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Pharmacy Edge Magazin

Issue

Fourteen

A Safe House for Heroin Injection May Not Be the Cure Student Pharmacists Current Job Market

e

June/2017

The Pet Medication Market Is Growing, Providing Opportunities for Independent Pharmacies

Will wearable technology

help improve outcomes for chronic conditions like diabetes?

Life After Pharmacy School

Gregory Moulthrop How to Combat

Counterfeit Drugs?


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Table of Contents Issue 14 / June, 2017

05

Vice President’s message

08

How to Combat Counterfeit Drugs? Here’s How

12

A Safe House for Heroin Injection May Not Be the Cure

14

Student Pharmacists Current Job Market

18

The Pet Medication Market Is Growing, Providing Opportunities for Independent Pharmacies

20

Will wearable technology help improve outcomes for chronic conditions like diabetes?

24

Life After Pharmacy school

28

Utah Pharmaceutical Wholesaler Faces up to 10 Years in Prison in Prescription Fraud Scheme


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Vice President’s message Brandon Welch As the new Vice President of Sales, I am humbled and honored to have the opportunity to build on a phenomenal foundation we have here at the American Pharmacy Purchasing Alliance. Not only has our membership grown exponentially since our inception in 2014, we have also found ways to expand member benefits to create more value. We consistently strive to build strong relationships with organizations within the pharmaceutical industry to work collaboratively and ultimately bring innovation to this growing industry. These accomplishments could not have been possible without the continued service of our valued members, leadership team, advisory board members, and sponsors. I would like to give them all a heartfelt thank you for all of their hard efforts in striving to make this organization the best it can be. Over the past few years, I’ve been fortunate to be able to acquire a host of knowledge from my experiences working in a variety of settings in the pharmaceutical industry. These specialties included Insurance adjudication, Independent pharmacy, retail pharmacy, specialty pharmacy, hospital, and compounding. Through these experiences, it has allowed me to better educate our members and provide a more holistic approach on the pharmaceutical industry. Outside of my experiences in pharmacy, I spent over 5 years in commercial investment banking.

I believe we are at a critical juncture to advance our services by recruiting more diverse audiences. Our industry’s changing demographics, demand for greater flexibility, and advancing technology are factors that play a key role in today’s Industry. Our members need us now more than ever. Our values are built on Advocacy, Education, Networking, Purchasing Solutions, and being able to adapt to the ever changing needs of our members. 2016 was an exciting year for APPA as we continued to build on work that began in the previous year. We completed the development of our new strategic plan. This will help guide the alliance over the next five years. The plan includes specific action items that will support the achievement of our strategic priorities. Our three strategic plans include the following: Operational Practices for the Alliance: APPA is committed to the principles and practices of sustainability in its management and operational strategies. The Alliance listens to and consults with its members to be sure that actions are in line with the needs of its members. This way, we could simultaneously work on advancing the organization toward a shared vision in changing times. »» Professional development: APPA offers timely professional development opportunities for continuing education and learning

through webinars, meetings, seminars and industry partners. It also fosters the development of leadership within the student pharmacist community. Partnerships: APPA engages with educational partners who provide learning opportunities for APPA. In the 2017 - 2018 year, our work as an association will focus on the following five priorities that support strategic directions: »» Advocacy – finding ways to inform and educate policy and decision makers on the importance of provider status to better serve the pharmacy community. »» Communities of Practice – supporting and expanding our communities of practice to serve the many constituents working in the field of continuing education. »» Benchmarking – collecting and disseminating meaningful data to our members »» Conference Model – re-imagining the conference model to leverage expertise and build capacity through our strategic partnerships. »» Relationship Building – Expand our network to provide more services and discounts for our members. Our collective work is an important part of the social fabric of our great nation. This is an exciting time to be part of the field of pharmacy, and I look forward to another prosperous year for APPA.

pharmacy edge

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We created InfiniTrak from a strong desire to bring a solution to market that ultimately helps protect the pharmaceutical supply chain from counterfeiting and theft. Functionality is simplified with workflow support in accordance with the requirements of Drug Supply Chain Security Act. Because dispensaries are the last line of defense in the publics’ exposure to drugs, InfiniTrak targets its work to secure the supply chain at the dispensary level. Choose us as your partner in what’s next with a Track and Trace solution that provides your pharmacy with greater control and compliance protection.

