its deepest appreciation to the each donor listed below for their generous contribution to this important fund. The Foundation will recognize these donors on a permanent display at IPAâ&#x20AC;&#x2122;s office in Des Moines. $100,000+ McKesson $50,000-$99,000 TEVA $10,000-$49,000 NuCara of Iowa, LTD Charles Porter Miller/Purcell, Inc. Pharmacists Mutual Insurance Thomas Temple $5,000-$9,999 AmeriSourceBergen Raymond Buser Kate Gainer Eugene & Susan Lutz Stephen Mullenix National Community Pharmacists Association Bob & Ann Osterhaus OutcomesMTM Anthony Pudlo Susan & Kevin Purcell Walgreens Wellmark $2,500-$4,999 Tim & Sherry Becker Jordan Cohen Michele Evink Joshua Feldmann Steve Firman John Forbes Gary Maly James Miller Leman Olson Osterhaus Pharmacy Pharmacists Mutual Foundation Jim Scott Jenelle Sobotka Jenny Tuttle $1,000-$2,499 Gary Albers American Society of HealthSystem Pharmacists Gilbert Banker Kevin Cassatt Carl Chalstrom Renae Chesnut Connie Connolly Jay Currie


Chris Decker Ryan Frerichs Felix Gallagher Tom Halterman Hy-Vee Inc. Russell Johnson Rick Knudson Julie Kuhle Donald L. Letendre Katherine Linder Ed Maier Erik Maki Manning Pharmacy Tom Menighan Matt & Marilyn Osterhaus Lisa Ploehn Quad Cities Area Pharmacy Association Mark Richards Heather Rickertsen Raylene Rospond Alan Shepley Mindy Smith Jennifer Spain Robert Stessman John & Sarah Swegle Brenda Thies CoraLynn Trewet Stevie Veach James Wallace $500-$999 Bruce Alexander Bill Baer Ginelle Bryant Paula Carlson Barry Carter Jonathan Clingman Bernard Cremers Neal Daley Sandra Dirks Martin Dunn Mike Fuller Bob Greenwood Mark Jones Chasity Mease Gary & Mary Milavetz Jen Moulton Brand Newland Kyle Peters PharmServe Solutions Premier Mike Pursel Frank Reznicek

| The Journal of the Iowa Pharmacy Association

Hazel Seaba Susan Shields Nora Stelter Toni Sumpter Tom Taiber Farah Towfic Wasker, Dorr, Wimmer & Marcouiller $250-$499 Bill Baker Ruth Clark Cheryl Clarke Christine Donner-Tiernan Carmen Dunphy Alisha Eggers Matthew Farndale Jessica Frank Betsie Frey Jim Hoehns Matthew Hummel Ryan Jacobsen Dennis Jorgensen Jack Kampf Laura Knockel Nicholas Lehman Lesley Leuwerke Steven Martens Marcia McNulty Sharon Meyer Andrew Miesner Mary Mosher Phyllis Olson Jane Osterhaus Heather Ourth Shannon Peter Andrew Peterson Charles Phillips Dwayne Plender Morgan Sayler Denise Soltis Patrick Verdun Sara Wiedenfeld $100-$249 Carol Anderson Kenneth Anderson Rockford Anderson Christina Baugmart Morry Bectel Dena Behm Dillon Darci Boehlert M. David Brothersen Michael Brownlee

Tammy Bullock Todd Burkle Melissa Corrigan Ashley Dohrn Darla Eastman Allen Fann Peter Fay Frank Filippelli Susan Frey Danette Gibbs Marghie Giuliano Charles Boyd Granberg Jason Hansel Lucinda Harms Richard Hartig Kari Heitzman Amy Jackson Harold Jackson Margaret Karbeling Michael Kelly Danielle Kennedy Jack Kiburz Dennis Killion Andrea Kjos Patty Kumbera Lisa Lambi Stephanie Lingen Nickolas Lund Shane Madsen Lisa Mascardo Randal McDonough Mark McMullen Emily Muehling Warren Narducci Steven Nelson Anh Thu Nguyen Alan Norgaard Wesley Pilkington Gordon Reed Kathy Rinehart Cheri Rockhold Schmit Jon-Michael Rosmann Lori Schirmer Allie Schlicher Kathy Schott Rachel Skoff Bernard Sorofman Angela Spannagel Ben Urick Thomas Vlassis Susan Vos Nancee Waterbury Dean Westergaard Jerod Work

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The IPA Foundation has a unique opportunity to claim your favorite day(s) of the year as your least on paper. With your charitable donation, you may purchase days in the 2016 IPA/IPAF Annual Report Calendar to celebrate ANY occasion! To reserve your days, contact David Schaaf at 515270-0713 or Donations are 100% tax deductible and will go to the Foundation. Hurry and claim your day(s) before someone else does and before April 1, 2017!

