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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
MPA Annual Convention & Exposition Feb. 23-25, 2018 • Detroit Marriott at the Renaissance Center
Inside 13 2018 MPA Executive Board 15 2018 MPA Annual Convention & Exposition
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
25 Overlooked Medication Wastage
MichiganPharmacists.org
IN THIS ISSUE
MEMBERSHIP 3 4 5 8 10 13
President’s Platform CEO Corner Events Calendar Student Focus From the Foundation 2018 MPA Executive Board
COVER 15 2018 Michigan Pharmacists Association Annual Convention & Exposition
PROFESSIONAL AFFAIRS 18 Legislative Update 20 Advocacy 21 Consultant and Specialty Pharmacists of Michigan Focus 25 Overlooked Medication Wastage 27 USP <800> Standard Implementation 28 That’s My Pharmacist 29 Cover Your Assets 31 2017-2018 HPLA Class
CONTINUING EDUCATION 32 33 35
Homestudy: Overview of Cancer-Related Pain MSHP Annual Meeting Recap 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 Jan./Feb./Mar. | Vol. 56, Issue 1
PRESIDENT’S PLATFORM
Pharmacy Associations: Why Then? Why Now? By SANDRA TAYLOR, R.Ph., M.S., administrator of clinical operations and director of pharmacy services, Beaumont Hospital, Wayne and Michigan Pharmacists Association president
How did we get here? In 1821, America began building the foundation of the pharmacy profession: “Faced with two major threats; deterioration of the practice of pharmacy, and a discriminatory classification by the University of Pennsylvania medical faculty, the pharmacists of Philadelphia held a tempestuous protest meeting in Carpenters’ Hall, February 23, 1821.” “At a second meeting, March 13, the pharmacists voted formation of: an association, which became The Philadelphia College of Pharmacy; a school of pharmacy; and a self-policing board. Sixty-eight pharmacists signed the Constitution of the ‘first pharmaceutical association’ in the United States; American Pharmacy’s first educational institution, bearing the same name, opened November 9.” The association quickly became a game changer. The college was not only founded to provide education but as an association to advance the discipline of the profession. Consequently, in 1824 the Philadelphia College of Pharmacy began publishing formulas for patent medications previously imported from the United Kingdom. These were impactful roads toward selfsufficient pharmaceutical manufacturing in the United States. Think about it: sixty-eight pharmacists coalesced and convened to save what was defined then as the “deterioration” of pharmacy practice. If it were not for this unity and collaboration within the association, pharmacy practice may not exist as we know it today. As they strategized and advocated to sustain our profession, they influenced and set the direction for several of our current
achievements in healthcare and pharmacy industry. This is an excellent characterization of the impact and effectiveness of associations. Later in 1852, a convention of representative pharmacists was held in the hall of the Philadelphia College of Pharmacy. There was a need to “improve intercommunication among pharmacists, standards for education and apprenticeship and quality control of imported drugs.” It was here and when the “American Pharmaceutical Association” was launched by twenty delegates. They created objectives and opened membership to “all pharmaceutists and druggists with integrity and those who subscribed to its Constitution and its Code of Ethics.” As we know, the American Pharmacists Association (APhA) is the largest pharmacists association in the United States today whose membership is comprised of more than 62,000 practicing pharmacists, pharmaceutical scientists, student pharmacists and pharmacy technicians. As we look back, several of the challenges we continue to incur in our practices and profession today are comparable to those incurred since the beginning of the foundation of pharmacy practice. Similarly, the infrastructure of associations has been historically framed around the need for networking, medication safety and quality, innovation, advocacy for the profession, legislation, regulation, education and more. Following the lead of the Philadelphia College of Pharmacy, pharmacy schools and professional associations commenced to grow. Thirty-one years later on Nov. 14, 1883, the Michigan Pharmacists Association (MPA) was established. Gathering in Lansing, the major objectives of the newly formed Michigan State Pharmaceutical Association were to elevate the profession of pharmacy and advance the legitimate interests of pharmaceutical trade.
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For more than 130 years, MPA has strived to provide its member pharmacists, pharmacy technicians and student pharmacists with the tools, resources and support needed to advance the profession of pharmacy and provide quality patient care. “The mission of MPA is to serve members by providing support, advocacy and resources that ultimately improve patient care, safety, health, and the practice of pharmacy.” “The vision of MPA, as the leader of pharmacy professionals in Michigan, is the premier source of professional development, information and practice innovations. Through the active involvement of its diverse members, MPA is an influential force in developing health policy and optimizing patient health, safety, and medication management.” In keeping with our mission and vision to sustain our profession, we must be dedicated to growing our membership. As the landscape of healthcare continues to change and becomes more complex, our voices must be heard. Let’s continue to build on the platform that was initiated by our forefathers who helped set the path for us today. Our patients, community and partner healthcare professionals need our expertise skill and knowledge that only we as healthcare professionals can provide. Again, I challenge every current member to recruit at least one pharmacy practitioner, pharmacy technician or pharmacist to join MPA. If we all commit to recruiting at least one member, we can double our membership, and double our impact. “Alone we can do so little, together we can do so much.”
– Helen Keller
“Coming together is a beginning, staying together is progress, and working together is success.” – Henry Ford
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
CEO CORNER
A Look Back at 2017 and A Look Ahead to 2018 By LARRY WAGENKNECHT, pharmacist, chief executive officer, Michigan Pharmacists Association
moving some of our issues.
A Look Back As the deadline for submitting this article is falling at the middle of December, we still don’t know how everything is going to end for 2017. This past year certainly has not been a year short of issues or challenges for pharmacists in all practice settings. Additionally, it has also been a busy year for the organization from the legislative and health policy dimensions. Unfortunately, some of the challenges are beyond the ability of Michigan Pharmacists Association (MPA) to correct or resolve. Nevertheless, the organization is committed to heightening the visibility of the issues before the individuals who have the best chance of finding reasonable solutions. MPA members and MPA staff have been very involved at both the local and State levels in trying to find solutions to resolve the devastating impact of the opioid epidemic currently ravaging the entire country. No community within the State has gone untouched by the opioid problem. MPA has been engaged in pharmacists as a solution in a variety ways. MPA was successful in our partnership with other health professionals to achieve significant changes in legislation introduced by the Michigan Legislature that addresses the opioid problem. In the final days of the 2017 legislative session, the Michigan House and Senate approved eleven (11) different bills ranging from requiring prescribers to conduct MAPS (Michigan Automated Prescription System) for new patients, to establishing limits on the amount of opioids that can be prescribed. More details about the bills will be shared via the Journal and MPA E-news once the legislation is signed into law. Advocacy and involvement in the legislative process, in addition to the opioid legislation, continues to be a high priority for the organization. MPA was successful in having Senate Bill 287 introduced that deals with PBM regulation and transparency. Unfortunately the bill has not moved in the Senate, so MPA is working with a member of the House of Representative to have the bill introduced in the House. In addition to this issue, there are approximately another 65 bills that have been introduced that could impact pharmacy that staff continues to monitor. Since there is not a pharmacist in the legislature, MPA has been successful in creating the House of Representative Pharmacy Caucus. Our Caucus is chaired by Rep. Hank Vaupel (R-Handy Township) and Rep. Scott Dianda (D-Calumet). In order to help move these legislative issues forward, you are encouraged to become a member of MPA’s Pharmacy Action Response Team (PART) where you will receive timely reports when contacting your legislators is important. Additionally, getting to know your U.S. Representative and Senators and your State representative and senator will be extremely helpful in MichiganPharmacists.org
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During 2017, MPA worked very closely with the Michigan Department of Health and Human Services (MDHHS), and specifically, the State’s Chief Medical Executive Dr. Eden Wells in developing a statewide standing order for pharmacists to provide naloxone to patients and their family members or caregivers at risk. The Department has been very impressed with the number of pharmacists that have utilized the standing order. MPA continues to work with MDHHS on assuring that pharmacists and pharmacy professionals are part of the State’s response to any special emergency that might arise. Pharmacy continues to be a critical player in the State’s immunization strategy, including the effort to address the hepatitis A virus spreading in southeast Michigan. Some of the issues that continue to challenge pharmacists across the State that will addressed in 2018 include: formalization of the Community Pharmacy Enhanced Service Network (CPESN) in Michigan, continued promotion of medication therapy management opportunities with Medicaid, PBM transparency, drug and supply shortages, Medicaid closed networks, fair pharmacy reimbursement, DIR (direct and indirect remuneration) fees and medication safety. Additionally the recent news of Amazon getting into the pharmacy business and the purchase of Aetna by CVS Health creates additional uncertainty about how healthcare may change in the future. With your continued support and involvement in the upcoming year, we can make sure that pharmacists, pharmacy technicians, and pharmacy students have a voice, thus resulting in a better future for pharmacy.
A Look Ahead In 2018 there are a variety of pharmacy related issues that are expected to be addressed by the Legislature. Some of the topics that are going to be carried over into the new year include the PBM transparency and fair business bill (addresses DIR fees, audits and more), Medicaid professional fee, biosimilars, behavioral health and other bills that are likely to be introduced in early 2018. The new State Legislature and new Congress are guaranteed to provide pharmacists both opportunities and challenges. The challenges can be turned into opportunities when pharmacists, pharmacy technicians and your patients (at the grassroots level) become engaged with those that you have elected to represent you. Make a New Year resolution to become more involved with advocacy! When you do, we all win!
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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.
JANUARY 2018
FEBRUARY 2018
MARCH 2018
Thursday, Feb. 1 – Wednesday, Feb. 28
Thursday, March 8
Monday, Jan. 1 – Wednesday, Jan. 31
Thyroid Awareness Month Nationwide
American Heart Month Nationwide
Thursday, Jan. 11
Michigan Society of Health-System Pharmacists (MSHP) Committee Day and Board Meeting Okemos Conference Center MSHP will hold the first Committee Day of 2018 on Thursday, Jan. 11. For more information about MSHP Committees visit www.MichiganPharmacists.org/mshp.
Tuesday, Jan. 16
Michigan Pharmacists Association (MPA) Executive Board Meeting MPA Headquarters
February is American Heart Month, dedicated to raising awareness of the impact heart disease and measures that can be taken to prevent it. Heart disease is the number one cause of death for both men and women in the United States. Pharmacists are in a unique position to help in this effort. For more information, visit www.Heart.org.
Thursday, Feb. 1
Consultant and Specialty Pharmacists of Michigan (CSPM) Board of Directors Meeting MPA Headquarters
Friday, Feb. 2
Michigan Society of Pharmacy Technicians (MSPT) Executive Committee Meeting Charter Health Care Training Center, Flint
Saturday, Feb. 3
National Wear Red Day for the American Heart Association Nationwide
Wednesday, Feb. 14 National Donor Day Nationwide
World Kidney Day Worldwide
Chronic kidney disease is a worldwide public health problem causing kidney failure and premature death in people worldwide. It effects nearly 195 million women worldwide, and is the 8th leading cause of death in women, with nearly 600,000 deaths each year. World Kidney Day is a day of promoting affordable and equal access to health education, healthcare and preventative care for those suffering worldwide. Learn more at www.WorldKidneyDay.org.