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How to Combat Counterfeit Drugs? Here’s How Gregory Moulthrop is the Founder and Chief Strategy Officer (CSO) of InfiniTrak. As InfiniTrak’s CSO he advises pharmacies on effective solutions to secure, manage, and grow their supply chain. Prior to InfiniTrak Greg worked at Booz Allen Hamilton doing business consulting in the Healthcare market and has a Master’s Degree in Supply Chain Management from the University of San Diego. Follow Greg on

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When you hear the phrase “drug supply chain security”, what comes to mind? Generally, people say, “I don’t know” or “what’s a drug supply chain?” Well for Greg Moulthrop, it means quite a bit. Greg’s background is in supply chain management, specifically focused on the pharmaceutical supply chain. As a supply chain professional, he takes a holistic view of the pharmaceutical supply chain. Starting from the source of the raw materials and active ingredients, manufacturing and distribution, to the pharmacists that fills prescriptions, he cares about the authenticity of these products and how they reach him. The many stakeholders in this complex global network include suppliers, manufacturers, distributers, and pharmacies and hospitals. He understands that the drug supply chain is vulnerable to theft, diversion and counterfeiting that can have life threatening results for innocent patients. More importantly, however, the youngest, oldest and those patients with chronic health issues are the most at risk of taking a diverted product that has been exposed to excessive temperatures impacting its efficacy, and ineffective counterfeited drugs. As a Type 1 Diabetic, he takes at least 4 injections of insulin per day and must take additional daily med-

ications to prevent complications or relieve complications related to his condition. It is therefore Greg’s personal mission to ensure that the drug supply chain is secure and that patients are dispensed authentic products in good quality. Greg also has a 2-year-old daughter and a5-year-old son. Greg’s son, Logan, became a Type 1 Diabetic at age 2. This means he has two other reasons to motivate him on succeeding in his mission. Unfortunately, most people in the United States are unaware of the impact counterfeit medicines have on patients. Many in the pharmaceutical industry say that the drug supply chain in the United States is the safest in the world… and it is by all accounts. However, counterfeit drugs in the U.S is increasing for different reasons and statistics only matter until you’re affected. Industry experts estimate the number of counterfeit drugs in the U.S market is around 1% and equates to approximately 50 million prescriptions annually. Concealing a Killing – Counterfeiters high-value and high-volume industry There is no universally agreed upon definition of counterfeit medicine, however, the World Health Organization (WHO) definition is, “A counterfeit medicine is one which is deliberately and fraudulently mislabeled with respect to identity and/

or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient (inadequate quantities of ingredient(s) or with fake packaging.” Counterfeiting is an illegal business and, with available sophisticated technology, one that is easy to setup and carries less risk than selling illegal drugs (narcotics); selling counterfeit pharmaceuticals is an illegal transaction that occurs in the future and far away. Counterfeit drugs exist because of economics As a pharmacists, have you knowingly sold a counterfeit drug? Of course not! That would be illegal. However, there is a good chance that some of you reading this article unknowingly sold counterfeit medication. How would you know? You have no way of authenticating. Challenges with compliance with regulation, health insurance companies, PBMs, DIR fees and all the other costs necessary to operate a pharmacy, pharmacy owners/management must focus on cost reductions and selling higher margin products. In this commercial environment, counterfeiters will recognize an opportunity to satisfy this need and provide pharmacies with any pharmaceutical drug and in any form.

Technology enables counterfeiters to produce fake products that look identical to the authentic ones. pharmacy edge

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Furthermore, there are low barriers to entry for counterfeiters and an opportunity to make a large profit which increases the pool of potentially dangerous suppliers in the market. Unlike the illegal drug trade (narcotics) that are smuggled into the U.S., counterfeit pharmaceutical drugs can be shipped using conventional logistics methods which makes them easy to move and hard for law enforcement to detect. It is the shipper and buyer’s liability to ensure that the product was purchased from an authorized trading partner and the product was inspected at the time of receipt to ensure it was not tampered with and matches the transaction data received from the trading partner. In today’s age of globalization and e-commerce the tools needed to counterfeit products are readily available to counterfeiters. Technology enables counterfeiters to produce fake products that look identical to the authentic ones. It doesn’t matter if your pharmacy is in a major city like Los Angeles, CA or in a rural area like Brainerd, MN. Counterfeit drugs are designed to move. Furthermore, counterfeiters are sophisticated and have extensive knowledge of the pharmaceutical drug supply chain and distribution channels. If you are a potential customer, they will find you.

Counterfeiters understand the profits that can be made selling counterfeit drugs. There’s always a market (internet), drug prices are high and the cost to manufacture counterfeits are low generating an attractive gross margin. The pharmaceutical drugs supply chain engages has many stakeholders and partners, worldwide. »» raw material suppliers: local, regional and global »» active ingredient suppliers: within the company, 3rd party manufacturers »» third party manufacturers to pharmaceutical companies: local, regional and global »» pharmaceutical company distribution network: local, regional and global »» third party distribution network to pharmaceutical companies: local, regional and global »» logistics and transportation companies moving goods between facilities: local, regional and global »» pharmaceutical customers: wholesalers, distributors re-selling to pharmacies and hospitals/ nursing homes »» pharmaceutical customers: direct selling to pharmacies, and hospitals/nursing homes »» employees receiving, warehousing, fulfilling orders, loading trucks »» freight forwarders, airlines,

