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MICHIGAN T H E O F F I C I A L J O U R N A L O F T H E M I C H I G A N P H A R M A C I S T S A S S O C I AT I O N

COVID-19: THE RACE TO IMMUNIZE PBM REFORM

2021 Apr./May/June | Vol. 59, Issue 2

MPA-backed legislation to reign in PBMs is moving quickly through the state Legislature. (p. 12)

OUTBREAK TO VACCINES

So much has happened since the onset of the COVID-19 pandemic. A brief history can put it all in perspective. (p. 16)

MichiganPharmacists.org

PHARMACIST OATH

Community pharmacists have faced a daunting year, lending fresh insight to the Oath of the Pharmacist. (p. 24)

IN THIS ISSUE LEGISLATIVE UPDATE

PROFESSIONAL AFFAIRS

ADV TECH CERTIFICATION

3 President’s Platform

8 S tudent Focus

10 From the Foundation

18 Convention & Expo

24 MSCP Focus

26 Legal Insights

In a year of unprecedented change, MPA President Heather Christensen addresses how community pharmacists are adapting.

MPA’s first virtual convention was a success. Get the recap of exciting events and see our honorable 2020-2021 award winners.

Embracing our mission means more than excellent patient care — it also means advocating for opportunities to better serve them.

The Oath of the Pharmacist has taken on new meaning during the COVID-19 pandemic, and even greater importance.

MPF is always looking to expand its positive impact — sending back what it receives in gifts like a boomerang in reverse.

Vaccine ethics have never looked quite like this. Learn how pharmacy professionals can navigate these uncharted waters.

EDITOR: Mark Glasper; ASSOCIATE EDITOR: Dianne E. Malburg; MANAGING EDITOR: Mary Beth Wardell Michigan Pharmacist (ISSN 1081-6089) is the official journal of the Michigan Pharmacists Association, published four times a year at 408 Kalamazoo Plaza, Lansing, MI 48933. Publication Number: USPS-345-600. Phone: (517) 484-1466, Fax: (517) 484-4893 Website: www.MichiganPharmacists.org, E-mail: MPA@MichiganPharmacists.org, Advertising Information: Visit www.MichiganPharmacists.org/news/advertising or contact Mary Beth Wardell, MPA communications manager, at (517) 377-0232 or MaryBeth@MichiganPharmacists.org

MichiganPharmacists.org

All opinions expressed in Michigan Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Michigan Pharmacist is subject to the standards established by the Association. Michigan Pharmacist is distributed as a regular membership service, paid for through allocation of membership dues. Nonpharmacist subscriptions are $40 annually. Postmaster send address changes to: 408 Kalamazoo Plaza, Lansing, MI 48933. Periodical postage paid at Lansing, Mich. Nothing in this publication may be reproduced in any manner, either in whole or in part, without specific written permission of the publisher. © Michigan Pharmacists Association, 2021

— PRESIDENT’S PLATFORM —

COMMUNITY PHARMACY:

Growing through a Time of Change

s we come off another successful Michigan Pharmacists Association (MPA) Annual Convention & Exposition (ACE), I welcome the added brightness as more sunlight points to springtime and change. Like the changes we see with spring blooming around us, we want to recognize the awesome changes that are occurring and that are possible right now for community pharmacy professionals.

BY HEATHER CHRISTENSEN,

Pharm.D., clinical pharmacy specialist, ambulatory care, Spectrum Health West Michigan; president, Michigan Pharmacists Association

Community pharmacy, often referred to as retail pharmacy, is the heart of what our community knows pharmacy to be and where most of the pharmacy teams across America work every day. At the ACE, we celebrated a community pharmacy team at Meijer with the “Excellence in Innovation Award.” This team of pharmacy professionals worked closely with Michigan Medicine under a collaborative practice agreement to manage patients with hypertension. Their work demonstrated improved outcomes, bringing patients to controlled hypertension and significantly increasing patient access and satisfaction. This serves as another example to share with policymakers that changing wording to recognize pharmacists as providers should no longer be controversial.

• Requiring PBMs be registered to operate in the state: This has multiple implications. Particularly, any willing pharmacy that has entered into a contract shall be included in the network to provide services for patients in their community. Recently, PBMs in Michigan prevented a group of pharmacies from participating in a network, thereby preventing long-time patients from using that pharmacy. Patients were forced to go to a new pharmacy if they wanted to use their pharmacy benefit, and often it was not near where they lived. This was particularly hard for smaller communities and Medicaid patients, many of whom do not have the option to use their pharmacy benefit.

Another noteworthy development for community pharmacies came in February when State Rep. Julie Calley (R-Portland) introduced House Bill 4348. This legislation, which is moving quickly through the legislative process, will, among other reforms, license pharmacy benefit managers (PBMs) in Michigan. Our state is one of only 25 that does not already do this, which has been an ongoing detriment for community pharmacies. I predict difficult discussions will come out of this bill, but transparency and equitable reimbursement of prescriptions and supplies for Michigan pharmacies is a must. With fair reimbursement, we can focus on improvements to the workplace environment and allow for meaningful advancements.

There are so many things community pharmacy professionals are working on to improve themselves and patient care. Continuing the annual tradition, the Michigan Society of Community Pharmacists (MSCP) has partnered with the Michigan Society of Pharmacy Technicians (MSPT) to host a virtual event, “Live Your Best Life,” on Saturday, May 15, from 9 a.m. to 4 p.m. It offers five hours of live continuing education credit. As pharmacy workplace balance is a continued focus of the staff and leadership of MPA, this event also emphasizes strong workplace support, which will enhance the care of our patients and communities as well. I remember my days working in community pharmacy when patients would ask me if they could speak to

“It is with excitement that I continue to watch community pharmacy professionals evolve, pioneering solutions amidst constant change themselves.” A few highlights of HB 4348 include:

• Prohibition of clawbacks: For those that are unfamiliar, PBMs review dispensations months after they have already reimbursed the pharmacy. If there are details they don’t support within the real-time adjudication of prescriptions, the PBM can take back those reimbursements. Today, the national average for clawbacks in a year is $100,000 per pharmacy.

• Requiring PBMs to reimburse the pharmacy for the cost of the drug dispensed: It is odd in a free market society that this is even something that needs to be reviewed in legislation.

the druggist. So much history in that question. It is with excitement that I continue to watch community pharmacy professionals evolve, pioneering solutions amidst constant change themselves. The pandemic led to increased demand on the distribution of labor, resulting in pharmacy technicians’ expanded role in immunization. The MPA House of Delegates in February approved Resolution 21-05 to pursue legislative changes to allow pharmacists to prescribe vaccines autonomously, even after the COVID-19 pandemic. There is great work being done all around us. I am proud and optimistic about what the future has in store for our teams, our communities, our families – and for us. 2021 Apr./May/June | Vol. 59, Issue 2

— CEO CORNER —

MPA Working for You

’ve been impressed with everything MPA does for you – Michigan pharmacists, pharmacy technicians and student pharmacists – in just my first few months as your CEO. Your engaged Executive Board, hard-working committees and professional staff keep your ever-changing organization always moving – forward. I’d like to report on some of the highlights that should make you proud to be an MPA member and excited for the future.

ACE Delivers BY MARK GLASPER, chief executive officer, Michigan Pharmacists Association

The Annual Convention & Exposition (ACE) was a resounding success on so many levels. It was MPA’s first virtual ACE due to COVID-19 restrictions but still attracted more than 500 attendees. That’s truly an amazing number with so many other online opportunities available for continuing education these days and networking opportunities diminished by the virtual aspect of the event. However, attendees found value in the 13 hours of CE we offered during the meeting and an additional 15 home study course hours available post-event. Plus, attendees found they could network with each other and with exhibitors. We offered two networking coffee hours, including one with me to kick off the event on Friday morning and another on Saturday morning featuring President Heather Christensen. I thoroughly enjoyed meeting so many members during my coffee hour. I encouraged everyone to introduce themselves, and I was impressed that practically all of the 100-plus attendees were somehow engaged in MPA activities. President Christensen attracted similar attendance to her coffee hour where she outlined the organization’s strategic plan. Other groups embraced virtual networking opportunities too, including the Michigan Society of Health-System Pharmacists, Michigan Society of Pharmacy Technicians and Student Pharmacist Executive Council. I want to thank our 30-plus sponsors and exhibitors who also created virtual networking opportunities by carrying on chat sessions with attendees, as well as making company literature and videos available for attendees to download. In addition, I want to thank everyone who supported the Michigan Pharmacy Foundation Charity Auction. The virtual platform allowed us to offer items for bidding before and after ACE, and we raised over $6,000 for MPF’s scholarships, research grants and more. We finished off ACE with the Annual Awards Ceremony on Saturday night followed by the House of Delegates meeting Sunday morning. MPA recognized many worthy awardees, including our 25-, 40- and 50-year members with the Years of Membership Awards, our Pharmacy Hall of Honor inductees, as well as our elected boards, leaders and fellows for their service. We also honored scholarship recipients, the MPA Pharmacist of the Year and other honorable awardees. Congratulations to all these worthy recipients!

MichiganPharmacists.org

I’d be remiss if I didn’t thank staff for an outstanding job presenting a first-class event to attendees. Everyone contributed mightily, but I do want to single out MPA Director of Education Mary Farrington who guided us all through our inaugural virtual ACE. Thanks, Mary!

HB 4348 Puts PBMs on Notice Introduced by Rep. Julie Calley (R-Portland), HB 4348 will reign in PBMs by requiring them to register with the state, while addressing transaction fees and prohibiting clawbacks. It also codifies the U.S. Supreme Court’s decision in Rutledge (Arkansas) v. PCMA (Pharmaceutical Care Management Association), which requires PBMs to reimburse pharmacies at no less than the cost of the drug. HB 4348 is being fast-tracked through the Michigan House of Representatives where it was passed out of the Health Policy Committee and subsequently by the House. President Heather Christensen, Pharm.D., provided key testimony for committee members to consider during hearings. As of the time of publication, the bill has passed the House, where it received overwhelming bipartisan support. We expect the bill to be taken up by the Senate this fall. Keep watching for e-blast and social media updates that ask for you to contact your legislators as the bill continues to move.

New Volunteer Opportunities Available I am pleased to announce your Executive Board has approved a new Government Affairs Committee and a Communications Workgroup which will facilitate the work of MPA in these two critical areas. The Government Affairs Committee will provide direction on legislative and regulatory issues to your Executive Board and staff, while the Communications Workgroup will supply staff with communications and social media support. Please contact me at Mark@MichiganPharmacists.org if you would like to volunteer for either of these opportunities.

MPA – Your COVID-19 Resource You can count on MPA as your go-to resource for all things COVID-19 related. We have our staff of MPA pharmacists monitoring state and federal vaccination efforts to bring you the latest news and education on serving your patients. Watch for our email and social media updates!

— EVENTS CALENDAR —

EVENTS CALENDAR MPA, local association and national pharmacy organization events as well as health observances are included below. For the most up-to-date information, please visit our online calendar at www.MichiganPharmacists.org/eventscalendar.

