IPA Journal Sep/Oct/Nov/Dec 2024

A Peer-Reviewed Journal | Vol. LXXIX, No. 3 | SEP.OCT.NOV.DEC. 2024

WELCOME IPA PRESIDENT

JIM HOEHNS

PHARMD, BCPS, FCCP

2024-2025 INSIDE:

IPA Annual Meeting 2024 2024 IPA Professional Awards Class of 2028 White Coat Ceremonies

TABLE OF CONTENTS 2570 106th Street, Unit D, Urbandale, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: ipa@iarx.org | www.iarx.org

PUBLICATION STAFF

Allison Hale Luther, Managing Editor Kate Gainer, PharmD Ryan McClellan, PharmD, SHIMSS Laura Miller Kellie Staiert, MPA George Appleseth, PharmD

COVER STORY Presidential Address: The End of a Beginning pg. 4

OFFICERS CHAIRMAN John Hamiel, PharmD – Evansdale PRESIDENT Jim Hoehns, PharmD, BCPS, FCCP – Cedar Falls PRESIDENT-ELECT Wes Pilkington, PharmD – Waterloo TREASURER Kristin Meyer, PharmD, BCGP, CACP, FASCP – Marshalltown SPEAKER OF THE HOUSE Laura Knockel, PharmD, BCACP – North Liberty VICE SPEAKER OF THE HOUSE Ryan Jacobsen, PharmD, BCPS – Iowa City

TRUSTEES REGION #1 Kelly Kent, PharmD – Williamsburg REGION #2 Natalie Hunter, PharmD – Cedar Falls REGION #3 Helen Eddy, RPh, MBA – Des Moines REGION #4 Wendy Kinne, PharmD – Boone AT LARGE Betsie Frey, PharmD, BCPS – Cedar Falls Andy Stessman, PharmD – West Des Moines Brett Faine, PharmD, MS – Iowa City Cory Garvin, PharmD – Wilton HONORARY PRESIDENT Mike Pursel, MBA, CHP, BS Pharm – Morrison, CO PHARMACY TECHNICIANS Connie Bentrott, CPhT – Ames Kelly Andersen, CPhT – Des Moines STUDENT PHARMACISTS Stacy Johnson – Drake University Sabrina Renner – 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 3 issues per year: January/February/March/April issue; May/June/July/August issue; and September/October/November/ December issue by the Iowa Pharmacy Association, 2570 106th Street, Unit D, Urbandale, IA 50322. Periodicals Postage Paid at Des Moines, Iowa and at additional mailing offices.

POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 2570 106th Street, Unit D, Urbandale, IA 50322. Published tri-annually, The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $80 per year, single copies are $30. Printed by Mittera; Graphic design by the Iowa Pharmacy Association.

IPA Annual Meeting pg. 6

IPA Awards pg. 11

FEATURES Standard of Care Symposium 2025 . . . . . . . . . . . . . . . . . . . . . . . 9 Speaker’s Address: My Personal Policies . . . . . . . . . . . . . . . . . . 12 Outgoing & Incoming Board Members . . . . . . . . . . . . . . . . . . 13 IPA House of Delegates Final Policy Statements . . . . . . . . . . . 14 Class of 2028 White Coat Ceremonies . . . . . . . . . . . . . . . . . . . 16 Current Use of Antiplatelet Agents for Stable CAD . . . . . . . . 18 Pharmacy Day on the Hill 2025 . . . . . . . . . . . . . . . . . . . . . . . . . 28 2023 Outcomes Grant Final Reports . . . . . . . . . . . . . . . . . . . . . 30 Two Pharmacy Technicians on the Board of Trustees . . . . . . 35

IN EVERY ISSUE CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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

SEP.OCT.NOV.DEC. |

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PRESIDENT’S PAGE

The End of a Beginning 2024 IPA PRESIDENTIAL ADDRESS

Jim Hoehns, PharmD, BCPS, FCCP IPA President Clinical Associate Professor, UI College of Pharmacy, Ambulatory Care Preceptor, Cedar Valley Primary Care

Today, I would like to start with introducing my lovely wife, Barb. Barb and I have been married for almost 30 years. Barb is not only the love of my life, she is the anchor of our family. Barb and I were classmates at the College of Pharmacy at the University of Iowa. The class of 1992. We had our first official date at the spring formal at the College back in 1991. In fact, we have a picture at home of the two of us that night which I love to share.

Barb, thank you for your endless love and support these many years.

Barb and I have been blessed with three wonderful children, Sarah, Taylor, and Jack. They are not with us today, but we are enormously proud of each of them. I’m not sure any will go on to study pharmacy, but maybe there is a chance? We will see.

to be able to work with you. You inspire me more than you know.

In February this year, I changed my practice site in Waterloo to Cedar Valley Primary Care and Cedar Valley Clinical Research. Before this change, I spent 28 years with the Northeast Iowa Family Medicine Residency/ MercyOne Northeast Iowa Residency in Waterloo. I have a mountain of respect for our physician colleagues, especially the many family medicine physicians I’ve been privileged to work with. I worked with many outstanding family medicine physicians and medical residents.

Some deserve special mention: Dr. John Sutherland, Dr. Bob Friedman, and Dr. James Poock. Dr. Sutherland introduced me to clinical trial research, which really has become a significant part of what I do.

When I started at the family medicine program in 1995, John was conducting a study of an investigational As you saw in the video, I grew up on a farm south of medication for diabetic foot ulcers. I recall doing a lot of Knoxville. I really had an idyllic rural Iowa upbringing. patient home visits and measuring Two wonderful, loving parents and diabetic foot ulcers. Perhaps, not extwo outstanding older brothers. Our actly the type of study I was interestrural community had a tight knit “Despite [our professional ed in at the time, but I learned new church family. Neighboring farm challenges], I remain a information and research skills while families we might see throughout the ‘glass-half-full’ person. doing it. John is now deceased, but week and usually in church together I truly believe that better after he retired, I had the pleasure on Sunday. days are ahead for of working with Dr. Poock, Dr. Nick our profession. ” Goetsch, and now back with Dr. One of our neighbors and church Poock once again. These were family leaders was a man named Lee medicine physician investigators. I’ve Nichols. Lee was a pharmacist who also worked with many excellent nurse study coordinaworked in a clinic pharmacy in Des Moines at the time. tors throughout this time.

I’m proud of my involvement Lee knew I was interested in pharmacy and took me to with these clinical trials and the opportunities they have work one day so I could shadow him. I’m grateful that created for patients in the Waterloo/Cedar Falls area.

Lee shared that small experience with me. It truly made

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Presidential Video

a difference. It was enough to convince me that the pharmacy profession might be a good future for me.

I owe a great deal to many of the outstanding teachers I have had throughout my early years, both in high school and in college. Some of these people are here today. I apologize as I know I will omit some important people, but here is a quick list: Doug Geraets, former faculty with the College; Mike Kelly—Mike was my Residency Director and was a great teacher; Paul Perry; Jay Currie; Gary Milavetz; Mary Teresi; Karen Baker; Lloyd Matheson; Hazel Seaba; Bruce Alexander; and Barry Carter. I also want to recognize Pat McCormick. If you were a pharmacy student at Iowa in the ’90s, you have a special place in your heart for Pat and everything she did for students. This is a group of individuals I have great respect and admiration for.

Several fellow faculty members from the University of Iowa College of Pharmacy are here today. To all of you, I thank you for your support. I feel especially privileged

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If you were a student pharmacist or resident pharmacist who spent time training with me in Waterloo, thank you! I sincerely hope you had a favorable educational experience. Working with and teaching young student pharmacists and residents has been one of the distinct joys of my career. I can promise that I have learned as much from you as you have from me.

I have benefitted from working with many outstanding pharmacists. Pharmacists from Waterloo, Waverly, Iowa City, and really across the state. Again, many of you are in this room. I worked across the street from Bob and Joe Greenwood for many years. One short story I want to share…Several years ago, I found out late in the residency recruitment season, after residency interviews were completed, that the funding for our resident position was not secured. I was despondent and unsure what to do. I reached out to several physicians and pharmacists in short order, trying to find a partner to salvage our residency plans. Bob Greenwood stepped up, on very

PRESIDENT’S PAGE short notice, and agreed to be our partner for one year. This was a tremendous lifeline at the time, and the College helped out as well. So, Bob, thank you for your generosity and collegiality. Your act has not been forgotten.

I have two main topics I’d like to briefly discuss today as we look to the future: the recent update to our Pharmacy Practice Act and encouraging others to consider the pharmacy profession.

As you all know, Iowa’s Pharmacy Practice Act has changed to a standard of care regulatory framework. This is the first significant change in our profession’s Practice Act in the last 40 years. This would not have occurred without the leadership from Kate Gainer and the staff at IPA. I also want to thank the pharmacists and technicians who served on the Practice Act Task Force. What a great accomplishment! I am delighted that IPA also recently announced a special educational symposium next February to educate us about this modernized Pharmacy Practice Act.

known for being leaders in improving practice. I am genuinely excited to learn from you, to learn with you, to share our experiences and continue to advance the practice of pharmacy.

Next, I want to share some pharmacy numbers with you, and I’m going to ask for some audience participation. How many licensed pharmacists are in Iowa? [3,048.] How many of these 3,048 pharmacists are members of IPA? [1,455 pharmacists and 613 technicians.] How many pharmacists are in the U.S.? [330,000.] How many pharmacist job postings were there in 2023? [79,000.]

In 2013, there were 17,600 applicants to U.S. schools of pharmacy. In 2023, only 10 years later, the number of applicants to U.S. schools of pharmacy has slipped to 11,200. This is a drop of 36%. I could go on, but we need to be better about encouraging young people who are potentially interested in pharmacy as a profession. Do we need more pharmacists nationally? Maybe and maybe not, according to pharmacy workforce predictions. That remains to be seen. But we need more engaged pharmacists. We need to continue to expand and create new roles for pharmacists on health care teams. And we especially need more pharmacy technicians. For technicians, the shortages are even worse.

So, what does our profession have to offer young people? Well, I can tell you what it has meant for me. I really enjoy helping people manage their medications and their health. I enjoy both the personal patient connection and the science behind medication problem-solving. Longterm, meaningful patient interactions and relationships are something I treasure. I love to learn about and contribute to new medication information. So, yes, we are the medication experts, and our profession has a lot to offer the next generation.

Raise your hand if you’ve encouraged someone to consider pharmacy as a career. Thank you. Now, please raise your hand if you’ve invited someone to shadow you or spend a few hours with you in your workplace. Thank you. Why did you become a pharmacist? Who helped guide you in choosing pharmacy as a profession? I hope you share those stories with others. I think we all need to do a better job of encouraging young students to consider pharmacy. It can really make a difference in a young person’s life.

As others have noted, the passage of this legislation is not the “end.” I’m reminded of a famous Winston Churchill quote: “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

Churchill included this in a wartime speech after a notable British victory in North Africa, after they had experienced a string of early defeats in World War II. I wonder in the future if we will look back at this time of the Practice Act change as an inflection point? Will it be a catalyst to help facilitate change in our profession in Iowa? I certainly hope so.

Yes, we must also acknowledge our professional challenges. These include inadequate access and reimbursement from payers and PBMs for medication and services. It has been and remains an enormous problem. As Dr. Mike Andreski at Drake University has aptly pointed out this past year, we have lost a number of pharmacies in Iowa. More than 10% over a 14-year period. Five percent of pharmacies closed over a more recent 3-year period. These are sobering numbers. And to be clear, the same is happening in other states. Independent pharmacies have been particularly hard hit with respect to closures.

Change. A short, simple word, but one loaded with significance. If we desire to change our practice, it is up to each of us to pitch in. If you’re like me, maybe you’ve already started to ask yourself questions. How are you going to change your practice to better share your talents and expertise with your patients? What new opportunities will you seek to improve medication use in your community? Iowa pharmacists are

I am excited to begin my year as President of IPA, and I greatly appreciate your support. This is an exciting time for all of us. We have a new Pharmacy Practice Act. The stage is set and ready for us. Now, we can all roll up our sleeves and get to work. It is the end of a beginning. I look forward to working together to empower pharmacists and improve patient care. ■­

However, despite this, I remain a ‘glass-half-full’ person. I truly believe that better days are ahead for our profession. One of the many benefits of teaching students is that it is easy to be optimistic for the future when you work with such talented young student pharmacists.

SEP.OCT.NOV.DEC. |

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ANNUAL MEETING

IPA Annual Meeting 2024

Over 250 pharmacy professionals and industry partners gathered in Cedar Rapids for the 2024 IPA Annual Meeting, June 20-21. This year’s meeting was high-energy— one of the most energetic meetings we’ve seen since the pandemic!

Michael Hogue, PharmD, FAPhA, FNAP, FFIP, CEO of the American Pharmacists Association (APhA), answered the “hardball” questions during his Q&A keynote, covering everything from professional involvement to provider status.

The following day, IPA welcomed Iowa-native Mark Boesen, PharmD, JD, to provide an attorney’s prospective on healthcare policy, PBMs and more.

IPA also welcomed a very special guest, Alex Oshmyansky, MD, PhD, CEO and Founder of Mark Cuban Cost Plus Drug Company. Dr. Oshmyansky spoke on the harsh realities of PBMs and efforts to make medications more affordable for Americans.

The IPA House of Delegates adopted policy regarding importation of drugs during shortages, pharmacy deserts and access, alternative payment models, and medication standards (see page 14). For the first time ever, the House also debated an emergency New Business Item.

