MICHIGAN T H E O F F I C I A L J O U R N A L O F T H E M I C H I G A N P H A R M A C I S T S A S S O C I AT I O N
MEMBER SURVEY RESULTS GUIDE MPA’S PATH FORWARD
MINORITIES & MENTAL HEALTH
2022 July/Aug./Sept. | Vol. 60, Issue 3
Many factors contribute to negative mental health outcomes among minorities. Pharmacists can take action. (p. 16)
MichiganPharmacists.org
PATH TO WELL-BEING MSHP President Shawna Kraft shares her experience bridging the wellness gap as a healthcare practitioner. (p. 24)
INFECTION DISEASE CONTRIBUTIONS
Michigan Medicine pharmacists take a multifaceted role in meeting the challenges of COVID-19 and beyond. (p. 26)
IN THIS ISSUE ADVOCACY UPDATES
LEGAL INSIGHTS
MEMBER SURVEY
13 3 President’s Platform
18 4 CEO Corner
28 9 Student Focus
10 From the Foundation
22 MPA Resolutions
30 Drug Update
Many don’t understand a pharmacy professional’s role. MPA’s volunteer leaders help close that gap.
MPA CEO Mark Glasper reflects on the promise of 2022’s Pharm.D. graduates and recognizes awardees.
MPF’s recent strategic planning retreat establishes a new mission and vision to chart its course.
Know the House of Delegate resolutions passed in 2022 that are helping to shape MPA’s priorities.
Being intentional about wellbeing is a vital skill U-M student pharmacists are learning in one innovative elective.
Paxlovid and more: Learn about the latest new and notable medications on the market.
CEO: Mark Glasper; EDITOR: Mary Wardell; PUBLISHER: Bryan A. Freeman Michigan Pharmacist (ISSN 1081-6089) is the official journal of the Michigan Pharmacists Association, published four times a year at 408 Kalamazoo Plaza, Lansing, MI 48933. Publication Number: USPS-345-600. Phone: (517) 484-1466, Fax: (517) 484-4893 Website: www.MichiganPharmacists.org, E-mail: MPA@MichiganPharmacists.org, Advertising Information: Visit www.MichiganPharmacists.org/news/advertising or contact Bryan Freeman, MPA marketing and communications director, at (517) 377-0257 or BryanFreeman@MichiganPharmacists.org
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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, 2022
— PRESIDENT’S PLATFORM —
LOUDEN OUR VOICE, VOLUNTEER A
few months ago, I resigned from my position with Walgreens, where I opened and managed its specialty pharmacy in Flint. I and the team there had grown the pharmacy from zero to over $100 million in revenue in just over three years. Though the next logical step for me may have been a district manager role, overseeing multiple stores didn’t pique my interest. It was time for me to explore what would be my next career move.
BY MICHAEL CROWE,
Pharm.D., MBA, CSP, FMPA, president, My Pharmacist Now; president, Michigan Pharmacists Association
In the interim, I had a lot of non-pharmacy friends and family members ask me what I was doing. I’m blessed with a wonderful wife and two daughters, so I suppose they were concerned for our financial well-being. When part of my answer included freelance work and exploring work-from-home positions, they all got a baffled look. I’d get questions like, “How can a pharmacist work from home?” and people incorrectly assumed “freelance” just meant temporarily working for someone else at their physical pharmacy. It was another reminder to me that our profession is often not well understood. This probably isn’t earth-shattering news to our members; however, the unique perspective I hope to provide here is how we, the members of the Michigan Pharmacists Association (MPA), have an opportunity to close these gaps.
Patient Expectations Let’s start with a pandemic and an epidemic. In the May issue of Drug Topics, a pharmacy owner describes the challenges he is seeing late in the COVID-19 pandemic, with uninsured patients expecting a free vaccine despite government funds being fully depleted.1 “Free,” he argues, is pharmacy’s new “dirty little F-word.” Indeed, the public often assumes all we do is put pills in a bottle and takes for granted any cognitive services provided. There’s also the landmark trial happening in Ohio, where two counties are suing Walgreens, Walmart and CVS for over $800 million in order to fund a five-year plan targeting the opioid epidemic.2 Although the cause of the opioid epidemic is multifaceted, I would definitely attribute a portion of it to the public’s expectation that so long as a valid order is provided, the pharmacy must dispense it. Imagine being part of the MPA Public Affairs Committee and helping the Association develop articles and stories for external publication, in order to tear down this misconception and the dangers related to it. Members of this committee could provide tools for pharmacists that could help them go way beyond “lick, stick, pour” and make more outcome-improving, valueadding interventions.
Threatened Providers What about physicians getting so worked up over recent announcements of pharmacy automation being adopted by one of the pharmacy chains? In this particular article, they’re concerned about the use of robots in the prescription filling process and
the impact on patient safety.3 They’re also incorrectly making assumptions like (1) the goal of robots is to free up time for diagnosing patients, and (2) that prescriptions filled via automation would be without a mechanism to verify product accuracy. This situation reminds us that under- and mis-informed non-pharmacy healthcare professionals will often be in the ear of legislators. Pharmacy professionals serving on the MPA Government Affairs Committee are needed to support MPA’s efforts to ensure healthcare legislation does not omit or misconstrue the valuable role of pharmacy.
Supportive and Supported Pharmacists There’s been a lot of talk about pharmacy benefit managers (PBMs) lately, especially with House Bill 4348 being signed into law by Gov. Gretchen Whitmer in February.4 Often, it seems all the negative practices of PBMs overshadow any good done by the pharmacists and technicians of PBMs in Michigan. We need to be a united profession, which means we need these professionals involved as members and engaged. Those serving on the MPA Marketing Committee or the MPA Membership Committee will have to consider these nuances as they develop their campaigns. Articles about imposter syndrome and implicit bias training remind me that we sometimes don’t fully understand ourselves.5,6 Fortunately, members of the MPA Education Committee and the MPA Workplace Environment Committee can help create training and resources to help pharmacy professionals better understand themselves and how they interact with others. Being that this understanding would be helpful early in one’s career, the MPA New Practitioners Committee would also serve a role here.
Important Opportunity Coming The suggestions above are just examples of how members with various interests, serving in various roles, could be united in addressing one thematic issue. This fall, MPA will be promoting a new volunteer form, giving members the opportunity to indicate their top areas of interest for 2023 appointments. If you have the bandwidth to join a volunteer group, please make it a priority to complete the brief form. It is a tremendous help to the MPA president and practice sections to have a pool of eager candidates from which to appoint. References available upon request 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— CEO CORNER —
PROUD OF OUR
PHARM.D. GRADUATES
I
had the honor of addressing this year’s Doctor of Pharmacy graduates from Michigan’s three colleges of pharmacy. I was also proud of the recipients of the Michigan Pharmacists Association (MPA) Dean’s Professionalism Award and the Michigan Society of Health-System Pharmacists (MSHP) Student Recognition Award from each of the colleges. Hopefully, you enjoyed my “Where’s Mark?” updates on Facebook from each of the graduation events I attended. Special thanks go to our college of pharmacy deans for their gracious invitations to address their respective graduates: • Bruce Mueller, Pharm.D., interim dean, University of Michigan College of Pharmacy, and Vicki Ellingrod, dean, effective July 1 • Stephen Durst, Pharm.D., dean, Ferris State University College of Pharmacy
BY MARK GLASPER, chief executive officer, Michigan Pharmacists Association
• Brian Cummings, Ph.D. Pharmacology, dean, Eugene Applebaum College of Pharmacy and Health Sciences at Wayne State University, and Susan Davis, Pharm.D., associate dean of pharmacy
Welcome to the Profession! My presentation at each college of pharmacy graduation event recognized the graduates for earning their Doctor of Pharmacy degrees and accomplishing their dreams of becoming a pharmacist. I urged them to seize this opportunity to demonstrate their knowledge, compassion and desire to improve the care of their patients. I also impressed upon them the importance, no matter where they may practice pharmacy, of joining a state pharmacy association, including MPA. Participation in these professional organizations and engagement in their activities will help them grow as pharmacists and advance their careers. Engagement with the national pharmacy associations is equally important as they are a driving force in advancing the profession in Washington, D.C. and nationwide. I closed by telling the graduates as I gazed out at them, that I was no doubt looking at a future president of MPA or even one of the national pharmacy associations. They didn’t need to look far for inspiration, because there was always one or more on the stage with me or in the audience!
MPA & MSHP Award Recipients Shine I also want to highlight this year’s Pharm.D. graduates who received the prestigious MPA and MSHP awards. Listed on the next page are each award’s criteria along with the recipients’ names and universities.
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— CEO CORNER —
Center, Emily Faltin, 2022 graduate of the Ferris State University College of Pharmacy, receives the MPA Dean’s Professionalism Award at the college’s doctoral hooding ceremony on May 7 from MPA CEO Mark Glasper, left, with FSUCOP Dean Stephen Durst, BS, Pharm.D.
Center, Cassandra Falk, 2022 graduate of the Ferris State University College of Pharmacy, received the MSHP Student Recognition Award at the college’s doctoral hooding ceremony on May 7 from MPA CEO Mark Glasper, left, with FSUCOP Dean Stephen Durst, BS, Pharm.D.
Left, Lauren Krumm, 2022 graduate of the Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, received the MPA Dean’s Professionalism Award at the college’s convocation on May 9 from MPA CEO Mark Glasper.
Left, Regina Pacitto, 2022 graduate of the Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, received the MSHP Student Recognition Award at the college’s convocation on May 9 from MPA CEO Mark Glasper.
MPA CEO Mark Glasper takes a “selfie” as he addresses the University of Michigan’s College of Pharmacy class of 2022 at their commencement banquet on April 22.
Jae Kim, U-M MSHP Student Recognition Award winner
Nour Kadouh, U-M MPA Dean’s Professionalism Award winner
MPA Dean’s Professionalism Award
MSHP Student Recognition Award
This award is given to a graduating student pharmacist who has demonstrated during his or her professional academic years an outstanding commitment to the achievement of high standards for the advancement of the ethics and professionalism of pharmacy. This commitment is reflected in both classroom studies and extracurricular organizational activities. The award consists of a Pharmacy Commemorative Award, an appointment to the MPA Public and Professional Affairs Committee for two years and five years of complimentary MPA membership.
This award of $100 and a distinctive plaque is given to a graduating student pharmacist with demonstrated interest in hospital pharmacy practice, academic achievement and professional extracurricular activities.
• University of Michigan, Nour Kadouh • Ferris State University, Emily Faltin • Wayne State University, Lauren Krumm
• University of Michigan, Jae Kim • Ferris State University, Cassandra Falk • Wayne State University, Regina Pacitto Congratulations to our award recipients and to the entire class of 2022!
2022 July/Aug./Sept. | Vol. 60, Issue 3
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— EVENTS CALENDAR —
EVENTS CALENDAR MPA 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.
JULY 2022
28
Thursday, July 28
World Hepatitis Day Nationwide
Please note: Some board and committee meetings may be subject to a change in format to virtual or in person at the discretion of the members. Please check the online calendar or contact MPA@MichiganPharmacists.org for more information.
AUGUST 2022
1-31 12 22 25
Monday, Aug. 1 – Wednesday, Aug. 31
National Immunization Awareness Month Nationwide
Friday, Aug. 12
MSPT Board of Directors Meeting Virtual & MPA Headquarters, Lansing
Monday, Aug. 22
Member Town Hall & New Member Welcome Virtual Only
Thursday, Aug. 25
MPF Board of Trustees Meeting Virtual Only
SUBMIT AN AWARD NOMINATION! Do You or a Colleague Deserve Recognition? Nominate one of your colleagues for a prestigious award to recognize their professional accomplishments! Choose from a large variety of Michigan Pharmacists Association (MPA) and practice section awards. Michigan Society of Health-System Pharmacists (MSHP) nominations are due Sept. 1. All other award nominations are due Oct. 1. Learn more and submit your award nominations online at www.MichiganPharmacists.org/awards.