APRIL 2021

1-30

14 15 22 28 29 30

Thursday, Apr. 1 – Friday, Apr. 30

Alcohol Awareness Month Nationwide

Wednesday, April 14

MPF Health Professional Leadership Academy Virtual Only

Thursday, April 15

MSHP Board of Directors Meeting Virtual Only

Thursday, April 22

CSPM Board of Directors Meeting Virtual Only

MAY 2021

1-31 6 13 15

Wednesday, April 28 MPA Law and Policy Symposium Virtual Only

Thursday, April 29

MPF Board of Trustees Meeting Virtual Only

Friday, April 30

MSPT Board of Directors Meeting Virtual Only

18 19 21 26 31

Saturday, May 1 – Monday, May 31 Asthma and Allergy Awareness Month Nationwide

Thursday, May 6

MSHP Committee Day and Board of Directors Meeting Virtual Only

Thursday, May 13

MPA Executive Board Meeting Virtual Only

Saturday, May 15

MSCP/MSPT Joint Continuing Education Event Live Your Best Life Virtual Only

Tuesday, May 18

MPF Health Professional Leadership Academy Virtual Only

Wednesday, May 19

PSI Board of Directors Meeting Virtual Only

JUNE 2021

10 17 18 23 27

Tuesday, June 8

Pharmacy PAC Committee Meeting Virtual Only

Thursday, June 10 MPA Third Party Committee Meeting Virtual Only

Thursday, June 17 MSHP Board of Directors Meeting Virtual Only

Friday, June 18

MPF Health Professional Leadership Academy 2021 Class Graduation Virtual Only

Wednesday, June 23 MPF Golf Classic Eldorado Golf Course Mason

Wednesday, June 27

National HIV Testing Day Nationwide

Friday, May 21

MPA Professional Affairs Committee Meeting Virtual Only

Wednesday, May 26 MSCP Committee and Board of Directors Meetings Virtual Only

Monday, May 31

MPA Offices Closed Memorial Day

2021 Apr./May/June | Vol. 59, Issue 2

— CE EVENTS CALENDAR —

APRIL 28

SEPT. 18

Delivery format: Virtual

Delivery format: To be determined

Target audience: Pharmacists, pharmacy technicians and student pharmacists

Target audience: Pharmacists, pharmacy technicians

MPA Pharmacy Law and Policy Symposium

MSPT Five-Live Continuing Education Event

Requirements met: Live, law Contact hours: Up to 6.0 Register online at www.MichiganPharmacists.org/ 2021PharmLaw

Contact hours: Up to 5.0

OCT. 29

Michigan Society of Health-System Pharmacists Annual Meeting Delivery format: To be determined

MAY 15

MSCP and MSPT Continuing Education Event

Target audience: Pharmacists, pharmacy technicians, student pharmacists

Delivery format: Virtual

Requirements met: Live

Target audience: Pharmacists, pharmacy technicians

Contact hours: Up to 6.0

Requirements met: Live Contact hours: Up to 5.0 Register online at www.MichiganPharmacists.org/ 2021mscpmspt

REGISTRATION NOW OPEN! May 15, 2021 TOPICS INCLUDE: Behavioral Health—Breaking Down Barriers: Helping Patients Live Their Best Lives Foundations of Health: Optimize Health Using Supplements and Diet Understanding The Human/Animal Bond A Healthy “Great Place to Work” Culture Begins With Trust Register online at:

www.MichiganPharmacists.org/2021mscpmspt ACPE Universal Activity # 0112-0000-21-202-L01-P, 0112-0000-21-202-L01-T • Up to 4.0 Contact Hours via Live Webinar

MichiganPharmacists.org

MEMORIES

— BIOS AND MEMORIES — Robert (Bob) Francis Slominski, R.Ph. Beloved husband, father, grandfather and great-grandfather, Bob passed away Monday, Dec. 14, 2020, at St. Francis Home of Saginaw at age 88 years. Bob was born on Feb. 20, 1932, to Martin and Alexandra (Dukarski) Slominski. He graduated from Saginaw High School in 1950. Bob married Mary O’Leary on May 21, 1955, in Saginaw. They were married 55 years. Mary preceded Bob in death on Feb. 19, 2011. Bob graduated from Ferris College in 1954 as a pharmacist. Mary and Bob owned Bob’s Pharmacy in St. Charles for 20 years. Bob was past president of the Saginaw County Pharmacists Association and treasurer for eight years. He also was chosen as Pharmacist of the Year in Saginaw County in 1988. Bob enjoyed his profession by helping and working with wonderful people in the many pharmacies he practiced in. Before and after Bob had their pharmacy, Bob did relief work in 25 stores in the region.

Bob was past president of St. Charles Chamber of Commerce and Lions Club, a member of the Ferris State University Football Alumni Club where he earned two varsity football letters, past chairman of Immaculate Conception Cemetery Comate for 10 years, member of the Knights of Columbus, and charter member and secretary of the St. Charles Jaycee’s. Bob enjoyed spending time with his family, golfing, fishing, hunting and walking. Surviving are his children and their spouses: Steve of St. Charles, Mark and Brenda of Garner, N.C.; Scott and Sandra of St. Charles; grandchildren, Carla Spears of Midland (Tommy), Heather Lawton of Garner, N.C. (Chris), Martin of Shields (Megan), and Jacob of Garner, N.C. (Amanda); great-grandchildren, Gavin and Magdalene, Lily and Nathan, Troy, Elliot Jo and Lainey Jane; and his brother Gerald (Marie) of White Lake, Mich. He will be missed by many cousins, nieces, nephews and friends. He was preceded in death by a daughter, Nancy, in 1993; his parents; and his wife Mary Slominski.

Virtual MPA Pharmacy Law & Policy Symposium April 28, 2021 • 5 Hours of LIVE Continuing Education Credit • Delivered by Webinar ACPE Universal Activity #0112-0000-21-208-L03-P, 0112-0000-21-208-L03-T

TOPICS INCLUDE:

Drug Supply Chain Security Act and Counterfeit Drugs FDA and Health-System Pharmacy Compounding Pharmacy Law and Ethics Update DEA Overview: Methods of Diversion and Drug Trends Pharmacy Law and Regulatory Update Register online at: www.MichiganPharmacists.org/2021PharmLaw

2021 Apr./May/June | Vol. 59, Issue 2

— STUDENT FOCUS —

EMBRACING OUR MISSION:

ADVANCING OUR PROFESSION A BY DANA HOSSAMI,

president, Student Michigan Pharmacists Association; Pharm.D. candidate class of 2023, Ferris State University College of Pharmacy

s student pharmacists, we often enter pharmacy school with big dreams of making a positive impact on patients and providing them a better quality of life. To this end, we consider medications, side effects, diet and exercise. However, our duty does not end here; we must also recognize that it is our responsibility to advocate for legislation that will empower us to help our patients. For example, pharmacists can only offer treatments that would benefit patients within narrow boundaries. This is especially frustrating given that pharmacists are the most accessible healthcare workers in a world where access to health care is becoming increasingly difficult due to social barriers, not the least of which is socioeconomics. Therefore, because the law shapes the boundaries of pharmacy care and the support given to patients, it is our role to defend the profession by advocating for new laws. This is our profession, and no one is going to do it for us; therefore, we must always demonstrate that we are well-equipped to handle new tasks that would benefit patients and make a positive impact on the healthcare system.

skills, pharmacists deserve to be acknowledged for all their work in the healthcare system and be given the ability to use their knowledge and expertise to the fullest. This would benefit both the public and the healthcare system because we would be able to make many basic and often expensive healthcare services more accessible and affordable. Pharmacy schools teach student pharmacists about the current laws that protect both patients and pharmacists. However, our educational programs generally fail to mention that these laws are subject to change. It is our responsibility, then, to advocate for new legislation that empowers pharmacists to maximize their knowledge and skills for the betterment of those we serve. Not only should student pharmacists be aware of the current laws, but they should also be capable of identifying gaps and advocating for change. They should feel that this profession should improve as our population grows and our needs change. Current pharmacists and student pharmacists should be pushing the profession forward and asking for new roles that would expand the profession and benefit the public.

Not only should student pharmacists be aware of the current laws, but they should also be capable of identifying gaps and advocating for change. They should feel that this profession should improve as our population grows and our needs change. Pharmacists have an average of six to eight years of formal education. In addition to the accredited program with specific requirements, most of us take our education further. For instance, many pharmacists complete a residency or get into research. During the COVID-19 pandemic, pharmacists have continued to show their value by performing tests, delivering vaccines and reaching out to the public. As a result, the profession is in a position to ask for more. We have the responsibilities; however, we do not have the independent authority granted by provider status, for example. After years of work toward building the profession and proving their

MichiganPharmacists.org

Pharmacy is our profession, and it is up to us to shape its structure in the coming years. We have been provided the necessary education and training, but we need to take it further and ensure that we maximize the ways in which we serve the public. We all took an oath, and this is part of it. We, the drug experts, have many, often underutilized capabilities, and we are known to be a profession of integrity that the public has confidence in. We should not lose track of why we chose this career and always remember that this is our profession, and it is our mission to advocate for it and for the patients we serve.

— MEMBERSHIP OVERVIEW —

YOUR MPA MEMBERSHIP AT WORK

BY SPENCER HIGGINS, membership development manager, Michigan Pharmacists Association

020 was a difficult year for the pharmacy profession and for the Michigan Pharmacists Association (MPA). Despite the challenges posed by a global pandemic, pharmacy professionals rose to the occasion, brought the fight to COVID-19 and leveraged tough circumstances to create powerful growth opportunities. Throughout the pandemic, MPA has been working tirelessly to keep pharmacy professionals armed with current information and analysis in a rapidly evolving landscape. We have found innovative ways to continue to provide networking opportunities, fundraise and be a force for advocacy for individual pharmacists in Michigan. MPA has recently seen some of the fruits of its labor in Lansing and Washington D.C. in efforts to advance legislative priorities impacting pharmacy practice every day. As Pharmacy Benefit Manager (PBM) reform legislation is quickly moving through the Michigan Legislature, it

reflects many years of advocacy and education, which has gradually built a groundswell of support to achieve this kind of bipartisan success. MPA also lent its financial support to the landmark U.S. Supreme Court case out of Arkansas, Rutledge v. PCMA, which has created powerful momentum in PBM reform efforts. But it’s not just PBM reform, and it’s not just advocacy the association is doing on behalf Michigan pharmacy professionals. MPA fosters pharmacist education and research, facilitates professional development and leadership training, provides opportunities for pharmacy professionals to connect and grow, recognizes the incredible achievements within the profession, offers a voice and a platform for individual pharmacy professionals, educates and promotes pharmacy outside of the profession, and so much more. None of this would be possible without you. MPA is YOUR Association. With your membership, we create a stronger voice for the profession. Your membership doesn’t just benefit the Association, it benefits the profession of pharmacy and, ultimately, your practice. It isn’t just your membership in MPA, but your engagement with MPA that is the foundation of everything we do. Hundreds of pharmacy professionals just attended our firstever virtual Annual Convention & Exposition (ACE), where they not only earned valuable continuing education (CE) credits, they reconnected with their peers and colleagues from around the state, celebrated shared achievements, reflected on a historic year in pharmacy, and learned valuable information and skills to meet the challenges of practice today. At the ACE and throughout the year, MPA members enjoy many opportunities to engage in networking and fundraising events, as well as advocacy efforts, such as joining the Pharmacy Advocacy Response Team (PART) and participating in Pharmacy Day at the Capitol. If you have yet to renew your membership for 2021, please take the time to renew as soon as you are able. MPA has switched to an annual membership model where all memberships run from Jan. 1 through Dec. 31 of each year. If you purchased a 12-month membership that expired after Dec. 31, 2020, and before Dec. 31, 2021, you’ll receive a credit for the time for which you’ve already paid. To renew online, go to www.MichiganPharmacists. org and click on ‘Join MPA’ on the Membership page. You do not need to be logged in. Additionally, please note that our auto-renewal system is undergoing maintenance, so if you set your membership to renew automatically, that feature is not currently functional. MPA regrets this inconvenience and is working diligently to upgrade our web services. If you have questions about your MPA membership, contact Membership Development Manager Spencer Higgins by calling (817) 846-1434 or emailing Spencer@MichiganPharmacists.org. 2021 Apr./May/June | Vol. 59, Issue 2

— FROM THE FOUNDATION —

MICHIGAN PHARMACY FOUNDATION

a Boomerang in Reverse

Scholarships Enhance Student Pharmacists’ Education, Future

BY DIANNE MALBURG, executive director, Michigan Pharmacy Foundation

There’s an old saying, “Life is a boomerang. What you give, you get.” While that is a powerful and true statement, for the Michigan Pharmacy Foundation (MPF), the reverse is also true. MPF operates on the principle that it gives what it gets! MPF raises funds to give dollars to worthy causes, such as to promising student pharmacists through its scholarship program.

