Issuu

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

MPA’s 138th President

MIKE

CROWE

DON’T FORGET TO VOTE!

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

Read about the 2022 candidates for president-elect vying to become the next leader of the organization. (p. 18-19)

COMPLIANCE CHILLS Learn the vital importance of an

operational compliance program and chilling consequences of going without. (p. 23)

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KINDNESS ANTIDOTE

In a time of pandemic alienation, the president of MSPT shares an inspired perspective on spreading contagious positivity. (p. 26)

IN THIS ISSUE ADVOCACY UPDATE

12 3 President’s Platform

The role of technicians is becoming more vital as it continues to expand alongside that of pharmacists.

16 Naloxone Dispensing

Community pharmacists have a huge role to play in combating the opioid epidemic through medication dispensing, as well as patient counseling.

CE HOMESTUDY

ON THE COVER

4 C EO Corner

11 L egislative Update

28 Technician Focus

34 Ivermectin

Signs that life is returning to normal can be mapped by “Where’s Mark” social media posts.

Get up close and personal with a pharmacy technician who has persevered through the pandemic, vaccinating her community and finding hope.

Electronic prescribing requirements are set to take effect in January 2022, but could be pushed back further.

As rates of Ivermectin prescriptions to treat COVID-19 skyrocket, pharmacists should be aware of increased audit risks associated with it.

EDITOR: Mark Glasper; MANAGING EDITOR: Mary Beth Wardell Michigan Pharmacist (ISSN 1081-6089) is the official journal of the Michigan Pharmacists Association, published four times a year at 408 Kalamazoo Plaza, Lansing, MI 48933. Publication Number: USPS-345-600. Phone: (517) 484-1466, Fax: (517) 484-4893 Website: www.MichiganPharmacists.org, E-mail: MPA@MichiganPharmacists.org, Advertising Information: Visit www.MichiganPharmacists.org/news/advertising or contact Bryan Freeman, MPA marketing and communications director, at (517) 377-0232 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, 2021

— PRESIDENT’S PLATFORM —

ON THE IMPORTANCE OF TECHNICIANS Applying Resources Wisely as Pharmacy Scope Expands

ll teams everywhere continue to be tasked with doing more with less. But are we being intentional to ensure that our work is optimized for the safety of our teams and our patients? Pharmacy operations in our community sector have long been seen as unsustainable, putting our patients and our teams at risk. This continues to be a focus for the Michigan Pharmacists Association (MPA), as shown by the work of our Director of Government Affairs Brian Sapita. Reimbursement reform is a fundamental need in pharmacy practice. There is a consensus among some that workplace concerns will only be addressed once reimbursement is corrected, as this will balance out the costs of doing business. This balance would then allow for redistribution of financial resources and allow for overlapping staff to accomplish the basic functions of dispensing medication safely.

BY HEATHER CHRISTENSEN,

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

However, there is so much more to the practice of pharmacy than dispensing medications and supplies, which further alters the demands of how work is and should be done. A major driver that impacted how pharmacy professionals work today emerged from the Affordable Care Act in 2010. This law codified language that pharmacists coordinate care through the provision of medication therapy management (MTM) or chronic care management (CCM). Organizations across the nation continue to build upon the expansion of pharmaceutical care that started in the 1980s, with advances such as provider status, vaccine administration at the local pharmacy, prescribing oral contraceptives and telepharmacy – resulting in more work, important work. The market currently demonstrates there is a surplus of pharmacists trained to work without sufficient jobs to support them. Conversely, we see that the pharmacy professionals comprising most of the workforce have not had adequate attention or support for growth: our pharmacy technicians. The advancement of pharmacy practice through expanding the scope of pharmacy technicians can result in fear among pharmacists that such changes would negate the role of the pharmacist.1 This fear is not new. It has been documented as early as 1970, but it has yet to come to fruition. Among the various roles I have worked in as a pharmacist in the past 14 years, I know without a doubt my work would never have been accomplished without the support of pharmacy technicians, and only when I have appropriate support through technicians can I do my best work. Other concerns about growing the scope of a pharmacy technician relate to standardized training of pharmacy support staff, particularly the inconsistency within each state on whether a technician is licensed, registered or certified. There is not even a consensus as to the level of training recommended for technicians. Michigan recognizes two competing boards through which technicians can be certified: the Pharmacy Technician Certification Board (PTCB) or the National Pharmacy Technician Association (NPTA). These boards attest a technician has passed an examination with the baseline knowledge to work within a pharmacy.

In reviewing literature about the different ways technician roles have evolved, I saw reference to multiple studies that demonstrate technicians are as accurate as pharmacists when performing various tasks. Expanded roles for a technician include technicians checking technicians on accuracy of filling, the administration of vaccines, performing Clinical Laboratory Improvement Amendment (CLIA) screens with point-of-care tests and gathering baseline data to start the process of medication therapy management. Technicians have also seen a larger role with the development of telepharmacies. They work to collect patient information for outreach, scheduling, or for MTM or CMM; they help with patient assistance applications, where cost is a burden to adherence to medication; and technicians can be found working in primary care, supporting the team by working through formulary management and prior authorizations for the many different insurance plans across the state. All these evolutions in practice are seen only through the lens of our pharmacy teams. When looking to improve care, we need to consider the lens of our patients. There are many barriers to receiving care, starting with the fact that everyone is busy and employers do not always support time off for medication consultation or pointof-care testing. There are barriers to travel as distances and transportation impact a patient’s ability to get to where care is offered. This has continued to drive the development of convenient care clinics, telemedicine and the expansion of work for pharmacy teams. Technicians and the support they provide must be included in discussions about infrastructure advancements as they make up such a large part of our workforce. As professionals at MPA, pharmacy technicians are highly underrepresented within our membership. The noble practice of pharmacy is everchanging. You are the profession; you are the future. It’s important for each of us to consider how we impact our practice and the direction it is going. REFERENCES: 1. B .Taylor, B.Mehta, The Community Pharmacy Technician’s Role in the Changing Pharmacy Practice Space. Innov Pharm 2020; 11(2): 10.24926/iip.v11i2.3325.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— CEO CORNER —

LIFE RETURNING TO “NORMAL” – “WHERE’S MARK?” TELLS THE STORY I didn’t think starting my “Where’s Mark?” social media posts would be anything more than fun photos depicting my travels to meet with Michigan Pharmacists Association (MPA) members. Looking back on just four months of the posts, they help to chronicle how COVID-19 restrictions have loosened, albeit with a wary – but hopeful – eye cast upon the future.

