IPA Journal - July/Aug/Sept 2013

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

In this issue....

Annual Meeting Highlights - Page 9 Iowa Patient Safety Task Force Executive Summary - Page 22 Legislative Session Recap - Page 37 Not an IPA Member? Tell us why!

Page 42

JULY/AUG/SEPT 2013

JULY/AUG/SEPT 2013 | Vol. LXVIV, No. 3

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

COVER IPA’s 134th President: Michele Evink . . . . . . . . . Cover

PUBLICATION STAFF Lynndi Koester, Managing Editor lkoester@iarx.org Kate Gainer, PharmD kgainer@iarx.org Anthony Pudlo, PharmD, MBA, BCACP apudlo@iarx.org Jennifer Moulton, RPh jmoulton@gotocei.org Joan Stover jstover@iarx.org

OFFICERS CHAIRMAN Julie Kuhle, RPh, Indianola 515.273.8876, jwkuhle@aol.com PRESIDENT Michele Evink, MS, PharmD, CGP, FASCP, Osceola 641.342.5322, mevink@clarkehosp.org PRESIDENT-ELECT John Swegle, PharmD, BCPS, Mason City 641.428.7182, john-swegle@uiowa.edu TREASURER Steve Firman, RPh, Cedar Falls 319.277.7540, steve@pmgrx.com SPEAKER OF THE HOUSE Randy McDonough, PharmD, MS, CGP, BCPS, Iowa City 319.337.3526, mcdonough9@mchsi.com VICE SPEAKER OF THE HOUSE Connie Connolly, RPh, DeWitt 563.652.5611, conniejconnolly@hotmail.com

TRUSTEES REGION 1 Steven Martens, PharmD, Grundy Center 641.366.3440, steven@nucara.com REGION 2 John Daniel, PharmD, Fort Dodge 515.573.3431, jfdaniel@frontiernet.net REGION 3 Lori Schirmer, PharmD, BCPS, BCNSP, West Des Moines 515.241.3264, lori.schirmer@drake.edu REGION 4 Ashley Dohrn, PharmD, Le Claire 563.324.5004, ashley.dohrn@me.com REGION 5 Pat Thies, RPh, MS, FACHE, Cedar Rapids 319.265.3647, thiespw@crstlukes.com AT LARGE Marilyn Aldrich, RPh, Urbandale 515-276-4845, marilyn.aldrich@dahlsfoods.com Cheryl Clarke, BPharm, RPh, CHC, Des Moines 515-271-3899, cheryl.clarke@drake.edu Felix Gallagher, PharmD, Des Moines 515.334.4293, fgallagher@pharmservstaffing.com Justin Rash, PharmD, CGP, Ankeny 515.331.2594, rash.justin@gmail.com HONORARY PRESIDENT Mark Jones, RPh, Davenport jonesma@genesishealth.com, 563.421.4458 PHARMACY TECHNICIAN Michelle Garvin, CPhT, Wilton 563.732.5238, mgarvin@westerdrug.com STUDENT PHARMACISTS Matt Farley, University of Iowa matthew-farley@uiowa.edu Kelsey Lawfer, Drake University kelsey.lawfer@drake.edu

FEATURES

CEO Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Annual Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Patient Safety Task Force Executive Summary . . . . . 22

IN EVERY ISSUE

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

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

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

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

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

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

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

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

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

Last Laugh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

24 26 30 36 38 40 46 50 52 54 54

ADVERTISERS

PharmServ . . . . . . . . . . . . . . . . . . . . . . . . . . Inside Cover HD Smith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Onnen Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 PACE Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 PQC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 TransworldSystems . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 TakeAway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Buy-Sellapharmacy.com . . . . . . . . . . . . . . . . . . . . . . . 32 IPRN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Hansen, McClintock & Riley . . . . . . . . . . . . . . . . . . . . 36 Pharmacists Mutual . . . . . . . . . . . . . . . . . . . . . . . . . . 41 PTCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Career Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 City of Hartley . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 OutcomesMTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 McKesson/RxOwnership . . . . . . . . . . . . . . . . . . . . . . . 56

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 $20. Printed

by Purcell Printing Graphics; Graphic Design done by Iowa Pharmacy Association.

July/Aug/Sept 2013 |

3

ceo editorial

LEAN IN … TO YOUR PROFESSION

W Kate Gainer, PharmD

Iowa Pharmacy Association Executive Vice President & CEO

hile I was on maternity leave last fall, a book written by Sheryl Sandberg, COO of Facebook, was released. “Lean In” intends to inspire women to lean in to their careers; laying a foundation for why future generations of leaders should include equal representation of both men and women. The book details how individuals, organizations, businesses, and our society can help get there. While the book has sparked as much criticism as it has gained praise, the simple message of ‘leaning in’ is an important one. Not only for females in the profession, but for the entire profession of pharmacy.

“While the book has sparked as much criticism as it has gained praise, the simple message of ‘leaning in’ is an important one.”

To lean in will mean different things to each pharmacist (or technician or student pharmacist) reading this. You may be the pharmacist who has an opportunity to lean in to a new project or apply for a new position. You may be the pharmacist who is asked to lean in as a committee chair or run for a board position. You may be the pharmacist who leans in while precepting students in a way that shapes not only how they formulate clinical decisions, but any life decision. You may be the pharmacist who needs to put your career on pause and lean in to your family during a critical time. All of these pharmacists are leaning in, and doing what is right for you, your family, and your profession.

Pressures facing the profession are significant, but only out of great challenges come the opportunity for

4

| July/Aug/Sept 2013

“All of these pharmacists are leaning in, and doing what is right for you, your family, and your profession.” great success. Will pharmacists be successful in providing care to patients in emerging healthcare models? Will pharmacists have the opportunity to provide care in traditional models? Will pharmacist services be demanded by patients? Will we be recognized and compensated as healthcare providers?

I believe the answer to these questions is yes - but not if pharmacists stand idly by. We need an organized approach and strong leadership. Lean in to your profession by becoming a preceptor, becoming an IPA member, being an advocate, and having a voice.

“…. In the future, there will be no female leaders. There will just be leaders.”

As the book concludes, “Each individual’s success can make success a little easier for the next. We can do this – for ourselves, for one another, for our daughters, and for our sons….

In the future, there will be no female leaders. There will just be leaders.”

So it is true in pharmacy. Pharmacy needs more leaders. I hope you will join the countless IPA members who have leaned in to the profession of pharmacy over the past 134 years.

How have you decided to lean in to your profession? Share your thoughts on IPA’s LinkedIn Discussion group or Facebook page.

July/Aug/Sept 2013 |

5

President’s Page

B Michele Evink

MS, PharmD, CGP, FASCP IPA President Presidential Address delivered at IPA’s 2013 Annual Meeting

eing president elect offered a great opportunity to travel to Washington and meet other pharmacy leaders. In my conversation with the president of the North Carolina Association, she shared that her children’s school had recently changed from the stoplight method (red, yellow, green) of rating the children’s days to a five color system and now a seven color system.

She quipped that it had become challenging. For instance, orange used to represent a pretty bad day under the five color system, but had moved up in the seven color system. What’s the best color day you can have, I asked?

Sparkle, she shared.

I welcome you to what I plan to be a sparkle presidency.

To those who know me, it wouldn’t surprise them to find me talking about music in my remarks. I live by the motto that there’s a song for everything and routinely attach a song to even the most every day tasks. As a child, when asked what I would like to be when I grew up, I’d often remark an opera singer. Later, I really felt my college major should be performance flute.

On hearing this, my dad told me flute was a nice hobby and I needed to find a career. Later, as I reflected on this I would tell him he was the only father in history to encourage their child to do drugs to support a flute habit.

My love for music and deep appreciation for it in its many forms brings me to the need for a personal theme song. You won’t be surprised that my adopted theme song is not “Memories” or “The Way We Were”. It’s kicky, upbeat, forward thinking and, from Disney.

More than focusing on where it comes from, I want to share with you the refrain that inspires me. It goes like this:

6

| July/Aug/Sept 2013

This could possibly be the best day ever And the forecast says that tomorrow will likely be a million and six times better So make every minute count, jump up, jump in, and seize the day And let’s make sure that in every single possible way Today is gonna be a great day This could possibly be the best day ever It could be the best day ever. But how does that happen? In pharmacy, it happens because great pharmacists like those in Iowa look at the possibility of each day and wonder how to make it the best day ever. They see opportunity in the challenges we face. They push to find an answer that meets the current needs of our patients and our profession. They create a practice that allows this day, this time, to be the best ever in pharmacy.

The best day ever happens when pharmacists find ways to make it the best day ever. They believe in their unique ability to promote proper medication use.

What does my best day ever look like?

It will contain the perfect moment when the information I provide collides perfectly with the moment it’s needed.

Sometimes that looks like predicting a drug level and hitting the mid range of a goal level. Sometimes, that looks like asking just right question of a patient to avoid a medication misadventure when they go home. Sometimes, that looks like reassuring a patient they are not the only one in need of medication to treat a mental illness. It’s encouraging

patients to use their medications to make their quality of life better.

Often, that means involving the patient in creating a plan to reach their goals.

After all, I entered pharmacy to be the librarian of medication information. Back in the day the librarian ruled information. They stood behind their giant counters and directed me to the perfect aisle, the perfect book, the perfect article.

I grew up with the same vision of pharmacists. The pharmacist directed me to the perfect medication, the perfect remedy. The best day ever.

And the forecast says that tomorrow will likely be a million and six times better.

The promise of pharmacy throughout my career has been that the future will be a place where pharmacists flourish in our roles as medication experts. In the short twenty-four years I’ve been a pharmacist, I’ve seen huge changes in the profession.

The largest change was probably the national switch to all PharmD programs. The forecast said that pharmacists would need to be trained with a stronger clinical focus to meet the needs of the profession for the future.

The forecast said pharmacists were going to need to move from behind the counter in the community and out of the basement in the hospitals to be available to provide information to our patients and our colleagues.

The forecast said pharmacists were going to need to be the shepherds of increasingly complex medication therapy.

This forecast has been 100% accurate! We have taken our place as medication experts. Pharmacists have become responsible for the information we provide to our

patients. We have moved front and center to serve both our patients and the providers around us.

So make every minute count, jump up, jump in.

What does every minute look like?

It looks like each encounter with a patient or another health care provider. A minute is the chance to educate, improve and learn together.

A minute is when you ask the right question and avoid a collision or fix a conflict.

However, it’s also jumping up and jumping in. It’s being the one to volunteer to consider new board of pharmacy rules. It’s putting yourself in front of your legislator. It’s reaching out to students. It’s putting yourself into the situation to try to make it better.

And seize the day.

Then, you must seize the day. Carpe Diem. There are opportunities that must be seized. By allowing them to pass by, we can miss the chance to ride a swelling wave or foresee a falling floor.

Part of our responsibility is to predict the future, forecast pharmacy for tomorrow. We must be ever vigilant to watch for changes that might seem like a neutral change, but can have a huge impact on the profession of the future. We must analyze change for unforeseen consequences.

Where would we be today if when the rules were being written for Social Security, pharmacists had insisted on being included as providers? At the time, pharmacists hadn’t worried about being paid for cognitive services because the margins on our product services were covering the services we provided. We are now scrambling to catch that wave that began decades ago. We must remain

vigilant to prevent a similar wave from passing us by.

We must be prepared to catch the swelling wave and help the profession ride it for our patients.

I often think of the dawn of Medicare Part D and the swelling wave it created. For the first time, phrases like medication therapy management were being tossed around in a large, public arena. The role pharmacists play in protecting the health of patients through our non-product contributions was realized and valued.

Fourteen years ago, Outcomes was created to reimburse pharmacists for those efforts. It took nearly nine years to pay out the first million dollars to pharmacists. But the day has been seized and we have started to ride this wave. Today, Outcomes pays out nearly a million dollars a month to pharmacists to provide these services. The wave continues to swell and we must make sure we’re there to both ride and harness the energy of that wave.

As I look at the goals of the pharmacy practice model initiative, I see the following themes: • Move pharmacists closer to the patient • Responsibility for safe use of medications and ensuring quality July/Aug/Sept 2013 |

7

President’s Page

continued from page 7...

• Well-developed technician workforce • Wide-spread use of technology Doesn’t that sound like a perfect opportunity to seize the day?

How about this?

Accountable Care Organizations (ACOs) are one way CMS is working to ensure better health care, better health, and lower growth in expenditures through continuous improvement.

Pharmacists are scientists with great access to patients and incredible information about medication therapy. Jump up, jump

in and be there for our patients and improvement of their health.

There are great things going on all around us that give pharmacists the opportunity to seize the day. We must remain vigilant and participate in these events to move the profession forward to the future we’ve forecasted and improve patient care.

Let’s make sure that in every single possible way, today is gonna be a great day.

We have great resources as a group.

The pharmacists surrounding you in Iowa represent some of the most talented professionals in the nation.

Look to each other for support and inspiration. Ask each other for assistance and input. Together, we move forward making sure that in every single possible way, today is gonna be a great day.

I’m infinitely honored to stand before you as president of the Iowa Pharmacy Association. I’m proud of our association’s work to unite the profession’s many practice settings.

Our pioneering work to bring the profession together is indicative of the marvelous things Iowa pharmacists can do together. Be assured, today is gonna be a great day.

GOES ELECTRONIC IPA’s Board of Trustees recently voted to send an electronic version of the IPA Journal each quarter in addition to members receiving a printed copy.

Members can request to receive the digital version only by contacting the IPA office.

Student pharmacist members will only receive the e-version quarterly.

Be on the look out for IPA’s e-Journal to hit your email inboxes every quarter!

8

| July/Aug/Sept 2013

2013 annual meeting

ANNUAL MEETING WEEKEND RECAP

T

his year’s 2013 IPA Annual Meeting was made a success by more than 240 pharmacists, pharmacy technicians, student pharmacists and pharmacy professionals. The meeting was held in Coralville, IA on June 22-23.

pharmacists developed a report with recommendations to the profession of pharmacy relating to patient safety.

Task Force panelists shared lessons learned, best practices, and the consensus recommendations from the report.

Themed JUMP RIGHT IN, IPA members did just that, by debating, discussing and ultimately adopting policy statements to address issues affecting the profession of pharmacy. Members were engaged in conversation with national pharmacy leaders on new efforts to obtain pharmacist provider status and what it means for practicing pharmacists.

Speaker of the House, Carrie Koenigsfeld presided over the final policy debate as well as the nomination of the 2013 Honorary President of Mark Jones from Davenport, ratification of the Nominations Committee Report, installation of Randy McDonough as Speaker of the House and the election at the 2013-2014 Vice Speaker of the House that went to Connie Connolly of DeWitt.

