Page 1

A Peer-Reviewed Journal | Vol. LXXIII, No. 2 | APR.MAY.JUN 2017

WATCHING

D.C. Expectations from the New Administration

New Pharmacy-Friendly Bills in Congress

INSIDE: Practice Advancement Initiative in Iowa Outcomes Grant Recipients 2017 Annual Meeting Preview


TABLE OF CONTENTS 8515 Douglas Avenue, Suite 16, Des Moines, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: ipa@iarx.org | www.iarx.org

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

COVER STORY Watching D.C. pg. 24

A look at what is happening with the new administration, new legislation and welcomed updates from CMS.

OFFICERS CHAIRMAN Bob Greenwood, RPh, Waterloo PRESIDENT Rick Knudson, PharmD, BCPS, MS, MBA, Clear Lake

Transforming how pharmacists in acute and ambulatory settings care for patients

PRESIDENT-ELECT Craig Logemann, RPh, BCACP, CDE, Ankeny

The Practice Advancement Initiative (PAI) is a profession-led initiative that is empowering pharmacists to take responsibility for patient outcomes in acute and ambulatory care settings.

TREASURER Sue Purcell, RPh, Dubuque

Care Team Integration

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 www.iarx.org. “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.

Annual Meeting Preview Don’t miss the all-star lineup of keynotes, networking, policy adoption and fun! pg. 8 

FEATURES

Promotes a team -based approach to health care

Leveraging Pharmacy Technicians 

Empowers the pharmacy team to ensure that pharmacy technicians perform all traditional preparation and distribution activities

Pharmacist Credentialing & Training 

Elevates the reputation of the pharmacy team

Leadership in Medication Use

Technology

Evaluates the available technologies to support patient safety and quality of care

Empowers pharmacists to take responsibility for patient outcomes

Practice Advancement Initiative in Iowa How ASHP’s Practice Advancement Initiative is taking shape in Iowa. pg. 18

Shifts the roles of the healthcare team to enable pharmacists to optimize their time with patients across the continuum of care

Enhances the relationship between pharmacists and patients by positioning pharmacists as healthcare providers

Urges technicians to handle non-traditional and advanced responsibilities and activities to allow pharmacists to take greater responsibility for direct patient care

Ensures pharmacists, residents, and students have the training and credentials for activities performed within their scope of practice now and in the future

Promotes the use of credentials to provide services at the top of the scope of practice

Encourages use of available automation and technology to improve patient safety, quality, and efficiency, while also reducing costs

Identifies emerging technologies to improve pharmacy practice

Positions pharmacists to promote health and wellness, optimize therapeutic outcomes, and prevent adverse medication events

Emphasizes that, given their extensive education and training, pharmacists are integral to achieving the best outcomes

Promotes technician training and certification requirements, such as the need for uniform standards for advanced technician roles

IPA Board of Trustees Election Results . . . . . . . . . . . . . . . . . . . . 7 Annual Meeting Preview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Midwest Pharmacy Expo Recap . . . . . . . . . . . . . . . . . . . . . . . . . 12 Student Column: Reconciling ‘Med Recs’ . . . . . . . . . . . . . . . . . 17 ASHP Practice Advancement Initiative in Iowa . . . . . . . . . . . 18 Cover Story: Watching D.C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Legislative Day Recap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

IN EVERY ISSUE

President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 IPA Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes. APR.MAY.JUNE 2017 |

3


PRESIDENT’S PAGE

A SEASON FOR RENEWAL AND INVIGORATION Rick Knudson, PharmD, MS, MBA, BCPS Clear Lake, Iowa IPA President

S

pring is beginning to show itself across Iowa. The robins have returned and the grass is beginning to show signs of life once again. The season of renewal is upon us. I like to think about spring as a time to tackle new projects and challenges both personal and professional. This year is no different as the Knudson clan is living through a major remodel at our house (you haven’t lived until you’ve been through eating frozen pizzas three times a week because you have no kitchen!). At the same time, I find myself thinking about my personal and professional future but also the future of pharmacy practice. I started out this year as president talking with all of you and trying to inspire each of you in your own endeavors. That has been a rewarding experience and I thank all of you for sharing your stories, both successes and sometimes failures, with me. It gives me great confidence in our profession here in Iowa when I hear the passion and see the talent that is apparent in each of you. I recently was able to attend the APhA Annual Meeting as an Iowa delegate

4

| The Journal of the Iowa Pharmacy Association

to the APhA House of Delegates. The APhA House functions much as IPA’s House does as the policymaking body for their organization. It was a lively session with much to discuss. Policy was discussed on many subjects such as: • Patient access to pharmacistprescribed medications • Pharmacists’ role in value-based payment models • Performance networks • Equal employment opportunities • Enhanced drug disposal • On-label indication and med safety • Work schedules • Clinically-validated blood pressure devices • Pharmacy technician education, training, and development If you are saying to yourselves “those all sound familiar” you would be right! Virtually all of the items debated at the national level were areas that IPA had addressed in one way or another, and in most cases we already had policy on the books. In fact, in several instances the Iowa delegation introduced language from our own policy statements that enhanced the items up for debate. This is what Iowa pharmacy is all about - innovation, trail blazing, risk taking. Working to enhance pharmacy practice so as to better

care for our patients and at the same time advancing our profession. Kudos to all of you for that level of dedication and keep up the good work! I’ll be cheering for you every step of the way!

“I can tell you that it will always be one of the experiences in my life that I treasure and will look back on fondly.” The saying goes “time flies when you are having fun” and that could not be truer for me over this last year as your president! It has been a wonderful experience to work with a talented team of professionals, both the IPA staff and the elected officers. I can tell you that it will always be one of the experiences in my life that I treasure and will look back on fondly. I encourage all of you who haven’t been as involved as maybe you think you should to make that leap. The energy and resources that you dedicate to IPA will truly be returned a hundred times over! With that I will say “thank you” for the opportunity to serve you and our association as president, and I can’t wait to see what the future holds for pharmacy practice in Iowa!

Thank you,


CEO’S COLUMN

BUILDING TOWARDS THE FUTURE

I

owa pharmacy has built a reputation of innovation and leadership across all areas of practice, and across the country, and that isn’t by chance or coincidence. Rather, as I’ve learned, it is the result of special factors and intentional actions. One of those factors is YOU – Iowa is fortunate to have pharmacists who are passionate about our profession and its future. Our intentional actions include partnership with and investing in our state’s two colleges of pharmacy at Drake University and The University of Iowa. The IPA Board of Trustees recently approved a financial gift of $10,000 to the current building campaigns at both universities in recognition of our strong history of collaboration and partnership. We invite you, as IPA members and associates, to join us by giving to one, or both, of the exciting campaigns on each campus. Your gift along with the founding gift from IPA will help surpass the goal of $50,000 to name a prominent space for IPA and list individuals that would like to be recognized with the association. For most of us, the current building campaigns at Drake and Iowa represent once in a lifetime opportunities for us to be a part of. The space at Drake University will

be a student collaboration room located along the primary corridor of the new STEM building and at The University of Iowa the space will be one of the classrooms within the Pharmacy Practice Learning Center located on the main floor of the college of pharmacy. Both areas were selected by IPA’s leadership because of the student-focused environment in high-traffic areas. The recognition plaque for each space will include IPA’s logo and the names of donors who contribute $2,500 or more (Note: the minimum contribution individual name recognition through the universities is $5,000). The new science connector building at Drake will be open for students the fall of 2017; while The University of Iowa College of Pharmacy is planned to open for classes in 2019. I’m delighted that IPA has the opportunity to help our colleges build their new facilities and enhance pharmacy education in Iowa. These initiatives signify strength in the future of our profession and IPA’s commitment to supporting student pharmacists and leadership development. I’m also excited to be part of Iowa pharmacy during this exciting time and personally contribute to both campaigns. Indeed, these buildings will help take our profession to new heights. ■

Kate Gainer, PharmD Executive Vice President & CEO Iowa Pharmacy Association

If you would like to contribute to one or both building campaigns, please make your donations directly to the universities.

To Donate to the Drake Building Campaign: Donate online at: www.alumni.drake.edu/SCB/IPA For additional information: Angeline Hartman, Major Gift Officer Drake University angeline.hartman@drake.edu 515-271-4050

To Donate to The University of Iowa Building Campaign: Donate online at: www.givetoiowa.org/ipa For additional information: Mundi McCarty, Director of Development UI College of Pharmacy The University of Iowa Foundation mundi-mccarty@uiowa.edu 319-467-3682

APR.MAY.JUNE 2017 |

5


Dedicated to Our Members since 1909. phmic.com 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 BOARD ELECTION

IPA’S NEWLY ELECTED LEADERS Congratulations to the newly-elected IPA Board of Trustee members! These members will be installed into office at the 2017 IPA Annual Meeting on June 16-17 in West Des Moines.

PRESIDENTELECT

PRESIDENT

Craig Logemann, RPh, PharmD, BCACP, CDE Ankeny

Cheryl Clarke, BS Pharm, RPh, FAPhA Waukee

TRUSTEE REGION 2 Thane Kading, RPh

TRUSTEE REGION 4 Carol Anderson, PharmD

Iowa City

Mason City

TRUSTEE AT LARGE Heather Ourth, PharmD, BCPS, CGP Ackworth

TRUSTEE AT LARGE Deanna McDanel, PharmD, BCPS, BCACP

Coralville

APR.MAY.JUNE 2017 |

7


FRIDAY, JUNE 16 Coralville Marriott Hotel & Conference Center 300 E 9th Street, Coralville, Iowa 52241 The IPA Annual Meeting brings together Iowa pharmacists, pharmacy technicians and student pharmacists to shape policy, celebrate achievement and connect with colleagues. This year promises lively debate in the House of Delegates, fun and furious bidding at the IPA Foundation Silent Auction and plenty of opportunities to network and connect with colleagues from across the state!

7:00 a.m.

REGISTRATION OPENS 8:30-11:30 a.m.

HOUSE OF DELEGATES SESSION 1 KEYNOTE*

Lisa M. Gersema, PharmD, MHA, BCPS, FASHP President, ASHP Tom Menighan, BS Pharm, MBA, (Hon) ScD Executive Vice President & CEO, APhA DeAnn Mullins, BS Pharm, CDE President, NCPA To energize the House and provide a national perspective to the weekend’s policy discussions, Annual Meeting kicks off with a diverse panel of national pharmacy leaders and an interactive discussion on issues like provider status, drug pricing and potential changes in healthcare delivery.

June 15, 2017 • Coralville Marriott IPA will once again be hosting the Practice Advancement Forum on the day before Annual Meeting. This year’s forum will focus on practical “how-tos” to implement change in your practice. See the full Practice Advancement Forum agenda on page 21 and register at www.iarx.org/PracticeAdv. If you plan on attending both events, be sure to select the “Practice Advancement Forum & Annual Meeting” bundle for a discount on registration!

8

House of Delegates Session 1*: IPA’s Speaker of the House, Susan Vos, will preside over delegate orientation, the report of officers, policy committee hearings and new business review. This is your opportunity to provide feedback and participate in the discussions that will shape the policy decisions at Saturday’s session. Susan Vos

IPA will also present the Pharmacy Technician of the Year, Health-System Pharmacist of the Year, and Excellence in Innovation awards. See this year’s policy topics at www.iarx.org/IPAAnnualMtg * Session accredited for CPE. Details at www.iarx.org/AMCPE

| The Journal of the Iowa Pharmacy Association


9:00-10:00 p.m.

11:30 a.m.-1:00 p.m.

IPA FOUNDATION SILENT AUCTION

LUNCH & MOTIVATIONAL KEYNOTE

The evening will conclude with the popular IPA Foundation Silent Auction to support the Foundation’s educational and student programs. Plan to bid on an impressive array of items and participate in the wine/beer ring toss and red envelope fundraiser. Plan to come early during the President’s Reception and preview the silent auction items before the doors open!

It’s Not About You – Audience-Centered Communication Lauri Freking Senior Trainer, Wixted & Company Pharmacists communicate with a wide variety of key stakeholders: patients, physicians, nurses, colleagues, insurance companies, lawmakers and others. Putting your audience first and communicating in a way that puts the focus on them – the person or group you are communication with – is key to being a successful leader. Learn how to analyze an audience, craft messaging that resonates and deliver it in a way that forms an immediate connection and moves issues forward more easily.

SATURDAY, JUNE 17 7:00-8:00 a.m.

FUN RUN/WALK

This Annual Meeting tradition is open to anyone who wants to start the day off on the right (or left) foot! If you plan to participate, indicate your shirt size when you register. 7:00-9:00 a.m.

Following the lunch keynote, IPA will present its 2017 Appreciation Awards.

REGISTRATION & INDUSTRY SYMPOSIUM 9:00-11:30 a.m.

1:00-2:30 p.m.

DESSERT, POSTER PRESENTATIONS & EXHIBITS

HOUSE OF DELEGATES SESSION 2

Enjoy dessert as you learn about the exciting research projects that are advancing practice and improving patient care in Iowa. Exhibitors will also be on hand to showcase their latest products and services.

KEYNOTE*

Rear Admiral Pamela Schweitzer, PharmD, BCACP Assistant Surgeon General Chief Professional Officer, Pharmacy U.S. Public Health Service

2:30-4:00 p.m.

OPEN NETWORKING & COMMITTEE MEETINGS

This time is set aside for you grow your professional network and meet pharmacy colleagues from across the state. Or, you are welcome to sit in on a committee meeting. 6:00-9:00 p.m.

PRESIDENT’S RECEPTION & ANNUAL BANQUET

The Annual Banquet is a celebration of the previous year for Iowa pharmacy. PresidentElect Craig Logemann will be installed as the 139th IPA President and give his inaugural address. The banquet will conclude with the presentation of IPA’s most prestigious awards.

Craig Logemann

As the top pharmacist at CMS, RADM Pamela Schweitzer will share her perspective on initiatives like the Part D Enhanced MTM pilot, Hospital Improvement Innovation Network (HIIN), and the Quality Payment Program (QPP) and the role of pharmacists in the future of healthcare delivery. House of Delegates Session 2: Speaker Vos will preside over the final policy debate, nomination of the 2017 Honorary President, ratification of the Nomination’s Committee report and the installation of Steven Martens as the Speaker of the House. In addition, the 2017-2018 Vice-Speaker of the House will be elected, and the Poster Presentation Award winner will be announced.

Questions? Contact IPA at 515-270-0713

Register online at www.iarx.org/IPAAnnualMtg ADDITIONAL INFORMATION Silent Auction & Red Envelope Prize Donations

If you or your pharmacy would like to donate to the silent auction, please contact Laura at lmiller@iarx.org and provide a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the weekend of Annual Meeting, in order to have your item listed in the silent auction catalog, please notify Laura prior to June 1.