Save the date for next year’s Annual Meeting, June 5-6, 2025 in downtown Des Moines! ■­

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Keynote Michael Hogue, CEO of APhA

Keynote Mark Boesen, Pharmacist & Attorney

Micaela Maeyaert, Chair, PAI 2030 Task Force

Dr. Alex Oshmyansky, Mark Cuban Cost Plus Drugs

ANNUAL MEETING The evening before each IPA Annual Meeting is a celebration of past, current and future leadership. This year, special recognition was presented to Renae Chesnut, EdD, MBA, RPh, Drake University College of Pharmacy & Health Sciences (Dean 2016-2024), and Don Letendre, BS Pharm, PharmD, FASHP, University of Iowa College of Pharmacy (Dean 2007-2024).

IPA sincerely thanks Don and Renae for their immense leadership over the years at the great colleges of pharmacy in our state.

Duffy Art Presented to Dean Letendre Final Words from Dean Chesnut

Thank You Sponsors

2024 IPA Foundation Poster Presentation “Utilizing Quality Improvement Organization Outreach and Community Pharmacies to Improve Nursing Home Vaccination Rates,” Megan Myers, PharmD; Lindsey Ludwig, RPh; Madelynn Aeilts, PharmD Candidate 2026

Aleve APMS Cardinal Health The Compliance Team CPESN-Iowa Independent Pharmacy Cooperative (IPC) J&J Innovative Medicine McKesson Pharmacists Mutual PharmServ Staffing

Renae Chesnut, Kate Gainer, and Don Letendre

50-Year Pharmacist Awards

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CEO’S COLUMN

Values Drive Our Actions At the 2024 IPA Board Retreat, our elected leadership worked on strategic planning and affirming IPA’s core values. These six values are the foundation of our association, shaping our mission and inspiring our actions.

They are the principles that bind us together as a community.

Exceptional Member Experience Kate Gainer, PharmD Executive Vice President & CEO, Iowa Pharmacy Association (IPA)

IPA members are the reason we exist. We are committed to understanding and serving our members at every encounter, fostering meaningful connections. The interactions among IPA members, staff, partners, and stakeholders are designed to create a lasting, impactful impression that enhances overall satisfaction.

Examples of Exceptional Member Experience include when first-time attendees at IPA events receive a warm welcome from board and staff members; it also includes when an IPA member reaches out to the staff with a question, we not only answer the question but think, ‘what else would be helpful for this member to know?’

IPA strives to make every member feel valued, appreciated and integral to our collective success.

Relationships Matter

Professional Excellence

Future Focused

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actions and decisions every day.”

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Positivity & Engagement

Lastly, IPA promotes a positive, fun, and engaging atmosphere within our association. We celebrate achievements and foster an inclusive environment to enhance the member experience. IPA serves as a beacon of optimism for the profession and inspires our members to reach new heights, or pivot in their career, or expand their training and skill sets. Positivity and Engagement are woven into our Association’s fabric.

These values are not just words; they are the principles that guide our actions and decisions every day. They reflect who we are as an association and our commitment “IPA unifies the to our members and the pharmacy profession and ensures profession. IPA will continue to embody these values, along with all voices are valued, you—our members—working which strengthens our together to achieve excellence, build community.” strong relationships, and create a bright future. ■­

IPA’s commitment to excellence drives us to represent and serve members with the utmost professionalism. We continuously advocate for and empower the pharmacy profession, ensuring Iowa pharmacists remain leaders in healthcare delivery and innovation.

Professional Excellence includes integrity with all member interactions; timely responses and accountability to one another.

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IPA believes in the power of collaboration to achieve our common goals. The proverb, "If you want to go fast, go alone. If you want to go far, go together," perfectly encapsulates our ethos. By fostering a Collaborative Culture, we harness the collective strength of our membership, driving progress and achieving outcomes that benefit all. One example of this was during the COVID-19 pandemic when pharmacists across all sites of care joined IPA’s weekly ‘Connecting Over COVID’ webinars to stay abreast of the challenges and strategies to take care of our state. Collaboration enables us to tackle challenges effectively and leverage the diverse expertise within our community.

IPA actively pursues innovative ideas and solutions, continuously advancing our strategic goals with creativity and inspiration. By staying at the forefront of trends and policy in the pharmacy profession, we ensure that we are prepared for the challenges and opportunities “These values are not of tomorrow. Our Future-Focused mindset allows us to anticipate just words; they are the change and adapt proactively. principles that guide our

IPA prioritizes building strong, trusting and lasting relationships with our members, partners, and staff by fostering a culture of active participation and mutual support. We welcome diversity and learn from all perspectives to create an inclusive environment. The staff team at IPA gets to know members beyond their names, hometowns, and practice sites. Incorporating shared passions, family life, or hobbies into member relationships builds trust and personal connection to the Association.

IPA unifies the profession and ensures all voices are valued, which strengthens our community.

Collaborative Culture

Review IPA’s Values at www.iarx.org/AboutUs.

R E G I S T E R T O D AY

FEBRUARY 22 WEST DES MOINES, IOWA Agenda at a Glance – Subject to Change 8:00-8:45 AM

Registration & Breakfast

8:45-9:00 AM

Opening Welcome

9:00-10:00 AM

KEYNOTE: Innovators & Early Adopters: How Standard of Care Can Transform Pharmacy Jennifer Adams, PharmD, EdD, FAPhA, FNAP, Associate Dean for Academic Affairs, Associate Professor, Idaho State University College of Pharmacy

10:00-10:30 AM

What’s in and What’s Out: IAC 481 Chapters 550-557 Iowa Board of Pharmacy Rule Updates Anne Schlepphorst, Executive Director, Iowa Board of Pharmacy, Bureau Chief of Monitoring, Iowa Department of Inspections, Appeals & Licensing (DIAL)

10:30-11:00 AM

Networking & Exhibit Break

11:00-11:30 AM

Wheel of Fortune – A Pharmacist’s Patient Care Process Refresher Kathryn Smith, PharmD, BCACP, Associate Professor of Instruction, Pharmacy Practice and Science, University of Iowa College of Pharmacy

11:30 AM-12:30 PM

The Employer Perspective Idaho Pharmacists: Hospital, Ambulatory Care & Community

12:30-1:30 PM

Exhibits & Lunch

1:30-3:00 PM

Get In Where You Fit In Peer Group Breakouts + Facilitated Workshop

3:00-3:30 PM

Networking & Exhibit Break

3:30-4:00 PM

Liability and Risk Management 101 with Pharmacists Mutual Kristen Jones, PharmD, AVP, Professional Liability Strategic Operations, Pharmacists Mutual Insurance Company

4:00-4:45 PM

Street Cred – Credentialing and the Path to Payment

4:45-5:00 PM

Closing Remarks

WWW.IARX.ORG/SOC_SYMPOSIUM SEP.OCT.NOV.DEC. |

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Protect your license and your practice with confidence!

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Compounding pharmacies incur some of the most severe claim losses, with an average loss paid of $430,375 in 2022.

$1,605,288

$8,821 The average loss paid for a license defense matter in 2022 was $8,821.

Wrong directions/drug/strength claims accounted for $1,605,288 of the total pharmacy malpractice claims in 2022.

Based on Pharmacists Mutual claims reported 1/1/2023-12/31/2023.

Choose confidence.

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IPA AWARDS

2024 IPA Professional Awards The Iowa Pharmacy Association takes great pride in recognizing individuals for their contributions of leadership, patient care, professional involvement, and public service. The following awards, presented during IPA’s 2024 Annual Meeting in Cedar Rapids, serve to capture Iowa pharmacy’s spirit of service and its culture of professionalism.

Bowl of Hygeia Steven Hoyman, PharmD, Emmetsburg

Robert G. Gibbs Distinguished Pharmacist

Thomas R. Temple Mentorship Award

Renae Chesnut, EdD, MBA, RPh, Johnston

Jeffrey Reist, BS, PharmD, BCPS, Cedar Rapids

Honorary President Marilyn Osterhaus, RPh, Maquoketa

Pictured with Pharmacists Mutual

Excellence in Innovation

Distinguished Young Pharmacist

Health-System Pharmacist

Lynn Kassel, PharmD, BCPS, Des Moines

Anne Zepeski, PharmD, BCPS, Iowa City

Ryan Jacobsen, PharmD, BCPS, Iowa City

Appreciation Award (Corporate)

Appreciation Award (Individual)

Pharmacy Technician of the Year

Jerry Karbeling Leadership

Iowa HHS, Bureau of HIV, STI, and Hepatitis

Representative John Forbes, RPh, Urbandale

Rhonda Eid, CPhT, Fort Madison

Rebecca Scribano (Iowa) Kaitlyn Thomas (Drake)

Patient Care Partner Dr. Linda Lee, MD, MHA, FACC, Iowa City

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SPEAKER’S ADDRESS

My Personal Policies 2024 IPA SPEAKER’S ADDRESS Take a moment to think about the policies that govern your life, both professionally and personally.

Wes Pilkington, PharmD IPA Speaker of the House Pharmacist in Charge, Evans Crossing Pharmacy

We all have our own internal policies that govern our lives. My personal policies have been crafted by a blend of life experiences mixed with others’ wonderful thoughts from books, podcasts and even music. Today, I will share a few of these personal polices. I hope my policies will inspire you to be a better person, pharmacist, and member of this House of Delegates.

We all have different values.

Our values are built by our background and life experiences. Everyone has a unique background that shapes their individual values. The values of others should be acknowledged and respected. We do not have to agree on everything, but rather we must recognize that our disagreements are usually based on our values. Knowing that my values are different than others has brought me a great deal of inner peace. As a pharmacy owner, I clearly value the fight against PBMs; whereas a pharmacist with a different practice setting might value provider status a great deal more. Our individual values are what bring greatness to this unified organization. When a delegate has the floor today, I challenge you to recognize that person’s values likely differ from yours, and think about what values might be bringing that person up to speak.

Everyone is struggling with something.

What are you struggling with today? Every single person has at least one issue in their life causing them some internal grief. I think about this quote often in the pharmacy. Most of the struggles we endure pale in comparison to those of our patients. Viewing life through this lens leads us to live with more kindness and compassion.

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Do what Bob would do.

I had the honor of spending five years of my career working for Bob Greenwood at his pharmacy in Waterloo.

During this time, I learned many things about running a pharmacy, inventory, staffing, PBMs, wholesalers—you name it, I probably learned about it. The most impactful learning came from simply watching Bob be Bob. He would go out of his way to grab a medication for a customer or go sit down in the waiting room and chat with them while they were waiting for their prescription to be filled. He would ask the patients about their lives, rarely missing a detail. He cared about them as customers, but he cared about them even more as people.

I watched him do things like deliver medications to the far reaches of town, well after the closing hours of the pharmacy. I even once saw him give a ride to a patient he didn’t even know who had ridden his bike to the pharmacy to pick up a prescription in the dead of winter.

Bob taught me what it means to really care about your patients as people and to always make sure they are taken care of. Bob also taught me that being a community pharmacist means more than just being a pharmacist.

It means being an engaged member of your community and profession.

I am often presented with situations where I must ask myself, What would Bob do in this situation? Handling the situation like Bob would has always steered me in the right direction.

Flush the bad. Keep the good.

This personal policy is from a wonderful Board of Trustee icebreaker that Cheri Schmit recently lead.

Pharmacies are places filled with external stress. This external stress often manifests in the form of unpleasant

SPEAKER’S ADDRESS interactions with our patients who are usually upset about problems that are beyond our control. It is easy to get into the habit of dwelling on these stressful moments and letting them control the rest of our day.

The easiest way to flush these moments is to channel all our focus on the positive interactions that we have with our patients. I make a point to reflect on these positive interactions both right after they happen and when I am lying in bed at night. I think of it as giving my brain a reward for the compassion I gave to others.

We have so many moments where we are positively impacting the lives of our patients. Let those incredible moments be the ones you remember.

Smile.

During one of my first virtual Board of Trustee meetings, I got a message from Diane Reist on Zoom. The message said something along the lines of, ‘You look so serious – smile!’ These words have echoed in my head since she sent them, and her and I now joke about whether I smiled enough. There is research that when you smile, it releases neurotransmitters that make you happier. Seeing a smile has a similar chemical reaction and can also lead to a loss of facial muscle control causing us to smile back! Each time a customer enters my pharmacy, I do my best to give them a big smile and heartfelt hello. It’s probably one of the many reasons why they keep coming back. Do your best to share your smile with everyone during this conference.

Less impressed. More involved.

I’ll leave you with a quote from Matthew McConaughey, who I never thought I would reference during a motivational speech.

No, the quote is not “alright, alright, alright.” The quote is an excerpt from his memoir, Greenlights: “The sooner we become less impressed with our life, our accomplishments, our career, our relationships, the prospects in front of us – the sooner we become less impressed and more involved with these things, the sooner we become better at them.” My challenge to each of you is to be less impressed with what you have done and more involved in what you will do. Alright, alright, alright. Let’s have a productive House of Delegates and a wonderful Annual Meeting! ■­

Thank you to the following IPA members for their leadership and willingness to serve the profession in this capacity!

