IPA Journal - Jan/Feb/Mar 2019

A Peer-Reviewed Journal | Vol. LXXV, No. 1 | JAN.FEB.MAR 2019

STATEWIDE PROTOCOLS IN IOWA What it Means & How to Participate INSIDE: 2019 IPA Board of Trustees Election IPA’s Legislative Priorities CBD - Can My Pharmacy Sell it?

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 Casey Ficek, JD Matthew Pitlick, PharmD, BCPS

COVER STORY Statewide Protocols in Iowa pg. 28

See how your pharmacy can participate in Iowa’s new statewide protocols to provide additional services to your patients.

OFFICERS CHAIRMAN Craig Logemann, RPh, BCACP, CDE - Ankeny PRESIDENT Cheryl Clarke, EdD, RPh, FAPhA - Waukee PRESIDENT-ELECT Connie Connolly, RPh, BCACP - DeWitt TREASURER Tim Becker, RPh, FACP - Mason City SPEAKER OF THE HOUSE Jim Hoehns, PharmD, FCCP, BCPS - Cedar Falls VICE SPEAKER OF THE HOUSE Ashley Dohrn, PharmD, BCGP - Le Claire

TRUSTEES REGION 1 Sharon Cashman, RPh - Waverly REGION 2 Jim Mennen, RPh - Coralville REGION 3 Sally Haack, PharmD, BCPS - Urbandale REGION 4 Carol Anderson, PharmD - Mason City AT LARGE Bill Baker, BS Pharm - Iowa City Craig Clark, RPh - Cedar Rapids Deanna McDanel, PharmD, BCPS, BCACP - Coralville Heather Ourth, PharmD, BCPS, BCGP - Ackworth HONORARY PRESIDENT John Rovers, PharmD, MIPH - Des Moines PHARMACY TECHNICIAN Jessica Burge, CPhT - Des Moines STUDENT PHARMACISTS Bridget Tunink - Drake University Austin Miller - 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.

Iowa Grant Projects Update on grant projects advancing pharmacy practice in Iowa pg. 20

Board of Trustees Election Meet the candidates for the 2019-2020 IPA Board of Trustees. pg. 6

FEATURES

2019 Board of Trustees Election . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Committee Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 CPESN Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 COVER STORY: Statewide Protocols in Iowa . . . . . . . . . . . . . 28 Deans’ Columns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Cannabidiol Oil - Can My Pharmacy Sell It? . . . . . . . . . . . . . . 35 Marijuana Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 IPA’s Legislative Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

IN EVERY ISSUE

President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Pharmacy Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Mission Statement

The Iowa Pharmacy Association empowers the pharmacy profession to improve health outcomes.

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PRESIDENT’S PAGE

MAGICAL MOMENTS Cheryl Clarke, EdD, RPh, FAPhA Waukee IPA President

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had the pleasure of representing IPA at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in December. IPA and the two colleges joined together to host the annual reception, with many students, residents, alumni, and other members of the Iowa pharmacy family in attendance.

Midyear Magic was the meeting theme with Earvin “Magic” Johnson serving as the keynote speaker. Of course, Mr. Johnson is well known for his basketball career, highlighted by championships at all levels of play and many MVP awards. Mr. Johnson continues his success through his business ventures and philanthropic endeavors, particularly benefiting underprivileged populations and persons with HIV. Although these accomplishments are impressive, it was the simple philosophies he shared and the actions he demonstrated that resonated with me.

Let me share a few select lessons that apply to us as individual pharmacists, pharmacy technicians, and student pharmacists, as well as our profession as a whole. Based on each lesson, I will issue a challenge to us (including me) to improve.

Connect: Mr. Johnson did not stand on the stage, even when asked to do so. He wanted to “be with the people.”

On multiple occasions, he selected people in the audience and talked to

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them like they were the only person there. He asked them their name and would continually use their name throughout the conversation. He asked about their pharmacy practices.

He posed for pictures, took selfies, and signed jerseys, while connecting with each individual. He didn’t make anyone look silly. I am sure each person felt special during their encounter with Mr. Johnson.

Challenge to Connect: How do you make people feel special? Do you use their names? Do you ask questions about them? Do you determine what they want and provide it when possible? Do you go out of your way to “be with the people” or hope people leave you alone so you can get work done? Connection makes others feel special while returning the favor.

Work Hard, Learn, and Self-Assess: Undoubtedly, Mr. Johnson has innate basketball talent that would have naturally led to some level of success.

But how does one become elite?

Hard work is the first step. Being the first to practice and last to leave, arriving 3 hours early as an NBA rookie. Arranging summer basketball practices for his high school team.

Attempting 1000 shots every day.

Another step is constantly learning from others and about yourself. Asking questions. Developing mentors, even those who might be considered a foe.

To self-assess, Mr. Johnson does a yearly SWOT analysis of himself as a person and as a professional.

Challenge to Work Hard, Learn, and Self-Assess: What are you doing to become elite? Are you creating a new pharmacy service? Are you providing patient care on a consistent basis as part of your daily routine? Who are

your mentors? Do they challenge you?

What new things have you learned about pharmacy, the healthcare system, or the business of health care?

What have you learned about yourself as a person and as a professional?

Know Your Team and Adjust: Mr. Johnson shared how each of his teammates had different needs. As point guard, his job was to recognize those needs and adjust his style. With some players, he could get in their face, yelling to psych them up but others needed him to be quiet. He learned when you could throw to a player and when to keep the ball.

Doing the same thing for every player would not allow the team to achieve at the highest level.

Challenge to Know Your Team and Adjust: How well do you know the strengths of your team members?

What motivates them? What communication style is most likely to be accepted? When you collaborate with other healthcare professionals, do you adjust to their needs to be effective? Do you expect people to adjust to your style, or do you adjust for the greater good of the team?

Overdeliver, learn from failures, respect talent, and lift up others were a few other lessons shared by Mr. Johnson. Take a few minutes to create your own challenges to emulate those behaviors. I am sure you can do that without an explanation as these concepts are not rocket science. They are simple, yet they are hard. But if we do these things, we can make magic. ■

CEO’S COLUMN

A NEW TWIST ON NETWORKING

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s a student pharmacist, I was a member of zero professional organizations – not one at the national level, the state level, or even the college level. My close friends found it incredibly ironic when I shared with them my first post-residency position would be working for a state pharmacy association as director of professional programs for IPA in 2005. My friends reminded me of the times they invited me to attend professional events, and how I always turned them down.

Thankfully, my PGY1 residency with Medicap Pharmacy (John Forbes) and Drake University (John Rovers) provided a strong bridge and a wealth of opportunities to learn about professional engagement and become involved at the local, state, and national levels.

The A-ha Moment

One of the most memorable moments on my professional journey was with a preceptor on my first rotation as a P4 student. When he learned I had no professional organization affiliations, he looked at me and shook his head. He then said, “it’s never too late.” He invested time in mentoring me on the importance of engagement, and belonging to associations, and how a residency could provide unique opportunities.

Now when I speak to pharmacists and student pharmacists, I share the story that it’s never too late to get engaged in your profession, and also if I knew then what I know now, I would absolutely, 100%, do things differently.

What I know now

Networking is a learned skill.

Networking should be intentional.

Networking can be self-serving, but it is also a chance to help others.

Networking is a lot more about listening than talking. Professional networking isn’t always 100 percent professionally focused conversations, but also about establishing personal connections.

The Power of Networking

Networking opens many doors. Many pharmacists working in their dream job learned about the opportunity through their professional network, not an online job board. Often times these dream job opportunities may never be posted. Today’s pharmacy job market in many parts of the country is saturated with dozens of applicants for each open position. A recommendation, a connection, or a personal introduction from a colleague in your network goes a long way.

But another twist? (Many of you probably already know this) professional networking isn’t solely about positioning yourself professionally for your next career move. Networking in professional settings is equally about supporting like-minded persons, and finding a network that can support YOU. I began my position as CEO for IPA six months after our first son was born. In the next three years, we had three more children. I can’t count the number of times IPA members and professional colleagues have asked me about my family; have given advice and guidance on parenting as a working professional; have said “you’re doing a great job,” even when I’ve felt the opposite; and provided invaluable insight as I try to navigate life.

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

Whether it’s dealing with personal issues such as parenting; shared hobbies and talents such as cycling or musicals; or feelings of burnout or moral injury that may otherwise feel isolating – networking at professional meetings and events (or even coffee shops and breakrooms) provides, not only encounters to expand your professional network, but also groups of colleagues and friends with shared experiences that you will come to lean on for years to come.

In the years following that first P4 rotation, I’ve witnessed firsthand the importance of engagement and building a professional network. What I’ve discovered, however, is that the personal support aspect of networks is just as - if not more - valuable than the professional benefits.

I would encourage you to lean on your network when you need a little extra support. And, likewise, be a support system for your colleagues and professional network. If you or someone you know needs a networking or professional engagement jump start, I encourage you to seek out colleagues or come to an IPA event to meet like-minded pharmacists and professionals. We’re all on this journey together. And It’s never too late. ■

You can network in different ways.

JAN.FEB.MAR 2019 |

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IPA BOARD ELECTION

BOARD OF TRUSTEES ELECTION Vote for the 2019-2020 Iowa Pharmacy Association Board of Trustees!

ELECTRONIC BALLOTS WILL BE SENT FRIDAY, FEBRUARY 1, 2019.

Each candidate’s personal statement and bio will be available online with the electronic ballots. All IPA pharmacist members vote for all elections. Ballots will close Wednesday, February 13 at 12:00 midnight.

To request a paper ballot, contact the IPA office at 515270-0713.

FOR THE OFFICE OF PRESIDENT-ELECT

Chris Clayton, PharmD, MBA Manchester

Christopher Clayton, PharmD, MBA, received his doctorate degree in pharmacy from the University of Iowa in 2000 and his MBA from the University of Iowa in 2009. Chris is currently the regional director of retail and pharmacy services for Unity Point Health Waterloo where he has practiced since graduation. He has direct oversight of inpatient pharmacies, retail pharmacies, outpatient MTM clinics, a hospital residency program, a community residency program, and the Occupational Health Clinic. He is also co-owner and the CFO of Clayton Drug in Strawberry Point, Sumner, and Elkader, Iowa.

Chris has also been the director over other departments such as DME and digestive health, served as project leader for numerous projects (including the Epic implementation at Allen Hospital), has served on numerous committees and has assisted several other hospitals as pharmacist in charge during interim roles. He has participated in ongoing performance improvement initiatives and has a background in FMEA, Lean and Adaptive Design. He was recognized by IPA and was selected for the annual leadership conference in 2008. Chris is married to Jennifer Clayton, PharmD, co-owner and CEO of Clayton Drug, and together they have 5 boys. Chris enjoys spending time with the family, listening to music, cars, motorcycles and most outdoor activities.

Bio’s edited for space, full bios available on ballot

FOR THE OFFICE OF PRESIDENT

Connie Connolly, RPh, BCACP DeWitt

Connie Connolly is a community pharmacist at Osterhaus Pharmacy in Maquoketa, Iowa. Her practice includes providing consultant services in long term care, adherence packaging, hospice care, MTM, immunizations and collaborative care with other providers. She is a preceptor for the Community Pharmacy Residency program at Osterhaus and is an adjunct professor for the University of Iowa and Drake University colleges of pharmacy. Connolly earned her BS degree from the University of Iowa College of Pharmacy and holds nationally recognized Board Certification in Ambulatory Care. She was a field facilitator training pharmacists in pharmaceutical care in the community setting.

Connolly was the founding president of North Iowa Pharmacy, Inc., a local pharmacy association serving the north central Iowa region. She served as co-chair of the IPA/Iowa Board of Pharmacy Patient Safety Task Force, a member of the Iowa Medicaid DUR Committee, the Editorial Advisory Board of the Journal of the American Pharmacists Association and was a public member of the Iowa Board of Optometry for 3 terms. Connolly serves on the Pharmacy Services Workgroup of CPESN Iowa and CPESN USA. She is an active member of APhA. In her 28 years of membership, Connolly has served on many IPA committees and task forces including the PBM Task Force in 1997; both the Public Affairs and Professional Affairs Committees, serving as the vice chair and chair of the former in 2010-2011; and vice speaker and speaker of the house in 2013-2015. She continues to participate as a house delegate and an IPA Long Term Care Committee member.

Connolly is a Leadership Pharmacy alumnus and is a recipient of the Distinguished Young Pharmacist Award.

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Diane Reist, BS Pharm, PharmD, RPh Cedar Rapids

Diane Reist is the clinical specialist in transitional care at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Through individualized care in a post-discharge ambulatory clinic; Diane helps to ease the transition of medically complex patients and facilitate communication among providers as the patient moves from the acute care hospital to their home or long term care (LTC) facility. Diane is also part of several integrated discipline research projects at UIHC and Carver College of Medicine in transitional and upstream care for rural Iowa patients and providers.

Diane received her BS in pharmacy from the University Of Iowa College of Pharmacy and her Doctor of Pharmacy degree from the University of Florida. Diane practiced for 29 years at Mercy Medical Center in Cedar Rapids in various roles. Diane has worked in several community pharmacies, a corporate PPO pharmacy, manager of a closed door LTC pharmacy and nursing home consultant at four LTC pharmacies.

As adjunct assistant professor at the University of Iowa College of Pharmacy, Diane has precepted multiple student pharmacists and residents. She also serves on the University of Iowa Graduate College faculty and precepts for the University of Iowa College of Public Health.

Diane has served in many capacities at IPA, including speaker of the house of delegates, vice speaker, delegate, chair of policy committees, board of trustees, and several task forces. She has been a member of the Johnson County Pharmacists Association, an officer of the Linn County Pharmacists Association and Iowa Society of Hospital Pharmacists, and an active member of ASHP, APhA, and ASCP.

IPA BOARD ELECTION FOR TRUSTEE - REGION 2

Shane Madsen, PharmD, BCPS North Liberty

Shane Madsen is a clinical pharmacy specialist in palliative care at the Iowa City VA Health System where he is establishing clinical pharmacy services. Previously, he was ambulatory clinical pharmacy manager at the University of Iowa Hospital and Clinics overseeing the clinical pharmacy operations in the ambulatory setting including family medicine, internal medicine, and specialty clinics. Shane graduated from the University of Iowa College of Pharmacy and completed a pharmacy practice residency at the Franciscan Health System in Tacoma, Washington. He is a graduate of the ASHP Foundation’s Pharmacy Leadership Academy and 2017 member of IPA’s Leadership Pharmacy Academy. He has practice experience in clinical leadership in acute and ambulatory care settings, as well as serving patients as a clinician in acute care, primary care, mental health, and specialty pharmacy. Shane is a professional mentor and preceptor for the University of Iowa College of Pharmacy. In addition, he has been a preceptor for pharmacy residents in numerous health care systems.

Shane currently serves as chair of IPA’s Health-System Liaison Board and has been a delegate to the IPA House of Delegates. He was a trustee for the Johnson County Pharmacy Association. Shane served as treasurer and president of the Minnesota Society of Health-System Pharmacists - Central and was chair of the public policy committee for the Minnesota Society of Health-System Pharmacists. Shane has been involved with ASHP, where he is serving as an inaugural member of the executive committee for the Section of Specialty Pharmacy Practitioners. He has participated on ASHP Section Advisory Groups for Workload and Productivity, Business Management, and Clinical Practice Advancement. Shane has represented Iowa and Minnesota as a delegate to the ASHP House of Delegates. Shane was recently appointed to the Board of Directors of Prelude Behavioral Services.

Heather Rickertsen, PharmD Delmar

Heather Rickertsen graduated from the University of Iowa College of Pharmacy in 2005 and completed a community care pharmacy practice residency with University of Iowa College of Pharmacy and Mercy Family Pharmacy. After graduation, she worked at Mercy Family Pharmacy as community residency site preceptor, developing employer health screenings, patient care services, including medication therapy management programs, JACHO accredited anticoagulation services, establishing 340b program At Crescent Community Health Center, she established and chaired clinical meeting, developing internal quality improvement program and pharmacist educational programing.

During this time, also served as faculty and coach for Health Resources and Service Administration Patient Safety and Clinical Pharmacy Collaborative, to grow clinical pharmacy services access for community health centers nationwide. Additionally she has co-chaired Quality Metrix Cardiovascular Cluster for Pharmacy Quality Alliance, and is a member of the APhA Community Residency Advisory Panel.

Currently, Heather is Director of Clinical Pharmacy Services at Crescent Community Health Center, advancing and growing 340b programs to increase access to medication and safe medication management through clinical pharmacy services. At Crescent pharmacy services continue to grow and are driven by collaborative practice, including anticoagulation, diabetes, hypertension, and medication management. Crescent Community Health Center and Mercy Family Pharmacy continue to be active and participate in Alliance for Integrated Medication Management Collaborative, working to improve workflow and integration of pharmacy services among primary care providers.

FOR TRUSTEE - REGION 4

Steven Hoyman, PharmD Emmetsburg

Steven Hoyman is a community pharmacist providing patient centric care at Hughes HealthMart Pharmacy in Emmetsburg, IA. After graduating from the University of Iowa, he also served at Convenent Medical Center in Waterloo as a staff pharmacist for five years. His practice includes providing consultant services in long term care, adherence packaging, hospice care, MTM, immunizations, managing two local hospital pharmacies, and collaborative care with other providers.

Gary Maly, PharmD Sioux City

A 1987 graduate of the University of Nebraska, Gary Maly, PharmD, began his career as a clinical pharmacist at Marian Health Center in Sioux City, Iowa where he was involved in decentralizing pharmacy services, becoming one of two pharmacists providing services in the intensive care units. He was also involved in formulary management through his work on the Pharmacy and Therapeutics Committee, and also helped begin pharmacy consultation services at the Siouxland Medical Education Foundation, a position that eventually became a full-time pharmacist position providing education to Family Practice residents. He transitioned to community practice in the 1990’s, working for two independent pharmacies, eventually purchasing Thompson Dean Drug in 2005. He is a graduate of the Iowa Center for Pharmaceutical Care and an alumnus of the IPA Leadership Conference, and is a member of NCPA and APhA. Community involvement includes being a member of the Mercy Medical CenterSioux City Foundation Board, member and past president of the Siouxland Business Leaders, and Special Olympics sponsor for the NAIA Division II Women’s volleyball and basketball championships held annually in Sioux City.

JAN.FEB.MAR 2019 |

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IPA BOARD ELECTION FOR TRUSTEE - AT LARGE

John Hamiel, PharmD Waterloo

John Hamiel, PharmD, is a 1997 graduate of the University of Iowa where he was a member of Rho Chi and the Curriculum Planning Committee.

He first served as a clinical pharmacist and later director of pharmacy at Washington County Hospital and Clinics. John now works as the regional director of pharmacy for some of the most recent additions to the Mercy Health Network: Covenant Medical Center, Sartori Memorial Hospital, Mercy of Franciscan Sisters and their retail pharmacies.

