The Kentucky Pharmacist - March/April 2020

Vol. 15 No. 2 March/April 2020

THE KENTUCKY

PHARMACIST Official Journal of the Kentucky Pharmacists Association

The Voice of Pharmacy in Kentucky

TABLE OF CONTENTS FEATURES Pharmacists Day at the Capitol Recap |4| Strategic National Stockpile Preparedness Training Course |6| Pharmacy Groups Unite to Fight PBMs in Landmark Supreme Court Case |8|

Mission Statement: The mission of KPhA is to advocate for and advance the profession through an engaged membership.

Editorial Office: ©Copyright 2020 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association.

Publisher: Mark Glasper Managing Editor: Sarah Franklin Editorial, advertising and executive offices at 96 C Michael Davenport Blvd., Frankfort, KY 40601.

Phone: 502.227.2303 Fax: 502.227.2258.

Email: info@kphanet.org.

Website: www.kphanet.org.

On the Cover 

Pharmacists and Pharmacy Students at the 2020 Pharmacists Day at the Capitol

IN EVERY ISSUE President’s Perspective |3| My KPhA Rx |10| March CE Article |12| March Quiz |16| March CE Answer Sheet |17| April CE Article |19| April Quiz |24| April Answer Sheet |25| Pharmacy Policy Issues |26| Campus Corner |27| New KPhA Members |29| Pharmacy Law Brief |30|

ADVERTISERS APMS |4| APSC|5| PTCB |7| EPIC |29| Pharmacists Mutual |32| Cardinal |33|

|2| Kentucky Pharmacists Association | March/April 2020

PRESIDENT’S PERSPECTIVE Two Bills, Two Perspectives The long legislative session in Frankfort, Kentucky was fascinating to watch unfold. All of the fundraising events, stretching from late summer to the holidays, prepared us for our work ahead. Senate Bill 50 (Medicaid Pharmacy Reform), sponsored by Sen. Max Wise, was signed by Governor Andy Beshear in March and represents a huge win for pharmacy in Kentucky. Pharmacist Rep. Steve Sheldon introduced friendly amendments to SB 50 which also improved the overall bill.

We owe both legislators our thanks for helping independent pharmacist in Kentucky. Unfortunately, House Bill 462 (Pharmacist Compensation), sponsored by pharmacist Rep. Danny Bentley was not passed out of committee in the House of Representatives. Rep. Bentley has indicated he is willing to carry this legislation again in the 2021 legislative session. We also owe Rep. Bentley our sincere thanks for his continued efforts to support pharmacy in Kentucky.

“If your practice includes patient care with the Board Approved Protocols, then please share how your activity improves the health of Kentuckians.”

agers. If your practice includes patient care with the Board Approved Protocols, then please share how your activity improves the health of Kentuckians. This will go a long way to support our efforts going into the 2021 legislative session.

Representing KPhA & You

Don Kupper

Every week, our staff and the President, KPhA KPhA leadership and our committee members are on conference calls working for Your KPhA. I am proud to be engaged with each of these leaders who represent our profession. KPhA Chair Chris Palutis and I have had a number of chances to represent our profession on the television networks and radio airwaves presenting our profession’s viewpoints regarding the issues related to PBMs and pharmacist well-being. I hope you have had a chance to see and hear these perspectives.

Lastly, the Kentucky Professional Research and Education Foundation (KPERF) has unFast Forward dergone a transforKPhA had a great turnout for Pharmacists Day at the Capital. mation over the 2019I hope you had a chance to see the many photos posted on our 2020 term. Lead by Past social media sites. KPhA would like to thank Dr. Joe Fink, KPhA President Bob Dr. Trish Freeman, Dr. Clark Kebodeaux and Dr. Ken RecOakley, a great deal of ord for attending and bringing the University of Kentucky work has been done and College of Pharmacy’s students to participate in the activities, continues to be done to which included an onsite Health Fair for legislators and their transform our foundastaff. Additionally, KPhA thanks Sullivan College of Pharma- tion for our future, incy Dean and current Board Member Dr. Misty Stutz, Dr. cluding a new fundraisChris Betz, and Dr. Scott Hayes, KPhA Government Affairs ing plan for our Center Committee Co-Chair and the many students from the College of Excellence. Please of Pharmacy for attending. stay tuned.

We continue working to get our pro-pharmacy message out to our legislators, their constituents and pharmacists across Kentucky during legislative session as well as after the final session is gaveled. If you have a personal relationship with your State Representative and/or Senator, please reach out to them and share your personal dealings with Pharmacy Benefit Man-

KPhA President, Don Kupper presents Sen. Jimmy Higdon with the 2019 Meritorious Service Award at Pharmacists Day at the Capitol.

KPhA sends email announcements weekly. If you aren’t receiving: eNews, Legislative Updates and other important announcements, send your email address to info@kphanet.org to get on the list. |3| www.KPHANET.org

Pharmacists Day at the Capitol Recap Happy Holidays Thursday, February 27, 2020 | Kentucky State Capitol

Sen. Max Wise visits with UK College of Pharmacy students at the health fair.

Rep. Danny Bentley receives services at the health fair.

We are proud to say we had more than 100 attendees for Kentucky Pharmacists Day at the Capitol on February 27. The day began with a welcome from Sen. Max Wise and “Pharmacy Caucus� members Rep. Danny Bentley and Rep. Steve Sheldon. Sen. Jimmy Higdon received the 2019 Meritorious Service Award. Kentucky Retail Federation Senior Vice President, Government Affairs Shannon Stiglitz shared insights about how to advocate to prepare the attendees for their scheduled legislator visits. We hosted 43 legislators for lunch (almost double from last year) and had a great showing of support. The UK College of Pharmacy hosted a health fair in conjunction with Pharmacists Day at the Capitol that was very well attended. Thank you to all those who attended - it is crucial for our unified voice to be heard in Frankfort!

Pharmacy Caucus member, Rep. Adam Bowling, (second from right) visits with (left to right) Chair Chris Palutis, Executive Director Mark Glasper, President Don Kupper and Board Member Matt Carrico at Pharmacists Day.

|4| Kentucky Pharmacists Association | March/April 2020

Rep. Steve Sheldon addresses Pharmacists Day at the Capitol attendees.

|5| www.KPHANET.org

Feature Article Strategic National Stockpile Preparedness Training Course

how to best plan and prepare for a public health emergency and how to use and manage the Strategic National Stockpile in response to a terrorist attack, natural disaster, or technological accident. The SNS is our nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency. In situations such as pandemic influenza outbreaks, mass anthrax exposures, or catastrophic Author: Michele Pinkston, KPhA Director of Pharmacy Emergency hurricanes, this supply is a lifeline to state, local, tribal, and Preparedness territorial first responders when local supplies are exhausted.

Michele Pinkston, During the immersive five-day training, students gained critiKPhA Director of cal skills and confidence to respond effectively to local inciPharmacy Emergency dents or potential WMD events. Along with learning about Preparedness, complet- the SNS formulary and regulatory procedures, the students ed the Strategic Nalearned the warehouse process of unloading materials, storing tional Stockpile (SNS) and creating inventory, and distributing to smaller locations.

Preparedness Training The student teams also learned to set up points of dispensing Course at the Center (PODs) and to manage administration and dispensing of medfor Domestic Prepared- ications during an emergency event. “The opportunity to ness (CDP) in Anniswork with others from different emergency preparedness ton, Alabama. The backgrounds and to learn from their experiences has given me CDP is operated by the a deeper appreciation for the dedication and hard work of United States Depart- those protecting our public health.” said Pinkston. ment of Homeland Training at the CDP campus is federally funded at no cost to Security’s Federal Emergency Manage- state, local, and tribal emergency response professionals or their agency. Resident training at the CDP includes ment Agency and is KPhA Director of Emergency Preparedhealthcare and public health courses at the Noble Training the only federally ness, Michele Pinkston chartered Weapons of Facility, the nation’s only hospital dedicated to training healthcare professionals in disaster preparedness and reMass Destruction sponse.

(WMD) training facility in the nation.

Dr. Pinkston joined 30 other public health preparedness professionals from across the nation in the course. “This was an incredible week of lectures and hands-on training,” Pinkston said. “The course gave me practical knowledge of the process to deliver large quantities of critical medications and supplies to the population in a short period of time. “

Information about CDP training programs can be found at http://cdp.dhs.gov. For more information about the CDP, contact the CDP External Affairs Office, at (256) 8472212/2316 or e-mail pao@cdpemail.dhs.gov.

The Strategic National Stockpile Preparedness Course is designed to give Federal, state, and local officials information on

United State Department of Homeland Security and the Center for Domestic Preparedness |6| Kentucky Pharmacists Association | March/April 2020

Stockpile supplies pictured inside the Center for Domestic Preparedness.

|7| www.KPHANET.org

Feature Article Pharmacy Groups Unite to Fight PBMs in Landmark Supreme Court Case Case seeks to clarify if the states can regulate runaway corporate middlemen Alexandria, VA (February 21, 2020) – The National Community Pharmacists Association (NCPA) and the Arkansas Pharmacists Association (APA), along with the American Pharmacists Association (APhA) and the National Alliance of State Pharmacy Associations (NASPA), announced today they will file an amicus curiae brief with the Supreme Court of the United States in support of a case that pits pharmacy benefit managers (PBM) against neighborhood healthcare providers.