Greg with his son Logan Moulthrop

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ocean carriers, customs processing goods The future of the pharmaceutical drug supply chain The counterfeiters and criminals are not going to go away on their own. With manufacturers, wholesalers, and dispensers beginning to make counterfeiting and drug diversion more difficult there are opportunities to raise the barriers to entry. Regulators and law enforcement are also starting to act by increasing the penalties and oversight of the drug supply chain, however, there are more opportunities to improve drug safety. Track & Trace technologies like InfiniTrak are available to stakeholders in the drug supply chain which is another tool to helping to make it more secure. As the industry continues to improve and implement new ways to secure the transmission of electronic transaction data, and manage the chain of custody, we will make it exceedingly difficult for counterfeiter to introduce their product into the pharmaceutical supply chain. Track & Trace technologies are the most effective solution supported by good business and supply chain practices. The Drug Supply Chain Security Act (DSCSA) is in no way perfect but it is moving in the right direction. The industry will end up finding more effective tools to implement that will deter counterfeiters and diverters because of the new barriers to entry. With it, people like Greg Moulthrop and his children will have 100% assurance that their medications will be safer from counterfeits.


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A Safe House for

Heroin Injection May Not Be the Cure Drug abuse is illegal in most places. But some countries in Europe are making the unhealthy vice more acceptable through “safe injections sites� in a bid to protect users against possible overdose. The same concept is on its way to the United States, which can have serious consequences, especially where heroin use is concerned. Is safe house for heroin injection really the solution to ensure heroin users stay safe and alive for longer?

12 pharmacy edge

Facts about Heroin Heroin, also called dope, junk, horse, and smack, is an opioid made from morphine. It is often injected, snorted or smoked. When it enters the brain, it transforms back into morphine and binds to brain receptors linked to feelings of pain and pleasure, creating a feeling of euphoria. Heroin is highly addictive and can lead to an overdose that could result in death. According to the Centers

for Disease Control and Prevention, nearly 13,000 people died of a heroin-related overdose in 2015. Most deaths involve males aged 25-44. Safe Injection Sites in the US Massachusetts and California are just two of the cities in the US that recommend the use of a safe house for heroin injection. The former has yet to make a vote, while the latter already has a bill that is just waiting to be passed.


There’s also a huge possibility that heroin addicts converging in one place will allow them to network with other addicts, have better and easier access to the drugs, and any hope of them getting better or opting for rehabilitation is lost.

The goal is to provide heroin users access to clean and safe injections that they can use and have a legally-sanctioned room where they can ride out their high under the supervision of a nurse or doctor. Supervised drug consumption facilities already exist in Europe, but has yet to be available in the US. Are Safe Injection Sites the Answer? In 2015, about 33,000 Americans died from an overdose of opioid use, which is a result of a deadly, and widespread opioid abuse. Prescription drugs OxyContin and Vicodin deliver similar effects as heroin, which is why most people who abuse them ended up using heroin. Officials in California and anywhere else in the US are simply looking for ways to deal with a deadly epidemic, and safe injection sites could be the answer. According to Assemblywoman Susan Talamantes Eggman, the facilities will keep addicts from infections due to use of unclean injections and from assaults.

She also pointed how this can limit the number of needles being thrown on the streets and then used by someone else, resulting in infections and, in worse cases, contracting HIV and hepatitis C. It is a fact that heroin users that inject drugs are at risk of getting HIV and HCV through the needles they use or share with someone else. But legislative director for the California State Sheriffs’ Association, Cory Salzillo, voiced concerns over what happens after a person leaves the facility. The aftereffects are still there, but the monitoring is no longer available. He also said that opening injection sites sends the wrong message and may even create liability issues. There’s also a huge possibility that heroin addicts converging in one place will allow them to network with other addicts, have better and easier access to the drugs, and any hope of them getting better or opting for rehabilitation is lost. Is a safe house for heroin injection really the answer?

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Student

Pharmacists Current Job Market

Around 20 years ago, the pharmacy industry offered the best opportunity to students: a six-figure income, a respected job title, a rewarding career that allows them to help people, and plenty of jobs waiting for them after they graduate. Today, however, this is NO longer the case. The pharmacist job market has become over-saturated to the point that student pharmacists are finding it hard to land a job. A 2013 study conducted by eight Midwest schools found out that, out of 783 pharmacy students who were about to graduate in four weeks,

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only 81 percent had found employment or was getting into a post-graduate program. Sixteen percent had not found a job, and three percent had not begun looking for employment. These figures contrast starkly with the observations of pharmacy professor Daniel L. Brown, who noted that, before 2009, almost 100 percent of pharmacy students had jobs waiting for them around six months before they graduated. Purdue University, which has one of the leading pharmacy schools in the country, has also observed this upward trend in unemployment among gradu-