Friday, March 16 – Saturday, March 17
National Alliance of State Pharmacy Associations (NASPA) Spring Meeting Nashville, Tenn.
Friday, March 16 – Monday, March 19
American Pharmacists Association Annual Meeting Nashville, Tenn.
Sunday, March 18 – Saturday, March 24 Poison Prevention Week Nationwide
Monday, Jan. 22 – Sunday, Jan. 28 National Drug and Alcohol Facts Week Nationwide
This week is dedicated to educating teens about the scientific facts regarding drugs and the impact these drugs have on the developing minds and bodies of adolescents. Bringing teens and scientists together, this week is filled with events around the country as well as scientists and science writers answering questions from teens around the country. To learn more about this event and how you can become involved visit teens.DrugAbuse.gov/ national-drug-alcohol-facts-week.
Tuesday, Jan. 30
Michigan Society of Community Pharmacists (MSCP) Committee and Board of Directors Meeting MPA Headquarters
Friday, Feb. 23 – Sunday, Feb. 25
Michigan Pharmacists Association’s Annual Convention & Exposition Detroit Marriott at the Renaissance Center MPA’s Annual Convention is taking place soon! Register today at www.MichiganPharmacists. org/convention18. Be sure to check out page 15 for more information on the upcoming event and programming. We can’t wait to see you there!
Wednesday, Jan. 31
Michigan Pharmacy Foundation (MPF) Board of Trustees Meeting MPA Headquarters
MichiganPharmacists.org
Tuesday, March 27
American Diabetes Association Alert Day Nationwide Every year, this Alert Day is used as a “wake up call” for the American people to remind them of the risks and complications of diabetes. This day is used to encourage patients to get screened for diabetes, take the diabetes risk assessment and learn about their family’s history of diabetes. To learn more about this Alert Day and how you can become involved, visit www.Diabetes.org/ are-you-at-risk/alert-day.
Wednesday, March 28
PSI Board of Directors Meeting MPA Headquarters
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CE EVENTS CALENDAR 2018 MPA Continuing Education and Professional Development Events
MPA is pleased to offer the following opportunities to earn continuing education credit that meet live, pain, patient safety and pharmacy law requirements.
Saturday, April 7 – Sunday, April 8
Northern Michigan Pharmacy Education Seminar Shanty Creek Resort, Bellaire • Target Audience: Pharmacists and pharmacy technicians • Requirements Met: Live •C ontact hours: Up to 8.0
Tuesday, April 17
MPF Leadership and Management Symposium Lansing Community College, West Campus, Lansing • Target Audience: Pharmacists, pharmacy technicians and student pharmacists • Requirements Met: Live • Contact hours: Up to 7.0
Wednesday, April 18
MPA Pharmacy Law and Policy Symposium Lansing Community College, West Campus, Lansing • Target Audience: Pharmacists, pharmacy technicians and student pharmacists • Requirements Met: Live, law •C ontact hours: Up to 6.0
Thursday, May 24
CSPM Reimbursement and Regulatory Changes: Surviving Tomorrow Diplomat, Flint
• Target Audience: Pharmacists, pharmacy technicians • Requirements Met: Live, law • Contact hours: Up to 6.5
SUPPORT MPA’S ADVERTISERS Compliant Pharmacy Alliance Cooperative: Back Cover Pharmacy Employment Service: P. 7
PSI Insurance Agency: P. 14 Burtka Law, PLLC: P. 23 Mitchell: P. 24
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PMP Management Partners: P. 26 AmerisourceBergen: P. 30 EPIC Pharmacies, Inc.: P. 34
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
BIOS AND MEMORIES BIOS
MEMORIES Jana Robinson
P4 Student, Jeffrey Holm, joins MPA for rotation! Jeffrey Holm is a fourth-year student pharmacist at the University of Michigan College of Pharmacy. He completed his undergraduate education at Olivet College in Olivet, Mich., where he earned his Bachelor’s degree in biology with a biochemistry minor. Jeffrey first became interested in pharmacy after he accepted a position at Twin Valley Pharmacy, an independent pharmacy in his hometown of Battle Creek, Mich. Jeffrey completed a five-week rotation with Michigan Pharmacists Association (MPA) and was excited to learn about the diverse roles MPA maintains within healthcare and legislation. Upon graduating pharmacy school and becoming a licensed pharmacist, Jeffrey plans to stay with Twin Valley Pharmacy where he will work as a community pharmacist. Although community pharmacy is on the forefront of Jeffrey’s mind, he is exploring other areas within the pharmacy profession as he finishes his final year of pharmacy school.
Jana Robinson, 81, passed away Oct. 2, 2017, at Abbey Park Independent Living Facility in Grand Blanc. She was employed by Crestwood Memorial Gardens in Grand Blanc. Jana married Dewaine V. Robinson on March 11, 1961, former Michigan Pharmacists Association (MPA) president. She later worked with her husband at their pharmacy businesses for many years. She is survived by many family members and loved ones. From 2010 to 2014, Jana made contributions to MPA’s Capitol Campaign fundraiser that resulted in the dedication of a meeting space at MPA Headquarters, the Robinson Leadership Center (RLC). Jana and her husband’s work and passion for the profession of pharmacy will impact generations of pharmacists to come.
Jeffrey resides in Battle Creek with his wife, Jessica, and his one-year-old daughter, Lyla. He enjoys spending most of his free-time with his family, but also enjoys hunting and fishing when extra time allows for it.
MEMBERSHIP Welcome New MPA Members! The number of new MPA members grew by 182 from September 2017 to November 2017.
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
Pharmacy Technicians
75 Student Pharmacists
Michigan Pharmacists Association (MPA) is working with CommonBond, a leader in student lending, to help you save money on your student loans. MPA members save over $24,000 on average by refinancing their student loans with CommonBond. If you refinance through CommonBond.co/mpa, CommonBond will give you a $200 cash bonus for being part of the MPA network. And for every loan that CommonBond funds, they also fund the education of a child in need in the developing world through their Social Promise. If you have questions, please email Care@CommonBond.co or call (800) 975-7812. Learn more at CommonBond.co/mpa, and submit your application!
90 Pharmacists
Introducing CommonBond for Student Lending Refinance!
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STUDENT FOCUS
MICHIGAN PHARMACY FOUNDATION Adopt-a-Student Program at the
2018 MPA Annual Convention & Exposition By KRISTINA BIRD, M.A., director of communications, Michigan Pharmacists Association
Again at the 2018 Michigan Pharmacists Association (MPA) Annual Convention & Exposition, the Michigan Pharmacy Foundation (MPF) will be hosting the Adopt-a-Student Program to help connect the future of pharmacy with today’s leaders. This is a great opportunity for student pharmacists to connect with experienced, practicing pharmacy professionals and will help students establish and grow their network while gaining valuable advice and insight into future career goals. But students aren’t the only ones who gain from the opportunity. This is also a great chance for current practitioners to learn new and innovative ideas from up-and-coming pharmacists and have the opportunity to directly impact the future generation of pharmacists. First and foremost, if you haven’t yet registered for the MPA Annual Convention & Exposition, do so now at www.MichiganPharmacists.org/convention18. Student pharmacists wishing to participate in the MPF Adopt-a-Student Program must complete both the online Convention registration and the Adopt-a-Student Submission Form found at www.MichiganPharmacists. org/foundation/adoptastudent. Be sure to submit all the required information on this form including a short biography and professional goals as well as a highresolution headshot for the Adopt-a-Student catalogue. The deadline to submit these materials is 4:30 p.m. Friday, Jan. 12. Don’t delay! Be sure to register today as there will be no onsite registration available for this Program. For anyone interested in adopting or sponsoring a student pharmacist to attend the Annual Banquet, be sure to indicate in your Convention registration your desire to adopt a student under MPFsponsored activities.
•C onnecting with your “Parent”: After all program participants have submitted materials, and interested pharmacy professionals complete their registration, MPF will provide you with the contact information for your “parent” prior to the event. You will be required to get in touch with your parent before the Annual Banquet and Awards Ceremony to make arrangements for meeting at the Convention. Parents will have your ticket for the Banquet, so it is imperative to reach out to organize where you will meet, or where they will leave your ticket , especially if they will not be attending the Annual Banquet. This is also your first opportunity to establish a relationship with your parent. Send them an email, or leave a voicemail for them introducing yourself. First impressions are extremely important, and how you manage this initial encounter will set the tone for the entire experience. The pharmacy professionals who are sponsoring students are just as excited to connect with the next generation of pharmacists and are eager to share their knowledge. •C onduct and Expectations: The MPF Adopt-aStudent Program is a unique opportunity available only to Student Michigan Pharmacists Association (SMPA) members. As such, it is important to participate in this program with integrity and positively represent the Association and your respective colleges of pharmacy. Remember that the pharmacy professionals adopting you are taking their own time and money to offer you a chance at growth and development. Therefore, treat this opportunity the same way you would any job,
Once you have completed your Convention registration and submitted your Adopt-a-Student MichiganPharmacists.org
Submission Form, you can begin preparing for your time at the Convention. Here are a few things to keep in mind as you prepare for the Convention and Program:
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STUDENT FOCUS
internship, residency or educational opportunity. If your plans for the Convention change ahead of time, communicate this with your parent. If you know that you will be late for a program, or that you may not make it to the Banquet on time, keep your parent in the loop. Submitting the Program Submission Form is committing to an obligation. If for any reason you are no longer able to participate in the Program after submitting your materials, contact MPA immediately to ensure we can provide actual matches to adoptive parents. The world of pharmacy can be a small place, so make the biggest and best impression now. •H ow to Prepare: What you get out of the Adopta-Student Program is what you put into it. If you approach the program with an attitude of “I won’t learn anything from my adoptive parent,” then you won’t learn anything from them. MPF can only facilitate so much with the student-parent relationship. In order to create a long-term mentor, you have to work at it. Before the Convention, brainstorm some questions you have for your parent. Perhaps you are curious how they landed the job they currently have. Or maybe you want to know how they navigated the change between pharmacy
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school and professional practice. And like many student pharmacists, you may be curious how they juggle the many demands of life while still providing optimal patient care and health outcomes. For the pharmacy professionals adopting you, work to think of some topics that may be of interest to them. Learn about your mentor’s background and where they might specialize. Share some interesting topics or discussions you recently had in class to expand your own perspective on the subject. What you can learn from your parent is not limited to your time at the Convention or the Annual Banquet. Work to foster a relationship with this individual as their knowledge, background and experience will be invaluable as you begin navigating the ever-changing landscape of pharmacy as a practicing professional. Making the most of opportunities like MPF’s Adopt-aStudent Program is integral to situating yourself ahead of your peers and laying the groundwork for a bright and meaningful career. Again, if you haven’t submitted your Convention registration and your Adopt-a-Student Submission Form, be sure to do so before Friday, Jan. 12! We can’t wait to see you at the Convention, and MPF looks forward to helping guide the next generation of pharmacists into the future.