“The PBMs have been hiding behind a vaguely worded section of a federal law that was never supposed to apply to them,” said B. Douglas Hoey, CEO of NCPA, which represents 21,000 locally owned pharmacies nationwide. “They operate without meaningful regulation, and because of that they’re able to stack the deck in their favor, and at the expense of community pharmacies and their patients.”

The case, Rutledge v. the Pharmaceutical Care Management Association, will be heard on April 27, 2020, the Court announced today. It originates from Arkansas, which passed a law in 2015 barring PBMs from reimbursing local pharmacies at a lower rate than what the pharmacies pay to fill the prescriptions. The PBM lobby, PCMA, challenged the law in court, which is when the APA and NCPA joined the effort to ensure the 2015 precedent stands.

“For countless years, PBMs have tightened the noose on pharmacists and their ability to serve their communities and provide access to life-saving medications and essential counseling,” said APA CEO and Executive Vice President John Vinson, Pharm.D. “Instead, PBMs have prioritized profits and stockholders by using anti-competitive practices, self-dealing, and monopoly-like business practices to create an environment where patients, pharmacists, and employers suffer the consequences – patients lose their choice, pharmacists lose their jobs, and employers lose their money.”

“This US Supreme Court will address regulation of an industry built for profits, not patients. The ever-increasing flow of health care funding to the proverbial unregulated middle can be halted, and good patient care can be enhanced when states are permitted to regulate PBMs,” said APhA Executive Vice President and CEO Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA. “Evidence is clear that the profits in the middle come at the expense of everyday Americans and is adversely impacting patient access to pharmacists’ patient care services.”

At the heart of the case is whether states like Arkansas can enact regulations that affect the PBMs, who argue that they are exempt by the Employee Retirement Income Security Act of 1974.

Rebecca Snead, CEO and Executive Vice President of NASPA, said the federal ERISA law was never meant to shield pharmacy benefit managers from state regulation.

“State pharmacy associations have championed pro-patient, pro-employer, pro-pharmacy legislation for over 25 years with limited success due to the PBMs’ claims that they are preempted under ERISA. But the federal ERISA law was never intended to thwart states’ attempts to regulate the business of PBMs or the business of insurance,” said Snead.

There is wide bipartisan agreement in the states that PBMs must be regulated. In fact, 33 state attorneys general, both Democrats and Republicans, signed on to an amicus brief in 2018 supporting Arkansas’s appeal of the 8th Circuit Court’s decision to the Supreme Court. Additionally, all 50 state pharmacy associations, as well as the District of Columbia, will join the brief.

“It’s rare to get bipartisan agreement on anything, so this level of support is overwhelming,” said Hoey. “State policymakers have an obligation to protect their residents and their local That case made its way to the federal 8th Circuit Court of Ap- businesses from predatory business practices. The PBMs are peals, where the judge ruled in favor of the PBMs. When Ardriving up costs for patients, and they are limiting access for kansas appealed the ruling, the Supreme Court asked the US patients by systematically shutting down their local pharmaSolicitor General to recommend whether to take the case. Not cies.” only did he urge the Court to take the case, but he argued The case will be decided by the end of June. strongly that the 8th Circuit erred in its decision.

For more information about: Continued on p. 27 |8| Kentucky Pharmacists Association | March/April 2020

|9| www.KPHANET.org

MY KPhA Rx Where do I Start?

Where do we go from Here?

ernor Andy Beshear and goes into effect immediately.

We should see significant improvement with pharmacy reimbursement in the short and long term. In the short term, PBMs currently serving MCOs will no longer be

By Mark Glasper able to use fees or effective rate contracting to lower reimbursements. Going forward with new Medicaid conKPhA Executive tracts, the Department for Medicaid Services will set Director/CEO reimbursement rates with the advice of pharmacists that I always survey the landscape of topics that I may adthe new state-selected PBM will use. That selected PBM dress in each issue of the Journal. Typically, one stands will be for all Medicaid MCOs and will be prohibited out, however we find ourselves in extraordinary times. from mandating mail order.

It would be easy for me to simply recount the steps that SB 50 represents a significant win for KPhA’s legislative brought us a huge legislative victory with SB 50, our efforts and for all pharmacy in Kentucky. We thank SB Medicaid Pharmacy Reform bill. Or, I could focus on 50 sponsor Sen. Max Wise, Max.Wise@lrc.ky.gov, and the efforts of so many who helped us develop the new also Rep. Steve Sheldon, Steve.Sheldon@lrc.ky.gov, 2020-2023 KPhA Strategic Plan. And then there’s the who marshalled the bill through the House with friendly daily fight pharmacists are facing with the COVID-19 health crisis. All three of these topics are worthy of my amendments that improved the overall bill. Please send each of these legislators your thanks if you haven’t alfocus and too difficult to ignore. ready.

Senate Bill 50 Victory I also want to express my appreciation for the hardworking efforts of the KPhA Comprehensive PBM Reform ad hoc Committee, the KPhA Government Affairs Committee, Kentucky Retail Federation Senior Vice President, Government Affairs Shannon Stiglitz who leads KPhA’s lobbying efforts, American Pharmacy Services Corporation (APSC) and dedicated KPhA members who tirelessly reached out to their legislators in support of SB 50. We also worked closely with our friends at the Kentucky Independent Pharmacist Alliance (KIPA) to present a united front to legislators all session long and this relationship paid dividends in the end.

New Strategic Plan to Drive us Forward KPhA held a Strategic Planning Retreat last August at KPhA Board of Directors celebrate the passage of SB 50.

Lake Cumberland Resort State Park. We had 33 participants, including members of the KPhA Board of DirecPharmacists across Kentucky can share in the success of tors and KPERF Board of Directors, invited guests and staff. Our discussion was facilitated by Tim Burcham, bringing SB 50 across the finish line. The long-awaited past Chairman of the Association of Fundraising Profeslegislation to provide relief for community pharmacies with patients in the Medicaid space was signed by Gov- sionals International Board and current Chair of the Ex|10| Kentucky Pharmacists Association | March/April 2020

ternal Major Gifts Committee for the AFP Foundation for Philanthropy.

measures to remain open, and Your KPhA staff members are working remotely to maintain our level of service during these trying times.

KPhA 2020-2023 Strategic Plan

A new Mission, Vision and set of Goals were developed from this session and a Strategic Planning ad hoc Committee was formed to continue the work from the retreat Booneville Discount Drugs staff prepare to serve their community and develop strategies to implement the plan’s goals. through the COVID-19 crisis.

The Center of Excellence ad hoc Committee which had been formed to develop a strategic plan on behalf of We are sending daily COVID-19 e-blasts to keep pharKPERF was folded into the Strategic Planning ad hoc macists across Kentucky up to date on developing news Committee to streamline the process. regarding the outbreak. We’ve also developed resources for you on the KPhA website, including an extensive The committee worked through the fall and winter to toolkit with helpful information from the Kentucky draft strategies in tandem with KPhA staff members.

Board of Pharmacy, Kentucky Department of Public The Strategic Plan was reviewed and approved at the Health, national pharmacy associations, and other naJanuary 23, 2020 KPhA Board of Directors meeting tional and international public health organizations. with staff assigned the task of developing action plans for 2020 implementation as well as ideas for 2021. The We are here for whatever you need – whatever your KPhA Board will be updated on the Strategic Plan’s pro- question – whatever your concern – throughout this crigress at each meeting going forward. You can see the sis and beyond. You encourage us with your stories of new Strategic Plan on these pages and it is posted on the going the extra mile to help your patients. You brighten KPhA website. our days with how you serve your communities in myriad of ways. And, you inspire us with your can-do spirit.

I want to thank everyone who participated in the StrateThank you for allowing us to serve YOU! gic Planning Retreat and on the Strategic Planning ad hoc Committee. We’ve developed a truly strategic plan with measureable goals and outcomes which will help us better serve you in the coming years.

COVID-19 Sets New Normal “The only constant in life is change.” And we are seeing change each and every day due to the coronavirus outbreak throughout the world, in the United States and right here in Kentucky.

As I write this column, our patients are hunkering down in their homes, pharmacies are taking extraordinary |11| www.KPHANET.org

March CPE Article 2020 Immunization Schedule Updates Authors: Ethan Kuszmaul, PharmD, Baptist Health Louisville; Whitney Hartlage, Doctor of Pharmacy Candidate, Class of 2020, and Julie N Burris, PharmD, Sullivan College of Pharmacy & Health Sciences The authors declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-0000-20-003-H06-P &T 1.0 Contact Hours (0.1 CEU) Expires 4/7/23

KPERF offers all CE articles to members online at www.kphanet.org

Goal: The goal of this article is to inform pharmacists and pharmacy technicians of recent updates to the adult and child and adolescent vaccination schedules recommended by the Centers for Disease Control and Prevention (CDC).

Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: Explain updated recommendations regarding the administration of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) versus the13-valent pneumococcal conjugate vaccine (PCV13) and in adults.

Identify changes to the anthrax, human papillomavirus, and tetanus toxoid vaccines.

Apply recent updates of the CDC’s 2020 vaccination schedules to pharmacy practice.

