IPA Journal Oct/Nov/Dec 2022

A Peer-Reviewed Journal | Vol. LXXVII, No. 4 | OCT.NOV.DEC. 2022

Welcome

2022 2023

IPA PRESIDENT CHERI SCHMIT INSIDE:

IPA Annual Meeting Recap Welcome Class of 2026 2022-2023 Iowa Pharmacy Residents

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

PUBLICATION STAFF

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

COVER STORY Let’s Plant Trees Together pg. 4

OFFICERS CHAIRMAN Christopher Clayton, PharmD, MBA – Manchester PRESIDENT Cheri Schmit, RPh – Ames PRESIDENT-ELECT John Hamiel, PharmD – Evansdale TREASURER CoraLynn Trewet, PharmD – Ankeny SPEAKER OF THE HOUSE Heather Ourth, PharmD, BCPS, BCGP – Ackworth VICE SPEAKER OF THE HOUSE Wes Pilkington, PharmD – Waterloo

TRUSTEES REGION #1 Robert Nichols, PharmD, BCPS – Waterloo REGION #2 Pamela Wiltfang, PharmD, MPH, BA, CHES – North Liberty REGION #3 John L'Estrange, PharmD, RPh, BCACP – Des Moines REGION #4 Grant Houselog, PharmD, CSPI – Sergeant Bluff AT LARGE Micaela Maeyaert, PharmD, BCPS, DPLA – Spirit Lake Morgan Herring, PharmD, BCPS, FAPhA – West Des Moines Jackie Gravert, PharmD, MPH – Cedar Rapids Angie Spannagel, PharmD, BCACP – Dubuque HONORARY PRESIDENT Betty Grinde, RPh – Story City PHARMACY TECHNICIAN Tammy Sharp-Becker, CPhT, CSPT – Des Moines STUDENT PHARMACISTS Nirjan Bhattarai – Drake University Sidney Vancil – University of Iowa The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see www.iarx.org/journal.

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

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

Annual Meeting 2022 pg. 10

White Coat Ceremonies pg. 16

FEATURES PharmaCE Expo 2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2022 IPA Professional Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2022 Speaker’s Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 IPA Policy Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 IPA Goes Local Reflection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Peer Review: Integration of Pharmacy Students . . . . . . . . . . . 22 Student Spotlight: Board of Trustees Edition. . . . . . . . . . . . . . 24 2022-2023 Iowa Pharmacy Residents . . . . . . . . . . . . . . . . . . . . 25 Peer Review: Contraception Care . . . . . . . . . . . . . . . . . . . . . . . 26

IN EVERY ISSUE President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO’s Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Time Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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

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PRESIDENT’S PAGE

LET’S PLANT TREES TOGETHER 2022 PRESIDENTIAL ADDRESS Watch President Schmit’s introductory video before you read her address!

Cheri Schmit, RPh IPA President Senior Manager, Product & Solutions Marketing, Cardinal Health

H

ello, and good afternoon. Thank you for being here to help me celebrate today, especially my husband, Mike, and my son, Jake. As you saw in the video, it’s been a busy week for our family. Our oldest son, Drew, got married last weekend, and we added a daughter to our family. It was a beautiful wedding, and we are still on cloud nine remembering the day and how much fun it was. Drew and Maddie are on their honeymoon, so they can’t be here today. They are with us in spirit, and I hope relaxing on the beach with a cocktail in hand.

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he was holding down the fort at home, shuttling the boys to all their activities, washing uniforms, coaching their teams, and making sure they were fed and homework was done. He has always been supportive of my career and professional involvement and picked up the slack when I dropped the rope. He seemed to know when I was extra stressed at work (probably because I was not very nice to be around) and would go out of his way to take some task off my plate at home. He has patiently listened to healthcare issues and complaints, even though half the time he has no idea what I’m talking about. Some of my best ideas were advice from his perspective outside of healthcare. He truly is my partner in every sense of the word, and I am blessed that he is my husband and father of our children. Mike, I love you, and I don’t tell you enough how much I appreciate you and how thankful I am to have you by my side.

Now that I’ve introduced you to my amazing family, let’s talk about my other amazing family – all of you, the members of the Iowa Pharmacy family. I want to share what IPA has meant to me over the years, including mentorship and friendship. You got a taste of that in the video, but here’s a few things that weren’t in the video.

My younger son, Jake, is here today. He is a senior at Coe College, just down the street, and took time out of his busy life to be here today to support me. And since he’s my only son here, I get to spend a little time bragging on him, which I’m sure will embarrass him. I am so proud of the young man he has become, and one of my greatest joys is being his mom and watching him grow from this cute little boy with a mischievous grin that I could never stay mad at into this amazing young man. He is a physics and computer science major and a pitcher on the baseball team at Coe. He is smart, talented, thoughtful, responsible, funny and so many other wonderful qualities, but his greatest quality is his kind and compassionate heart. We used to joke that he “collected stray cats” because he always seemed to find and befriend those kids who needed one most. His example has often inspired me to be a better person, and he would have been a great healthcare provider because he has always been able to empathize and put himself in someone else’s shoes. Jake, I hope you know how proud I am to be your mom and how much I love you.

To talk about what IPA has meant to me, let’s go back to why I joined IPA in the first place. I was about to graduate from Iowa, and IPA was holding a ‘Welcome to the Profession’ reception. I’m not sure what I expected from this reception other than free drinks and appetizers and some type of sales pitch to join, but instead, I met Tom Temple. Tom walks up to me with a smile that lights up the room and a twinkle in his eye and introduces himself to me. He then proceeds to ask me all kinds of questions to get to know me: where I was from, why I went into pharmacy, what my plans were after graduating. And this was not small talk. Tom was genuinely interested in me, and instead of telling me all the things that IPA could do for me (which have been numerous, by the way), Tom told me how much he would love to have me involved because of all the things he thought I had to offer IPA. I’m not even a registered pharmacist yet, and he thinks I have things to offer!? How could this be? And how could I not join this organization and get involved when I just met such a genuinely kind and authentic person who wanted to hear what I had to say and thought I had value for this profession. Tom makes everyone feel special and inspires us to believe that together we can accomplish anything. I will never forget how Tom made me feel on that day – important, valued and welcomed.

And then there’s my husband, Mike. Many of you may think that he is Snuffleupagus and does not exist, so this is a rare sighting!

As I said in the video, work/life balance would not have been possible without him. All the times that I was here,

Speaking of mentors, this day would not be complete if I didn’t mention Mark Nessen. Mark was the pharmacist in Corydon, Iowa near my hometown and the reason I am a pharmacist today. After interviewing Mark for

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PRESIDENT’S PAGE a class, I asked to work for him for free. He laughed and said anyone who offers to work for free is hired. I started working for him in high school, running the cash register, stocking the Hallmark cards and wrapping the giftware purchased off bridal registries. Over the years, I graduated to putting away the order, doing his accounts receivable, filling OPUS cassettes for nursing homes, and becoming his student intern.

He had the traditional community pharmacy on the town square, provided meds and consulting for the area nursing homes, and contracted the service at Wayne County Hospital. While I learned so much about pharmacy and had such a diverse experience of different practice settings, what I learned working for Mark Nessen was that pharmacy was about people. As the IPA saying goes, “If it’s right for the patient, it’s right for pharmacy.” Mark meant so much more to his community than just being their pharmacist. He was integral to the fabric of the community, caring for his patients cradle to grave, generation after generation, putting others first, planting trees to make his community a better place in years to come. As I said in the video, I have always been passionate about pharmacist-led patient care that improves patient outcomes and provides value to the healthcare industry, and this all started at Nessen Pharmacy with Mark’s mentorship and friendship.

You also heard about my first job at Hartig Drug in Dyersville. This mentorship story does not just include Dick Hartig. Dick believed in me and not only let me create my dream pharmacy, but he offered me the position of PIC of the pharmacy in Dyersville STRAIGHT OUT OF COLLEGE! This gave me quite a bit of anxiety. How could I be a PIC when I didn’t even have experience being a pharmacist yet? Could I really do this? Was I ready?

Before accepting the position, I messaged Dr. Gary Milavetz, my advisor. We met for lunch, and I don’t know if he remembers this conversation but I will never forget it. I shared my pros and cons, concerns and anxieties with him, and he patiently listened and asked questions. At the end, he told me that he thought I had more experience and was more prepared for this role than I thought. He said he believed in me and that the college would be here for me even after I graduated.

He also said that Dick Hartig clearly saw something in me that made him believe I would be successful, and that Dick is a pretty good businessman so I should trust that and trust myself but not be afraid to ask my mentors for help and advice.

One of the pharmacy rules: if you don’t know, don’t guess. Instead, go research the answer. Learning never ends.

While at Hartig Drug, I attended an NCPA conference and brought back some one-page patient care documentation forms that were created so

that pharmacists would start documenting what they were doing and sending it to NCPA. NCPA would start to tell the story so we could eventually be recognized and paid for it. Because as we all know, if you didn’t document it, you didn’t do it!

I started documenting every patient interaction. This was around 1994, and Randy McDonough came to visit me as ICPC (Iowa Center for Pharmaceutical Care) was being formed. I pulled out my filing cabinet drawer full of documented forms, and Randy said, “You need to be part of ICPC.” I was thrilled but also intimidated by this awesome group of pharmacists that were assembled for this very important mission for pharmacy. But I need not worry as Randy, Jay and all the pharmacists participating worked collaboratively to share ideas and strategies to move the needle and help us all succeed.

Are you starting to see a theme for mentorship? Believing in, encouraging and giving confidence to the mentee and helping them see the qualities and potential that you see in them.

And working collaboratively for a shared passion and vision.

While I would have stayed at Hartig Drug and been happy my whole career, Mike’s job was transferred, and we moved to Ames. I worked for Ken Hampson at Clinic Pharmacy in a building with 200 physicians who might just tap you on the shoulder at any minute to ask you a question.

Here, I had a chance to be mentored not only by Ken but also by the physicians, nurses and other providers in the clinic.

I learned how to interact with other healthcare providers and how we all wanted what was best for the patient. And if we kept that central to our conversations, we could work together collaboratively and have better patient outcomes than if we worked independently.

After Ken sold the business, I met John Forbes and became a Medicap pharmacist. John gave me free rein to run the pharmacy as my own, implement patient care services, collaborate with other providers, and get involved within the community. Again, John believed in me, trusted me, and supported my vision of what the Medicap in Ames could be for the community. I had already developed great relationships with local providers while working at Clinic Pharmacy, and two big things

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PRESIDENT’S PAGE happened while at Medicap in Ames. First, pharmacist immunization authority was granted; and second, OutcomesMTM was born, and the city of Ames was one of their first clients. I was elated! I was finally able to get paid for providing and documenting patient care, which I had been doing since the Hartig Drug days for FREE! It's now 2001, and I am documenting patient interventions on paper Outcomes forms and getting paid. And I’m providing influenza immunizations, which quickly grew to shingles and pneumonia to our now fully expanded scope. You saw some pictures of me giving immunizations, which is one of my passions.

One of the silver linings of the COVID-19 pandemic has been the broad recognition by the public, payers, providers and other stakeholders of the pharmacist’s role in healthcare. We are on the cusp of changing the profession of pharmacy forever with expansion of pharmacist scope of practice and payment for pharmacist-led clinical services.

Here in Iowa, you may see legislation to modernize the Pharmacy Practice Act, as was just debated in the House of Delegates. The time is right, and we need to be ready to perform when the opportunity arises.

John eventually sold the Ames Medicap to Greg Johnasen, and I became a Medicap GRx pharmacist. Greg grew GRx to the point where he created a corporate office staff to support the stores. Greg and Karen Merrill gave me the opportunity to create my dream position. I said I wanted to help other pharmacies provide clinical services, and they told me to put pen to paper and show them the business case and how it would help the company. I will forever be grateful to John and Greg for my time at Medicap. I have told them both that you can take the girl out of Medicap, but you can’t take Medicap out of the girl. The lessons I learned and the trust and confidence they gave me allowed me to develop into the pharmacist and professional I am today and to keep my passion for advancing the profession alive. Now at Cardinal Health, it is my goal to strive for this for pharmacists, not just at Medicap or in Iowa, but across the United States and Puerto Rico.

I have been fortunate to work for and with these amazing leaders and mentors who have been supportive of my role with IPA and my vision and passion for pharmacist-led patient care. I never saw myself as a leader, and I never imagined I’d be standing in front of you today. I am humbled and honored to serve as your next IPA President and do not take that responsibility lightly. I look at those who have held this position, most recently Chris, Diane and Connie, and I know I have big shoes to fill.

Our profession has some very real issues that keep you up at night.

I want to engage with all of you to hear your ideas, your challenges, your anxieties and your successes. I do believe that working together, anything is possible.

My 2003 Speaker of the House address to the delegates was around the Aerosmith lyrics, “Life is journey, not a destination.” While we might feel like kids on a road trip, just wondering, Are we there yet?, I shared my hope that our profession would never be “there” yet, as that would mean the profession has stopped growing and evolving. I think we can say that we are definitely not “there” yet! There is still work to do, and I am looking forward to the journey! As my walk-up song said, “Put me in, Coach, I’m ready to play!”

When I look around this room, I see mentors, and I see friends. To me, one of the best things about IPA is the networking and the friendships I have made. I can’t name everyone but I do want to call out a few.

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Starting with my professors at Iowa; Dean Letendre; Dean Chestnut; all the Drake staff I’ve worked with; the pharmacists I have worked for and with throughout the years; the students I have precepted who have now become colleagues, like Brandon Gerleman; and those of you I have had the fortune of working and serving with at IPA, like the current IPA staff led by Kate Gainer or former staff, like Jen Moulton and Anthony Pudlo. Some of you could have been “competitors,” but we never saw each other that way and instead were collaborators, like TJ Johnsrud and his staff, or the CPESN Luminary group of Lindsey Ludwig, Matt Osterhaus, Randy McDonough, Bob Greenwood and Ryan Frerichs. And I can’t forget my “conference husband,” Bob Stessman, who was my plus-one while Mike was home holding down the fort. And so many others! My point is that I look around this room and I see friends: friends who have helped support me, who have given me confidence, inspired me, enlightened me with their different practice views of pharmacy and helped to mold and shape me into the person and the professional that I am today. And all of that started because I met Tom Temple, and he inspired me to join IPA. I have tried (and often failed) to follow Tom’s example and be a mentor for others. Anytime I go to a pharmacy event, I look for the students and sit at a table with them and get to know them. I am not Tom Temple, but if I can make one student feel the way Tom made me feel, I will consider myself successful.