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
FROM THE FOUNDATION
Michigan Pharmacy Foundation Activities at the 2018 Annual Convention & Exposition By DIANNE MALBURG, executive director, Michigan Pharmacy Foundation
Every year, Michigan Pharmacy Foundation (MPF) hosts a variety of events during the MPA Annual Convention & Exposition, held Feb. 23-25 this year at the Detroit Marriott at the Renaissance Center. MPF will again conduct its annual Charity Auction, one of the Foundation’s cornerstone fundraising events. MPF hosts the Charity Auction to raise funds in support of three core initiatives: leadership development activities, student scholarships and grants that encourage practice innovation. Not only can individuals peruse the auction items, but MPF Trustees are also available every morning during the coffee service to visit with Convention participants and provide updates on upcoming MPF activities. It’s a great way to support the Foundation and find out more about how MPF is helping to advance pharmacy and develop current and future leaders in the profession. In addition, the Foundation will again be offering an opportunity to purchase a gift card from the tree for just $20 per selection. Each envelope on the tree will have at least a $25 dollar gift card but could be worth $50 to $100. Last year’s gift card tree sold out, so visit the Charity Auction early to make your selection from the gift card tree. MichiganPharmacists.org
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FROM THE FOUNDATION “It’s a great way to support the Foundation and find out more about how MPF is helping to advance pharmacy and develop current and future leaders in the profession.” Charity Auction
Bay Cliff Health Camp – Children’s Therapy and Wellness Center
Mackinac Center, Level 5 •T hursday, Feb. 22, 6-8 p.m. (Open bidding) • F riday, Feb. 23, 7 a.m.-6 p.m. (Open bidding) • S aturday, Feb. 24, 7 a.m.-6 p.m. (Open bidding); 9:30-10:30 p.m. (Winner Pick-up) • S unday, Feb. 25, 7 a.m.-1 p.m. (Winner Pick-up) •N ote: You don’t have to lose a bid at the last minute. MPF offers a “Buy It Now” option so you can pay the price and take away the item you want. The MPF Charity Auction offers many unique items and experiences for attendees to bid on including hotel packages, themed baskets, sporting event tickets, autographed memorabilia, jewelry and more. At the time of the journal print, MPF has already received a wide variety of donations, including overnight accommodations at Hilton Garden Inn and Weber’s Inn (Ann Arbor), Ann Arbor Marriott at Eagle Crest (Ypsilanti), The English Inn (Eaton Rapids), Stay & Dine Package at Odawa Casino (Petoskey) and Stay & Golf Package at Shanty Creek Resorts (Bellaire). Also available for bidding are golf packages at Pilgrim’s Run Golf Club (Pierson) and The Jewel at the Grand Hotel (Mackinac Island), a Michigan Princess Riverboat Gift Certificate, four passes to Splash Universe, four passes to The Henry Ford, a variety of women’s jewelry and fashion accessories, unique gift baskets and much more! Be sure to visit the Charity Auction at the times listed and bid on your favorite items, or take advantage of the “Buy It Now” option for all Charity Auction items.
MPF Adopt-a-Student Program The Foundation’s Adopt-a-Student Program provides an opportunity for student pharmacists to connect with experienced, practicing pharmacy professionals to network, develop potential long-term mentors and gain valuable advice for their future career. The program also provides an opportunity for current practitioners to learn fresh, new ideas from up-and-coming pharmacists and impact the future of the profession by instilling knowledge in those who are just beginning their journey in pharmacy. If you are a Student MPA member, and you would like to participate in the Adopt-a-Student Program, register for the Convention online at www. MichiganPharmacists.org/convention18 and complete the Adopt-a-Student Submission Form at www. MichiganPharmacyFoundation.org/adoptastudent. Both the Convention registration and Submission Form must be submitted by Friday, Jan. 12. Pharmacists wishing to adopt a student can register online at www. MichiganPharmacists.org/convention18 with their Convention registration to support one or two student pharmacists in the MPF-sponsored activities section. MichiganPharmacists.org
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Every year, the Foundation Board of Trustees selects another worthy charitable organization to support. The Board voted for a second year to support Bay Cliff Health Camp, located in Big Bay in the Upper Peninsula. Bay Cliff is a year-round, nonprofit therapy and wellness center for children and adults with physical disabilities. Bay Cliff’s priority program is a seven-week summer therapy camp session serving children with orthopedic, speech, hearing and vision disabilities. The children work toward goals of increased independence and living 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 summer programs, family programs for children with cerebral palsy, spina bifida, and obesity as well as a professional development workshop for pediatric therapists. Bay Cliff is in need of a variety of tangible donations including children’s clothing, art supplies, housekeeping items and toiletries. For a full list of preferred items, please visit www.MichiganPharmacists. org/Portals/0/mpf/events/BayCliffWishList.pdf. To make donating items more convenient for all of our members, MPF will be collecting items for Bay Cliff at the MPA Headquarters during the months of January and February. Just drop off your donations during normal business hours (8:30 a.m.-4:30 p.m.). If you plan to attend the MPA Annual Convention & Exposition, take your donated items directly to the Mackinaw Center on Level 5 of the Detroit Marriott at the Renaissance Center. Our goal is to overflow the truck that will be used to transport the items to the Upper Peninsula. Please help MPF reach its goal by donating items that will improve the lives of numerous children in need. Mackinac Center, Level 5 •T hursday, Feb. 22, 6-8 p.m. • F riday, Feb. 23, 7 a.m.-6 p.m. • S aturday, Feb. 24, 7 a.m.-2 p.m.
Can’t Make the Convention – You Can Still Support the Foundation If you can’t make the Convention, but would like to support MPF, visit www.MichiganPharmacists. org/foundation/contribute. Log in to the website to make a tax-deductible donation in any dollar amount meaningful to you. Recurring annual, quarterly and monthly donation options are also available. Your contributions can make a world of difference so consider donating today.
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
FROM THE FOUNDATION
Michigan Pharmacy Foundation
GRANT PROGRAM By DIANNE MALBURG, executive director, Michigan Pharmacy Foundation and MELODY ARNST, executive office administrator, Michigan Pharmacists Association
Michigan Pharmacy Foundation (MPF) provides grant funding for projects that support its mission to advance pharmacy, leadership, education and research and to promote pharmacy practice to the highest level of patient care. For more than 20 years, the Foundation has awarded in excess of $250,000 in grant funding for projects that advance the profession. The Foundation received more grant applications this year than in any year previous which made the selection process very challenging for the Trustees. MPF is proud to announce that it has awarded a total of three grants for projects being conducted in 2018. These grants are in addition to five $2,500 scholarships being awarded to student pharmacists in February. The grant recipients and their projects are described below. Non-Pharmacologic Pain Management Initiative Insaf Mohammad, Pharm.D., clinical assistant professor, Wayne State University, Detroit The goal of this study is to determine whether nonpharmacologic pain management with heat and cold therapy are effective for pain management among geriatric patients. The Non-Pharmacologic Pain Management Initiative is an effort to improve pain management and safety, while extending alternative pain management approaches to the community. The opioid epidemic in our nation is among one of the issues that pharmacists have the opportunity to impact. Via this project, pharmacists will be improving patient, prescriber and a community’s understanding of alternative solutions for pain management that may help tackle the opioid epidemic.
Pharmacist-led Inhaler Training to Reduce Readmissions Sean M. McConachie, Pharm.D., BCPS, Harper University Hospital, Detroit Chronic obstructive pulmonary disease (COPD) and asthma are prevalent disease states associated with significant patient morbidity and increased hospital readmissions. Transitions of care programs employ pharmacists in innovative ways in order to educate patients, optimize medication regimens and reduce hospital readmissions. This study will target hospitalized patients with COPD and asthma who have high hospital readmission rates to be trained by a clinical pharmacist specialist, resident or student pharmacist using a vitalograph machine to improve inhaler technique during hospitalization in an effort to reduce 30- and 90-day hospital readmissions. The study will use a case-control design to match counseled patients to those that did not receive pharmacist counseling. A study demonstrating reduced readmission rates, effective face-to-face patient counseling and the innovative use of MichiganPharmacists.org
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student pharmacists to impact patients could demonstrate beneficial economic, clinical and academic outcomes simultaneously.
Spread of Respiratory Health in the Community Souhelia N. Hachem, 2019 Pharm.D. candidate, Wayne State University – Student Society of Health System Pharmacists Pharmacists are becoming more involved in the care and maintenance of patients with asthma and chronic obstructive pulmonary disease (COPD). These patients are at risk for worsening health outcomes if they are non-adherent to their medication or use improper inhaler technique. This project seeks to provide a free service to patients in the community who may not be able to appropriately use their inhalers and/or adhere to their medication regimen making them vulnerable to poor health outcomes. This study will assess how well the patient uses their inhaler(s) and adheres to their inhaler regimen. Intervention will be conducted by providing patients with education regarding the importance of smoking cessation in achieving optimal inhaler outcomes, tools to optimize medication adherence and disease state counseling. The program will also be integrated at various community events and with the pharmacist-run ambulatory care practice in Henry Ford Health System’s Pulmonary Clinic. By implementing these goals in the clinic, the pharmacist will be able to encourage smoking cessation to obtain better assessment of patients’ inhaler technique while also helping to advance the pharmacist’s ambulatory care practice. Congratulations to all awardees! If you have a project to advance the profession of pharmacy, we encourage you to apply for grant funding in 2018 for distribution in 2019. Grants applications are due Oct. 1 of each year. The grant application is available online at www.MichiganPharmacyFoundation.org/grantsscholarships. 2018 Jan./Feb./Mar. | Vol. 56, Issue 1
MEMBERSHIP
Meet the 2018
MPA EXECUTIVE BOARD Elections for the 2018 MPA Executive Board were held last October, and the new President-elect and Board members took office Jan. 1, 2018. Installation ceremonies will be held at the Annual Banquet on Saturday evening of the MPA Annual Convention & Exposition.
SECRETARY/CEO
C H AIR
PR ESI DENT
PRESIDENT-ELECT
JIM LILE
SANDRA TAYLOR
JESSICA BESSNER
Midland
Farmington Hills
Hubbell
Haslett
GHADA ABDALLAH
LARRY WAGENKNECHT
TREAS U RE R
SPEAK ER O F THE HO USE
VICE SPEAKER OF THE HOUSE
HEATHER M. SOMAND
MIKE CROWE
MARK BOMIA
Superior Township
Grand Blanc
Livonia
LINDA ARRABI
HEATHER L. CHRISTENSEN
LINDSEY GHIRINGHELLI
RYAN GREENLEY
Grosse Point Shores
Greenville
Oakland Township
Chassell
Grosse Pointe
DOREEN KERN
MARGARET MALOVRH
LISA MENY
CHARLES MOLLIEN
CYNTHIA PEITZSCH
Traverse City
Okemos
Alto
Wyoming
Royal Oak
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
Attend the Largest
State Pharmacy Association Meeting in the Nation! MPA Annual Convention & Exposition Feb. 23-25, 2018 Detroit Marriott at the Renaissance Center By MARY FARRINGTON, CMP, director of education, Michigan Pharmacists Association
Members are encouraged to register to attend the 2018 Michigan Pharmacists Association (MPA) Annual Convention & Exposition! From Feb. 23-25, pharmacy professionals will gather for this outstanding event that you will not want to miss. Pharmacists, pharmacy technicians, student pharmacists and other industry professionals will have the opportunity to earn live continuing education (CE) credit, network during special events and enjoy attractions in the heart of Detroit. As you anticipate your arrival for the Annual Convention, be prepared to make the most of your weekend by reviewing all this first-rate event has to offer. MichiganPharmacists.org
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
sition
n & Expo o ti n ve n o C l a u n n A A P M
to also help attendees grow in their healthcare setting as a community, consultant, specialty or health-system pharmacist and as a pharmacy technician.