Pre-Meeting CPE Webinars

Hotel Information

Present Your Poster

When making your lodging reservation, please call 319-688-4000 and indicate that you will be attending the IPA Annual Meeting to receive the rate of $103.00, which is available through May 18, 2017.

IPA has developed two 30-minute webinars that provide additional background on two policy topics for CPE credit. These webinars are free to registered Annual Meeting attendees. Visit www.iarx.org/AMCPE for details.

If you would like to present a poster, please submit an abstract at www.iarx.org/IPAAnnualMtg.

Coralville Marriott Hotel & Conference Center 300 E 9th Street, Coralville, Iowa 52241 319-688-4000

APR.MAY.JUNE 2017 |

9


BEComE A mEmBEr of THE iowA PhArMAcy AssociAtion

Position yourself to lead and shape the future of your profession and join a network of pharmacists, pharmacy technicians and student pharmacists advocating the advancement of practice for the health and well-being of our patients.

AdvAntAges for You Equipping you for today’s rapidly evolving health care system with free and convenient CPE and opportunities to connect with colleagues across the state.

AdvocAcy for Your ProfEssion Enabling you to confidently engage your elected officials while representing your interests with the Board of Pharmacy, state agencies, health care organizations, and provider groups.

85

%

of membership dues directly fund initiatives that advance the pharmacy profession

AdvAnceMent for Your PrACTiCE Creating opportunities for you and your colleagues to collaborate with healthcare teams and integrate pharmacy practice into emerging healthcare models.

iowA PhArMAcy needs your unique voice And exPerience!

leArn More & join todAy At

www.iArx.org FREE CPE!

iPA members receive cei’s relicensure or recertification cPe Buckets for free!

All the required CPE for relicensure or recertification conveniently bundled by CEi and free for iPA members!


HEALTHCARE HOT TOPICS

Former Deputy Commissioner to Head FDA

On March 10, 2017, President Trump announced that he will nominate Scott Gottlieb to head the Federal Drug Administration. Gottlieb is a medical doctor and former acting deputy commissioner of the FDA during the President George W. Bush administration. Dr. Gottlieb also serves as a partner at a venture capital fund and has strong ties to the biotech and pharmaceutical industries.

Verma Confirmed as CMS Administrator

The Senate voted 55-43 on March 13 to confirm Seema Verma as head of the Centers for Medicare and Medicaid Services. She will play a key role in the implementation of any form of healthcare reconstruction. Verma’s past work includes Medicaid expansion in Indiana under former Governor Mike Pence that included a deal with the Obama Administration to charge monthly premiums to enrollees under the expansion.

Trump Delivers Ultimatum; House GOP Leaders Pull Efforts to Repeal & Replace ACA

In the wake of a decision by House leaders to postpone a vote scheduled for Thursday, March 23 on the Republican healthcare bill, President Trump delivered a blunt message to lawmakers to vote on repealing and replacing the Affordable Care Act (also known as Obamacare) on Friday. The following day, House GOP leaders faced a revolt among conservatives and moderates in their ranks, and pulled legislation to repeal the Affordable Care Act from consideration on the House floor, which was seen as a defeat for President Trump on the first legislative showdown of his presidency.

12 Bacteria Pose Greatest Threat

The World Health Organization (WHO) released a list of antibiotic-resistant “priority pathogens” that pose the greatest threat to human health. The specific bacterial families identified kill millions of people globally, causing the WHO

to produce the list to encourage the development of new antibiotics and to trigger governments to incentivize the process. The list categorizes bacteria into critical, high and medium priority groups, according to the urgency of need for new antibiotics. Those bacteria listed as critical priority, include: Pseudomonas aeruginosa, carbapenem-resistant; Enterobacteriaceae, carbapenem-resistant, ESBL-producing; and Acinetobacter baumannii, carbapenem-resistant.

Antipsychotic Drug Labeling Adds New Warning

A label update has been added to all antipsychotic medications including a warning to the prescribing information. The updated labeling indicates that antipsychotic drugs can cause postural hypotension, somnolence, and motor and sensory instability. The side effects can lead to falls which could cause bone fractures or other serious injuries. Fall risk assessments are recommended when initiating patients on antipsychotics and should be repeated if the patient remains on long-term therapy.

In the Midst of Match

Phase 1 of ASHP’s 2017 Match process revealed that 5,752 applicants sought one of 4,592 residency positions. Of those total positions, 3,750 were filled in the first phase, with the remainder to be filled in Phase 2 of the Match. ASHP also reported that residency positions have increased by 1,594 over the past five years. This is the second year for ASHP’s twophase approach with the Match, which gives applicants who did not match in Phase 1 another opportunity to connect with postgraduate training programs.

NECC Owner Found Not Guilty of Murder After Meningitis Outbreak

A federal jury in Boston acquitted Barry Cadden, the owner and head pharmacist at the New England Compounding Center (NECC), of second-degree murder charges but convicted him of racketeering, mail fraud, and other crimes in connection with the sale of a contaminated pain medication that caused a deadly U.S. outbreak of fungal

meningitis in 2012. CDC estimated that some 13,000 people in multiple states could have been injected with the possibly tainted medicine.

Meningitis Serotype B Prevalence

From March 2013 to February 2016, the United States experienced five serogroup B meningococcal outbreaks across college campuses in California, Oregon, Rhode Island, and New Jersey. The five major serogroups of meningococcal disease are A, C, W, Y and B. Serogroup B is the most common cause of meningitis in adolescents and is responsible for one-third of U.S. cases. In the past, only serogroups A, C, W and Y had vaccinations for prevention. Currently, there are two vaccines that provide protection against serogroup B: Bexsero and Trumenba.

Trump Creates Opioid Commission

President Trump signed an executive order on March 30, 2017, establishing the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Based on the signed order, the commission will: • Identify existing federal dollars to combat drug addiction, including opioids • Assess availability and access to addiction treatment centers and overdose reversal and identify underserved areas • Measure the effectiveness of state prescription drug monitoring programs • Evaluate public messaging campaigns about prescription and illegal opioids, and identify best practices for drug prevention Trump chose New Jersey Governor Chris Christie to chair the Commission. Gov. Christie has devoted the final year of his gubernatorial term to taking on the opioid crisis in New Jersey which has led to naloxone access expansion, prescription limits, and insurance coverage for substance abuse treatment. ■

APR.MAY.JUNE 2017 |

11


2017 EXPO RECAP

Unseasonably warm weather greeted the 300 pharmacists, pharmacy technicians and student pharmacists from across the Midwest who attended the 2017 Midwest Pharmacy Expo in Des Moines. A change in location to the Des Moines Airport Holiday Inn and Conference Center brought everyone and everything back under one roof. Expo kicked off on Friday with the Ambulatory Care Advancement Conference featuring presentations from national leaders in the field covering transitional care, population management, documentation, communication and more. Bob Chiusano, author of Mediocrity is Not an Option, gave a motivational keynote on Saturday morning, urging the Expo audience to learn something, have fun, and make a difference every day. From there, it was a full day of live continuing education with sessions covering a broad range of timely topics from speakers from across the country. Expo wrapped up on Sunday with long time favorites New Drug Update and Gamechangers in Pharmacy sandwiching a session on reducing compliancy risk. Mark your calendars for February 16-18, 2018, for next year’s Midwest Pharmacy Expo! We will be under one roof again at the Des Moines Airport Holiday Inn and Conference Center. We can’t promise another weekend of 70-degree weather in February, but we can promise you plenty of opportunities to learn, connect and be inspired with your colleagues from across the Midwest!

See Also: Sec. Tom Vilsack Speaks at Political Leadership Reception, pg. 30

12 | The Journal of the Iowa Pharmacy Association


APR.MAY.JUNE 2017 |

13


IOWA PHARMACY NEWS

Pharmacy Technician Stakeholder Consensus Conference In February, the Pharmacy Technician Certification Board (PTCB) hosted the Pharmacy Technician Stakeholder Consensus Conference in Dallas. Stakeholders from across the country met with the goal of building a roadmap for the evolution and advancement of pharmacy technicians. The conference sought consensus on the following issues: 1. The necessity of public confidence in pharmacy’s process for ensuring that competency of pharmacy technicians 2. An optimal level of basic (“generalist”) knowledge, skills, and abilities that pharmacy technicians should have regardless of practice site 3. An optimal definition of entry-level (“generalist”) pharmacy technician practice 4. The desirability and feasibility of developing a process for recognizing competencies of pharmacy technicians beyond entry-level practice 5. The desirability and feasibility of minimizing variability among states in the definition and regulation of pharmacy technicians 6. The entities that potentially could take responsibility for any changes in pharmacy’s process for ensuring the competency of pharmacy technicians Iowa was well represented at the conference: Anthony Pudlo presented on the New Practice Model, Matt Osterhaus provided his community pharmacy perspective, and Iowa Board of Pharmacy Executive Director Andrew Funk , The University of Iowa College of Pharmacy Dean Donald Letendre and Iowa pharmacist Mike Brownlee also attended. PTCB will present their recommendations stemming from this conference during IPA’s 2/2/2 webinar on June 13. Watch IPA communications for registration information.

14

| The Journal of the Iowa Pharmacy Association

Naloxone Statewide Standing Order Update

Recently, Kaleo Pharma the makers of the Evzio autoinjector, announced that the Evzio 0.4mg naloxone autoinjector will be discontinued and the company will now have Evzio 2mg naloxone autoinjector available. This change was made after studies showed that 2mg was safe and effective to use in patients with opioid overdose. Pharmacies may still dispense Evzio 0.4mg if in stock as there are no concerns with safety and efficacy of this product. The Iowa Board of Pharmacy has updated the naloxone statewide standing order to reflect the change in strength of Evzio. For more information on the naloxone statewide standing order and resources to implement the standing order into your pharmacy go to www.iarx.org/naloxone.

IPA to Publish New Resource for MPJE

IPA has created a new resource to assist student pharmacists and pharmacists who move to Iowa in studying for the Iowa Multistate Pharmacy Jurisprudence Examination. The MPJE Study Guide features information on registering for the exam, what to bring to the exam, and multiple questions on the unique aspects of pharmacy law in Iowa. Additionally, each question has a brief explanation of the answer and a reference to where to find the answer in Iowa Code or Iowa Administrative Code. The study guide has been reviewed by a group of new practitioners, student pharmacists, and pharmacists who recently became licensed in Iowa. IPA will be releasing the Iowa MPJE Study Guide for sale in May 2017 to assist the pharmacy graduate class of 2017 in studying for the Iowa MPJE.

Pace Alliance Buying Group Merges with IPC

Pace Alliance announced in February that it ceased operations as an independent pharmacy buying group and merged with the Independent Pharmacy Cooperative (IPC). Pace will continue to offer insight and consulting to IPC related to state and

federal pharmacy advocacy. The merger agreement doesn’t alter Pace’s corporate structure, ownership, board of directors or management staff. The merger was completed on April 1, 2017. IPA is one of 19 state pharmacy organizations that have an ownership stake in Pace.

Trends in Iowa Pharmacy Workforce in 2015

The University of Iowa, Office of Statewide Clinical Education Programs, Iowa Health Professions Tracking Center, tracks the healthcare workforce in Iowa each year. The advisory committee met on November 18, 2016 to review the trends from 1996 to 2015. The trends include: • A 25% increase in the number of pharmacists in Iowa since 1996 with a total of 2927 pharmacists in 2015 • The increase in the number of pharmacists retiring has increased the number of pharmacists leaving the profession in the state • The average age of pharmacists in Iowa is 44 years old • In 2015 the percentage breakdown of highest degree held by pharmacist was 57% PharmD and 43% BS in the state of Iowa • The gender breakdown for pharmacists practicing in Iowa in 2015 was 63% female and 37% male • There is at least one pharmacist practicing in every county across the state of Iowa who is a graduate from either Drake University College of Pharmacy & Health Sciences or The University of Iowa College of Pharmacy

University of Iowa PharmD Program Accredited Through 2025 The University of Iowa College of Pharmacy’s Doctor of Pharmacy program received full accreditation by the Accreditation Council for Pharmacy Education (ACPE) through June 2025. The accreditation was granted based on the ACPE Board of Directors’ review of


IOWA PHARMACY NEWS

an on-site evaluation, the college’s selfstudy and other communications from the institution.

CPF Awards IPA Grant to Research & Advance Pharmacy Performance Networks

As IPA continues to facilitate dialogue amongst Iowa pharmacists around value-based performance models of care, two initiatives have developed creating community pharmacy performance networks. One initiative with a large commercial payer that has created a value-based pharmacy program that will pay pharmacies based on patient health outcomes and specific quality metrics. The second initiative is the establishment of a Community Pharmacy Enhanced Services Network in Iowa (CPESN Iowa), which is being led by five volunteer pharmacy leaders, known as luminaries. These networks have brought together pharmacies focused on improving quality and care, and demonstrating value to healthcare payers, providers, and consumers. While Iowa pharmacies in these networks have already begun to implement enhanced pharmacy services into their daily workflow, value based payments to pharmacies are being further explored as payers recognize the significant impact pharmacists can have on quality metrics and health outcomes. With recent support from the Community Pharmacy Foundation and key strategic partnerships with the Collaborative Education Institute, Drake University College of Pharmacy & Health Sciences, and the University of Iowa College of Pharmacy, IPA will coordinate research and educational activities that study the effective implementation of enhanced pharmacy services and determine effective ways to train pharmacists in providing these services. The specific goals and objectives of this joint collaboration include: • Provide training and education specific for practice transformation

to pharmacies in Iowa pharmacy performance networks • Describe the performance of the high-performing pharmacy network through effects on quality indicators, total cost of care, and overall performance scores

to further children’s medicine at The University of Iowa.

Iowa Health Information Network (IHIN) Under New Management

• Market and promote the advanced performance networks to providers, payers, and pharmacists

In 2015, the Iowa Legislature authorized the movement of the Iowa Health Information Network (IHIN) into a nonprofit status, outside of state government. Following a bidding process by the Iowa Department of Public Health (IDPH), the Hielix/Koble Group (HKG) application was selected to take over stewardship of the non-profit IHIN. HKG has more than a decade of handson experience forming and operating HIEs in multiple states and officially began stewardship of the IHIN on March 31, 2017.

This collaboration brings together key pharmacy stakeholders in Iowa to focus on important pharmacy initiatives in Iowa. Close to 150 pharmacies are part of these pharmacy performance networks. The research and educational initiatives are scheduled to begin in late spring 2017 and continue into 2018. Findings will be distributed via reports to all stakeholder groups, presentations at national meetings and conferences, and various scholarly publications.

Under the new nonprofit organization structure, developed with guidance from Hielix/Koble, the IHIN will continue to operate, as well as begin identifying opportunities to modernize and improve services for the benefit of Iowans. The IHIN reach will expand to include long-term care, pharmacies, labs, home health, behavioral health, hospice, and other providers in the Iowa healthcare ecosystem. Currently, IHIN serves primarily hospitals and physician clinics.