The future of our profession lies in those new graduates entering the profession, but we can’t just turn it over to them and say, “Good luck!”

They need nurtured and shaped. We need to help them believe in themselves and become confident leaders. We also need to share the rich history of our profession, the journey we’ve been on, who we are, what we stand for, and those who planted trees before us.

Iowa Pharmacy is a revered leader, and many pharmacists are jealous of Iowa for a reason. That reason is the collaboration that happens in this state between all stakeholders of the profession and how we speak with one voice. IPA is the compass that guides us and reminds us who we serve – the patient. IPA is also the scale that balances the tradition and history with the innovation of moving the profession forward.

This balance improves the profession, while not losing our identify and mission.

In closing, I have a challenge for all of you here today.

I challenge you to pay it forward and be a mentor, the type of genuine mentor that follows Tom’s example. Take time to get to know someone here this weekend. Learn their story. And for the next IPA event you attend, invite someone to attend with you. Maybe it’s a new graduate.

Maybe it’s someone that is a member but hasn’t attended anything recently. Maybe it’s someone burned out who needs to find hope and joy in the profession again. I challenge myself to do the same.

To end, I’ll share a quote by Carl W. Buechner: “They may forget what you said, but they will never forget how you made them feel.” I know you will forget what I say today, but as I interact with and get to meet more of you over the next year, I hope that I can make you feel special, valued, important, inspired, and welcome like Tom made me feel. And I hope that you feel my passion and optimism for the future. Together, let’s plant trees and leave the profession in a better place for the next generation of Iowa pharmacists.

Thank you! ■­

LEARN

CONN

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P BE INS

FEBRUARY 3-5, 2023 Hilton Des Moines Downtown | Des Moines, IA

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FRIDAY

SATURDAY

SUNDAY

11:00 AM-12:00 PM

7:00-8:00 AM

6:45-7:45 AM

12:00-2:00 PM

8:15-8:30 AM

7:45-8:00 AM

8:30-9:30 AM

8:00-9:30 AM

9:45-10:45 AM

9:45-10:45 AM

Industry Symposium Lunch Program Point-of-Care Testing (POCT) – Skills Assessment (0.2 CEU)

12:00-1:00 PM

Effective Interprofessional Communication: Leveraging Opportunities to Optimize Care (0.1 CEU) Change is Inevitable: Updates in the Management of Anticoagulation Therapy (0.1 CEU)

1:15-2:15 PM

A Time and Place for Everything: Creating Effective SOPs (0.1 CEU) Change is Inevitable: Updates in the Management of HIV Therapy (0.1 CEU)

2:30-4:30 PM

Immunization Administration – Skills Assessment (0.2 CEU)

2:30-3:30 PM

Managing Opioid Use Disorders: The What, Why, and How (0.1 CEU) Change is Inevitable: Updates in the Management of Breast Cancer Therapy (0.1 CEU)

3:45-4:45 PM

Test to Treat: The What, Why, and How (0.1 CEU) Change is Inevitable: Updates in the Management of Asthma Therapy (0.1 CEU)

Industry Symposium Breakfast Program Welcome

From Surviving to Thriving (0.1 CEU) Create a Great Work Culture: Empower for Engagement (0.1 CEU) Patients with Chronic Kidney Disease: Optimal Care is RENALLY Important (0.1 CEU)

11:00 AM-12:00 PM

Efficient Pharmacy Management: Optimizing Resources, Maximizing Outcomes (0.1 CEU) Taking a Deep Dive into Medical Literature (0.1 CEU)

ED

Industry Symposium Breakfast Program Welcome

New Drug Update (0.15 CEU) Is this Legal? (0.1 CEU)

11:00 AM-12:30 PM

Gamechangers in Pharmacy (0.15 CEU)

Accredited for Pharmacists and Pharmacy Technicians Accredited for Pharmacists ONLY

12:00-1:30 PM

Lunch & Exhibit Hall

1:30-2:30 PM

Projecting Success for Expanded Services (0.1 CEU) Women’s Health: Give Them a Seat at the (Examination) Table (0.1 CEU)

2:45-3:45 PM

Servant Leadership: Meeting the Needs of Others (0.1 CEU) Understanding Research Statistics: They’re Not Too Mean (0.1 CEU)

REGISTER One, Two & Three Day Registration

14+ HOURS CPE Available for Pharmacists & Technicians

4:00-5:00 PM

Pharmacy Collaborations Across Care Settings (0.1 CEU)

www.PharmaCEExpo.com

Gender Affirming Hormone Therapy: A Pharmacist’s Guide (0.1 CEU) OCT.NOV.DEC. |

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CEO'S COLUMN

PARTNERSHIPS MAKE PROGRESS

T Kate Gainer, PharmD IPA Executive Vice President & CEO

he week before Thanksgiving, I received a call from Ilisa Bernstein, Interim CEO for the American Pharmacists Association. She had an idea to share and a request. Would I be able to fly to Washington, D.C. and join APhA, ASHP and NCPA in a meeting with Senator Grassley? She still needed to request the meeting with his office and coordinate with the other national organizations. It was a long shot, but first she needed to know if I agreed it was a good idea, and—importantly—if I could get there.

The federal provider status legislation (ECAPS – Equitable Community Access to Pharmacy Services Act) was not gaining traction in the U.S. Senate, and help from Iowa’s Senator Charles Grassley was needed. Sen. Grassley has been a champion for pharmacist provider status the past four congressional sessions, and his colleagues defer to him on pharmacy issues. So, what was different about ECAPS and this congressional session from previous sessions and Grassley’s Pharmacy and Medically Underserved Areas Enhancement Act (PMUAEA)?

In short, the PMUAEA allows pharmacists to be paid as providers by Medicare Part B for any services within their state scope only in federally designated medically underserved and health provider shortage areas. ECAPS allows pharmacists to be paid as providers by Medicare Part B in any geographical area only for limited services related to certain respiratory illnesses, testing and treatment.

IPA’s national association partners—including APhA, ASHP and NCPA—have weekly interaction on Capitol Hill with members of Congress, their staff, and federal agencies. These national partners (and others) paved the way for ECAPS to be introduced in the House of Representatives; gained cosponsors (more than any previous Congress); funded a coalition that researched the impact and associated costs and cost savings of the

L to R: Ilisa Bernstein (APhA), Kate Gainer (IPA), Sen. Grassley, Tom Kraus (ASHP), Kasey Thompson (ASHP), Douglas Hoey (NCPA)

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proposed legislation; and identified barriers to progress in the Senate. In short, the ECAPS legislation is closer to becoming a reality than any previous provider status effort.

Through our national partners, IPA learned that Senator Grassley’s main concern was that the ECAPS legislation was not meaningful to rural pharmacists and independent pharmacies. With this knowledge, IPA lit up your inboxes and voicemails asking you, our members, to reach out and share the impact ECAPS would have on your practice and patients and the importance of the policy.

During my 12-hour visit to D.C. that day, one statement really stands out. The Senate staff member emphasized that “hearing from Iowa pharmacists is what made the greatest impact.” With IPA’s unified efforts, and the voice of Iowa pharmacists providing grassroots advocacy, progress was made.

It was clear that the messages from IPA members to Senator Grassley and his staff had made an impact. They had brought him to a level of support, where he had previously been silent on ECAPS policy and legislation.

Our national partners were grateful for Iowa pharmacists’ advocacy and IPA’s leadership.

I’m grateful for IPA’s strong partnerships with national pharmacy organizations. They are a quick call, email or text message away. And when the call comes, we’re prepared to jump on a plane and work together. ■­

“If you want to go fast, go alone.

If you want to go far, go together.”

– African Proverb

Executives from IPA, APhA, ASHP and NCPA with Nic Pottebaum, Sen. Grassley’s Health Policy Advisor

2022 IPA AWARDS

CONGRATULATIONS 2022 IPA AWARD HONOREES! The Iowa Pharmacy Association (IPA) takes great pride in recognizing individuals for their contributions of leadership, patient care, professional involvement and public service. The following awards were presented at IPA’s Annual Meeting on September 22, 2022.

Bob Stessman, RPh Bowl of Hygeia

Mylo Wells, PharmD Distinguished Young Pharmacist of the Year

Donald E. Letendre, BS Pharm, PharmD, FASHP

Thomas R. Temple, BS Pharm, MS, FAPhA

Robert G. Gibbs Distinguished Pharmacist

Thomas R. Temple Mentorship Award

Ashley Cook, PharmD, BCCCP

Daniel P. Runde, MD, MME

Health-System Pharmacist of the Year

Patient Care Partner

Sharon Cashman, RPh Honorary President

Deanna L. McDanel, PharmD, BCPS, BCACP Excellence in Innovation

Jillisa Legg, CPhT

CEimpact​

Pharmacy Technician of the Year

Appreciation Award (Corporate)

*Presented by the IPA Foundation

IPA Members Appreciation Award (Individual)

Jose Rodriguez, University of Iowa

Molly Nelson, Drake University

Karbeling Leadership*

Karbeling Leadership*

Nominate a deserving pharmacy colleague to be recognized at IPA Annual Meeting 2023 (June 15-16)!

Darla Eastman, PharmD, BCPS Anna Laire, PharmD Candidate 2023 Shannon Dicken, PharmD Candidate 2024 Poster Presentation Award*

“A Pharmacist-Created Guideline for Opioid Prescribing at Hospital Discharge Following Acute Traumatic Injury” 50-Year Pharmacist Awards

DEADLINE: January 31, 2023

www.iarx.org/IPAAwards

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ANNUAL MEETING 2022

CELEBRATING IOWA PHARMACY IPA’s 2022 Annual Meeting, the first in-person Annual Meeting since 2019, was packed with opportunities to make meaningful connections, share innovative ideas and advance pharmacy practice. This year’s meeting took place September 22-23 in Cedar Rapids with over 200 Iowa pharmacy professionals in attendance.

2022 keynote Bruce Berger, PhD, kicked off the meeting with a session on preventing self-deception and objectification in practice and everyday life. During two lively in-person House sessions, the 2022 House of Delegates debated policy surrounding the pharmacist’s role in HIV PrEP/PEP, Just Culture, forced dispensing, reimbursement, standard of care, and practice mobility (final policy statements listed on pg. 14). New this year, 2022-2023 IPA President Cheri Schmit and the Board of Trustees were installed over a Leadership Luncheon on Thursday. This year’s event also included a Residency Showcase of programs across the state and beyond with a Meet the Residents reception following.

Keynote Bruce Berger kicks off Annual Meeting 2022

Day 2 of the Annual Meeting featured a keynote panel of national pharmacy association leaders, including Christene Jolowsky, RPh, MS, Treasurer of ASHP, Michele Belcher, RPh, President of NCPA, and Wendy Mobley-Bukstein, PharmD, BCACP, CHWC, CDCES, FAPhA, President of APhA–APPM. The pharmacy leaders discussed ways the national organizations are strategically working to achieve health equity, as well as how individuals can help decrease disparities in their own communities.

Raising over $3,200 for the Iowa Pharmacy Political Action Committee (IPPAC) through the Pie-In-TheFace fundraiser, Kate Gainer took a pie in the face from President Schmit Friday afternoon. The meeting concluded with a Boosting Confidence in Communication workshop by Wixted & Co.

President Cheri Schmit toasts to inaugural Mentorship Award recipient Thomas R. Temple

Delegate Andrew Stessman speaks to the House

Speaker Deanna McDanel, APhA-APPM President Wendy Mobley-Bukstein, NCPA President Michele Belcher, ASHP Treasurer Christene Jolowsky, and Kate Gainer

IPA Board members Heather Ourth, Pamela Wiltfang, and Candy Jordan

IPA recognizes 2021-2022 President Chris Clayton

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Students explore residency opportunities

Wine Ring Toss fun!

ANNUAL MEETING 2022

THANK YOU SPONSORS APMS

NPR

Bayer

Outcomes

CPESN-Iowa

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IPA BOARD OF TRUSTEES THANK YOU Diane Reist, PharmD, RPh, Chairman of the Board Deanna McDanel, PharmD, BCPS, BCACP, Speaker Wes Pilkington, PharmD, Trustee Region #1 Candace Jordan, PharmD, BCPS, MBA, Trustee Region #3 Emily Beckett, PharmD, BCPS, Trustee at Large Nancy Bell, PharmD, Trustee at Large 2022 Residency Showcase

Outgoing IPA Foundation Board members Steve Firman and Carl Chalstrom with bobble heads

Mahi Patel, Student Pharmacist (Drake) Jose Rodriguez, Student Pharmacist (Iowa)

WELCOME John Hamiel, PharmD, President-Elect Heather Ourth, PharmD, BCPS, BCGP, Speaker Wes Pilkington, PharmD, Vice Speaker

Kate Gainer gets the IPPAC pie from President Cheri Schmit

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 Betty Grinde, RPh, Honorary President

Outgoing Policy Committee Chairs Emma Kraayenbrink and Laura Knockel

Nirian Bhattarai, Student Pharmacist (Drake) Sidney Vancil, Student Pharmacist (Iowa) 2022 Annual Banquet

Wes Pilkington is installed as Vice Speaker of the House by Speaker Heather Ourth

For more Annual Meeting photos, visit IPA’s Facebook page: www.facebook.com/iowapharmacy

OCT.NOV.DEC. |

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SPEAKER’S ADDRESS

MADE FROM GRIT BUT FULL OF GRACE 2022 SPEAKER’S ADDRESS

T Deanna McDanel, PharmD, BCPS, BCACP Speaker of the House Clinical Pharmacy Specialist, University of Iowa Hospitals and Clinics (UIHC)

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hank you, Vice Speaker Ourth. Good morning to my fellow delegates, student attendees, and all others in attendance. Man, I missed seeing all of your beautiful and smiling faces! First and foremost, I would like to take this time to thank the delegates who had faith in me two years ago when you elected me to this role, as I had big shoes to follow after Speaker Meyer. I hope that I will not let you down. It has truly been my honor to be your Speaker of the House over the last year.

cannot hold us as long as we continue to create our own light. We are just like a pearl – made from grit but full of grace. We are unstoppable – we know it is not what happens but how we choose to respond, with perseverance in our minds and passion in our hearts.”

This is a powerful message, something I did not take lightly when reading it. I hope you all can resonate with some part of this message as you think back over the last three years personally, professionally, and as an association. We have had courage and resolve to make it through this trying time. Breaking the word GRIT down even further, there are themes within the meaning of grit that have influence. Maybe some of these are words that came to you when we did the reflective exercise.

