April/May/June 2018

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PHARMACIST T H E O F F I C I A L J O U R N A L O F 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

Hormonal Contraceptive Prescribing for Michigan Pharmacists Inside 12 Years of Membership Recognitions 20 Contacting Your Legislator

2018 Apr./May/June | Vol. 56, Issue 2

33 2018 MPA Annual Convention & Exposition

MichiganPharmacists.org

IN THIS ISSUE

MEMBERSHIP 3 4 5 9 10 12

President’s Platform CEO Corner Events Calendar Euchre for a Cause “Funraising” while Fundraising Years of Membership Recognition

COVER 16 Hormonal Contraceptive Prescribing for Michigan Pharmacists

PROFESSIONAL AFFAIRS 18 Legislative Update 20 Contacting Your Legislator 23 Michigan Society of Community Pharmacists Focus 26 Navigating a Licensing Investigation or Complaint 27 Are You PMP-AWARxE? A Review of the New MAPS 29 That’s My Pharmacist 30 Cover Your Assets 31 Leadership Focus

CONTINUING EDUCATION 32 Homestudy: Patient Safety in Patients with Depression 33 2018 MPA Annual Convention & Exposition 39 MPA Time Capsule Editor: Larry D. Wagenknecht; Associate Editor: Dianne E. Malburg; Managing Editor: Kristina E. Bird 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.

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 Kristina Bird, MPA director of communications, at (517) 377-0232 or Kristina@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, 2018

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2018 Apr./May/June | Vol. 56, Issue 2

PRESIDENT’S PLATFORM

Another Amazing

Annual Convention and Exposition!

By SANDRA TAYLOR, R.Ph., M.S., administrator of clinical operations and director of pharmacy services, Beaumont Hospital, Wayne and Michigan Pharmacists Association president

I was once again amazed with the entire 2018 Michigan Pharmacists Association (MPA) Annual Convention & Exposition itinerary! While I was not able to attend all the sessions, the feedback I received regarding the topics covered and the speakers was extremely positive. In addition, as I am sure you would agree, it was great meeting and networking with colleagues within and outside of our individual practice settings. A special thanks and accolades to the MPA staff for preparing and coordinating such a phenomenal Annual Convention & Exposition!

I hope you were able to attend the Opening and Keynote sessions!

During the Opening session, “Battling the Opioid Epidemic - What you can do TODAY!”, we heard from three outstanding and passionate panelists: Dr. David Neff, chief medical director of the office of Medical Affairs within the Michigan Department of Health and Human Services; Phil Pavona, founder and vice president of Okemos/Ingham county chapter of Families Against Narcotics and Dr. Stephen Bell, board certified internal medicine physician in adult and bariatric care. Moderated by our chief executive officer Larry Wagenknecht, we learned about the current opioid epidemic, the deadliest drug crisis in American history. Opioid overdose is the leading cause of death for Americans under the age of 50.

This epidemic is killing thousands,

“...more than guns or car accidents, and doing so at a pace faster than the H.I.V. epidemic did at its peak.”1 In addition, Rony Foumia, R.Ph., pharmacy district manager for Rite Aid, presented “Overview of the Opioid Epidemic Crisis in Michigan and the United States”, which led us through the history of how the opioid epidemic started. He also incorporated a Michigan and national overview. Pharmacy professionals were strongly encouraged by all presenters to get involved in preventing further spread of the crisis and engage with our community. While the crisis is very disheartening, I left the Convention better informed, inspired and extremely motivated.

During the Keynote session on Saturday, the President of Global Centurion, a nonprofit organization fighting human trafficking, Laura J. Lederer, J.D. presented “Health and Human Trafficking: What Pharmacists Need to Know.” She shared facts about the physical and mental issues of human trafficking victims and provided ways pharmacy professionals can assist in responding to the human trafficking crisis. The presentation was both moving and enlightening.

The weekend provided educational sessions covering a broad variety of interesting current and relevant topics including pain, law, safety, quality, disease state management and more. Special thanks to our speakers for their dedication to education.

The number of students in attendance at the Annual Banquet and Awards Ceremony was impressive.

Through the Adopt-a-Student Program, student MPA members were given the opportunity to attend the Annual Banquet by being sponsored by a practicing pharmacy professional. Again this year, all students participating in the Program were adopted. Thank you to all who supported the Michigan Pharmacy Foundation Adopt-a-Student Program and thereby the future of our profession.

At the House of Delegates Session, several thought-provoking resolutions were proposed and directed to the MPA Executive Board for review and recommendation.

A special thanks and congratulations is necessary to all those who were presented with awards throughout the weekend. Thank you for your dedication and going the extra mile to advance our profession! And to all the sponsors of the Convention, thank you for your support of MPA! As mentioned in my address at the Awards Banquet, I challenge all pharmacy professionals to imagine themselves as their favorite superhero with super powers to change the world of healthcare. What would that change look like? As you travel through your changed world, I remind you that all our dreams, hopes and aspirations can come true! We don’t have to be superheroes to change the world of healthcare. We can make change just as we are.

References:

1. Salam, Maya. The Opioid Epidemic: A Crisis Years in the Making. The New York Times website. https://www.nytimes.com/2017/10/26/us/opioidcrisis-public-health-emergency.html. Accessed March 2018.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has!”

Margaret Mead MichiganPharmacists.org

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2018 Apr./May/June | Vol. 56, Issue 2

CEO CORNER

A Look AHEAD

By LARRY WAGENKNECHT, pharmacist, chief executive officer, Michigan Pharmacists Association

Update on CPESN Efforts Michigan Pharmacists Association (MPA) and Pharmacy Services Inc. (PSI), MPA’s for-profit subsidiary, are continuing to learn more about the Community Pharmacy Enhanced Services Network (CPESN) efforts across the country. A little over two years ago, PSI began interactions with the CPESN leadership out of North Carolina.

Community Care of North Carolina received a grant from the Center for Medicare and Medicaid Innovation (CMMI) to test new reimbursement models. CPESN is focused on increasing resources for patients with the highest needs and to analyze payment reform for state and federal health programs. The CPESN effort is attempting to bring some of the successes that were realized during the grant into other areas of the country.

Thus far, PSI has evaluated the structure and models being pursued in other states, participated on regular CPESN “luminary” calls, evaluated the benefits of community pharmacies contracting with CPESN USA and addressed the monthly fees that will be charged for participation in the CPESN USA national network.

Additionally, PSI has reviewed and evaluated the CPESN USA network legal documents for both the local community pharmacy and the state network.

PSI has assembled an advisory group of Michigan pharmacists who have expressed interest in creating a CPESN-like network in our state. Based on their recommendations, PSI is moving forward to serve as the statewide-management group. The advisory group is working to combine the local expertise of pharmacists with the influence and abilities of the Association and PSI. More information will be provided as it becomes available. Pharmacists interested in learning more about establishing a CPESN in Michigan should contact PSI Chief Operations Officer, Dianne Malburg, at Dianne@ PSI.solutions.

in each emergency response. Signing up on the Registry allows you to be credentialed now, so in the event of a disaster, it becomes much easier to get pharmacy-related assistance to locations where it is needed.

For more information, visit www.MIVolunteerRegistry. org or contact Dianne Malburg at Dianne@ MichiganPharmacists.org.

PBMs in the Spotlight In recent weeks, pharmacy benefit managers (PBMs) have been thrust into the limelight of public opinion.

For many in pharmacy, the activities of PBMs have provided significant challenges to the pharmacists and pharmacies in community practice. These challenges have included, but are not limited to: DIR (direct and indirect remuneration) fees, unfair audit practices, low reimbursement and an overall lack of transparency to the groups that ultimately pay for pharmacy services.

Recently the Arkansas Attorney General initiated a special investigation into PBM practices with state-funded programs. Additionally, in mid-March, the Speaker of the Ohio House of Representatives announced an investigation of the state auditor on the practices of the state PBM with Medicaid. Armed with the information from Michigan pharmacists and information from other states, MPA has reached out to the Michigan Attorney General to encourage that a similar assessment be done to PBMs that provide services to state employees and Medicaid. At the time this issue is going to print, we do not know whether the conversations will translate into action. In addition to the communications with the Attorney General’s office, MPA staff continues to work to advance Senate Bill 287 that would require PBM transparency in the state of Michigan and some other benefits to community pharmacy.

Please contact your State Representative and State Senator and encourage them to support Senate Bill 287!

More information will be provided in upcoming MPA communications!

Sign up for the Michigan Volunteer Registry!

The MI Volunteer Registry is an electronic registry open for those willing to volunteer their time and expertise during an emergency event. The Registry allows the volunteer (pharmacists and pharmacy technicians) to choose the field, area and time commitment they are able to provide, allowing them to customize their own volunteering schedule. While the Registry is open for anyone over the age of 18, it lacks adequate pharmacy professional participation.

MPA’s main goal is to promote the Registry and increase pharmacy participation during a local, state or national emergency event, should it ever occur. As a MI Volunteer, you will determine your level of involvement MichiganPharmacists.org

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2018 Apr./May/June | Vol. 56, Issue 2

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.

For continuing education events, please see page 6 of this issue.

APRIL 2018

MAY 2018

JUNE 2018

Sunday, April 1 – Monday, April 30

Tuesday, May 1 – Thursday, May 31

Friday, June 1 – Saturday, June 30

Tuesday, May 1 – Thursday, May 31

National Cancer Survivors Day Nationwide

National Alcohol Awareness Month Nationwide

Monday, April 2 – Friday, April 6 National Public Health Week Nationwide

National Asthma and Allergy Awareness Month Nationwide

Mental Health Month Nationwide

Saturday, April 7

Tuesday, May 1 – Thursday, May 31

World Health Day Worldwide

Hepatitis Awareness Month Nationwide

Monday, April 9

Tuesday, May 1 – Thursday, May 31

MPA Executive Board Meeting MPA Headquarters, Lansing

National High Blood Pressure Education Month Nationwide

Wednesday, April 11

MPF Board of Trustees Meeting MPA Headquarters, Lansing

National Safety Month Nationwide

Sunday, June 3

Monday, June 11 – Sunday, June 17 Men’s Health Week Nationwide

Thursday, June 14

MSHP Board of Directors Meeting MPA Headquarters, Lansing

Wednesday, June 27 HIV Testing Day Nationwide

Thursday, April 12

MSHP Board of Directors Meeting MPA Headquarters, Lansing

Saturday, April 21 – Saturday, April 28

National Infant Immunization Week Nationwide

Tuesday, April 24

World Meningitis Day Worldwide

Thursday, May 3

MSHP Committee Day and Board Meeting Okemos Conference Center, Okemos MSHP will hold the second Committee Day of 2018 on Thursday, May 3. Committees will continue to address their charges for the year, and the MSHP Board will meet following the adjournment of all committee meetings. For more information on MSHP Committees, visit www.MichiganPharmacists.org/mshp.

Tuesday, April 24 – Monday, April 30

World Immunization Week Worldwide

Thursday, April 26

CSPM Board of Directors Meeting MPA Headquarters, Lansing

Friday, May 4

MSPT Executive Committee Meeting Charter Health Care Training Center, Flint

Sunday, May 13 – Saturday, May 19

Wednesday, June 27

MPF Golf Classic Timber Ridge Golf Club, East Lansing Join the Michigan Pharmacy Foundation for its annual Golf Classic! Compile a team and come show your support of the Foundation in this 18-hole, 4 person scramble. Men’s, women’s and mixed team flights are welcome.

Learn more and register at www.MichiganPharmacists.org/ eventscalendar/mpfgolfclassic2018.

National Women’s Health Week Nationwide

Thursday, May 17

MPA Executive Board Meeting MPA Headquarters, Lansing

Thursday, May 17 – Friday, May 18

Saturday, April 28

National Prescription Drug Take Back Day Nationwide On National Prescription Drug Take Back Day, the DEA provides events throughout the nation that give Americans the opportunity to dispose of unused, unwanted or expired medications helping keep them off our streets and out of our environment. To learn about a disposal site near you, visit TakeBackDay.DEA.gov.