A lot of student pharmacists feel that pharmacy schools should consider decreasing their student enrollment since the rising number of graduates contributes to the over-saturation of the job market. ating pharmacy students. In 2009, Purdue’s pharmacy students had 12 job offers before they graduated, but that number dwindled to one to three offers a few years later. In 2008, only one student out of the entire graduating class was still looking for work; in 2013, 12 students were still looking for a job a few weeks before graduation. Data collected by the Pharmacist Demand Indicator (formerly the Aggregate Demand Index) also reflect the challenges in the pharmacist job market. Its Quarter 4 2016 report shows that only a handful of states have high employment demands and are finding it hard to fill positions. The rest have moderate demand or are maintaining a precarious balance between demand and supply, and some even don’t have enough jobs for the number of pharmacists in the area. Why Is This Happening? There are many factors that contribute to the downward trend of the pharmacy job market. Laws that would have expanded the roles of pharmacists and allow them to take on some client counseling responsibilities have not yet been approved both on state and federal levels. This means that pharmacists can’t charge for their counseling and advisory services and that the industry as a whole cannot financially support the influx of more pharmacy professionals.

decided to conduct a student pharmacists job market survey. It took place in April 2017 and had 122 participants, who were asked to answer five questions about the job market. The purpose of this survey was to find out how students feel about their job prospects and the future of pharmacy as a career. Their opinions are an important part of the job market discussion because they are the demographic that is most impacted by the decrease in demand of professional pharmacists. With fewer job opportunities plus rising student loan debts, many student pharmacists can find themselves in difficult situations after graduation. The APPA student pharmacists job market survey found out that a lot of students feel there is currently a surplus of PharmD graduates. Some have noted that many of their fellow student pharmacists have left their hometowns to secure employment. Others have observed that doing Postgraduate Year One (PGY1) is no longer enough to distinguish pharmacists, which pushes many professionals to do PGY2. According to one participant, there might come a time when third-year postgraduate studies become necessary for pharmacists to stand out and be noticed by employers.

Academic expansion is also an issue. When the Pharmacy Workforce Center predicted in 2001 there would be a shortage of over 150,000 pharmacists in the next two decades, colleges and universities all over the U.S. opened new pharmacy programs and increased their class sizes. As a result, more and more students received pharmacy degrees, saturating the market and competing with each other for limited job vacancies.

A lot of student pharmacists feel that pharmacy schools should consider decreasing their student enrollment since the rising number of graduates contributes to the over-saturation of the job market. Some point out that the current state of enrollment rates decreases the amount of competition to get into pharmacy schools and produces graduates who are less competent in their field. Others, meanwhile, feel that the increasing number of people with PharmD degrees decreases the value of the degree.

Survey: What Do Student Pharmacists Think of the Job Market? With everything that’s happening in the job market, the American Pharmacy Purchasing Alliance (APPA)

The student pharmacists job market survey also touched on the issue of pharmacists who study abroad and have less schooling than those who study in the United States. Many of the participants

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have noticed that these overseas-educated pharmacists do have an impact on the U.S. pharmacy job market, especially in the retail and community setting. Some of the study participants point out that the issue might be influenced by American pharmacists’ belief that pharmacy education abroad does not match the United States’ standards. The study participants were also asked to give advice to current pharmacy students on how they could secure employment right after graduation. Many important tips were given, including positioning themselves as a leader even while they’re still in school and doing networking activities to build relationships with other professionals and potential employees. Joining relevant clubs, obtaining internships, and doing volunteer activities in the pharmacy community are other strategies to stand out as a candidate, either for a job or for a residency position. The final question of the APPA student pharmacists job market survey asked the participants if they would consider picking another profession, considering what they know about the employment outlook for pharmacy students. A lot of the participants revealed that they would NOT switch professions even if the current job market presents challenges instead of opportunities. Some revealed that being a pharmacist was their dream since it allows them to help other people, so giving it up is not an option. Others state that, aside from reducing the number of pharmacy schools and making class sizes smaller, another way to improve the job market is to make the profession more focused on people and service and less on sales. Still others point out that all job markets — not just pharmacy — are saturated, so it all boils down to finding a niche in your industry where you can build your success. How Can You Find Success in the Current Job Market? Among the topics tackled in APPA’s student pharmacists job market survey, perhaps the most important is the strategies that students can use to improve their employment practices. As mentioned above, there are several ways for students to secure a job before or right after they graduate. One of the most effective is getting into a niche market. Many pharmacy niches are not as saturated as the traditional markets, which means you’ll deal with less competition and find it easier to stand out from the crowd. A lot of niches focus on new and interesting branches of pharmacy, making them a great option if you’re looking for exciting and challenging work that test your skills and knowledge. 16 pharmacy edge

