IPA Journal Apr/May/Jun 2022

A Peer-Reviewed Journal | Vol. LXXVII, No. 2 | APR.MAY.JUN. 2022

LACK OF TRANSPARENCY & REGULATION:

COMBATING PBMS INSIDE:

2022 Board of Trustees Election Case Study: Deprescribing IPA Legislative Day Recap

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

PUBLICATION STAFF Allison Hale, Managing Editor Kate Gainer, PharmD Emmeline Paintsil, PharmD, MSLD, BCPS Elizabeth Orput, PharmD Kellie Staiert, MPA

COVER STORY Combating PBMs pg. 6

OFFICERS CHAIRMAN Diane Reist, PharmD, RPh – Cedar Rapids PRESIDENT Christopher Clayton, PharmD, MBA – Manchester PRESIDENT-ELECT Cheri Schmit, RPh – Ames TREASURER CoraLynn Trewet, PharmD – Ankeny SPEAKER OF THE HOUSE Deanna McDanel, PharmD, BCPS, BCACP – Coralville VICE SPEAKER OF THE HOUSE Heather Ourth, PharmD, BCPS, BCGP – Ackworth

TRUSTEES REGION #1 Wes Pilkington, PharmD – Waterloo REGION #2 Pamela Wiltfang, PharmD, MPH, BA, CHES – North Liberty REGION #3 Candace Jordan, PharmD, BCPS, MBA – Winterset REGION #4 Grant Houselog, PharmD, CSPI – Sergeant Bluff AT LARGE Emily Beckett, PharmD, BCPS – Johnston Nancy Bell, PharmD – West Des Moines Jackie Gravert, PharmD, MPH – Cedar Rapids Angie Spannagel, PharmD, BCACP – Dubuque HONORARY PRESIDENT Sharon Cashman, RPh – Waverly PHARMACY TECHNICIAN Tammy Sharp-Becker, CPhT, CSPT – Des Moines STUDENT PHARMACISTS Mahi Patel – Drake University Jose Rodriguez – University of Iowa The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see www.iarx.org/journal.

“The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) publishes 4 issues per year: January/February/March issue; April/ May/June issue; July/August/September issue; and October/November/December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices.

POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly, The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by Mittera; Graphic design done by the Iowa Pharmacy Association.

Student Column pg. 10

Board Election Results pg. 12

FEATURES IPA Annual Meeting 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Iowa MPJE Study Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Case Study: Deprescribing to Resolve Oversedation . . . . . . . . 16 IPA Legislative Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2022 Legislative Session Update . . . . . . . . . . . . . . . . . . . . . . . . . 24 IPA Foundation Scholarships . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2022 Bill Burke Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 IPA Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

IN EVERY ISSUE President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Healthcare Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Mission Statement The Iowa Pharmacy Association empowers the pharmacy profession to improve the health of our communities.

APR.MAY.JUN. |

3

PRESIDENT’S PAGE

INVEST IN IPA TO INVEST IN IOWA PHARMACY

O

ver my twenty-two years in practice, I have often been asked ‘why pay to be an ENGAGED member of IPA, why spend the money?’ Personally, I have a pretty long list of reasons for doing so, including the professional networking with a lot of amazing people, but there is one reason that stands out.

Christopher Clayton, PharmD, MBA IPA President Director of Pharmacy & Population Health, Buchanan County Health Center

I believe every pharmacist, technician, support person and pharmacy owner should be an active member and contribute to IPA. IPA represents our profession in Iowa, where all of our pharmacies and practice sites are located. There is a lot we can do in our own state to practice at the top of our license or registration, and our state efforts assist legislative priorities at the federal level. Evidence of this includes the work done in Iowa to support vaccination efforts and technician product verification.

IPA members help determine the state legislative priorities for our profession. IPA employs and contracts to build an advocacy team equipped to represent our profession through the legislative process at our State Capitol. Did you know that every year there are dozens of proposed bills that would impact our profession submitted for consideration?

IPA’s advocacy team provides both offense and defense on proposed legislation.

While some of these bills are submitted by IPA, many are not, and some of those would increase your blood pressure if you realized what they were requesting to change…For example, in 2022, numerous bills were submitted that would strip pharmacists of the right to

Chris Clayton sharing personal experiences as a pharmacist and pharmacy owner in support of the PBM bill at the State Capitol.

4

| The Journal of the Iowa Pharmacy Association

refuse the dispensing of ivermectin and other medications that are prescribed off-label. In addition, these bills did not remove liability if something bad happened.

On the other end of the spectrum, we have the IPA-submitted PBM bill that we certainly want to support and see move across the finish line. The PBM bill supports the profession across multiple practice settings to assure our patients have proper access to local care, allowing Iowa-based pharmacies to be included in specialty networks, assisting in fair payment practices for those services rendered, and strengthening appeal processes as well as oversight and enforcement by the Iowa Insurance Division.

These legislative activities alone are so important for the future of our profession that I believe all of us need to do our part. If you can’t spare your time, paying for an ENGAGED membership or donating to the Iowa Pharmacy Political Action Committee (IPPAC) helps the IPA advocacy team represent us at the State Capitol and keep members informed on legislative updates and grassroots efforts.

Just like investing or planning for retirement, investing in state legislative support for our profession will help shape and secure our future goals.

If you are reading this as an ENGAGED IPA member – thank you! I hope you continue to share IPA membership with fellow co-workers and colleagues and help them navigate the process of joining our One Voice. ■

ANNUAL MEETING September 22-23, 2022

Cedar Rapids, IA

DoubleTree by Hilton Convention Complex www.iarx.org/IPAAnnualMtg

VIRTUAL HOUSE OF DELEGATES SEPT. 13 SEPT. 14

House of Delegates – Session I Policy Committee Meetings on Professional & Public Affairs

THURSDAY, SEPTEMBER 22 8:00 AM 8:45 AM 9:00 AM

Coffee Hour & Open Networking Welcome House of Delegates – Session II

KEYNOTE: Self-Deception & Objectification: Implications for Providing Care

12:15 PM 1:30 PM 1:30 PM 3:30 PM 6:00 PM 9:00 PM

Lunch – IPA President & Board Installation Exhibit Hall & Poster Presentations Open Networking/Roundtable Discussions Residency Showcase + Meet the Residents President’s Reception & Annual Awards Banquet IPA Foundation Silent Auction

FRIDAY, SEPTEMBER 23 6:30 AM 7:30 AM 8:30 AM

FUN Run/Sunrise Stretch Coffee Hour & Open Networking Keynote & House of Delegates – Session III

KEYNOTE: Pharmacy’s Important Role in Health Equity: National Pharmacy Association Panel (ASHP, APhA and NCPA)

11:30 AM 11:45 AM 1:00 PM

IPPAC Pie-in-the-Face Lunch & Industry Symposium Boosting Confidence in Communication

APR.MAY.JUN. |

5

COMBATING PBMS

A LOOK INTO COMBATING UNETHICAL PBM PRACTICES

By Elizabeth Orput, PharmD, IPA Executive Fellow "Pharmacy Benefit Managers" (PBMs), a phrase that makes any pharmacy professional’s ears perk up. A phrase that comes with questions, doubt and uncertainty. What steps are being taken in Iowa to combat unethical PBM practices? How are states across the country tackling this issue? Is there a light at the end of the tunnel?

PBMs are third-party middlemen who were initially designed to reduce costs, administer plan benefits, and negotiate costs between health plans and pharmacies.1 Today, these middlemen thrive on a lack of transparency, lack of regulation, and general lack of understanding as to what role they play in healthcare. This lack of regulation and understanding has placed PBMs in the prime position to exert their power and become behemoth corporations.

At the Iowa Pharmacy Association (IPA), there is a team of hard working, dedicated individuals spending countless hours at the State Capitol educating legislators and advocating for PBM reform. In January, HF 2384/SF 2231, Pharmacy Benefit Managers II, was introduced. This bill establishes PBM fiduciary responsibility, prohibits steering and clawbacks, and addresses reimbursement and network issues.2 With the help of IPA members’ grassroots efforts, HF 2384 was passed unanimously by the Iowa House. If signed into law by the Governor, the following provisions would apply.

PBMs would be required to: • Treat Iowa pharmacies the same as their own out-of-state PBM owned pharmacies; • Allow pharmacies to appeal reimbursements below acquisition cost; • Act in the best interest of payors.

Patients would have the choice to access care through Any Willing Pharmacy.

Retroactive clawbacks for patients and pharmacies would be eliminated.

PBM pricing would be more transparent for all parties involved.

Iowa is not the only state viciously fighting this battle. Over the last year, there have been over two dozen PBM bills introduced across the country. Some of these bills have been signed into law, and others are awaiting their fate. States pushing for PBM reform have seen two things in common: 1) An aggressive state legislative momentum, and 2) aggressive employer opposition.2 In West Virginia, HB 4112 was recently signed into law by Governor Jim Justice. This bill gives patients greater authority to choose which in-network pharmacy they fill their prescriptions at and addresses the specialty medication designation PBMs utilize

6

| The Journal of the Iowa Pharmacy Association

COMBATING PBMS to steer patients to their pharmacies.1 In Nebraska, LB 767 was signed into law by Governor Pete Ricketts. This bill requires PBMs to be licensed to operate in the state and provides the state with regulatory oversight of PBMs.2 In Michigan, Governor Gretchen Whitmer signed HB 4384 into law. PBMs are now required to be licensed to operate in the state, and patients can choose their pharmacy provider.2 This bill also ensures a fair audit process and requires pricing transparency.2 The states are not in this alone. The National Community Pharmacists Association (NCPA) has ramped up its efforts in working with state insurance departments to ensure legislation that is signed into law is appropriately enforced.2 NCPA has also been working closely with the National Association of Insurance Commissioners (NAIC), specifically in two focus groups, the PBM Issues Subgroup and the ERISA Working Group. Together, NCPA and NAIC have created white papers and drafted an analysis of the Rutledge decision that will be included in NAIC’s ERISA Handbook.2 NCPA is not the only national organization fighting this battle alongside the states. The American Pharmacists Association (APhA) signed on as an equal partner in the federal lawsuit, NCPA v Becerra, that challenges retroactive DIR fees.3 Between 2010 and 2020, DIR fees have increased by 107,400 percent.4 The last reported increase from CMS between 2010 and 2017 was 45,000 percent.3 This lawsuit would not eliminate DIR fees but would ensure PBMs are not taking money away from pharmacies months after the sale of a prescription.2 In addition to NCPA and APhA’s work, the Federal Trade Commission (FTC) has been taking steps to investigate PBM practices. In February, the FTC requested and accepted comments from the public regarding PBM practices and how they impact practice and patient care. After the comment period closed, the FTC voted on whether to launch an inspection. Unfortunately, that vote ended in a tie (2 -2). With the addition of a new Commissioner, the FTC re-opened the public comment period and is now accepting comments until May 25, 2022. A re-vote will occur once comments have been collected.

U.S. Senator Chuck Grassley has also been ferociously working to combat PBM practices across the country. In 2020, the “Prescription Drug Pricing Reduction Act of 2020” (S.4199) was introduced in the Senate. If signed into law, S.4199 would have provisions that would require PBMs to “report aggregate information on prescriptions, price concessions, and PBM payments to pharmacies,” require Part D and Medicare Advantage (MA) plans to “conduct audits of PBM contract terms and direct and indirect renumeration data to account for the true net cost of covered Part D drugs,” and require the Secretary to “make the information on aggregate price concessions currently reported by plans or PBMs under Part D publicly available on the HHS website.”5 Members can learn more about S.4199 during IPA's May 16 Insight to Advocacy webinar (available on-demand).

United, national, state and local advocacy efforts will continue to push this important work forward. Does one voice matter? Absolutely. But combined, pharmacy professionals have the power to save pharmacies, keep access to healthcare in rural communities, and support patients long into the future. PBMs come with a lot of questions, doubt and uncertainty, but together, we can combat the unethical practices pharmacies in all settings encounter daily.