The House of Delegates Session II kicked off Sunday morning starting with the Iowa Patient Safety Task Force Report and Best Practice Pearls. Through an active task force in 2012-2013 led by IPA and the Iowa Board of Pharmacy,

Policy statements were adopted to address: 1) Preferred Pharmacy Networks 2) Regulation of Compounding Practices

3) Classification and Regulation of Medications with Abuse Potential 4) Provider Status Recognition 5) 340B Drug Pricing Program 6) Veterinary Medication Distribution In addition, the IPA House of Delegates addressed two New Business Items, “Iowa Patient Safety Task Force” and “Antipsychotic Medication Use”; both were adopted into policy by the House of Delegates.

This journal highlights the weekend’s main events, including: • Inaugural address by IPA President, Michele Evink • Speakers address by Carrie Koenigsfeld • Policy adopted by the House of Delegates • Sponsors and contributors • Presentation of professional awards • IPA-F Silent Auction

July/Aug/Sept 2013 |

9

10

| July/Aug/Sept 2013

July/Aug/Sept 2013 |

11

2013 annual meeting

A Carrie Koenigsfeld

MS, PharmD, CGP, FASCP IPA President Speaker of the House Address delivered at IPA’s 2013 Annual Meeting

t one of our Board meetings this past year, a few members were discussing things on their bucket lists. One stated they were taking up running as a new exercise option. With this being a milestone year for myself (I’m not going to tell how old I will be), I had also been considering this at some point in my lifetime. Having never been a runner myself, instead of consulting the many avid runners in our profession, I decided to consult a less reputable resource : “Running for Dummies.” The first few pages talk about taking your first run or possibly returning to the sport after a layoff. It suggests the following as you journey into this new sport: 1) Run at a comfortable pace until you begin to feel fatigued, 2) slow down and start walking briskly, and 3) when you feel like you can begin running again, start running. With our theme this weekend of Jump Right In, I thought it fitting to draw a connection to these words of wisdom.

1) “Run at a comfortable pace until you begin to feel fatigued.” Many in this room started their career running straight out of the gate, possibly being guided along by a mentor or colleague, and never looking back. Enthusiasm, passion, endurance, pride, teamwork. These are all words that come to mind when we think of Iowa pharmacy. This weekend, don’t be afraid to join the race. There are many important policy topics that we will discuss this weekend. No matter what practice setting you are in, they all have the potential to impact our pharmacy world, some of them directly and some more indirectly.

Remember we are ALL on the same team, and our teams’ goal is to ensure the best care possible for patients and to ensure we can do this for many years to come.

I encourage all of you, those attending this meeting for the first time and those who are more “seasoned”, to stand up and share your voice this weekend.

Remember dissonance is good; we all have an opinion and these opinions are what makes our pharmacy association so successful.

12

2) “Slow down and start walking briskly.” As we discuss the many topics this weekend, remember to slow down | July/Aug/Sept 2013

and listen. I realize I just told you to come to the microphone to share your thoughts, but then take a deep breath, slow down, and listen as others share their perspective. Remember the best ideas come from putting it all on the table.

This statement I also feel directly relates to the balance of our professional and personal lives. We have many priorities.

A wise friend recently shared with me: “consider how pretty a bouquet of flowers is when arranged properly.” What makes us one of the most trusted health care professional is that we are all real people.

Being actively involved in our profession takes significant time and energy. It’s important that we remain cognizant that nurturing all the flowers in our bouquet will ensure we bloom for many years to come. There may be times in our careers where we need to slow down and reflect upon where we have been and where we would like to go. Our balance may require a shift from time to time. This does not mean we leave the team, but we might hand the baton to another runner while we remain in the stadium. In this notion, this weekend, take the time to meet someone you have never met before or possibly encourage someone else to get more involved. Give them your support. I know there have been multiple times in my professional career where people in this room have encouraged me to step out of my comfort zone, try something new, or possibly run for an office. I thank you all for this. This personal encouragement and support we can offer each other will ensure our association remains energized with significant depth in our bench for many years to come.

3) “When you feel like you can begin running again, start running.” In regards to this meeting, after you have listened to the discussion and are refreshed following a great dinner meeting many new friends last night, know when to break the silence. We are all likely to wake up tomorrow fired up. However, as Helen Keller so eloquently stated- “I long to accomplish a great and noble task, but it is my chief duty to accomplish small tasks as if they were great and noble.” Ponder specific action steps for the issues we discuss and consider what your role might

2013 annual meeting

be in achieving them. Consider your strengths, which are often directly related to your passions, your true motivators. Remember your time is precious so set your focus to your passions. I want each of us to leave this weekend knowing what needs to be done and having clarity in knowing a role you are willing to play if called to serve.

I now bring you back to the bucket list. I’d like to ask all of you to reflect right now on what is in your bucket list and consider both your personal and professional bucket list. Is it sky diving? Is it a dream vacation? Is it training dolphins at Sea World? Yes, another one of mine. Is it serving in a leadership role in the future with IPA or possibly a new career opportunity you would like to pursue? Or maybe it is simply spending more time with your friends and family and slowing down. Whatever it is, it is likely

something that brought a smile to your face just thinking about it. As we walk (or run) through this meeting together this weekend, I want to encourage you to keep that smile.

Have fun. Share your bucket list with others and discuss how you can make those things happen. Find commonalities you were unaware others shared with you in this room.

Remember this is our weekend to recharge, to get the necessary annual tune-up we all need and to focus on what is important to us to make our bouquets complete.

We have been running hard for this past year. We have actively participated in committees, served in leadership roles, and attended many local, state and national meetings. We have had many success stories, such as expanded pharmacist immunization authority, and continue to run the relay towards the finish line of provider status and

equitable payment for medications and services. Although we have an agenda of policies to discuss this weekend, this weekend is about our pharmacy family. I thank all of you for the opportunity to serve as your Speaker this past year and wish you all a successful meeting.

AARON THOMAS INSPIRES ANNUAL MEETING one year after he led the effort to rebuild the community of Parkersburg following an EF-5 tornado in May 2008. Aaron’s incredible story to IPA members focused on his dad’s life and the family’s loss, and how the Thomas family showed uncommon strength during the darkest of times.

Rather than shun the family of their father’s murderer and perpetuate the tragedy that Parkersburg faced, Aaron and his family called for understanding and forgiveness— because that’s what Ed Thomas would have wanted them to do.

Aaron Thomas, the son of AplingtonParkersburg’s beloved football coach, Ed Thomas, was the keynote speaker at the 2013 IPA Annual Meeting.

Coach Thomas was murdered by a former player in June 2009, just

IPA members were a captive audience, as many pharmacists, technicians, and student pharmacists related to the stories of community, high school sports, and mentorship from a small town in Iowa. The story of the Thomas’s tragedy brought many to tears.

Aaron’s message inspired those in attendance to be better community leaders, better parents and children, and better people. If you missed this incredible presentation, you can learn more about the Thomas’ story by viewing the 2010 ESPY Award YouTube video (http://youtu.be/ukodLTOTens).

FOLLOW AARON

on Facebook (Aaron Thomas) or Twitter (@aaronwthomas).

See Aaron’s Facebook post prior to speaking at Annual Meeting: ”Excited to speak for the Iowa Pharmacy Association in a couple minutes. I am confident I have the lowest ACT in the room! #ETFF Legacy cont” July/Aug/Sept 2013 |

13

2013 annual meeting

T

he Iowa Pharmacy Association’s 2013 House of Delegates welcomed over 100 delegates consisting of pharmacists, pharmacy technicians, and student pharmacists to Coralville on June 22-23, 2013. The chairs of the Policy Committees on Public and Professional Affairs presented their thoughtful recommendations to the House for debate. The direction of the Iowa Pharmacy Association will be led by the following policy statements that were adopted by the delegates:

3. IPA supports the collaboration of the Iowa Board of Pharmacy, other Boards of Pharmacy, and the FDA in regulating non-resident pharmacies licensed by the state of Iowa that primarily engage in the practice of compounding, with ultimate authority by the Iowa Board of Pharmacy.

13-U3: Classification and Regulation of Medications with Abuse Potential

13-U1: Preferred Pharmacy Networks

1. IPA recognizes that prescribers, pharmacists, and patients each have a collaborative responsibility to prevent medication abuse and misuse, to avoid patient harm, and to protect public health.

2. IPA supports pharmacy benefit design that allows any willing pharmacist or pharmacy the opportunity to negotiate a transparent and non-restrictive contract to participate in a preferred pharmacy network.

2. IPA supports evidence-based measures and system-wide sharing of information in an efficient manner to help decrease the problem of medication abuse and misuse.

1. IPA reaffirms 85-RES3, 90-U2, 95-U1, 02-NBI-02.

3. IPA encourages pharmacy benefit design that is clear, transparent, and standardized in order for patients to make informed decisions regarding plan enrollment, co-payment structure, and access to pharmacy services.

13-U2: Regulation of Compounding Practices

1. Reaffirm IPA Policy 93-U3.

2. IPA supports the compounding of customized medications to help meet the needs of patients who have unique health concerns and that are compounded utilizing

14

quality and safety standards.

| July/Aug/Sept 2013

3. IPA supports initiatives to prevent medication abuse and misuse that do not place a disproportionate burden on any one health care provider or other stakeholders.

4. IPA encourages increased clarity in the DEA’s classification structure of drugs with abuse potential. IPA supports a classification structure that creates clear and measurable criteria for assessing a drug’s abuse potential.

5. IPA encourages ongoing monitoring of the effect of rescheduling medications and

other abuse-prevention efforts (e.g. prescription monitoring programs, prescriber education) to assess the impact on: • Patient access to medications • Appropriate use of medications • The burden on health care providers

13-R1: Provider Status Recognition

1. Reaffirm IPA Policy 99-NBI-01 2. IPA supports national, state, and local advocacy to recognize pharmacists as health care providers who improve access, quality, and value to patient care.

3. IPA advocates for patient access to pharmacists’ clinical services in public and private health plans by properly valuing these services in payment models.

13-R2: 340B Drug Pricing Program

1. IPA recognizes the 340B drug pricing program as a means to ensure patient access to medications and safety net providers.

2. IPA supports the education of pharmacists and pharmacy technicians on available resources to properly utilize the 340B drug pricing program.

13-R3: Veterinary Medication Distribution 1. IPA supports collaboration with the Iowa Veterinary Medical Association and professional licensing boards to develop best practices for the distribution of veterinary medications or drug products.

2. IPA supports the animal owner’s right to access veterinary medications or drug products at a licensed pharmacy equipped with veterinary drug information references and policies and procedures.

3. IPA encourages pharmacists who dispense veterinary medications or drug products to complete appropriate continuing professional education.

New Business Items

In addition, two New Business Items (NBI) were presented for the House to discuss. Delegates Cheryl Clarke and Connie Connolly introduced NBI-1 for IPA to support the recommendations of the Iowa Patient Safety Task Force (PSTF). (See page 22 for Executive Summary of PSTF). NBI-2 was introduced by delegates Justin Rash and Kristin Meyer for IPA to support appropriate antipsychotic medication use in nursing facility patients. Both New Business Items were adopted into policy by the House of Delegates as written:

13-NBI-01: Iowa Patient Safety Task Force

1. IPA supports the consensus recommendations of Iowa Patient Safety Task Force including: A. Review of pharmacist in charge responsibilities by the Iowa Board of Pharmacy: The Board of Pharmacy Rules Committee shall update the responsibilities of pharmacists, pharmacists in charge, and pharmacy license holders.

B. Evaluation of the Oregon Board of Pharmacy rules pertaining to patient safety: The Board of Pharmacy, in cooperation with the Iowa Pharmacy Association, shall consider the current Oregon rules related to patient safety for adoption in Iowa including advertising or soliciting that may jeopardize patient safety; providing sufficient personnel and time to practice safely; and providing opportunities for rest periods and meal breaks.

C. Establishment of a standing joint committee: The Board of Pharmacy and IPA shall establish a joint committee to promote public

awareness and education regarding the pharmacist’s role in health care.

D. Creation of a communication process: The Board of Pharmacy and IPA shall establish a communication process to share best practices related to patient safety, medication error prevention, quality improvement, and related matters.

13-NBI-02: Antipsychotic Medication Use

1. IPA supports pharmacist integration into an interdisciplinary team in nursing facilities that is focused on the appropriate use of antipsychotic medications in maintaining functional status and improvement of the quality of life in these specific patient populations.

2. IPA supports nonpharmacologic approaches as initial therapy for management of behavioral and psychological symptoms of dementia, when feasible, unless behaviors present immediate serious threat to the patient or others.

July/Aug/Sept 2013 |

15

2013 annual meeting

THANK YOU IPA BOARD MEMBERS 2013-2014 IPA Board of Trustees:

IPA would also like to welcome the incoming 2013-2014 Board of Trustee members. The 2013-2014 BOT met for a strategic planning retreat July 10-11 at Bos Landen in Pella, IA, where they reviewed the Strategic Plan and Leadership Agenda and updated IPA’s Priority Projects to guide the Board and staff in the upcoming year. The Board also heard a presentation from David Lyons, CEO of CoOpportunity Health, on health insurance exchanges, upcoming changes and opportunities for pharmacists to be aware.

2012-2013 Board of Trustees Members pose for a picture at IPA’s Annual Meeting. (L to R) Front Row: Carrie Koenigsfeld, Michele Evink, Julie Kuhle and Kate Gainer. Second Row: Marilyn Aldrich, Cheryl Clarke, Linda Krypel, Susan Vos, Kara Llano and Michelle Garvin. Back Row: Pat Thies, Randy McDonough, Carl Chalstrom, Gayle Mayer, Lori Schirmer and Steven Martens. (Not Pictured: Bill Robinson, Natalie Schmitz, Al Shepley, Luke Watson and Kristin Williams).

Outgoing 2012-2013 IPA Board of Trustee Members:

IPA would like to sincerely thank the members listed below for their dedication and service to the profession of pharmacy in Iowa. The outgoing Board of Trustee members have served the association during an important time of transition. The time and effort that these members gave to direct IPA and ensure a smooth transition of leadership has been invaluable.

