IPA Journal - Apr/May/June 2015

The Journal of the Iowa Pharmacy Association | A Peer-Reviewed Journal

Provider Status in in 2015?

Iowa Senator Charles Grassley leads the way, but needs the support of Iowa’s pharmacists. (p. 28)

APR.MAY.JUN 2015

PBM Bill Passed Unanimously; Signed Into Law 2015 IPA Annual Meeting: Partners in Practice Feature: New Opportunities CCM & TCM Services

APR.MAY.JUN 2015 | Vol. LXXI, No. 2

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 dschaaf@iarx.org Kate Gainer, PharmD kgainer@iarx.org Anthony Pudlo, PharmD, MBA, BCACP apudlo@iarx.org Laura Miller lmiller@iarx.org

OFFICERS

Chairman Michele Evink, MS, PharmD, CGP, FASCP, Osceola 641.342.5322, mevink@clarkehosp.org PRESIDENT John Swegle, PharmD, BCPS, Mason City 641.428.7182, john-swegle@uiowa.edu PRESIDENT-ELECT Bob Greenwood, RPh, Waterloo 319.234.1589, bob@greenwoodpharmacy.com TREASURER Steve Firman, RPh, Cedar Falls 319.277.7540, steve@pmgrx.com SPEAKER OF THE HOUSE Connie Connolly, RPh, BCACP, DeWitt 563.652.5611, conniejconnolly@hotmail.com VICE SPEAKER OF THE HOUSE CoraLynn Trewet, MS, PharmD, BCPS, CDE, Ankeny 515.360.0065, coralynn.trewet@sanofi.com

TRUSTEES REGION 1 Kristin Meyer, PharmD, CGP, CACP, FASCP, Marshalltown 641.753.4580, kristin.meyer@drake.edu REGION 2 John Daniel, PharmD, Fort Dodge 515.573.3431, jfdaniel@frontiernet.net REGION 3 Erik Maki, PharmD, BCPS, Johnston 515.326.0171, erik.maki@drake.edu REGION 4 Ashley Dohrn, PharmD, Le Claire 563.324.5004, ashley.dohrn@me.com AT LARGE Justin Rash, PharmD, CGP, Ankeny 515.331.2594, rash.justin@gmail.com Felix Gallagher, PharmD, Des Moines 515.334.4293, fgallagher@pharmservstaffing.com David Weetman, RPh, Iowa City 319.356.2577, david-weetman@uiowa.edu Laura Knockel, PharmD, North Liberty 319.354.7121, lauraknockel@gmail.com HONORARY PRESIDENT Bruce Alexander, PharmD, BCPP, Iowa City bruce.alexander@va.gov PHARMACY TECHNICIAN G. Jean Gallogly, CPhT, Vincent crittersandstuff@yahoo.com STUDENT PHARMACISTS Grant Houselog, University of Iowa grant-houselog@uiowa.edu Carson Klug, Drake University carson.klug@drake.edu

FEATURES

President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Board of Trustees Election Results . . . . . . . . . . . . . . . . . . . . 5 Annual Meeting Preview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 New Opportunities for Pharmacists in CCM & TCM Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Naloxone: Increasing Access to Reduce Overdose Related Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Midwest Pharmacy Expo Recap . . . . . . . . . . . . . . . . . . . . . . 14 CPE Made Easy with New CEI Website & Buckets . . . . . . . 20

IN EVERY ISSUE

Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

College of Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . .

Student Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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ONLINE FEATURES!

Where you see this banner, additional content is available for a story in our electronic Journal edition at www.iarx.org (Click on the Journal Cover).

ADVERTISERS

PharmServ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inside Cover Onnen Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 OutcomesMTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 McKesson/RxOwnership . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 IPRN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 PACE Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Career Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 PQC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Hansen, McClintock & Riley . . . . . . . . . . . . . . . . . . . . . . . . . 39 PTCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Buy-Sellapharmacy.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Pharmacists Mutual . . . . . . . . . . . . . . . . . . . . . . . . Back Cover

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) is published 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 Iowa Pharmacy Association.

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President’s Page

Challenges and Opportunities John Swegle

PharmD, BCPS, BCACP IPA President

O

ur profession plays an integral part in the care of many patients. Yet aside from patient care, there are numerous ways we give back to the profession. As my term draws to a close, I thought it would be good to review just a few things that make me realize how active pharmacy is in the state of Iowa.

Through our voice…

IPA continues to work on our legislative priorities. In February, pharmacists and student pharmacists from across the state came to Des Moines for IPA Legislative Day. Excellent programming and the opportunity for all to visit with their legislators at the Capitol made this a successful event. Nationally, bills recognizing pharmacists as Medicare providers have been introduced in the House and Senate. These legislative efforts are not possible without help from all of you. We thank you for your efforts and encourage ongoing dialogue with your elected officials. And please be sure you thank them for their support of our profession.

Through our support…

Pharmacy technicians fill a vital role in helping our profession provide patient care. Beginning in 2020, pharmacy technicians who wish to become certified must graduate from an accredited training program. The Pharmacy Technician Summit was held in Des Moines in February with the hope of developing one accredited pharmacy technician training program that can be offered at Community Colleges across the state. The success of this Summit and the partnerships that were formed will help the profession in

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providing education to future technicians (see page 16 for details).

Through volunteer efforts…

IPA is fortunate to have members who are willing to serve in various capacities.

Spring is an active time for numerous committees as we gear up for our Annual Meeting. Newly elected Board Members will soon be installed as we continue to advance our Strategic Plan.

All of us appreciate those individuals who volunteer their time and effort to support IPA and our profession.

Through our recognition…

We are fortunate to have so many individuals who give back to the profession. It is a great honor to recognize these individuals for the their work.

Congratulations to the recipients of IPA awards this year! In addition, it is wonderful to see the number of people from Iowa being recognized at the national level. We appreciate the work and dedication that all of you provide for this profession and our state!

I would like to thank all of you for your support this past year! It truly has been an honor for me to serve as the President of this wonderful Association! ■

board of trustees

IPA’s Newly Elected Leaders The election results have been ratified for the 2015-2016 officer and trustee election for the IPA Board of Trustees. Those elected will be installed on June 12, 2015 during IPA’s Annual Meeting in Coralville, Iowa. Thank you to all of the pharmacists who volunteer to serve the association and those who exercised their right to vote.

Congratulations to these six new officers and trustees:

Bob Greenwood, RPh President Waterloo

Rick Knudson, PharmD, BCPS, MS, MBA President Elect Clear Lake

Ryan Jacobsen, PharmD, BCPS Trustee Region 2 Iowa City

Jerod Work, PharmD Trustee Region 4 Sioux Center

Stevie Veech, PharmD, BCACP Trustee At Large Tiffin

Brett Barker, PharmD Trustee At Large Nevada

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Thursday, June 11

Friday, June 12

12:00-2:00 pm – IPA Board/Past Presidents’ Luncheon & Meeting

8:30-11:30 am – House of Delegates Session 1*

8:00 am-4:30 pm – Practice Advancement Forum

6:00-10:00 pm – Leadership Dinner (invite only)

Thursday, June 11, 2015 | 8:00 a.m - 4:30 p.m.

Coralville Marriott Hotel & Convention Center The Iowa Pharmacy Association, in collaboration with the Iowa Department of Public Health, organized the Practice Advancement Forum in an effort to support statewide implementation of innovative approaches to utilizing pharmacists as the medication expert in prevention and management of chronic diseases with a focus on diabetes and heart disease. The Forum will provide attendees with an update on national and state practice initiatives while providing practical applications to advancing their pharmacy practice.

7:00 am – Registration

House Session 1: Speaker of the House, Connie Connolly, will preside over the Delegate Orientation, Report of Officers, Policy Committee Hearings and New Business Review. This is your opportunity to learn about and shape Iowa pharmacy’s priority directions and policy decisions at Saturday’s session.

Policy Topics for Debate: • Pharmacy Practice in Managed Care • Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) • Statewide Protocols • Pharmacy’s Role in Meaningful Use • Medication Adherence • Use of Social Media

11:30 am-1:00 pm – Lunch Motivation Keynote: Dr. Richard Deming, Medical Director of Mercy Cancer Center in Des Moines and the Founder and Chairman of Above + Beyond Cancer

Dr. Deming

This forward-thinking program explores the methods to improve various pharmacy practice settings to address improving patient outcomes and care delivery. The forum features keynotes on the patient-centered care process, provider status, and health IT integration. With presentations and panels of practice leaders from around the country and the state of Iowa, attendees can have meaningful networking and information exchange for the betterment of patient outcomes.

We hope you’ll join us at this premier event designed for Iowa pharmacy professionals looking to further advance their practices. Find more information and the full forum agenda at www.iarx.org/PracticeAdv.

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Connie Connolly

Dr. Deming’s organization, Above + Beyond Cancer takes survivors on incredible adventures.

He will be speaking about his journeys leading participants to places like Mount Everest Base Camp and the top of Mount Kilimanjaro.

1:00-2:30 PM - Poster Presentation & Exhibit Program Following the Friday luncheon and keynote speaker, we will adjourn to the Exhibit Hall for the poster presentations, company sponsored exhibits and desserts. This session will spotlight exciting projects and research which advance the practice of pharmacy and increase the quality of care provided to patients in Iowa. * CPE available for these sessions when indicated. Complete CPE information is available at www.iarx.org/ipaannualmtg.

2:30-4:00 PM – Breaking Down the Silos* Roundtable discussions on practical applications to expand and justify services across practice settings. Discussions will be led by practice leaders with plenty of opportunity for Q&A. Policy Committees on Professional and Public Affairs will meet in executive session.

New Practice Model Task Force will hold a private meeting for practice sites of this initiative.

6:00 pm – Presidents Reception & Annual Banquet

Saturday, June 13

Bob Greenwood, RPh, will be installed as the 136th President of the Iowa Pharmacy Association and deliver his presidential address.

The Annual Banquet will also feature the presentation of IPA’s prestigious awards.

7:00 am – Fun Run/Walk

This run/walk has become an annual tradition. If you plan to participate, please indicate your shirt size when you register.

Bob Greenwood

9:30 pm – Silent Auction

The evening will conclude with delicious desserts and amazing auction items at the popular IPA Foundation Silent Auction. All proceeds from this event support the activities of the Foundation, which includes leadership programming, scholarships, and student participation in state and national professional meetings.

7:00 am – Registration & Continental breakfast 9:00 AM-12:00 pm – House of Delegates Session 2 Keynote: Dr. David Carlyle, MacFarland Clinic Dr. Carlyle will provide team-based viewpoints from a family practice perspective. From his over 30 years of practice, Dr. Carlyle will offer practical solutions for working together as a team of healthcare professionals.

House Session 2: Speaker of the House Connie Connolly will preside over the final policy debate as well as the nomination of the 2015 Honorary President, ratification of the Nominations Committee Report and installation of CoraLynn Trewet as Speaker of the House and the election of the 2015-2016 Vice Speaker of the House.

CoraLynn Trewet

12:00 Pm – Adjournment

QUESTIONS?

Contact IPA at 515-270-0713 Hotel Information Coralville Marriott Hotel & Convention Center 300 E 9th St., Coralville, IA 52241 866-204-0539 or 319-688-4000 www.coralvillemarriott.com (use group code phmphma for group rate)

REGISTER ONLINE AT: www.iarx.org/ipaannualmtg

www.iarx.org/ipaannualmtg. Daily registration includes the programs and activities for that day.

Target Audience Pharmacists, pharmacy technicians, student pharmacists and their guests.

When making your lodging reservation, please indicate that you will be attending the IPA Annual Meeting to receive the Rate of $97.00. To guarantee availability and rate, please make you reservation on or before May 20, 2015.

Cancellations The refund policy is full refund less a $50.00 administrative fee, before June 1. No refund after June 1. An additional $25.00 will be added to registrations after June 1 and to onsite registrations.

Registration Full registration includes attendance at all Friday and Saturday programs and activities. CPE information is available on IPA’s website at

Poster Presentation Submission If you would like to present a poster, please submit an abstract at www.iarx.org/ipaannualmtg.

Student Sponsorship Meeting attendees are encouraged to support IPA’s ability to provide student pharmacists discounted meeting rates by donating to the student attendance fund.

Silent Auction & Red Envelope Prize Donations Contact Laura Miller at lmiller@iarx.org regarding items you would like to donate. Donations will be accepted during the Annual Meeting weekend - however, only those items contributed or committed with notification by June 6, will be included in the Silent Auction promotional piece recognizing individual contributors.

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Feature

New Opportunities for Pharmacists in Chronic Care Management & Transitional Care Management Services

T Katy Brown PharmD Telligen Quality Improvement Organization

he Medicare Physician Fee Schedule final rule for calendar year 2015 that CMS released in October 2014 relaxed some of the rules around incident-to billing for chronic care management (CCM) and transitional care management (TCM), making it possible for medical practices to bill Medicare for services of a pharmacist or other non-physician personnel (NPP) under general supervision (as opposed to direct supervision as was the previous rule).

For CCM and TCM service, for which the incident-to billing rules have changed, the clinician providing the service is no longer required to be employed by/contracted with the physician, NPP, or the practice in order for the provider to bill for their services.

Also, the supervision requirement is looser.

Physicians and NPPs are no longer required to be onsite for services to be rendered.

The point is for CCM and TCM services to be available to patients 24/7.

Furthermore, in a letter to the CMS Administrator Marilyn Tavenner, the American Academy of Family Physicians requested clarification that: if all the requirements of the ‘incident-to’ statute and regulations are met, a physician may bill for services provided by a pharmacist as incident- to services. Tavenner agreed.

Chronic Care Management

There are 3 core requirements for a provider to bill for CCM. They are written consent, have 5 specific capabilities needed to perform CCM (outlined below), and provide 20+ minutes of non-face-to-face care management services per calendar month.

This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

11SOW-IA-C3-03/15-083

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The national average reimbursement will be about $40 per beneficiary per calendar month. The beneficiary will be responsible for any co-payments and deductibles.