What is the Annual Convention All About? MPA’s Annual Convention & Exposition is a three-day event that occurs annually in February. In 2017, the event attracted nearly 1,300 pharmacists, pharmacy technicians, student pharmacists, pharmaceutical representatives and academics. Here’s what you can look forward to this year:
What Special Events and Convention Highlights Should I Anticipate?
•O ver 40 live CE programs, including the required pain, law and patient safety training pharmacists and pharmacy technicians need for relicensure and certification renewal. • An Exhibit Hall with hundreds of representatives ready to introduce you to a full spectrum of pharmacy products and services to help you advance in your career and improve patient care. •N etworking events that allow you to connect with peers, discover best practices and find out how others are advancing the profession and reconnect.
How Do I Register? Register for the Annual Convention online at www. MichiganPharmacists.org/convention18. Log in to your member account to take advantage of your built-in member discounts. Pre-registration ends at 4:30 p.m. on Feb. 12, so be sure to register early. In addition, you have an opportunity in the registration process to adopt-a-student. Individuals can support the Michigan Pharmacy Foundation (MPF) Adopt-aStudent program by making a tax-deductible donation of $100 for one Student MPA (SMPA) member or a $185 donation for two SMPA members. Contributors will be mailed a receipt acknowledging their gift. If you have questions while you are registering for the Annual Convention, please call Jennifer Crawford, education planning assistant, at (517) 377-0225.
What Types of Continuing Education Programming Will Be Available? CE programming will begin on Friday, Feb. 23 at 7:30 a.m. and will end as the Opening Session concludes at 3:30 p.m., offering 6.75 hours of credit. Saturday’s CE programming will provide 8.25 hours of credit with program hours ranging from 7:30 a.m. to 6 p.m. Sessions on Sunday run from 8 a.m. to 2 p.m. with 5.75 hours of credit. Participants will also be able to attend CE programs between noon and 1:30 p.m. on Friday. Careful attention has been given to create CE programs that not only help pharmacists and pharmacy technicians fulfill their relicensure and recertification requirements, but MichiganPharmacists.org
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Special events and exciting Annual Convention features have been planned throughout the weekend for attendees. Be sure to make time to explore the Exhibit Hall this year. Convention attendees will be able to meet and network with hundreds of professionals and learn about the latest products and services for their businesses and careers in pharmacy. The Exhibit Hall will be open on Friday from 3:30-6 p.m. with a cash bar and on Saturday from 11 a.m.-1 p.m. MPF will once again offer the Charity Auction where you can bid on fabulous items or purchase items at the “Buy it Now” price. Bidding will close at 6:30 p.m. on Saturday, so be sure to visit the Auction Thursday, Friday and Saturday to win items. Additionally, the Foundation will provide a continental breakfast to Convention participants for just $5 for each morning of the Convention. You will also want to browse the MPA Product Store during the weekend where you can purchase miscellaneous pharmacy and Association-related items. Visit during posted hours from Thursday evening until Sunday morning. Several MPA practice sections, entities and Committees will be holding special luncheons, meetings and events during the Convention. These events, as well as other opportunities, are detailed below. • MPA 50/50 Raffle 50/50 raffle tickets can be purchased in the MPA Product Store and the drawing will be held on Sunday at 12:30 p.m. Participants do not need to be present to win. MPA will donate proceeds to Pharmacy PAC Corporate. • PAC V.I.P at the ACE Join our 2018 Michigan Pharmacy PAC V.I.P. @ the Annual Convention & Exposition Campaign for special benefits like a fast-track registration lane and more. PAC donations help support legislators friendly to pharmacy. • Pharmacy PAC Luncheon The annual Pharmacy PAC Luncheon will be held on Friday from noon to 1:30 p.m. Current pharmacy- and political-related issues will be discussed. The Legislator of the Year, Hank Fuhs Good Government and Good Public Health Policy Awards will be presented. Luncheon proceeds will be used to support Pharmacy PAC Corporate. Tickets are $100. 2018 Jan./Feb./Mar. | Vol. 56, Issue 1
Contact Arika Sinnott, MPA manager of governmental affairs, at Arika@MichiganPharmacists.org for more details. •N ew Practitioner Night on the Town Due to its popularity last year, a New Practitioner Night on the Town will occur again on Friday evening at 9 p.m. Student pharmacists are also invited to attend. •M SPT Pharmacy Tech Connect Reception MSPT will host an informal reception for pharmacy technicians on Friday evening from 6 to 7 p.m. • L ocal Association Meeting and Breakfast Local association leaders are invited to attend this informative breakfast meeting. The program will be held on Saturday from 7:30 to 9 a.m. by invitation only. •M SPT Annual Meeting and Luncheon On Saturday, pharmacy technician members are invited to attend the MSPT Annual Meeting and Luncheon from noon to 1:30 p.m. The MSPT Technician of the Year Award and Service Award will be presented during this event. Ticket required. •C SPM Annual Meeting and Luncheon On Saturday, consultant and specialty pharmacist members are invited to attend the CSPM Annual Meeting and Luncheon from noon to 1:30 p.m. The CSPM Pharmacist of the Year Award will be presented during this event. Ticket required.
•M SHP Delegate Caucus Breakfast The MSHP Delegate Caucus breakfast will be held on Sunday from 7:30 to 9 a.m., by invitation only. •H ouse of Delegates MPA’s 2018 House of Delegates Session will be held on Sunday from 9:30 a.m to 12:30 p.m., and the Local Association Achievement Awards, Distinguished Local Association Achievement Award and the Ernie Koch Striving for Excellence Award will be presented.
How Do I Make Hotel Accommodations?
•M SCP Annual Meeting and Luncheon On Saturday, community pharmacist members are invited to attend the MSCP Annual Meeting and Luncheon from noon to 1:30 p.m. The MSCP Pharmacist of the Year Award will be presented during this event. Ticket required. •M SHP Student Pharmacist Luncheon Student pharmacists, join your classmates and future colleagues on Saturday from noon to 1:30 p.m. for a luncheon sponsored by MSHP.
MichiganPharmacists.org
•A nnual Banquet and Awards Ceremony Please join us on Saturday at 6:30 p.m. for a cocktail reception and at 7 p.m. to formally inaugurate 2018 MPA President Sandra Taylor. Awards to be presented include the Pharmacist of the Year, American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations Bowl of Hygeia, Michigan Pharmacy Foundation Fred W. Arnold Public Relations, Outgoing President, Executive Board Service, Upsher-Smith Laboratories, Inc. Excellence in Innovation, Pharmacy Services Inc. Distinguished New Pharmacist Practitioner, Cardinal Health Generation Rx Champions, Executive Board Medal, Hall of Honor, Fellow of Michigan Pharmacists Association and Years of Membership. Ticket required.
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Convention participants may make reservations at a special group rate by visiting the Marriott website at https://aws.passkey.com/go/MPAAnnualConvention2018 or by calling Marriott reservations directly at (800) 3520831 before 5 p.m. on Feb. 1, 2018. Be sure to mention that you are attending the MPA Annual Convention to receive the special rate. MPA’s 2018 Annual Convention & Exposition is the event for pharmacy professionals to attend in Michigan! You can look forward to networking with colleagues, learning about new services in the Exhibit Hall, earning up to 20.75 hours of live CE credit and experiencing the excitement of downtown Detroit from Feb. 23-25, 2018.
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LEGISLATIVE UPDATE
2017 End of Year Legislative Update The following provides recent actions in the Michigan Legislature and at the federal level that could impact your practice. Please not that this is the most current information as the issue is going to press. •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 4425 and HB 4426: HB 4425 would rescind R 325.175 of the Michigan Administrative Code which requires a physician or other person who attends to a case of communicable disease to arrange for appropriate barrier protections, treatment, or isolation, as necessary, to prevent the spread of the infection. It also allows the physician or other person to obtain information on precautionary measures from the local health officer or the Michigan Department of Health and Human Services (MDHHS). This bill would also prohibit MDHHS from promulgating a rule that allows health officers to keep unvaccinated children from attending school if a classmate has or is reasonably suspected of having a communicable disease. HB 4426 would make corresponding changes to the Revised School Code. House Bills 4425 and 4426 are tie-barred together, meaning that neither could take effect unless the other is also enacted. STATUS: Referred to House Education Reform 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 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. •H B 5228: This bill would require that a provider contract contain a provision that says pharmacists must disclose drug prices of drugs dispensed by that pharmacy when requested. STATUS: Referred to House Health Policy Committee.
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•H B 5229: This bill requires that a pharmacy or pharmacist shall not enter into a contract that prohibits the disclosure of the current selling prices of a drug dispensed by that pharmacy. STATUS: Referred to House Health Policy Committee. •S B 47: This bill would amend the Public Health Code to expand upon reporting requirements under the Michigan Automated Prescription System (MAPS). It would also exempt dispensing of a controlled substance from reporting requirements to MAPS in the following instances: 1.) A licensed hospital that administers the controlled substance to an inpatient, 2.) A licensed health facility or agency if the controlled substance is dispensed by a dispensing prescriber in a quantity adequate to treat the patient for not more than 48-hours. STATUS: Signed by the Governor on Dec. 27, 2017. •S B 166 and SB 167: SB 166 would require a licensed prescriber to obtain and review a patient’s MAPS report before prescribing a Schedule 2-5 controlled substance to the patient. This requirement would not apply if the dispensing occurs in a hospital and the controlled substance is for the patient’s inpatient use. Senate Bill 167 would include violation of the requirement described in SB 166 as grounds for disciplinary action. That violation would be punishable by denial, fine, reprimand, probation, limitation, suspension, revocation or permanent revocation, as applicable. SBs 166 and 167 are tie-barred together, which means that neither would take effect unless the other is also enacted. STATUS: Signed by the Governor Dec. 27, 2017. •S B 270: This bill would require a bona fide prescriber/patient relationship before a licensed prescriber could prescribe a schedule 2-5 controlled substance, with certain exceptions. STATUS: Signed by Governor Dec. 27, 2017. •S B 272: This bill would amend the Public Health Code to require a licensed prescriber to provide information on certain topics to a patient or the patient’s representative before prescribing an opioid controlled substance to the patient. STATUS: Referred to Senate Health Policy Committee. •S B 274: This bill would allow a pharmacist to partially fill in increments a prescription for a schedule 2 controlled substance in certain situations. It would also limit the supply of an opioid a prescriber could prescribe to a patient being treated for acute pain, beginning July 1, 2018. STATUS: Signed by the Governor on Dec. 27, 2017.