Carl Chalstrom, RPh, Anamosa - Chairman of the Board Carrie Koenigsfeld, PharmD, Johnston - Speaker of the House Al Shepley, RPh, Mount Vernon - Treasurer Linda Krypel, PharmD, FAPhA, Des Moines - Honorary President Gayle Mayer, RPh, Spirit Lake, - Trustee, Region 2 Kara Llano, PharmD, Rock Island, IL - Trustee, Region 4 Bill Robinson, RPh, Oakland - Trustee at Large Kristin Williams, PharmD, Council Bluffs - Trustee at Large Susan Vos, PharmD, BCPS, Iowa City - Trustee at Large Natalie Schmitz, 2014 PharmD Candidate, Drake University Luke Watson, 2014 PharmD Candidate, University of Iowa

Julie Kuhle, RPh, Indianola - Chairman of the Board Michele Evink, MS, PharmD, CGP, FASCP, Osceola - President John Swegle, PharmD, BCPS, Mason City - President-Elect Randy McDonough, PharmD, MS, CGP, BCPS, Iowa City Speaker of the House Steve Firman, RPh, Cedar Falls - Treasurer Connie Connolly, RPh, DeWitt - Vice Speaker of the House Mark Jones, RPh, Davenport - Honorary President Steven Martens, PharmD, Grundy Center - Region 1 Trustee John Daniel, PharmD, Fort Dodge - Region 2 Trustee Lori Schirmer, PharmD, BCPS, BCNSP, West Des Moines Region 3 Trustee Ashley Dohrn, PharmD, Le Claire - Region 4 Trustee Pat Thies, RPh, MS, FACHE, Cedar Rapids - Region 5 Trustee Marilyn Aldrich, RPh, Urbandale - Trustee At-Large Cheryl Clarke, BPharm, RPh, CHC, Des Moines - Trustee At-Large Felix Gallagher, PharmD, Des Moines - Trustee At-Large Justin Rash, PharmD, CGP, Ankeny - Trustee At-Large Michelle Garvin, CPhT, Wilton - Pharmacy Technician Matt Farley, 2015 PharmD Candidate, University of Iowa Kelsey Lawfer, 2015 PharmD Candidate, Drake University

Pharmacy Leadership is Important Join your colleagues in addressing the diverse opportunities for pharmacy. Please consider serving on the Board of Trustees or IPA Committee.

• Contact Anthony Pudlo at apudlo@iarx.org.

16

| July/Aug/Sept 2013

Newly elected Board of Trustees Members being sworn in at IPA’s Annual Meeting. (L to R) John Swegle, Steve Firman, Randy McDonough, John Daniel, Felix Gallagher and Ashley Dohrn.

THANK YOU ANNUAL MEETING CONTRIBUTORS AND SPONSORS Amgen Cardinal Health CarePro Health Services Advance Health CarePro Compounding Pharmacy CarePro Home Infusion Pharmacy Liberty Pharmacy Tipton Pharmacy Shepley Pharmacy A Avenue Pharmacy CarePro at the Pavilion

CSL Behring CVSCaremark Drake University College of Pharmacy & Health Sciences Iowa Immunization

Coalition IPA Foundation

Iowa Pharmacy Recovery Network Iowa Prescription Drug Corporation iMedicare McKesson Nucara Pharmacies Omnicell Otuska OutcomesMTM PBA Health Pharmacists Mutual PharmServ Sharps Silent Auction Contributors University of Iowa College of Pharmacy QS1

SUPPORT FOR STUDENT ATTENDANCE: William Baker Tim Becker Carl Chalstrom Cheryl Clarke Kate Gainer Steve Firman Dennis Jorgensen Julie Kuhle

Ed Maier Kristin Meyer Jim Miller Lisa Ploehn Anthony Pudlo Morgan Sayler Al Shepley

July/Aug/Sept 2013 |

17

2013 annual meeting

2013 PROFESSIONAL AWARDS The Iowa Pharmacy Association takes great pride in recognizing individuals for their contributions of leadership, patient care, professional involvement and public service. The following awards, presented by IPA’s Chairman of the Board, Julie Kuhle, and IPA’s Executive Vice President & CEO, Kate Gainer, during the associations 2013 Annual Meeting, serve to capture Iowa pharmacy’s spirit of service and its culture of professionalism.

Bowl of Hygeia Award - Bernie Cremers, RPh, Iowa City

18

Robert G. Gibbs Distinguished Pharmacist Award Raylene Rospond, BS, PharmD, FCCP

Honorary President Award - Linda Krypel, PharmD, FAPhA

Distinguished Young Pharmacist Award Matthew Cantrell, PharmD, BCPS Presented by Karla Krogman, Bobby Albright and Kim Dornbier, Pharmacists Mutual

Excellence in Innovation Award Heather Ourth, PharmD, BCPS, CGP

| July/Aug/Sept 2013

Health System Pharmacist of the Year Award - Lisa Mascardo, RPh

Patient Care Partner Award - Crescent Community Health Center (L to R) Julie Woodyard, Exec. Director and Jim Miller

Individual Appreciation Award - Epilepsy Task Force (L to R) Brett Barker, Geoff Wall and Chasity Mease

Corporate Appreciation Award - PBA Health Jim Young, JD, Director of Third Party Services

Pharmacy Technician of the Year Award - Spencer Hospital 7 Certified Techs who implemented Tech-Check-Tech

GenerationRx Award - Jennifer Seyfer, RPh Presented by Cardinal Health’s Kylie Bobbett & Shane Smith

Poster Presentation Award - John Hamiel PharmD “Demonstrated Improvement of Dispensing Accuracy Through Implementation of Tech-Check-Tech” Presented by Tim Becker, IPA Foundation

Poster Presentation Award Honorable Mention Craig Logemann, Jerod Work and Gayle Mayer (L to R) Craig Logemann, Jack Van Norman & Jerod Work “It Takes a Pharmacist to Raise a Village of Pharmacists: The Story of Swea City, Iowa and Arlan “Jack” Van Norman” July/Aug/Sept 2013 |

19

2013 annual meeting

50-Year Pharmacist Award - Judy Woolums & Gus Erickson IPA pays special tribute to pharmacists who have achieved the milestone of 50 years of professional practice and service to the Iowa public.

2013 Honorees: Monte Baugher, West Des Moines Robert Bellinger, Fort Dodge Byrl Blackmer, Ankeny Robbin Burns, Waterloo

William Dimig, Atlantic Gus Erickson, Clear Lake Thomas Hofer, Kalona Larry Hurst, Runnells Cornellius Maris, Spirit Lake Kenneth Moorman, Atlantic Robert Nieland, Eldridge Thomas Sullivan, Keosauqua Paul Twedt, Ames Judith Woolums, Ottumwa

A Buying group for independent retAil phArmAcies

...owned by 19 state pharmacy organizations ...a leader negotiating on behalf of independents ...saving pharmacies money for more than 25 years ...financially supports the state pharmacy organizations ...serving pharmacies nationwide

1-888-200-0998 | www.pacealliance.com

20

| July/Aug/Sept 2013

2013 annual meeting

IPA 2013 LEADERSHIP DINNER

c

urrent and past leaders of the Iowa Pharmacy Association and IPA Foundation gathered for an evening of fellowship and recognition of IPA’s 2012-2013 leaders. IPA thanked outgoing Board of Trustee members, Committee chairs, IPA Foundation Directors,

Board of Pharmacy members, national pharmacy leaders, Deans, and past presidents and honorary presidents for their service and commitment to the profession of pharmacy. Equally important, IPA thanked the spouses and families of these individuals for their support.

2012 - 2013 Committee and Task Force Chairs recognized

THANK YOU, RAYLENE ROSPOND

T

he guest of honor at IPA’s 2013 Leadership Dinner was Raylene Rospond. A portion of the evening was dedicated to recognizing Raylene for her 10 years of service to the profession and College of Pharmacy and Health Sciences at Drake University as Dean. In preparation for receiving IPA’s highest honor – the Robert G Gibbs Distinguished Pharmacist Award - IPA’s CEO, Kate Gainer, presented Raylene a special medal to wear for the weekend. In addition to comments provided by Gainer on behalf of the Iowa Pharmacy Association, Dean Don Letendre and Drake alumnus Melissa Corrigan shared special remarks with those in attendance. Though unable to attend in person, remarks were also provided by Deneese Jones, PhD, Drake University Provost; Jack Ellis, Drake alumnus and NAC member; Lucinda Maine, Executive Vice President of AACP; and recent Drake graduate Jordan Ruestman.

“Only in Iowa would the Dean from another college be invited to give remarks recognizing the service and leadership of a Dean from another institution. I am proud of all Raylene has achieved for the College of Pharmacy at Drake, and to call her a colleague. And a friend.” ~ Dean Don Letendre Raylene Rospond

Raylene’s Family (L to R) Doyle Woods, Cloretta Woods, Joshua, Scott, Ethan and Raylene Rospond

“Raylene appreciates the juggling act more than many. For years she has juggled so many professional and personal priorities so successfully and has contributed tremendously to AACP and academic pharmacy.” ~ Lucinda Maine “… She had so much excitement and enthusiasm for pharmacy and the changes we could make in the profession. She talked to us and treated us like we were already professionals and left us with a challenge every time she spoke to us. This was my FIRST week of college, and I walked out of Dean’s Hour thinking, ‘what changes can I make to improve the profession?

How can I lead?’ … I can’t thank her and Drake enough.” ~ Jordan Ruestman

“The collaboration between pharmacy stakeholders in the state of Iowa is truly unique… This collaboration exists because we continually work to share ideas, foster innovation and openly communicate. Your leadership at Drake has contributed immensely to the state of Iowa’s reputation.” ~ Kate Gainer “You have led Drake into a premier institution, one of which I could not be more proud. It is fair to say that you are the person singly most responsible for that reputation. .. On a personal level, your interest in the well-being of my late wife Audrey has been touching in a way that goes beyond expression.” ~ Jack Ellis

July/Aug/Sept 2013 |

21

feature article

THE IOWA PATIENT SAFETY TASK FORCE EXECUTIVE SUMMARY - JUNE 2013

B

ackground

Two primary priorities of the Iowa Pharmacy Association (IPA) and the Iowa Board of Pharmacy (IBOP) are patient safety and the prevention of prescription medication errors. Both organizations work closely with one another to address prescription accuracy and quality concerns to improve the pharmacy profession and patient outcomes. To further this effort, IBOP solicited input from pharmacists on workload issues by sending Pharmacist Opinion Survey on Workload Issues in 2011. The results of the survey highlight areas of concern to respondents: • Certain business practices interfere with the pharmacist’s ability to serve as the safety net in the medicationadministration process.

• The IBOP should require pharmacies/pharmacists-in-charge to determine and make pharmacyspecific policies for maximum average number of prescriptions dispensed per pharmacist per hour.

• Pharmacy companies should not be allowed to offer incentives to encourage patients/customers to transfer prescriptions.

• Pharmacies should have a required meal break for pharmacy staff.

22

| July/Aug/Sept 2013

In addition, IPA’s House of Delegates adopted policy 11-U1 Pharmacy Workplace and Patient Safety in 2011 to address patient safety and medication errors in the following ways: • IPA supports identification, monitoring, and evaluation of practice and workplace concerns as they relate to medication-error prevention and patient safety.

• IPA shall establish A Culture of Safety in the Workplace Committee to include practicing pharmacists, administrative and corporate leadership, academic researchers, student pharmacists, and pharmacy technicians for the purpose of addressing common workplace concerns affecting patient safety.

In recognition of the need for a task force to address these issues, IPA and IBOP collaborated to form the Iowa Patient Safety Task Force (PSTF) in 2012. IPA and IBOP solicited volunteers through communications to all Iowa pharmacists to participate on a task force addressing patient safety and pharmacy practice environments. On April 27, 2012, a joint press release announcing the members of the task force and their goals was released. The members were charged to discuss pharmacy

work environments and the patient safety implications connected to these environments in order to present recommendations to IPA and IBOP.

Patient Safety Task Force Workgroups and Process

IPA and IBOP received 112 applications from Iowa pharmacists to participate on the PSTF, and 46 total members were selected by the staff of IPA and IBOP to serve on either the management or practitioner subgroup. To lead the two subgroups, four committee co-chairs were selected based on previous committee and Board experience.

The PSTF includes Iowa-licensed pharmacists, Board members of IPA and IBOP, and pharmacy management employees from a variety of pharmacy practice settings.

The volunteers selected attended meetings and actively participated in the process to determine consensus recommendations to present to IPA and IBOP to improve patient safety and pharmacy workplace environment.

The first three meetings of the PSTF (June–November 2012) were structured so that each subgroup met separately to discuss their concerns and ideas. By allowing each group to have their own meetings with

feature article pharmacists in similar positions, the members felt more comfortable participating in group discussion.

Both subgroups evaluated workplace issues and patient safety, public perception of pharmacists, and the best practices for a culture of safety in all pharmacy settings. The practitioner subgroup focused on issues faced in their pharmacies and personal struggles with providing prescriptions and patient care services in a safe environment. The management group discussed currently implemented safety measures, while focusing on the role pharmacists should play in the broad healthcare system. After discussing the patient safety and workforce topics, each group voted to select the top three areas for which they would present recommendations to the full Patient Safety Task Force.

Key areas of focus included: • pharmacist role in healthcare system • professionalism • public perception of pharmacists • work environment/culture/resources • technology and pharmacy technicians • medication errors • “Just Culture” and error reporting The fourth meeting was structured as a Joint Committee meeting and included representatives from both subgroups to discuss the final recommendations and determine areas of consensus.

Consensus Recommendations

On March 6, 2013, the final meeting of the PSTF included 9 members from each subgroup and their committee chairs to finalize the combined recommendations of both subgroups.

The Joint Committee members openly discussed and came to consensus on four recommendations that satisfied both the practitioner and management subgroups. These final recommendations include: 1. Review of pharmacist-in-charge (PIC) responsibilities by the Iowa Board of Pharmacy. The Board of Pharmacy Rules Committee shall consider the

responsibilities of pharmacists, PICs, and pharmacy license holders.

2. Evaluation of the Oregon Board of Pharmacy rules pertaining to patient safety by the Iowa Board of Pharmacy with input from the IPA House of Delegates.

Summary of the Oregon rules:

• Prohibits advertising or soliciting that may jeopardize patient health, safety, or welfare; • Prohibits advertising that is false, fraudulent, deceptive, or misleading; • Prohibits the pharmacy from incenting or inducing the transfer of a prescription absent professional rationale; • Requires the pharmacy to provide sufficient personnel to prevent fatigue, distractions, or conditions that interfere with a pharmacist’s ability to practice safely; • Requires the pharmacy to provide opportunities for rest periods and meal breaks; • Requires the pharmacy to provide adequate time for a pharmacist to complete professional duties and responsibilities; and • Prohibits introduction of external factors such as productivity quotas or programs such as time limits that interfere with the pharmacist’s ability to provide appropriate professional services.

3. Establishment of a standing joint committee of IBOP and IPA to promote public awareness and education regarding the pharmacist’s role in health care.

4. Creation of a process for Iowa pharmacy professionals to communicate patient safety, medication errors, quality improvement information, and related matters.

Conclusion

The Iowa Patient Safety Task Force demonstrated a valuable collaboration between the Iowa Pharmacy Association and the Iowa Board of Pharmacy. IPA and IBOP

brought together pharmacists from various practice settings to address pertinent topics involving pharmacy workplace environments and subsequent patient safety. Over 100 Iowa pharmacists responded to the request for participation on the task force, demonstrating the significant importance of patient and workplace safety. The development of separate practitioner and management subgroups allowed for pharmacists in similar positions to voice their opinions and suggestions in a comfortable environment.