Outgoing Board Members Cheri Schmit, RPh, Chairman of the Board Wes Pilkington, PharmD, Speaker of the House Robert Nichols, PharmD, BCPS, Trustee – Region #1 John L'Estrange, PharmD, RPh, BCACP, Trustee Region #3 Micaela Maeyaert, PharmD, BCPS, DPLA, Trustee At-Large Morgan Herring, PharmD, BCPS, FAPhA, Trustee At-Large Marilyn Osterhaus, RPh, Honorary President Kayla Batdorf, Student Pharmacist, Drake University Rebecca Scribano, Student Pharmacist, University of Iowa

Incoming Board Members John Hamiel, PharmD, Chairman of the Board Jim Hoehns, PharmD, BCPS, FCCP, IPA President Wes Pilkington, PharmD, President-Elect* Laura Knockel, PharmD, BCACP, Speaker of the House* Ryan Jacobsen, PharmD, BCPS, Vice Speaker of the House Kelly Kent, PharmD, Trustee – Region #1* Helen Eddy, RPh, MBA, Trustee Region #3 Betsie Frey, PharmD, BCPS, Trustee At-Large* Andy Stessman, PharmD, Trustee At-Large* Mike Pursel, MBA, CHP, BS Pharm, Honorary President* Kelly Andersen, CPhT, Pharmacy Technician* Stacy Johnson, Student Pharmacist, Drake University* Sabrina Renner, Student Pharmacist, University of Iowa* *Photographed below – Board installation at IPA Annual Meeting

SEP.OCT.NOV.DEC. |

13

ADOPTED POLICY

Final Policy Statements The following policy was adopted by the IPA House of Delegates during the 2024 IPA Annual Meeting in Cedar Rapids.

24-U1 Choice in Prescription Drug Pricing Models 1. IPA supports prescription drug pricing models, including cost-plus models, that create pricing transparency and equity in the drug supply chain; enhance patient access to affordable and quality care; and promote financial sustainability and viability for pharmacy practice settings.

2. IPA supports the pharmacy’s ability to select prescription drug pricing model(s).

3. IPA calls for the use of a publicly available, standardized national benchmark for determining pharmacy drug acquisition costs.

24-R1 Pharmacy Deserts and Access to Pharmacy Services 1. IPA recognizes geographic proximity and transportation to pharmacies as key determinants in equitable access to care.

2. IPA supports the development and implementation of new practice models to promote equitable access to medications, vaccines, and patient care services provided by pharmacy professionals.

3. IPA calls upon the Centers for Medicare and Medicaid Services to define critical access pharmacy.

4. IPA advocates for enhanced collaboration among healthcare leaders and providers to safeguard and mitigate loss of access to pharmacy services.

5. IPA calls for the development of education, training, and business resources for pharmacy owners to implement and operationalize additional revenue streams that enhance patient care and maintain financial viability.

6. IPA calls for state loan forgiveness programs and other financial incentives for pharmacists, student pharmacists, and pharmacy technicians to recruit and retain the pharmacy workforce in Iowa.

24-R2 State Drug Importation Plans 1. IPA recommends longitudinal research to be conducted at the state level to evaluate the supply chain integrity, impact on patient safety, and liability associated with prescription drugs eligible for importation under state drug importation plans.

2. IPA advocates for the required involvement of pharmacy organizations in the decision-making process for state drug importation plans.

24-NBI-1 Medication Standards 1. IPA advocates for all sites that compound drug products meant for human use to meet the same medication standards for sourcing, preparation and administration to ensure safety and quality.

2. IPA supports adequate oversight and registration with the Iowa Board of Pharmacy for sites that prepare and administer sterile or non-sterile compounded medications to humans.

24-NBI-2 Fair Access to State Medicaid Networks 1. IPA urges Iowa Medicaid and their contractors to maintain separate pharmacy networks, distinct from their commercial and Medicare networks.

2. IPA urges Iowa Medicaid and their contractors to prohibit contracted entities and subcontractors from requiring pharmacies to contract for all current and future products offered.

3. IPA will advocate through legislative and regulatory channels, working with Iowa Medicaid, MCOs, PBMs and other stakeholders to ensure fair access to pharmacy services for all Iowans.

14 | The Journal of the Iowa Pharmacy Association

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WHITE COAT CEREMONIES

CPHS Welcomes Newest Classes of Healthcare Professionals Drake University’s College of Pharmacy and Health Sciences (CPHS) recently welcomed their newest cohorts of professional students: the Doctor of Pharmacy (PharmD) Class of 2028, the Occupational Therapy Doctorate (OTD) Class of 2027, the Masters of Athletic Training Class of 2026, and the Nursing Class of 2025, the first cohort of the brand-new program.

The College continued its tradition of formally inducting the incoming students through its White and Blue Coat Ceremonies. Since 1988, these ceremonies have marked the beginning of a journey for Drake CPHS students in our professional programs.

The four ceremonies were held on Friday, August 23, in Sheslow Auditorium. Students were each presented with their coat and name tag.

Together, each cohort recited their pledge of professionalism before their families, friends, and the CPHS faculty and staff.

PharmD and Nursing students received traditional white coats, and OTD and MAT students received symbolic blue coats. For OTD students, the blue coat honors the pioneers of the occupational therapy profession, who wore slate blue uniforms when they served in World War I over a century ago. For MAT students, a sporty blue windbreaker was chosen for its appropriateness and practicality for the athletic training profession as students enter clinical rotations.

Athletic training students were given remarks and advice by Sami Miller, a 2025 AT candidate. The athletic training students also received a professional speech from Melanie Mason, Health and Movement Science Department Chair at Graceland University.

“We are so excited to welcome these new students into our professional programs, and we look forward to supporting them throughout their journey here at Drake,” Dean Maki noted following this year’s ceremonies.

The academic performance and demographics of the four new classes reflect Drake’s intent to maintain high academic standards for admitted students, recruit diverse cohorts, and attract students from a wide range of geographic locations. Across the four cohorts, more than 75 percent of students identify as female. The classes are also geographically diverse with students coming from 19 different states including Virginia, Texas, Puerto Rico, Idaho, Colorado, Kentucky, Michigan, Mississippi, New York, Arkansas, California, Oregon and internationally, joining students from Iowa and surrounding states. ■­

Erik Maki, Dean of CPHS, provided opening remarks for each of the four ceremonies. Michael Nelson, CPHS Assistant Dean of Affairs, served as the marshal. Chuck Phillips, CPHS Associate Dean of Curriculum and Assessment, announced each student by name, hometown, and coat donor as they walked the stage to receive their blue or white coats for the first time.

Pharmacy students heard remarks and advice from Olivia Kube, a 2025 PharmD candidate. The PharmD students also received a professional greeting from Kate Gainer, CEO of the Iowa Pharmacy Association. Gainer led the PharmD students in reciting the Professional Pledge of a Student Pharmacist.

Nursing students were given a professional introduction into their program

by Lance Schmitt, Chief Nursing Officer and President of Nursing at Broadlawns Medical Center in Des Moines.

Occupational therapy students heard remarks and advice from Paige Fernety, a 2025 OTD candidate, and a professional welcome from Abi Swidergal, the OTA Program Director and Associate Professor at Black Hawk College in Moline, Illinois. Swidergal led the students in reciting the Professional Pledge of an Occupational Therapy Student.

Credit: Drake University CPHS August 30, 2024

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WHITE COAT CEREMONIES

College Welcomes 116 1st-Year PharmD Students Alexis Vander Werff always knew she wanted to help people and make a difference in their lives. She became a pharmacy technician through a family friend and was fascinated by the work pharmacists did. “I thought it was amazing how they knew so much about all the medications, and they knew exactly what to say when counseling patients. It inspired me to want to become a pharmacist,” she said.

WELCOMING ENVIRONMENT

Vander Werff is one of 116 University of Iowa (UI) Doctor of Pharmacy (PharmD) students who donned their new lab coats for the first time at the recent UI College of Pharmacy Welcome to the Profession White Coat Ceremony. It was held at Hancher Auditorium in Iowa City and sponsored by Walgreens.

“It is an honor and privilege to wear this white coat, which signifies caring, trustworthiness, and compassion,” said Ray. “This white coat also connects us to everyone else who shares this profession and those who care for patients daily.”

The class spent the week before the event completing the course Engagement: Professional Skills and Values. It’s a chance to get to know each other, develop as professionals prior to classes starting, meet faculty, and become familiar with the College.

Jill Kolesar, Jean M. Schmidt Chair in Drug Discovery, Dean and Professor, presided over the ceremony—her first since taking the helm in July. “We are here today to celebrate the significance of this coating and the importance of each of you joining the health care profession to improve humankind in your own ways,” said Kolesar.

Adjunct faculty member Wesley Pilkington, ’11 PharmD and owner of Evans Crossing Pharmacy in Evansdale, Iowa, represented the Iowa Pharmacy Association as its President-Elect. He welcomed students to a noble profession.

Randy McDonough, ’87 BSPh, ’97 MS, ’00 PharmD, Chief Executive Officer and co-owner of Towncrest Iowa City and several other pharmacies and businesses, delivered the keynote address. “You are entering the profession at a very exciting time—there are more opportunities today than I have ever witnessed in my forty-year career,” he said.

Clinical Professor Michelle Fravel and Clinical Associate Professor Laura Knockel alternated coating the Class of 2028. Others on the stage included fourth-year pharmacy student Ruth Black, who led the "Oath of a Pharmacist" recitation, and Associate Dean of Academic Affairs Mary E. Ray.

These faculty members are three of many embracing personalities that impressed Vander Werff as she considered pharmacy school. “(Everyone is) so welcoming and willing to put in the time and effort to help you be your best,” she said about choosing the UI College of Pharmacy.

Vander Werff applied to the College through its Assured Admissions Program, which guarantees a seat in the program pending successful completion of all prerequisites, at the same time she submitted to the UI for undergraduate. “I am excited to explore the different areas of pharmacy and find the one that best suits me. I want to help people understand the best ways to take care of themselves so they can live happy and healthy lives,” she said.

Classmate Marcus Rodriguez co-founded a chapter of a Healthcare Exploration club in high school, and a pharmacy speaker made him realize the many options in field. “I was impressed with the welcoming environment and two-plus-four-year (two undergraduate years, four years of pharmacy school) opportunity to complete my PharmD,” said Rodriguez. “My professors have been friendly and I’m looking forward to all the classes I get to take from here on out.” ■­

McDonough shared seven tips to the class for their pharmacy experience: Maximize your education and knowledge.

Engage with the profession.

Become an advocate for your profession.

Explore alternative paths in your journey.

Don’t let fear stop you.

To get the most out of your profession, you need to give back to your profession.

Have fun and enjoy the journey.

Alexis Vander Werff

Marcus Rodriguez

Credit: UI College of Pharmacy September 10, 2024

SEP.OCT.NOV.DEC. |

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ANTIPLATELET AGENTS

Current Use of Antiplatelet Agents for Stable Coronary Artery Disease Among Patients on Chronic Warfarin Therapy Authors: Taylor L. Smith, PharmD, BCACP1,2; Pharmacist Nathan D. Votroubek, PharmD, BCPS1,3; Clinical Pharmacy Specialist Jordan L. Schultz, PharmD1,3,4,5; Assistant Professor, Psychiatry & Neurology Deanna L. McDanel, PharmD, BCPS, BCACP1,3; Clinical Pharmacy Specialist, Clinical Associate Professor 1. Department of Pharmaceutical Care, University of Iowa Health, 200 Hawkins Drive, Iowa City, IA 2. Department of Pharmacy, Lawrence Memorial Hospital Health, 325 Maine Street, Lawrence, KS 66044 3. University of Iowa College of Pharmacy, Department of Pharmacy Practice and Sciences, 200 Hawkins Drive, Iowa City, IA 4. Carver College of Medicine at the University of Iowa, Department of Psychiatry, 200 Hawkins Drive, Iowa City, IA 5. Carver College of Medicine at the University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA Corresponding Author: Nathan D. Votroubek, PharmD, BCPS 200 Hawkins Dr. Iowa City, IA 52242 Department of Pharmacy, CC101 GH Phone: 785-505-4009 Fax: 319-384-8084 Nathan-Votroubek@uiowa.edu Conflicts of Interest related to this research: The authors report no conflicts of interest related to this work.

ABSTRACT

Background: Current guidelines and consensus documents recommend oral anticoagulation alone one year post-cardiac event or intervention for patients with coronary artery disease (CAD) and concomitant indications for anticoagulation therapy yet many of these patients remain on antiplatelet medicines. This study compared clinical outcomes between patients with stable CAD taking warfarin alone versus patients taking warfarin and an antiplatelet and assessed the efficacy of a targeted intervention for antiplatelet deprescribing by a pharmacist-run anticoagulation clinic.

Methods: A retrospective chart review of patients followed by a pharmacist-managed Anticoagulation Management Service at an academic medical center was performed. Included patients had stable CAD and were on chronic warfarin therapy. They were divided into two cohorts; warfarin monotherapy or combination therapy (warfarin plus antiplatelet) at baseline. Logistic regression modeling was used to compare the odds of major ischemic events/death from any cause and major bleeding events between groups. For patients on combination therapy,

18 | The Journal of the Iowa Pharmacy Association

a message was sent to providers to reassess the appropriateness of continuing antiplatelet therapy.

Results: The likelihood of an ischemic cardiovascular event or death from any cause for combination therapy compared to warfarin monotherapy was not significantly different; 16.92% vs 12.12% respectively (OR 1.48, P = 0.484). The likelihood of a major bleeding event was also similar between the combination therapy group and the warfarin monotherapy group; 21.3% vs 15.32% respectively (OR 1.5, P = 0.466).

After the targeted intervention by a pharmacist to de-prescribe the antiplatelet, providers recommended antiplatelet discontinuation in 12 of 57 eligible patients (21%).

Conclusions: There was no significant difference in the likelihood of the composite outcome of ischemic cardiovascular events and death from any cause or major bleeding events between groups. Some clinicians are hesitant to deprescribe antiplatelet therapy among anticoagulated patients. A pharmacist-directed intervention showed some success in decreasing antiplatelet use in this population.