MPF Student Scholarships

Larry Wagenknecht Endowment

For decades, the Foundation has sponsored student pharmacist scholarships at each of the Michigan colleges of pharmacy. Originally, the program was administered by each college until 2013, when the Board of Trustees made the decision to operate the programs through an application process in an effort to grow awareness about the program. The scholarship program was redesigned to recognize a P2 or P3 student pharmacist currently enrolled in a pharmacy program at an accredited college of pharmacy in the state of Michigan. Student pharmacists are required to submit a formal application that gathers information about their leadership skills, academic performance and interest in professional advancement.

In 2020, the MPF Board of Trustees, working collaboratively with the Michigan Pharmacists Association (MPA) Executive Board, established the Larry Wagenknecht Endowed Scholarship as a legacy tribute to former MPA CEO Larry Wagenknecht for his 37 years of service to the Association and the profession of pharmacy. The initial goal was to raise $50,000 by his retirement date to ensure the scholarship can be provided annually.

MPF guarantees at least one $2,500 scholarship will be awarded to three impressive student pharmacists, but in recent years, based on successful fundraising, the Foundation has been able to provide more than three scholarships. Most notably in 2018, MPF awarded a total of five scholarships. While the long-standing tradition of awarding scholarships has allowed the Foundation to invest well over $100,000 through scholarships, the Board of Trustees has not been satisfied with just these achievements alone.

MichiganPharmacists.org

Thanks to generous donors, that goal was met. The inaugural Larry Wagenknecht Endowed Scholarship was awarded at the MPA Annual Convention & Exposition on Saturday, Feb. 27, to Nicole Farah from the University of Michigan, which coincidentally is Wagenknecht’s alma mater.

A Catalyst “Through financial support, MPF is the catalyst for the innovation, leadership and learning that expands the role of pharmacy in society.” That MPF Vision Statement is a testament to MPF’s commitment to the profession. Providing student pharmacists with extra financial help to pay their tuition and support activities to enhance their awareness and make them better leaders is just one aspect of the Foundation’s reverse boomerang effect.

— FROM THE FOUNDATION —

If you don’t believe it, here is what past scholarship recipients have stated: “You have done much more than just donate money, you have greatly improved my academic experience. … I hope that one day I too will able to help a student as much as MPF has helped me.” — M.D., University of Michigan Pharm.D. candidate

“The MPF Scholarship has helped lift a great financial burden off my shoulder. As a Canadian student, it has allowed me to cross the border on days I would not normally have to, so I could work on projects and volunteer without financial repercussions. Receiving a generous scholarship like this makes you see the value of giving back in the future, so other students may continue to have these opportunities. I am honored to have been given this scholarship in recognition of the work we do. Thank you to the MPF and MPA for all you do.”

“Being awarded the Michigan Pharmacy Foundation Student Scholarship is an honor. As a pharmacy student, there is a great deal of academic and financial stress. However, as students it is important that we are active in our field and keep up with regulatory issues. When I applied for this scholarship, I really had to think about what I believe are the most important regulatory issues facing pharmacy today and how I can help inform other students as well as the community about these important issues. Since receiving this scholarship, I have been able to be active in the profession and maintain my academic success. I am so thankful that both MPF and MPA have given me the tools to be the best student pharmacist I can be.”

“I was honored and grateful to be awarded one of the Michigan Pharmacy Foundation scholarships this year. By financially supporting Michigan pharmacy students, the MPF not only helps reduce the financial burden of a pharmacy education, but also promotes engagement in pharmacy advocacy and policy early in our careers and creates a culture of generosity that we will pay forward into the future.”

— A.B., Ferris State University Pharm.D. candidate

— K.S., University of Michigan Pharm.D. candidate

— R.M., Wayne State University Pharm.D. candidate

MPF has made significant progress moving towards its vision. Individuals in many different stages of their careers and groups across the state have benefited from the goodwill of MPF donors through many different projects and programs. The student pharmacist scholarship program is just one initiative supported by donors through the Michigan Pharmacy Foundation. To learn more about the Michigan Pharmacy Foundation, visit www.MichiganPharmacists.org/foundation/about. To contribute to the Larry Wagenknecht Endowed Scholarship, visit www.MichiganPharmacists.org/foundation to download a donation form that you can use to mail your contribution to MPF at 408 Kalamazoo Plaza, Lansing, MI 48933, or make a donation online at www.MichiganPharmacists.org/foundation/contribute. To contribute to the MPF general fund that supports not only scholarships, but grant funding and leadership development programs as well, visit fs27.formsite.com/7jFRIO/form4/index.html to submit your gift online.

“We make a living by what we get, but we make a life by what we give.” — Winston Churchill

2021 Jan./Feb./March | Vol. 59, Issue 1

— LEGISLATIVE UPDATE —

2021PHARMACIST

THE YEAR OF THE

uring the legislative panel at the Michigan Pharmacists Association’s (MPA) Annual Convention & Exposition (ACE), Rep. Mary Whiteford (R-Casco) made the bold statement that “2021 will be the year of the pharmacist.” She made this statement after a discussion of the new bipartisan 15-bill legislative package that was introduced in Michigan during the last week of February.

By BRIAN SAPITA, government affairs manager, Michigan Pharmacists Association

The package, passed by the Michigan House of Representatives March 24 after being unveiled by Speaker Jason Wentworth (R-Farwell) on Feb. 24, is aimed at lowering the cost of health care in Michigan. Of the 15 bills in the package, three of them address pharmacy benefit managers (PBMs) and their harmful tactics. These three bills are a direct result of education and input MPA has provided to the Legislature over recent years. As the voice of pharmacy in Michigan, we have been bringing our members’ questions and concerns to our elected officials, and these bills are the culmination of the association’s hard work. They will now move onto hearings in the Senate Health Policy Committee. The next steps will be a vote of the Senate and signature from Gov. Gretchen Whitmer. The three bills that will affect MPA members are House Bills 4348, 4351 and 4352. HB 4351 would require a PBM to offer the same medication reimbursement to a 340B entity as a non-340B entity within the same network. HB 4352, as originally written, would prohibit and penalize a pharmacist from entering into a contract with a PBM if the PBM included a gag clause within their contract. MPA worked successfully to amend the language to put the responsibility on the PBM rather than the pharmacist.

• The U.S. Supreme Court’s 8-0 decision in Rutledge v. PCMA affirmed that states can put limits on how much or how little a PBM can reimburse a pharmacy for the cost of the medication. We took the Arkansas language, which requires PBMs to reimburse for at least the medication cost, and inserted it into the bill.

• Clawbacks and PBM audit practices are two concerns that are brought up by our members consistently. We took these concerns to the chair of health policy and asked for them to be addressed. HB 4348 requires PBMs to report to the director of DIFS how much in clawbacks they receive each year and prohibits the use of them except in cases of fraud and abuse.

• The bill also changes the way audits take place. When the bill is passed, audits will no longer be unannounced affairs. PBMs will need to create an audit appeal process and address any appeal within 60 days. The days of waiting for an answer from the PBM will be over.

HB 4348 was passed March 24 with bipartisan support in a 97-10 vote on the House Floor.

House Bill 4348 is one of the largest bills in the package

While the healthcare package is the largest piece of legislation MPA is working on, it doesn’t mean we aren’t working on other practice issues. MPA has been working directly on Senate Bill 166, which will allow Michigan pharmacists to fill non-controlled prescriptions written by out-of-state midlevel providers. This bill was passed in a vote of the Senate and, at the time of publishing, has been sent to the House Health Policy Committee. Additionally, MPA is working on expungement language

at 30 pages long. The bill, which is based on MPA’s legislation from last session, will do a multitude of things for the pharmacy practice.

for non-clinical violations on a pharmacist’s license, as well as legislation that will address “white bagging” in a hospital setting.

Left: President Heather Christensen testifies March 10 in the House Health Policy Committee on HB 4348. Right: from left, MPA Executive Fellow Zack Mueller, President Heather Christensen and CEO Mark Glasper head into the Capitol to testify March 10.

MichiganPharmacists.org

• The bill will require PBMs to be licensed with the Department of Insurance and Financial Services (DIFS). Michigan is one of 25 states that doesn’t require licensure, and MPA wants to see that changed.

Almost all the issues MPA works on are brought to us by members. If you have an idea for legislation, please email MPA Government Affairs Manager Brian Sapita at Brian@MichiganPharmacists.org. Together, we can make 2021 the year of the pharmacist!

— ADVOCACY UPDATE —

Michigan Pharmacy PAC REVIEW BY BRIAN SAPITA, government affairs manager, Michigan Pharmacists Association

The Michigan Pharmacy Political Action Committee (PAC) makes sure your voice is heard whenever regulatory decisions that impact pharmacy professionals are being made. It allows the Michigan Pharmacists Association (MPA) to support pro-pharmacy legislators with donations to help them continue to fight for pharmacy. The PAC funds important events, such as the legislative panel at the Annual Convention & Exposition (ACE); MPA’s campaign school, held every other October; and the MPA Pharmacy Day at the Capitol (PDAC), which every September invites the state colleges of pharmacy along with any interested members to engage directly with legislators one-on-one. It also allows MPA to contribute to special causes, such as helping the Arkansas Pharmacists Association with legal costs for Rutledge v. PCMA, the historic recent U.S. Supreme Court decision that delivered a massive win to pharmacists in the fight for pharmacy benefit manager (PBM) reform.

gave $24,600 to the Pharmacy PAC, which averages to $150 a donation. Last year, only 56 members gave $8,802 to the Pharmacy PAC, which averages to $157 a donation. While we are grateful for every generous donation, as fewer members donate to the PAC, we risk losing our voice in influencing legislation and regulations in Lansing and Washington DC. As one of the most regulated professions in the country, this is something we do not want to leave up to the politicians to decide for us.

The Pharmacy PAC remains healthy, but with annual donations declining in recent years, we risk losing the effectiveness and momentum that we have built. The PAC has made it a practice to try not to spend more than we receive during a calendar year. Unfortunately, lower revenues over the past five years have the potential of threatening how much and how effectively the PAC can help shape policy. In 2016, 163 members

Many members ask which political party the Michigan Pharmacy PAC supports, and the easy answer is both. The PAC doesn’t look at party affiliation as much as it looks at a legislator’s stance on policy that impacts our profession. However, because the Republican Party currently holds the majority in the Michigan Legislature and chooses committee chairs, they have been favored over the Democratic Party in recent years. PAC leadership is always aware, though, that during each election cycle, this can change, and the minority party has a chance to become the new majority party. The pharmacy PAC is 100 percent funded by our member’s donations. It is an investment in your profession and your voice in policy. Your donation, no matter how large or small, allows MPA to continue to advocate for the advancement of pharmacy. Whether you are making a one-time investment of $1,000 or a monthly investment of $10, your donation will help MPA directly affect your working environment and the rules and regulations that surround it. Without your crucial support, legislators and bureaucrats will decide what is best for the practice of pharmacy. Please make your donation today at www.MichiganPharmacists.org/pharmacypac/contribute.