References: 1.

2.

3.

4.

5.

National Community Pharmacists Association. Pharmacy benefit managers (PBMs) 101. Accessed May 4, 2022. [online] Available at: http://www.ncpa.co/pdf/leg/nov12/ pbm_one_pager.pdf Barker B, Cassity A, Magner M. PBM legislative action – national landscape & Iowa. Oral presentation for: IPA Insight to Advocacy; April 15, 2022; Des Moines, IA – virtual.

APhA. Federal lawsuit challenging retroactive DIR fees: NCPA V Becerra. Accessed April 28, 2022. [online] Available at: https://www.pharmacist.com/Advocacy/Issues/Federal-Lawsuit-Challenging-Retroactive-DIR-Fees NACDS. 2022. DIR fees. Accessed April 28, 2022. [online] Available at: https://www. nacds.org/dir-fees/?print=pdf Staff of Senate Finance Committee. Prescription drug pricing reduction act of 2020.

Accessed April 29, 2022. [online] Available at: https://www.finance.senate.gov/imo/media/ doc/PDPRA%202020%20Section%20by%20Section.pdf

APR.MAY.JUN. |

7

Congratulations 2022

SCHOLARSHIP

WINNERS

Pharmacists Mutual is proud to support pharmacy students interested in serving in an independent or small chain community pharmacy or an underserved geographic or cultural community.

EACH STUDENT LISTED RECEIVED A $3,000 SCHOLARSHIP. Marlee Clements Mercer University Allison Welsh North Dakota State University Amber Conklin Ohio Northern University Bailey Bartley Sullivan University Celia Mix North Dakota State University Casey O’Quinn Medical University of South Carolina Dylan Johnston Husson University

ACCEPTING APPLICATIONS FOR 2023 SCHOLARSHIP

October 1, 2022 - December 1, 2022 phmic.com/scholarship

Elizabeth Braun University of Wisconsin–Madison Laura Harris Auburn University Kaia’ Harrison Duquesne University Katelyn Carswell Auburn University Kaylen Luginbill Schier Southwestern Oklahoma State University Peyton Gilbert University of Texas at Tyler Natalie Morton Novak Mercer University Lauren Williams University of Kentucky Megan Navarro University of the Incarnate Word Trey Carter University of Kentucky Taylor Williams University of Kentucky

Pharmacists Mutual Insurance Company Algona, Iowa phmic.com

Savannah Rose Sullivan University Victoria Vo Virginia Commonwealth University

'

ERE! PJ YG

Everything graduates and new­ to-Iowa pharmacists need to prepare for the Iowa Multistate Pharmacy Jurisprudence Examination, including:

CopyrightMay 2022, all righis reserved Iowa Pharmacy Association 851SDouglasAve,Suite 16 �esMoines,IAS0322 ma@ianco!& I www.Jarx.org . . lnd1v1du als wishing to reproduce portions of this tcx1,must

IOWA PHARMACY

obmin express writ1en pennission to do

ASSOCIATION

so by writing 10 the ..lowa PhannacyA

• Information on how to register for the exam • Questions in a table format to fill in your answers • Answers to each question with references to information in Iowa code and administrative code • Terminology section of key terms to know

Original Price: $75

Discounted Price: $40

IPA members enjoy a substantial discount!

For INFORMED Pharmacists and Non-members

For Student Pharmacists, ENGAGED Pharmacists, CONNECTED Pharmacists, and Business Partners

.. ssocrnuo n."

STUDENT COLUMN

1 UNIFIED VOICE: A STUDENT PHARMACIST PERSPECTIVE

H

Jose Rodriguez

Student Pharmacist, IPA Board of Trustees The University of Iowa College of Pharmacy

aving the opportunity to serve on the IPA Board of Trustees has substantially elevated my knowledge and understanding of the practice of pharmacy. During the quarterly meetings, I have met with some of the state’s most prominent and involved pharmacists while also learning and discussing the most pressing issues faced by the profession. I think it is easy as a wide-eyed student to grow oblivious to issues that present both immediate and long-term threats to our work environments and salaries. As students, we primarily focus on gathering clinical knowledge, passing our exams, and getting a job.

It isn’t until after we secure a job that we tend to see a lot of the larger issues affecting our profession.

I was truly blessed to have received this opportunity to learn and serve on the Board; it is an opportunity I wish more students were able to have. I am very excited to bring all that I have learned back to the University of Iowa College of Pharmacy, and I hope to find ways to make learning about our profession more practical and prevalent. Our school does an excellent job of preparing us to apply our pharmaceutical knowledge in a practice setting, but I would like to see Iowa’s colleges educate students further and make them aware of the issues in the real world that might limit or restrict our abilities to provide healthcare. As students, we can have such a collectively loud voice, but if we are unaware of what it is we should be taking action against, then our voices go unheard.

From my time on the Board, I have learned that the more student pharmacists get involved, the better off our profession is. Iowa is well-known for its grassroots activism because a majority of our practice settings are located throughout rural Iowa, providing healthcare to all communities. A lot of Iowa pharmacy students are

from the state, and many of these same students come from rural towns. They have stronger connections to their state legislators than any lobbyist IPA could hire.

We must utilize the voices of our students to sway local politicians in supporting our cause. The cause we fight for every year in the state of Iowa is a simple one; we wish to keep and expand access to healthcare for our rural populations.

My time on the Board has highlighted a major issue Iowa pharmacies are facing. The current practices of PBMs are quite frankly unlawful, and it will take the cooperative effort of all to combat these practices. With the help of patients, student pharmacists and pharmacists alike, we can fight back against PBMs and continue providing care for members of our communities, no matter how far in the country they live.

If there’s one thing that stands out from my experience on the Board as a student, it’s the inspiring sense of camaraderie. Coming from across the state and very different practices, our amazing Board always finds a way to come together and fight for the most pressing issue, even if it’s not currently affecting their practice setting.

They all understand the strength in the association’s unified voice, and when the time comes that they need help, they know there will be a reciprocated effort.

I am most thankful for the in-person conversations I was able to have with the pharmacist board members, where I learned what they envision for the evolution of pharmacy practice. The biggest takeaway from serving on the IPA Board of Trustees was learning about what Iowa pharmacists believe in and fight for: “If it’s not right for the patient, then it’s not right for the profession.” I plan to take this message and keep it alive wherever I end up practicing. ■­

2021 IPA Board Retreat November 4-5 in Des Moines

10

| The Journal of the Iowa Pharmacy Association

HEALTHCARE HOT TOPICS

AHA ISSUES PRESIDENTIAL ADVISORY FOR HIGH-RISK RHD PATIENTS

Published on January 20, the American Heart Association (AHA) released a new presidential advisory that indicates oral penicillin may be a safer option than injections for patients with rheumatic heart disease (RHD). Currently, an intramuscular injection of benzathine penicillin G (BPG) is administered every 3-4 weeks for a prolonged period of many years. A growing body of evidence shows that some patients with RHD who have severe valvular heart disease are dying from cardiovascular compromise following BPG injections. AHA continues to advocate that BPG is the most effective form of secondary prophylaxis and should be prescribed to all low‐risk patients with RHD who have no contraindication to penicillin, but the association strongly advises the use of oral prophylaxis for high-risk patients.

FIRST FOUR BULK DRUG SUBSTANCES ADDED TO FDA’S 503B LIST

In late January, the FDA announced the first four bulk drug substances added to the agency’s 503B Bulks List, which identifies bulk drug substances that may be used in compounding by outsourcing facilities. This move originates from the agency’s efforts to ensure access to compounded medications when FDA-approved products do not meet a patient’s medical needs. The four substances approved are diphenylcyclopropenone (DPCP) for topical use, glycolic acid for topical use in concentrations up to 70 percent, squaric acid dibutyl ester (SADBE) for topical use, and trichloroacetic acid (TCA) for topical use. None of these substances are current components of FDA-approved drugs. The agency also determined that eight other bulk drug substances would not be added to the list at this time.

FDA APPROVES VONJO FOR TREATMENT OF RARE BONE MARROW DISORDER On March 1, the FDA granted accelerated approval for Vonjo (pacritinib) capsules to treat adults with a rare form of a bone marrow disorder. The condition, myelofibrosis, causes a hindrance in platelet production and enlarges the patient’s spleen. For individuals with

myelofibrosis, platelet counts can be as low as 50,000µL, which can lead to anemia and increased risk of bleeding. In a randomized, controlled Phase 3 study, Vonjo was dosed at 200mg twice daily and spleen volume reduction was measured over the course of 24 weeks, finding over 35% spleen volume reduction among nine patients compared to the placebo group. Common side effects of Vonjo include diarrhea, thrombocytopenia, nausea, anemia and peripheral edema.

FDA APPROVES TRANSDERMAL PATCH FOR TREATMENT OF ALZHEIMER’S

In March 2022, the FDA approved Adlarity (donepezil), a transdermal delivery system for treatment of patients with mild, moderate, or severe Alzheimer's disease. Adlarity was granted swift approval as it is identical to an approved drug already on the market, oral donepezil, which is notorious for causing gastrointestinal symptoms in patients.

Alternatively, the once-weekly donepezil patch will deliver consistent doses of the medication through the skin, bypassing the digestive system and greatly decreasing GI adverse events. The new delivery system will also help improve adherence for this patient population. Adlarity is available in 5mg- and 10mg-per-day patches and can be placed on the back, buttocks or thighs.

DEA ISSUES PUBLIC SAFETY ALERT ON COUNTERFEIT MEDICATIONS

In recent months, the DEA issued a Public Safety Alert on counterfeit medications containing fentanyl and methamphetamine, the first alert in approximately six years. This issue is a growing concern as over 9.5 million counterfeit pills were seized in 2021, which is more than the previous two years combined. The COVID-19 pandemic has played a role in the rise of counterfeit drugs across the country; many of these medications are being purchased online by individuals who believe they are legitimate. Although many consumers are unaware, the lethal doses of synthetic opioids in these medications are contributing to an increase in drug overdoses and deaths. Pharmacy professionals can help mitigate this issue by educating patients about the risks of counterfeit medications and how to identify websites that may be selling them.

APR.MAY.JUN. |

11

IPA BOARD OF TRUSTEES

2022 IPA BOARD ELECTION Congratulations and welcome to the newly elected members of the IPA Board of Trustees!

The following individuals will be installed at the 2022 IPA Annual Meeting, September 22-23 in Cedar Rapids. In addition, Cheri Schmit, IPA's current president-elect from Ames, Iowa will be installed as the association's 144th president at the Annual Meeting.

PRESIDENT-ELECT

TRUSTEE REGION 1

TRUSTEE REGION 3

John Hamiel, PharmD

Rob Nichols, PharmD, BCPS

John L'Estrange, PharmD, RPh, BCACP

Evansdale

Waterloo

Des Moines

“I became aware of the importance of being involved and a spokesperson for our profession. It became very clear to me that both giving back and pushing forward the profession of pharmacy are crucial in keeping Iowa Pharmacy the best in the country.”

“The COVID-19 pandemic has brought about a hodge-podge of experiences...We are faced with an opportunity to make sure our impact and our value in the larger healthcare picture is not forgotten.”

“There has never been a more important time to empower pharmacy professionals to improve the health of our communities.

The COVID-19 pandemic has spotlighted how critical our profession is to our healthcare system.”

TRUSTEE-AT-LARGE

PRESIDENT-ELECT

TRUSTEE-AT-LARGE

Micaela Maeyaert, PharmD, BCPS, DLPA

Cheri Schmit, RPh

Morgan Herring, PharmD, BCPS, FAPhA

Spirit Lake

Ames

West Des Moines

“As I have grown throughout my career, I have learned that leadership is not about the title you hold and is no longer about what you can accomplish on your own. Leadership is about serving others...and about what your team can accomplish.”

“Pharmacists are part of a CARE TEAM, and it has never been more evident than now. We have an opportunity!