Now all I can say is…THREE years! Can you believe it has been three years since we have been able to come together in person to celebrate the success of the assoG – GRATITUDE & GENEROSITY ciation, join our collective minds in debating policies I am so grateful for all of you! I am grateful to call you live at a microphone (and not through Zoom), and feel colleagues, friends and my pharmathe palpable energy of bringing our cy family. Look around. I guarantee pharmacy family back together. As you will see at least one, if not many, I reflect over the last three years, I people in the room who you have “We always show up know it has had a profound impact connections with and have no doubt on me, professionally and personand never give up. impacted your life in one way or ally.

We are unshakable, another. As an association, we are not because we stronger together. Our collective I hope you can all bear with me, as ideas, vision, voices and profesI would like us all to take a few secdon’t know pain or sional pursuits help amplify the onds in silence to do a mindfulness failure, but because ONE VOICE we have as a unified exercise. I would like for you over we always push association. the next fifteen seconds to reflect through.” on the last three years and hold on You have all been so generous with to the first few words that come to you time, love for the profession and mind. kindness to the patients we serve.

Having generosity in spirit means we give liberally and Thank you for joining me in this exercise. For me, one share with those in need. I think about how we rose to word that I feel represents the last three years is GRIT. the challenge of the pandemic, especially as the vacciWhy grit, you may ask? Well, I wear this pearl necklace nation, treatment and prevention efforts of COVID-19 today, as this was a gift from a very dear friend of mine fell upon pharmacy as the first point of contact in many early on in the pandemic. The message that came in the ways. I know so many of you spent numerous hours, box about the pearl was about GRIT, and that message hours you likely did not have, and hours away from your really resonated with me as I was preparing this address family and friends to ensure that we provided the most to the House. I would like to share part of this message optimal patient care to the public. For the first time, we with you, modifying the pronouns with the association were finally being recognized as healthcare providers! in mind.

That alone is a success we must celebrate.

“We always show up and never give up. We are unshakable, not because we don’t know pain or failure, but R – RESILIENCE & RESPECT because we always push through. We believe anything is I know some of you probably cringed when I said the possible no matter the odds. We are beautiful because word resilience. I have heard this word so many times of the way we choose to live and embrace life’s experiover the years, but it is true. We ARE resilient. We ences – good or bad. We are willing to bend but never have had to have the capacity to recover quickly from break, and we have courage to believe that darkness difficulties faced in our profession and personal lives.

| The Journal of the Iowa Pharmacy Association

SPEAKER’S ADDRESS

Deanna McDanel serving as Speaker of the House at IPA Annual Meeting 2022

We did not have time to give up or break. We had to bounce back when times got hard so we could provide quality care to our patients and be sustainable in the workforce. Coworkers and patients relied on us.

Through much adversity, we persevered.

Pharmacy is still one of the most respected professions in healthcare.

We have a responsibility entrusted to us by the public. We take an oath as a pharmacist to maintain the highest principles of moral, ethical and legal conduct. We do not see patients as mere customers but as human beings that need our help. We are accessible and admired for our professional abilities, qualities and achievements, and we devote ourselves to a lifetime of service.

I – INSPIRATION & INNOVATION

I have been inspired by all of you. I have tried to serve the past two years as your Vice Speaker and now Speaker of the House while listening with my ears wide open. I have witnessed collaborative work and sharing of ideas, especially in the policy making process. I have firsthand experienced the outcomes of this teamwork in continuing to advance practice, advocate for change, lead in legislative efforts, educate and promote leadership amongst our members.

The innovation that exists in our pharmacy profession is astounding.

Pharmacy has so many pathways that one can take. As I look out in the room, I see the far-reaching impact your innovative practices and roles have had in the state of Iowa and beyond. Other states look to us to be the guiding light to inspire their innovative ideas and pursuits.

T – TECHNICIANS & TRUST

LONG overdue. Without the dedication and diligence of our technicians, we would not be where we are today. You are important and vital to our association’s success, and we thank you for all that you do!

Last, but not least, is trust. Patients and other healthcare providers put faith in us because we provide reliable care with profound ability.

Trust is earned, respect is given and loyalty is demonstrated. We place trust in the association to carry out the strategic plan with the pillars of practice transformation and amplified voice. I have full trust that the association carries forth our mission of “empowering the pharmacy profession to improve the health of our communities.”

In closing, I want to thank the IPA staff for working so hard to facilitate a re-energized Annual Meeting and thank the Board of Trustees, the Executive Team and staff at IPA for their amazing support over the last year. I have learned so much from you, and your dedication to serving the association is amazing. It has been my honor to serve alongside such a wonderful team. Additionally, I would like to thank our committee members for their commitment of time, service and expertise to prepare these policies before you over the next two days, especially the committee chairs, Laura Knockel, Emma Kraayenbrink and Michele Evink.

As we kick off our second session of the House of Delegates, I am looking forward to conducting the business brought before us. I look forward to the debate of another lively IPA House of Delegates. I would like to thank all of you for the GRIT you have shown over the last few years, and just remember, like a pearl, “We are unstoppable.” ■­

This is a time for us to really celebrate the efforts of our pharmacy technicians. Who would have thought three years ago that we would have such advanced roles for technicians in pharmacy? It was, however,

OCT.NOV.DEC. |

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POLICY STATEMENTS

FINAL POLICY STATEMENTS The following policy was adopted by the House of Delegates during IPA’s 2022 Annual Meeting.

22-U1: PRESCRIPTION DRUG PRODUCT REIMBURSEMENT

1. IPA recognizes that inadequate reimbursement for dispensing prescription drug products compromises sustainability of pharmacies which jeopardizes patient care, public safety, and access to pharmacy-related services.

2. IPA supports collaboration with payers and policymakers to implement equitable and consistent methods of reimbursing pharmacies for prescription drug products.

3. IPA supports a transparent, predictable, and sustainable payment model for reimbursing pharmacies for the cost of prescription drug products procured and dispensed.

4. IPA advocates for the payment of a dispensing fee that is commensurate with the full cost of dispensing, including clinical review, patient counseling, and associated overhead costs.

5. IPA opposes the reduction of reimbursements for clean claims including any aggregate adjustments or recoupments.

22-U2: STANDARD OF CARE MODEL FOR PHARMACIST PRACTICE

1. IPA supports an Iowa Pharmacist Practice Act based on standard of care.

2. IPA supports a standard of care regulatory framework, consistent with other healthcare providers, to allow flexibility based on the individual circumstances that present in professional practice.

3. IPA supports educating and empowering pharmacy professionals to practice using a standard of care model.

22-U3: PRACTICE MOBILITY

1. IPA supports practice mobility through efficient portability of licenses and state credentials for individual pharmacy professionals in good standing.

2. IPA encourages the Iowa Board of Pharmacy in collaboration with the National Association of Boards of Pharmacy to make license and state credential portability for pharmacy professionals a priority.

3. IPA supports the Iowa Board of Pharmacy retaining jurisdiction over pharmacy professionals providing care to patients in Iowa.

22-R1: PHARMACIST ROLE IN INCREASING ACCESS TO HIV PRE-EXPOSURE PROPHYLAXIS AND POST EXPOSURE PROPHYLAXIS

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1. IPA supports pharmacist collaboration with a broad array of health care professionals to increase access to HIV Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) as part of public health initiatives.

2. IPA supports training, continuing education, and prescribing privileges for pharmacists participating in providing HIV PrEP and PEP services.

3. IPA supports the education of healthcare professionals and the public regarding the role of PrEP and PEP in HIV prevention and awareness.

4. IPA supports pharmacists’ role in PrEP and PEP for HIV prevention, including, but not limited to, assessment and screening, monitoring, laboratory ordering, and prescribing PrEP and PEP. 5. IPA supports payment for pharmacist services related to HIV PrEP and PEP.

22-R2: JUST CULTURE

1. IPA endorses the concept of Just Culture as a systems-oriented process that focuses on optimizing systems rather than assigning blame or punishing individuals.

2. IPA advocates for the integration of Just Culture into practice settings to support professional wellbeing and improve patient safety.

3. IPA encourages reporting of patient safety events, including near misses, as part of continuous quality improvement.

4. IPA opposes criminal prosecution of healthcare professionals involved in inadvertent patient safety events.

5. IPA advocates for the provision of support and resources to healthcare professionals impacted by inadvertent patient safety events.

6. IPA encourages education on Just Culture to student pharmacists and pharmacy professionals.

22-R3: PHARMACIST FORCED DISPENSING AND PROFESSIONAL JUDGEMENT

1. IPA recognizes the professional autonomy of pharmacists and affirms pharmacists have the authority and obligation to use their training, education, and experience to make clinical decisions for safe and effective patient care.

2. IPA supports public awareness of a pharmacist’s right to refuse to dispense a medication or provide a service based on professional judgement.

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WHITE COAT CEREMONIES

THE UNIVERSITY OF IOWA Ninety-one Doctor of Pharmacy students recited the Oath of the Pharmacist and were officially welcomed into the profession and College during the annual White Coat Ceremony on August 20, 2022 at Hancher Auditorium in Iowa City.

During the ceremony, students were coated by Associate Professor and Director of Diversity Equity and Inclusion Erika Ernst, Clinical Associate Professor Shellie Fravel, and Professor and Executive Associate Dean Gary Milavetz. Diane Reist, chairman of the Iowa Pharmacy Association Board of Trustees, provided ‘Welcome to Iowa Pharmacy’ remarks. Jose Rodriguez, past president of the Student Leadership Council and a fourth-year student pharmacist, presided over reciting the Oath of the Pharmacist.

The event marked the end of the course, "Engagement: Professional Skills and Values," during which students were introduced to the college community and profession, curriculum highlights, student resources, service, and outreach opportunities, and participated in self-development and awareness activities.

Among the Doctor of Pharmacy Class of 2026, seventy percent identify as female, seventeen percent indicate they are First Generation, sixty-six percent are from Iowa, and four percent are international students. Members of the Class of 2026 represent nine different states and countries. Twenty-one percent identify as African American, American Indian, Native Hawaiian or other Pacific Islander, Asian, Latinx/a/o, or two or more ethnicities. The class ranges in age from 19 to 35, with an average age of 22.

WELCOME CLASS OF Perkins Aiyegbeni Hannah Barmore Joslin Bawek Spencer Behning Zach Boten Aaron Boyle Kieler Brown Jennah Brygger Sarah Canfield Kailey Casper Erin Caylor Morgan Christ Jared Clement Madelynn Clement Jayden Cooper Emma Creech Jenna Davey Kristina Dibert

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Eryka Dickey Sara Dodge Jamie Dugan Stephanie Ekufu Faith Fiedler Julia Fischer Allison Frale Jayna Freeman Hallie Frohn Beca Gengler Brandon Gibson Allison Gieswein Brandon Gillip Noah Graalfs Jenah Greiner Anne Guthrie Claire Horsfield Brock Hunt

| The Journal of the Iowa Pharmacy Association

Holly Huynh Chris Ingram Isabelle Johnson Seungri Kang Tobey Klungseth Aurora Korfist Leslie Lai Nina Lanciloti Delaney Lantz Eesha Lawande Sophia Lee Kevin Li StanleyLiu Mallory Loussaert Lauren Lowry Neana Malow Madisyn Martin Darlyn Mendoza

Karli Michael Maxwell Monterastelli Phoebe Moore Dawson Mueggenberg Alvin Nguyen Nicholas Nielsen Ochain Okey Lucas Pitzen Kaden Porter Benjamin Ragan Sabrina Renner Conner Riley Anna Roshek Bomi Ryang Sarah Schade Natalie Schemmel Megan Schreur Mason Selk

Madeline Sherwood Mahaa Siddiqi Autumn Smith Alexandria Snell Sydney Soeder Anna Sprenger Andrew Sundberg Dat Tran Hannah Tucker Ellie Twedt Carley Uhl Emily Van Daele Shaochen Wang Tressa Weimerskirch Natalie Wessel Emily Woodhouse Madeleine Wood-Smith Madalynne Yenter Ruoyi Zhang

WHITE COAT CEREMONIES

DRAKE UNIVERSITY CPHS Drake University’s College of Pharmacy and Health Sciences (CPHS) recently welcomed first-year students into the Doctor of Pharmacy (PharmD) Class of 2026. The College continued its tradition of welcoming the incoming students through a two-day professional orientation program, culminating with the White Coat Ceremony on August 26, 2022.

The academic performance and demographics of the class reflects the intent of Drake to maintain its high academic standards for admitted students, recruit a diverse cohort of students, and attract students from a wide range of geographic locations. The PharmD Class of 2026 begins their professional journey with a solid academic foundation with a pre-professional average GPA of 3.6 on a range from 3.0 to 4.0. Seventeen percent of the PharmD Class identify as students of color, and eighty percent identify as female. The PharmD class is also geographically diverse. Students come from as far as Arizona, Florida, Oregon, and internationally, joining students from Iowa and surrounding states.

2026 Madelynn Aeilts Kristen Alford Haris Ali Brianna Anderson Mackenzie Beam Courtney Becker Sophia Bell Dara Brandt Zoe Bryant Georgia Bunkers Nicole Dacus Ayla Danabasoglu Abby Ditsworth Armin Dogic Tiffany Flohr

Alexander Frank Olivia Franklin Christopher Hallum Elaina Hines Victoria Incandela Calea Jones Samuel Karrick Anastasia Kirillov Ryan Krumholz Olivia Kube Emma Kuss Tom Le Olivia Lenz Emra Oglecevac Yeo Yoon Park

Renae Chesnut, Professor and Dean of the College, provided opening remarks during the White Coat Ceremony. Chuck Phillips, Associate Dean of Curriculum and Assessment, announced the students as they walked across the stage one by one and donned their white coats for the first time. The pharmacy students heard remarks and advice from Megan Hartle, the 2022 Lon N. Larson Engaged Practitioner Award recipient, and a professional welcome from Emmeline Paintsil, PH’18, GR’20, Director of Professional Affairs at the Iowa Pharmacy Association.

Paintsil led the PharmD students in reciting the Professional Pledge of a Student Pharmacist.

Homeen Patel Zeel Patel Laura Peterson Kitri Reimer Ava Ressler Haley Rupert Sydney Sears Megan Seiler Seth Simonson Isabella Smith Alexa Tinder Irma Vlahovljak Kaitlyn Wallace Abbygail Weiler Elise Young

Photo Credit: The University of Iowa College of Pharmacy Drake University College of Pharmacy & Health Sciences OCT.NOV.DEC. |

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IPA GOES LOCAL 2022

RETHINKING VACCINE COMMUNICATION

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was honored to be asked to develop and deliver the programming for IPA Goes Local 2022 on vaccine communication alongside my co-presenter, Deb Thompson. I have enjoyed meeting pharmacists across the state who have administered many thousands of COVID-19 vaccinations. We have engaged in discussions about vaccine communication and their experiences, from heartwarming to challenging and exhausting.