Hank Fuhs presents Dr. David Miller with the Hank Fuhs Good Government Award.

Kim Gaedeke, chief deputy director of the Michigan Department of Licensing and Regulatory Affairs, holds her Good Public Health Policy Award.

CEO Mark Glasper presents Rep. Joseph Bellino (R-Monroe) (left) and Rep. Kevin Hertel (D-St. Clair Shores) (right) with Good Public Health Policy Awards.

2021 Apr./May/June | Vol. 59, Issue 2

MichiganPharmacists.org

2021 Apr./May/June | Vol. 59, Issue 2

— PROFESSIONAL AFFAIRS —

A BRIEF HISTORY OF COVID-19: FROM OUTBREAK TO VACCINES Origins of the Outbreak The World Health Organization (WHO) was first informed about cases of pneumonia with unknown etiology in Wuhan City, Hubei on Dec. 31, 2019.1 The cause of the infection was then identified as a new variant of the novel coronavirus on Jan. 7, 2020, with evidence suggesting that the outbreak was due to exposures at a seafood market in Wuhan.2 By Jan. 30, 2020 there were a total of 7,818 confirmed cases worldwide, including 82 cases reported in 18 countries outside of China.3 This led the WHO director-general to declare the coronavirus outbreak a public health emergency of international concern and the virus to be named COVID-19.3

By AMANDA PETERS, Pharm.D. candidate 2021, Ferris State University College of Pharmacy

Eventually COVID-19 made its way to the United States, with the first nontravel-related coronavirus-confirmed case reported in a California resident on Feb. 26, 2020 and the second case confirmed two days later in a Washington resident.4 By March, 114 countries had reported COVID-19 cases with over 1,000 cases in the United States.5 These numbers were thought to be much larger due to the limited understanding of COVID-19 and limited availability of COVID-19 tests. This swift increase in number of cases of COVID-19 worldwide led the WHO to declare the coronavirus a global pandemic on March 11, 2020.6

Development of a Vaccine The most effective way to control the COVID-19 virus, and resume social and economic norms, is through vaccination. This caused the launch of a rapid global development effort of many vaccines to target the virus under the WHO’s Emergency Use Listing Procedure.7 Development began in January 2020, leading to 181 vaccines undergoing pre-clinical trials and 12 vaccines in phase 3 of their clinical trials currently worldwide.8 These vaccines include four from China (CanSino, Sinopharm [Beijing], Sinopharm [Wuhan], and Sinovac), one from India (Bharat), two from Russia (Gamaleya, Vector Institute), one from the United Kingdom (Oxford-AstraZeneca), three from the U.S. (Janssen, Moderna, Novavax), and one the result of combined effort from both the U.S. and Germany (Pfizer-BioNTech).9 In the U.S., President Donald Trump’s Operation Warp Speed Vaccine Initiative was announced on May 15, 2020 to advance the development, manufacturing and distribution of vaccines, therapeutics and diagnostics.10 The U.S. government, including the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA) and the Department of Defense, set to aid in any technical, logistic or financial hurdles in delivering these therapies to the American population as quickly as possible.10,11 The goal of the initiative was to deliver tens of millions of doses of the COVID-19 vaccine, hoping to have up to 300 million of those doses available by mid-2021.11 Eight vaccines were included in the Warp Speed portfolio; two mRNA vaccines (Moderna and Pfizer/ BioNTech), two replication-defective live-vector vaccines (AstraZeneca and Janssen), two recombinant-subunit-adjuvanted protein vaccines (Novavax and Sanofi/GSK) and two whole virus vaccines that will enter clinical trials soon. Their thought was that by including two vaccines from each of the technologies, their vaccine portfolio would be diverse, limiting the risk of failure and allowing the selection of the most appropriate vaccine for different subpopulations.10,11

At the beginning of March, over 100 million vaccines had been distributed to U.S. states, but under 79 million had been administered.

MichiganPharmacists.org

— PROFESSIONAL AFFAIRS —

The most effective way to control the COVID-19 virus, and resume social and economic norms, is through vaccination.

Moderna, Pfizer-BioNTech and Janssen vaccines are currently authorized by the FDA for emergency use and are being manufactured at scale.11 The Pfizer-BioNTech vaccine was the first vaccine authorized for use by the FDA under an emergency use authorization (EUA) on Dec. 11, 2020.12 The Moderna vaccine followed on Dec. 18, 2020.13 Both of these manufacturers are on track to fill their order commitment of 300 million doses, hoping to deliver 200 of those doses by May 2021.14-16 Janssen’s single-dose vaccine has recently been approved as the third COVID-19 vaccine approved in the U.S. under an EUA, predicting they will be able to provide 20 million doses to the U.S. by March and 100 million doses by June.17-19 At the time of this writing, AstraZeneca is the fourth vaccine expected to be given EUA by the FDA. Although it is already approved for use in the UK, the data from their UK clinical trials had a manufacturing error where a portion of the participants were administered only half a dose for their first vaccine followed by a fulldose for their second vaccine.20 AstraZeneca is now undergoing a larger trial in the U.S. with 30,000 participants and once they are approved, the U.S. is expected to receive 300 million doses for its $1.2-billion funding.21,22

Vaccine Deployment Now that we are seeing more vaccines being approved, we face new challenges with getting the majority of the U.S. population vaccinated. At the beginning of March, over 100 million vaccines had been distributed to U.S. states, but under 79 million had been administered.23 This reflects a current logistical challenge that is being faced by state and local health departments. Dr. Julie

Morita of President Joe Biden’s COVID-19 advisory panel stated, “The vaccine was approved by the FDA, recommended by the CDC, and the vaccine arrived within days. That didn’t give the local departments much time to really ramp up their systems.”24 More federal guidance, consisting of a comprehensive plan on what to do once vaccinations began to arrive, would have been useful for more efficient vaccination efforts.23 This includes how many mass vaccination sites there should be state-wide, how many vaccines should be given to physician’s offices or pharmacies, how to build up the state immunization registry systems, and how to move down from different priority groups if you have excess doses that need to be used. Dr. Ashish Jha of Brown University’s School of Public Health also commented that the state departments need more assistance from the federal government, focusing on inefficiencies and wasted vaccine doses due to the lack of planning on how the vaccines were going to get distributed. According to Dr. Jha, “There is a mismatch right now between supply and demand, and the way you deal with that is a well streamlined [vaccination sign-up] system.”24 Another new challenge is to get vaccine acceptance from those skeptical of the COVID-19 vaccine to increase demand once the supply improves. When the U.S. government suggested that they would have a COVID-19 vaccine ready before the election, it sparked an increased concern about the integrity of the vaccine’s safety, efficacy and development process.25 The most important way to decrease vaccine hesitancy is to increase vaccine knowledge and awareness.26 The current serious adverse monitoring systems (e.g., VAERS and V-safe) put in

place by the CDC may increase confidence in the vaccine’s safety. Additionally, Deputy Director of the Immunization Action Coalition Dr. Kelly Moore advocates the need for outreach teams to go out into communities and educate, answer questions, dispel myths and encourage the public to get vaccinated.27 Another way to increase acceptance and trust in the vaccine is to form partnerships with local community groups who already have trusted leaders such as faith-based networks, health worker programs or local activism groups.28 Extensive efforts are also being made to target disadvantaged groups as they are likely to have lower trust in the medical community.27 This includes a focus on the Black, Latino and Native American populations as they are also more vulnerable to experience high COVID-19 mortality rates.28

Conclusion Numerous organizations across the world have been working hard to get the global population vaccinated for COVID-19. Although more vaccines are being approved and manufactured at scale, there still lie challenges ahead, especially at the local level. Increased federal support is needed to increase the efficiency of vaccination efforts once the vaccine doses arrive. This should include a more structured vaccination plan with guidance on the most effective way to distribute doses. With more vaccines getting approved and supply increasing, improving vaccine acceptance is also vital. More effort is needed from both state and federal governments to campaign and advocate for vaccinations to decrease hesitancy from the public. References available upon request from the MPA office.

2021 Apr./May/June | Vol. 59, Issue 2

— CONVENTION & EXPO —

MPA HOLDS FIRST VIRTUAL

ANNUAL CONVENTION & EXPOSITION BY MARY FARRINGTON, CMP, director of education, Michigan Pharmacists Association

The 137th Michigan Pharmacists Association (MPA) Annual Convention & Exposition (ACE) was held virtually for the first time ever on Feb. 26-27. The virtual platform provided participants an opportunity to engage with exhibitors, attend education programs, socialize at networking activities, recognize award recipients and chat with fellow attendees. The Convention kicked off on Friday, Feb. 26 with a coffee hour featuring MPA’s new CEO Mark Glasper. This event was sponsored by Pharmacy Management Partners. What followed was a full day of exceptional continuing education programs, providing attendees with 6.75 hours of live credit on timely and relevant topics such as a new drug update, SARS-CoV-2 testing, opioid allergies, virtual rotations and others. During the Legislative Priorities of the 101st Legislature program, the Michigan Pharmacy Political Action Committee (PAC) presented awards to the Legislator the Year recipients, Good Public Health Policy Award recipients and Hank Fuhs Good Government Award recipients. The program was sponsored by Ascension, American Pharmacies, Kroger, Meijer, Pharmacy Management Partners and Walgreens.

MichiganPharmacists.org

— CONVENTION & EXPO — Dr. Parker Crutchfield, Ph.D., associate professor of medical Ethics, humanities and law and Western Michigan University’s Homer Stryker M.D. School of Medicine in Kalamazoo, Mich. was part of a group of medical ethicists that were consulted curing the allocation and distribution process of therapeutics throughout the pandemic. He spoke on the ethical allocation of vaccines specifically related to COVID-19 during the Opening Session. On Friday evening, a couple of networking socials were held. The Michigan Society of Pharmacy Technicians (MSPT) Tech Connect Social provided an occasion for pharmacy technicians to network with peers and colleagues. MSPT Past President Keith Binion served as Master of Ceremonies. During the reception, the MSPT Technician of the Year and MSPT Service Award recipients were recognized for their accomplishments. The SMPA Student social provided an evening of games and trivia to create friendly competition among student pharmacists from each of the three Michigan colleges of pharmacy. To wrap up the evening, the Michigan Society of Health-System Pharmacists (MSHP) held a virtual wine tasting event conducted by Wagner Vineyards. Saturday, Feb. 27 began with a coffee hour sponsored by Pharmacy Management Partners where participants were able to talk to MPA President Heather Christensen about her goals for the coming year. After that, convention registrants had the chance to earn an additional 7.5 hours of live credit participating in an entire day of educational programs on topics such as workplace violence, low health literacy, contraception prescribing and the Michigan Volunteer Registry, to name a few. The Keynote Session, sponsored by Partnership for Safe Medicines, was delivered by Dr. Jason Wasserman, Ph.D., associate professor in the Department of Foundational

Medical Studies at Oakland University William Beaumont School of Medicine in Rochester, Mich. He spoke on the timely topic of the Social Determinants of Health and Contemporary Pharmacy Practice. The first Larry Wagenknecht Endowed Scholarship recipient was also recognized. The NASPA-NMA Student Pharmacist Self-care Championship was held as well. Three student pharmacists from each college of pharmacy participated in a three-round jeopardy-style competition showcasing their extensive over-thecounter knowledge. The winning team from the University of Michigan have bragging rights for the year! Additionally, the Michigan Pharmacy Foundation (MPF) Student Scholarship Program recipients were honored. Closing out the educational programming was Paul Osincup, a speaker and self-described positive workplace strategist who helps organizations create happier, healthier and more connected places to work. His presentation, “Burnout is a Laughing Matter: Using Humor to Decrease Stress & Boost Resilience,” was a hit. The MSHP Leadership Networking Program for Student Pharmacists provided student MPA members with the opportunity to interact with a health-system pharmacy leader to talk about professional practice issues, career options and share stories. The virtual delivery platform provided a unique opportunity for exhibitors to participate in the Convention as well. Participants took advantage of and appreciated the product literature and resources that exhibitors provided. The MPF Charity Auction was also available during the Convention. MPF launched a new virtual format and the Charity Auction was open for bidding on unique items from Feb. 15 through March 1. This year’s MPF Adopt-a-Student Program was also conducted virtually. The MPF Board of Trustees created a program to ensure the most valuable component of the program – connecting student pharmacists with engaged, experienced pharmacy professionals for a great networking experience – still occurred in our virtual world. Sponsors (aka

“parents”) selected a student pharmacist from an “adoption” catalogue. Student pharmacists were responsible for contacting their sponsor and arranging a 30-minute Zoom meeting, and if all requirements were met, they were provided with a $25 restaurant gift card to enjoy a meal as a result of their sponsors’ generous support of this program.