BY MARK GLASPER, chief executive officer, Michigan Pharmacists Association

MPA offices “opened” back up June 1 after state officials allowed employers to invite employees back to on-site work. We decided on a hybrid approach that let staff work on site three days per week and two days remotely. Our dedicated professional staff had demonstrated they could work effectively during the previous 15 months of working remotely, so it was a way to ease staff back into working on site. My first “Where’s Mark?” photo showed me getting my COVID vaccine shot from Sue Arens, Pharm.D., co-owner of PGPA Pharmacy Inc. in Okemos. That opened the door to my travels.

Back to Business I didn’t stray too far away at first. It was just nice to get out to see and work with members again! No work has been more important in 2021 than getting our pharmacy benefit manager (PBM) reform legislation, House Bill 4348, passed. President Heather Christensen, Pharm.D., lent her expertise in testimony before House and Senate committees. MPA Director of Government Affairs Brian Sapita and MPA Director of Professional Development Farah Jalloul accompanied me to hear President Christensen’s Senate testimony in June. American Pharmacists Association (APhA) Executive Vice President/Chief Executive Officer Scott Knoer underscored our advocacy work with a visit to MPA in July. It was our first meeting with a guest since the pandemic started in March 2020! Scott briefed us on APhA’s advocacy efforts and offered his assistance in whatever Michigan needed to get HB 4348 across the finish line. MPA member and APhA Senior Vice President of Pharmacy Practice & Government Affairs Ilisa Bernstein joined Scott, staff and me for a photo commemorating his visit. I’m also extremely pleased to announce that Scott Knoer will be our Keynote Speaker at the MPA Annual Convention & Exposition (ACE) in 2022! You won’t want to miss his presentation as ACE becomes a hybrid event for the first time. We plan to hold the event in person and offer live streaming of select presentations. However, you’ll want to attend Scott’s dynamic presentation in person to get the full effect! Our work back at the office also got a shot in the arm over

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the summer with new staff additions, including Director of Membership Scott Walsh, Director of Marketing & Communications Bryan Freeman and Director of Finance & Administration Jennifer Mora. Their association management and non-profit experience completes an effective Management Team at headquarters that helps me guide the work of the organization.

Looking to the Future We held a Strategic Planning Retreat in July at MPA headquarters for our second in-person meeting since reopening the office. Fifty participants from every group under the MPA umbrella met to discuss and formulate a strategic plan for 2022-2024. Our work continues this fall as the final touches of the plan are added and staff begin to work on an implementation plan. I couldn’t resist taking a selfie with this hard-working group of members! Our future is bright with the incoming classes to our colleges of pharmacy. I had the pleasure of attending and speaking at the Wayne State University and Ferris State University White Coat Ceremonies. Nothing energizes me more than visiting the campuses and meeting our student pharmacists. I look forward to visiting the University of Michigan, too! MPA’s Pharmacy Day at the Capitol at the end of September was our first in-person event away from headquarters and brought together approximately 200 member pharmacists, pharmacy technicians and student pharmacists. We descended on the Capitol en masse to educate our legislators about the importance of PBM reform and the need for HB 4348 to pass.

Let’s be Hopeful As I glance at my calendar, I’m excited by the “Where’s Mark?” photo opportunities to come. The National Community Pharmacists Association (NCPA) held its first Annual Meeting in two years when community pharmacists from all over the country met in Charlotte, NC this October. I was there as well to meet with exhibitors about attending ACE – networking with colleagues and taking selfies galore! It is also National Pharmacists month in October with Michigan Pharmacists Week scheduled for Oct. 18-22. Our local associations are beginning to meet in person again, and I hope to visit as many upcoming meetings as possible. My schedule is open to meet with as many members as possible before hunkering down for the winter. Let’s get YOU on my schedule and into my “Where’s Mark?” social media posts!

— CEO CORNER —

“My schedule is open to meet with as many members as possible before hunkering down for the winter. Let’s get YOU on my schedule and into my “Where’s Mark?” social media posts!”

CEO Mark Glasper receives his second shot of the COVID-19 vaccine from Sue Arens, Pharm.D., co-owner of PGPA Pharmacy Inc., Okemos in June.

CEO Mark Glasper takes a selfie at MPA’s Strategic Planning Retreat with nearly 50 members and staff from every MPA component organization.

CEO Mark Glasper, Director of Government Affairs Brian Sapita, Director of Professional Development Farah Jalloul and President Heather Christensen attend Senate testimony for House Bill 4348 at the Michigan Capitol in June.

CEO Mark Glasper speaks at the White Coat Ceremony at Wayne State University in August in front of WSU’s 2021 P1 students.

APhA CEO/EVP Scott Knoer, APhA Senior Vice President of Pharmacy Practice & Government Affairs Ilisa Bernstein and MPA staff, board members and CEO Mark Glasper take a selfie in front of MPA headquarters in Lansing during APhA’s visit in July.

Pharmacy Day at the Capitol on Sept. 28 brought together pharmacy volunteers and student pharmacists to run a medication takeback event on the Capitol lawn, as well as attend meetings with legislators to discuss PBM reform and other vital healthcare policies. 2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— EVENTS CALENDAR —

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

OCTOBER 2021

1-31

Thursday, Oct. 1 – Saturday, Oct. 31

1-31

Thursday, Oct. 1 – Saturday, Oct. 31

28 29

American Pharmacists Month Nationwide

Health Literacy Month Nationwide

Thursday, Oct. 28

MSHP Board of Directors Meeting Virtual Only

Friday, Oct. 29

MSHP Annual Meeting Virtual Only

NOVEMBER 2021

1-31

Sunday, Nov. 1 – Monday, Nov. 30

1-31

Sunday, Nov. 1 – Monday, Nov. 30

8 11 12

Please note: Some virtual board and committee meetings may be subject to a change to inperson at MPA headquarters, at the discretion of the members. Please check the online calendar or contact MPA@MichiganPharmacists.org for more information.