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LEGISLATIVE UPDATE •S B 287: This legislation would add a new section to the Michigan Insurance Code that would regulate practices related to pharmacy audits, pricing standards, hidden fees charged to the pharmacy and network access for patients. The intent is to increase transparency for PBMs. STATUS: Referred to Senate Insurance Committee. •S B 360 (Public Act 165 of 2017): This bill was signed into law on Nov. 28, 2017. The new law will allow a pharmacist to dispense, at one time, additional quantities of a prescription drug up to the number of dosage units authorized by the prescriber on the original prescription and any refills of the prescription. This would be allowed if, after consulting with the patient, the pharmacist determines in his or her professional judgement that it is appropriate. However, this provision does not apply in the case of a prescription for a controlled substance, except for those controlled substances in schedule 5 that do not contain an opioid. STATUS: Enacted.
•S B 492: The bill would require a health insurance policy that provided coverage for orally administered and intravenously administered prescriptions or injected anticancer medications to ensure that treatment limitations applicable to the orally administered prescriptions 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: Referred to House Insurance Committee.
2018 LEGISLATIVE PRIORITIES The MPA Executive Board has determined that the following will be the legislative focus of the Association for 2018 at the State and federal levels. For more information about these priorities as well as talking points, visit www.MichiganPharmacists.org/adovcacy/priorities. Michigan Legislative Agenda •P harmacy Benefit Manager (PBM) Transparency: Educate policymakers on healthcare reimbursement and work to facilitate fair business environments by promoting legislation that addresses issues such as prescription drug pricing and reimbursement, fair audit practices, mandatory mail order programs and PBM transparency. •O pioid Epidemic: Work with stakeholders to create and pass public health policy, including the utilization and reporting methods implemented to decrease diversion and keep patients safe, while also maintaining access to medications for appropriate use. • I nterchangeable Biologic Substitution: Educate policymakers on the importance of allowing substitution of interchangeable biologics without the implementation of administrative barriers. • I mmunizations: Work with stakeholders to ensure that patients have access to immunizations, and to educate policy makers on the importance of pharmacists providing accessibility to vaccinations in the community through establishing a statewide standing order for immunizations and other efforts. •M edication Safety: Educate policy makers on the importance of promoting and supporting a culture of safety while emphasizing the potential negative impacts to healthcare that occur when medication errors are not reported due to a punitive environment.
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• E mergency Preparedness: Work with stakeholder groups to ensure that qualified individuals have the ability to participate in protecting communities during unforeseen events and are afforded the same professional immunity as other emergency responders. Ensure that pharmacies have the ability to operate, provide care and acquire medications through the proper channels during emergencies.
Federal Legislation and Issues •D irect and Indirect Remuneration (DIR) Fees: Support national efforts to limit the inappropriate use of DIR fees as a method of recouping dollars from pharmacies after a claim has been adjudicated. •P rovider Status: Work with national organizations and pharmacy stakeholders to support access of pharmacy services to patients through the recognition of pharmacists as providers under Medicare Part B. •R eimbursement: Support national efforts to improve the frequency of updates to drug pricing standards, expand upon Medicare’s any willing pharmacy provisions and increase transparency requirements for PBMs.
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ADVOCACY
Michigan House
PHARMACY CAUCUS By ARIKA SINNOTT, manager of governmental affairs, Michigan Pharmacists Association
The Michigan House Pharmacy Caucus is a bipartisan alliance of legislators who advocate on behalf of pharmacists across the State. The intent of the Caucus is to provide information, opportunities for discussion and solutions that promote the important role pharmacists play as healthcare providers in Michigan. For the first time, the Pharmacy Caucus met on Oct. 5, 2017, to discuss those pharmacy issues that are most important to the profession. Chairing the meeting were Rep. Hank Vaupel (R-Handy Township) and Rep. Scott Dianda (D-Calumet). It was a great turnout with seven members of the House of Representatives in attendance. The first meeting was intended to be a “welcome” session so that all new members would have a chance to get together and discuss future topics for the caucus. The meeting quickly turned to a discussion on the opioid epidemic. By the conclusion of the meeting, it was decided that the topic of the second caucus would continue to be the opioid epidemic. Many members expressed interest in hearing from first-responders and law enforcement.
The second meeting of the House Pharmacy Caucus took place on Nov. 9, 2017. Jackson County Sheriff Steve Rand kicked off the meeting and shared some important information on the opioid and heroin crisis from a law enforcement point of view. He provided relevant statistical data as well as personal stories related to his use of naloxone. The second speaker was Michigan Pharmacists Association Chief Executive Officer Larry Wagenknecht. Larry spoke about the increase in opioid and heroin overdoses and led the discussion on the Michigan Automated Prescription System and how it is not fully utilized. The next meeting of the caucus is tentatively scheduled for Feb. 1, 2018. It’s never too late for a legislator to become a member of the House Pharmacy Caucus. Please encourage your State representative to join by calling or emailing their offices directly. Stress how important pharmacists are to solving many of the current and anticipated healthcare challenges. Information about who your legislator is and how to contact them is available on the MPA website at www.MichiganPharmacists.org/advocacy/legislators.
Members of the Pharmacy Caucus meet on Nov. 9, 2017.
MPA CEO Larry Wagenknecht (center) with Caucus co-chairs Rep. Hank Vaupel (left) and Rep. Scott Dianda (right).
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From left to right: MPA Director of Professional Affairs Eric Liu with MPA CEO Larry Wagenknecht, Jackson County Sheriff Steven Rand, Rep. Julie Alexander (R-Jackson County) and co-chair Rep. Hank Vaupel.
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
CSPM FOCUS
Evolving with the
Profession By JOHN MOHLER, R.Ph., director of pharmacy, Oaklawn Hospital, Marshall and president, Consultant and Specialty Pharmacists of Michigan
It is an honor serving on the Consultant Specialty Pharmacists of Michigan (CSPM) Board of Directors, let alone being able to serve as the president. CSPM has had a long history of being the place where pharmacists from unique and emerging practice settings fall. Pharmacy is ever changing, and I have been proud to spend my career collaborating with these unique minds of pharmacy. I started my pharmacy career in 1993 and have seen the shrinkage of independent pharmacies, a shortage of pharmacists to oversaturation, a change in the mentality of “right drug, right dose and right patient” in pharmaceutical care and a significant increase in new molecular entities and emerging specialty medications. In this era of Medicare reform, educational improvements, legislative control, 340b reform and economic uncertainty for the profession, it is hard to imagine where pharmacy will end up. We are also in an era of high deductible plans, coverage gaps, escalating healthcare costs and highly effective specialty medications that cost more than a patient’s income. We struggle as a profession daily with not just procuring medications for our patients, but finding ways to make it affordable, then monitoring the therapy of these medications for safety and efficacy. I have witnessed this evolving era of hospital reimbursement cuts as a result of these medications. The cuts of the 1990s to the community pharmacies are now the cuts of the 2000s to the health-systems in both the acute and ambulatory settings. These high tech medications and changing reimbursement models are now moving healthcare into the ambulatory markets. Pharmacy has to embrace this and use its unique practice setting models to keep up with these changes. As pharmacists, we need to increase our presence wherever we can to prove our commitment to quality, our cost-effective healthcare and define our role. I am proud to be a pharmacist, and I know the huge impact we have on patient care and healthcare costs. Pharmacists need to be committed to making sure that as a profession we make certain that the legislature, PBMs, industry and the public are aware of the impact we have on quality, cost-effective healthcare.
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I am proud to say that the Board of Directors for CSPM has established their goals for 2017 and 2018. They revolve around three main categories: professional issues, value of membership and education. Professional issues include provider status, patient monitoring standards, the impact of the 21st Century Cares Act on pharmacy, drug shortages and third party issues. Third party audits continue to be biased, directed, opportunistic and too numerous, with a continued need for transparency and governing rules. As with community pharmacy, there continues to be emerging third party issues related to outlying areas like compounding, quality standards, special packaging, specialty medications and any willing qualified provider. Specialty products continue to be funneled to national providers with a lack of transparency. The value of membership goal includes enhancing our professional image, networking opportunities and establishing a “brand” for CSPM. We are always looking to identify other unique areas of pharmacy and try to determine what to offer CSPM members, as well as working to shift the perspectives of students who only see two types of pharmacy careers. The lines drawn between community and hospital career paths are getting blurrier with technology, education, high tech medications and emerging ambulatory markets. The third and final priority for CSPM is education. I have always been proud of the quality programs that CSPM continues to host, and the quality of speakers we attract for the Michigan Pharmacists Association Annual Convention & Exposition. On May 24, 2018, CSPM will be holding a continuing education (CE) session covering reimbursement and regulatory changes. This event will include CE programing on USP 800, ICD 10 coding, medication therapy management, reimbursement issues and a legislative update. Watch your MPA communications for information about registration soon. I look forward to a very eventful couple of years on the CSPM Board of Directors and hope that we can make strides in achieving these goals for pharmacy and CSPM.
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CSPM FOCUS
CONSULTANT and SPECIALTY PHARMACY:
A CLOSER
LOOK
Consultant and specialty pharmacy practice is a unique practice setting that utilizes many different skills of the pharmacist and the healthcare team. While not as prevalent as other settings, consultant and specialty pharmacy is a growing practice area with the opportunity to provide care to diverse patient populations while working as a member of the healthcare team.
SPECIALTY PHARMACY By EMILY KRUMBACK, Pharm.D. candidate 2018, University of Michigan College of Pharmacy, Ann Arbor Specialty pharmacy is a growing field of patient care coordination which seeks to improve and simplify the multi-faceted realm of specialty drug distribution for patients treating diseases such as cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS, hepatitis, Crohn’s disease and other chronic or rare conditions. In 2015, the specialty revenue market represented 27 percent of pharmacy industry revenues at $98 billion. This share is expected to increase to almost 50 percent by 2020 with estimated specialty revenues of $212 billion.1 While specialty medications have no standard definition, they are generally considered to be high cost, high touch and high tech. In 2015, the average annual retail price of therapy for specialty drugs was over $52,486—a cost nine fold higher than the average annual price of brand name therapy and 100 fold higher than the average annual price of retail therapy. High touch medications are those that may require ongoing assessment, specialty training to administer (i.e., injections/infusions), or increased side effect monitoring. Specialty drugs are also considered high tech because they may be subject to Risk Evaluation and Mitigation Strategy (REMS) requirements and Food and Drug Administration (FDA) mandated safety reporting or limited distribution chains.2,3 Additionally, many of these drugs require special handling such as refrigeration which complicates delivery options.2
will verify insurance coverage, identify any requirements for prior authorization and apply for copayment assistance programs on behalf of the patient if needed before the medication is ordered.4 Once this process is complete, a pharmacist contacts the patient to provide education regarding use and administration instructions, potential side effects or adverse events and the importance of adherence to the medication regimen.5 Follow-up calls to the patient to assess side effects and compliance are routine.3
MANAGED CARE By KARINA ABDALLAH, Pharm.D., clinical operations manager, Medicare Advantage Pharmacy Services, Blue Cross Blue Shield of Michigan, Detroit
The role of the managed care pharmacist is to provide high-quality medication management to plan members as well as optimize pharmacoeconomic outcomes for the patient population. The aim of the managed care pharmacist is to ensure patients have access to the medications they need, and ensure these medications are appropriate.6 According to the Academy of Managed Care Pharmacy, managed care pharmacists have a large variety of roles including: ensuring patient safety, drug utilization review, serving on pharmacy and therapeutics committees, designing medication therapy management programs, developing quality assurance programs, creating programs to detect fraud, waste and abuse of medications, designing drug benefit and helping clients evaluate and improve their pharmacy benefit.7
As a result, many retail pharmacies do not have access to the broad range of specialty drugs. This has allowed specialty pharmacy to develop a niche service benefiting clinics and physicians managing specialty conditions, payers administering benefits and manufacturers requiring data and reporting on drug distribution and patient adherence.2 Services provided by specialty pharmacies aim to ensure appropriate medication use, maximize medication adherence and optimize economic outcomes by avoiding unwarranted drug expenditure.4
The role of the managed care pharmacist while serving on pharmacy and therapeutics (P&T) committees is to work with a variety of healthcare professionals to continually update formularies. These formularies are developed with the goal of promoting safety, effectiveness and affordability. The P&T committee evaluates clinical and medical literature to ensure access to safe, costeffective and evidence-based medication therapy.7 The medications selected are specific to, and best serve, the plan’s patient population.