The COVID-19 pandemic and COVID-19 vaccines came with a widespread emotional component like no other health issue in recent memory. Given the range of emotions and experiences, I wanted to ground my message in these emotionally charged conversations.

This notion fit hand-in-glove with Deb’s application of the Moral Foundations theory and the metaphor of the elephant and rider. It is important that we as pharmacists recognize we have emotions too, including visceral reactions when we hear resistance to vaccination based on misinformation. It’s understandable that we have strong feelings given the training and first-hand experiences of pharmacists working hard to promote vaccines and make them accessible. You may find it a relief to unburden yourself from the need to convince someone to get vaccinated, and instead pursue a curiosity to uncovering the reasons for their hesitancy.

Matthew Witry, PharmD, PhD Associate Professor, University of Iowa College of Pharmacy

Pharmacists have always been considered among the most trusted health professionals. During these sessions, I offered an approach to starting conversations when there is vaccine hesitancy. By letting the patient talk and seeking not to argue but to gain understanding and communicate that understanding back, we can build on that trust and hopefully get the patient to dismount from their elephant and perhaps invite the pharmacist to offer some additional information that may be useful in their decision. This seems particularly relevant now more than ever as people are looking for a sense of connection.

So, see what it feels like to catch yourself before you get into the next argument with someone where you feel the need to correct their argument against vaccination.

Instead, get off your elephant and let your rider listen to how the other person is weighing the pros and cons of the vaccination. You might build enough trust through your listening to open an opportunity to share what you know, now as an advisor rather than an adversary.

And just maybe, the act of being listened to rather than argued with has helped them tame their elephant a bit too. ■­

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PRACTICE ADVANCEMENT 1815 UPDATE

RCORP UPDATE

VACCINE EQUITY GRANT

HCV SURVEILLANCE & PREVENTION

In July, IPA began the final year of the 1815 project with the Iowa Department of Health and Human Services (HHS). To recognize the work of pharmacists in community, ambulatory care and hospital pharmacies, IPA is providing technical assistance and support to twenty-two pharmacies across the state on initiatives around diabetes, hypertension and hyperlipidemia. The IPA team will be meeting with pharmacists and their teams throughout the year to help review policies and procedures, develop workflow processes, and aid in the development of services to help patients achieve better health outcomes. As part of the grant, IPA staff are developing resources and education on data collection and billing for these services. For more information on this project, please contact IPA’s Director of Professional Affairs, Emmeline Paintsil, at epaintsil@iarx.org.

The IPA team and membership have had an active past few months supporting initiatives within the vaccine equity grant. IPA continues to partner with HHS on increasing COVID-19 vaccine confidence, engaging trusted messengers, and addressing vaccine hesitancy for populations that have been disproportionately affected by COVID-19.

IPA has been collaborating with external stakeholders, such as the Iowa Public Health Association and Iowa Medical Society, to identify opportunities to boost confidence around COVID-19 boosters and vaccines for pediatric patients and adolescents.

Additionally, IPA continues to highlight the work of our members who serve as trusted messengers in communicating evidence-based information regarding COVID-19 to the media and their communities.

While this grant ends in December of this year, the IPA team is exploring opportunities with HHS to continue this work in 2023. For more information on this project and how to collaborate with IPA, please contact IPA’s Director of Professional Affairs, Emmeline Paintsil.

HEALTH DISPARITIES GRANT

Health equity and addressing social determinants of health remains important to IPA and HHS. IPA is expanding opportunities to collaborate with pharmacies in providing education, screenings, and testing for chronic disease states that have been impacted by COVID-19. We are currently looking to work with researchers from Drake University and the University of Iowa on health equity topics, most notably in our rural communities. Additionally, IPA staff are developing plans for IPA Goes Local 2023, which will focus on trauma-informed care and how pharmacy teams can support their patients. IPA hopes to bring back Mental Health First Aid (MHFA) trainings in 2023 with the support of funding from the health disparities grant. To learn more about this project or collaborate with IPA, please contact IPA’s Director of Professional Affairs, Emmeline Paintsil.

PTCB PARTNERSHIP FUND

With funding received from PTCB, IPA launched its IPA Pharmacy Technician Advancement Fund to support the education, training and advancement of pharmacy technicians in Iowa. This scholarship may provide compensation, varying from 25-100%, for the Pharmacy Technician Certification Exam (PTCE), PTCB point-of-care testing certificate, or other advanced certificate credentialing for technicians.

Online applications were accepted through December 1, 2022. Pharmacy technicians will be notified of their selection in January. For more information, visit www.iarx.org/techadvancement.

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Over the last three months, IPA has worked diligently to gather resources to support pharmacists and providers in three rural counties caring for patients with chronic and acute pain. These resources were combined to create a document titled, “Best Practices of Pain Management: A Team-Based Approach.” This document highlights best practices for pain management under collaborative practice, non-pharmacologic and non-opioid treatment options, when opioid treatment should be considered, calculation of morphine milligram equivalents (MME), and appropriate patient monitoring and follow-up. In addition to pain management best practices, IPA has spent time researching naloxone access laws, distribution methods, and reporting requirements to gain insight on how other states navigate naloxone distribution and administration for opioid overdose.

IPA has been leading a multi-year grant project implementing HIV and HCV screenings in community pharmacies since 2019. This project has been in collaboration with the Iowa Department of Health and Human Services (HHS) Bureau of HIV, STI, and Hepatitis.

Because of the success of the testing project and the relationship with HHS, IPA was awarded additional funding to assess policies and practices related to the sale of syringes without a prescription and naloxone distribution within pharmacies across the state. The Board of Pharmacy will assist IPA in data collection for this project by adding additional questions on pharmacy license renewal applications. Once data is collected, IPA will identify opportunities to provide targeted technical assistance and education related to syringe sales and the availability of naloxone.

This project is part of the Iowa Hepatitis Action Plan created by Iowa HHS and the Iowa HIV and Hepatitis Community Planning Group.

This collaboration created a blueprint for the delivery of prevention and care services with the goal to improve access to sterile syringes and naloxone.

Increasing access to testing plays a large part in the fight against the HIV epidemic. IPA is looking to gain more interest in the HIV and HCV screening project, specifically in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Lucas, Monroe, and Wapello. These are areas of the state HHS considers focus areas based on their epidemiology reporting. If you are interested in participating or would like to learn more, please contact Kellie Staiert, IPA’s Lead Project & Partner Manager, at kstaiert@iarx.org.

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PEER REVIEW

INTEGRATION OF PHARMACY STUDENTS INTO CLINICAL INTERNSHIPS IN THE WORKPLACE AUTHOR

Lucia A. Ernst

ACKNOWLEDGEMENTS

Jennifer Morris, PharmD, MBA Stacy Livingston, PharmD Jamie S. Sinclair, M.S., RPh, FASHP, FMSHP

There are no conflicts of interest relating to the subject matter of this manuscript.

ABSTRACT

Integrating pharmacy students in a meaningful way to bring better care to patients, and creating competent, caring pharmacy providers for the future.

The practice of pharmacy is continuously evolving and advancing; with these changes, many pharmacy students feel the pull to pursue diverse work experiences to prepare themselves for future goals.

These experiences may include a mix of research, non-traditional job opportunities, hospital pharmacy or community pharmacy. Pharmacy students have recognized the importance of having a well-rounded CV to set themselves apart in the highly competitive post-graduate world, both in pharmacy residency programs and the job market. This has led to pharmacy students juggling multiple employments in a variety of pharmacy avenues. This contributes to complex scheduling, burnout, and grief for students and employers. Although a multitude of internships held may indicate a wide breadth of experiences to draw from, it may conversely impede the ability to foster depth of experience and development of rich relationships and mentorships with one employer.

Given this reality, Mercy Medical Center (MMC) Pharmacy in Cedar Rapids, IA looked to retool the existing internship program to better meet the needs of both interns and pharmacy department operations.

The goal was complex: develop an integrated internship program that would offer students experience in a multitude of areas, prepare interested students for PGY-1 pharmacy residency programs, offer a diverse set of working experiences and skills at one place of employment, and support the operational needs of the pharmacy department. The undertaking started with an assessment of all the workplace experiences MMC Pharmacy could provide and pharmacy students sought: experience in hospital, community and ambulatory care practice, clinical skills development, research, and professional development. Staff pharmacists, interns, and technicians were interviewed to identify areas for improvement within the program. Subsequently, the identified areas were targeted with the development of four objectives and associated activities to meet the expressed needs of all parties and create mutual goals. Changes were discussed extensively with the pharmacy leadership team, and the final version was presented to all department staff to

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maximize buy-in and engagement of existing team members.

Four core objectives and activities were developed: clinical skills and decision making, soft skills and communication, an independent research project and a service staffing component. Each objective was structured similarly to the Mercy Medical Center PGY-1 Pharmacy Residency program, with specific activities required to both remain in and successfully complete the internship program. Evaluation of each intern is completed on an on-going basis to ensure competency and accuracy in skills development. The new program structure naturally lends to more meaningful mentorships with pharmacy staff and leadership, and in turn provides interns with a competitive advantage in future career opportunities, including residency. Leaders discussed the revised program with current interns and applicants with the understanding that active participation in all components of the program was required. The benefit of access to the variety of experiences includes the expectation that each intern is fully invested in the entire program.

If an intern fails to meet required program elements, they may be removed from all non-staffing components.

Enhancement of clinical skills and decision-making is achieved primarily through completion of inpatient medication education for patients newly started on warfarin or direct-acting-oral-anticoagulants, as well as education following open heart surgeries such as coronary artery bypass grafting. In addition to medication education, interns complete medication histories and medication reconciliations in the Emergency Department. These activities provide opportunities for the intern to develop interview and communication skills, discuss patients’ experiences with medications, and work to prevent medication errors with a focus on ensuring proper care transitions for the patient. Interns also gain experience working in the ambulatory care setting at Mercy’s Anticoagulation Clinic where they interpret lab results and accordingly adjust anticoagulation therapy and dosing at the discretion and direction of a supervising pharmacist. These shifts are key in developing clinical skills and provide a foundation for the second objective of the program: soft skills and communication.

Effective communication with patients, interdisciplinary care team members, and other professionals such as administrators or policymakers is critical to ensuring successful patient outcomes and highlighting the role of the pharmacist on the care team. Interns join the pharmacy residents for half of the year in monthly soft skills training with a residency preceptor, where interns improve upon their communication, listening, and problem-solving skills through discussion of actual situations at work. Interns are expected to practice these skills outside these trainings, during clinical and central distribution shifts as well as the third objective of the program, an independent research or quality improvement project. These projects range from medication use evaluations, antimicrobial stewardship initiatives, and pharmacy informatics. These projects allow the intern to gain real-world experience in research and quality improvement needed for future residency and work

PEER REVIEW experiences. Dedicated staffing hours working central distribution shifts for the inpatient pharmacy with opportunities to staff in the outpatient pharmacy to explore community practice is also required and rounds out the program objectives. These shifts create a foundational understanding of the technical and workflow systems necessary to operationalize the ultimate goal of medications reaching the patient in a timely and safe manner and are critical to understanding the important role of central pharmacy distribution chains. This understanding is foundational for success in future residency or career endeavors. The staffing role is a necessary component to the internship, particularly as pharmacies around the country are experiencing workforce shortages.

According to ASHP, “a majority of pharmacy administrators in a recent survey reported turnover rates of at least 21% in 2021, and nearly 1 in 10 noting they had lost 41% or more of their technicians.” (1)

pharmacy interns in a unique and meaningful way. As the vast majority of pharmacy students seek employment experience during their professional education, it is critical that employers develop opportunities that provide benefit to both the employer and the intern to maximize the experience for both. With the implementation of the new program structure and maximizing pharmacy interns’ unique skill set, support of Mercy Medical Center’s mission to provide the best patient care is achieved, while significantly contributing to creating competent, engaged, caring pharmacist professionals for the future.

References: 1.

Hospitals and health systems experiencing severe shortage of pharmacy technicians. ASHP. (2022, March 15). Retrieved July 25, 2022, from https://www.ashp. org/news/2022/03/15/hospitals-and-health-systems-experiencing-severe-shortage-of-pharmacy-technicians?loginreturnUrl=SSOCheckOnly

The integrated pharmacy internship program described above lays the foundation for how workplaces can engage and utilize the skill set of

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STUDENT SPOTLIGHT

INTRODUCING OUR STUDENT PHARMACIST BOARD MEMBERS

A

lthough born and raised in a Nepalese refugee camp, Nirjan Bhattarai has lived in Des Moines for the past ten years. Nirjan chose to pursue a career in pharmacy to serve his community through healthcare after finding value and purpose while working in a community pharmacy in high school.

At Drake University, Nirjan is involved in many student organizations. Last year, he served as President of the Student National Pharmaceutical Association (SNPhA) and is currently serving as the Operation Immunization Chair. Nirjan serves as the IPA liaison for Drake as part of the Drake Pharmacy (Rx) Unified Group of Students (DRxUGs).

Nirjan Bhattarai Student Pharmacist Drake University College of Pharmacy & Health Sciences

In addition, the Drake Entrepreneurial Leadership Tools for Advancement (DELTA Rx) Institute has been an important part of Nirjan’s student pharmacist career. He served as a DeltaRx intern for Hartig Drug, which gave him “invaluable experience” surrounding independent pharmacy. Nirjan also competed at the DeltaRx Next Top Entrepreneur Competition (NTEC), an event that allows student pharmacists to creatively solve a current issue in the healthcare system.

Nirjan is also interested in education. Within the college, Nirjan has worked as a teaching assistant for two years, and he is a member of the Rho Chi Pharmacy Honor Society, where he has the opportunity to host tutoring sessions on topics of interest. Nirjan describes being able to work one-on-one with peers and assisting in small ways as “extremely rewarding.” Outside of pharmacy, Nirjan loves reading and following Arsenal FC in the Barclays Premier League. ■­

O

riginally from Perry, Iowa, Sidney Vancil is a third-year student pharmacist at the University of Iowa College of Pharmacy. Sidney became interested in pharmacy at a young age when one of her middle school teachers encouraged her to research and present on pharmacy at their career fair. Her passion for pharmacy grew after learning more about the accessibility, patient care, and variety of settings pharmacists can practice in.