The separate meetings exposed the differences in perception of the current culture and safety environment between the management and practitioner subgroups. The management subgroup maintained a focus on their current safety measures and pharmacist participation in the United States’ health care system. Conversely, the practitioner subgroup maintained a front-line focus by narrowing in on safety in the work environment and expressing concern about serving patients in a safe manner. Due to the different approaches for addressing patient safety, each subgroup established unique recommendations for the Joint Committee. At the beginning of this process, it seemed unlikely that consensus would be reached. However, after deliberation in the Joint Committee meeting, members from both subgroups agreed on a final list of four strong consensus recommendations to present to IPA and IBOP. Following the development of the task force consensus recommendations, and presentation to the IPA House of Delegates, IPA and IBOP must take additional action to complete the PSTF goals and objectives. The IBOP recommendations relating to administrative rules will need to pass through a formal rulemaking process.

In addition, IPA recommendations will be presented to the Board of Trustees for action. The final report of the Iowa Patient Safety Task Force is set to be released in the Fall of 2013.

July/Aug/Sept 2013 |

23

health care hot topics THE PROFESSION OF PHARMACY CONTINUES TO CHANGE AND EVOLVE WITH EACH DAY THAT PASSES. HERE IS A SHORT SUMMARY OF EVENTS THAT HAVE HAD AN EFFECT ON OUR PROFESSION. Plan B One-Step Approved for Women 15 years and Older

• On April 30, 2013, the FDA announced approval of Teva’s application to sell and market Plan-B One Step as overthe-counter for women ages 15 and older. The manufacturer, Teva, will now be allowed to place the product in OTC aisles so long as there is a pharmacy on site. The pharmacy does not need to be open in order to sell the pill. In addition, a new label will be placed on the medication stating that it is “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.”

The product will also have a code that, when scanned, will prompt the store employee to check the purchaser’s age. Security tags provided by Teva will be fastened to the product to deter stealing. The FDA explained their decision by citing a recent study that demonstrated 15 year olds understood how to properly take the medication, what it was capable of doing, and that it did not provide protection against STDs.

Decreased Medication Costs of 2012 • The amount of money

Americans spend on their medications decreased for the first time in over 55 years in 2012. Due to a bundle of patent expirations (i.e. Lipitor, Plavix), patients had cheaper generic medications available for the first time.

It is estimated that nearly $28.9 billion was attributed to savings generated by newly available generic medications.

The U.S. also spent one percent less on their medications in 2012 than in 2011 for a lower overall total of $325.8 billion. In addition, total per

24

| July/Aug/Sept 2013

capita spending on medications dropped 3.5 percent for a total of about $898 billion. IMS concludes that the drop in cost during 2012 is not an isolated year for savings, and in future years medication costs will continued to be lower than overall healthcare costs.

UnityPoint Health, the point of unity is you, reflects their team-based approach through patient-centered, coordinated care. This change has also allowed for further growth into other states, which will allow UnityPoint to share costs and resources in order to increase efficiency and quality of care for patients.

Performance Benchmarking System for Pharmacies and Health Plans • In March 2013,

Boston Bombing • The Boston

Pharmacy Quality Alliance (PQA) and CECity.com, Inc (CECity) launched Pharmacy Quality Solutions, Inc. (PQS). PQS is a joint venture that was created in order to launch the first national pharmacy quality measurement, benchmarking, and reporting platform for pharmacies and health plans, Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP). This new platform allows pharmacists to evaluate their performance as well as the quality of their patients’ medication use, across several patient plans, utilizing data sharing. EQuIPP will also provide resources to pharmacies in order to enhance continuous professional development and patient engagement. This will allow pharmacies to better adapt to a value-driven healthcare system.

Iowa Health System Now UnityPoint Health • In April 2013, Iowa Health Systems (IHS), including all affiliated services, changed their name to UnityPoint Health. The main focus of the new name and brand,

Marathon bombing on April 15th, 2013 shook the nation and the foundation of Boston’s healthcare system. Two hundred and sixty four people were injured, and three individuals were killed. Healthcare providers worked together, and any trained emergency room pharmacists helped wherever they were needed.

Pharmacy was a vital component of healthcare teams in providing the best care possible to the Boston Marathon injured patients.

Bashful? Buy Viagra Online

• On May 6th, 2013, Pfizer Inc. began selling Viagra online to patients with a prescription instead of having patients visit their local pharmacy to combat black market online sales of this multi-million medication. The prescriptions will be processed and delivered through CVS/ Caremark. Many investors and other industry drug makers are watching to see how Pfizer’s bold move will turn out, potentially leading to other companies to follow suit. To entice customers, Pfizer is offering three free pills with the first online purchase and thirty percent off the second to attract patients to participate.

July/Aug/Sept 2013 |

25

iowa pharmacy news

Pharmacy Reimbursement Concerns Continue • Pharmacy

drug product reimbursement has been a priority for IPA for nearly two decades. As PBMs gain greater control, and individual pharmacies have less control regarding payment for pharmacy products, advocacy from the profession is critical to community pharmacy practice. Two significant changes have impacted Iowa pharmacies in the past six months: 1. Acquisition of Wellmark’s PBM, Catalyst, to form Catamaran 2. Implementation of new Medicaid reimbursement methodology AAC + $10.02 IPA is working on several fronts regarding pharmacy payment concerns.

Iowa Insurance Division

In 2008, Iowa passed legislation authorizing the Iowa Insurance Division to adopt rules for the regulation of PBMs. Since that time, PBM practices have continued to evolve in a detrimental fashion for pharmacies. IPA first met with Iowa’s newly appointed Insurance Commissioner, Nick Gerhart, in January to discuss PBM practices.

Mr. Gerhart also presented at IPA’s Legislative Day and heard firsthand from many concerned pharmacy owners. Thus far, IPA has engaged in six meetings with the insurance commissioner and multiple communications with staff. The Insurance Division is also interviewing several pharmacies of different size to collect additional data to be used in making a decision how to best amend the current regulations. The insurance division has also created a guidance document specifically for pharmacy PBM complaints at: http://www.iid.state.ia.us/sites/ default/files/page/2010/07/28/ instructiontopharmacist_pdf_90653.pdf.

26

| July/Aug/Sept 2013

Catamaran

IPA participated in a meeting on June 18th with Wellmark, Catamaran, Iowa Insurance Division, and IPA members relating to pharmacy audit practices

by Wellmark’s new PBM, Catamaran.

The meeting addressed: Catamaran’s current audit process, their plan for the future, IPA member concerns, and next steps. Catamaran has been working to change their audit processes to communicate with pharmacies within 24-48 hours following a prescription fill that is outside their established algorithms and parameters of typical use. IPA and Board members that attended were appreciative of Catamaran’s willingness to listen and cooperate with pharmacists in Iowa to address egregious audits occurring across the state.

Medicaid

Over the past months, IPA has worked with Iowa Medicaid to ensure a smooth transition to the AAC reimbursement methodology. The primary concern reported to IPA from our members was problematic FULs below Iowa’s AAC, that were unable to be adjusted. The Iowa Medicaid Enterprise (IME) has implemented a process to manually override FULs that are below AAC retroactive as far back as February 1, 2013. Eligible medications for this override and the effective date for which a claim can eligible are available on IPA and IME’s websites. Providers may request that the IME review the FUL and average AAC price for the particular drugs through the Myers and Stauffer Help Desk at 800.591.1183.

While working on these important reimbursement issues, IPA’s Board continues to place an emphasis on creating new opportunities for pharmacy business models to position pharmacists as key health

care providers in accountable care organizations, medical homes, and other emerging health care delivery models.

Understanding Immunization Expansion • Iowa pharmacists

have made huge strides in advancing patient access to immunization services. On March 28, 2013, Governor Terry Branstad signed Senate File 353 relating to vaccine administration by licensed pharmacists. This statute allows licensed pharmacists to provide additional vaccinations via protocol signed by a local authorizing prescriber that are limited by certain age groups.

The first major change allows influenza and emergency immunizations for patients 6 years and older. The second major change allows for all vaccinations recommended by US Centers for Disease Control and Prevention (CDC), including international travel, for patients 18 years and older.

Now that the bill has been signed by the Governor, you may ask what is next? After the statute’s official effective date of July 1, 2013, the Iowa Board of Pharmacy will swiftly adopt rules to make this law effective. It is important for pharmacists to know that the Board must first pass rules before you expand immunization services. It is the intention of the Board of Pharmacy and IPA to have these new rules take effect prior to the 2013-2014 flu shot season.

In order to anticipate these approaching changes, IPA is organizing a comprehensive education plan for pharmacists across the state. This will include continuing education opportunities, sample immunization protocols, and marketing materials.

Rules noticed by BOP – open comment period ends on August 13th. If you would like to present written comments, data, or views on the proposed regulations, please share your insight with IPA and email Anthony at apudlo@iarx.org.

iowa pharmacy news

Trinity Pioneer ACO – MTM Program Set To Begin • The

Trinity Pioneer ACO, UnityPoint (previously Iowa Health Systems), Iowa Pharmacy Association (IPA), the University of Iowa (UI), and OutcomesMTM are partnering with community pharmacies in the eight counties served by the ACO to study the impact of community pharmacistprovided medication therapy management (MTM) services to the ACO’s high risk patients, especially those recently discharged. The ACO believes that MTM services within this “ONE TEAM” approach will lead to reduced hospitalizations, hospital readmissions, emergency department visits, and per capita costs through a 2 year study period.

Thirty pharmacies from the eightcounty region have been asked to participate by providing MTM services to identified ACO patients. The eight counties involved are: Buena Vista, Calhoun, Hamilton, Humboldt, Pocahontas, Sac, Webster, and Wright.

In order to coordinate the MTM service delivery and payments, OutcomesMTM will be managing the MTM program with eligible pharmacies. The ACO will screen patients to identify highrisk patients, particularly those being discharged, after which the patients are triaged by an ACO pharmacist who will determine how soon MTM services will be provided.

IPA has supported the project throughout the development phase, and most recently is providing up to ten hours of continuing pharmacy education (CPE) training to all participating pharmacists and pharmacy technicians. The CPE training with open discussions has been used to prepare pharmacists and pharmacy technicians to engage themselves within the ACO. This project was made possible through grant funding from the National Association of Chain Drug Stores (NACDS) Foundation, Community Pharmacy Foundation, and McKesson.

The Centers for Medicare and Medicaid

Services (CMS) has recently approved final data sharing agreements for the various stakeholders involved in the project. It is estimated that pharmacists will begin providing MTM services in July 2013.

New Practice Model Initiative Update • To address the call

to improve patient safety and coordination of chronic care, the IPA New Practice Model (NPM) Task Force began in early 2010 to develop a new model for community pharmacy practice. Given the prevalence of medication therapy to manage chronic conditions, it is reasonable to have pharmacists engaged in the medical home team and to utilize community pharmacists to deliver services, such as MTM.

addition, IPA will be working closely with the Collaborative Education Institute (CEI) to create technician training materials for participating pharmacies. The current NPM timeline would see full implementation at participating pharmacies in early 2014.

PNI Board of Directors Meeting • PNI, Inc, IPA’s for-profit

subsidiary, met on Thursday, June 6, 2013 at IPA Headquarters. The PNI Board is comprised of six past presidents and meets once annually.

Bob Stessman, Manning, serves as the President. Currently, the primary activity of PNI, Inc, is ownership of the IPA headquarters and ownership of PACE Alliance (buying group) shares.

The Board considered obtaining an appraisal for the building headquarters, but tabled the issue at this time.

Revenue from PACE has been stable since 2008, but has the opportunity to increase through the exclusive McKesson/PACE relationship when Iowa pharmacies utilize this program.

IPA has been working with interested community pharmacies to submit an application for a pilot project to the Iowa Board of Pharmacy to assess the implementation of a TechCheck-Tech program in community practice on patient safety measures, provision of patient care services, and finances of the community pharmacy business model.

This proposal will CASH FLOW MANAGEMENT PROGRAM be submitted to the Board of Pharmacy Change Your Current A/R Into Cash later this summer.

Profits With the Smart Solution

IPA has collaborated with additional stakeholders for this initiative. A research team at Drake University College of Pharmacy and Health Sciences will be assisting IPA and community pharmacists to evaluate and report on important safety measures required by the Board of Pharmacy. In

• Net More Money No Financial Risk • Pay Less: Flat fee - No %’s taken • Rapid Results: Increase Cash Flow • Keep Your Valued Patients/Customers • Endorsed by the IPA Scott Miller (563)249-9003 cell (515)226-9394 office scott.miller1@transworldsystems.com July/Aug/Sept 2013 |

27

iowa pharmacy news

Iowa TakeAway: 60,000 Pounds Collected And Growing! • This November will

mark the four year anniversary of Iowa’s TakeAway program and based on the first half of 2013, it is safe to say that TakeAway will continue to grow with anticipated changes to the DEA regulations on disposal of controlled substances and more pharmacies participating in the program. Pill Dude continues to make appearances around the state at many community pharmacies and. Many TakeAway pharmacies participated in the nationwide DEA-sponsored Take-Back Day on April 27th and participating pharmacies continue to host independent drug disposal days on a regular basis. In May, TakeAway Iowa surpassed the mark of 60,000 pounds of properly disposed drugs!

In addition to these ongoing events, 2013 has presented TakeAway with new experiences. In January, TakeAway submitted comments on the proposed DEA regulations addressing the disposal of controlled substances.

IPA estimates the new DEA regulations to be released later this summer.

Throughout spring various grant requests were submitted for additional program funding.

Currently, TakeAway leaders are evaluating a process to better streamline the distribution of TakeAway units. All of this activity reinforces the fact that

28

| July/Aug/Sept 2013

TakeAway Iowa continues to be the leading statewide drug disposal program in the nation!

On June 11, 2013, IPA attended the Pharmaceutical Waste Summit hosted by the Product Stewardship Institute (PSI) and the University of Wisconsin Extension (UWEX) in Milwaukee, WI to gather and discuss issues on pharmaceutical waste with more than eighty other leaders in prescription drug disposal. The focus of the 2013 Summit was the progress towards obstacles facing a comprehensive solution to pharmaceutical waste stewardship. Attendees learned about the Extended Producer Responsibility (EPR) legislation passed in Alameda County, California in June 2012 and the recent take-back legislation in King County, Washington that would require manufacturers to support pharmaceutical waste efforts.

IPRN 2013 Spring Meeting Report • On April 8th, 2013, the

Iowa Pharmacy Recovery Network (IPRN) held their Spring meeting at the Iowa Board of Pharmacy Office in Des Moines. The meeting began with a presentation from HarborView and the St. Gregory Retreat Center.

HarborView is an Iowa-based rehab clinic aimed at helping patients avoid addiction to prescription painkillers, while St. Gregory’s is a retreat center aimed at treating addiction. Their representatives discussed the services they provide, including a 2-month recovery program, followed by Smart Recovery support group meetings.

The committee discussed addition of HarborView and St. Gregory’s to the list of suggested resources for IPRN clients in need of assistance.

The Drake and University of Iowa PRN chapter representatives discussed the activities happening on campus.

Both schools will send several students to the University of Utah School on Alcoholism and Other Drug Dependencies in June, thanks in part to the support provided by

IPRN. Drake’s PRN chapter has developed magnets with the IPRN hotline information to be distributed to area pharmacies. The University of Iowa PRN chapter brought multiple presentations to area middle schools on prescription drug abuse, and they also had Dr. Kevin McCauley from Utah, speak to students on campus and to the P2 Substance Abuse class.