INTRODUCTION

The benefits of antiplatelet medications in patients with stable coronary artery disease (CAD) are widely accepted.1-5 These patients who haven’t had a coronary event or intervention in over a year are at increased risk for recurrent coronary events. However, among patients with stable CAD who are anticoagulated with oral anticoagulants (OAC) for other indications, the benefits of antiplatelet medicines may not outweigh the risks. Large studies have failed to demonstrate additional protection from thrombotic events in patients with stable CAD when antiplatelet agents are prescribed along with OAC.6-8 Conversely, the combination of OAC and antiplatelet therapy (APT) has been associated with a 1.5-1.7 fold increase in bleeding risk compared to oral anticoagulant use alone in this population.6-7 To mitigate this additional risk of bleeding, guidelines and consensus documents recommend transitioning from combination therapy (OAC plus APT) to OAC monotherapy at one year post-coronary event and recommend considering extended duration of combination therapy for only those patients at extremely high thrombotic risk.2-5 This is based mostly on retrospective data and only one completed prospective, randomized trial.6-8 Real-world adaptation of these recommendations has been limited in our practice, and there is sparse literature describing antiplatelet de-prescribing efforts in this high-risk population.9 Our study aimed to assess both the current use of antiplatelet agents for stable CAD among patients on chronic warfarin therapy and the benefit of a targeted pharmacist intervention on antiplatelet deprescribing in this population of patients who are followed by a pharmacist-managed Anticoagulation Case Management Service (ACMS) at a large academic medical center.

ANTIPLATELET AGENTS METHODS

Study Design and Population We conducted a retrospective chart review to identify adult patients followed by the ACMS between July 1, 2016 and July 1, 2020 who had a history of stable CAD with planned extended duration of warfarin.

Patients were excluded if they had a compelling indication for combination OAC and APT (e.g., presence of left ventricular assist device or mechanical heart valve), peripheral vascular disease, or history of heart transplant. (Online Appendix A). Patients who met inclusion criteria were divided into two cohorts, which were patients taking warfarin monotherapy (n=38) or patients taking a combination of warfarin plus one or more antiplatelets (n=151). Patients who had any chronic antiplatelet agent during the study period were allocated to the combination therapy arm only for the period of time that they were taking antiplatelet therapy. If an event occurred after stopping the antiplatelet agent, this was scored as an event in the warfarin monotherapy arm.

Patients with a history of stable CAD still being followed by ACMS who remained on combination therapy as of May 2021 (n=57) entered the targeted intervention phase of the study. First, a message was sent within the electronic medical record to each patient’s referring provider to notify them of the quality improvement project and that the patient remained on combination therapy. Referring providers were given a brief summary of guidance statements supporting discontinuation of antiplatelet therapy. Additionally, they were given the patient’s cardiovascular, thrombotic, and bleeding history (if applicable) and asked if the antiplatelet could be discontinued. Providers who declined our recommendation were asked to give a rationale for continued antiplatelet treatment (Online Appendix A; Table A5). Next, the patients who had approval from their referring physicians to discontinue the antiplatelet agent were contacted by an ACMS pharmacist to recommend stopping the medicine. If a patient preferred not to stop the antiplatelet, reasons for a patient refusing the discontinuation were also documented (Online Appendix A; Table A6).

Outcome Measures In the first phase of this study, the primary efficacy outcome was the likelihood of a composite of ischemic cardiovascular events or death from any cause using a binomial logistic regression model. Ischemic cardiovascular events were defined as myocardial infarction (MI), unstable angina (UA) requiring revascularization, stroke, transient ischemic attack (TIA), systemic arterial embolism, venous thromboembolism (VTE), revascularization, or in-stent thrombosis. The primary safety outcome was the likelihood of major bleeding events, as defined by the International Society on Thrombosis and Hemostasis (ISTH) (Online Appendix A).10 For our pharmacist intervention phase, the primary outcome was the percent of patients whose antiplatelet therapy was discontinued after pharmacist communication with providers and patients.

Statistical Analysis Independent samples t-tests were used to compare the baseline demographics of the cohorts. We used binomial logistic regression models to estimate the odds of experiencing the primary outcomes based on whether the patient was on warfarin monotherapy or combination therapy at baseline. These models included the covariates age, sex, diagnosis of chronic kidney disease (CKD), race, and history of multiple prior CAD events. All analyses were performed in RStudio version 1.3.159 and p-values < 0.05 were considered statistically significant.

RESULTS

From July 1, 2016 to July 1, 2020, a total of 1,842 patients were followed by the ACMS. Of these patients, 189 patients met the inclusion criteria and 1,653 patients were excluded (Table A1 in Online Appendix A). Of the 189 patients included, 38 (20.1%) patients were on warfarin monotherapy and 151 (79.9%) patients were on combination therapy. The baseline demographics between groups were similar, except a higher percentage of patients on combination therapy had diabetes (Table 1).

The mean age was 72 years and 74.6% of patients were male. Of those on combination therapy, 95.4% were on single antiplatelet therapy plus warfarin and 4.6% were on dual antiplatelet therapy plus warfarin (Table A2 in Online Appendix A). Aspirin 81 mg daily was the most common antiplatelet prescribed in combination with warfarin (Table 1).

When examining the types of index coronary events or interventions for inclusion in our study, 72 (38.1%) patients had a history of MI (27 without stenting and 45 with stenting) (Table 1). An additional 61 (32.3%) patients had a history of stenting without MI (Table 1). Fifty (26.5%) patients underwent CABG and 6 (3.2%) patients had coronary angioplasty without MI (Table 1). More patients who had undergone stenting remained on combination therapy (n=92; 61%), as compared to warfarin monotherapy (n=12; 37%) (Table 1). Drug-eluting stents were the most common stent type utilized in both groups (Table A3 in Online Appendix A).

The adjusted odds of experiencing an ischemic cardiovascular event or death from any cause were not significantly increased for patients undergoing combination therapy as compared to those using warfarin monotherapy 16.92% vs 12.12% respectively (OR = 1.48, 95% CI [0.49 – 4.39], p=0.484; Figure 1). The results were similar when looking at the unadjusted event-rate in each group. Ischemic cardiovascular events or death from any cause occurred in 28 (18.5%) patients in the combination therapy group and in 5 (13.2%) patients in the warfarin monotherapy group. In the warfarin monotherapy group, the composite outcome was primarily driven by death from any cause as this accounted for 80% of outcomes (Table 2). There was greater heterogeneity in the combination therapy group for individual components of the composite outcome (Table 2).

The adjusted odds of experiencing a major bleeding event were not significantly increased in patients utilizing combination therapy compared to those using warfarin monotherapy; 21.3% vs 15.32% respectively (OR = 1.50, 95% CI [0.51 – 4.42], p=0.466; Figure 1). The unadjusted rate of major bleeding was 17.2% (n=26) in the combination therapy group and 13.2% (n=5) in the warfarin monotherapy group (Table 2). Of the patients in the warfarin monotherapy group that had a major bleeding event, 3 of 5 (60%) had an INR greater than one full point above their target range at the time of the event, as compared to 4 of 26 (15.4%) patients in the combination therapy group who suffered a major bleeding event. Eight patients had an upper gastrointestinal (GI) bleeding event; 2 in the warfarin monotherapy group and 6 in the combination therapy group. None of the patients with upper GI bleeds on combination therapy were on a proton-pump inhibitor (PPI) at the time of the bleeding event. One of the 2 (50%) patients that had an upper GI bleed in the monotherapy group was taking a PPI. We identified two bleeding events which led to death in the combination therapy group (one GI bleed and one hemorrhagic stroke), compared to no fatal bleeding events in the warfarin monotherapy group.

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ANTIPLATELET AGENTS Of the 189 patients included in the first phase of our study, 70 were still managed by ACMS in May 2021. Thirteen patients were on warfarin alone and 57 (81%) remained on combination therapy. The 57 patients on combination therapy entered the targeted intervention phase. All of these patients were on aspirin as their antiplatelet medication. Providers communicated a decision in 43 of the 57 patients. Providers recommended discontinuing aspirin therapy in 12 (28%) of the patients (Table 3). Of these 12 patients, 10 agreed to stop aspirin based on their referring provider’s recommendation. Thus, pharmacist intervention led to successful de-prescribing of the antiplatelet in 10 of 57 (17.5%) patients during the targeted intervention phase.

DISCUSSION

In this single-center, retrospective, cohort study, we found that ischemic events were not increased among patients with stable CAD who were on warfarin monotherapy compared to those who were also on antiplatelet therapy. Bleeding risk was numerically higher in the combined treatment group, though our study was not sufficiently powered to show a statistically significant difference. These results align with other studies and guidelines that highlight the additional bleed risk, without corresponding antithrombotic benefit, when aspirin is taken along with antithrombotic therapy.1-8 In our study, a high proportion of patients (79.9%) with stable CAD who were on warfarin for other indications remained on antiplatelet therapy despite guideline recommendations to deprescribe antiplatelets for all but the highest risk patients. [3-5] We showed there is value in a pharmacist driven intervention to recommend antiplatelet deprescribing in this population. In the last 10 years, studies have consistently shown increased bleeding risk when combining antiplatelets and anticoagulation. A retrospective cohort study in 2014 demonstrated a significant increase in the risk of bleeding with no significant difference in the risk of recurrent coronary events or thromboembolism for patients with stable CAD on combination antiplatelet and vitamin K antagonist (VKA) therapy, as compared to VKA alone.6 Later, the OAC-ALONE study was the first randomized trial to compare OAC alone versus combination OAC and APT for patients with stable CAD.8 The trial was stopped early due to slow enrollment, mostly driven by providers’ reluctance to withdraw APT in this population.

Consequently, it was not statistically powered to detect the noninferiority of OAC alone compared to OAC plus APT. However, the two groups had nearly identical rates of the composite outcome of all-cause death, myocardial infarction, stroke, systemic embolism, or ISTH major bleeding.

The only prospective, randomized trial completed on topic was the AFIRE study. Researchers compared rivaroxaban monotherapy with combination therapy (APT plus rivaroxaban) in patients with stable CAD, who also required indefinite rivaroxaban therapy for atrial fibrillation. The results showed no significant increase in the risk of thrombotic complications in the rivaroxaban monotherapy group as compared to the combination therapy group. However, there was a significantly lower risk of major bleeding events in the rivaroxaban monotherapy group, as compared to combination therapy.7 Although AFIRE provides high quality evidence, the results should be applied cautiously for patients taking any OAC other than rivaroxaban.

Although our logistical regression model accounted for covariates such as age, sex, diagnosis of chronic kidney disease (CKD), race, and history of multiple prior CAD events, we could not control for every factor influencing the risk of recurrent CAD events between groups. The group of patients in the combination therapy group had a higher incidence

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of coronary stenting at baseline (61% vs 37%) and may still have had more complex CAD or lesions in higher-risk coronary locations than the group of patients in the warfarin monotherapy group. Anecdotally, providers often mentioned a patient’s uniquely high CAD risk as a reason for continuing antiplatelet therapy. This leaves some potential for selection bias to be affecting the safety and efficacy outcomes of our study. There was also a significantly higher percentage of patients in our combination therapy group that had a diagnosis of diabetes at baseline as compared to the warfarin monotherapy group (46.4% vs.

26.3%, P=0.040). This may have factored into the provider’s decision to continue antiplatelet therapy given the known link between diabetes and CAD. We found that 14 patients (50%) in the combination therapy group that had the primary outcome of an ischemic cardiovascular event or death from any cause had a diagnosis of diabetes at baseline.

This demonstrates the importance of addressing other risk factors for CAD as part of the approach to lowering a patients’ risk of recurrent thrombotic complications, especially when deprescribing antiplatelet therapy.

Fatal bleeding was rare and was only found in the combination group (2 events vs 0). Interestingly, 77.4% of patients who suffered a major bleeding event did not have an INR more than 1 point above their goal range at the time of their major bleeding event, which demonstrates the additive risk of bleeding associated with use of APT and OACs occurs even when the medications are being used at standard doses and therapeutic levels, respectively. The 6 patients in the combination therapy group who had upper gastrointestinal bleeding were not on proton pump inhibitors (PPI). This is despite the recommendation for gastrointestinal protective therapy with a PPI be prescribed for patients on combined antithrombotic and antiplatelet therapies.3 It is possible that the combination therapy group would have had fewer bleeding events had PPI use been more common.

The high rate of antiplatelet use in our study (79% from July 1st, 2016 to July 1st, 2020 and still 81% as of May 2021) provided an opportunity for clinical pharmacists to impact patient care. After a targeted pharmacist intervention, providers recommended deprescribing APT in 12 of the 57 patients (21%). The hesitancy for our providers to deprescribe antiplatelets for stable CAD was largely driven by the perception that bleed risks with aspirin were less consequential than the potential benefit in preventing CV events (Online Appendix Table A5). The decision whether to continue aspirin therapy was deferred to the patient’s primary cardiologist in 41 of the 57 (71.9%) patients. The remaining 16 patients were managed by a family practice or internal medicine provider.

Ten of the 12 providers who approved antiplatelet deprescribing (83.3%) were cardiologists. This may show that cardiologists are generally more comfortable de-prescribing aspirin in this unique population than their primary care counterparts.

In a prior quality assurance study completed at our institution, we examined the prescribing trends of antiplatelets for primary prevention of cardiovascular disease among patients on chronic warfarin therapy followed by the ACMS. We found that 16.5% of patients followed by the ACMS during the study period were on aspirin for primary prevention of cardiovascular disease and pharmacist intervention in this study led to aspirin discontinuation in 71% of those patients during the targeted intervention phase. This difference in success rates demonstrates that providers were much less comfortable in de-prescribing concomitant aspirin therapy for secondary prevention in patients with stable CAD than for patients taking concomitant aspirin for primary prevention.