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SEPTEMBER 2022
1-30 1 5 8 9
21 22 29
Thursday, Sept. 1 – Friday, Sept. 30
Healthy Aging Month Nationwide
Thursday, Sept. 1
CSPM Board Meeting Virtual Only
Monday, Sept. 5 Labor Day Nationwide
Thursday, Sept. 8
MSHP Board of Directors Meeting & Retreat Location TBD
Friday, Sept. 9
MSCP Committee & Board Meeting Virtual Only
Wednesday, Sept. 21
MPA Executive Board Meeting Virtual & MPA Headquarters, Lansing
Thursday, Sept. 22
Pharmacy Day at the Capitol Lansing
Thursday, Sept. 29
MSHP Board of Directors Meeting Virtual Only
— CE EVENTS CALENDAR —
SAT., SEPT. 17, 9 a.m.-4 p.m.
MON., AUG. 22, 2-3:30 p.m. TUES., SEPT. 20, 10-11:30 a.m.
MSPT Five-Live The Michigan Society of Pharmacy Technicians will hold its Annual Five-Live Continuing Education Event in-person at MPA’s headquarters AND virtually on Saturday, Sept. 17 from 9 a.m. to 4 p.m. The following topics will be offered, many of which meet educational requirements for pharmacy technicians: implicit bias training, jurisprudence and ethics, patient safety, and pain.
SAT., SEPT., 17, 9:30-11:30 a.m. Implicit Bias Training The Michigan Pharmacists Association (MPA) is offering a series of implicit bias trainings to meet the new licensure requirement that took effect June 1. The rules require a minimum of two hours of implicit bias training within the five years immediately preceding issuance of the license or registration and an ongoing minimum of one hour of implicit bias training for each year of the applicant’s license or registration cycle. This course is not accredited for continuing education but satisfies the new licensure requirement.
MPA Immunization Trainings will continue to be regularly scheduled. The next available date is to be determined in October. Details will be posted on MPA’s website and in email communications. https://michiganpharmacists.org/Education-Events/Pharmacy-basedImmunization-Delivery-Program-Aug-4. QUESTIONS
If you have any questions about any of these MPA education events, please email MPA@MichiganPharmacists.org.
Pharmacy Technician Immunization Administration As a nationally-recognized leader in the development of technician training resources, the Michigan Pharmacists Association (MPA) has developed Pharmacy Technician Immunization Administration training recognized as fulfilling the education requirement for the Pharmacy Technician Certification Board (PTCB) Immunization Administration Certificate Program. The homestudy portion of the course must be completed prior to joining the live review webinar. If registration for the Aug. 22 course is low, registrations will be moved to Sept. 20. All registrants for the Aug. 22 course will be notified if this occurs. https://michiganpharmacists.org/education/pharm_ tech_immun
THURS., AUG. 18, NOON-4:30 p.m. Outpatient Antimicrobial Stewardship Innovations Symposium (OASIS) The 2022 OASIS, sponsored by the Michigan Society of Healthsystem Pharmacists (MSHP) and Ferris State University College of Pharmacy, will be a four-hour educational meeting, held on Thursday, Aug. 18, 2022, with both in-person and virtual options for attendees. Topics will focus on understanding, promoting and improving antimicrobial stewardship in the outpatient setting, in addition to highlighting the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) Dashboard. Michigan Pharmacists Association (MPA) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
— BIOS AND MEMORIES — JASON CORMIER, Student Pharmacist Jason Cormier, a fourth-year student pharmacist from Wayne State University, recently completed a six-week rotation at the Michigan Pharmacists Association (MPA). In the past, Jason has held positions in the Student MPA, the American Pharmacists Association – Academy of Student Pharmacists, and the Student Pharmacist Diversity Council. He also sat on the House of Delegates at MPA’s Annual Convention & Exposition as a student representative of Wayne State. From these experiences, he divined the value of professional advocacy and the organizations who propagate it. Jason got his start in pharmacy as a technician working for Target way back in 2013, and he hasn’t looked back since. He collects pharmacy paraphernalia and drink coasters. You should try his famous BLT pasta.
JACKSON MAURER, Student Pharmacist Jackson Maurer is beginning his fourth year of pharmacy school at Ferris State University with plans to graduate in May 2023. He was excited to complete a rotation at MPA, where he could expand his knowledge of the field of pharmacy and was able to see some of the many ways pharmacists impact their communities. He enjoyed learning about, being involved in, and taking with him the knowledge from this new area of pharmacy experience. He is originally from Battle Creek, Mich. and has four years of pharmacy experience in the community setting. After graduation, Jackson plans on returning to community practice but wants to be involved in making positive changes for both his patients and the field of pharmacy. 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— BIOS AND MEMORIES — COREY ROWE, MPA Executive Fellow Corey Rowe, a new graduate of the pharmacy program at Wayne State University, joins the Michigan Pharmacists Association as the 20222023 executive fellow. In his four years as a student pharmacist, he gained a passion for advancing advocacy initiatives within the profession and the realm of public policy. As an active member of the Oakland County Pharmacists Association, he has defended many resolutions aimed at bettering the lives of patients while driving pharmacy practice to the top of the pharmacy license. He’s excited to continue engaging with community leaders and elected officials alongside MPA as a new practitioner.
KARYN PEDDICORD, Education and Events Manager
LISA POWERS, Education and Events Director
Karyn Peddicord has been promoted to the position of education and events manager after joining the Michigan Pharmacists Association (MPA) earlier this year as the executive administrative assistant. With more than 15 years of managerial experience, Karyn has been involved in project management, training and the development and implementation of company policy and procedures. She volunteers her time with organizations like the PTO and Scouts BSA and has also worked closely with Great Start to Quality. In her spare time, she enjoys spending time with her son, attending sporting events, traveling and hosting events.
Lisa N. Powers, CAE, CTA joins the Michigan Pharmacists Association (MPA) as the director of education & events. She graduated with a Bachelor of Science degree in business management from Cornerstone University. With over a decade of association experience with the Michigan Restaurant and Lodging Association and the Michigan Association of School Boards, Lisa solidified her experience by receiving the Certified Association Executive (CAE) designation in 2018. She volunteers her time serving as president of the Kiwanis Club of Grand Ledge Area Board of Directors, as well as serving meals at the Lansing City Rescue Mission. In her spare time, she enjoys spending time with her two boys, trying new cuisine, traveling and enjoying social time with friends and family.
DOUGLAS SCOTT ETTEMA Douglas Scott Ettema, 72, former president of the Michigan Pharmacists Association (MPA), passed away Monday, June 13, at Munson Medical Center in Traverse City. Ettema served as president of MPA in 1988. He served as delegate to the MPA House of Delegates and held a number of leadership positions with local MPA associations. Ettema was inducted into the MPA Hall of Honor in 1989. He was born Jan. 16, 1950, in Almont, Mich., the son of Bernard and Elaine (Vanderark) Ettema. Following high school, he went on to graduate from the Ferris State University pharmacy school and was an active member of the Phi Delpha Chi Fraternity. He married Judith A. Kalchik on Aug. 12, 1972, in Bellaire, Mich. They had two daughters. He began his career in Caro, Mich., where he worked at Caro Pharmacy and subsequently purchased the business in 1978, operating it until 1999. Since Ettema did not want to retire, he moved up north and worked in pharmacy at Munson Community Health Care from 2001-2019. He enjoyed traveling and was an avid golfer, but woodworking was his greatest passion. Memorial donations may be made to the Cowell Family Cancer Center, c/o Munson Healthcare Foundation, 1150 Medical Campus Dr., Traverse City, MI 49684 or to the Torch Conservation Center, P.O. Box 1142, Bellaire, MI, 49615.
HOWARD KREMER Howard F. Kremer, age 75, of Coleman, Mich., died unexpectedly of natural causes on April 29. He had been a member of the Michigan Pharmacists Association (MPA) for 50 years and was recognized with an award at MPA's Annual Convention & Exposition in February. Kremer was born in St. Johns, Mich., on Jan. 15, 1947, the first son of Forest and Dorothy (Williams) Kremer. Growing up on a dairy farm instilled his great work ethic and a curiosity in the sciences. He graduated from Elsie High School in 1965 with honors. He then attended Ferris State College, where he was a member of the marching band, a fraternity brother of Kappa Psi, and earned a Bachelor of Science Degree in Pharmacy. Kremer married Linda Sue Herington, of Grand Rapids, Mich., on May 6, 1972. They settled close to both their families in St. Johns, Mich. He was a pharmacist at Parr’s Pharmacy until 1985. Upon making a move to live “Up North,” he became the neighborhood pharmacist for the rural communities of Hale and AuGres, while living in Lupton, Mich. This allowed him to enjoy the great outdoors and his hobbies of fishing, hunting and gardening to the fullest with his family. Kremer also enjoyed woodworking, cooking, reading and music. In 2006, they moved to Coleman where he enjoyed working as a relief pharmacist for several pharmacies in the Mid-Michigan cities of Mt. Pleasant, Auburn, Beaverton, Saginaw and Bay City. He enjoyed retirement and still being able to work part-time to help customers.
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— STUDENT FOCUS —
WELL-BEING:
Taking the Time to Be Intentional
A
t the University of Michigan College of Pharmacy, we take well-being especially seriously. First-year student pharmacists are encouraged to enroll in the “Well-Being for Professional Success” course in the fall semester. This is a class that promotes health and wellness as part of the student’s success. The course covers a wide range of important topics, such as: transitioning into professional school, time management, promoting self-care, minimizing isolation and mindfulness. The course is offered only to P1 students in the fall term, and enrollment tends to be about 60 students per year.
BY MARY WESTOVER,
Doctor of Pharmacy candidate 2024, University of Michigan; member, Student Pharmacist Executive Council
During the course, students are challenged to reflect on their own personal definition of well-being. Weekly reflections and challenges help the first-year student pharmacists identify areas of strength and weaknesses. Students also engage with a semester-long well-being project to focus on one area of interest. Examples of past projects include art, music and exercise. Overall, this course allows students to take a break from their hectic school and work schedules in order to focus on their individual well-being journey.
future patients. I want the students to participate just like I want my patients to be adherent to their medications, and I had to create ways to get student engagement just like I will have to with my future patients.”
Emily Barker served as a teaching assistant (TA) this past fall. She had the opportunity to take the course as a first-year student and was then asked to stay on board as a TA. The course historically has two to three TAs from the previous class. The teaching assistants have an opportunity to directly teach the material, as well as facilitate group discussions.
“Right now, the college of pharmacy is the only professional school at the University of Michigan that offers a course dedicated to well-being,” she said. “We are essentially trailblazing the path for future schools to adopt the course. Right now, there is discussion with other health professional schools, like the medical and dental school, about implementing a well-being course for their students.”
I sat down with Ms. Barker and spoke to her about the course. “I originally took the course, because I’ve always been a big fan of self-improving,” she said. “When I saw the elective, I thought of it as a chance to improve my well-being. I went into it thinking I was good at taking care of myself. … I was humbled, week after week, when I learned all the different ways that I don’t take care of myself that well or show myself compassion. I was able to identify my weak points. I learned that it takes time to understand what your body needs, but also what your mental wellness needs. Once you have that understanding of your needs, it’s about creating a system to implement (meeting them). My biggest takeaway was self-empowerment. I really do control my own wellness, and I understand how necessary it is for pharmacy school.”