The meeting concluded with a report on current clients within IPRN, the importance of the monthly support meetings, and the success of IPRN in helping clients on their paths to sobriety.

Newest IPA Staff Addition

• Laura Miller joined the Iowa Pharmacy Association staff and IPA Foundation on August 8, 2013, to serve as the Membership & Development Director.

Prior to joining IPA, Laura worked for five years as Assistant Director of Development for Children & Families of Iowa in Des Moines. During this time she was responsible for managing the annual fund campaign, donor and volunteer relations, public speaking and building community awareness. Most recently Laura has worked in Community Relations for the American Cancer Society in Polk, Dallas, Jasper and Madison Counties. She holds a Bachelor of Arts degree from the University of Northern Iowa. Laura and her husband Eric reside in Urbandale with their two year old son, Tyler, and four month old daughter, Hayden.

Laura will work with IPA to increase membership recruitment and retention efforts, while also devoting a percentage of her time to the activities and initiatives of the IPA Foundation.

Please help IPA welcome Laura to the Iowa Pharmacy Family! Laura Miller can be reached at lmiller@iarx.org.

iowa pharmacy news

IPA Continues To Go Local!

• IPA has partnered with local pharmacy associations across Iowa throughout 2013. This partnership allows IPA to provide one hour of continuing pharmacy education on patient safety to attendees. IPA Goes Local events also create opportunities for IPA staff and leadership to visit pharmacy practices and local communities across the state.

IPA has already ‘gone local’ in 2013 with Blackhawk-Bremer County Pharmacy Association (March 14th), Dubuque Area Pharmacy Association (April 15), Central Iowa Pharmacy Association (May 6th) and North Iowa Pharmacy Association (May 14th).

Over 150 pharmacists and pharmacy technicians attended these events.

IPA Executive Vice President and CEO, Kate Gainer, stopped into pharmacies and hospitals to meet with fellow

Iowans. Below is a map representing the places IPA has gone and plans to go this year. In orange are the counties IPA has already visited and dark blue represents the areas IPA plans to visit by end of 2013. Contact Lynndi at lkoester@iarx.org to set up a visit to your practice in 2013-2014.

Southwest Iowa Pharmacists Association: August 29th in Omaha, NE Kate Gainer visits the Iowa State University Student Health Pharmacy in Ames, IA. Hosted by IPA Member, Greg Yeakel

Mark your calendars for these remaining 2013 IPA Goes Local events

Johnson County Pharmacy Association: September 19th in Iowa City, IA Northwest Iowa Pharmacy Association: October 22nd in Spencer, IA Quad Cities Area Pharmacy Association: Fall 2013

Already Visited Upcoming Visit Scheduled

watch for ipa to visit your area!

July/Aug/Sept 2013 |

29

ipa foundation

THANK YOU IOWA PHARMACISTS

Y

our generosity supports the pharmacy profession. 2012-2013 proved to be a remarkable year for the IPA Foundation. In addition to the work on the new strategic plan, IPPAC continues to grow it’s our support for student pharmacists, leadership development, continuing professional education, and pharmacy practice innovation.

Tim Becker; RPh, FASCP IPA Foundation President

The IPA Foundation will accomplish this mission through:

IPA Foundation Mission Statement:

• Student Pharmacist Support. Providing scholarships and facilitating professional development programs for student pharmacists in Iowa.

“Inspiring generosity and fulfilling the aspirations of the pharmacy profession through support of education, practicebased research and practice development.”

• Leadership Development. Facilitating programs of leadership skill development for student pharmacists and new pharmacist-practitioners.

• Continuing Professional Education.

Supporting the development, in cooperation with Iowa’s two colleges of pharmacy, of CPE programs for pharmacists and pharmacy technicians.

• Pharmacy Heritage. Preserving pharmacy’s rich heritage and promoting its culture to the profession and the general public.

• Resource Development. Obtaining resources from pharmacy-related organizations and professionals via annual fundraising programs, estate gifting, memorials, and endowed programs of scholarship, recognition, and professional development.

Our fundraising initiatives in 2012 all experienced considerable growth.

In particular, the Thomas R. Temple Leadership Pharmacy Endowment Fund grew by more than $50,000, grants for practice development exceeded $70,000, a successful golf classic resulted in four student scholarships and the Foundation secured commitment for two named scholarship programs through deferred/ estate giving contributions. In addition, the Foundation partnered with the APhA Foundation on the development of a Bowl of Hygeia Endowment Fund, securing $10,000 of support from Iowa pharmacists.

We ask you to consider how you might best help our profession by making a taxdeductible contribution in support of our great profession.

Indeed, the generosity of Iowa pharmacists is something we all greatly cherish. Thank you!

• Professional Recognition. Spotlighting excellence in leadership and practice innovation through award programs.

2012-2015 strategies & goals: Create and Strengthen Brand Identity Among the Pharmacy Community Complete the Leadership Pharmacy Endowment Campaign - $750,000 Goal Develop and Implement a Comprehensive Plan for General IPA-F Fundraising

30

| July/Aug/Sept 2013

IPA FOUNDATION

IPA-F Board of Directors: May Meeting Recap • The spring IPA

Board of Directors meeting was held on May 9, 2013, at IPA headquarters.

The board meets quarterly to discuss support of education, research, and practice development while inspiring generosity and fulfilling the aspirations of the profession. The next board meeting is scheduled for September 13th, in conjunction with the EgglestonGranberg Golf Classic. Discussion at the May meeting included: Leadership Pharmacy Endowment Fund Tom Temple, IPA-F consultant, reviewed efforts to pursue contributions to the leadership endowment through solicitation to past participants, IPA membership, and corporations.

He highlighted the strategy of the Pharmacy Society of Wisconsin to raise $100,000 in the 2013 calendar year. The Board discussed methods to achieve 100% participation of past conference attendees.

Sustainable Fundraising The Board discussed a variety of fundraising methods for sustainable

funding into the Foundation including endowment funds and recognizing levels of giving.

The Board also heard updates from IPA and CEI staff on current professional and educational programs.

Foundation Student Scholarship Awardees

• Congratulations to the 2013-2014 IPA-F Student Pharmacist Scholarship Awardees! Your commitment to your professional education and outstanding contributions to the profession of pharmacy do not go unnoticed! Keep up the great work!

University of Iowa College of Pharmacy • Parth Patel • Shannon Eddy • Trent Geurts: Eggleston-Granberg Golf Classic Scholarship Drake University College of Pharmacy & Health Sciences • Allison Stephens • Jaclyn Stoffel • Janelle Behnke: IPA-F Mike & Terry Pursel Scholarship

• Jade Engstler: Eggleston-Granberg Golf Classic Scholarship • Ben Koenig: Eggleston-Granberg Golf Classic Scholarship

Successful IPA Foundation Silent Auction • This year

proved to be another successful IPA Foundation Silent Auction. More than 94 items were donated and auctioned at the Annual IPA-F Silent Auction and Dessert Reception held during the 2013 Annual Meeting. More than 20 people contributed bottles of wine and spirits to the 1st Annual Ring Toss.

Those who attended the reception enjoyed a variety of desserts as they bid on items. Over $11,000 was raised to help support the mission and activities of the IPA Foundation.

In Memoriam • IPA Member, Jim

Stangel (1953-2013) lost his battle to ALS Saturday, July 20th. Jim served on the IPA Board of Trustees from 2007-2009. Jim practiced pharmacy in Onawa, IA where he owned Stangel Pharmacy and served his community in numerous ways.

REGISTER tODAY! Eggleston-Granberg Student Scholarship Golf Classic is a fun amateur golf event, sponsored by IPA-F, to support pharmacy student scholarships at Iowa’s colleges of pharmacy.

FRIDAY, SEPTEMBER 13TH

1:00pm Shotgun Start 6:30pm BBQ & Awards Dinner Copper Creek Golf Course | Pleasant Hill, IA

Register at www.iarx.org - { Golf Classic button on the right } July/Aug/Sept 2013 Participant Registration Includes: 18 Holes of Golf, Cart, Prizes and BBQ Dinner

|

31

32

| July/Aug/Sept 2013

IOWA PHARMACY RECOVERY NETWORK

Assisting Impaired Pharmacists, Student Pharmacists, and Pharmacy Technicians

Where do you turn when you, a coworker 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/ July/Aug/Sept 2013 |

33

ipa foundation

Congratulations to the 2013 Selected Leadership Pharmacy Conference Participants from Iowa! • The Leadership Pharmacy Conference is a unique opportunity for pharmacists in Iowa and Wisconsin who are interested in becoming leaders in the profession of pharmacy.

The conference is designed to provide an unequalled opportunity for pharmacists in their first fifteen years of practice to develop leadership skills which will enable both personal and professional growth.

Amber Baybayan, PharmD Hometown: Ankeny OutcomesMTM Senior Associate, Clinical Services

Amanda Bushman, PharmD, BCPS Hometown: Des Moines Unity Point Health Clinical Infectious Disease Pharmacist

Ashley Dohrn, PharmD Hometown: Le Claire Main Healthcare Pharmacy Consultant Pharmacist

Shannon Peter, PharmD Hometown: Omaha Medicap Pharmacy—Glenwood Pharmacist

Carmen Dunphy, PharmD Hometown: Humboldt Unity Point Health—Trinity Regional Clinical Pharmacist

Morgan Sayler, PharmD, BCPS Hometown: Indianola The University of Iowa Assistant Professor (Clinical)

Nic Lehman, PharmD, BCACP Hometown: Urbandale Drake University Assistant Professor of Pharmacy Practice

Katie Starbuck, PharmD Hometown: Waukee Medicap Pharmacy—Waukee Clinical Pharmacist

Mary Mosher, PharmD Hometown: Cedar Rapids UnityPoint Health—Jones Regional Director of Pharmacy

THANK YOU LEADERSHIP PHARMACY SPONSORS:

Sara Newton, PharmD Hometown: Argyle Walgreens Pharmacy—Burlington Pharmacy Manager

Congratulations!

Amanda bushman, Carmen dunphy and Mary mosher on being selected to participate in the 2013 TRT Leadership Pharmacy Conference

Amanda Bushman, PharmD, BCPS

34

| July/Aug/Sept 2013

Carmen Dunphy, PharmD

Mary Mosher, PharmD

Congratulations, Morgan!

Way To Go, Ashley!

Congratulations to

Ashley Dohrn, PharmD

for her selection in the 2013 Leadership Pharmacy Conference

Morgan Sayler, PharmD, BCPS

on being selected to attend the 2013 TRT Leadership Pharmacy Conference

A BIG thank you to all pharmacists and technicians in the state for the health care and leadership you provide every day to Iowans!

Thank You Ad Sponsors For Your Support To IPA July/Aug/Sept 2013 |

35

public affairs

Board of Pharmacy Updates

• The Iowa Board of Pharmacy (BOP) met on April 23-24 in Adair and June 25-26 in Des Moines. The Board met in a closed session on the first day to review administrative hearings, and held an open session day to discuss various requests for rule waivers or proposals, proposed legislation, and proposed rule changes. Highlights from each open session include: Immunization Expansion The BOP released proposed regulations for public comment (deadline August 13, 2013) that would implement the immunization expansion legislation passed in March 2013. The proposed rule establishes training and continuing education requirements, identifies the immunizations that a qualified pharmacist may administer via protocol, and describes the process

for verification of a patient’s immunization history. In addition, the proposed regulation clarifies whether a pharmacist may administer any immunization pursuant to a prescription.

Telepharmacy The Board of Pharmacy continues to receive requests from pharmacies in various practice settings to implement telepharmacy services.

The Board of Pharmacy evaluates each proposal individually as the Board’s Telepharmacy Task Force is evaluating current regulations on telepharmacy practice in Iowa. Each proposal is commonly evaluated by the Board as a pilot or demonstration research project.

TakeAway Medication Disposal The BOP held discussion on funding for the Iowa TakeAway Medication Disposal Program for 2013-2014.

The Board of Pharmacy approved funding for a fifth year as final DEA regulations regarding disposal of controlled substances will increase use of the TakeAway program. IPA continues to seek additional sponsors of this program to supplement the support by the Board of Pharmacy.

Diagnosis on Controlled Substance Prescriptions At the June meeting, the Board held discussion around the practice

36

| July/Aug/Sept 2013

of pharmacies requiring a diagnosis code on all controlled substance prescriptions.

The Board will continue to monitor this activity and may convene a meeting with the Board of Medicine, IPA and the Iowa Medical Society to discuss this practice in Iowa.

Pilot/Demonstration Research Projects The BOP released proposed regulations for public comment (deadline August 13, 2013) that would allow the Board to extend or renew additional time for a pilot or demonstration research project, that was initially approved for a period up to 18 months. The provisions of this change are meant to implement legislation that passed in this session.

Three Synthetic Cannabinoids Added to Schedule I Status The BOP adopted and filed an emergency rule to temporarily classify three synthetic cannabinoids as Schedule I in conformance with recent control of these same substances by the US Department of Justice, Drug Enforcement Administration. The substances, UR144, SLR11, and AKB48, have a high potential for abuse, have no currently accepted medical use in treatment in the US, and lack accepted safety for use under medical supervision.

These substances are being abused mainly by smoking for their psychoactive properties, and have been identified as a reason for numerous emergency room visits and calls to poison control centers.

public affairs

2013

Legislative session highlights IPA actively advocates on behalf of the profession - both during the legislative session and throughout the interim.

IPA would like to highlight the following accomplishments of the 2013 Legislative Session:

1. Expanded pharmacist immunization authority.

Governor Branstad signed SF 353, a law that provides expanded authority for pharmacists to administer immunizations via protocol to patients 18 years and older (all CDC recommended) and patients 6 years and older (influenza and emergency ordered). IPA worked closely with legislators and the medical community to compromise on language that ensured patient safety, increased access, lowered healthcare costs, and improved public health outreach through pharmacist immunizations.

Your support is needed!

2. Medicaid dispensing fee from $10.02 to $10.12 effective July 1, 2013.

IPA successfully lobbied for a 1% increase in the pharmacy dispensing fee in 2013, when no cost-of-dispensing survey is conducted. As part of a costsavings strategy for the state, language was included in the DHS budget to provide MTM (medication therapy management) services for Medicaid recipients. Unfortunately, this section did not pass out of conference committee during the final hours of session.

3. Extended timeframe for pilot projects, including telepharmacy.

Legislation passed in 2013 granting the Board of Pharmacy authority to extend innovative practice pilot projects, including telepharmacy sites, beyond 18 months. The Board shall report back to the legislature what is necessary to fully implement telepharmacy in the state of Iowa by December 2013.