MPA Executive Board Retreat MPA Headquarters, Lansing

Friday, May 18

HIV Vaccination Awareness Day Nationwide

Wednesday, May 23

PSI Board of Directors Meeting MPA Headquarters, Lansing

Thursday, May 31

MSCP Committee and Board of Directors Meeting MPA Headquarters, Lansing

Thursday, May 31

World No Tobacco Day Worldwide

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SUPPORT MPA’S ADVERTISERS AmerisourceBergen: P. 22 Bowl of Hygeia Recipients: P. 28 Burtka Law, PLLC: P. 23 Congratulatory Ads: P. 6, 15, 21 EPIC Pharmacies: P. 19, 38 Pharmacy Management Partners: P. 37 PSI Insurance Agency: Back Cover

2018 Apr./May/June | Vol. 56, Issue 2

CE EVENTS CALENDAR Saturday, May 5

MSCP/MSPT Continuing Education Event Richard M. DeVos Center, Grand Valley State University, Grand Rapids

• Target Audience: Pharmacists and pharmacy technicians • Requirements Met: Live, human trafficking, law, pain • Contact hours: Up to 5.25 • Registration: www.MichiganPharmacists.org/eventscalendar/ mscpmsptce050518

Tuesday, May 22

APhA Pharmacy-based Immunization Delivery Program MPA Headquarters, Lansing • Target Audience: Pharmacists and pharmacy technicians • Requirements Met: Live, homestudy • Contact hours: Up to 12.0 self-study, 8.0 live hours • Registration: www.MichiganPharmacists.org/eventscalendar/imm052218

Thursday, May 24

CSPM Reimbursement and Regulatory Changes: Surviving Tomorrow Diplomat, Flint • Target Audience: Pharmacists and pharmacy technicians • Requirements Met: Live • Contact hours: Up to 6.5 • Registration: www.MichiganPharmacists.org/eventscalendar/cspmreg05242018

Welcome New MPA Members!

The number of new MPA members grew by 201 from December 2017 to February 2018.

Pharmacy Technicians

77 Student Pharmacists

Pharmacists

98

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2018 Apr./May/June | Vol. 56, Issue 2

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2018 Apr./May/June | Vol. 56, Issue 2

BIOS AND MEMORIES MEMORIES Donald Dahlquist

Kenneth Fagerman Jr.

Donald Edward Dahlquist, age 90, passed away Wednesday, Feb. 21, 2018. He served his country in the US Army during World War II and married Ardis Benson on Aug. 26, 1950.

Mr. Dahlquist had been the owner and pharmacist at Benson Drugs and the pharmacist at Brookhaven for many years until retiring in 1993. Donald was the past President of the Western Michigan Pharmacy Association, was a regular Red Cross donor and liked to winter in Port Richey, Florida.

He is survived by his wife of 67 years, Ardis; daughter, Sue (Robert) Erickson; son, Randy (Debra) Dahlquist.

In lieu of flowers please consider giving to Muskegon AMBUCS, Linne Lodge #57 Viking Scholarship Fund or Language Camp Fund. Please visit www.ClockFuneralHome.com to leave a memory or sign the online guest book.

Kenneth Edwin Fagerman, Jr., 63, of Sand Lake, Mich., passed away suddenly on Wednesday, Feb. 14, 2018.

He is survived by his wife of 43 years, Denise (Knapp); one son, Eric (Hayley) Fagerman and two daughters, Kimberly (Chris) Peters and Laura (Ryan) Watts.

He graduated from Ferris State University in 1977 with a Bachelor of Science in Pharmacy and achieved his Master of Management from Aquinas College in 1988.

Ken also served as president of the St. Joseph County (Indiana) Pharmacy Association and director of pharmacy at several hospitals throughout his career. Ken had many accomplishments in life both professionally and personally, including the implementation of a highly successful pharmacy crime watch program for St. Joseph County, Ind. Donations are welcomed in memory of Ken at Ferris State University School of Pharmacy, The Southwest Michigan Underwater Preserve, C/O Michigan Maritime Museum, Buoy Project, 260 Dyckman Avenue, South Haven, MI 49090, and The Boy Scouts of America Council #781 of Sand Lake.

STUDENT FOCUS

STUDENT SCHOLARSHIP PROGRAM Every year, a $2,500 scholarship is awarded to at least one student pharmacist at each of Michigan’s three colleges of pharmacy. This year five students were recognized during the Student Pharmacist Self-care Challenge at the 2018 Michigan Pharmacists Association Annual Convention & Exposition. Congratulations to Benjamin August, Stephanie Gryebet and Andrew Stone from Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Dylan Kosaski from Ferris State University College of Pharmacy and Jean Huang from University of Michigan College of Pharmacy.

Ferris State University College of Pharmacy

Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences

Dylan Kosaski Benjamin August

Stephanie Gryebet

University of Michigan College of Pharmacy

Andrew Stone Jean Huang

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2018 Apr./May/June | Vol. 56, Issue 2

STUDENT FOCUS

Euchre for a CAUSE

By DANIELLE RUSTEM, 2019 Pharm.D. candidate, Student Pharmacist Executive Council member, Ferris State University College of Pharmacy

Pass…farmer’s hand…pick it up…stick the dealer…

Goin’ alone! These phrases are familiar to many Michiganders. In fact, they are often heard exchanged between friends after classes on most college campuses throughout Michigan. In a state where many euchre fanatics are known to carry a deck of cards with them wherever they go (myself included), it is not uncommon to have a go-to partner for entering tournaments or playing friendly games. On one particular Friday night, however, a group of Ferris State University (FSU) students came together from across campus to play a few hands of euchre with new partners. Last year, on April 7, 2017, these brave souls spent their night participating in the Ferris Chapter of the Student Michigan Pharmacists Association’s Second Annual Euchre Tournament to benefit the Michigan Lupus Foundation.

The Michigan Lupus Foundation is a nonprofit volunteer organization, “working to build a brighter future for all lupus patients and their families” by providing support groups, lupus education and encouraging future lupus research. The Lupus Love Project is an emergency grant provided by the Michigan Lupus Foundation to individuals with lupus currently

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experiencing a financial need for lupus-related emergencies or treatment. The grant is available to any patient with lupus in need. Applicants can receive up to $400 in 12-months through this grant and can use the money for a variety of lupus-related expenses.

Thanks to funds allocated by the Michigan Pharmacists Association (MPA) to the student chapters at each of the three Michigan colleges of pharmacy, our chapter was able to host a euchre tournament in FSU’s University Center as well as provide snacks and beverages to the tournament participants. Prizes for the top students were donated by local Big Rapids businesses. Approximately 30 students from various academic programs registered and attended this Second Annual Euchre Tournament. Because of the generosity of these student participants, and the support of MPA, we were able to donate $200 to the Michigan Lupus Foundation’s Lupus Love Project. The FSU Student Michigan Pharmacists Association’s Third Annual Euchre Tournament to benefit the Michigan Lupus Foundation took place on April 5, 2018, and again provided funds to the Foundation in this fun and unique format. Look forward to more information about funds raised and future events soon!

2018 Apr./May/June | Vol. 56, Issue 2

FROM THE FOUNDATION

“Funraising” while

FUNDRAISING

By DIANNE MALBURG, executive director, Michigan Pharmacy Foundation

Every year during the Michigan Pharmacists Association (MPA) Annual Convention & Exposition, the Michigan Pharmacy Foundation (MPF) hosts a variety of activities from “funraising” to fundraising! The fun began with the MPF Adopt-a-Student Program that provides an opportunity for fellow pharmacy professionals to sponsor students to attend the MPA Annual Awards Banquet. The Program was started as an initiative to connect practicing pharmacy professionals with student pharmacists and promote networking and mentorship between individuals at different stages of their career. Students who sign up to participate in the program submit a photo and brief biography that is placed in an adoption catalogue where “parents” can choose the “child” they desire to adopt for the Convention. Approximately 120 students signed up to participate in the Program. In exchange for their adoption, each student pharmacist is required to volunteer one to two hours of their time during the Convention. Student assignments vary from selling raffle tickets, introducing speakers or helping a staff member at the registration desk. While the success of the program is due to the generous sponsors, the real value is seen when a student and pharmacy professional establish a long-lasting relationship because of the connection they made through the MPF Adopt-aStudent Program. Students who participate in the program are also encouraged to “pay-it-forward”, stay involved in the Association after graduating and even work to provide this opportunity for other students in the future.

2018 Charity Auction

everyone who participated in this year’s Charity Auction with a special “thank you” to such a large number of local associations and practice sections who created unique baskets. The monies raised through the Charity Auction were used to help fund the Foundation’s grant programs, student scholarships and leadership development programs. Items not sold during the MPA Annual Convention were taken to the Northern Michigan Pharmacy Education Seminar on April 7-8 where individuals who may not have attended the Convention had the opportunity to win great items while supporting the Foundation.

Another fun activity hosted by MPF was the “Gift Card Tree.” The MPF Board of Trustees solicits and/or donates gift cards placed in envelopes that decorate the tree. Each envelope is guaranteed to have at least a $25 gift card up to $50. Convention attendees could purchase an envelope for just $20. Every participant was delighted to win a gift card worth more than their investment, and the tree was bare by Saturday afternoon due to the popularity of the activity. Some attendees stated the thrill of selecting an envelope from the tree was addicting and caused them to purchase four or more envelopes! The Gift Card Tree activity raised nearly $1,000 this year.

While it’s always great to receive, it’s equally important to give, and that’s just what MPF does every year when it

Student pharmacists Allison Bouwma and Linda Arrabi, generously adopted by Marie & Gary Kadlec, with surrogate parent Dianne Malburg

The Foundation’s Annual Charity Auction also occurs every year during the Convention. The MPF Charity Auction Committee and staff begin soliciting donations in September for this fundraiser. Donated items included sports memorabilia, artwork, hotel stays, restaurant meals, golf packages, antiques, jewelry and much more.

This year, MPF received a record number of baskets with themes ranging from beer, wine and coffee to sports themes, beauty treatments and a family game package!

The Foundation would like to extend a big “thank you” to MichiganPharmacists.org

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Items donated by Convention attendees to Bay Cliff Health Camp

2018 Apr./May/June | Vol. 56, Issue 2

FROM THE FOUNDATION

Donors to the 2018 Charity Auction Amway Grand Plaza

Grand Hotel & The Jewel Golf Course

Ann Arbor Marriott Ypsilanti at Eagle Crest

Hilton Garden Inn

Odawa Casino Resort

J & K Steamboat Line, Inc.

Pilgrim’s Run Golf Club

Bavarian Inn Lodge & Conference Center

Jeffrey Farber, Owner of Auburn Pharmaceuticals

Bayshore Resort

Radisson Lansing at the Capitol

John & Lani Ochs

Brian Swartz

Ron & Nikki Devers

Kathy Jones

Shanty Creek Resorts

Pharmacists Association

PohlCat Golf Course

Buddy’s Restaurant Pizzeria

Kent County Pharmacists Association

Capital Area Pharmacists Association

Sheraton Detroit Novi Hotel

Kristi Zoar

Carrie & Rick Germain

Lansing Convention & Visitors Bureau

Sixth Street Pharmacy (Munson Services Inc.)

Consultant and Specialty Pharmacists of Michigan

Lansing Country Club

Somerset Inn Troy

Larry Wagenknecht Little River Casino Resort

Southwest Michigan Pharmacists Association

Cynthia Rowe Denise Markstrom & John Brubaker

Mackinaw Brewing Co.

Splash Universe Water Park Resorts

Detroit Marriott at the Renaissance Center

Mark Rhode & Putvin Drug Store

Stafford’s Hospitality

Detroit Metro Convention & Visitors Bureau

MCHC Munson Center Community Health Pharmacy & Munson Specialty

Suburban Collection Showplace

Melissa Lile Photography

Susan DeVuyst-Miller

Dianne Malburg

Melody Arnst

The English Inn

Dori Kern, CPhT, MPA Executive Board

Motor City Casino Hotel

The Henry Ford

Family Jewelers

NCG Cinemas

The Kensington Hotel

Feighner Boat Lifts & Docks

Northwestern Michigan Pharmacists Association

U of M College of Pharmacy

Detroit Red Wings Charitable Donations

Franz & Joan Neubrecht Gary & Marie Kadlec

Northern Michigan Pharmacists Association

Genesee County Pharmacists Association

Oakland County

Stephanie LaPointe Susan & Clayton Erickson

Weber’s Inn Western Michigan Pharmacists Association Wineguys Restaurant Group

is a year-round nonprofit therapy and wellness center for children and adults with physical disabilities. Children attend the camp with the goal of increasing their independence so they can live a fuller life. Bay Cliff also sponsors a week-long recreational camp for adults with physical disabilities, an adaptive paddling workshop, a health and wellness retreat for polio survivors, winter recreation for the children and adults that attend its summer programs, family programs for children with cerebral palsy, spina bifida and obesity as well as a professional development workshop for pediatric therapists.