If you decide to use strategy, the next thing you should do is to pick a pharmacy niche to focus on. We’ve listed some of them below to help you choose the right option: • Specialty Pharmacy — This niche focuses on dispensing high-cost specialty medications for rare, chronic, and complicated health conditions, including cancer, rheumatoid arthritis, hepatitis C, and HIV. Specialty pharmacies are on the rise because they help with proper drug administration and patient education and contribute to better compliance and better patient health. • Clinical Pharmacy — This niche originated in clinics and hospitals, although clinical pharmacies can now be found in any healthcare setting. If you decide to become a clinical pharmacist, you’ll need to work closely with doctors and other healthcare providers to promote patient recovery and disease prevention. • Long-Term Care Pharmacy — While any pharmacy can technically offer long-term care, this niche usually refers to pharmacy services that are found in nursing homes, mental health facilities, correctional institutions, rehabilitation centers, and the like. Pharmacies in these settings usually offer medications and care that are customized to the resident population’s specific needs. • Pharmacy Genomics — It is a well-known fact that people can react differently to medications due to the differences in genetic makeup. Pharmacy genomics takes advantage of this fact by tailoring drug treatments according to the patient’s DNA blueprint and unique metabolic processes. • Diabetes Management — Diabetes is on the rise both in kids and adults. To help manage this, many pharmacies now specialize in the diabetes management niche. They provide not only the right medications for diabetes but also educate patients on how to improve their lifestyle and keep their blood sugar at a healthy level. These are just some of the pharmacy niches you can explore. Choosing the right niche to specialize in can be overwhelming, so it’s important to take the time to make your decision. Consult your professors and mentors and get their perspective; they can help you go over possible niches and choose one that best suits your strengths. Once you’ve identified a niche that you might like, look for volunteer opportunities that will give you the chance to test the waters and see if this niche really is the right choice for you.


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We are seeking a Vocational Pharmacy Technician Instructor with on-the-job pharmacy experience and a current Pharmacy Tech License for our Las Vegas, NV campus. Our instructors operate in an innovative, blended learning environment where teaching means being a role model, giving lots of one-to-one assistance to students as well as delivering effective lectures and leading classes. This full-time onsite campus opportunity requires flexible weekday hours; including some evening and Saturday work. The successful candidate will have strong experience and knowledge in medical terminology, anatomy and physiology, pharmaceutical calculations, pharmacology, pharmacy practice, computer basics, and Microsoft Office. Creative problem solving ability and solid communication skills are also important. Please send your resume and cover letter to bzavatchin@asher.edu to be considered. Local candidates only please. Photo created by Pressfoto - Freepik.com


The Pet Medication Market Is Growing, Providing Opportunities for Independent Pharmacies In 2015, Market research firm Packaged Facts published a report called Pet Medications in the U.S.: Over-thecounter and Prescription Remedies as Consumer Products, 3rd Edition which estimated the pet medication market to be a $10 billion industry by 2018. More families are now keeping pets and are treating them as members of the family which means that owners are willing to spend for grooming and medication for their furry creatures. It’s this concern for the welfare of animal companions that will drive the growth of the

18 pharmacy edge

pet medication market. In fact, the American Pet Products Association estimates expenditure in the pet industry to be $69.36 billion in 2017. In 2013, pet medication sales hovered at $7.6 billion. That figure is now bound to increase at an annual growth rate of 5% by 2018 to $10.2 billion. The study by Packaged Facts looked into different areas including parasite prevention and control, behavioral health, cognitive dysfunction, heart health, ear care, obesity/ overweight, and allergies.


Veterinarians have, for years, dominated sales of veterinary prescription and over-the-counter drugs. However, that started to change in the late 90s when establishments such as brick-and-mortar shops and online retailers began to take larger control of the market share. In 2013, veterinarians accounted for 58% of pet medications – although still a large amount, the percentage two years prior was 63% which shows that there is growing competition from retail stores. Independent pharmacies can take advantage of the growth of the pet medication industry by offering pet prescription medication. This idea could work best in areas where residents need to travel many miles just to get to a specialist store that sells medications for pets. Doing this is advantageous for local pharmacies because they will be making it more convenient for pet owners to get prescription medication for their dogs or cats without having to travel a long way. Providing pet prescription medication also allows an independent pharmacy to build relationships with the local veterinary clinics. Clinics can refer their pet owners to an independent pharmacy which provides the prescriptions they need for their furry companion. There is growing concern among veterinarians that pet owners will no

longer be turning to them for advice to rely on lay people instead. Independent pharmacies can address this concern by establishing relationships with veterinarians in their local area. For example, pharmacies can supply the medication prescribed by a vet for a local resident’s pet. The scenario would be one of collaboration instead of competition. Independent pharmacies can even partner with local veterinarians to provide information needed by pet owners to keep their companions happy and healthy. On top of that, local pharmacies can also supply specialty pet products. While it’s true that some veterinarians might lose profits with pharmacies and other retail outlets taking a share of the pet prescription market, there are always areas where they can join heads for the benefit of local pet owners and their furry creatures. Besides, the Federal Trade Commission criticized the established policy of selling medications only through veterinarians in 2015. In a report called Competition in the Pet Medications Industry Prescription Portability and Distribution Practices released in May 2015, the FTC cited broader access to portable prescriptions, greater choice of generic drugs, and wide access by non-veterinary retailers to supplies as consumer benefits of the increased completion in the pet medications market.