Introduction Vaccines have been a crucial development in human history and have led to significant reductions and eradications of many diseases that once harmed both adults and children. The Advisory Committee on Immunization Practices (ACIP), a committee within the United States Centers for Disease Control and Prevention (CDC), routinely reviews scientific data to develop recommendations on how to use vaccines to control diseases in the United States.

all adults aged ≥65 years.

As pharmacists are capable of making a considerable impact on the public’s access to immunizations, it is vital that pharmacists keep up to date on annual CDC changes to the recommended immunization schedules for both adults and children and adolescents. Likewise, it is also important for pharmacy technicians to stay up to date on these items as the technician often first identifies patients that are candidates for vaccinations.

The tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been routinely recommended for adolescent and adult populations for over a decade2. In the previous recommendations by the Advisory Committee of Immunization Practices (ACIP), individuals should receive one Tdap dose preferably at 11-12 years of age followed by booster doses of tetanus toxoid and reduced diphtheria toxoid (Td) every ten years afterwards for life. In addition, if a tetanus toxoid vaccine was indicated for wound management or as part of a catch-up schedule, Td was recommended for individuals who had previously received a Tdap vaccine.

2020 CDC Vaccine Schedule Updates Pneumococcal Vaccines Pneumococcal disease is a bacterial infection caused

by Streptococcus pneumoniae. This infection is a common condition in young children, but older adults are at a greater risk of serious illness and death. The two pneumococcal vaccines that are currently approved for use include a 13-valent pneumococcal conjugate vaccine (PCV13) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Previously, the ACIP routinely recommended the PCV13 vaccine for

ACIP’s recent update recommends a single dose of PPSV23 for routine use in adults aged ≥65 years.1 The PCV13 vaccination is no longer routinely recommended. However, the PCV13 continues to be recommended in series with PPSV23 for adults ≥19 years with immunocompromising conditions, CSF leaks, or cochlear implants.1 Tetanus, diphtheria, and pertussis vaccination

Recently, ACIP updated its recommendation to include both Td and Tdap as options for patients that meet the previous criteria for a Td vaccine3. This allows more flexibility from a point-of-care standpoint regarding which vaccines can be administered while still maintaining safety and immunogenicity. These recommendations come in large part from multiple

|12| Kentucky Pharmacists Association | March/April 2020

Figure 1: Summary of the General Recommendations for the Pneumococcal Vaccines

Patient Categories

Immunocompetent

Specific Underlying Medical Condition None of the below

Recommendations for Ages 19-64

Recommendations for Ages ≥65

No recommendation

Alcoholism, chronic heart disease, chronic liver disease, chronic lung disease, cigarette smoking, diabetes mellitus

1 dose PPSV23

Cochlear implant, CSF leak

1 dose of PCV13 followed by 1 dose of PPSV23 ≥8 weeks after PCV13 1 dose of PCV13 followed by 1st dose of PPSV23 ≥8 weeks after PCV13 and 2nd dose of PPSV23 ≥5 years after first PPSV23 dose

-1 dose PPSV23 -If PCV13 has been given, then give PPSV23 ≥1 year after PCV13 -1 dose PPSV23 -If PCV13 has been given, then give PPSV23 ≥1 year after PCV13 and ≥5 years after any PPSV23 at age <65 years -1 dose of PCV13 followed by 1 dose of PPSV23 ≥8 weeks after PCV13 and ≥5 years after any PPSV23 at <65 years

Immunocompromised

Differences from Previous Recommendations 1 dose of PCV13 followed by 1 dose of PPSV23 1 year later

1 dose of PCV13 followed by 1st dose of PPSV23 ≥8 weeks

trials that found no increased risk of harm in patients that had received Tdap instead of Td years after receiving an initial dose of Tdap.4-6 No changes have been made regarding Tdap recommendations for pregnant women. Pregnant women should still receive a Tdap dose during every pregnancy regardless of their vaccine history. Figure 2 below summarizes these recommendations.

Figure 2: Summary of General Recommendations for Tdap Vaccination

Patient Categories

≥10 Years Old (Adolescents and Adults)

Pregnant Women

Recommendation - 1 dose of Tdap preferably at age 11-12 - Dose of either Td OR Tdap for: Decennial booster Tetanus prophylaxis for wound management Catch-up doses if a person has already received at least 1 Tdap dose 1 dose of Tdap during each pregnancy, regardless of vaccination history (preferably during 27-36 weeks’ gestation but can be at any time during pregnancy)

Difference from Previous Recommendations Previously recommended only Td vaccine for decennial booster, tetanus prophylaxis for wound management, and catch-up doses if a person had already received at least 1 Tdap dose No differences

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anthracis. The disease is transmissible to humans after exposure to infected animals or contaminated The human papillomavirus (HPV) vaccination is animal products. The vaccine is recommended for recommended by the ACIP in order to prevent preexposure prophylaxis (PrEP) in adults aged 18HPV-associated diseases, such as anogenital and 65 years at high risk for exposure to B. anthracis oropharyngeal cancers. The ACIP recommends this (e.g. members of the U.S. military deployed to arevaccination for adolescents at age 11 or 12 but it as with high risk of exposure, laboratory workers can be given as early as 9 years old7. Previously, working with high concentrations of B. anthracis, catch-up vaccinations were recommended for feand individuals such as farmers, veterinarians, and males through the age of 26 and for males through livestock handlers who have the potential to interthe age of 217. Additionally, ACIP did not recomact with infected animals or contaminated animal mend a catch-up vaccination for adults aged 27 products). AVA is also recommended for postexpothrough 45 years due to minimal population benefit sure prophylaxis (PEP) in combination with antimievidence.8 crobials for adults aged 18-65 years with suspected In a recent update, ACIP has now recommended or known exposure to B. anthracis spores.10 that both males and females through the age of 26 Given newly published data, ACIP recently updatreceive a catch-up vaccination for HPV9. In addied its recommendations for the anthrax vaccine. tion, ACIP has recognized that some individuals The differences from the previous recommendaHuman papillomavirus (HPV) vaccination

Figure 3: Summary of General Recommendations for HPV Vaccination

Patient Categories

9-26 Years Old

>26 Years Old

Recommendation - HPV vaccine recommended at age 11 or 12 years and can be given starting at 9 years old - Catch-up HPV vaccination recommended for all persons through 26 years old who have not been vaccinated -Catch-up HPV vaccination is not recommended for all patients

Difference from Previous Recommendations Previously catch-up vaccinations were recommended for females through the age of 26 and for males through the age of 21

Recommendation of shared clinical decision -making for adults 27-45 years of age at risk of HPV and who have not been vaccinated

-Shared clinical decisionmaking is recommended for adults 27-45 years of age who have not been adequately vaccinated

older than 26 years old may still benefit from receiving the HPV vaccine. Therefore, shared clinical decision-making regarding the HPV vaccine is recommended for individuals between the ages of 2745 years old who have not been vaccinated but may be at risk for HPV infection. The HPV vaccine is not recommended in adults >45 years of age.9 Anthrax Vaccine (AVA) The anthrax vaccine (AVA) is recommended by ACIP to prevent an infection caused by Bacillus

tions first include that a booster dose of AVA for PrEP can be given every 3 years instead of annually for those not at high risk for Bacillus anthracis and who previously received the initial 3-dose priming and 2-dose booster series. Additionally, AVA for PEP can be administered using an intramuscular route during a large-scale emergency response if the subcutaneous route of administration poses significant material, personnel, or clinical challenges that might delay or preclude vaccination. Lastly, the duration of antimicrobial therapy for PEP in immunocompetent adults is 42 days when used in conjunc-

|14| Kentucky Pharmacists Association | March/April 2020

Figure 4: Summary of the General Recommendations for the Anthrax Vaccine (AVA)

Patient Categories

Recommendations

Preexposure Prophylaxis (PrEP)-18-65 Years with Potential Risk for Exposure

-0.5 mL IM at 0, 1, 6, 12, and 18 months -Additional booster doses should be given based on risk level. If high risk, every 1 year. If not at high risk, every 3 years. **Only after completion of the 3-dose primary and 2-dose boosters** 0.5 mL SC at 0, 2, and 4 weeks post exposure (unless the emergency response requires change to IM route) plus a 42 day course of antimicrobial therapy 0.5 mL SC at 0, 2, and 4 weeks post exposure (unless the emergency response requires change to IM route) plus a 60 day course of antimicrobial therapy

Postexposure Prophylaxis (PEP)-Immunocompetent 18-65 Years with Suspected or Known Exposure Postexposure Prophylaxis (PEP)Immunocompromised 18-65 Years with Suspected or Known Exposure

Differences from Previous Recommendations Annual booster doses were recommended in all individuals regardless of risk level

-Option to administer IM during emergency responses -Previous duration of antimicrobial therapy was at least 60 days Option to administer IM during emergency responses

tion with the AVA vaccine.10

vaccine schedule.

2020 CDC Additional Child and Adolescent Immunization Schedule Updates

Conclusion

For persons aged ≥10 years determined by public health officials to be at increased risk during a meningococcal outbreak, a one-time booster dose is recommended if it has been ≥1 year since completion of a MenB primary series. A booster dose interval of ≥6 months may be considered by public health officials depending on risk.

2. Broder KR, Cortese MM, Iskander JK, et al. Advisory Committee on Immunization Practices (ACIP). Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep. 2006;55(RR-17):137.