President-elect Jessica Bessner and MPF Trustee and MPA Executive Board Member Ryan Greenley transporting donated items for Bay Cliff Health Camp across the bridge

selects another worthy charitable organization to support. The Foundation Board of Trustees chose to support Bay Cliff Health Camp again in 2018 by taking donations during its collection drive during the MPA Convention.

Items collected have typically been those that are easily found in any pharmacy such as personal care items, food staples and supplies. The Foundation conducts this donation drive to demonstrate one more example of how the pharmacy profession gives back to individuals in need. Bay Cliff Health Camp, located in Big Bay, Mich., MichiganPharmacists.org

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MPF Trustee and newly elected MPA Executive Board member, Ryan Greenley, generously agreed to transport the items from the Convention to Bay Cliff. While generous donations were made last year to Bay Cliff including $325 in monetary donations, the Foundation challenged MPA members to open their hearts even more in 2018 and to fill Ryan’s truck! Many must have heard this plea because not only was Ryan’s truck much fuller than last year, the Foundation also collected over $2,000 in monetary donations that will be sent to Bay Cliff. Thank you to everyone for your support of this worthy charitable organization!

2018 Apr./May/June | Vol. 56, Issue 2

MEMBERSHIP

YEARS OF MEMBERSHIP Michigan Pharmacists Association congratulates the following pharmacy professionals on achieving significant membership milestones.

5 Years Susan Abrash Azadeh Ali-Moghaddam Samuel Anderson Katie Axford James Aylmer Lisa Bade Jessica Benzer James Bonifer Frank Brettschneider Ben Bringedahl Megan Buchinger Courtney Carroll Thomas Dillon Jessica Efta Amber Erving Timothy Findley Ziad Ghamraoui Nicholas Greiner Christi Gross Sandra Guckian Cheila Halsey Malissa Hanovich Leah Heffernan Eleonora Huskey Steven Jensen Karen Katt Heather Kauffman Viannah Khouri Charles Kinsey Stephanie Klepser Benjamin Korman Johanna Kurnik Joel Kurzman Linda Lampi Stephanie LaPointe Simon Leung Thomas Magnifico Adam Mayes Karen McNally Kimberly Moon Brittany Myland Joslyn Neal Janice Nolan Pravin Patel Alan Perrin Libin Philip Kristin Raredon Aimrie Ream Juanita Redelinghuys Andrea Rowinski Alexander Runowski Laurie Sarnacki

James Schaeffer Amanda Soyad Eric Szydlowski Cynthia Toman Gary Vachon Natalie Washburn Scottb Wheeldon Stephen Woltanski Heather Young

10 Years Lara Alexander William Bice Shannon Bice Moges Bogale Betty Chaffee John Clark Michelle Dehoorne Patricia Ellenburg Jocelyn Heksem Anthony Hunter Shelby Kelsh Michael Kraft Suzan Kubinec Michael Mankowski Wayne Melchior Christopher Munden William Runyon Debra Watson Maria Young Jason Young

15 Years Sabine Barnhart Fawn Bass Eleni Butzin Kaci Chamberlin Nofal Cholag David Collins Diana Cooper Kathryn Courser Racheal Crane Lawrence Curtis Ahmad Dabliz Leo Dark Heather Girand Heidi Grebe James Grzegorczyk Jennifer Hagerman Jacquelyn Heidelbaugh Karen Hennesey Amy Jacobs Kathleen Janus

Simon Kue Sarah Kuhns Joseph Leonard Kimberly Long Zbigniew Martusiewicz Ned Milne Charles Mollien Kenneth Murphy, Jr Bradley Noon Mary Beth O’Connell Jean Osborn Derek Quinn Andrew Reeves Kevin Roeder Amy Roeder Beverly Ross Nada Saad Deanna Scully Craig Straley Fred Tarver

20 Years Brian Baars Robert Boyko Linda Bubenko Ronald Coleman Jeanette Gooden Charles Hastings Mark Isopi Kyle Kronemeyer Brian Linne Tammra McAllister Carl Olson Karen Purcell-Kobel Michael Rose Nellie Sahakian Rima Shafie Christine Shoens Donna Stark Joan Toutant Anne Wierenga Frances Zalewski

25 Years Dawn Badgley Jeffrey Bates Carol Behr Robert Bodjanac Shalonda Byrd Susan Conway Michael Curran Amy Engelhardt Stephen Felkey

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Karen Fenton Myriam Gennaoui Marc Giannetti Kathleen Goldberg Marc Guzzardo Rachel Henegar Kriste Hollenbaugh Jamal Kakish Alice Karasiewicz Keith Kocher Karen Miron John Mohler Wanda Moscicki Theresa Mozug John Muir Ellen Munro Deborah Pulver Kim Raymond Linda Ringer Noreen Schira Saad Shafie James Stevenson H. Arthur Sugarman Christopher Szefi Sheehan Thelen Kevin Wenzel George Wonsul

30 Years Luc Beaudreau Linda Branoff Larry Cowden Rolanda Davis John Gallizzi Andrew Grodman Denise Hoeksema Janis Huffman Carolyn Kinsman Amy Lawless Robert Loveland Deidre Nordlund-Briegel Rowland Rickert Stephen Roell James Safie Julie Schrantz Otto Sohn Carolyn States

35 Years Kristine Burchard Patricia Camazzola Ronald Chrovian Randel Clapsaddle

2018 Apr./May/June | Vol. 56, Issue 2

Jay Duprey Patrice Eid Suzanne Enquist Vahram Fantazian Paula Goudreau Gene Hancock Ronda Hawkins Marilyn Kirking Randy Oleynik Denise Pratt Douglas Samojedny Kathleen Sheehy Dale Tucker

40 Years John Bicking Michael Breen Craig Cooper Terrence Currin William Dudewicz, Jr. Falah Garmo Paul Jensen Suzanne Keeley Thomas Klaasen Ronald Knoth Diana Kovnat Suzanne Lake-Willyard Andrew McNab Judith McNab Mark Mittlestat Martin Newman David Poirier Mark Sancrainte Kim Sveska James Yinger

45 Years Stuart Bas Douglas Ettema Ralph Heuerman Gary Kadlec

50 Years Robert Conway Richard Dillon Arthur Gustafson Robert Hodges Elizabeth Kereji Jack Newberry Frederick Schmid Terry Skoglund William Urfer Myron Winkelman

MEMBERSHIP

NEW Member Benefit

Sword and Shield Identity Protection Sword and Shield provides members with:

•O ngoing monitoring that proactively searches through thousands of financial and non-financial databases to detect the early stages of identity theft.

If suspicious activity is found, members will be notified immediately by a personal phone call • I dentity risk score searches hundreds of billions of records where we apply unique and proprietary analytics to create a risk score that helps determine if the member is currently a victim of identity theft or in the beginning stages of having their identity stolen •R estoration solutions to provide members with highly-trained fraud specialists that can help restore your name to a pre-theft status • F ree 60 minute legal consultation with an attorney resolving identity theft concerns

• F ree 60 minute financial counseling

• I nsurance protection up to $1,000,000 to reimburse expenses incurred in reclaiming your identity

• L egal defense fees

•C osts of refiling loan applications

•C osts of notarizing documents

•P ostage reimbursement

• L ost wages

•C ivil suites

•R eceive victim advice, access free credit reports, stop credit card offers, access your Social Security Statements, receive coverage on fraud and false arrest and receive protection for financial and medical information

All of these great benefits are available to MPA members for an exclusive price of $100 a year, a $25 discount off the normal price of $125! For more information about how to take advantage of this new member benefit, contact Mike Wolf, MPA director of membership, at Mike@ MichiganPharmacists.org or (517) 377-0231.

Covered services include, but are not limited to:

ENGAGE YOUR COLLEAGUES Now is the time to share with your friends and colleagues in pharmacy why you belong to one of the strongest state pharmacy associations in the country!

As an active member, you know first-hand the value of a strong MPA – more services and resources for members, more recognition and advocacy and a louder voice protecting your interests and advancing your profession. Here is your chance to be recognized for recommending MPA to your friends and colleagues.

It’s win, win, win! MPA benefits by representing another pharmacy professional. The new member benefits by taking advantage of all that MPA membership has to offer. You benefit by strengthening MPA and receiving rewards for your efforts!

Let’s work together to shape the future of pharmacy.

GREAT RECRUITS = GREAT REWARDS Progressive Reward Scale

1-2 RECRUITS

Recruit 1-2 members and receive: $25 per pharmacist $10 per technician on your first two recruits

5+ RECRUITS

Recruit 5 or more members and receive: $100 per pharmacist $20 per technician

3-4 RECRUITS

Recruit 3-4 members and receive: $50 per pharmacist $15 per technician on your next two recruits

MONTHLY DRAWINGS Plus for every member you recruit during a month, you get a chance to win a $50 Amazon gift card!

The more members you sponsor, the greater your chances to win!

Recruitment rewards will be paid by check from MPA. You may recruit new members or re-enlist former members who have not had membership since 2014. New MPA members and sponsors are eligible for only one membership promotion at a time. This offer excludes any discounted membership offers as well as associate and student memberships.

Members earning more than $600 per year will be issued a 1099. MPA reserves the right to discontinue this program at its discretion. Monthly drawings begin in April and run through September. Monthly drawings may continue past September at MPA discretion. Rewards will be paid 90 days after new member join date.

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2018 Apr./May/June | Vol. 56, Issue 2

Golf Classic Wednesday, June 27 Timber Ridge Golf Club, East Lansing Join MPF for an 18-hole, 4-person scramble! Men’s, women’s and mixed team flights are welcome.

Golf Schedule 8 - 9 a.m.

Registration, driving range and putting green open.

Sale of golfer package and registration for putting contest.

9 - 9:30 a.m.

Putting Contest 10 a.m.

Play (shotgun start) 3 p.m.

Awards Ceremony Registration is $160 per individual or $600 per foursome. Payments must be received by June 19 in order for the early registration discount to apply. Please register foursome teams at the same time to secure the discounted rate. After June 19, rates increase to $175 per individual or $700 per foursome.

If you are interested in sponsorship opportunities, please contact Sam McNerney at (517) 377-0259 or Sam@MichiganPharmacists.org.

Register online at www.MichiganPharmacists.org/eventscalendar/mpfgolfclassic2018 by Tuesday, June 19, to save on rates!

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2018 Apr./May/June | Vol. 56, Issue 2

MEMBERSHIP

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2018 Apr./May/June | Vol. 56, Issue 2

ON THE COVER

HORMONAL CONTRACEPTIVE PRESCRIBING

for Michigan Pharmacists

By MEGAHN LAMMERS, Pharm.D. candidate 2019, University of Michigan College of Pharmacy, Ann Arbor and KAREN B. FARRIS, Ph.D., Charles R. Walgreen III professor of pharmacy administration, chair, department of clinical pharmacy, University of Michigan College of Pharmacy, Ann Arbor

In the United States, 45 percent of pregnancies were unintended in 2011.1 Notably, births from unintended pregnancies are associated with adverse effects for both mother and child.1 This issue is a significant burden, and the U.S. Department of Health and Human Service’s Healthy People 2020 initiative seeks to increase the number of intended pregnancies by ten percent.1 Unfortunately, Michigan faces a proportion higher than the national average, as data from 2009 to 2011 reports an estimated 50 percent of births in Michigan were unintended.1, 2 Pharmacists can reduce unintended pregnancies in Michigan. It is important to recognize that two thirds of women who consistently use birth control comprise only five percent of the unintended pregnancies.1 In 2014, Michigan publicly funded family planning centers met only 16 percent of women’s contraceptive needs.1 Further, three out of four counties in Michigan have a shortage of primary care physicians.3 These factors suggest that there is an opportunity to improve access to hormonal contraception via non-physician providers. One solution to this issue is to allow pharmacists the authority to prescribe hormonal contraceptives.