AWARDS RECOGNITION While the realities of the pandemic prevented us from gathering at a banquet, the virtual platform allowed the tradition of honoring distinguished individuals who serve and advance the profession of pharmacy and the health of our patients at our Annual Awards Ceremony. MPA recognized a number of worthy awardees, including our 25-, 40- and 50-year members with the Years of Membership Awards, our Pharmacy Hall of Honor inductees, as well as our elected boards, leaders and fellows for their service. MPA also honored scholarship recipients, practice section awardees, the MPA Pharmacist of the Year and other honorable awardees. Congratulations to those who were honored.

YEARS OF MEMBERSHIP

25 40 50

25-Year Recipients: Rosilyn Andrews Tracey Bershing Bessie Bone Andrew Brockway Ann Decker

Michael Halstead Glenyce Jansma Christopher LeFave Neal Miller Gregg Potter

40-Year Recipients: Jeffery Bismack Mark Bomia Donald Budden David Edwards Duane Kirking

Richard Lucarotti Margaret Malovrh Carolyn Schultz Theodore Toland

50-Year Recipients: Hanley Abramson Wayne Conti Ralph Heuerman

Paul Miller Gerald Petrosky

2021 Apr./May/June | Vol. 59, Issue 2

— CONVENTION & EXPO — PHARMACY HALL OF HONOR CAROL BUGDALSKI-STUTRUD

FELLOW OF MICHIGAN PHARMACISTS ASSOCIATION

FRED W. ARNOLD PUBLIC RELATIONS AWARD

CELIA “KAE” FRENCH CURTIS COLLINS DANA STAAT LISA BADE REBECCA MAYNARD JACQUELINE A. MORSE

THOMAS BREEDEN

EXECUTIVE BOARD SERVICE AWARDS

DISTINGUISHED NEW PHARMACIST PRACTITIONER AWARD

LINDSEY GHIRINGHELLI

JESSICA BESSNER

MARY BETH O’CONNELL

LINDSEY GHIRINGHELLI

JASON WILLIAMSON

PHARMACIST OF THE YEAR AWARD

JASON WILLIAMSON

EXCELLENCE IN INNOVATION AWARD MEIJER PHARMACY TEAM

LISA MENY

MARGARET “PEGGY” MALOVRH

OUTGOING PRESIDENT AWARD

BOWL OF HYGEIA

EXECUTIVE BOARD MEDAL

CHARLIE MOLLIEN

JOANN SANBORN

REP. MARY WHITEFORD

MICHIGAN PHARMACY FOUNDATION STUDENT SCHOLARSHIP PROGRAM

AMBER DUCHE

MichiganPharmacists.org

KRISTIN KHOSHABA

ZAID SIMON YOUSIF

LARRY WAGENKNECHT ENDOWED SCHOLARSHIP

NICOLE FARAH

— CONVENTION & EXPO —

OTHER 2020-2021 AWARDS CSPM PHARMACIST OF THE YEAR

MSCP PHARMACIST OF THE YEAR

MSHP PHARMACIST OF THE YEAR

MSPT TECHNICIAN OF THE YEAR

Stephanie LaPointe

Rony Foumia

Stanley Kent

Shannon Horgan

PAC LEGISLATOR OF THE YEAR AWARD

Rep. Graham Filler

PAC HANK FUHS GOOD GOVERNMENT AWARD

Rep. Frank Liberati

Lisa Ausmus

Dave Miller

ERNIE KOCH STRIVING FOR EXCELLENCE AWARDS

PAC GOOD PUBLIC HEALTH POLICY AWARD

Rep. Kevin Hertel

Kim Gaedeke

Jack Schick

DISTINGUISHED LOCAL ASSOCIATION ACHIEVEMENT AWARD

Oakland County Pharmacists Association

Meghan Groen

Rep. Joseph Bellino

Kirsten Smith

MSPT SERVICE AWARD Sarah E. Hill

Pharmacy Technician Educators Council

2021 ECONOMIC SURVEY Each year, the Michigan Pharmacists Association (MPA) conducts an economic survey of pharmacy professionals in Michigan to evaluate salaries and benefits received as well as other practice issues. Please take a few minutes to anonymously add your responses which will help provide pharmacy professionals and employers with valuable salary and benefit information. Survey responses must be received no later than Friday, May 28, 2021. The results of the 2021 Michigan Pharmacy Economic Survey will be published and available to MPA members in the July issue of the Michigan Pharmacist journal. Nonmembers who provide their email address will be provided with a summary of survey results. If you have any questions, please contact MPA at (517) 484-1466 or MPA@MichiganPharmacists.org. Thank you in advance for your participation! 2021 Pharmacist Economic Survey 2021 Student Pharmacist Economic Survey 2021 Pharmacy Technician Economic Survey Find these surveys online at

www.MichiganPharmacists.org/ economicsurvey. 2021 Apr./May/June | Vol. 59, Issue 2

— MPF CHARITY AUCTION —

RISING TO THE CHALLENGE: 2021 MPF Charity Auction, Virtual Edition

he Michigan Pharmacy Foundation’s (MPF) virtual Charity Auction this year presented both challenges and opportunities. Ultimately – with the support of members like you – MPF achieved its goal of raising thousands of dollars for scholarships, research grants and more.

BY SPENCER HIGGINS, membership development manager, Michigan Pharmacists Association

MPF holds the Charity Auction annually in conjunction with the Michigan Pharmacists Association (MPA) Annual Convention & Exposition (ACE). This year, to adapt to the challenges of COVID-19, the ACE, as well as the auction, had to be moved to a virtual platform. A virtual auction presented certain opportunities. Typically, the auction is held at the ACE for the duration of the weekend-long event. Bids were capped, so bidders seeking to leave the convention early could take an item with them by paying a buy-it-now price, instead of waiting around for the auction to close. However, with a virtual platform, the auction ran for a period of two weeks, increasing opportunities for bidders to engage.

FISHING WITH LARRY This item offered up to 5 hours of fishing on the Munuscong Bay in the beautiful eastern U.P. with retired MPA CEO Larry Wagenknecht serving as guide/fishing partner, with lunch or dinner included.

MichiganPharmacists.org

We were also able to remove caps from the prices, which led to some items – such as a fishing trip with retired CEO Larry Wagenknecht – having bids escalate above and beyond their original estimated value. Despite the challenges posed by the pandemic, the auction ended up surpassing last year’s auction in net revenue. The funds raised by the auction support MPF’s programs to provide scholarships to student pharmacists during a time when the costs of education are rising, to develop the leadership skills of pharmacy professionals through the Leadership Academy, and to provide grants supporting practice research and projects impacting patient care in order to advance the profession. We offer our thanks to all of those who contributed to and participated in the auction. Your leadership and generosity are an inspiring investment in the future of the pharmacy profession.

FERRIS STATE UNIVERSITY EXPERIENCE This included tickets for four at the winner’s choice of either a football or hockey game with the FSU Dean of Pharmacy Stephen Durst (and of course Brutus), dinner prior to the game, university merchandise, a guided tour and more.

VIRTUAL COOKING CLASS WITH DIANNE Participants could buy a 60-minute virtual cooking class with MPA Chief Operations Officer Dianne Malburg, learning how to make her “Favorite Friendship Bread.”

— MSCP PRESIDENT —

MSCP President 2021: ORIGINS AND OUTLOOK A Vision for Opioid Solutions I BY JOSEPH N. FAKHOURY,

R.Ph., president, MSCP Board of Directors

was introduced to the world of community pharmacy during my teens while working as a produce clerk at a Detroit supermarket. The produce department was adjacent to the pharmacy. I was always intrigued by this brightly lit, clean area of the store. The pharmacist – surrounded by lines of people and the noise of phones ringing – seemed to effortlessly manage the chaos, like a symphony the pharmacist was conducting. That pharmacist was Greg Baise, someone I now consider a brother and dear friend. Greg recognized my curiosity and interest in pharmacy. He would eventually let me into the pharmacy, answering my questions and later encouraging me to apply to pharmacy school after graduation from high school. I don’t need to tell anyone how that turned out.

Approximately nine years ago, while shopping in a supermarket near Wayne State University in Detroit, I noticed Greg Baise working in the store’s pharmacy. Déjà vu! After exchanging hugs and pleasantries, Greg immediately started telling me about the Wayne County Pharmacists Association (WCPA). Within a few weeks, I was in Dearborn attending one of the WCPA meetings, eventually becoming a board member. This group of community pharmacists inspired me to get involved and share my close to 30 years’ experience. Joining the Michigan Pharmacy Association (MPA) was a requirement for joining WCPA. During this time, a colleague on the WCPA Board encouraged me to throw my name in the upcoming elections for the Michigan Society of Community Pharmacists (MSCP), a practice setting under the umbrella of MPA. I was surprised when I was elected as a board member. To this day, I am greatly appreciative of Sarah Hill. She saw my enthusiasm and understanding of community pharmacy and gave me the nudge I needed to get more deeply involved. Now, here I am entering 2021 during the COVID-19 pandemic as president of MSCP. Considering the events of the last year, let there be no doubt as to the importance of community pharmacists. Our contribution to our country’s healthcare system is crucial. Our track record and the public’s positive opinion of pharmacists speak for themselves. Being on the front lines has made us the eyes and ears of our healthcare system. As we continue to push for provider status considering our significant contributions, we will continue to fulfill our purpose and mission on the healthcare team, during the pandemic and beyond.

Before COVID-19 took center stage, the opioid crisis was at the forefront. Anxiety permeated the country, and the public was in a panic over how to stem the growing overdose rates. Politicians were beside themselves to try to find a way to help. Many American citizens, especially African Americans, wondered, “Where was this response in the 1980s and thereafter when so many lives were being lost by substance use and addiction?” At the end of the day, the response both then and now has netted the same result: failure. The so-called “war on drugs” has been a disaster. The sooner the country accepts this, the sooner we can present viable, actionable solutions. Community pharmacists have a significant role to play in offering such solutions – which will be needed, as early studies indicate the COVID-19 pandemic has worsened the outlook for the opioid epidemic.