Vaccinations are a crucial component of healthcare that can significantly reduce the incidence of many In addition to the aforementioned immunization diseases in society. New vaccines are continually schedule updates, other relevant updates to the 2020 child and adolescent immunization schedules emerging to help prevent the spread of diseases, and recommendations are being re-evaluated and updatare listed below. ed based on new data and research. Pharmacists For children up to age 1811: and pharmacy technicians are integral to helping Haemophilus influenzae type b catch-up vaccinapromote the safe and effective use of vaccinations tion is not recommended for previously unvaccinat- and must continuously stay up-to-date on these new ed children 5 years (60 months) or older who are approvals and recommendations not at high risk.

References All children and adolescents 2-18 years of age who 1. Matanock A, Lee G, Gierke, Kobayashi M, Leidner A, Pilishvili T. Use of have not previously received hepatitis A vaccine 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polyshould receive catch-up vaccination and complete a saccharide vaccine among adults aged ≥65 years: updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal 2-dose series.

Wkly Rep. 2019;68(46):1069-1075.

**Note: This is not a complete list of all updates as there were also some updates that included clarifications or rewording of some components of the

3. Havers FP, Moro PL, Hunter P, et al. Advisory Committee on Immunization Practices (ACIP). Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertusssis vaccines: Updated recommendations of the Advisory Committee on Immunization Practices – United States, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(3):77-83.

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March 2020 — 2020 Immunization Schedule Updates

1. What is the recommended dosing schedule of the pneumococcal vaccine for a 68 year old male who has not previously received a pneumococcal vaccination?

A. 1 dose of PCV13

5. In the recent ACIP update regarding the HPV vaccine, what is the maximum age male patients should receive a catch-up HPV vaccine (unless otherwise indicated through shared clinical decision making with their provider)?

B. 1 dose of PPSV23

A. 19 Years Old

C. 1 dose of PCV13, then 1 dose of PPSV23 ≥ 1 year after

B. 21 Years Old

D. 1 dose of PPSV23, then 1 dose of PPSV23 ≥ 5 years after

D. 46 Years Old

C. 26 Years Old

6. What age does ACIP recommend as the earli2. If a PPSV23 dose was given before the age of est age an individual can receive the HPV vac65, when should the next dose of PPSV23 be giv- cine? en?

A. 9 Years Old A. None; another dose is not recommended B. 11 Years Old B. 8 weeks

C. 12 Years Old

C. 1 year

D. 26 Years Old

D. 5 years 3. What tetanus and diphtheria toxoidcontaining vaccine is now recommended by ACIP for the decennial booster?

A. Tdap B. Td C. DTaP D. A or B

7. To qualify for an every 3 year booster dose of AVA for PrEP, what should the initial series have included?

A. Priming series at 0, 1, and 6 months B. Priming series at 0, 1, and 6 months and booster doses at 12 C. Priming series at 0, 1, and 6 months and booster doses at 12 and 18 months

4. What vaccine does ACIP recommend for preg- 8. What duration of antimicrobial therapy is recommended in a 55 year old woman with breast nant women to receive during each pregnancy, cancer receiving postexposure prophylaxis regiregardless of vaccination history? mens of AVA? A. Tdap A. 21 days B. Td B. 42 days C. DTaP C. 60 days D. A or B D. Not recommended

|16| Kentucky Pharmacists Association | March/April 2020

This activity is a FREE service to members of the Kentucky Pharmacists Association.

The fee for non-members is $30. Mail completed forms to: KPERF, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: 4/7/2023 Successful Completion: Score of 80% will result in 1.0 contact hour or .1 CEUs. TECHNICIANS ANSWER SHEET March 2020 — 2020 Immunization Schedule Updates Universal Activity # 0143-0000-20-003-H06-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C 2. A B C D 4. A B C D 6. A B C D 8. A B C D Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet.

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7. A B C 8. A B C D

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet.

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Quizzes submitted without NABP eProfile ID # and Birthdate cannot be accepted. |17| www.KPHANET.org

Have an idea for a continuing education article? WRITE IT! Continuing Education Article Guidelines The following broad guidelines should guide an author to  completing a continuing education article for publication in The Kentucky Pharmacist.  



Average length is 4-10 typed pages in a word processing document (Microsoft Word is preferred).



Articles are generally written so that they are pertinent to both pharmacists and pharmacy technicians. If the subject matter absolutely is not  pertinent to technicians, that needs to be stated clearly at the beginning of the article.



Article should begin with the goal or goals of the overall program – usually a few sentences.



Include 3 to 5 objectives using SMART and measurable verbs.



Feel free to include graphs or charts, but please submit them separately, not embedded in the text of the article.



4. Jackson ML, Yu O, Nelson JC, et al. Safety of repeated doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine in adults and adolescents. Pharmacoepidemiol Drug Saf. 2018;27(8):921–925.

5. Halperin SA, Donovan C, Marshall GS, et al. Tdap Booster Investigators. Randomized controlled trial of the safety and immunogenicity of revaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) in adults 10 years after a previous dose. J Pediatric Infect Dis Soc. 2019;8(2):105–114.

6. Kovac M, Kostanyan L, Mesaros N, et al. Immunogenicity and safety of a second booster dose of an acellular pertussis vaccine combined with reduced antigen content diphtheria-tetanus toxoids 10 years after a first booster in adolescence: an open, phase III, non-randomized, multi-center study. Hum Vaccin Immunother. 2018;14(8):1977–1986.

7.Markowitz LE, Dunne EF, Saraiya M, et al. Advisory Committee on Immunization Practices (ACIP). Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63(RR-05):1-30.

8. Chesson H. Overview of health economic models for HPV vaccination of mid-adults. Presented at the Advisory Committee on Immunization Practices meeting, Atlanta GA; June 26, 2019.

9. Meites E, Szilagyi PG, Chesson HW, et al. Advisory Committee on Immunization Practices (ACIP). Human papillomavirus vaccination for adults: Updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68(32):698-702.

10. Bower W, Schiffer J, Atmar R, et al. Use of Anthrax Vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;6(4):1-14.

11. Child Immunization Schedule Changes for 2020. Centers for Disease Control and Prevention website.

|18| Kentucky Pharmacists Association | March/April 2020

Include a quiz over the material. Usually between 10 to 12 multiple choice questions.

Articles are reviewed for commercial bias, etc. by at least one (normally two) pharmacist reviewers.

When submitting the article, you also will be asked to fill out a financial disclosure statement to identify any financial considerations connected to your article.

Articles should address topics designed to narrow gaps between actual practice and ideal practice in pharmacy. Please see the KPhA website (www.kphanet.org) under the Education link to see previously published articles.

Articles must be submitted electronically to the KPhA director of communications and continuing education (info@kphanet.org) by the first of the month preceding publication.

https://www.cdc.gov/vaccines/schedules/hcp/schedulechanges.html#child. Updated: 2020 Feb 3; accessed 2020 Mar 9.

April CPE Article Pre-exposure Prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) â&#x20AC;&#x201C; A Pharmacologic Review and the Role of the Pharmacist Author: Nina Carrillo University of Kentucky PharmD Candidate 2020; Frank Romanelli PharmD, MPH, FAPHA, BCPS, AAHIVP The author declares that there are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-0000-20-004-H02-P &T 1.0 Contact Hour (0.10 CEU) Expires 4/7/23

KPERF offers all CE articles to members online at www.kphanet.org

Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.

Recognize patients at increased risk of contracting human immunodeficiency virus (HIV).

2.

Evaluate at-risk patients and determine eligibility PrEP of HIV.

3.

Discuss pharmacologic options for PrEP and considerations when choosing agents.

4.

Understand the public health implications of PrEP and the pharmacistsâ&#x20AC;&#x2122; role in therapy.

Introduction

who need them.

This effort has heightened the already crucial role pharmacy can have in ending HIV by employing our comprehensive knowledge of disease states and medication management to ensure the proper prescribing and monitoring of preventative treatments, such as PrEP. When taken as prescribed, multiple studies have found that PrEP is safe and effective in the prevention of HIV. With regards to sexual exposure, PrEP appears to have an estimated effectiveness of 99% and an effectiveness of 74-84% with regards to intravenous drug use (IVDU).3 With some of the barriers related to drug costs having been eliminated by the U.S. Department of Health and Human Services (HHS) Ready, Set, PrEP The current presidential administration released Ending program, there is still a need for pharmacist-driven pubthe HIV Epidemic: A Plan for America in 2019 outlinlic education regarding the importance of PrEP in ating objective goals to eradicate HIV in the United States risk individuals. within 10 years by focusing on four key strategies: At-risk Populations 1. Diagnose all individuals with HIV as early as possiThe initial decline in HIV transmission rates have not ble. been all-inclusive, with some of the most at-risk popula2. Treat people with HIV rapidly and effectively to tions actually experiencing increases in new infections. reach sustained viral suppression.

Population specific studies have shown that men who have sex with men (MSM); minorities, especially Afri3. Prevent new HIV transmissions by using proven can Americans, Latinos, and American Indians and interventions, including PrEP and syringe services Alaska Natives; and those who live in the southern programs (SSPs).