John is an active member of IPA, ASHP, ACCP and APhA. He has served as an elected member of the House of Delegates for both IPA and ASHP multiple times. John has participated on IPA’s New Practice Model Task Force, Health System Liaison Board, Patient Safety Task Force and the Hospital Leadership Committee. He is a reviewer of ASHP position statements and for the IPA journal. John has been awarded the U of I College of Pharmacy Preceptor of the Year, IPA Health System Pharmacist of the Year and Worldwide Leader in Healthcare.

Dr. Hamiel has a driving passion for the advancement of technician, student and pharmacist roles in all areas of healthcare. He has been particularly active in developing Technician Verification programs for both hospitals and retail pharmacies. He has helped to develop pharmacy presence in ambulatory care sites, antibiotic stewardship committees, Emergency Departments and in transitions of care settings. John is an adjunct faculty member for Iowa, Drake and Creighton Universities and has created a PGY1 residency program.

FOR TRUSTEE - AT LARGE

Bill Doucette, PhD, RPh Iowa City

Bill Doucette is professor and head in the Division of Health Services Research in the University of Iowa College of Pharmacy, where he holds the Deborah K. Veale Professorship in Healthcare Policy. In over 20 years at the University of Iowa he has taught courses on managing pharmacy practices, developing and marketing pharmacy services, and the delivery of health services.

Bill is an active researcher of pharmacy practice, especially in the community setting. He has been principal investigator on grants exceeding two million dollars, has co-authored more than 160 peerreviewed articles and has made over 240 scientific presentations. His research includes work done with the Iowa Department of Public Health on fostering clinic-community pharmacy team care approaches, development of the Drug Adherence Work-up (DRAW) tool, and studies involving medication management by pharmacists. He is participating in an evaluation of Wellmark’s Value-Based Pharmacy Program. He is leading the 2019 national pharmacist workforce survey by the Midwest Pharmacy Workforce Coalition.

Bill has been an active member of IPA, as well as APhA and the American Association of Colleges of Pharmacy (AACP). He has served on the IPA policy committees and as a house delegate at IPA’s annual meetings. He has served as a member of the State of Iowa’s Medicaid P&T Committee. Bill has been a member of the Quality Committee of the Community Pharmacy Enhanced Services Network (CPESN) of Iowa. As a member of APhA, he has served as Chair of the Economic, Social & administrative Sciences (ESAS) section of the Academy of Pharmaceutical Research and Science. In addition, Bill has served on the Editorial Advisory Board of JAPhA.

Patty Kumbera, RPh Johnston

NOTE ON TRUSTEE AT LARGE BALLOT Patty Kumbera, BS Pharm, RPh, is the COO of PrescribeWellness. Prior to joining PrescribeWellness, Patty served as vice president pharmacy solutions for Digi SmartSense (TempAlert), director of clinical quality programs for Wellmark Blue Cross Blue Shield and was a co-founder of and served as chief operating officer for OutcomesMTM for its first 15 years. A graduate of the Drake University College of Pharmacy, Patty has been active in the evolution of medication therapy management (MTM) services, even before Medicare Part D formalized it in 2006.

She incited progress in MTM by urging CMS and Medicare Part D plan sponsors to regard MTM beyond its basic necessity—to comprehend its profound potential for enhancing quality health care and reducing costs for all parties involved in its delivery. In 2011, she proceeded to implement MTM services at the nation’s largest patientcentered medical home (PCMH). Patty most recently facilitated a pharmacy profession-wide consensus of definitions related to MTM and SNOMED CT codes used to create MTM Value Sets hosted by AMCP, PQA and the PHIT Collaborative – with interoperability being the driver of forward progress in patient care. Patty has spent over two decades advocating the value of local community pharmacist-delivered MTM services all over the country, and she received the inaugural APhA-APPM Distinguished Achievement Award in Pharmacy Management in 2013 - an honor she continues to uphold. Patty is an active member of a variety of professional associations including IPA, American Pharmacists Association, National Community Pharmacists Association, National Association of Chain Drug Stores, and the Academy of Managed Care Pharmacy, where she has served as the MTM Advisory Board Chair for 5 years.

The second candidate for this Trustee at Large position withdrew after the slate of candidates was ratified by the IPA House of Delegates during the 2018 IPA Annual Meeting.

Per the association’s bylaws, another candidate may not be added to the ballot once it has been ratified by the House of Delegates.

As such, Bill Doucette, as the remaining approved candidate for this Trustee at Large position, will run unopposed.

JAN.FEB.MAR 2019 |

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HEALTHCARE HOT TOPICS

President Signs Comprehensive Opioid Bill

Chronic Disease Guidelines Updated

President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, a comprehensive bill that addresses the country’s opioid epidemic. Several pharmacy associations were in support of the bill and attended the signing at the White House. The bill provides provisions that will broadly affect the opioid supply chain, education, and the development of FDA activities.

The guidelines for both cholesterol management and diabetes management have been updated. Both guidelines emphasize a detailed and personalized risk assessment when developing a treatment plan, taking into account several factors including family history, ethnicity, and other health care conditions. The choice of second-line medications to treat both conditions and guidance on lifestyle interventions such as weight loss, diet, and exercise are highlighted in the guidelines

ARB Recall Continues Angiotensin Receptor Blockers continue to make headlines with recalls. Valsartan, losartan, and irbersartan, including combination products, have all had recalls from several manufacturers due to a potentially cancer-causing compound (NDEA) found in several lots of the medications. Be sure to stay up to date on all recall notifications from the FDA.

ASHP Helps Publish Recommendations for Drug Shortages Five healthcare organizations, including the American Society of Health-System Pharmacists (ASHP), jointly released a set of 19 recommendations for regulatory, legislative, and marketplace solutions to address shortages of critical medications. Recommendations include commissioning a Government Accountability Office (GAO) study to identify new and emerging factors contributing to shortages, creating a list of critical drugs deemed essential for emergency response and saving and preserving life and offering incentives to manufacturers that create contingency production plans for pharmaceuticals on the critical drug list.

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CMS Proposes DIR Fee Reform CMS released a proposed rule that includes provisions for DIR fee reform.

The proposal would redefine “negotiated prices” under Part D to mean “the lowest amount a pharmacy could receive as reimbursement” and add a definition for “price concession” to include “all forms of discounts and direct or indirect subsidies or rebates that serve to reduce the costs incurred under Part D plans

by Part D sponsors.” Several pharmacy organizations have praised the proposed reforms which could be implemented as soon as 2020.

HHS Proposes Easing Scope of Practice Laws A joint report from the U.S. Departments of Health and Human Services, Labor and Treasury, called for the easing of scope-of-practice laws among its recommendations to reform the healthcare system. The report, “Reforming America’s Healthcare System Through Choice and Competition,” says states should consider changes to their scope-of-practice statutes, allowing all healthcare providers to practice to the top of their license, utilizing their full skill set. Additionally, the report

recommends the federal government and states should consider accompanying legislative and administrative proposals to allow non-physicians to be paid directly for their services.

FDA Approves DNA Test for Medication Effectiveness The FDA approved the first DNA test to be marketed directly to consumers to determine the personal effectiveness of some drugs. Developed by 23andMe, the test allows a person to mail a spit sample to test how well they respond to over 50 prescription and over-thecounter medications. Additionally, the FDA is alerting patients and health care providers that claims for many genetic tests to predict a patient’s response to specific medications have not been reviewed by the FDA and may not have the scientific or clinical evidence to support this use for most medications.

In its approval, the FDA stressed that the test cannot determine if a drug is appropriate and patients should not use it to make medical decisions on their own.

Doing so could lead to inappropriate treatment decisions and potentially serious health consequences.

CMS Hospital VBP Results for FY 2019 The Hospital Value-Based Purchasing (VBP) Program adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of inpatient care the hospitals provide to patients. For fiscal year (FY) 2019, the law requires CMS to reduce a portion of the base operating Diagnosis-Related Group payment, otherwise applicable to a participating hospital for each discharge, by two percent. Additionally, these reductions should be redistributed to participating hospitals based on their performance on

HEALTHCARE HOT TOPICS

a previously-announced set of quality and cost measures. CMS estimates that the total amount available for valuebased incentive payments in FY 2019 will be approximately $1.9 billion, which means a majority of hospitals will have an increase in their Medicare payments.

In total, more than 1,550 hospitals (over 55 percent) will receive higher Medicare payments.

Federal Judge Rules ACA is Unconstitutional A federal judge in Texas ruled that the Affordable Care Act is against federal law stating the mandate requiring people to buy health insurance is unconstitutional and the entire healthcare law rests on this mandate. The judge ruled in favor of 20 state attorneys general who challenged

the law when Congress eliminated the penalty for not having insurance. No major impact has been seen yet as the ruling is currently being challenged.

However, if the ruling stands there will likely be further disruption across the US healthcare system.

OECD: Superbugs Pose Increasing Threat A new report from the Organization for Economic Co-operation and Development (OECD) states superbug infections could kill millions of people and cost the healthcare system $65 billion over the next 30 years unless more is done to prevent antimicrobial resistance.

Be sure to review the antimicrobial stewardship resources on the IPA website.

CVS Announces New Prescription

Benefit CVS announced that beginning in 2019, a new prescription benefit option for employer-sponsored health plans called “guaranteed net cost” which is supposed to ensure clients receive all rebates and discounts paid by drug manufacturers.

The impact of the benefit, designed to increase drug price transparency, will depend on how many health plans adopt the new benefit, but it will take notable results to change the view of PBM’s role in healthcare. ■

IOWA PHARMACY NEWS

IPA Partners with Meyvn Group

In addition to presenting the 2019 IPA Goes Local events, IPA has partnered with the Meyvn Group to provide additional professional burnout and resiliency resources to members. IPA members will have access to the Meyvn Group’s custom-designed and broad professional services including 1:1 burnout and resiliency coaching, leadership training, and organizational burnout consulting.

There will be a discount provided for IPA members. Look for more information on IPA’s website, www.iarx.org.

Iowa Falls Prevention Coalition Develops Statewide Strategy

As part of a multiple stakeholder coalition, IPA advocated for the role of the pharmacist to help achieve a vision for Iowa in which patients will have fewer falls and fall-related injuries, maximizing a patient’s independence and quality of life. This coalition hopes to facilitate collaboration among state, community, and healthcare system partners to reduce falls by building awareness, providing education, and supporting implementation of a 3-year fall prevention action plan. With two primary goals of increasing awareness and knowledge and promoting best practice assessment and timely referral, IPA will assist the group in key areas focused on educational programming related to medications that increase fall risk as well as ensuring that routine medication reviews focus on medication fall risk.

EcoReturns Program Continues to Collect Unwanted, Expired Medications

Now in its tenth year, the EcoReturns program helps Iowa pharmacies continue to be a resource in providing patients the opportunity to dispose of their unwanted or expired medications. As part of a statewide program, with funding from the Iowa Board of Pharmacy, the EcoReturns program is a collaboration between IPA and SafeNetRx to provide medication disposal units for noncontrolled substances in community or outpatient-based pharmacies across Iowa.

12

| The Journal of the Iowa Pharmacy Association

The program complements other options for medication disposal for controlled substances, including the Board of Pharmacy’s program with Assured Waste Solutions or programs funded for disposal units at local law enforcement facilities. In 2018, the EcoReturns program remained a strong and viable option for medication disposal with close to 12,000 pounds collected.

adherence, administration of long-acting antipsychotic injectables, naloxone therapy, medication assisted treatment, smoking cessation, and acute/inpatient psychiatric services. This white paper will serve as guidance for IPA in working with the legislature, healthcare associations, and other key stakeholders.

As a reminder to participating pharmacies, when your EcoReturns box is full, you do not have to call IPA to request a new box. Ship your box using the pre-paid UPS shipping label. If you do not have regular UPS pick-ups, you may contact UPS to schedule an EcoReturns box pick-up at your pharmacy.

EcoReturns will auto-ship a new box once the full box is received.

IPA and the Iowa Public Health Association co-hosted an Immunization Stakeholder Meeting at the IPA headquarters on November 27, 2018.

There were 20 attendees representing a diverse group, including various associations, health-systems, community pharmacy, industry, quality improvement organizations, and the Iowa Department of Public Health. Discussed were the goals of the stakeholder group and different programs and initiatives that are in operation to improve adult immunization rates in the state, in particular, the APhA Foundation’s Project IMPACTImmunizations. The group will meet again in February 2019 to develop a joint policy statement to improve adult immunization rates, a public awareness campaign proposal, and a document with sources of coverage for adult immunizations.

To learn more about EcoReturns or to sign up for this free program, visit www.iarx.org/ecoreturns.

IPA Issues White Paper on Behavioral Health Services

Millions of people are suffering from behavioral health conditions and complications in the United States, which are commonly debilitating and interfere with activities of daily living. As healthcare continues its extensive transition to a team and value-based approach, Iowa pharmacists should be recognized as a key component in a patient’s healthcare team due to their medication expertise and the relatively high number of interactions pharmacists have with patients. IPA issued a white paper in response to recommendations by IPA’s Behavioral Health Ad Hoc Committee that was convened by then IPA president Craig Logemann during the winter of 2017-2018.

The white paper provides a critical review of the role that pharmacists play in behavioral health in Iowa and across the country. With a thorough review of the literature and best practices, Iowa pharmacists can impact behavioral healthcare through health screenings, collaborative drug therapy management, metabolic monitoring, medication

IPA Co-Hosts Adult Immunization Stakeholder Meeting

Pharmacy Stakeholders Discuss Legislative Priorities

A group of stakeholders met to discuss 2019 legislative priorities and implementation of the passed legislation in 2018. The group included representatives from IPA, the Iowa Board of Pharmacy, Drake University, the University of Iowa, the Collaborative Education Institute (CEI), Rep. John Forbes, and Sen. Tom Greene. The group had a very engaging discussion regarding legislative priorities, implementation strategies, continued struggles with PBM practices, and hardships regarding compliance with USP standards. The stakeholder group will meet again prior to IPA’s Legislative Day on January 29, 2019.

Cannabidiol Dispensaries Open

On December 1, Iowa’s five medical cannabidiol (CBD) dispensaries, located

IOWA PHARMACY NEWS

in Council Bluffs, Davenport, Sioux City, Waterloo, and Windsor Heights, opened for business. Patients with a valid registration card are now able to purchase three dosage forms of medical CBD gel capsules, tincture, and cream. To be eligible for a registration card, Iowans must have a qualifying condition listed here:

SAVE THE DATE

• Cancer (if the illness or its treatment produces severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting) • Seizures • Crohn’s disease • Untreatable pain • Multiple Sclerosis with severe and persistent muscle spasms • AIDS or HIV (as defined in Iowa Code, section 141A.1) • Amyotrophic lateral sclerosis (ALS) • Parkinson’s disease • Any terminal illness with a probable life expectancy of under one year (if the illness produces severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting)

New Thursday-Friday Agenda!

New Format • Engaging Programming • Home for the Weekend!

Thursday, June 20, 2019

IPA’s August 2/2/2 webinar featured members from the Iowa Department of Public Health’s (IDPH) Office of Medical Cannabidiol to explain Iowa’s medical CBD program. The recording and follow up information is available at www.iarx.org/222.

8:00-9:00 am

Registration/Breakfast

9:00-Noon

House of Delegates Session 1

12:30-1:30 pm

Lunch & Motivational Keynote

1:30-3:00 pm

Policy Committee on Professional Affairs

2:00-3:30 pm

Project Presentations

3:00-4:30 pm

Policy Committee on Public Affairs

CVS/Aetna Merger Approved

5:00-6:00 pm

President’s Reception

6:00-8:00 pm

Annual Banquet

8:00-10:00 pm

Silent Auction

The Iowa Insurance Division approved the merger of CVS/Aetna in Iowa following a public hearing on October 24. While Commissioner Doug Ommen did raise concerns surrounding the scrutiny of PBM practices, the hearing was relatively drama-free. The deal, which won approval from the Department of Justice in October, is one of several expected to transform the current U.S. healthcare system. Fellow pharmacy benefit manager Express Scripts is finalizing its merger with insurer Cigna after receiving federal approval in September. ■

Friday, June 21, 2019 7:00-8:00 am

Fun Run

7:00-8:00 am

Registration

8:00-9:00 am

Keynote - Breakfast

9:00-Noon

Project Presentations

Noon-1:00 pm

Lunch Keynote

1:15-3:30 pm

House of Delegates Session 2

3:30 pm

Adjourn

Agenda subject to change

JAN.FEB.MAR 2019 |

13

COMMITTEE REPORTS

Advisory Committee on Medicaid & Pharmacy Benefits Programs

The IPA Advisory Committee on Medicaid & Pharmacy Benefit Programs met in Des Moines at IPA Headquarters on October 2, 2018. Shortly after the meeting began, Chair Randy McDonough introduced Lindsey Ludwig, executive director of CPESN Iowa, to provide an overview of the history of CPESN in Iowa and to review the current care programs available for compensation to pharmacies within CPESN Iowa.

Another committee discussion point was over the innovative payment models for medication costs for which the committee reviewed the basics of a potentially new model for medication compensation, predictive acquisition cost.

2018 IPA Health-System Liason Board meeting

IPA ADVISORY COMMITTEE REPORTS IPA advisory committees provide guidance to the Board of Trustees and staff regarding specific practice areas.

Committees meet at least once a year at IPA headquarters in Des Moines, and may be asked to provide feedback by email or conference call throughout the year.

The committee moved on to evaluate concerns with specialty pharmacy distribution while spotlighting opportunities for pharmacy technicians to advance specialty pharmacy practice opportunities. The last point on the agenda was discussing recent PBM regulations in Iowa. Casey Ficek highlighted the successes of the past legislative session and provided insight from the legislative oversight committee’s investigation of PBM practices.

Recommendations to IPA leadership and staff: • Continue to investigate mechanisms to address all aspects of professional burnout among pharmacy professionals in Iowa.

• Create presentation on predictive acquisition cost to followup and better understand the potential benefit for use of this model in Iowa.

• Investigate expansion of vaccine coverage by Medicaid as a pharmacy benefit and coverage of continuous glucose monitoring.

The following pages feature recaps from this year’s fall committee meetings, including topics discussed and recommendations given.

Serving on a Committee

Serving on an IPA committee gives you the opportunity to influence the direction of the association and the advancement of pharmacy practice across the state. Each year, IPA’s president selects pharmacists, residents, pharmacy technicians and student pharmacists from a variety practice settings and areas of the state to serve on committees.

See the list of committees at: www.iarx.org/committeestaskforces IPA committees are formed in the late summer months.

If you are interested in serving on a committee, contact Anthony Pudlo at apudlo@iarx.org or 515-270-0713.