Text & Photo - $100.00

Description (under 10 words):

Text Only - $50.00 Month/Day: _______/_________ Name: ___________________________________________________________________________________________________________________ Address: _________________________________________________________________________________________________________________ City: _____________________________________________________________ State: ________________ Zip: _____________________________ Phone: _______________________________________________ Email: ______________________________________________________________

PAYMENT INFORMATION Make checks payable to: Iowa Pharmacy Association Foundation, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322 Please Charge my Credit Card $___________ Card Type (circle one):




American Express

Cardholder Name: _________________________________________________________________________________________________________ Card Number: ____________________________________________________________ Exp Date: ________________ Card ID #: _____________ Billing Address (if different from above): _______________________________________________________________________________________ Signature: ________________________________________________________________________________________________________________ MAIL TO: Iowa Pharmacy Association Foundation 8515 Douglas Avenue, Suite 16 Des Moines, Iowa 50310

Fax: 515-270-2979 Questions? Contact: Laura Miller - 515-270-0713

F201-350-000@ ___________________ F201-350-000@ ___________________ Ck#__________ Date _______________ ID number_________________________

LETS RIDE! Join the 4th Annual IPA Foundation RAGBRAI Team! The Register’s Annual Great Bicycle Ride Across Iowa (RAGBRAI) is scheduled for July 23-29, 2017. Join the IPA Foundation and your pharmacy colleagues as ambassadors for the association and our profession. The IPAF RAGBRAI team connects with Iowa pharmacists and pharmacies along the route, educates Iowans on the important role of pharmacy, and serves riders with OTC treatments. Any Iowa pharmacist, pharmacy technician or student pharmacist is welcome to ride one day, a few days, or the entire week and spread the word about pharmacy from river to river. Sign up early to guarantee a spot on the team! The team will be limited to 20 weekly riders and an additional 10 riders per day. A wait list will be used for additional interested riders. The team will be divided into three groups: beginner, intermediate and advanced. Each team will have a captain and 5-7 additional riders with a list of pharmacies to visit for the day.

Not a Cyclist? No problem!

IPAF RAGBRAI team is more than riders. We need volunteers to help get the team from the Missouri River to the Mississippi River, as well as help with outreach efforts along the RAGBRAI route with screenings and other pharmacy promotions. Donations to support individual riders are also welcomed!

Interested in participating and have questions? Contact Laura Miller at or 515-270-0713.

WHAT DO YOU GET WHEN YOU RIDE THE IPAF TEAM? Week-Long Riders receive all benefits of the daily rider, plus: • IPAF Team Bike Jersey (free) • Transportation to the start and from the finish to a central Iowa meeting location • 2 days of laundry service • Indoor accommodations with host families (as available) Daily Riders (up to 3 days): • IPA-F Team Bike Jersey (discounted rate) • Transportation of gear and supplies • Official registration through RAGBRAI • Official RAGBRAI wristband • Camping with Host families or the RAGBRAI campgrounds (if needed) • Snacks for each day • Water and coffee available each day • Personal shower tents (shower bag is rider’s responsibility) • SAG service for tired riders if needed or half-day riders • Electrical charge station

HOW TO JOIN THE IPAF TEAM Go to for instructions on how to join the IPA Foundation team.

Important Registration Deadlines: Weekly Riders Early Bird: March 1 Final: March 31

Daily Riders Early Bird: March 1 Final: May 31


Week-Long Rider MAX 20 Riders

Early (by 3/1)

Late (by 3/31)

Pharmacist Member



Technician/Student Member



Non-IPA Members (includes spouse & children)



Daily Rider (max 3 days)

Early (by 3/1)

Late (by 5/31)



JAN.FEB.MAR 2017 |





Written by:

Marshall Johnson 2017 PharmD Candidate The University of Iowa College of Pharmacy

Home of the popular show American Pickers, Le Claire Iowa is no stranger to rare treasures. Two gentlemen travel the nation in search of rare items that go unnoticed. If they had taken the time to look in their own backyard they would have found a valuable treasure of the pharmacy profession Ashley Dohrn. A Montana native born in Whitefish, Ashley became an Iowa resident after graduating with a biochemistry degree from The Colorado College in 2001. Upon completion she moved to the Quad Cities with her (now) husband in search of career and prosperity. Ashley quickly realized her degree would have her working in a lab. After some soul searching she realized that wasn’t the life she wanted and began to explore graduate programs “The patient engagement and autonomy of the profession made pharmacy seem right for me.” Ashley was always drawn to healthcare. She admits as a child she wanted to be a veterinarian. She began contemplating several professions and ultimately decided a career in pharmacy was right for her. “The patient engagement and autonomy of the profession made pharmacy seem right for me”.