​Sidney Vancil Student Pharmacist The University of Iowa College of Pharmacy

At the University of Iowa, Sidney is involved in the Student Leadership Council, Graduate Student Government, Pediatric Pharmacy Association, Pharmacy Student Ambassador Network, Rho Chi, Phi Lambda Sigma, and APhA. She also volunteers with Stead Family Children’s Hospital and Special Olympics. Sidney is excited to expand her involvement in the Iowa Pharmacy Association (IPA) and learn more about current issues facing the profession and how pharmacy can work together towards positive change.

In regards to future plans, Sidney is currently interested in pediatrics, ambulatory care, or association management. ■­

Nirjan Bhattarai and Sidney Vancil with full IPA Board of Trustees at Board Retreat in November

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| The Journal of the Iowa Pharmacy Association

Nirjan Bhattarai participating in brainstorming exercise

2022-2023 RESIDENTS

IOWA PHARMACY RESIDENTS Alexis Clouse, PharmD PGY1 Pharmacy Practice UnityPoint Health Iowa Methodist

Ashley Desmet, PharmD PGY1 Pharmacy Practice UnityPoint Health Iowa Methodist

Elizabeth Harvey, PharmD PGY1 Pharmacy Practice UnityPoint Health Iowa Methodist

Lainie Thomas, PharmD PGY1 Pharmacy Practice MercyOne Des Moines

Allison Bich, Emily Griffith, Oksana Karpenko, PharmD PharmD PharmD PGY1 Pharmacy Practice PGY2 Emergency Medicine PGY1 Pharmacy Practice MercyOne MercyOne MercyOne Des Moines Des Moines North Iowa

Jacob Van Oort, PharmD PGY1 Pharmacy Practice Mercy Medical Center Cedar Rapids

AJ Dollmeyer, PharmD PGY1 Pharmacy Practice UnityPoint Health/Allen Waterloo

Kassidy Lawler, PharmD PGY1 Pharmacy Practice UnityPoint Health/Allen Waterloo

Logan Mougin, PharmD PGY1 Pharmacy Practice UnityPoint Health/Allen Waterloo

Jacob Johnson, PharmD PGY1 Ambulatory Care MercyOne Waterloo

Jenna Van Beek, PharmD PGY2 Pediatrics University of Iowa Hospitals & Clinics

Meredith Lumberg, PharmD PGY2 Oncology University of Iowa Hospitals & Clinics

Johanna Goeman, PharmD PGY2 Critical Care University of Iowa Hospitals & Clinics

Sarah Greiner, PharmD PGY2 Ambulatory Care University of Iowa Hospitals & Clinics

Sara El-Hattab, PharmD PGY1 Ambulatory Care University of Iowa Hospitals & Clinics

Kayla Wilson, PharmD PGY1 Ambulatory Care University of Iowa Hospitals & Clinics

Julia Christ, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Thomas Tuggle, Christine Lawson, Emma Murter, PharmD PharmD PharmD PGY1 Pharmacy Practice PGY2 Emergency Medicine PGY2 Pain/Palliative Care University of Iowa University of Iowa University of Iowa Hospitals & Clinics Hospitals & Clinics Hospitals & Clinics

Katelyn Gordon, Zachary Hitchcok, Lauren Reist, Danielle Schuyler, PharmD PharmD PharmD PharmD PGY2 Health-System Adm. PGY2 Health-System Adm. PGY1 Health-System Adm. PGY1 Health-System Adm. University of Iowa University of Iowa University of Iowa University of Iowa Hospitals & Clinics Hospitals & Clinics Hospitals & Clinics Hospitals & Clinics

Thy Le, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Katelyn Michalski, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Callahan Schlueter, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Sarah Schumacher, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Marissa Stewart, PharmD PGY1 Pharmacy Practice University of Iowa Hospitals & Clinics

Jamie Heren, PharmD PGY1 Pharmacy Practice Iowa City VA Health Care System

Gabriella Tagliapietra PharmD PGY1 Pharmacy Practice Iowa City VA Health Care System

Courtney Krall PharmD, MPH PGY1 Pharmacy Practice Iowa City VA Health Care System

Caroline Hartman, PharmD PGY1 Pharmacy Practice Iowa City VA Health Care System

Delaney Brainerd, PharmD PGY2 Psychiatry Iowa City VA Health Care System

Jennifer Hernandez, PharmD PGY1 Pharmacy Practice Des Moines VA Health Care System

Tarah Fisher, PharmD PGY1 Pharmacy Practice Des Moines VA Health Care System

Alexander Goss, PharmD PGY1 Pharmacy Practice Mercy Medical Center Cedar Rapids

Ben Fox, PharmD PGY1 Managed Care OutcomesMTM

Jonathan Brewster, Emma Piehl, Kole Gallick Shelby Reid, Christine Chang, Kalyca Nardy, Elizabeth Orput, PharmD PharmD PharmD PharmD PharmD PharmD PharmD PGY1 Community Practice PGY1 Community Practice PGY1 Community Practice PGY1 Community Practice PGY1 Community Practice PGY1 Community Practice PGY2 Executive Fellowship Towncrest Pharmacy MercyOne Pharmacy Osterhaus Pharmacy Greenwood Drug UnityPoint Health UnityPoint Health Iowa Pharmacy Iowa City Dubuque Maquoketa Waterloo Allen Hospital Allen Hospital Association

OCT.NOV.DEC. |

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PEER REVIEW

NAVIGATING THE MURKY WATERS SURROUNDING CONTRACEPTION CARE AUTHORS

Morgan Herring, PharmD, BCPS, FAPhA Sara Wiedenfeld, PharmD, BCPS, BCACP Nicole Hanna, PharmD Candidate 2023 Emily Steimel, PharmD Candidate 2023 On June 24, 2022, the United States Supreme Court overturned the historical precedent of Roe v. Wade. This 1973 legislation protected the constitutional right to a legal abortion (within certain limits). When Roe was overturned, this automatically turned legal authority on abortions over to individual states. Since this change, there has been a lot of confusion in the healthcare landscape regarding if and when new state laws are violated. What treatments and at what doses are now considered abortive? Where are the legal boundaries for fault if a pharmacist were to fill a prescription that ended up being used for abortion? How will patients get access to legal abortive medications often used for other purposes or for procedures that if left untreated could endanger the life of the mother, like ectopic pregnancy or an incomplete spontaneous abortion (“miscarriage”)?

This caused the American Medical Association, American Pharmacists Association, National Community Pharmacists Association, and American Society of Health-System Pharmacists to put out a joint statement conveying the need to provide clarity to avoid loss of access by patients to necessary therapies.1 As a profession, pharmacists pride themselves, especially in Iowa, on providing access to our patients. To prevent access issues—often inadvertent—it is important to know all the current data.

Table 1.

Code Section

Iowa Code 707.7, et seq. Feticide2

Senate File 3593

Statutory Definition of Illegal Abortion

“Feticide”: Intentional termination of human pregnancy after end of second trimester.

“Abortion”: Termination of a human pregnancy with the intent other than to produce a live birth or remove a dead fetus.

“Abortion”: Termination of a human pregnancy with the intent other than to produce a live birth or remove a dead fetus.

“Unborn Child”: Individual organism of the species homo sapiens from fertilization to live birth.

“Partial Birth Equivalent”: A person who intentionally kills a viable fetus aborted alive shall be guilty of a Class B felony.

Statutory Definition of Legal Abortion

Necessary to preserve life or health of mother or fetus; after end of second trimester with every reasonable effort made to preserve life of viable fetus

An abortion performed in a medical emergency (a situation in which an abortion is needed to preserve the life of a pregnant woman)

Penalty for Unlawful Abortion

Class C felony (attempted feticide-Class D felony)

Class C felony (attempted feticide-Class D felony)

Consent Requirements

–

Consent from mother that she received fetal heartbeat attestation (i.e.- there was no heartbeat)

–

–

Iowa’s Current Legal Stance on Abortion

Iowa laws on access to abortive medications and procedures are in flux.

The current Iowa statute, as of the writing of this article, is Iowa Code 707.7, et seq.2 New code that is currently under judicial review was approved by Governor Reynolds and discussed as “The Fetal Heartbeat Bill” or Senate File 359.3 An injunction was placed on the bill by a district court judge in 2018. With the overturn of Roe v. Wade, Governor Reynolds is reviewing the legal options in hopes of having this bill considered a pre-existing law. Several other states have similar pre-existing laws that were considered “trigger laws.” Trigger laws are pre-existing laws that were deemed unconstitutional by the 1973 enaction of Roe v.

Wade. By overturning Roe v. Wade, they can again be considered legal.

A comparison of the two bills can be seen in Table 1.

The current position of these laws does not provide fault on the pharmacist for dispensing the medications that may be used for an illegal abortion but do bring to light some gray areas where potential civil litigation or penalty assessment could occur. This puts into question how pharmacists are to continue to provide access to patients while following state legal guidelines. Easy answers to these questions start with being informed on the data behind these therapies and providing the best counseling for patients on contraception efficacy, emergency contraception and abortive therapies.

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“Fetal Heartbeat” means cardiac activity, the steady and repetitive rhythmic contraction of the fetal heart within the gestational sac.

Typically at 6 weeks gestation.

Waiting Period

Conditions included: • Pregnancy as a result of rape if reported within 45 days of the incident.* • Pregnancy as a result of incest and must be reported within 140 days after incident.* • A spontaneous abortion (miscarriage), if not all the products of conception are expelled.

• An attending physician has certified that the fetus has a fetal abnormality that is incompatible with life.

*Incidents must be formally reported to law enforcement or to a private or public healthcare agency which may include a family physician

Contraception Efficacy

With the legal changes in Iowa, there is a potential to have additional questions from patients looking to avoid pregnancy. Pharmacist accessibility and medication knowledge make them the ideal candidate to have this discussion with patients. It is important when discussing contraceptive options with patients to understand that not all methods

PEER REVIEW are equivalent, even in ideal use situations. The World Health Organization ranks contraceptive efficacy based on both perfect and typical use situations.4 Even defining some options as “least effective,” these would be options that allow for 20% or greater chance of pregnancy in typical or imperfect use (Table 2). One of which is considered less effective is the progesterone-only pill (“mini-pill”) norethindrone 0.35mg.5 It is typically used in patients that are breast feeding or would like to avoid complications from estrogen containing contraceptive products but has an extremely tight compliance qualification. Each dose must be taken at the same time each day, with a 3-hour deviation from the time of usual dose considered a missed dose.5 This leads to an efficacy rate that could be lower than combined oral contraceptive pills which have a 24–48-hour window for missed doses due to extended duration of action.

Medication Abortion/Medical Abortion

Table 2.

Mifepristone is a selective progesterone receptor modulator that binds to the progesterone receptor with an affinity greater than progesterone itself but does not activate the receptor, thereby acting as an antiprogestin. Mifepristone’s actions on a uterus during pregnancy include decidual necrosis, cervical softening, increased uterine contractility and prostaglandin sensitivity. Mifepristone is taken orally.10 The FDA currently restricts mifepristone access under the REMS (Risk Evaluation and Mitigation Strategy) program. The REMS program requires that pharmacies that dispense mifepristone be certified. Mifepristone must be prescribed by or under the supervision of a certified healthcare provider who meets certain qualifications. In December 2021, FDA announced modifications to the REMS program removing the in-person dispensing requirement. Removing the in-person dispensing requirement allows dispensing of mifepristone by mail via certified prescribers or pharmacies, in addition to in-person dispensing in clinics, medical offices, and hospitals as currently outlined in the Mifepristone REMS program.11 Cramping and vaginal bleeding are expected effects of the regimen. Patients should be instructed to call their clinician if heavy bleeding occurs (more than two pads per hour for two consecutive hours or blood clots larger than a lemon) or if fever or chills are experienced for more than four hours. Patients can use NSAIDs for management of pain and cramping.10 US Attorney General Merrick Garland has stated publicly that states cannot ban mifepristone based on disagreement with the federal government on its safety and efficacy.

Method

Typical Use Effectiveness8,9

Surgical Sterilization

99%

Copper IUD (intrauterine devices)

99%

Hormonal IUD

99%

Implant (Nexplanon)

99%

Injection (Depo-Provera)

96%

Combined Contraceptives pill

93%

Progesterone-only pill (“mini-pill”)

93%

Patch

93%

Hormonal Vaginal Contraceptive Ring

93%

Male Condom Sponge

87% Nulliparous: 86%, Multiparous: 73%

Cervical Cap

84%

Diaphragm

83%

Female Condom

79%

Spermicide

79%

Withdrawal Fertility Based Awareness

78% 77-98%

Of note, the progesterone-only pill with norgestrel is currently being considered by the FDA (Food and Drug Administration) for use as the first over-the-counter option for contraception; it has the same consideration for a missed dose as the norethindrone and would require two days of secondary protection until the norgestrel can get back to steady state concentrations.6,7 The most effective contraceptive options do not require adherence or effort from the patient. These methods include surgical sterilization and the long-acting reversible contraception options, implants and intrauterine devices. With the variety of contraception options available, choosing the right option should be patient specific, considering patient preference, effectiveness, comorbidities, desire for return to fertility and adverse effects.

Emergency Contraception vs. Abortive Therapies

Misinformation is common with emergency contraception and abortive agents. Pharmacists need to be prepared to dispel myths and discuss medications honestly and compassionately with patients.

Distinguishing medication abortion from emergency contraception is important.

Medications related to abortion include misoprostol, mifepristone, and methotrexate.

The most common medication abortion regimen in the United States involves the use of two different medications: mifepristone and misoprostol. This drug combination can be used for medication abortion up to 70 days of gestation. Misoprostol is a prostaglandin E1 analogue that has multiple uses. Misoprostol causes cervical softening and uterine contractions. It is FDA approved for prevention of gastric ulcers in individuals who take anti-inflammatory drugs. Misoprostol is also used for treatment of early pregnancy loss, IUD insertion, induction of labor and post-partum hemorrhage. Misoprostol can be used orally, buccally, vaginally, and sublingually.10

Current use of methotrexate related to pregnancy is in a patient diagnosed with an ectopic pregnancy. An ectopic pregnancy is a pregnancy that occurs outside of the uterine cavity, most commonly in the fallopian tube. Medical management with methotrexate is preferred over surgery in most cases to preserve future fertility. Methotrexate is a folate antagonist that binds to dihydrofolate reductase, which interrupts the synthesis of purine nucleotides and the amino acids serine and methionine, thereby inhibiting DNA synthesis and cell replication.