We can capitalize on the momentum of the day to make real change legislatively and within our daily practices.”

“All settings are struggling. We train all of our pharmacy students to accomplish amazing things, and it is time that we advocate for them to not only have the freedom to do that, but also be given the resources to do it safely and in a supported environment.”

12

| The Journal of the Iowa Pharmacy Association

35 Years of Supporting Independents to Become the Largest GPO for Independent Pharmacies Owned by Independent Pharmacies.

Delivering Top Value to Independent Pharmacy Independent pharmacies nationwide access IPC’s programs in order to thrive in today’s competitive marketplace. IPC offers comprehensive distribution purchasing opportunities for today’s successful community pharmacy in a variety of important categories. Let us help take your pharmacy to the next level with our incredible selection of programs and services designed with independent pharmacy in mind.

IPC Opportunities Rx Advantage

Contract Opportunities

• Huge Selection of Generic Rx

• 65+ Offerings

• Weekly Generic Rx Specials

• Specialty Pricing & Offers

• Bonus Monthly Generic Rx Rebates

OTC Advantage

• Additional Rx Specials Year-round

• Average Savings = Cost -15%

• Brand Rx at Cost -3.00% or Better

• Starter Displays and Planograms

• Controlled Substances to Qualifying Stores

www.ipcrx.com 800.755.1531

IT’S YOUR CAREER. You can’t afford to be wrong.

PHARMACISTS MUTUAL IS COMMITTED to providing you with coverage designed with your needs in mind. With over 110 years’ experience in the pharmacy profession, we understand the risk and challenges you face. As you know, the pharmacy profession is ever-changing and expanding. With these changes, there is increased professional liability exposure.

The Pharmacists Mutual professional liability policy is tailored specifically to meet your evolving needs.

LEARN MORE AT: phmic.com/pharmacy-professional-liability Professional | Commercial | Personal | Life & Disability

phmic.com

Policy terms and conditions control. Coverage may not be available in all states.

Life and disability insurance are written through PMC Advantage Insurance Services, Inc., a wholly-owned subsidiary of Pharmacists Mutual Insurance Company.

PRACTICE ADVANCEMENT 1815 UPDATE

IPA continues to work closely with the Iowa Department of Public Health (IDPH) in partnering with Iowa pharmacies to advance education and services that improve outcomes for patients with chronic diseases. The 1815 project largely focuses on diabetes but also looks at expanding care and addressing the needs of patients with hypertension and dyslipidemia.

IPA has been working with two pharmacies, Pharmacy on 8th, LLC in Wellman, IA and Main Street Drug in Charles City, IA to establish Diabetes Self-Management Education and Support (DSMES) Programs.

IPA has been working with other community pharmacies to increase referrals into surrounding DSMES and Diabetes Prevention Programs (DPP). IPA is working with IDPH to establish priorities for the 20222023 grant cycle. If your pharmacy is interested in expanding services for patients with diabetes, hypertension and hyperlipidemia, please contact Emmeline Paintsil at epaintsil@iarx.org.

TEST & TREAT TOOLKIT: VERSION 2.0 AVAILABLE NOW

As more pharmacies begin providing test and treat services for influenza, strep and COVID-19, IPA supports the expansion and advancement of practice with the aid of our Test & Treat Toolkit. The toolkit includes information on CLIA certification, education and training requirements, and frequently asked questions on topics such as billing and payment. Additionally, the toolkit includes sample documentation for provider communication, screening tools and patient evaluations.

Version 2.0 includes new Informational Letters from IME and updates to the COVID-19 section with the expiration of Iowa’s Public Health Disaster Emergency Proclamation. The updated toolkit was released in early May. As a reminder, the toolkit is free for ENGAGED Pharmacist, Associate, Platinum Business Partner and Technician members. INFORMED, CONNECTED and non-members can purchase the toolkit for a fee. Visit www.iarx.org/store_home.asp.

VACCINE EQUITY GRANT UPDATE

ing with trusted messengers across the state and providing education on how to address hesitancy, navigate misinformation and promote confidence in COVID-19 vaccines. A full listing of upcoming IPA Goes Local events is available on Page 38.

For more information on this project and how to collaborate with IPA, please contact Emmeline Paintsil at epaintsil@iarx.org.

HEALTH DISPARITIES GRANT UPDATE

In February, IPA was awarded a grant from IDPH to address social determinants of health needs to reduce COVID-19-related health disparities. IPA is working to advance health equity for vulnerable populations, most notably in Iowa’s rural communities. Pharmacists can help address the needs of rural patients who have foregone health visits and delayed care by providing education and increasing access to disease state management services.

The association seeks to promote education on chronic disease management (obesity, hypertension, diabetes, etc.) and expand access to screening and testing services (STDs, diabetes, cholesterol, etc.) for patients. Additionally, IPA seeks to promote educational resources for pharmacy professionals on the socio-economic and long-lasting health impacts of COVID-19 for underserved and disproportionately affected communities. To learn more about this project or to collaborate with IPA, contact Emmeline Paintsil at epaintsil@iarx.org.

IPA AWARDED PTCB PARTNERSHIP FUND IPA was awarded funds from the Pharmacy Technician Certification Board (PTCB) to promote medication safety and help advance the role of pharmacy technicians. Through 2023, IPA will be providing funds through a scholarship program to pharmacy technicians looking to obtain advanced certifications in point-of-care testing from PTCB or CEimpact. IPA is currently formalizing the scholarship and award process. To learn more about this program, contact Emmeline Paintsil at epaintsil@iarx.org.

UPDATED PNEUMOCOCCAL VACCINE RECOMMENDATIONS GRANT PROPOSAL

In March, IPA and the Iowa Medical Society submitted a joint-grant proposal aimed to educate providers and patients on the new ACIP pneumococcal vaccine recommendations. The project has three goals to increase pneumococcal immunization rates among eligible Iowans: 1. Develop and provide tailored education opportunities to vaccine providers, providing the latest clinical guidance and recommendations to enable identification of all appropriate patients and safely administer appropriate vaccine product for each patient.

IPA continues to partner with IDPH in working to increase COVID-19 vaccine confidence, engaging trusted messengers, and addressing vaccine hesitancy for populations that have been disproportionately affected by the COVID-19 pandemic. The IPA team has been exploring new and innovative ways to engage the membership and deliver timely information. To revamp the association’s Connecting Over COVID-19 webinars, IPA will be shifting this content to a podcast format to provide members a new way to engage and listen at their leisure.

2. Empower providers with evidence-based patient engagement and communication skills to optimize vaccine counseling techniques to positively aid in patient shared decision-making, address vaccine confidence concerns, and promote vaccine acceptance.

In addition, IPA is looking forward to getting back on the road and into communities for IPA Goes Local events. We look forward to engag-

To learn more, contact Emmeline Paintsil at epaintsil@iarx.org.

3. Create support tools and resources for providers that offer quick, convenient, in-time access to updated information and patient support materials to reinforce provider communications and aid in patient care.

APR.MAY.JUN. |

15

DEPRESCRIBING

Deprescribing to Resolve Oversedation and Confusion in an Older Person Treated for Auditory Hallucinations and Poststroke Seizure Prophylaxis AUTHOR

Mark Branum, PharmD, BCGP, Adjunct Assistant Professor, Drake University; Adjunct Assistant Professor, University of Iowa This article was published in The Senior Care Pharmacist by the American Society of Consultant Pharmacists (ASCP). Doi:10.4140/TCP.n.2021.645.

INTRODUCTION

This case study reviews the pharmacotherapy of a resident in a longterm care facility being treated for poststroke seizure, hallucinations, and dementia, a geriatric syndrome that is both common in regard to its prevalence and severe in regard to its impact on the individual, families, caregivers, and health care system. This case describes the past medical history of an older resident in a skilled nursing facility that was receiving pharmacological therapy for auditory hallucinations and for poststroke seizure prophylaxis, was noted to be having side effects from drug therapy, and how the nursing staff communicated with the consultant pharmacist to resolve these issues.

KEY WORDS: Antipsychotic medication, Case study, Dementia, Geriatric syndrome, Hallucinations, Interprofessional communication, Older person, Poststroke seizure, Deprescribing, Potentially inappropriate medications.

ABBREVIATIONS: CVA = cerebrovascular accident, D2 = dopamine receptor D2, PIMs = Potentially inappropriate medications, SVA = synaptic vesicle protein type 2A, SV2A = synaptic vesicle glycoprotein 2A. Sr Care Pharm 2021;36:645-51.

depressive disorder with psychotic features.” She had a stroke approximately two years prior to her recent hospitalization for pneumonia and had subsequent left-sided hemiplegia and hemiparesis. Progress notes from the psychiatrist prior to her hospitalization for pneumonia included “auditory hallucinations,” a “euthymic mood,” and also that she “does not hear well.” A similar note from a telehealth psychologist noted that Betsy had a “pleasant and cooperative demeanor” with some “auditory hallucinations” but no visual hallucinations noted.

Upon admission to her present nursing facility after her hospitalization, nursing staff noticed that Betsy was quite lethargic and asked if medications could be contributing. Nursing staff, including one that happened to be Betsy’s niece, reached out to the facility’s consultant pharmacist with their concerns regarding Betsy, her medications, and possible side effects. Nursing staff raised questions about her Seroquel dose at bedtime for “auditory hallucinations” and questioned whether the “man singing” that she hears might be either tinnitus or perhaps sounds overheard from another resident's television in the neighboring room. As the consultant pharmacist for the facility, you listened to the staff members’ concerns regarding Betsy’s medications, sedation, and began a thorough medication regimen review.

Past Medical History

Any medication therapy can cause adverse effects, especially in older patients.

Betsy: A 91-Year-Old Female Living in a Skilled Nursing Facility Betsy is a 91-year-old resident of a skilled nursing facility where most residents are 80 years of age or older, many have significant functional limitations in terms of mobility, and most need partial or total assists with activities of daily living. The facility has an occupancy of 55 residents with a central dining room, several common areas including a sunroom, patio, activities area, chapel, and an attached clinic-run physical therapy office.

HISTORY OF PRESENT ILLNESSES

Betsy was admitted to her present nursing facility after a brief hospitalization for pneumonia. Prior to her hospitalization, she was living in a different nursing facility and was doing reasonably well. She was seen by her primary care physician every two months in that facility and was treated by a telehealth psychiatrist who diagnosed her with “major

16

| The Journal of the Iowa Pharmacy Association

Heart failure, vascular dementia, cerebrovascular accident (CVA), hypertension, chronic atrial fibrillation, anxiety, depression, chronic obstructive pulmonary disorder, osteoarthritis, depression with psychotic features.

Social History

Alcohol use: none noted; nicotine: former smoker for many years, no indication of pack/year history.

Physical Exam

Height: 66”, Weight: 165 lbs, BP: 129/77, HR: 66, RR: 16, Blood sugar: 153, O2 sat: 95%, pain level: 0.

Laboratory Results

RBC = 4.53 M/uL, Hgb = 14.4 g/dL, Hct = 44.4%, Na = 137 mmol/L, K = 4.2 mmol/L, Cl = 95 mmol/L, Anion Gap = 13 mmol/L, Cr = 0.70 mg/dL, eGFR = 76 mL/min/1.73 m2, glucose = 186 mg/dL.

DEPRESCRIBING Medications

Medication Aspirin Duloxetine Atorvastatin Lisinopril Furosemide Potassium Quetiapine Acetaminophen Apixaban Levetiracetam Metoprolol tartrate

Dose 81 mg daily 30 mg daily 80 mg daily 2.5 mg daily 40 mg twice daily 20 mEq daily 12.5 mg nightly 650 mg twice daily 5 mg twice daily 250 mg twice daily 25 mg twice daily

ASSESSMENT

The medical team ruled out other potential causes of her presenting symptom of unusual lethargy. She was not dehydrated; her electrolytes were within normal limits, and her vitals were in check. Therefore, medications were suspected to be the possible cause of her symptoms.