United States have the highest risk of contracting the 4. Respond quickly to potential HIV outbreaks to get virus.2 needed prevention and treatment services to people Between 2010 and 2017 targeted HIV prevention measures have proven effective, yielding an average 11% annual decrease in new HIV diagnoses in the United States. Despite the FDA approval of antiretrovirals for pre-exposure prophylaxis (PrEP) in 2012, the Centers for Disease Control and Prevention (CDC) reported in 2019 that the once dramatic decline in new infections had stabilized with approximately 39,000 having been reported. 2 This plateau is believed to be directly attributable to the inadequate use of effective HIV prevention strategies, especially in high-risk patients that would most benefit from them.1,2

|19| www.KPHANET.org

The CDC estimates that approximately 1.1 million peo- Image 2. Geographic focus in phase I of Ending the HIV Epidemic: A Plan for America ple in the U.S. would benefit from PrEP, yet since approval in 2012 only an estimated 135,000 prescriptions have been filled, almost all of which have been white males who identified as MSM and reside in the Northeast and West Coast. Therefore, it is not surprising that there has been a substantial decline in infection rates among white, gay and bisexual men, but little change in African American men with the same sexual identity. Of further concern is the drastic increase in cases amongst the Latino MSM population.

Currently, 50% of new HIV cases occur among Black and Latino gay and bisexual men and approximately 15% occur among heterosexual women, with roughly three-quarter being women of color.5 The racial, gender, and geographic disparities associated with appropriate prescribing of PrEP are major obstacles in the push to end HIV and create specific targets for providers to focus their efforts.

As part of the first phase of the Ending the HIV Epidem- Who should receive PrEP? PrEP is approved for HIV negative patients who are at Image 1. CDC Fact Sheet; HIV Incidence: Estimated Annu- increased risk of disease acquisition from sex or injecal Infections in the U.S. 2010-2016 tion drug use.1 It is a common misconception that PrEP can only be prescribed by clinicians specialized in infectious disease or HIV. In reality, any licensed prescriber can initiate PrEP.3 A major faction of the federal push for HIV eradication is focused on educating primary care providers, who routinely see people at risk for HIV, on the importance of offering PrEP to eligible patients.5 Per the CDC’s updated 2017 PrEP guidelines, the following persons are considered at-risk and should be assessed for initiation of PrEP: 

Sexually active gay and bisexual men (MSM)

I. Any male sex partners in the past 6 months II. Not in a monogamous relationship with recently tested HIV-negative partner AND at least one of the following III. Any anal sex without condoms in the past 6 months 

ic: A Plan for America initiative, geographic regions with highly concentrated HIV diagnoses are being specifically targeted with preventative measures. In the United States, 48 counties and rural areas in seven states, including Kentucky, have been identified as having >50% of new HIV diagnoses in 2016 and 2017. Of the 220 counties nationwide identified by the CDC as high-risk for an HIV outbreak related to heavy IVDU, 54 were in Kentucky alone, highlighting the necessity of targeted preventative measures such as PrEP and SSPs in the commonwealth.6

A bacterial STI diagnosed in the past 6 months

I. Sexually active heterosexual men and women II. Any opposite sex partners in the past 6 months III. Not in a monogamous relationship with recently tested HIV-negative partner AND at least one of the following IV. Infrequently uses condoms during sex with 1 or more partners of unknown HIV status who are known to be at substantial risk of HIV infection (IVDU or bisexual male partner) V. Is in an ongoing sexual relationship with an HIVpositive partner

|20| Kentucky Pharmacists Association | March/April 2020

VI. A bacterial STI diagnosed in the past 6 months 

Sexually active transgender persons



Persons without HIV who inject drugs



Any injection of drugs not prescribed by a clinician in the past 6 months AND at least one of the following

 Any sharing of injection or drug preparation equip-

ment in the past 6 months  At risk for sexual acquisition

Table 1. Current PrEP Regimens in the United States1 Truvada® (F/TDF)

Descovy® (F/TAF)

Emtricitabine (F)

200 mg

Tenofovir disoproxil fumarate (TDF) Emtricitabine (F)

300 mg

Tenofovir alafenamide (TAF)

25 mg

200 mg

Considerations in agent selection: Truvada® (F/TDF) 1,8

Persons who have been prescribed non-occupational Recommended to prevent HIV infection among all perpost-exposure prophylaxis (PEP) and report contin- sons at risk through sex or injection drug use. ued risk behavior, or who have used multiple cours- Approved for use in eCrCl >60 ml/min es of PEP Potentially associated with small changes in renal and Baseline Assessment bone function Before a PrEP regimen can be initiated providers must Generic formulation expected in 2020 document three baseline laboratory values: Descovy® (F/TAF) 1,7 1. A negative HIV screening test and absence of acute HIV symptoms should be documented within Recommended to prevent HIV infection among persons at risk through sex, excluding people at risk through recepa week of initiating (or re-initiating) PrEP medicative vaginal sex. tions. 

a. Antigen/antibody tests using an approved FDA de- Approved for use in eCrCl ≥30 ml/min vice or assay preferred Linked to weight gain and changes in cholesterol b. Oral rapid tests should not be used Recommended monitoring after initiating PrEP: 2. Renal function should be evaluated prior to initiating PrEP due to the potential rare occurrence of acute renal Table 2. CDC Guidelines for Patient Monitoring on PrEP 1 failure from tenofovir. a. Refer to “Current PrEP Regimens” section below for specific agent recommendations

3 months after PrEP initiation:

· Patient specific tests: MSM: screen for bacterial STIs

a. HBV infection is not a contraindication to PrEP, however, if PrEP is initiated, these patients’ liver function should be closely monitored for reactivation of HBV. Currently, two combination antiretroviral medications are FDA approved for PrEP in adults and adolescents weighing at least 35 kg. Both medications contain two antiretroviral agents in a single oral dosage form intended to be taken once daily. Prescribing of these medications should be considered as part of a comprehensive prevention plan that includes discussions regarding adherence to PrEP, condom use, other sexually transmitted infections (STIs), and other risk reduction methods.1

· Measure SCr and eCrCl · Provide medication adherence and behavioral risk reduction support.

3. Current Hepatitis B (HBV) status should be documented due to the potential of rebound hepatitis if treated with PrEP and abruptly discontinued.

Current PrEP Regimens

· Test for HIV

Women with reproductive potential: pregnancy test

Every 3 months after first 3-month follow-up:

IVDU: assess access to sterile needles/ syringes and to drug treatment services · Test for HIV · Provide medication adherence and behavioral risk reduction support. · Patient specific tests: MSM: screen for bacterial STIs Women with reproductive potential: pregnancy test

Every 6 months after the first 3month follow-up:

IVDU: assess access to sterile needles/ syringes and to drug treatment services · Measure SCr and eCrCl · For all sexually active patients: Screen for bacterial STIs

|21| www.KPHANET.org

Of note, both Truvada® and Descovy® are manufactured by Gilead Sciences Inc., with Truvada® gaining FDA approval for PrEP in 2012 and Descovy® in 2019.

Gilead has argued that F/TAF is safer and more effective than the latter F/TDF, which has a generic option anticipated this year.10 However, a recent study compared the available data on the safety, efficacy, and public health context for the two PrEP regimens. The efficacy of F/TDF is backed by robust data in all priority populations at risk for HIV, including gay and bisexual men, transgender women, people who inject drugs, and heterosexual people whose partners are living with HIV. The only efficacy data for F/TAF comes from the DISCOVER trial, which only evaluated use in gay and bisexual men and a small number of transgender women, but excludes other at-risk populations.9,10 It is therefore recommended that Truvada® (F/TDF) remain the first-line agent for the majority of PrEP users.9,10

come previous adherence barriers and help to build patient trust. Similarly, encouraging patients to follow-up with their provider and reinforcing the importance of routine monitoring (Table 2) can assist in overall efficacy of PrEP. In addition to medication counseling, reiterating that PrEP is only one part of a comprehensive prevention plan. Additional measures such as condom use and other risk reduction methods should be discussed.

2. Providing community education Pharmacists can provide unbiased, evidence-based answers to decrease the spread of unfounded beliefs and stigma surrounding PrEP, especially in rural areas where patients may have an innate distrust of the healthcare system.

Having varied resources available to patients of different health literacy levels and languages can assist in not only Additionally, it is argued that if F/TDF is perceived as reducing barriers to education, but also build trust beless safe than the newer alternative, coupled with patient tween patients and providers. misconception that brand name is superior to generic, The CDC provides numerous resources in both English there might be significant public health and economic implications of opting for the newer Descovy® over the and Spanish specific to your community at the following less expensive generic F/TDF option.9 These public con- link: cerns of efficacy and cost, as well as importance of adher- https://www.cdc.gov/stophivtogether/index.html ence and patient education, are critical roles for pharma3. Identifying at-risk populations cists in terms of dissemination of information to at-risk populations.

Disparities amongst populations treated with PrEP remain particularly troublesome in rural areas, the South and among African-Americans and Latino populations.