Physicians, ARNP, PA, Clinical nurse specialists, and CNM’s are eligible to bill for CCM. There are services for which a provider cannot bill during the same calendar month including TCM. Please refer to CMS for the complete listing.

CMS maintains a Chronic Condition Warehouse including information on 22 specific chronic conditions, however this list is not exclusive and CMS may recognize other conditions for purposes of providing CCM. The Chronic Condition Warehouse can be found at www.ccwdata.org The Requirements for CCM include: 1. Beneficiaries written consent 2. Use of a certified Electronic Health Record (EHR) for specified purposes 3. Maintain an electronic care plan 4. Ensure beneficiary access to care 5. Facilitate transitions of care 6. Coordinate care 7. Provide 20+ minutes of non-face-to-face (nF2F) care management services The pharmacist’s role in CCM is via an agreement with the billing provider to provide the 20+ minutes of nF2F time. The following have been identified as counting toward this time: 1. Performing medication reconciliation and overseeing the beneficiary’s selfmanagement of medication 2. Ensuring receipt of all recommended preventive services 3. Monitoring the beneficiary’s condition The requirements surrounding the EHR are the burden of the billing provider, as long as the pharmacist has access to the care plan. This can be accomplished via an EHR or via secure encrypted email. Faxing it does not qualify. This was clarified on a Medicare Learning Network webinar. Since the pharmacist does not need direct access to the EHR, this alleviates some of the previous concerns of pharmacists needing access to the physician’s office EHR system.

The CPT Code for the 20+ minutes nF2F time is 99490 and the following apply: 1. 2 or more chronic conditions expected to

Feature last at least 12 months, or until death of the patient 2. The chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline 3. Comprehensive care plan established, implemented, revised, or monitored

Transitional Care Management

The National average payment rates are expected to be $172 for CPT 99495, and $243 for CPT 99496 (face to face visit within 14 days and 7 days respectively). The nF2F component is a part of the F2F TCM service and is not billed under a separate CPT code. MD’s, DO’s, PA, ARNPs, Clinical Nurse specialists and CNM are eligible to bill for TCM services.

Beneficiaries eligible to receive TCM services are those discharged from an acute care hospital, rehab hospital, long-term acute care hospital, skilled nursing facilities, and community mental health center partial hospitalization program. This does not include patients discharged to an SNF or community mental health center partial hospitalization program.

The billing provider is responsible in general to provide or oversee the management and coordination of services, as needed, for all medical conditions, psychosocial needs, and ADL support.

The required elements of TCM services include: 1. Communication with patient or caregiver within 2 business days of discharge 2. Face-to-face visit within seven days (99496) or 14 days (99495) 3. Medication reconciliation and management performed no later than the date of the face-to-face visit 4. Non-Face-to-face care management services 5. Medical decision making of moderate complexity (99494) or high complexity (99496) One component in which a pharmacist may participate includes assessing and supporting treatment regimen adherence and medication management.

The inclusion of an off-site pharmacist’s time for nF2F medication management in chronic care management and transitional care management services is a step in the right direction for recognizing the important role of a pharmacist in better outcomes for patient care. ■ Download more information on CCM here.

Download more information on TCM here.

For more information, join IPA’s 2/2/2 webinar on June 9, 2015.

Register or listen to the recording afterwords at www.iarx.org/222.

Resources can also be found at www.iarx.org/pharmacypractice.

Feature: NALOXONE

Naloxone: Increasing Access to Reduce OverdoseRelated Deaths Krystalyn Weaver PharmD Director, Policy and State Relations National Alliance of State Pharmacy Associations (NASPA)

With deaths from prescription drug abuse reaching an all time high, doubling from 1999 to 20131, health care professionals, policy makers, and advocates are looking for solutions to address the issue. While some states have taken action to restrict access to prescription narcotics – prescription drug monitoring programs, limits on days supply that can be dispensed, encouragement of the use of abuse deterrent formulations – others are looking to increase access to life-saving opioid reversal agents.

Naloxone works by antagonizing the mu receptor, has no addictive potential, and has virtually no pharmacological effects if the patient has not taken an opioid. Naloxone has traditionally been used in the hospital setting and available under the trade name Narcan®.

However, there are now ways to access naloxone products that can be administered outside of the hospital through the use of an auto-injector or with a kit that adapts the injected formulation into a product that can be administered intranasally.

Evzio®, Naloxone Auto-injector

New to the market in 2014, Evzio® is an auto-injector device that provides visual and auditory cues for administration by a family member or caregiver, with no medical training.

Designed to be pocket sized and withstand “temperature excursions” up to 104°F, it is meant to be kept on hand by those who may need it – or their caregivers.2 To assist patients with cost, the manufacturer, Kaléo, offers a patient savings card and patient assistance program for those who qualify.3

Naloxone, Intranasal Kits

Another method of using naloxone in the out patient setting is intranasal administration of the injectable product. Of note, there have been no FDA approved products marketed using this approach, though one may be approved in the future. According to Pharmacy

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Times, it has been reported that the FDA has granted Fast Track designation to a product in development by Adapt Pharma.4 Despite a lack of FDA approval, there has been significant attention given to intranasal naloxone use, due to the low cost of obtaining the kits used to adapt the injectable product.

Pharmacist Involvement

Pharmacists have the opportunity to play a key role in addressing America’s prescription drug overdose crisis. Pharmacists are in a key position to identify patients who are obtaining prescriptions from multiple prescribers or are at risk of overdose due to abuse, medication interactions, or comorbidities. Some states have implemented policies that allow pharmacists to dispense naloxone to not only patients at risk of overdose, but also to their caretakers. Others, starting with New Mexico and California are allowing pharmacists to directly prescribe naloxone to patients who are in need of access to the life saving drug. In lieu of prescriptive authority for the lifesaving drug, pharmacists in Rhode Island, Washington, and elsewhere have entered into collaborative practice agreements with prescribers in order to more easily provide their patients with access to naloxone.

All pharmacists should be sure they are upto-date on the products currently available on the market and fully understand the risks and benefits of naloxone use so that they can identify and counsel the patients who need it.

To learn more, many resources are available from the Centers for Disease Control and Prevention’s or from the Office of National Drug Control Policy’s websites5,6. ■ References 1. Centers for Disease Control and Prevention.

National Vital Statistics System mortality data.

Accessed March 2015. Available at: http://www.cdc. gov/nchs/deaths.htm 2. Kaleo. Size and Storate of EVZIO. Accessed March 2015. Available at: http://evzio.com/hcp/aboutevzio/size-and-storage-of-evzio.php 3. Kaleo. EVZIO Savings Program. Accessed March 2015. Available at: http://evzio.com/hcp/patientsavings/evzio-savings-program.php 4. Pharmacy Times. FDA Fast-Tracks Naloxone Nasal Spray. Accessed March 2015. Available at: http:// www.pharmacytimes.com/product-news/FDA-FastTracks-Naloxone-Nasal-Spray 5. Centers for Disease Control and Prevention, Home & Recreational Safety. Prescription Drug Overdose in the United States: Fact Sheet. Accessed March 2015. Available at: http://www.cdc.gov/ homeandrecreationalsafety/overdose/facts.html 6. Office of National Drug Control Policy. Prescription Drug Abuse. Accessed March 2015. Available at: https://www.whitehouse.gov/ondcp/prescriptiondrug-abuse

member section

health care hot topics

The profession of pharmacy and health care continues to change and evolve each day. Here is a short summary of events that have had an effect on our profession.

Measles Outbreak

From January 1 to March 13, 2015, 176 people from 17 states and the District of Columbia were reported to have measles. The majority of these cases (74%) are part of a large, ongoing multi-state outbreak linked to the Disneyland Amusement Park & Resorts in California. This outbreak has sparked some controversial discussion at both the state and national levels regarding the requirements for measles vaccinations in children.

Precautions Over OTC Products in New York In February 2015, U.S. Senators Dick Durbin (D-IL) and Richard Blumenthal (D-CT) requested the FDA conduct a nationwide investigation of dietary supplements. This request came as several mass merchants and chain pharmacies were accused of selling mislabeled and tainted products in New York stores. New York Attorney General sent letters to locations to request that they immediately stop selling store-brand supplements at New York locations. These actions have nothing to do with clinical effectiveness of the products, an issue that is not required under the 1994 Dietary Supplement Health and Education Act (DSHEA).

President Obama Urges for Personalized Medicine

In his State of the Union address, President Obama announced his plan to create a national genomic database made up of genetic profiles, medical histories and other data from one million volunteers. The President made it clear that it is necessary and

expedient to use modern technology to provide personalized treatment for all Americans, not just those suffering from complex diseases. This database could help pharmacists manage and implement patients’ medications with regards to their genomic makeup.

FDA Commissioner Resigns

FDA Commissioner Margaret A. Hamburg stepped down from her position at the end of March 2015. Hamburg has led the FDA since 2009, presiding over a number of thorny issues, such as the approval of morning-after contraceptives at young ages and tainted compounded drugs. However, her tenure has also seen several classes of drugs win faster approval, by such means as breakthrough drug designation, accelerated approval, and wide use of easier endpoints.

FDA Compounding Advisory Committee Convenes

The FDA named 14 experts in pharmaceutical compounding, medicine, and regulation, including seven pharmacists, as members of the new Pharmacy Compounding Advisory Committee. The first meeting held on February 23-24 heard comments from national pharmacy organizations, including NCPA. The committee considered proposed revisions to the list of drug products that may not be compounded and proposed criteria for developing the list of bulk drug substances that may be used to compound drug products.

The committee concurred with FDA’s

suggestion that 26 drugs be listed as unsafe or not effective for compounding.

Testosterone Label Requirements Change

On March 3, the FDA issued a ruling that will require makers of testosterone drugs to include a new warning on their labels and would prohibit them from marketing their products for agerelated low testosterone. The number of men being prescribed testosterone jumped more than 75 percent, to 2.3 million, between 2009 and 2013. The warning labels will need to specify that the products are only meant for use by men with certain conditions and add information about the increased risk for heart attack and stroke.

Catamaran to be Acquired by UnitedHealth

UnitedHealth Group Inc. agreed to buy Catamaran Corp., in a deal that is expected to close by the fourth quarter 2015 for about $12.8 billion.

Catamaran would become part of OptumRx and the combined pharmacy management entity would become one of the largest in the county, behind Express Scripts Holding and CVS Health Corp. Catamaran CEO Mark Thierer will become CEO of OptumRx once the transaction closes.

OptumRx’s current CEO, Timothy Wicks, will serve as president. ■

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FRIDAY

“We need to shift to doing things FOR people instead of to them.”

Interprofessional Palliative Care Conference

The Interprofessional Palliative Care Conference featured speakers from across the state who brought perspectives from several health care fields on palliative care. Over 100 pharmacists, physicians and health care practitioners took advantage of this interprofessional education opportunity.

Over 350 pharmacists, pharmacy technicians and student pharmacists attended the 2015 Midwest Pharmacy Expo at a new location - the Community Choice Credit Union Convention Center in downtown Des Moines.

Speakers discussed the multidisciplinary nature of the care that encompasses the physical, emotional and spiritual needs of palliative care patients. In closing the conference, keynote speaker Dr. Timothy Ihrig stated the need to “shift to doing things FOR people instead of to them.”

Here is a recap of what was seen and heard at this year’s Expo…

Expo Pharmacy Celebration

The Expo Pharmacy Celebration dinner and social was held at the historic World Food Prize Hall of Laureates. Pharmacists from around the Midwest had the opportunity to network with each other while taking in the exhibits and artwork at the World Food Prize.

Save the Date!

2016 Midwest Pharmacy Expo February 12-14, 2016 Iowa Events Center, Des Moines

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SATURDAY “Pharmacists need to be recognized for what you do and what you can do.”

Political Leadership Breakfast

Senator Charles Grassley (R-IA) spoke to pharmacists and student pharmacists at the Political Leadership Breakfast. (See pg. 29 for a recap)

Keynote: A Never Event

Evelyn McKnight, author of A Never Event: Exposing the Largest Outbreak of Hepatitis C in American Healthcare History and her husband Dr. Thomas McKnight shared their experience from the largest institutional outbreak of Hepatitis C in U.S. history.

The McKnights shared their story of how Evelyn was infected with Hepatitis C along with 99 other patients while receiving treatment for breast cancer at a Nebraska facility. They discussed how their ordeal turned them into advocates for safe injections and outbreak prevention. The McKnights shared the startling need for reform through other cases of infection from the reuse of disposable medical equipment.

Education

Pharmacists and pharmacy technicians had the opportunity earn up to 6 hours of continuing education on Saturday with the general session and 5 breakout sessions. Sessions featured speakers from across the country discussing topics like medical marijuana, hepatitis C, 340b and more. Student pharmacist programming addressed topics like professional dress, NAPLEX and MPJE preparation and leadership as a student and a professional.

SUNDAY “I’ve never seen so much unity on an issue.”

Keynote: Importance of Provider Status

Sunday started with an important keynote session with Paul Abramowitz, CEO of ASHP, and Tom Menighan, CEO of APhA, in a joint discussion on provider status. The national association leaders shared the history of provider status and discussed the current legislation in Congress.

While provider status is the goal, they emphasized that the legislation would not be the end of the effort. Pharmacists will need to work within their states to ensure that pharmacy services are fully recognized. Despite work still to be done, both were optimistic about the future of the initiative. As Dr. Abramowitz said, “I’ve never seen so much unity on an issue.”

Sunday Sessions

Expo wrapped up with a look back at the previous year in pharmacy. Dr. Daniel Hussar gave his view of new therapeutic agents that were introduced in 2014. He was followed by Geoffrey Wall who presented Game Changers in Pharmacy which highlighted the top ten events in 2014 that affected the pharmacy profession.

ONLINE FEATURE!

See more photos from Expo on the IPA Facebook page.

APR.MAY.JUN 2015 |

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iowa pharmacy news TakeAway Program Tops 100,000 Pounds Collected!