Betsy’s clinical information provided some insight into her medication therapy. Her stroke occurred just over two years prior to her admission.

The telehealth psychiatrist’s progress notes prior to her hospitalization indicated depression, anxiety, and auditory hallucinations. However, there was no indication in the progress notes as to what the auditory hallucinations were, nor if they were bothersome to Betsy.

The psychiatrist’s notes also indicated that the resident was “pleasant and cooperative,” “alert and oriented x 4,” had a euthymic mood, some avoidance and withdrawal behaviors resulting from depression, but was not agitated, delusional, or suicidal. The progress note indicated she was taking Seroquel 12.5 mg every night at bedtime and duloxetine 30 mg every morning. The psychiatrist’s progress notes indicated a plan to increase the Seroquel to 25 mg every night at bedtime, but this dose was not tolerated due to sedation and was decreased back to 12.5 mg nightly at bedtime after only four days. The final progress note from the psychiatrist before her hospitalization indicated that “Betsy does not hear well” but was “better with voices” since initiating Seroquel. Betsy had been evaluated for hearing aids and tried to adapt to using them but failed.

After her discharge from the hospital into her present facility, nursing notes indicated that Betsy was disoriented, alert only to person and had undecipherable, mumbled speech. Her respirations were easy and nonlabored at the time of admission, and she appeared to be recovering from pneumonia well. Nursing staff also affirmed that Betsy was very pleasant, cooperative, not delusional, and not at risk of harm to herself or others. She was also not complaining of hearing any voices at the time of her admission. Her niece, also a nurse in the current nursing facility, wondered if the voices she had heard were due to tinnitus or possibly from a neighbor’s loud television in the room next to hers at the prior nursing facility. Therefore, the nursing staff all affirmed that they felt Betsy would be a good candidate to taper and discontinue her Seroquel dose. Also, given that her stroke had occurred more than two years ago and she had remained seizure-free, you as the consultant pharmacist determined that her levetiracetam 250 mg twice daily for poststroke seizure prevention may no longer be necessary. It appeared as if there were at least two medications that were potentially inappropriate medications (PIMs) for Betsy that may have been contributing to her lethargy and sedation.

Sedation with levetiracetam is more prevalent in older patients.

Plan

• Taper levetiracetam dose gradually over a few weeks, then discontinue entirely.

• Gradual dose reduction of quetiapine to 12.5 mg every other night for three doses, then discontinue entirely.

• Follow-up after discontinuation of quetiapine and levetiracetam for improvement; if not improved, next consider gradual dose reduction of duloxetine 30 mg daily.

Outcome/Follow-up

Four weeks later, at the next month’s medication regimen review, Betsy was much more alert, social, and interactive. Both medications, beginning with levetiracetam, were gradually dose reduced and discontinued entirely. Nurses’ notes affirmed that Betsy seemed to be doing well, was able to speak clearly and make herself understood, and had no issues related to tapering off and discontinuing either medication. Additionally, her niece who works at the nursing facility approached the consultant pharmacist and exclaimed, “I need to thank you for helping with my aunt’s medications, she’s doing much better. It’s nice to have my aunt back.”

Sedation with quetiapine occurs mainly at lower doses because of strong histaminergic antagonism.

DISCUSSION

Betsy’s case provides an interesting example of polypharmacy, PIMs, and their consequences in an older person. Because of her stroke (CVA), she was prescribed levetiracetam to prevent poststroke seizures. CVAs are the most common cause of seizures in the older person,1 so prophylaxis after a CVA may appear warranted. However, guidelines from the American Heart Association and the American Stroke Association do not recommend prophylactic administration of antiepileptic drugs to prevent seizures in stroke patients due to a lack of data to properly guide therapy.2 Nonetheless, in this case, levetiracetam 250 mg twice daily was prescribed to prevent poststroke seizures.

Levetiracetam is believed to exert its antiepileptic effect via binding to the synaptic vesicle protein SV2A in the brain and thereby modulating synaptic neurotransmitter release3,4 (Figure 1). SV2A is one of three isoforms of SV2, which is part of all vertebrate synaptic vesicles.5 The synaptic vesicle protein SV2A is the most common type and is found in both excitatory and inhibitory synapses of the brain.5 SV2A is also the only SV2 isoform that is expressed in many inhibitory (GABAergic) neurons.5 Levetiracetam has been shown to decrease presynaptic glutamate release in neurons with sustained and high frequency firing.5,6 While levetiracetam is generally considered to be well tolerated,7,8 older people are well-known to be more susceptible to side effects because of physiological changes related to aging. Levetiracetam can cause drowsiness and somnolence with a range between 5% and 20% in adult trials.7,9-13 However, drowsiness has been found to be more common in

APR.MAY.JUN. |

17

DEPRESCRIBING older people, reported in 12% of younger patients and 24.7% of older patients.4 Quetiapine is a second-generation, atypical antipsychotic that is indicated for the treatment of bipolar disorder both as monotherapy or as an adjunct agent, major depressive disorder as adjunctive therapy, and for the treatment of schizophrenia. Despite questionable efficacy, quetiapine is frequently used for the off-label purpose of treating dementia with behavioral disturbance or behavioral and psychological symptoms of dementia. For the treatment of schizophrenia, a common dosage range of 150 mg to 750 mg is typically seen because of its low affinity for D2 receptors.14-16 At lower doses, quetiapine’s strong antagonism at histamine receptors seems to predominate,17 thereby causing sedation as the main pharmacologic effect.

In the present case, Betsy was receiving lowdose quetiapine (12.5 mg at bedtime) for auditory hallucinations. Besides the side effect of sedation at low doses, the diagnosis itself may have been suspect. Based on nursing notes and conversations with nursing staff, it was not entirely clear whether these were actual auditory hallucinations, as was diagnosed by medical staff. Nursing staff felt that it may have been caused by excess TV noise from a neighboring room, which may have resulted in confusion as to the source of the sound in an elderly patient with a diagnosis of dementia. Further, the symptom overlap between tinnitus and auditory hallucinations18,19 can lead to misdiagnosis and unnecessary treatment with medications like antipsychotics that have the potential for significant adverse effects.

Betsy’s medication regimen was adjusted by first tapering and discontinuing the levetiracetam, as she had been seizure-free for a period of longer than two years and the risk of adverse effects from medication

18

| The Journal of the Iowa Pharmacy Association

was determined to outweigh the potential benefit. Next, her quetiapine dose was tapered and discontinued. Thankfully, the tapering and discontinuation of these two medications did significantly improve her cognition and decrease her sedation, as was verified by nursing staff, including her niece, and the attending medical provider.

Tapering off low-dose, sedating, quetiapine may help clear and improve symptoms of lethargy, confusion, and sedation in older patients.

GERIATRIC CLINICAL PEARLS

Any medication can cause adverse effects. Any medication therapy, whether appropriately indicated or not, has the potential to cause adverse effects, especially in older patients because of their increased sensitivity to medication side effects. The use of antiepileptic drugs to decrease the risk of or to prevent further poststroke seizures is a relatively common practice. However, despite levetiracetam’s favorable mechanism of action and relative lack of drug-drug interactions, it can cause sedation in approximately 5% to 20% of patients, and this effect is more prevalent in older patients.4 Quetiapine is appropriately indicated for psychiatric disorders including treatment-refractory depression, bipolar disorder, and psychosis.

At low doses, however, the effect seems to mainly be sedation, which is a function of its strong histaminergic antagonism. In clinical practice, however, medical providers often seem to overlook this fact and may be hesitant to discontinue antipsychotic medications, even at very

DEPRESCRIBING low doses for fear of treatment failure or worsening of psychiatric or behavioral symptoms. In Betsy’s case, this was not an issue as she was noted to be pleasant, had a euthymic mood, and was alert and oriented x 4. Tapering off from the quetiapine had no untoward effects, and as hoped for, also helped clear and improve her cognition.

Clinical collaboration and communication are key factors in successful medication therapy adjustment. Clinical collaboration and communication were key factors in the successful reassessment and adjustment of Betsy’s medication therapy. Consultant pharmacists are valuable members of the health care and interdisciplinary teams and are medication experts who are the most accessible health care providers. For successful collaboration, and to help ensure optimal patient outcomes, consultant pharmacists should strive to make themselves readily available and accessible by interacting with staff and by actively seeking and encouraging the routine communication of clinically useful information for their medication regimen reviews. Table 1 reviews reasons and common characteristics for good communication and successful interdisciplinary collaboration.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

References: 1.

2.

3.

4.

Kramer G. Epilepsy in the elderly: some clinical and pharmacotherapeutic aspects.

Epilepsia. 2001:4255-4259.

Winstein CJ, Stein J, Arena R, et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169. doi: 10.1161/ STR.0000000000000098. Epub 2016 May 4. Erratum in: Stroke. 2017;48(2):e78. Erratum in: Stroke. 2017;48(12):e369. PMID: 27145936.

Abou-Khalil B. In the treatment of epilepsy levetiracetam. Neuropsychiatr Dis Treat.

2008;4(3):507-523.

Löscher W, Gillard M, Sands ZA, et al. Synaptic vesicle glycoprotein 2A ligands in the treatment of epilepsy and beyond. CNS Drugs. 2016;30(11):1055-1077.

17.

18.

19.

20.

21.

22.

Yang XF, Weisenfeld A, Rothman SM. Prolonged exposure to levetiracetam reveals a presynaptic effect on neurotransmission. Epilepsia. 2007;48:1861-1869.

Meehan AL, Yang X, McAdams BD, et al. A new mechanism for antiepileptic drug action: vesicular entry may mediate the effects of levetiracetam. J Neurophysiol. 2011;106:12271239.

Ben-Menachem E, Falter U. Efficacy and tolerability of levetiracetam 3000 mg/d in patients with refractory partial seizures: a multicenter, double-blind, responder-selected study evaluating monotherapy. European Levetiracetam Study Group. Epilepsia.

2000;41(10):1276-1283.

Alsaadi TM, Shatzel A, Marquez AV, et al. Clinical experience of levetiracetam monotherapy for adults with epilepsy: 1-year follow-up study. Seizure. 2005;14(2):139-142.

Cereghino JJ, Biton V, Abou-Khalil B, et al. Levetiracetam for partial seizures: results of a double-blind, randomized clinical trial. Neurology. 2000;55:36-42.

Shorvon SD, Lowenthal A, Janz D, et al. Multicenter double-blind, randomized, placebo-controlled trial of levetiracetam as add-on therapy in patients with refractory partial seizures. European Levetiracetam Study Group. Epilepsia. 2000;41:1179-1186.

Berkovic SF, Knowlton RC, Leroy RF, et al. Placebo-controlled study of levetiracetam in idiopathic generalized epilepsy. Neurology. 2007;69:1751-1760.

Brodie MJ, Perucca E, Ryvlin P, et al. Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology. 2007;68:402-408.

Noachtar S, Andermann E, Meyvisch P, et al. Levetiracetam for the treatment of idiopathic generalized epilepsy with myoclonic seizures. Neurology. 2008;70:607-616.

Richelson E, Souder T. Binding of antipsychotic drugs to human brain receptors: focus on newer generation compounds. Life Sci. 2000;68:29-39.

Gefvert O, Lundberg T, Wieselgren I-M, et al. D2 and 5HT2A receptor occupancy of different doses of quetiapine in schizophrenia: a PET study. Eur Neuropsychopharmacol.

2001;11:105-110.

Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223.

Stahl SM. Selective histamine H1 antagonism: novel hypnotic and pharmacologic actions challenge classical notions of antihistamines. CNS Spectr. 2008;13:1027-1038.

Santos RM, Sanchez TG, Bento RF, Lucia MC. Auditory hallucinations in tinnitus patients: emotional relationships and depression. Int Arch Otorhinolaryngol. 2012;16(3):322-327.

Alvarez Perez P, Garcia-Antelo MJ, Rubio-Nazabal E. “Doctor, I hear music”: a brief review about musical hallucinations. Open Neurol J. 2017;11:11-14.