This course has been available to pharmacy students for more than five years. The school plans to continue it indefinitely. Ms. Barker speculated about where she sees the course going in the future.
When it comes to incorporating and applying what is learned in this class to their daily lives, students are going to get out what they put in. Nonetheless, this thoughtful course is a step in the right direction for students learning to be intentional about their well-being.
THE 8 PILLARS OF WELL-BEING
The course focuses on each of the pillars.
Ms. Barker said that becoming a TA wasn’t an opportunity she was expecting. “But in that moment, I realized that it was exactly what I needed,” she said. “I found out I have a huge passion for teaching. … That is where I thrive. It was also interesting making the connection between my students and my 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— FROM THE FOUNDATION —
MPF Board Embarks on
STRATEGIC PLANNING PROCESS BY RICK DRABEK, executive director, Michigan Pharmacy Foundation
A
fter commencing a strategic planning process this spring, the Michigan Pharmacy Foundation (MPF) has new mission and vision statements, with an operational plan in the works. The MPF Board of Trustees gathered at the Michigan Pharmacists Association (MPA) headquarters in Lansing on April 28-29 for the strategic planning retreat, charting a path to ensure the future relevance, success and sustainability of the Foundation and its work. A strategic plan is a formal guide that describes how an organization will meet its goals and objectives in future years. The strategic planning process itself allows the MPF Board, staff and key stakeholders to outline the Foundation’s most important priorities, ensuring that everyone is aligned around the Foundation’s mission, vision and values. Board members and staff had robust discussions over the two-day retreat, which focused on revisiting the Foundation’s mission and vision statements along with elements that will be included in the final version of the Foundation’s strategic plan. MPF’s previous mission statement was:
“The Foundation seeks to advance pharmacy through education, practice innovation and research focused on patient care, for the improvement and promotion of public health and public education.” The MPF Board opted to change the MPF mission statement to be broader, more succinct and so that it would open additional opportunities for the Foundation. The new mission statement adopted for the Foundation is:
“To foster the future of pharmacy.” MPF Board members also spent time discussing options for greater alignment between MPF and MPA. As part of this discussion, participants examined MPF’s previous vision statement, which was:
“Through financial support, MPF is the catalyst for the innovation, leadership and learning that expands the role of pharmacy in society.” The Board established a structure to further strengthen the relationship between MPF and MPA and officially adopted MPA’s vision statement, which is:
“One pharmacy profession, maximizing health and wellness.” The Board completed additional work on goals, objectives and strategies, which are being drafted by MPF’s consultants, TwoCan Management, who helped facilitate the two-day strategic planning retreat. The MPF Board convened again in mid-June to finish work on the goals, objectives and strategies. MPF staff is now developing a detailed operational action plan with steps identified to accomplish the goals set by the Board-approved MPF strategic plan.
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Executing this strategic plan is a journey that will take place over the next three to five years. The plan will most likely change over time as it is reviewed and evaluated regularly and as the Foundation’s success is measured toward attainment of the Foundation’s goals. I look forward to providing future updates as the strategic plan is finalized and the Foundation embarks on executing the strategies to increase the impact that the Foundation delivers “To foster the future of pharmacy.”
— FROM THE FOUNDATION —
LEAD PHARMACY INTO THE FUTURE Apply for the Health Professional Leadership Academy Today
The Michigan Pharmacy Foundation (MPF) is now accepting applications for the 2022-2023 Health Professional Leadership Academy (HPLA), a six-month program aimed at developing pharmacy professionals (pharmacists, pharmacy technicians) and other health disciplines who are equipped and motivated to lead others and their profession in the years ahead. The HPLA aims to strengthen professional and leadership skills, provide information and resources for practitioners to be more effective in their roles, help them build meaningful relationships, and provide them with opportunities to be active in and lead their profession. The 2022 Leadership Academy includes one face-to-face workshop at the Michigan Pharmacists Association Annual Convention & Exposition in Detroit, along with interactive webinars and a personal leadership project. Upon successful completion, participants will earn 30 continuing education credits, including 20 live and 10 homestudy hours, along with a certificate. Pharmacy professionals and other healthcare providers from all practice settings are welcome to apply. Tuition for the six-month program is $1,500, with an application deadline of 5 p.m. on Wednesday, Aug. 31. The class of 2022 Leadership Academy is limited to 20 participants. The Leadership Academy will kick off on Thursday, Oct. 6, 2022. For more information, please email MPF Executive Director Rick Drabek at Rdrabek@ MichiganPharmacists.org or call him at (517) 377-0227.
www.michiganpharmacists.org/foundation/initiatives/HPLA 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— LEGISLATIVE UPDATE —
GAINS & GOALS:
MPA Counts Wins, Looks to Fall for More
T
he Michigan Pharmacists Association (MPA) has enjoyed many legislative successes so far during the 2021-22 legislative session, and we look forward to advocating for our fall priorities when session returns after summer break. The Legislature has less than 30 scheduled session days for the rest of the year, which promises to make for a very busy fall.
BY BRIAN SAPITA,
government affairs director, Michigan Pharmacists Association
Senate Bill 155/Public Act 36 of 2021: Sen. Kevin Daley (R- Lapeer) introduced legislation, now signed into law, that allows a pharmacist to dispense an emergency refill of insulin to a patient who doesn’t have a refill left on their prescription. The law allows up to three 30-day supplies to be dispensed in a calendar year. Also introduced by Daley and signed into law is Senate Bill 156/Public Act 37, which requires insurers to cover an emergency refill of insulin dispensed by a pharmacist. House Bill 4348/Public Act 11 of 2022: Rep. Julie Calley (R-Portland) introduced legislation, now signed into law, that will: • Require pharmacy benefit managers (PBMs) to be licensed with the state in order to operate in Michigan, • Allow the director of the Department of Insurance and Financial Services to suspend the license of a PBM if they are breaking the law, • Require PBMs to exercise “good faith and fair dealing” in their contracts, • Prohibit retroactive fees and steering, • Require PBMs to submit annual reports to the Legislature and state, and • Create a quicker appeals process.
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Senate Bill 166/Public Act 80 of 2022: Sen. Curt VanderWall (R-Frankfort) introduced legislation, now signed into law, that allows Michigan pharmacists to fill non-controlled prescriptions from out-of-state and Canadian nurse practitioners and physician assistants as long as the midlevel provider has the authority to prescribe in their own state or Canada.
Fall Legislation With just 30 voting days expected between now and when the Legislature adjourns for the year, any legislation that is going to be vetted and signed into law will need to move quickly through the legislative process. MPA is working to ensure our legislative priorities are ready to be heard by our legislators and moved. Our fall priorities are outlined below. Independent Immunization Authority: This bill would allow pharmacists to order and administer any approved vaccine to a patient independent of a collaborative practice agreement. A pharmacist who administers a vaccination will be required to input this information to the Michigan Care Improvement Registry (MCIR). Refill Authorization: This legislation would allow a pharmacist to prescribe and dispense a medication to a patient when no refills exist on their original prescription. This bill would only apply to noncontrolled substances. A companion bill would require insurers to reimburse pharmacists for dispensing the medication. Oral Contraceptive Prescribing: House Bill 5655 and 5654 would allow a pharmacist to consult with a patient, prescribe and dispense hormonal contraceptives to patients without supervision from a prescriber. Additionally, the bill requires insurers to reimburse pharmacists for the consultation and dispensing.
— ADVOCACY UPDATE —
Summertime Action
Fight for Pharmacy, Make a Difference BY BRIAN SAPITA, government affairs director, Michigan Pharmacists Association
It’s summertime in Michigan, and you know what that means. If you guessed construction season, you are correct. But it also means that the Legislature won’t be found anywhere near Lansing. Instead, senators and representatives are back in their home districts on summer break, going door to door, walking in parades and trying to get reelected. As a quick refresher from fourth-grade government class, Michigan has 110 members of its House of Representatives and 38 members of the state Senate. Every four years, all 148 seats in the Legislature are up for grabs, and this year, 46 of the 148 legislators will not be returning to Lansing next year due to term limits. This means new members will be taking over those seats. The Michigan Pharmacists Association (MPA) is constantly lobbying for pharmacy in Lansing, but believe it or not, legislators listen to their constituents more than they listen to any lobbyist in Lansing. When they hear a personal story about a problem back home, they want to fix it. Since the Legislature will be in district for most of the summer, this is a perfect time to advocate for anything near and dear to your heart, including school funding, the deterioration of our roads – or perhaps your pharmacy profession. Most legislators post on their website or Facebook the next time they hold legislative office hours. These usually take place at a local coffee
shop or library, and constituents are invited to come and discuss issues they are facing with the person representing them in Lansing. This is a great way to ensure your legislator knows about pharmacy issues that are important to you. Additionally, a personal invitation to visit your pharmacy would open your legislator’s eyes to everything a pharmacy professional can do within their scope of practice. Invite your legislator to visit your pharmacy for an hour and show them that pharmacists are more than just “pill counters.” And don’t forget, if an unelected candidate comes to your door, make sure they are aware of how important pharmacy issues are to you. Stories heard on the campaign trail often lead to legislation introduced in Lansing. Feeling a little overwhelmed? Not sure who to reach out to? Contact MPA. We are happy to organize and attend these meetings – or to support you in whatever way you need. We can lead the discussion with the legislator about pharmacy issues or let you do most of the talking, backing you up with similar stories and experiences from around the state. The important thing is that you show up and ensure your voice is heard. For more information or to have MPA set up a legislative meeting, please reach out to Brian Sapita, MPA director of government affairs, by calling 517-377-0254 or emailing Brian@MichiganPharmacists.org. 2022 July/Aug./Sept. | Vol. 60, Issue 3
13
— MEMBERSHIP —
FROM THE DESK OF
I
MEMBERSHIP
hope everyone is enjoying their summer and taking advantage of the amazing summer activities here in Michigan. To make the most of the recreational opportunities in this great state, one needs to plan ahead, and that is exactly why the Michigan Pharmacists Association (MPA) membership department recently sent a membership priority survey to our current membership. My experiences through 12 years of association membership management have taught me many valuable insights, but the most valuable insight for any membership department comes from you, our members. It’s vitally important that we not only find out where we are succeeding as a membership department, but what areas we can improve upon to help us continue to grow as an association and a membership department.
BY SCOTT WALSH,
director of membership, Michigan Pharmacists Association
The results I’m analyzing confirm exactly why I wanted to create this survey. We have a lot of positives going for us, but we also have areas we can improve upon. These results will help us plan for the rest of 2022 and going forward into 2023 and beyond. A few highlights that stuck out to me are: • 85 percent of our members who took the survey are either satisfied or very satisfied. • 15 percent, however, are neither satisfied nor dissatisfied. This tells me we have work to do, and I look forward to dissecting the responses in more detail to see how we can improve. • 55 percent of our members who took the survey would like to see a multi-year membership opportunity. I look forward to exploring ways to implement this change. • 88 percent of our members who took the survey are likely to recommend MPA membership to a friend or a colleague. Word-of-mouth recommendations are the No. 1 channel for associations to recruit new members. This will help us continue to grow as an association. As MPA’s director of membership, I want you to know that we are listening to you. We not only are listening, we are learning, and that means you will see changes going forward. If you didn’t have a chance to fill out the membership survey – that’s okay. Please reach out to me any time to let me know how we are doing. Thank you for your continued support. I hope you have a great rest of your summer in this scenic and incredible state.