As of April 2015, the TakeAway medication disposal program in Iowa surpassed 100,000 pounds of properly disposed prescription and over-the-counter drugs! Since 2009, the TakeAway program has given Iowans the opportunity to dispose of their medications at participating community pharmacies.

With the support of the Iowa Board of Pharmacy, TakeAway was implemented by the Iowa Pharmacy Association as the preferred method for Iowans to dispose of their expired and unused medications. November 2014 marked the fifth full year of existence of Iowa’s TakeAway medication disposal program and the year of 2014 alone brought in over 22,000 pounds of properly disposed medications!

As additional research is being analyzed

by The University of Iowa regarding the current TakeAway program, preparations are being made to provide TakeAway pharmacies the opportunity to accept controlled substances. These upcoming changes to the program will allow pharmacies to serve as a valuable resource to their communities to safely and effectively dispose of their unwanted or expired medications.

IPA President-Elect Bob Greenwood and IPA VP of Professional Affairs Anthony Pudlo speak at the Alliance of Coalitions for Change (AC4C) on the medication disposal.

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IPRN Spring Meeting Provides Hope for Recovery

The Iowa Pharmacy Recovery Network (IPRN) serves as a confidential monitoring and advocacy peer-review program to assist impaired pharmacists, student pharmacists, and pharmacy technicians looking to return to the profession of pharmacy. IPRN works with clients on an individual level and assists them in receiving an evaluation, treatment, and aftercare support.

The IPRN Committee hosted its semiannual meeting on April 20, 2015 in Iowa City to coordinate activities between members of the committee. IPRN discussed recent concerns by clients regarding public access to discipline against a client. The Committee plans to submit a New Business Item to the IPA House of Delegates to gather support of IPA in this effort. In addition, IPRN will continue to support students and one pharmacist to attend the newly established APhA Institute on Alcoholism and Drug Dependencies on June 5-8, 2015 in Salt Lake City, Utah (previously operated by the University of Utah).

The accomplishments of IPRN and all of its stakeholders are only possible through the efforts of many dedicated professionals. Recognizing addiction as a disease is no small task, but every bit of effort put into IPRN translates to positive outcomes for a person’s life. IPRN encourages pharmacy professionals to attend its monthly client meetings at the Des Moines Fellowship Church. Anyone interested in addiction and recovery can attend these events, which occur on the first Sunday of each month at 6:00 p.m. Become an IPRN advocate today by contacting IPA at ipa@iarx.org!

Review the November 11, 2014, 2/2/2 webinar for how IPRN can help you or a colleague in need of assistance! www.iarx.org/222

Pharmacy Leaders Explore the Future of Pharmacy Technician Education in Iowa Leaders in pharmacy education and practice gathered in Des Moines on February 5 to explore ideas and partnerships that could broaden the educational programs available for Iowa’s pharmacy technician workforce. The state’s first-ever Iowa Pharmacy Technician Education Summit, at the John and Mary Pappajohn Education Center, drew representatives from the state’s colleges of pharmacy, community colleges, as well as from state and national pharmacy associations and the Iowa Board of Pharmacy.

By 2020, technicians who take the certifying exam from the Pharmacy Technician Certification Board (PTCB), must have completed a pharmacy technician education program that is accredited by the American Society of Health-System Pharmacists (ASHP)/ Accreditation Council for Pharmacy Education (ACPE). There are currently no ASHP/ACPE accredited pharmacy technician training programs in Iowa.

The University of Iowa College of Pharmacy facilitated the conference, engaging Iowa’s community colleges to discuss ideas for achieving accreditation before 2020. Dean Donald Letendre launched the conference with his vision for pharmacy technician training in the state. He proposed that a costeffective, unified pharmacy technician curriculum be developed for use in community colleges across the state.

Conference sessions included a national perspective about technician education and accreditation of programs, information about statewide demographics and technician education programs, and facilitated discussions about what the future may hold.

iowa pharmacy news

2/2/2 is IPA’s monthly webinar series designed to keep you engaged and informed on hot issues impacting the pharmacy profession. These webinars are free of charge to all pharmacy professionals in Iowa.

When is it? 2nd Tuesday of every month at 2:00 p.m. CST. Upcoming topics you won’t want to miss: June 9: Updates on Incident-To Billing with CCM & TCM Codes July 14: Compounding Standards According to USP (tentative) August 11: Iowa Medicaid Modernization Take advantage of these virtual engagement opportunities by registering at www.iarx.org/222.

A Case for Change: A Multidisciplinary Approach to Medication Safety and Effectiveness The 2015 IPA Goes Local events will focus on empowering Iowa healthcare professionals to collaborate on a medication safety and effectiveness plan for Iowans. With case examples on ways to collaborate across practice settings, this year’s IPA Goes Local will bring together pharmacists and physicians to discuss medication safety and effectiveness.

Join Dr. Tom Evans, President and CEO of the Iowa Healthcare Collaborative and Anthony Pudlo, IPA’s Vice-President of Professional Affairs, to discuss the strategies to improve safe and effective medication use in Iowa.

Remaining Schedule

August 20, 2015 - Southwest Iowa Pharmacists Association (Council Bluffs) September 17, 2015 - Johnson County Pharmacy Association (Iowa City) October 2015 - Northwest Iowa Pharmacy Association (Spencer)

This a multidisciplinary program so invite your pharmacist, technician, physician and other prescriber colleagues!

Watch your email for updates from IPA and your local association or check www.iarx.or/goeslocal for registration for upcoming events.

Recordings of previous 2/2/2 programs are available at no charge at www.iarx.org/222.

2/2/2 webinars are not accredited for CE.

IPA on Social Media

IPA uses social media to keep you updated on association activity and events and the latest news in the pharmacy profession. Thank you to all who follow IPA on Facebook and Twitter.

Follow us at: Facebook: facebook.com/iowapharmacy

IPA Goes Local Kicks off in Des Moines with Central Iowa Pharmacy Association

50 pharmacists attended the first IPA Goes Local of 2015 in Des Moines at Drake University’s Olmsted Center.

Twitter: @IowaPharmacyIPA APR.MAY.JUN 2015 |

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iowa pharmacy news

Advancing As One: APhA 2015 Annual Meeting Over 100 Iowa pharmacists, residents, and student pharmacists were in San Diego for this year’s Annual Meeting of the American Pharmacists Association.

Highlights from this significant year for the state of Iowa are recapped below.

House of Delegates

The House of Delegates debated timely issues including medical cannabis, interoperability of health IT, prescription drug monitoring programs and adherence, and pharmacy’s role in executions.

Iowa Reception

The Annual Iowa Reception, hosted by IPA, Drake University, and the University of Iowa Colleges of Pharmacy attracted over 400 pharmacists and student pharmacsits. All were welcomed with special remarks from Deans Wendy Duncan and Don Letendre, IPA President John Swegle, and APhA President Matt Osterhaus.

Iowa Pharmacist Matt Osterhaus Concludes Term as President Iowa’s delegation in the APhA House of Delegates included:

Matt Osterhaus, RPh, FASCP, FAPhA, completed his term as the 159th President of APhA. Matt’s installation marks the fourth time in APhA history that two generations of pharmacists from the same family have served as the Association’s top elected leader.

Matt’s father, Bob Osterhaus, served as APhA president 1992-1993.

John Swegle, IPA President Steve Firman, IPA Treasurer Connie Connolly, IPA Speaker of the House Susan Vos, APhA New Business Review Committee Other IPA members served as delegates: Cheryl Clarke (APhA-APPM) Bob Greenwood (NCPA) Carrie Koenigsfeld (APhA-APPM) Hilary McCants (APhA-ASP) Bob Osterhaus (Past APhA President) Matt Osterhaus (APhA President)

Awards and Recognition

Susan Vos, PharmD, BCPS, installed as APhA Fellow Cheryl Clarke, BSPharm, installed as APhA Fellow Matt Osterhaus, RPh, FASCP, FAPhA, finished term as APhA President Steve Firman, RPh, MBA, serving as APhA PAC Chair Thomas Temple, RPh, MS, serving on the APhA Foundation Board Brian Wall, PharmD, serving as APhA Executive Resident Shiny Parsai, Student Pharmacist (Iowa), received 2015 APhAF Juan & Esperanza Luna Scholarship Yvette Mitchell, Student Pharmacist (Drake), placed in the Top 10 of the National Patient Counseling Competition Drake ASP Chapter, 2014 PharmFlix Competition Most Humorous Video University of Iowa ASP Chapter, Second Place in Back-the-PAC Campaign

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IOWA PHARMACY RECOVERY NETWORK

Assisting Impaired Pharmacists, Student Pharmacists, and Pharmacy Technicians

Where do you turn when you, a co-worker or someone you care about needs help with an addiction, physical illness or psychiatric disorder?

Providing support . . . through caring volunteers

HOPE FOR RECOVERY 1-877-890-IPRN

http://www.iowarecovery.org/

CPE made Easy with NEW CEI Website & Buckets The Collaborative Education Institute has launched a new website designed to be more intuitive, easier to use, and allow learners to manage their education more effectively. In addition to a bolder, more modern look, the website navigation is simplified, reflecting the introduction of CEI’s streamlined access to their programming.

Buckets of CPE

CEI’s “Buckets” are prepackaged bundles of CPE activities that give learners easier access all year long to the programs that they need.

Purchasing a whole bucket will grant access to programs required for Pharmacist Relicensure and Pharmacy Technician Recertification or to hone your skills in Preceptor Teaching, Student Professional Development, and Leadership.

For example, by purchasing the Relicensure bucket, a pharmacist receives access to CPE activities in the areas of pharmacy law, patient safety, immunizations, current drug therapy topics and other categories that are required in most states. Completion of the activities in this bucket fill the CPE requirements for relicensure.

In addition to the buckets, learners can also browse the Featured Events tab to view upcoming live events and on demand activities offered by CEI. Learners still have the option to choose their activities individually under the All Activities tab.

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Easy to Manage

Profiles have been redesigned to make it easier to manage your continuing education. From the “My Profile” screen, learners can change their demographic information, enter a live activity access code, and sort their activities so they are easy to find.

The “My Activities” tab lists all active programs so learners can easily see what needs to be completed before they can claim their credit. Once credit has been claimed, the program will move to “Completed Activities” to confirm its completion and eliminate confusion about the credit’s status.

The new “Not Now” button allows learners to change their minds and

decide not to do a program. If they want to do it later, they simply move it back to the “My Activities” section.

Gone Social

In addition to the new website, CEI has also launched a social media presence. Follow them on Facebook and Twitter to receive updates on upcoming programs and events. facebook.com/GoToCEI twitter.com/CEI_Education

Questions?

If you have any questions about the website or submitting CPE, contact Cindy Smith at 515-270-8118 or csmith@gotocei.org.

CEI Buckets

A quick overview of CEI’s new CPE buckets.

Relicensure Pharmacist CPE activities in categories that are required in most states. Annually, new activities in the area of pharmacy law, patient safety, immunizations, current drug therapy topics and live webinars are included.

CPhT Recertification Technician Recertification CPE activities in categories consistent with the PTCB Domains, structured as 10, one-hour written modules that you can print and complete on the go. Also included are live and on demand webinars in the area of pharmacy law and patient safety.

Preceptor Teaching Practical tools to help engage students and residents including CEI’s monthly online journal club discussion, Log-in To Learn; and an entire suite of programs to help preceptors make the most of their teaching site.

Students Activities designed with the student in mind, helping them to develop the professional skills to transition from classroom to practice.

FREE Relicensure or Recertification Bucket for IPA Members!

IPA is excited to announce this new benefit for our members through the Collaborative Education Institute (CEI). With the Relicensure or Recertification buckets, IPA pharmacist and pharmacy technician members receive all of the CPE they need for relicensure or recertification for FREE. To make managing your CPE even easier, you can now access your CEI profile directly from your IPA member page on IPA’s website. Simply login to your IPA membership profile and click on the My Education tab and you will be taken directly to your CEI profile – logged in and ready to go!

Accessing your Free Bucket

Your access code is available at www.iarx.org/cei_buckets (member login required).

From IPA Member Profile 1. Log in to IPA member Profile 2. Click on “My Education Tab” (you will be taken directly to your CEI profile)* 3. Click on the CEI logo to be taken to the CEI homepage 4. Click on the white “Partner” bucket.

5. Locate and click on the IPA logo 6. Enter your access code in the field provided and click APPLY 7. Click CONFIRM at the bottom of the page.

From CEI Website 1. Log on to www.GoToCEI.org. Click on the white “Partner” bucket.

2. Locate and click on the IPA logo 3. Enter your access code in the field provided and click APPLY 4. You will be prompted to login or if you are new to CEI, begin by clicking “LOGIN” and create an account.

Leadership COMING SOON! Quick, on the run podcasts on leadership topics that will keep the brain’s creative ideas flowing, help learners better manage anything from personal to professional, and maintain worklife balance.

5. Click CONFIRM at the bottom of the page.

You will only have to enter your access code the first time.

Your Profile will be populated with your bucket. From now on, after logging in, you can click on the activity name under MY ACTIVITIES to begin or resume. *Your username must be the same for both CEI and IPA. You can change your login information for IPA from your profile.

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PRACTICE ADVANCEMENT Pharmacy Practice Model Initiative (PPMI) Advances Hospital Practice in Iowa

In support of ASHP’s Pharmacy Practice Model Initiative (PPMI), IPA reached out to hospitals across the state regarding the value of the PPMI and its Hospital Self-Assessment (HSA) survey tool. The mission of this initiative is to generate passion, commitment, and action among hospitals to advance pharmacy practice across the country. The HSA survey consists of 106 questions relating to the services offered at hospitals, and is easily completed by any pharmacists, residents, or student pharmacists. Upon survey completion, tools are readily available for participants to compare themselves to peer hospitals or all hospitals in the database and develop an action plan to identify priorities for advancement opportunities.