2014 LEGISLATIVE DAY & CAPITOL SCREENINGS DAY

Thursday, February 20, 2014 Des Moines Downtown Embassy Suites & Iowa State Capitol

Does one person’s support matter? The answer is yes – every contribution, large and small, helps pharmacy maintain a visible presence and relationship with legislators. Please help keep Iowa pharmacy a viable, strong, and active participant in the legislative process. IPA actively advocates on behalf of the profession- both during the legislative session and throughout the interim. We need your continued support in order to remain effective.

Please consider making your contribution today by going online to:

www.iarx.org/Resources/Legislation/IPPAC.aspx

July/Aug/Sept 2013 |

37

peer review

CARBAPENEM-RESISTANT ENTEROBACTERIACEAE IN IOWA Adam Baird, PharmD PGY-1 Pharmacy Practice Resident University of Iowa Hospitals & Clinics 825 Oakcrest St. Apt.8 Iowa City, IA 52246 adam.baird@outlook.com 414-534-3330 Conflict of Interest: I have no actual or potential conflicts of interest associated with this case presentation

A

bstract Carbapenem-resistant enterbacteriaceae (CRE) infection rates have been increasing over the last decade. This family of bacteria is resistant to several antibiotics commonly used in current clinical practice. A 61-year old male resident of a long-term care ventilator facility was infected with Klebsiella pneumonia (resistant to ertapenem, meropenem and imipenem-cilastatin) and other susceptible bacteria. Blood cultures were negative and the patient was treated with 12 days of tigecycline and cefepime. The Centers for Disease Control and Prevention (CDC) has issued public health information and several journal articles involving CRE have been published within the past year. Current antibiotics have many shortcomings to treatment, and mortality rates remain high. The best form of treatment is prevention of its spread through education of all health care workers about this new group of resistant bacteria, and precautions that can be made when treating an infected patient.

Introduction Carbapenem-resistant enterbacteriaceae (CRE) infections have become a sobering reality that health care professions are quickly running out of antibiotics for certain types of infections due to increasing

38

| July/Aug/Sept 2013

resistance to current antibiotics.

According to the Centers for Disease Control and Prevention (CDC), CRE is defined as being non-susceptible to either doripenem, meropenem, or imipenem, AND resistant to 3rd generation cephalosporins (e.g. ceftriaxone, cefotaxime, and ceftazidime).1,2 This definition is very broad, and encompasses many enterobacteriaceae that produce beta-lactamase. The most common types with the most global interest include Klebsiella pneumonia carbapenemase (KPC) and New Delhi metallo-beta-lactamase (NDM).3 Other beta-lactamases include the Verona integrin-encoded metallo-betalactamase (VIM) and imipenemase metallo-beta-lactamase.1 It is important to note that these bacteria are not the same as extended-spectrum beta lactamase (ESBL)-producing bacteria, which are ordinarily susceptible to carbapenem therapy. Therefore, it is important to distinguish that ESBLproducing bacteria are susceptible to carbapenems, while CRE bacteria are resistant to at least one carbapenem.

Rates of these new resistant “superbugs” have been increasing over the last decade, with the largest number of infections being reported in the northeastern United States.2 Patient Case Presentation A 61-yo male was transferred from a critical access hospital for ICU support secondary to respiratory failure. The patient was a resident of a long-term care ventilator facility, and had a severe metabolic acidosis upon presentation (pH=7.09, bicarbonate=13 mEq/L, PaCO2 = 44 mmHg). Other remarkable labs and vitals at presentation included SCr=5.1 mg/dL, BUN=149 mg/dL, K=6.9 mEq/L, BP=79/50mmHg, temperature=101.1oF, and oxygen saturation=93% on 80% FiO2. He did have a significant past medical

history for C. diff. infection, acute renal failure, Parkinson’s disease, CAD, several CVAs, and a recent hospitalization in Florida prior to placement in the ventilator facility in Iowa. Initially, the patient received fluid boluses of normal saline, infusions of dopamine and sodium bicarbonate, and the antibiotics cefepime and linezolid empirically. These antibiotics were chosen due to the risk of Pseudomonas and vancomycinresistant Enterococcus bacteria from his recent hospitalization, placement in a ventilator facility, and overall poor initial presentation.

The patient cultures returned with several bacteria from multiple sites.

These included carbapenem-resistant Klebsiella pneumonia from the sputum, PEG tube, and tracheostomy site (also resistant to all laboratory tested antibiotics). Cultures also showed ESBL E. coli colonization in the anus, and a Proteus mirabilis in the sputum. Blood cultures were negative (x2).

The final antibiotic choices for him were tigecycline 50 mg IV twice daily (following 100 mg IV first dose) and cefepime IV 500 mg daily as determined through interpretation of the cultures by the attending hospitalist, pulmonologist, nephrologist, and clinical pharmacy team to treat both the Klebsiella pneumonia and Proteus mirabilis.

Blood cultures were repeated and were negative (x2) after 5 days of therapy.

In total, the patient received 12 days of tigecycline and cefepime. During the hospitalization, the patient’s renal function did not improve, and required hemodialysis after 10 days of hospitalization. At the time of writing, the patient is awaiting long-term care placement complicated by the new additional need of hemodialysis along with long-term ventilator support.

peer review

Discussion When interpreting laboratory cultures, one needs to critically evaluate the results before considering treatment options. First of all, one should determine whether the cultures represent an active infection or colonization based on the site of the sample, normal flora of site, and in the context of overall patient presentation.

This can sometimes be difficult when the cultures are taken from nonsterile sites such as wounds, the respiratory tract, or from the urine.4 Secondly, the levels of susceptibility should be evaluated with breakpoints and not merely susceptible/ intermediate/resistant. The current Clinical and Laboratory Standards Institute breakpoints for antimicrobial resistant include an MIC > 4µg/mL for doripenem, imipenem, and meropenem, and > 2 µg/mL for ertapenem.5 These breakpoints were first lowered in 2010, and has helped practitioners to identify resistance to carbapenems that was not previously reported.6,7 CRE infections have a high risk of mortality compared to other infections. One retrospective study of 60 patients with CRE bacteremia found that the all-cause hospital and 14-day mortality was 58% and 42% respectively.8 An alarming issue with CRE infections is resistance can be transferred to other strains, species, and genera of bacteria.9 This makes CRE bacteria a “triple threat”, since they are nearly resistant to many antibiotics, have high mortality rates, and can transfer resistance to other bacteria.

Treatment options are limited for CRE bacteria. Two of the more common therapies include the older polymyxin class (i.e. polymyxin B, colistin), and tigecycline.4 These antibiotics are not commonly used in standard clinical practice due to adverse effects, mechanism of action, and pharmacokinetic principles.

The polymyxins have a high rate of nephrotoxicity (14-53%) and are not commonly used due to that adverse effect.4 Tigecycline is bacteriostatic and has relatively low plasma concentrations, making it not the best

antibiotic for serious infections and bacteremia. In fact, the FDA issued a warning regarding the increased mortality rate when tigecycline is used as a single agent compared to other antibiotics.10 Other antibiotics that have been used for treatment include aminoglycosides, fosfomycin, rifampin, and high-dose prolonged-infusion of carbapenems in combination with a polymyxin or tigecycline.11 At this time, optimal treatment and outcomes for CRE infections remain undefined due in part to the fact that many of the current studies are retrospective small-single center reports.4 When it came to treating our patient, tigecycline was ultimately chosen over a polymyxin due to the poor renal function of the patient, and the negative blood cultures.

The CDC has issued recommendations to health care facilities to help prevent spread of CRE infections.1 The recommended measures include having the patient in a single room, and practicing good hand hygiene with contact precautions. This includes wearing a new disposable gown and gloves every time before entering the patient room, disposing of them before leaving the room, and washing hands with soap and water prior to exiting. Other recommendations include minimizing device use on the patient, have equipment dedicated to the patient that stays in the room, and dedicated staff to limit the number of individuals potentially exposed. Lastly, there should be protocols in place for rapid notification of laboratory results, CRE screenings for suspected patients, and education for all health care personnel on all of these issues. This way, facilities can attempt to limit the spread, and slow the development of resistance to current antibiotics.

Conclusion CRE is a class of resistant bacteria that is quickly growing in the United States with cases occurring in Iowa. Antibiotic choices through antimicrobial stewardship need to

be carefully selected to ensure the correct bacteria are being treated while minimizing the risk of increasing resistance. Practicing good infection control and prevention is the best way to decrease the spread of CRE. References

1. Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE); 2012 CRE toolkit.

National Center for Emerging and Zoonotic Infectious Diseases (U.S.), Division of Healthcare Quality Promotion. Available online at http://www. cdc.gov/hai/organisms/cre/cre-toolkit/. Accessed April 26, 2013.

2. Vital signs: carbapenem-resistant Enterobacteriaceae. MMWR. Morbidity And Mortality Weekly Report. March 8, 2013;62(9):165170. Accessed April 26, 2013.

3. Apisarnthanark A, Hsu LY, Khawcharoenporn T, Mundy LM. Carbapenem-resistant Gram-negative bacteria: how to prioritze infection prevention and control interventions in resource-limited settings?

Expert Review Of Anti-Infective Therapy. February 2013; 11(2): 147-57. Accessed June 21, 2013.

4. Van Duin D, Kaye K, Neuner E, Bonomo R. Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes. Diagnostic Microbiology And Infectious Disease. February 2013;75(2):115-120. Accessed May 1, 2013.

5. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty Second Informational Supplement (January 2012). CLSI document M100-S22. Wayne, Pennsylvania, 2012.

6. Viau RA, Hujer AM, Marshall SH, et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K pneumoniae carbapenemase in a longterm care facility for children and young adults in Northeast Ohio. Clin Infect Dis 2012; 54:1314– 1321. Accessed June 21, 2013.

7. Perez F, Van Duin D. Carbapenem-resistant Enterobacteriaceae: a menace to our most vulnerable patients. Cleve Clin J Med. April 2013; 80(4):223-33. Accessed June 21, 2013.

8. Neuner EA, Yeh J-Y, et al. Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Diagn Microbiol Infect Dis 2011;69:357–62. Accessed June 21, 2013.

9. Mathers AJ, et.al. Molecular Dissection of an Outbreak of Crabapenem-Resistant Enterobacteriaceae Reveal Intergenus KPC Carbapenemase transmission through a Promiscuous Plasmid. mBio. November 2011.

2(6):e00204-11. Accessed June 21, 2013.

10. FDA Drug Safety Communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections.

September 1, 2010. Available online at http://www. fda.gov/Drugs/DrugSafety/ ucm224370.htm.

Accessed June 21, 2013.

11. Petrosillo N, Giannella M, Lewis R, Viale P. Treatment of carbapenem-resistant Klebsiella pneumonia: the state of the art. Expert Review Of Anti-Infective Therapy. February 2013; 11(2):159177. Accessed May 7, 2013.

July/Aug/Sept 2013 |

39

member section

IPA Member Spotlight on:

JOHN HAMIEL, PHARMD

By: Nick Dahlke, PharmD Drake University College of Pharmacy Pharmacy is in a very interesting time of change right now. We are in a time when the profession is moving towards a more clinical role and moving away from the typical “lick, stick, and pour” type of pharmacy.

We are seeing technicians begin to play a much larger role in helping pharmacists utilize their time better.

John Hamiel is one person at the forefront of this change and leading the charge with his implementation of the second Tech-Check-Tech program in the state of Iowa. After speaking with John, it is obvious the passion he has for pharmacy.

John graduated with his PharmD from the University of Iowa College of Pharmacy in 1997. He had taught high school chemistry and physical science and coached the Track and Field team at Cedar Rapids Prairie in Cedar Rapids, IA for seven years. He was always interested in chemistry and the health sciences, and decided to go into pharmacy because that was “when pharmacy was just starting to get out of the lick, stick, and pour mentality. Pharmacy was starting to move into more collaborative agreement practice opportunities with patients, nursing, and medicine and it was an area where I could use my talents in teaching and still get the advantages of being in healthcare.”

John is currently the regional director for Wheaton Franciscan in Iowa and is the director for three hospitals and three outpatient pharmacies. He spends most of his time at Covenant

40

| July/Aug/Sept 2013

Medical Center in Waterloo, which is where the Tech-Check-Tech program is based. He hopes to expand the program to Sartori Memorial Hospital in Cedar Falls in the future.

John started the application to the Board of Pharmacy in January 2012, received Board approval in March and was fully up and running in July 2012. Every medication filled to their Pyxis machines used to be checked by a pharmacist before it was sent up to the floor. Now a technician is able to do that final check on many medications, is able to do the final check on narcotic counts, and even check ambulance kits.

Wheaton Franciscan keeps all their narcotics in a locked container and maintains a perpetual inventory on all narcotics; because of this they are comfortable with the technician having control in this area. The technicians are not allowed to check IVs, first dose checks, pre-packaged medications, nor orders when there is an opportunity to make a clinical decision. “The technicians appreciate that,” said John about the technician’s responsibility. “They love and understand the new abilities for what they can do. It makes them feel like and have a much bigger ownership in the pharmacy work force and day to day tasks.”

By allowing technicians to have more responsibility in the pharmacy, it has allowed a pharmacist to have approximately 4 more hours for clinical services per day. John has been able to assign a pharmacist to become an antibiotic stewardship pharmacist and go on daily rounds with the infectious disease physician. The pharmacist helps determine whether the patient is “on the right drug, for the right amount of time, for the right indication, and as quickly as possible get that patient

switched from an IV to PO formulation.”

Increasing doctor and patient interaction with pharmacists have been two big values of this program, and John said that they were happy to have had so much buy-in from the doctors at the facility.

With all of the changes that we are seeing in pharmacy, freeing up pharmacist time for clinical improvements is going to be crucial.

John stated that “with the financial crisis that we are currently facing, there is little likelihood that we will be able to hire pharmacists like we used to be able to do. So, utilizing the technician is becoming a more important priority.”

“Tech-Check-Tech is an ongoing quality improvement initiative,” John commented. “It has to be fluid enough to fit your needs and your situation, in the time frame that you need it to.

I see us moving forward on this and improving what the techs can do, what the pharmacists can do, and I see it as a golden opportunity for the profession.”

John and his team were awarded the 2013 IPA

Foundation Poster Presentation Award for

their poster entitled, “Demonstrated Improvement of Dispensing Accuracy Through Implementation of Tech-Check-Tech.”

July/Aug/Sept 2013 |

41

member section

IPA MEMBER MILESTONES • Raylene Rospond, BS PharmD, FACCP, recently transitioned to Drake University’s Deputy Provost from Dean of the College of Pharmacy and Health Sciences.

• Jordan L. Cohen was named Interim Executive Director of National Institute for Pharmaceutical Technology and Education (NIPTE) starting July 1, 2013.

• CoraLynn Trewet, MS, PharmD, BCPS, CDE was recently hired as the Diabetes Regional Medical Liaison with Sanofi in Des Moines, IA. • Candace Jordan, PharmD has been chosen to serve as the Pharmacy Manager of Mercy Medical Center-West Lakes.

• Kerianne Roder, PharmD was hired as Pharmacy Manager for new Waukee Hy-Vee store.