17 18 18-24 19 25-26

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American Diabetes Month Nationwide

COPD Awareness Month Nationwide

Monday, Nov. 8

MPA Executive Board Meeting Virtual & MPA Headquarters, Lansing

Thursday, Nov. 11

MSHP Board Meeting Virtual & MPA Headquarters, Lansing

Friday, Nov. 12

MPF Board of Trustees Meeting Virtual Only

DECEMBER 2021

1-7 1

5-11 9

Thursday, Nov. 18

CSPM Board of Directors Meeting Virtual Only

Thursday, Nov. 18 – Wednesday, Nov. 24

U.S. Antibiotic Awareness Week Nationwide

Friday, Nov. 19

MSPT Board of Directors Meeting Virtual & MPA Headquarters, Lansing

Thursday, Nov. 25 – Friday, Nov. 26

MPA Office Closed: Thanksgiving MPA Headquarters, Lansing

National Handwashing Awareness Week Nationwide

Wednesday, Dec. 1 MSCP Board and Committee Meetings Virtual Only

Sunday, Dec. 5 – Saturday, Dec. 11 National Influenza Vaccination Week Nationwide

Tuesday, Dec. 9

MPA Third Party Committee Meeting Virtual Only

24-27

Friday, Dec. 24 – Monday, Dec. 27

30-31

Thursday, Dec. 30 – Friday, Dec. 31

Wednesday, Nov. 17 PSI Board of Directors Meeting Virtual Only

Wednesday, Dec. 1 – Tuesday, Dec. 7

MPA Office Closed: Holidays MPA Headquarters, Lansing

— BIOS AND MEMORIES — IN TRIBUTE

BRUCE C. FIELD Bruce C. Field, longtime member of the Michigan Pharmacists Association (MPA), passed away unexpectedly, Thursday, April 1, 2021. Field was born on Sept. 5, 1943, to the late LaMott and Ingrid (Nelson) Field in Owosso. He was a graduate of Laingsburg High School and in 1967, graduated from Ferris State University, the same year he married Ruth Poffinbarger. Field was the owner and pharmacist of Field Pharmacy for 46 years, teaching first aid and EMT classes and volunteering on the Laingsburg Ambulance Service for 36 years. He was an active supporter of the Laingsburg Band Boosters and the Boy Scouts of America. An MPA member since 1967, Field served as MPA treasurer from 1976-1988. Also active as a member of the American Pharmacists Association (APhA), Field served as APhA-APPM President/APhA Trustee from 2001-2002 and earned the APhA Fellow Award. He was an adjunct professor of pharmacy at Ferris State University and was inducted into the Golden Eagle Society for 50 years of service in 2017. Locally, he was a member of the Capital Area Pharmacists Association, the Laingsburg Lions Club and a past member of the Laingsburg Business Association. He was a charter member of the University Reformed Church of East Lansing and served as a former deacon, usher and sound technician there. Field was a loving husband, father and grandfather. He is survived by his wife, Ruth, of 53 years; his children, Mary Sieben, Pamela (Thomas) Danckaert and Kevin Field; and his grandchildren, Tyler Sieben, Audrey Sieben, Isabella Danckaert, and Anneliese Danckaert.

NEW STAFF BIOS ALIVIA BOWERS, STUDENT PHARMACIST Alivia Bowers is a Michigan native currently finishing her last year at South University School of Pharmacy in Savannah, Georgia. While on her five-week rotation at the Michigan Pharmacists Association (MPA), Alivia hopes to learn more about career paths available to pharmacists outside of clinical and retail pharmacy environments. She hopes that the knowledge, experience and training she gains during her rotation with MPA will enable her to begin her career as a pharmacist with a broadened perspective and skill set. After graduation, Alivia plans to return to her hometown of Alpena, which is a medically underserved but close-knit community, to serve her patients and further strengthen her relationship with the community.

CHELSY VITANZA, STUDENT PHARMACIST Chelsy Vitanza is a fourthyear pharmacy student at Creighton University with 11 years of community pharmacy experience. She looks forward to earning her Doctor of Pharmacy degree in May 2022 and is excited to begin her career as a pharmacist. She is originally from Pittsburgh, Pa., where she worked in a Transitions of Care Program at a psychiatric hospital for the past three years. She will be joining the MPA from Oct. 25 to Nov. 24 for an experiential rotation in leadership. Through this experience, she hopes to further develop her leadership skills to be able to advocate more for the poor and vulnerable. Chelsy aims to pursue a career in leadership with a Master of Business in Healthcare Administration in an effort to be the voice of pharmacy someday.

AARON WITTBRODT, MEETINGS AND EDUCATION MANAGER Aaron Wittbrodt joins MPA as the meetings and education manager, with more than two years of experience as a meetings professional. He graduated from Central Michigan University with his bachelor’s degree in integrative public relations with a minor in event management and public affairs. Prior to MPA, Aaron was an event planner at the Michigan Public Health Institute where he planned state-wide conferences for healthcare clients. When not engaged in planning, Aaron enjoys spending time reading and writing, performing or spending time with family and friends. He is very excited to interact with and get to know the members of MPA and looks forward to assisting them in having successful meetings, trainings and networking events. 2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— BIOS AND MEMORIES —

FORMER STATE REP EHARDT REMEMBERED PHARMACY ADVOCATE DIES AT 66 BY MARY WARDELL, communications

manager, Michigan Pharmacists Association

Stephen R. Ehardt, past president of the Michigan Pharmacists Association (MPA) and former state representative, died Thursday, July 29, 2021, in Boyne City, leaving behind a legacy of advocacy and service. A longtime resident of Lexington, Mich., Ehardt was 66 and had been diagnosed with cancer. President and CEO of Ehardt’s Pharmacy, Inc. for 36 years, Ehardt served as MPA president in 1999 and received MPA’s Pharmacist of the Year Award in 2005. He was born June 13, 1955, in Port Huron to the late Robert and Catherine (Matthews) Ehardt, and he married Ardis Adams in 1979. Ehardt earned a pharmacy degree from Ferris State University and did postgraduate work in geriatric pharmacy and nutrition. Ehardt served as a Republican State House representative from 19992004. He was memorialized in an article by Gongwer News Service as “a big man with a distinct coiffe of red hair” who cut an imposing figure at the Capitol and brought unmatched passion to his priorities. In his final term in the House, Ehardt was chair of the Health Policy Committee where he spearheaded a series of bills designed to relieve local pharmacies of some insurer-imposed requirements, according to Gongwer. Insurance lobbyists mounted a furious effort to block Ehardt’s approach in favor of rival legislation. His fellow House Republicans followed Ehardt for most of the debate, but eventually, the lobbyists won over most House Republicans, along with the Democrats and the Senate.