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| The Journal of the Iowa Pharmacy Association

Committee Members

Randy McDonough*, Jess Smith**, Nancy Bell, Abby Cate, Chelsea Cave, Sharon Cashman, Craig Clark, Sarah Dean, Jessica Frank, Terry Jacobsen, Bridget Jermeland, Mercy Macharia, Katie McDaniel, Robert Nichols, Mark Richards, Shannon Rudolph, Marshall Sanders, Kim Spading, Aaron Stangel, Stevie Veach

COMMITTEE REPORTS

Health-System Liaison Board

The IPA Health-System Liaison Board met on October 24, 2018, at IPA headquarters in Des Moines. Chair Shane Madsen and IPA staff reviewed IPA’s strategic plan, focusing on membership retention and engagement and professional burnout and resiliency amongst Iowa pharmacy professionals.

The committee discussed several issues and ways for IPA to address them. For drug shortages, they looked to leverage the network of IPA members to better collaborate with each other to resolve a drug shortage in their hospital. The committee also turned to topics like opioids and naloxone therapy and USP 800.

Before completing the meeting, IPA staff reviewed IPA’s legislative agenda and the need for growing the network of grassroots advocates. They described the comments submitted

by IPA to the board of pharmacy regarding the recently proposed changes to the hospital pharmacy practice chapter of the board of pharmacy’s rule and reviewed IPA’s efforts to communicate with Iowa’s Congressional delegation on the 340B drug pricing program.

Recommendations to IPA leadership and staff: • Ongoing collaboration with other healthcare disciplines regarding provider burnout.

Education Advisory Committee

The IPA Education Advisory Committee convened via conference call on October 9, 2018. The first topic for discussion was 2019 IPA Goes Local events. The committee recommended resources be provided to IPA Goes Local attendees regarding provider burnout and professional resiliency. They also discussed potential topics for 2/2/2 webinars and the committee recommended converting the webinars into podcast recordings available for member listening.

Last, the committee discussed plans to celebrate the 20th anniversary of the unification of IPA and ISHP in 2019 in which IPA staff reviewed the current plan, and other upcoming events.

The next committee meeting will take place in the Spring of 2019, after evaluations are collected for the Midwest Pharmacy Expo to review and plan for the 2020 event.

Recommendations to IPA leadership and staff: • Provide tangible resources to IPA Goes Local attendees regarding provider burnout and professional resiliency.

• Convert 2/2/2 webinars into podcast recordings for the IPA membership.

• Host a webinar to provide pearls of developing or growing an antimicrobial stewardship program.

• Educational effort with public campaign regarding the Choosing Wisely recommendation on appropriate units of measure.

• Create a document showcasing all current opioid dispensing limitations from third-party payers and other stakeholders.

• Pilot the forum capabilities of the IPA website as a tool for hospitals to communicate regarding current drug shortages.

• Brainstorm additional mechanisms to fulfill the IDPH mandate for reporting of naloxone administered by EMS. • Host a 2/2/2 webinar from Surescripts on opportunities to communicate among providers and pharmacies for e-prescribing of controlled substances.

• Develop a sample policy and procedures for accepting and dispensing naloxone by an institution if product is received

by IDPH.

Committee Members

Shane Madsen*, Amanda Bushman**, Carol Anderson, Abby Beane, Geena Hopwood, Micaela Maeyaert, Eliza DyBoarman, Darla Eastman, Angie Fouts, Levi Gates, Tracy Harlan, Fischer Herald, Jeff Houseman, Amber Johnson, Candy Jordan, Mindi Jorgenson, Nick Kayser, Sara Leistico, Alex Mersch, Kiera Murray, Jen Morris, Melissa Nelson, Jessica Nesheim, Heather Ourth, Brittany Sulkowski

Committee Members

Chris Parker*, Pamela Wiltfang**, Emily Beckett, Sally Haack, Kayla Hughes, Ryan Jacobsen, Lynn Kassel, Carrie Koenigsfeld, Deanna McDanel, Emily Neddermeyer, Nancee Waterbury, JP Webb, Sara Wiedenfeld

*Chair **Vice Chair

JAN.FEB.MAR 2019 |

15

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COMMITTEE REPORTS

Long-Term Care & Senior Care Advisory Committee

IPA Long-Term Care & Senior Care Advisory Committee chair Mark McMullen opened the meeting on October 31, 2018, with discussion on IPA’s Strategic Plan. This committee focused on burnout and resiliency in the profession, and reviewed current strategies that hope to be completed in 2019. The committee then discussed multiple collaboration efforts, of which the committee concluded that additional education be allotted to IPA members on appropriate use of antipsychotic medications and mechanisms for communication with prescribers.

Another large area of discussion for the committee were the multiple issues surrounding practice transformation. The committee reviewed concerns amongst the membership related to drug shortages, care transitions, falls prevention, inappropriate antipsychotic use, and interoperability amongst healthcare providers.

Before concluding the meeting, the committee discussed regulatory affairs. They examined various changes within CMS regulations for drug regimen review (DRR) upon admission and provided suggestions for a follow-up meeting with representatives from the Iowa Department of Inspections and Appeals (DIA).

Recommendations to IPA leadership and staff: • Additional education to the IPA membership on appropriate use of antipsychotic and mechanisms for communication with prescribers.

• Pilot the forum capabilities of the IPA website as a tool for pharmacies to communicate regarding current drug shortages.

• Communicate with the Hospital Leadership Team to develop a standardized form for discharge communications to pharmacies for LTC patients.

• Host webinars on interoperability amongst providers, falls prevention, and appropriate antipsychotic use.

Committee Members

Mark McMullen*, Jeff Reist**, Jen Alexander, Rocky Anderson, Mark Branum, David Brothersen, Connie Connolly, Megan Elsbury, Anisa Fornoff, Katarina Hockey, Chelsea Khaw, Kristin Meyer, Marcia McNulty, Dick Michael, Rachel Otting, Justin Rash, David Scott, Kathy Stone, Jesse Upton, Michael Williams, Jr.

Pharmacy Technician Advisory Committee

The IPA Pharmacy Technician Advisory Committee convened on September 18, 2018 at IPA’s Headquarters in Des Moines, to discuss issues surrounding pharmacy technicians within the state. The meeting was called to order by Chair Tammy Sharp-Becker and the committee proceeded to provide their recommendations to increase membership and retention, along with increasing pharmacy technician participation at IPA meetings and events.

The committee then moved on to discuss technician training for entry-level and advanced-level pharmacy technicians.

They discussed current pass rates for the national pharmacy technician certification examinations and ideas on creating a pharmacy technician study group program. Before concluding the meeting, the committee discussed new initiatives and other practice issues in the state, including: HIV screening and referral, USP 800, and the AMA STEPSforward toolkit. Finally, the committee discussed upcoming dates and rule changes from the Board of Pharmacy including the addition of a pharmacy technician member to the Board.

Recommendations to IPA leadership and staff: • Develop new member onboarding process for pharmacy technicians, including membership videos at employment orientation and team huddles/meetings.

• Develop marketing postcards to pharmacy technicians for anniversaries as a registered pharmacy technician in Iowa.

• An outreach event to nearby pharmacies and hospitals during the IPA Annual Meeting for pharmacy technicians.

• Add a regulatory update section within the monthly Tech Tidbit e-newsletter.

• Survey the IPA membership regarding the key components needed of a pharmacy technician certification exam study group program.

• Survey of the IPA membership to better understand advanced roles and responsibilities of pharmacy technicians in the state.

Committee Members

Tammy Sharp-Becker*, Amanda West**, Jessica Burge, Meg Finn, Lori Foster, Shannon Hahn, Sonya Jones, Judy Mentzer, Angie Miller, Maggie Rice, Kelly Simon, Lindsay Stinson, Alyce Steig, Julia Strause, Daniel VandeVoort

*Chair **Vice Chair

JAN.FEB.MAR 2019 |

17

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

The Midwest Pharmacy Expo brings together pharmacists, pharmacy technicians and student pharmacists from across the Midwest for the region’s premier live continuing pharmacy education event.

16.75 hrs of CPE for Pharmacists & 10.25 hrs of CPE for Technicians • Clinically Intensive Workshops (Friday) featuring high-level clinical programming

• Keynote from Paul Radde on professional burnout • 4 tracks including pharmacist-pharmacy technician integrated programming:

• Continuity of Care • Professionalism • Provider Readiness • Hot Topics

• Sunday Favorites New Drugs, Law, and Gamechangers

Build Connections Connect with pharmacists and pharmacy technicians from across 9 Midwestern states, plus hear from experts from across the country!

BRAND NEW LOCATION! The 2019 Midwest Pharmacy Expo’s new location is the brand new Des Moines Hilton Downtown!

• AGENDA • Friday, February 8, 2019

12:30 pm

Clinically Intensive Workshops

2:00 pm

6.5 hrs CPE for Pharmacists

7:45 am 8:30 am 8:45 am

Registration

Biostatistics and Trial Design: An Interactive Review for Pharmacists -Break-

12:30 pm

Lunch & Networking (lunch provided)

3:00 pm

-Break-

11:00 am 1:30 pm 3:30 pm 5:00 pm

SESSION 3

1. Taking the “Pain” out of Inpatient Pain Management 2. Mentors: The Importance of Having One and Being One T

Welcome

10:45 am

Lunch and Exhibit Hall

3. Culture Shock: Advanced Practice in Infectious Disease 4. Having Difficult Conversations with Patients T

Chronic Care Management Part I: Infectious Disease

3:00 pm

Pitfalls and Pearls: Interpreting Common Labs in Clinical Practice

3:15 pm

SESSION 4 1. Critical Care: Updates for the Non-ICU Pharmacist 2. Medication Errors: Combat the Impact of Stress T 3. 8 Things I Never Wanted to Learn about Diabetes

Chronic Care Management Part II: Cardiology Wrap-up and Adjourn

-Break-

4. Medical Cannabis Status Update T 4:15 pm 4:30 pm

Saturday, February 9, 2019 Midwest Pharmacy Expo

6.25 hrs CPE for Pharmacists & Pharmacy Technicians

-Break-

SESSION 5 1. Partnering for Success: How Community Pharmacists can Reduce Hospital Readmissions T 2. Setting Boundaries & Saying NO - Nicely T 3. Time to Deprescribe: When Less is More

6:30 am

Registration Opens

8:45 am

Keynote: “Re-igniting from Professional Burnout: Assess, Prevent and Reverse the Syndrome” by Paul Radde T

7:15 am 8:30 am

4. On the Front Lines: Impacting Outcomes in Mental Health

Industry Symposium Breakfasts

5:30 pm

Welcome

10:00 am

-Break-

10:15 am

SESSION 1

5:45 pm

Midwest Pharmacy Expo

1. Peri-operative Medication Management: Focus on Anticoagulation

3. Advancing Care with Point of Care Testing 4. Troubleshooting USP 800 and Handling of Hazardous Meds: Key Issues in the Hospital T 11:30 am

Political Leadership Reception**

Sunday, February 10, 2019

2. Keeping Up with the Studies: The Challenge of Staying Current in Pharmacy T

11:15 am

Adjourn

-Break-

SESSION 2 1. Case-based Challenges in Hospital Medicine 2. Rx: Inoculate from Burnout T

4.0 hrs CPE for Pharmacists & Pharmacy Technicians

6:30 am

Registration Opens

9:30 am

-Break-

6:45 am

8:00 am

4. USP 800: Drugs of Concern in the Community Pharmacy T

New Drug Update T

9:45 am

Electronic Messaging: Staying HIPAA Compliant T

12:30 pm

Adjourn

10:45 am 11:00 am Tracks:

3. Give It Your Best Shot: Maximizing Immunizations in Your Patients

Industry Symposium Breakfasts

-Break-

Gamechangers in Pharmacy: 2018 T

1. Continuity of Care 2. Professionalism

3. Provider Readiness 4. Hot Topics

CE accredited sessions in bold T - Accredited for both pharmacists & pharmacy technicians ** - Additional ticket purchase required

Register today at

MidwestPharmacyExpo.com JAN.FEB.MAR 2019 |

19

PRACTICE ADVANCEMENT

= 1815 = HIV/Hep C = C3

IOWA GRANT PROJECTS HIV Screening Initiative Underway Across the State

In conjunction with the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis, IPA delivered a comprehensive training for the first cohort of the HIV point-of-care screening initiative in November. Objectives of the training were to understand the need for additional HIV testing resources within their communities as well as counseling patients on reactive and non-reactive test results. As of January 1st, this first cohort of eight pharmacies began offering free HIV screenings in their communities.

The first cohort of pharmacies were identified based on statistical data from the Iowa Department of Public Health’s epidemiology report and are considered focus areas for the project. These pharmacies are located in Black Hawk, Winneshiek, Cass and Marion counties.

While marketing materials are being

20

| The Journal of the Iowa Pharmacy Association

finalized, some pharmacies (Donlon Pharmacy in Decorah and Greenwood Pharmacy in Waterloo) were spotlighted for their efforts in their local news.

IPA is currently recruiting pharmacies for the second cohort to launch in early 2019.

In addition to Black Hawk, Winneshiek, Cass and Marion counties, additional counties of focus are highlighted on the map. Participating pharmacies will receive a grant to help offset the costs of implementing the project.

practice with local prescribers in their communities. As an effort to expand the role of a pharmacist providing medication management for chronic diseases such as diabetes and hypertension, pharmacists will be provided grant stipends to collaborate with prescriber practices in specified high-risk counties around the state. IPA will provide technical assistance to pharmacists selected to participate in this opportunity.

To participate in the project or to learn more, please contact Kellie Staiert, IPA’s lead project manager at kstaiert@iarx.org.

If you are a pharmacist practicing in one of the identified 1815 Grant counties on the map, please contact Anthony Pudlo at apudlo@iarx.org to learn more about participation.

Ambulatory Care Practice Advancement Opportunities

Sustainability of the State Innovation Model (SIM)

In collaboration with the Iowa Department of Public Health, IPA is working to identify pharmacists that seek to expand their ambulatory care

Over the past five years, IPA closely worked with the Iowa Department of Public Health and Iowa Healthcare Collaborative on the State Innovation

PRACTICE ADVANCEMENT

Model (SIM) initiative. The SIM vision is “Iowans experience better health and have access to accountable and affordable healthcare in every community,” while utilizing the quadruple aim of “better outcomes, better care, affordable costs, and joy in practice.” As funding of the SIM initiative winds down in 2019, the efforts of specific communities and stakeholders will continue to move forward as Iowa communities work to address gaps in healthcare delivery with local strategies. IPA has long advocated for pharmacists to be connected to these local strategies and be a part of the discussions. The SIM initiative directly aligns with the profession’s efforts for coordinated care and improved access to the knowledge and skills of a pharmacist.

The SIM initiative was a key component of the Healthcare Innovation and Visioning Roundtable established by Gov. Reynolds. This roundtable engaged a diverse group of business leaders, payers, providers and public agency leaders from rural and urban communities across the state. In September 2018, this roundtable provided a report to the Governor’s Office that called out the need for more appropriate surveillance of high need and high cost populations as well as creation of a sustainable statewide shared platform to facilitate real time exchange of healthcare information. As these themes and others within the SIM initiative, IPA encourages all pharmacists and pharmacy personnel to plug yourself into these local community discussions and showcase the knowledge and skills that pharmacy can bring to the table.

A portion of technical assistance is also deployed at the local level to facilitate Community and Clinical Care (C3) health management initiatives: The C3 is a group of pilot communities demonstrating how operational alignment, performance improvement and population health can be applied collaboratively with health providers and health care systems. ■

Journey for Control Conversation Map Trainings Offer Resources to Patients with Diabetes

As part of a CDC grant offered through the Iowa Department of Public Health, IPA offered two trainings for pharmacists, student pharmacists, diabetes educators, and other pharmacy personnel on the Journey for Control Conversation Map. Over 30 people were trained between two events held on October 11, 2018, in Iowa City and October 25, 2018, in Des Moines.

Training in Iowa City on October 11

Journey for Control is an educational engagement program that connects patients and diabetes educators through a personalized support to improve type 2 diabetes self-management. The curriculum utilized within Journey for Control helps fulfill the requirements for diabetes self-management training and support (DSMTS) accreditation, which is a reimbursable service by Medicare and Iowa Medicaid.

IPA, APhA Foundation Continues to Partner on Project IMPACT Immunizations

The next phase of Project IMPACT Immunizations launched on December 7, 2018. Project IMPACT Immunizations is a multi-phase initiative that integrates an innovative care model into each participating pharmacy in an effort to identify unmet adult vaccination needs.

IPA has partnered once again with the APhA Foundation to work with 16 community pharmacies to increase vaccination rates of routinely recommended adult vaccines. Any patient over the age of 18 years is eligible for a vaccination history review as part of this six-month study. The goal for this project is to have each pharmacy address the vaccine needs for at least 200 patients, especially those patients with high-risk disease states.

Value-Based Pharmacy Program Shows Success in First Year

As the Wellmark value-based pharmacy program moves into its second year, the network of participating pharmacies has grown from 68 pharmacies to 74 in 2019. This growth allows for further distribution across the state of Iowa as well as more opportunity for impact on patient health outcomes.

In a recent conference call with participating pharmacies, Wellmark reported that the program is showing success in total cost of care for their beneficiaries thus far. In 2019, Wellmark will continue to improve upon its data integration and outcome analytics and reporting for participating pharmacies.

In addition, there is discussion within Wellmark to add new performance metrics to further showcase the impact of the pharmacies participating in the program. ■

Training in Des Moines on October 25

To learn more or to find another training near you, please visit www.journeyforcontrol.com.

JAN.FEB.MAR 2019 |

21

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CPESN IOWA

CPESN IOWA: A YEAR IN REVIEW

W

hat a year it has been for the CPESN in Iowa!

CPESN Iowa is a leading community pharmacy enhanced services network of pharmacies across the state that provide extra services such as medication optimization activities or case management to help improve the health of their patients. Much of the heavy lifting in getting pharmacies interested and agreeing to participate in this Clinically Integrated Network (CIN) came from our luminaries and the Iowa Pharmacy Association.

Early last year the Iowa luminaries identified the need for someone to lead the network and support the network members. This led to an agreement with PrescribeWellness to fund this position in Iowa and I was hired in May to oversee the Iowa network. The luminaries also were able to execute a network contract with Tabula Rasa Health Care in March 2018. This multi-year contract kicked off in May with a small group of pharmacies and quickly expanded to 78 pharmacies providing Medication Safety Reviews. The pharmacists and staff participating in the network program were presented with a short timeline, extensive training and high-risk patients. Even with these challenges the network pharmacists rose to the occasion. I could not have been more proud of the work they did to execute on this project. Between April and December over 165 pharmacists were trained, they completed over 1,300 Medication Safety Reviews, and payments of over $200,000 were made to participating network pharmacies.

While many of the network pharmacies ramped up quickly to engage in one or more of the network projects many were also participating in the Wellmark Value Based Pharmacy Program; IPA/IDPH

HIV/Hep C project; local Chronic Care Management, Transition of Care or other prescriber coordinated programs focused on optimizing patient care and demonstrating value to a variety of different stakeholders.

It is my hope that in 2019 our network will execute another network wide contract. My goal is to also assist in developing or expanding many of the local programs already in place and to work with pharmacies to consistently document encounters and care provided in the Pharmacist eCare plan.