WELCOME NEW IPA MEMBERS Thank you for supporting IPA! April 1 - June 30: Scott Armstrong, Windsor Heights Mark Branum, Decorah Angie Danielson, Davenport Wendy Duncan, Des Moines Melanie Furman, Solon Ashley Geisinger, Waverly Tessa Huff, Sioux City

• Gregory Daniel Maddy was born May 3 to Beth, PharmD (Windsor Heights Hy-Vee) and Eric Maddy. Welcomed home by big sisters Meredith and Bridget.

Jeff Lindoo, Plymouth Aaron Lott, Cedar Rapids Dana McDougall, Waverly

• Elsie Ranae Rude was born on June 17th to proud parents Amber, PharmD (Medicap Pharmacy) and Steve Rude.

• Congratulations to over 200 newly licensed pharmacists in Iowa! Whether you are a new graduate or a transfer into Iowa, IPA congratulates you on passing your NAPLEX and/or MPJE! • Congratulations to Meyer Pharmacy who is celebrating 100 years of service to Waverly and the surrounding communities.

Philip Ostrem, Iowa City Traci Peters, West Des Moines Amber Rude, Des Moines Kristen Timmerman, Dubuque Suzanne Von Seggern, Spencer Timothy Welty, Des Moines

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

NOT AN IPA MEMBER? Tell us why!

It’s important to our profession that you’re engaged. No matter your age, practice site or level of engagement tell us why by filling out a short survey at http://www.surveymonkey.com/s/K9D722H or access it on our website at www.iarx.org.

42

| July/Aug/Sept 2013

member section

OUR MISSION

The Iowa Pharmacy Association is the state society representing the profession of pharmacy, united for the purpose of advancing public health, particularly the pharmaceutical care of all Iowans. The Iowa Pharmacy Association is organized to preserve and advance the interests of the profession and to serve the professional needs of all pharmacists, student pharmacists, and pharmacy technicians.

The mission of the Iowa Pharmacy Association is to promote safe and effective medication use to improve the health of patients by serving the pharmacy profession.

MEMBERSHIP MATTERS. To You. To Patients. To The Profession.

JOIN TO RECEIVE: • Weekly Top 5 e-updates • Subscription to quarterly IPA Journal • 2/2/2 Virtual Engagement Series • Quality CPE Opportunities • FREE Law & Patient Safety CE • Discount to IPA Events • Professional Networking Opportunities

IME 1ST T RS PAY BE MEM 105

$ ONLY

• Legislative Advocacy • Regulatory Representation • Liaison with Health Care Organizations & Providers • Public Relations & Patient Education Tools • Professional initiatives & promotion of pharmacist services

JOIN IPA AT WWW.IARX.ORG

Pharmacy Technician Education for Association Members

NEW PHARMACY TECHNICIAN BENEFIT! Become an IPA Pharmacy Technician Member and receive the Pharmacy TEAM Series - a new benefit which

will give you 10 FREE HOURS OF CPE! The complete TEAM Series of 10 CPE activities can be found at www.GoToCEI.org (Under Of Interest).

{ Click on the Membership Link }

IOWA PHARMACY ASSOCIATION

8515 Douglas Ave., Suite 16 • Des Moines, IA 50322 • 515.270.0713 • Fax: 515.270.2979 July/Aug/Sept 2013 | Website: www.iarx.org • E-mail: IPA@iarx.org

43

Iowa Pharmacy Association

MEMBERSHIP ENROLLMENT FORM Pharmacist • Retired • Resident • Associate • Technician

Please return this form to: Iowa Pharmacy Association

8515 Douglas Avenue, Suite 16

Des Moines, IA 50322 (Ph) 515.270.0713 | (Fax) 515.270.2979 | www.iarx.org

44

| July/Aug/Sept 2013

member section

THANK YOU VOLUNTEERS IPA would like to sincerely thank the members of the Advisory Committees and Policy Committees for their dedicated service to the profession of pharmacy in Iowa!

As a membership-driven organization, IPA achieves success through the pharmacists, pharmacy technicians, and student pharmacists who volunteer their time and expertise. IPA appreciates the work of all 2012-2013 committee members!

To see a complete list of committee members, please see the IPA Annual Report available online at: www.iarx.org/AnnualReport/2013.html.

2013 – 2014 VOLUNTEERS NEEDED!

It is never too early or too late in your pharmacy career to become actively involved in IPA. If you are interested in volunteering or would like to nominate a colleague to serve on an IPA committee, please contact Mindy Pertzborn at mpertzborn@ iarx.org. Opportunities to serve on a committee include: • Policy Committee on Professional Affairs • Policy Committee on Public Affairs Legislative Advisory Committee • Iowa Pharmacy PAC Advisory Committee

• Health-System Liaison Board • Long Term Care and Senior Care Advisory Committee • Advisory Committee on Medicaid and Pharmacy Benefit Programs • Pharmacy Technician Advisory Committee • IPA Foundation Golf Classic Planning Committee • Iowa Pharmacy Recovery Network

Is your subscription up-to-date?

For your convenience, manuals are available in a paper-version or electronic (CD-ROM) version.

LAW MANUAL SUBSCRIPTION PROVIDES YOU *Two updates per year *Two 30-min ACPE-accredited law CE webinars *Access to IPA staff for specific questions

To order an Iowa Pharmacy Law and Information Manual subscription: www.iarx.org/MarketPlace/Store.aspx#2 Annual Subscription Fee: $250 Iowa state law mandates that each licensed pharmacy maintain an updated copy of the Iowa Pharmacy Law and Information Manual as part of its reference library.

Questions? Contact the IPA Office at 515.270.0713.

July/Aug/Sept 2013 |

45

technician’s corner

UNDERSTANDING THE MEDCAID LOCK-IN PROGRAM

D Connie Bentrott, CPhT Hy-Vee Pharmacy Des Moines

IPA Technician Commentary

o you know what it means if a patient is “locked-in” to Medicaid and the procedure to process that prescription?

The goal of the lock-in program is to prevent harmful practices such as duplication of medical services, drug abuse and possible drug interactions.1 A patient is “locked-in” to ONE physician, ONE hospital, and ONE pharmacy, and the patient may also have a specialized physician (i.e., pain management, psychiatrist, etc…). After a 24 month period, each patient is reviewed, and if the guidelines have been followed, the patient may be removed from the lock-in program.

If removed from the program, it is reviewed again in 6 months to make sure that the guidelines have been followed.

“The reasons that a patient may be locked-in are: multiple ER visits, multiple outpatient visits in a six month period, several prescribers, several prescriptions, and numerous controlled medications.”

A lock-in patient is not allowed to pay cash for the prescriptions or early refills.

A controlled prescription cannot be filled until the day that it is due. Medicaid must be contacted for each refill for the non-PCP prescription but you do not need to call the PCP each time.

For a prescription (lock-in patient) to be paid through Medicaid, the prescription must be written or approved by the primary care physician. If the prescription has been written by the PCP, pending no other problems with

46

| July/Aug/Sept 2013

the prescription, it will be approved.

However, if the prescription is written by another physician, there are several steps that need to be followed. First, process the prescription so that you get the denial, contact the PCP to get their approval for the prescription and document on the hard copy (Note: they can deny it). After receiving the approval from PCP, contact Iowa Medicaid to give them the information that is needed, such as prescription number, prescriber, authorizing agent, quantity, days supply, and date last filled if it is a refill. Finally, once approved, they will tell you to reprocess in one hour, or they will call if problems arise.

Hours to contact Medicaid are 8:00 am to 3:30 pm Monday through Friday. No weekends; no holidays.

Case scenario: Patient John Doe is locked in to Dr Black. He needs his prescription for Hydrocodone written by Dr. White, and it is due to fill on the Sunday after Thanksgiving. The steps to assuring that this prescription will be approved for the patient to get on Sunday are: A. Call Dr. Black’s office to get the approval to fill the prescription (document on hard copy) B. Call Iowa Medicaid on WEDNESDAY to get the approval to fill the prescription on Sunday. (Iowa Medicaid is closed for the holiday and the weekend) C. Process the prescription on Sunday. (this process only works for Thanksgiving. If the holiday falls on Monday, call Medicaid on Friday.)

References: 1. Iowa Medicaid Enterprise. Overview of the Lock-in Program. Iowa Department of Human Services. http://www.ime.state.ia.us/docs/ IMELock-InCard.pdf. Accessed June 24, 2013.

technician’s corner

Future Changes in PTCB Requirements • In February

2013, the Pharmacy Technician Certification Board (PTCB) publicized the planned modifications to the PTCB Certification program approved by the Board of Governors. During the next several years, the PTCB board will adapt new changes such as background checks, recognized educational requirements, and adequate continuing education (CE) programs for recertification.

Beginning in 2014, candidates for PTCB certification will be required to complete criminal background checks. As part of the 20 hours of CE required for recertification, individual CPhTs will need to complete one hour of medication safety CE, effective in 2014, in addition to the one hour of law CE already required. Furthermore, all 20 hours of CE for recertification will have to be pharmacy technicianspecific CE by 2015. By 2020, PTCB will require candidates for initial PTCB certification to successfully complete an American Society of Health-System Pharmacists (ASHP)-accredited education program.

These changes are an outcome of a PTCB initiative which began with a 2011 summit that placed emphasis on five areas related to pharmacy technicians: Consumer awareness, Resources, Education, State policy and Testing (C.R.E.S.T.). The initiative is to be customized to each state’s existing laws, regulations and other factors. All PTCB new initiative implementation will be completed by 2020.

IPA’s Board of Trustees will evaluate how these changes will be impacted by current policy and state law and regulations.

2013 Pharmacy Technician Educational Forum: A Great Educational Day for Technicians!

in a Fast-Paced Work Environment.

Those in attendance enjoyed the day networking with other technicians around the state and many shared what they learned back to their practice.

IPA and CEI would like to thank The Onnen Company for sponsoring this year’s Forum. Thanks to all the speakers for developing informative CE activities for pharmacy technicians.

In 2014, Tech Forum is moving to the fall! Be on the lookout for more details to come.

2014 TEAM Topics for Technicians Announced

PHARMACY TECHNICIAN EDUCATIONAL FORUM

• This year’s Pharmacy Technician Educational Forum was held on Saturday, April 13th, at the West Des Moines Marriott. Over 70 pharmacy technicians earned a total of 6.5 hours (0.65 CEUs) of CPE credit developed specifically around the roles and responsibilities of the pharmacy technician.

This year programming focused on Women’s Health Issues; Men’s Health Issues; The Health of Kids Today; A Look at Weight Loss; Medical Error Prevention Strategies; and how to handle Stress Control

• IPA and CEI are again partnering to provide pharmacy technicians with 10 hours of continuing pharmacy education in 2014. The CPE articles, TEAM (Technician Education for Association Members), are provided free for all IPA pharmacy technician members. Beginning in January 2014, pharmacy technician members can access the articles on CEI’s website with the access code provided to them.

THE TOPICS FOR 2014 INCLUDE: • Pharmacy Payment Models and Methods • The Role of the Pharmacy Technician in Obtaining a Medication History • Getting To The Core of CMS Measures • Protecting Patient Privacy • Pour Some Sugar On Me: New Drugs for Type 2 Diabetes Mellitus • Vitamins and Minerals During Pregnancy and Lactation • Pharmacogenomics: Pharmacy’s Role in Personalized Medicine • Hot Topics in Infectious Disease • Ethics for Pharmacy Technicians • Communication and Teamwork – Strategies for Pharmacy Technicians

July/Aug/Sept 2013 |

47

48

| July/Aug/Sept 2013

technician’s corner

NEWLY PTCB CERTIFIED IOWA TECHNICIANS January 1, 2013 through March 31, 2013 Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified!

Nicole Andersen Zachary Anderson Samuel Assani Marquisha Babcock Tonia Baker Tammy Beardmore Shari Bedard Jamie Bigelow Nicholas Braye Candice Breen Emeline Britton Brianna Brown Peggy Bushore William Carroll Andrew Clancey Danielle Crady Jennifer Creps Estefani Pineda Cruz Ashley Cuevas

Tomas Daly Jeanita Dennis Jessica DeWitt Magdalene Engler Paul Forbes Timothy Geerlings Christina Greenfield Mark Greiner Kaitlyn Helmers Tessa Hiatt Jessica Hill Jory Hilpipre Anani Hodedin Katherine Houston Graham Houselog Erica Hoye Katherine Huyck Tracy Irwin Safura Ismail

Sarah Jackson Jennifer Jahn Jennifer Jalas Gail Jensen Matthew Koppes Jody Kristensen Emily Krueger Amber Kundert Jesse Lair Jordan Langreck Lizbeth Lara Maria Lewis Damien Lihs Wendy Linduski Samantha Martin Jordan McCormick Amber McLaughlin Ian McNees Jessica McPherson

Adam McVicker Amanda Mendoza Andrew Meyer Melissa Moreland Dane Nealson Britta Nelson Andrea Norland Cassandra Oberlin Amy Overman Kaitlyn Paulson Maria Phelps Jeffrey Phillips Kari Phillips Michelle Popp Michael Pryor Hillary Recker Cynthia Reel Christopher Sanchez August Schrock

Amanda Schmerbach Kelly Schriever Stephanie Shebetka Matthew Stutzman Kelsey Swinnerton Lindsi Thacker Janet Thomsen Shane Heinrich-Tran Kris Tuttle Loretta Vander Streek Samoane Waddy Michael Weber Taylor Westpheling Wendy Wettstein Andrew Willems Angela Williams Becky Willie Amanda Wurth

The City of Hartley is

SEEKING A PHARMACY BUSINESS TO LOCATE TO THE CITY. After 40 years of serving the region, the local pharmacy business closed upon the retirement of the pharmacist.

The City of Hartley offers parks, recreation and cultural amenities, municipally owned utilities; water, sewer, electric, gas, solid waste, telephone, digital cable TV, Internet, cellular telephone and other services. There are two medical clinics, 68-bed nursing home and 16 assisted living apartments.

Hartley is a welcoming rural community with a population of 1,672. The city is located in northwest Iowa in O’Brien County on Iowa Highway 18 and nineteen miles from Iowa Highway 60. Just twenty-five minutes northeast of the city is the Iowa Great Lakes tourism region.

For more information contact: Patty Anderson, City Administrator Hartley City Hall | 11 S Central Avenue, Hartley, IA 51346 (p): 712-928-2240 | (e): patty@tcaexpress.net www.cityofhartley.com

July/Aug/Sept 2013 |

49

college of pharmacy news

College of Pharmacy and Health Sciences begins construction on Johansen Skills Assessment Laboratory

• A lead gift from Greg Johansen to distinctlyDrake will fund the Johansen Skills Assessment Laboratory in the College of Pharmacy and Health Sciences. The gift from Johansen will allow for the creation of several flexible collaborative learning spaces that will allow students to practice skills in a controlled environment.