Methotrexate affects actively proliferating tissues, such as bone marrow, buccal and intestinal mucosa, respiratory epithelium, malignant cells, and trophoblastic tissue. Methotrexate has many other therapeutic uses including in the treatment of rheumatoid arthritis and cancer.12

Emergency Contraception

Emergency contraception (EC) is used to prevent pregnancy after unprotected or inadequately protected sexual intercourse. The most used form of EC is the levonorgestrel tablet that can be purchased over the counter. Labeling recommends use up to 72-hours after unprotected sex but is most effective if used as soon as possible. Levonorgestrel delays follicle development when taken before ovulation. Ulipristal, which requires a prescription, is a selective progesterone receptor modulator and can be taken up to five days after unprotected sex. Ulipristal inhib-

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PEER REVIEW its the rupture of the follicle even after luteinizing hormone has started to increase. The copper IUD can also be used for EC as an off-label indication. It is highly effective if placed within five days of unprotected sex. The copper IUD prevents fertilization by affecting sperm function and viability. EC is only effective before a pregnancy is established and unlikely to prevent implantation of a fertilized egg. Studies have not shown risk to an established pregnancy. Access to EC has significantly increased since it was approved for OTC (over-the-counter) use for any age in 2013, however significant barriers remain.16

Table 3. Medications that can be used for abortion and common uses and counseling points Drug

Indications

Misoprostol (Cytotec)13

FDA Approved:

Pharmacists can play many roles in contraception. As of September 1, 2022, twenty-one states have protocols for pharmacist prescribing of contraception.17 With the potential approval of an OTC contraceptive pill in the near future, pharmacists will further need to have expertise in this area. A recent review in the Journal of Managed Care and Specialty Pharmacy also found that a patient will visit a pharmacy one and a half to two times more than their primary care provider or other qualified health professional.18 This reinforces the need of pharmacists to be at the forefront for providing education and access to necessary medications.

Encourage communication and access for patients throughout the state. By providing education and collaboration with prescribers, myths about the use of these medications can be dispelled. Ideally, using this education on these common medications to continue conversations with health-systems and pharmacies will ensure these medications are accessible for proper legal use. Continue to tell patients' stories to help those that may not speak for themselves.

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200 mcg orally 4 times daily

Off-label uses:

Pharmacists’ Role in Contraception

A major barrier to contraception is access. A 2016 study reported that twenty nine percent of women had issues obtaining contraceptives.

This included barriers from getting an appointment with a provider to accessing a pharmacy.19 Often the “conscience clause” is cited as a reason to avoid filling medications on moral or religious grounds.20 In order to provide access for patients that either require or prefer legally appropriate medications filled, it is recommended to have an alternative pharmacist at your pharmacy to provide timely dispensing or another local pharmacy that can provide the prescribed therapies.

As the laws in Iowa evolve, it is important to know that recent changes have unearthed confusion and apprehension for prescribers, pharmacists, and patients alike. This situation is difficult to navigate, and it is important to have some grace with each other and provide clear communication on what the legal standards say. It is helpful for providers to be reminded to include a diagnosis code on a prescription, especially ones related to recent changes. Often in the electronic health record, the diagnosis is attached when prescribers enter the prescription, but it can be variable whether that information is transmitted to the pharmacy. Clear communication and documentation of standards when talking with prescribers is essential. Asking thoughtful questions and avoiding assumptions can help calm the nerves of all involved by allowing productive conversation.

NSAID-induced gastric ulcer; Prophylaxis

Typical Dosing Schedule

Mifepristone (Mifeprex)14

Cervical Ripening Procedure • Hysteroscopy • IUD placement • Induction of labor

Gel: 25 mcg vaginally every 4 hours (max 400 mcg) Insert: 200 mcg vaginally, leave in 24 hours or until active labor onset Tablet: 20 mcg to 25 mcg orally every 2 hours

Postpartum hemorrhage

600 to 1000 mcg orally, sublingually, or rectally one time

Ulcer of Duodenum

800 mcg/day in 2 or 4 divided doses for 4 weeks

Termination of Pregnancy

800 mcg buccally taken a minimum of 24 hours after mifepristone 200 mg orally in a single dose. A repeat dose of misoprostol 800 mcg buccally may be taken for incomplete expulsion with pregnancy

FDA Approved: Hyperglycemia: Idiopathic Cushing Syndrome

300 mg to 1,200 mg daily

Off-label uses: Endometriosis

5 to 10 mg daily

Induction of Labor

200 mg or 400 mg once

Miscarriage

200 mg orally followed by vagi-nal dose 24 hours later if <13 weeks' gestation

Ovarian Cancer

200 mg daily

Dilation of cervical canal

Not specified

Comments Common Adverse Events: Gastrointestinal: Abdominal pain, diarrhea (including severe diarrhea), constipation, dyspepsia, flatulence, nausea, vomiting, headache

Common Adverse Events: hypertension, peripheral edema, hypokalemia, abdominal pain, decrease in appetite, diarrhea, nausea, vomiting, dizziness, headache, endometrial disorder, hypertrophy, fatigue

PEER REVIEW

Methotrexate15

FDA Approved: Psoriasis, moderate to severe

10 to 25 mg/ week

Rheumatoid arthritis

7.5 to 25 mg/ week

Various oncology uses

Varies

Off-label uses: Tubal ectopic preg-nancy, termination of intrauterine pregnancy

50 mg/m2 (max 100 mg) x 1-2 doses, intramuscular injection

Various autoimmune disorders

Varies

Various oncology uses

Varies

Common Adverse Events: Diarrhea, nausea, oral mucosal ulcers, vomiting, hepatic cirrhosis, hepatic toxicity, increased liver enzymes, renal toxicity, dizziness, fatigue, headache, cough The dosage form indicated for ectopic pregnancy and termination of intrauterine pregnancy is intramuscular only.

The dosage form recommended for other indications varies between oral, subcutaneous, or intramuscular.

REFERENCES 1.

2.

3.

4.

5.

6.

7.

8.

Table 4. Emergency Contraception Agents Type of Emergency Contraception

Timing of use after un-protected intercourse

16

Efficacy

Access

9.

10.

Copper IUD (Para-Gard®)

Up to 5 days

Almost 100% effective

Requires office visit for insertion

Ulipristal (Ella®) tablet

Up to 5 days

Less effective if over 195 pounds

Rx only

Levonorgestrel tablet (Plan-B®)

Up to 3 days

Most effective if used ASAP

OTC

11.

12.

13.

TAKE HOME POINTS:

14.

• Legislation involving abortive therapies is complex and communication between all parties involved is important.

15.

• Pharmacists should dispel misinformation on abortive agents, hormonal contraception, and emergency contraception.

• Common abortive therapies have other non-abortive uses that should be considered in the dispensing process. Pharmacists should be aware of counseling points related to their use.

• Many contraception options are available. Pharmacists can help guide patient choice based on efficacy, past medical history, adverse effects, return to fertility, cost, ease of use, and adherence.

16.

17.

18.

19.

20.

American Medical Association (AMA), American Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP) and the National Community Pharmacists Association (NCPA). press release.

(September 9, 2022) AMA, APhA, ASHP, NCPA Statement on State Laws Impacting Patient Access to Medically Necessary Medications. [Press Release] https://www.pharmacist.com/APhA-Press-Releases/ama-apha-ashp-ncpa-statement-on-state-laws-impacting-patient-access-to-medically-necessary-medications Accessed September 30, 2022.

Iowa Code § 707.7. https://www.legis.iowa.gov/docs/code/707.7.pdf Accessed September 19, 2022.

Senate File 359. May 4, 2018. https://www.legis.iowa.gov/legislation/BillBook?ga=87&ba=SF359 Accessed September 19, 2022.

World Health Organization Department of Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge for Health Project. Family Planning: A Global Handbook for Providers (2018 update). Baltimore and Geneva: CCP and WHO, 2018.

Ortho Micronor (norethindrone) [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc.; 2008.

Opill (norgestrel) [package insert]. Paris, France: Laboratoire HRA Pharma; 2017.

FDA to review first ever over-the-counter birth control pill. Reuters.com.

Published July 12, 2022. Accessed September 27, 2022. https://www.reuters. com/business/healthcare-pharmaceuticals/perrigo-unit-submits-approval-application-fda-otc-birth-control-pill-2022-07-11/.

Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.

Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of fertility awareness-based methods for pregnancy prevention: A systematic reviewexternal icon. Obstet Gynecol 2018; 132:591-604.

Creinin, Mitchell D. MD; Grossman, Daniel A. MD; Committee on Practice Bulletins—Gynecology Society of Family Planning. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225. Obstetrics & Gynecology: October 2020 - Volume 136 - Issue 4 - p e31-e47.

Center for Drug Evaluation and Research. “Questions and Answers on Mifeprex.” U.S. Food and Drug Administration, FDA, https://www.fda.gov/ drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex.

Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 191: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018 Feb;131(2): e65-e77.

Misoprostol. Micromedex (electronic version). IBM Watson Health; 2022.

Accessed September 20, 2022. https://www.micromedexsolutions.com.

Mifepristone. Micromedex (electronic version). IBM Watson Health; 2022.

Accessed September 20, 2022. https://www.micromedexsolutions.com.

Methotrexate [Package Insert]. Huntsville, AL: DAVA Pharmaceuticals, Inc.; 2016.

American College of Obstetricians and Gynecologists. Emergency contraception. Practice Bulletin No. 152. Obstet Gynecol. 2015;126: e1–e11.

Pharmacists prescribing: hormonal contraceptives. Available at: https://naspa. us/resource/contraceptives/ 2022. Accessed November 17, 2022.

Valliant SN, Burbage SC, et al. Pharmacists as accessible healthcare providers: quantifying the opportunity. J Manag Care Spec Pharm 2022;28(1):85-90.

Grindlay K, Grossman D. Prescription birth control access among U.S. women at risk of unintended pregnancy. J Womens Health. 2016;25(3):249-254.

US Department of Health and Human Services. (n.d.) Conscience protections for healthcare providers. Retrieved September 27, 2022. https://www.hhs.gov/ conscience/conscience-protections/index.html.

• Pharmacists play a key role in optimizing contraceptive efficacy by counseling on missed doses and need for additional protection (back-up).

• Access to legally prescribed medications is a barrier that pharmacists can help patients overcome.

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PUBLIC AFFAIRS

IOWA BOARD OF PHARMACY UPDATE Compounding Practices

During the August 24 Iowa Board of Pharmacy meeting, the Board adopted and filed amendments to Chapter 20, “Compounding Practices.”

This rule requires documentation of all ingredient sources, lot numbers and expiration dates, as well as the steps and personnel involved in the compounding process for all nonsterile and sterile compounded preparations. These changes occur in response to inspections by the Board that indicated some pharmacies were not documenting information to a sufficient degree in their compounding records. Namely, the records lacked information relating to the ingredients and components of medications. This rulemaking went into effect on October 26, 2022.

FEDERAL UPDATE TRICARE

On October 24, approximately 15,000 community pharmacies left the TRICARE retail pharmacy network due to significant reductions in reimbursements for prescriptions dispensed at in-network pharmacies

by Express Scripts (ESI). This news comes after the Defense Health Agency (DHA), a division of the Defense Department, awarded a 5-year, $4 billion contract to ESI to administer the pharmacy benefit and simultaneously reduced pharmacy network requirements ESI must meet.

During the October 25 meeting, the Board issued a Notice of Intended Action to amend several sections of the Iowa Administrative Code to implement legislation passed during the 2022 Legislative Session. The proposed amendments conform various sections of the administrative code to changes made in House File 771. The bill relates to licensed nurses engaging in the practice of nursing pursuant to a pharmacist’s order and the issuance of a prescription in the name of a school district to obtain a bronchodilator, a bronchodilator and spacer, or an opioid antagonist.

The announcement that nearly 400,000 beneficiaries—largely active-duty military, veterans and their family members—would be impacted prompted widespread backlash. Three members of Iowa’s federal delegation, Senator Chuck Grassley, Representative Mariannette Miller-Meeks and Representative Randy Feenstra, joined 104 other members in a letter asking DHA for answers regarding oversight of the TRICARE pharmacy benefit by ESI. Senator Jon Tester (R-MT) also authored a letter to the Defense Department Undersecretary for Personnel and Readiness, Gil Cisneros.

In addition, IPA recently updated the Iowa Pharmacy Law and Information Resource Center (LIRC), which is now completely digital and provides ongoing updates regarding pharmacy regulation and law.

This update includes changes to Iowa regulations, including changes by the Board of Pharmacy, from August 2021 to September 2022. See the LIRC and the LIRC Regulatory Tracker for details on these rule changes, as well as previous rule changes you may have missed. If you have any questions or comments, please contact Seth Brown at sbrown@iarx.org.

IPA actively engaged Iowa’s congressional delegation on this matter and created various resources to assist pharmacies and patients affected by this announcement. Additionally, IPA partnered with other state associations in support of a Change.org petition asking DHA to address the patient access, safety and health outcomes imposed on TRICARE patients following ESI’s cut in reimbursements.

Equitable Community Access to Pharmacist Services Act (H.R. 7213)

On September 19, Representative Cindy Axne joined 53 other members of the U.S. House of Representatives in co-sponsoring the Equitable Community Access to Pharmacist Services Act (H.R. 7213). The bill would permanently expand Medicare coverage to include pharmacist services related to testing and vaccines for COVID-19, influenza and strep throat, as well as provide general coverage of pharmacist services during a public health emergency. Representative Axne’s announcement follows meetings between IPA staff (Brett Barker and Seth Brown pictured below) and Representative Axne’s team in Washington D.C. during ASHP’s 2022 Policy Week and Legislative Day.

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

IARX.ORG/BOP_PODCAST

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PUBLIC AFFAIRS

LEGISLATIVE VISITS IPA advocacy kept busy this summer visiting and facilitating pharmacy tours with lawmakers at the state and federal levels.

D.C. Visit

IPA staff Seth Brown and Brett Barker attended ASHP’s 2022 Policy Week and Legislative Day in Washington D.C. to discuss challenges faced by health-system pharmacies with members of Congress. Alongside ASHP Board member and Director of Pharmacy Services at Mercy Medical Center, Jamie Sinclair, IPA met with Senator Joni Ernst and Representative Randy Feenstra, as well as staff members of Senator Chuck Grassley and Representative Cindy Axne.

Congressional Visits in Iowa

Senator Chuck Grassley participated in two Q&A sessions throughout the summer at Estherville Pharmacy(Estherville) and Sumpter Pharmacy (Adel). The Senator addressed questions ranging from his bipartisan PBM bill (Pharmacy Benefit Manager Transparency Act of 2022) to provider status legislation (Equitable Community Access to Pharmacist Services Act). At the Estherville Pharmacy visit, state Representative Jacob Bossman (HD 6) attended and addressed questions from constituents. State Representative Carter Nordman (HD 19) also attended the Sumpter Pharmacy visit.