Hospitals across the state receive astonishing results from the HSA, and have taken full advantage of the assessment report. Please see what IPA member Dr. Brian Benson of UnityPoint Health – Des Moines has discovered.

“Completing the assessment allowed me to assess our current place in professional practice in a thorough fashion.

Dr. Brain Benson The assessment assisted our strategic planning initiatives in that it provided supporting material for service expansion such as antimicrobial stewardship and additional clinical roles that we may want to perform that aligns with our organizations strategic plan. We also developed ideas and actions around advancing technician roles – tech check tech programs, involvement in medication reconciliation and other advanced roles as a result of completing the survey.

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Many times during the assessment we found ourselves asking why don’t we do this and to take a critical look at the level of clinical services we “think” we provide versus actually provide. Along with the clinical assessment the survey also assisted us in determining our level of technology use; can we use our EMR better, safer and more proactively.

Technology not only for patient safety and outcomes but for operational efficiencies as well; inventory management and dispensing.”

To complete the HSA survey tool, go to www.ppmiassessment.org. Fellow colleagues have reported the HSA takes 30-45 minutes to complete.

IPA has the ultimate goal of 80% completion rate for Iowa hospitals by June 2015. We are currently at 45% as of April 30, 2015 with several hospitals currently in progress with their survey.

To get spotlighted in the next Journal of the IPA, share your success of implementing the results of your survey by contacting IPA at ipa@iarx.org.

Trinity Pioneer ACO MTM Program Approaches End of Study Period

In June 2015, the study period will end for the MTM program associated with the Trinity Pioneer ACO based in Fort Dodge, Iowa. The objectives of this MTM program were to: 1. Assess the effects of an integrated MTM program on all-cause hospitalization rates 2. Assess the 30-day hospital readmission rates 3. Assess the effect of an integrated MTM program on per capita Part A, Part B, and Part D Medicare costs 4. Characterize the types and frequencies of drug-related problems identified and resolved by the pharmacist-delivered MTM services While Trinity ACO hospital pharmacists identified patients on high-risk medications and assessed the need for post-discharge follow-up, community pharmacists across a rural

eight-county coverage area completed MTM activities including medication reconciliation for all referred patients. As preliminary results are being collected and shared with the leadership of the Trinity Pioneer ACO, IPA has continued to provide support to pharmacists and pharmacy technicians across the ACO service area. While preliminary results show promise for the positive impact of the profession on a Medicare ACO patient population, the final results will ultimately provide the determination for continuation of this innovative pharmacy practice model.

IPA will communicate the final results to our members once they are compiled.

Community Clinical Practice Surveys Compiled; Forum Scheduled Annual Meeting

In collaboration with the Iowa Department of Public Health (IDPH) and the Centers for Disease Control and Prevention (CDC), IPA is working to align practice advancement efforts to support statewide implementation of cross-cutting approaches to promote health and prevent and control chronic diseases and their risk factors with a focus on diabetes and cardiovascular disease. IPA will conduct 1) a survey of community-based pharmacies to determine their services that achieve the work of the IDPH and CDC, 2) IPA Goes Local presentations on healthcare transformation initiatives, and 3) a Practice Advancement Forum in conjunction with the 2015 Annual Meeting.

Current responses from the statewide survey are being analyzed by researchers at Drake University and IDPH. Thanks to a successful response rate of about 33%, the results of this survey will be used to direct IPA resources for practice advancement focused on collaborative practice agreements and integration of pharmacy services within the state health information exchange. In addition, IPA will be meeting with CDC representatives in mid-May to share

PRACTICE ADVANCEMENT results of this survey and provide updates on IPA Goes Local events and the planning for the Practice Advancement Forum scheduled for Thursday, June 11, in Coralville.

Wellmark PQAC Continues to Evaluate Advanced Payment Models for Pharmacies

As part of an effort to assess and create a mechanism to appropriately compensate pharmacies for the services they provide to beneficiaries, the Wellmark Pharmacy Quality Advisory Council (PQAC) met on April 14, 2015. As a Wellmark-led initiative, several IPA members have been invited to contribute to the conversation for payment model reform for Iowa pharmacies. With current advancing models of pharmacy practice in Iowa, the state’s largest commercial insurance payer has sought the input from advanced practice locations across the state to provide input for this critical transition. The current discussions have focused on the necessary initial qualifications and outcomes measures as Wellmark plans for an effective rollout. With limited information to share at this time, IPA

will continue to keep the membership apprised of this evolving initiative.

New Practice Model Continues to Transform Practice Sites

IPA’s New Practice Model Initiative (NPM) continues to build momentum.

With the support of the National Association of Chain Drug Stores (NACDS) and the Community Pharmacy Foundation, 17 pharmacies across the state have implemented TechCheck-Tech for refill prescriptions as a means to provide advanced pharmacy services. Seven phase 1 locations implemented Tech-CheckTech in June 2014 and 10 phase 2 locations implemented Tech-CheckTech in February 2015. IPA continues to actively support these sites through calls, live meetings and site visits.

Information on technician error rates, number of patient care services completed, and measures on how pharmacists spend their time at each site will be collected throughout 2015.

Phase 2 locations are adjusting to the new workflow of Tech-Check-Tech and are in the beginning stages of expanding pharmacy services. Phase

1 locations are working hard to implement a variety of clinical services.

ONLINE FEATURE!

View the full size poster that was presented at APhA’s Annual Meeting

Medication synchronization has been implemented or expanded at most sites. Since the beginning of the NPM initiative, 5 of the 7 Phase 1 sites initiated formal MedSync programs.

One site expanded current efforts with incorporation of technology to help identify more patients and ramp up enrollment in their current program.

Three NPM sites are in the process of setting up collaborative practice agreements through the help of a University of Iowa College of Pharmacy study by Dr. William Doucette to manage patients with diabetes and/ or hypertension. Pharmacies have also made efforts to increase adult immunizations, medication therapy management opportunities, and spending more time with each patient while counseling. ■

Explore Initiatives to Advance Pharmacy Practice and Improve Patient Outcomes Register at www.iarx.org/PracticeAdv

JUNE 11, 2015

Coralville Marriott Hotel & Convention Center, Coralville, Iowa Held in conjunction with the IPA Annual Meeting APR.MAY.JUN 2015 |

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ipa foundation

Leadership Conference Endowment Nearing Completion

IPA Welcomes the 2015 Max W. Eggleston Executive Intern, Elizabeth Bald!

Meet Elizabeth.

Hello! My name is Elizabeth Bald, and I will be serving as the 2015 Max W. Eggleston Executive Intern in Association Management for the Iowa Pharmacy Association. This is a position I have dreamed of having since beginning pharmacy school and I look forward to all of the exciting opportunities that it provides.

The Thomas R Temple Leadership Endowment continues to grow! To date more than $324,400 in pledges and contributions have been made to ensure that the conference continues on in perpetuity. We are getting that much closer to reaching the goal of $375,000 - Iowa’s portion of the $750,000 total endowment goal split with Pharmacy Society of Wisconsin.

I am originally from Freeport, a small city in northwestern Illinois, and am in my second year of the pharmacy program at Drake University. While at Drake, I have enjoyed being involved in numerous organizations. I currently serve as the chairperson-elect for the Drake Pharmacy Unified Group of Students (DRxUGS) and am a member of the Pharmacy and Health Sciences Day Planning Committee.

This year I was inducted into Rho Chi, the Academic Honor Society, and Phi Lambda Sigma, the Pharmacy Leadership Society.

The 135 Challenge

With IPA celebrating its 135th anniversary, we would like to issue a challenge to each member: Anyone who donates a minimum of $135.00 to the Leadership Endowment by June 1 will receive a $35.00 voucher for an IPA meeting (Annual Meeting, Midwest Pharmacy Expo, Legislative Day, etc.).

To accept the challenge, visit www.iarx.org/ipaleadershipacademy.

2015 IPA-F Eggleston/ Granberg Golf Classic

Join us as we bring together student pharmacists, alumni and friends for fun and recreation with a purpose.

All proceeds provide for support for student pharmacists at Drake University and The University of Iowa Colleges of Pharmacy.

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Otter Creek Golf Course 4100 Otter Creek Dr. Ankeny, Iowa 50021 Friday, September 11, 2015 1:00 p.m. Shotgun Start

I have gained so much from being a member of the Iowa Pharmacy Association the past four years and have enjoyed attending events including IPA College Nights, Legislative Day, and the Midwest Pharmacy Expo. This past year I attended the Bill Burke Leadership Conference and served as a member of the IPA Legislative Committee.

These experiences have given me a passion for the work that IPA does and I am excited to have the opportunity to work with the IPA Board of Trustees, staff, and members from across the state this summer to advocate for and advance our profession.

IPA FOUNDATION Support IPA-F and pharmacy colleagues as we ride across Iowa to provide care and promote the pharmacy profession along the way

Legacy Society

The IPA Foundation established the Legacy Society as a way to recognize pharmacists and their families who have created a Named Scholarship or who have made provisions for a deferred gift to the Foundation through their will or trust. This commitment sets an example for the generations to follow for the work and opportunities provided by the IPA Foundation.

These gifts are truly critical for funding the charitable programs of the IPA Foundation and provide for the future of the profession. Contact the IPA Foundation if you are interested in language to be used in your will, revocable trust or beneficiary designation or to establish a Named Scholarship.

If you have already included the IPA Foundation in your estate plan, please tell us so that we may thank you and recognize your support.

Visit www.iarx.org/ipafoundation to learn more about the programs of the IPA Foundation.

IPA-F Silent Auction

The 2015 IPA Annual Meeting is set for Friday and Saturday, June 12-13 in Coralville. Friday evening will conclude with the popular IPA Foundation Silent Auction to support the Foundation’s educational and student programs.

Plan to bid on your favorite items and participate in the wine/beer ring toss and red envelope fundraiser.

If you or your pharmacy would like to donate to the silent auction, please contact Laura at lmiller@iarx.org and provider a short description and approximate value (if available) of the item(s) you plan to donate. While items will be accepted up through the weekend of Annual Meeting, in order to have your item listed in the silent auction catalog, please notify Laura prior to June 6. ■

Join the Team

We have availability for daily riders to be a part of the team! For $100/day (max 3 days) you can hop on a bike and help spread the word about pharmacy across the state. Go to www.iarx.org/iparagbrai for more information and registration. You must register by June 1.

Not a Cyclist, Want to Help?

We are looking for volunteers to help get the team from the Missouri River to the Mississippi River. We have two, 15 passenger vans and are in need of drivers who can help with a day or two. Help is also needed with outreach efforts along the way by providing screenings and other pharmacy promotions.

Can’t Participate During the Week?

Sponsorship opportunities are available to support the entire team or a specific rider. Visit www.iarx.org/iparagbrai to make a sponsorship payment in honor of a rider or host.

2015 Hosts

Thank you to our fellow pharmacists that have agreed to host our team along the route. We appreciate your hospitality.

Sioux City: Sara & Terrell Wiedenfeld

Bill Drilling Storm Lake: Mike Porsch

Ed McKenna Fort Dodge: John Daniel Eldora:

Bill Stonebraker The Hilsabeck Family

Cedar Falls: Jim & Barb Hoehns

Lisa Bennett Hiawatha: Adriane & Mike Miller Coralville:

Lisa Mascardo Susan Vos Kate Pape (back up) Ben Urick (back up)

Week-Long Riders

Mark Adams, Drake Student Sharon Cashman, RPh Sarah Cashman Theresa Legg, DPT Ann Moore Bob Moore Marshall Moyer Kate Pape, PharmD Anthony Pudlo, PharmD, MBA Daniel Ricci, PharmD Bob Soltis, PhD Denise Soltis, RPh Abby Soltis Emmy Soltis Sarah Soltis Ben Urick, PharmD

Daily Riders

Melanie Firman, PharmD Ethan Sabers, Iowa Student Amanda Stefl, Iowa Student Sara Wiedenfeld, PharmD Terry Wiedenfeld, PharmD

2015 Jerseys Are Here!

Be part of the team with your official IPA-F RAGBRAI Jersey! Visit the IPA Store at www.iarx.org/ipastore to order.

APR.MAY.JUN 2015 |

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public affairs

Iowa Medicaid Program to move to Managed Care Organizations In response to Governor Branstad’s announcement to transition the Iowa Medicaid program to Managed Care Organizations (MCO) beginning in 2016, IPA has advocated for key principles to ensure continued patient access to pharmacy services during this transition. IPA has advocated for a carve-out of pharmacy medication reimbursement due to the recent history in transitioning to an AAC-based methodology for drug product costs with the use of a biennial cost-of-

dispensing survey of pharmacy to set the dispensing fee.

Pharmacy Network & Access to Care

Maintaining access to care and payment for prescription medications and pharmacist-provided services should be required in managed care programs. Iowa Medicaid currently has an open network, which provides local and easily accessible pharmacy services to beneficiaries. IPA believes patients should be allowed the freedom to select a pharmacy that best fits their personal health needs and provides the most accessible care.

An open network will maintain greater continuity of care for Iowa Medicaid beneficiaries, and access to patient’s local healthcare providers.

Fair and Honest Pricing

Proper transparency must be incorporated into contracts between the MCO and the PBM (pharmacy benefits manager) as well as between the PBM and participating pharmacies.

The current methodology has been

established using objective data from Iowa pharmacies to align the drug product cost (AAC) with actual costs and the pharmacists’ professional service and costs of doing business within the dispensing fee (DF). As MCOs and their contracted PBM often reduce pharmacy reimbursement, without notification, after pharmacies sign a network contract, IPA believes such changes should be subject to approval by the Department.