This practice is already being done successfully in several states including California, Oregon and New Mexico.4-6

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ON THE COVER When developing a protocol, Michigan should consider the features of other protocols (Table 1).4-10 Generally, pharmacists must go through training, screen patients for inclusion/exclusion criteria via a patient questionnaire, provide written documentation and follow-up with the patient’s primary care physician. In Michigan, Public Health Code 333.16215 allows licensed professionals such as physicians to delegate an act, task or function (including prescribing authority) to other individuals such as pharmacists. Pharmacies that are interested in this service would need to have their pharmacists trained and establish an agreement about delegated authority with a local physician.11 Once the agreement is in place, operations to prescribe hormonal contraceptive can be set up. Based on review, our recommendation is the model/protocol from Oregon and Colorado should be used. We propose the following features for a Michigan protocol for pharmacists to prescribe hormonal contraceptives:

pharmacist about the impending service. Once the pharmacist assesses the patient and the patient meets the inclusion criteria with no exclusion criteria, a form of hormonal contraceptive will be determined. It is important to note that the inclusion/exclusion criteria are not time-consuming to consider. Some examples of exclusion criteria are a possible pregnancy or blood pressure greater than or equal to 140/90 mm Hg.5 After the contraceptive is determined, the technician could process and fill the new prescription. Once the interaction with the patient is complete, the pharmacist would complete the documentation, and the technician could fax the information to the patient’s primary care doctor.

When pharmacists from states that already prescribe hormonal contraceptives were asked about the barriers to this new service, the majority stated that pharmacist staffing and lack of time were the most concerning issues.13 Overcoming these barriers can be partially alleviated by blocking out time that pharmacists are available for seeing patients who seek hormonal contraceptives. Advertising these specific blocks of time without specific appointment times, such as 4-7 p.m. Wednesday and Thursday, would allow pharmacy scheduling to be simplified. Another way that pharmacies could improve access would be to post the patient screening questionnaire online so that it could be prepared and completed ahead of time and for the pharmacist to review. Similarly, pharmacies could use a pre-set form for providing a summary statement to patients and faxing to primary care physicians. A walk-in service could also be considered and having trained nonpharmacist personnel manage, check-in, assist in form completion and check-out could improve efficiency.

• required pharmacist training • a dministration of a patient screening questionnaire modeled after Colorado or Oregon • i nclusion of all self-administered hormonal contraceptives •p harmacist follow-up with patient’s primary care provider •p rovision of written documentation to patient summarizing the encounter.

The American Pharmacists Association (APhA) is currently offering a program about hormonal contraceptives that can be accessed online and meets most of the requirements for states whose pharmacists can currently prescribe.12

Prescribing hormonal contraceptives is being done successfully in several states. Developing models where pharmacists increase access to hormonal contraception may reduce the state’s unintended birth rates. We know Michigan pharmacists can meet this challenge.

To maximize efficiency in the pharmacy, technicians could give patients the screening form and inform the

Table 1: Features of State-based Hormonal Contraceptive Protocols Characteristics

Calif.

Colo.

HI

N.M.

Ore.

DC

Md.a

X

X Xb X

X

X

X

X

X X X X X

X X X

X Xc X X

X X X

X X X

X

X

X

Pharmacist training required Prescribing flow charts available

X X X

Patient screening questionnaire required Able to prescribe all self-administered hormonal contraceptivesd Required PCP follow-up from pharmacist Pharmacists are NOT allowed to set up appointments

X

Pharmacists must provide written documentation to patient

X X X

X

a Maryland’s legislature does not until 2018 b https://copharm.org/wp-content/uploads/2017/02/Standard-Procedures-Algorithm.pdf c http://www.oregon.gov/pharmacy/Imports/ContraceptivePrescribing/OregonStandardProceduresAlgorithmforRPhPrescribing12.17.pdf d Self-administered hormonal contraceptives are those administered via the following routes: oral, transdermal, vaginal or depot injection

References: 1. Office of Disease Prevention and Health Promotion. Healthy People website. https:// www.healthypeople.gov/2020/topics-objectives/topic/family-planning/nationalsnapshot. Accessed March 2018.

2. Michigan Department of Health and Human Services. Unintended pregnancies and percents. MDHHS website. www.mdch.state.mi.us/pha/osr/Abortion/ unintendestimates.asp. Accessed Oct. 12, 2017.

5. New Mexico Board of Pharmacy. Protocol for pharmacist prescription of hormonal contraception. New Mexico Regulation and Licensing Department Board of Pharmacy website. http://www.rld.state.nm.us/uploads/files/OCProtocolApproved(1).pdf.

Accessed Oct. 12, 2017.

A full list of references can be found on the MPA website.

3. Frisch, S. The primary care physician shortage. BMJ. 2013;347(4):f6559.

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4. California State Board of Pharmacy. Protocol for pharmacists furnishing selfadministered hormonal contraception. California Board of Pharmacy website. http:// www.pharmacy.ca.gov/laws_regs/1746_1_pt.pdf. Accessed Oct. 12, 2017

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2018 Apr./May/June | Vol. 56, Issue 2

LEGISLATIVE UPDATE

Legislative Update

The following provides recent actions in the Michigan Legislature and at the federal level that could impact your practice. Please note that this is the most current information as this issue is going to press.

•P UBLIC ACT 41 OF 2018 (HB 4472): This new law will allow pharmacists to substitute FDAdesignated interchangeable biological drug products, instead of dispensing higher cost brandname drugs. It will also require that a pharmacist notify a prescriber within five days that he or she has dispensed an interchangeable biological drug product. The notification may be made by making an entry that is electronically accessible to the prescriber through an interoperable electronic medical records system, an electronic prescribing technology, a pharmacy benefit management system, a health information exchange or a pharmacy record. If these methods are not available, then notification may be made by fax, telephone, electronic transmission or other prevailing means. This requirement would not apply if either of the following occurs: 1.) There is no FDA-licensed interchangeable biological drug product for the original product; or 2.) A refill authorization does not change the product that was dispensed on the prior filling of the prescription.

STATUS: Enacted and signed by the Governor on Feb. 28, 2018.

•H B 4405: This bill would allow a pharmacist to refuse to fill a prescription for a schedule 2-5 controlled substance if the pharmacist has a reasonable belief that it was not written in good faith or would not be filled for a medical purpose. A pharmacist who refuses to dispense a prescription under those circumstances would not be liable for damages in a civil action for injury, death or loss to person or property arising from the pharmacist’s refusal to dispense the prescription.

STATUS: Passed the House and was referred to Senate Health Policy Committee.

•H B 5223: If a manufacturer has a prescription drug with a wholesale acquisition cost of $10,000 or more per course of treatment, this bill would require them to file an annual report with the Michigan Department of Health and Human Services (MDHHS) on costs associated with that prescription drug for the preceding year. A manufacturer must also obtain an audit by an independent third party before the required report is filed. In addition, MDHHS must post on the internet a searchable database with data from the reports filed. Any manufacturer that fails to file a report is subject to a fine of $100,000. This bill also creates “the prescription drug cost advisory commission.” STATUS: Referred to House Health Policy Committee.

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•H B 5592: This bill allows prescribers to prescribe and pharmacists to dispense auto-injectable epinephrine to a school board. A prescriber and pharmacist would not be liable in a civil action for properly stored and dispensed epinephrine that was a proximate cause of death or injury due to the administration or failure to administer the epinephrine. STATUS: Referred to House Health Policy Committee.

•S B 492: This bill would require a health insurance policy that provided coverage for prescribed orally administered and intravenously administered or injected anticancer medications to ensure that treatment limitations applicable to the orally administered medications were not more restrictive than those applicable to intravenously administered or injected medications. Additionally, the health insurance policy would have to ensure either of the following: 1.) That financial requirements applicable to prescribed orally administered anticancer medications were not more restrictive than those applicable to intravenously administered or injected medications covered by the policy, and that there were no separate cost sharing requirements applicable only to the orally administered medications, and 2.) that the financial requirement for a 30-day supply of orally administered medication did not exceed $100 (subject to an annual adjustment for changes in the consumer price index for prescription drugs).

STATUS: Passed the Senate and referred to House Insurance Committee.

•S B 802: Beginning Jan. 1, 2020, a prescription for a controlled substance that is an opioid or a benzodiazepine must be transmitted electronically to a pharmacy. The electronically transferred prescription must include the information described in section 17754 (see below) and must be transmitted directly to a pharmacy of the patient’s choice by the prescriber or prescriber’s agent. If a prescriber cannot meet these requirements, the prescriber may apply to MDHHS for a waiver. The Department shall grant the prescriber a waiver if the prescriber does not have the electronic equipment or system that meets these requirements. STATUS: Referred to Senate Health Policy Committee.

Sec. 17754: (1) Except as otherwise provided under article 7, article 8, and the federal act, a prescription may be transmitted electronically if the prescription is transmitted in compliance

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LEGISLATIVE UPDATE with the health insurance portability and accountability act of 1996, Public Law 104-191, or regulations promulgated under that act, 45 CFR parts 160 and 164, by a prescriber or his or her agent and the data are not altered or modified in the transmission process. The electronically transmitted prescription shall include all of the following information:

( a) The name, address, and telephone number of the prescriber.

( b) Except as otherwise authorized under section 5110, 17744a, or 17744b, the full name of the patient for whom the prescription is issued.

( c) An electronic signature or other identifier that specifically identifies and authenticates the prescriber or his or her agent.

(d) The time and date of the transmission.

( e) The identity of the pharmacy intended to receive the transmission.

( f) Any other information required by the federal act or state law.

(3) Before dispensing a prescription that is electronically transmitted, the pharmacist shall exercise professional judgment regarding the accuracy, validity, and authenticity of the transmitted prescription.

(4) An electronically transmitted prescription that meets the requirements of this section is the original prescription.

(2) The electronic equipment or system utilized in the transmission and communication of prescriptions shall provide

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adequate confidentiality safeguards and be maintained to protect patient confidentiality as required under any applicable federal and state law and to ensure against unauthorized access. The electronic transmission of a prescription shall be communicated in a retrievable, recognizable form acceptable to the intended recipient. The electronic form utilized in the transmission of a prescription shall not include “dispense as written” or “d.a.w.” as the default setting.

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•S B 829: This bill allows an opioid antagonist to be prescribed and dispensed to public libraries. It also allows a public library employee who is trained in the administration of an opioid antagonist to possess and administer an opioid antagonist that was dispensed to the public library. STATUS: Referred to Senate Health Policy Committee.

2018 Apr./May/June | Vol. 56, Issue 2

ADVOCACY

Contacting Your Legislator

By REPRESENTATIVE HANK VAUPEL, of Fowlerville, chair of the House Health Policy Committee

The ability to personally contact your lawmaker is one of the things that makes our nation great. There have been several instances in my own office where a constituent or industry expert has called with a concern for state government that has inspired me to introduce a bill. Every single citizen truly does have the opportunity to be an agent for change. The first step is knowing how to get in touch with your legislator.

Contacting your legislator starts with finding out who represents you at the Capitol. Finding this information is easy by logging on to House.MI.gov and clicking on “Representatives.” Then, simply input your address into the fields provided and submit. Your representative’s webpage will include a phone number, email address and office address to get in touch with them.

If there is a particular issue you’re concerned about, you may want to sign up for committee notices from the appropriate committee. Log on to Legislature.MI.gov and click on “Committees” to find a list of committees and sign up for meeting notifications. From here you can also learn who the committee chair is and contact them accordingly.

When communicating with your legislator’s office, be sure to provide as much information as possible, including your background as an industry expert. The representative’s scheduler will be happy to assist you in setting up a meeting time with the lawmaker.

After meeting with the legislator about drafting legislation, he or she may invite you back to testify if the bill is taken up for consideration by a committee. This is a

wonderful opportunity for your voice to be heard by the entire committee firsthand and answer any questions they may have.