Representative Mariannette Miller-Meeks toured the Towncrest Wellness Apothecary in Iowa City to learn about compounding, cashbased pharmacies, and PBM reform. The Congresswoman also visited NuCara Pharmacy in Fairfield to hear about issues faced by pharmacies in her district, including payment for services, PBMs, and rural access to healthcare.

Representative Randy Feenstra displayed an extensive knowledge of pharmacy on a tour of Medicap Pharmacy in Audubon. The Congressman discussed the 340B program, pharmacy workforce shortages, and DIR fees with IPA and pharmacy staff.

Representative Ashley Hinson toured Bennett Pharmacy in New Hampton and learned about the various services rural community pharmacies provide.

PHARMACIST DAY ON THE HILL January 25, 2023 EMBASSY SUITES • IOWA STATE CAPITOL

AGENDA AT A GLANCE 9:00 AM Welcome & Introductions 9:15 AM Advocacy 101: Legislative Briefing 10:15 AM Break 10:30 AM Keynote Address – Elizabeth Matney, State Medicaid Director, Iowa HHS 11:00 AM IPA Legislative Awards Legislative Champion & Good Governance Award 11:30 AM Legislative Panel & Lunch 12:30 PM Advisory Committee Kickoff (Invitation Only) 12:30 PM Capitol Hill Visits 3:30 PM IPA Group Photo White coats encouraged!

4:00 PM Legislative Reception

State Legislative Visits

In September, Hartig Drug welcomed state Senator Pam Jochum, Representative Chuck Isenhart, and Representative Lindsay James for a tour of Hartig Drug headquarters in Dubuque. The legislators discussed the importance of pharmacy to the health of the community, the range of services offered, and the need for adequate reimbursement for the viability of pharmacies.

Wester Drug in Wilton hosted Representative Bobby Kaufmann to discuss pharmacy issues likely to be encountered during the 2023 Legislative Session, the impact of PBM reform, and to thank him for his longstanding support of pharmacy.

In October, Medicap Pharmacy in Perry hosted Representative Carter Nordman for a tour and discussion of the issues faced by rural pharmacies. The Representative asked questions relating to PBM reform passed in the 2022 Legislative Session, the cash-based pharmacy model, and accessibility of community pharmacies.

Registration closes January 18!

www.iarx.org/Capitol-Hill-Day OCT.NOV.DEC. |

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TECHNICIAN CORNER

NEWLY CERTIFIED IOWA PHARMACY TECHNICIANS JULY 1–SEPT. 30, 2022 Shannon Arkema Brianna Aspleaf Guinevere Austin Lindsey Bass Grace Bauer Madeline Bausman Taylor Beebe Morgan Beery Tracy Bergthold Tiffany Berka Safi Birindwa Nadia Boeding Zaidin Boehmke Lauren Brady Tisha Brant Jennifer Brown Hannah Brown Sara Burrell Erica Capron Carly Chance Rhonda Cook Sandra Cornwell Chloe Crandell Samantha Curnane Sydni Curtis Nicholas Dahlhauser Cassidy Davis Jazlyn Davis Teresa Davis Emily Deignan

Congratulations to these newly certified technicians!

Jessica Diaz Noah Dietrich Isabella Dippel Carolyn Dohrer- Theisen Erica Dohrer-Robe Gabriel Dunkle Kaylyn Eaves Morgan Egeland Molly Emery Krystal Estell Alexis Fehl Shaylen Fliehler Mia Fontanini Anissa Forero Jayna Freeman Katie Frerichs Grace Friel Jesus Fuentes Gabrielle Fuhs Caleb Gehris Madison Gilkison Alisa Godfrey Bella Gooding Samantha Grems Almira Hasic Ammie Hrabik-Sanger Evern Hunter Ranolfo Isidro Stacy Jackson Brooke Jasper

Libby Jensen Katelyn Johnson Breann Johnston Nicole Jones Halleigh Kelchen Ann Khanthaphengxay Isabelle King Austin Kurimski Kristopher Langner Priscilla Lee Cortnee LeMoyne Rebecca Lewis Noah Liddiard Adamari Lopez Samantha Luecking Marcus Lundy Sarah Lvea Emyrald Martinez Jaron McRoberts Emma Meyer Nichole Miller Brooklyn Mills Asiya Mohammed Mikayla Mouw Vanessa Munoz Alamo Lauren Murray Colston Neilson Makayla Nelson Aaron Newman Amy Nguyen

Reanna O'Brine-Young Alexis Olson Abigail Ott Tonya Palen Dallas Parker Afton Patton Lucille Paul Sydney Peifer Emma Raymond Jennifer Riddle Lauren Roth Katrina Ruggle Osman Salama Angela Sandburg Rebecca Schneider Alexandria Schuety Madison Sebetka Julie Seiwert Aaron Seymour Kethe Shankle Nenette Shappell Shaylee Shedenhelm Kelly Shipley Hayley Slocum Kennedy Soper Zachary Stallman Ryan Stanley Charles Stansfield Cade Stine-Smith Skylar Stock

Haley Stockdale Kalen Stuelke Carol Swartz Nell Sybesma Sabrina Taylor Samantha Ten Napel Shayleen Thomas Catrina Tounjian Christina Turnbull Leann Van Donselaar Grace Vandersee Cynthia Waters Tressa Weimerskirch Chantel Westermeyer Kassandra White Lynette White Bailey Williams Blaine Williams Angela Williamson Signe Wilson Kaylei Wise Micah Wittenberg Alexia Zerba

IPA MEMBER BENEFIT Have You Accessed Your FREE Continuing Education Benefits Yet? WWW.IARX.ORG/ACCESSCPE 32

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TECHNICIAN CORNER

BEST PRACTICES FOR REDUCING MEDICATION ERRORS IN THE ELDERLY From IPA’s August 2022 Tech Tidbits AUTHOR: Sarah G. Francis, MS, PhD Candidate, University of Wisconsin – Madison

The author declares no potential conflicts of interest with respect to the research, authorship and/or publication of this article. The author received no financial support for the research, authorship, and/or publication of this article.

The sentencing and conviction of RaDonda Vaught, former Tennessee nurse who made a medication error that resulted in the death of 75-year-old Charlene Murphy, has attracted international attention.1 This case has brought medication errors in the elderly and vulnerable to the forefront of people’s minds.

Even elderly patients who are not impaired may experience medication errors, and those medication errors can have a negative impact on their health.2 There is a continuum of care in elderly and aging populations that ranges from independent living to round-the-clock care; regardless of an older patient’s living situation, there are steps that pharmacy technicians can take to potentially reduce medication errors.

DIFFERENT SETTINGS

Some of the most common settings on the continuum of care for the elderly and aging are: • In-home care where individuals receive caregiver assistance with activities of daily living (ADLs) in their own homes.3 • Assisted living facilities for residents who do not require roundthe-clock medical care or skilled nursing but still need assistance in completing some ADLs.4 • Skilled nursing facilities (SNFs) where individuals receive professional nursing services. SNFs provide room and board, meals, social activities, and arrange for medical services.5 • Respite care, a facility or service that provides short-term care to people in the absence of the primary caregiver.6 While each setting is different in regards to the level of independence and autonomy that individuals have in terms of their care, there are some best practices that a pharmacy technician can take to aid in medication dispensing and adherence to support patients and their caregivers.

BEST PRACTICES

Here are some best practices that pharmacy technicians can utilize, backed by research and common usage along with examples and explanations.

1. Alert the pharmacist or prescriber when a more appropriate dosage is available to see if the prescription can be changed.7 • There is a 2.5-mg tablet available when one-half of a 5-mg tablet is prescribed.

2. Flag any non-standard dosages or administration routes for review by the pharmacist when necessary.8 • When there is an ointment that is to be used in the eye instead

of on the skin, check that this information will be explained to the patient or caregiver by the pharmacist or provider.

3. Circle any atypical quantities.

• When a location that typically fills a prescription for 28 tablets of a particular medication fills a prescription for 30 tablets of that medication, circle the filled quantity to indicate that this difference has been recognized.

4. When available, use stickers or auxiliary labels to identify time of day medication should be taken.9 • Use stickers or labels that read ‘bedtime,’ ‘night,’ ‘10:00 PM’ or have a symbol such as a moon to denote that the medication should be taken at night.

5. When available and necessary, match the diagnosis for look-alike/ sound-alike drugs to the medication prescribed.8,10 • When a patient is prescribed diphenhydramine for allergies but has a previous prescription of dimenhydrinate for motion sickness an error may occur.

6. Have a complete medication list for the patient if possible.11 • Many medication errors in the elderly occur from drug-drug interactions and polypharmacy; therefore, knowing all the medications and supplements that a patient takes can help prevent interaction errors.

When pharmacy technicians take the time to engage in best practices, the various individuals involved in the care of the aging and elderly populations will have additional supportive measures to ensure that patient safety is prioritized.

References: 1.

Kelman B. Tennessee nurse convicted in lethal drug error sentenced to three years probation. https://www.npr.org/sections/health-shots/2022/05/13/1098867553/nurse-sentenced-probation (accessed 2022 Jun 28).

2. Metsälä E, Vaherkoski U. Medication errors in elderly acute care - a systematic review.

Scand. J. Caring Sci. 2014;28:12-28.

3. Wisconsin Office of the Commissioner of Insurance. Consumer’s guide to long termcare. https://oci.wi.gov/Documents/Consumers/PI-047.pdf (accessed 2022 June 28).

4. Erskine S. 4 Types of Long-Term Care Facilities for Your Elderly Loved One. https:// www.homecarebyseniors.com/4-types-long-term-care-facilities-elderly-loved-one/ (accessed 2022 July 10).

5. University of Rochester. Types of facilities. https://www.urmc.rochester.edu/senior-health/long-term-care/facility-types.aspx (accessed 2022 July 10).

6. The Lewin Group. CMS review of current standards of practice for long-term care pharmacy services: Long-term care pharmacy primer. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/downloads/lewingroup.pdf (accessed 2022 July 11).

7. Grissinger M. Tablet splitting—only if you “half ” to. P T. 2010 Feb;35(2):69–70.

8. Tariq RA, Vashisht R, Sinha A, Scherbak Y. Medication dispensing errors and prevention. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/ 9. Locke MR, Shiyanbola OO, Gripentrog E. Improving prescription auxiliary labels to increase patient understanding. J Am Pharm Assoc (2003). 2014;54(3):267-74.

10. Institute for Safe Medication Practices (ISMP). Adopt strategies to manage look-alike and/or sound-alike medication name mix-ups. ISMP Medication Safety Alert! Acute Care. 2022;27(11):1-4.

11. Remtulla S, Brown G, Frighetto L. Best possible medication history by a pharmacy technician at a tertiary care hospital. Can J Hosp Pharm. 2009 Sep;62(5):402-5.

OCT.NOV.DEC. |

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TECHNICIAN CORNER

TECHNICIAN SPOTLIGHT: JAKE KLEIN, CPhT

P

harmacy as a profession continues to evolve quickly. With this fast-paced advancement, the profession needs all innovative and creative professionals to be on board. Pharmacy technicians like Jake Klein help shape and develop best practices.

Jake Klein, CPhT Pharmacy Technician, SafeNetRx Charitable Pharmacy

Jake Klein grew up in Clear Lake, Iowa, where his parents and grandparents still live. When Jake was sixteen, he needed a job, and someone told him about a local drug store, Thrifty White, needing help. In addition to the pharmacy, the store had clothing, an old-time soda fountain and giftware merchandise. Jake worked at Thrifty White Pharmacy throughout high school and college.

about how to serve patients when the pharmacist’s plate is overflowing. He is excited about some big projects coming up at SafeNetRx that will continue to help more patients get affordable medication. Jake feels IPA does an excellent job supporting members and providing timely information.

In furthering IPA’s advocacy efforts, Jake thinks it is important to continue to advocate for the profession, so pharmacies are able to provide the best care to their patients without the need to think about monetary consequences. He also thinks it is important for pharmacy technicians to know their patients and their needs, just as Jake did when he started his career at a hometown drugstore. That homey feeling of a small-town pharmacy is something he tries to take with him to any pharmacy he works in. Jake has found his pharmacy footing through mentors like Tim Becker, Rick Knutson, Suzy Rolling and many other greats.

Eventually, Thrifty White purchased another pharmacy in town and needed additional pharmacy technicians to accommodate the growth. The pharmacy offered Jake a new position as a pharmacy technician in training. Before he knew it, Jake found himself working for Thrifty White Pharmacy for ten and a half years. He then moved to Des Moines and started working for Medicap “It’s heartbreaking Pharmacy, floating across their stores to hear new patients in the metro area for almost three years. Then, an amazing opportunisay they can only ty came forth, and Jake took a new afford food or position with SafeNetRx Charitable their medication, Pharmacy, where he has been working for a little over a year now. not both.”

In his current role, Jake collaborates with formerly incarcerated patients who are in the work release facility to ensure they have access to needed medications upon their release from incarceration. Through the Charitable Pharmacy, Jake can provide patients’ medications at low to no cost, regardless of their history. He also provides medication needs to underinsured patients. Jake states, “It’s heartbreaking to hear new patients say they can only afford food or their medication, not both.” When asked about challenges in this role, Jake says tracking down patients in need of help getting access to medications can be difficult. Once he locates the patient, Jake talks with them or their parole officer on the phone to understand their needs and how SafeNetRx can help. Jake finds it extremely rewarding to help people get their medications at an affordable price.

Throughout his career, Jake has seen the pharmacy technician’s role evolve to providing immunization, doing CMR and MTM, and being more knowledgeable

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Outside of pharmacy, Jake’s hobbies include riding his bike, enjoying Hawkeye football games, and spending time with friends and family.

Jake and his partner, Robert, have three dogs, Gabby, Ellie and Teddy.

They enjoy taking them to the dog park to run and play. Jake is also the Co-Membership Chair on an advisory committee for a Des Moines art center, Art Noir. The advisory committee engages people aged 21 to 40 in the arts.

Thank you, Jake, for your great work serving your patients and community! ■

IPA FOUNDATION

FOUNDATION FUNDRAISING STEP, CYCLE, SWING FOR STUDENT SCHOLARSHIPS

During the month of September, the IPA Foundation hosted its third STEP, CYCLE, SWING fundraiser, allowing members to get active however they choose and wherever they are to raise money for student scholarships.

Nearly 50 pharmacist and student pharmacist members took part in this year’s fundraiser, raising over $3,500 for student pharmacists at Drake University and the University of Iowa.

Participants posted photos of themselves getting active in their 2022 STEP, CYCLE, SWING t-shirts almost 30 times (plus many other posts when their t-shirts were dirty!).