Other areas of concern expressed by IPA focus on: full integration of pharmacist clinical services into the MCO model, definition and utilization of specialty pharmacy services and the use of mail order pharmacies, the timeline of implementation, alignment amongst all contracted MCOs, and coordination between MCOs. Finally, IPA staff and leadership have met with several MCOs that are seeking application to the state’s request for proposal (RFP). The concerns listed above have been shared with these MCOs as IPA continues to advocate for the profession during this time of transition. ■

public affairs

Governor Branstad Signs PBM Bill into Law On April 2, Iowa Governor Terry Branstad signed H.F. 395, the PBM bill, into law. The bill passed unanimously with strong bipartisan support in both the Iowa House and Senate on its way to the Governor’s desk. Now, under Iowa law, the Iowa Insurance Division has the explicit authority to audit PBMs as outlined in the legislation passed last year. The law went into effect immediately.

What does this mean?

As you may recall, last year’s PBM bill - H.F. 2297 - was signed into law after also passing unanimously in both the House and Senate. That law was to give the Iowa Insurance Division (IID) complete authority to investigate PBMs operating in Iowa and requires that those PBMs disclose MAC (Maximum Allowable Cost) pricing lists and MAC pricing methodology to the IID. However, the PBMs stonewalled the IID’s efforts, claiming that the IID did not have the explicit authority under Iowa code to audit them.

ONLINE FEATURE!

Refresh your memory of last year’s PBM bill - H.F. 2297 with this FAQ.

This law fixes that. After working with the IID, this bill was written with the language needed for the Insurance Commissioner to enforce the law as it was intended.

Now What?

Keep sending your complaints to the IID. The Commissioner now has the

explicit authority to investigate them. If you have any questions, contact IPA at 515-270-0713 or ipa@iarx.org.

Thank You Members!

IPA appreciates the grassroots efforts of members in responding to IPA’s Advocacy Alerts and contacting their legislators throughout this process.

The relationships that IPA members have with their legislators and their willingness to participate in grassroots advocacy is an invaluable asset that the PBMs simply can’t match.

Grassroots Advocacy by the Numbers

Participation of IPA members in the political process is vital to the advancement of the profession. IPA provides several ways for members to participate in grassroots advocacy throughout the political season.

In addition to hosting events like Legislative Day, IPA sent Advocacy Alerts, personalized call to action emails, asking members to contact their state or national legislators on important legislation for pharmacy.

Here is a quick look at how members have participated: • 32 Iowa Senator contacts on PBM bill (S.S.B. 1107/S.F. 235/H.F. 395) • 47 Iowa Representative contacts for PBM bill (H.S.B. 68/H.F. 395) • 14 Additional contacts with Iowa Legislators • 49 Thanking Senator Grassley for provider status bill (S. 134) • 75 Political Leadership Breakfast with Sen. Grassley attendees • 156 Legislative Day participants Thank you to all who have responded to IPA’s Advocacy Alerts or attended a political event.

Please remember to contact David Schaaf (dschaaf@iarx.org) to let IPA know of any contact that you make with a legislator. Every contact is important in order to keep legislators supporting pharmacy issues. ■

2015 PBM Bill Timeline January 12: 2015 Iowa legislative session begins January 21: House version of the PBM bill (H.S.B. 68) introduced and assigned to Commerce Subcommittee January 27: House Commerce Subcommittee passes HSB 68 unanimously (3-0) January 28: Senate version of the PBM bill (S.S.B. 1107) introduced and assigned to Commerce Subcommittee January 29: IPA Legislative Day February 10: Senate Commerce Subcommittee passes S.S.B. 1107 unanimously (3-0) February 12: Senate Commerce Committee passes S.S.B. 1107 unanimously (15-0) (Bill changes designation to S.F. 235) February 23: House Commerce Committee passes H.S.B. 68 unanimously (23-0) (bill changes designation to H.F. 395) March 6: First legislative funnel. Both bills passed through their committees and survived first “funnel” March 12: House passes H.F. 395 unanimously (95-0); bill sent to the Senate March 23: Senate passes H.F. 395 unanimously (47-0); bill sent to the Governor April 2: Governor Branstad signs HF 395

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public affairs

National Provider Status Gains Momentum in Congress

Medically Underserved Populations (MUPs), or Health Professional Shortage Areas (HPSAs) as designated by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).

• Reimbursement – Consistent with Medicare reimbursement for other non-physician practitioners, pharmacist services would typically be reimbursed at 85% of the physician fee schedule.

ONLINE FEATURE! Provider status is critically important to allow pharmacists to practice at the top of their training and provide patient care services in their communities. With bills introduced in both chambers of Congress, momentum is building this year for pharmacists to be recognized as providers under Medicare Part B. On Wednesday, January 28th, Representatives Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Todd Young (R-IN), and Ron Kind (D-WI) introduced H.R. 592, the Pharmacy and Medically Underserved Areas Enhancement Act in the House of Representatives.

On the next day, Senators Chuck Grassley (R-IA), Sherrod Brown (D-OH), Robert Casey (D-PA), and Mark Kirk (RIL) introduced the senate companion bill S. 314.

Similar to 2014’s H.R. 4190, the provisions of these bills will provide access to pharmacist provided patient care services to patients in medically underserved communities.

The Patient Access to Pharmacists’ Care Coalition (PAPCC) summarized the scope of the bills as follows: • Who – State-licensed pharmacists who may have additional training or certificates depending on state laws.

• What – Pharmacist services according to state scope of practice.

• Where – Medically underserved communities (i.e., Medically Underserved Areas (MUAs),

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Use HRSA’s online tool to determine if you live in an MUA, MUP or HPSA.

As of April 3, 2015, H.R. 592 has 83 cosponsors including Iowa Congressmen Dave Loebsack and Rod Blum. The Senate version has 10 cosponsors including lead sponsor Senator Chuck Grassley from Iowa.

Leadership from Iowa

Iowa pharmacists were pleased to hear that Iowa Senator Chuck Grassley was the lead sponsor of the senate version of the bill. Grassley’s health policy director Rodney Whitlock and other staff have been working closely with the IPA while drafting this bill.

“Pharmacists provide services and need to be reimbursed for those services,” stated Senator Grassley as he shared his perspective on the importance of provider status during the Political Leadership Breakfast at this year’s Midwest Pharmacy Expo.

Optimistic, but Work Still to be Done

“I’ve never seen so much unity on an issue,” said Dr. Paul Abarmowitz, CEO of the American Society of HealthSystem Pharmacists his Sunday morning keynote at the 2015 Midwest Pharmacy Expo.

This unity and the introduction of bills in both chambers this year provide optimism that provider status will be realized in 2015. Both bills have strong

sponsorship of well-respected members from both sides of the aisle in both chambers of Congress, including Sen. Grassley. While this is a good start, more work will need to be done.

To keep these bills moving forward, Congress needs to hear from pharmacists from all practice types about the importance of provider status in delivering quality and accessible care to Americans.

Take Action Now

If you are looking to get involved in the push for provider status, here is what you can do right now: 1. THANK SENATOR GRASSLEY IPA worked closely with the Senator and his staff and we need to back up the support! Sen. Grassley’s contact information can be found on his website – www.grassley.senate.gov.

You may also contact his health policy director Rodney Whitlock at Rodney_Whitlock@grassley.senate.gov.

2. Contact Your Representative and Senator Ernst Contact your representative and Senator Ernst and ask them to support the bill in their respective chamber. You can find your representative at www.house.gov and Sen. Ernst’s contact info is available on her website -www.ernst.senate.gov.

Online forms are also available on the American Society of Health-System Pharmacists website (www.ashp.og) or at PharmacistsProvideCare.com 3. Stay Informed Watch for updates through IPA’s Top 5 e-newsletter and social media accounts, national associations and these websites: www.pharmacistsprovidecare.com www.pharmacistscare.org For additional resources or examples of legislator contacts, contact David Schaaf at dschaaf@iarx.org or 515-270-0713. ■

public affairs

Dick Hartig, Janelle Behnke and Keith Bibelhausen

Pharmacists Storm Capitol Hill at RxIMPACT Day!

More than 350 pharmacy advocates from 44 states met with members of Congress during the seventh annual NACDS RxIMPACT Day on Capitol Hill on March 25-26, 2015. RxIMPACT Day brings together pharmacy leaders from across the country to educate legislators about pro-patient, propharmacy policy, including: provider status, payment for professional pharmacy services, problematic reimbursement methodologies, any willing provider provisions for all Medicare Part D beneficiaries, and TRICARE mail order provisions.

Sen. Grassley Addresses Provider Status at Political Leadership Breakfast “Pharmacists need to be recognized for what you do and what you can do” was Senator Charles Grassley’s message to over 75 pharmacists and student pharmacists at the Political Leadership Breakfast held in conjunction with the 2015 Midwest Pharmacy Expo. Senator Grassley shared his perspective of pharmacy in healthcare and discussed S. 314, Pharmacy and Medically Underserved Areas Enhancement Act (the provider status bill) that he cosponsored. The Senator also took questions from the audience about ACO, provider status and world affairs.

After Senator Grassley spoke, he took time to meet with pharmacists and student pharmacists and pose for pictures. Many pharmacists in attendance took the opportunity to thank Senator Grassley for his leadership on the provider status issue and sponsoring S. 314. Among those were APhA CEO Tom Menighan, ASHP CEO Paul Abramowitz and association leaders from surrounding states.

“Times have changed and the pharmacists role in healthcare has changed.”

Several Iowa pharmacists and other pharmacy advocates participated in this two-day event, and were able to meet with all of Iowa’s Congressional delegation or their staff and Andy Slavitt, Acting Director of CMS. These Iowa pharmacy professionals, included: Keith Bibelhausen and Dick Hartig (Hartig Drug); Randy Edeker, Bob Egeland, and Tom Watson (Hy-Vee Pharmacy); Brett Barker (NuCara Pharmacy); Mike Fuller and Jason Hansel (Walgreen’s Pharmacy); and Janelle Behnke (Drake P4 student pharmacist). ■

Dick Hartig meets Representative Buddy Carter (GA01), the only pharmacist holding national office.

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2015 IPA Legislative Day Legislative Day marked the unofficial kickoff of IPA’s legislative efforts for 2015. On Janurary 29, 2015, over 150 pharmacists and students braved a cold, blustery January day to advocate face-to-face with their legislators on behalf of pharmacy and gain a better understanding of the issues facing the state this year.

Prep Sessions

With the capitol visit the highlight of Legislative Day, the morning programming was focused on preparing pharmacists and student pharmacists to confidently engage legislators. Bill Wimmer and Angela Davis, IPA’s legislative counsel, provided an overview of procedure and the issues at hand for pharmacy this year, particularly the PBM bill. Members were briefed on shaping a consistent PBM message and answering legislator questions.

Paint It White

Pharmacists and student pharmacists descended upon the state capitol and were easy to spot with their white coats spread throughout the building. Legislators listened as pharmacists and students presented their case. Some legislators in turn educated them on the capitol and legislative process.

“We thought the time was very worthwhile and especially successful. We feel all of these legislators are definitely in our court on our legislative issues.”

- Bernie Cremers, Pharmacist, Iowa City

Pharmacists and students reported positive discussions with legislators about PBMs and other pharmacy issues. Pharmacists and legislators alike used these meetings as an opportunity to establish and strengthen relationships moving forward.

Opportunities and Priorities

After an active morning and the traditional photo on the capitol stairs, participants heard and provided feedback about health and pharmacy policy in the state with Gerd Clabaugh, director of the Iowa Department of Public Health and Julie Lovelady, interim director of Iowa Medicaid Enterprise.

Next, Sen. Janet Petersen (D-18) and Rep. Guy Vander Linden (R-79) provided their bipartisan perspective on PBM’s and listened to feedback from pharmacists in the audience. Both legislators are instrumental in the PBM bill passage as both serve on the Commerce committee in their respective chambers (Sen. Petersen is the Chair) where the bills were assigned.

Legislative Day wrapped up with remote session with Jennifer Mallon, Vice President of the National Community Pharmacists Association discussing the PBM issue from national perspective and the effort taking place in other states and across the country.

“Overall, I had a fantastic experience and learned quite a bit.”

- Brandon Gerleman, P2 Student, The University of Iowa

The Result

Legislative Day was important first step in both the legislative process for IPA and for members to build a comfort level for engaging legislators. The dialogue that was started had carried though the session as IPA pushed through the PBM bill and will continue to be valuable in future legislative efforts.

Thank you to our 2015 IPA Legislative Day Sponsors: American Pharmacy Cooperative, Inc., National Association of Chain Drug Stores, Miller-Purcell, Inc., Hartig Drug, NuCara Pharmacy

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SAVE THE DATE : January 27, 2016 IPA’s 2016 Legislative and Capitol Screenings Day

public affairs

The Latest FROM the Board of Pharmacy

Pharmacist in Charge Rules

As the work of the Iowa Patient Safety Task Force carries forward, the Board of Pharmacy has worked to update regulations that specify individual and shared responsibilities for the management of a pharmacy between a pharmacy owner, pharmacist-incharge, and staff pharmacist. The purpose of updated regulations is to assign responsibility for pharmacy activities and functions to the party or parties that have the ability to control those activities and functions. These new regulations will become effective on May 20, 2015, and will affect multiple chapters within the Board of Pharmacy rules.

Iowa PMP (Prescription Monitoring Program)

On February 20, 2015, the Board of Pharmacy convened multiple stakeholders as part of the Iowa PMP Conference in Johnston, IA. The conference was held to discuss the current status of PMPs across the country, spotlight success of PMPs, and formulate an action plan for improving Iowa’s PMP. Currently the

Board of Pharmacy and the PMP Advisory Council are evaluating the recommendations provided during this conference before moving forward with changes. In addition, the Board of Pharmacy continues its work to integrate Iowa’s PMP for data sharing with neighboring states’ (plus Kansas) PMPs, which is pursuant to legislation passed in 2014.

The Board of Pharmacy has appointed a group of current Board members to undergo a search process for a new Executive Director for the Board of Pharmacy. IPA and other stakeholders will have an opportunity to interact with potential candidates during open sessions of the Board of Pharmacy before a final candidate is selected.

Pharmacy Compounding Rules

The Board of Pharmacy has utilized recommendations of a Compounding Task Force to evaluate its current regulations for sterile and non-sterile compounding in the wake of the New England Compounding Center disaster.