Throughout the year the network luminaries and I have been talking to payors, partners and purchasers about the services the network of pharmacies can provide. IPA staff has coordinated meetings to assist us in growing the awareness of CPESN Iowa and engage us in conversations with appropriate payors. The network luminaries and I also have continued to talk to and meet with pharmacies interested in joining our network. I’m very happy to report that we closed December with 99 participating network pharmacies and CPESN USA has now grown to over 2,000 pharmacies in 44 local networks.

Network pharmacists are getting called frequently to discuss possible collaborations with prescribers, ACOs, Behavioral Health Networks and others. 2019 is a year of opportunity for all of us to transform and execute on initiatives that continue to demonstrate the high quality and value of our network.

Transformation is hard but with the help of those in the network and from partners like PrescribeWellness, IPA and others we will succeed. If you have questions or would like to join the Iowa network, contact Lindsey Ludwig at lludwig@cpesniowa.com. ■

Lindsey Ludwig, RPh Executive Director CPESN-IA

2018 Highlights:

February • Network conducted Prescriber Outreach on Opioid Prescribing March • Signed a network wide contract with Tabula Rasa Health Care to conduct Medication Safety Reviews for high risk Medicare BlueRx patients • Awarded IPA-F Outcomes Innovative Pharmacy Grant April • Wave 1 pharmacies began EMTM training May • Hired an Executive Director • Wave 1 pharmacies began providing EMTM services.

June • Signed sales & marketing agreement with ClaritasPSM • Pharmacy waves 2 & 3 initiated training and began providing EMTM services August • PharmacyUnited opioid project offered to CPESN network pharmacies to conduct encounters with patients at high risk for respiratory depression September • Submitted over 300 Medication Safety Reviews October • 9 network pharmacies selected to participate in a transformation of practice grant initiative funded by the Community Pharmacy Foundation December • Signed the 99th CPESN-Iowa network pharmacy

JAN.FEB.MAR 2019 |

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PEER REVIEW

EXPERIENCE OF AN IOWA COMMUNITY PHARMACIST IN SEEKING REIMBURSEMENT FOR GROUP DIABETES EDUCATION. Melissa Ernzen, PharmD, CDE Clinical Pharmacist, Certified Diabetes Educator Mercy Family Pharmacy Anthony Pape, PharmD Clinical Pharmacist Mercy Family Pharmacy Corresponding Author Matthew Witry, PharmD, PhD Assistant Professor University of Iowa College of Pharmacy 115 S. Grand Ave S515 PHAR Iowa City, IA 52242 Matthew-witry@uiowa.edu 319.335.8763 Conflict of Interest Ernzen and Pape are employees of Mercy Family Pharmacy. This paper was supported by a grant from the Iowa Pharmacy Associathion Foundation. The University of Iowa received payment for the Analysis conducted by Witry as part of the grant.

Data on this project previously was presented at the 2018 Iowa Pharmacy Association Annual Meeting in Des Moines, Iowa.

Abstract Background Type 2 Diabetes is a significant public health issue, and pharmacists have demonstrated their ability to intervene and improve clinical markers. Fee for service payment for diabetes education has been challenging to obtain, even for certified pharmacists.

Methods This was a descriptive, practicebased study. Group diabetes education was provided to a sample of patients over a 2-month period by a licensed pharmacist, certified in diabetes education. Claims were submitted to multiple payers, and results of the claims were documented and reported.

Results Claims for diabetes education were submitted to the respective Medicare, Medicaid managed care, health management organization, or employer-sponsored insurance provider. Despite multiple resubmission attempts and communication with the payers, no claims were successfully paid.

Conclusions Changes in reimbursement approaches for community pharmacists providing group diabetes education appear needed. Alternative strategies, such as individual contracts and arrangements may be necessary for pharmacists to secure reimbursement for diabetes education.

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Introduction

For years, community pharmacists have demonstrated their ability to help patients manage their diabetes and improve outcomes like blood pressure and glucose control.1,2 Community pharmacists who also are certified diabetes educators (CDEs) may be in a unique position to help ambulatory patients with diabetes better manage their condition.3,4 Community pharmacists are accessible, have access to dispensing data, and have ongoing opportunities for interaction and monitoring.5,6 Community pharmacist CDEs could be an important resoruce for facilitating diabetes self-management since patients sometimes have barriers to accessing diabetes education.7 While pharmacists are increasingly pursuing credentials such as certified diabetes educator, reimbursement for services has lagged behind.8,9 Community pharmacists are being reimbursed for some patient care services such as comprehensive medication reviews, which could include patients with diabetes. Pharmacies also may receive payments in the form of bonuses for the overall performance on measures like medication adherence for oral antidiabetic medications. While community pharmacists are engaged with diabetes management, little has been reported about U.S. pharmacists receiving fee-for-service reimbursement for their efforts in diabetes education, including in the community setting.

As part of a pilot and feasibility project, supported by the Iowa Pharmacy Foundation’s Outcomes Innovative Pharmacy Grant, Mercy Family Pharmacy in Dubuque provided group diabetes education to patients to determine if, and under what payment mechanisms,

PEER REVIEW

reimbursement could be obtained. The objective of this manuscript is to describe the experience of one Iowa community pharmacy seeking reimbursement for group diabetes education. The rationale for sharing this information is to allow other pharmacies to learn from, and build on, these findings.

Methods

This manuscript details the billing outcomes of a pharmacy seeking reimbursement for group diabetes education. The study pharmacy is a small Midwestern U.S. chain. The pharmacist delivering the diabetes education was a certified diabetes educator (CDE). The certification was through the National Certification Board for Diabetes Educators (NCBDE). The study pharmacy has an AADE recognized Diabetes Education program which also is certified by the Iowa Department of Public Health (IDPH).

Claims were submitted using both the pharmacist’s and the pharmacy’s NPI. These billing outcomes were based on a pilot intervention where interested patients from the pharmacy could participate in group diabetes education classes. These patients were recruited through the mail and non-responders were called to verify receipt of the mailing and answer questions about participating.

Patients could participate regardless of insurance type. Patients were assured that while the pharmacy would attempt to obtain reimbursement, there was financial assistance available to cover their participation should their claims be rejected by the insurer. Recruitment letters were mailed in July 2017, and telephone follow-up was made during late July and August The series of group diabetes education classes was offered over 8 weeks between September and October 2017. Participants had 2 time options: around lunch or in the early evening. The class sequence included an overview of diabetes, education on short and long-term complications, nutrition and exercise, and other topics related to their diabetes diagnosis and selfmanagement. The patients also completed surveys about diabetes management and medication adherence (not reported here). The study was approved by the IRB

of Mercy Hospital, Dubuque, Iowa.

Claims for group diabetes education were submitted by the pharmacy billing department in collaboration with the CDE pharmacist. Claims were not submitted for the initial diabetes workup because the initial workup was where permission was obtained for the pharmacist to request that the patient’s physician send an order for diabetes education. Claims submission and resubmissions occurred between October 2017 and June Rejection codes were documented and are reported.

Results

Of the 207 letters were mailed out for recruitment. 18 patients (8.7%) participated in the initial one-on-one diabetes workup. During this workup, all 18 patients agreed to have the pharmacy seek authorization from the patient’s physician for pharmacist-provided group diabetes education and each primary care physician responded positively.

Of these patients, 14 participated in at least 6 of the 8 group diabetes education classes, and 2 patients attended only 1 class. For the 4 patients not completing the sequence of classes, 2 were unable to be contacted again, 1 patient withdrew because of a language barrier, and 1 cited a transportation barrier.

Insurance claims were submitted to 4 different insurers for the 16 patients.

These included Medicare Part B/ Medicare Advantage plan (n=6), an Iowa Medicaid managed care plan (n=3), a private insurer (n=2), and an area HMO (n=5). No claims were paid after multiple attempts, detailed below.

Medicare – The Medicare billing approach was based on the Diabetes Self-Management Education/Training Reimbursement Toolkit by the Delmarva Foundation for Medical Care, a quality improvement organization for CMS. Steps included 1) calling the area CMS office and the regional Medicare Administrative Contractor (MAC) to inquire about billing for diabetes education and to submit details about the pharmacy’s certified diabetes education program; 2) completing forms about

the program and CDE pharmacist, and 3) completing the Medicare Enrollment Application for Physician and NonPhysician Practitioners and the Medicare Enrollment Application Reassignment of Medicare Benefits (CMS-855R and CMS855I). These forms were submitted by mail and reciept of delivery was obtained.

The pharmacy was later notified that form CMS 855S- Medicare Enrollment Application Durable Medical Equipment, Prosthetics, Orthotics and supplies (DMEPOS) Supplier was also needed.

This form, however, already was on file with CMS. The issue appeared to be that the pharmacy, not the pharmacist, needed to bill for the services.

Next, the specific Medicare Advantage plan used by several patients was contacted to inquire about how to bill for group diabetes education and the pharmacist was instructed to complete several forms and include the program certification. The pharmacy billing department submitted claims to Medicare Part B using the 1500 form and the pharmacy NPI number. Denials were returned due to incomplete forms which were corrected and returned. Upon resubmission, however, claims were then rejected based on the following codes.

• CO16- Contractual obligation- Claim /Service lacks information which is needed for adjudication • M51- Missing/incomplete/invalid procedure codes or rates • MA130- Your claim contains incomplete and or invalid information, and no appeal rights are afforded because the claim is unprocessable.

• MA28- Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision.

Medicaid – Claims were submitted by paper claim using a 1500 form for one of Iowa’s Medicaid managed care plans. Each claim was rejected. The CDE pharmacist called the office for the insurer to follow JAN.FEB.MAR 2019 |

25

ENGAGE CONNECT ENERGIZE ADVANCE

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PEER REVIEW

up and was told that the service code for diabetes education was not part of the pharmacy contract. We were told to contact our regional representative to add codes. The pharmacist contacted the regional representative and was told they were not anticipating adding the code.

That private Medicaid payer ended up withdrawing their participation in the Iowa Medicaid system soon after.

HMO – Claims were submitted using the paper claim 1500 form to a local Health Management Organization (HMO). The claims were denied with the explanation that the pharmacy was not eligible to bill the patient individually for the claim.

Follow up with the insurer’s billing department was unsuccessful as the representative explained that diabetes education and support are offered to beneficiaries using in-house nurses only.

Private Employer Insurer – A private insurer offering mainly employer-based coverage denied claims when submitted using a paper 1500 claim form. When called to inquire, the pharmacist was told that the pharmacy was required to become certified to dispense durable medical equipment (DME) for that particular insurer to submit claims for diabetes education.

Discussion

Despite multiple billing attempts, many hours on the telephone, corrections, and resubmissions, the study pharmacy was unable to obtain reimbursement for group diabetes education classes offered by a pharmacist with a CDE credential and IDPH certification. Rejections ranged from the service being offered inhouse by the insurer, to cost prohibitive certification requirements, to complex and cryptic rejection codes. While this was discouraging, several paths may still exist should the pharmacy decide to invest more time and effort into pursuing payment for group diabetes education.

One potential option is to undertake DME certification for the specific private insurer. This, however, was not deemed to be financially viable since getting such a certification would be costly, timeconsuming, and only open up payment

for a small number of patients. Even then, reimbursement may not be guaranteed.

An upside would be that the pharmacy could start providing other DME for those beneficiaries such as nebulizers.

Pharmacies that already have a DME certification for the private insurer may be better positioned to add group diabetes education as a service offering, although fee-for-service payment still may be a challenge to obtain. A second avenue is to have further discussions with the area HMO. While not currently covered, it may be fruitful for the pharmacy to pursue meetings with the managers that shape benefit design and coverage.

Data from this pilot could be used to demonstrate that pharmacist-provided group diabetes education could be a useful benefit.

Several months after completing the pilot, the pharmacy applied for funding from an area foundation to provide comprehensive diabetes self-management education to patients of a local Federally Qualified Health Center. The pharmacy used participation and satisfaction data from the pilot to support their application which was funded. It may be possible for a pharmacy to approach local employers to provide a similar service to employees.

However, it is unknown if individual plans would still choose to offer services in-house or with a restricted network of providers. Aside from group diabetes education, CDE pharmacists may be positioned to provide annual wellness visits or chronic care management in collaboration with area clinics. Also, little is known about how other credentials like the Board Certified-Advanced Diabetes Management (BC-ADM) may affect reimbursement. More experience reports need to be disseminated in these new areas.

This descriptive report has several limitations. First, only the reimbursement approaches attempted could be described.

There may be other avenues that were not pursued or other work-arounds that may have led to claims being paid.

Second, this was a convenience sample of patients, and as a result, did not represent all area payers. Furthermore, pharmacists practicing in other states may be subject

to different regulations and payer contracts which could result in fee-forservice claims being paid.

Conclusions

Efforts to obtain fee-for-service reimbursement for group diabetes education were not successful for a variety of reasons which varied by the particular payer. The pharmacy, however, was able to use data from this pilot to apply for, and receive, foundation funding to provide comprehensive diabetes self-management education to patients of a local Federally Qualified Health Center. Emerging reimbursement opportunities, such as those that may accompany provider status, may give CDE pharmacists additional ways to be reimbursed for the services they can provide patients with diabetes.

References

1. Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569-1582.

2. Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist interventions in the management of type 2 diabetes mellitus: a systematic review of randomized controlled trials. Journal of managed care & specialty pharmacy.

2016;22(5):493-515.

3. Lo A, Lorenz K, Cor K, Simpson SH. Factors affecting number of diabetes management activities provided by pharmacists. Canadian journal of diabetes. 2016;40(6):535-542.

4. Shane‐McWhorter L, Fermo JD, Bultemeier NC, Oderda GM. National survey of pharmacist certified diabetes educators. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2002;22(12):1579-1593.

5. Goedken AM, Butler CM, McDonough RP, Deninger MJ, Doucette WR. Continuous Medication Monitoring (CoMM): A foundational model to support the clinical work community pharmacists. Research in Social and Administrative Pharmacy. 2017.

6. Kelling SE. Exploring accessibility of community pharmacy services. Inov Pharm.

2015;6(3):6.

7. Peyrot M, Rubin RR, Funnell MM, Siminerio LM. Access to diabetes self-management education. The Diabetes Educator.

2009;35(2):246-263.

8. McDonough RP. Community pharmacists: Retailers or clinicians? Pharmacy Today.

2016;22(5):49.

9. Painter JT, Gressler L, Kathe N, Slabaugh SL, Blumenschein K. Consumer willingness to pay for pharmacy services: An updated review of the literature. Research in Social and Administrative Pharmacy. 2018.

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STATEWIDE PROTOCOLS

STATEWIDE PROTOCOLS IN IOWA

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s the practice of pharmacy continues to advance, states are increasingly recognizing the value of utilizing pharmacists to increase access to important public health services. In 2018, Iowa took an important step in this direction by passing legislation that creates statewide protocols for immunizations, naloxone, and nicotine replacement therapy (NRT).

What does this mean for my practice?

Iowa pharmacists who meet certain qualifying criteria will now have the ability to prescribe immunizations, naloxone, and NRT based on protocols developed by the Iowa Board of Pharmacy, in consultation with the Iowa Department of Public Health.

Statewide protocols have an advantage of expanding pharmacists’ contributions to patients’ and public health needs because of their broad application. Also, because any pharmacist in the state who meets the education requirements can opt into the statewide protocol, the services provided are predictable and consistent across the state.1

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Immunizations

Currently, Iowa’s law allows for a pharmacist to administer immunizations and vaccines only through a local protocol with a prescriber or pursuant to a valid prescription. However, beginning July 1, 2019, pharmacists will now be an independent prescriber of vaccines and immunizations. While this represents a major step forward, pharmacists will need to prepare for the transition by ensuring they understand the new requirements.

What will be required to participate?

To participate in the protocol, an authorized pharmacist will be required to complete an organized course of study in a college or school of pharmacy or an ACPE-accredited continuing education program on vaccine administration that: (1) Requires documentation by the pharmacist of current certification in basic cardiac life support through a training program designated for health care providers which includes hands-on training. (2) Is an evidence-based course that includes study material and hands-on training and techniques for administering vaccines, requires testing with a passing score, complies with current CDC

STATEWIDE PROTOCOLS

guidelines, and provides instruction and experiential training in a list of content areas relating to patient safety and appropriate standards.

A participating pharmacist will also be required to document at least one hour of ACPE-approved continuing education with the ACPE topic designator “06” followed by the letter “P,” as well as maintain current certification in basic cardiac life support through a training program designated for health care providers which includes handson training. While the age for which pharmacists can order and administer influenza vaccinations will be six months or older, the age for all other approved vaccines and subsequent HPV doses (not the initial dose) remains at 18 or above.

Nicotine Replacement Therapy

Through expanded authority and national efforts to advance the tobacco cessation knowledge and skills of student pharmacists and licensed pharmacists, the profession’s role in tobacco cessation has evolved substantially in recent years.2 In Iowa, an authorized pharmacist will now be allowed to prescribe and dispense nicotine replacement tobacco cessation products to patients 18 years and older. Common forms of NRT products include gum, patches, sprays, inhalers, or lozenges.

While these products are typically already available over the counter, allowing a pharmacist to issue a prescription can potentially aid patients in obtaining insurance coverage, as well as coverage under Medicaid. Reducing out-of-pocket costs for evidence-based cessation treatments increases use of these treatments and increases the number of tobacco users who quit.3,4 What will be required to participate?

To participate, a pharmacist will be required to document successful completion of an ACPE-approved continuing education program of at least one-hour related to NRT product utilization. The pharmacist will also be required to assess a patient for

appropriateness of receiving an NRT product, as well as provide counseling and instruction to the patient prior to dispensing. Finally, the pharmacist will be required to notify the patient’s primary health care provider of the NRT product provided to the patient as soon as reasonably possible. If the patient does not have a primary health care provider, a written record of the NRT product should be provided to the patient and the patient should be advised to consult a physician.

Naloxone

Pursuant to a 2016 Iowa law, Iowa pharmacists already have the authority to dispense naloxone by a standing order to an individual at risk of an opioid-related overdose or to a person who may be in a position to assist an individual at risk of an opioid-related overdose. Now pharmacists will also be able to independently dispense naloxone pursuant to a statewide protocol.

What will be required to participate?

While age, education, training, and reporting requirements remain similar to those of NRT, it is important to note that dispensing naloxone to a patient requires more stringent patient education. Upon assessment and determination that a patient is eligible to receive and possess naloxone, the pharmacist must provide training and education to the patient.

This training and education includes: (1) The signs and symptoms of opioidrelated overdose as described in the statewide protocol; (2) The importance of calling 911 as soon as possible and the potential need for rescue breathing; (3) The appropriate use and directions for administration of the naloxone to be dispensed pursuant to the statewide protocol; (4) Adverse reactions of naloxone as well as reactions resulting from opioid withdrawal following administration; (5) The proper storage conditions, including temperature excursions, of the naloxone product being dispensed; (6) The expiration date of the naloxone product being dispensed and the appropriate disposal of the naloxone product upon expiration.