ANTIPLATELET AGENTS There were several limitations to this study in addition to those previously mentioned. As a retrospective chart analysis, we relied on accurate documentation of antiplatelet therapy on the outpatient medication list. As an over-the-counter medication, aspirin may not have always been documented on the medication list within the electronic medical record, which could have led to an under-estimation of patients on combination therapy. Additionally, we had a small control cohort with a relatively low number of events. As described previously, this was a single-center study, which contained only the patients referred to the ACMS for management of warfarin. It did not encompass all patients of our health system who may be on an inappropriate combination of warfarin, or other oral anticoagulants, and antiplatelet therapy for stable CAD. We excluded patients with peripheral vascular disease (PVD) because our intent was to focus on patients with stable CAD, however guidelines give similar recommendations for patients with stable PVD and we could have increased our study’s power had we included them. Lastly, we did not examine the rates of thrombotic or bleeding complications within the first 12 months post-index coronary event or intervention, which may have provided insight as to why the patients were chosen to continue on warfarin monotherapy or combination therapy after one year. Lastly, this study looked at prescribing patterns from 2016 to 2021. Several trials and guideline updates were published during this time period and even more since 2021 which have strengthened the support for de-prescribing aspirin in this population.

Providers may have changed their practice within this time period and may now be more comfortable de-prescribing aspirin than they were during this study period.

One consideration for future directions and for quality assurance projects of this nature would be to complete an educational presentation for the referring provider team on the project and its supporting data. For this study’s pharmacist intervention phase, referring providers were not made aware of the project until the intervention phase began and they were sent messages within the electronic medical record to assess appropriateness of continuation of antiplatelet therapy for their respective patients. As the decision of whether to continue antiplatelet therapy was deferred to the patient’s primary cardiologist in close to three quarters of the patients, working more closely with the cardiology team could have led to a higher success rate in the targeted deprescribing intervention.

WHAT IS NEW AND CONCLUSIONS

Until recently, there was limited evidence to support guidance on the management of antiplatelet and anticoagulation therapies for patients with coronary artery disease on indefinite oral anticoagulation for atrial fibrillation or venous thromboembolism.3-5 Studies have begun to highlight the additive bleeding risk without a significant reduction in risk of thrombotic complications when combining antiplatelet therapy with OAC for patients with stable CAD.6,7 Our study showed use of antiplatelet agents for stable CAD among patients on chronic warfarin therapy followed by our ACMS was relatively high. We found no significant difference in the likelihood of a major bleeding event or the composite outcome of ischemic cardiovascular events and death from any cause between groups. We found that a targeted pharmacist intervention can be effective at limiting inappropriate antiplatelet use but will likely be met with hesitancy in de-prescribing. Our findings support current guidelines to recommend oral anticoagulation alone in most anticoagulated patients with stable CAD. Future research is necessary to clarify the ideal antithrombotic strategy in these high-risk patients.

ACKNOWLEDGEMENTS

The authors would like to acknowledge Tracy Weber, PharmD, BCPS for her help in shaping this project, as well as Marissa Stewart, PharmD (Class of 2022) and Annie (DeVries) Halfman, PharmD (Class of 2022) from The University of Iowa College of Pharmacy for their assistance in data collection.

FUNDING

This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

DISCLOSURES

The authors declare that there is no conflict of interest.

References: 1.

Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery [published correction appears in Circulation. 2016 Sep 6;134(10):e192-4]. Circulation.

2016;134(10):e123-e155. doi: 10.1161/CIR.0000000000000404.

2. Joglar JA, Chung MK, Armbruster, AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;83(1):109-279. doi: 10.1161/ CIR.0000000000001193.

3. Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. Chest. 2018;154(5):1121-1201. doi: 10.1016/j.chest.2018.07.040.

4. Kumbhani DJ, Cannon CP, Beavers CJ, et al. 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2021;77(5):629-658. doi: 10.1016/j.jacc.2020.09.011.

5. Angiolillo DJ, Goodman SG, Bhatt DL, et al. Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2018 Update. Circulation.

2018;138(5):527-536. doi: 10.1161/CIRCULATIONAHA.120.050438.

6. Lamberts M, Gislason GH, Lip GY, et al. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation. 2014;129(15):1577-1585. doi: 10.1161/CIRCULATIONAHA.113.004834.

7. Yasuda S, Kaikita K, Akao M, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med. 2019;381(12):1103-1113. doi: 10.1056/NEJMoa1904143.

8. Matsumura-Nakano Y, Shizuta S, Komasa A, et al. Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation. Circulation. 2019;139(5):604-616. doi: 10.1161/ CIRCULATIONAHA.118.036768.

9. Draeger C, Lodhi F, Geissinger N, Larson T, Griesbach S. Interdisciplinary Deprescribing of Aspirin Through Prescriber Education and Provision of Patient-Specific Recommendations. Wis Med J. 2022; 121(3):220-225. PMID 36301649.

10. Schulman S, Kearon C; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692-694. doi:10.1111/j.1538-7836.2005.01204.x.

SEP.OCT.NOV.DEC. |

21

ANTIPLATELET AGENTS Table 1: Characteristics of the Patients at Baseline Warfarin Monotherapy (n=38)

Combination Therapy (n=151)

P Value

Age – yr (mean ± SD)

69.5 ± 16.1

72.0 ± 10.8

0.245

Male Sex – no. (%)

29 (76.3)

112 (74.2)

0.950

Characteristic

0.243

Race – no. (%) White

33 (86.8)

142 (94.0)

--

Other

5 (13.2)

9 (6.0)

--

10 (26.3)

70 (46.4)

0.040

Chronic Kidney Disease – no. (%)

4 (10.5)

14 (9.3)

1.000

Multiple Prior CAD Events^ – no. (%)

10 (26.3)

55 (36.4)

0.326

AF or Atrial Flutter

27 (71.1)

111 (73.5)

History of VTE

5 (13.2)

16 (10.6)

History of VTE with Thrombophilia

1 (2.6)

3 (2.0)

Multiple Indications

3 (7.9)

14 (9.3)

Other

2 (5.2)

7 (4.6)

Current Smoker

3 (7.9)

16 (10.6)

Former Smoker

22 (57.9)

76 (50.3)

Never Smoker

13 (34.2)

59 (39.1)

Diabetes* – no. (%) #

Indication for Warfarin – no. (%)

Smoking Status – no. (%)

Type of Antiplatelet Therapy (Combination Therapy Group Only)

NA

Dual antiplatelet therapy – no. (%)

7 (4.6)

Single antiplatelet agent – no. (%)

144 (95.4)

Aspirin 81 mg daily

127 (88.2)

Aspirin 325 mg daily

5 (3.5)

Clopidogrel 75 mg daily

10 (6.9)

Other**

2 (1.4)

Type of Index Coronary Event – no. (%) Previous MI without stent implantation

10 (26.2)

17 (11.2)

Previous MI with stent implantation

2 (5.3)

43 (28.5)

Previous stent implantation without MI

12 (31.6)

49 (32.5)

Previous PCI without MI or stent implantation

2 (5.3)

4 (2.6)

Previous CABG

12 (31.6)

38 (25.2)

*Hemoglobin A1C ≥ 6.5% | ** Aspirin 81 mg every 48 hours, Aspirin 81 mg twice daily # Chronic dialysis, history of renal transplant, or serum creatinine ≥ 2.26 mg/dL ^ One or more coronary events or interventions prior to the index coronary event or intervention for this study Abbreviations: AF, atrial fibrillation; CABG, coronary artery bypass grafting; CAD, coronary artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; VTE, venous thromboembolis

22 | The Journal of the Iowa Pharmacy Association

ANTIPLATELET AGENTS Table 2: Observed Efficacy and Safety Outcomes Outcome – no. (%)

Warfarin Monotherapy (n=38)

Combination Therapy (n=151)

5 (13.2)

28 (18.5)

MI

0

3

UA requiring revascularization

0

2

Stroke or TIA

1

4

Systemic arterial embolism

0

0

VTE

0

1

Revascularization

0

3

In-stent thrombosis

0

1

Death from any cause

4

14

Major bleeding event

5 (13.2)

26 (17.2)

Fatal bleeding

0

2

Symptomatic bleeding in critical area

1

10

Fall in Hgb ≥ 2 g/dL

1

12

Transfusion of ≥ 2 PRBCs

3

2

Ischemic CV event or death from any cause

Abbreviations: CV, cardiovascular; Hgb, hemoglobin; MI, myocardial infarction; PRBC, packed red blood cell; TIA, transient ischemic attack; UA, unstable angina; VTE, venous thromboembolism.

Table 3: Results of Targeted Intervention Phase Step 1: Physician Response (n = 57)

Step 2: Patient Response (n = 12)

Continue antiplatelet

31 (54.4)

Stop antiplatelet

12 (21.0)

Other¥

14 (24.6)

Patient agreed to stop antiplatelet

10 (83.3)

Patient refused

2 (16.7)

Complete Acceptance of Pharmacist Intervention

10 (17.5)

¥ Patient no longer met criteria for diagnosis of stable CAD, no response from provider, no longer followed by ACMS, or death during intervention phase not related to anticoagulation

Please contact the corresponding author for Online Appendix A and additional figures.

SEP.OCT.NOV.DEC. |

23

PRACTICE ADVANCEMENT

Cardiovascular Health Improvement Grant – Cohort 1 Launches IPA started the second year of the Cardiovascular Health Improvement Grant in the summer of 2024. The grant, which focuses on improving cardiovascular health and reducing health disparities, particularly related to hypertension and high cholesterol, is in collaboration with the Iowa Department of Health and Human Services (HHS), Bureau of Chronic, Congenital and Inherited Conditions and is funded by the National Cardiovascular Health Program and Centers for Disease Control and Prevention (CDC).

Participating pharmacies will be tasked with creating a quality improvement project, leveraging one of the following efforts to address social service needs and support this high-risk population: advancing health information systems, utilizing multidisciplinary teams, enhancing community clinical partnerships; or supporting training for pharmacy technicians as community health workers. With the aim to initiate or expand services within these areas, IPA will gather quantitative and qualitative data from the improvement projects.

To best guide IPA and Iowa HHS, the pharmacies will also complete various surveys to aid in creating a roadmap to identify professional support and guidance, as well as any resources needed along the way.

With the goal of gaining commitment from ten pharmacies over the year, IPA has identified the first cohort of the project and has received commitment from the following pharmacies: Bedford Drug, Greenfield; Broadlawns Medical Center, Des Moines; Main at Locust Pharmacy, Davenport; Your Neighborhood Pharmacy, Wayne County Hospital, Corydon. Pharmacies are paid a stipend for participating in the project and are also provided funds for hitting various benchmarks.

CPESN Iowa and the University of Iowa are also participants in the grant. IPA has met with CPESN and the University of Iowa to ensure a broad reach in achieving the grant’s objectives, identifying specific data that can be collected to highlight the critical role of pharmacy in improving health outcomes and demonstrating the need for payment for pharmacy services.

IPA is seeking additional ambulatory care pharmacies for this grant. If your pharmacy is interested in participating in the project or would like to learn more, please contact Kellie Staiert, IPA’s Director of Grants & Partnerships, at kstaiert@iarx.org.

HIV Testing Project: Greenwood Pharmacy Makes an Impact Since 2018, IPA has collaborated with Iowa HHS’ Bureau of HIV, STI and Hepatitis in offering free HIV (12 pharmacies) and HCV (3 pharmacies) testing in select community pharmacies across the state. In better understanding the landscape and need of testing services in the state, undergoing comprehensive trainings, sharing best practices and applying lessons learned, the focus of the project in 2024 is to increase testing numbers at participating pharmacies.

Participating pharmacies in the project have found success by engaging directly with their community outside the four walls of their pharmacy.

Earlier this year, pharmacists from Greenwood Pharmacy in Waterloo attended the Cedar Valley Pride Festival and delivered free HIV tests, highlighting the availability of PrEP at their pharmacy and talking with attendees about the importance of HIV testing. In 2023, meeting a milestone within the project, Greenwood Pharmacy signed a collaborative practice agreement with a provider in their community to prescribe and dispense PrEP (Truvada, Descovy, Apretude).

Greenwood Pharmacy staff also attended the Hawkeye Community College Fall Fest earlier this year. Pharmacists built relationships with student organizations and had meaningful conversations with college students, not only about the importance of HIV testing but also the various services available at their local pharmacy.

From January to August 2024, there have been a total of 14 HIV tests delivered, with one being a reactive test. This was the second reactive test in the project, highlighting the critical role pharmacies play in expanding access to essential health care services. The pharmacist who delivered the tests credited his training and the project’s technical assistance for his confidence in counseling upon the results and linking the patient to care.

Pharmacy involvement in HIV testing not only increases testing rates but also facilitates early diagnosis and intervention, underscoring the importance of pharmacy’s efforts in this public health initiative. IPA looks forward to continuing the project in 2025!

IPA Health System Leadership Team Reconvenes In July, the IPA Health System Leadership Team reconvened, bringing together representatives from various health systems, including Genesis Health System, Unity Point Health, MercyOne Health, Avera Health, Waverly Health Center, Broadlawns Medical Center, Van Buren County Hospital, Spencer Hospital, Common Spirit Health, University of Iowa Health Care, and Nebraska Methodist Health System.

The meeting focused on critical topics such as workforce trends, legislative advocacy, and ongoing challenges associated with the 340B program. Discussion centered around how health systems rely on 340B to sustain operations, with the group debating strategies for advancing state legislation to protect this vital program. Concerns were also raised

24 | The Journal of the Iowa Pharmacy Association

about payer-mandated restrictions on biosimilars, which have financial implications for hospital systems, particularly in oncology.

The team also discussed HF 555 and its impact on health systems, specifically related to job descriptions, telepharmacy activities, and other operational aspects. Updates on the Bureau of Professional Licensure and the Department of Inspections and Appeals (DIAL) were shared, highlighting the shift in responsibilities and potential challenges with compliance monitoring under the new standard of care framework.