— MEMBER BENEFIT —
A
YOUR VOICE IN POLICY
s a member of the Michigan Pharmacists Association (MPA), you’re entitled to many benefits, including legislative updates and our advocacy on your behalf each day at the Capitol. Over the course of the past year, we have provided you with more than 110 legislative updates through numerous channels including dedicated e-blasts, our biweekly Pharmacy-Related News (PRN) electronic newsletter, the print Michigan Pharmacist journal, Facebook, Instagram and more. Because our membership is so engaged, we sent out updates on many legislative successes, such as: • House Bill 4348 is Michigan’s first pharmacy benefit manager (PBM) reform bill. • Senate Bill 155 allows a pharmacist to dispense an emergency refill of insulin and requires insurers to cover the medication. • House Bill 4352 prohibits gag clauses in pharmacy contracts, allowing a pharmacist to disclose a lower-cost option to the patient. • Senate Bill 247 reforms prior authorizations and requires them to be dealt with more quickly by insurers and pharmacy benefit managers (PBMs).
Our legislative accomplishments would not be possible without the support of our members and the advocacy efforts you make possible. Last year, we teamed up with Voter Voice Software to help you, our members, connect with your legislators to advocate for the things most important to you with just the click of a button. This software allows you to send a pre-populated letter on any pharmacy issues to your state and federal legislators, which helps us strengthen our grassroots efforts and make sure that policymakers at every level understand the importance of their decisions as they relate to pharmacy. As we move forward with the rest of 2022 and beyond, MPA will continue to be the voice of pharmacy as we meet with legislators on an almost daily basis. Take advantage of this member benefit and let your voice be heard through our Voter Voice Software , online at www.MichiganPharmacists.org/Advocacy/Advocacy-Action-Center/MPAction, or reach out to us here at the MPA office and let us know how we can better serve you.
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— EDUCATION UPDATE —
ELLINGROD NAMED
DEAN OF U-M COLLEGE OF PHARMACY
V
icki Ellingrod, Pharm.D., professor of pharmacy, was named the next dean of the University of Michigan (U-M) College of Pharmacy after a year-long national search. Her five-year term began July 1 and was approved by the U-M Board of Regents on May 19. She succeeds James Dalton, who stepped down to become executive vice president and provost at the University of Alabama. Senior Associate Dean Bruce Mueller served as interim dean for the year starting July 1, 2020. As reported by U-M’s The University Record, Ellingrod was a senior associate dean at the college, a professor of psychiatry in the Medical School and an adjunct professor of psychology in the U-M College of Literature, Science and the Arts. She has 16 years of service at U-M, having joined the College of Pharmacy’s Department of Clinical Sciences in 2006 as an associate professor with tenure, as well as in the Medical School’s Department of Psychiatry. She was promoted to professor in 2012. Among many leadership roles at U-M, Ellingrod served as associate chair of the Department of Clinical, Social and Administrative Sciences between 2013-15 and associate dean for research and graduate education from
2016-20. She was appointed senior associate dean in 2020. Ellingrod is one of only three Doctors of Pharmacy who have received fellowship status within the American College of Neuropsychopharmacology, a premier psychiatry organization. In her research, she has been continually funded by the National Institutes of Health for more than 20 years. Her service to the profession includes an editorial role for scientific publications, as well as a co-author on more than 130 articles, reviews and book and book chapters. Prior to joining U-M, she held numerous positions in the clinical and administrative pharmacy division of the College of Pharmacy at the University of Iowa from 1996-2005, including associate in the division, director of the Pharmacogenetics Laboratory, assistant professor, associate professor with tenure, and chair of the clinical pharmaceutical sciences Ph.D. program. Ellingrod also was an adjunct clinical instructor at the University of Iowa College of Nursing from 1999-2006. She earned a bachelor’s degree in pharmacy in 1992 and Doctor of Pharmacy degree in 1994, both from the University of Minnesota.
PTCB Launches New Certificate for Pharmacy Technicians As part of its mission to ensure pharmacy technicians meet the evolving challenges in medication safety, the Pharmacy Technician Certification Board (PTCB) recently launched a new Supply Chain and Inventory Management Certificate. This advanced credential assesses pharmacy technicians’ knowledge of laws and regulations, administrative processes, inventory management, documentation requirements and key players in the supply chain. Pharmacy technicians play an increasingly vital part in patient care teams, and fluency in supply chain and inventory management can help keep the focus on safety at every step, from the manufacturing lab to the medicine cabinet. By earning this certificate, technicians can demonstrate their understanding of supply chain and inventory management regulations, processes, and responsibilities and better adapt to changing guidelines.
View all pharmacy technician credentials at ptcb.org/credentials 2022 July/Aug./Sept. | Vol. 60, Issue 3
15
— PROFESSIONAL AFFAIRS —
MINORITIES & MENTAL HEALTH: How Pharmacists Can Help Improve Outcomes
By DENISE MARKSTROM, Pharm.D., clinical pharmacist, Michigan Medicine; adjunct clinical assistant professor, University of Michigan School of Pharmacy
M
ental health, as defined by the World Health Organization (WHO), is “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1 Unfortunately, many minority populations do not live with conditions that promote mental health. Living in environments with increased stress can lead to anxiety, depression, worsening chronic medical conditions, substance abuse and suicide. This article will review some risk factors for poor mental health in minority populations and how pharmacists can aid in improving care and outcomes in these populations.
Discrimination For decades, studies have shown a positive correlation between discrimination and poor mental health.2 In 2015, the American Psychological Association conducted a survey among nearly 3,400 adults assessing discrimination-related stress and its link to mental health (e.g., anxiety, depression, etc.).3 This survey found that 81 percent of American Indian/Alaska Natives, 76 percent of Blacks, 74 percent of Asians and 72 percent of Latinos experienced everyday discrimination (being treated as if they are less intelligent, with less courtesy or respect or receiving poorer service) compared to 61 percent of all adults. Almost 40 percent of Black men and 25 percent of lesbian, gay, bisexual, transexual and queer (LGBTQ+) adults reported being unfairly stopped, searched, questioned, physically threatened or abused by police. For many experiencing discrimination, this leads to a heightened sense of awareness and hypervigilance that can lead to behavior changes and can trigger the stress response – so much so that just the anticipation of being discriminated against can lead to stress.4
Lack of access to health care It is well described that underserved communities of color have poorer access to health care compared to their White counterparts. Factors that drive these disparities include poor quality care, lack of insurance coverage, availability of providers and pharmacies, and access to care that is culturally and linguistically inappropriate.5 The Surgeon General’s report in 2001 found that racial and ethnic minorities had less access to mental health care when compared to White patients, were less likely to receive care, and when they did receive care, it was of poor quality.6 In 2019, 7.8 percent of Whites lacked medical insurance
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coverage, compared to 11.4 percent of Blacks, 12.7 percent of Asian American and Pacific Islanders, 20 percent of Latinos and 21.7 percent of American Indian and Alaska Natives.7 While the Affordable Care Act (ACA) enacted in 2010 helped bridge the gap in insurance coverage, it did not eliminate it. Policy changes to the ACA during the Trump administration led to reduced coverage and decreased enrollment, leading to higher rates of uninsured individuals.8 The COVID-19 pandemic exacerbated longstanding structural and systemic inequities in minority populations. For example, in April 2020, while only 14 percent of the state of Michigan’s population was Black, they suffered 40 percent of the deaths from COVID-19.9 As of this writing, compared to Whites, when standardized for age, hospitalizations for COVID-19 are three times more likely for Latinos and twice as likely for Blacks and American Indian and Alaska Natives. Blacks, Latinos and American Indians and Alaska Natives are about twice as likely to die from COVID-19.10
Employment In the first quarter of 2022, U.S. unemployment rates for Blacks were almost double that of Whites (6.8 percent to 3.6 percent, respectively); the rate for Latinos was 4.9 percent.11 In Michigan, Black unemployment is 9 percent, compared to 3.8 percent for Whites (data not available for Latino/American Indian Alaska Native populations).12 The COVID-19 pandemic’s effect on unemployment in persons of color, the LBGTQ+ community and lowincome people was disproportionate as well. Almost 60 percent of Latinos and 51 percent of Blacks reported a household job loss during the pandemic, compared to 39 percent of Whites.8 Money and work remain the top two sources of significant stressors.2,13
— PROFESSIONAL AFFAIRS — Violence Violence against minorities is on the rise in the U.S., and no group is immune. Within the past seven years, the following mass murders have occurred: nine Black parishioners at a church in Charleston, S.C. in 2015; 49 patrons at Pulse, a gay nightclub in Orlando, Fla. in 2016; 12 Jewish worshippers in two different synagogues in 2019; 23 Latinos in a Walmart in El Paso, Texas in 2019; eight people, six of them of Asian descent, in a spa in Atlanta, Ga.; and 10 Black customers at a grocery store in Buffalo, N.Y. There are also more than 300 killings of Black people (about 25 percent of them unarmed) per year by law enforcement. A 2018 study revealed that the killing of an unarmed Black person led to three months of poor mental health for Black people living in the state where the shooting occurred.14 In one week following George Floyd’s murder by a Minneapolis police officer, rates of anxiety and depression in the Black community climbed from 36 percent to 41 percent.15 In 2020, with the arrival of COVID-19 in America, anti-Asian hate crimes increased exponentially. Between March 19, 2020, and December 31, 2021, more than 10,900 hate incidents were reported.16 The overwhelming majority (63 percent) were verbal insults; however, 16 percent of the incidents were physical assaults. Most of these incidents occurred in public spaces. A study surveying college students found that Asian American and Pacific Islander students were 17 times more likely than White students to have experienced racial discrimination during the COVID-19 pandemic in 2020.17 They found that of the Asian American and Pacific Islander students experiencing discrimination, 25 percent of the students showed signs of moderate to severe depression, 40 percent demonstrated signs of moderate to severe anxiety and 14 percent experienced suicidal ideations.
How Pharmacists Can Help Improve Mental Health Care Outcomes18-19 The pharmacist’s role has morphed over the years from a purely dispensing role to working in collaboration with other members of the healthcare team. Working in concert with the patient and their healthcare providers is key to improving mental healthcare outcomes. Pharmacists may be the first member of the healthcare team that identifies signs and symptoms of anxiety and/or depression and may be able to encourage the patient to seek help. By developing an empathetic and trusting relationship with patients, pharmacists can help patients overcome the stigma of mental illness that is observed in many cultures. A few simple steps can facilitate improving mental health outcomes: 1. Counsel to improve medication adherence. Patients with poor mental health often have low adherence rates to their medication. Rates of non-compliance have been shown to be as high as 56 percent for patients on antidepressants, 60 percent for patients with bipolar disorder and 61 percent for patients with schizophrenia. Education should be provided on what the medication is being used for, how to properly take the medication and how long it will take to see the effects. A review of potential adverse effects and when to contact their physician is also recommended. 2. Follow up on refill prescriptions. Studies have shown that pharmacists often focus on patients who are initiating therapy but are rarely having discussions with patients who are on maintenance medications. Continued conversations regarding their progress and monitoring for adverse effects have been shown to increase adherence rates.