Pharmacists have a unique role as one of the most widely With Kentucky being one of the seven states identified as accessible health care professionals. In addition to our being high-risk for an HIV outbreak, it is important that comprehensive knowledge of medications and disease all health professionals assist in identifying at-risk popustates, we often build strong relationships with patients lations. and are considered trusted health professionals. Because Providing patients that are considered high-risk for infecof this, an increasing number of states have introduced tion due to sexual behavior or intravenous drug use with legislation allowing pharmacists to prescribe and dispense HIV PrEP and PEP medications. Currently, phar- evidence-based educational information on HIV transmacists in California, Colorado, Missouri, New Hamp- mission as well as available providers in the area is a useshire, New Jersey, New York, Utah and Washington all ful tool in decreasing the stigma surrounding HIV and PrEP. As previously mentioned, pharmacists often build have prescriptive authority for PrEP, with introduction trusting relationships with their patients and can thereof similar legislature in other states anticipated this 12 year. Though Kentucky does not yet have prescriptive fore be at the forefront of a lifesaving intervention. authority for PrEP medications, the profession of pharThrough the National Prevention Information Network, macy can continue to improve public health outcomes providers in your community that offer PrEP can be through direct patient care and the following intervenfound at the following link: tions: https://npin.cdc.gov/preplocator 1. Increasing medication adherence & monitoring The “Let’s Stop HIV Together” campaign makes educaAppropriate daily adherence is crucial for these medica- tional resources easily accessible for providers and pations to be effective. Providing patient education and tients. In addition, informative display posters and pamcounseling on importance of adherence prior to dispens- phlets can be obtained from the below resource to ining is a simple, but valuable intervention. Methods for crease patient understanding and desire to discuss PrEP. increasing adherence, such as a pill-planner, unit-dose packs and instructions in their native language can over- https://www.cdc.gov/stophivtogether/index.html Role of the pharmacist

|22| Kentucky Pharmacists Association | March/April 2020

4. Decreasing cost barriers

1-866-512-3861

One major barrier to receiving PrEP is cost. One year of PrEP can cost an uninsured patient roughly $24,000, leaving the most vulnerable populations unable to afford the hefty price tag.10 Until the US Preventive Services Task Force gave PrEP a grade A recommendation in June of 2019, even patients with private insurance were subject to high copays that were often unaffordable.11 In addition to drug costs, required laboratory tests and routine provider check-ups while taking PrEP are generally not covered by most insurers. The new grade A recommendation requires private insurers to now cover PrEP at no cost to their policyholders. However, there is concern that insurers will now require a lengthy prior authorization process before approving payment, leading to delay in therapy or abandonment altogether by the patient.11 Increasing pharmacy communication with providers and relaying vital information to patients can help to lessen these repercussions and encourage patients to continue to seek PrEP.

PrEPCost.org: website to help patients choose the best marketplace health plan to cover PrEP Prepcost.org Please PrEP Me – Kentucky: comprehensive information on PrEP including cost savings programs and financial assistance specific to Kentucky. pleaseprepme.org/Kentucky Conclusions

With the national charge to end HIV by 2030 through the implementation of federal programs outlined in President Trump’s Ending the HIV Epidemic: A Plan for America, there is a clear role for pharmacists to contribute to this public health cause. Through patient education, multidisciplinary communication and advocacy for PrEP, pharmacists can target populations that are at highest-risk and have previously had poor uptake in preventative strategies. The value that pharmacy can add is Most state Medicaid programs have expanded coverage even more influential in rural Kentucky, where misconto include Truvada® for PrEP as well as associated clin- ception, lack of medical access and drug costs are major barriers. By readily supplying patients with PrEP reical and laboratory work. However, in many southern states where HIV infection rates are high, Medicaid has sources, being a voice of education to the public and renot been expanded and patients may have less access to maining knowledgeable on new preventative regimens PrEP.11 As of February 2020, all of the Kentucky Medi- and considerations for patients, the profession of pharcaid formularies include Truvada® as a preferred drug, macy has a unique role in ending the HIV epidemic. but may have different stipulations such as quantity limits and prior authorizations before covering, which could further hinder patient access.

Commonly working closely with patients and their insurance providers, pharmacists can reduce the financial burden of PrEP by providing their patients with resources. There are several financial programs available to decrease the cost of PrEP and increase patient access: Ready, Set, PrEP Program: offers PrEP completely free to patients who are uninsured or without prescription drug coverage.

Kentucky Professionals Recovery Network (KYPRN) is a free-standing organization that provides confidential monitoring of licensed professionals struggling with the disease of addiction.

www.getyourprep.com 1-855-447-8410 Gilead Advancing Access ®: offers a medication assistance program for uninsured patients and a copay assistance program for those with commercial insurance.

However, the patient may still incur some costs.

www.kyprn.com

GileadAdvancingAccess.com 1-800-226-2056 Patient Advocate Foundation: offers copay relief for all insurance types for patients 400% or less of the Federal Poverty Guideline.

Copays.org/funds

jobs.kphanet.org THE location for pharmacy job seekers + employers for targeted positions. |23| www.KPHANET.org

April 2020—Pre-exposure Prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) – A Pharmacologic Review and the Role of the Pharmacist 1. Which of the following patients would not be considered at-risk for contracting HIV? A. Adolescent African American heterosexual male with multiple, unprotected sexual partners and history of chlamydia B. Homosexual Caucasian female with monogamous, HIVnegative partner C. Sexually active bisexual Latino male not in monogamous relationship D. Heterosexual Caucasian male IV drug user who confirms needle sharing behavior

6. Which of the following resources would be best for a patient who is uninsured, unable to currently enroll in insurance and unable to afford the prescription costs of PrEP? A. Ready, Set PrEP Program B. Patient Advocate Foundation C. CDC.gov D. Gilead’s copay assistance program 7. Which of the following states is not currently considered at high-risk for an HIV outbreak?

A. Kentucky

2. Which of the following should be documented within a week of initiating PrEP?

B. Tennessee

A. Hepatitis C status

D. Oklahoma

B.

Liver Function values

C. HIV Ag/AB screening D. Partner(s) HIV status 3. Which of the following patient populations is considered a candidate for PrEP with Descovy®?

C. Alabama

8. Efficacy and safety data for Descovy® comes from the DISCOVER trial, but did not evaluate which of these atrisk patient populations?

A. Homosexual men B. Small number of transgender women

A. Transmission through IVDU

C. Bisexual men

B. Transmission through vaginal intercourse

D. Heterosexuals living with HIV(+) partners

C. Renal failure patients with eCrCl <15 mL/min

9. The largest increase in newly reported HIV infections between 2010 and 2016 occurred in which high-risk patient population, making them a key target population for current campaigns?

D. Sexual transmission in MSM 4. A negative HIV Ab/Ag screening assay should be documented every months after initiation of PrEP. A. 6 B. 3 C. 4 D. 12

A. African American heterosexual women B. Latino gay and bisexual men C. White gay and bisexual men D. People who inject drugs

5.True or False: Active Hepatitis B infection is an absolute contraindication to the initiation of PrEP?

10. The Ending the HIV Epidemic: A Plan for America federal campaign recommends which of the following preventative services in addition to PrEP?

A. True

A. Syringe services programs (SSPs)

B. False

B. Rapid treatment programs (RTP) C. Act Against AIDS (AAA)

|24| Kentucky Pharmacists Association | March/April 2020

This activity is a FREE service to members of the Kentucky Pharmacists Association.

The fee for non-members is $30. Mail completed forms to: KPERF, 96 C Michael Davenport Blvd., Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

Expiration Date: 4/7/23 Successful Completion: Score of 80% will result in 1.0 contact hours TECHNICIANS ANSWER SHEET. April 2020—Pre-exposure Prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) – A Pharmacologic Review and the Role of the Pharmacist (1.0 contact hours) Universal Activity # 0143-0000-20-004-H02-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 2. A B C D

3. A B C D 4. A B C D

5. A B 6. A B C D

7. A B C D 8. A B C D

9. A B C D 10. A B C

Information presented in the activity:

Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________ Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

PHARMACISTS ANSWER SHEET April 2020—Pre-exposure Prophylaxis (PrEP) of Human Immunodeficiency Virus (HIV) – A Pharmacologic Review and the Role of the Pharmacist (1.0 contact hours) Universal Activity # 0143-0000-20-004-H02-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________

PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 2. A B C D

3. A B C D 4. A B C D

5. A B 6. A B C D

7. A B C D 8. A B C D

9. A B C D 10. A B C

Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieved the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No If yes, please explain on a separate sheet.

Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party.

Signature ____________________________________________Completion Date___________________________

Personal NABP eProfile ID #_____________________________ Birthdate _______ (MM)_______(DD)

The Kentucky Pharmacy Education & Research Foundation is accredited by The Accreditation Council for Pharmacy Education as a provider of continuing Pharmacy education. |25| www.KPHANET.org

Pharmacy Policy Issues The Continuing Challenge of Drug Product Shortages Author: Shelby L. Ferrell is a member of the Pharm.D. class of 2021 at the UK College of Pharmacy. A native of Lexington, KY, she completed her pre-professional education at the University of Kentucky while earning the degree Bachelor of Public Health.

Issue: I recall hearing about drug shortages perhaps five years ago, but then that issue seemed to go away and now it is back in the news again. I suspect that is most likely due to the hurricane that hit Puerto Rico.

50mL and 100mL IV Saline was hit. Hospitals reacted by switching to medium size bags and when those ran out, they switched to large bags, exacerbating the drug shortage.