In my own office, I was honored to advocate for mothers of children with spina bifida. These mothers reached out to me because they saw a need for improvement when it came to the support they received from their healthcare providers after receiving their child’s diagnosis. These mothers were scared and overwhelmed at the time of the diagnosis and many did not receive any information about the condition or resources they could access for support. I’m so glad these women came forward, so we could work together to find a solution. Because of them, I was inspired to introduce a bill requiring medical providers to direct patients with a positive diagnosis of spina bifida to resources with additional information. The bill was passed in the House and now waits to be considered by the Senate.

As you can see, anyone can inspire change.

As chairman of the House Health Policy Committee, I’m happy to meet regarding any pharmacy issues. To contact my office visit www.GOPHouse.org/representatives/southeast/vaupel/contact.

State Rep. Hank Vaupel was elected to his first term in the Michigan House of Representatives in November 2014. He represents the people of Livingston County, including the village of Fowlerville, townships of Conway, Cohoctah, Deerfield, Hartland, Howell, Handy, Iosco, Unadilla, Oceola, Marion, and Tyrone; the city of Howell and part of the city of Fenton. Vaupel serves as the chair of the committee on Health Policy. He is also a member of the committees on Insurance, Michigan Competitiveness and Tax Policy.

Add Your Voice to MPA’s Pharmacy Advocacy Response Team!

What do PART members Do? Our members are concerned citizens, community leaders and the experts that legislators turn to when they need background information on pharmacy-related issues. You can be a part of a growing number of pharmacy professionals from all practice settings who recognize the value of being directly involved in advocating for the profession. MPA will equip you with information and resources and schedule appointments, legislative events or education opportunities.

When there is an issue that pertains to your practice setting, we will let you know!

Participate. MPA will provide you with opportunities to get involved at a local level!

Advocate. Stand up for what you believe in as a Michigan professional!

Respect. The best health policies cultivate respectful cooperation among allied health professions.

Teach. You will have opportunities to inform your legislator about the important work done in your practice setting every day!

Visit www.MichiganPharmacists.org/advocacy/part to learn more and sign up today!

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2018 Apr./May/June | Vol. 56, Issue 2

AT PRESS TIME Transfer of Unfilled Controlled Substance Prescriptions A number of members have reported some confusion regarding federal regulations and the transfer of unfilled electronic prescriptions for controlled substances. The question is – can a pharmacist transfer an unfilled electronic prescription for controlled substances?

Confusion exists because in Title 21, Code of Federal Regulations, Section 1306.25, the DEA made a specific exception so that a pharmacy can transfer the original prescription information to another pharmacy once it has filled an original prescription for a Schedules III-V controlled substance. However, forwarding of an unfilled prescription from one pharmacy to another pharmacy is not allowed.

The DEA published information in the preamble of the Notice of Proposed Rulemaking (NPRM) on Electronic Prescribing of Controlled Substances (EPCS) 73 FR 36722 and the preamble of the Interim Final Rule (IFR) on EPCS 75 FR 16235. As stated in the preambles of the NPRM and the IFR, an unfilled original EPCS prescription can be forwarded from one pharmacy to another pharmacy, which includes Schedule II controlled substances.

According to the DEA, because this was in the preamble and not in the EPCS regulations, the above statement represents DEA’s policy. However, even though the transfer is “legal” it is likely that many pharmacy software systems are unable to transfer the unfilled prescription. For more information related to this issue, please contact us at MPA@MichiganPharmacists.org.

Member Michael Klepser Awarded 2018 APhA Clinical Research Paper Award At the 2018 American Pharmacists Association (APhA) Annual Meeting in Nashville, Michigan Pharmacists Association member, Michael Klepser, was awarded the Clinical Research Paper Award. This award is presented annually and works to encourage high-quality clinical research or practice-based re-

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search in the clinical sciences. Criteria for the award include research that is well-designed around patient care intervention or practice-based initiatives and innovative research topics. Michael Klepser, Pharm.D., is currently a professor of pharmacy at Ferris State University.

Student Michigan Pharmacists Association Members Hold National Positions The American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) provides students with opportunities for growth and professional development.

Currently, three Gillian Leung, Dylan Kosaski and Andrew Stone Student Michigan Pharmacists Association (SMPA) members are serving in leadership capacities for APhA-ASP. Dylan Kosaski of Ferris State University currently serves as the APhA-ASP Region 4 Member at Large. In this role he works to communicate between chapters in his region about membership, patient care and APhA-ASP activities. Andrew Stone of Wayne State University is currently serving as the APhA-ASP Chair of the National Standing Committee on Policy. This Committee works to educate members about Academy resolutions, policies and advocacy initiatives that will advance the profession. And finally, Gillian Leung of University of Michigan is currently serving as Chair of the National Standing Committee on Communication. This Committee is dedicated to providing members with information to increase awareness of membership and engagement opportunities via external communications. Their dedication as students to both Michigan pharmacists and pharmacists throughout the nation will provide the leadership necessary to bring the profession into the future.

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2018 Apr./May/June | Vol. 56, Issue 2

FROM THE MSCP PRESIDENT

HOW FAR WE’VE COME AND WHERE WE’LL GO

By SHEROYL KIRBY, owner and pharmacist, Fred’s Pharmacy, Three Rivers and Michigan Society of Community Pharmacists president

First and foremost, I would like to thank our members who support Michigan Pharmacists Association (MPA) and those who are members of our practice section, Michigan Society of Community Pharmacists (MSCP). I know I have benefited greatly from being a member, and I am honored to be part of a team that is devoted to improving our profession and helping those who practice in it.

At the MPA Annual Convention & Exposition, I was reflecting with other colleagues about how much community pharmacy has changed over the past 30 years. Many of us remembered when our daily activities included counting tablets and labeling bottles. We did much of this on our own and did not have many pharmacy technicians to assist us. We also did very little patient education, and disease management was unheard of. The Omnibus Budget Reconciliation Act of 1990 (OBRA’90), which required pharmacists to educate patients, represented a point when the profession of pharmacy would forever change. MSCP has been there to assist pharmacists through this journey in many ways.

Looking at how far the profession has come today, it will be exciting to see what the next 30 years has to offer!

is necessary for their patients without the assistance of proficient, talented technicians. Realizing the importance of this relationship, the MSCP Board of Directors now has a member that is a pharmacy technician. We are also finalizing a continuing education program that is jointly sponsored by MSCP and the Michigan Society of Pharmacy Technicians. This event will take place on Saturday, May 5, 2018, at the Richard M. DeVos Center at Grand Valley State University in Grand Rapids. Participants will have the opportunity to obtain 5.25 hours of live continuing education. The programs will include pain, patient safety, law and human trafficking. We are looking forward to this time when pharmacists and pharmacy technicians can learn together outside of the pharmacy, thus building a great team. Pharmacists and technicians can look for more detailed information soon in your MPA and MSCP communications!

Currently, pharmacists offer a variety of services including immunizations, rapid diagnostic testing and education for disease management. Pharmacists help patients understand their medication and health by offering medication therapy management, and they offer adherence programs to assist patients in taking their medications. Pharmacists can offer education and Naloxone to patients at risk of opioid overdose. The MSCP Clinical Practice Committee has provided resources on many of these subjects and links to various sites that can assist pharmacists with many of these tasks. This information is easily available on the MPA website at www.

MichiganPharmacists.org/practiceresources/communitypractice. The MSCP Education and Communications Committee also continually works to provide valuable information and educational opportunities to our members. This year at the MSCP Luncheon, attendees were able to talk to several pharmacists who are involved in new and innovative practices in their workplace.

These practices provided and reinforced ideas that we could bring back to our own practice and improve our patients’ care.

Pharmacy technicians have also grown to be a vital part of our profession. Technicians provide the “body armor” for pharmacists, so they can provide effective services to patients. Pharmacists could not do all that MichiganPharmacists.org

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2018 Apr./May/June | Vol. 56, Issue 2

MSCP FOCUS

Inspired to

INNOVATE

With contributions from GHADA ABDALLAH, R.Ph; LISA BADE, Pharm.D.; DAVID BRIGHT, Pharm.D., BCACP; KATHLEEN BROWN, R.Ph.; ROBIN CURTIS, Pharm.D.; NANCY J.W. LEWIS, Pharm.D., M.P.H.; THOMAS MAGNIFICO, R.Ph. and STUART ROCKAFELLOW, Pharm.D.

At the 2018 Michigan Pharmacists Association (MPA) Annual Convention & Exposition, Feb. 23-25, the Michigan spirit of innovation was on full display when a group of pharmacists shared their experiences in providing innovative services during the Michigan Society of Community Pharmacists (MSCP) Luncheon on Saturday of the Convention. The pharmacists’ practices varied in responsibility and scope (Table 1), but some key insights could be drawn from their approaches to innovation. What follows is what attendees learned from their personal stories.

The Motivation to Innovate What compels a pharmacist to “go out on the edge”?

Often the desire to positively impact patient lives and make a difference in the health of the community drives a pharmacist to go beyond their usual scope of practice.

Sometimes it was a suggestion from a colleague or a pharmacy residency experience that was the spark.

Maria Young said she “... fell in love with the possibility that pharmacists can play an active role with patients.”

Kathleen Brown credits her Ferris State University professors who advocated for students to become engaged in patient education. A tragedy close to home rocketed Ghada Abdallah into advocacy work. Others said they felt compelled to expand pharmacists’ role in healthcare.

Forging New Models of Practice New technologies and models of care helped the pharmacists’ motivation flourish into established practices. The advent of pharmacogenomics, pointof-care testing technologies and rising consumer investment in pet care fostered new practices. The national movement toward improving patient care and population health combined with containing healthcare costs advanced support for medication MichiganPharmacists.org

therapy management (MTM) efforts. This support, combined with Michigan law that allows pharmacists to practice under physician-approved protocols, expanded pharmacist responsibilities in patient care.

Innovation requires collaboration. These pharmacists all cited the importance of creating partnerships with other practitioners. Tom Magnifico said his attendance at local veterinary association meetings was key to breaking down professional barriers that can stymie service referrals. Pharmacists who practice within medical offices talked about the importance of teamwork. Maria Young harnessed the contributions of pharmacy students from six universities into her practice. For some, community partnerships were essential. Ghada Abdallah shared her mission with “all who would listen,” leading to collaborations with family advocacy groups, local coalitions, government agencies, religious organizations and business and health professional groups.

What kept these pharmacists moving forward was the “thank you” that came from patients and prescribers as well as their own recognition that they improved patient care. Some enjoyed the opportunity to influence the next generation of pharmacists by showcasing their practice, and all mentioned that the thrill of learning, innovating and taking on new challenges kept them going.

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MSCP FOCUS qualified health center to create a private medical practice. Robin Curtis took a resident’s pharmacy project and expanded it into a program that encompasses 61 pharmacies across Michigan, and Tom Magnifico credits attendance at an American College of Veterinary Pharmacists conference as the spark for his practice.

David Bright encourages “developing a learning plan.”

For these pharmacists, that plan included pragmatic steps including:

But innovation is not for the weak of spirit. David Bright mentioned experiencing “pushback from some that believe that pharmacogenomics is beyond the scope of a pharmacist.” Robin Curtis said that people questioned why she wanted to work with drug addicts and heroin users. Lisa Bade saw the “fear of the unknown” as a barrier to innovation. But being willing to fail, staying determined and continued persistence were all cited as necessary actions. With innovation came the need to educate others about pharmacists’ qualifications, navigation to avoid potential interdisciplinary conflicts and attention to the business aspects of sustaining a new service.

•T aking continuing education courses • Investing in professional reference manuals or online services • Using MPA practice resources, such as the Naloxone toolkit

What it Takes to Innovate

• Seeking residency or advanced training

For these pharmacists, lack of formal academic training was not a barrier to innovation. Kathleen Brown stated that her current practice is the culmination of her experiences in community pharmacy, outpatient pharmacy MTM and cardiac rehabilitation counseling.

While Stu Rockafellow completed an ambulatory care residency, it was his experience in a team care model at the University of Michigan that led him to a full-time practice as a clinical pharmacist within medical clinics.

Lisa Bade built on her experience within a federally

For each of these pharmacists, the professional and personal benefits of creating an innovative practice outweighed any challenges. Stu Rockafellow summed up his advice by encouraging others to “keep your eyes open for opportunities. Engage, collaborate, and seize opportunities to demonstrate your ability.” Ghada echoed this: “lean in, contribute, let your voice be heard.”