University of Iowa Stead Family Children’s Hospital Receives First Patients

HKG is in discussion with Nebraska and Missouri about providing connections across state borders to better serve patients in Iowa’s border communities, such as Sioux City, Council Bluffs, Keokuk, Centerville, Mason City, and Osage. A fully functioning IHIN will be able to supply critical treatment information to the care provider at the point of care and at the time of service to enhance the patient’s treatment plan and improve patient outcomes.

• Assess the relationships between pharmacy care activities and pharmacy performance reported for participating network pharmacies • Characterize qualitative feedback from patients receiving the advanced pharmacy care at high-performing network pharmacies

On Feb. 25, 2017, patients began moving into the new University of Iowa Stead Family Children’s Hospital. Seven of the facility’s 14 levels are now open with the remaining levels set to open at a later date. Construction on the $360 million facility, one of the state largest construction projects, began in 2012. The project included a 507,000-squarefoot hospital - plus another 56,250 square feet of renovated existing space on the main campus. The hospital was named honor of alumni Jerre and Mary Joy Stead, recognizing the couple’s $25 million commitment

IPA continues to have conversations with HKG leadership about the value of integrating pharmacies into the state HIE. For more information about the IHIN, visit www.iowaehealth.org/provider/. ■

APR.MAY.JUNE 2017 |

15


YOUR

&

PROFESSIONAL SKILLS

REPUTATION DON’T HAVE TO BE DAMAGED AS A RESULT OF IMPAIRMENT.

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.

I

O W A

IOWA MONITORING PROGRAM

for Pharmacy Professionals

To learn more about IMP3, visit imp3.iowa.gov. To self-report to IMP3, contact IMP3 staff at 515.725.2253.


STUDENT COLUMN

STUDENT PHARMACIST PERSPECTIVE

RECONCILING ‘MED RECS’

O

nce a year Gallup famously publishes its poll on honesty and ethics in professions, and nearly every year pharmacists and nurses are voted to the top two positions. In 2016 this trend continued with pharmacists and nurses again finishing ahead of other respected professions such as physicians, journalists, and educators. For me—a nurse of seven years who is about to start rotations as a student-pharmacist—these results have validated my career choices, but more importantly they reflect our reputation of being strong patient advocates.

“For me—a nurse of seven years who is about to start rotations as a studentpharmacist—these results have validated my career choices” Pharmacy and nursing have served as the backbone of patient safety for decades and our patients know it. During the course of a hospital admission both professions assess, educate, and serve as the final safety checks before a prescription medication reaches the patient. This complementary care begins the moment a patient enters the hospital, follows them through their admission, and continues beyond discharge while the patient transitions back home. For these reasons it is easy to see what sets our professions apart from the rest, but there is one area of patient care

where we continue to come up short— the dreaded medication reconciliation. Over the past decade I have had clinical experiences in hospitals across Iowa, and what I have learned is that medication reconciliations or “med recs” are very important and can be very time-consuming. This is because potential consequences from a subpar med rec such as doubled doses, omissions of important home medications, and missed OTC medications. What really surprises me, however, is that despite the risks inherent to the med rec process we still don’t have a consensus on who should be completing them. Because of this I believe going forward this responsibility should end with the pharmacist—healthcare’s medication use expert.

“What really surprises me, however, is that despite the risks inherent to the med rec process we still don’t have a consensus on who should be completing them.” I understand this notion might ruffle some feathers, and why shouldn’t it? After all, there isn’t a single pharmacy that doesn’t feel the squeeze of rising drug costs and stagnant reimbursement. However, the case for pharmacy-driven med recs has been made at the IPA Practice Advancement Forum, discussed during several 2/2/2 webinars, and is even a core service of the Community

Casey O’Connell 2018 PharmD Candidate The University of Iowa 2016-20117 IPA Board of Trustees

Pharmacy Enhanced Services Network (CPESN). Furthermore, the hospitals that have already shifted their med recs to being pharmacydriven are seeing significant decreases in adverse events. When I think back to what I once allowed as a med rec serving as a nurse prior to pharmacy school, it makes me shudder. Our professions have many overlapping skills, but I had never even heard of med rec until after graduating nursing school and my patients suffered because of it. Pharmacy’s position among the top rankings for honesty and ethics is well-deserved, but now is not the time to rest on our laurels. Pharmacists must continue to earn the reputation as patient care advocates, and that starts by taking ownership of the medication reconciliation process. ■

APR.MAY.JUNE 2017 |

17


PAI IN IOWA

PAI IN BRIEF

T

Transforming how pharmacists in acute and ambulatory settings care for patients

he ASHP/ASHP Foundation PAI A similar process was undertaken to The survey data also have value to The comprehensive Practice Advancementdetermine Initiative (PAI) is a profession-led initiative that is empowering website provides best practice recommendations ASHP state affiliates. Each state society pharmacists to take responsibility for patient outcomes in acute and ambulatory carethe settings. information about this critically for ambulatory care. The Ambulatory can access aggregate data from important initiative, which aims Care Conference and Summit was held the hospitals and ambulatory care to advance pharmacy practice in hospitals in Dallas, TX in March of 2014. Unlike practice sites in their respective state. Leveraging Pharmacy Pharmacist Leadership in andCare health systems. the first conference the Ambulatory Technology Predetermined reports will enable state Team Integration Technicians Credentialing & Training Medication Use Care Conference and Summit was society leaders to assess where the most In November of 2010 over 150 hospital open to all who registered and more significant gaps exist (current status Promotes a team -based Empowers the Elevates the reputation  Empowers pharmacists and health system pharmacist leaders than 400 pharmacists convened to Evaluates thevs.available PAI recommendations) and the approach to health care pharmacy team to of the pharmacy team technologies to support to take responsibility for convened in Dallas, TX at the PPMI prepare and vote on recommendations. characteristics of patient hospitals or ambulatory ensure(this that pharmacy patient safety and quality outcomes  Shifts roles of the as PAI) Summit technicians perform25 all recommendations  Ensures pharmacists, initiative isthe now known for ambulatory of care care practice sites that have successfully healthcare team to traditional preparation residents, and students  Positions pharmacists to to determine what they care practice were determined. A selfthe promote PAI recommendations. enable pharmacists to collectively and distribution activities have the training and  Encouragesimplemented use of health and optimize for activities available automation and wellness, believed weretheir thetime keywith areas of focus assessment credentials web-based tool was prepared This information has the optimize potential patients across the  Urges technicians to performed within their technology to improve therapeutic outcomes, neededcontinuum for positioning pharmacy practice based on the summit recommendations. to drive state‐based educational of care handle non-traditional scope of practice now patient safety, quality, and prevent adverse and the advanced and in the future and practitioner and efficiency, while medication eventspractice in hospitals and health systems for A system self-assessment programming, sharing of best  Enhances the responsibilities and also reducing costs future.relationship The summit attendees reached self-assessment are available. An action examples, andtheEmphasizes development of tools between activities to allow  Promotes the use of that, given consensus on assumptions, beliefs, and to takeplan can becredentials created based on the selfand materials thattheir willextensive drive practice pharmacists and pharmacists to provide  Identifies emerging education patients by positioning greater responsibility for the top of the to improve and training, pharmacists recommendations to advance pharmacy assessment services and theat action plan also technologiesforward in an organized manner. pharmacists as direct patient care scope of practice pharmacy practice are integral to achieving practice. The overarching PAI vision is includes articles and resources correlated healthcare providers the best outcomes  Promotes technician that pharmacists will be the members with each recommendation. When For more information, please visit the PAI training and certification of the interdisciplinary health care team suchthe website http://www.ashpmedia.org/pai. ■ requirements, as database reaches adequate size the need who are responsible and accountable forfor uniformcomparative reports will be available to standards for advanced patients’ medication outcome. technician roles compare practice in similar practice sites. In order to enable an actionable agenda from the summit recommendations, ASHP and the ASHP Foundation created a 106 question hospital self‐ assessment web‐based tool from the summit recommendations. Every hospital should complete the individual self‐assessment. Coupled with the self‐ assessment is an action plan created for each individual hospital. Not only is the action plan individualized, it also includes articles and resources correlated with each recommendation. Additionally, because the survey is a web‐based tool, pharmacists at each hospital can compare their hospital to others in the state or others of similar sizes across the country.

Transforming how pharmacists in acute and ambulatory settings care for patients The Practice Advancement Initiative (PAI) is a profession-led initiative that is empowering pharmacists to take responsibility for patient outcomes in acute and ambulatory care settings.

Care Team Integration

Promotes a team -based approach to health care

Shifts the roles of the healthcare team to enable pharmacists to optimize their time with patients across the continuum of care

Leveraging Pharmacy Technicians 

Enhances the relationship between pharmacists and patients by positioning pharmacists as healthcare providers 

Empowers the pharmacy team to ensure that pharmacy technicians perform all traditional preparation and distribution activities Urges technicians to handle non-traditional and advanced responsibilities and activities to allow pharmacists to take greater responsibility for direct patient care

Pharmacist Credentialing & Training 

Elevates the reputation of the pharmacy team

Ensures pharmacists, residents, and students have the training and credentials for activities performed within their scope of practice now and in the future

Promotes the use of credentials to provide services at the top of the scope of practice

Leadership in Medication Use

Technology

Evaluates the available technologies to support patient safety and quality of care

Encourages use of available automation and technology to improve patient safety, quality, and efficiency, while also reducing costs

Identifies emerging technologies to improve pharmacy practice

Empowers pharmacists to take responsibility for patient outcomes

Positions pharmacists to promote health and wellness, optimize therapeutic outcomes, and prevent adverse medication events

Emphasizes that, given their extensive education and training, pharmacists are integral to achieving the best outcomes

Promotes technician training and certification requirements, such as the need for uniform standards for advanced technician roles

Article reprinted with permission from ASHP

18

| The Journal of the Iowa Pharmacy Association


PAI IN IOWA

PRACTICE ADVANCEMENT INITIATIVE IN IOWA: HAVE YOU HEARD ABOUT IT? The Iowa Pharmacy Association has joined the nationwide Practice Advancement Initiative (PAI) campaign to advance care coordination across practice settings and improve utilization of ambulatory care pharmacy services. The campaign will center on the PAI recommendations from ASHP and the ASHP Foundation, which focus on care team integration, leveraging pharmacy technicians, pharmacy credentialing and training, technology, and leadership in medication use. With guidance from the IPA Board of Trustees and the Health-System Liaison Board, the Iowa PAI Workgroup was formed to help guide the Association toward the PAI recommendations. The Iowa PAI Workgroup first convened on February 18, 2017, in conjunction with the Midwest Pharmacy Expo. The workgroup welcomed Vanessa Freitag, PharmD, vice president of ambulatory services and operations with Acension Wisconsin and a PAI facilitator from the ASHP Foundation. After reviewing the five core areas of the PAI as it relates to Iowa pharmacy practice, Freitag noted the primary drivers for PAI in Iowa should be: decreasing readmissions; increasing quality and pay for performance; decreasing cost of care; and improving medication safety. The largest concern for the workgroup to consider is the lack of basement data from the PAI Ambulatory Care Self-Assessment. While Iowa is near 80% completion of the Hospital Self-Assessment, the group needs to consider completion of this survey

as a primary step moving forward. This self-assessment survey evaluates ambulatory care services against national recommendations and creates an action plan for pharmacy practice settings. The workgroup will focus their effort on identifying and providing a framework to achieve short-term and long-term goals to address the five PAI core areas. Collaboration amongst key stakeholders such as pharmacy residency programs, the colleges of pharmacy, and other statewide professional organizations will be essential to achieve the PAI recommendations in Iowa.

Assess Your Practice Against National Recommendations on Provision of Patient Care Services While you may not call it ambulatory care services, every pharmacy practice in Iowa provides some level of patient care services. How do you align with the national recommendations? IPA encourages you as a practitioner or you as a community-based or outpatient pharmacy to complete an Ambulatory Care Self-Assessment. The results of this assessment and accompanying action plan will not only help you improve your practice’s provision of direct patient care services, but the aggregate results will be utilized by IPA to help better serve our members and pharmacists across the state. To complete the free ambulatory care self-assessment, visit www.amcareassessment.org, create an account, and get your results today. ■

Who’s Involved?

Here are the IPA members that will contribute to the Iowa PAI Workgroup. Elisha Andreas Hy-Vee Pharmacy – Iowa City Rebecca Brannan Mercy Medical Center – Des Moines Eva Coulson University of Iowa Hospitals & Clinics Lauren Cumings Mercy Medical Center – Cedar Rapids Brittany Dougherty Mercy Medical Center – Cedar Rapids Jen Goings Mercy Medical Center – Cedar Rapids Derek Grimm Spencer Regional Hospital Kari Heitzman UnityPoint Health – Des Moines Geena Hopwood VA Medical Center – Des Moines Jen James UnityPoint Health Clinics Mary Lacy UnityPoint Health – Des Moines Rachel Lienemann Northeast Iowa Family Medicine Residency Program John L’Estrange UnityPoint Health Clinics Emily Muehling UnityPoint Health – Des Moines Anh Ngo The University of Iowa College of Pharmacy Emily Prinz University of Iowa Hospitals & Clinics Justin Rash Martin Health Services Diane Reist University of Iowa Hospitals & Clinics Tyler Sandahl VA Medical Center – Iowa City Trisha Smith University of Iowa Hospitals & Clinics Mark Sorensen University of Iowa Hospitals & Clinics Chayla Stanton-Robinson CarePro Pharmacy

APR.MAY.JUNE 2017 |

19


PRACTICE ADVANCEMENT

DON’T STARE AT THE CLOSED DOOR TOO LONG... Randy McDonough, BS, PharmD, MS, CGP, BCPS, FAPhA Iowa City, Iowa CPESN Luminary

“Don’t stare at the closed door too long…You’ll miss the window opening” - Anonymous

I

n my thirty-year career as a pharmacist I have experienced the peaks and valleys of our profession. In fact, it was as recent as 2013 when I hit the deepest valley of my professional life. Overnight, from December 2012 to January 2013, I saw that the effective reimbursement rate for dispensing products for our largest payer in the state was reduced by 50% across the board because of the unscrupulous acts of their pharmacy benefit manager (PBM). To be honest I was scared, not only for my own financial ruin, but for the long term viability of community pharmacy practice, and its impact on patient care. I finally understood that payers only saw us (community pharmacists) as nothing more than retailers—providing only product— with no recognition of our value to patient care. Today there are opportunities that are bountiful, exciting, and unlimited. For the first time in my professional career, pharmacists are part of the discussions regarding the transformation of our health care system. At the national level, our professional organizations continue to work with legislators to elevate pharmacists as providers and be recognized by the Centers for Medicare and Medicaid Services