In a traditional community pharmacy model, pharmacies purchase medications from a wholesaler and then dispense the medication to the patient upon receiving a prescription from the prescriber. The medication is typically billed to the patient’s insurance, and the patient is responsible for the remaining copay. In this model, adherence and medication monitoring often fall back to the original prescriber.2 Patient intake at a specialty pharmacy differs in that, upon receipt of a prescription, a benefit specialist or financial advisor
Another role the managed care pharmacist serves in is to participate in drug utilization review (DUR). A DUR is, “a comprehensive, internal review of a patient’s prescription and medical information at regular stages of treatment in order to ensure patient safety and evaluate cost-saving opportunities.”7 There are three types of DUR: prospective, concurrent and retrospective. A prospective DUR occurs prior to dispensing a medication. This type of review includes checking for interactions, appropriate
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CSPM FOCUS dose, medication allergies and verifying appropriate directions for use.7 A concurrent DUR occurs during the time of treatment. This type of review includes assessing for over or underutilization of medications, identifying doses that may be too high or too low and identifying any interactions.7 A retrospective DUR occurs when previously given medications are evaluated to assess for any trends. This type of review includes reviewing charts and electronic health records to identify patterns that may indicate inappropriate use or prescribing of medications.6 Some other functions of the managed care pharmacist include participating in electronic prior authorization, determining if appropriate step therapy is being utilized and performing medication therapy management.
LONG-TERM CARE By LINDSEY GHIRINGHELLI, Pharm.D., BCGP, geriatric and consultant pharmacist, PharMerica, Midland A long-term care consultant pharmacist oversees all aspects of pharmacy services within a skilled nursing facility. A typical consultant will oversee multiple facilities each month. As outlined by the Centers for Medicare and Medicaid Services (CMS), the pharmacist reviews the chart for every patient in the facility at least monthly to identify medication-related problems. These problems are communicated in the form of written recommendations to the prescriber, nursing staff, social worker or pharmacy, depending on the nature of the concern. A summary of all recommendations is provided to the director of nursing, administrator and medical director for review. Pharmacist recommendations must be addressed within 30-days and cover a wide variety of issues. These include disease state management, drug interactions, geriatric, renal and hepatic dosing, duplicate therapies, evaluating continued need of therapy, appropriate psychotropic medication use, pain management, fall prevention, adverse drug reactions, medication administration errors (timing, crushing, giving with/without food, etc.) transcription errors, medication administration documentation, safety and efficacy monitoring. Trends identified from these reviews can lead to facility-specific recommendations, reported to the nursing homeâ&#x20AC;&#x2122;s quality assurance committee, and the pharmacist can assist in developing a plan of action and follow-up.
HOMECARE By SISTER PHYLLIS KLONOWSKI, Pharm.D., pharmacist, HealthFirst Pharmacy, Owosso
Homecare pharmacy includes service in a patientâ&#x20AC;&#x2122;s own home, in assisted living, long-term care, rehab or acute care, dementia units and all across transitions of care. Homecare pharmacy requires observation and documentation of medication changes and effectiveness as the patient ages or their health changes. Multidisciplinary care team communication is essential to homecare pharmacy, as it involves the direct involvement of patients, families, caregivers and other healthcare professionals. Getting to know the residents is necessary for optimal treatment. Some of the things homecare pharmacists think about are how to improve patient assessment and reduce psychotropic medication use, recognizing presepsis before shock sets in, optimizing pulmonary function to avoid asthmatic exacerbations and how to contribute to antibiotic stewardship while still providing the necessary medications to the patients who need them. Homecare pharmacy patients are typically older (80 to 110 years) who live, for the most part, independently in their own homes but need assistance and adapted functioning for one or more chronic diseases in need of treatment including asthma, COPD, diabetes, challenged cardiac function, and congenital and genetically inherited health issues that are treatable. Homecare pharmacy has also seen an increase in patients being treated for aging, diminished renal function, and sometimes malnutrition or long-standing obesity. A full list of references can be found on the MPA website.
In addition to medication regimen reviews, the consultant pharmacist reviews medication error reports for appropriate action, oversees the handling of controlled substances (documentation of receipt, perpetual inventory of patient medications, emergency stock and drug destruction), ensures compliance with pharmacy policies (proper storage, labeling, expiration and administration of medications) and assists with the facilityâ&#x20AC;&#x2122;s antibiotic stewardship program and compliance with CMS regulations regarding the prescribing of psychoactive medications within skilled nursing facilities. The pharmacist also keeps the facility apprised of new medications, vaccines, safety alerts, CMS regulation changes and new prescribing guidelines as well as providing educational programming to staff and prescribers while assisting with any other requests by the facility or state surveyors. It is a rewarding career to serve as an advocate for the elderly population and work with the healthcare team to ensure appropriate medication use in the nursing home setting. MichiganPharmacists.org
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
PROFESSIONAL PRACTICE
Overlooked
MEDICATION Wastage
By KATHERINE YANG, Pharm.D. candidate 2018, University of Michigan College of Pharmacy, Ann Arbor
In today’s practice, significant emphasis is placed on medication adherence, and the issue of patients not taking their medications as prescribed or forgetting refills has sparked another provoking issue: medication waste. Medication waste is a driver of cost inefficiencies in the U.S. healthcare system. The accumulation of unused medications may occur as a result of various factors including patient nonadherence, expiration dates that occur too soon to enable use of a given initial quantity, over-purchase by the consumer or overprescribing by the prescriber.1 However, two often overlooked types of inefficiencies can be attributed to syringes that are used to deliver injectable medications and abandoned initial fills which result in waste and avoidable costs.2,3 A study published in JAMA Internal Medicine highlighted researchers at the University of North Carolina Eshelman School of Pharmacy who found injectable medication waste attributable to syringe dead space. Syringe dead space is the volume of fluid left in a syringe after the plunger has been pushed down completely. This study compared high dead-space syringes (HDSS) to low dead-space syringes (LDSS). The HDSS classification is characterized by a detachable needle, whereas the LDSS classification is characterized by a permanently attached or integrated needle and/or a conical plunger to reduce dead space in the needle hub. The study indicated that HDSS contribute to excess cost of injectable medication waste compared with LDSS. Researchers determined that the median cost of wastage for self-injectable drugs delivered through HDSS was $5.43 per single dose and $1,637.91 annually.2 In comparison, waste from medication dispensed through low dead-space syringes (LDSS) was significantly less at a median $0.54 per single dose and $124.52 annually.2 Replacing HDSS syringes with LDSS syringes can be one way to avoid preventable medication waste. In addition to syringe dead space, abandoned first fills have been contributing to the medication waste concern. Abandoned first fills of medications may be linked to patients who cannot tolerate medication side effects, unaffordable cost, perceived lack of benefit and failure to meet patient expectations. A study published in the American Journal of Managed Care that evaluated the categories, quantities and prescribers of unused first-fill prescriptions found that, “the top 3 US Pharmacopeial Convention (USP) categories of unused first-fill prescriptions returned were analgesics (34%), of which 84% were opioids; antibacterial agents (13%); and cardiovascular agents (8%).”3 Moreover, of the “categories with MichiganPharmacists.org
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the highest average percent returned compared with the original quantity prescribed were metabolic bone disease agents (100%), hormonal agents (91%), and central nervous system agents (91%).”3 First-fill prescriptions returned by patients, which consisted of several USP categories, impose wasteful expenditures on patients and third-party payers and raise additional concerns regarding diversion, unintended poisoning, and environmental protection. In light of the medication accumulation and waste issue, state agencies, federal agencies and insurance companies are using innovative methods to help increase adherence to first-time prescriptions. Notably, partial fills have been proposed that aim to optimize drug selection for individual patients and reduce wasted medication. Since the beginning of 2013, rules from the Centers for Medicare and Medicaid Services (CMS) have required that in long-term care (LTC) facilities, prescribers must write prescription cycles of 14-days or less for Medicare Part D benefits.4 CMS has also encouraged patients to obtain a “trial size” of first-fill prescriptions for medications treating chronic conditions, along with prorated cost sharing based on the daily cost of the drug.4 This two-week initial fill would allow the patient to assess their response to, and tolerance of, a certain drug. Additionally, according to CMS, the proposal would aid in decreasing environmental waste, discouraging drug diversion, giving patients time to determine if they can tolerate a medication and savings for Medicare and Part D sponsors. CMS expects that these efforts will promote savings of more than $1.8 billion by 2018, assuming a rate of 32 percent discontinued first fills.5,6 Injectable medication waste attributed to syringe dead space and abandoned first-fill prescriptions returned by patients impose wasteful expenditures on patients and third-party payers while also contributing to the inefficiencies in the US healthcare system. Because HDSS have the potential to significantly add to overall healthcare system costs and medication waste, strides toward implementing LDSS as the standard for all syringes should be sanctioned. Furthermore, state and federal agencies and insurance companies should continue to implement and enforce proactive and innovative measures against medication accumulation and the associated negative consequences. Continuing to address syringe waste and first-fill quantities may be one strategy to address this national concern. References available on the MPA website. 2018 Jan./Feb./Mar. | Vol. 56, Issue 1
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
PATIENT SAFETY
USP <800> AND PERSONAL PROTECTIVE EQUIPMENT By TROY A. SHIRLEY, Pharm.D., M.B.A., system director of pharmacy, Bronson Healthcare Group, Kalamazoo
The United States Pharmacopeial General Chapter 800 (USP <800>) provides the standards for the safe handling of hazardous drugs in healthcare settings.1 USP recently announced a delay in the official date of USP <800> until December 2019.2 Hospital pharmacy departments have been working diligently to achieve compliance with the standards of this chapter by the previous effective date of July 2018, and most pharmacy departments should be fully or nearly compliant with the aspects of USP <800> specific to hazardous drug compounding. As USP <800> applies to all healthcare workers, this delay in effective date now allows organizations the opportunity to ensure compliance with all of the requirements of the chapter, including the components outside the walls of the pharmacies. Even before the publishing of USP <800>, the Occupational Safety and Health Administration (OSHA) had established guidelines for the safe handling of cytotoxic drugs in the workplace dating back thirty years.3 The National Institute for Occupational Safety and Health (NIOSH) and the American Society of Health-System Pharmacists (ASHP) expanded the recommendations of handling cytotoxic drugs to handling hazardous drugs resulting in a much larger list of potential exposure risks. It is estimated that over 8 million healthcare workers are exposed to hazardous drugs.4 Activities by non-pharmacy personnel associated with potential exposure include hazardous drug administration, patient-care activities (handling of body fluids or body-fluid contaminated materials), spill generation, management and disposal, moving of hazardous drugs and collection and disposal of hazardous waste.4 The amount of exposure by healthcare workers is challenging to quantify, and the long-term health effects are difficult to determine. The OSHA document on controlling occupational exposure to hazardous drugs outlines the evidence known to date on human effects. The evidence demonstrates a trend toward adverse reproductive effects and increases in cancer risk for any healthcare worker exposed to hazardous drugs. This includes physicians, nurses, pharmacists, pharmacy technicians and environmental service workers. In an effort to protect healthcare workers, personal protective equipment (PPE) is required at many steps during the handling of hazardous drugs beyond those required during drug compounding within the pharmacy. NIOSH does provide guidance on the specific types of PPE required for different types of activities around handling of hazardous drugs.4 Any PPE used to administer or handle hazardous drugs must be treated as contaminated and disposed of in appropriate containers. The elements of PPE used for non-compounding activities are described below: Gloves: Chemotherapy gloves (two pair) are required when administering and disposing of antineoplastic MichiganPharmacists.org