Unfortunately, a great deal of stigmatization and misinformation about opioid use disorder persists within the public, particularly for communities with strong cultural traditions that stifle open dialogue – and even within the healthcare system. The Michigan Pharmacists Association (MPA), with all our different practice settings, is the perfect vehicle for countering misinformation. Community pharmacists on the front lines are in the perfect position to help correct the conversation – not to mention engage in interventions. Our colleague, Zachary Mueller, Pharm.D., in his recent continuing education home study article, “Screening for Opioid Use Disorder in the Community Pharmacy,” published in the January/February/March 2021 Michigan Pharmacist, presents a clear and thoughtful approach for community pharmacists to participate in SBIRT (screening, brief intervention and referral to treatment).* Let’s start a conversation based on truth, compassion and a willingness to change. As a first step, I invite you to join me Nov. 10-12 in attending the International Drug Policy Reform Conference in Seattle, Wash. We can put together our own fact-finding mission. Let’s learn what works, how to implement it and how to influence our state legislators to do what’s best for Michiganders. This will not be the first time, nor the last, that community pharmacists lead the way in implementing solutions and solving problems. *This article can be found online at www.MichiganPharmacists.org/education/online. It is free for MPA members and $20 for nonmembers. 2021 Apr./May/June | Vol. 59, Issue 2

— MSCP FOCUS —

THE OATH OF A PHARMACIST Deriving New Meaning in a Time of Pandemic

s I was sitting down to write this article, my eyes landed on my framed copy of the Oath of a Pharmacist. Truth be told, it has been awhile since I read it. As I did so, I couldn’t help but see my role in the COVID-19 pandemic staring me in the face. The latest version of the Oath of a Pharmacist reads as follows:

BY LISA BADE,

Pharm.D., FMPA, clinical care coordinator, SpartanNash; presidentelect, MSCP Board of Directors

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: • I will consider the welfare of humanity and relief of suffering my primary concerns. • I will apply my knowledge, experience and skills to the best of my ability to assure optimal outcomes for my patients. • I will respect and protect all personal and health information entrusted to me. • I will accept a lifelong obligation to improve my professional knowledge and competence. • I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. • I will embrace and advocate changes that improve patient care. • I will utilize my knowledge, skills, experiences and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.” – The American Association of Colleges of Pharmacy (AACP)1

Applying the Oath in the COVID-19 Pandemic Human welfare is defined as the state of doing well, especially in respect to good fortune, happiness, wellbeing or prosperity of a human being.2 I think it is safe to say that the COVID-19 pandemic has cast a very dark shadow over human welfare in the past year. At the time of this writing, there have been more than 114 million confirmed cases of COVID-19, including over 2 million deaths, globally.3 The United States has reported more than 28 million confirmed cases of COVID-19, including over 500,000 deaths.3 In Michigan alone, there have been nearly 600,000 confirmed cases of COVID-19, and more than 15,000 deaths.4 If nothing else, the COVID-19 pandemic has highlighted our need, now more than ever, to focus on the welfare of humanity and relief of suffering.

MichiganPharmacists.org

There are many applications of our knowledge, experience and skills to aid in the prevention, diagnosis and education of COVID-19 to assure optimal outcomes for our patients and communities. Education is critical. As accessible healthcare professionals, we can serve to educate our patients and communities regarding those at highest risk for COVID-19, symptoms of COVID-19, proper social distancing, and recommendations for quarantine and self-isolation. In order to do so, it is important to use reputable and validated sources, such as the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), World Health Organization (WHO), Michigan Department of Health and Human Services (MDHHS), Immunization Action Coalition (IAC), American College of Immunization Practices (ACIP), the American Pharmacists Association (APhA), and the Michigan Pharmacists Association (MPA). An additional application of our knowledge, experience and skills is the administration and delivery of the COVID-19 vaccines. On Saturday, Feb. 27, 2021, the FDA approved Johnson & Johnson’s COVID-19 vaccine for emergency use. This brought the total number of vaccines granted emergency use authorization (EUA) in the United States up to three. As we vow to improve our professional knowledge and competence, Table 1 (on the following page) provides the key points with which to be familiar for each vaccine, while Table 2 outlines storage guidelines. Finally, embracing change is hard, and I think for many of us, advocating for change may be even harder. With the onset of the COVID-19 pandemic, we have been forced to embrace more change than we might have been ready for. Or perhaps, more accurately, we have been forced to adapt to ensure survival. Some of these changes may “stick” and hopefully change our profession for the better. However, there is still much more to be done. In early 2020, the United States Department of Health and Humans Services (HHS) issued a declaration that allowed pharmacists and pharmacy interns the ability to prescribe and administer vaccines to children between the ages of 3 to 18 years for the duration of the public health emergency. This declaration is entitled “Third Amendment to Declaration Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19” and applies to every state regardless of local scope of pharmacy practice law.5 However, practical implementation of this declaration is limited due to reimbursement. Most third-party payers still do not reimburse for prescriptions issued by a pharmacist’s National Provider Identifier (NPI). Advocacy in this area is needed. After all, if we are deemed qualified to issue a treatment, then we should be qualified to get paid for rendering that treatment.

— MSCP FOCUS —

“Unite and empower pharmacy professionals through engagement, advancement, and advocacy to optimize care and pursue health equity.” Bringing It All Together The new mission statement for MPA is to “Unite and empower pharmacy professionals through engagement, advancement, and advocacy to optimize care and pursue health equity.”6 In an effort to honor our oath, as well as the mission of MPA, we can embrace and advocate changes that improve patient care by becoming more involved. MPA, the Michigan Society of Community Pharmacists (MSCP) and MPA advocacy programs are just a few ideas to get started. At the most recent MSCP Board meeting, the Clinical Practice Committee made the decision to form an MSCP COVID-19 Workgroup. The workgroup seeks to provide helpful information, guidance and best practices to Michigan community pharmacies that would like to, are ready to, or are currently providing the COVID-19 vaccines. Moreover, the workgroup seeks to focus on:

• Identifying the challenges community pharmacies are facing as a result of the COVID-19 pandemic and how to overcome them.

• Providing important information on how to become a provider for the COVID-19 vaccines in the community pharmacy setting.

• Outlining best practices to assist in the provision of safe, highlevel patient care during the COVID-19 pandemic.

We took the Oath of the Pharmacist voluntarily and of our own free will, to take on the responsibilities the public and our patients have assigned to us. To all my colleagues in the profession of pharmacy, I encourage you to consider what comes to mind when you read the oath during this time. I think the time has come for us to own it. A special thank you to Amanda Peters, Pharm.D. candidate, for her contributions to this article.

TABLE 1. COMPARISON OF CURRENT EUA COVID-19 VACCINES Type

Pfizer BioNTech7

Moderna8

Johnson & Johnson9

mRNA

Ad26 vector

Doses

2 doses

1 dose

Dosing interval

21 days

28 days

Not applicable

Deltoid of the upper arm

Multidose vial with up to 6 doses per vial

Multidose vial with up to 10 doses per vial

Multidose vial with up to 5 doses per vial

Yes

0.5 mL

Location Preparation Reconstitution Dosage

0.3 mL

Adverse drug reactions Age restriction Contraindications

Pain, swelling and redness of injection site, chills, tiredness, headache

Pain, swelling and redness of injection site, Pain, swelling and redness of injection site, headache, chills, tiredness, headache fatigue, myalgia, nausea, fever

16 years and older

18 years and older

Patients with an allergy to polyethylene glycol or polysorbate

Patients with a history of allergic reaction (e.g. anaphylaxis) to any component of the vaccine

TABLE 2. STORAGE OF CURRENT EUA COVID-19 VACCINES

Unopened

Pfizer BioNTech7

Moderna8

Frozen in an ultra-low temperature freezer between -80º to -60ºC (-112º to -76ºF) for up to 6 months

Frozen between -25º to 15ºC (-13º to 5ºF) for up to 6 months

May be stored between -25º to -15ºC (-13º to -5ºF) for up to 2 weeks. Vials stored at this temperature for up to 2 weeks may be returned one-time to -80º to -60ºC (-112º to -76ºF)

Refrigerated at 2º to 8ºC (36º to 46ºF) for up to 30 days

Original thermal container temporarily based on the re-icing guidelines on the thermal container when consistently re-filled with dry ice

Room temperature for 30 minutes (no more than 2 hours) Thawing

Refrigerated at 2º to 8ºC (36º to 46ºF) for up to 5 days Do not refreeze

Room temperature for no more than 12 hours

Johnson & Johnson9 Store between 2º to 8ºC (36º to 46ºF) Do not store frozen May be stored between 9º to 25ºC (47º to 77ºF) for up to 12 hours

Do not store on dry ice or below -40ºC Room temperature for 1 hour. Use within 12 hours Refrigerated at 2º to 8ºC (36º to 46ºF) for 2 hours. Let stand at room temperature for 15 minutes before administering Do not refreeze

The vaccine is initially stored frozen by the manufacturer. If the vaccine is still frozen upon receipt, thaw at 2º to 8ºC (36º to 46ºF) If needed immediately, thaw at room temperature. Do not refreeze

After dilution, store between 2º to 25ºC (36º to 77ºF) Opened

Use within 6 hours from time of dilution if refrigerated

Discard vial 6 hours after puncture

Not applicable

Use within 2 hours from time of dilution if at room temperature

References available upon request from the MPA office. 2021 Apr./May/June | Vol. 59, Issue 2

— LEGAL INSIGHTS —

VACCINE ETHICS IN THE AGE OF COVID-19

he public clamor for vaccine access is causing ethical, and in some cases legal, issues that the vast majority of medical community members have never seen. Every year, we work through those who are eager, hesitant or even outright resistant to flu vaccines, regular childhood immunizations or immunizations required for employment, military service and more. But this is different. Pharmacists are again being called upon (and happily, willingly stepping up) to facilitate a public COVID-19 immunization campaign. This is the largest such effort in American history, with more people needing a vaccine than has ever before been experienced.