3. Have resources for patients available when needed. Many patients will visit a pharmacy before seeing their healthcare provider. Have a list of local mental healthcare providers (psychiatrists, psychologists and free clinics offered through hospitals and/or local health departments) handy. Have a list of hotline numbers available (see Table 1), ideally posted in patient waiting areas. Encourage patients to check whether their employer offers employee assistance that may be available; these programs are usually provided at no cost to the employee. 4. Look for medications that can potentiate mental illness. Many drugs, e.g., corticosteroids, smoking-cessation medications and benzodiazepines, can affect mood. Be proactive about educating patients on the adverse effects of these medications and work with healthcare providers to update the medication plan if needed. Minority populations face significant societal hurdles that jeopardize their mental health. Pharmacists, by developing trusting relationships with patients, providing education and helpful resources, and working in concert with interdisciplinary medical teams are well positioned to make positive impacts on mental health outcomes.
Table 1. Mental Health Hotlines and Web Services Mental Health Support
Phone #
Hours
1-800-4-A-Child 1-800-422-4453
www.childhelp.org
24/7
Text HOME to 741741
www.crisistextline.org
24/7
Disaster Distress Helpline
1-800-985-5990
DisasterDistress.samhsa.gov
24/7
National Alliance on Mental Health (NAMI)
1-800-950-NAMI 1-800-950-6264
www.nami.org
M-F 10 am10 pm (ET)
National Domestic Abuse Hotline
1-800-799-SAFE 1-800-799-7233 Text 88788 Chat available
Domestic Violence Support | The National Domestic Violence Hotline (thehotline.org)
24/7
National Sexual Assault Hotline
1-800-656-HOPE 1-800-656-4673 Chat available
www.rainn.org
M-F 10 am10pm (ET)
1-800-273-TALK 1-800-273-8255 After July 16, 2022, dial 988 (or use above#s)
www.suicidepreventionlifeline.org
24/7
Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline—get help finding treatment here also
1-800-662-HELP 1-800-662-4357
www.samhsa.gov FindTreatment.gov
24/7
The Trevor Project (For LBGTQ+ Youth)
1-866-488-7348 Text START to 678-678 Chat online
www.thetrevorproject. org
24/7
Child Abuse Hotline Crisis Text Line
National Suicide Prevention Lifeline
2022 July/Aug./Sept. | Vol. 60, Issue 3
17
— ON THE COVER —
Membership Priority Survey Results
I
A Look at MPA Member Satisfaction and Engagement
n April 2022, the Michigan Pharmacists Association (MPA) surveyed members asking for insights and feedback regarding MPA’s priorities. MPA wanted to hear from members as the Association continues to focus on achieving the goals and objectives outlined in the 2022-2024 MPA strategic plan. About 250 MPA members (nearly 20 percent of members at the time of the survey) completed the survey, an excellent response rate. The team at MPA is grateful for the time taken by these members to share their experience and insight.
Some of the key findings from members who took the survey include: 1. 85 percent are either satisfied or very satisfied with MPA and their membership. “Members first” is the primary theme of the strategic plan, and a number of strategies are being developed to strengthen member value. 2. 88 percent are likely to recommend MPA membership to a friend or a colleague. MPA will focus more attention on strategies to grow membership through referrals. 3. Nearly 15 percent did not know their local pharmacist association affiliation. MPA is developing more strategies to help existing and new members connect with their local associations. 4. 82 percent are either very satisfied or satisfied with MPA’s advocacy efforts. Legislative and advocacy efforts are consistently MPA’s highest rated membership benefit. BY BRYAN FREEMAN,
marketing and communications director, MPA
5. More than 90 percent prefer to receive updates and news from MPA via email. Members also appreciate the other channels MPA uses. However, when looking at social media engagement, close to 30 percent responded that they do not follow MPA on social media. While the number of followers Responses by Membership Type on MPA’s social media accounts has grown significantly in the past two 5.76% years, MPA will develop additional % 7 strategies to increase the number of members who follow MPA. MPA is currently reviewing member insights related to product and service offerings obtained from the survey. This information will be shared in the next issue of the Michigan Pharmacist. MPA thanks those members who took the time to complete the survey and welcomes member feedback at any time.
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n Pharmacist n Pharmacy Technician
87.24%
n Student Pharmacist
— ON THE COVER — VISA Gift Cards Winners
Finally, MPA is excited to share the survey contest prize winners who entered the drawing to win one of four (4) VISA gift cards and a free registration to the 2023 Annual Convention and Exposition. Please join MPA in congratulating:
2023 Annual Convention and Exposition Winner
Sarah Bumba • Ryan Bickel Jamie Tharp • CJ Heisler
Recommend MPA to Colleague or Friend
Michele Schillerstrom
Membership Satisfaction .78%
.33% 10.18%
13.33% 27.56%
n Somewhat unlikely
30.09
%
58.41%
n Dissatisfied
n Neutral
n Neutral
n Somewhat likely
n Satisfied
n Very likely
n Very Satisfied
57.33%
Why Did You Join MPA Access to MPA staff expertise
26.99%
It was expected of me
11.06%
Advocacy
38.50%
My peers are members
14.16%
Legislative updates
46.46%
Discounted ACE registration
11.50%
Continuing education offerings
67.26%
Connect with other member
64.16%
Other
10.61%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Members could make up to three selections.
Preferences for Receiving Updates from MPA eNews (PRN, section newsletter, emails)
90.87%
Michigan Pharmacist journal
47.95%
MPA website
37.90%
Social media
32.88%
Other
2.38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Members could select all that apply. 2022 July/Aug./Sept. | Vol. 60, Issue 3
19
— ON THE COVER — MPA Advocacy Efforts Satisfaction 3.64% 14.09% n Dissatisfied
39.09
%
n Neutral n Satisfied n Very Satisfied
43.18%
Responses by Practice Section CSPM
10.20%
MSCP
37.96%
MSHP MSPT
31.43% 4.49%
SMPA
5.71%
Don't Know
14.29%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Members can belong to more than one practice setting.
Do Members Follow MPA on Social Media I do not use social media
30.23%
I do not follow MPA
27.44%
YouTube
.40%
6.05%
21.40%
8.84%
33.95% 0%
5%
10%
15%
20%
Members could select all that apply.
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25%
30%
35%
40%
2022 July/Aug./Sept. | Vol. 60, Issue 3
21
— PROFESSIONAL DEVELOPMENT —
KNOW YOUR RESOLUTIONS
MPA House of Delegates Passes Six Resolutions in 2022
T
he Michigan Pharmacists Association’s (MPA) House of Delegates convened on Sunday, Feb. 27, 2022, at the MPA Annual Convention & Exposition (ACE) to review MPA bylaws and discuss policy resolutions. A total of seven resolutions were presented to the 2022 House of Delegates, with the following six passing out of the session. Resolution 22-02: Implementing a Non-Reportable Notice of Non-Compliance Action for non-clinical violations of the Michigan Public Health Code
BY FARAH JALLOUL,
Pharm.D., MBA, director of professional development, Michigan Pharmacists Association
Therefore, be it resolved: MPA to work with the Department of Licensing and Regulatory Affairs, and the Michigan Board of Pharmacy Disciplinary Subcommittee to create a non-reportable Notice of Non-compliance action for first-time administrative violations of the Act that did not have any impact on a patient’s health safety or welfare. Resolution 22-03: Implementing a permanent virtual meetings option for all public participants in all Board of Pharmacy open meetings Therefore, be it resolved: MPA to work with the Michigan Legislature to amend Open Meetings Act to conduct all public meetings with a virtual meetings option for public participants and accept virtual public comments. These virtual meetings will be recorded, permanently archived online, and made available to public for review. Resolution 22-04: Authorization and Reimbursement for Contraception Services Therefore, be it resolved: MPA should advocate within the Legislature to introduce legislation to include the prescribing and dispensing of selfadministered birth control to eligible individuals within pharmacist scope of practice.
Resolution 22-05: Climate Change and Pharmacy Practice Therefore, be it resolved: That MPA provide resources for pharmacy professionals to educate patients about the link between climate change and health, and how to implement improvements to diminish the impact of pharmacy practice on climate change. Resolution 22-06: Independent Long-Acting Injectable Administration Authority for Pharmacists Therefore, be it resolved: For patients in Michigan, the MPA pursue legislative changes to allow pharmacists to administer and be reimbursed for the administration of prescribed injectables autonomously, independent of a physicianauthorized collaborative practice agreement. Resolution 22-07: Support for Pharmacy Professionals in the Health Professional Recovery Program (HPRP) Therefore, be it resolved: That MPA encourages the Michigan Pharmacy Foundation (MPF) to create a committee/review board to accept donations and oversee the provision of financial assistance for licensed pharmacy professionals who have disclosed to have entered the Health Professional Recovery Program (HPRP).
Therefore, be it further resolved: MPA initiates discussion with Medicaid on reimbursement model for self-administered birth control prescribed and dispensed by a pharmacist.
The MPA Executive Board met in March to discuss the resolutions and decide to which MPA organizational units they should be referred. MPA organizational units were given until June 1 to provide feedback to the MPA Executive Board. The House shall receive the reports of the MPA organizational units, along with the Executive Board’s recommendation for action, where delegates shall vote on the Executive Board’s recommendation for each resolution no later than October. This will allow MPA staff to incorporate the adopted resolutions into the MPA 2023 budget year as deemed necessary.
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— PROFESSIONAL DEVELOPMENT —
Standing at left, MPA Chair Heather Christensen recognizes the newly elected officers of the MPA House of Delegates at the MPA Annual Convention & Exposition in February. The 2022 House of Delegates re-elected Katie Axford, standing center, as House speaker and elected Robin Curtis, standing right, as vice speaker of the House. MPA executive board and staff would like to thank immediate past Vice Speaker Joe Leonard, seated at center, for his service to MPA, as well as Dan Lobb, MPA House of Delegates parliamentarian, seated at left. MPA CEO Mark Glasper is seated at right.
IMPLICIT BIAS TRAINING REQUIREMENT What You Need to Know
BY FARAH JALLOUL, Pharm.D., MBA, director of professional development, Michigan Pharmacists Association
By now, everyone is aware of the new implicit bias training (IBT) requirement set forth by the Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA). The Michigan Public Health Code – General Rules were revised last year to require IBT for healthcare professionals, including pharmacists, student pharmacists and pharmacy technicians. Rule 338.7001(c) defines implicit bias as “an attitude or internalized stereotype that affects an individual’s perception, action, or decisionmaking in an unconscious manner and often contributes to unequal treatment of people based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or other characteristic.” The requirements apply to both new applicants and those renewing their existing licenses as of June 1, 2022. New Applicants for licensure must have completed two hours of IBT within the five years immediately preceding issuance of the license. Renewing licensees must complete one hour of IBT for each year of their license cycle. However, since the rule was put forth during
the middle of a licensure cycle, for initial renewal after June 1, 2021, licensees will only need to have one hour for each year since the rule’s promulgation date of June 1, 2021. For example, if you are scheduled to renew your license in August of 2022, you would only be required to have one hour of training, even if the length of your license was two years. Then, subsequent renewals will require one hour of implicit bias training for each year of the license, meaning two hours for pharmacists and pharmacy technicians and one hour for student pharmacists. Note that IBT is in addition to any continuing education training required for license renewal. This is not a “one-time” training, unlike human trafficking and the opioid and controlled substance awareness training requirement. Implicit bias training is required every time you renew your license. Members can reach out to Michigan Pharmacists Association Director of Professional Development Farah Jalloul for additional questions at FJalloul@MichiganPharmacists.org.