IN TRIBUTE

HERM FISHMAN, RPH BY LOU SESTI, former MPA CEO, 1966-1994 Coming off years of political in-fighting and power politics within the Michigan Board of Pharmacy, organized pharmacy was able to advocate through the Michigan Pharmacists Association (MPA) for a new kind of leadership. It succeeded in securing the appointment of Pharmacist Herm Fishman by then Gov. George Romney to be secretary of the Board of Pharmacy – what was then a powerful position within the Michigan Department of Licensing and Regulatory Affairs (LARA). Fishman was a Wayne State University College of Pharmacy graduate and an active member of the since-disbanded Downriver Pharmacists Association. Fishman brought a new kind of public and professional responsibility to the work of the board in both the licensing of qualified pharmacy graduates and the professional practice of licensed pharmacists. Fishman bridged the gap between the unique role of the Board of Pharmacy in its responsibility to advance public health and safe pharmacy practices consistent with the then-rapidly changing role of pharmacists. Fishman respected the synergistic role, yet distinctly different responsibilities, of the colleges of pharmacy in Michigan, the

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It was an incredible, emotional scene on the House floor, according to Gongwer. Ehardt gave an impassioned, tearful speech warning against the rival legislation. He received a standing ovation, followed by a loss in the vote. Then-Rep. Charlie LaSata, a fellow Republican who stood with Ehardt, derided the standing ovation as a “clap and screw.” His speech concluded, Ehardt collapsed into his seat, inconsolable, as fellow members tried to buck him up. Ehardt’s start in politics began in local government as a member of the Lexington Planning Commission. He later was elected to the village council, where he served for 10 years, and was a member of the CrosLex Chamber of Commerce. He was CEO of Your Primary Care, LLC, created in 2017, and was also a member of the American Pharmacists Association (APhA). Paul Schmansky, a fraternity brother and fellow MPA board member, knew Ehardt since the early 1970s. “He paid attention to what needed to be done and did whatever he could do to get it done – that’s why he went to the Legislature,” Schmansky recalled. “He put in a lot of time for the community and for the profession. He was an outstanding, quality individual, a dear friend, and a great advocate. He leaves behind a powerful legacy.” Ehardt enjoyed golf, tennis, motorcycles, fishing and sailing, and he was an instrument rated pilot. He is survived by his wife Ardie; son Allen and daughter Erica (Scott) Hooker; three grandchildren Colton, Easton and Sutton; brothers Paul (Helen), John (Robin) and Philip (Kelly).

association and the licensure power of the Board of Pharmacy. Fishman was always available to the profession, often speaking at statewide meetings, at local association meetings and serving on critical committees and task forces of the association. Fishman was “on the job” when Michigan implemented the prescription drug program by Medicaid and, a year later, the Blue Cross Blue Shield Prescription Drug Program for United Auto Workers (UAW) members on July 1, 1969. Fishman was again “on duty” when the Public Health Code was first adopted by the Michigan Legislature in 1978, which, for the first time, codified all licensing and registration laws relative to every health occupation. Fishman was again there when the profession wrestled with the existence and functioning of pharmacy supportive personnel now known as pharmacy technicians, which previously were not even allowed within the pharmacy practice area. Herm’s leadership within all the health licensing boards, coupled with his integrity, sustainability, as well as his management and governance style, led to his promotion as deputy director of the department for two administrations prior to his retirement. Pharmacist Fishman was a man of honor and professional integrity. He was a humble man, yet also a person very proud of his profession as Michigan pharmacy achieved pinnacle achievements within national pharmacy circles. Herm was dedicated in so many ways, among them to his family, friends and profession. He is preceded in death by his wife, Kate. He is survived by his treasures – his children: Sherri Prins, Tamara Brandt and Greg Fishman.

— FROM THE FOUNDATION —

THAT’S A WRAP

MPF to Close Year Strong

As 2021, a challenging year for the pharmacy profession and our nation, comes to an end, the Michigan Pharmacy Foundation (MPF) will be reviewing scholarship applications as well as grant applications requesting funding for innovative projects. We reflect on a challenging year for fundraising, during which it was often impossible to host in-person events, but we continue to move forward with our mission. This year, we are accepting applications for an additional scholarship to further aid student pharmacists during a time when they face growing costs and obstacles to learning. MPF is the charity arm of the Michigan Pharmacists Association (MPA), an endeavor by pharmacy professionals across Michigan to invest in the future of the profession for the improvement and promotion of public health and public education. We have accomplished this through the years with the consistent generosity of our donors. BY SPENCER HIGGINS, membership development manager, Michigan Pharmacists Association

As we prepare to turn the page on 2021, it’s the perfect time to aid us in these efforts with a year-end tax-deductible contribution before filing your taxes. You can make a donation online at www.MichiganPharmacyFoundation.org to help the Foundation support the future of the profession.

MPF Scholarship Applications Due Nov. 1 Every year, the Michigan Pharmacy Foundation (MPF) awards a scholarship to a current P2 or P3 student pharmacist from each of the three accredited colleges of pharmacy in the state of Michigan. These scholarships are awarded to student pharmacists who exhibit exceptional academic, leadership and professional achievement. In addition, the Larry Wagenknecht Leadership Scholarship is awarded to a student who especially exhibits exceptional leadership capabilities. MPF may award additional student pharmacist scholarships when additional annual funds are available. The deadline for scholarship applications is Nov. 1. MPF will be doing everything possible to encourage student pharmacists to apply to take advantage of this benefit. Practicing pharmacists of the profession can help by reaching out to student pharmacists they know and drawing their attention to the opportunity. Student MPA members can apply at www.michiganpharmacists.org/foundation/scholarships. MPF looks forward to announcing the awardees at the 2022 MPA Annual Convention and Exposition!

Don’t Miss the 2022 MPA Annual Convention & Exposition The Michigan Pharmacists Association (MPA) is pleased to announce that the 2022 Annual Convention & Exposition (ACE) will be held at the Detroit Marriot at the Renaissance Center from Friday, Feb. 25 to Sunday, Feb. 27, 2022. MPA staff is very excited to bring Michigan pharmacy professionals together in-person once again in Detroit! MPA staff will be monitoring health safety precautions and doing everything possible to ensure all participants stay safe and healthy at this event. MPA is committed to providing you with quality continuing education programming and networking opportunities, as well as a chance to visit with vendors. Registration will open in November. Watch for upcoming communications from MPA to learn more about details as they become available. See you in Detroit!