The meeting emphasized the importance of collaboration and knowledge exchange, especially as joint commission accreditation becomes increasingly crucial.

PRACTICE ADVANCEMENT

Supporting the Pharmacy Technician Workforce: PharmTech Bridges Grant Initiative This year, IPA has been working to advance PTCB’s PharmTech Bridges initiative, with the aim of building innovative, robust career lattices that highlight the expanded roles and responsibilities of pharmacy technicians across the state of Iowa. The project, titled “Charting a Pathway Forward: Career Development for Pharmacy Technicians,” focuses on supporting the growth and sustainability of the pharmacy technician workforce.

IPA initially identified pharmacy practice sites that have successfully implemented career pathways for technicians. Engaging directly with these technicians and employers across various settings allowed IPA to explore unique responsibilities and emerging titles.

This research culminated in the development of materials and agendas for symposiums, highlighting sites with technicians excelling in advanced roles. IPA hosted four symposiums over the spring and summer, both live and virtual, that provided a platform for idea-sharing and offered practical steps for implementing technician career lattice programs in other settings.

A primary goal of the project was to ensure that pharmacy technicians play an active role in developing these pathways. The idea-sharing symposiums brought together technicians, employers, and other stakeholders to discuss various roles and opportunities, necessary training, pay ranges, and more. The insights generated during these symposiums will form the foundation of IPA’s forthcoming resource, “Charting a Pathway Forward – A Pharmacy Technician Career Guidebook.” The guidebook will provide comprehensive recommendations and guidelines for technician career advancement. Key sections will include: • Examples of unique roles and new titles across different practice settings (e.g., 340B Specialist, Business Analyst, Controlled Substances Auditor) • Competencies and skill mapping to advanced credentials, training and education • Guidance on professional development (e.g., resume crafting, professional identity formation, active involvement in associations) • Work-life harmony and support for technician well-being Addressing the two largest reasons for technicians leaving the profession—lack of pay and career opportunities—is critical. Resources like the idea-sharing symposiums and guidebook will help employers support and retain Iowa pharmacy technicians.

SEP.OCT.NOV.DEC. |

25

PUBLIC AFFAIRS

IPA Responds to 90-Day Supply Amendment

Summer Grassroots & Pharmacy Visits

The Iowa Department of Health and Human Services (HHS) has approved amendments to allow an optional 90-day supply for select generic maintenance medications, aiming to provide cost savings and improve the patient experience for Iowa Medicaid members. IPA submitted feedback, emphasizing three key concerns: member experience, health outcomes, and pharmacy cost-savings.

This summer, IPA was actively engaged in grassroots advocacy, laying the groundwork for the 2025 Legislative Session.

While Iowa HHS estimates annual savings of $7 million, IPA highlighted potential patient confusion over why some medications are still restricted to 30-day supplies. Pharmacists will likely handle these inquiries, increasing their work load. IPA shared that fewer touchpoints between patients and pharmacists could reduce clinical interventions, potentially increasing healthcare costs in the long run.

Additionally, IPA urges HHS to assess the impact of the 90-day supply on medication adherence, a factor directly linked to improved health outcomes. IPA recommends that any savings from this amendment be used to support an increase in the pharmacy cost of dispensing, as indicated by a 2022 survey.

IMP3 Program Name Change: IPHP-Pharmacy Under the state government realignment bill (SF 514), the Iowa Board of Pharmacy was moved from the Department of Health and Human Services (HHS) to the Department of Inspections, Appeals, and Licensing (DIAL). Upon the transition to DIAL, all health profession programs were combined into one with one set of rules, requiring a common naming convention. The Iowa Monitoring Program for Pharmacy Professionals (IMP3) is now the Iowa Professional Health Program-Pharmacy (IPHP-Pharmacy). The program’s role is to provide pharmacy professionals and student pharmacists support for recovery from substance use, mental health issues, and other physical conditions.

IPC Hires Iowa Lobbyist As IPA gears up for the 2025 Legislative Session, with a focus on PBM reform and access to pharmacy care, additional partners are also focused on advocacy efforts in our state. The Independent Pharmacy Cooperative (IPC), a buying group and secondary wholesaler based in Sun Prairie, Wisconsin, has hired a lobbyist to work on PBM reform in Iowa in 2025. IPC’s mission is to improve the economic environment of independent pharmacy across the nation. IPC hired Conlin State Strategies, with associates Andy Conlin and Dennis Tibben.

Working with IPC will add voices at the state capitol supporting PBM reform. Coalition building has always been an important piece of IPA’s advocacy strategy, and IPA continues to seek partners to grow the coalition supporting PBM reform in Iowa.

26 | The Journal of the Iowa Pharmacy Association

A primary goal was identifying key districts across Iowa, focusing on those areas where legislative influence will be crucial.

By pinpointing these districts, IPA can mobilize pharmacists to educate their local legislators on pharmacy’s legislative priorities and underscore the importance of addressing these issues to maintain healthcare access in our communities.

IPA has been working to provide pharmacists with resources on urgent issues, such as pharmacy benefit manager (PBM) reform, reimbursement challenges, and statistics demonstrating the impact these issues have on both the profession and patient care.

IPA emphasizes the need for building strong relationships with legislators to ensure pharmacists can serve as trusted resources on these critical topics.

In addition, IPA staff and Iowa legislators have visited several pharmacies across the state.

These visits are invaluable in deepening our elected officials’ understanding of the challenges Iowa pharmacies are facing, especially in rural communities.

These efforts have laid a strong foundation for IPA’s advocacy work, and we are committed to continuing this momentum as we approach the 2025 session.

Hughes Health Mart Pharmacy Emmetsburg, IA

L to R: Greg Hoyman, RPh; George Appleseth, PharmD; Steven Hoyman, PharmD; Ed Maier, RPh; Representative John Wills (District 10); Maddie Mews (Drake); Peyton Anderson (Iowa)

Parkersburg Pharmacy Parkersburg, IA

L to R: Val Bovy; Brent Bovy, PharmD; Representative Pat Grassley (District 57); Kate Gainer, PharmD; George Appleseth, PharmD

Evans Crossing Pharmacy Evansdale, IA

L to R: George Appleseth, PharmD; Kate Gainer, PharmD; Wes Pilkington, PharmD; Senator Eric Giddens (District 38)

South Side Drug Ottumwa, IA

L to R: George Appleseth, PharmD; Representative Hans Wilz (District 25); Eric Carlson, RPh

Support IPA’s advocacy efforts through the IPPAC!

PUBLIC AFFAIRS

Iowa Board of Pharmacy Rules Update & IPA’s Response On November 5, the Iowa Board of Pharmacy noticed for intended action the new rules contained in 481 IAC, Ch. 550-557, as part of a comprehensive regulatory overhaul following Governor Reynolds’ Executive Order 10 (EO10) and the passage of HF 555. These changes are administered by the newly restructured Department of Inspections, Appeals, and Licensing (DIAL).

Pursuant to the Notice of Intended Action (NOIA), there is a public comment period, followed by a public hearing, and then future action for the Board of Pharmacy to adopt the rules.

Chapter 550, 551: Definitions; Licenses, Registrations, and Permits These chapters unify the definitions and set out the requirements for licensing, registration, and permits related to pharmacy practice, handling controlled substances, and distributing prescription products in Iowa.

Chapter 552: Standards — Practice of Pharmacy Establishes baseline standards for facilities, security, personnel, patient care services, prescription handling, technology, quality improvement, and record-keeping. These rules aim to ensure consistent quality and safety across pharmacy operations.

2024 IPPAC Update FUNDRAISING

The Iowa Pharmacy Political Action Committee (IPPAC)’s latest activity involves the LimitedEdition Single Malt Whiskey fundraiser. To date, there have been over 40 bottles sold, raising nearly $1,700. The proceeds from this fundraiser are crucial in supporting IPPAC’s mission to promote legislative advocacy and strengthen pharmacy’s influence across Iowa.

MEMBER COLLABORATIONS

This quarter, IPPAC has made significant progress in delivering checks to our member pharmacies, with 20 check deliveries completed so far.

These interactions, either by phone or in person, have allowed us to engage with pharmacists directly and discuss the impact of our advocacy efforts while building stronger relationships within the pharmacy community.

CANDIDATE SUPPORT

So far, IPPAC has supported 29 candidates with financial contributions to their campaigns, demonstrating our commitment to fostering strong political relationships with legislators who understand the importance of pharmacy practice and healthcare reform in Iowa. In providing support to these candidates, IPA aims to advance key issues for the profession during future legislative sessions.

Chapter 553: Controlled and Precursor Substances This chapter provides comprehensive regulations for controlled and precursor substances, covering records, security, policies and procedures, physical counts and inventories, theft or loss reporting, and other critical aspects to streamline substance management.

Chapter 554: Operational Standards — Distribution & Drug Supply Chain Focuses on FDA-registered outsourcing facilities and limited distributors, incorporating federal standards and defining the necessary policies, procedures, and facility requirements to ensure compliance within the drug supply chain.

Chapter 555: Standards — Drugs in EMS Programs Sets minimum standards for the use of prescription drugs, including controlled substances, in Emergency Medical Service (EMS) programs. It requires EMS programs handling controlled substances to register under the Controlled Substances Act (CSA) and establishes comprehensive standards for their safe and regulated use.

Chapter 556: Iowa Prescription Monitoring Program Defines the functional requirements for the Iowa Prescription Monitoring Program (PMP) Advisory Committee, practitioner registration, reporting requirements, security, and access to PMP information.

Chapter 557: Board of Pharmacy Operations Outlines the operations and responsibilities of the Board of Pharmacy, including details on Board meetings, administrative fees, and references to other Department rules adopted by reference.

IPA has been actively engaged in the rulemaking process, submitting detailed comments on behalf of IPA members across the state. IPA aims to ensure the final rules support both the safety of patients and the operational efficiency of Iowa pharmacies, in line with the standard of care framework passed in the new Pharmacy Practice Act earlier this year. IPA’s involvement ensures that Iowa pharmacy professionals are involved in the development of a regulatory framework that fosters a strong and sustainable profession in our state. As these new chapters progress through the rulemaking process, IPA will continue to advocate and provide further guidance to members as necessary.

SEP.OCT.NOV.DEC. |

27

PUBLIC AFFAIRS

DEA Considers Rescheduling of Marijuana The Drug Enforcement Administration (DEA) is considering rescheduling marijuana from a Schedule I to a Schedule III substance under the Controlled Substances Act. In May, the Department of Justice published a notice of proposed rulemaking (NPRM) that aligns closely with a recommendation from the Department of Health and Human Services (HHS), acknowledging that while marijuana has a high potential for abuse, it also has recognized medical uses and presents fewer serious adverse outcomes than other Schedule I and II substances. Following the public comment period, the DEA will hold a hearing in early December 2024 to gather more evidence and expert opinion. If marijuana is reclassified to Schedule III, it would be subject to Schedule III regulatory controls, existing marijuana-specific requirements, and any additional measures, including those for U.S. treaty obligations.

“Big Three” PBM Executives Attend Congressional Hearing In August, the House Committee on Oversight and Accountability held a critical hearing to address malpractice by the nation’s leading pharmacy benefit managers (PBMs) in the wake of the Federal Trade Commission’s (FTC) interim report. This report exposed how the largest PBMs—CVS Caremark, Express Scripts, and OptumRx—exploit their vertical integration and market concentration to control drug availability, inflate medication costs, and impose unfair terms on America’s pharmacies. Despite intense questioning, executives from these PBMs failed to provide clear answers, underscoring the opaque nature of their operations. The hearing revealed the significant influence PBMs wield in the pharmaceutical supply chain and their role in driving up drug costs for their own financial gain. Since the hearing, there has been

ongoing federal litigation introduced against the “Big Three” PBMs and their group purchasing organizations (GPOs) in an FTC lawsuit alleging their anticompetitive practices have led to inflated insulin prices and limited access to cheaper alternatives.

Addressing NADAC Reimbursement Issues This year has seen considerable volatility in National Average Drug Acquisition Cost (NADAC) pricing, with notable dips in reimbursement rates, particularly in May. The American Pharmacists Association (APhA) team is set to meet with the Centers for Medicare & Medicaid Services (CMS) to address these reimbursement issues and to discuss potential mandatory reporting requirements, such as a NADAC survey.

The outcomes of these discussions could significantly impact pharmacy reimbursement models.

ECAPS Stalls in the Senate On July 25, 2024, the Equitable Community Access to Pharmacist Services (ECAPS) Act was reintroduced in the Senate. This bipartisan legislation seeks to ensure that Medicare beneficiaries can receive essential services from pharmacists, particularly in underserved rural areas. H.R. 1770 would establish Medicare Part B direct reimbursement for specific pharmacist services, including testing for COVID-19, influenza, RSV, and strep throat, as well as vaccinations and treatment for COVID-19 and influenza. With over 190 organizations supporting this legislation, ECAPS has widespread support but has seemingly halted in the Senate.

Most recently, it was referred to the Committee on Finance, where there is hope it will be added to an end-of-session bill before the conclusion of the 118th Congressional Session.

Join us to advocate for meaningful PBM reform!

REGISTER

FEBRUARY 5, 2025 Embassy Suites Iowa State Capitol 28 | The Journal of the Iowa Pharmacy Association

Pharmacy Law Resource Available as Membership Add-on THE LIRC INCLUDES: • Monthly email updates

Featuring state and federal updates, opportunities for public comment, newly adopted rules, sign-on letters, and more!