2022 July/Aug./Sept. | Vol. 60, Issue 3
23
— MSHP PRESIDENT —
BRIDGING THE WELLNESS GAP Finding a Path to Well-being as Healthcare Providers
A
BY SHAWNA KRAFT,
Pharm.D., BCOP, clinical pharmacy specialistambulatory oncology, Michigan Medicine; clinical associate professor, University of Michigan College of Pharmacy; president, Michigan Society of Health-System Pharmacists
s I reflect on the past year and think about the coming year, I sometimes feel exhausted and overwhelmed. How can we continue to live in this peri/post-pandemic world? While the pandemic has been and continues to be stressful for many, a silver lining for me has been that it has forced me to focus on personal well-being more than I had before. Prior to the pandemic, I would have learners working with me on rotations develop a wellness goal in addition to professional goals, and I would also have one for myself for the year or month. While this is an excellent foundational step, now I have elevated this beyond learners’ goals to providing resources to colleagues, trying to create a positive and supportive culture at my workplace and expanding my wellness work for myself. This has helped my mental health overall, lowered my heart rate and improved my attitude in approaching work. Easier said than done though, right?
If you search for research articles on well-being or wellness for pharmacy professionals, you won’t find much. To no one’s surprise, you will, however, find a plethora of articles on burnout among pharmacy professionals and other healthcare providers. They often state similar reasons for burnout with similar recommendations, including focusing on well-being to prevent burnout.1 However, we all know it isn’t simple. It is a continual process that starts with a decision to improve wellness for your health and, subsequently, for all the patients that you care for. It will not be all sunshine and roses every day. Well-being does not equal happiness. But having some focus on well-being means you will also be better equipped to approach what is difficult as it happens. I recognize many colleagues feel so overwhelmed, they don’t even know where to start. I have a few suggestions: 1. Pick something small, such as I will sit and enjoy my coffee for 5 minutes without checking my email,
or I will do deep breathing for 10 seconds before I start my shift. You really can start that small and go from there as you are able. 2. Utilize free resources. There is so much out there for free for you (and your patients) to use, such as Calm.com (also a smartphone application) and psychcentral.com. Also, many healthcare providers and insurers now cover stress management led by a healthcare professional. 3. Make wellness a priority. Many of us would agree we make our health a priority when we are sick. However, this is about more than being reactive when we must, and rather, being proactive when we can, including for our mental health and wellness. I refer you again to suggestion No. 1 and recommend scheduling it on your calendar. 4. If you are ready to take it to the next level or have a colleague or learner who might be interested, the American Society of Health-System Pharmacists (ASHP) also has a new program to train “wellbeing ambassadors” that is free, self-paced and completely virtual. You do NOT have to be an ASHP member to participate, nor is it focused on health-system practice. This can help you focus on your wellness and learn how to promote wellness for others, including that of your patients. See the website, well-being.ashp.org, for further details and how to apply. You are needed and you are valued, so please take care of yourself. This is the only way we can move forward as a profession, continue to grow and bridge the gap into a new normal.
REFERENCES: 1. Hosp Pharm. 2021 Aug;56(4):374-377.
“While the pandemic has been and continues to be stressful for many, a silver lining for me has been that it has forced me to focus on personal well-being more than I had before.” 24
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— MSHP EVP —
EDWARD SZANDZIK SELECTED AS
NEW MSHP EXECUTIVE VICE PRESIDENT
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he Michigan Society of Health-System Pharmacists (MSHP) Board of Directors in May announced the selection of former Michigan Pharmacists Association (MPA) President Edward G. Szandzik, RPh, MBA, FASHP, to be MSHP’s executive vice president (EVP). His term follows that of Dianne Malburg, RPh, vice president of pharmacy for HomeTown Pharmacy in New Era, Mich., who served in the role for four years. “MSHP has been a meaningful part of my life, and I am honored to have the opportunity to help lead an organization that has been so instrumental in promoting safe, effective and economic medication use throughout Michigan’s hospitals and other organized healthcare settings, and in advancing the profession,” Szandzik said. “I am very familiar with the challenges and opportunities we face in our profession and look forward to helping the MSHP Board execute its strategic objectives and maximize the contributions of MSHP members.” Szandzik, of Grosse Pointe Woods, received his Bachelor of Science in Pharmacy in 1980
and Master of Business Administration in 1986 from Wayne State University (WSU), where he is also an adjunct professor of pharmacy practice. Szandzik worked at Henry Ford Health (HFH) for 42 years, serving as vice president, pharmacy, for the last seven years before retiring July 1, 2022. He has also published and lectured extensively throughout his career. He is a past chair of the Michigan Hospital Association Hospital Pharmacy Management Committee, member of the Premier Academic Innovators Committee and former member of the WSU Pharmacy Alumni Association Board of Governors. Szandzik was recognized as a fellow of the American Society of Health-System Pharmacists (ASHP) in 2013 and served as MPA president in 2012. He received the 2012 ASHP Foundation Pharmacy Practice Research Literature Award, the 2009 MSHP Joseph A. Oddis Leadership Award and the 2007 Distinguished Alumni Award from the WSU College of Pharmacy and Health Sciences, among others. In 2020, he was named Michigan Pharmacist of the Year. He has been a member of ASHP for more than 35 years and a member of MSHP/MPA since 1986.
“Ed has been a dedicated trailblazer, mentor and esteemed colleague in the small community of Michigan health-system pharmacy for many years,” said MSHP President Shawna Kraft, Pharm.D., BCOP. “His leadership acumen, substantial experience and personal integrity make him an obvious choice for this important role. The MSHP Board is excited to welcome him to the team and looking forward to continuing the important work of the organization with his support and partnership.” The EVP is an independent contractor hired by the MSHP Board of Directors for a threeyear term. The responsibilities of the EVP include acting as the primary contact with ASHP, serving as secretary to the MSHP Board and its committees, coordinating and facilitating planning and leadership events and opportunities, acting as MSHP historian, working with MPA staff, and supporting the MSHP Board in executing its goals and objectives. MSHP, a practice section of MPA, is governed by a board of directors and supported by a committee structure and regional societies. It is an affiliated chapter of ASHP. 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— MSHP FOCUS —
INFECTIOUS DISEASE PHARMACISTS IN THE COVID-19 PANDEMIC: The Michigan Medicine Experience
Gregory Eschenauer, Pharm.D., BCPS, of Ann Arbor, won the 2021 Michigan Society of Health-System Pharmacists (MSHP) Professional Practice Award for his leadership in the development of influential COVID-19 management guidelines.
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BY GREGORY ESCHENAUER,
Pharm.D., BCPS, clinical associate professor, University of Michigan College of Pharmacy; clinical specialist, infectious diseases, Michigan Medicine
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ike many institutions, the Michigan Medicine Antimicrobial Stewardship Program (ASP) sprang into action when the COVID-19 pandemic reached Michigan in March 2020.1 The team of infectious disease pharmacists and physicians, tasked with optimizing patient outcomes for patients with infections, had to rapidly pivot to developing, promoting and implementing evidence-based, dynamic treatment and prevention guidelines for a new disease while maintaining the same clinical roles (albeit now dramatically expanded to include caring for patients with COVID-19). The first step was the development of inpatient treatment guidelines.2 Meetings were held, often daily, with the team presenting, debating and scrutinizing any available literature. Given the lack of clinical trial data to guide therapy, the ASP requested the assistance of researchers at the Michigan Institute for Clinical and Health Research (MICHR) to assess whether investigational therapies being used were having an impact on patient outcomes. This collaboration resulted in a study that suggested that the immunomodulator tocilizumab may have benefit in critically ill patients with COVID-19.3,4 Thankfully, randomized clinical trials soon became available, often in torrents on pre-print servers, thus resulting in the need to frequently assess the guidance and update accordingly, resulting in more than 50 significant revisions to date (as captured in the Appendix of the guidelines).2 Such frequent guideline revisions also required constant communication and education to pharmacists and providers on clinical services, so that care could quickly pivot to the new “best practice” when such evidence became available.
This also required continuous auditing of therapies such as remdesivir, tocilizumab and baricitinib to be able to rapidly identify areas of inconsistency or confusion. In December 2020, guidance for treatment of outpatients was created.5 The goal of outpatient therapy is to prevent patients with mild disease in the outpatient setting from progressing to requiring hospitalization. This guidance was spurred by the emergency use authorization (EUA) of monoclonal antibody (mAb) therapy and a new challenge of how to administer these parenteral therapies to outpatients with COVID-19. As a result, the ASP’s outpatient leads, Nicholas Dillman, Pharm.D., and Lindsay Petty, MD, developed a workflow by which pharmacists, largely picking up extra shifts, screened Michigan Medicine patients with new positive SARS-CoV-2 test results for eligibility, called the patients to discuss consent and then placed a referral for scheduling.6 In some weeks, upwards of 400 patients were screened, with over 3,600 patients receiving a mAb in the Michigan Medicine system to date, as of this writing. However, these therapies were largely developed based on neutralizing activity against the “original” SARS-CoV-2 variant, and subsequent variants had key mutations that impacted the efficacy of specific antibody products. As a result, team member Jason Pogue, Pharm.D., collaborated with others in infectious diseases to develop an algorithm based on local virus epidemiology to inform which mAb preparations should be utilized.7 In addition, antibodies were allotted by the Food and Drug Administration (FDA) to the state, and so quantifying current use – and predicting future need – was necessary to ensure that therapy was available when needed.
— MSHP FOCUS —
“Our experience in navigating the twists and turns of this pandemic has crystallized the truth that the team is infinitely superior to its individual parts.” It was not until a year later in December 2021 that oral antivirals became available, again requiring new guidance on how to stratify what patients should receive which therapy. An added wrinkle with the most effective oral agent, Paxlovid, was that it contains a SARS-CoV-2 antiviral, nirmatrelvir, co-administered with ritonavir. Ritonavir is a strong CYP3A4 enzyme inhibitor, which is used to increase (“boost”) the blood concentrations of nirmatrelvir to efficacious levels. Of course, this also makes Paxlovid susceptible to numerous serious drug-drug interactions. This is a major impediment to routine use of this effective therapy, especially in some populations most in need, such as immunocompromised patients. So the ASP, led by Samuel Aitken, Pharm.D., developed comprehensive interaction guidance and a local workflow for providers to reach pharmacists when necessary.8 This document has been incorporated into the Michigan Department of Health and Human Services toolkit for outpatient therapies.9 Dr. Aitken was also the pharmacy lead in developing a process for administering tixagevimab/cilgavimab, a long-acting monoclonal antibody preparation that is effective in preventing COVID-19 in patients who may not mount an adequate immune response to COVID-19 vaccination due to an immune compromising condition.10 The work described above outlines in broad strokes the role of the Michigan Medicine ASP in combatting COVID-19. However, it leaves out many other initiatives and obstacles, many of which highlight the crucial role of constant communication and collaboration with other entities in pharmacy services. For example, the drug shortage team at Michigan Medicine has been an essential partner throughout the pandemic. The Investigational Drug Service has facilitated Michigan Medicine’s compassionate use of monoclonal antibody therapies for immunocompromised patients who do not meet EUA criteria for use. Clinical informatics pharmacists were instrumental in communicating recommendations and shortages, while building order sets, tools and reports in our electronic health record, as well as dashboards to facilitate optimal therapy. And of course, front-line pharmacists in
clinical services delivered recommendations to the bedside. It should be emphasized that the work performed by the Michigan Medicine ASP is not unique. Pharmacists across the country have filled similar roles at their institutions, as well as serving other integral roles throughout the pandemic, from providing expert analysis of key clinical trials,11 informing the public of the latest treatment and preventative strategies and addressing misinformation,12 to the profoundly essential role that pharmacists play in vaccination. Pharmacists have led calls and outlined strategies to better serve minoritized patients, who have been disproportionately affected by COVID-19.13 In addition, pharmacists have informed national guidelines. For example, Alice Pau, Pharm.D., a graduate of the University of Michigan College of Pharmacy, is the executive secretary of the National Institutes of Health COVID-19 Treatment Guidelines Panel.14 At its inception, she was joined by Susan Davis, Pharm.D. (also a U-M graduate), as the Society of Infectious Diseases Pharmacists’ representative on the panel, along with other pharmacists with expertise in pediatrics, viral infections, drug-drug interactions and critical care, for example. Together with their colleagues, they rapidly developed national treatment guidelines, a profoundly challenging task given the circumstances.15 In May of 2021, with Dr. Davis becoming interim (and now permanent) associate dean for pharmacy at the Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, I was honored to join the panel. Similarly, Jason Gallagher, Pharm.D., is a member of the Infectious Diseases Society of American Guidelines on the Treatment and Management of Patients with COVID-19.16 Pharmacists, in close collaboration with their interprofessional colleagues, have played numerous instrumental roles in treating and preventing COVID-19. At Michigan Medicine, our experience in navigating the twists and turns of this pandemic has crystallized the truth that the team is infinitely superior to its individual parts. References available upon request 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— LEGAL INSIGHTS —
LAW ALLOWS MICHIGAN PHARMACIES TO FILL PRESCRIPTIONS FROM OUT-OF-STATE, MID-LEVEL PRACTITIONERS
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egislation initially written by the Michigan Pharmacist Association and groups representing nurse practitioners and physician assistants was recently enacted into law and signed by Gov. Gretchen Whitmer. The new laws amend three sections of the Public Health Code, with a key provision being the addition of midlevel practitioners as prescribers, which includes physician’s assistants and advanced practice registered nurses, generally referred to as nurse practitioners.