| The Journal of the Iowa Pharmacy Association

Ashley graduated from The University of Iowa College of Pharmacy in 2006 after which she pursued a residency. In 2008, she received her Board Certification in Geriatric Pharmacy. Upon reflecting on her education, she recalls a rotation during her fourth year at Main at Locust pharmacy in which Randy McDonough was a key player in shaping her perception of the profession. His energy and excitement for all things pharmacy pushed her to complete a community practice residency. Nearing completion of her residency, Ashley was offered a consultant pharmacist position at the long-term care pharmacy Main Healthcare Pharmacy in Bettendorf. She currently has responsibility for three nursing homes and 2 assisted living facilities. In 2008 a new physician became the medical director of one of her facilities. Ashley recognized an opportunity to showcase the skills and talents of the pharmacy profession and established a collaborative practice agreement for managing patient’s warfarin and INR testing. Since that time she has increased the number of facilities managed from one to three and contracts with two different medical directors. Ashley serves as the primary preceptor at Main Healthcare Pharmacy for The University of Iowa APPE students. This is an extremely rewarding experience for her. She understands how important teaching is and recalls preceptors who were key in her development as a pharmacy professional; individuals such as Randy McDonough, Kara Kuruthers, and Mark McMullen. These pharmacy champions impacted her life, her practice, and Ashley pays it forward each day with every student she mentors. “With long term care facilities it’s hard to see patients on

a regular basis” so she continually makes her site clinically challenging and relevant for her students. Preceptors are mentors and mentors are in a unique position to change the culture of our profession. Ashley recognizes her actions will give future graduates the confidence necessary to practice at the top of their ability. “Involvement...creates connections and opportunities that one might not have otherwise leading to greater professional fulfillment.” Ashley highlights the importance of involvement. Through her involvement on the IPA Board of Trustees and current service as Chair of the Policy Committee on Public Affairs, Ashley leads by example. It is apparent that pharmacy is changing and dispensing can no longer remain the sole support of our profession. “Being involved in local, state, and national associations allows you to stay in touch with your profession”. Technicians, students, pharmacists, we’re all in this together and this connection with your profession creates a sense of family and unity. “Involvement with these pharmacy organizations creates connections and opportunities that one might not have otherwise leading to greater professional fulfillment”. When asked where she sees’s pharmacy’s future and how IPA members can prepare for change Ashley states “Oh boy, this could be a long essay!” “If we keep pushing the envelope by working with legislatures, prescribers, and payers we can ensure a better future for our profession and better outcomes for our patients”. Ultimately this is what really matters, our patients and Ashley’s actions and guidance to the profession will ensure future generations will provide the level of care our patients deserve from pharmacists. ■


WELCOME NEW IPA MEMBERS OCTOBER 1 - DECEMBER 31, 2016: Tara Bergland, North Liberty Jaime Clark, Oskaloosa Nathan Evers, Mason City Angela Hoth, Iowa City Brady Hunter, Riceville Korey Kennelty, Iowa City Ashley Loeffelholz, Ankeny Peggy Munger, Sac City Dorraine Reynolds, Phoenix, AZ Kyle Shinn, Cedar Rapids Chris Van Norman, Clear Lake Lisa Veit, Waterloo Nickolas Vogel, Mt Ayr Pat Wilsbacher, Waukee Todd Wragge, Hampton Kay Zepeski, Dubuque Genesis Medical Center West Pharmacy, Davenport Mercy Family Pharmacy - Clear Lake


MEMBER MILESTONES Ashley Brehme, PharmD, became owner of Brehme Drug (formally Blakesley Drug) in Manchester, Iowa. Congratulations Ashley! Congratulations to Bill Blakesly, RPh, who recently retired as owner of Blakesley Drug in Manchester, Iowa. Derek Grimm, PharmD, BCPS, became director of pharmacy services at Spencer Hospital in Spencer, Iowa. Congratulations Derek! Congratulations to Tom Temple, BS Pharm, MS, FAPhA, CEO emeritus of IPA, who was re-elected as chairman of the U.S. Pharmacopeia (USP) Board of Trustees. Shane Madsen, PharmD, BCPS, was named Ambulatory Clinical Pharmacy Manager at the Univeristy of Iowa Hospitals and Clinics. Congratulations Shane! Congratulations to Chayla Stanton-Robinson, PharmD, a PGY1 Resident at CarePro Pharmacy in Mount Vernon, Iowa, who received a 2017 Incentive Grant for Practitioner Innovation in Pharmaceutical Care.