20

| The Journal of the Iowa Pharmacy Association

(CMS). We are closer to achieving this status more than we have ever been in the history of our profession. At the state level, the windows of opportunity have not only cracked opened, but are beginning to bring new light into our profession. This includes a value-based pharmacy program with a large commercial payer. There are a significant number of community-based pharmacies that have been selected for the initial roll out of this new value-based payment model. In this model, pharmacists will be paid for their performance for moving clinical metrics and total cost of care. This is in addition to their product-based reimbursement. In other words, if a community-based pharmacy practice can demonstrate that it can improve patient clinical outcomes and reduce overall health care utilization, then a bonus incentive payment will be given to the pharmacy. In the past year, the formation of the Community Pharmacy Enhanced Services Network of Iowa (CPESNIowa) has occurred. Currently there are 83 community-based pharmacies that have signed the participation agreement to be part of the network. Recently, CPESN-Iowa has been in discussions with a health plan that is rolling out an enhanced MTM model for our region. Starting in 2018, the plan wants to push patients out to community-based pharmacies to provide MTM services. The plan is interested in the partnering with the CPESN-Iowa network as a provider of enhanced MTM services. There are ongoing discussions with health-systems, Accountable Care Organizations (ACOs), and physicians groups on how community-based pharmacists can be more integrated within their practice structures. Also,

IPA continues to have discussions with the Iowa Medicaid Managed Care Organizations (MCOs) about the integration and payment for pharmacist medication management services. The practice of community-based pharmacy is changing and it is changing fast. Reimbursement for product is no longer the driver—that door is shutting, but reimbursement for patient care services is happening and will continue to grow in our new value-based health care system and payment models. We have to take full advantage of this window of opportunity. It requires change. All of us have to critically evaluate our practices and determine if our practices are capable of supporting the provision of enhanced clinical services. In addition, we need to critically evaluate our own skills and knowledge to be ready to practice at the top of our degree. We will need to find ways to free up the pharmacists from technical duties to allow for more patient care responsibilities. In other words our business model has to change as we move from a volumebased practice to one that is focused on value. The time for our profession to respond to these opportunities is now. We can no longer wait until tomorrow because our opportunities are today. If we do not take full advantage of these new opportunities, then the real danger is that the window will shut and we may never be given another opportunity. I believe our profession is ready to embrace these new opportunities and succeed—but it requires full participation and engagement from all of us. The future looks bright for our profession and now is the time to prepare. I believe in pharmacy, but most importantly I believe in all of you! ■


June 15, 2017 Coralville Marriott Hotel & Conference Center The Practice Advancement Forum brings together pharmacists from across the state to strengthen opportunities for collaboration and practice advancement in Iowa.

See the full agenda and register at www.iarx.org/PracticeAdv

Agenda 8:00 am

Welcome

8:15 am

Keynote: Achieving Patient Health Outcomes in Value-Based Payment Model

9:30 am

How to Utilize Tech-Check-Tech to Re-Engineer Your Practice

10:45 am

Break

11:00 am

Leveraging Data Standards in Enhanced Service Provider Networks

12:00 pm

Lunch

1:00 pm

How to Communicate with and Collaborate on Difficult Patients

2:15 pm

Break

2:45 pm

How to Impact Adherence in Your Practice

4:00 pm

Call to Action/Next Steps

IPA’s 2017 Annual Meeting will start the day after the Practice Advancement Forum. Attend both for discount and additional opportunities to network with colleagues from across the state and shape pharmacy practice in Iowa. If you plan on attending both the forum and Annual Meeting, be sure to select the “Practice Advancement Forum & Annual Meeting” registration option.


PRACTICE ADVANCEMENT

The State Innovation Model in Iowa In 2015, the Center for Medicare & Medicaid Innovation (CMMI) awarded Iowa as one of the 11 states to receive a federal grant over four years to participate in the State Innovation Model (SIM) Phase Two Test States. The SIM aligns Iowa payers in payment reform that focuses on value; equips Iowa providers with tools to perform in value based, population focused models; and aligns and integrates public health strategies into how health care is delivered. Six communities across the state that have been identified as a part of the SIM initiatives.

The Iowa Healthcare Collaborative (IHC) was awarded this grant and has subcontracted with IPA, the Iowa Medical Society, the Alliance for Medication Management and the Iowa Academy of Family Physicians to carry out the work of the SIM project. IPA is working closely with these partners to reach out to pharmacists in the six communities identified to assist with coordination of care and connect pharmacists with other stakeholders in their community to provide better care.

CPESN Progress Continues

IPA members and Iowa Community Pharmacy Enhanced Service Network (CPESN Iowa) luminaries Ryan Frerichs and Matt Osterhaus participated in the CPESN USA live meeting in Raleigh, North Carolina, on February 8-9, 2017. In attendance at this meeting were members from multiple states with CPESN initiatives. The meeting agenda included a variety of sessions that provided pharmacists with the tools to implement the CPESN and learn more about how CPESN USA can assist these sites in successfully providing enhanced services. In addition, CPESN Iowa held a meeting on March 17, 2017, for all CPESN sites in Iowa. During this meeting the luminaries (Ryan Frerichs, Bob Greenwood, Randy McDonough, Matt Osterhaus, and Cheri Schmit) discussed the current state of the network, resources available to pharmacists in Iowa, and the direction of

22

| The Journal of the Iowa Pharmacy Association

State Innovation Model Community Care Coalition Initiative Grantees Dickinson

Emmet

O’Brien

Clay

Palo Alto

Cherokee

Buena Vista

Osceola

Lyon Sioux

1

Plymouth

Woodbury

Monona

Crawford

Harrison

Shelby

Pottawattamie

Kossuth Hancock

Poca- Humboldt Wright hontas

Mitchell

Howard

Cerro Gordo

Floyd

Chickasaw

Franklin

Butler

Bremer

Grundy

Black Hawk

6

Calhoun Webster Hamilton Hardin

Sac

Ida

WinnebaWorth go

Carroll

AuduGuthrie bon

Cass

Boone

Greene

Adair

Mills

Montgomery

Adams

Fremont

Page

Taylor

Dallas

2

Polk

Marshall

Tama

Jasper

Powe shiek

Allamakee

Fayette

Clayton

Buchanan Delaware Dubuque

Jones

Linn

Benton

4

Iowa

Jackson Clinton

Johnson

Cedar Scott Muscatine

Madison

Union

Story

Winneshiek

Warren

Clarke

Ringgold Decatur

Marion Mahaska

Lucas Wayne

5

Keokuk

Washington

Monroe Wapello Jefferson Appanoose

Davis

Van Buren

Louisa

Henry Des Moines Lee

3

1. Community Partners of Sioux County

4. Linn County Board of Health

2. Dallas County Public Health Nursing Services

5. Marion County Public Health Department

3. Great River Health Center

6. Webster County Health Department

the network in the next three years. The first step to advancing CPESN Iowa is through conducting initial site visits with all 83 sites. The intent of these visits is to gain a baseline understanding of current services provided at each site and what additional education is needed to allow the sites to be successful in the CPESN. Approximately 20 volunteers from CPESN Iowa will be conducting these initial visits across the state during the month of April. Following these visits, the luminaries plan to review the information collected and work with IPA to develop education and other materials that will support CPESN sites in transforming the practice of pharmacy.

Technician Product Verification & The New Practice Model

A Pharmacy Technician Stakeholder Consensus Conference was held in Texas at the end of February. The event was hosted by the Pharmacy Technician Certification Board (PTCB) and included several national stakeholders with the goal of building a roadmap for the evolution and advancement of pharmacy technicians. Iowa was well represented: Anthony Pudlo presented on the New Practice model, Matt Osterhaus gave a

community pharmacy perspective, and the Iowa Board of Pharmacy Executive Director Andrew Funk, The University of Iowa College of Pharmacy Dean Donald Letendre and Iowa pharmacist Mike Brownlee were also in attendance. PTCB will be releasing a summary of this conference in the near future. The New Practice Model was also on the agenda three times at the 2017 American Pharmacists Association Annual Meeting in San Francisco. Michael Andreski, Kate Gainer, and Anthony Pudlo each presented on the successes of implementing technician product verification in the community setting. Attendees were excited to hear about this work and had many questions on implementation of technician product verification in the community setting. National recognition of the New Practice Model at this meeting has sparked other states to consider legislation and implementation of similar programs. The New Practice Model pilot sites came together for a live meeting on Thursday, March 30 to hear updates on the project, CPESN, and Wellmark. The pilot sites had great discussion regarding work flow, clinical services, patient care successes, and incorporating the


patient care process into practice. Phase III of the New Practice Model began in November 2016 and successfully has added new prescriptions to technician product verification. IPA continues to partner with Drake University College of Pharmacy and Health Sciences to evaluate the safety and success of this project. IPA plans to pursue legislation during the 2018 session which will allow technician product verification in communitybased pharmacy settings. If legislation passes during the 2018 session, IPA will collaborate with the Board of Pharmacy to craft regulations for technician product verification.

Advanced Training to Improve Quality Metrics Coming Soon!

Community pharmacists can and must positively impact performance measures to continue with a successful practice as part of a preferred provider network. This may require adaptations to current practice strategies to allow evaluation of all patients’ drug therapy through workflow and appointment-based services. In other words, pharmacists need to “Make Every Encounter Count” with all patients. Make Every Encounter Count is a 10-week training program on the implementation of a continuous medication monitoring, or CoMM, in your practice. The program guides you and your team, week by week, through a checklist of steps that must be taken to be successful, including: • Completion of a CPE-accredited webinar each week (15-60 minutes depending on the week) • Practice Change Workbook with reflection questions about what steps you need to take in your practice that week By the end of 10 weeks, you will have the tools, workflow, knowledge, and skills you need to successfully participate in preferred provider networks, and most importantly, to positively affect all patients’ drug therapy. ■

The Iowa Monitoring Program for Pharmacy Professionals (IMP3) was established in 2016 to monitor and support pharmacy professionals who report problems with mental health, physical disabilities, or drug and alcohol abuse or dependence. The IMP3 believes pharmacy personnel’s professional skills and reputation do not have to be damaged as a result of impairment if monitoring and supportive services are put in place at an early stage. IMP3 is designed to assist pharmacists, pharmacist interns and pharmacy technicians in obtaining the necessary help for a successful rehabilitation from substance abuse as well as mental and physical disabilities. With a recent overhaul in the recovery program for impaired pharmacy professionals and now administration directly by the Iowa Board of Pharmacy, there are significant changes to the program that pharmacy professionals need to understand. With a greater emphasis in the IMP3 on self-report and engaging professionals into the program, all pharmacy professionals should understand how the program operates, the eligibility requirements, and privacy issues that are dictated in Board of Pharmacy regulations. This one hour program (planned for pharmacy law CPE accreditation for pharmacists and pharmacy technicians) will provide case-specific discussions on where and how the IMP3 will be useful for you and your colleagues. Events are being planned in coordination with local pharmacy association meetings, so plan to attend a local event near you in 2017!

EVENTS PLANNED:

Dubuque - May 25, 2017 Council Bluffs - July 20, 2017 Spencer -July 25, 2017 Waterloo/Waverly - August 17, 2017 Johnson County - August 22, 2017 Des Moines - October 12, 2017 Mason City - October 19, 2017 Quad Cities - TBD APR.MAY.JUNE 2017 |

23


COVER STORY

WATCHING

D.C.

Change is the only certainty as a new administration sets its sights on transforming healthcare

W

ith Donald Trump’s unexpected election win, and his penchant for unpredictability, all eyes are on the nation’s capital. The Republicancontrolled Congress, emboldened by a Republican president and his administration, has its sights set on reforming significant areas of the nation’s health care system. Change is coming, but what it will look like remains uncertain. What is known is the issues the president has spoken about and the people he has appointed to those government agencies responsible for the nation’s health care. A better understanding of the key players can provide some insight into what the Trump administration has in mind.

Key Players

Rep. Tom Price (R-Ga.), was confirmed to lead the Department of Health and

24

| The Journal of the Iowa Pharmacy Association

Human Services which oversees Medicare and Medicaid, the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration (FDA). As a chairman of the House of Representatives’ Budget Committee, Price, an orthopedic surgeon, was one of the top Republicans working to dismantle the Affordable Care Act (ACA). In a statement following his nomination, the Georgia Pharmacy Association noted that Price “has expressed support for GPhA on a range of pharmacy issues.” Trump’s choice to lead the Centers for Medicare and Medicaid Services (CMS), Seema Verma, founded SVC, a healthcare consulting firm that has worked with several states, including Iowa, on Medicaid expansion and waivers. Proponents and critics alike look to her work on Indiana’s Healthy Indiana Program while Vice President Mike Pence was governor, which incorporates personal responsibility, from both a health and financial stand point. Scott Gottlieb, a physician, is Trump’s nominee (yet to be confirmed) for

commissioner of the FDA. He is currently a partner at a venture capital fund and has been a consultant or board member of several pharmaceutical companies. Gottlieb worked in several positions at the FDA under President George W. Bush, including deputy commissioner. He has been a strong advocate for deregulation and expedited drug approvals.

Key Issues

With Price and Verma in place, the president has his “dream team that will transform our health-care system for the benefit of all Americans.” Throughout his campaign rallies, presidential press conferences and, of course, his Twitter feed, Trump outlined the health care issues he and his administration intend to address. Drug Prices Though he did not mention the issue much on the campaign trail, Trump has made it clear since his election that high drug prices are in his crosshairs. In a news conference prior to his inauguration, Trump stated that drug companies are “getting away with murder” when it comes to drug prices, especially in


WATCHING D.C.