Current recommendations will rescind the two separate chapters within the Iowa Administrative Code related to compounding, and adopt one chapter that endorses USP Chapters 795 and 797 as standards of compounding practice in Iowa.

Congratulations to IPA member Jason Hansel of Bettendorf. Jason has been appointed to the Board effective May 1, 2015. Dr. Hansel is Hansel a district pharmacy supervisor for Walgreens and a PharmD graduate of the University of Iowa. He will replace Susan Frey on the Board.

Thank you for your nine years of service on the Board of Pharmacy, Susan!

Due to some debate in the process around flavoring of medications, adoption of these recommendations will not occur in the immediate future. With current recommendation, flavoring of reconstitutable medications will be excluded in the definition of compounding and pharmacies that only flavor reconstitutable and not engage in other forms of compounding will not have to follow USP standards.

Susan Frey (second from the right with her family) was recognized for her service at a retirement party on April 28, 2015 in Des Moines.

Jessen Retires as Board of Pharmacy Executive Director

Lloyd Jessen, RPh, JD announced his retirement as executive director of the Iowa Board of Pharmacy effective Friday, March 27th.

Jessen came to the Board in 1987 after serving as staff in the Iowa Supreme Court and had been executive director for the Board since 1990. IPA would like to congratulate Lloyd on his service and dedication to the profession of pharmacy.

Congratulations & Thank you!

Congratulations also to Iowa Pharmacist Ed McKenna of Storm Lake, who has been reappointed to a second term on the Board of Pharmacy. ■

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peer review

The Opioid Boom in the United States: A Review of the Fallout Zone and Approaches to Defuse the Situation

Brittany A. Bruch, PharmD PGY1 Pharmacy Practice Resident with an Ambulatory Care Focus University of Iowa Hospitals and Clinics Ryan B. Jacobsen, PharmD, BCPS Clinical Pharmacy Specialist/Clinical Coordinator, Ambulatory Care University of Iowa Hospitals and Clinics Clinical Assistant Professor University of Iowa College of Pharmacy Corresponding Author Brittany Bruch 200 Hawkins Drive, CC101GH Iowa City, Iowa 52242 319-356-2577 Fax: 319-353-8443 brittany-bruch@uiowa.edu Authors have no disclosures concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this article.

The Opioid Boom in the United States

Opioids have seemingly become the pain reliever of choice throughout the United States, adding to growing concern surrounding the prescribing epidemic of opioid medications.1 A CDC report determined that in 2012, for every 100 people in the United

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States, there were 82.5 prescriptions written for opioids, for a total of 259 million prescriptions.2 This is twice as much per capita as Canada, the second highest prescribing country.1 Major emphasis is now being placed on combatting this epidemic due to an increase in prescription drug overdoses and subsequent deaths.

If acknowledgement of and solutions to these issues does not become a priority, further fallout is highly likely.

Recent statistics on controlled substance prescribing have helped to identify areas of highest use within our country. Analyses show increased opioid prescribing in southern states such as Alabama, West Virgina, Oklahoma, Tennessee, and Kentucky; with lowest prescribing in the states of New Jersey, New York, Hawaii, Minnesota, and California.1 Exact reasoning for this prescribing discrepancy is unknown, but may indicate differences in prescriber educational background or training.

For reference, the state of Iowa averages 73 painkiller prescriptions per 100 people, which is just below the national average.1

The Fallout Zone and Impact of Opioid Abuse and Misuse

The impact of drug abuse and misuse in this country is evidenced by alarming statistics. In 2013, there were 22,767 pharmaceutical (prescription plus heroin) drug overdose deaths in the United States—71.3% of these deaths included opioids.3 On a local scale, Iowa ranks seventh lowest in the United States in terms of annual overdose mortality with 8.6 deaths per 100,000 people.4 Compared to other states, the rate in Iowa may be low but this is still particularly concerning given that the annual rate has quadrupled since 1999, at which time there were 1.9 deaths per 100,000 people.4 Drug overdose mortality rates throughout the rest of the United States can be found in Figure 1.4 There are a number of factors which have likely contributed to the current state of opioid prescription abuse and misuse in the United States.

Over the last few decades, there has

been an increased emphasis on pain assessment and management. In the 1990s, pain became increasingly known as the “5th vital sign” and all healthcare practitioners were encouraged to assess and treat pain at each encounter.5 In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) published new pain management standards regarding patient rights to assessment and treatment of pain.6 Concurrently, there was an emphasis on the utility of opioid medications for the treatment of pain and a general whitewashing of the risks of opioid addiction and misuse. At that time, the purportedly low risk of addiction was largely based on studies in the treatment of cancer pain.7 However, the increased use of opioids has predominantly been for the treatment of non-cancer pain for which studies indicate a higher risk of addiction and misuse.8 The downstream effects of these messages were twofold. Prescribers felt pressure to address pain at each encounter and they became more accustomed to prescribing opioids for various painrelated conditions that may have been treated with other therapies in the past. Second, patients became more aware of the emphasis on pain. As a result, they may have come to expect, or even demand, prescription pain medications such as opioids. This led to a significant increase in the number of prescriptions being issued for opioid pain medications and a subsequent increase in abuse and misuse.

To achieve meaningful and positive change in the face of such a complex problem, a concerted and multipronged effort will be required by pharmacists, prescribers, patients, regulatory bodies, and society.

Critically evaluating and responding to prescribing patterns of opioid medications, assessing the use of rescue medications for accidental overdose, as well as providing options for safe disposal are all active pursuits by government and non-profit organizations to curb prescription drug abuse. Pharmacists are uniquely positioned for involvement within all of

peer review Nebraska and Missouri.11 Nebraska’s prescription monitoring program is voluntary; therefore, does not have designated update intervals.11 Missouri is the only state that has not enacted state legislation requiring prescription drug monitoring programs.11 To further address the prescription opioid epidemic and subsequent problems at the state level, the Trust for America’s Health organization has identified 10 measures as indicators of progressive action against prescription drug abuse.4 These suggestions include: • Existence of a PMP • Required PMP use by prescribers • Laws requiring patient disclosure of other prescribers • Medical coverage for substance abuse treatment services • Required or recommended prescriber education on controlled substances • Good Samaritan laws • Naloxone expansion policies

Figure 1

these ventures due to frequent patient contact and a broad understanding of these medications and their appropriate therapeutic role.

Initiatives to Defuse the Situation

Several initiatives are currently in place or are being devised to decrease the risk of abuse in regards to opioid-based treatment regimens. One of these initiatives includes development and implementation of prescription drug monitoring programs (PMPs). These databases assist in recognizing drugseeking behaviors as well as identifying potential diversion, misuse, or abuse of controlled substances. New York and Tennessee have already demonstrated the promising effect that PMPs can have—they have seen 75% and 36% decreases, respectively, in the number of patients seeking prescriptions from multiple providers.9 Florida has also implemented a program which places greater emphasis on opioid prescribing from specialized pain clinics

and; therefore, less dispensing from physician clinics. These projects, along with other legislative initiatives, have led to a 50% decrease in overdose deaths from oxycodone.9 The Iowa Prescription Monitoring Program is the statewide service that tracks all outpatient prescriptions (C-II, C-III, C-IV) dispensed in Iowa. This information is available at nearly real-time to licensed prescribers (medical doctors, dentists, physician’s assistants, advanced registered nurse practitioners, podiatrists, optometrists, and veterinarians), resident physicians (using a DEA number assigned by the residency program), and licensed pharmacists.10 Controlled substance prescription information is uploaded to the database on a weekly basis.10 Those registered may also authorize up to 3 other healthcare professionals to process requests for patient prescription histories.10 Currently each state is responsible for establishing regulations regarding prescription drug reporting. Most states surrounding Iowa update weekly, with the exception of

• Physical exam requirement prior to prescribing controlled substances • Identification requirement prior to dispensing • Pharmacy lock-in programs that restrict patients to one pharmacy, one hospital, and one primary care physician Iowa has currently implemented 6 out of the 10 measures including PMP existence, patient disclosure regarding other providers, substance abuse treatment coverage, prescriber education, physical exam requirement, and Medicaid lock-in program.4 Nationally, two states have achieved 10 out of 10 measures, four states 9 out of 10, eleven states 8 out of 10, five states 7 out of 10, and twelve states 6 out of 10, respectively.4 These efforts are believed to have contributed to a decrease nationally in the number of Americans abusing prescription drugs from 7 million in 2010 to 6.1 million in 2011.4

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peer review The scheduling of opioid medications has been a hot topic this past year.

Hydrocodone is one of the most abused opioid medications in the United States.12 Given concerns regarding hydrocodone abuse, the Drug Enforcement Agency (DEA) reclassified hydrocodone as a schedule II controlled substance on October 6, 2014. It was hypothesized that a stricter schedule would help to prevent diversion and further exacerbation of opioid abuse. It remains unknown whether or not this will influence the number of prescriptions written for hydrocodone as well as if this will correlate to a decrease in opioidrelated deaths. It is also possible that this regulatory change will shift prescribing to products within a lower schedule, such as tramadol, which was reclassified as a schedule IV controlled substance on August 18, 2014.

Another current topic in pain management involves the use of products capable of reversing an opioid overdose in the community setting or in instances where medical professionals are not immediately available. One such product is naloxone. Its efficacy in reversing an overdose is well known; however, recent publicity regarding its potential role within the community setting has sparked controversy throughout the United States.13 Supporters of expanded-use naloxone tout this as an opportunity to reduce opioid-related overdoses and deaths. Conversely, critics suggest this may only further exacerbate our country’s abuse and misuse of opioid medications.

This discussion has challenged the healthcare community to review illicit drug use from a different perspective and readdress the historical stigma that surrounds drug overdose.

Naloxone functions as a pure opioid antagonist, displacing medications from opioid receptors; thus, reversing effects of respiratory depression, sedation, and hypotension.14 Naloxone can be administered intravenously, intramuscularly, subcutaneously, or intranasally. While naloxone is generally viewed as safe by community advocates, there is

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concern surrounding unmonitored use of this product by non-healthcare providers due to the potential for rapid precipitation of opioid withdrawal.

With the recent approval of EvzioÂŽ (naloxone hydrochloride) auto-injector, naloxone prescription programs are being formed by citizens and non-profit organizations with the ultimate goal of decreasing opioid-related deaths within communities. These programs focus on training community members to identify an overdose, call 911, deliver rescue breathing, and lastly, administer naloxone.13 Project Lazarus represents one of these community programs which was established in 2008 in Wilkes County, North Carolina.15 This initiative involves a monitoring and surveillance program, community awareness, prevention of overdoses, and use of emergency rescue medication by community members to reverse active overdose.15 Along with support from the North Carolina state medical board, Project Lazarus encourages practitioners to prescribe an emergency dose of intranasal naloxone concurrently with every opioid prescription for use in the event of accidental overdose.13 Based on data collected between 2009 and 2011, overdose deaths decreased by 69% in Wilkes County.16 Several community pharmacies are also advocating for increased naloxone accessibility.

Walgreens and CVS Pharmacies in Rhode Island are currently participating in a collaborative practice model that allows pharmacists, at their discretion, to dispense naloxone to high-risk patients or their caregivers if opioid overdose seems probable during the course of therapy.17 Increased support for naloxone use has led some practitioners to lobby for the reclassification of naloxone to nonprescription status.13 Regardless of its designation, pharmacists play a crucial role in patient education surrounding appropriate naloxone use and the importance of involving a medical professional as soon as possible.

The risk of potential liability remains an issue for bystanders who may try to help at the time of an opioid overdose. Several states have already

passed legislation that protects good Samaritans from legal reprimand if they provide assistance to an opioidoverdosed individual.13 While these laws have continued to emphasize the importance of seeking medical help immediately for suspected overdoses, they also provide protection for any care administered in the interim.13

Updates to Disposal Regulations

Lastly, new regulations released by the DEA in September 2014 have eased restrictions and increased accessibility for disposal of controlled substances. Federal ruling that went into effect October 9, 2014 now permits manufacturers, distributors, reverse distributors, opioid treatment programs, hospitals and clinics with an on-site pharmacy, and retail pharmacies to register as collection sites.18 Once registered, locations may take back any unwanted prescription products, including controlled substances (C-II through C-IV). This is an expansion on past disposal programs, which excluded controlled substances. Increased availability of controlled substance disposal is expected to remove excess medication from the public arena and ultimately prevent misuse and diversion.

Conclusion

As opioid prescribing and usage continues to be problematic throughout our country, pharmacists remain key participants in many ongoing initiatives to reduce the abuse and misuse of opioid medications. It is essential that our profession devotes time and effort to understanding pain management to prevent further escalation of current opioid trends.

Continuing to stay educated on these issues and understanding the impact pharmacists can have will undoubtedly be pivotal in combatting this problem.

Pharmacists are encouraged to work together as a profession and to collaborate with other key stakeholders including prescribers, patients, and community groups to collectively address and defuse the opioid boom in the United States. â–

peer review References

and dependence among recipients of chronic opioid therapy: Results from the TROUP Study.

Drug Alcohol Depend 2010;112(1-2):90-8.

14. Product information. Evzio (naloxone hydrochloride). El Monte, CA: International Medication Systems, Limited, March 2011.

Retrieved from http://www.cdc.gov/vitalsigns/ opioid-prescribing/index.html (accessed 2014 Nov 8).

9. Prescripton Drug Monitoring Program Center of Excellence at Brandeis. Mandating PDMP participation by medical providers: current status and experience in selected states. Retrieved from http://www.pdmpexcellence.org/sites/all/ pdfs/COE%20briefing%20on%20mandates%20 revised_a.pdf. February 2014.

15. Albert S, Brason FW, Sanford CK, Dasgupta N, Graham J, Lovette B. CDC: Project Lazarus: community-based overdose prevention in rural North Carolina. Pain Medicine 2011;12:S77-85.