Table 1: Community-based Practice Innovations Shared at the 2018 MSCP Luncheon Pharmacist

Practice Description

Highlighted Responsibilities

Ghada Abdallah, R.Ph. Park Pharmacy, Grosse Pointe

Pharmacy owner and practitioner that advocates for substance use disorder (SUD) prevention and treatment

Presentations to community groups, business coalitions, healthcare organizations, advocacy within SUD coalitions, Naloxone dispensing under statewide protocols, opioid use counseling to patients

Lisa Bade, Pharm.D., SpartanNash, Grand Rapids

Outpatient clinical pharmacist providing MTM and pharmacy care management to selected patients in collaboration with primary care practices

MTM using various reimbursement strategies, program development focusing on all needs, desired endpoints and the importance of team-based care to improve outcomes

David Bright, Pharm.D., BCACP Ferris State University, Big Rapids

Pharmacy educator that assists pharmacists in establishing pharmacogenomic services

Collaboration with pharmacists, physicians and other healthcare team members to incorporate pharmacogenomics into drug therapy selection and monitoring

Kathleen Brown, R.Ph., Northern Physicians Organization, Traverse City

Clinical pharmacist practicing within an internal medicine clinic and a family practice clinic

MTM, protocol-guided prescribing, laboratory test ordering and monitoring, development of population health management initiatives

Robin Curtis, Pharm.D. SpartanNash, Grand Rapids

Clinical coordinator for statewide pharmacy-based opioid safety and naloxone dispensing program

Raise awareness about SUD, educate pharmacists on safer opioid use, discuss naloxone with at risk individuals, work with community groups to reduce stigma of addiction

Thomas Magnifico, R.Ph. Keystone Pharmacy, Grand Rapids

Community pharmacist that specializes in veterinary compounding

Compounding of veterinary prescriptions, collaboration with veterinarians regarding pet therapy, education of pet owners about medications

Stuart Rockafellow, Pharm.D., Northern Physicians Organization, Traverse City

Clinical pharmacist practicing within two primary care clinics and a neurology clinic

Protocol-driven medication management, patient and family member education, development of interventions to improve quality metrics

Maria Young, R.Ph., University Pharmacy, Detroit

Community pharmacy owner and practitioner offering point-of-care testing

Pharmacy practice and management activities, pointof-care testing, immunizations, patient care research, pharmacy student precepting

The Michigan Society of Community Pharmacists (MSCP) and MPA stay on top of pharmacy practice regulations, including developments in medication therapy management, diabetes, Naloxone and other clinical services delivered in the community pharmacy setting. Be sure to visit the Community Practice Resources on the MPA website to stay up-to-date and educated about these topics and more at www.MichiganPharmacists.org/practiceresources/communitypractice.

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2018 Apr./May/June | Vol. 56, Issue 2

PROFESSIONAL PRACTICE

Navigating a Licensing Investigation or Complaint

By JEFFREY BURTKA, J.D., Burtka Law PLLC, Royal Oak

Receiving an administrative complaint or request for an interview from a Michigan Department of Licensing and Regulatory Affairs (LARA) investigator can be terrifying. Therefore, it’s imperative for pharmacists to understand the investigation and complaint process so they can avoid or limit sanctions against their licenses.

Investigative File and Compliance Conference

The Investigation and Interview Anyone who believes a pharmacist has violated the Public Health Code (Code) can file a complaint with the state. If the state believes a complaint might be valid, it initiates an investigation. During the investigation, a Michigan Department of Licensing and Regulatory Affairs (LARA) investigator often requests a meeting with the pharmacist to discuss the violations.

Pharmacists have no obligation to speak with any investigator, but sometimes a meeting could benefit the pharmacist. It is important to consult with an attorney familiar with licensing investigations before agreeing to a meeting. In addition, pharmacists should have an attorney present at the meeting in order to protect the pharmacist’s rights and point out any legal deficiencies about the allegations. At the end of the investigation, the state will issue an administrative complaint if it believes a violation occurred or will close the case if it believes the evidence is insufficient.

Administrative Complaint and Summary Suspension Either the Attorney General or LARA can issue an administrative complaint, the formal document that charges violations of the Code. The office that issues the administrative complaint handles initial negotiations, but LARA will transfer a matter to the Attorney General if the pharmacist demands an administrative hearing.

If the state believes the pharmacist is an imminent threat to the public’s health, safety or welfare, it will issue a summary suspension order with an administrative complaint, but this rarely happens. A summary suspension bars a pharmacist from practicing until the administrative complaint is resolved or until the pharmacist successfully petitions the state to dissolve the order.

The Answer The pharmacist must answer the administrative complaint within 30 days of receipt, or the state will automatically sanction the pharmacist’s license. Do not let the deadline to answer pass!

The answer is a formal legal pleading and is not the place to write lengthy explanations or defenses. Lengthy answers can result in inadvertent admissions that could sink the pharmacist’s case. The pharmacist should consider consulting with a lawyer to draft an answer that leaves the burden on the state to prove its case.

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Pharmacists should consider asserting two important rights: obtaining the investigative file and requesting a compliance conference.

The investigative file includes the investigator’s witness interviews, the documents that the state will use at the administrative hearing and any expert reports. Most importantly, the investigative file might include favorable evidence that the state overlooked. The state must provide a copy of the file in every contested case if the pharmacist requests it.

A compliance conference is a confidential meeting where the pharmacist and their attorney can ask for leniency, explain why the allegations are false and/or attempt to settle the case. If LARA is handling the case, a LARA analyst likely will be the only state representative present. If the Attorney General’s Office is handling the matter, an assistant attorney general and Board conferee will represent the state. The conferee is a member of the Board of Pharmacy’s Disciplinary Subcommittee (DSC) and will make any recommendations to settle or dismiss the case to the DSC, even if the conferee did not attend the compliance conference.

Administrative Hearing If settlement negotiations fail, the case will proceed to an administrative hearing before an administrative law judge (ALJ). The ALJ will consider evidence from the state and the pharmacist and will issue a proposal for decision (PFD) that makes conclusions of fact and findings of law for the DSC to consider.

Disciplinary Subcommittee The DSC makes all final decisions regarding licensing matters. It can reject the PFD and make its own findings as well as rejecting any settlement agreements between the state and the pharmacist. However, it is rare for the DSC to reject a settlement agreement because its conferee has recommended it.

A pharmacist can appeal the DSC’s final order to the Michigan Court of Appeals. The court will not hear new evidence, but will determine whether the DSC’s findings are supported by competent material and substantial evidence. The court will not overrule the state unless the state made a serious error in judgment or misapplied the law.

All pharmacists have a right to defend their licenses against investigations and administrative complaints, and knowing their rights goes a long way toward preserving their licenses.

Jeffrey Burtka is an attorney and the owner of Burtka Law PLLC. He primarily practices in the areas of professional licensing defense and defending healthcare professionals against Medicare revocations and overpayment claims. He represents clients throughout the State of Michigan.

The information in this article is provided for informational purposes and is not legal advice, nor does it create an attorney-client relationship between you and Burtka Law PLLC. Nothing herein should be relied on or used without consulting a lawyer to consider your specific circumstances and possible changes to applicable laws, rules, and regulations.

2018 Jan./Feb./Mar. | Vol. 56, Issue 1

PATIENT SAFETY

ARE YOU PMP-AWARxE? A Review of the New MAPS

By PRESTON TAYLOR, Pharm.D., staff pharmacist, Mercy Health Muskegon In 2016, the misuse of prescription opioid analgesics (CMR). Inquiries made by delegates are electronically claimed nearly 63,600 lives, no doubt making the opioid linked and appear in the “Recent Requests” queue of epidemic one of the largest public health issues facing the the delegator. Registering a delegate is similar to primary United States today.1 For multiple years, the Institute for users, requiring independent registration and creation of Safe Medication Practices (ISMP) has identified narcotics as an individual login. The delegator’s PDMP-linked email the drug class with the most reported medication errors.2,3 address is required at the end of registration. The request Managing the risks of misuse, abuse and diversion may must be confirmed by the delegator and state administratseem insurmountable, especially when patients have the ing body.8 ability to “doctor shop” or utilize multiple pharmacies.

Prescription drug monitoring programs (PDMPs) have NarxCare been one of the most effective strategies in combatting NarxCare is a robust data analytics tool which aggregates opioid misuse. Originating in the 1930s, PDMPs are stateand analyzes PDMP data. Interactive dispensing histories based data repositories of pharmacy-reported dispensing are scanned for red flags, and patient-centered resources information purposed for preventing the misuse, abuse are more readily available for prescribers. The Narx Score and diversion of federally classified controlled substances. and Overdose Risk Assessment collate variables to evaluate Technologic advances like the internet and data streaming a patient’s unintentional overdose risk. While there is no has allowed for faster reporting, more intricate data analydefinitive action recommended, prescribers and pharmasis and point-of-care/dispense access for providers. The cists should consider utilizing these tools to initiate converNational Alliance for Model State Drug Laws (NAMSDL) sations with patients to deliver the safest care possible.8 has published a guideline outlining components of a • Narx Scores strong prescription monitoring program. All fifty states Narx Scores are a scaled, weighted, population-based currently have PDMPs, but there are differences in their derivation of mined PDMP data. A three-digit score is capabilities, administration and utilization.4,5 generated ranging from 000 – 999 for an individual’s In April 2017, Michigan transitioned to a new PDMP use of narcotics, stimulants and sedatives. Patients 6 platform, PMP-AWARxE, powered by Appriss Health. are unevenly distributed across the continuum such The change has resulted in increased usability, functionalthat 75 percent of patients score < 200, five percent ity and an overall cosmetic appearance. If implemented are > 500, and one percent are > 650, with higher properly, these updates can help improve the safety and scores being more associated with increased risk. The handling of controlled substances. Some accessibility first two digits are calculated using population-based features of PMP-AWARxE are particularly noteworthy: references. The third digit represents the number of •U sers, including pharmacists, may delegate access active prescriptions in the respective class.8,9 • I ntegration into electronic health records and phar • Overdose Risk Assessment macy dispensing software Commensurate with Narx Scores, the Overdose Risk Assessment (ORA) is a three-digit score (range: • I nterstate data exchange capability between 24 other 000 – 999) correlating to a patient’s relative risk of states utilizing PMP-AWARxE unintentional overdose death. The long-term goal of •N arxCare, a proprietary tool which identifies red flags this metric is to include additional discrete variables and assesses risk for overdose mortality beyond PDMP data in the algorithmic calculation. A positive correlation has been noted between ORA and Legislative Changes unintentional overdose death with risk approximately Beginning June 1, 2018, providers must obtain and doubling for every 100-point increase in ORA.8,9 review a MAPS report prior to prescribing a controlled Based on calculated odds ratios and observed mortalsubstance unless intended for inpatient use or written for ity within the population, an ORA score of 650 has been less than a 3-day supply.7 Lt. Gov. Brian Calley has also approximately equated to 90mg/day milligram morphine announced initiatives to integrate PDMP software into equivalents (MME), the recommended maximum in the electronic medical records and pharmacy dispensing Centers for Disease Control and Prevention chronic pain systems, alleviating the management of secondary logins guideline. Additionally, patients with an ORA between 400 and easing access to the MAPS system. See the MAPS to 650 may be considered equivalent in risk to 50+ mg/ webpage on the Michigan Department of Licensing and day MME, and offering a home Naloxone prescription as a 6 Regulatory affairs at www.Michigan.gov/mimapsinfo. result of this score may be a valid recommendation.8,10 PDMPs are useful tools for assuring the proper utilization Delegating Access of federally scheduled controlled substances. In response to In the wake of legislative changes, prescribers may the growing opioid crisis, state legislatures are mandating the look to pharmacists to help meet the requirements for utilization of this software for prescribers and investing in its PDMP querying. This provides a unique opportunity for continued growth. One benefit has been the incorporation pharmacists to make recommendations on appropriate of new tools and resources which can help guide discusand judicious opioid use. Delegating access to office sions with patients. Pharmacists should be able to navigate staff and pharmacy technicians will create more time for the new MAPS and seek opportunities to make meaningful pharmacists in the workflow for evaluation and clinical interventions in the care of these patients. decision making. Technicians could also query MAPS A full list of references can be found on the MPA website. in anticipation of a comprehensive medication review MichiganPharmacists.org

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2018 Apr./May/June | Vol. 56, Issue 2

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2018 Apr./May/June | Vol. 56, Issue 2

THAT’S MY PHARMACIST

How You Can Bring Patient Attention to National Observances

By STEFANI CHUDNOW, MPA communications intern, senior, Michigan State University

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 observance flyers 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 the nationally-recognized 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 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 easily-understood format.