With flu season on the rise, hospitals became overwhelmed Discussion: The FDA identifies the following quality man- with patients requiring IV saline products. Healthcare profesufacturing issues as the source for drug shortages: facility re- sionals were urged to think twice prior to ordering saline. If mediation efforts; product manufacturing issues; discontinua- the patients were able to take oral fluids, then they were given fluids by mouth instead of IV. An effort was made to give tion of product; raw materials shortage; other component patients Gatorade® or Pedialyte® when appropriate, while shortage; increased demand, and loss of manufacturing. In not withholding IV fluids to those that required their medical2013, oncology injectable medications were in short supply. ly necessary use. Nurses have been instructed to “push” the This drug shortage was due to manufacturing issues such as drugs and fluids instead of relying on an IV saline product. lack of quality of the product, at that time related to sterility and impurities leading to large number of recalls. UnfortuAs of November 30, 2017, the FDA Commissioner Scott nately, sterile injectables require a complex manufacturing Gottlieb, M.D., released a statement to update on the Puerto process. The FDA has tried to mitigate drug shortages by Rico related drug shortages. In his statement he noted that encouraging the manufacturers to notify the FDA when a the electricity supply had been “reliably restored”, though potential shortage may occur. There has been a decrease in many manufacturers would continue to use a generator or the number of drug shortages in recent years, pointing to this require a generator for backup. Over the next few weeks, the as a success, but what can be done when an unexpected disFDA responded to drug shortages for IV saline products and aster strikes and drug shortage is unforeseen? amino acids for injection by monitoring approximately 90 On September 20, 2017, Hurricane Maria, a Category Four hurricane, made landfall on Puerto Rico. Puerto Rico has been noted as the world’s largest hub for drug manufacturing, producing 13 of the world’s largest selling brand-name drugs.

Over 80 manufacturing plants were affected when Hurricane Maria wreaked havoc on the island.

medical products – drugs, biologics and devices. The FDA approved IV saline products from two additional manufacturers to offset the shortage; both companies increased saline production. The FDA was able to activate a temporary importation of amino acids for injection from the same manufacturer but from a different facility.

Two weeks later most of the island lack electricity. Manufacturers resorted to using diesel fuel generators, a temporary fix. An unstable electric supply puts the manufacturer at risk for drug degradation if the system were to fail. This could result in their medications losing their effectiveness and not being safe for patient use. With Puerto Rico being a major source of critical drugs for life-threatening disease states, the FDA stepped in to assess the issue; the agency reported a list of 40 drugs that were the focus of their concern. Of these 40 drug products, 12 of them were considered “sole-source” meaning that only one company made the product.

As of January 4, 2018, the FDA Commissioner released an updated statement that efforts were still being made to mitigate shortages of IV saline products and amino acid for injection. In his statement, he noted that all facilities had returned to the power grid and reported that the shortage would improve early in the year. Manufacturers have reportedly increased their production to offset the shortage.

Since 2014, the United States has been experiencing a shortage of IV saline products; this shortage was further escalated by natural disaster when Baxter, a major company supplying

The FDA drug shortage website contains the most updated information regarding product availability. Hospitals have reported that they have products nearing expiration. FDA has asked the companies to submit data to extend expiration dates. If approved, IV saline products could be used safely past the expiration date originally noted.

Continued on p. 31

|26| Kentucky Pharmacists Association | March/April 2020

Campus Corner Innovation & Agility: The Power of a Pharmacist in the Community Author: Jacob Lewis, UK College of Pharmacy To call Cathy Hanna successful would be an understatement. A member of the University of Kentucky College of Pharmacy (UKCOP) Class of 1986, Hanna went on to earn her PharmD from UKCOP in 2004 after earning her BS in Pharmacy and has been focused on enhancing the community pharmacy experience ever since.

precept incoming pharmacy students and helping to develop educational programs for the general public.

Hanna emphasizes training pharmacists to get out from behind the counter and implementing new services. Fighting to expand the role of the pharmacist to include immunization training and being able to assist in diabetes care are just a few of the impacts Hanna has had. This serves to make pharmacists a more dynamic part of the patient-care system and can help improve overall patient care.

Being open to change is especially important when it comes to patient care; the healthcare industry changes frequently, necessitating pharmacists be able to adjust their practice at any given moment. It’s for that reason that Hanna is a major adShe didn’t start out in pharvocate for expanding upon the Entrustable Professional Activmacy school though; Hanities (EPAs). Providing students with a fluid and regularly na received her first degree updating curriculum is crucial in ensuring that all new pharas a Bachelor of Science in macy graduates are equipped with the proper skill set to thrive Cathy Hanna Agriculture Economics at in the outside world.

UK. This major change is the first example of what would soon become a defining asHanna credits the University of Kentucky for instilling the pect of her career: adaptability. importance of adaptability in her, saying, “UK has always been at the forefront of pharmacy and has inspired me to keep Hanna’s experience spans all the way from retail pharmacy, a pushing and be ready to accept challenges as they come.” consultant pharmacist, and even starting her own long-term Hanna’s drive and dedication have made her a vital member care practice. Running her own business pushed Hanna out of of the UKCOP family, and she will continue to have an imher comfort zone and challenged her in more ways than one, pact as she guides the next generation of student pharmacists.

“Everything I’ve done as a pharmacist has led me to another journey and allowed me to do things I never thought I was capable of. And I have loved every bit of it.” said Hanna.

Hanna’s passion for patient care and dedication to pharmacy led her to be a part of the American Pharmacy Services Corporation (APSC). Now, Hanna is the Vice President of Professional Affairs and has helped to facilitate a relationship between APSC and the University of Kentucky. APSC includes over 400 independently run community pharmacies and now offers a residency program through the University of Kentucky College of Pharmacy via their partnership with Wheeler Pharmacy.

Through Wheeler Pharmacy, a Lexington staple since 1958, pharmacy residents are involved in all aspects of running a community pharmacy. Like Hanna’s experience, residents are exposed not only to the pharmaceutical side of the job, but also the behind the scenes aspects like development, design, marketing, and implementation of enhanced pharmacist care and clinical services.

Continued from Feature Story pg. 8 National Community Pharmacists Association, visit www.ncpanet.org. Contact: Jack Mozloom, (703) 600-1177, or Jack.Mozloom@ncpa.org Arkansas Pharmacists Association, visit www.arrx.org.

Contact: Jordan Foster, (501) 944-6450, or jordan@arrx.org American Pharmacists Association, visit www.pharmacist.com. Contact: Chad Clinton, (202) 429-7558, or cclinton@aphanet.org

Hanna’s dedication to educating new pharmacists on all aspects of the industry is evidenced through her involvement in the residency program; participants are able to learn how government regulations and policy impact community pharmacy, |27| www.KPHANET.org

|28| Kentucky Pharmacists Association | March/April 2020

Welcome to KPhA! We’re so happy to have you!

The list reflects new memberships received from January 1, 2020— February 29, 2020.

Brent Bridges, Henderson Jordan Caldwell, Prestonsburg Brittany Dominick, Lexington Adria Eubanks, Lewisport Ethan Gibson, Lexington Amanda Gillum, Ashland Joan Haltom, Danville Julie Hines, Lexington Kathy Jones, Glasgow Hope Maniyar, Louisville Erik Mayes, Louisville

Justin Mills, Louisville Billy Rowe, Pikeville Kim Rowe, Pikeville Patricia Steele, Somerset Taylor Sullivan, Owensboro

|29| www.KPHANET.org

Pharmacy Law Brief Insights about Law School Author: Joseph L. Fink III, BSPharm., JD, DSc (Hon), FAPhA, Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy Question: During a somewhat slower period at the pharmacy I was talking with a patient whose daughter is starting her undergrad studies this year with the ultimate goal of attending law school. As the conversation progressed we both acknowledged that we didn’t know much about law school.

Can you provide some background or context?

Response: Law school is three years in duration with a curricular structure and instructional approach that differs quite a bit from pharmacy school. The first-year curriculum consists of all required courses. This include courses such as civil procedure, contracts, property, and torts, in addition to an extensive introduction to legal research and writing. After that academic year, nearly all the other courses in the 90 semester credit hour curriculum are elective except for Professional Responsibility, the legal ethics course.

The magnitude of elective choices is surprising to some because many people assume that certain courses that are not required would be – wills and estates or law of evidence, for example. This degree of flexibility enables the law student to focus or specialize to some degree while in law school. For example, I had a roommate who knew he want to specialize in tax law. So during the four semesters after completing firstyear course work he was able to schedule six tax law courses.

This flexibility of schedule planning also enables one to explore areas or topics in the law that may be appealing. It also highlights the importance of selecting a law school with a larger number of course offerings. An additional requirement one would see in many law school curricula is that during each of the final four semesters the student must take at least one course with a substantial legal research and writing requirement. The law is all about words, their proper use and their impact.