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

MichiganPharmacists.org

— LEGISLATIVE UPDATE —

E-PRESCRIBING DEFERRED

Enforcement Expected 2022-2023

BY BRIAN SAPITA, government affairs director, Michigan Pharmacists Association

nforcement of the new electronic prescribing requirement passed into law in 2020 is expected to take effect later than originally set in statute. Implementation has been moved to Jan. 1, 2022, but it could be pushed to January 2023 pending further action on the part of the Centers for Medicare and Medicaid (CMS).

In July of last year, Gov. Gretchen Whitmer signed House Bill 4217 and Senate Bills 248 and 254 into law. These new public acts state that any medication, scheduled or non-scheduled, were required to be electronically prescribed beginning Oct. 1, 2021. However, the enacting date in the bill is tied to the implementation date of electronic prescribing in Medicare Part D by CMS. At the time of publication, CMS had pushed back their implementation date to Jan. 1, 2022, so the state of Michigan has pushed back the implementation of e-prescribing to the same date. However, the 2022-2023 Physician Fee Schedule established by CMS has proposed pushing back the date to Jan. 1, 2023. This 2023 date has not been finalized, but MPA will inform its members immediately if the date is pushed back again.

Exceptions: The legislation allows a waiver from the e-prescribing mandate to be obtained by a prescriber for certain exemptions. The requirement to transmit the prescription electronically does not apply under any of the following circumstances: • The prescription is issued by a licensed veterinarian. • Electronic transmission is unavailable due to a temporary technological or electrical failure. • The prescriber has received a waiver from the Michigan Department of Licensing and Regulatory Affairs (LARA). A waiver is valid for up to two years and is renewable. • The prescriber reasonably believes that electronically transmitting the prescription makes it impractical for the patient to obtain the prescription drug in a timely manner and that the delay would adversely affect the patient’s medical condition. (In documenting this exception, which is required, the prescriber must document the specific reason for his or her belief that the delay would have an adverse effect on the patient’s medical condition.)

• The prescription for a Schedule 2 through 5 controlled substance is dispensed orally due to a specified emergency situation. • The prescription would be dispensed outside of Michigan. • The prescription would be dispensed in Michigan, but the prescriber is located out of state. • The prescription is issued, dispensed and used exclusively in a hospital, nursing home, hospice, dialysis treatment clinic, freestanding surgical outpatient facility or assisted living residence. • The prescription contains content not supported by the prescriber/ pharmacist script standard of the National Council for Prescription Drug Programs. • The prescription is for a drug for which the federal Food and Drug Administration (FDA) requires content that cannot be transmitted electronically. • The prescription is issued under circumstances in which the prescriber is not required to include the name of the patient on the prescription. • The prescription is prescribed under a research protocol. If a prescription was not electronically transmitted because of an exception specified above, the prescriber must document the applicable exception in the patient’s medical record and provide the documentation to the Department of Licensing and Regulatory Affairs (LARA) upon request. A pharmacist does not have to determine whether an exception applies before dispensing a prescription that was not transmitted electronically. LARA has encouraged all prescribers to implement e-prescribing as soon as possible. Once the law goes into effect, there will be no leeway given to prescribers who are not prepared. Additionally, any prescriber who does not obtain a waiver and does not use e-prescribing after the implementation date will be fined $250 per prescription by LARA.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— ADVOCACY UPDATE —

YOUR RETURN ON INVESTMENT:

What Pharmacy PAC Is Doing for You

BY BRIAN SAPITA, government affairs director, Michigan Pharmacists Association

he Michigan Pharmacists Association (MPA) Pharmacy Political Action Committee (PAC) is essential to the continuation of the pharmacy profession. It allows MPA to be the unified voice of pharmacy before the Michigan Legislature. When legislators see MPA CEO Mark Glasper or MPA Director of Government Affairs Brian Sapita enter their office, they know we are there to speak to them about pharmacy –whether it’s the challenges of pharmacy benefit managers (PBMs) our independent members are facing or perhaps a hospital issue such as white bagging. Either way, the legislator knows who we are and what we are passionate about, and that is largely due to the Pharmacy PAC. We were the only pharmacy group in the room when negotiations were going on around the increased Medicaid reimbursement and when the PBM reform bill was being discussed. Legislators look to MPA, an association they know and trust, not an out-of-state group who might be attempting to cash in on MPA’s success. Many ask, “What does the PAC actually do?” To be clear, MPA has two PACs. The first is a normal Political Action Committee, which we use to donate to pro-pharmacy legislators who help us move legislation through the process. The second PAC is an advocacy fund, which means the money donated to this PAC cannot be given to a legislator or campaign. Instead, it must be used on advocacy actions, such as our Pharmacy Day at the Capitol (PDAC), the Law and Policy Symposium or some of the functions at MPA’s Annual Committee and Exposition (ACE). Our Pharmacy PAC donated $11,350 during the state’s fiscal year 2019-2020.

Because we were supporting our friends in the Capitol, they were able to appropriate $11 million to independent pharmacies through the state’s budget process; that is a return of $969 on every dollar spent. This year, MPA is fighting PBMs and the Pharmaceutical Care Management Association (PCMA), which works on behalf of PBMs, to get our PBM Reform bill passed. In order to do this, MPA’s PAC is in need of contributions. If MPA can get an ROI of $969 per dollar on an increased Medicaid dispensing fee, just imagine what your $100 donation will be able to help us do when it comes to combating PBMs and direct and indirect remuneration (DIR) fees. It is unfortunate, but a fact, that money and the appropriate distribution of money in our political system is necessary to create opportunities and build relationships that allow MPA to present pharmacists’ positions on issues that affect our profession. Simply stated, we need more pharmacists to make a financial commitment to the PAC. It is the responsibility of every pharmacist to support the pharmacy profession with your time, talent or treasure. Please do not believe that if you don’t support pharmacy, others will do it for you. Pharmacy is a wonderful profession with a variety of opportunities for all of us. We need your financial help to maintain the vibrancy and stability of our profession. Please consider making a donation to either of our PACs to help advance the profession of pharmacy by contacting MPA Director of Government Affairs Brian Sapita at 517-377-0254 or visiting www.MichiganPharmacists.org/pharmacypac/contribute.