BY KIM SVESKA, R.Ph., Pharm.D., J.D., Foley, Baron, Metzger, and Juip, PLLC
The mid-level practitioners must hold a valid license in another state or province of Canada. However, the new laws provide for a “savings provision” not requiring the pharmacist to verify the license of the practitioner or physician’s assistant from out of state. The specific section is as follows:
The revisions do not allow for out-of-state or Canadian mid-level practitioners to prescribe controlled substances.
“Notwithstanding any provision of this section, a pharmacist who receives a prescription under subsection (2) from an advanced practiced registered nurse prescriber or a physician’s assistant prescriber in another state or province of Canada may dispense a drug or device without determining whether the advanced practiced registered nurse prescriber or physician’s assistant prescriber is authorized under the laws of the other state or province of Canada to issue the prescription.”
The pharmacist’s duty to review the prescription – determining that it is authentic, appropriate and necessary for the treatment of a condition and that the prescription falls within the scope of practice of the prescriber – is still a necessary review. It will be interesting to observe whether out-of-state patients wish to use Michigan pharmacies under the new laws, which could create issues for third party payors and insurance plans to the extent that the patient does have insurance.
While it is likely that this section will be interpreted literally and pharmacists who dispensed medications from out-of-state or Canadian mid-level practitioners would not be required to verify the practitioner’s license, it certainly would be a good practice for pharmacies that receive multiple prescriptions from individual mid-level practitioners to at least confirm licensure at some point.
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There may be logistical issues with regard to Canadian prescriptions due to the probable need for “paper” prescriptions and/or phoned-in prescriptions as opposed to electronic prescribing.
Whitmer approved the laws on May 19, 2022, and they will take effect 90 days after the adjournment of the 2021-22 legislative session. A copy of the law can be found online at https://www.legislature.mi.gov/ documents/2021-2022/publicact/ pdf/2022-PA-0080.pdf.
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Heather Meyers Account Manager 517-214-6778 hmeyers@rxpmp.com 2022 July/Aug./Sept. | Vol. 60, Issue 3
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— DRUG UPDATE —
NEW & NOTABLE
NOVEL MEDICATIONS WORTH KNOWING BY FARAH JALLOUL,
director of professional development, Michigan Pharmacists Association; JACKSON MAURER, P4 student pharmacist, Ferris State University; and JASON CORMIER, P4 student pharmacist, Wayne State University
“When a new brand of medication enters the market, one of the first questions asked, by both healthcare professionals and patients alike, is what the cost will be, especially on the patient end?”
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Novel Medications for Type 2 Diabetes Just as Michigan was starting to warm up for summer this year, a novel injectable medication by Eli Lilly and Company, Mounjaro™ (tirzepatide) entered the world of medicine. Mounjaro™ received approval from the U.S. Food & Drug Administration (FDA) for adjunct treatment of patients with type 2 diabetes with concurrent diet and exercise, becoming the first and only medication of its kind in regard to its mechanism of action. Unlike all previous diabetic injection therapies, Mounjaro™ has a dual mechanism of action acting on both glucosedependent insulinotropic polypeptide (GIP) and glucagonlike peptide-1 (GLP-1) receptor agonism. Once-weekly injections, established auto-injector pens and a pre-attached hidden needle device are a few of the advantages of this dual-acting agent. Mounjaro™ markets therapeutic maintenance doses of 5 mg, 10 mg and 15 mg with 2.5 mg increments available for titration purposes. In a study, patients in the approval-based SURPASS program had a decrease in A1C of 1.8 percent to 2.1 percent with the 5 mg dose and 1.8 percent to 2.4 percent with both 10 mg and 15 mg maintenance doses. These were superior to all comparators in the trials including weekly semaglutide. Mounjaro™ is not currently indicated for weight loss; however, it was an endpoint throughout the SURPASS program with patients receiving treatment losing between 12 to 25 pounds on average. Weight loss is significant for this patient population, as 90 percent of patients are overweight and 60 percent are obese. This weight loss is one of the benefits leading to proposed healthcare savings for patients, as well as the theorized possibility of improving other concurrent disease states. The side effect profile of Mounjaro™ mirrors that of its GLP-1 injection counterparts, being low incidents of hypoglycemia. The highest reported side effects were nausea, diarrhea and other gastrointestinal distress. Mounjaro™ is not indicated for use in patients with type 1 diabetes, history of pancreatitis, and it does carry a black box warning of thyroid C-cell tumors. When a new brand of medication enters the market, one of the first questions asked, by both healthcare professionals and patients alike, is what the cost will be, especially on the patient end? The manufacturer of the medication is providing patient assistance; for those who qualify, patients will have a $25 copay, lasting for the first year of treatment using Mounjaro™. For more information on cost savings options please visit www.Mounjaro.com. Further information on coverage and accepted plans will come with time.
A New Addition to Weight Loss Therapy In June 2021, Wegovy® (semaglutide) became the first drug in over a decade to receive an FDA approval for chronic weight loss management. Wegovy® is now one of only five medications approved for this indication. This approval comes in the midst of the ongoing COVID-19 epidemic, with studies tying obesity to overall worse health outcomes in COVID-19 patients, including higher rates of hospitalization, higher risk of being placed on ventilation and increased mortality. The Semaglutide Treatment Effect in People with Obesity (STEP) program, a 68-week trial, showed a 14.9 percent decrease in patient mean body weight on Wegovy® – a marked improvement over a shorter 56-week trial (SCALE 2015) that itself showed an 8 percent decrease in mean body weight. Wegovy® boasts a weekly injection schedule, as compared to the daily administration of similar product Saxenda®; both have similar common side effects and titration schedules that mirror one another in purpose and duration. Weekly dosing of Wegovy® for this indication, 2.4 mg, exceeds the maximum recommended dose for semaglutide’s other indication, treatment of type-2 diabetes mellitus (2.0 mg). Following this data, Wegovy® appears to be a good option for the patient populations included in the study, with fewer injections, similar side effects, and greater efficacy than Saxenda.® The downside to new medications is always cost, and Wegovy® is no exception. However, patient assistance programs exist from the manufacturer for those who qualify.
NEW with Norliqva® Norliqva® 1 mg/mL is the first FDA-approved liquid solution of amlodipine indicated for the treatment of hypertension and coronary artery disease in adults. It is indicated for the treatment of hypertension in children 6 years of age and older to lower blood pressure; it is kidfriendly, with a mild peppermint flavor. Adult recommended starting dose: 5 mg orally once daily with a maximum of 10 mg orally once daily. Small, fragile or elderly patients, or patients with hepatic insufficiency, may be started on 2.5 mg orally once daily. Pediatric starting dose: 2.5 mg to 5 mg orally once daily. To learn more about Norliqva, visit: www.Norliqva.com. Patients may qualify for the EasyPay Copay program, visit: www.CMPPharma.com/EasyPay for more information.
— DRUG UPDATE — Paxlovid:™ Summary and Updates In addition to vaccination and isolation procedures to combat COVID-19, providers can also recommend oral antiviral agents to COVID-positive patients to lessen the duration and severity of infection. Paxlovid™ was granted emergency use authorization (EUA) by the FDA in December 2021. Since then, millions of treatment kits have made their way across the United States and into the hands of participating pharmacists. Paxlovid™ is a Pfizer®-designed oral drug consisting of tablets of nirmatrelvir (a peptidomimetic inhibitor of the SARS-Cov-2 main protease that prevents viral replication by inhibiting processing of polyprotein precursors) and ritonavir (an antiviral given to reduce metabolism of nirmatrelvir in the liver). It is packaged as daily blister cards; each card containing six tablets (four x 150 mg pink tablets of nirmatrelvir and two x 100 mg white tablets of ritonavir). Three tablets (two nirmatrelvir and one ritonavir) are taken twice daily for a total of five days.
Under the EUA, the FDA has specifically elucidated that it should NOT be used: • for initiation of treatment in patients requiring hospitalization due to severe or critical COVID-19. • for pre-exposure or post-exposure prophylaxis for prevention of COVID-19. • for longer than five consecutive days. Paxlovid™ is contraindicated in patients taking certain CYP3A4 substrates and potent inducers which includes certain antiarrhythmics, immunosuppressants, anticonvulsants and anticancer medications. Pharmacists Authorized to Prescribe Most recently, pharmacists have gained prescribing authority under the EUA, with some regulations. Michigan pharmacists can prescribe Paxlovid without delegation from a physician as long as adequate medical documentation to evaluate the patient’s renal and hepatic function is established, as well as information to gauge the risk for potential drug interactions as defined in the EUA. According to the updated FDA EUA fact sheet, Paxlovid can be prescribed by a pharmacist under the following conditions: • Sufficient information is available, such as through access to health records less than 12 months old or consultation with a healthcare provider in an established provider-patient relationship with the individual patient, to assess renal and hepatic function; and • Sufficient information is available, such as through access to health records, patient reporting of medical history, or consultation with a healthcare provider in an established provider-patient relationship with the individual patient, to obtain a comprehensive list of medications (prescribed and non-prescribed) that the patient is taking to assess for potential drug interaction.
On April 14, 2022, the FDA expanded its EUA to include a new package with doses appropriate in patients with moderate renal impairment. These packages consist of dose cards with four tablets (two x 150 mg pink tablets of nirmatrelvir and two x 100 mg white tablets of ritonavir). Two tablets (one nirmatrelvir and one ritonavir) are taken twice daily for a total of five days. So, who should receive Paxlovid™? According to the EUA, patients who: • have at least mild-to-moderate COVID-19, with a positive test within five days of symptom onset. • are over 12 years of age. • weigh at least 40 kg (88 lbs). • are at high risk for progression to severe COVID-19, including hospitalization or death.
• Pharmacists should refer patients for clinical evaluation (i.e., telehealth, in-person visit) with a physician, advanced practice registered nurse or physician assistant, if any of the following scenarios apply: • Sufficient information is not available to assess renal and hepatic function.