Providing pet prescription medication also allows an independent pharmacy to build relationships with the local veterinary clinics.


Will wearable technology help improve outcomes for chronic conditions like diabetes? Statistics According to the CDC (Centers for Disease Control and Prevention) 29.1 million people (9.3%) of the population have diabetes. Only 21.0 million are diagnosed, leaving 8.1 million people undiagnosed (27.8% people are undiagnosed). 86 million are PreDiabetic. 1.9 billion adults are overweight, 600 million adults are obese, and the prevalence of obesity has nearly doubled over the past few years.

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Currently, there is a lot of work trying to be done between healthcare companies and tech companies to help eradicate this issue. Medtronic’s, Fitbit, IBM Watson, and Apple hope to combine wearable technology with data analytics to better improve outcomes in patients with chronic conditions such as diabetes. Compliance has always been an issue with wearable technologies. Consumers aren’t wearing their technology on a daily basis. Research has showed 1/10 consumers who have fit bit do not wear their device on a consistent basis.


Developing smaller sensors for these wearable technologies is where these developers are headed. Dexcom (Continuous Glucose Monitoring) The Dexcom G5 Continuous Glucose Monitoring (CGM) System provides real-time glucose readings for patients with type 1 or type 2 diabetes every five minutes. With Dexcom G5 Mobile, dynamic glucose data can be accessed and shared safely and conveniently anywhere, anytime to your smart device. The Dexcom G5 Mobile is the only CGM system approved for adults and pediatric patients two years of age and older. Video:https://www.dexcom.com/continuous-glucose-monitoring Future Healthcare Technology Medtronics has a partnership with IBM that will leverage the artificial intelligence powers of Watson. With Watson, they will analyze all this EMR (Electronic Medical Records) data and use this population information to develop a real-time personalized care for the patient. The recent real-time launch was the development of a cognitive app called SugarIQ. This app detects important patterns and trends for people with diabetes. It uses real-time continuous glucose monitoring (CGM) and insulin information from Medtronic insulin pump and glucose sensors. It leverages IBM cognitive computing power, combined with Medtronic’s expertise in diabetes. SugarIQ includes features that will send personalized messages in real-time to help people understand how a specific action and habits can affect their blood glucose levels. It also adds features such as Glycemic Assist, and Food Logging for an easier way to track and control a food log, that will illustrate how certain foods can impact a diabetic. Apple is currently working on a technology for the apple watch that involves measuring your blood glucose levels. Their looking at a non-invasive continuous glucose monitor sensor that doesn’t involve pricking of the finger (invasive). Their trying to figure out a way to develop

an optical sensor to read glucose levels by shining light through the skin and integrate that data with the data you have on your apple watch. Novartis is currently working with Verily Life Sciences on a smart contact lenses that you put in your eyes that measures blood sugar levels through your tears. Their hoping it changes color if it’s not within normal level ranges. Merck and Amazon challenge developers to build Alexa apps for patients with diabetes. Their plans are to harness artificial intelligence for diabetics. The contest will aim to help incent upstarts and individual developers to create apps that harness Amazon’s Alexa voice-enabled technologies specifically for patients recently diagnosed with Type 2 Diabetes. Data Being able to analyze healthcare analytics and translate it into improved patient outcomes will become increasingly important for healthcare professionals. There is a mountain full of healthcare data that tends to make health data look like a giant puzzle. As healthcare providers we can see some of the moving pieces such as prescriptions, medical images, and test results, but there is still a lot of data available that were missing. We have to be able to see the complete picture. The amount of valuable health data continues to grow with experts estimating it to double in the next few years. Concerns of Healthcare Technology • Accuracy of the data- Concerns that it may not be healthcare quality accurate • Security and privacy concerns- The sharing of information of who gets to see it and who doesn’t get to see • Patient adherence- Will patience be willing to wear these technologies all the time for it to be collected as accurate data. We want to make sure we can marry healthcare outcomes with wearable technology that really resonates with consumers.