“If MPA can get an ROI of $969 per dollar on an increased Medicaid dispensing fee, just imagine what your $100 donation will be able to help us do when it comes to combating PBMs and DIR fees.” 12

MichiganPharmacists.org

— MEMBERSHIP —

RENEW NOW! Save on 2022 Membership Dues As we are nearing the end of 2021, we want to share our appreciation for your membership in the Michigan Pharmacists Association (MPA). We have gone through many challenges and changes in the past year, and now is the time to help MPA continue its successes by renewing your membership for 2022. Our members have done so much for our community this year. As we continue to move forward with a more robust organization, we wanted to recognize our members for your service and show you our appreciation. We offered a 30 percent discount to the cost of your 2022 dues if you renewed by the end of September. We’re also offering a 20 percent discount to your 2022 dues if you renew your MPA membership by the end of October. In November, this year-end promotion will still provide a generous discount of 10 percent off 2022 dues if you renew by Nov. 30. With your membership this last year, we were able to: BY SCOTT WALSH,

director of membership, Michigan Pharmacists Association

• Provide members with access to pharmacy law experts to answer your practice and legal questions. • Champion PBM reform in Michigan. • Help draft administrative rules on Pharmacy Technicians, Pharmacists CE rules, and Pharmacists General Rules. • Create legislation that allows pharmacists to dispense an emergency refill of insulin. • Create draft legislation that addresses white-bagging in health-system pharmacies. • Create legislation that will allow pharmacists to perform and be reimbursed for point-of-care testing and independent vaccine administration. • Recruit pharmacies to participate in medication therapy management (MTM) grant opportunities. • Provide critical COVID-19 updates as the pandemic has evolved. • Be the advocate for pharmacy practice at the Michigan Capitol. Renew now to take advantage of this offer, while continuing to aid your fellow pharmacy professionals in moving the profession forward. We offer three options for you to submit your payment with optional donations to the Michigan Pharmacy Foundation and/or Pharmacy PAC: 1. P ay online using your credit card by visiting www.MichiganPharmacists.org/membership and use the promo code renew2022. 2. C all Scott Walsh at (517) 377-0241 or Spencer Higgins at (517) 377-0259, and they can take your payment over the phone.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— MEMBER SPOTLIGHT —

Brittany Kinney and other graduates completed the Health Professional Leadership Academy through the Michigan Pharmacy Foundation in 2017.

GROWING WITH MPA

HOW MPA’S SUPPORT, CONNECTIONS AND RESOURCES HELPED ME THROUGH SCHOOL, RESIDENCY AND A GLOBAL PANDEMIC

BY BRITTANY KINNEY, Pharm.D., clinical pharmacy specialist, Priority Health

y involvement with the Michigan Pharmacists Association (MPA) began similarly to most – as a student pharmacist. Throughout my education at Ferris State University College of Pharmacy, I became involved in multiple activities organized by MPA, including Pharmacy Day at the Capitol, Medication Take Back Day, the Annual Convention & Exposition and the Adopt-AStudent program. These activities provided me with the opportunity to network with numerous professionals, including pharmacists, technicians other student pharmacists and faculty members. These relationships and conversations fueled my passion for the expansive role of the pharmacist and ultimately helped to solidify and support my decision to complete residency training.

of challenges as far as how to care for my patients, for my colleagues, for my family and for myself in a time of uncertainty and fear. For a couple of months, it was hard to know where to turn to find accurate information quickly and the support necessary for navigating the pandemic. Thankfully, MPA quickly provided that support. The connections I have gained over the years with the MPA team became crucial to my ability to support my organization through the pandemic. The team at MPA was always available for questions either by email or phone regardless of the time of day. I additionally found support through the COVID updates, various publications and monthly Town Hall meetings that the MPA team kindly organized with various speakers from different sectors of the healthcare field.

As I transitioned from student pharmacist to pharmacy resident, my involvement with MPA continued to grow through my completion of the Health Professional Leadership Academy (HPLA). HPLA is a nine-month program organized by the Michigan Pharmacy Foundation to support personal and organizational leadership development. Through this program, I learned important life lessons about what it takes to be an exceptional leader in both my personal and my professional roles. The knowledge and experiences I gained from this program set me up with the tools and confidence to accept a leadership position following the completion of my residency training.

Recently, I was given the opportunity to participate in the development of MPA’s current Mission, Vision and Purpose (i.e., MVP Team). The decision to gain insight from numerous pharmacy professionals representing various practice settings exemplifies MPA’s commitment to listen to member feedback. I strongly believe MPA diligently pursues their mission to “unite and empower pharmacy professionals through engagement, advancement and advocacy to optimize care and pursue health equity.”

Fast forward a couple of years and we find ourselves fighting a global pandemic. Like many, the year 2020 became one of the most impactful and powerful years of my life thus far. The pandemic brought with it a lot

My membership in MPA has provided numerous connections, robust knowledge and considerable support as I have navigated my first few years as a pharmacy professional. Although life can be hectic and busy, I would challenge all pharmacy professionals in Michigan to get involved in MPA. You won’t regret it!

“These relationships and conversations fueled my passion for the expansive role of the pharmacist and ultimately helped to solidify and support my decision to complete residency training.”

MichiganPharmacists.org

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2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— PROFESSIONAL AFFAIRS —

DISPENSING NALOXONE

Community Pharmacists Fight Opioid Epidemic

pioids are a class of drugs derived from the opium plant used to alleviate pain. Opioids work by blocking pain signals from traveling throughout the body. Misuse of opioids can cause addiction and possibly lead to death. In the past 20 years, deaths from opioid overdose have increased by 18-fold.1 The opioid antagonist Naloxone was approved to help lessen the chances of acute opioid overdose. Naloxone is on the World Health Organization’s list of essential medicines. Community pharmacists play a huge role in helping to combat this epidemic by promoting Naloxone dispensing.

Naloxone By RANI SAADALLAH, Pharm.D., pharmacy manager, Kroger

Naloxone is a medication, approved by the U.S. Food and Drug Administration (FDA), that is used to reverse opioid overdoses. It works by binding to opioid receptors in the body to reverse or block the effects of recreational and nonrecreational opioids. Naloxone will only work on patients who already have opioids in their system. Naloxone can be administered as an injectable, mainly used by healthcare professionals, or administered through a nasal spray called “Narcan” which is much easier to use, especially for non-healthcare professionals. Healthcare professionals should familiarize themselves with signs of opioid overdose and withdrawal to be able to educate patients. Regardless of which method of delivery is used, proper training is required to ensure the best outcome. Once a naloxone dose has been administered, it is still necessary to call 911 immediately and continue to monitor the person until emergency care arrives.