• Sufficient information is not available to assess for a potential drug interaction.
• Modification of other medications is needed due to a potential drug interaction.
• PAXLOVID is not an appropriate therapeutic option based on the authorized Fact Sheet for Healthcare Providers or due to potential drug interactions for which recommended monitoring would not be feasible.
MPA continues to fight to ensure patient access to important medical care by removing red tape and empowering our pharmacists with testto-treat authority. The situation is continually developing – the MPA will continue to provide updated information to membership. References available upon request
2022 July/Aug./Sept. | Vol. 60, Issue 3
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— COVER YOUR ASSETS —
Protect Your Income,
PROTECT YOUR FAMILY
Illness or Injury? Disability Insurance Has You Covered
BY RON DEVERS,
CIC, CPIA, director of operations, PSI Insurance Agency
One in four of today’s 20-year-olds can expect to be out of work for at least a year because of a disabling condition before they reach the normal retirement age, according to the Social Security Administration. It’s no wonder that medically related work loss continues to be a leading contributor to bankruptcy. While it’s standard to insure our homes, cars, toys, businesses, etc., many people neglect to insure their largest asset—their ability to work and earn a living.
business. They could not afford to collect a paycheck for themselves and pay a replacement pharmacist.
What is disability insurance? Disability insurance provides a person with a portion of their income if an illness or injury prevents them from working. The cost depends on several factors, but, typically, it is approximately 1-3 percent of a person’s annual salary. The most common reasons for short- and long-term disability claims include musculoskeletal disorders, pregnancies and cancer.
Statistically, 375,000 Americans become disabled every year, and approximately 110 million Americans don’t have long-term disability insurance. The truth of the matter is that in the course of their career, a person is 3.5 times more likely to be injured and need disability insurance coverage than they are to die and need life insurance, according to the Health Industry Association of America. A 35-year-old has a 48 percent chance of suffering a disability that lasts longer than 90 days before age 65. The average length of said disability is 4.7 years. At age 50, the chance drops to 34 percent, but the length of disability increases by 1.5 years, according to the National Safety Council.
Some common myths exist regarding disability insurance. One myth is that people don’t need it, because they are covered by workers’ compensation. While workers’ compensation insurance is important and required in most cases, according to the Michigan Workers Compensation Act, it only covers work-related injury and illness. If the injury or illness occurs outside of the workplace, workers’ compensation would provide no coverage. Additionally, many business owners exclude themselves from workers compensation, as they legally can do, emphasizing the importance for business owners to carry disability insurance. Unfortunately, I know of several pharmacists who regrettably had to sell their business due to an injury or illness that prevented them from running their
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Another myth is if a person is young and healthy, they don’t need disability insurance. But no one knows what the next minute holds, and tragically, accidents happen to healthy people all the time. Many people become afflicted with a variety of health conditions that can have long-lasting effects on their ability to provide for their households.
Don’t be a statistic. Call PSI Insurance Agency, and let’s talk about this and other ways to protect your family. We’re in business to protect your business and family.
TripPlanet welcomes MPA members by giving them access to deeply discounted airfare and hotel rates through a private, invite-only platform
&
2022 July/Aug./Sept. | Vol. 60, Issue 3
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— LADC FEATURE —
LOCAL ASSOCIATION SPOTLIGHT:
WAYNE COUNTY PHARMACISTS ASSOCIATION BY SARAH HILL, president-elect, WCPA and DAN LOBB, president, WCPA
Jessica Efta, then-WCPA president, center left, presents a check to Rev. Frank Julian, head of Fighting Aids with Nutrition (FAWN), at Comerica at the 2017 WCPA Detroit Tiger fundraiser to benefit FAWN. Joining them are students from Wayne State University, WCPA Board members and FAWN Executive Board members.
Ashley Blanchette, Macomb County Pharmacists Association president, joins WCPA in its annual Putt-Putt for PAC/Al Tendler Invitational in 2019.
WCPA Chairman Dan Lobb sizes up the competition at WCPA’s annual Feather Bowling competition celebrating National Pharmacy Week in October 2019.
WCPA Board member and Wayne State faculty member Insaf Mohammad, left, joins WCPA Chairman Dan Lobb at the Unify Detroit Coalition Health Fair in August 2019.
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What activities does your local organize and conduct? The Wayne County Pharmacists Association (WCPA) has several annual events that we host each year. In the early summer, we organize a social baseball outing to raise funds for Fighting Aids with Nutrition (FAWN), we hold Putt-Putt for PAC in the late summer to raise funds for the Pharmacy Political Action Committee (PAC), and we do a fun night of Feather Bowling at Cadieux Café in Detroit to celebrate National Pharmacy Week in October. Other activities vary slightly by the year but have included many health fairs, a student law review, meetings with local representatives, participating in a fun run/walk, educational programming, movies at the Redford theater and more! We try to provide our members with a mix of social events, advocacy opportunities and educational programming. What is an example of an innovative event or initiative that your local has recently been engaged in and how did it have a positive impact? I don’t feel like we’ve done anything new since COVID-19! However, we resumed our annual baseball game raising funds to benefit FAWN on June 25! How would someone get involved in your local if they were interested? How could they express interest in serving on the WCPA Board of Directors? WCPA holds regular meetings the third Tuesday of the month at 7:30 p.m., 11 months of the year (we do not have an official meeting in December, though usually we meet to discuss resolutions for the Michigan Pharmacists Association House of Delegates). Our meetings are hybrid and are held via zoom and in-person at Henry Ford Community College in the Ghafari meeting room. Zoom links are sent out prior to our meetings and are a great way to join the meetings, especially if you are joining from a distance. We have several board members who virtually commute to our meetings from over an hour away. To be added to our email mailing list, please email WCPA President Dan Lobb at Gandalf480@aol.com. The address for our in-person meeting space is: 5101 Evergreen Road, Dearborn, 48128. If you are attending in person, please be aware that we follow Centers for Disease Control & Prevention (CDC) guidelines for in-person meetings. We practice social distancing and ask that each participant bring a computer or phone so that they can use a personal video to help facilitate the hybrid format. Like our page on Facebook for more updates and event announcements! What is one thing that you would like student pharmacists and pharmacy professionals who are not involved in their local to know? WCPA has a proud history of welcoming student pharmacists and young practitioners to all our meetings. In fact, there is a designated voting board member position held specifically for student pharmacists. For the past several years, we have had a student liaison from the University of Michigan, in addition to our traditional Wayne State University student liaison. WCPA also has a designated board position for a pharmacy technician. We would love to have more pharmacy technicians involved in our association! Wayne County Pharmacists Association is home to pharmacy professionals from all practice sections of pharmacy. We pride ourselves in the diversity of practice sections represented on our board. We are always looking for pharmacy professionals to serve on our board, committees and to work with us on our service projects throughout the year!
— LADC EVENTS —
LOCAL MEETINGS AND EVENTS Capital Area Pharmacists Association (CAPA) Sept. 14: Monthly Meeting, 5 p.m., virtual via zoom
Southwest Michigan Pharmacists Association (SWMPA)
Oct. 18: Monthly Meeting, TBD, in person
Aug. 25: Monthly Meeting, 6:30 p.m.
Dec. 8: Monthly Meeting, TBD Oct. 18: Wits & Wagers CE, time TBD
Macomb County Pharmacists Association (MCPA) Sept. 15: Monthly Meeting, 7 p.m., Zoom/hybrid Oct. 20: Monthly Meeting, 7 p.m., Zoom/hybrid
MPA-Upper Peninsula Division (MPAUPD) Sept. 23: Monthly Meeting, 5:30-6:30 p.m. (tentative) Sept. 24-25: Annual Fall Seminar, Ramada Inn, Marquette
Wayne County Pharmacists Association (WCPA) Aug. 16: Monthly Meeting, 7:30 p.m., TBD for Zoom or hybrid Sept. 20: Monthly Meeting, 7:30 p.m., TBD for Zoom or hybrid Oct. 18: Monthly Meeting, 7:30 p.m., TBD for Zoom or hybrid
Great Lakes Bay Pharmacists Association (GLBPA) Aug. 12: GLBPA at the Midland Loons game, 7:05 p.m.
Kent County Pharmacists Association (KCPA) Sept. 20: Monthly Meeting, 7:30 p.m. Oct. 18: Monthly Meeting, 7:30 p.m.
Oakland County Pharmacists Association (OCPA) Sept. 8: Monthly Meeting, 7 p.m.
Genesee County Pharmacists Association (GCPA) July 23: GCPA Annual Picnic at Abernathy Park, 5 p.m. Sept. 17: 11th Annual GCPA Golf Outing, Tyrone Hills Golf Club
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2022 July/Aug./Sept. | Vol. 60, Issue 3
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— PAAS NATIONAL —
CASH COPAY COLLECTION
N
umerous pharmacy benefit managers (PBMs) are conducting audits and asking for proof of copay collection. This is relatively easy to respond to (albeit annoying) when patients have paid by check or credit card as there is a “paper trail” of the financial transaction. PAAS National® analysts have seen some pharmacies struggle to provide evidence of cash transactions as they do not have sophisticated point-of-sale systems that record the method of payment or they lack consistent cash handling policies and procedures, or both.
BY TRENTON THIEDE,
Pharm.D., MBA, president, PAAS National®, expert third party audit assistance and FWA/HIPAA compliance
Of particular concern recently has been Caremark, who requires that pharmacies provide bank deposit slips as evidence of cash copays (the final step in the “paper trail” evidence). While, clearly, individual bills received from a patient at the register cannot be linked to a particular transaction, Caremark may be suspicious of large copays paid in cash and will demand to see bank deposit slips that exceed (in the aggregate) the amount of the individual copay. If your pharmacy cannot provide sufficient evidence of copay collection, then PBMs may recoup claims during audit and potentially terminate your pharmacy agreement. Consider the PAAS tips below to strengthen your cash handling procedures where needed.
PAAS Tips: • Don’t wait for an audit, with Proof of Copay Collection requirements, to upgrade to an integrated Point-Of-Sale system. Benefits may include: F Creation of itemized sales receipts with date and time of sale, individual items sold, dollar amount of each item (e.g. copay) and method of payment received. F Additional features often include: - Incorporate electronic signatures as proof of dispensing and acknowledgment of Health Insurance Portability and Accountability Act (HIPAA) notice of privacy practices - Link to over-the-counter (OTC) inventory levels for reporting and automatic reorder points - L ink to pharmacy dispensing software to update a work queue, mark prescriptions as “sold” or even hard-stop prescriptions if trying to sell a certain number of days after fill date (may prevent dispensing beyond PBM returnto-stock window)
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- Query transactions such as when responding to a PBM audit or if a customer disputes payment amount or receipt of a medication at a later date • Develop or revise cash handling policies that include: F Making deposits to the bank at regular intervals (e.g., weekly) F Avoid taking money out of the register to run the business (e.g., buying stamps, staff lunch, etc.) F Balance the register at the end of every business day - Breakdown cash by denomination and document for comparison against the next deposit - Leave a set minimum amount for open of next business day - Additional funds should go into a safe until the next scheduled bank deposit - If you have a point-of-sale system, it should be able to reconcile every transaction of the day to ensure you have the right amounts onhand and identify any lost payments or theft PAAS National® is committed to serving community pharmacies and helping keep hard-earned money where it belongs. Contact us today at (608) 873-1342 or info@paasnational.com to see why membership might be right for you. ©2022 PAAS National® LLC All Rights Reserved
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