Moving Forward

The Board of Pharmacy is still in the process of finalizing the individual protocols described in this article.

While this article provides a general guideline, it is crucial that any pharmacist seeking to prescribe under the new statewide protocol law has a thorough understanding of the requirements established in the individual protocols.

Furthermore, while many pharmacists will meet the requirements to participate, ensuring Medicaid and private payors recognize pharmacists as the prescriber when it comes time to bill presents new challenges. IPA is working diligently to ensure this transition is also smooth and we encourage you to stay tuned for more information.

References

1. Krystalyn K. Weaver. Policy 101: Statewide protocols increase patient access to public health services. Pharmacy Today 2016; 22:7:57.

2. Adams J, Hudmon K. Pharmacist prescriptive authority for smoking cessation medications in the United States. 58 JAPhA, 3, 253–257 (2018).

3. Fiore MC, Jaen CR, Baker TB, et al.

Treating Tobacco Use and Dependence: 2008 Update. Clinical practice guideline.

Rockville, MD: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2008. http://www. ahrq.gov/professionals/clinicians-providers/ guidelinesrecommendations/tobacco/index. html#Clinic 4. Community Guide Task Force on Community Preventive Services. Reducing Tobacco Use and Secondhand Smoke Exposure: Reducing Out-of-Pocket Costs for Evidence-Based Cessation Treatments Web site. http:// www.thecommunityguide.org/tobacco/ outofpocketcosts.html.

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FROM THE DEAN

THRIVING Renae Chesnut, RPh, EdD, MBA Dean Drake University College of Pharmacy & Health Sciences

T

he Drake University College of Pharmacy and Health Sciences continues to thrive and I am proud to share the national accomplishments that reflect on our college as well as the Iowa pharmacy family. From outstanding students to the success of new programs and partnerships, the college is going non-stop, with everyone working to ensure our students have access to unsurpassed opportunities.

Our faculty continue to exhibit strong professional leadership and commitment to patient care, and our students are actively engaged in advocacy and will be alumni who help transform the profession.

Faculty Updates

The academic year brought four new faculty members across multiple disciplines. Jared Butler, PH’11, joined the clinical sciences department and has an acute care, adult medicine practice site at the Des Moines VA. The occupational therapy department has added Sara Johnston and Christine Urish who have brought their expertise in research and mental health. Alisa Drapeaux, a physical therapist, joined our health sciences department as the director of the experiential capstone.

Effective May 20, Dr. Tim Welty will be moving into a new role in the college, serving as director of innovation, research and international initiatives. As he moves into that position, Erik Maki was selected to become the next clinical sciences department chair.

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Student Successes

New Opportunities

Lauren Blum, P4, and Kaitlin Crane, O3, partnered with two Des Moines University medical students last spring, winning the prestigious CLARION National Case Competition that focused on tackling the opioid addiction plaguing rural communities.

Our Occupational Therapy Doctoral (OTD) program has received full accreditation status from the Accreditation Council for Occupational Therapy Education (ACOTE) for seven years – the maximum amount allowed for initial accreditation. Drake University has the only ACOTE accredited entrylevel doctoral program in central Iowa and is one of only 29 OTD programs in the nation. The first cohort of OTD will graduate in May 2019.

We continue to have an abundance of student success within our PharmD program. The class of 2018 was second in the nation for the ASHP PharmD Residency Phase I Match rate, with over 50 students pursuing a residency. Additionally, many Drake students have been selected for highly competitive national fellowships, PhD programs, and non-ASHP residencies. It is also notable that the 2017 graduates exceeded the national average of NAPLEX pass rates by 10 percent which put us in the top 10 out of 130 programs.

Matt Glasow, P4, won the Next-Generation Future Pharmacist, sponsored by Parata and Pharmacy Times.

This award honors pharmacists, pharmacy technicians, students, and other industry advocates in multiple categories who are going above and beyond in the pharmacy profession.

Matt is the second Drake student who has won the award and the 6th finalist out of 7 years of nominations.

Kelli Jo Welter, P3, was elected national president-elect of the American Pharmacists Association-Academy of Student Pharmacists (APhA-ASP).

This position, which involves services and leadership for approximately 34,000 student pharmacists across the country, will prepare her for the presidency as she is inducted at the annual meeting in March.

This year was the inaugural selection of the Granberg Student Excellence Scholarship Award. Lauren Blum, P4, was selected for this award due to her demonstrated leadership and involvement in professional pharmacy organizations.

The admission process for the inaugural class of the Master of Athletic Training (MAT) program began this fall. Applications to the program are accepted on a rolling basis through the Athletic Training Centralized Application Service (ATCAS). The first cohort of students will begin the two year program in Fall 2019.

As a result of all of the work of our faculty, staff, preceptors, alumni, and students through these accomplishments and many others, the Drake University College of Pharmacy and Health Sciences continues to be recognized nationally for our excellence, commitment, and engagement. To all of the IPA members who support our college and assist us in these endeavors, we thank you! ■

FROM THE DEAN

PHARMACY’S DIZYGOTIC TWINS

W

itnessing the unique bond between twins is truly fascinating. And when that observation is applied to Pharmacy there is no better example, in my opinion, than the special bond that exists between Iowa and Wisconsin. Born initially out of a very special friendship between CEOs Tom Temple and Chris Decker, PSW and IPA became the first unified state pharmacy associations in the nation, an astonishing accomplishment. As Dean at Iowa and as an honorary UW residency graduate, I have had the unique privilege of witnessing firsthand for many years the extraordinary efforts of both organizations, their forward-thinking governing boards, and their equally amazing legacy of leadership. On countless occasions, I have gushed with pride as I trumpeted the many wonderful examples of the highest professional ideals exhibited by pharmacists from both states. Just think for a moment the profound impact their actions have had on countless students, residents, and other young practitioners launching their careers who have laid witness to such exemplary professionalism. ‘Leadingby-example’, ’walking-the-talk’, and ‘work-hard-play-hard’ are most deserving phrases to include in the Iowa/Wisconsin pharmacy lexicon!

Careful examination of the fundamental objectives of both organizations is instructive: Collaboration; advocacy through a unified voice; innovation; education; active engagement; promoting leadership development; and, pursuing positive patient outcomes that make a difference in patients’ lives are among those that stand out.

And while these words are simple to scribe, what separates these two organizations from most of their counterparts is the purposeful, vigorous, dedicated, and resolute

manner in which they approach these lofty goals. Doing so requires sustained, thoughtful leadership, an unwavering commitment, and a determined membership. Is it any wonder then that Kate Gainer, IPA’s CEO since 2012 is a Wisconsinite by birth and education, and PSW’s Chris Decker, conversely, is an Iowan by birth and education…how ironic yet, how fitting!

Dizygotic twins…separate, but in oh so many ways they have clearly emerged from the same organizational DNA. As a consequence, there is a notable level of mutual trust, caring, and outward expressions of respect that are both palpable and visibly noticeable even to the most casual of observers. Throughout the years, these shared virtues have been on full display through joint efforts like “Leadership Pharmacy”, a unique leadership development program dedicated to new practitioners (no more than 15 years of active practice since graduation), and the annual PSW/IPA Leadership Dinner that brings together presidential officers, academic leaders, key thought leaders from both states, and their respective association executives and protégées. These annual events provide meaningful opportunities to share programs, perspectives, policies, best practices, and strategies as well as foster a depth of fellowship that is simply uncommon in today’s fast-paced, ever-changing healthcare environment. Moreover, these efforts have helped facilitate the growth and development of national leaders.

One need only to look at the roster of presidential and board-elected officers to many of the nation’s pharmacy organizations over the past few decades to fully appreciate the dramatic impact both organizations have had. Consequently, it is with little wonder that the cultures

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

exhibited by both organizations mirror each other so closely.

PSW was formed in 1998 and IPA followed suit a few months later in January 1999. As both organizations celebrate 20 years of exemplary leadership, it seems only fitting that we take pause to celebrate their achievements as two of the nation’s most premiere, productive, prolific, and purposeful state pharmacy organizations. Not unlike decades past, pharmacy continues to face many daunting challenges. Yet, there is no doubt in my mind that the leadership of both organizations will be at the fore tackling these challenges head-on just as they have done since the birth of their existence.

Frankly, I am in awe observing the highly professional manner in which PSW and IPA consistently and deliberately go about their business.

PSW and IPA….I salute you!

Born out of a shared vision….united by a shared cause….truly, truly amazing!

With profound respect and admiration, Donald E. Letendre Dean and Professor

JAN.FEB.MAR 2019 |

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PUBLIC AFFAIRS

Iowa Medicaid Diabetes Test Strip Reimbursement IPA advocated on your behalf to remedy the reimbursement issues with preferred diabetes testing supplies submitted to Amerigroup/Express Scripts. The supplies returned to WAC pricing at pharmacy point of sale on October 16, 2018. Express Scripts completed the reversal and resubmission of the claims from June 1 to October 15, 2018, on December 5, 2019.

If you have any questions or have not seen back payment yet, it is recommended to first call Express Scripts at 888-5718182. Please contact IPA if there are any continued issues.

Diabetes Supplies to be billed as DME Starting April 1, 2019, the Iowa Medicaid Enterprise (IME) will require all diabetes supplies to be billed under the medical benefit as durable medical equipment (DME) and no longer at pharmacy point of sale. IME will no longer require use of preferred diabetes supplies which created an exception to the previous policy of billing the supplies as DME. IPA has communicated with IME the difficulties we have heard regarding pharmacies enrolling as DME providers. Please reach out to IPA if you are having trouble enrolling as a DME provider. Look for more information and communication from IPA on steps to become a DME provider. IPA will continue to advocate on your behalf to provide best care for Medicaid beneficiaries.

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stated she believes this an opportunity to increase access by “eliminating some of the barriers and making it available through a pharmacist.” IPA met with the Governor’s office to provide input on crafting the proposal and will continue to be involved as the potential legislation is finalized and introduced during the 2019 legislative session.

USP 800

In August, the Board of Pharmacy introduced a proposed rule that encouraged pharmacies to implement protective methods identified in United States Pharmacopeia general chapter 800. During the public comments period, the Board received comments, including those of IPA, to provide more certainty surrounding the enforcement of USP 800 by the Board. After taking these comments into consideration, the Board re-noticed the rules to provide for a Dec. 1, 2019 effective date.

Given the significant financial impact pharmacies face in becoming compliant, IPA has encouraged the Board to delay implementation by 18 months or to allow pharmacies to submit a proposal to the Board to demonstrate their plan to become compliant.

New Legislator Visits

Gov. Reynolds Proposes Pharmacist Provided Contraception

Following the midterm elections, there will be many new faces in the Iowa Legislature. IPA is committed to expanding our grassroots network in 2019. To do so, we are surveying members in these districts to see who may have existing relationships with their new state representative or senator and who would be willing to host them for a pharmacy visit.

During an October debate with her democrat challenger Fred Hubbell, Governor Reynolds unveiled a proposal to allow birth control to be available through a pharmacist without a prior prescription from a doctor. Reynolds

If you do not have an existing relationship, no worries! IPA would still love to help you set up a pharmacy visit to begin familiarizing your new legislator with the practice of pharmacy.

| The Journal of the Iowa Pharmacy Association

Any pharmacy practice setting (community, clinic, hospital pharmacy, LTC) is a great opportunity to showcase what pharmacists do and how pharmacists impact patients. This is also a chance for you to discuss issues directly affecting your pharmacy practice, your patients, or your business.

If interested, IPA can send you your legislator’s email address and a template email to use. Prior to your visit, IPA will also send a packet with background information to share during the visit. If you would like, IPA can also participate in the visit. We promise, it’ll be easy! Please contact Casey Ficek at cficek@iarx.org if you are interested.

Board of Nursing Introduces Pharmacist CPA Rules In November, the Iowa Board of Nursing introduced rules that would allow an Advanced Registered Nurse Practitioner to enter into a collaborative drug therapy management agreement with a pharmacist. IPA submitted comments in support of the rules during the public comment period and during the Administrative Rules Review Committee Meeting in December. ■

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.

PUBLIC AFFAIRS

BOARD OF PHARMACY: REGULATORY UPDATE

IPA WORKING FOR YOU

The Iowa Board of Pharmacy convened for open session on September 19 and November 14, 2018 to discuss multiple requests, reports and informational items, as well as several proposed rules.

Addressing Your Iowa Medicaid & MCO Concerns

Appointments to the Board

The Governor’s office is still in the process of finding a candidate to fill the newly created seat on the Board for a certified pharmacy technician. To maintain gender and geographical balance on the board, the Governor’s office is seeking a male technician from western/southwestern or northern Iowa.

Proposed Legislation

At the November meeting, the Board discussed their proposed legislative agenda for the 2019 session. The Board decided to propose legislation that will seek amendments to the pharmacy practice act, Iowa Code Chapter 155, and to Iowa Code Chapter 124, Controlled Substances. These changes include lowering the immunization age for pharmacists to age six and creating statutory authority for the Board to expand their collaborative practice rules.

Vote of Adoption on New Regulations

Adoption of Rules Amending Chapter 1, “Purpose and Organization” During the 2017 and 2018 legislative sessions, changes were made to the Iowa Code to allow the Board to designate a pool of up to seven alternate board members, to hear contested case hearings when needed, and to add a Certified Pharmacy Technician to the composition of the Board. The amendments also updated the definitions

of wholesale distributors and limited distributors, as well as defined third-party logistics providers. These amendments incorporated language to implement these changes and were approved by the Board.

Adoption of Rules Amending Chapter 3, “Pharmacy Technicians” and Chapter 6, “General Pharmacy Practice” (ARC 4030C) The Board adopted amendments to allow a certified pharmacy technician to transfer a prescription for a noncontrolled substance to another pharmacy or receive a prescription transfer for a noncontrolled substance from another pharmacy, allow a technician to dispense a verified prescription which has been deemed to not require counseling to a patient while the pharmacist is on a break, and simplify rule language relating to the electronic transfer of prescriptions in anticipation of enhanced technologies in pharmacy software system capabilities. These changes will be effective January 23, 2019.

Other Adoption and Filings The Board adopted new Chapters 42, “Limited Distributor Licenses” and Chapter 43, “Third-Party Logistics Provider Licenses,” as well as amended Chapter 17, “Wholesale Distributor Licenses.” These changes were also a result of legislation passed last year. The Board agenda also included intended action to adopt rules relating to the implementation of USP 800. However, after receiving comments requesting clarification on the expected enforcement date, the Board decided to make changes and re-notice the rules for public comments. ■

Effective December 1, 2018, the PCN for OptumRx, the PBM for United Healthcare, claims processing has changed to 4401. All members received new ID cards with the updated PCN and all claims are messaging at pharmacies to process with the new PCN. As of November 4, 2018, Amerigroup will have a new prior authorization telephone and fax number. The new telephone number is 1- 800-454-3730 and fax number is 1-844-512-9004.

Electronic Prior Authorization can also be done at www.covermymeds.com IPA has begun to engage Iowa Total Care, a subsidiary of Centene, which will become the third MCO July 1, 2019.

A pharmacy director for the MCO has yet to be named.

JAN.FEB.MAR 2019 |

33

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.

PUBLIC AFFAIRS

CANNABIDIOL OIL – CAN MY PHARMACY SELL IT? Article originally appeared in the September 2018 Iowa Board of Pharmacy newsletter and is republished with permission from the Iowa Board of Pharmacy

T

he short answer? No.

There has been a multitude of confusion over the legality of selling oils labeled as containing cannabidiol (CBD) in Iowa pharmacies.

Various out-of-state CBD oil producers are marketing their products directly to pharmacies claiming they are legal to sell in all 50 states. These manufacturers are citing the “United States Farm Bill of 2014” as a legal means by which they may ship CBD oil containing less than 0.3% tetrahydrocannabinol (THC) throughout the country. There is a false belief held by the producers/distributors of these products that industrial hemp can be grown/distributed without restrictions.

The truth is, there are restrictions outlined in the Farm Bill, but those restrictions are overlooked by the producers.

The Iowa Department of Public Health (IDPH) released the “IDPH Position Statement on CBD Product Availability in Iowa” on August 17, 2018. Included in the statement are the four exceptions in Iowa in which natural or synthetic cannabinoid products can be legally used.

The exceptions are: 1. The following appropriately prescribed, Food and Drug Administration (FDA)-approved drugs: Marinol®, Syndros®, Cesamet® 2. Epidiolex®, produced by GW Pharmaceuticals, which has been approved by FDA but is awaiting action by DEA 3. Sativex®, produced by GW Pharmaceuticals, as part of an FDAapproved clinical trial 4. Products produced and approved pursuant to Iowa Code Chapter 124E, the Medical Cannabidiol Act,

that contain less than 3% THC and are in a form recommended by the Medical Cannabidiol Board, approved by the Iowa Board of Medicine, and adopted by the IDPH pursuant to administrative rule (see 641— 154.14(124E) for the approved forms).

Products manufactured in the state under the provisions of Iowa Code Chapter 124E will be available at IDPH-licensed dispensaries only, starting in late 2018.

The Iowa CSA, also known as Iowa Code Chapter 124, mirrors the federal CSA and classifies marijuana as a Schedule I CS, and defines marijuana in the following way: “Marijuana” means all parts of the plants of the genus Cannabis (this includes hemp), whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture or preparation of the plant, its seeds or resin, including tetrahydrocannabinols. It does not include the mature stalks of the plant, fiber produced from the stalks, oil or cake made from the seeds of the plant, any other compound, manufacture, salt derivative, mixture, or preparation of the mature stalks (except the resin extracted therefrom), fiber, oil or cake or the sterilized seed of the plant which is incapable of germination.

The following is an excerpt from a DEA write-up called “Clarification of the New Drug Code (7350) for Marijuana Extract,” which lays out which parts of the cannabis plant cannabinoids are found in, and which parts of the cannabis plants are legally defined as marijuana:

...scientific literature indicates, cannabinoids, such as tetrahydrocannabinols (THC), cannabinols, and CBD, are found in the parts of the cannabis plant that fall within the federal and state CSA definition of marijuana,1 such as the flowering tops, resin, and leaves.2 According to the scientific literature, cannabinoids are not found in the parts of the cannabis plant that are excluded from the CSA definition of marijuana, except for trace amounts (typically, only parts per million)3 that may be found where small quantities of resin adhere to the surface of seeds and mature stalk.4 Thus, based on the scientific literature, it is not practical to produce extracts that contain more than trace amounts of cannabinoids using only the parts of the cannabis plant that are excluded from the CSA definition of marijuana, such as oil from the seeds. The industrial processes used to clean cannabis seeds and produce seed oil would likely further diminish any trace amounts of cannabinoids that end up in the finished product. However, as indicated above, if a product, such as oil from cannabis seeds, consisted solely of parts of the cannabis plant excluded from the CSA definition of marijuana, such product would not be included in the new drug code (7350) or in the drug code for marijuana (7360), even if it contained trace amounts of cannabinoids.5 1. The CSA states: “The term ‘marihuana’ means all parts of the plant Cannabis sativa L., whether Continued on next page

growing or not; the seeds thereof; the resin extracted from any part of JAN.FEB.MAR 2019 |

35

PUBLIC AFFAIRS

Continued from previous page

Advance IPA’s Legislative Agenda by Becoming a Champion Advocate Are you interested in becoming an important partner in helping IPA advance its legislative and regulatory agenda throughout the year? IPA is looking for Champion Advocates across Iowa to build relationships with their elected officials. Help us achieve our goal of having a Champion Advocate in every House and Senate district!