Eliminating Barriers In 2021, pharmacists were ranked as the third most trusted profession in the U.S. Community pharmacists are by far the most accessible healthcare professionals and can help reduce opioid overdose deaths. Community pharmacy professionals need to close the gaps between a healthcare provider and patient.

MichiganPharmacists.org

— PROFESSIONAL AFFAIRS —

“Healthcare professionals should familiarize themselves with signs of opioid overdose and withdrawal to be able to educate patients.” First, pharmacists need to increase awareness of the state’s standing order to dispense naloxone without the need for a prescription from a provider. Many patients may not be aware of how accessible naloxone is in their community pharmacies. Second, pharmacists need to be able to build trust with our patients in order to make a clear and strong recommendation about why Naloxone is important to reverse accidental misuse of opioids, by using the correct verbiage. This is a sensitive topic, and some patients might feel uncomfortable or embarrassed to discuss it. However, through clear communication and by building trust with our patients, we can come one step closer to ending this epidemic.

Community pharmacists are the most accessible healthcare providers. Increasing awareness of a lifesaving medication such as naloxone will slow down this epidemic and hopefully put an end to it soon. It is our duty as pharmacists to have it in stock at all times and to be able to make a strong recommendation when needed.

Cost

3. T he Pharmacist’s Role in Naloxone Dispensing to Combat the Opioid Epidemic. Pharmacy Times. https://www.pharmacytimes.com/view/the-pharmacist-s-role-innaloxone-dispensing-to-combat-the-opioid-epidemic. Accessed August 19, 2021.

Naloxone can be expensive since it is a prescription medication. However, more insurance plans are covering naloxone, including Medicare and Medicaid. If a patient is unable to afford naloxone, the manufactory of the nasal spray formulation will offer Narcan once per year for free without any questions asked. Some county clinics are also able to give a naloxone kit for free. A simple claim that the pharmacy can process will be able to provide the estimated cost of the naloxone, especially since pharmacies have a standing order from the state.

REFERENCES: 1. U nderstanding the Epidemic. Centers for Disease Control and Prevention. https://www. cdc.gov/opioids/basics/epidemic.html. Published March 17, 2021. Accessed August 19, 2021. 2. P harmacist Role in Dispensing NARCAN® (naloxone) Nasal Spray. https://www.narcan. com/pharmacists/pharmacist-role/. Accessed August 19, 2021.

4. C DC WONDER. Centers for Disease Control and Prevention. https://Wonder.cdc.gov/. Accessed August 19, 2021.

Confidential Portal Allows Pharmacy Personnel to Report Workplace Experiences The American Pharmacists Association (APhA) and the National Alliance of State Pharmacy Associations (NASPA) have launched the first confidential reporting mechanism of its kind to collect anonymous reports from pharmacists, pharmacy technicians and student pharmacists about their positive and negative experiences in the pharmacy workplace. The Pharmacy Workplace and Well-being Reporting (PWWR) portal was developed in response to the desire by pharmacy personnel across many practice settings for a venue to address workplace concerns and suggest improvements, without fear of retribution. “Pharmacists and pharmacy personnel workplace issues and their relationship to personal well-being continue to be a critical, complex issue across all practice settings,” said APhA President Sandra Leal, Pharm.D., MPH, FAPhA, CDCES. “In recent decades, considerable work has been done to identify and understand medication errors, including near misses, and characterize the root causes. What has been lacking in the research is a critical examination of workplace factors and solutions to determine how they affect pharmacy personnel well-being and patient safety.”

improvement in pharmacy personnel well-being and patient safety. The information collected is protected by the confidentiality and privilege provisions of the Patient Safety and Quality Improvement Act of 2005. Submissions to the PWRR portal cannot be disclosed or subpoenaed, and are not subject to discovery in a legal proceeding. “Pharmacists have asked for a way to discuss these issues without fear of retribution. They want to learn about solutions colleagues have instituted to make real changes in their pharmacy practice to better take care of their patients,” said Garth Reynolds, BSPharm, RPh, MBA, president of NASPA. “PWWR was developed by APhA and NASPA to address their request. What is learned from their positive and negative experiences and solutions can serve as the foundation of best practices, education and recommendations to enhance the pharmacy workplace, patient safety and pharmacy personnel well-being.” The portal can be accessed online at www.pharmacist.com/pwwr.

The reports will be collected and analyzed by the Alliance for Patient Medication Safety, a federally recognized Patient Safety Organization, to help tell a collective, powerful story to spark change and 2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— MPA IN ACTION —

2022

PRESIDENT-ELECT CANDIDATES

HOPE M. BROXTERMAN, a clinical pharmacist at Munson Medical Center in Traverse City, received her

Doctor of Pharmacy degree from Ferris State University (FSU) in 2010. She attained Board of Pharmacy certification in pharmacotherapy in 2014 and board certification in cardiology in 2019. Broxterman was awarded MPA’s Distinguished New Pharmacist Practitioner Award in 2018. In 2019, Broxterman was recognized as the Residency Preceptor of the Year by Munson Medical Center. Broxterman has served as co-chair for the Michigan Society of Health-System Pharmacists (MSHP)/Michigan Pharmacists Association (MPA) Membership Committee, as a delegate to the MPA House of Delegates, and as a member of the Pharmacy Advocacy Response Team (PART). She has also served as treasurer of the MSHP Board of Directors, as a member of the MSHP Educational Affairs, MSHP Finance, MSHP Organizational Affairs, MSHP/MPA Membership and MSHP/MPA Public Affairs committees. In 2015, Broxterman completed the Michigan Pharmacy Foundation’s Health Professional Leadership Academy and Munson Medical Center’s Frontline Leadership program in 2016. Broxterman is a member of the Northern Michigan Society of Health-System Pharmacists (NMSHP), having served as the organization’s treasurer since 2014. She also serves as an active member of the American College of Clinical Pharmacy and the American College of Cardiology. An active MPA member since 2008, Broxterman resides in Traverse City.