Anti-Smurfing Campaign Other resources you can also find on the That’s My Pharmacist webpage include two informational posters about anti-smurfing. Smurfing is when individuals purchase cold and allergy medicines that contain pseudoephedrine to manufacture methamphetamines, either for themselves or others. Display these posters 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. Here you can also find national observance flyers for every other month of the year.

If you have any questions or comments regarding any of the above information or further flyers you would like to see, please feel free to contact MPA Director of Communications, Kristina Bird, at Kristina@MichiganPharmacists.org.

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2018 Apr./May/June | Vol. 56, Issue 2

COVER YOUR ASSETS

Plan for What’s Ahead, Protect What You Leave Behind

By RON DEVERS, CIC, CPIA, CAWC, PSI Insurance Agency manager

Wow! Where does the time go? The first quarter of 2018 is behind us, and spring is upon us, hopefully. For my spring offering in the journal, I just wanted to mention a few updates and items to keep in mind.

New Agency Website Our new PSI Insurance Agency website is up and running. We are excited to give you the capability to request a quote online. Just fill in your contact information and submit your request with one easy click! The website also features a new “Report a Claim” page. Just select “Report a Claim” from the homepage and submit that information. We hope to make more enhancements as time goes by, so be sure to check it out at www.PSIinsurance.net.

Why is Life Insurance Important?

February was “Insure Your Love” month. Life insurance is one of the many products we sell here at the Agency, but is often the one most overlooked. Life insurance is important as it provides financial protection against the unexpected and funds received can be used to supplement lost income, pay bills, or help maintain a standard of living. Life insurance goes up with age, so it’s important to lock in a rate and start now.

Consider this from Life Insurance Marketing and Research Association: • Eight out of 10 Americans overestimate the true cost of life insurance.

Pick up your “Sword and Shield” and Protect Yourself from Identity Theft PSI Insurance Agency and Michigan Pharmacists Association (MPA) are pleased to offer a member-only service to help protect your identity: Sword and Shield Identity Theft Protection. At a discounted price of only $100 annually, this program will monitor thousands of databases to keep your identity safe. While no one can guarantee that your identity will not be stolen, you can rest more comfortably knowing you have the protection of Sword and Shield to help watch, warn and restore your identity with a $1,000,000 limit to protect you from financial hardships. Call Mike Wolf, MPA membership MichiganPharmacists.org

director, at (517) 377-0231 or Ron Devers, agency manager, at (517) 377-0250 for more information.

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• One in three households would have immediate trouble paying living expenses if the primary wage earner died.

• Eight in 10 Americans say family is most important to them, but only half (55 percent) have life insurance to protect them.

• Six in 10 married households with children have an average life insurance gap of nearly $200,000.

Don’t be a statistic. Talk to PSI Insurance today and review your coverage needs to put this important protection in place.

2018 Apr./May/June | Vol. 56, Issue 2

LEADERSHIP FOCUS

Developing Future Leaders

By FARAH JALLOUL, Pharm.D., MBA, MPA/PSI executive fellow

For six years, the Michigan Pharmacy Foundation (MPF) has operated the Health Professional Leadership Academy (HPLA). HPLA consists of face-to-face workshops and online webinars, along with coaching and ongoing mentorship facilitated by Academy faculty, Michigan Pharmacists Association (MPA) staff and past HPLA participants. The program focuses on the characteristics of a leader, and provides valuable education for healthcare professionals establishing strong, effective leadership skills. The Academy also develops participantsâ&#x20AC;&#x2122; knowledge of teamwork and defines different approaches that could be used when leading and coaching individuals.

2017-2018 HPLA Class

HPLA has four main objectives/outcomes: 1. Strengthen leadership skills.

2. Provide participants with information and resources to be more effective in their respective roles, practice settings and with patients.

3. Build and strengthen important relationships and expand interdisciplinary networks.

4. Provide participants with opportunities to be active in and lead the healthcare profession.

Participants are also expected to identify personal leadership goals and a leadership project to work on throughout the program, thus allowing for a handson learning experience for the individual. In short, as participants go through the program, they will be better equipped and motivated to lead themselves, individuals, teams, departments, organizations and the healthcare profession in the future, as the entire program is aimed to equip established and inspired health professional leaders with appropriate leadership skills and knowledge.

As a current participant of the academy, I value the networking opportunities that the academy offers as well as leadership self-development. Every year, HPLA brings together participants from multiple sectors of the healthcare field providing a very diverse network.

Learning from other healthcare fields and understanding their accomplishments, struggles and lessons learned is an added value. The current HPLA class of 20172018 encompasses an array of participating health professionals, including: pharmacists, pharmacy technicians, registered nurses, clinical services managers, health information and billing managers.

Furthermore, HPLA has built a loyal alumni support MichiganPharmacists.org

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system that expands the network even more. Graduates of previous years lend their skills and experience through their mentorship of current participants. They serve as role models offering support to participants throughout the program and beyond. As a result of their ongoing commitment to the Academy, the MPF Board of Trustees hosted the first annual HPLA Graduate Luncheon on Saturday, Feb. 24, at the Detroit Marriott at the Renaissance Center during the MPA Annual Convention & Exposition. The Luncheon was intended to celebrate achievements and network with other HPLA graduates from across Michigan. Each graduate in attendance received a special recognition pin to signify their successful completion and contribution to the Leadership Academy.

If you are looking for an opportunity to fine-tune your leadership skills, and are eager to advance and enrich your career, then HPLA is right for you. HPLA can provide you with valuable leadership skills to empower any aspiring leader. The next class will be starting in the fall of 2018. To learn more about the program visit www.MichiganPharmacists.org/foundation/initiatives or contact MPF Executive Director, Dianne Malburg, at Dianne@MichiganPharmacyFoundation.org.

Graduates of HPLA that attended Luncheon received recognition for their accomplishment

2018 Apr./May/June | Vol. 56, Issue 2

CONTINUING EDUCATION

Patient Safety in Patients with Depression: The Role of the Community Pharmacist and Pharmacy Technician

By ANTHONY LEWIS, Pharm.D. candidate 2018, Ferris State University College of Pharmacy, Battle Creek

Introduction Mental illness is encountered

every day in pharmacy practice, with the most common issues being anxiety and depression. Depression can be caused by many factors including a death in the family, divorce, stressful work situation or life in general. In 2015, approximately 16.1 million adults over the age of 18 had some sort of depressive episode in the prior year.1 Depression can manifest in different age groups and different sexes in many ways, but major symptoms include either an overwhelming feeling of sadness or a loss of interest or pleasure in parts of their life.1 While patients are not diagnosed in the pharmacy, it is important that pharmacists and technicians understand depression so they can support patients and ensure they receive the necessary care and appropriate treatment. Pharmacy professionals must be aware of suicidal warning signs to maintain their patients’ safety with the appropriate use of medications and recognize when a patient should be referred back to their primary care provider for follow-up care.

Pharmacist’s and Pharmacy Technician’s Role Pharmacists and technicians are naturally the last healthcare professionals seen by patients before starting a new medication. It is important that pharmacists and technicians speak with patients about side effects, when to expect a change in their condition and when to refer to a pharmacist or the prescribing prescriber. One of the pharmacist’s main roles is medication safety and there is an abundance of underutilized tools that are available to further ensure patient safety while managing depression. Services like medication therapy management (MTM), patient adherence, proper drug knowledge, lifestyle changes, communication and suicide recognition can help the pharmacist and pharmacy technician prevent and recognize safety issues. This article

Target Audience:

This continuing education activity was developed specifically for pharmacists and pharmacy technicians.

Learning objectives for the pharmacist:

At the end of this activity, pharmacists should be able to: 1. Describe initial drug therapies for treating depression.

2. Describe the common transient side effects of antidepressants that patients should be warned about.

3. Describe common presentations of a patient who may be suicidal.

4. List strategies to improve patient safety in those with depression.

Learning objectives for the pharmacy technician:

At the end of this activity, pharmacy technicians should be able to: 1. List common antidepressants used when a patient is beginning a treatment regimen for depression.

2. Describe adherence issues in the patient being treated for depression.

3. Describe common presentations of a patient who may be suicidal so the pharmacist may be alerted.

4. List some strategies to improve patient safety in those with depression.

Important Information Regarding Continuing Education Credit Due to the length of this continuing education article MPA has posted the complete article online. Upon completion of this activity, participants must complete an evaluation and posttest with a passing score of 70 percent on the MPA Web site at www.MichiganPharmacists.org/education/online. A failed test may be retaken only once without additional cost. There are no refunds for failed tests. If all requirements are met, participants will receive pharmacy continuing education (PCE) credit through CPE Monitor, a national, collaborative effort by ACPE and the National Association of Boards of Pharmacy (NABP) that went into effect on Jan. 1, 2013, 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 register for a CPE activity or complete activity evaluations. It will be the responsibility of the participant to provide the correct information (i.e., e-Profile identification number and date of birth in MMDD format). If this information is not correctly provided, NABP and ACPE prohibit MPA from issuing CPE credit. Online access to their inventory of completed credits will allow pharmacists and pharmacy technicians to easily monitor their compliance with CPE requirements and print statements of credit. Therefore, MPA will not provide printed statements of credit to pharmacists and pharmacy technicians. Partial credit will not be awarded.

If you have yet to sign up for CPE Monitor, go to MyCPEMonitor.net. Please note that this activity is only accredited for pharmacists due to the topic discussed; therefore, Michigan Pharmacists Association is accredited by pharmacy technician credit does not apply. For the Accreditation Council for Pharmacy Education more home study activity options for pharmacists as a provider of continuing pharmacy education.

ACPE Universal Activity # 0112-0000-17-006-H05-P and pharmacy technicians, please visit www. and #0112-0000-17-006-H05-T. Initial release date: MichiganPharmacists.org/education/online.

11/24/2017; Expiration Date: 11/24/20; 1.5 contact

will discuss the ways both pharmacists and technicians can help improve patient safety as well as how they can recognize barriers that may be present in their practice.

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For the complete article, visit www.MichiganPharmacists.org/ education/online.

2018 Jan./Feb./Mar. | Vol. 56, Issue 1

2018 MPA Annual Convention & Exposition

By MARY FARRINGTON, CMP, director of education, Michigan Pharmacists Association

This year’s Michigan Pharmacists Association (MPA) Annual Convention & Exposition, held Feb. 23-25, was a great success! Attendees enjoyed the opportunity to earn 20 hours of live continuing education (CE) credit on hot topics in pharmacy, including programming on pharmacy law, pain and symptom management, patient safety and human trafficking to assist pharmacists and pharmacy technicians in meeting their CE requirements. The Convention also offered an Exhibit Hall, practice section, new practitioner and student pharmacist activities, and the Annual Banquet & Awards Ceremony to honor leaders in Michigan pharmacy. The 2018 Convention brought together more than 1,000 pharmacists, pharmacy technicians, student pharmacists and other industry professionals to Detroit for one of the largest state pharmacy conventions in the nation!

The Opening Session on Friday featured David R. Neff, D.O., chief medical director for the Office of Medical Affairs, Medical Services Administration in the Michigan Department of Health and Human Services; Phil Pavona, executive director for Families Against Narcotics and Stephen Bell, D.O., board certified internal medicine physician in adult and bariatric care. The program focused on the impact of the opioid epidemic on healthcare in Michigan, actions that pharmacies can implement to help prevent the epidemic from spreading, areas where pharmacists play a significant role and strategies for engaging at the community level. This session was moderated by MPA’s Chief Executive Officer Larry Wagenknecht.