Nancarrow SA, Booth A, Ariss S, et al. Ten principles of good interdisciplinary team work.

Hum Resour Health. 2013;11:19. doi:10.1186/1478-4491-11-19.

Babiker A, El Husseini M, Al Nemri A, et al. Health care professional development: working as a team to improve patient care. Sudan J Paediatr. 2014;14(2):9-16.

O’Daniel M, Rosenstein AH. Chapter 33: Professional communication and team collaboration. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US); April 2008.

Accessed October 15, 2020. https://www.ncbi.nlm.nih.gov/books/NBK2637/.

Table 1. Reasons and common characteristics for good communication and successful interdisciplinary collaboration Reasons consultant pharmacists need good communication skills20,21 • The number of geriatric patients with complex care needs is increasing • The complexity of skills and knowledge needed to provide care is increasing

Common characteristics of good communicators21,22 • Promote open communication • Help maintain a respectful environment • Share responsibility for team success

• Specialization within health care and fragmentation of disciplinary knowledge increases the number of practitioners providing care for residents

• Regular and routine communication and sharing of information

• To promote safe continuity of care with a focus on continuous quality improvement

• If there is a lack of clear information, talking with several staff members to get their feedback

• Ensure positive interactions with other staff members to achieve optimal patient care

• Ask questions to get patient-specific and actionable information

• Focus on what is right for the patient

APR.MAY.JUN. |

19

HIV TESTING PROJECT

PLANNING TO STOP HIV IN IOWA: HIV & HCV TESTING PROJECT In January, the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis hosted a meeting to kick-off their strategic planning process. IPA staff, along with representatives from local and state health agencies, community advocates, and people living with HIV attended the virtual event. IDPH outlined the planning process and focus areas of the Stop HIV Iowa plan.

While the state of Iowa has seen a nearly 30% reduction in new HIV diagnosis since 2016, ranks second in viral suppression among all states, and is within the top four states for other key measures along the HIV care continuum, challenges still remain. Health disparities and other barriers must be addressed to stop the HIV epidemic in Iowa. IDPH is asking for assistance in creating a plan to reduce new HIV Diagnoses 75 percent by 2025 and 90 percent by 2030. In 2020, the baseline was 100 HIV diagnoses among Iowans.

Increasing access to testing has been a priority for IDPH in fighting the HIV epidemic. Since 2019, IPA has been collaborating with IDPH to manage a multi-year project implementing HIV screenings in community pharmacies. There are currently twelve Iowa pharmacies offering free HIV screenings for their communities, and three of those are also offering free HCV screenings.

STOP HIV IOWA FOCUS AREAS: Primary Prevention & Diagnosing Medical Care & Support Services Addressing Sexually Transmitted Infections Viral Hepatitis Workforce Behavioral Health Health Equity Social Determinants of Health Stigma

IPA is looking to gain more interest in the project in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Lucas, Monroe, and Wapello. These are areas of the state that the Iowa Department of Public Health considers focus areas based on their epidemiology reporting.

To participate or to learn more, please contact Kellie Staiert, IPA’s Lead Project Manager, at kstaiert@iarx.org. To learn more about Stop HIV Iowa, visit www.stophiviowa.org.

IPA MEMBER FORUMS Learn, Network & Engage Independent & Community Pharmacy Practice Forum – June 21, 2022

STAY TUNED FOR 2023 DATES! Open and FREE to ENGAGED Pharmacist, Pharmacy Technician and Student Pharmacist members.

20

| The Journal of the Iowa Pharmacy Association

Help Advance IPA’s Legislative Agenda...

Become a Champion Advocate!

Are you interested in becoming an important partner in helping IPA advance its legislative and regulatory agenda throughout the year? IPA is looking for Champion Advocates across the state of Iowa to build relationships with their elected officials. Help us designate a Champion Advocate in every House and Senate district!

Our goal is to establish trust and familiarity with legislators. As you work to educate your legislators on key issues facing pharmacy, we can help build their understanding of our concerns regarding patient care and the roles of pharmacists and pharmacy technicians.

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

What Do Champion Advocates Do? •

Build relationships outside of the legislative session by hosting pharmacy visits with legislators and delivering PAC contributions when needed

•

Contact legislators during session to explain how pending legislation would affect their pharmacy practice

•

Relay personal experiences to help legislators understand the important roles that today’s pharmacists and pharmacy technicians play in enhancing the health care of Iowans

•

Stay informed with bill tracking/IPA legislative priorities and participate in bi-weekly update calls

Interested? Contact IPA at ipa@iarx.org or 515-270-0713.

We’ll help you identify your senator and representative and get started with setting up a pharmacy visit.

IPA LEGISLATIVE DAY

IPA LEGISLATIVE DAY 2022 IPA Legislative Day took place in person in Des Moines on March 7, 2022. Over 150 pharmacists, pharmacy technicians and student pharmacists were in attendance to learn about IPA’s legislative priorities and other healthcare issues. The day began with breakfast and welcoming remarks from IPA CEO Kate Gainer and Board President Chris Clayton. Following introductions, IPA’s advocacy team, including Brett Barker, Vice President of Government Affairs, and contract lobbyists Matt Eide and Kate Walton, provided a briefing on IPA’s PBM bill and other 2022 legislation to discuss with legislators.

Iowa’s 47th Lieutenant Governor, Adam Gregg, gave this year’s keynote, applauding pharmacy’s efforts throughout the COVID-19 pandemic and sharing his support of rural healthcare access. Hawarden natives and family friends, the Lt. Governor and Porter Hummel, student pharmacist at the University of Iowa College of Pharmacy, snapped a picture together following the presentation!

Following the keynote, 2022 IPA Legislative Awards were presented. Greg Johansen, RPh, FACA, President of GRX Holdings, gave his remarks virtually for the Legislative Champion Award, recognizing an IPA member who has made significant contributions to the association’s advocacy efforts. Representative Brian Best (District 12) was presented with the Good Governance Award for his close work with IPA and support of the PBM bill. Representative Best gave live remarks before joining the legislator panel for the next session.

Pharmacist Representative John Forbes and Representative Best joined IPA’s Brett Barker on stage to describe what’s happening at the Capitol in relation to healthcare and pharmacy issues. Representatives Forbes and Best gave advice on communicating with legislators and continuing strong grassroots advocacy.

After lunch, attendees traveled by bus to the Iowa State Capitol to meet with their state senators and state representatives. Many attendees were able to enter the chambers and listen in on debate, and some even got a private tour to the top! (Thanks, Representative Forbes!) The day concluded with a reception at the downtown Des Moines Hilton, where attendees enjoyed refreshments, networking, and further connecting with Iowa legislators.

22

| The Journal of the Iowa Pharmacy Association

IPA LEGISLATIVE DAY

LEGISLATIVE AWARDS GOOD GOVERNANCE AWARD Representative Brian Best (R-12)

LEGISLATIVE CHAMPION Greg Johansen, RPh, FACA

APR.MAY.JUN. |

23

PUBLIC AFFAIRS

2022 LEGISLATIVE SESSION UPDATE The 2022 Iowa Legislative Session began on January 10. With IPA’s team active at the Capitol, the PBM reform bill was introduced in the Senate (SF 2092) on February 9 and in the House (HSB 623) on February 14. Shortly after, the bill passed both the House and Senate Commerce Committees and became eligible for floor debate. In addition, IPA registered in support of SSB 3128, focusing on contract pharmacies and covered entities that participate in the 340B drug program IPA continued meeting with key stakeholders at the Capitol, and the following week, the PBM bill (now SF 2231/HF 2384) had officially passed the first funnel. The 340B bill (SSB 3128), unfortunately, did not move on. At this point, IPA’s advocacy team knew Legislative Day would occur at a crucial stage in the session timeline.

• Requires PBMs to treat Iowa pharmacies the same as their own out-of-state PBM owned pharmacies; • Adds transparency to PBM pricing; • Requires PBMs to allow pharmacies to appeal reimbursements below acquisition cost; • Requires PBM to act in the best interest of payers.

On April 2, IPA’s advocacy team held a webinar for all members to learn about the status the PBM bill and perfect their grassroots communications to legislators. IPA members continued to send personalized emails, make phone calls and meet with their legislators, efforts that made a huge impact.

Soon after, IPA drafted a sign-on letter of support for PBM reform in the state of Iowa. Over 600 pharmacy professionals from diverse practice settings across the state added their name to the letter, covering all 99 counties and filling in the map of Iowa. This letter was delivered to House and Senate leadership on May 3.

On March 7, IPA hosted an extremely successful Legislative Day at the Iowa State Capitol. Members from across the state spoke with key legislators from their districts, sharing personal stories and highlighting the importance of IPA’s PBM bill in protecting patient access to local care.

IPA's advocacy team worked closely with key stakeholders on amendments to continue to advance the bill in both chambers.

Grassroots efforts were called upon time and time again, and IPA members continuously answered the call. In direct correlation, the Iowa House passed the PBM bill (HF 2384) on March 23 96-0! Bill provisions included the following: • Provides patient choice and access through Any Willing Pharmacy and anti-mandatory mail order provisions; • Eliminates retroactive claw backs for patients and pharmacies;

24

| The Journal of the Iowa Pharmacy Association

As of May 13, the legislature is still in session, and the PBM bill is still alive. IPA is awaiting a final vote in the Senate.

“Busy” would be an understatement for IPA’s advocacy team this year.

Staff, contract lobbyists and members across the state have committed countless hours onsite at the State Capitol and through grassroots advocacy to support pharmacy priorities.

Thank you to all who have used their voice to communicate with state legislators and push pharmacy practice in Iowa forward. We’re not done yet!

PUBLIC AFFAIRS

BOARD OF PHARMACY: REGULATORY UPDATE BOARD CHANGES

With the departure of Brett Barker, who had been serving as Board Chair, the Board of Pharmacy elected Kathy Stone as the new Chair.

Gayle Mayer continues to serve as Vice-Chair of the Board. In addition, Governor Reynolds appointed Robert Egeland to fill the vacancy on the Board. Dane Nealson (technician member), Kathy Stone (pharmacist member), and Joan Skogstrom (public member) were all reappointed for a second term.

COLLABORATIVE PRACTICE AGREEMENTS & COMPLIANCE CONCERNS

The Board of Pharmacy met on January 11. During the meeting, the Board voted to support IPA’s legislative priorities for the 2022 legislative session and adopted rules updating collaborative practice agreements. The Board also approved a notice of intended action regarding veterinary office stock of compounded preparations and a new update of security standards with significant changes pursuant to public comment on previously noticed rules changes. Compliance officers gave their report, noting an increase in licensee concern about the impact of staffing and workload, specifically vaccinations, on a possible increase in errors.

TELEPHARMACY & PHARMACY OWNERSHIP

At the March 1 meeting, the Board adopted and filed updated telepharmacy rules. These include a provision to allow a Pharmacy Support Person to practice in a telepharmacy setting and the creation of a committee to consider requests for exemption to the technician practice experience requirements in exceptional circumstances that would otherwise result in the closure of a telepharmacy site. The Board also approved a notice of intended action to allow for remote delegation of prescription processing technical functions to an Iowa-registered certified pharmacy technician who is at a location other than where the supervising pharmacist is physically located. Another notice of intended action was approved that proposes to modify the handling of pharmacy ownership changes. The Board will consider public comment on these proposed changes at an upcoming meeting.

Tune in to IPA’s BOP: What, Why & How podcast following each Iowa Board of Pharmacy meeting to recap the Board’s actions and earn Pharmacy Law CE! Each episode will focus on WHAT actions were taken by the Board of Pharmacy, WHY the BOP took the actions it did, and HOW BOP action will impact practice in Iowa.