References: http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav https://www.dexcom.com/g5-mobile-cgm https://www.medtronicdiabetes.com/blog/first-live-experience-of-sugar-iq-with-watson-for-people-with-diabetes/ https://www.medtronicdiabetes.com/blog/cognitive-computing-for-improved-diabetes-outcomes-part-ii-the-healthcare-system/ http://www.mobihealthnews.com/content/merck-amazon-challenge-developers-build-alexa-apps-diabetes The Motley Fool Podcast: Healthcare: Will Wearable Technology Makes Us Healthier

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Life After Pharmacy School By: Rizwan Khaliq Pharmacy is an ever-evolving profession. In order to stay abreast to the rapid changes, intense focus on the latest developments is necessary. I made a goal upon my graduation from pharmacy school in 2016 to enter a niche of pharmacy that piqued my specific interest of practicing pharmacy within the health insurance industry so I can assist with improving patient health outcomes while helping to manage the soaring costs of healthcare. The healthcare system within the United States is quite complex so I decided to put my best foot forward and applied for residency programs through the rigorous online application process via American Society of Health-System Pharmacists(ASHP) last year. The decision to apply was a good one as I landed a position as in a PGY-1 Managed Care Residency program at Health First Health Plans(HFHP) in Melbourne, Florida. My residency training focuses on the practice of pharmacy in the managed and ambulatory care settings.   The decision to do a residency is a difficult one for recent graduates due to high student loans and the drastic cut in salary for the year. I feel it was the correct decision for me as I am a firm believer in the need to maximize education and training opportunities in order to lead to a great payoff in the long run with respect to both financial rewards and personal satisfaction. Being trained in a residency program allows for one to develop skills in time management, honing of clinical expertise, and the gaining proficiency in the niche of the chosen residency program. The average amount of hours dedicated during my residency period is approximately 65-70 hours each week. It has been strenuous but quite worth it. During my nearly year-long training thus far, I have gained a solid grasp on concepts including that of prior authorizations, quality measures, and the impact of direct patient care in the ambulatory care setting. 

24 pharmacy edge

A process that I have been intricately involved in as a longitudinal responsibility is prior authorizations. This process is one of interest for several sectors in the healthcare system. Sectors involved include that of community pharmacies, physician offices, and the health insurance company. The aforementioned list is not an all-inclusive list of those who have a role within prior authorizations. The portion of this process that is my responsibility is with that of clinical reviewer. I review the request received electronically and ensure that


the request is clinically appropriate with respect to safety and efficacy, verifying that requirements (step therapy, quantity limit, etc.) established on the formulary associated with the specific medication request have been met and that the therapy being utilized is applying evidence-based medicine.  According to the Centers of Medicare and Medicaid Services(CMS), quality measures are tools that help to quantify healthcare processes, outcomes  achieved, and the perceptions that patients have. Goals of the measures include efficacy, safety, and efficiency with respect to care provided. I would like to mention a few key organizations that focus on quality and what they entail.  These include Healthcare Effectiveness Data and Information  Set(HEDIS), Pharmacy Quality Alliance(PQA), and the CMS’s Star Rating System. HEDIS is an instrument utilized by more than 90 percent of the United States health plans to measure the performance on important dimensions of care and service. In total, HEDIS is composed of 81 measures across 5 domains of care. The Pharmacy Quality Alliance’s(PQA) focus is on the optimizing of patient’s health by improving the qual-

ity of medication use. PQA is a non-profit alliance with over 200 member organizations. CMS uses it’s five-star quality rating system to determine the experience that Medicare beneficiaries experience with their health plans and healthcare system. Ambulatory care clinical practice is another major component of my residency training that I have had the ability gain expertise in. In this setting, I worked alongside physicians in their group medical practice setting. My preceptors had their own office within these settings in which I co-inhabited. The aforementioned topics of prior authorizations and quality measures also play a role in the daily workings within this setting. As pharmacists with access to the electronic medical record (EMR) and insurance claims data, we added immense value to physicians. We were able to make recommendations to physicians regarding pharmacological therapy with having information regarding the formulary at our disposal and assist with the completion of any prior authorizations needed in real time to ensure timely access to the medications for the patient. In addition to the prior authorizations, we were able to assist with physicians in achievement of their quality measures for their facilities with respect to those that are heavily focused on medication management.  As I am completing my residency over the next couple of months, a lot of concepts have been solidified and I have reached a level of proficiency that I can confidently enter a dialogue with experienced professionals within the managed care and ambulatory care settings. The knowledge of these respected realms of pharmacy is important for each person within the profession to have at least the basics of as it helps to improve communications amongst these entities when we are aware of the challenges that are faced within them. No matter what the next step of my journey in my career is, the knowledge and experience obtained during my residency will add to value to my respective organization.

According to the Centers of Medicare and Medicaid Services(CMS), quality measures are tools that help to quantify healthcare processes, outcomes achieved, and the perceptions that patients have.