BY JULIE JANEWAY,

associate principal, Foley, Baron, Metzger and Juip, PLLC

Simple economic theory tells us that when the supply of a needed commodity is limited, demand increases, and COVID-19 vaccines are the hottest commodity around.1 That means those who have control of these scarce resources have a sort of power over who gets access to the needed commodity. Limiting this discussion to pharmacy professionals, most don’t even recognize such power, but some are acutely aware and choose to use it to unethical or even illegal ends. The most infamous of examples involves the Wisconsin pharmacist who made the unilateral decision to destroy hundreds of doses of vaccines meant for his medical frontline coworkers because of his personal beliefs about its effects and the nefarious objectives of the pharmaceutical industry. Leaving his beliefs aside, this pharmacy “professional” made a decision for hundreds of other people about whether or not they received at least some level of protection from a danger they were facing on a daily basis. He took not only that personal decision from each and every worker, but he appropriated it for himself – the most unethical of decisions. That pharmacist didn’t just take away personal control, he took away hope and possibly life. Pharmacists, pharmacy technicians and student pharmacists have been on the front lines since the beginning of this pandemic and know first-hand the sense of powerlessness and the loss of control felt by so many they serve and serve beside. It is in the face of this that the morality, ethics and law related to vaccine administration have become so relevant. Morality concerns what an individual believes is right and wrong.2 Ethics is adherence to a code of conduct or behavior.3 American author and philosopher Aldo Leopold told us that “ethical behavior is doing the right thing when you know no one else is watching – even when doing the wrong thing is perfectly legal.”4 Ethical behavior is even harder when one is making decisions about allocating a

scarce resource among so many people who need it. In the case of pandemic-related medical treatment and vaccines, prioritizing who gets it and when has been an excruciating exercise. We should all be glad if we were not called upon to make such monumental decisions. Pharmacists didn’t think they would have to make them – until they started making appointments and telling people they weren’t yet “eligible,” or deciding between precious vaccines going to waste or calling whoever they could just to make sure those doses went in arms. Turning away vulnerable, desperate people is painful. And making that pain go away can lead to some unethical decisions, often colored by individual morality. For example, say a pharmacist, pharmacy technician or another pharmacy employee decides to fill appointments with their personal friends and family members, thereby failing to offer the appointments to the pharmacy’s eligible patients and community members first. Even if the family and friends were eligible (and it is a whole different story if they weren’t), the pharmacist has an ethical and legal fiduciary duty to the patients of the pharmacy to act in their best interests, not in the pharmacist’s own or those of their friends. Similarly, under the law of agency, the pharmacist is also responsible for the acts of those who assist the pharmacist and has a duty to supervise such individuals. The pharmacist is legally responsible for their actions as well, and if they break the law (even if it is a temporary law), the pharmacist is legally responsible.5 A situation like this can have multiple variants. What if I fill all the appointments with people I think should have the shots, because I think they are sicker than other eligible people? These are decisions that medical ethicists, public health officials, physicians, researchers and other qualified people have made for the good of our state and communities. Do not unilaterally second-guess that structure, because you may not be privy to the bigger algorithm in which that structure resides. What if the eligible

What if I fill all the appointments with people I think should have the shots, because I think they are sicker than other eligible people? 26

MichiganPharmacists.org

— LEGAL INSIGHTS —

Many independent pharmacies are in an ethical quandary about getting involved with the vaccine program – not because they are unwilling to do their part, but financial and staffing issues may make it unfeasible. family or friends who are called first are patients of the pharmacy? Okay, and so much the better. Schedule away. What constitutes being a patient of the pharmacy? Prescriptions filled designate a patient of the pharmacy, not items bought in the store in which the pharmacy occupies space. The word patient means a person who is ill or undergoing treatment for a medical condition or disease.6 There is a legal relationship established with a pharmacist because the pharmacist has reviewed, checked and filled the medication that will comprise some or all of the treatment for the patient, and the patient has acted in reliance.7

While this may be stating the obvious, do not “fake” patients, if doses had to be wasted, in order to seek reimbursement. That is federal program fraud, healthcare fraud, a violation of the state and federal false claims acts, and wire or mail fraud. And don’t lie or try to cover it up either (words to live by about every transgression or violation). Also, maintain robust security and inventory control systems to prevent anyone from purloining vaccine and selling it on the side. That would be a viper’s nest of legal problems that no one wants to encounter.

Many independent pharmacies are in an ethical quandary about getting involved with the vaccine program – not because they are unwilling to do their part, but financial and staffing issues may make it unfeasible. Conversely, pharmacies may face criticism and backlash for not participating in the vaccine program. It is a complex ethical conundrum. I have no advice other than to hunt for alternative resources for your patients if participating in the vaccine effort is not a possibility. Make those resources as widely available as possible. Perhaps work with another pharmacy or administration site, but try and do something to let your patients and community know you are not just abandoning them because you don’t care. Communication and transparency are key.

Also included in the vaccine participation decision-tree are the issues of data reporting, employee training, state and federal certifications, and building or integrating the necessary data and computer infrastructure. The integration of pharmacy systems and software with government reporting and tracking software can be a challenge, as well the fact that somebody has to do the tracking. On the issue of data reporting, it is important that it be honest, accurate and complete with regard to race and ethnicity data. It may be tempting to report more ethnic or minority vaccinees than may have actually been administered to improve statistics, especially in communities that may have a reputation for being less than equitable. It may also be tempting for some to exclude the race and ethnicity of vaccinees entirely. In all instances: wrong, unethical and illegal. These are medical records,8 even if they are not in an individual’s personal medical record with their physician or hospital. The records may violate state and federal laws if they are intentionally altered or an individual intentionally leaves out the data required to be reported to the state or any other agency.9

Finally, here are some additional legal issues to consider: • Every person you are administering a vaccine to is now a patient of the pharmacy. You are responsible for:

- Ensuring patients of the pharmacy have up-to-date allergy and interaction information on file that is checked before administration of the dose.

- Ensuring that social distancing is maintained at all times.

- Documenting and properly reporting the administration of the vaccines and any other required information or data.

- Proper post-administration observation for any reactions to the vaccine for the appropriate recommended timeframe.

- Ensuring that second-dose appointments are made and reminders provided by some preferred method.

• Store, thaw and use all vaccine properly and in compliance with all CDC and manufacturer requirements and guidelines.

• Properly dispose of remaining amounts or expired/improperlystored doses, and document waste fully.

• Until the CDC approves pooling remaining amounts of vaccine in vials, you cannot pool.

In the event something goes wrong and a patient sues, you will want the federal immunity provided under the Public Readiness and Emergency Preparedness (PREP) Act, so comply fully with all requirements of the vaccine administration program to ensure that it will cover you in the event you need it. References available upon request from the MPA office.

2021 Apr./May/June | Vol. 59, Issue 2

— ADV TECH CERTIFICATION —

Advanced Technician Certification: What’s In It For Me? Often, one of the first questions that typically comes to mind when one is asked to take on new duties and responsibilities is, “What’s in it for me?” This is a very valid response at a time when we are already stretched to our limits with personal and professional obligations, while we all have learned to navigate life in a crisis during the COVID-19 pandemic.

CPhT-Adv, director, MSPT Board of Directors; liaison, MSCP Board of Directors

So why would a pharmacy technician pursue the Advanced Certified Pharmacy Technician (CPhT-Adv) credential? To put it bluntly, pharmacy technicians must continue to prove and expand their value to the healthcare team by adapting to the evolving needs of the profession – or risk becoming obsolete. Pharmacists are determinedly moving forward to apply their expertise and education to the clinical aspects of appropriate and safe medication utilization and more direct patient care. This shift in responsibilities opens exciting opportunities for pharmacy technicians to pick up many of the remaining critical non-clinical tasks previously performed by pharmacists.

DIANNE MALBURG,

Pharmacy technicians should be willing and ready to step up to claim these tasks and can do so most effectively by proactively preparing to be the logical choice to take on these responsibilities. The CPhT-Adv credential can be earned by an active Pharmacy Technician Certification Board (PTCB) CPhT who has a minimum of three years of work experience and completes at least four Assessment Based Certificate programs (ABCs) or three ABCs and PTCB’s Compounded Sterile Preparation Technician (CSPT) Certification. Current ABCs available include medication history, technician product verification, billing and reimbursement, hazardous drug management, controlled substances diversion prevention and, now, immunization administration.

BY ANGELA FASZCZEWSKI,

R.Ph., chief operations officer, Michigan Pharmacists Association

As one of the original founders of PTCB, the Michigan Pharmacists Association (MPA) continues to offer educational programs to support technician development

MichiganPharmacists.org

and advancement. Early in 2020, MPA released The Certified Compounded Sterile Preparation Technician Exam Study Guide, designed to assist pharmacy technicians with successful preparation for the CSPT exam. The guide includes a 75-question practice exam, including answers and explanations to simulate the CSPT exam. Later in 2020, MPA launched its “Medication History and Reconciliation: Gathering All of the Pieces of the Puzzle Together for the Patient’s Complete Medication Picture” training program. The program is recognized as fulfilling the education requirement for the PTCB Medication History Assessment-based Certificate Program and prepares the pharmacy technician to complete the PTCB Medication History and Medication Reconciliation Certificate Program. MPA recently announced the release of its “Pharmacy Technician Immunization Administration” training program also recognized by PTCB as fulfilling the education requirements for the PTCB Immunization Administration Certificate Program. The program provides a total of six hours of continuing education credits consisting of 4.5 hours of home study and 1.5 hours of live study. This will be a highly desirable credential as COVID-19 vaccine is becoming widely available in pharmacies and flu season immunizations will be coming soon. MPA is planning to release additional training programs later in 2021 to support pharmacy technicians achieving their advanced certification designation through PTCB. So, what’s in a CPhT-Adv credential for pharmacy technicians? Only an investment in yourself and a chance to be a pioneer in your profession! To learn more about MPA’s educational opportunities designed specifically for pharmacy technicians, visit the MPA website at www.MichiganPharmacists.org/education/techadvtrain. To learn more about PTCB’s advanced technician certification visit www.ptcb.org/credentials/advancedcertified-pharmacy-technician-cpht-adv.

— ADV TECH CERTIFICATION —

Pharmacy Technician Immunization Administration MPA Offers New Program for Advanced Certification www.MichiganPharmacists.org/education/techadvtrain In 2020, the United States, and most of the world, encountered first-hand the devastating effects of a pandemic. While health care has historically focused on treating disease, our best weapon as healthcare professionals is the prevention of disease. Increasing the availability of pharmacybased immunization services has become critical in the area of disease prevention, especially to those patients who are most vulnerable. Pharmacy technicians can play a vital role in this effort. By working synergistically through team collaboration, the pharmacist and pharmacy technician can increase the capacity to immunize patients resulting in decreased healthcare costs. This four-part program, consisting of required readings, video-recorded lectures, a virtual live seminar and an observed demonstration of immunization technique, has been specifically designed for pharmacy technicians to provide them with a foundation of knowledge on existing vaccines and will provide pharmacy technicians with the skills training to administer immunizations.

TEACHING FORMAT

This program consists of four parts, including a home study and live components. The home study component consists of Part 1: a collection of resource documents and self-study reading materials, and Part 2: an online videorecorded PowerPoint lecture. The live component consists of Part 3: an interactive overview lecture, including a question and answer session, and Part 4: a practice demonstration exercise proctored and evaluated by a certified pharmacist immunizer who has successfully completed the American Pharmacists Association PharmacyBased Immunization Delivery Certificate Training Program and is an experienced immunizer. Each participant must complete all four parts of the program, correctly answer at least 70 percent of each set of self-assessment questions, demonstrate successful injection techniques to a proctor, submit all required documentation, as well as earn both the home study and live PCE credit to have successfully completed this training program.

Self-Study (Parts 1 and 2) Learning Objectives Upon completion of this program, the participant will be able to: 1. Describe the role of pharmacy technicians in supporting immunizations. 2. Define key terms in the immunization process. 3. List common vaccines and vaccination schedules including COVID-19 Vaccine. 4. Identify the techniques required to prepare a vaccine for administration. 5. Describe the procedures for vaccine administration and safety considerations. 6. Identify procedures for immunization-related documentation. 7. List procedures for receiving, storing and handling vaccines. 8. Describe methods for managing vaccine-related adverse reactions and emergency situations

Live Seminar and Demonstrations (Parts 3 and 4) Learning Objectives Upon completion of this program, the participant will be able to: 1. List the most common vaccines administered in pharmacies and summarize their associated vaccine schedule. 2. Describe and demonstrate the techniques required to prepare a vaccine for administration. 3. Demonstrate successful subcutaneous injection technique. 4. Demonstrate successful intramuscular injection technique. 5. Describe procedures for managing an adverse reaction to an immunization.

The Pharmacy Technician Advanced Training was created specifically for pharmacy technicians.