IARX.ORG/BOP_PODCAST

APR.MAY.JUN. |

25

TECHNICIAN CORNER

MISUSE & ABUSE OF OVER THE COUNTER MEDICATIONS From IPA’s January 2022 Tech Tidbits Prescription drug misuse is unfortunately nothing new to the pharmacy profession. Having worked through the highs and lows of the opioid epidemic, pharmacy professionals have come to recognize signs and symptoms of prescription drug abuse. Often thought of as “less harmful” than their prescription counterparts, certain over-the-counter (OTC) drugs have their own adverse health effects and addiction risks that patients need to be aware of. Many OTC medications that can be misused or abused have psychoactive (mind-altering) properties. It is for this reason that these medications are sought after. We will examine two commonly misused and abused OTC medications and what you need to know as a pharmacy technician to help keep your patients safe.

Dextromethorphan (DXM) is a common ingredient found in many OTC cough suppressants and cold medicines like Mucinex, Robitussin and Corididin. High-dose syrups, tablets or gel capsules labeled “Extra-Strength” are the more commonly abused dosage forms of this drug. DXM is an opioid, but it doesn’t have effects on pain reduction like other opioids due to its ineffectiveness on the brain’s opioid receptors.1,2 If taken in large doses, however, this ineffectiveness can be overcome and a mild short-term hallucinogenic effect, similar to alcohol or cannabis intoxication, can occur. Adverse health effects from DXM abuse can include poor motor control, high blood pressure, paranoia, anxiety and aggression.1,2 Another OTC medication to be cautious of is the anti-diarrheal medication loperamide, commonly known through brand names like Imodium, Imotil or Diamode. Similar to DXM, loperamide is an opioid medication designed not to enter the brain.1,2 But if taken in extremely high doses, the medication starts to enter the brain and bind to its opioid receptors. As a result, patients can experience a euphoria similar to

26

| The Journal of the Iowa Pharmacy Association

pain-relieving opioids. This euphoric state is often sought after to help cope with opioid withdrawal syndrome or for the dissociative effects it can produce. Misusing loperamide can lead to severe constipation, vision changes, irregular heartbeat and kidney problems.1,2 It is imperative that these medications be taken as directed. With the misuse and abuse of these two medications rising every year, addiction, overdose and even death are becoming more common.3 Currently, there are no medications specifically approved to treat loperamide or DXM addiction.1 Behavioral therapies like cognitive behavioral therapy (CBT) and lifestyle management may be helpful and could be considered for first-line therapy.1 If you ever encounter someone with a DXM or loperamide overdose, you should call 911 immediately and start CPR if the person has stopped breathing. Since DXM and loperamide are structurally similar to other pain-relieving opioids, the opioid reversal agent Naloxone can and should be used for DXM and loperamide overdoses if available.1,4 References: 1.

2.

3.

4.

National Institute on Drug Abuse. (2021, June 7). Over-the-counter medicines Drugfacts. National Institute on Drug Abuse. Retrieved January 5, 2022, from https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines Abuse, N. I. on D. (2021, December 9). Cough and cold medicine. NIDA for Teens.

Retrieved January 5, 2022, from https://teens.drugabuse.gov/drug-facts/cough-andcold-medicines Cooper, R. J. (2013, April). Over-the-Counter Medicine Abuse - A review of the literature. Journal of substance use. Retrieved January 5, 2022, from https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3603170/ Arnold, C., & Martinez, C. J. (2019, May 25). Loperamide overdose. Cureus.

Retrieved January 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6663275/

TECHNICIAN CORNER

WORKPLACE ERGONOMICS: PREVENTING MSI From IPA’s February 2022 Tech Tidbits When the topic of workplace injury comes up, you likely picture someone in a very labor intensive job hurting and straining themselves, not a pharmacy technician standing behind a counter. Although you may not assume so, pharmacy is subject to a significant amount of MSI or muscle-skeletal injury. In 2018, the Centers for Disease Control and Prevention (CDC), in conjunction with the National Institute for Occupational Health and Safety (NIOSH), produced a report examining the incidence of MSI in pharmacies and provided recommendations to prevent harm to pharmacy professionals.

According to the CDC’s ergonomic assessment, the most common injuries in a pharmacy are wrist, neck, back and shoulder injuries either caused by repetitive actions, improperly positioned workstations, or standing for long, extended hours. While these conditions may be common in pharmacies across the country, there are some very practical ergonomic solutions that can be implemented with little cost. The first and easiest solution is to adjust your workstation after you take over for someone.

The CDC recommends positioning adjustable screens 58"–71" above the standing surface, where the top of the display is in an employee’s line of vision. Also, maintain the viewing distance for adjustable displays at 18"–30" or 23" for fixed displays. Another recommendation is to store items 24"–70" above the standing surface. The most frequently used medication bottles should be kept in the middle of this range to reduce bending at the back and reaching above the shoulder. The report also highlights removing child-resistant caps from larger quantity bottles that are used to fill prescription medications manually and varying task assignment to prevent someone from performing the same task continuously as other helpful ways to prevent MSI in the workplace.1 While the CDC has published these recommendations relating to workplace safety, Mayo Clinic has also released some workplace

stretches that can help prevent and relieve straining at the pharmacy and beyond. The first stretch is good for individuals standing for extended periods of time. 1) Place one hand on a chair or desk for stability. 2) Grab one of your ankles, and bring it up toward your buttock.

You'll feel tension in the front of your thigh. Remember to maintain an upright position, keeping your back straight and your knees parallel to one another. If you have a hard time grabbing your ankle, grab your pant leg instead. 3) Hold the stretch for 15 to 30 seconds and return to the starting position. 4) Repeat the stretch with your other leg. While stretching, aim to keep it gentle and expect some tension, but pain indicates you’ve pushed too hard.2 As just one example of workplace stretching you can implement in your day, OSHA has several others with illustrations that can be found on their website.

Working at a pharmacy can be hard and stressful, and the risk of developing MSI only exacerbates that stress. Considerable focus has been placed on the issue of self-care, especially as it relates to burnout, but mental care and physical care go hand-in-hand. Going to work in pain or doing work that causes physical discomfort is going to cause stress and burnout to an even greater degree. At the end of the day, the most important aspect in preventing MSI is communication. Communicate with managers about any possible pain or issues before they develop into larger medical issues, and begin discussing how to make the workplace a healthier space for everyone.

References: 1.

2.

Ramsey JG, Musolin K. Ergonomic Evaluation of Pharmacy Tasks. Cdc.gov.

Published March 2018. Accessed January 12, 2022. https://www.cdc.gov/niosh/hhe/ reports/pdfs/2016-0042-3306.pdf Mayo Clinic. Healthy Lifestyle: Adult Health. Mayoclinic.org. Published December 11, 2021. Accessed January 13, 2022. https://www.mayoclinic.org/healthy-lifestyle/ adult-health/multimedia/standing-stretches/vid-20084701

MEMBER TIP: Follow IPA Staff on Social Media!

IPA staff are on a variety of social networks! Follow them, in addition to IPA’s pages, to stay up-to-date on national meetings, events, legislative session and more, as well as see what innovative, practice-advancing things the staff are working on day-to-day!

Kate Gainer

Emmeline Paintsil

Brett Barker

linkedin.com/in/kategainer

linkedin.com/in/emmelinepaintsil

twitter.com/brettbarker

APR.MAY.JUN. |

27

TECHNICIAN CORNER

NEWLY CERTIFIED IOWA TECHNICIANS JANUARY 1, 2022 – MARCH 31, 2022 Congratulations to the following pharmacy technicians on becoming PTCB-certified!

Dawn Adams Yassir Ali Jamie Alsarraf Jasmine Anderson Carrie Baack Alexandria Bartel Gannon Bennett Kelsey Bolte Cassie Borchardt Alana Bowne Sara Breitwieser Julia Brooks Sterling Brunk Lillian Camp Savannah Cavan Helen Clark

Grant Cornick Hattie Dukes Cierra Endicott Emily Fitz Sarah Gajda Rosa Garcia Mya Gibbons Mitchell Godfredson Erica Goodknight Kaitlyn Cody Guerrero Niki Guillen Mary Havlik Jergens Elizabeth Hayes Samuel Hazlewood Delaney Healey

Frederick Helm Lauren Hooper Aubry Ivey Isabelle Johnson Chloe Konrad Dakota Lau Tressa Lauer Eesha Lawande Hannah Lester Bianca Llamas Joshua Loomis Katie McNamara Grace Milbrodt Emilee Miller Paola Gonzalez-Moreno

Joshua Motley Delaney Osborn Tasabih Osman Taylor Porter Meghan Powers Jessica Ramirez Dannielle Reedy Sheryl Rensink Kelsey Reyes Donald Rhodes Alisa Richardson Kasandra Rosenbum Katherine Ryan Lana Salih Amber Schories

Patient safety.

Professional practice.

Community impact.

Build your team with confidence.

Assessment-Based Certificates BILLING AND REIMBURSEMENT CONTROLLED SUBSTANCES DIVERSION PREVENTION HAZARDOUS DRUG MANAGEMENT IMMUNIZATION ADMINISTRATION MEDICATION HISTORY

MEDICATION THERAPY MANAGEMENT POINT-OF-CARE TESTING REGULATORY COMPLIANCE* SUPPLY CHAIN AND INVENTORY MANAGEMENT* TECHNICIAN PRODUCT VERIFICATION (TPV)

*Planned for 2022

Certifications Certified Pharmacy Technician (CPhT)

Compounded Sterile Preparation Technician® (CSPT®) Certification

View PTCB’s full suite at ptcb.org/credentials

Advanced Certified Pharmacy Technician (CPhT-Adv) Certification

Sarahmarie Schuh Teresa Shaw Chaylen Simmons Heather Buchanan Smith Shelby Sperfslage Sloan Speten Cole Spiewak Katie Springsteen Hunter Thompson Michael Trinh Josephine Vonderhaar Benjamin Walter Asya White Diamond Williams Madalynne Yenter

IPA FOUNDATION

2021 IPAF SCHOLARSHIPS The IPA Foundation provides scholarships each year to student pharmacists from both Drake University and the University of Iowa.

The Foundation works with each college to determine recipients that exude the values of the Foundation and the best of the profession.

Congratulations to the 2021 IPA Foundation scholarship recipients!

DRAKE UNIVERSITY

UNIVERSITY OF IOWA

2021-2022 Academic Year

2021-2022 Academic Year

IPAF Eggleston-Granberg Scholarships

IPAF Eggleston-Granberg Scholarships

Rachel Dietz Christopher Karch

IPAF Mike & Terry Pursel Scholarship Autumn Campbell

IPAF Russell E. Johnson Jr. & Lucille Johnson Scholarship Jerime Gendron

Emily Gajda Lynn Bui

IPAF General Scholarships Jose Rodriguez Alexis Clouse Travis Johnston Alyssa Yahnke

IPAF General Scholarships Emily Albers Ashlie Bunten Grace Dahlen Haley Pertzborn

MAKE AN IMPACT: JOIN THE INSTITUTE OR DONATE TODAY! Make a donation or join the IPA Foundation Institute with your sustained gift.

Your donation to the IPA Foundation supports initiatives to build strong leaders, invest in innovative practice advancements and secure high-quality education for tomorrow’s practitioners.

www.iarx.org/IPAFoundation

SUPPORT THE FOUNDATION

BY DONATING TO THE SILENT AUCTION! If you or your pharmacy would like to donate to the IPAF Silent Auction taking place during IPA’s 2022 Annual Meeting, please email Laura Miller at lmiller@iarx.org with a short description and approximate value (if available) of the item(s) you plan to donate.

While items will be accepted through the week of Annual Meeting (September 22-23), please notify IPA prior to September 2nd to have your item listed in the catalog.

APR.MAY.JUN. |

29

IPA FOUNDATION

REGISTRATION CLOSES MAY 31!

Traditional Foursome Two + Two-some Individuals Students

JUNE 9, 2022

Finkbine Golf Course, Iowa City 10 AM Shotgun Start

Get active however you enjoy for student scholarships!

JUNE Register AUGUST Get T-Shirt SEPTEMBER Get Active!