Medicare and Medicaid. That statement and others in Time magazine and Tweets, caused a sharp drop in stock prices for several drug manufacturers. “We are the largest buyer of drugs in the world, and yet we don’t bid properly,” Trump stated following a February meeting with pharmaceutical executives. Trump wants to end the government ban on negotiating with drug companies for Medicare Part D and leverage its purchasing power to drive prices lower. In early March, the president and Sec. Price met with U.S. Reps. Elijah Cummings (D-Md.) and Peter Welch (D-Vt.), where the congressmen outlined draft legislation that would allow for such negotiations and the establishment of a formulary for Part D. Critics argue that direct Medicare Part D negotiations will have little effect on drug prices and are quick to point out that the insurers managing Part D plans already negotiate with drug companies on behalf of beneficiaries using their own formularies. Sec. Price has previously been opposed to government negotiations on drug prices but seemed to warm up to the idea during his confirmation hearing. FDA Regulation One of President Trump’s first actions in office was signing an executive order requiring all government agencies to cut two regulations for every new one that is approved, signaling in no uncertain terms his intention to cut federal regulations. The president has specifically taken aim at the FDA, stating that as much as 80% of the agency’s regulations are unnecessary. “Our slow and burdensome approval process at the [FDA] keeps too many advances…from reaching those in need,” stated Trump, calling out the agency in his first presidential address. Trump wants to streamline the process and shorten the time it takes for a drug to be approved. In addition to getting new drugs to patients faster, fewer regulations could lower drug costs. Theoretically, manufacturers would be able to recoup their development costs quicker, lessening

the need for price increases and extended exclusivity. There is also the potential benefit of more affordable medications improving adherence and, in turn, lowering overall healthcare costs. But opponents argue that reducing the rigorous testing requirements puts consumers and patients at risk. While most pharmaceutical companies welcome the changes, others fear it will be more difficult to distinguish legitimate breakthrough products from bogus ones. Medicaid Reform With the inevitable repeal and replace of the ACA, Republicans and Trump will look to reform Medicaid by reducing federal spending and involvement. Changes in the program will likely reduce or eliminate the ACA’s Medicaid expansion, leaving questions on what to do with those who received coverage in states that expanded eligibility. Both the president and Sec. Price have stated their support for shifting open-ended Medicaid funding to block grants, where states receive a fixed sum for each participant. The block grants would give the states more power and flexibility in administering their Medicaid programs, but would likely be working with less money moving forward. This approach seems to fall in line with Verma’s background in working with states on Medicaid program waivers to give them more flexibility in their programs. Her “skin in the game” approach could also come into play to help reduce Medicaid costs. In several state program waivers, she has proposed an element of personal responsibility though HSA-like accounts that beneficiaries would pay into which serve as an “incentive to make cost-conscious healthcare decisions” and thus driving down the cost of their care. Opponents argue that personal contributions and penalties for missed payments create barriers to care.

Uncertainty Mixed with Optimism

changes that benefit the pharmacy profession. The administration’s desire to reduce costs creates an opportunity for pharmacists to assert their value in prevention and chronic disease management. Both Price and Verma have signaled their support of MACRA, which would open opportunities for pharmacists to collaborate with other providers to improve outcomes and be paid for it. Along those lines, provider status could be close to becoming a reality. During his confirmation hearing, Sec. Price voiced his support for it, stating, “Paying pharmacists in underserved areas to engage in certain medical services could work well in those states where pharmacists have such licensure and a setting appropriate to the services, where primary care doctors continue to be involved in care, and where there is a patient and consumer demand for such services.” On the other end of the spectrum, Trump’s focus on drug prices and increased scrutiny from Congress, CMS, and the media could finally bring much needed regulation and transparency to the PBM industry. In an interview, Trump acknowledged the PBM’s “middle-man system” as one of the “bad systems” contributing to higher drug prices.

What’s Next?

Though failing once already, replacing the ACA with the Republican-authored American Health Care Act is still a top priority for the administration and Congress, but after that, plenty of uncertainty remains. National pharmacy associations are taking advantage of a reform minded executive and legislative branches by aggressively advocating for legislation for provider status and to regulate PBMs (see page 27 for a list a pharmacy friendly bills now in Congress). One thing is clear. Healthcare, or at least how it is paid for by many Americans, will likely be quite different in a year from now. ■

Despite a number of unknowns, Washington’s eagerness for healthcare reform opens the door for possible

APR.MAY.JUNE 2017 |

25


WATCHING D.C.

CMCS Encourages Expansion of Scope of Pharmacy Practice

Guidance published on January 17, 2017, by the Center for Medicaid and CHIP Services (CMCS) recommended that states expand their scope of pharmacy practice to “facilitate easier access to medically necessary and time-sensitive drugs for Medicaid beneficiaries.” Specifically, the guidance calls on states to allow pharmacists to prescribe, modify, or monitor drug therapy for certain medications through tools or “flexibilities” like independent prescribing, collaborative practice agreements or statewide standing orders. CMCS cited four public health issues that states are addressing through an expanded scope of pharmacy practice: 1. Naloxone dispensing is increasing access to the opioid antagonist and ensure a more timely administration of the drug in case of an overdose. 2. Pharmacists in New Mexico and California are able to initiate, modify and manage tobacco cessation drug therapy, creating experience that increase the chances of success. 3. The convenience of flu shots in community pharmacies leading to increased vaccinations and preventing epidemics. 4. Allowing pharmacists to prescribe and dispense emergency contraception pills provides easier access to this time sensitive medication. The guidance encourages states to use the tools to optimize the role of pharmacists and remove barriers to care created by provider access issues and the prescription process.

CMS: DIR Fees Increase Part D Beneficiaries’ Costs

The Centers for Medicare and Medicaid Services (CMS) published an analysis of DIR fees in Medicare Part D that provided transparency to the effect of the post point-of-sale fees on the program. The analysis was in response to the significant

increase in the amount and usage of DIR fees by plans and the growing disparity between gross Part D drug costs at the point of sale and net costs that CMS had observed in recent years. The CMS analysis points out that collecting additional fees after the point of sale, rather than reducing the list price of the drug, increases the beneficiaries out of pocket costs and thus pushes them to the catastrophic coverage phase quicker. The government then faces an increased financial burden as a result of more beneficiaries entering catastrophic coverage at a faster rate. CMS noted that higher levels of DIR fees can reduce premiums and some costs. However, they are unclear of the net effect of the reduced premiums and plan costs versus the costs of more beneficiaries receiving catastrophic coverage. The analysis was lauded by several industry groups for finally shedding light on the effect of DIR fees on the program.

Rep. Carter Appointed to House Energy and Commerce Committee Rep. Buddy Carter (R-Ga.), the only pharmacist serving in Congress, was appointed to the House Energy and Commerce Committee. The committee is responsible for telecommunications, consumer protection, food and drug safety, public health research, environmental quality, energy policy, and interstate and foreign commerce. This committee has jurisdiction over key healthcare and pharmacy legislation including any potential replacement for the ACA, DIR fees, MAC transparency, and any willing pharmacy.

In announcing the appointment, Speaker of the House Paul Ryan stated, “Buddy’s insight will be extremely valuable to the committee as the only pharmacist in Congress. Since the day he became a member of Congress, he has wasted no time offering his unique health care expertise in hopes of creating a better system for all patients.” ■

PHARMACY BILLS NOW IN CONGRESS Several pharmacy-related bills were quickly introduced in the new Congress.

Pharmacy and Medically Underserved Areas Enhancement Act (S. 109, H.R. 592) The companion provider status bills were reintroduced in both the House and Senate. The bill would give pharmacists provider status under Medicare Part B. Iowa Sen. Chuck Grassley, again, introduced the Senate version of the bill. Iowa Sponsors: House: Reps. Rod Blum, Steve King, Dave Loebsack, & David Young Senate: Sens. Chuck Grassley & Joni Ernst Improving Transparency and Accuracy in Medicare Part D Drug Spending Act (S. 413, H.R. 1038) The bill would effectively ban DIR fees applied retroactively and increase transparency and accuracy in Medicare Part D prescription drug spending. This same bill was introduced in the House last September. Iowa Sponsors: House: Reps. Blum & Loebsack Senate: Sen. Grassley Prescription Drug Price Transparency Act (H.R. 1316) The bill, introduced by pharmacy advocate, Rep. Doug Collins (R-Ga), aims to bring transparency to PBM prices and curb harmful practices by regulating MAC lists, prohibiting patient information sharing with PBM-owned pharmacies and forbidding mandated use of affiliated pharmacies. Iowa Sponsors: Reps. Blum & Loebsack Creating Transparency to Have Drug Rebates Unlocked (S. 637) The C-THRU Act would require PBMs to disclose the amount of rebates they receive from manufacturers and how much go to Medicare beneficiaries. Bill sponsorships are current as of April 1, 2017.

APR.MAY.JUNE 2017 |

27


LEGISLATIVE DAY

LEGISLATIVE DAY 2017 Feb. 7 was a crowded day at the Iowa State Capitol, but the white coats of over 200 Iowa pharmacists, pharmacy technicians and student pharmacists who attended IPA’s Legislative Day were easy to spot. Despite a busy day on the hill, legislators were eager to hear from pharmacy professionals. Members discussed IPA priorities including Medicaid reimbursement. Legislators took advantage of the opportunity to ask questions about immunization exemptions, step therapy, telepharmacy and other healthcare issues Iowans and the legislature were facing. Everyone reported positive and supportive conversations with their legislators. New this year was the ability to earn both patient safety and pharmacy law CPE from Legislative Day’s afternoon programming, which featured a panel of statewide stakeholders on prescription drug abuse; a discussion with Iowa’s two pharmacist legislators Rep. John Forbes and Sen. Tom Greene; a perspective from Nic Pottebaum, the governor’s health policy advisor; and a presentation on what lies ahead in Washington, D.C. with Mike Tomberlin, NCPA’s vice president of government affairs. The face-to-face grassroots advocacy that takes place during Legislative Day is critical for advancing pharmacy practice in Iowa. The relationships built by our members at the capitol and throughout the year provide the building blocks for IPA staff and lobbyists to engage legislators on pharmacy and healthcare issues facing our patients and profession.

28 | The Journal of the Iowa Pharmacy Association

Save the Date: IPA Legislative Day - January 24, 2018.


LEGISLATIVE DAY

THE FIRST TIME ADVOCATE Samantha Alukas 2018 PharmD Canditate The University of Iowa

I

t was a busy day at the Iowa State Capitol. Chants from citizens filled the halls, state legislators darted between meeting rooms, and white coats of pharmacists and students alike flooded in from the entrance. I had never been to the capitol or participated in advocacy before February’s IPA Legislative Day. With no background in politics, I thought, “how could I, one person, make a difference?” But I am not just one person. The wonderful thing about pharmacy in Iowa is the strong presence of grassroots advocates and the broad network of support created by our state pharmacy association. That day, I was surrounded by individuals with a fierce passion for pharmacy and public health. Although

I was nervous (what if I said the wrong thing?), I was equally as inspired by the seasoned pharmacists and advocates who enthusiastically offered their help and guidance. Over the course of the day, with encouragement from my new network, I was able to speak with multiple state legislators who openly listened to what I had to say. With each meeting, I became more confident in my ability to promote the pharmacy profession. I grew that day in a way I was not expecting. I learned that advocacy is not just for those we feel are more accomplished or politically savvy; it is for everyone. Whether you are a first time advocate trying to find your voice, like me, or you have advocated one thousand times, every voice matters. Every voice can make a difference.

REP. VANDER LINDEN RECEIVES IPA’S FIRST GOOD GOVERNANCE AWARD IPA awarded its inaugural Good Governance Award to State Rep. Guy Vander Linden (R-Oskaloosa). The award recognizes a legislator who has worked strongly on behalf of pharmacy and public health issues. Rep. Vander Linden was a strong voice as IPA pursued PBM legislation in 2014 and 2015 in Iowa. He worked with pharmacists, the association and stakeholders from both sides to understand the need for this legislation and its impact on the health of Iowans. Under his guidance, the two bills were passed unanimously in the Iowa House on their way to being signed into law. IPA presented Rep. Vander Linden with the award during Legislative Day.

APR.MAY.JUNE 2017 |

29


PUBLIC AFFAIRS

Appellate Court Sides with PCMA, Overturns Lawsuit Dismissal On January 11, 2017, the U.S. Court of Appeals for the Eighth Circuit issued a decision that effectively struck down Iowa’s PBM transparency law. The court sided with the Pharmaceutical Care Management Association (PCMA) on their claim that Iowa’s law is preempted by the Employee Retirement Income Security Act (ERISA). Specifically, the court stated the law interferes with the uniform administration of ERISA plans nationwide.

As you may recall, thanks to a strong grassroots effort by IPA members, the Iowa legislature unanimously passed H.F. 2297 in 2014 (and clarifying legislation in 2015) that provided transparency to PBM MAC lists. PCMA sued the State and the insurance commissioner over the law on five claims, including the ERISA claim. That suit was dismissed in September 2015. PCMA appealed that ruling, leading to appellate court’s decision after hearing oral arguments in June. In response to the Eight Circuit’s ruling, the State of Iowa filed for an en banc rehearing, disputing the court’s opinion

on ERISA preemption. However, the court denied the State’s request. The next step would have been to appeal the decision to the U.S. Supreme Court, however, the State chose not to pursue an appeal. As the originator of the contested legislation, IPA has reached out to these offices to offer our continued assistance as they evaluate potential next steps. The association remains committed to bringing transparency and common sense regulation to the PBM practices.

Tom Vilsack as the featured speaker at the Midwest Pharmacy Expo’s Political Leadership Reception. Vilsack encouraged the audience of pharmacy professionals stating, “You are the life blood in the healthcare system.” Vilsack also thanked pharmacists for taking a leadership role on opioid abuse. In a break from tradition, the event was held as an evening reception rather than its normal Expo Saturday breakfast time slot.

Sec. Vilsack Speaks at Political Leadership Reception

IDPH Publishes Draft Healthy Iowans Plan

On Saturday, February 18, IPA and the Midwest Pharmacy Expo welcomed former Iowa governor and recently retired U.S. Secretary of Agriculture

IPA is one of the 59 entities collaborating with IDPH on the plan. For this initiative, IPA specifically recommended collaborative efforts

The Iowa Department of Public Health (IDPH) published a draft of its Healthy Iowans 2017-2021: Iowa’s Health Improvement Plan. The plan identifies Iowa’s top health concerns and will set the public health agenda for the next 5 years. The top three on the list of 23 issues are obesity, nutrition and physical activity; mental health, illness and suicide; and substance abuse.

STRENGTHEN ADVOCACY. STRENGTHEN PHARMACY.

The Iowa Pharmacy Political Action Committee is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. Your contributions to the IPPAC aid in advocating for practice advancement, PBM regulation and other important issues facing our profession. For more information or to contribute, visit www.iarx.org/IPPAC IPPAC can only accept individual contributions. Corporate contributions can be made to the Legislative Defense Fund or the Pharmacy Practice Preservation Fund. Visit the website above for more information.

30 | The Journal of the Iowa Pharmacy Association


PUBLIC AFFAIRS

to reducing prescription drug abuse, reducing medication errors through medication reconciliation and MTM, and broadening availability and knowledge of immunizations to increase Iowa’s immunization rates. The draft was open for public comment during the month of March. The final version of the plan will be published at a later date.

provided an invaluable experience for them while showcasing the strength of students’ voices and actions for the future of the profession.

SHARE YOUR MCO CONCERNS WITH IPA

IPA, NCPA, and Senate Staff Visit Iowa Pharmacies

IPA has been collecting member specific concerns regarding the transition of Medicaid to an MCO model since June 2016. 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.

Student Pharmacists Provide Screenings on Capitol Hill

On Feb. 8, IPA staff and Mike Tomberlin, vice president of government affairs at NCPA, visited several pharmacies in central Iowa.

Prior to Legislative Day, student pharmacists from Drake University and The University of Iowa showcased the value of pharmacy to legislators with the annual Capitol Screening Day on Jan. 25. For the first time, IPA was excited to have several pharmacy residents helped oversee the screenings. Students and residents provided nearly 70 blood pressure, bone density, blood glucose and lipid screenings to legislators and other State Capitol guests.