Skills-based education is required and valued in the education of health care professionals. This type of education focuses on the development and demonstration of competence in specific skills, such as using medical devices, taking vital signs, counseling patients, providing drug information, and preparing sterile products. It is vital for health care professionals to demonstrate competence in these areas, and the creation of the Johansen Skills Assessment Laboratory will allow students to learn, practice, and demonstrate proficiency.

Each of the collaborative learning spaces will be furnished with modular tables and chairs, along with learning technology for projection from a laptop to a large - screen television. The learning spaces will be utilized for the following purposes: • Skill-based instruction and competence assessment in support of the Pharmacy Skills and Applications Course, Immunization Course, Patient Assessment and Health Coaching courses • Student team - based learning • Faculty - student appointments • Individual student study areas

50

| July/Aug/Sept 2013

• Faculty collaborative discussions • Student organization meetings Construction is already underway with a goal to have the facility completed and ready for use at the start of the fall semester.

community and professional leader.

Recipients of the award demonstrate leadership in one or more of the following areas: professional education, association work, community service, and pharmacy practice.

Huy-hoang Nguyen receives 2013 Karbeling Memorial Leadership Award • The Drake

Congratulations to the recipients of the 2013 Graduate Awards • The following

College of Pharmacy and Health Sciences (CPHS) honored Huy-hoang Nguyen as the recipient of the 2013 Karbeling Memorial Leadership Award. Nguyen was honored during the 2013 Doctor of Pharmacy Hooding Ceremony, held on May 18, 2013. As the award recipient, Nguyen received a commemorative plaque and financial support to attend a national meeting where he will have the opportunity to further his professional involvement.

“I feel humbled to have been chosen to receive the Karbeling Leadership Award,” says Nguyen. “I am so grateful that the CPHS has provided a great environment where I could develop my leadership throughout my time in the pharmacy program. I hope to continue growing as a leader so I can better contribute to advancing pharmacy practice and health care.”

The Karbeling Memorial Leadership Award is given annually to one full-time PharmD student. The Drake University pharmacy class of 1974 created the award in memory of Jerry Karbeling, PH’74, who is remembered as an inspiring pharmacist, patient advocate, and

awards were announced at the PharmD Hooding Ceremony, Saturday, May 18: • Excellence in Clinical Communication Skills: Robert Sbertoli • Outstanding Student Award: Emily Podeschi • Excellence in Pharmacy: Abigail David • Outstanding Community Practice Pharmacy Graduate: Raquel Rost • Excellence in Diabetes Disease Management: Rebecca Dieter • Natural Medicines Comprehensive Database Recognition Award: Daniel Ricci • Scholastic Achievement in Pharmacy Studies: Caitlyn Pryor, Ross Hogan and Greg Tallman • Research Collaboration Award: Nathan Verlinden • Senior Recognition Certificate: Andrea Mickelson • Jerry L. Karbeling Memorial Leadership Award: Huy-hoang Nguyen

college of pharmacy news

Jannet Carmichael, PharmD,

BCPS, ’75, is the recipient of ASHP’s 2013 Harvey AK Whitney Lecture Award. During her 30-year career with the VA Health Care System, Dr. Carmichael has made significant contributions to the system’s progressive pharmacy practice model, including the use of quality metrics to improve patient care and patient safety while lowering health care costs.

In her current role, she leads clinical pharmacy management initiatives that contribute to optimal prescribing practices for mental health and metabolic syndrome, osteoporosis, pain management, oncology, congestive heart failure, hypertension, diabetes, and hyperlipidemia and coordinates initiatives to improve patient care and drug safety. Dr. Carmichael will receive the award June 4 during ASHP’s summer meeting.

of pharmacists who share an interest in precepting student pharmacists or pharmacy residents.

AcademyHealth announced the

2013 recipients of its Presidential Scholarship for New Health Services Researchers, which provides early career researchers with financial support to attend the organization’s Annual Research Meeting (ARM) and offers exclusive networking and mentoring opportunities with AcademyHealth leadership and staff, and distinguished leaders in the field.

Among the 2013 Presidential Scholars is UI College of Pharmacy’s Amber Goedken, PharmD, PhD.

Gail Ardery, a research manager in

the Department of Pharmacy Practice and Science, was among a select group of UI students, faculty, staff, and alumni recognized with the university’s highest honors at the annual Finkbine Dinner on April 9. She was the recipient of a Hancher-Finkbine Medallion recognizing leadership, learning, and loyalty.

Ryan Jacobsen, clinical assistant

Iowa Congressman Bruce Braley Visits UI • Congressman

Bruce Braley visited the UI College of Pharmacy on March 26. He delivered a presentation titled “Health Care Reform Perspectives from Washington, D.C.” as part of the course Contemporary Issues and Leadership.

After the presentation, Braley met with Dean Letendre and UI President Sally Mason. Braley has served in the U.S. House of Representatives since 2007.

Susan Vos was elected as the coordinator-elect for the Preceptor

Special Interest Group with APhAAPPM. The mission of the Preceptor SIG is to create a professional network

professor, was selected to receive the Ben Pardini Interdisciplinary Teaching Award from the College of Medicine.

According to Carver College of Medicine Professor Joel Gordon, “Ryan is an excellent choice to receive this award as he models and exemplifies what excellent interprofessional teaching is for the medical and pharmacy students we share in our Wednesday afternoon Renal Clinic”.

Jennifer Fiegel, Assistant Professor, received a new two-year R21 award from the National Institutes of Health (NIH) in the amount of $405,652.

Her proposal is entitled, “Synergistic Drug Strategies Against Pseudomonas Aeruginosa Biofilms”.

Larry Fleckenstein, Professor

was awarded a subcontract with Case Western Reserve University for his project, “Pharmacodynamics

and Pharmacokinetics Studies for Triple Drug Therapy to Treat Human Lymphatic Filariasis (LF): Diethylcarbamize (DEC), Albendazole (ALB) and Ivermectin (IVM) to Measure and Analyze Drug Levels.”

The University of Iowa College of Pharmacy recently announced several new appointments for faculty and staff • These changes allow the

college to streamline workflow, increase efficiency, and expand educational and research opportunities. New appointments include: • Bernard Sorofman, PhD, Executive Associate Dean • Maureen Donovan, PhD, Associate Dean for Undergraduate Education • Jay Currie, PharmD, FCCP, Chair of the Department of Pharmacy Practice and Science • Lawrence Fleckenstein, PharmD, Interim Chair of the Department of Pharmaceutical Sciences and Experimental Therapeutics • Gary Milavetz, PharmD, Head of the Division of Applied Clinical Services • Aliasger Salem, PhD, Head of the Division of Pharmaceutics and Translational Therapeutics • Amber Seaton, MBA, Chief of Staff

Peer Mentorship Recognized

• Peer mentorship was recognized during a special dinner with Dean Letendre on May 1. Over 70 UI College of Pharmacy students gathered to celebrate the mentorships that help to establish a support system within the college. In the first official year of the program, 26 mentors logged over 250 hours working with first-year pharmacy mentees.

student section

DRAKE UNIVERSITY COLLEGE OF PHARMACY CLASS OF 2013 Lauren Adair* Megan Airy Ryan Anderson Nathan Arnold Danielle Backus Adam Baird# Julie Baldassarra* Catherine Bangasser Derek Bergquist Kelsey Berneking* Christopher Brabeck Mariah Brandt* Logan Brinn Kathryn Brower Brianna Buck Collin Cameron Jennifer Casey Christina Cherayil Philip Cooper Katie Cope Eric Corrao Royce Cyriac Nicholas Dahlke Abigail David* Amber Demuth*# Jenna Denman Rebecca Dieter Reed Dix Laura Engelmeyer Kristin Fouts Ryan Fox Timothy Frank Jared Frost Jameson Groot Hannah Grubb

Ashley Gulvik Andrew Hale Kathryn Hamilton Lisa Hansen Deborah Hartman Rachel Herrild Boyd Higgins Patrick Hogan Ross Hogan* Thomas Hoopes Katie Hovick Steven Jacob Chad Johnson Erin Jung * Sarah Jurgens Sara Kampf Kimberly Karwoski*# Jessica Kelling Emily Kirkwold*# Matthew Korte Michael Lahart* Tamara Lallier Lauren Lusch Nadia Makousky Lauren McCaulley Molly McConville Annalyse McDowell Andrea Mickelson# Alex Middendorf Laura Minard* Michelle Mitchell Shimpei Miyano Russell Mulkey Stephanie Nelson Nicole Ng

Huy-hoang Nguyen*# Megan Ohrlund Lauren Olson Mariah Olson Neel Patel Daniel Pelletier Peter Peter Angela Plooster Emily Podeschi* Jessica Poehls*# Amy Powell Matthew Praechter Caitlin Pryor* Falguni Rana Eric Rauch Daniel Reesman Joseph Revak Spenser Rhines Daniel Ricci Kathleen Richardson Timothy Roach* Mattie Robertson Raquel Rost* Robert Sbertoli Caitlin Schaapveld Eric Schafernak Alex Schoenhard Anne Sciurba Kathryn Searing Jessica Shalita# Nicholas Skibba* Emily Southard Johanna Sprang* Allison Stephens Bridget Sterling

Samuel Taft Gregory Tallman* Taryn Thompson Adam Ungerer Bryan VanderLinden* Stefanie VanFleet Nathan Verlinden# Anupam Verma Kelsey Vinzant Andrew Wehrhan* Kendall White Breann Williams Matthew Winkler Abigail Winter Amy Woodside Melanie Yanzick Maria Zhorne Cynthia Zoeller * Rho Chi Honorary Society # Phi Lambda Sigma Honorary Society

Dr. Ronald Torry and Dr. Timothy Welty presenting PharmD hood to Christina Cherayil

Welcome by Dean Rospond

2013 Drake PharmD graduates prepare for the hooding ceremony

52

| July/Aug/Sept 2013

Drake University 2013 PharmD Graduating Class

student section

UNIVERSITY OF IOWA COLLEGE OF PHARMACY CLASS OF 2013 Jennifer Anderson Kerry Anderson Kyle Anderson Carrie (Bailey) Gray Christopher Barnett Matthew Bauer Andrea Bennett Stephanie Berns** Daniel Blonsky Sunny Bounyalath Alexandra Brosnahan Anthony Buerger* Joseph Campanelli* Melita Campbell Jennifer Cardines Justin Carr Ryan Clark John Corrigan Nicole Cox Katie Croegaert** McKenzie Dearborn Katelyn Deiber*** Sara Dempsey Andrew DeSio Samantha Dow** Michael Dunn Jennifer Elwood* Megan Erickson** Rachel Finkelstein Andrew Fiorella Michelle Gleason** Brian Glenn Abby Goerdt**

Danielle Gradeler** Justin Graff* Sharon Griffiths Laura Halder* Brett Hamann Samuel Houmes David Huhtelin Joel Huisenga Tony Huynh*** Sawsan Ikram Marwa Ithman Jason Jared Paula Juhn Elizabeth Keltner Bobby Kessler Kazuhiko Kido** Jaime Kimmel** Emily Klatt Jessica Koehlert* Daniel Kraft** Ashley Kral Sean Kubik Na-young Kwon Jacquelyn Lansing Kaye Lapcewich Jacqueline Lee Alicia Lynn** Amanda Mather Jennifer Meuwissen Sarah Minner* John Mora Sara Naughton Elaine Nguyen**

Amy Nicholson Victoria Okon Jennifer Parker Rebecca Pashek* Prit Patel Katheryne Photijak Jennifer Preinitz Daniel Priest Hussein Razick Nikhila Reddy Venumula Meagan Reese Caitlin Reinking Samantha Reiser Jonathon Relph Cara Richardson Alison Rier Jessica Ritchey Yujun Rong Deborah (Jane) Routheaux* Kerry Schueler*** Jordan Schultz* Anna Sciegienka* Kayla Scott Jacob Shell Natalie Simmons Amanda Smith Jonathan Smith Melanie Smith* Rachel Smith Tarik Smith Annie Springsteen* Andrew Spurgin Courtney Thomas***

Ryan Thurm* Monica Verma Janelle Vittetoe** Michael Vogt Andrea Wacker Adam Wilcox Zachary Wittenburg Deng Wour Dalin Wu Theresa Tracey Wylie Jill Zimmerman Thomas Zlatohlavek *With Distinction **With High Distinction ***With Highest Distinction

Commencement speaker Melissa Murer Corrigan reminded students that “a career in pharmacy can be a true journey.�

Student Sean Kubik is hooded with his academic attire by Associate Professor Jonathan Doorn.

Students Tarik Smith, Victoria Okon, and Melita Campbell.

Class President Jordan Schultz delivered remarks to the Class.

Dean Donald Letendre, Melissa Murer Corrigan, and UI President Sally Mason.

July/Aug/Sept 2013 |

53

last laugh

“Joseph is in Relief” Joseph H. Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322

1.888.278.0846 or 515.278.0846

Advertise in our publications Place your classified ad here!

All ads, contracts, payments, reproduction material and all other related communication should be addressed to Lynndi at lkoester@iarx.org or call the IPA office at 515.270.0713 for more information.

AUGUST 2013 1-4 TRT Leadership Pharmacy Conference - Galena, IL 4 IPRN Group Support Meeting - Des Moines

Fellowship Church 10-13 NACDS Total Store Expo - Las Vegas, NV 14 Log-in To Learn e-journal Club 21 2013 Immunization Update

(Live webinar) 28 Immunization Administration Training

(Live workshop, Des Moines, IA) 29 IPA Goes Local - Southwest Iowa Pharmacists Association SEPTEMBER 2013 5 Drake University’s Back to School Webinar Series

(Live webinar) 8 IPRN Group Support Meeting - Des Moines

Fellowship Church 10 2/2/2 - Immunization Expansion 11 Log-in To Learn e-journal Club 12 Drake University’s Back to School Webinar Series

(Live webinar) 13 IPA-F Board of Directors Meeting, Copper Creek Golf Club,

Pleasant Hill, IA

54

| July/Aug/Sept 2013

SEPTEMBER 2013 13 Eggleston/Granberg Golf Classic - Copper Creek Golf Club,

Pleasant Hill, IA 19 IPA Goes Local - Johnson Co. Pharmacy Association 19 Drake University’s Back to School Webinar Series

(Live webinar) 26 Drake University College Night - Marriott, West Des Moines 26 Drake University’s Back to School Webinar Series

(Live webinar) OCTOBER 2013 4 University of Iowa Cardiovascular Update

(Live conference, Iowa City, IA) 6 IPRN Group Support Meeting - Des Moines

Fellowship Church 8 2/2/2 - PBM Reimbursements and Audits 8 Resident’s Meeting - Iowa City 8 University of Iowa College Night - Marriott, Coralville 9 Log-in To Learn e-journal Club 13-16 ACCP Annual Meeting - Albuquerque, NM 16-18 AMCP’s 2013 Educational Conference - San Antonio, TX 22 IPA Goes Local - Northwest Iowa Pharmacy Association

July/Aug/Sept 2013 |

55

56

| July/Aug/Sept 2013