Our goal is to have pharmacists or pharmacy technicians establish trust and familiarity with their legislators to keep them aware of the key issues facing pharmacy. As you work to educate our representatives and senators, we can help build their understanding of our concerns regarding patient care and the role of the pharmacist.

such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin. Such term does not include the mature stalks of such plant, fiber produced from such stalks, oil or cake made from the seeds of such plant, any other compound, manufacture, salt, derivative, mixture, or preparation of such mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of such plant which is incapable of germination.” 21 U.S.C. § 802(16).

2. H. Mölleken and H. Hussman.

Cannabinoid in seed extracts of Cannabis sativa cultivars. J. Int. Hemp Assoc. 4(2): 73-79 (1997).

3. See id.; see also S. Ross et al., GCMS Analysis of the Total Δ9-THC Content of Both Drug- and FiberType Cannabis Seeds, J. Anal.

Toxic., Vol. 24, 715-717 (2000).

4. H. Mölleken, supra.

By volunteering as a Champion Advocate, you would be kept up to date on the latest information relating to IPA’s advocacy agenda and would be ready to answer the call when IPA needs to make a grassroots push with legislators.

Responsibilities would include:

• Building relationships outside of the legislative session by hosting pharmacy visits with legislators and delivering PAC contributions when needed • Contact legislators during session to explain how pending legislation would affect your pharmacy practice • Relaying your personal experiences to help legislators understand the important role that today’s pharmacists play in enhancing the health care of Iowans • Stay informed with bill tracking/ IPA legislative priorities and participate in bi-weekly update calls

If you are interested in becoming a Champion Advocate or have any questions, contact Casey Ficek, IPA’s director of public affairs, at cficek@iarx.org or 515-270-0713. Casey can help you identify your senator and representative and get started with setting up a pharmacy visit.

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| The Journal of the Iowa Pharmacy Association

5. Nor would such a product be included under drug code 7370 (tetrahydrocannabinols). See Hemp Industries Association v. DEA, 357 F.3d 1012 (9th Cir. 2004) (Hemp II). However, as the Ninth Circuit stated in Hemp II, “when Congress excluded from the definition of marijuana ‘mature stalks of such plant, fiber . . . , [and] oil or cake made from the seeds,’ it also made an exception to the exception, and included ‘resin extracted from’ the excepted parts of the plant in the definition of marijuana, despite the stalks and seed exception.” Id. at 1018. Thus, if an extract of cannabinoids were produced using extracted resin from any part of the cannabis plant (including the parts excluded from the CSA definition of marijuana), such an extract would be included in the CSA definition of marijuana.

Based on the cited literature, products purporting to be CBD oil that are being offered for sale over-the-counter are either derived from portions of the plants in the genus Cannabis prohibited under the CSA (ie, the resin), or the products are most likely misbranded as defined by FDA.■

PUBLIC AFFAIRS

MARIJUANA DEVELOPMENT

B

ack in 2014, this series explored the legality of marijuana, medical and otherwise, as state laws diverged from Federal law.

This divergence started with California in 1996. Two concepts discussed in that article have not changed; the Supremacy Clause and Enforcement Discretion.

The Supremacy Clause is a provision in the United States Constitution and it states that Federal law is supreme to state law. Generally, states may enact laws that are more stringent than Federal laws, but not more lenient. For example, a state can move a Schedule III up to a Schedule II or move a non-controlled drug into Schedule IV within their borders. But a state is unable to move a Schedule II down to Schedule III. This is a basic tenet in the relationship between Federal and state laws. However, this tenet seems to have been forgotten as states moved to legalize marijuana and associated products within their borders.

One reason that this has occurred is another concept known as Enforcement Discretion. This occurs when an agency responsible for the enforcement of a law decides to not enforce that law.

An earlier example of this concept was the importation of prescription drugs from Canada. The Food & Drug Administration (FDA) stated that all importation was illegal, but they exercised their discretion and would not prosecute those bringing in these drugs for their own use. In essence, the activity is still illegal, but the agency chooses to do nothing about it. The Drug Enforcement Administration (DEA) has been following this course since at least the publication of the Ogden memo in 2009.

The caveat here is that the agencies always have the ability to change their minds.

Two recent developments have the potential to radically change the marijuana discussion. The first is the publication of a DEA internal directive on May 22, 2018. The clarification provided in this directive is that products and materials made from the

parts of the marijuana plant that are not included in the definition of marijuana under the Controlled Substances Act (CSA) are not themselves controlled under the CSA. The directive goes on to say, “the mere presence of cannabinoids is not itself dispositive as to whether a substance is within the scope of the CSA . . .” This is a reversal from the position taken by DEA in a news release in 2001 that stated that any product that causes THC to enter the human body is a Schedule I substance. Essentially they were saying at that time was that any product that has any THC in it is a controlled substance. What this change in direction might mean for future enforcement actions by DEA is uncertain at this time.

The second recent development was the introduction of a bill by Senator Charles Schumer of New York on June 28, 2018. This bill may render the previous discussions moot. The main objective of the bill is the removal of marijuana and THC from Schedule I of the CSA. The bill also amends a number of U. S. Code sections to remove marijuana and THC from them. Examples of these include removing them from the definition of felony drug offense and from the mandatory sentencing guidelines. If marijuana and THC are no longer Schedule I substances, there is no longer any disconnect between state and Federal law. The states would clearly be free to regulate marijuana as they see fit.

The law also creates some other related funds and requirements. First, the bill creates a fund to provide small business loans to women and socially and economically disadvantaged people who want to operate a marijuana business. It also directs the National Highway Traffic Safety Administration to study the impact of driving under the influence of THC on highway safety.

The bill goes on to direct the Secretary of Health and Human Services to conduct research on various health issues involving marijuana, such as the effects of THC on the brain, efficacy of marijuana as treatment for specific conditions, and the identification of additional medical uses for marijuana.

Don McGuire, RPh, JD General Counsel, Senior Vice President, Risk Management & Compliance Pharmacists Mutual Companies

The bill would also restrict advertising of marijuana products if needed for the protection of the public health, especially for individuals who are 18 years old or younger. Lastly, the bill would provide funds for grants to states to allow them to set up programs to expunge previous marijuana convictions.

If passed, this bill would completely change the conversation on marijuana in the United States. There has been a huge shift in public opinion on this issue, especially in the last 20 years or so. It is too early to tell if the bill has enough support in Congress to get passed. If anything gets in the way, it may be the additional requirements and studies that are created in the bill.

Each of them comes with their own appropriations, so the fight may come down to the budget. Stay alert for new developments – there will almost assuredly be more coming!

References

1. Article 6 - This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding.

2. https://www.deadiversion.usdoj.gov/ schedules/marijuana/dea_internal_ directive_cannabinoids_05222018.html 3. Marijuana Freedom and Opportunity Act - https://www.congress.gov/bill/115thcongress/senate-bill/3174/text?q=%7B%22s earch%22%3A%5B%22schumer+marijuan a%22%5D%7D&r=1

This article discusses general principles of law and risk management. It is not intended as legal advice.

Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

JAN.FEB.MAR 2019 |

37

THANK YOU!

Thank you to all who contributed to the IPPAC or LDF in 2018!

The Iowa Pharmacy Political Action Committee (IPPAC) is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. The IPPAC is funded by contributions from individual pharmacists, pharmacy technicians, or student pharmacists, as well as member PACs of other organizations.

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

2018 IPPAC Donors

2018 LDF Donors

Michael Andreski Elizabeth Bald Brett Barker Vernon Benjamin Allison Bernard Anna Burns Samantha Campbell Sharon Cashman Cheryl Clarke Connie Connolly Kyra Corbett Bernard Cremers Jay Currie Neal Daley Sarah Derr Ashley Dohrn Kimberly Dornbier Gus Erickson Lucas Faley Joshua Feldmann Casey Ficek Steve Firman John Forbes Ryan Frerichs Stanley Fullerton Kate Gainer Matthew Glasow Robert Greenwood Derek Grimm John Hamiel Richard Hartig James Hoehns Gregory Hoyman Grant Jerkovich June Johnson Thomas Johnsrud Margaret Karbeling

Anderson Pharmacy Kenneth Anderson Ryan Pharmacy Mitchell Barnett Reinbeck Pharmacy Brent Bovy Brehme Drug, Inc. Ashley Brehme Eagle Grove Pharmacy Michele Cooper Daniel Pharmacy John Daniel III Drilling Morningside Pharmacy Inc - William Drilling Meyer Pharmacy Ryan Frerichs Thomas Greene Valley Drug Store Linda Grimm Maier Family Pharmacy Kari Hanneman Denver Drug Brett Hansen Widner Drug Store Shelley Kallenbach

Laura Knockel Rick Knudson Craig Logemann Jeffrey Longstaff Micaela Maeyaert Edward Maier Erik Maki Gary Maly Deanna McDanel Maryanne Menge Karen Merrill Kristin Meyer Gary Milavetz Robert Nichols Marilyn Osterhaus Matthew Osterhaus Robert Osterhaus Wesley Pilkington Matthew Pitlick Lisa Ploehn Charles Porter Anthony Pudlo John Rovers Shannon Rudolph Susan Shields Anne Stella Robert Stessman Thomas Taiber Alexandria Taylor Joseph Thompson CoraLynn Trewet Stevie Veach James Wallace Ryan Weber Kristin Williams Pat Wilsbacher Michael Wolnerman

NACDS Joel Kurzman Towncrest Pharmacy Randal McDonough Mahaska Drug Jane Nicholson Bellevue Pharmacy Inc Remsen Pharmacy Dwayne Plender Dowd Drug Julie Priestley Rashid Pharmacy, P.L.C. Joseph Rashid Bedford Drug Co. Michael Schweitzer Stangel Pharmacy Inc Aaron Stangel South Side Drug Inc David Voss Pharmacists Mutual Company Pat Wilsbacher Koerner Whipple Pharmacy Todd Wragge

Your contributions to either the IPPAC or Legislative Defense Fund aid in advocating for practice advancement, PBM regulation, and other important issues facing our profession.

STRENGTHEN ADVOCACY. STRENGTHEN PHARMACY. For more information or to contribute, visit www.iarx.org/IPPAC

LEGISLATIVE PRIORITIES

2019 LEGISLATIVE PRIORITIES & POLICY POSITIONS The Iowa Pharmacy Association’s Legislative Committee and Board of Trustees have established the following legislative priorities for 2019.

State Legislative Priorities

Increasing Access to Patient Care Services IPA supports increasing access to patient care services through the expansion of pharmacist statewide protocols and collaborative practice agreements.

Allowing pharmacists to provide medications and services via statewide protocols and collaborative practice agreements can increase the public health impact of pharmacists’ services.

Modifying existing statewide protocols, such as lowering the age at which a pharmacist can administer vaccines, can aid in this effort. Additionally, allowing all prescribers to enter into collaborative practice agreements with pharmacists for specific patient populations can increase patient access to services provided by pharmacists in collaboration with other healthcare providers.

Recognizing Pharmacists as Providers Recognizing pharmacists as equal to other healthcare providers under state law can increase opportunities for pharmacists to receive payment for their services.

Decades of research have proven the value of including pharmacists on healthcare teams. Improved health outcomes, lower costs, and increased access to care could be a reality for Iowa residents if pharmacists were fully recognized as patient care providers. While pharmacists already provide patient care services through collaborative practice agreements, reducing barriers that prevent pharmacists from billing for those services is necessary to create sustainable access to care.

Ensuring Sustainable and Transparent Medicaid Reimbursement IPA supports laws and regulations that

ensure pharmacy reimbursement under Medicaid is sustainable, predictable, and transparent.

During the privatization of Iowa’s Medicaid system, IPA successfully advocated for the state to continue using the methodology of Average Acquisition Cost + Cost of Dispensing fee based on a bi-annual survey. It is imperative to maintain this Medicaid reimbursement formula for pharmacies that is sustainable, predictable, and transparent. IPA supports the enactment of laws and regulations that reflect this principle and will ensure that it remains this way into the future.

Pharmacy Benefits Managers IPA supports oversight that ensures the protection of patients, sustainable reimbursement to pharmacies for pharmaceutical products and pharmacist’s professional services, and assurance that state dollars are being properly managed by pharmacy benefits managers.

IPA is committed to working with the legislature and state agencies to ensure patient protection and fair PBM practices for Iowans, publicly funded health plans, and pharmacy providers. IPA’s strategic plan also places emphasis on non-legislative strategies to educate health plan sponsors and to influence PBM practices in Iowa.

Policy Positions

Opioids IPA continues to support the efforts of lawmakers and stakeholders to address the opioid crisis and encourages the utilization of pharmacists and pharmacies to serve patients in treatment and recovery.

misuse of prescription opioids can be an important piece in stemming the opioid crisis. IPA will continue to take every opportunity to offer solutions to the opioid crisis from the pharmacy perspective, including the prescription monitoring program, patient and provider education, and medication assisted treatment.

Medical Cannabis IPA supports an active role for pharmacists in the medication management of cannabis used for legal medical purposes in the state of Iowa.

While current state law excludes pharmacists from the dispensing process, it is important that pharmacists be included in the medication management of cannabis. Patients that meet the criteria for receiving cannabis to treat their medical conditions most likely take numerous other prescription medications.

To ensure the highest level of patient safety, a pharmacist review of the patient’s full medication profile should be conducted as is required by state law with every new prescription medication.

Needle Exchange IPA supports hypodermic needle exchange programs and safe disposal options as part of a comprehensive approach in preventing the spread of infectious diseases.

IPA will continue to monitor legislation and work with stakeholders and lawmakers to promote education on the risks of sharing hypodermic needles and syringes, and the potential to reduce this risk with needle exchange programs.

Engaging pharmacists and utilizing their expertise to help prevent the abuse and

JAN.FEB.MAR 2019 |

39

TECHNICIAN CORNER

Outcomes Names Top Iowa Technicians

The following Iowa pharmacy technicians were recognized recently as Top Technicians by OutcomesMTM during their annual Technician Involvement Month: Jamie Bodley, CPhT, of NuCara Pharmacy in West Union Jillisa Legg, CPhT, of NuCara Pharmacy in Conrad Nichole Lincoln, CPhT, of Medicap Pharmacy in Glenwood Cynthia Mitchell, CPhT, of Medicap Pharmacy in Red Oak Cate Unternahrer, CPhT, of Hy-Vee Pharmacy in Washington Winners were selected based on overall performance in the following medication therapy management categories: • Number of claims documented under his/her personal account • Percentage of the pharmacy/MTM Center’s total claims submitted by the technician • Number of logins to the OutcomesMTM platform Congratulations on your hard work and dedication to the profession!

QUITLINE Iowa

(From IPA’s October 2018 Tech Tidbits newsletter) Smoking is the leading cause of preventable deaths nationwide.

Encouraging our patients to quit smoking is important and quitting takes time and, in a pharmacy, time is valuable commodity. If we are able to get our patients interested in quitting, understanding what programs Iowa has available is important so that we can properly refer patients.

What does QUITLINE offer?

QUITLINE Iowa offers coaching for patients by phone, text, instant message, and email. Coaches are available 24/7. Also, QUITLINE offers

40

| The Journal of the Iowa Pharmacy Association

different medication options (nicotine replacement therapy: patches, lozenges, gum, varenicline, and bupropion), planning and educational materials, and membership into an online community.

Who can refer patients to this program?

Pharmacists and pharmacy technicians are able to refer patients to the QUITLINE program. Smoking, either starting or quitting, can cause interactions with different medications. Having that information on file is important but also gathering that information allows you to start a conversation with the patient about the possibility of quitting and getting the patient enrolled in the program.

How do I refer patients to Quitline?

• Fax: 1-800-261-6259

Check that there are areas available to receive and unpack, store, and compound hazardous drugs; as applicable to your site.

3. Verify that your site has the correct personal protective equipment and employees understand what protective equipment needs to be worn when handling hazardous drugs.

4. Confirm that employees handling hazardous drugs have been properly trained and that training is reassessed every 12 months. The training and competency assessment must be documented.

5. Verify that spill kits are available in areas where hazardous drugs are being compounded, transported, and administered.

• Online: https://iowa.quitlogix.org/ • Phone: 1-800-QUIT-NOW, 1-855-DÉJELO-YA What is the cost?

It is free for a patient to enroll and receive coaching through QUITLINE. Medications may have a cost associated depending on the patient’s insurance coverage. Iowa Medicaid has prior authorization forms available on the Iowa Department of Human Services website, the Amerigroup website, and the UnitedHealthcare website for coverage of nicotine replacement products. Medicare coverage depends on the patient’s Part D plan. Quitline does have a limited supply of nicotine replacement products that patients may be able to obtain at no additional cost.

5 Things That Can Be Done Now to Prepare for USP 800 (From IPA’s November 2018 Tech Tidbits newsletter)

1. Confirm that your workplace has an up to date list of the hazardous drugs it handles. Also, make sure that the list has been reviewed within the last 12 months.

2. Ensure that there is signage notifying other employees of the location of hazardous drug handling areas.

Pseudoephedrine - Double Check

(From IPA’s December 2018 Tech Tidbits newsletter) Recently, methamphetamine was highlighted by the Des Moines Register for its resurgence in Iowa. According to the Governor’s Office of Drug Control policy, over 10,000 Iowans were treated for methamphetamine-related substance use so far in 2018. Although some of the methamphetamine is smuggled from outside the state and country, there are growing concerns over the use of pseudoephedrine by local meth labs. Pharmacy technicians must be knowledgeable on state and federal laws to prevent misuse of pseudoephedrine.

The Iowa Code for over-the-counter sales of pseudoephedrine states: • Pseudoephedrine must be in a locked cabinet or behind the counter.

Purchasers must be 18 years of age, have a government-issued photo ID card present when purchasing pseudoephedrine and must sign an electronic logbook with the purchaser’s name, address, date of purchase, time of purchase, name of product, and quantity.

• A patient may not purchase more than 360 milligrams of pseudoephedrine in a 24-hour period nor more than 7,500

TECHNICIAN CORNER

milligrams of pseudoephedrine within a 30-day period.

How does the Federal Combat Methamphetamine Epidemic Act (CMEA) of 2005 differ from the Iowa Code? The amount of pseudoephedrine a patient can purchase is 9,000 milligrams per 30 days according to federal law.

However, we must follow the more stringent Iowa Code (above).

Understanding pharmacy regulations is extremely important to daily tasks. There are contradicting views on whether the laws are beneficial in preventing misuse of pseudoephedrine. Pharmacy technicians are among the frontline of healthcare workers in our communities and are an important asset to the regulatory process.