MPA also welcomed Laura J. Lederer, J.D., president of Global Centurion, a non-profit organization fighting human trafficking by focusing on the perpetrators and end-users fueling the market. Her presentation addressed the basic physical and mental health issues of human trafficking victims, the critical role of healthcare providers, including pharmacy professionals, resources for training and how to connect with local resources in Michigan.

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On Friday afternoon, the Michigan Pharmacy Political Action Council (PAC) held their annual luncheon where MPA members and legislators were honored. In addition, PAC held a special event for Governor’s Club members to recognize their contributions in advancing pharmacy and supporting advocacy efforts. PAC VIP contributors also enjoyed special privileges for making a contribution while at the Convention.

The Michigan Society of Pharmacy Technicians (MSPT) held a social event for member and nonmember technicians on Friday to allow them the opportunity to network with peers.

The Michigan Pharmacy Foundation (MPF) also organized several activities at the Convention, including the Charity Auction, Adopt-a-Student Program and donations to Bay Cliff Health Camp as well as the presentation of this year’s student scholarships.

On Saturday morning, the Local Association Development Committee (LADC) sponsored an invitational leadership breakfast for local association officers. This breakfast provided local association officers with the opportunity to discuss local association activities and learn about new benefits LADC has created to support locals.

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n& MPA Annual Conventio

Exposition

On Saturday afternoon, teams of four students from each Michigan College of Pharmacy participated in the National Alliance of State Pharmacy Associations (NASPA)-Nonprescription Medicines Academy (NMA) Student Pharmacist Self-care Championship, a Jeopardy!-style interactive event. The University of Michigan team took home the traveling trophy.

Other special events were held on Saturday, including luncheons for each practice section of MPA, as well as the MPF Health Professional Leadership Academy.

The Exhibit Hall was open on Friday and Saturday and offered attendees a chance to learn about new products and services. On Friday, reception sponsor, Smith Drug Company, provided complimentary beverage tickets to individuals visiting their booth.

MPA’s House of Delegates session was held on Sunday. Additionally, the Michigan Society of Health-System Pharmacists (MSHP) hosted a delegate caucus breakfast to prepare health-system delegates for the House of Delegates session.

Special activities for student pharmacists were held during the Convention, including the student pharmacist social, sponsored in part by Rite Aid and Walgreens, and a night on the town outing hosted by the MPA New Practitioner Committee at the Punch Bowl Social, both occurring on Friday evening. On Saturday, the Michigan

Society of Health-System Pharmacists (MSHP) sponsored a student pharmacist luncheon, and the MPA New Practitioner Committee coordinated mock interviews for P3 and P4 student pharmacists to gain real-life interview experience as well as learn techniques and tips to prepare them for their future career search. Additionally, student pharmacists participating in the MPF Adopt-aStudent Program attended the MPA Annual Banquet and joined colleagues in congratulating the accomplishments of individuals receiving awards.

MPA would like to thank all those who attended the 2018 Annual Convention, helping us make it successful.

Without the support of sponsors, exhibitors, vendors and attendees, we would not be able to make this great event possible! Mark your calendars for the 2019 Convention, Feb. 22-24 in Detroit. You will not want to miss attending Michigan’s leading event for pharmacy professionals.

2018 MPA

Annual Convention & Exposition Awards Those attending the 2018 Annual Convention & Exposition celebrated by honoring award recipients’ service in the profession, their community and the Association during the awards ceremony on Saturday evening and select programs and events throughout the weekend.

Pharmacist of the Year Award Kathleen Pawlicki was presented with the Pharmacist of the Year award for her endless dedication to the profession and serving as a role model for future pharmacy leaders. She has served in numerous leadership roles in health-system pharmacy as well as national and state pharmacy associations. She provides the strength, stability and dedication to see the profession into the future.

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Bowl of Hygeia Award Sponsored by the American Pharmacists Association and the National Alliance of State Pharmacy Associations with support from Boehringer Ingelheim

Philip Hagerman was presented with the Bowl of Hygeia award for over 40 years of advancing opportunities for pharmacists and providing optimal patient care. His position on the Diplomat Board of Directors and his service on several national, state and local associations has provided the innovation and growth necessary to meet the continuous changes in healthcare.

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Executive Board Medal Mike Anderson was presented with the Executive Board Medal Award for his service to the Association, Michigan Pharmacy Foundation and Pharmacy Services Inc. He has been instrumental in implementing and achieving the Association’s and affiliated companies investment policies and goals, and he has helped ensure the continual financial success and security of the Association to accomplish its mission.

Fred W. Arnold Public Relations Award Sponsored by Michigan Pharmacy Foundation

Libin Philip was awarded the Fred W. Arnold Public Relations Award for creating a public platform for pharmacists to share their stories, advice and wisdom via the “Pharmacists of Michigan” Facebook page. The goal of this project is to shift the perspective of pharmacists to more than medication dispensers and create a forum for humanizing the profession.

Excellence in Innovation Award Outgoing President Award

Sponsored by Upsher-Smith Laboratories, Inc.

Gregory Pratt was presented with the Excellence in Innovation Award for his ongoing work educating pharmacists for their role in emergency preparedness efforts as well as being instrumental in offering lead blood level testing to Flint communities. His work in emergency preparedness has been adopted as a standard across the state and nation.

James M. Lile, Midland The Outgoing President Award honors the outgoing MPA president for service provided to the Association.

Distinguished New Pharmacist Practitioner Award Sponsored by Pharmacy Services Inc.

Hope Broxterman was presented with the Distinguished New Pharmacist Practitioner Award for her dedication early in her career to the Association. She has held several leadership roles since completing her Doctor of Pharmacy in 2010 and continues to mentor and foster growth in pharmacy students and young practitioners.

Her involvement with the Association will foster the growth necessary to navigate the continual changes in healthcare.

Executive Board Service Awards Amy E. Smendik, Stephanie A. Klepser and Sister Phyllis Klonowski were presented with the Executive Board Service Award in honor of their service to the Association as outgoing members of the MPA Executive Board.

Generation Rx Champions Award Sponsored by the Cardinal Health Foundation

Susan DeVuyst-Miller was presented with the Generation Rx Champions award for her dedication to underserved populations, including those impacted by the opioid epidemic and substance abuse. She contributed to PrO2NE: Prescription Opioid Overdose Naloxone Education and holds leadership roles in organizations working to prevent drug abuse and misuse and to promote healthcare services to at-risk populations.

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Fellow of Michigan Pharmacists Association Jennifer K. Hagerman, Stephanie L. LaPointe, Amy E. Smendik and Frank K. Zaran The designation Fellow of Michigan Pharmacists Association (FMPA) recognizes the honoree’s achievements and dedication to the practice of pharmacy and the community. This distinction signifies the recipients’ actions well beyond regular pharmacy practice. The fellowship is divided into three areas: professional actions in practice, public service and Association participation, all of which help define a well-rounded pharmacist.

2018 Apr./May/June | Vol. 56, Issue 2

Pharmacy Hall of Honor

Distinguished Local Association Achievement Award

The Pharmacy Hall of Honor was established by Michigan Pharmacists Association (MPA) in 1986 to recognize members who have provided volunteer leadership in service to the Association by participating on Committees and in designated Association programs. This yearâ&#x20AC;&#x2122;s recipients are Michael L. Anderson, Hope M. Broxterman, Philip R. Dast, Susan DeVuyst-Miller, Cathleen M. Edick, Angela Faszczewski, David J. Kalis, Stephanie A. Klepser, Sister Phyllis Klonowski, Shawna L. Kraft, Denise L. Markstrom and Michelle L. Dehoorne.

Capital Area Pharmacists Association

Ernie Koch Striving for Excellence Award Joseph M. Leonard, Flushing

50 Years of Membership Years of Membership Awards are given to honor and thank pharmacy professionals for their many years of continuous membership and dedicated service to MPA. Celebrating 50 years are Robert Conway, Richard Dillon, Arthur Gustufson, Robert Hodges, Elizabeth Kereji, Jack Newberry, Frederick Schmid, Terry Skoglund, William Urfer and Myron Winkleman. See page 12 for the full Years of Membership Recognitions.

Consultant and Specialty Pharmacists of Michigan Pharmacist of the Year Award Peter Lewyckyj, Rochester

Michigan Pharmacy PAC Legislator of the Year Award

Rep. Scott Dianda (Calumet)

Hank Vaupel (Handy Township)

Michigan Pharmacy PAC Good Public Health Award

Michigan Society of Community Pharmacists Pharmacist of the Year Award Hanadi L. Thomas, Waterford

Rep. Abdullah Hammoud (Dearborn)

Michigan Society of HealthSystem Pharmacists Pharmacist of the Year Award

Rep. Bronna Kahle (Clinton)

Michigan Pharmacy PAC Hank Fuhs Good Government Award

Denise M. Pratt, DeWitt

Michigan Society of Pharmacy Technicians Service Award

Michael L. Alverson

Carrie S. Germain

University of Michigan Hospital Department of Pharmacy MichiganPharmacists.org

Linda Arrabi

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2018 Apr./May/June | Vol. 56, Issue 2

MPA TIME CAPSULE

TIME CAPSULE Reflecting back upon MPA’s rich history, it is easy to track how far the organization has come and how much it has evolved and adapted from its early days to address the changing profession. The following passage from the May 1983 edition of Michigan Pharmacist details how the Association developed in the late nineteenth and early twentieth century, as well as the impact Michigan pharmacists had more than a hundred years ago.

From “100 Years of Michigan Pharmacy The Halfway Mark: 1908-1933” by Michael C. Shannon in collaboration with Cynthia Beeber, Michigan Pharmacist, May 1983: “Although the association’s initial success in obtaining passage of the pharmacy law had attracted members, the continued inability to impact trade conditions afflicting practitioners began to result in a loss in membership. As already noted the high membership mark was reached in 1888 with 971 members. By 1893, this number decreased to 581 members, and in 1898 the decrease continued with the association secretary reporting only 286 members. By 1902, only 230 individuals were listed as members of the association. During these same years, the number of registered pharmacists slowly increased. In 1888 there were 3,065 registered pharmacists, including 230 assistants; in 1893, there were 3,119 registered pharmacists plus 295 registered assistants; and in 1898, there were 3,115 registered pharmacists plus 328 registered assistants. It was apparent that the association was not representative of the average pharmacist in practice.

No activity of the association was successful in combatting the drug trade problems. Meetings with the manufacturers and wholesalers failed to stop differential pricing. Mutual manufacture of proprietary goods by the association was espoused by A.E. Webber in his presidential address but did not get past the talking stage. Conditions were so bad that during the 1898 annual meeting, secretary Charles F. Mann (Detroit) called for a reorganization of the MSPA [Michigan State Pharmaceutical Association]. Mann was convinced that the association must become a business organization to meet the changes of the times. He charged “the average retail druggist depends more on his ability as a merchant than upon his qualifications as a professionalist for an MichiganPharmacists.org

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existence.” Mann favored reorganization as the Michigan Retail Druggists Association with active membership limited to retail druggists. Honorary membership would be awarded to all others. Mann concluded his remarks by pointing out the drop in membership and urged his plan to save the association.

Although Mann’s suggestion was never completely adopted, a second state association, named the Michigan Retail Druggists Association, did emerge in 1910 only to affiliate with MSPA in 1912. In any event, such a development should not be surprising given the emotions aroused by the conditions in practice. Certainly, the rocketing rise in NARD [National Association of Retail Druggists] membership during its first six years indicated the seriousness of the problems and gave support to ideas like that espoused by Mann. Mann favored NARD, joined that organization, and became national president in 1906.....

The years 1883-1908 were fruitful years for pharmacy and for Michigan pharmacy in particular. Michigan practitioners had influenced the nation in the areas of pharmacy education and pharmaceutical manufacturing. Pharmacists had been active in national pharmacy organizations providing major service to the profession.

At home, these practitioners had started a state association and had worked hard to obtain passage of Michigan’s first pharmacy law. Three educational programs for men and women desiring to obtain a formal pharmacy education had been started and were continuing. The major cloud in this picture was the unrelenting competition facing the majority of practitioners in the retail sphere of practice. Even here, successes were to be found and many practitioners managed to survive, prosper and serve the public. This legacy of hard work and perseverance allowed these men and women to pass along the flame of profession to the next generation.”

2018 Apr./May/June | Vol. 56, Issue 2

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