The first stop was Montross Pharmacy in Winterset. Following that visit, IPA and Mike were joined by staff from Sens. Joni Ernst and Chuck Grassley’s offices to visit Sumpter Pharmacy in Adel and Medicap Pharmacy in Waukee. Pharmacists took the opportunity to discuss their experience with DIR fees and advancing pharmacy practice.

In the last couple of months IPA has been working closely with each of the MCOs and the Iowa Medicaid Enterprise to find resolutions to complicated concerns. IPA is currently in the process of resolving several concerns regarding durable medical equipment (DME) contracts, coverage, and billing processes. To assist member’s with DME, please refer to the DME reference in Medicaid FAQ section on the IPA website. Additionally, IPA is having candid discussions on the Medicaid preferred drug list and sharing IPA member’s concerns regarding the PDL. IPA staff will continue to work in partnership with the MCOs and IME to resolve any concerns that members submit. If you or your pharmacy has concerns or questions 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 www.iarx.org.

The Capitol screenings offer a great opportunity for students to directly meet and greet their legislators and showcase the various skills that pharmacists are capable of providing. For many of the student pharmacists and residents, it was their first time at the Capitol! This event

APR.MAY.JUNE 2017 |

31


PUBLIC AFFAIRS

BOARD OF PHARMACY: SPRING UPDATE Two Pharmacists Appointed to the Board of Pharmacy

In April 2017, two Iowa Board of Pharmacy members will complete their terms of service. Edward Maier and James Miller have both provided invaluable expertise to guide board decisions during their terms. • Edward Maier is a licensed pharmacist from Mapleton, Iowa, and was appointed by Gov. Chet Culver in 2008 and was re-appointed in 2011 and 2014 by Gov. Terry Branstad. • James Miller is a licensed pharmacist from Dubuque, Iowa. Appointed by Gov. Branstad, he began his service on May 1, 2011 and was re-appointed to his second term in 2014. Subsequently, two new pharmacist members were recently appointed to the board. IPA members Gayle Mayer, RPh, BS Pharm, FASHP, and Brett Barker, PharmD, were appointed by Gov. Branstad. Gayle is from Spencer, Iowa, and recently retired as director of pharmacy at Spencer Hospital. Brett is from Nevada, Iowa, and is vice president of operations for the NuCara Management Group. Their term will begin May 1, 2017.

Prescription Monitoring Program Annual Report

During their March meeting, the board summarized its annual report on the Prescription Monitoring Program (PMP). There has been an increase in the number of pharmacists and prescribers that are currently registered for the program along with an increase of requests for patient prescription history. Nearly all of the registered pharmacists in Iowa have enrolled to access the database

32

| The Journal of the Iowa Pharmacy Association

and in 2016, approximately 1000 new prescribers have registered. The board has been authorized to submit a request for proposal (RFP) for a new PMP software vendor. The board is also collaborating with the Iowa Department of Public Health to ensure funding for PMP expansion in order to address increased prescription opioid use in Iowa.

Telepharmacy Proposed Rules

The board released its Notice of Intended Action for telepharmacy rules. The board has proposed rules that will meet the needs of the telepharmacy industry while keeping patient safety a priority. Four key changes in language include: 1. A managing pharmacy must be within 200 miles of a telepharmacy site. 2. Technicians employed in a telepharmacy must be certified with 2000 hours of practice experience with 1000 hours taking place in a licensed Iowa pharmacy and 160 of the hours taking place within the managing pharmacy. 3. A pharmacist shall be onsite at the telepharmacy for a minimum of 16 hours a month to complete inspections and provide pharmaceutical care services.

agendas, special projects, probation monitoring and assisting with the Prescription Monitoring Program. Prior to joining the Iowa Board of Pharmacy, she worked at the Iowa Board of Medicine as a licensure specialist. Amanda lives on the Southside of Des Moines with her 14-year-old twin sons.

Make Your Voice Heard - Advocate for Your Practice While IPA submits formal comments on any proposed regulatory changes by the board, you can also have a voice and submit comments online. All proposed rules that are available for public comments are posted at https://rules.iowa.gov/.

Upcoming Open Meetings of the Iowa Board of Pharmacy • Wednesday, June 28 at 9:00 a.m. • Wednesday, Aug. 30 at 9:00 a.m. *Unless otherwise noted, all meetings are held at the board offices located at: RiverPoint Business Park 400 SW 8th Street, Suite E Des Moines, Iowa 50309

4. A maximum of 150 prescriptions can be dispensed per day at a telepharmacy site. The board will accept public comments on the Notice of Intended Action through May 16, 2017.

New Board Staff Member

Amanda Woltz will be joining the Iowa Board of Pharmacy on March 24, 2017, as an administrative assistant. Her duties will include coordinating meetings and

Tune-in to IPA’s BOP: What, Why & How podcast following each Iowa Board of Pharmacy meeting to recap the board’s actions and earn pharmacy law CE. More information at www.iarx.org/BOP_Podcast.


TECHNICIAN CORNER

A FIRST HAND LOOK:

THE PHARMACY TECHNICIAN STAKEHOLDER CONSENSUS CONFERENCE and regulation of pharmacy technicians. Judith Neville, CPhT Omaha, NE

A

n invitation-only conference, of which I had the privilege to attend, was held in Irving, Texas, to build consensus on the evolving role of pharmacy technicians. The conference proved to be anything but simple and average. Rather than a sit-andlisten type of atmosphere, this was a unique conference requiring active participation from attendees to meet conference goals. 1. The necessity of public confidence in pharmacy’s process for ensuring the competency of pharmacy technicians. 2. The entry-level (“generalist”) knowledge, skills, and abilities that all pharmacy technicians must have regardless of practice site. 3. The definition of entry-level (“generalist”) pharmacy technician practice with respect to (a) legally recognized scope of practice; (b) educational requirements; (c) training requirements; (d) certification requirements; and (e) state board of pharmacy registration or licensure. 4. The desirability and feasibility of developing a process for recognizing competencies of pharmacy technicians beyond entry-level practice. 5. The desirability and feasibility of minimizing variability among the states in the definition

34

| The Journal of the Iowa Pharmacy Association

6. The entities that optimally should take responsibility for any changes in pharmacy’s process for ensuring the competency of pharmacy technicians. Key pharmacy technician issues related to conference goals were presented from the public sector, academia and community and health-system pharmacy. The public opinion of pharmacy technicians was represented by testimony from the father of a young daughter who lost her life due to a preventable error of a pharmacy technician. It’s always touching to hear firsthand stories from those who have been adversely affected by medication errors. Following the conference opening, guests were divided into small workgroups of 25-30 experts. This was our opportunity to roll up our sleeves and contribute to the conference goal of aligning a common vision for the role of the pharmacy technician. Establishing uniform standards related to competencies of an entry level pharmacy technician was challenging. It was interesting to hear opinion from various sectors, and even though practices are situated in different parts of the country, workflow is similar. The conference ended with a 3-hour session of voting for consensus on recommendations brought forth by the small workgroups. What are my main takeaways of the Stakeholder Consensus Conference? The entire profession of pharmacy has a stake in the future role of the pharmacy technician. We (the profession) gained momentum

by defining entry-level pharmacy technician practice and from this point can proceed with outlining advanced roles, standardization in education and aligning states’ laws. We have a hefty agenda ahead of us that may be achieved by stepping out of our comfort zone and embracing progressive change. The overwhelming majority of conference attendees were pharmacists with pharmacy technicians in the minority. As technicians, this makes it especially important for us to speak out to our scope of influence about pharmacy technician education, technician state regulations, entrylevel competencies and advanced practice for pharmacy technicians. With a profession of many variables, our goal is in finding a sweet spot. The outcomes for standardization of pharmacy technician practice and education will not be perfect for all but all factors should be considered to formulate the best possible outcomes. Your voice makes a difference! ■

Categories Voted on for Consensus Recommendations Concerning: • Standardized Education and Training and Training for EntryLevel Pharmacy Technicians • Certification for Entry-Level Pharmacy Technicians • Reducing the Variability among States in Technician Regulation • Phase in Period for Achieving National Consistency • Advanced Practice Pharmacy Technicians • Achieving State to State Consistency • General Recommendations and Findings


TECHNICIAN CORNER

NEWLY PTCB CERTIFIED IOWA TECHNICIANS January 1 - March 31, 2017

Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Marni Adam Brietta Anderson Carlie Aswegan Beth Aylward Jackie Baethke Julia Baray Alvarado Kayla Bennett Timothy Biang Jessica Binsfield Kori Bohlken Patricia Brass Mary Jo Burger Emily Burrell Cassie Burrs Collins Krystle Carr Megan Castellano Carrie Chaplin BreAnn Conrad Stacy Cook Thomas Coons Mindy Courtier Stacia Creason

Kelly Cullen Emma Davis Brittany DeLanoit Amanda Devall Preet Dhugga Holly Dischler Maria Draughn Venhar Ejupi Courtney Emery Brandi Ernst Katelyn Escher Lucas Everman Julie Garetson Chasity Greco Madison Green Christina Hamann Lindsey Hamill Catherine Hansen Melynda Henry Jordan Hirsch Farrell Holland Brooke Huegli

Sabra Ives Zachary Jepsen Nina Jocic Anna Kane Molly Kayser Shyanna Kimm Tara Kintigh Vaughn Koch Faith Kramer Caitlin Lancial Diana Lee-West Nikkole Leick Esther Lewis Rebecca Lidgett Steven Lister Dylan Lloyd Gordon Lund Ryan Lux Stephanie Lyons Mark Maher Lisa Marczewski Eileen Mayer

Emma McDonald Maria McFarland Amanda Merck Jenna Meyer Christian Murphy Jaelyn Olson Kimberly Owen Paige Oxenford Dixita Patel Jamie Phillips Bonnie Pitz Amy Pollpeter Jordan Rath Ashley Reese Troy Reinking Michelle Reittinger Mason Roberts Amanda Rohrer Heather Rowe Aida Salihovic Karlie Seiler Allison Sheesley

Rachel Soppe Raeann Sutherland Madison Temperly Audrey Thoma Ashley Thomson Louis Tiberi Tatum Torode Nikishia Tracy Richard Uhlenhopp Elizabeth Urban Nina Vilenica Pamela Watson Laura Weber Hillary Weir Angela Wilkerson Keri Witt Quentin Woods Rebecca Wunder Shelby Young

APR.MAY.JUNE 2017 |

35


TECHNICIAN CORNER

TECH TIDBITS Highlights from IPA’s monthly e-newsletter specifically for pharmacy technician members. Tips for Working with StudentsIn-Training

We’ve all had the experience of being new in the workplace. Though you may be confident in your knowledge and skills, learning the ins and outs of a new job can be difficult. As an experienced technician, chances are you’ve worked with a number of new pharmacy personnel especially student pharmacists or student technicians, which is not always an easy task. Acting as a preceptor for students can be a daunting task as well, but it can also be personally and professionally rewarding. Here we’ve provided you with a few tips to remember when dealing with the new student face behind the pharmacy counter. Patience It may seem obvious, yet patience is extremely important when working with students. You may need to explain a certain task multiple times before a concept is understood. Things that are second nature to you as an experienced technician may be utterly foreign to a student. It may be beneficial to explain a process and allow the new learner to “shadow” you a few times before sending them off on their own. Being patient allows your learner to gain some confidence along the way. A few extra minutes early on with a student can pay dividends throughout the time the student is at your pharmacy. Organization As an integral team member of the pharmacy, it is important to remain organized when serving the needs of a student. By creating and following a manual or learning syllabus, you can ensure you’re teaching the same things to each new student. Whether you provide a checklist of tasks for the learner or an information sheet for yourself about certain aspects of your workplace, maintaining order and continuity are

36

| The Journal of the Iowa Pharmacy Association

extremely important when dealing with new people in the pharmacy. Ultimately, patient safety is the number one priority; therefore organization in training students is essential. Understanding When working with students in the pharmacy, it is important to realize that they are there to learn to become an integral member of the healthcare team. Students come in with new ideas and experiences from the classroom that could have a positive impact on your pharmacy. Understand that as a student, they are still learning. By providing constructive feedback, you may be able to assist a student with something they still need help understanding. Keeping the lines of communication open will also help make the transition smoother for everyone involved. Continuous communication develops and sustains trust among pharmacy staff and new students transitioning through the pharmacy. Know that these tips can be very useful for working with student pharmacists and student technicians, as well as any new pharmacy personnel.

Calculations Review on Ratios & Proportions

Calculations are an important component of any pharmacy practice, and most technicians and pharmacists use basic math on a daily basis. Most math problems encountered can be solved using the ratio and proportion method. This technique allows you to compare two fractions or ratios to each other. One side of the equation shows the known fraction, and the other side contains the value you want to solve for. If you’re studying for a certification exam or want to brush up on your math skills, try these example problems: 1. A patient’s weight is recorded as

165 lbs. Their medication is dosed by kilogram weight. How many kilograms does this patient weigh? a. Set up the ratio and proportion to this problem (remember: 1 kg = 2.2 lbs.) 2.2 lbs 1 kg

=

165 lbs X kg

b. Use basic math to rearrange 2.2 lbs • X kg = 1 kg • 165 lbs 1 kg • 165 lbs

X kg =

2.2 lbs

X kg = 75 kg

c. The patient weighs 75 kg. 2. A patient drops a script off at your pharmacy written for amoxicillin suspension “Take 600 mg BID x 10 days.” You plan to dispense a 400mg/5mL amoxicillin suspension product. How many milliliters will be in each dose? a. Set up the ratio and proportion to this problem 400 mg 5 mL

=

600 mg X mL

b. Use basic math to rearrange 40 mg • X mL = 600 mg • 5 mL X mL =

600 mg • 5 mL 400 mg

X mL = 7.5 mL

c. Each dose should be 7.5 mL (1.5 teaspoons) Additional study materials are available in multiple review books. Sample test questions are also available for purchase through the PCTB.


TECHNICIAN CORNER

Exercise “Snacking”: A New Way to Encourage Exercise for Patients We’ve heard all our lives that exercise is good for us. It helps us lose weight, is good for our hearts, and can make us healthier overall. But when you think of the length of a workout, what do you envision? To many people, a proper workout lasts 30 minutes or more, and that can be intimidating, especially to those who do not exercise regularly.