1. Centers for Disease Control and Prevention.

Vital Signs: Opioid Painkiller Prescribing.

2. Kuehn BM. CDC: Major Disparities in Opioid Prescribing Among States: Some States Crack Down on Excess Prescribing. JAMA 2014;312(7):684-6.

3. Centers for Disease Control and Prevention.

Prescription Drug Overdose in the United States: Fact Sheet. Retrieved from http://www.cdc.gov/ homeandrecreationalsafety/overdose/facts.html (accessed 2014 Nov 8).

4. Trust for America’s Health. Prescription Drug Abuse: Strategies to Stop the Epidemic.

Retrieved from http://healthyamericans.org/ assets/files/TFAH2013RxDrugAbuseRpt16.pdf.

October 2013.

5. McCaffery M, Pasero CL. Pain ratings: The fifth vital sign. Am J Nurs 1997;97:15-6.

6. Phillips DM. JCAHO pain management standards are unveiled. JAMA 2000;284(4):428-9.

7. Porter J, Jick H. Addiction is rare in inpatients treated with narcotics. N Engl J Med 1980;302:123.

8. Edlund MJ, Martin BC, Fan MY, Devries A, Braden JB, Sullivan MD. Risks for opioid abuse

10. Iowa Prescription Monitoring Program.

Retrieved from https://pmp.iowa.gov/ IAPMPWebCenter (accessed 2014 Nov 8).

11. National Alliance for Model State Drug Laws.

Prescription Monitoring Programs—State Law and Policy Profiles. Retrieved from http://www. namsdl.org/library/8DB6720C-91EE-8472E365F7818C02C8B5 (accessed 2014 Nov 8).

12. Drug Enforcement Administration. Drug Fact Sheets. Retrieved from http://www.dea.gov/ druginfo/drug_data_sheets/Hydrocodone.pdf (accessed 2015 Jan 23).

13. Beletsky L, Burris S, Kral A. Closing death’s door: Action steps to facilitate emergency opioid drug overdose reversal in the United States. The Center for Health Law, Politics, and Policy at Temple University Beasley School of Law. Published online through Social Science Research Network. 21 July 2009.

Retrieved from http://www.researchgate.net/ publication/228295812.

16. Community Care of North Carolina: Project Lazarus. Retrieved from https://www. communitycarenc.org/population-management/ chronic-pain-project/ (accessed 2014 Dec 12).

17. Bor L. By the end of August, CVS will offer Narcan without prescription to counter opiate overdoses. Providence Journal Online.

23 Aug 2014. Retrieved from http://www. providencejournal.com/article/20140823/ Lifestyle/308239953.

18. Drug Enforcement Administration.

Department of Justice. Federal Register 2014;79(174):53520-70.

Looking to get Published?

Consider submitting your research manuscript to be peer-reviewed by the Journal of IPA. Please send articles to IPA@iarx.org.

member section IPA Member Spotlight:

Joe Beraldi, RPh

By: Jennifer Elliff 2015 PharmD Candidate University of Iowa College of Pharmacy It’s not uncommon to work past retirement age, some people may need to for financial reasons and others may just need something to fill their day, but for 89 year-old pharmacist Joe Beraldi, his passion for people keeps him in the work place.

Joe is the owner of Oard-Ross Drug, a small neighborhood pharmacy located in Council Bluffs, Iowa. Oard-Ross Drug has been in service for over 100 years and is one of the oldest independent pharmacies still open in the area. According to Joe, they are still standing because of good customer service and referrals from their loyal patients. Joe Beraldi has had the opportunity to serve the needs of generations of families, and his love for people and his work has kept him in the profession.

Joe has been working at Oard-Ross Drug for 75 years. At age 14, he started as a soda fountain clerk and delivery boy, where he was able to begin meeting the members of his community. After graduation from Creighton University School of Pharmacy in 1948, he began working as a registered pharmacist.

He has been the sole owner of the pharmacy since 1967, and now runs

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the pharmacy alongside his son Tony Beraldi, who is also a registered pharmacist. When asked why he pursued pharmacy as a career, he responded, “I grew up around the business and I knew I wanted to be a pharmacist. I am proud of the role of the pharmacist in administering to the needs of the community.”

“I grew up around the business and I knew I wanted to be a pharmacist.”

Joe prides himself on the service that he provides to the patients of his pharmacy. While he admits their pharmacy can’t compete with size, buying power, and advertising, they shall always continue to give great service and the best value possible to their patients. The primary pharmacy services provided at Oard-Ross Drug include focused prescription and overthe-counter medication counseling.

When asked what he likes best about his pharmacy and what keeps him motivated, he responded, “We know most of our patients by their first name and we have served generations of members of our community.”

“We know most of our patients by their first name and we have served generations of members of our community.”

Throughout his years as a pharmacist, Joe has remained active in the profession as well as in his community. He is a member of multiple professional and area organizations, such as the Southwest Iowa Pharmacists Association (SIPA), the Iowa Pharmacy Association, and he is a past president of the Southwest Iowa Creighton University Alumni Association. He is the recipient of multiple honors, including an honorary Doctor of Pharmacy degree

from the National Association of Retail Druggists (NARD) in 1982, the 50-Year Pharmacist Award from IPA in 1998, and the Governor’s Volunteer Award in 2000.

Joe has also served his community in many other ways. He was a member and also chairman of the Pottawattamie County Board of Health for many years. He was a member of the Visiting Nurse Association Board and the Civil Defense Board.

He also served as the auditor for the Pottawattamie County Welfare Board.

And, he was active in the Council Bluffs Lions Club.

“If I could start over again, I would not change a thing. I have always loved what I am doing.”

With such a fulfilling career in the profession of pharmacy, Joe was asked, if you could start your life all over again what would you do? He responded, “If I could start over again, I would not change a thing. I have always loved what I am doing.” As the local corner drugstore, he has built strong relationships within his community and provided years of service to ensure his patients received the care they desire.

While the pharmacy profession is evolving and the roles of pharmacists are changing, we should value the impact that pharmacists like Joe Beraldi have already had on our profession and their communities.

Joe is the epitome of displaying the important qualities that pharmacists’ possess; passion for people, caring to the needs of the community, and commitment to the profession. ■

• FREE CPE “relicensure” & “recertification” buckets

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member section

MEMBER MILESTONES Professional

Greg Johansen, RPh, BS (GRX Holdings) was elected to Drake University Board of Trustees. Johansen is a 1976 graduate and a long-time supporter of the University.

Congratulations Greg!

Tom Temple, BSPharm, MS, FAPhA was selected to the United States Pharmacopeial Convention Board of Trustees. Congratulations Tom!

Congratulations to Cheryl L. Clarke, BSPharm (Drake University); Susan S. Vos, PharmD, BCPS (University of Iowa); and Jonathan G. Marquess, PharmD, CDE on being named APhA Fellows for 2015!

Vos

Thank you for supporting IPA! Jan 1 - March 31:

Congratulations to Jim Scott, RPh (Bettendorf) who has retired after a 44 year career as a pharmacist. Jim was a 1970 graduate of the University of Iowa.

Clarke

Welcome NEW IPA MEMBERS

Marquess

PERSONAL Tessa Rose and Tellis Cardell were born on March 9, 2015 to proud parents Kate Gainer, PharmD (IPA Exec. VP and CEO) and her husband Bob, and big brother Ray and big sister Genevieve.

Danielle Kennedy PharmD, MBA (Rochester, MN) and Tim Roach, PharmD were engaged on February 14, 2015.

Danielle is a 2012 graduate of Drake University and Tim graduated from Drake in 2013.

Beth Benesh, Clear Lake Michael Bilden, Nevada Jordan Burger, Coralville Christopher Clayton, Manchester Erin Cook, Durant Paula Deck, LaVista, NE Colleen Dickinson, Ottumwa Amanda Fortune, Dubuque Brenda Foust, East Dubuque, IL Mattie Haas, Hamilton, IL Ashley Hartwig, Anamosa Jennifer Hayes, Dubuque Jonathan Kallenbach, Manchester Christina Kunz, Johnston Bari Lloyd, Clive Justin Manning, Tiffin Stephanie Martin, Dubuque Danielle Milbrandt, Boone Veronica Montefusco, Des Moines Sean Moorhead, Coralville Brian Parker, Marshalltown James Ray, Charlottesville, VA Tamara Risse, Waterloo Jana Roberts, Lancaster, MO Randall Samyn, Marion Celine Schweer, Denver Heather Storey, Spencer Sara Tapya Salem, Coralville Joseph Truong, West Des Moines Abigail Turek, Dubuque Valerie Wersching, Maquoketa

In Memoriam Ron Onnen, of West Des Moines, passed away on March 8, 2015. Ron was the founder of the Onnen Company and made many friends during his 20 plus years on the road calling on customer he knew as friends.

Lisa Marie Hulsing, RPh, of West Des Moines, passed away on April 10, 2015. Lisa graduated from Drake University in 1989.

Karith Remmen, of Decorah, passed away on April 1, 2015. Karith worked at the Iowa Department of Public Health’s Office of Health IT.

Send your member milestones to ipa@iarx.org for inclusion in the next IPA Journal.

APR.MAY.JUN 2015 |

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technician’s corner

technician’s corner

Newly PTCB Certified Iowa Technicians January 1, 2015 through March 31, 2015

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

Amber Adams Meghan Alexander Nicole Andrew Richards Quinn Andrew Joshua Andrews Latoya Baker Dawn Ball Kenneth Bargloff Britany Benjegerdes Collin Beyer Joanna Blomquist Dawn Boerner Chelsie Booker Mary Braida Mikayla Brockmeyer Teresa Bruck Callie Bryan Michelle Bunce Travis Bushaw Laura Callahan Carri Camp Dana Conrad Jessica Cristini Mikayla Cummings Cindy Davis Tanya Dennison Connor Duggan Rebecca Duryee

Taylar Estal Brittany Faley Danielle Fett Joshua Formanek Brittney Frees Levi Gates Sally Gibbs Spencer Gray Christina Grimes Briana Gulbranson Ashley Haight Nicholas Hansen Sierra Hauert Sarah Hecht Hannah Hemry Molly Holman Denise Jacobsen Valorie Jansen Andrew Johnson Whitney Jones Cejae Ketelsen Sara Kniffen Husein Kurdic Darci Legore Michelle Lesline Kyle Maere Chyrele Mahjouba Jacquelyn Marmion

Megan McKim Demerest McPheeters Faith Mills Wendy Mitchell Sherry Mohling Jessica Nurre Jodie Pelletier Christine Probst Jessica Rahlf Lisa Roberts Austin Sack Tatjana Sehic Holly Shepard McKenzie Smeltzer Alyssa Smith Kelsey Smith Shelby Stender Caitlin Stephens Amanda Stiverson Karlee Stubbe Michael Taylor Kristina Thomas Kiara Vander Pol Charles Verduzco Sheri Voy Aimee Wiedenman

Pharmacy Technicians:

We Want to Hear from You! Do you or someone you work with continually demonstrate excellence as a pharmacy technician?

Each quarter, IPA highlights one IPA pharmacy technician member whose dedication to patient care and innovation within the pharmacy profession makes them an example for others.

If you or someone you know exemplifies these characteristics, please contact IPA at ipa@iarx.org to be able to spotlight their passion for the profession.

IPA technician members receive all required CPE for CPhT recertification for FREE! Looking for recertification CPE? Pharmacy technician members of IPA now receive the Recertification Bucket from CEI for FREE!

The Recertification Bucket includes Pharmacy Technician Certification CPE activities in categories consistent with the PTCB Domains, structured as 10 one-hour written modules that you can print and complete on the go. Also included are live and on demand webinars in the area of pharmacy law and patient safety.

Login at www.iarx.org/cei_buckets to take advantage of this new benefit for members and spread the word to your colleagues.

Interested in becoming a member and receiving your free recertification bucket? Contact IPA at 515-270-0713 or ipa@iarx.org.

APR.MAY.JUN 2015 |

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college of pharmacy news Drake’s Pharm.D. Program Receives 8 Year Accreditation!

The Drake University College of Pharmacy & Health Sciences is pleased to report that its Pharm.D. program is accredited until June 30, 2023, as determined by the ACPE Board of Directors at their January meeting.

This eight-year accreditation term is the maximum available to pharmacy programs and represents the high quality of the CPHS pharmacy program in fulfilling the standards set forth through the accreditation process.

Drake University and Community Engagement

Drake University was recently recognized for it’s long-standing commitment to community engagement & service - learning.

Feedback from the Community Engagement Audit conducted fall of 2013 showed that: • Over 80% of Drake students participate in a community service or service-learning experience before they graduate • More than a quarter of our courses include service-learning as a tool for teaching • 70% of Faculty and Staff serve in the community with nonprofits, boards, professional organizations, and schools • Collectively, the nine members of the cabinet serve as board members with more than 40 different nonprofit organizations • More than 120 pharmacy students provide free immunizations and health screenings to members of Des Moines’ underserved communities, totaling about 1,450 immunizations and 1,100 screenings each year The College of Pharmacy & Health Sciences students, faculty and staff have played a large role in Drake receiving this recognition.

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Jacqueline Chorzempa – Kappa Psi Scholarship Recipient CPHS’s Jacqueline Chorzempa,was one of 10 recipients of the prestigious 2014 Kappa Psi Scholarship from the Kappa Psi Pharmaceutical Foundation.

Among Jacqueline’s other significant achievements, she was recently reelected to serve as Historian for the six states (9 chapters) of the NPP (Northern Plains Province) for Kappa Psi Fraternity over the next year.

CPHS Dean Receives National Leadership Award Wendy Duncan, dean of the College of Pharmacy and Health Sciences, has recently received multiple awards for her influence and leadership in the fields of healthcare and higher education.

The St. Louis Branch of American Association of University Women named Duncan as one of 250 women who have made an impact on the city. Duncan was honored for her leadership as dean of pharmacy at St. Louis College of Pharmacy. The Association said she positively shaped the college and was instrumental in the creation of an innovative curriculum which is now coming into being.