JAN.FEB.MAR 2017 |


IPA ACTION ASCP Annual Meeting: IPA Members Shine!

The American Society of Consultant Pharmacists (ASCP) held their Annual Meeting on November 3-6 in Dallas, Texas with five IPA members in attendance. With the high quality education and networking opportunities, attendees learned about opportunities in LTC medication management, pain management, osteoarthritis, and falls prevention as well as better understanding PBMs and implications of the national election.

Pharmacists Highlighted During November SIM Learning Community Meeting At the November 9, State Innovation Model (SIM) Learning Community meeting, Drake University College of Pharmacy and Health Sciences professor Tim Welty and IPA’s executive fellow Sarah Derr presented on the importance of medication management in the community setting. The audience had the opportunity to discuss examples of medication management in their community and ask questions about how pharmacy can play an essential role in healthcare for Iowans. Other topics discussed at this meeting included social determinant of health, care coordination in the rural environment and in managed care.

Iowa Pharmacy Celebrates Award Recipients at NCPA Annual Convention

The 2017 Annual Meeting was a special event for Iowa as IPA member Kristin Meyer, PharmD, CGP, CACP, FASCP of Drake University College of Pharmacy & Health Sciences & the Iowa Veterans Home was honored with the Armon Neel Senior Care Pharmacist Award. This award honors individuals who apply their knowledge of geriatric pharmacotherapy on a daily basis through their practice setting.

Iowa Hospital Association Annual Meeting This year the Iowa Hospital Association (IHA) held its largest Annual meeting from October 18-20 with over 1,700 attendees. IPA member Michele Birdsell from Mount Pleasant, Iowa was awarded one of the Iowa Hospital Association Hero Award for her positive impact on patient lives and her continued work with students over the last 20 years. Her colleagues shared that Michele is “a shining example of selflessness, caring and compassion.” Meeting highlights included keynote speakers including award winning author Doris Kearns Goodwin, boxing legend Sugar Ray Leonard, and surgeon Marty Makary. Programming was extensive and included topics such as ACO models, MACRA/QPP, Medicaid and MCO programs, orphan drugs, and pharmacists in the community hospital setting. IPA is working to partner with IHA to provide webinars and speakers at future meetings to discuss the role of the pharmacist in hospital healthcare.


| The Journal of the Iowa Pharmacy Association

IPA hosted a reception at the NCPA Annual Convention celebrating Randy McDonough, BS, PharmD, MS, CGP, BCPS, FAPhA, who received the 2016 Willard B. Simmons Independent Pharmacist of the Year, and The University of Iowa College of Pharmacy’s NCPA Student chapter, the 2016 NCPA Student Chapter of the Year. The NCPA Annual Convention took place October 15-19, 2016, in New Orleans and was attended by over 3,000 pharmacists.

IPA ACTION Iowa Reception at Midyear

IPA, Drake University College of Pharmacy and Health Sciences and The University of Iowa College of Pharmacy hosted 288 members of Iowaâ&#x20AC;&#x2122;s pharmacy family at the annual Iowa Reception at ASHP Midyear on December 5, in Las Vegas.

Everyone Wins at the Iowa-Wisconsin Pharmacy Tailgate

2017 A Health Professional Approach to Opioid Abuse The 2017 IPA Goes Local program will feature a 90-minute patient safety CPE presentation and roundtable discussion. IPA is partnering with the Alliance of Coalitions for Change (AC4C) to present on the emerging public health crisis of opioid abuse and the role health care professionals have to help combat the trends of increasing abuse. Attendees will then discuss local strategies for collaboration and solutions to this multifaceted problem. Angie Asa-Lovstad, AC4C Director, and Al Fear, Cedar Rapids Police Officer, will serve as the facilitator and presenter.

Well, Wisconsin may have won a little more (17-9 Badgers over the Hawkeyes), as Iowa pharmacy hosted our colleagues from the north for at tailgate party in Iowa City prior to the IowaWisconsin football game.