The instructional approach used in many law school classes is known as the Socratic Method because it was adopted and fine-tuned by Socrates many centuries ago. The students will have been given a number of items to read to prepare for the class session and when the class begins the instructor will call upon a student to recite about the case, let’s say. The instructor will pepper the student with questions as the recitation unfolds, all in an attempt to prepare students for what they may well face upon graduation, either from a judge in court or from a legislator in the legislature. So, in essence, the students teach the course with the instructor conducting the flow

Disclaimer: The information in this column is intended for educational use and to stimulate professional discussion among colleagues. It should not be construed as legal advice. There is no way such a brief discussion of an issue or topic for educational or discussion purposes can adequately and fully address the multifaceted and often complex issues that arise in the course of professional practice. It is always the best advice for a pharmacist to seek counsel from an attorney who can become thoroughly familiar with the intricacies of a specific situation, and render advice in accordance with the full information.

of classroom conversation. One who is thinking about going to law school can arrange to sit in on a class to see this in action. Another way to get a glimpse of that format would be to view the 1970’s movie, The Paper Chase, starring John Houseman as Prof. Charles Kingsfield. In the role for which he was recognized with the Academy Award for Best Supporting Actor, this actor truly captured the mien of a law professor and the resultant angst of a law student.

To gain admission the student must have an undergraduate degree but the field of major academic focus is not as constrained as one might think. Traditionally, many law students had completed degrees in political science or history. It is noteworthy that “pre-law” is not an academic major; it is an intention. Now law schools emphasize that the field of study is not as important as is taking courses that require writing and logical reasoning. The focus should be on developing skills of value to one entering a professional field whatever it may be – listening, analyzing, communicating, and creative problem solving.

Taking the Law School Admission Test is a requirement for admission and the score on that is evaluated along with the applicant’s academic transcript, letters of reference, and perhaps the assessment of an interview.

There are slightly over 200 law schools in the U.S. for which accreditation is handled by the American Bar Association Section of Legal Education and Admissions to the Bar [see https://www.americanbar.org/ groups/legal_education/].

There are three in Kentucky. The degree conferred on one completing the law school curriculum is Juris Doctor, a professional doctorate parallel to many others in the same category, e.g., DMD, VMD, MD, DO, OD, PharmD, DNP, DPM, DPT, etc.

It has been estimated that about seventy percent of law

|30| Kentucky Pharmacists Association | March/April 2020

school graduates in the U.S. embark on a career of active law practice. The others pursue opportunities where their skills are valuable but where admission to the bar is not a requirement. For example, two of the most prominent commercial real estate developers in Lexington over the year were two brothers who both had graduated from the UK College of Law.

tional Conference of Bar Examiners. The Multistate (MBE) bar examination, consisting of 200 multiple choice questions, is graded by the National Conference of Bar Examiners (NCBE).”

Pharmacy Policy Issues Continued from p. 26

hurricane-maria-pharmaceutical-manufacturers.html

Kentucky follows an approach known as having an “integrated bar”, meaning that attorneys admitted to practice in Kentucky must be members of the Kentucky Bar AssociaEach state has a Board of Bar Examiners to supervise the ad- tion. This requirement exists because the KBA is responsible mission to practice, similar to what the Board of Pharmacy for enforcing standards of professional practice, a role disdoes for pharmacists. The two-day examination is described charged in pharmacy by the Kentucky Board of Pharmacy. this way by the Kentucky Office of Bar Admissions: The KBA also monitors attorneys’ compliance with continuing legal education (CLE) requirements for renewal of licen“The first day is devoted to the Kentucky essay portion of the sure. That expectation is a total of twelve hours of CLE credit examination, which is prepared and graded by the Board of per year, with two of those twelve dealing with ethical issues.

Bar Examiners and the Multistate Essay Examination (MEE), which is prepared by the National Conference of Bar Examiners (NCBE). The essay portion of the exam consists of six (6) Kentucky essay questions and six (6) Multistate Essay (MEE) questions. The second day is devoted to the Multistate (MBE) Bar Examination, which is prepared by the Na-

https://www.theatlantic.com/science/archive/2017/10/ what-happened-in-puerto-rico-a-timeline-of-hurricaneAs of January 31, 2018 the FDA alerted health care professionals of thirteen IV saline products (Sodium Chloride, Man- maria/541956/ nitol, Dextrose, Potassium Chloride) manufactured by Baxter HealthCare Corporation to be used beyond the manufacturer’s expiration date. The extended shelf life of these products varied from an additional 13 days to 9 months.

In conclusion, pharmacists should review their protocols for drug shortages within their facility. It is important to develop a protocol in advance so all healthcare professionals within the facility are on agreement as to the conservation of products. Pharmacists can receive the most updated information regarding drug shortages by visiting the FDA website.

Resources: https://www.fda.gov/downloads/AboutFDA/ CentersOffices/OfficeofMedicalProductsandTobacco / CDER/UCM516143.pdf https://www.fda.gov/Drugs/DrugSafety/DrugShortages/ ucm593084.htm http://www.biopharminternational.com/fda-warns-aminoacid-shortage-due-hurricane-maria-0 https://www.fda.gov/NewsEvents/Newsroom/ PressAnnouncements/ucm591391.htm https://www.nytimes.com/2017/10/04/health/puerto-rico|31| www.KPHANET.org

|32| Kentucky Pharmacists Association | March/April 2020

|33| www.KPHANET.org

KPhA BOARD OF DIRECTORS Chris Palutis, Lexington chris@candcrx.com

Chair

Don Kupper, Louisville donku.ulh@gmail.com

President

Joel Thornbury, Pikeville jthorn6@gmail.com

President-Elect

Brooke Hudspeth, Lexington brooke.hudspeth@kroger.com

Secretary

Chris Killmeier, Louisville cdkillmeier@hotmail.com

Treasurer

Chris Harlow, Louisville cpharlow@gmail.com

Past President Representative

Directors

Jessika Chilton, Beaver Dam jessikachilton@ymail.com

Chair

Clark Kebodeaux, Lexington clark.kebodeaux@uky.edu

Secretary

Chris Killmeier, Louisville cdkillmeier@hotmail.com

Treasurer

Don Kupper, Louisville donku.ulh@gmail.com

President, KPhA

Kevin Lamping, Lexington kevin.lamping@twc.com

KPhA Staff University of Kentucky Student Representative

Chad Corum, Manchester pharmdky21@gmail.com

Mark Glasper Executive Director mglasper@kphanet.org Sarah Franklin Director of Communications & Continuing Education sarah@kphanet.org

Cathy Hanna, Lexington channa@apscnet.com

Angela Gibson Director of Finance & Administrative Services agibson@kphanet.org

Cassy Hobbs, Louisville cbeyerle01@gmail.com

Jeff Mills, Louisville jeff.mills@nortonhealthcare.org

Bob Oakley, Louisville rsoakley21@gmail.com

Sarah Lawrence, Louisville slawrence@sullivan.edu

Matt Carrico, Louisville matt@boonevilledrugs.com

Anthony Seo, Louisville jseo0516@my.sullivan.edu

KPERF BOARD OF DIRECTORS

Paul Easley, Louisville rpeasley@bellsouth.net

Angela Brunemann, Union Angbrunie@gmail.com

Scotty Reams, London scotty.reams@uky.edu

*At-Large Member to Executive Committee

Sullivan University Student Representative

Jody Jaggers, PharmD Director of Public Health jjaggers@kphanet.org

Richard Slone, Hindman richardkslone@msn.com

Jessica Johnson, PharmD Director of Pharmacy Education Jessica@kphanet.org

Ben Mudd, Lebanon* Speaker of the House bpmu222@gmail.com

Michele Pinkston, PharmD, BCGP Director of Emergency Preparedness Michele@kphanet.org

Martika Martin, Somerset Vice Speaker of the House 12marmar@gmail.com

Lisa Atha Office Assistant/Member Services Coordinator latha@kphanet.org

Misty Stutz, Crestwood mstutz@sullivan.edu |34| Kentucky Pharmacists Association | March/April 2020

“If individual pharmacists continue to remain politically naïve or inactive, a power vacuum will continue to exist, so that other groups will continue to move in and make decisions which may be vital to pharmacy’s best interests.”

- From The Kentucky Pharmacist, March 1970 Volume XXXIII, Number 3

Frequently Called and Contacted Kentucky Board of Pharmacy

Kentucky Regional Poison Center

State Office Building Annex, Ste. 300

(800) 222-1222

125 Holmes Street

American Pharmacists Association (APhA)

Frankfort, KY 40601

2215 Constitution Avenue NW

(502) 564-7910

Washington, DC 20037-2985

www.pharmacy.ky.gov

(800) 237-2742

Pharmacy Technician Certification Board (PTCB)

www.aphanet.org

2215 Constitution Avenue

National Community Pharmacists Association (NCPA)

Washington, DC 20037-2985

100 Daingerfield Road

(800) 363-8012

Alexandria, VA 22314

www.ptcb.org

(703) 683-8200 www.ncpanet.org

Kentucky Society of Health-System Pharmacists

National Association of Chain Drug Stores (NACDS) 1776 Wilson Blvd., Suite 200 Arlington, VA 22209 www.nacds.org 703-549-3001

info@ncpanet.org

P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 www.kshp.org info@kshp.org

KPhA/KPERF HEADQUARTERS 96 C Michael Davenport Blvd.

Frankfort, KY 40601 502.227.2303 (Phone) 502.227.2258 (Fax) info@kphanet.org www.kphanet.org www.facebook.com/KyPharmAssoc www.twitter.com/KyPharmAssoc www.youtube.com/KyPharmAssoc |35| www.KPHANET.org

THE

Kentucky PHARMACIST 96 C Michael Davenport Blvd.

Frankfort, KY 40601