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hazardous drugs. The gloves currently must meet American Society for Testing and Materials (ASTM) standard D6978-05 (2013). The ASTM standard protocol for glove manufacturers requires testing the glove material against seven drugs: carmustine, cyclophosphamide, doxorubicin, etoposide, fluorouracil, paclitaxel and thiotepa. In addition, two more drugs must be tested and are left to the glove manufacturerâ&#x20AC;&#x2122;s discretion. ASTM provides a suggested list for these additional drugs in their standard protocol.5 Gowns: A gown that is resistant to permeability by hazardous drugs is required when administering injectable antineoplastic hazardous drugs. Though ASTM currently has no performance standard for gowns as it relates to permeability of hazardous drugs, USP <800> does specify that gowns made of polyethylene-coated polypropylene or other coated materials offer better protection as opposed to uncoated gowns.1 The gown must be disposable, must close in the back, must be long sleeved, have closed cuffs and have no seams or closures. The disposable gown must not be reused. Additionally, gowns worn in hazardous drug handling areas must not be worn to other areas.1,3 Eye and Face Protection: Eye and face protection should be worn whenever the risk of exposure from a splash exists. This includes compounding outside of a primary engineering control, working at or above eye level, cleaning a primary engineering control, or cleaning a spill. Eye glasses or safety glasses with a side shield do not provide adequate protection from a splash. A face shield alone also does not provide adequate protection. Either a full face respirator or a face shield in combination with goggles provides the required protection.1,3 Respiratory Protection: Respiratory protection should be worn any time there is risk of respiratory exposure, including spill clean-up in the amount greater than what can be contained with the spill kit (i.e., broken IV bag or leaking IV line), cleaning of the primary engineering controls or there is a known or suspected airborne exposure to powders or vapors. For most activities a fit-tested NIOSH-certified N95 respirator provides sufficient protection; however, these do not protect against gases, vapors or direct liquid splashes. In these situations a powdered airpurifying respirator (PAPR) should be worn.1,3 Proper compliance with USP <800> affects many workers in healthcare facilities, and the deadline for compliance, while delayed, will happen soon. Pharmacists are uniquely qualified to lead their organizational efforts around appropriate use of PPE when handling hazardous drugs. Appropriate use of PPE ensures that all healthcare workers are safe when handling hazardous drugs. A full list of references can be found on the MPA website. 2018 Jan./Feb./Mar. | Vol. 56, Issue 1
THAT’S MY PHARMACIST
Build Trust with Your Patients in the New Year By STEFANI CHUDNOW, MPA communications intern, senior, Michigan State University
In this fresh New Year, we’re predicting that the That’s My Pharmacist campaign will be stronger than ever before. Designed and implemented several years ago, this campaign aims to provide resources to pharmacists that educate and inform the public about the services and benefits of pharmacy professionals. As a result, the That’s My Pharmacist webpage has a plethora of materials available for any pharmacy professional’s use. There, you can find various brochures, medical information cards, monthly observance flyers and even large-sized posters. New this year are three crucial flyers that have the ability to make a great deal of difference to pharmacy patients. These flyers inform patients about the significance of pharmacy professionals in everyday Michigan life, and coach patients on how to talk to these professionals about their health. The “Did you Know?” Flyer: This flyer serves to answer questions that may be on any patient’s mind: “What makes my pharmacist qualified to provide me with medical advice and treatment?” The three sections of this handout work together to communicate pharmacists’ fields of expertise, their background and everything that makes them qualified to provide medical assistance to patients. An added bonus of this flyer is that patients can easily learn what specific healthcare services pharmacists can offer them, information that could otherwise be confusing to some. New Fact Flyer: This easy-to-navigate fact sheet lists a variety of Michiganrelated facts that cover various health issues, including but not limited to: asthma, heart disease, diabetes and chronic kidney disease. Underneath those facts are ways in which Michigan pharmacists have directly impacted patient health outcomes related to those disease-states. Combined, the facts included demonstrate to patients how pharmacy services have been, and still are, shown to be beneficial to the health of Michigan’s citizens. Hospital Release Guide: For patients who were just recently released from the hospital, this guide is perfect for sharing important information regarding transitions of care. Not only does this flyer contain a checklist of what to do immediately after leaving the hospital, but it also provides a comprehensive list of questions to ask the pharmacist about how their hospital visit may affect their medication use. Along with these three flyers are quite a few others, all available for viewing and usage on the That’s My Pharmacist campaign’s webpage all year round at www.MichiganPharmacists.org/resources/thatsmypharmacist. In addition, if you’re a member of Michigan Pharmacists Association (MPA), we will mail posters to you completely free of charge. If you have any outlying questions or comments regarding any of the above information, or further flyers ideas you’d like to see, feel free to contact MPA Director of Communications, Kristina Bird, at Kristina@ MichiganPharmacists.org. MichiganPharmacists.org
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
COVER YOUR ASSETS
A Good Investment for the
FUTURE By RON DEVERS, CIC, CPIA, CAWC, PSI Insurance Agency manager
Purchasing life insurance for children has many advantages, and it is important in protecting their insurability at a young age. Life insurance is generally purchased for final expenses and replacement income. While children donâ&#x20AC;&#x2122;t have income to replace, the death benefit can be used to pay for outstanding medical bills, memorial services and other final expenses. Premiums are typically less expensive for children than comparable insurance for adults. The underwriting process is less strict, making it easier and faster to obtain than insurance for adults, usually with no medical, blood or urine tests. Looking past the mortality aspect, it is easy to see the benefit of purchasing childrenâ&#x20AC;&#x2122;s life insurance to guarantee a childâ&#x20AC;&#x2122;s future insurability. With low-cost premiums and minimal underwriting, the application process is easy, quick and affordable. The decision to purchase life insurance for a child is a great investment for their future. Four savvy insights about life insurance:
1. It costs less than you think.
2. You can have more than one policy.
3. Money can be left to more than just relatives (charitable giving can help to create your legacy).
4. There are drawbacks to waiting to get life insurance.
If you have any questions about these topics, feel free to contact PSI Insurance Agency at 800.678.2774. Ask for Ron or Ellen.
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
LEADERSHIP FOCUS
2 0 1 7 - 2 0 1 8
MPF Health Professional LE A DE RS H I P ACAD E M Y The 2017-2018 class of the Michigan Pharmacy Foundation (MPF) Health Professional Leadership Academy began on Oct. 7, 2017, at the Michigan Pharmacists Association headquarters in Lansing, marking the sixth year of the Academy. This year’s group of participants is one of the most diverse yet, encompassing practitioners from various aspects of the pharmacy profession including pharmacists, pharmacy residents, certified pharmacy technicians as well as expanding into nursing and health management. We are very excited about the coming year, and look forward to seeing the great things that will come from this year’s participants. Meet this year’s class below!
DIANA BENHAM
CHRISTOPHER BLACKMORE
AUSTIN BROWN
JACOB CHAFFEE
Pharmacist – Genesys Regional Medical Center
Pharmacy Supervisor – Ascension, St. John Providence
Pharmacist – Advanced Care Pharmacy Services
Clinical Pharmacist, Emerging Therapies – Blue Cross Blue Shield of Michigan
RHONDA DEAN
JESSICA EFTA
MELISSA HANOVICH
FARAH JALLOUL
Clinical Services Manager – Matrix Medical Network
Pharmacist – Henry Ford Hospital
Clinical Pharmacist – Senior Health Services
MPA/PSI Executive Fellow – Michigan Pharmacists Association
STEPHEN KAURALA
BRITTANY KINNEY
AIMEE LAGUIRE
KRISTEN PRECORD
PGY2 Oncology Pharmacy Resident – Henry Ford Health System
Pharmacy Resident – HomeTown Pharmacy
Pharmacy Technician Supervisor – University of Michigan
Clinical Community Health Manager – Thunder Bay Community Health Services
ALLISON RIDER
KELLY ROMEL
LYNDSEY SCHULZE
LAUREN WOLF
Clinical Pharmacist – Spectrum Health
Health Information & Billing Manager – Thunder Bay Community Health Services
Certified Pharmacy Technician – OptiMed Specialty Pharmacy
Clinical Pharmacist, Emergency Medicine – Mercy Health Saint Mary’s
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
CONTINUING EDUCATION
Overview of Cancer-Related Pain By CHIVONNE GAMMON, Pharm.D. candidate 2018, University of Michigan College of Pharmacy
Introduction Cancer is characterized by abnor-
mal cell proliferation and describes over 100 diseases.1 A common feature of these diseases is the propensity for pain. Cancer-related pain (CRP) is directly caused by cancer processes and healthcare interventions such as disease monitoring and treatment.2 Multiple painful stimuli and potentiating factors contribute to the complexity and challenges of treating CRP. Inadequately controlled pain may negatively affect sleep, cognition, emotional wellbeing, sexual function and cardiovascular health.3 Though evidence suggests that adequate pain control can be achieved for up to 90 percent of patients with guideline-based care, less success is achieved in practice.4,5
Pharmacists are poised to significantly improve quality of life by implementing care plans and monitoring pain symptoms for patients with cancer. Opportunities to improve pain management occur by active listening, accessibility and approachability. In direct care settings, pharmacists are essential for navigating pharmaceutical solutions to pain; particularly when it is severe, refractory or etiologically complex.6 Optimal care plans are evidenced-based and crafted with an understanding of patient preference, cancer pathology and pain expression.7
Epidemiology In 2014, over 14.7 million people in the United States had a cancer diagnosis, affecting approximately 4.6 percent of the population.8 The most commonly diagnosed cancers include female breast, prostate, lung/bronchus, colon/rectum and uterine.1 Pain prevalence varies throughout cancer treatment and is estimated at the following rates: 25 percent at diagnosis, 33 to 55 percent during treatment, 40 percent after curative treatment and 66 percent in advanced disease.7,9 About 2 to 10 percent of the pain reported by cancer patients is unrelated to cancer.10 The subjective nature of pain and variable methods of reporting
Learning Objectives
By the end of this activity, participants should be able to: 1. Outline the pathogenesis of cancer pain. 2. Describe goals and challenges associated with analgesia in cancer patients. 3. Evaluate pain symptoms and infer pain etiology. 4. Recognize signs and symptoms of cancer pain syndromes.