Duncan was also elected to Distinguished Fellowship in the National Academies of Practice and the Pharmacy Academy as a Distinguished Scholar and Fellow. This honor acknowledges Duncan’s work as a recognized leader in the healthcare field.

Laura Vollmer Published in Pharmacy Times

Laura Vollmer, 2015 PharmD candidate and winner of the ParataPharmacy Times Next Generation Future Pharmacist Award, has had an article published in the Pharmacy Times entitled “The Future of Pharmacy.”

CPHS Faculty and Students Awards

The College of Pharmacy & Health Sciences was well-represented at the Des Moines University Research Symposium, held on December 4, 2014. The following awards were received: Selected for oral presentation: Biosynthesis of MBX-2168 Triphosphate in Herpes Virus-Infected Cells Hannah Sauer, Marie Nguyen, Brian Gentry Best poster award, undergraduate biomedical division: Identification and Sequencing of the GSTP1 Gene and Transcript(s) in Dogs Keller Toral and James Sacco Best poster award, undergraduate movement science division: Effects of a Pre-Exercise Supplement on Anaerobic Power and Blood Lactate Levels in Males and Females Bradley Duwe and Kimberly Huey Other posters presented at the event: • Pharmacological Enhancement of Anti-Viral DNA Polymerase Inhibitors via Reduction of Endogenous Nucleoside Triphosphates Joseph Zieminski, Laura Vollmer, Brian Gentry • DNA Polymerase Inhibitors Enhance the Anti-Viral Effect of Terminase Inhibitors When Used in Combination Against HCMV Mary Shea O’Brien and Brian Gentry • Effects of VEGF Loss on Muscle Hypertrophy and Growth Factor Responses Induced by Functional Overload in Mice Christopher Lee, Ellen Breen, Kimberly Huey ■

ONLINE FEATURE!

Read Laura Vollmer’s article “The Future of Pharmacy” in Pharmacy Times

college of pharmacy news Kerns Appointed Chair of the Department of Pharmaceutical Sciences and Experimental Therapeutics

Robert J. Kerns has been appointed to serve as the college’s first official Chair of the Department of Pharmaceutical Sciences and Experimental Therapeutics (PSET).

Kerns’ term as Chair will run through June 30, 2020. In his capacity as Chair, he will have responsibility for all departmental matters including, but not limited to, faculty reviews and corresponding plans for professional growth; budgetary oversight and resource deployment; full realization of departmental consolidation as envisioned in the organizational plan developed 3 ½ years ago; and administrative oversight of the planned Iowa Institute for Drug Discovery and Development (I2D3).

With Kerns’ transition to Department Chair, Jonathan Doorn will serve as Head of the Division of Medicinal and Natural Products Chemistry (MNPC). As Division Head, Doorn will work closely with Kerns to help build one of the strongest drug discovery and pharmaceutical development departments in the country and especially work to advance the graduate program that is aligned with MNPC. Similarly, Aliasger Salem will continue as Head of the Division of Pharmaceutics and Translational Therapeutics (PTT) assisting Kerns in building a nationally recognized department and also focusing on graduate education.

UI College of Pharmacy Represented in Search for New UI President

A member of the College of Pharmacy family was chosen to serve on the search committee for the next President of the University of Iowa.

Aliasger Salem, Head of the Division

of Pharmaceutics and Translational Therapeutics, will be on the 21-member committee.

College of Pharmacy Students, Faculty Receive National and State Appointments Aliasger Salem has been appointed as the associate editor for the AAPS Journal, the journal of the American Association for Pharmaceutical Scientists Society.

Robert Nichols has been selected to be a part of the NCPA Student Leadership Council for 2015-2017.

Nichols is a PharmD candidate in the class of 2017.

Alyssa Billmeyer was recently appointed as Vice Chair for the 2015-2016 APhA-ASP Policy National Standing Committee. Billmeyer is a third-year Doctor of Pharmacy student.

Shiny Parsai was selected as the National Project Coordinator for APhAASP/IPSF’s International Standing Committee. Parsai is a PharmD candidate in the class of 2016.

Duba to Serve as Chair of CAPE Editorial Review Board

Vern Duba, clinical assistant professor and instructional services specialist, was named chair of the CAPE Editorial Review Board by AACP. An initiative of the Center for the Advancement of Pharmacy Education, the educational outcomes define the curricular priorities of Doctor of Pharmacy programs and inform other health professions of those priorities, inspire and guide curricular revision and innovation, serve as the target for curriculum mapping, and function as a core component of a comprehensive assessment plan to assure achievement of the outcomes by the end of the professional program.

Sorofman Appointed to IRHA Board

Bernard Sorofman was appointed to the board of the Iowa Rural Health Association. Sorofman is a Professor and Executive Associate Dean at the University of Iowa College of Pharmacy. IRHA is a nonprofit membership organization of individuals and organizations dedicated to ensuring optimal health for all Iowans, particularly those in rural areas.

The Iowa Drug Information Service’s 50 Years of Service

The Iowa Drug Information Service began in 1965 as a result of a federally-supported study on patient care under a unit dose drug distribution system. The service was founded by William W. Tester, an early innovator and researcher in the area of hospital-based unit dose drug distribution systems.

Tester established the Iowa Drug Information Service (IDIS) to promote better patient care through drug therapy by improved availability of drug information, to stimulate the effective use of drug information resources by pharmacists and physicians, and to expand the role of the pharmacist in providing drug information services to the hospital and community.

IDIS became an internationally recognized drug information database that grew to over 1000 subscribers, and represented over 60 foreign countries. The database itself contains over three-quarters of a million documents.

After 50 years of publishing a vital resource to assist decision-making in the use of medications and health care services, the Iowa Drug Information Service (IDIS) closed its doors on Dec. 31, 2014. ■ APR.MAY.JUN 2015 |

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STUDENT SECTION

Healthcare Culture Grant Houselog 2016 PharmD Candidate The University of Iowa 2015-2016 IPA Board of Trustees

As healthcare providers, we constantly strive to improve medication safety for our patients by decreasing medication errors, improving medication error rates, and avoiding adverse drug events. So what happens when errors do occur?

There is a concept of “Just Culture” that emphasizes shared accountability for outcomes and emphasizes identifying where and why mistakes happen. “Just Culture” cites three types of behaviors: human error, at-risk behavior, and reckless behavior. How we respond to each of these types of behaviors will determine the magnitude of improvement in patient outcomes.

Human error is unintentional and unpredictable. This type of error is often due to flaws in the system design. Through diligent engineering of the process and improvement when human error does occur, human error can be minimized.

However, when human error does occur, typically discipline is not appropriate.

At-risk behavior occurs when an individual drifts into unsafe habits and loses sight of the risks they are taking. The most common example is an attempt to save time by taking a shortcut and bypassing safeguards. When an error occurs as a result of at-risk behavior, this presents an opportunity to coach the individual to increase situational awareness and remove incentives for such behaviors.

Reckless behavior occurs when the individual understands the risks they are taking and understands that there is a possibility of harm. They disregard the risk and intentionally engage in a behavior that is unjustified. In this situation, remedial and/or punitive action may be required.

APR.MAY.JUN 2015 2015 44 | |jan.feb.mar

If all those involved in patient care, either directly or indirectly, learns about the nature and causes of medication errors, there is a greater probability of error prevention and optimal medication use.

As the Iowa Board of Pharmacy adopts new and shared responsibilities between a pharmacy owner, pharmacist-in-charge (PIC), and staff pharmacist, this can be seen as an opportunity to create a culture of safety within your pharmacy. If all those involved in patient care, either directly or indirectly, learns about the nature and causes of medication errors, there is a greater probability of error prevention and optimal medication use. ■

Assist the IPAF team along the RAGBRAI route Pharmacists and student pharmacists will be providing various clinical screenings to showcase the advancing role of the pharmacist in today’s healthcare system.

These screenings will be held along the RAGBRAI route. Screenings planned will provide: blood pressure, sunscreen info, TakeAway info and other services available at nearby pharmacies. If you are interested in assisting with these screenings, please contact Laura at lmiller@iarx.org.

2015 RAGBRAI Route Sioux City – Sat, July 18 Storm Lake – Sun, July 19 Fort Dodge – Mon, July 20 Eldora – Tues, July 21 Cedar Falls – Wed, July 22 Hiawatha – Thurs, July 23 Coralville – Fri, July 24 Davenport – Sat, July 25

Student Pharmacists Attend ASHP Student Advocacy Day in Washington, DC

from their respective home states.

Both of us are from Illinois, therefore we were able to meet with Legislative Aides representing Senator Dick Durbin, Senator Mark Kirk, Representative Randy Hultgren and we were fortunate enough to meet with Representative Adam Kinzinger.

By: Christina Bravos, 2017 PharmD/ MBA Candidate, Drake University Alexa DeVita, 2018 PharmD/MBA Candidate, Drake University

Drake University student pharmacists, Christina Bravos and Alexa DeVita sought after their passion of legislation and policy by attending the ASHP Student Advocate Training & Legislative Day on February 3-4, 2015.

This was the inaugural ASHP Student Advocate Training & Legislative Day, and it was the first time for us to visit Washington DC. Prior to the conference, both of us had an interest in legislation and policy as it relates to pharmacy. Although we have never had any formal training, we both attended IPA’s 2015 Legislative Day and got our feet wet at the state level. In Washington, D.C., student

L to R: Alexa DeVita, Rep. Adam Kizinger (IL-R), Christina Bravos

pharmacists from across the United States came together to be educated on pharmacy legislation and policy and how to conduct a meeting with your Congressional delegation on Capitol Hill.

This was a tremendous opportunity for the both of us that we are incredibly grateful we were able to experience.

Moving forward we hope to continue to pursue our passion of providing for and promoting our professional career at both the state and national level.

Our Capitol Hill visit discussions focused on the provider status bills (S. 314/H.R. 592). On the second day, ASHP had made appointments for students to visit with the Congressmen Attendees of the 2015 ASHP Advocacy Day

Students Showcase to Legislators that Pharmacists Provide Care

While Legislative Day occurred in late January, IPA had a second opportunity to showcase the value of pharmacy to legislators with the annual Capitol Screening Day on Tuesday, April 7th.

With over 15 students in attendance, legislators and other State Capitol guests were provided nearly 60 blood pressure and blood sugar screenings.

This was a great opportunity to directly meet and greet with legislators and show them the variety of skills that pharmacists are capable of providing. For many of the student pharmacists, it was their first time to the State Capitol! This event provided an invaluable experience for them, yet also showcased the strength of students’ voices and actions for the future of the profession.

APR.MAY.JUN 2015 |

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Calendar of Events 2015 Calendar of Events May 2015 14 IPA Goes Local - Black Hawk/Bremer Co

Pharmacy Association - Waterloo, IA

July 2015 11-15 AACP Annual Meeting - Washington, DC

19

19-25 RAGBRAI

IPA Goes Local - North Iowa Pharmacy Association - Mason City, IA

JUNE 2015 3 Iowa Healthcare Collaborative Care

Coordination Conference - Des Moines, IA

14

2/2/2 Webinar

NACDS Total Store Expo - Denver, CO

4

Immunization Training - Johnston, IA

6-10

ASHP Summer Meeting and Exposition - Denver, CO

September 2015 8 2/2/2 Webinar

9

Iowa Immunization Conference Des Moines, IA

11

IPA-F Golf Classic - Ankeny, IA

9

2/2/2 Webinar: Updates on Incident-To Billing with CCM & TCM Codes

11-12

Bill Burke Leadership Conference - Altoona, IA

11

Practie Advancement Forum Coralville, IA

22

IPA Residents Meeting - Iowa City, IA

22

IPA College Night - University of Iowa

11-13

IPA Annual Meeting - Coralville, IA

24

IPA College Night - Drake University

Advertise in our publications

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Joseph Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322 1.888.278.0846 h. 515.278.0846 c. 515.991.2684

August 2015 11 2/2/2 Webinar 22-25

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Place your ad/classified ad with us. All ads, contracts, payments, reproduction material and all other related communication

should addressed to David at dschaaf@iarx.org or call the IPA office at 515.270.0713 for more information.

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| APR.MAY.JUN 2015

2014 Recipients of the “Bowl of Hygeia” Award

Mike Mikell Alabama

Scott Watts Alaska

Crane Davis Arizona

Eric Shoffner Arkansas

Walter Cathey California

Wendy Anderson Colorado

Philip Bunick Connecticut

Donald Holst Delaware

Norman Tomaka Florida

Robert Bowles Georgia

Jeani Jow Hawaii

Susan Cornell Illinois

Sean McAlister Indiana

Craig Clark Iowa

Richard Bieber Kansas

Jerrold White Kentucky

Robert Hollier Louisiana

Mark Polli Maine

Donald Taylor Maryland

Erasmo Mitrano Massachusetts

Joseph Leonard Michigan

Brent Thompson Minnesota

Carter Haines Mississippi

Kenneth Michel Missouri

Mark Donaldson Montana

Christopher Shea Nevada

Lawrence Routhier New Hampshire

Maria Leibfried New Jersey

Stephen Burgess New Mexico

Karl Fiebelkorn New York

Ronald Maddox North Carolina

Charles Peterson North Dakota

James Liebetrau Ohio

Henry Roberts Oklahoma

Larry Cartier Oregon

Julie Gerhart-Rothholz Pennsylvania

Blanca Delgado-Rodriguez Puerto Rico

Katherine Kelly Orr Rhode Island

Gene Reeder South Carolina

Earl Hinricher South Dakota

Robert Shutt Tennessee

May Jean Woo Texas

Brent Olsen Utah

Cynthia Warriner Virginia

Patricia Slagle Washington

Wallene Bullard Washington D.C.

Arlie Winters West Virginia*

Nicole McNamee West Virginia

Terry Maves Wisconsin

Ardis Meier Wyoming

The “Bowl of Hygeia”

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

* 2013 recipient not previously pictured.