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Utah Pharmaceutical Wholesaler Faces up to 10 Years in Prison in Prescription Fraud Scheme 28 pharmacy edge


Originally indicted in late 2015, the owner of a Utahbased wholesale drug distribution company pled guilty to selling more than $100 million in black market prescription drugs. Randy Crowell, the owner and operator of Green Valley Medical Distributors LLC (Green Valley), faces up to 10 years in federal prison for his role in the scheme. Crowell has already agreed to forfeit $13 million in illegal profits. As described in the indictment filed in the U.S. District Court for the Southern District of New York, Crowell, along with up to 50 others involved in the nationwide scheme, defrauded private insurers as well as Medicaid and other government programs out of hundreds of millions of dollars by purchasing contraband drugs and reselling them to pharmacies across the country as legally-sourced pharmaceuticals. The scheme operated by cutting into and displacing the legitimate flow of pharmaceuticals from manufacturer to pharmacy. Crowell and his co-conspirators, rather than purchasing medications from manufacturers or legitimate distributors at market prices, acquired drugs via an underground, and lucrative, black market in prescription drugs. Scheme participants targeted both the cheapest possible source of supply for these drugs and some of the most expensive medications, particularly drugs for the treatment of HIV and AIDS-related diseases, in order to maximize profits. According to the indictment, Crowell targeted “Medicaid patients and other individuals who received…prescription drugs on a monthly basis for little or no cost, and who were then willing to sell their medicines rather than taking them as prescribed.” The patients sold their drugs to scheme “Collectors,” who worked

street corners and bodegas and paid in cash. Collectors then sold the second-hand drugs (often after “cleaning” off the labels with lighter fluid and other hazardous chemicals) to scheme “Aggregators” who “bought dozens, and sometimes hundreds, of bottles at a time from multiple collectors before selling them to higher-level scheme participants with direct access to legitimate distribution channels, including corrupt wholesale companies” like Green Valley. Between 2010, when Crowell opened Green Valley, and July 2012, Green Valley had no legitimate sources of supply—all of the drugs ultimately distributed to pharmacies were “sourced” by Aggregators from the black market. Per the indictment, the drugs often arrived at Green Valley packaged in unsealed, unsecure cardboard boxes. “On some occasions, bottles of medication arrived at [Green Valley] with the initial patient labels still affixed to them. On other occasions, bottles arrived having already been opened, or containing what appeared to be the wrong medication.” After repackaging, the black market drugs were then sold back to pharmacies across the United States, with their true provenance concealed through fraudulent records. Crowell’s sentencing is scheduled for May 11, 2017. Though Crowell’s sentencing memorandum has asked for leniency and less than five years in prison, federal prosecutors are pushing for a “substantial sentence,” citing Crowell’s leadership role, the dangerous nature of the activity for those on the receiving end of the black market drugs, and the lengthy sentences already handed down to other co-conspirators.

The FisherBroyles Pharmacy and Health Care Law team is pleased to keep you updated on events of interest to those in the healthcare and pharmaceutical industries. Questions may be directed to any of the following attorneys:

Brian E. Dickerson, Esq. brian.dickerson@fisherbroyles.com fisherbroyles.com

Anthony j. Calamunci anthony.calamunci@fisherbroyles.com fisherbroyles.com

Nicole H. Waid nicole.waid@fisherbroyles.com 202-906-9572

Amy L. Butler amy.butler@fisherbroyles.com 419.340.8466

Katy Wane katy.wane@fisherbroyles.com 502.890-5920

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Brian E. Dickerson PARTNER

202.570.0248 brian.dickerson@fisherbroyles.com

At FisherBroyles, we take pride in our depth of knowledge and experience representing pharmacies, pharmacists, health systems and providers, drug wholesalers, technology companies and other entities involved in the drug delivery system. Our Health and Pharmacy attorneys offer significant experience across the broad scope of issues facing the industry including: • Administrative/Regulatory Compliance Plans • PBM Audits/Network Exclusion Issues • Buy/Sell Pharmacy & Healthcare Transactions • Pharmacy & Healthcare Licensing Issues • Government Investigations (DOJ, HHS-OIG, DoD, DEA, FDA, State) • Business Litigation • Specialty and Compounding Pharmacy Matters

Anthony J. Calamunci PARTNER

419.376.1776 anthony.calamunci@fisherbroyles.com

Nicole H. Waid PARTNER

202.906.9572 nicole.waid@fisherbroyles.com

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The latest and the most significant industry-related news and trending stories. This magazine is produced by APPA - American Pharmacy Purchasing Alliance If you wish to submit an article-to Pharmacy Edge, or would like to request a media kit for sponsorship The latest and thesend most industry-related news opportunities, ansignificant email to info@joinappa.com. and trending stories. This magazine is produced by APPA - American Pharmacy Purchasing Alliance If you wish to submit an article-to Pharmacy Edge, or would like to request a media kit for sponsorship opportunities, send an email to info@joinappa.com.

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Pharmacy Edge  

Issue 14, June 2017

Pharmacy Edge  

Issue 14, June 2017

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