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 as a provider of continuing pharmacy education. more home study activity options for pharmacists ACPE Universal Activity #0112-0000-007-H01-P and and pharmacy technicians, please visit www. #0112-0000-17-007-H01-T. Initial Release Date: MichiganPharmacists.org/education/online.
11/24/17; Expiration Date: 11/24/20; 1.0 contact hour
are challenges for assessing management of cancer-related pain at the population level. An observation of cancer pain syndromes (CPS) elucidates challenges of treating cancer pain. Over one-third of CPS patients have a pain intensity score of five or higher and two-thirds experience breakthrough pain. Moreover, one third of CPS patients suffer from more than one pain pathology.5,10 Cancer treatment
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is responsible for pain in approximately 20 percent of CPS patients and approximately 90 percent of CPS patients have tumor-associated pain. Bone and joints are the tissues most commonly involved with tumor-associated pain, followed by soft tissue, viscera and nervous tissue.10 For the complete article, visit www.MichiganPharmacists.org/ education/online.
2018 Jan./Feb./Mar. | Vol. 56, Issue 1
CONTINUING EDUCATION
Michigan Society of Health-System Pharmacists Annual Meeting Recap By ANUVRAT CHOPRA, Pharm.D., BCPS, pharmacy resident, St. John Hospital and Medical Center, Detroit
MSHP 2017 Award Winners (left to right): Amber Lanae Martirosov, Denise Pratt, Richard Lucarotti, Henry Ford Oral Chemotherapy Management Program Team (Jessica Yoo, Marcy Snell and Diana Kostoff) and Paul Walker.
Clinical Skills Competition winners Maryam Abbo and Adina Poparad from Wayne State University.
The Michigan Society of Health-System Pharmacists (MSHP) Annual Meeting was held on Friday, Oct. 27, 2017, at the Kellogg Hotel and Conference Center in East Lansing. The event offered several networking opportunities for all attendees along with numerous continuing education seminars and chances to meet and interact with fellow MSHP/Michigan Pharmacists Association (MPA) members and delegates. The event began with registration and continental breakfast, during which attendees networked over coffee and light refreshments. The keynote session was delivered by Scott J. Knoer, Pharm.D., chief pharmacy officer at Cleveland Clinic, Cleveland, Ohio, and Nadia Haque, Pharm.D., clinical pharmacy specialist at Henry Ford Hospital, Detroit, where population health management strategies related to medication use were discussed as well as guidance regarding the role of pharmacists participating in population health initiatives was provided. The Town Hall Meeting followed the keynote session, where Board Directors and Officers were sworn in as members of the MSHP Board, committee chairs and members were recognized for their services and the annual MSHP awards were handed out. Winners of this year’s MSHP Awards were: Pharmacist of the Year, Denise Pratt, Pharm.D., critical care specialist, Sparrow Hospital, Lansing; Joseph A. Oddis Leadership Award, Paul Walker, Pharm.D., clinical professor, University of Michigan College of Pharmacy, Ann Arbor; Professional Practice Award, Henry Ford Oral Chemotherapy Management Program Team, Henry Ford Health-System, Detroit, and lastly, President’s Award, Amber Lanae Martirosov, assistant clinical professor, Wayne State University, Detroit. This year, MSHP also awarded Rich Lucarotti, long-time executive vice president of the Society with the Service Award for his 25+ years of service and dedication to the Society and its mission. The morning concluded with the general session presented by Susan DeVuyst-Miller, Pharm.D., assistant professor at Ferris State University College of Pharmacy, Grand MichiganPharmacists.org
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Rapids. Dr. DeVuyst-Miller explained the role of opioid medications, signs of opioid overdose, the role of naloxone in preventing accidental prescription overdose and the current recommendations of the State and local opioid task force. The Clinical Skills Competition was also held in the morning, where teams composed of the best and brightest students from each Michigan College of Pharmacy competed to create a patient care plan. Winners of this year’s clinical skills competition were Maryam Abbo and Adina Poparad, Wayne State University pharmacy students. After an excellent lunch with exhibitors, attendees had the option of choosing between three tracks: clinical, leadership/management and residency. Attendees choosing to start with the clinical track attended a very informative presentation of recent updates in oral anticoagulation. Attendees who chose to start with the leadership track attended a presentation where new regulations for hazardous drugs mandated by USP 800 standards were discussed, and those interested in the residency track attended a seminar about new practitioner transitions and self-assessment skills. After the first round of presentations, the next clinical track seminar clinical updates in infectious diseases, pulmonary hypertension, oncology and hematology were discussed. The afternoon leadership/management track included a very informative session where tactics to approach the Joint Commission Antimicrobial Stewardship survey were discussed. The final residency track presentation covered mentorship in the profession of pharmacy. Attendees also had the option to attend the reverse exhibitor program where pharmacy representatives had the opportunity to have one-on-one discussions with key pharmacy decision makers about their products and company information. Next year’s meeting is planned for Friday, Nov. 2, at the Sheraton Detroit Novi Hotel in Novi, Mich. We can’t wait to see you there! 2018 Jan./Feb./Mar. | Vol. 56, Issue 1
LEADERSHIP
SAVE THE DATE 2ND ANNUAL MPF LEADERSHIP AND MANAGEMENT SYMPOSIUM The 2nd Annual Michigan Pharmacy Foundation (MPF) Leadership & Management Symposium will be held on Tuesday, April 17 at Lansing Community College, West Campus, Lansing. Attendees can earn up to six hours of live continuing education while learning new skills critical to the success of pharmacy leaders and managers in todayâ&#x20AC;&#x2122;s professional environment. The symposium will give attendees tools to launch innovative practice ideas and develop members of their team to make projects more successful.
FOR TWO GREAT EVENTS!
6TH ANNUAL MPA PHARMACY LAW & POLICY SYMPOSIUM The sixth annual Michigan Pharmacists Association (MPA) Pharmacy Law and Policy Symposium will be held Wednesday, April 18, also at Lansing Community College, West Campus, Lansing. This event occurs every year in April and attracts over 130 pharmacy professionals. The MPA Pharmacy Law and Policy Symposium is intended to provide pharmacists, pharmacy technicians and student pharmacists with information on important legislative and regulatory changes that impact their profession. The 2018 event will feature presentations on opioids and guidelines, fraud and diversion, counterfeit drugs, medicinal marijuana and a law update. Donâ&#x20AC;&#x2122;t miss this exciting event! Watch for registration to open online soon. If you have any questions on either of these upcoming events, please contact Jennifer Crawford, education planning assistant, at (517) 3770225 or Jennifer@MichiganPharmacists.org.
Registration will be opening soon!
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2018 Jan./Feb./Mar. | Vol. 56, Issue 1
MPA TIME CAPSULE
TIME CAPSULE This year marks 135 years of Michigan Pharmacists Association (MPA) serving the pharmacists throughout the state of Michigan. For over 13 decades, MPA has been devoted to advancing the needs of the profession, addressing concerns of patients and providing resources and knowledge to help pharmacists evolve throughout the ever-changing profession. 1983 marked the 100 year celebration of MPA, and staff devoted several issues of the 1983 Michigan Pharmacist journal to a complied history of the Association – from the early days, to the middle years, the successes and the challenges – this history provided the perspective, context and inspiration for members and staff to continue working tirelessly for the profession and patients. What will follow throughout the issues of 2018 are excerpts from these articles to remind all MPA members, friends of pharmacy, legislators, and the historians compiling the 200 year history, why pharmacists in Michigan came together to create what we know today as the Michigan Pharmacists Association and just how valuable all their contributions were. From “100 Years of Michigan Pharmacy The Early Years: 1883-1908” by Michael C. Shannon in collaboration with Cynthia Beeber, Michigan Pharmacist, April 1983: Jacob Jesson of Muskegon decided it was time. Indeed, it was past time to rouse the pharmacists of Michigan to band together in association to address some of the problems facing the profession. Never mind that 10 years earlier, Jesson’s employer, S.H.Wagner, had responded to the call of the Saginaw Valley Pharmaceutical Association to form such an association only to have the attempt die out in 1877. Never mind that state-wide transportation and communications were spotty and difficult. The pharmacists of Michigan needed an organization, an association, to promote the public interest through elevation of the profession. And so, Jesson penned his call for action, dated October 1, 1883, and mailed his circular to “every known drug firm in the state.” In this provocative circular, Jesson pointed out that only Michigan of the midwestern states did not have an association. He indicated the usefulness such an association could have on obtaining passage of needed legislation, providing input into national pharmacy organizations, and in combining the just interest of science and business MichiganPharmacists.org
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to represent pharmacy to the state and its population at large... Nearly 300 druggists signified their readiness to join and formalize an association of Michigan pharmacists. With such support, Jesson was confident of success. He issued an announcement that the organizing meeting would be held in Lansing on November 14-15, 1883, in the Chamber of the House of Representatives to form the Michigan Pharmaceutical Association. Attendees were housed at the Lansing House... The deliberations in Lansing in November of 1883 moved quickly. The objectives of this association of Michigan pharmacists were stated in Article II of the adopted constitution: ‘to unite the reputable pharmacists and druggists of this state, to improve the science and art of pharmacy, to elevate its standard and ultimately to restrict the practice of pharmacy to properly qualified pharmacists, and to promote by all legitimate means the business interests of its members.’ Reflective of these objectives was the decision to pursue passage of pharmacy legislation for Michigan as a number one priority. Jesson had a draft of a proposed pharmacy law ready for discussion which would establish a Board of Pharmacy, impose license requirements for practice, regulate the sale of poisons and penalize those selling or using adulterated drug stuffs...By far the most important event occurring during these early years was the enactment of the first Michigan Pharmacy Act on June 2, 1885...This legislation was quite progressive for the times. It included provisions for the following: established a State Board of Pharmacy, required all practitioners to register with the Board to obtain a license (either as registered pharmacists or registered assistant), made all future licensees subject to an examination, included a grandfather clause allowing three months for registration, authorized the Board to collect fees, made adulteration a misdemeanor and exempted physicians not keeping a retail shop. The Board of Pharmacy was appointed on June 12, 1885.
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