Felix Gallagher, PharmD, was the winner of this year’s hashtag competition.

IPA hosted Step Up for Students, an additional one-day fundraising event, on Saturday, September 24. Pharmacists were paired with student pharmacists and pledged to donate $0.01 for each step taken by their sponsored student over the 24-hour period. Collectively, the participating student pharmacists logged an astounding 160,000 steps! The winners of this year’s Step Up for Students competition, student pharmacist Jordan Bloodgood and pharmacist sponsor Cheryl Clarke, reported 25,609 steps.

Thank you to all who participated to support the IPA Foundation and student scholarships!

IPA FOUNDATION SILENT AUCTION

The 2022 IPA Foundation Silent Auction was back in person for the first time since 2019, and over 60 items were auctioned to support Foundation initiatives. New this year, IPA created a custom scoreboard for the live event so participants could see who they were bidding against, sparking some friendly competition. This year’s Silent Auction raised over $10,000 to support student pharmacists, leadership development and practice advancement across the state.

DECKER-TEMPLE LEADERSHIP PHARMACY CONFERENCE In collaboration with the Pharmacy Society of Wisconsin (PSW), IPA held the Annual Decker-Temple Leadership Pharmacy Conference August 4-6 at Eagle Ridge Resort in Galena, IL. This conference is a unique opportunity for pharmacists in Iowa and Wisconsin in their first 3 to 15 years of practice to develop leadership skills, enabling both personal and professional growth. Each year, ten pharmacists from each state are selected to participate. The DeckerTemple Leadership Pharmacy Conference would not be possible without the support of the Wisconsin Pharmacy Foundation, IPA Foundation, and McKesson.

Jenna Beninga, PharmD, Greenwood Drug Rachel Hall, PharmD, Greenfield NuCara Jessie Johnson, PharmD, Osterhaus Pharmacy Namaro Kone, PharmD, Mental Health Institute Olivia Lehman, PharmD, BCPS, MercyOne West Des Moines Nick Lund, PharmD, MPA, Nevada NuCara

Kayla Manning, PharmD, Ankeny Hy-Vee Hailey Elizabeth Steuber, PharmD, University of Iowa Stead Family Children’s Hospital Leeta Votsmier, PharmD, Cresco Family Pharmacy Jennifer Williams, PharmD, BCPS, Mercy Medical Center

OCT.NOV.DEC. |

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MEMBERS SECTION

PHARMACIST SPOTLIGHT: PAMELA WILTFANG, PHARMD

T Pamela Wiltfang, PharmD, MPH, BA, CHES Pharmacist-in-Charge, NuCara Health Solutions & NuCara Pharmacies

he profession of pharmacy appeals to many people in many ways. A shared commonality is the joy of helping people, which is one of the main reasons why Pamela (Wong) Wiltfang chose to pursue a career in pharmacy. Growing up, she didn’t know she would become a pharmacist, but she did know her love of science, teaching and helping people could not be ignored. In high school, Dr. Wiltfang was fortunate to job shadow Diane Reist, BS, PharmD, RPh, at Mercy Hospital, where she was able to experience her passion for science, teaching and helping people all together in one place. After that first exposure to pharmacy, Dr. Wiltfang fell in love with the profession and all that it had to offer.

Dr. Wiltfang attended the University of Iowa College of Pharmacy and the University of Iowa College of Public Health, pursuing her PharmD and Master’s degree in Public Health. After graduating in 2012, Dr. Wiltfang accepted a position as the pharmacist-in-charge (PIC) for NuCara Pharmacy in Marshalltown. She soon became PIC for the Fairfield NuCara, and after that, she accepted the position as the Director of Clinical Services & Innovative Practice for all NuCara pharmacies. Currently, she serves as the PIC for NuCara Health Solutions in Coralville and NuCara pharmacies in Montezuma, Traer, Ackley and Conrad. To fulfill her desire for teaching, Dr. Wiltfang is an adjunct assistant professor at the University of Iowa College of Pharmacy.

She teaches Fundamentals of Compounding to first-year student pharmacists. She also serves as the primary preceptor for students undergoing their introductory or advanced pharmacy practice experiences at the NuCara Health Solutions site.

With all of these different roles, no two days are the same. As Director of Clinical Services & Innovative Practice at NuCara, Dr. Wiltfang works largely from home or from her office in Coralville. Her day usually consists of countless emails, phone calls and Zoom meetings with students, staff or patients. As the pharmacist-in-charge of five pharmacies (four telepharmacies) and overseeing forty employees on payroll, there are numerous questions to be answered, prescriptions to be checked, and patients to be counseled. Dr. Wiltfang’s role as adjunct assistant professor at the University of Iowa makes Thursday her favorite day of the week in the fall.

Being a full-time pharmacist and full-time mom, Dr. Wiltfang has become an expert in work-life balance. She

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does admit she would not be able to do it alone. With incredible support from her husband, Jason, who also has a busy schedule as a partner attorney at Scheldrup Wiltfang Corridor Law Group, they are able to spend quality family time with their three children, Bradley (5), Jackson (3) and Ava (6 mo.). Some of their favorite family memories are visiting Lake Okoboji in the summertime and flying down to Marsh Harbour in the Bahamas to visit Jason’s friends, family and childhood home. Their youngest child, Ava, was born in July of 2021, so she has not yet been able to meet many of Jason’s family and friends due to the COVID-19 pandemic. They hope they can make a trip down to Marsh Harbour once the pandemic calms down, so Ava can have that same hometown experience.

In regards to IPA, Dr. Wiltfang knows how impactful grassroots advocacy can be, so she takes full advantage of IPA’s resources. She feels networking is one of the greatest opportunities the association offers. As an IPA Board member and committee member, Dr. Wiltfang meets IPA members from all areas of pharmacy practice and is able to discuss ideas, working conditions and hardships that they are all experiencing. In doing so, she is able to see the broader issues pharmacy is facing and take action to better the profession.

Dr. Wiltfang’s involvement in professional organizations does not end there. She also serves as the Vice Regent for the Iowa Graduate Chapter of the Kappa Psi Northern Plains Province professional pharmacy fraternity, is on the Montezuma Iowa Chamber of Commerce, and has been a member of the American Pharmacists Association for over thirteen years. Through her involvement in IPA and success as a young pharmacist, Dr. Wiltfang received the Iowa Pharmacy Association’s Distinguished Young Pharmacist of the Year Award in 2020.

In the future, Dr. Wiltfang sees pharmacy services continuing to expand for pharmacists and pharmacy technicians. With the COVID-19 pandemic, she says the silver lining for pharmacy has been the trust to vaccinate, test and treat COVID-positive patients within the community. Dr. Wiltfang is extremely grateful to work as a pharmacist in Iowa, where she and other pharmacists are able to pilot and lead many of these programs to advance the profession of pharmacy.

Thank you, Dr. Wiltfang, for your leadership and continued passion for the profession! ■

MEMBERS SECTION

MEMBER MILESTONES Best of luck to Candy Jordan, PharmD, MBA, BCPS, in her new role as Manager of Health Plan Pharmacy Services at Molina Healthcare!

Congratulation to Ryan Jacobsen, PharmD, MS, who was awarded the University of Iowa College of Pharmacy’s Faculty Preceptor Excellence Award!

Best of luck to Jared Butler, PharmD, MS HIA, BCPS, DPLA, in his new role as Pharmacy Program Manager – Informatics and Medication Quality and Safety at the VA Central Iowa Health Care System!

Congratulations to James Ray, PharmD, CPE, who was named President-Elect of the Society of Pain and Palliative Care Pharmacists for the upcoming year!

Best of luck to Dalton Fabian, PharmD, in his new role as Data Scientist – Senior Analytics at Wellmark Blue Cross and Blue Shield!

Congratulations to Iowa State Representative John Forbes, RPh, who was awarded Drake University’s Community Service Award as part of its 2022 annual Alumni Awards!

Best of luck to Kyle Hilsabeck, PharmD, in his new role as VP of Quality at Eco Lips, Inc.!

Congratulations to Charlie Hartig, PharmD, JD, who was awarded Drake University’s Young Alumni Achievement Award as part of its 2022 annual Alumni Awards!

Congratulations to Dena Dillon, PharmD, AAHIVP, who was awarded the University of Iowa’s Longevity Award for 25 years of continuous service!

Congratulations to fourth-year student pharmacist Molly Nelson at Drake University CPHS, who was named one of three national finalists for the 2022 Next-Generation Future Pharmacist™ Award!

WELCOME NEW IPA MEMBERS

JULY 1–SEPT. 30, 2022

Madelynn Aeilts

Nuttika Estvander

Amelia Koster

Nicholas Nielsen

Dani Schuyler

Haris Ali

Mary Fanshaw

Ryan Krumholz

Emra Oglecevac

Alicia Seifert

Brianna Anderson

Tiffany Flohr

Olivia Kube

Morgan Olhausen

Megan Seiler

Mackenzie Beam

Olivia Franklin

Emma Kuss

Jennifer Panther

Samantha Shaffer

Johanna Goeman

Janel Larew

Rebecca Park

Seth Simonson

Courtney Becker Allison Bich Kari Bradley Jonathan Brewster Georgia Bunkers Matthew Busalacchi

Katelyn Gordon

Thy Le

Zeel Patel

Bella Smith

Grace Heikens

Tom Le

Homeen Patel

Jessica Strobl

Jamie Heren

Darci Lewis

Constance Penzotti

Lainie Thomas

Jennifer Hernandez

Sara Mask

Sharon Prombo

Alexa Tinder

Elaina Hines

Julie McPhillips

Mitchell Reeser

Christopher Toporek

Victoria Incandela

Kelsey Mews

Ava Ressler

Thomas Tuggle

Calea Jones

Katelyn Michalski

Lauren Roscizewski

Jenna Van Beek

Oksana Karpenko

Ashley Muenzenmeyer

Haley Rupert

Bryce Verzani

Bailey Davis

Samuel Karrick

Lindsay Murphy

Cassandra Schendt

Irma Vlahovljak

Ashley DeSmet

Anastasia Kirillov

Emma Murter

Callahan Schlueter

Abby Weiler

Armin Dogic

Justin Klein

Sohida Muslem

Sarah Schumacher

Elise Young

Andres Cancel Christine Chang Kyung Choi Ayla Danabasoglu

OCT.NOV.DEC. |

37

CALENDAR OF EVENTS

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

JANUARY 2023 10

2/2/2 Webinar

11

Ask IPA Anything

20

IPA Resident Forum

25

Pharmacist Day on the Hill

Onnen Company has been serving our customers’ needs since 1964. Fourth generation owned and operated, we offer endless industry knowledge through dedicated sales reps, management and owners with well over 100 years combined experience. We have a knowledgeable, unparalleled, and dedicated customer service staff to help you through the order process. Thank you for trusting us to continue to serve your prescription packaging and pharmacy supply needs.

What can Onnen do for you?

Prescription Labels and Forms.

Laser and Thermal formats available.

FEBRUARY 2023 3-5

PharmaCE Expo 2023

8

Ask IPA Anything

8

IPA Specialty Pharmacy Forum

14

2/2/2 Webinar

15

Resident Fireside Chat – Advocating for the Profession

MARCH 2023 8

Ask IPA Anything

14

2/2/2 Webinar

28

IPA Long Term Care Forum

APRIL 2023 5

IPA Payment for Pharmacy Services Forum

11

2/2/2 Webinar

12

Ask IPA Anything

Currently scheduled events are subject to change.

Watch IPA communications regarding any updates.

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Vials in most brands. Save money on Secure brand.

Free logo on Secure caps.

Wide selection of Prescription Equipment and Compounding supplies.

Pill Cards in both Cold Seal and Heat Seal versions.

Stock and Custom printed bags for pharmacy.

Rx Tape • Dosing Supplies • Custom Forms • Checks Envelopes • Padded Mailers • Shipping Supplies Toners • Printer Supplies • Pens • Calendars Magnets • Ad Specialties • and much more!

Phone Toll Free 800.373.7162 Local Phone 515.276.0479 Fax Toll Free 800.373.7163 Local Fax 515.276.8341 www.onnencompany.com email: sales@onnencompany.com

PHARMACY TIME CAPSULE

19 72

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

JANUARY:

New revisions were made to the Controlled Substance Act of 1970. The new regulations put into place recategorized amphetamine and methamphetamine combination products into the Schedule III class.

MARCH:

The Commissioner of the Food and Drug Administration (FDA), Charles C. Edwards, announced the FDA had officially initiated a program to review all drugs and drug products sold, including over-thecounter (OTC) medications. The goal of the new program was to ensure that drug products were safe, effective and labeled accurately. Prior to the 1972 legislation, the FDA had not been regulating OTC medications, and this new regulation would be a step in the right direction for patient safety.

Dr. Charles C. Edwards

New York Times, Associated Press

APRIL:

At the 93rd Iowa Pharmaceutical Association Convention, Berenice Connor Kennedy, a consultant to Lederle, an Editor of Girl Talk and the President of the Feminine Forecast Inc., was invited to speak about the consumer’s opinion in pharmacy and lead a stimulating, informative and controversial discussion. This special feature discussion was introduced to recognize innovative ideas and stir up some debate.

Rex Moorman received the Bowl of Hygeia at the Iowa Pharmaceutical Association Convention. Moorman, the owner of Rex Pharmacy, was recognized for being an active member of IPA, the National Association of Retail Druggists, and the American Pharmaceutical Association. Moorman stayed involved in his community through guest lectures at the University of Iowa, a sponsor of Little League baseball, and was responsible for the establishment of the Heritage House (a retirement home in Atlantic).

MAY:

A recognition dinner was held for Dean Louis C. Zopf, in which over 400 hundred friends and pharmacy professionals gathered at the Iowa Memorial Union to acknowledge and award the impact and successes of former Dean Louis C. Zopf of the University of Iowa College of Pharmacy. Dean C. Louis was recognized for being one of the nation’s great pharmacy leaders, serving on many different councils and associations.

Dean Louis C. Zopf pharmacy.uiowa.edu

JUNE:

The United States had been fighting against the spread of STDs across the country. Former President and California Governor Ronald Reagan recognized that the state of California was finally showing its first signs of decrease in gonorrhea in ten years, and he attributed pharmacists’ efforts in educating the patient population on preventative measures and safe practices for this success.

SEPTEMBER:

The FDA published a new policy statement regarding the packaging, labeling and dispensing of nitroglycerin, which became effective on September 1, 1972. The new policy recognized the volatility of nitroglycerin and required pharmacists to put in extra effort when dispensing nitroglycerin.

Gov. Ronald Reagan

Britannica, Ronald 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.

OCT.NOV.DEC. |

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