• Detailed regulatory tracker • In-depth FAQ webpage • What, Why & How Podcast

EXPLORE LIRC >>

The Iowa Pharmacy Law & Information Resource Center (LIRC), now completely digital, provides access to an online database containing Iowa Code, Board of Pharmacy rules, Controlled Substance laws, Medicaid and other Healthcare Provider rules, as well as updates and analysis of recent changes, frequently asked questions, and additional resources. The LIRC is your go-to resource for standard of care practice changes, new Board of Pharmacy rules, and more!

PURCHASE LIRC >>

Available on Spotify and Apple Podcasts

$300 VALUE for just $75! (for ENGAGED Pharmacists)

Seeking an educational and accessible law resource? ENGAGED and CONNECTED Pharmacist members can now add a LIRC subscription to their current IPA membership at a discounted rate!

WWW.IARX.ORG/LAWMANUAL SEP.OCT.NOV.DEC. |

29

2023 OUTCOMES GRANT

Outcomes Grant: Final Reports Implementation of and Patient Experience with a Test-and-Treat Service in a Community Pharmacy AUTHOR: Maya Boguslawski, PharmD, University of Iowa PGY1 Community-based Pharmacy Resident, Greenwood Pharmacy AWARD: $1,100 Background: Recent Iowa state legislation has allowed pharmacists to order and administer point-of-care (POC) testing for group A streptococcus pharyngitis infections and influenza, as well as order and dispense prescription treatments for those infections. In addition, recent federal legislation allows pharmacists to order and dispense COVID-19 therapeutics. Our study explores the implementation and impact of a cash-based POC test and treat (T&T) service delivered at an independent community pharmacy.

Objective and Rationale: Our objective was to evaluate the feasibility and acceptability of a cash-based T&T service. Recent state and federal legislation empowers pharmacists to order and administer POC tests for streptococcus pharyngitis, influenza, and COVID-19 and dispense prescription treatments. Our study dives into the practical implications.

Methods: Prior to POC T&T implementation, pharmacists completed 13 hours of training to obtain certification. Medicaid provider enrollment was also completed in order to bill Medicaid for the service.

Positive results lead to immediate prescription treatment, while negative results prompt OTC recommendations or medical referrals. Marketing efforts included boosted Facebook posts, flyers, posters, and digital signage.

Patient Satisfaction: Survey results were obtained from two patients who both strongly recommended the service to others, found it more convenient than clinic or urgent care visits, appreciated the professional staff and efficient service, and considered it a good value for their health.

Revenue: The pharmacy generated $590 from 6 strep tests, 5 flu tests, and 2 COVID-19 tests. One patient received subsequent treatment based on their test results.

Future Strategies and Conclusion: Explore marketing avenues like flex spending and health savings accounts. Continuously improve service quality based on evaluation data. This cash-based T&T service bridges the gap between diagnosis and treatment, potentially enhancing patient access and outcomes. More work is needed to better position the service to increase patient uptake.

Evaluation and Intervention of Vitamin D Supplementation in a Supermarket Community Pharmacy AUTHOR: Alice Chang, PharmD, University of Iowa PGY1 Community-based Pharmacy Resident, Hy-Vee AWARD: $1,000 Deficiencies or depletions of vitamin D can predispose people to a weakened immune system, calcium absorption issues, increased cancer risk, increased risk of falls or fractures, and other health concerns. Evidence suggests that supplemental vitamin D can reduce falls, strengthen bones and the immune system, and reduce cancer risk. Patients are commonly started on vitamin D2, but vitamin D3 has several benefits including closer physiological similarity to natural vitamin D made in the skin, higher bioactivity due to a higher affinity for vitamin D receptors and enzymes required for activation. Vitamin D3 is also more potent and capable of maintaining higher levels over time.

In this study, we identified patients with active prescriptions for vitamin D2 and faxed the prescriber suggesting a change from vitamin D2 to vitamin D3. A total of 29 patients were included in the study who had

30 | The Journal of the Iowa Pharmacy Association

an initial vitamin D2 prescription sent to the pharmacy in August 2023 until May 31, 2024. Half of the patients had Medicaid coverage while the remaining patients were covered by Medicare Part D plans, commercial insurance, or paid via cash or discount. The recommendation to switch to vitamin D3 was made to each prescriber as well as an offer by the pharmacist to determine a dosing regimen for each patient.

Out of the 29 total recommendations, 8 were accepted, 6 were rejected, and 15 had no response after 3 attempts to reach out. All but one of the prescribers requested a dosing regimen of 50,000 IU once weekly themselves. An updated serum vitamin D level was provided for one patient by the prescriber.

The service is an easy intervention to make and could increase frontend sale of supplements. Pharmacists and interns could make other supplement recommendations and potentially implement a fee-forservice supplement consultation in the future.

2023 OUTCOMES GRANT

Implementation and Evaluation of a Long-Term Care AtHome Service in a Rural Community Pharmacy Setting AUTHOR: Megan Ditzman, PharmD, University of Iowa PGY1 Community-based Pharmacy Resident, Osterhaus Pharmacy AWARD: $2,000 Objectives: This project evaluated a long-term care at home (LTC@ Home) service offered at Osterhaus Pharmacy. Evaluation of outcomes included a description of the implementation and challenges, pharmacist clinical interventions, and patient/caregiver satisfaction.

Methods: This was a single-group pilot study evaluating a community pharmacist-delivered LTC@Home intervention. The pharmacy’s database software was queried to identify potential patients who had polypharmacy, had ≥ 3 chronic conditions, and had ≥ 3 ADL/iADL limitations. A community health worker used a qualification form to approach eligible patients and determine eligibility. For enrolled patients, a pharmacist performed a comprehensive medication review to identify drug therapy problems and communicate with providers as necessary. Patients’ prescriptions were synchronized, placed into monthly adherence packaging, and were delivered to the patient’s home.

When warranted, a pharmacist could visit the patient’s home to administer vaccinations or provide education. This process occurred monthly.

Following the data collection period, a paper survey was mailed to patients/caregivers, with a return envelope and stamp, to assess satisfaction and suggestions for improvement. Data collected included the average number of medications and conditions per patient, pharmacist-identified drug therapy problems, patient/prescriber accepted interventions, insurance type, reimbursement amounts, and overall patient/ caregiver satisfaction.

Results: Fourteen patients were enrolled in the study. 3 of the enrolled patients were living in a group home setting. Seven of the enrolled patients were receiving compliance packaging before the study. All 14 patients received at least 1 clinical intervention performed by a pharmacist. 4 patients were visited in their homes by a pharmacist at least once.

Seven patients completed the satisfaction survey and were universally satisfied with the service.

Conclusion: Overall, implementing an LTC@H service was successful during this study. Challenges faced were primarily reimbursement.

Clinical interventions were successful. Survey results showed unanimous satisfaction with the survey.

Implementing Vaccine Screening and Administration in Appointment-Based Medication Synchronization Program AUTHOR: Christy Nguyen, PharmD, University of Iowa PGY1 Community-based Pharmacy Resident, MercyOne Pharmacy AWARD: $1,200 Pharmacists play a vital role in public health by providing vaccines to patients, contributing to disease prevention and immunization efforts.

However, workflow issues can hinder their ability to efficiently administer vaccines, potentially leading to delays or missed opportunities for vaccination. In medication synchronization (med sync) patients, an efficient vaccine consultation service may provide an opportunity for pharmacists to engage with patients to address gaps in comprehensive immunization coverage and complete comprehensive medication reviews (CMRs).

The purpose of the project was to create an ideal workflow to include vaccine screening in med syncs and identify which vaccines were often recommended through the Iowa Immunization Registry Information System (IRIS). After reviewing over 150 patient profiles through, the top recommended vaccines included, COVID-19, influenza, RSV, Td/ Tdap, and Zoster vaccines. Meningococcal vaccines and pneumococcal vaccines often appeared in recommended vaccines, but they involved a more extensive screening for eligibility and not included in the vaccine screening process unless patients requested a more thorough review of their vaccine profile.

Of the 41 patients successfully contacted via phone to discuss vaccines, only 2 (4.9%) patients scheduled vaccines. The 2 patients were employees of the institution and scheduled multiple vaccines including Tdap boosters and Shingrix vaccines. Other screened patients were either not interested (17.1%), already completed their vaccines (14.6%), would follow up with their primary care provider (17.1%), or would consider vaccines later (34.1%). All patients that were successfully called were willing to undergo vaccine screening. Of those patients, 61% also requested additional pharmacy services, including resyncing medications, discontinuing medications, filling additional medications, and requesting refills.

Despite the low success rate of vaccines scheduled, the vaccine screenings created an opportunity to engage with patients to review their medication profiles and provide services that may have been missed during the regular med sync process.

Learn more and review previously funded projects!

SEP.OCT.NOV.DEC. |

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IPA FOUNDATION

Silent Auction At IPA Annual Meeting 2024, the IPA Foundation Silent Auction featured 85 items up for bid—and some friendly competition on several hot items! The event also included the Red Envelope Challenge and wine ring toss. The IPA Foundation thanks everyone who donated items, placed winning bids, threw rings, and accepted a Red Envelope challenge. This year’s silent auction raised over $14,900 to support student pharmacists, leadership development, and practice advancement across the state.

STEP, CYCLE, SWING for Student Scholarships This year’s STEP, CYCLE, SWING fundraiser raised $6,000 for the IPA Foundation and student scholarships.

With nearly 40 participants—pharmacists, pharmacy technicians and student pharmacists alike—IPA members got active throughout the summer, starting with the 2024 kick-off at IPA Annual Meeting. Congratulations to our 2024 Step Up for Students winner, Hannah McMurrin (University of Iowa), who logged an impressive 21,388 steps during the 24-hour period. Thank you to Hannah’s pharmacist sponsors, Diane Reist, John Hamiel and Terry Wiedenfeld—and thank you to all who participated!

Decker-Temple Leadership Pharmacy In August, rising pharmacy leaders from Iowa and Wisconsin came together in Galena, Illinois to develop their leadership potential and learn about key issues impacting the profession. Each year, ten pharmacists in their first 3-15 years of practice are selected to participate from each state. This is a fun weekend designed to develop future leaders for the profession and association.

2024 Decker-Temple Leadership Pharmacy Class Karissa Fritsch, PharmD, BCPS, University of Iowa Hospital & Clinics Natalie Gadbois-Mincks, PharmD, MPA, BCACP, Drake University College of Pharmacy and Health Sciences Kimberly Graham, PharmD, BCPS, BCPPS, MercyOne Des Moines, Pediatrics Kirre Hannan, PharmD, MercyOne Waterloo Medical Center Morgan Jacks, PharmD, Waverly Health Center Adam Jones, PharmD, MBA, BCSCP, University of Iowa Health Care, Acute Care Rachel Kinn, PharmD, BCPPS, University of Iowa Health Care, Specialty Lynette Koch, PharmD, Meyer Pharmacy Anna Shook, PharmD, BCPS, BCOP, Mary Greeley/Drake University College of Pharmacy and Health Sciences Kathryn (Kate) Smith, PharmD, BCACP, University of Iowa College of Pharmacy

WWW.IARX.ORG/IPAFOUNDATION

32 | The Journal of the Iowa Pharmacy Association

2023 Recipients of the “Bowl of Hygeia” Award

J. C. Weeks Jr. Alabama

Dan Nelson Alaska

Shareen Y. El-Ibiary Arizona

Denise Clayton Arkansas

I.R. Patel California

Connie Valdez Colorado

Gene B. Decaminada Connecticut

Elizabeth Ryan Delaware

William Garst Florida

Ben Flanagan Georgia

Sudhir Manek Illinois

Ryan S. Ades Indiana

Wendy Kinne Iowa

Michael K. Conlin Kansas

Trish Freeman Kentucky

Anthony L. Walker Louisiana

James D. Nash Maine

Marie-Therese N. Oyalowo Maryland

Dennis G. Lyons Massachusetts

Heidi L. Diez Michigan

Tim J. Gallagher Minnesota

Leigh Ann Ross Mississippi

Heather Lyons-Burney Missouri

Mark Eichler Montana

David Randolph Nebraska

Samantha Marie Strong Nevada

Derick B. Anderson New Hampshire

Linda Witzal New Jersey

Mona Ghattas New Mexico

Zarina Jalal New York

Ritesh Patel North Carolina

Justin Wilson Oklahoma

Juancho Ramirez Oregon

Lucrezia Finegan Rhode Island

Kathy Quarles Moore South Carolina

Travis Anderberg South Dakota

Jeff Harrell Washington

Bill Greene Tennessee

The “Bowl of Hygeia”

Harvey J. Hanel North Dakota

Laura Jo Miller Ohio

Mary S. Klein Texas

Jason Turner West Vrginia

David C. Young Utah

Nicole Schreiner Wisconsin

James Marmar Vermont

Kristopher Stewart Ratliff Virginia

Craig A. Jones Wyoming

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

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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.

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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.