Combating pseudoephedrine abuse and meth-related deaths is a community and public health issue, of which pharmacy technicians should feel empowered to embrace at the local, state, and federal levels. If you have any questions regarding state or federal legislation on pseudoephedrine products, you may contact IPA at ipa@iarx.org or 515-270-0713. ■

NEWLY PTCB CERTIFIED IOWA TECHNICIANS October 1 - December 31, 2018

Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified!

Shelly Bahr Sushant Bartaula Delora Beal Adnana Becirovic Brianna Bengtson Lillian Camp Charlotte Carr Genevieve Darnell Theresa Do Sandra Falcon Diana Flores Zamudio Kathleen Franck Michelle Griffin Ashley Harrington Jill Hatting Sarah Lynne Honts Lisa Janzer-Mott Laura Johnson Kelsey Jones Shelley Kallenbach

McKayla Karr Rebekah Kauffman Samantha Klatt Carlos Laverde-Soto Kia Lindsey Vienna Massner Kori Minor-Nidey Staci Morgan Mary P Murrane Lacey Newsom Ryan Noble Carlos Nunez Aguillon Apexa Rutvikkumar Patel Hannah Rindels Elizabeth Rogers Katy Rude Erin Ruden Tammy M Sharp-Becker Madeline Slater Taylor Sorensen

Shelby Spading Melissa Stoddard Devin Thompson Kali Umble John Voller Amanda J. West Helen Willet Brendan Wood Lynette Woods Lauryn Wright

CPhT Recertification CPE for FREE! Join IPA for your FREE subscription to CEI’s Technician Catalog!

CEI’s Technician Catalog is a web-based subscription that contains accessible and convenient continuing education courses for technicians to recertify and advance their career path.

Members: Login at www.iarx.org/cei_libraries 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

JAN.FEB.MAR 2019 |

41

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Claim your 1001 toward your student loans at sofi.com/IPA. Checking your rate will not affect your credit score.2 Terms and Conditions Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower must be a U.S. citizen or permanent resident in an eligible state and meet SoFi’s underwriting requirements. See SoFi.com/elgibility for details.

SoFi refinance loans are private loans and do not have the same repayment options that the federal loan program offers such as Income Based Repayment or Income Contingent Repayment or PAYE. Licensed by the Department of Business Oversight under the California Financing Law License No. 6054612. SoFi loans are originated by SoFi Lending Corp., NMLS # 1121636. Information as of July 2018.

1 Additional terms and conditions apply. Offer is subject to lender approval. To receive the offer, you must: (1) register and/or apply through the referral link you were given; (2) complete a loan application with SoFi; (3) have and provide a valid US bank account to receive bonus; (4) and meet SoFi’s underwriting criteria. Once conditions are met and the loan has been disbursed, you will receive your welcome bonus via automated clearing house (ACH) into your checking account within 30 calendar days. Bonuses that are not redeemed within 180 calendar days of the date they were made available to the recipient may be subject to forfeit. Bonus amounts of $600 or greater in a single calendar year may be reported to the Internal Revenue Service (IRS) as miscellaneous income to the recipient on Form 1099-MISC in the year received as required by applicable law. Recipient is responsible for any applicable federal, state or local taxes associated with receiving the bonus offer; consult your tax advisor to determine applicable tax consequences. SoFi reserves the right to change or terminate the offer at any time with or without notice.

2 To check the rates and terms you may qualify for, SoFi conducts a soft credit pull that will not affect your credit score. A hard credit pull, which may impact your credit score, is required if you apply for a SoFi product after being pre-qualified.

4

Celebrate your savings.

STUDENT PHARMACISTS: APPLY TODAY!

Bill Burke Student Pharmacist Leadership Conference September 20-22, 2019 Application Deadline - May 1, 2019

The Bill Burke Student Pharmacist Leadership Conference is scheduled for September 20-22, 2019, in St. Charles, Iowa. The conference will provide additional opportunities for networking and learning.

The Bill Burke Student Leadership Conference aims to: • Instill quality organizational leadership skills

The Max W. Eggleston Executive Internship in Association Management Application Deadline – March 1, 2019

The Max W. Eggleston Executive Internship in Association Management is a 12-week program held each year during the summer months in the IPA offices in Des Moines.

During the internship experience, the intern will receive educational instruction in each of the association’s divisions as follows:

• Increase awareness of issues impacting the profession of pharmacy

• Public Affairs and Business Development

• Encourage development of leadership skills and involvement in professional and community activities

• Organizational and Administrative Affairs

• Recognize pharmacy students who have displayed leadership potential • Improve communication and teamwork skills

To Apply

Current P1 through P3 student pharmacists from Drake University and the University of Iowa can go to www.iarx.org/BillBurke for more information or to complete an application before May 1, 2019.

• Professional and Educational Affairs • Foundation and Charitable Giving The ideal candidate is an IPA student pharmacist member currently in their second year of pharmacy school.

To Apply

Applicants should submit their online application at www.iarx.org/ExecIntern along with a current resume and writing sample to Anthony Pudlo at apudlo@iarx.org by March 1, 2019. For more information, please review the IPA website or contact IPA at 515-270-0713.

The Bill Burke Student Pharmacist Leadership Conference and the Max W. Eggleston Executive Internship in Association Management are supported by the Iowa Pharmacy Association Foundation as part of its mission to support student pharmacists and leadership development within the pharmacy profession in Iowa.

JAN.FEB.MAR 2019 |

43

IPA FOUNDATION

THANK YOU FOR SUPPORTING THE IPA FOUNDATION IN 2018!

The Iowa Pharmacy Foundation sincerely thanks those members who made a contribution to the future of the profession by supporting the efforts of the foundation‌these contributions truly make a difference!

The following list of contributors is for January 1, 2018 – December 31, 2018.

Platinum Level ($1000+) Tim & Sherry Becker Ashley Branham Sarah Cashman Sharon Cashman Renae & Eddie Chesnut Connie & Chris Connolly Jay & Ann Currie Steve Firman Kate & Bob Gainer Tom Halterman Carson Klug Gary & Mary Milavetz Katie Owen & Ben Urick Lisa & Andy Ploehn Anthony Pudlo Al Shepley Troy Trygstad Gold Level ($500-$999) Mark Adams Carol & Gary Anderson Bill Baer Carl Chalstrom Chris Clayton Nick Dahlke Sarah Derr Michele & Michael Evink Brett Faine Bob Greenwood Derek Grimm Patty Kumbera Donald E. Letendre Ed Maier Gary Maly Kevin Moores Jen Moulton Rachel Otting Chuck & Janalyn Phillips Wes Pilkington Jeff & Diane Reist Doug Schara Mark Sorenson

44

Amy Van Gorp Amanda West Silver Level ($250-$499) Mike Brownlee Tammy Bullock Matthew Cantrell Carter Chapman Cheryl Clarke Ashley Dohrn Allen Fann John & Cindy Forbes Christopher Fox Ben Fox Levi Gates Trent Geurts Sally & Jeremy Haack John Hamiel Tracy Harlan Kyle Hilsabeck Denny Jorgensen Margaret Karbeling Matt Kent Tyson Ketelsen Julie Kuhle Craig Logemann Zach Lough Lindsey Ludwig Kristin Meyer Matt & Marilyn Osterhaus Nate Peterson Jim Scott Susan Shields Bob Stessman Marla Tonn CoraLynn Trewet Stevie Veach David Wright Bronze Level ($100-$249) Samm Anderegg Rocky & Megan Anderson Allison Bernard Adam Boon

| The Journal of the Iowa Pharmacy Association

Michelle Bottenberg Amanda Bushman Michele Cooper Joe Cunningham Angie Danielson Dena Dillon Paula Emerson Laura Gansen Philip Greazel Tom Greene Linda & Larry Grimm Morgan Herring Jim Hoehns Greg Hoyman Hal Jackson Ryan Jacobsen Arden Jasper June Johnson Sandra Johnson Thomas Kelly Laura Knockel Rick Knudson Nic Lehman John Lichty Gene & Susan Lutz Steven Martens Lisa Mascardo Karen Merrill Phyllis Olson Bob & Ann Osterhaus Lauren Pedersen Michael Pursel Frank Reznicek Andrew Riesberg Richard Riesberg Alan Robinson Shannon Rudolph Kayla Sanders Jenelle Sobotka AJ Steahr John & Sarah Swegle Tom Temple Sonya Thiessen

Joseph Thompson Leslie Tierney Susan Vos JP Webb DeeAnn Wedemeyer Oleson Sara Wiedenfeld Pat Wilsbacher Timothy Wright Business Partner Contributors Cardinal Health CEI Impact Drake University College of Pharmacy & Health Sciences Dubuque Area Pharmacy Association Eagle Grove Pharmacy Greenwood Pharmacy and Compounding Center GRX Holdings Johnson County Pharmacy Association Kappa Psi Pharmaceutical Fraternity Main At Locust Pharmacy Manning Pharmacy McKesson Corporation Miller Purcell Montross Pharmacy North Iowa Pharmacy Association NuCara Pharmacies Osterhaus Pharmacy Pharmacy Times Quad City Area Pharmacy Association Sanofi-Aventis Spencer Hospital Taylor Pharmacy Towncrest Pharmacy University of Iowa College of Pharmacy Vonnahme Chiropractic Clinic Wells Fargo Advisors

THE FOUNDATION INSTITUTE To keep Iowa pharmacy thriving requires a sustained commitment to supporting our student pharmacists, developing future leaders and advancing initiatives to innovate practice. Since 1960, Iowa’s pharmacy professionals have understood this and responded generously by regularly supporting the IPA Foundation.

In response, the IPA Foundation Institute was created to recognize those who, through a sustained commitment to an annual or monthly gift, are committed to supporting foundation initiatives with students, leadership development and practice advancement.

In addition to joining a prestigious group of donor leaders, recognized by their level of annual giving, the Foundation Institute is an easy and convenient way to show your support for your profession. Simply designate an amount and frequency, and your gift is automatically deducted from your account.

Current Foundation Institute Members Bill Baer Tim & Sherry Becker Carl Chalstrom Renae Chesnut Connie Connolly Steve Firman Kate Gainer Bob Greenwood Derek Grimm Tom Halterman Julie Kuhle Kristin Meyer Anthony Pudlo Jeff & Diane Reist Susan Shields Bob Stessman Jim Wallace If you share the Foundation’s vision of advancing pharmacy practice in Iowa, consider joining the Foundation Institute.

For Giving Tuesday, the IPA Foundation asked for stories of those mentors who lead by example along with a $30 donation in honor of the 30th Leadership Pharmacy Conference held in 2018.

CoraLynn Trewet Dr. Trewet has been a mentor since I was a student. She taught me to listen to your gut and follow your heart, especially when faced by adversity. I’m grateful to have her in my life. This type of leadership is what makes Iowa special.

- Samm Anderegg Mark Nessen I am a pharmacist today because Mark showed me what it REALLY means to be a COMMUNITY pharmacist. He had such great passion for his community and was a very integral member of not only the healthcare team but the entire community and he always put the patients first.

- Cheri Rockhold-Schmit Bob Stessman Bob Stessman at Manning Pharmacy has served as a leader/mentor for me in so many aspects. Bob continually works to advance the profession of pharmacy and teaches the value of collaboration among healthcare professionals and pharmacists. One of his greatest assets is his ability to see the “big picture” and help me to see what the future looks like in various pharmacy projects.

- Jennifer Morris Jennifer Moulton Jennifer Moulton is a mentor to me personally and professionally. Her impact has reached beyond my work as a pharmacist and educator to a wife and mother. She has taught me to think outside the box to go after things others said could not be done. She always treated me like a peer and made me feel like I was the most important person in the room. Lots of advice over blood, sweat and tears...but the best may be “low expectations” which is important for all of us Type A perfectionist pharmacists.

- CoraLynn Trewet Raylene Rospond Raylene was an inspiration to me as a leader.

She helped me to develop my leadership skills by thoughtfully guiding and coaching me through challenging situations, and encouraged me to examine all angles of a situation before I made a decision. She is a professional of high integrity, work ethic, and compassion.

- June Johnson Tom Temple and the IPA Membership Tom saw something in me that made him believe I had something to contribute to the pharmacy profession. His mentorship continues and remains invaluable to me. The

IPA membership inspires me as each and every person cares so deeply for our profession and works tirelessly to advance our roles so we can impact the health of our patients.

I feel mentored collectively from the IPA membership to do what is right for our patients and our profession. Thank you!

- Jennifer Moulton Tom Temple - Michael Pursel Lon Larson Lon had a huge impact on me through mentoring me and setting an example for involvement. He generously gave his time and talents to students, Drake, and the pharmacy profession.

- Charles Phillips CoraLynn Trewet CoraLynn has always been a positive pharmacy role model to many, but after her rotation and keeping in touch throughout the years here and there, she is also a great person and mother.

She inspired my love for ambulatory care as well as academia!

- Christina Baumgart 30 for 30 (For leadership and passion, in no particular order) Jim, Tom, Tom, Jerry, Ed, Bill, Jennifer, Shirley, Kate, Bill, Bob, Jay, Jenelle, Randy, Mike, Tim, Connie, Anthony, John, Renae, Cheryl, Tony, Bernie, Steve, Michele, Curt, Connie, Patty, Joan, Geoff - Gary Maly Ed Maier & Julie Kuhle I have had the benefit of many mentors who have impacted my professional and personal life. I would like to single out Ed Maier and Julie Kuhle. They both encouraged me to apply for the Leadership Pharmacy Program and have always lead the way in being respectful and professional in challenging situations. I am thankful that they share their ability to be inclusive.

- Connie Connolly Bob Greenwood Bob Greenwood has taught me more about the profession of Pharmacy than he will ever know.

I always tell people that when I look back on my career in Pharmacy I will look most fondly on the times I got to work along side Bob in the pharmacy. I am so grateful to have shared these experiences with someone so important to our profession.

- Wesley Pilkington JAN.FEB.MAR 2019 |

45

OWN A DAY!

or 2!...or 3!

The IPA Foundation has a unique opportunity to claim your favorite day(s) of the year as your own...at least on paper.

With your charitable donation, you may purchase days in the 2019 IPA/IPAF Annual Report Calendar to celebrate ANY occasion!

To reserve your days, contact David Schaaf at 515270-0713 or dschaaf@iarx.org. Donations are 100% tax deductible and will go to the Foundation.

Hurry and claim your day(s) before someone else does and before April 1, 2019!

Text & Photo - $100.00

Description (under 10 words):

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

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

Visa

Mastercard

Discover

American Express

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

Fax: 515-270-2979 Questions? Contact: Laura Miller - 515-270-0713 lmiller@iarx.org

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

READY FOR RAGBRAI 2019 Ride with the IPA Foundation RAGBRAI Team! July 21-27 The Register’s Annual Great Bicycle Ride Across Iowa (RAGBRAI) is scheduled for July 21-27, 2019, and the IPA Foundation will be sponsoring a team of cycling pharmacy ambassadors!

Now in its 6th year, the IPA Foundation RAGBRAI team connects with Iowa pharmacists and pharmacies along the RAGBRAI route, educates Iowans on the important role of pharmacy, and serves riders with OTC treatments.

Any Iowa pharmacist, pharmacy technician or student pharmacist is welcome to ride one day, a few days, or the entire week and spread the word about pharmacy from river to river.

Sign up early to guarantee a spot on the team! The team will be limited to 20 full week riders and an additional 10 riders per day. A wait list will be used for additional interested riders.

The team will be divided into groups supported by a captain, who will have a list of pharmacies for their group to visit each day along the route.

Not a Cyclist? No problem!

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

Interested in participating and have questions?

Contact Dawn Morse at dmorse@iarx.org or 515-270-0713.

The IPA Foundation RAGBRAI team serves as a representative of the pharmacy profession and as such, all riders are expected to conduct themselves in a professional manner during their time with the team.

IPA Foundation Team Riders Receive...

Full Week Riders receive all benefits of the daily rider, plus: • IPA Foundation Team Bike Jersey (free) • Transportation to the start and from the finish (meet at IPA’s office in Des Moines) • 2 days of laundry service • Indoor accommodation preference with host families (as available) Daily Riders (up to 3 days): • IPA Foundation Team Bike Jersey (discounted rate) • Transportation of gear and supplies • Official registration through RAGBRAI • Official RAGBRAI wristband • Camping with host families or on the RAGBRAI campgrounds (if needed); indoor accommodations when available • Bathroom facilities with host families • Shower access with host families or on the RAGBRAI campgrounds (if needed) • Snacks for each day • Water and coffee available each day • SAG service for half-day riders or tired riders if needed • Electrical charge stations

How to Join the IPA Foundation Team Go to www.iarx.org/RAGBRAI for instructions on how to join the IPA Foundation team.

Important Registration Deadlines: Weekly Riders: Early Bird - Feb. 28; Final - March 31 Daily Riders: Final - May 31

FEES Full Week Rider (20 max)

Early (by 2/28)

Late (by 3/31)

Pharmacist Member

$800

$1000

Technician/Student Member

$450

$600

Non-IPA Members (includes spouse & children)

$1000

$1150

Daily Rider (max 3 days)

(by 5/31) $125/day JAN.FEB.MAR 2019 |

47

MEMBERS SECTION

IPA MEMBER SPOTLIGHT:

Jessica Nesheim, PharmD, BCPS

Written by:

Mackenzie Meade 2019 PharmD Candidate University of Iowa

H

ave you ever wished you could start a clinical practice site from the ground up?

This IPA member did just that with some help from her friends and colleagues. Jessica Nesheim is a native Iowan who grew up in Mason City. She graduated from the PharmD program at Drake University and then continued on at Mercy Hospital in Des Moines to complete her PGY1 pharmacy residency. Since then, she’s been practicing as an Emergency Medicine Pharmacist at Mercy and living in Des Moines with her husband and their two children.

Jessica didn’t picture herself in the emergency medicine setting until she attended an American Society of Health-System Pharmacists (ASHP) residency networking session. She stated, “I was floating around the areas that I had heard of – internal medicine, critical care, etc. The pharmacist at the emergency medicine table was so passionate about what he did, and I was inspired.

He made it sound like this exciting area of pharmacy I just had to be a part of.”

At that time, there were very few emergency medicine residencies

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| The Journal of the Iowa Pharmacy Association

in the state of Iowa. Mercy Des Moines was interested in fostering Jessica’s enthusiasm for emergency medicine. During her residency year, she had the chance to develop the emergency medicine program — track the interventions, prevent adverse drug events, and monetarily show the benefit of a pharmacist in the emergency department. Due to these efforts in large part, Jessica was able to stay with Mercy Des Moines following her residency. “It was a potential to stay here close to family and have the career I wanted.

I definitely saw that I was going to be on my own to learn how to operate this new position, so reaching out to different communities through IPA, ASHP, and ACCP for advice and finding a network of people was crucial,” Nesheim described.