2021 Apr./May/June | Vol. 59, Issue 2

— PROFESSIONAL DEVELOPMENT —

PHARMACY TECHNICIANS TAKE ON IMMUNIZATION MPA Offers New Training for Immunization Administration

BY FARAH JALLOUL,

Pharm.D., M.B.A., state pharmacy emergency preparedness coordinator, Michigan Pharmacists Association

he pharmacy technician’s role has been evolving throughout the years, and the COVID-19 pandemic has further expanded the role of pharmacy technicians to now include immunization as well. Certified pharmacy technicians have recently been authorized to administer immunizations under the direction and supervision of a pharmacist, according to the “Guidance for Public Readiness and Emergency Preparedness (PREP) Act Coverage for Qualified Pharmacy Technicians and State-Authorized Pharmacy Interns for Childhood Vaccines, COVID-19 Vaccines, and COVID-19 Testing” issued Oct. 20, 2020, by the Michigan Department of Health and Human Services (MDHHS). By following the guidance and undergoing proper training, including that which is newly offered by the Michigan Pharmacists Association (MPA), pharmacy technicians will be able to successfully carry out this critical responsibility. MDHHS made this change in response to a nationwide decrease in childhood and adolescent immunizations. The guidance authorizes immunization of patients between 3 and 18 years old. It also grants immunity under the PREP Act with respect to all claims for loss caused by, arising out of, relating to or resulting from the administration or use of the vaccine, as long as all requirements are met. To qualify, pharmacy technicians must satisfy the following requirements: • The vaccination must be ordered by the supervising qualified pharmacist, who must be readily and immediately available to the immunizing qualified pharmacy technician.

• The vaccine must be authorized or licensed by the U.S. Food and Drug Administration (FDA). In the case of a COVID-19 vaccine, the vaccination must be ordered and administered according to the Advisory Committee on Immunization Practices’ (ACIP) COVID-19 vaccine recommendations.

• In the case of a childhood vaccine, the vaccination must be ordered and administered according to ACIP’s standard immunization schedule.

• The qualified pharmacy technician must complete a practical training program – such as the one now available through MPA – that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include handson injection technique and the recognition and treatment of emergency reactions to vaccines.

• The qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation.

MichiganPharmacists.org

• The qualified pharmacy technician must complete a minimum of two hours of ACPE- approved, immunization-related continuing pharmacy education during the relevant state licensing period(s).

• The qualified pharmacy technician must, if the patient is 18 years of age or younger, inform the patient and the adult caregiver accompanying the patient of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.

The supervising qualified pharmacist must also:

• comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient’s primary care provider when available and submitting the required immunization information to the state or local immunization information system (vaccine registry).

• comply with requirements related to reporting adverse events.

• review the vaccine registry or other vaccination records prior to ordering the vaccination to be administered by the qualified pharmacy technician.

• comply with any applicable requirements (or conditions of use) as set forth in the Center for Disease Control and Prevention’s (CDC) COVID-19 vaccination provider agreement and any other federal requirements that apply to the administration of COVID-19 vaccine(s).

Note that this authorization preempts any state or local law that prohibited or effectively prohibited those who satisfy these requirements from administering COVID-19 or routine childhood vaccines, according to the guidance. MPA has created a new ACPE-approved program to satisfy the training requirement. The MPA training program, Pharmacy Technician Immunization Administration, also meets the requirements for the Pharmacy Technician Certification Board (PTCB) credentialing program for advanced Certified Pharmacy Technician (CPhT-Adv) Immunization credential. The MPA customized training program helps prepare pharmacy technicians for the new PCTB certificate focused on pharmacy technician immunization administration. It is recognized as fulfilling the education requirement for the PTCB Immunization Administration Certificate Program. For more information on the program, go to: www.MichiganPharmacists.org/ Education/Pharm_Tech_Immun. References available upon request from the MPA office.

— COVER YOUR ASSETS —

Protect Your Family’s Most Valuable Asset….

YOUR PAYCHECK!

May is Disability Insurance Awareness Month! Your ability to earn a living is your most important asset. One of the best ways to protect it is with disability insurance. Think of it as insurance for your paycheck. Many people think their home or other possessions and investments are their greatest asset. In reality, their earning potential is usually their greatest asset.

BY RON DEVERS,

CIC, CPIA, manager, PSI Insurance Agency

Lost income from a serious illness or injury can prevent you from working, and the cost can be substantial. Everything from paying the mortgage to saving for future needs, like a child’s education, depends on your ability to earn money from your job. Accidents are not the major cause of most disabilities in today’s workplace. Back issues, cancer, heart disease and other illnesses account for most long-term disability cases. Workers’ Compensation only covers time from work if the disabling illness or injury happens directly from a work-related activity. Many business owners choose to be excluded from this coverage, increasing the need for them to consider some form of disability insurance.

Many believe Social Security will help them out. From 2006 to 2015, only 34 percent of Social Security Disability Insurance (SSDI) claimants were approved, while it takes on average three to five months to get the initial approval or denial. If denied, the appeals process can last a year or longer. Since only 48 percent of Americans have enough savings to cover living expenses for three months, then what? The average duration of a long-term disability is 34.6 months – almost three years! Proper planning BEFORE the claim happens can protect your paycheck and your family’s dreams! Let PSI Insurance Agency work with you to protect your most important assets. For more information, call PSI Insurance Agency at (517) 484-1468 or visit www.PSIInsurance.net.

One Note About MICHIGAN No-Fault Reform

On July 2, 2020, auto insurance reform took effect in the state of Michigan. While most people have made their selection, they may not know you are required to fill out the forms for your Personal Injury Protection at every renewal. The exception is if you choose unlimited coverage; then you do not need to submit the form. Feel free to contact us at (517) 484-1468 or visit www.PSIInsurance.net if you have any questions. 2021 Apr./May/June | Vol. 59, Issue 2

— THAT’S MY PHARMACIST —

Throughout the upcoming months, there are a variety of That’s My Pharmacist flyers on the MPA website that correspond to several national observances. Use these monthly observances to talk to your patients about important healthcare topics and how they can best utilize their pharmacist and pharmacy services. Here’s just a small sampling of the upcoming That’s My Pharmacist resources: April – Alcohol Awareness Month

In April we observe Alcohol Awareness Month. This observance was originally founded in 1987 in order to reduce the stigma surrounding alcohol and alcoholism. Pharmacists play a significant role in educating patients year-round about the dangers of mixing alcohol and medications, but April is the designated month to make further strides in educating and informing patients about alcohol and alcoholism. This flyer aims to support pharmacists in this mission, addressing specific facts about alcohol that will help prompt patients to reach out to their pharmacists about this tangible danger.

May – Asthma and Allergy Awareness Month

In the middle of spring, when allergies are at their worst and asthma is particularly sensitive, Asthma and Allergy Awareness Month is a crucial observance. Millions of Americans suffer from asthma, spring allergies and food allergies. As a result, May is a nationallyrecognized month where pharmacists have the unique opportunity to offer advice about medications that can minimize the effects of allergies and asthma as well as how to properly utilize these medications. Use the Asthma and

MichiganPharmacists.org

Allergy Awareness Month flyer to start conversations between yourself and patients who may need assistance alleviating allergy or asthma symptoms.

June – National HIV Testing Day

Held annually on June 27, National HIV Testing Day was first recognized in 1995 and has been a continuous observance ever since. Fifty thousand Americans are infected by HIV every year, with many not even realizing that they have been infected, so it is up to their healthcare providers to help patients recognize the symptoms and recommend when to take an HIV test. Display this flyer to convey complex information about HIV, its testing process and how to avoid contracting the disease in a concise and easilyunderstood format.

Anti-Smurfing Campaign

Other resources you can also find on the That’s My Pharmacist webpage include two informational posters about antismurfing. Smufing is when individuals

purchase cold and allergy medicines that contain pseudoephedrine to manufacture methamphetamines, either for themselves or others. Explore these posters and post them in your practice settings to bring public awareness to the dangers of smurfing and potentially deter customers from buying pseudoephedrine medications illegally for the purpose of producing methamphetamines. In addition to the above flyers and posters at www.MichiganPharmacists.org/patients/ thatsmypharmacist, you can also locate medication cards, brochures and additional posters to eliminate the divide between pharmacists and patients as well as national observance flyers for every other month of the year.

— CE HOMESTUDY —

PHARMACY LAW & ETHICS UPDATE Method of Delivery: Video recording from MPA’s Annual Convention & Exposition available on MPA’s website Target Audience: Pharmacists, Pharmacy Technicians Disclosure Statement: The speaker does not have any conflicts of interest or financial relationships with a commercial interest related to this activity. Pharmacist Objectives: At the end of this activity, participants should be able to: 1. D iscuss changes to Michigan Administrative Rules affecting pharmacists, technicians, and pharmacies 2. D iscuss ways to resolve potential ethical conflicts 3. D iscuss the likelihood of a pharmacist or technician being named as a defendant in a malpractice lawsuit given new case law

New continuing education requirements (R 338.3041) for Michigan pharmacists took immediate effect in December 2020, requiring pharmacists to complete at least one hour of continuing education in pharmacy ethics and jurisprudence. According to the Department of Licensing and Regulatory Affairs, this requirement is to be met by the time an applicant files for renewal in their first full cycle. For example, a pharmacist filing for renewal in 2021 will not be required to obtain the ethics and jurisprudence CE until their next renewal cycle in 2023. A complete copy of the new rules can be found at www.michigan.gov/bpl. For specific questions, contact LARA at (517) 335-0918, or email to BPLHelp@michigan.gov. To meet this requirement, the Michigan Pharmacists Association (MPA) offered a Pharmacy Law and Ethics Update at the MPA Annual Convention & Exposition in February. This program is now being offered as a recording for one hour of home study credit. Delivered by Kim Sveska, MS, JD, Principal and Lawyer with Foley, Baron, Metzger, Juip, PLLC in Livonia, Mich., this program discusses changes to Michigan Administrative Rules affecting pharmacists, pharmacy technicians and pharmacies; discusses ways to resolve potential ethical conflicts; and discusses the likelihood of a pharmacist or Important Information Regarding Continuing Education Credit pharmacy technician being named as a defendant in a malpractice Upon completion of this activity, participants must complete an online evaluation. Participants will receive pharmacy continuing education (PCE) lawsuit given new case law. credit through CPE Monitor, a national collaborative effort by ACPE and the National Association of Board of Pharmacy (NABP) to provide an electronic system for pharmacists and pharmacy technicians to track their completed PCE credits. MPA, as an ACPE-accredited provider, is required to report pharmacist and pharmacy technician PCE credit using this tracking system. Pharmacist and pharmacy technician participants must provide their NABP e-Profile identification number and date of birth (in MMDD format) when they complete a PCE activity. It will be the responsibility of the participant to provide the correct information. If this information is not correctly provided, NABP and ACPE prohibit MPA from issuing PCE credit. Online access to their inventory of completed credits will allow pharmacists and pharmacy technician to easily monitor their compliance with PCE requirements and print statement of credit. Partial credit will not be awarded. If you have not yet signed up for CPE Monitor, go to https://nabp.pharmacy/programs/ cpe-monitor/. For more home study activity option for pharmacists and pharmacy technicians, visit https://www.michiganpharmacists.org/ education/online.

This recording is available for purchase at www.MichiganPharmacists.org/education/lawethics.

Michigan Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity #0112-0000-21-121-H03-P & #0112-0000-21-121-H03-T, 1.0 contact hour, Initial Release Date: 2/27/21, Expiration Date: 2/27/24, Knowledge-based Activity. This program meets pharmacy law educational requirements for pharmacy technicians and ethics and jurisprudence educational requirements for pharmacists.

This program is now being offered as a recording for one hour of home study credit.

2021 Apr./May/June | Vol. 59, Issue 2

MichiganPharmacists.org

2021 Apr./May/June | Vol. 59, Issue 2

MichiganPharmacists.org