As health care professionals, we often tell our patients that exercising 30 minutes a day, most days of the week, is the best way to gain the health benefits they desire. Generally, this information is targeted towards patients who have diabetes, high cholesterol, or may be overweight. These patients may be in this position because exercise has not been a priority in their lives. For some patients, the diagnosis may be enough of a “wake-up call” to begin regular exercise but others still need more motivation. When we tell these

patients that they should be working out 30 minutes a day, 3 to 5 days a week, are we properly encouraging and preparing them for that type of commitment? If we broke this recommendation into three 10 minute workouts before mealtimes; patients may not see this as such a daunting task. Recent research conducted by scientists in New Zealand, and published in Diabetologia in May 2014 stated that “Exercise Snacks,” or short bursts of exercise, may be more effective at controlling blood sugars than one large workout during the day. The researchers studied a handful of men and women who had been diagnosed with insulin resistance, a precursor to diabetes, to see the difference in overall blood sugar control made by exercising once during the day versus exercising in three short intervals throughout the day. The researchers asked participants to break up their exercise into three 10-12 minute “snacks,” which they were to complete before their meals. The results of this

study showed that breaking workouts into small portions before meals can help control blood sugars throughout the entire day, rather than just at one point during the day. What does this mean for us? We can encourage shorter workouts more frequently throughout the day, so that patients could see the sustained effects and be more encouraged by the visible progress. According to the study, patients enjoyed this type of workout regimen much more than one longer workout, which means they could be more be consistent in exercising. ■

Technician Members!

To receive the Tech Tidbits newsletter each month, be sure that your email is up-to-date in your member profile on IPA’s website www.iarx.org.

PTCB SUSPENDS 2020 EDUCATION REQUIREMENT

CPhT Recertification CPE for FREE!

The Pharmacy Technician Certification Board (PTCB) has suspended its plan to require pharmacy technicians to complete an accredited training program before receiving PTCB Certification. The requirement was announced in 2013 as part of a larger initiative to keep pace with the evolving role of pharmacy technicians and was to be implemented in 2020.

Join IPA and receive CEI’s Technican Libarary for FREE!

PTCB determined that more time was needed to address stakeholder input and continue to research pharmacy technician roles. ■

The Technician Library includes pharmacy technician certification CPE activities in categories consistent with the PTCB Domains, including pharmacy law, patient safety, immunizations, and current drug therapy. Also included are live webinars to get those live credit hours. Members: Login at www.iarx.org/cei_buckets to take advantage of this new benefit for members and spread the word to your colleagues.

JOIN NOW & Receive Your Free CPE! www.iarx.org/membership | 515.270.0713 | ipa@iarx.org

APR.MAY.JUNE 2017 |

37


IPA FOUNDATION

1974: Douglass Pharmacy Museum at the Iowa State Fairgrounds opened with foundation support.

1987:

1960: The Iowa Pharmacy Foundation is established The first student scholarships and loans are awarded by the foundation to student pharmacists at Drake University and The University of Iowa

1970

1960

A $1.7 million endowment is established as a result of the sale of the Iowa Pharmacy Service Corporation. The funds supported several initiatives including ICPC, CEI, building projects at both colleges of pharmacy and expended student scholarship programs.

1994: Iowa Center for Pharmaceutical Care (ICPC) established with the help of $300,000 and staff support from the foundation, Drake University College of Pharmacy and the University of Iowa College of Pharmacy to allow community pharmacists to implement more patient care services

1980

1967: First two grants given by the foundation to each college of pharmacy in Iowa to advance their facilities and education they could provide for student pharmacists.

1978: Max W. Eggleston Executive Internship in Association Management is established to provide student pharmacists an educational experience in professional association management.

1989: The Leadership Pharmacy Conference is established to assist new practioners with developing their leadership skills.

1990 1992: Funding is given to Claxton Pharmacy – CR for a project evaluating the implementation of pharmaceutical care in an independent community pharmacy. The outcome of this research helped lay the framework for modern MTM models.

Inspiring generosity and fulfilling the aspirations of the pharmacy profession through support of education, practice based research, and practice development 38

| The Journal of the Iowa Pharmacy Association


IPA FOUNDATION

2011: The Thomas R. Temple Leadership Endowment established to support leadership initiatives, including the Leadership Pharmacy Conference. The endowment was completed in 2016. The foundation engages community pharmacists in discussions regarding the Trinity Pioneer ACO MTM program.

2007: With support from both colleges of pharmacy and the IPA Foundation, the Collaborative Education Institute (CEI) was incorporated to serve continuing education needs of Iowa pharmacists and pharmacy technicians.

2016:

2010 1995:

2000

The first Student Pharmacist Leadership Conference is held. The conference hosts 30 student pharmacists from Drake University and The University of Iowa to develop leadership skills and encourage professional involvement. The conference was renamed the Bill Burke Student Leadership Conference in 2008.

The IPA Executive Fellowship in Association Management is established to provide an exceptional learning experience for a pharmacist interested in being a leader in the health care system.

2010: The New Practice Model Task Force began meeting as a continuation of an unofficial discussion group started by the foundation in 2009. The task force leads to the creation of the New Pratice Model pilot program to study techcheck-tech in 17 Iowa community pharmacies.

Douglass Pharmacy Museum moved from the Iowa State Fairgrounds to the Schafer Drug Store at Living History Farms

2017: The first grants are awarded through the Outcomes Innovative Pharmacy Endowment, which was established by generous donations from OutcomesMTM shareholders follow the company’s purchase by Cardinal Health.

Since its establishment in 1960, the Iowa Pharmacy Association Foundation has invested in the future of the pharmacy profession in Iowa by building strong leaders, investing in innovative practice initiatives and securing high quality education for tomorrow’s practitioners. The result has been, and continues to be, a progressive and innovative culture in Iowa that continues to lead in how pharmacy is practiced across the country. Consider investing in the future of your profession by donating to the IPA Foundation general fund today at www.iarx.org/IPAFWaystoDonate. All donations to the IPA Foundation are 100% tax deductible.

APR.MAY.JUNE 2017 |

39


IPA FOUNDATION

IPA NAMES SHANNON RUDOLPH 2017-2018 EXECUTIVE FELLOW IPA welcomes Shannon Rudolph, PharmD, as the association’s 2017-2018 executive fellow. Shannon is a 2016 graduate of the University at Buffalo School of Pharmacy and Pharmaceutical Sciences and is completing a community pharmacy residency with the University of North Carolina at Chapel Hill and Moose Professional Pharmacy in Conrad, North Carolina. In addition to her passion for advancing the profession and providing excellent patient care, Shannon brings extensive experience in advanced community pharmacy services, association work, leadership and advocacy through her participation in CPESN USA, NCPA and other organizations. As the IPA fellow, she will be immersed in the day-to-day activities of the association and work closely with IPA staff to continue advancing IPA’s mission. She will work to expand IPA’s clinical initiatives, attend state and national pharmacy meetings, gain exposure to all aspects of association work, and provide insight and assistance to the association. Many IPA members may have met her at the 2017 Midwest Pharmacy Expo. Shannon will also be attending the 2017 Annual Meeting, so feel free to introduce yourself then or throughout her time as executive fellow. She will officially start with IPA on July 5, 2017. The IPA Executive Fellowship in Association Management was created to support the development of individuals interested in association management through training and experience in leadership, advocacy, professional affairs and problem-solving at IPA. Individuals who complete the fellowship will be well prepared for leadership positions in a variety of settings in the profession of pharmacy and health care. The fellowship is supported by the IPA Foundation.

MEET MATT GLASOW, IPA’S 2017 EXECUTIVE INTERN IPA is excited to introduce the 2017 Max W. Eggleston Executive Intern in Association Management, Matthew Glasow. Matt is originally from Maple Grove, Minnesota, and currently completing his second year of pharmacy school at Drake University. Matt is also pursuing his MBA at Drake. Matt has been involved with various pharmacy organizations including APhA-ASP and the Central Iowa Pharmacy Association, and is a dedicated member of his social fraternity, Sigma Phi Epsilon. Matt has had the opportunity to work on a research project over the past year as well. Matt is employed at Walgreens and hopes to use that experience during the internship. Matt has a passion for improving the quality of care patients receive from their pharmacists and is looking forward to working with IPA to work towards this goal. Matt is “eager to begin working with IPA and learning from the various members that make up such a vital organization for our profession. I have come to understand the importance of continually improving the work we do as pharmacists and I believe that IPA is a leader in making those improvements happen. I am grateful for the opportunity to serve as the executive intern this summer, and hope to meet many of you along the way!” Please welcome Matt to the IPA staff when you see him at the IPA Annual Meeting or other events. The IPA Foundation’s Max W. Eggleston Executive Internship in Association Management is a 12-week program held each year during the summer months at IPA’s office in Des Moines to provide student pharmacists with an educational experience in professional association management.

PREPARE TO BID AT THE 2017 SILENT AUCTION Plan on an exciting atmosphere and friendly competition at the IPA Foundation’s Silent Auction on June 16 at the Coralville Marriott Hotel and Conference Center. Following the Friday activities of IPA’s 2017 Annual Meeting, bid on your favorite items and participate in the wine/beer ring toss and red envelope fundraiser. You can preview items during the President’s reception and on the Annual Meeting app. Proceeds support the foundation’s educational and student programs.

40

| The Journal of the Iowa Pharmacy Association

To Donate an Item

If you or your pharmacy would like to donate to the silent auction, please contact Laura at lmiller@iarx.org and provide a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the weekend of Annual Meeting, in order to have your item listed in the silent auction catalog, please notify Laura prior to June 1.


IPA FOUNDATION AWARDS 3 OUTCOMES INNOVATIVE PHARMACY GRANTS The IPA Foundation has awarded $38,000 to three unique projects in the inaugural cycle of the Outcomes Innovative Pharmacy Grant program. The IPA Foundation Outcomes Innovative Pharmacy Grant program was established to provide financial support for research, education and promotion of innovative pharmacy practice initiatives within the state of Iowa. Congratulations to the recipients and their innovative projects!

TEEING OFF FOR THE FUTURE OF PHARMACY

“An Examination of the Effect and Synergy of Combining a Medication Adherence Intervention and Group Diabetes Education” submitted by Melissa Ernzen, PharmD, from Mercy Family Pharmacy in Dubuque “Creation and Implementation of a Pharmacy Performance Network in Iowa” submitted by Randy McDonough, PharmD, MS, for the CPESN Iowa “Pharmacist Led Medicare Annual Wellness Visits at a Family Medicine Clinic” submitted by Sara Wiedenfeld, PharmD, from Siouxland Medical Education Foundation Each recipient will be required to present a poster on their project at the 2018 IPA Annual Meeting and the summaries will be published in a subsequent issue of the Journal of the Iowa Pharmacy Association.

FRIDAY, SEPT. 8, 2017 The Legacy Golf Club Norwalk, IA

The grant program stems from the Outcomes Innovative Pharmacy Endowment that was established by the original investors of OutcomesMTM, a medication therapy management (MTM) service provider based in Iowa. In 1999, IPA provided seed money to support this innovative startup, which became a national leader in MTM services. Following the purchase of OutcomesMTM by Cardinal Health in 2015, the endowment was created as a way for those original investors to give back to the pharmacy profession and keep the innovative spirit and legacy of the company and Iowa pharmacy alive. Applicants must be an Iowa-licensed pharmacist or an Iowa-based researcher working with Iowa pharmacists in an innovative pharmacy practice. Applicants must also be active members of the Iowa Pharmacy Association. The application deadline for the next grant cycle is Dec. 1, 2017.

Proceeds benefit the IPA Foundation’s support of student pharmacists at Drake University & The University of Iowa. APR.MAY.JUNE 2017 |

41


IPA FOUNDATION

CRESCO CLEAR LAKE

SPENCER

LET’S RIDE!

ALGONA

ORANGE CITY

Join the IPA Foundation RAGBRAI Team! It is not too late to be a part of the RAGBRAI team! This team is more than just riders. See where you fit in:

CHARLES CITY

LANSING

WAUKON

JULY 23-29, 2017

The Team, So Far

Here is a look at the foundation team so far and a special “thank you” to those who volunteer to host the team each night.

HOSTS

The deadline to join the team for the week-long ride has passed, but you can still register to ride for up to 3 days as a daily rider. For details and registration instructions, visit www.iarx.org/RAGBRAI.

Orange City: Donald Vaas, RPh Spencer: Derek Grimm, PharmD, BCPS Algona: Jon Greter/Pharmacists Mutual Companies Clear Lake: Rick Knudson, PharmD, BCPS, MS, MBA Charles City: Alecia Rottinghaus, University of Iowa Student Cresco: Amy Farlinger, RPh Waukon: Neal Daley, RPh

The deadline to register as a daily rider is May 31, 2017.

WEEKLY RIDERS

Ride

Drive

We are looking for volunteers to help get the team from the Missouri River to the Mississippi River. Volunteer to drive our support van for a day or two. If interested, contact Laura Miller at lmiller@iarx.org or 515-270-0713.

Fix-a-Flat

Help keep the team rolling with Fix-a-Flat kits! For a $30 donation per kit, you can make sure the team is prepared for any roadside repair!

Sponsor

Sponsorship opportunities are available to support the entire team or a specific rider. Visit www.iarx.org/ RAGBRAI for details.

Mark Adams, Drake Student Ashley Branham, PharmD Barry Carter, PharmD, FCCP, BCPS, FAHA Sharon Cashman, RPh Carter Chapman, Drake Student Donald Letendre, PharmD Matthew Letendre Zachary Lough, Drake Student Kevin Moores, RPh Anthony Pudlo, PharmD, MBA Mark Sorenson, RPh Troy Trygstad, PharmD, MBA, PhD Ben Urick, PharmD

DAILY RIDERS

Kate Gainer, PharmD Manda Johnson, PharmD Ethan Sabers, University of Iowa Student Doug Schara, RPh Amanda Stefl, University of Iowa Student

APR.MAY.JUNE 2017 |

43


MEMBERS SECTION

IPA MEMBER SPOTLIGHT:

Ryan Frerichs, PharmD Pharmacy with his wife, Kate. They currently reside in Waverly, IA with their 4 children; Elizabeth, Margaret, Anna, and Jackson.

Written by:

Laura Nesheim 2017 PharmD Candidate The University of Iowa College of Pharmacy

Robert Nichols 2017 PharmD Candidate The University of Iowa College of Pharmacy

L

ike many in the field of pharmacy, IPA member Ryan Frerichs’ passion for the profession began with an interest in chemistry. During his high school years, Ryan invested time into researching the world of pharmacy. The balance of science, mixed with patient interaction, solidified his commitment. His initiative in his early years provided the foundation for a vast career. In the fall of 1997, Ryan set off to attend his first year of pharmacy school at The University of Iowa College of Pharmacy in Iowa City, IA. He began working towards his prerequisite hours at Meyer Pharmacy in Waverly, IA as a student pharmacist. This internship set the stage for a career in independent pharmacy. He obtained his Doctor of Pharmacy degree in 2001. During his first year as a new practitioner, Ryan was recognized as Albertson’s Pharmacist Rookie of the Year. Eventually he would become the owner and operator of Meyer

44

| The Journal of the Iowa Pharmacy Association

After years of experience and a natural instinct to lead, Frerichs’ led Meyer Pharmacy through the Medicare accreditation process, the addition of two full-time respiratory therapists, solidifying a hospice contract, and initiating vaccination services. The primary focus for the three full-time pharmacists and two part-time pharmacists is immersing themselves in patient care.