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www.medicationsafety.org

3

TECHNICIAN CORNER

Two Pharmacy Technicians on the IPA Board of Trustees For the first time, per an IPA Bylaws update in 2022, two pharmacy technicians are serving on the IPA Board of Trustees. These terms are asynchronous, like current Trustee positions, with one new technician elected to the Board each year. Connie Bentrott, CPhT, pharmacy technician at Hy-Vee Pharmacy in Ames (L), will finish her two-year term in June of 2025. Kelly Andersen, CPhT, Pharmacy Administrative Coordinator at MercyOne Des Moines (R), who was installed at this year’s Annual Meeting, will complete her twoyear term at IPA Annual Meeting 2026. IPA is thrilled to expand professional development and leadership opportunities for pharmacy technicians in the state! ■

Newly Certified Iowa Pharmacy Technicians May 1–Aug. 31, 2024 Sara Abdalla Ali Ahmed

Gabrielle Darnell

Ayla Hefner

Dana Leners

Thomas Ogilvie

Caide Steffen

Salwa Abdalmokram

Kaydence Davis

Michael Henkle

Malori Leonard

Chloe Ovel

Justin Steiff-Ellison

Victoria Aldana Banegas

Daniel Delay

Maddie Hinkel

Maggie Leonard

Olivia Pahlkotter

Rowan Stewart

Lydia Alley

Mylanah Derrer

Izabella Ho

Jia Qian Liu

Kira Parkis

Livia Stibal

Jennifer Amora

Kaylee Devore

James Hofer

Jaden Logan

Nidhi Patiyal

Gail Strickler

Ashley Ankney

Kimberly Diesburg

Jaden Holland

Beau Lucart

Samantha Patterson

Osam Suleiman

Jennifer Bartlett

Kristen Dolan

Ashley Hosch

Arina Luu

Jacquelyn Paul

Jaelyn Taeger

Adam Bench

Sharon Driscoll

Brittney Hudson

Bethany Maddick

Blake Petersen

Alexa Terrell

Karl Benson

Natalia Dunnington

Meagan Ira

Megan Mahalla

Vladimir Petrov

Dylan Thompson

Rishem Bhogal

Tori Eckard

Memphis James

Jacob Main

Taylor Pettit

Cheyenne Thurman

Hannah Bladt

Isela Enriquez

Peyton Jensen

Caitlin Marsh

Stephanie Priest

Olivia Towsley

Rylie Blume

Fnu Farhana

Hannah Jin

Elizabeth Martin

Courtney Rainey

Ariel Tripses

Evie Boblenz

Stephanie Faught

Courtney Johnson

Reilly McMurphy

Tracy Riedell

Halley Trucks

Tina Bodensteiner

Diamond Finley

Jenna Jones

Owen Meerbeek

Chandra Riley

Hallie Vallejo

Gabrielle Boustead

Lora Fiscus

Savannah Jones

Jessica Meier

Sara Roerig

Andres Viveros Renee Wagner

Diana Boyd

Sarah Fitzjarrald

Jordan Juett

Stephanie Miller

Delaney Rowland

Amy Breitsprecker

Courtney Fletcher

Tamera Kacer

Karen Milligan

Love Saffold

Kelsey Walter

Alyssa Campbell

Amelie Foster

Christa Kacer-Reynolds

Mikayla Mingus

Rachel Salisbury

Kyrstin Waychoff

Emily Carney

Sasha Frasier

Grace Kamberger

Laura Morelli

Shannon Sayre

Jesse Webbmausbach

Alexa Carter

Sadie Freudenberg

Josie Kaski

Joseph Mosbach

Stacey Schakel

Haleigh Weghorst

Nicolas Casabella

Katrina Ganseveld

Amiiee Keomanivong

Tessy Murray

Abigail Schelle

Marissa Westfall

Kaylyn Casassa

Nathan Gates

Audrey Kindred

Lorrena Myers

Johannah Schilling

Mia Whalen

Shihua Chen

Abigail Gossman

Alexander Kline

Engy Narouz

Lauren Schladetzky

Stephanie Wierema

Morgan Cleveland

Steven Grau

Randi Knop

Mebrahtom Negash

Stephany Schoen

Brittany Wildermuth

Sheri Cooper

Lydia Grond

Janet Kores

Jacob Nelson

Gloria Pascual Sebastian

Kelsie Wosepka

Jessica Cordero

Micaela Haffey

Madison Kuns

Kailey Netolicky

Kristal Sell

Erica Wubben

Josephine Cross

Amra Hajric

Melissa Lakey

Mikayla Newquist

Lynne Shotola

Ainsley Young

Danica Curry

Mya Hardman

Joseph Van Landschoot

Danielle Nicks

Cassie Sievers

Annalise Zeinemann

Uyen Dam

Chyenne Harris

Bailey Langos

Nathan Norrell

Sarah Simmons

Ellen Zelenskiy

Danny Dang

Emily Hartkopp

Bailee Leerar

Mia O’Brien

Tionna Slater

Hooria Zubair SEP.OCT.NOV.DEC. |

35

IPA IN ACTION

IPA Goes Local & Pharmacy Visits IPA hosted two successful Goes Local events this fall—with many pharmacy visits along the way! In August, IPA staff road-tripped to Dubuque, visiting Towncrest Pharmacy, Towncrest Wellness Apothecary, and UI Healthcare. In September, staff visited Parkersburg Pharmacy, Evans Crossing Pharmacy, Cedar Valley Primary Care, and MercyOne Waterloo Medical Center on the way to Black Hawk/Bremer County’s event.

This year’s IPA Goes Local program explores the pharmacy team’s role in providing whole-person care for people living with dementia, considering the unique needs of each patient and their caregivers. The program offers 1 hour of CE (0.1 CEU) and features a virtual reality simulation so participants can see and hear the world through the eyes and ears of their patients with dementia.

Using virtual reality equipment (Dubuque)

Black Hawk/Bremer (Waterloo)

2024 IPA Board Retreat In July, IPA Board members gathered in Clear Lake to get to know each other and begin drafting an updated strategic plan for the association.

Great discussion was had surrounding PBMs and payment reform, attracting and retaining young practitioners, and further enhancing the member experience for each individual member. The IPA Board and staff enjoyed a tour of McKesson’s Distribution Center and some team bonding in the evening hours.

District 5 Meeting on Regional Education Matters In August, IPA Executive Fellow George Appleseth attended the NABP/AACP District 5 meeting in Omaha.

Pharmacy leaders from Iowa, Minnesota, Nebraska, North Dakota, and South Dakota met to discuss barriers and opportunities surrounding pharmacy school enrollment and pharmacy workforce. Attendees also learned about NABP’s Uniform Pharmacy Jurisprudence Examination (UPJE) that will serve as a standardized resource for state boards of pharmacy. IPA looks forward to the 2025 NABP/AACP District 5 meeting to be hosted by the University of Iowa College of Pharmacy in Iowa City!

Welcome Ryan McClellan, VP of Professional Affairs Please help us welcome Ryan McClellan, PharmD, SHIMSS, IPA’s new Vice President of Professional Affairs! Ryan brings over 20 years of pharmacist experience, including clinical and industry experience in various medical affairs operations and field medical roles. An Iowa native, Ryan earned his Doctor of Pharmacy from Drake University College of Pharmacy and Health Sciences and completed a Specialty Residency in Primary Care at the Iowa City VA. Ryan officially joined the IPA team at the end of August.

New Professional Services

NASPA President-Elect Retreat

IPA has added two new professional service contract positions to bring expertise to the association. Chayla Morris, PharmD, will serve as IPA's Ambulatory Care Advisor, leading the Ambulatory Care Work Group and Cardiovascular Health Grant initiative. Jen James, PharmD, will serve as the editor of our monthly Law & Information Resource Center (LIRC) newsletter, reviewing Iowa laws and regulatory bulletins for changes our members should be aware of. Chayla and Jen will provide these part-time, contract services remotely.

In May, the National Alliance of State Pharmacy Associations (NASPA) hosted its annual President-Elect Leadership Conference in Denver, CO. Over 30 state and six national pharmacy associations participated. IPA was represented by President-Elect Jim Hoehns and CEO Kate Gainer. The Leadership Conference brings together incoming board presidents to learn about good governance, state and national policy topics, and leadership. It is sponsored annually

by Pharmacists Mutual.

36 | The Journal of the Iowa Pharmacy Association

MEMBER’S SECTION

Member Milestones Congratulations to Diane Reist, BS Pharm, PharmD, RPh, who was selected for inclusion in Marquis Who’s Who! Marquis Who’s Who® has chronicled the lives of the most accomplished individuals and innovators. Congratulations, Diane!

Congratulations to Michael Ernst, PharmD, who was awarded the Russell R. Miller Award from the American College of Clinical Pharmacy (ACCP)! This prestigious honor recognizes substantial contributions to the literature of clinical pharmacy.

Congratulations to Robert Greenwood, RPh, NCPA’s 2024 Calvin J. Anthony Lifetime Achievement Award recipient! This award honors a pharmacist who has dedicated their career to the advancement of the pharmacy profession. Well deserved, Bob!

Happy retirement to Helen Eddy, RPh, MBA, who has served as the Polk County Health Department Director since 2018! After leading Polk County through the COVID-19 pandemic and other public health initiatives, Helen will officially retire on January 17, 2025.

L to R: NCPA CEO Douglas Hoey, Bob Greenwood, Calvin J. Anthony

Congratulations to Michelle Fravel, PharmD, BCPS, who was recognized as the University of Iowa College of Pharmacy’s Class of 2026 (P2) Teacher of the Year!

Congratulations to Andrew Wagner, PharmD, who received Drake University College of Pharmacy’s 2024 APPE Preceptor of the Year Award in recognition of outstanding contribution to pharmacy education!

Congratulations to Brett Faine, PharmD, MS and Anne Zepeski, PharmD, BCPS as the University of Iowa College of Pharmacy launches its new, first-of-itskind certification in Emergency Medicine and Critical Care! Well done, Brett and Anne!

Congratulations to Drake University College of Pharmacy & Health Sciences and Mary Greeley Medical Center’s PGY1 Pharmacy Residency Program, which achieved accreditation for eight years, the maximum time allowed for a continued accreditation cycle!

Congratulations to Jim Hoehns, PharmD, BCPS, FCCP, who was recognized as the University of Iowa College of Pharmacy’s Class of 2025 (P3) Teacher of the Year!

Congratulations to Matt and Marilyn Osterhaus, who were honored with the 2024 Osterhaus Medal for Lifetime Achievement! This medal is a pinnacle award presented by the University of Iowa College of Pharmacy to a recipient who has advanced the practice of pharmacy in profound ways.

Congratulations to Sara Wiedenfeld, PharmD, who received the University of Iowa College of Pharmacy’s 2023-2024 APPE Preceptor Excellence Award!

Happy retirement to LuAnn Ihnken, RPh, after many years of service at Rex Pharmacy in Atlantic!

Congratulations to Lorin Fisher, PharmD, BCACP, who received the University of Iowa College of Pharmacy’s 2023-2024 Faculty Preceptor Excellence Award!

Congratulations to Heather Vande Kieft, PharmD, pharmacy manager of Hy-Vee Pharmacy in Sioux Center, who was selected as Iowa’s 2024 Immunization Champion by the Association of Immunization Managers (AIM) and the CDC!

SEP.OCT.NOV.DEC. |

37

CALENDAR OF EVENTS

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

DECEMBER 2024 5

IPA Independent & Community Pharmacy Practice Forum

9

Iowa Reception at ASHP 2024 Midyear (New Orleans, LA)

10

2/2/2 Webinar: Navigating State Laws in Harm Reduction – Impactful Guidelines for Pharmacists

JANUARY 2025 14

2/2/2 Webinar

24

IPA Long Term Care Pharmacy Forum

FEBRUARY 2025 5

Pharmacy Day on the Hill 2025 (Des Moines, IA)

11

2/2/2 Webinar

20

IPA Specialty Pharmacy Forum

22

Standard of Care Symposium 2025 (West Des Moines, IA)

TBD Insight to Advocacy

MARCH 2025 11

2/2/2 Webinar

TBD Insight to Advocacy Events are subject to change. Watch IPA communications for updates.

38 | The Journal of the Iowa Pharmacy Association

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19 88

Issues & Events That Have Shaped Iowa Pharmacy (Or Are Fun to Remember!)

FEBRUARY:

Members of the Iowa Pharmacy Service Corporation (IPSC) approved a plan to sell IPSC to Blue Shield of Iowa. Additionally, a plan was authorized to transfer the sale proceeds, approximately $1.75 million, to the Iowa Pharmacy Foundation. Established by the Iowa Pharmacy Association in 1967, IPSC was the sole third-party program in the United States to reimburse pharmacists based on the usual, customary, and reasonable (UCR) model.

MARCH:

IPA hosted its 9th Annual Legislative Day, where over 125 pharmacists convened in Des Moines to engage with lawmakers on legislative matters pertinent to the pharmacy profession. Key topics of discussion included Medicaid reform, among other significant issues.

APRIL:

The Prescription Drug Marketing Act (PDMA) passed, establishing a legal framework to ensure the safe and effective distribution of prescription drugs. The PDMA aims to prevent the sale of compromised, expired, and counterfeit drugs that could otherwise be sold in an unregulated wholesale market.

JUNE:

Steve Firman was inaugurated as the 110th President of the Iowa Pharmacy Association. In his President’s Address, he articulated his commitment to enhancing the public image of pharmacists.

Katy’s Kids Program

OCTOBER:

With the support of IPA, Governor Terry Branstad signed a State of Iowa proclamation designating October as Patient Education Month. As part of this initiative, IPA introduced the Katy’s Kids program, designed to educate first-grade children about the proper use of medications. The program has since been acquired by the American Pharmacists Association (APhA) and is now incorporated into their APhA-Academy of Student Pharmacists patient care projects.

NOVEMBER:

The Anti-Drug Abuse Act of 1988, passed by the U.S. Congress, aimed to tackle the ongoing War on Drugs. With the goal of creating a drug-free America, the law established the Office of National Drug Control Policy and brought back the option of the death penalty for certain federal drug offenses.

Ronald Reagan Signing Anti-Drug Abuse Act

DECEMBER:

The Board of Pharmaceutical Specialties (BPS) officially acknowledged two areas within pharmacy practice as distinct specialties: nutrition support pharmacy and pharmacotherapy. This recognition expanded the scope of recognized pharmacy specialties, which previously consisted solely of nuclear pharmacy.

Reagan Library

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.

SEP.OCT.NOV.DEC. |

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