“I definitely saw that I was going to be on my own... so reaching out to different communities through IPA, ASHP, and ACCP for advice and finding a network of people was crucial.”

The network that she built through membership and engagement with IPA, helped her to understand what an emergency medicine pharmacist did day-to-day and assist in building a PGY2 residency program practice site. “Trying to figure out how a career here looked was definitely an experience but then after that first six months I felt like I was continuing to grow, learning something new every single day, expanding my clinical knowledge, and collaborating with my network.” Through IPA

she connected with other clinical pharmacists throughout the state of Iowa. As a member of the HealthSystem Liaison Board at IPA, Jessica has been instrumental in talks about creating a platform for these networks and professionals to connect, “Because that’s one thing I really enjoy about other memberships is getting networks in your field but they’re not necessarily from your state, and state laws can really impact how you practice.” Currently, Jessica is working on a naloxone dispensing protocol for the Mercy Emergency Department, “I have a few other examples from other Emergency Departments who created a protocol but none specific to Iowa.”

She’s hoping that a platform through IPA could help fill in these gaps.

Jessica realizes that residencies are incredibly competitive and advises pharmacy students and PGY-1 residents to get involved in their profession, “Don’t just be a member but get involved and explore. I don’t think I’ve ever met a pharmacist who isn’t willing to share their wisdom, advice, or knowledge with a student.

So, take advantage of that to leverage yourself into a really good candidate.”

Jessica advocates reaching out to different pharmacists even if you do not match or decide that a residency isn’t for you, “stay involved at a local and national level and then you can really find a way to get to wherever you want to be.”

Jessica sees emergency medicine pharmacy expanding in the future and disseminating down into smaller hospitals and critical access hospitals, “there is the same risk of adverse drug events occurring there where pharmacists can intervene.”

MEMBERS SECTION

She also believes that pharmacists will continue to expand in their clinical services offered and become more involved in the prescribing process.

IPA has played an important part in Jessica’s pharmacy career.

Being a participant in IPA’s Leadership Pharmacy Conference, “I’ve met influential mentors I know that I can reach out to in other areas of pharmacy. Because emergency medicine is so encompassing, if I have a question in an area I’m not well versed, I can rely on that network.” Jessica has experienced the benefits of networks over the course of her career and advocates for the importance of reaching out through local and national associations. When you’re experiencing difficulties or burnout Jessica recommends to, “take a step back and reach out to your network of people.”

“When you’re experiencing difficulties or burnout Jessica recommends to, ‘take a step back and reach out to your network of people.’”

There are opportunities and connections to be made when the pharmacy profession comes together to support colleagues working to advance the profession. IPA recognizes Jessica in her efforts to grow these professional communities. ■

WELCOME NEW IPA MEMBERS! OCTOBER 1 - DECEMBER 31, 2018: Lisa Duric, Cedar Falls Hannah Lauer, Waucoma Amy Orendorff, Mt Ayr Shelby Powers, Clarinda Nathaniel Raney, Harlan Kimberly Ray, Des Moines Amy Sherwood, Evansdale Andy Steichen, Clear Lake Breanna Sunderman, Villisca Halden VanCleave, Iowa City Adam Weinkauf, Iowa City Megan Wright, Clarinda

THANK YOU FOR SUPPORTING IPA!

MEMBER MILESTONES Congratulations to Leigh Boehmer, PharmD, BCOP, as he starts his new role as medical director of education for the Association of Community Cancer Centers Congratulations to Renae Chesnut, EdD, MBA, BS, who celebrated 25 years at Drake University College of Pharmacy and Health Sciences in November.

Congratulations to Kate Gainer, PharmD, and Lisa Ploehn, PharmD, on receiving the University of Iowa College of Pharmacy’s 2018 Honorary Alumni Award.

Kate Gainer

Lisa Ploehn

Congratulations to Hy-Vee on being named the 2018 Drug Store News Retailer of the Year!

Erik Maki, PharmD, BCPS, became the clinical sciences department chair and at the Drake University College of Pharmacy and Health Sciences. Congratulations, Erik!

Congratulation to Marilyn Osterhaus, RPh, and Matthew Osterhaus, BSPharm, FASCP, FAPhA, on receiving the University of Iowa College of Pharmacy’s 2018 Distinguished Alumni Award.

Congratulations to the Osterhaus family - including Bob, Ann, Matt, and Marilyn – as the inaugural recipients of the University of Iowa’ Family Spirit Award, recognizing families who have support the university over several generations.

Emily Rogers, PharmD, on her new role as director of pharmacy for Mahaska Health Partnership. Congratulations, Emily!

Bernard Sorofman, PhD, was named an 2018-2019 Honorary Chair for the Social and Administrative Sciences Section of the American College of Clinical Pharmacy.

Congratulations, Bernard!

Congratulations to Farah Towfic, PharmD, on receiving the University of Iowa College of Pharmacy’s 2018 Genesis Award.

Tim Welty, BSPharm, MA, PharmD, was named director of innovation, research and international initiatives at the Drake University College of Pharmacy and Health Sciences.

Congratulations, Tim! JAN.FEB.MAR 2019 |

49

IPA IN ACTION Pharmacists (once again) Center of Attention at APHA Annual Meeting For the second year in a row, a special workshop was held in conjunction with the American Public Health Association (APHA) Annual Meeting on November 10, 2018 in San Diego. The workshop, Advancing Health Equity and Patient Care through Community Pharmacy & Public Health Partnerships, was coordinated through a partnership with the CDC Foundation, APHA, and NACDS. The event served as an opportunity for IPA to be part of a conversation with public health, pharmacy, and healthcare stakeholders to discuss how public health and pharmacy are well-aligned in their mission to improve health outcomes for all patients.

Through the multiple initiatives between IPA and the Iowa Department of Public Health, the role of Iowa pharmacists was described to various attendees whether it related to HIV screening and referral, mental health first aid training, chronic disease monitoring and management, or immunizations.

Iowa Diabetes Summit 2018

The third annual Iowa Diabetes Summit was held on November 16, 2018 in Des Moines. The summit provided attendees with updates on the American Diabetes Association’s standards of care and new technologies to improve healthcare provider’s access to at-home patient data.

Iowa pharmacy native, CoraLynn Trewet, educated attendees about current diabetes medications and practice guidelines.

Breakout sessions focused on establishing diabetes prevention programs in Iowa communities and the strategies current programs use to increase patient participation and retention. The summit concluded with LeAnn Thiemann, author of 14 Chicken Soup for the Soul books, speaking on the importance of self-care for healthcare providers.

If you missed this year’s summit, don’t worry, the organizers are planning to continue the annual diabetes summit in 2019.

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| The Journal of the Iowa Pharmacy Association

State of Iowa Discusses DrugImpaired Driving

The Governor’s Traffic Safety Bureau hosted a summit on drug-impaired driving on November 28, 2018 in Des Moines. This summit welcomed representatives from the National Highway Traffic Safety Administration (NHTSA) to provide framework of this discussion and others around the country, as well as from NHTSA to learn what Iowa is doing to address the issue.

With law enforcement, public health, department of transportation and numerous other stakeholders, they discussed the efforts of training law enforcement as drug recognition experts (DRE) in Iowa. A DRE is a law enforcement officer trained to identify people whose driving is impaired by drugs other than, or in addition to, alcohol. Representatives from the Colorado Traffic Safety Resource Prosecutors shared their stats on the effects of marijuana use (both recreational and medicinal) in Colorado drugimpaired driving crashes and fatalities.

IPA was able to provide insight to this group on the role of the pharmacist and current patient counseling requirements and labeling on medications. As this group continues to build consensus on additional steps to address drug-impaired driving in Iowa, IPA will continue to offer recommendations on how the profession of pharmacy can offer assistance.

Programming Shines at IHC Annual Conference Several IPA members were in attendance at the Iowa Healthcare Collaborative’s 15th Annual Conference on November 7, 2018 at the Downtown Des Moines Marriott. The conference this year featured a keynote presentation by Dennis Wagner, MPA, director of the Quality Improvement and Innovation Group in the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality. Mr. Wagner focused on current efforts to address systematic quality improvement to improve care in tens of thousands

of hospitals, nursing homes, clinical practices and communities across the nation. In addition to the keynote address, attendees were able to learn in various breakout sessions covering topics on leading organizational transformation, population health, integrated systems of care, and hospital-focused issues.

Iowa SIM Learning Community

On November 6th, IPA members and staff attended the Iowa Healthcare Collaborative’s State Innovation Model (SIM) Learning Community in Des Moines. Various speakers from across the county shared their ideas on how to improve community health and reach patients in rural areas of our state.

One such speaker, Dr. J. Lloyd Michener, from the Duke School of Medicine, spoke about re-designing healthcare to improve community health outcomes and provided examples of traveling to patients that need healthcare, instead of coming to his office. Other presenters shared their experiences as they try to transform rural medical care by combining healthcare access with business and industry to bring the best primary care and behavioral health services for their patients. The final presenter of the day was Dr. Don Klitgaard from the Iowa Healthcare Collaborative, and he reviewed Medicaid reimbursement and trends across the industry.

IPA Attends HealthMart McKesson Town Hall Meeting

IPA staff attended and participated in one of the HealthMart McKesson Town Hall Meetings September 27, 2018, in West Des Moines. The focus of the town hall meeting was developing partnerships with prescribers in your community to provide different patient care activities and new pharmacy revenue sources. Ideas discussed included truly understanding the needs and challenges of the prescribers in your communities and positioning your pharmacy to collaborate with those prescribers. Individuals also took time to work through and discuss a new idea for a patient care service with fellow participants.

IPA IN ACTION 14 in Ankeny. Over the course of the event, participants engaged in interactive discussion, brainstorming, and visioning.

A summary document is being created from this Forum to be used at the state and local level to guide understanding of and planning for the rural health landscape in Iowa.

Rural Health Summit: It Takes A Village – The Power of Rural

The Iowa Rural Health Association held its 2018 Annual Conference on National Rural Health Day, November 15, 2018, in Grinnell. Iowa pharmacists were able to discuss with other attendees how the profession serves as an access point in the healthcare system and is well suited to address social determinants of health in collaboration with other providers in their communities. During the event, IRHA President, Jon Rosmann from SafeNetRx, announced the 2018 IRHA Jerry Karbeling Award to Gloria Vermie from the Iowa Healthcare Collaborative.

Gloria has been a great advocate for rural health issues and a great friend of Iowa pharmacy.

NAMI of Iowa: Annual Conference Highlights Integrated Care Models

The Iowa chapter for the National Alliance on Mental Illness (NAMI) held its Annual Conference on November 16, 2018. IPA represented the profession at this year’s meeting to spotlight the valuable behavioral health services that pharmacists provide across practice settings in Iowa. Attendees heard presentations on the value of evidencebased practices in mental health, plans to build a children’s mental health system, the impact of the opioid epidemic, and innovative practice of peer support.

Concluding the event was a familiar face – mental health advocate, Joan Becker, who presented at the IPA Annual Meeting several years ago.

2018 NCPA Annual Convention

Hundreds of pharmacists, pharmacy technicians, and student pharmacists, along with a dozen IPA members, came together on October 6-9 in Boston to energize, elevate and evolve their pharmacy business as part of the NCPA Annual Convention. Sharing the latest developments on critical industry-related issues like DIR fees, CPESN, and specialty medications, the 2018 Annual Convention offered numerous learning and networking opportunities for Iowa pharmacists.

Matthew Glasow receives the 2018 Next Generation Pharmacists’ 2018 Future Pharmacist of the Year.

In addition to the normal conference programming, Pharmacy Times and Parata Systems named the winners of the 2018 Next-Generation Pharmacist Awards. Now in its ninth year, the Next-Generation Pharmacist Awards is a national program that salutes pharmacy professionals who are defining the industry’s future. Matthew Glasow, Drake student pharmacist and past IPA executive intern, was named the 2018 Future Pharmacist of the Year!

Strong Showing by Iowa at ASHP Midyear Clinical Meeting

Over 200 pharmacists, residents, students, and IPA staff attended the 2018 ASHP Midyear Clinical Meeting in Anaheim, California held December 1 – 6, 2018.

Former NBA basketball player and businessman, Earvin “Magic” Johnson, was the keynote speaker and discussed his personal journey and overcoming obstacles including his diagnosis of HIV. IPA staff participated in several sessions which will help to make progress on the 2018-2020 Strategic Plan including different areas of practice transformation, burnout and resiliency resources, and provider status. IPA, the University of Iowa, and Drake University hosted a wonderful reception that brought together alumni, students, residents, and current pharmacists to network and reconnect.

Profession Represented at Iowa Rural Health Forum

On behalf of the Iowa Department of Public Health and the Iowa Healthcare Collaborative, IPA attended the Iowa Rural Health Forum on December 13-

As IPA members know all too well, rural health is the crux of healthcare transformation in Iowa. The Rural Health Forum served as an opportunity to convene rural health champions and representatives from across the state to examine the current state of rural health, identify priorities affecting our rural healthcare systems, and capture opportunities for advocacy and collaboration. This event built upon existing conversations and efforts being held throughout the state to establish a unified voice to help inform rural health stakeholders at all levels.

IPA shared with the group about the important role of the pharmacist as an underutilized medication expert in Iowa rural communities across the spectrum of care. While the discussion focused on current gaps in behavioral healthcare, the value of technology or telehealth, and the concerns of the opioid epidemic, the stakeholders agreed with IPA’s comments on the need to better utilize pharmacists and pharmacy technicians to improve access to care in rural Iowa.

IPHA Legislative Forum; Focus on Behavioral Health

On December 6, IPA staff attended the Iowa Public Health Association’s Legislative Forum in Ankeny. The forum brought together interested stakeholders and legislators to discuss Iowa’s pressing public health issues prior to the 2019 legislative session. Major topics of discussion included improving behavioral health access, as well as creating a children’s mental health system in Iowa. The forum was capped off by a legislative panel that included Senator Mark Costello, Senator Joe Bolkcom, Representative Heather Matson, and Representative Timi Brown-Powers. ■

JAN.FEB.MAR 2019 |

51

IPA IN ACTION

CALENDAR OF EVENTS

Find additional details to these events and more at www.iarx.org. Click on the “Calender of Events” link under the Events tab.

FEBRUARY 2019

APRIL 2019

5

IPA Goes Local: Burnout & Resiliency - Mason City, IA

3-6

6-9

American College of Apothecaries Annual Conference and Expo - St. Pete Beach, FL

7-10 CPNP Annual Meeting - Salt Lake City, UT

HOPA Ahead Annual Conference - Forth Worth, TX

9

IPA 2/2/2 Webinar: Technician Product Verification: Where to Start

12 IPA 2/2/2 Webinar: Impact of New EPA Rules on Your Practice

9

IPA Goes Local: Burnout & Resiliency - Quad Cities, IA

15

16-18 2019 ASCP Forum & Fly-In - Washington, DC

8-10 Midwest Pharmacy Expo - Des Moines, IA

Mental Health First Aid Training - Sioux City, IA

27-3/2 NCPA Multiple Locations Pharmacy Conference -

Clearwater, FL

MARCH 2019

10-14 Annual PPAG Meeting - Oklahoma City, OK 23–24 Emergency Preparedness Conference - Washington, DC 23-24 Iowa Governor’s Conference on Public Health Des Moines, IA

5

IPA Goes Local: Burnout & Resiliency Council Bluffs, IA

24

12

IPA 2/2/2 Webinar: Statewide Protocols: Next Steps

13

Iowa Board of Pharmacy Meeting - Des Moines, IA

30

IPA Goes Local: Burnout & Resiliency - Waterloo, IA

27-29 NACDS Annual Meeting - Palm Beach, FL Mental Health First Aid Training - Fort Dodge

MAY 2019

21-22 ASCP Geriatric Pharmacist Boot Camp - Seattle, WA

1

22-25 APhA Annual Meeting - Seattle, WA 25-28 AMCP Managed Care & Specialty Pharmacy Annual

Meeting - San Diego, CA

Iowa Board of Pharmacy Meeting

8-11 2019 MAD-ID Annual Meeting (MAD-ID) - Orlando, FL 15

IPA Goes Local Burnout and Resiliency Programming - Fort Dodge

Burnout and Resiliency Programming: Awareness. Management.

Care.

IPA’s free monthly webinar series held on the second Tuesday of every month at 2:00 p.m. CST. February 12, 2019 Impact of New EPA Rules on Your Practice March 12, 2019 Statewide Protocols: Next Steps April 9, 2019 Technician Product Verification: Where to Start Register for an upcoming 2/2/2 or view previous webinars at www.iarx.org/222.

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| The Journal of the Iowa Pharmacy Association

This educational program, co-hosted by the Iowa Pharmacy Association and Iowa Medical Society (IMS) in conjunction with Meyvn Group, will explore what you can do to prevent burnout and how to recognize the warning signs; help you identify changes that can mitigate burnout; and explore simple, evidence-based solutions to enhance your joy in practicing medicine and reduce stress.

Schedule March 5 – Council Bluffs April 9 – Quad Cities April 24 - Waterloo May 15 – Fort Dodge June 11 – Cedar Rapids

August 13 – Atlantic September 11 – Ottumwa October 8 – Sioux City November 5 – Iowa City December 3 – Ames

For more information and to register for the nearest event, visit www.iarx.org/GoesLocal

PHARMACY TIME CAPSULE

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

JANUARY

The first annual IPA Political Leadership Breakfast was held on January 22 with Rep. Greg Ganske (R-Iowa) the featured speaker.

FEBRUARY:

Rep. Greg Ganske (R-Iowa) C. Boyd Granberg, IPA’s 82nd president (1967-1968), received the Weaver Medal of Honor in Des Moines. Granberg was highly devoted to his profession and served as a teacher, mentor, and friend to the Iowa pharmacy community.

C. Boyd Granberg

MAY:

With the completion of the legislative session, several significant achievements were made. Fifty-five million dollars were committed to the tobacco settlement with $15 million of those funds going to cessation assistance and patient education. This session also passed legislation which required contraceptive medications and devices to be covered under health insurance plans.

JUNE:

The Iowa Pharmacy Foundation celebrated 40 years and kicked off the campaign “Celebrating the Past… Building the Future” and initially received 100% commitment from the leadership of the foundation.

JULY

New Accreditation Council for Pharmacy Education (ACPE) standards went into effect.

From this point on all pharmacy students would graduate with a PharmD rather than a bachelor’s degree.

AUGUST

The FDA released a new web page to highlight information on drug shortages and worked to develop policies and procedures surrounding medically necessary shortages.

OCTOBER

Effective October 1, Iowa Medicaid implemented a payment system to cover pharmaceutical case management (PCM) services. This allowed pharmacists and physicians to work together to proactively identify, prevent, and resolve medication related adverse events in an attempt to achieve better patient outcomes.

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

JAN.FEB.MAR 2019 |

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ADVERTISER

Your Next Great Hire is Here Post your next open position to reach our top-level talent pool of active and passive job seekers to join your practice today!

www.iarx.org/CareerCenter

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.

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| The Journal of the Iowa Pharmacy Association

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