“We try to stay in front of providers, get them to know us by name, and gain their trust in our clinical knowledge.” Ryan believes in building trustful relationships with providers in his community. He states daily conversation about their mutual patients is vital. “We try to stay in front of providers, get them to know us by name, and gain their trust in our clinical knowledge.” The most rewarding part of Ryan’s ownership of Meyer Pharmacy is the patient appreciation. He understands that patient care goes beyond dispensing medications. What stands out the most to Ryan is “the ‘thank yous’ from our patients and our patient’s families”.

“Work every day to optimize the care of patients within your realm. Understand that it is a marathon, and not a race.”

Change is something that Ryan does not shy away from. He is one of five luminaries who is creating a statewide network of pharmacies called the Community Pharmacy Enhanced Services Network which has five core services to enhance patient care. When asked how IPA members can influence change, Ryan states “continue to polish your craft. Stay up-to-date and embrace challenging yourself. Work every day to optimize the care of patients within your realm. Understand that it is a marathon, and not a race.” Challenges commonly coincide with change. Ryan is currently working on his ability to fully staff his pharmacy for quality care, while working towards adequate reimbursement. Another challenge that he is preparing for involves adapting pharmacy services in a retail market. This evolution not only affects pharmacists, but certified pharmacy technicians also. Ryan believes in advancing his employees’ responsibilities for their own career satisfaction, and for the good of the patient. As Ryan reflects on how pharmacists can direct change, he believes that being a champion for pharmacy is key. “Advocate, advocate, advocate. Get involved with the hot topics in our profession. Talk to people about the value of the pharmacist and pharmacy technician in the healthcare system.” ■


MEMBERS SECTION

MEMBER MILESTONES Amanda Steele, PharmD, (Fort Dodge) will join the hospital pharmacy team at UnityPoint Health – Fort Dodge as a staff pharmacist. Congratulations, Amanda!

Congratulations to Kari Heitzman, PharmD, (Des Moines) on her new position as clinical pharmacist with the OSF Saint Francis Medical Center in Peoria, Il.

Lisa Ploehn, PharmD, (Bettendorf) received the 2017 Weaver Medal of Honor from the Drake University College of Pharmacy and Health Sciences. Congratulations, Lisa!

John Forbes, RPh, (Urbandale) received APhA’s 2017 Hubert H. Humphry Award during the APhA Annual Meeting in San Francisco, Ca. Congratulations, John!

Congratulations to Emily Muehling, PharmD, BCPS, (Urbandale) on her new role as system pharmacy director of clinical services for UnityPoint Health!

Leslie Noty, PharmD, was selected to serve as Pharmacy Manager for Hy-Vee Pharmacy in Council Bluffs. Congratulations, Leslie!

If you have a member milestone to share, please submit it to ipa@iarx.org

WELCOME NEW IPA MEMBERS! JANUARY 1 - MARCH 31, 2017: Ganesh Adhikari, Des Moines Katelyn Bey, Des Moines Taylor Blackford, Des Moines Sandhya Bolar, Johnston Shana Brunsvold, Northwood Cherrie Christopher, Decorah Steven Clark, Coralville Marsha Doebel, Clear Lake Brittany Dougherty, North Liberty Vicki Dunkel, Dyersville Ryan Flugge, Omaha, NE Brian Glenn, Osceola Joseph Greenwood, Waterloo Larry Grimm, Missouri Valley Jennifer Husemann, Dubuque Michelle Jenkins, Adel Kristin Jensen, Excelsior, MN

Misty Johnson, Nevada Mindi Jorgenson, Pella Lisa Knapp, Urbandale Namaro Kone, Cedar Rapids Alana Kroll, West Des Moines Tressa Kurtz, Cedar Rapids Dawn Lockman, Iowa City Dawn Maluchnik, Utica, MI Megan McGehee, State Center Tammy Michels, Decorah Jennifer Nienhaus, Muscatine Trisha Reicks, Decorah Shannon Rudolph, Concord, NC Morkos Salib, Des Moines Andrew Segebart, Carroll Diane Simko, Asbury Anne Spurlock, Ankeny

Kayla Sturm, Waverly Brad Tice, Thompsons Station, TN Brittany Urbaniak, Diamondhead, MS Julie Vollmer, Des Moines Ben Walton, Des Moines Ashly White, Hunt Valley, MD Steve Wilkens, Des Moines Mitchell Wood, Des Moines Curant Health Georgia LLC, Smyrna, AL Performspecialty, LLC, Orlando, FL Gundersen Palmer Lutheran Hospitals and Clinics, West Union Martin Health Services, Inc., Denver Lloyd VMC Pharmacy, Ames Brehme Drug, Inc., Manchester Prairie Parkway Pharmacy, Cedar Falls

THANK YOU FOR SUPPORTING IPA!

APR.MAY.JUNE 2017 |

45


IPA ACTION

APhA ANNUAL MEETING The 2017 APhA Annual Meeting was held in San Francisco on March 24-27 and featured a full agenda for the Iowa pharmacists and student pharmacists in attendance. Members of the Iowa pharmacy family and extended family attended the Iowa Reception to network and catch up with colleagues. IPA celebrated with past-president John Forbes as he received the 2017 APhA Hubert H. Humphrey Award which recognizes APhA members who have made major contributions in government and legislative service at the local, state or national level. IPA also celebrated Randy McDonough who was installed on the APhA Board of Trustees. The APhA House of Delegates debate policy on topics including patient access to pharmacist-prescribed medications, pharmacists’ role within value-based payment models, and pharmacy performance networks. Iowa was represented by delegates Steve Firman, Rick Knudson, Stevie Veach, and Susan Vos.

Iowa delegation selfie at the APhA House of Delegates (L to R): Stevie Veach, Susan Vos, Rick Knudson and Steve Firman

Student pharmacists from Drake and The University of Iowa pose with their respective deans at the Iowa Reception

L to R: Steve Firman, Bob Greenwood, John Forbes with his 2017 APhA Hubert H. Humphrey Award, and Kate Gainer

HAVE YOU REDEEMED YOUR FREE CPE LIBRARY YET? Through a partnership with the Collaborative Education Institute (CEI), IPA members receive all of the relicensure and recertification, be sure to redeem your free library and complete your CPE at your convenience. IPA members can access CEI’s Pharmacist Library or Technician Library and by logging into their member profile on the IPA website and clicking on the My Education tab. After entering the code**, activities for the 2017 library will automatically populate into each member’s Library as they become available. Members are then notified when an activity has been added to the Library. Activities may be completed at any time. The Pharmacist Library includes pharmacist CPE activities on pharmacy

46 | The Journal of the Iowa Pharmacy Association

law, patient safety, immunizations and current drug therapy topics. The Technician Library includes pharmacy technician certification CPE activities in categories consistent with the PTCB Domains, including pharmacy law, patient safety, and current drug therapy. Both libraries include live webinars for those live credit hours. Both libraries also include IPA’s BOP: What, Why & How podcast which is available following each Iowa Board of Pharmacy meeting. The podcast reviews actions of the board during the meeting and is accredited for pharmacy law CPE. Please note that the deadline to enter the code for the 2017 libraries is Dec. 31, 2017.

How to Access Your 2017 Library: 1. Log in to your IPA account 2. Click on “My Education Tab” (you will be taken directly to your CEI profile)* 3. Enter your access code** in the ‘Partner Code’ field provided and click APPLY 4. Click CONFIRM at the bottom of the page. 5. Activities will automatically populate when available *Your username must be the same for both CEI and IPA. You can change your login information for IPA from your profile. **Access code is available at www.iarx.org/ cei_buckets (member login required)


IPA ACTION

IPA GOES LOCAL KICKS OFF IN DUBUQUE The 2017 IPA Goes Local program kicked off on March 14 in Dubuque. Over 50 pharmacists and community stakeholders attended and participated in the roundtable discussions on local solutions for opioid abuse. For the 2017 IPA Goes Local program, 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, a Cedar Rapids police officer, will serve as the facilitator and presenter. 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!

Remaining Dates: May 1 - Des Moines May 18 - Davenport August 31 - Council Bluffs September 21 - Iowa City October 10 - Spencer

APR.MAY.JUNE 2017 |

47


IPA ACTION

CALENDAR OF EVENTS MAY 2017 6

Zada Cooper Leadership Symposium - University of Iowa College of Pharmacy, Iowa City

9

2/2/2 Webinar: Open Forum of Proposed IPA Policies

9

Compass HIIN Learning Community - Ankeny

12

Addressing Iowa’s Critical Need for Health Care Providers in Rural Areas - Fayette

16

2017 HPV and Cancer Conference - Ankeny

16

Addressing Iowa’s Critical Need for Health Care Providers in Rural Areas - Storm Lake

7-8

2017 IHA Summer Leadership Forum & EngagedMD - Cedar Rapids

13 2/2/2 Webinar: Advancing the Role of Pharmacy Technicians 13

Managing Medication-Seeking Patients and using Screening and Brief Interventions - Johnston

14-15 Iowa Immunization Summit - Des Moines 15

Practice Advancement Forum - Coralville

16-17 IPA Annual Meeting - Coralville 23-25 PBA Health Conference

17-19 PQA Annual Meeting - Baltimore, MD

28

18

IPA Goes Local: Quad Cities Area Pharmacy Association - Davenport

JULY 2017

25

IMP3 Live - Dubuque

11

JUNE 2017 3-7

ASHP Summer Meetings & Exhibition Minneapolis, MN

6

IHC Care Coordination Conference

Iowa Board of Pharmacy Meeting - Des Moines

2/2/2 Webinar

12 State Innovation Model (SIM) Learning Community - Altoona 23-29 RAGBRAI

IPA’s free monthly webinar series held on the second Tuesday of every month at 2:00 p.m. CST. May 9, 2017: Open Forum of Proposed IPA Policies June 13, 2017: Advancing the Role of Pharmacy Technicians July 11, 2017: TBD Register for an upcoming 2/2/2 or view previous webinars at www.iarx.org/222.

48

| The Journal of the Iowa Pharmacy Association

FRIDAY, SEPT. 8, 2017 The Legacy Golf Club Norwalk, IA


PHARMACY TIME CAPSULE

19 70

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

JANUARY The controversial anti-smoking measure H.R. 6543 was passed in the Senate. The bill banned cigarette advertising on radio and television. It went into effect on January 1, 1971. Provisions were included to discourage cigarette advertisements in publications. The Federal Trade Commission required printed advertisements to contain warnings of smoking hazards. The Agency approved the statement “warning; cigarette smoking is dangerous to your health”.

MARCH Iowa University College of Pharmacy Dean Louis C. Zopf wrote the article “An Important Decision.” He stated that pharmacists in all areas of practice have a responsibility to assist young people in responsible decision making. He wrote, “help them understand misuse, abuse, and disregard for drugs.” He believed pharmacists played an important role in shaping the youth of America.

MAY Methadone (Dolophine) was the topic of positive studies regarding management of opiate addiction. The increased popularity of methadone among physicians spurred increased methadone prescriptions. Yet it was the responsibility of pharmacists to realize that this indication for methadone has not received FDA approval. This solidified the notion of corresponding liability between the pharmacist who fills prescriptions and the prescriber who writes them.

JUNE Governor Robert Ray vetoed S.F.1144 in order to address serious concern of the drug abuse problem in Iowa and the United States. The bill would allow prescriptions written by an out-of-state physician for amphetamines, barbiturates, and other covered drugs, to be dispensed. He recognized the need to prevent illegal drug diversion of commonly abused drugs in order to protect the people of Iowa.

DECEMBER The White House hosted a conference on aging which focused on drugs in the elderly. Pharmacists gathered to discuss solutions to health problems that plague the elderly population. The event pinpointed the pharmacist as a familiar face to many older patrons of the community. Pharmacists can assist the elderly not only with drug problems, but insurance coverage issues as well.

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.

APR.MAY.JUNE 2017 |

49


ADVERTISER

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 dschaaf@iarx.org or call the IPA office at 515.270.0713 for more information.

50

| The Journal of the Iowa Pharmacy Association


2016 Recipients of the “Bowl of Hygeia” Award

Buddy Bunch Alabama

John Cotter Alaska

Carl Labbe Arizona

Jon Wolfe Arkansas

Fred Mayer California

Randy Knutsen Colorado

Ernie Mrazik Connecticut

Pat Carroll-Grant Delaware

Armando Bardisa Florida

Hugh Chancy Georgia

Marcella Chock Hawaii

Joyce Fogleman Illinois

H. Christian Johnson Indiana

Ken Anderson Iowa

David Schoech Kansas

Ron Poole Kentucky

Marty McKay Louisiana

Roberta Brush Maine

Ellen Yankellow Maryland

Diane Martin Massachusetts

Geri B. Smith Michigan

Linnea Forsell Minnesota

Robert Salmon Mississippi

David Eden Missouri

Tobey Schule Montana

Adam Porath Nevada

John V. Mini, Jr. New Hampshire

Stephen Brickman New Jersey

Jack Volpato New Mexico

Mike Duteau New York

Joseph Moose North Carolina

James Carlson North Dakota

Marialice Bennett Ohio

Greg Huenergardt Oklahoma

Ann Murray Oregon

Gayle Cotchen Pennsylvania

Francisco Javier Jiménez Puerto Rico

Heather Larch Rhode Island

Dan Bushardt South Carolina

Curt Rising South Dakota

Ronnie Felts Tennessee

Nathan Pope Texas

Gerald Petersen Utah

Alex Wiatt Virginia

Nanci Murphy Washington

The “Bowl of Hygeia”

Patricia Noumedem Washington DC

Robert Stanton West Virginia

James Olson Wisconsin

Jaime Hornecker Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.


Buying, Selling or Starting a Pharmacy?

RxOwnership helps you practice pharmacy your way. ®

As advocates for independent pharmacy, RxOwnership is fully dedicated to helping you achieve your goals at every step along the way. We partner with current and prospective pharmacy owners, pharmacy associations, buying groups, and pharmacy schools to help independent pharmacy thrive. RxOwnership has assisted over 1,600 pharmacy owners since 2008.

Visit RxOwnership.com or call 800.266.6781.

©2014 McKesson Corporation. All rights reserved. RTL-08073-01-14

Let us guide you to your pharmacy ownership goals. • No-fee planning advice, industry experience and resources • Confidentiality, trust and respect • Financing options • Individualized matching of qualified buyers and sellers • Career, internship and junior equity opportunities

IPA Journal - Apr/May/Jun 2017  
Read more
Read more
Similar to
Popular now
Just for you