Watch for an announcement from IPA or your local association for registration details. Invite pharmacists, physicians, dentists, nurses, social work and treatment programs, law enforcement, substance abuse coalitions and interested stakeholders to attend this community focused event! March 14 - Dubuque, IA April 6 - Mason City, IA April 13 - Waverly, IA May 1 - Des Moines, IA May 18 - Davenport, IA August 31 - Council Bluffs, IA September 21 - Iowa City, IA October - Spencer, IA

JAN.FEB.MAR 2017 |




APRIL 2017


Minnesota Cancer Alliance Summit - Minneapolis, MN


Compass PTN Learning Community


IPA Legislative Day - Des Moines


IPC Independent Pharmacy Conference


2/2/2 Webinar: CMS Enhanced MTM Pilot Program

11-12 2017 Iowa Governors Conference on Public Health - Des Moines

17-19 Midwest Pharmacy Expo - Des Moines

26-27 NCPA Congressional Pharmacy Fly-In - Washington, DC

MARCH 2017 8

Iowa Board of Pharmacy Meeting - Des Moines


State Innovation Model Learning Community - Altoona

14 14

MAY 2017 3-4

ASCP Forum - Arlington, VA

2/2/2 Webinar


Iowa Board of Pharmacy Meeting

Iowa Healthcare Collaborative Patient Safety Conference - Ankeny


2017 HPV and Cancer Conference

17-19 PQA Annual Meeting

14-15 NACDS RxIMPACT Day - Washington, DC 15-16 PSW Senior Care Conference - Waukesha, WI 24-27 APhA Annual Meeting & Exhibition San Francisco, CA 26

Iowa Reception at APhA Annual Meeting

IPAâ&#x20AC;&#x2122;s free monthly webinar series held on the second Tuesday of every month at 2:00 p.m. CST. February 14, 2017: CMS Enhanced MTM Pilot Program March 14, 2017: TBD April 11, 2017: Iowa Residents Leading Practice Change Register for an upcoming 2/2/2 or view previous webinars at


| The Journal of the Iowa Pharmacy Association

June 15, 2017 Coralville Marriott Hotel & Conference Center


19 78

Issues & events that have shaped Iowa pharmacy (or are fun to remember!)


Mandatory participation in continuing education (CE) as a condition to renew a pharmacist license become effective. Max W. Eggleston elected as President of the American Council on Pharmaceutical Education (ACPE).


Eugene Vaden White (Presentation: The “and others” Profession) awarded the APhA Remington Award


Annual Meeting is held on June 9-11 in Iowa City; Harles Cone presents at Annual Meeting on ‘Building Your Professional Image’ Gary Thudium installed as the 99th president of the association; emphasized “we must maintain close political contact and credibility with our legislators or we will forfeit our right to affect laws regulating our profession…” The Board of Pharmaceutical Specialties (BPS) recognized nuclear pharmacy as a specialty in pharmacy practice

Gary Thudium


According to a workforce survey conducted by the association, the overall average number of prescriptions dispensed per day was 179. The overall average base salary for a pharmacist was $18,701. Bob Bellinger, chief pharmacist at Trinity Regional Hospital in Fort Dodge, was newly appointed to the Iowa Board of Pharmacy. Susan Lutz, Lutz Pharmacy in Altoona, was re-appointed to her second 3-year term on the Iowa Board of Pharmacy.

Harles Cone


Department of Social Services institutes the use of the standard or universal claim form for Medicaid billing Allen J. Brands (Presentation: “The patients pharmacist”) awarded the ASHP Harvey A.K. Whitney Award in San Antonio. IPA staff member Virginia Gamble retires after 14 years of service.

Virginia Gamble

The Iowa Pharmacy Association Foundation is committed to the preservation of the rich heritage of pharmacy practice in Iowa. By honoring and remembering the past, we are reminded of the strong tradition we have to build upon for a prosperous future for the profession.

JAN.FEB.MAR 2017 |



NEED A RELIEF PHARMACIST? CONTACT “JOSEPH IN RELIEF” Joseph Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322 h. 515.278.0846 c. 515.991.2684

ADVERTISE IN OUR PUBLICATIONS Place your ad/classified ad with us. All ads, contracts, payments, reproduction material and all other related communication should be addressed to David Schaaf at or call the IPA office at 515.270.0713 for more information.


| The Journal of the Iowa Pharmacy Association





The Iowa Monitoring Program for Pharmacy Professionals (IMP3), a voluntary, confidential program of the Iowa Board of Pharmacy, is designed to assist pharmacists, pharmacist interns and pharmacy technicians in

P 3 I M

obtaining the necessary help for successful rehabilitation from substance abuse as well as mental and physical disabilities. This provides an opportunity for licensed professionals to receive proper treatment and maintain their professional status, while protecting the safety of the public.




for Pharmacy Professionals

To learn more about IMP3, visit To self-report to IMP3, contact IMP3 staff at 515.725.2253.

Dedicated to Our Members since 1909. 800.247.5930

Our Mission To help our customers attain peace of mind through specialized insurance products, risk management solutions, and superior personal service.

IPA Journal - Jan/Feb/Mar 2017  
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