SEPTEMBER 24 Step Up! An additional one-day fundraising event

OCTOBER 3 Announcement Winners and total money raised

September 1-30, 2022 Learn more at www.iarx.org/Step_Cycle_Swing 30

| The Journal of the Iowa Pharmacy Association

BILL BURKE CONFERENCE

2022 BILL BURKE STUDENT PHARMACIST LEADERS BILL BURKE STUDENT PHARMACIST LEADERSHIP CONFERENCE

This event is made possible through a partnership between IPA, Drake University, the University of Iowa, and support from Main at Locust Pharmacy in Davenport, Iowa.

DRAKE UNIVERSITY

IPA hosted 19 student leaders from Drake University College of Pharmacy & Health Sciences and the University of Iowa College of Pharmacy for the 26th Annual Bill Burke Student Pharmacist Leadership Conference April 8-10 at Wildwood Hills Ranch in St. Charles, Iowa.

For many students, it was their first in-person conference and large event since starting pharmacy school during the COVID-19 pandemic.

Adrianne Bentzinger Nirjan Bhattarai Leah Bishop Megan Hartle Haley Pertzborn Isaac Ramos Braden Weiser Peyton Wood Caesar Yeaman

THE UNIVERSITY OF IOWA George Appleseth Tiffany Bui Riley Clark Jill Guetersloh Spencer Heggen Mark Nagel Emily Paulus Jose Rodriguez Sydney Ross Sidney Vancil

BILL BURKE P1 STUDENT PHARMACIST LEADERSHIP WORKSHOP

The conference began on Friday afternoon with a motivational welcome from Dean Don Letendre (University of Iowa College of Pharmacy). Dean Letendre shared words of wisdom and key characteristics student leaders should seek to embody. Afterwards, students heard from Mike Pursel, owner of MERIT, LLC, who shared insights on how leadership opportunities, as well as barriers, surface throughout a career in pharmacy. The students spent the evening building connections and learning the importance of telling your personal leadership story.

On Saturday, Sara Ennis of SparkPoint, Inc. led the students through a series of interactive discussions on communication, helping the students develop skills for building relationships and empowering themselves and others to meet diverse needs. The students learned how to navigate conflict, adapt their communication style, and lean into difficult conversations. After lunch, conference participants completed a high ropes course, which forced them to navigate obstacles together and apply the communication skills they learned that morning. Later, the student pharmacists learned Kotter’s 8-Step Process for Leading Change and ways to apply the change management model to issues in healthcare.

On Sunday, conference attendees reflected on what they learned over the weekend. The student leaders engaged in focus groups to identify issues they will face as pharmacists in their careers, what the impact of those issues will be, and what they can do as soon-to-be practitioners to address them. The students regrouped for discussion and idea sharing to identify what actionable steps they can begin taking in their respective organizations and communities. Overall, it was a transformational weekend for the selected student pharmacist leaders.

Due to a high number of P1 applicants this year, a unique one-day Bill Burke P1 Student Pharmacist Leadership Workshop was held on April 2 at IPA Headquarters. Five students from Drake University and five from the University of Iowa were selected to participate. Dean Renae Chesnut (Drake University CPHS) welcomed the students, sharing her career journey and the importance of leadership in pharmacy. The selected student pharmacists learned about the imposter experience, the importance of building confidence, and how to use John Kotter’s 8-Steps to Lead Change. In the afternoon, Benjamin Jagow, Clinical Services Advisor with OutcomesMTM, shared insights for overcoming barriers both in pharmacy school and as a new practitioner. Workshop participants ended the day with a team building activity to put their communication and leadership skills to the test. Overall, it was an inspiring weekend and provided several student pharmacists their first of many leadership experiences.

DRAKE UNIVERSITY Stacia Humphrey Anna Holden Austin Lampman Deena Alsabbah Paula Ornelas

THE UNIVERSITY OF IOWA Abigail Crowner Samson Bishop Emily Weyenberg Charlie Iles Sarah Hou

APR.MAY.JUN. |

31

MEMBERS SECTION

WELCOME NEW IPA MEMBERS! JANUARY 1, 2022 – MARCH 31, 2022 ENGAGED

Shondalette Adams Nicole Diveley Karissa Fritsch Danikah Grobe Alicia Jahnke Anthony McEvoy Jacey Redman Rachael Renfrew Rachel Rutter Kyle Vaughn Suriya Xiong

CONNECTED

Michael Coleman Lindsey Collett

INFORMED

Kori Bohlken Eric Bulak Laurene Hendricks Emmett McVey Kyle Robb Hailey Steuber Asha Thiele Omobola Thompson Vanessa Vesely

STUDENTS

Reed Timmer

TECHNICIANS

Shahad Abbood Maxwell Acheampong Marissa Alber Sharlett Allen Anna Amos Olena Andrushko Elizabeth Ashlock Wendy Atcher Elizabeth Auen Tyler Bailey Taylor Baker Jaidyn Ballard Samantha Barnes Sonny Barsetti Tiffany Bartenhagen Lily Bassett Lily Bejarno Ashlyn Boecker

32

Hailee Boisen Aiden Brock Destiny Brockway Tori Bronson Gabrielle Burke Shannon Burnette Samantha Butler Michelle Carpenter Guadalupe Carranza Kailey Casper Kaitlin Ceder Nyah Chamberlain Maura Cole Debra Conwell-Cole Debora Cortes Drake Cory Anne Crawford Jacqueline Cress Sneha Cyriac Maranda Daniels Alexis Dauner Hunter Daws Sophia Dehl Jillian Den Herder Kenzie Dills Marsha Doebel Sydney Dose Kylie Duesing Alliene Eisenmann Francesca Eklund Jeann Farrell Sarah Ference Jennifer Ferriss Gustavo Flores Mia Fontanini Bethany Frerking Hannah Friesth Megan Galle Kate Gabrielle Gallinero Emma Garcia Madison Gilkison Ava Glass Heather Gleason Ali Goldensoph Ashley Gonzales Dillon Graf Lisa Gross Molly Gugel Rachel Gunn

| The Journal of the Iowa Pharmacy Association

Bree Hagg Amanda Haggard Shelly Haley Rhonda Hamman Elizabeth Hancock Heather Hannon Andrea Hanse Collin Havel Hannah Hefel Hunter Hessong Madison Hewett Samantha Hill Grace Hingst Megan Hoenig Rachelle Houlette Christine Hoye Kristy Hudgins Kristine Hutt Michelle Icenogle Taylor Johansen Kendra Johnson Calea Jones Caroline Jones Abbe Kaufmann Mallory Keech Heather Keithley Samantha Kelley Tracy Kielman Cameron Kincaid Samantha King Tracy Kleinschrodt Lauren Knox Jana Kay Lacanlale Amy Laing Letitia Landes Quyen Lang Alison Laubenthal Lindsay Lewis Isabel Libke Krista Littleton Jennifer Lopez Ramirez Nathan Luu Jared Mangels Nicole Manuel Wajeeha Mariam Kendra McClintock Corinne McCormick Bailie McDonald Jack McLoone

Stephanie McNear Amanda Mendoza Madeline Mews Karli Michael Kimberly Miller Lillian Monson Carole Musch Angela Nail Maria Lorraine Navalta Kourtney Newhouse Beth Newman Nicholas Nielsen Olivia Oard Jessica Okeeffe Jada Olson Julie Olson Mackenzie Onorato Connie Pa Jordan Paeper Bailey Palmer Raegan Parham Carli Parmely Samantha Pedelty Krista Pettepier Kevin Poster Katrina Potts Traigh Priest Kalee Pruitt Isaac Ramos Kitri Reimer David Reimers Victoria Rensink Ava Ressler Jessica Roberts Sanisa Rodriguez Fatima Saadiq Layla Saadiq Mohsin Saadiq Megan Salas Aneth Sanchez Brooklyn Sanderson Nathaniel Santos Brock Schmelzer Haley Schmidt Morgan Schrage Selena Schuldt Blu Schultz Haylee Schwenn Nicholas Shaw

Quintwan Simmons Hailey Simon Ethan Spires Grace Stackhouse Douglas Stewart Kristin Stonehocker Robyn Stoner Christina Stuerman Sarah Sudduth Kristen Sumpter Brooke Sutton Brittany Swenson Alexandra Swestka Gabriella Tagliapietra Andrew Taylor Ann Taylor Mackenzie Tetmeyer Meghan Thimmesch Jill Thomason Barbara Thompson Adna Tokmic Susan Toolin Gina Tran Patricia Trimble Samantha Upham Hoang Van Nancy Versluys Nina Vilenica Eric Vo Angela Walderbach Abigail Wallace Kelly Walvatne Nathaniel Ward Ashley Warne Sharon Whisenant Carol Wood Victoria Wood Miles Wyllie Kimberly Zweibahmer

ASSOCIATES Kara Gainer Lina Reinders

BUSINESS PARTNERS

Hy-Vee Pharmacy (1224) Hy-Vee Pharmacy (1459) Hy-Vee Pharmacy (3434) Spring City Pharmacy

MEMBERS SECTION

PHARMACIST SPOTLIGHT: ROBERT NICHOLS, PHARMD, BCPS

I

owa has a reputation for being a leader in pharmacy practice through its innovation and expanded pharmacy services. It is because of active IPA members like Rob Nichols that this is possible.

Like many of us, Rob did not start college with the goal of becoming a pharmacist. He was entering his junior year at Wartburg College when he went on vacation to visit his aunt in Arizona. He was on track to complete a degree in business management when his aunt asked, “What do you plan to do with that business degree?” He didn’t have a good answer for her at the time, and that’s when she recommended exploring pharmacy. When he returned to Iowa, he had extensive conversations with his advisors and took the initiative to land a job at the local independent pharmacy, Meyer Pharmacy.

Rob graduated from the University of Iowa College of Pharmacy with his Doctor of Pharmacy in 2017. Upon graduation, he became the first University of Iowa College of Pharmacy Community-Based Pharmacy Resident at Greenwood Pharmacy and Compounding Center in Waterloo. He was subsequently hired at Greenwood after his residency and has been the site preceptor since.

According to Rob, the most rewarding part of his position at Greenwood is his ability to expand and optimize enhanced clinical services. Greenwood is a cutting-edge community pharmacy that provides many enhanced services to its patients. They have partnered with a family practice clinic to provide chronic care management planning services in the pharmacy. They have also partnered with Pathways Behavioral Services as a referral for HIV and Hepatitis C testing. Through collaborative practice agreements with clinics, they manage long-acting injectable birth control therapy and long-acting injectable antipsychotics. The pharmacists also go to provider’s offices to provide educational seminars on Medicare part D, specific drug class-related education, and insurance coverage education.

If you know Rob, you know he is heavily involved in the profession, but he also has a significant presence in his community and takes pride in his family. He is married to his beautiful bride, Bryndee, and they have two beautiful children, daughter Arie (4) and son Alijah (1). Rob’s current interests are listening to audiobooks, everything about being a dad, and playing volleyball around the Cedar Valley. Although he stays busy with his career and being a father of two, he still finds the time to participate in state and national pharmacy organizations.

Rob is an active member of both IPA and NCPA and serves on the advisory board for Prescribe Wellness.

Rob is also engaged at the public health level, acting as Vice-Chair of the Iowa Commission on Tobacco Use, Prevention, and Control. In 2019, he received the Iowa Immunization Champion award and was recently invited to the Decker-Temple Leadership Pharmacy Conference.

Robert Nichols, PharmD, BCPS Pharmacist & Preceptor Greenwood Pharmacy

Advocacy at all levels is crucial to expand pharmacy services. Rob understands that change won’t happen unless IPA members are involved and part of that change.

He advises members to not only get involved within the profession but also in their respective communities. He lives by his words and is very active in his community of Waterloo, Iowa.

Rob is on the Board of Directors for the Black Hawk County YMCA and North Star Community Services, and he serves as Board Chair for the Project Ready Community Outreach. He also participates in iJAG, promoting the pharmacy profession to middle school students; the Black Men Read program; and Donuts with Dad book readings at the Soul Book Nook bookstore. As of this year, Rob now serves on the Waterloo City Council At-Large.

Through his career and involvement in national, state and local organizations, Rob understands the importance of advocacy to advance the profession of pharmacy. He hopes that the future of pharmacy is one where the responsibility of acute and chronic drug therapy management more ubiquitously rests on the pharmacist across all practice settings.

Thank you, Rob, for your continued leadership and inspiration of student pharmacists, like myself. ■

Written by: Alexis Clouse, UICOP Class of 2022

APR.MAY.JUN. |

33

MEMBERS SECTION

2022 POLICY, ADVISORY AND FORUM PLANNING COMMITTEES THE POLICY COMMITTEE ON PUBLIC AFFAIRS Laura Knockel – Chair Namaro Kone – Vice Chair Andy Stessman – Past Chair Eliza Dry-Boarman Rachel Finkelstein Tom Fisher Courtney Gent Lisa Lambi Miriam Loewen Robert Nichols Jessica Rosenhamer Sarah Tierney Kate Waack Kelly Andersen Aimee Wiedenman Leah Bishop

THE POLICY COMMITTEE ON PROFESSIONAL AFFAIRS Emma Kraayenbrink – Chair Brian Benson – Vice Chair Sarah Sougstad – Past Chair Adam Baird Jared Butler Dalton Fabian Brian Glenn Valerie Hanken Ben Jagow Bridget Jermeland Dana McDougall Jessica Nesheim Michael Schnackenberg Susan Shields Nancee Waterbury DeeAnn Wedemeyer-Oleson Shanna Zwanziger Kelsey Ihns Meredith Drummond Sharon Weber

LEGISLATIVE ADVISORY COMMITTEE Brent Bovy Mike Brownlee Mindi Chamberlain Bill Drilling Dalton Fabian Steve Firman Brandon Gerleman Bob Greenwood Charlie Hartig Nic Lehman Ed Maier Jen Goings-Morris Angie Nelson Robert Nichols Nathan Peterson Wes Pilkington Matthew Pitlick George Appleseth

HEALTH-SYSTEM ADVISORY COMMITTEE Emmeline Paintsil – Chair Micaela Maeyaert Jen Morris Emily Muehling Brian Seifert David Weetman

COMMUNITY & AMBULATORY CARE PHARMACY ADVISORY COMMITTEE Emmeline Paintsil – Chair Josh Davis Jennifer Clayton Jacob Crimmins Bridget Jermeland Stevie Veach

SENIOR CARE ADVISORY COMMITTEE Emmeline Paintsil – Chair Rhonda Edwards Namaro Kone Kristin Meyer Jeff Reist Jess Smith

EDUCATION ADVISORY COMMITTEE Emmeline Paintsil – Chair Gary Christensen Lynn Kassel Tyson Ketelsen Dana McDougall

PHARMACY TECHNICIAN ADVISORY COMMITTEE Emmeline Paintsil – Chair Macy Calderwood Meredith Drummond Michelle Garvin Kimerly Metcalf Amanda West

STUDENT ADVISORY COMMITTEE Elizabeth Orput – Chair Leah Bishop Keaton Higgins Kylie Juenger Mahi Patel Jose Rodriguez

Interested in serving on an IPA committee?

Scan the QR code to complete our volunteer survey!

34

| The Journal of the Iowa Pharmacy Association

MEMBERS SECTION HEALTH-SYSTEM LEADERSHIP FORUM John Hamiel Tracy Harlan Sarah Tierney

LONG TERM CARE PHARMACY FORUM Mark Branum Anisa Fornoff Hansen Edyta Judge Rachel Otting David Scott Joyce Wheeler

INDEPENDENT & COMMUNITY PHARMACY PRACTICE FORUM Carson Klug Emma Kraayenbrink Robert Nichols Becky Reutzel Suzy Rolling

SPECIALTY PHARMACY FORUM Chad Mentele Amanda Rosmann

PAYMENT FOR PHARMACY SERVICES FORUM Natalie Hunter Nic Lehman Austin Oyen Kate Waack

PHARMACY TECHNICIAN FORUM Jessica Burge Meredith Drummond Meg Finn Lori Foster

IPA MEMBER BENEFIT Have You Accessed Your FREE Continuing Education Benefits Yet? WWW.IARX.ORG/ACCESSCPE

IPA ENGAGED Pharmacist and Pharmacy Technician members receive a FREE membership to CEimpact’s Pharmacist or Pharmacy Technician Course Catalog, which includes all required CPE for pharmacist relicensure and pharmacy technician recertification.

APR.MAY.JUN. |

35

MEMBERS SECTION

MEMBER MILESTONES

36

Congratulations to Farah Towfic, PharmD, MBA, RPh, Director of CEO Operations at U.S. Pharmacopeia (USP), for being one of 31 women honored with the 2022 Women Making History Award for her extraordinary work as part of USP’s response to the COVID-19 crisis. This award is presented by the Montgomery County Commission for Women and Montgomery Women.

Best of luck to Michael Andreski, BS, MBA, MJ, PhD, Associate Professor of Social and Administrative Pharmacy at Drake University College of Pharmacy & Health Sciences, as he’s announced his candidacy in the Democratic Primary for the Iowa House in District 31. Andreski’s run is grounded in his research about reimbursement issues affecting the ability of Iowa pharmacies to advance their practices.

Best of luck to Michelle Garvin, CPhT, co-owner of Wester Drug, as she serves on PTCB’s Stakeholder Advisory Council. Garvin took part in the council’s organizational planning and strategy meeting on March 1st in Washington D.C.

Congratulations to Erika Ernst, PharmD, BCIDP, FCCP, Associate Professor at the University of Iowa College of Pharmacy, who was named the college’s inaugural Director of Diversity, Equity and Inclusion (DEI). This is a two-year appointment to the DEI committee.

| The Journal of the Iowa Pharmacy Association

You Need a CQI Program Mistakes happen. Risky processes become normalized and your operations can shift slightly with staffing changes, new products, and new procedures.

The APMS Patient Safety Organization (PSO) provides Pharmacy Quality Commitment+ (PQC+) Compounding, a confidential, highly secure, continuous quality improvement program. Track and analyze how, when, and where the risk in your workflow occurs so you can reduce Rx corrections and operational costs.

Our program includes: 1

Pharmacy Quality Commitment+ A web-based reporting portal to collect patient safety events Tools to chart, graph, and analyze data Expert advice, tips, and safe practices Resources to help you meet accreditation and quality improvement requirements Support to build a just culture of safety QA Continuing Education and training opportunities

2

APMS PSO Services Patient Safety Organizations (PSOs) provide a safe space for members to conduct patient safety work. When you partner with our PSO for your Quality Improvement activities, the collection of quality assurance data and patient safety work is in a protected environment.

Customer Service

We are passionate about medication safety in community pharmacy and are here to walk you through the entire process.

Our customer service team has years of experience in pharmacy and is excited to help.

Let's chat! (866)365-7472 info@medicationsafety.org

www.medicationsafety.org

3

CALENDAR OF EVENTS

UPCOMING IPA EVENTS Find additional details to these events and more at www.iarx.org. Click on “Calendar of Events” under the Events tab.

MAY 2022 26

IPA HITS THE ROAD FOR GOES LOCAL

IPA Goes Local is a partnership between IPA and Iowa’s regional pharmacy associations to bring live CPE to locations across the state and see what our members are doing on a local level. This year’s CPE program, “Rethinking Vaccine Communication – The Elephant in the Room,” dives into moral foundations for vaccine beliefs and provides best practices for productive vaccine conversations.

So far, IPA has hosted two successful Goes Local events on April 21st in Mason City and May 3rd in Davenport. Both events saw great participation and engagement! Prior to April’s dinner program, Wixted & Company led a session on building communication skills for working with patients, managers, caregivers and more.

IPA Goes Local: Southwest Iowa Pharmacists Association

JUNE 2022 9

Eggleston-Granberg Golf Classic

14

2/2/2 Webinar: Pharmacists and the HIV Care Continuum

Register today for the upcoming IPA Goes Local programs below. IPA staff aim to visit members at their practice sites on the way to these events – Send an email to ipa@iarx.org if you’re interested!

May 26, 2022, 6:30-8:00 PM Southwest Iowa Pharmacists Association, Council Bluffs, IA August 18, 2022, 6:00-8:00 PM Black Hawk/Bremer Co. Pharmacy Association, Waterloo, IA

21

IPA Independent and Community Pharmacy Practice Forum

28

Iowa Board of Pharmacy Meeting

October 6, 2022, 6:00-8:00 PM Johnson County Pharmacy Association, Iowa City, IA

30

IPA New Member Orientation

October 20, 2022, 6:00-8:00 PM Central Iowa Pharmacy Association, Des Moines, IA

JULY 2022 12

2/2/2 Webinar: Expanding Patient Access to Care – Financial Resources

AUGUST 2022 9

2/2/2 Webinar: House of Delegates Policy Topics Preview

18

IPA Goes Local: Black Hawk/Bremer County Pharmacy Association

23

Iowa Board of Pharmacy Meeting

Currently scheduled events are subject to change.

Watch IPA communications regarding any updates.

38

| The Journal of the Iowa Pharmacy Association

September 6, 2022, 6:00-8:00 PM Dubuque Area Pharmacy Association, Dubuque, IA

November 10, 2022, 6:00-8:00 PM Northwest Iowa Pharmacy Association, Sioux City, IA

IPA MEMBER FORUMS

On April 20, IPA hosted its 2022 Payment for Pharmacy Services Forum virtually, welcoming some all-star panelists and energetic attendees. Michael Murphy, Advisor for State Government Affairs at the American Pharmacists Association (APhA), provided the opening session, exploring the national landscape of payment for pharmacy services. After great breakout group discussion, Stu Beatty, Director of Strategy and Practice Transformation at the Ohio Pharmacists Association, and Randy McDonough, co-owner of Towncrest Pharmacies, gave advice on carving out your niche.

Learn, network and engage with your profession! IPA Member Forums are an exclusive member benefit for ENGAGED Pharmacist, Technician, and Student Pharmacist members. Visit www.iarx.org/forums.

PHARMACY TIME CAPSULE

19 98

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

THE 1998 IPA CHALLENGE:

Pharmacists across the state were challenged to give 1,000 total presentations to community organizations, schools, career fairs and other groups to speak about the importance of pharmacists and the services they can provide.

JANUARY:

The Iowa Pharmacists Association and the Iowa Society of Health-System Pharmacists formed a unification task force and met to discuss a mission statement for the newly merged organization that would represent pharmacists across the state from all practice settings.

This was the last year of publication for the Iowa Pharmacist. In 1999, the inaugural edition of The Journal the Iowa Pharmacy Association was published.

MARCH:

The 20th Annual Legislative Day took place at the Embassy Suites Hotel in Des Moines. Speakers included Senator Mary Kramer and Representative Robert Osterhaus, RPh. IPA’s legislative priorities included increasing Iowa Medicaid’s professional fee for pharmacists, health insurance coverage for diabetic equipment/supplies, and the development of regulatory oversight for collaborative practice agreements.

NOVEMBER:

Actiq (fentanyl) was approved as the first pain medicine to treat breakthrough cancer pain. Enbrel (etanercept), a TNF blocker, was also approved by the FDA to treat rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis.

Four Iowans were among the 243 pharmacists who passed the Specialty Certification Examination administered by the Board of Pharmaceutical Specialties.

HONORS & AWARDS : • • •

Jerry Karbeling, RPh, of Polk City was awarded the prestigious Bowl of Hygeia.

Bill and Shirley Winckler, RPh, were named Honorary President of IPA. Michele Evink, PharmD, RPh, received the Distinguished Young Pharmacist of the Year Award.

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

APR.MAY.JUN. |

39