What will be your top priority as president of MPA? Why do you believe this issue is important? Although this past year has proven to be challenging, our pharmacy profession demonstrated the ability to adapt to whatever a pandemic may throw at us. As a profession, despite many of our everyday activities needing to be adjusted this past year, we accomplished many important, valued, and exciting things such as: delivering thousands of vaccine doses, navigating drug shortages, performing a multitude of patient education visits virtually, and with focused effort passing legislation for PBM reform. While we have accomplished many milestones, there remain many challenges. For example, increased daily responsibilities and burnout, drug pricing

MichiganPharmacists.org

and patient affordability, PBM transparency, telemedicine and remote verification, curbing the opioid epidemic and gaining provider status are just a few. Yet, as important as all these are to our profession, the pandemic exposed a bigger challenge that needs to be addressed, health equity. As pharmacists we are patient advocates. We are the most accessible healthcare professional. To me, harnessing our collective effort to address the disparity of healthcare access is an emerging issue that MPA members should tackle. I don’t have an answer to this. Yet our history as a professional association focused on patient care gives me encouragement that we can find ways to address this issue and create a new space for our profession to demonstrate our commitment to patient care.

Why do you think it is important for MPA members to be actively involved in the association? While challenges will always loom, we have the perfect solution for all the trials we face, our members and the talented team at MPA. By collaborating and sharing ideas we can improve reimbursement and limit inappropriate DIR fees, expand upon health information technology to improve patient outcomes, and provide necessary tools to ensure the health of our communities is accessible to all in need. Having the opportunity to continue to work on your behalf and support MPA through the many transitions it faces as your next president would be a true honor.

— MPA IN ACTION —

he Michigan Pharmacists Association (MPA) is currently holding elections for the 2022 Executive Board. Two candidates are vying for president-elect this year: Hope Broxterman of Traverse City and Sarah Hill of Fowlerville. Read the information provided to learn more about the candidates and be sure to vote by Friday, Oct. 29. SARAH E. HILL has worked for Ascension Michigan Retail Pharmacy in Lansing for the past 10 years.

Prior to her time with Ascension (formerly St. John Providence), Hill practiced with CVS Pharmacy in Holt. She received her Doctor of Pharmacy degree from Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences in 2010. Hill first joined the board of the Wayne County Pharmacists Association (WCPA) as a student pharmacist. She has since served as the secretary, president and chairman of WCPA. She spearheaded several projects for WCPA, including the production of a television public service announcement on the role of the pharmacist, and the creation of an annual law review to prepare graduating student pharmacists for the Multistate Pharmacy Jurisprudence Examination (MPJE). After serving as chairman of WCPA, Hill decided to get involved with the association at the state level. She was first appointed as the co-editor of the Michigan Society of Community Pharmacists (MSCP) newsletter. She was then elected to two consecutive terms on the MSCP board, including serving as president and chairman of the board. Hill also chaired the MSCP Member Education and Communication Committee. She was a member of the MPA New Practitioner Committee and has been a delegate to the MPA House of Delegates for many years. Currently, Hill is serving as a member of the WCPA Board of Directors and is a director on the MPA Executive Board. Hill has been an MPA member for 14 years and currently resides in Fowlerville.

What will be your top priority as president of MPA? Why do you believe this issue is important? The mission and vision of MPA involve uniting and empowering members to represent the profession of pharmacy with one voice. While MPA strives to be home to all Michigan pharmacy professionals, currently, many do not feel a sense of connection within the association. My top priority during my presidency would be to cultivate a culture of belonging at MPA. I want to initiate a shift from pharmacy professionals thinking about MPA as the pharmacy association in Michigan, to MPA being their pharmacy association. Those two additional letters make such a difference in recognizing the role of MPA in our individual lives. This culture shift includes intentionally recruiting leaders from groups historically underrepresented at decision-making tables. For example, we need the voices of new practitioners and unfortunately, many feel excluded. As a mother of four young children, I see the need for family-friendly consideration

for activities (not being held during bedtime, having spaces for nursing/pumping, etc.). Millennial and Gen Z professionals will soon constitute the majority of the workforce, and while MPA has taken some steps to engage those voices, efforts must be expanded. Pharmacy technicians make up over half of the pharmacy workforce, yet they continue to be severely underrepresented in MPA’s leadership. We need to assure our technicians that MPA is their association too. Another way to encourage members to find their home at MPA is to invest in growing and developing local associations. I have seen firsthand how important this grassroots level of MPA is in creating a sense of belonging. The desire to serve our local communities is a desire that unites us all. Belonging to a local association gives members opportunities to network with other local pharmacists, volunteer in their communities and more. As your president, I would like to hear how we can make MPA feel like home to you.

Why do you think it is important for MPA members to be actively involved in the association? Active participation in MPA is vital for all pharmacy professionals in Michigan. MPA gives pharmacy a unified voice when advocating legislatively, and when educating the public on the role of the pharmacy team. Many battles we face in advancing the profession could be won if we had the public pulling with us. For this to happen, the public needs to be educated on all that the pharmacy team can provide. The pandemic has shed a whole new light on the importance, and accessibility, of pharmacy services and we need to work together to harness this momentum. Being an active member of MPA, means contributing to that movement. The best way for MPA to respond to your needs is for you to become actively involved, so that your perspective can be heard. Your time and unique talents will help MPA move forward to a future where all pharmacy professionals feel seen, understood and represented by the association.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— ON THE COVER —

MPA’s 138th President

MIKE

CROWE The Unexpected Gifts of Giving Back BY MARY WARDELL, communications manager,

Michigan Pharmacists Association

hen incoming Michigan Pharmacists Association President Mike Crowe was faced in 2018 with the prospect of losing the job he loved, it didn’t look much like an opportunity at the time. Discouraged, but not deterred, he reached out to his network of colleagues and fellow MPA members. The response was overwhelming. “While it was certainly disheartening to be let go, the timing could not have been better,” Crowe said. Diplomat was the Michigan-based specialty pharmacy that had launched his career, first through its residency program and then through an eight-year stint in clinical services working with managed care organizations, pharmaceutical manufacturers, and even with several cutting-edge adherence technology companies. Crowe loved the opportunities and development he experienced at Diplomat, but the company’s growth led to its decision to go public, and that led to internal changes. “Eventually, expenses needed to be reduced.” Crowe said, “And one lineitem cut was my salary.”

“Working together with a united voice is the only way we will move the mountains ahead of us.” — MIKE CROWE 20

MichiganPharmacists.org

Three of the MPA contacts Crowe reached out to after discovering this grim news happened to be with Walgreens, and they knew about a special opportunity coming down the pike. “They all redirected my resume to the hiring manager of a soon-to-beopened local specialty pharmacy, which would be located just minutes from Diplomat,” he explained. “I was hired! And three years into it, it has been my favorite role to date.” Leading the effort to open this specialty pharmacy remains one of Crowe’s proudest accomplishments. He credits the opportunity with the network he built through MPA as a volunteer leader. Crowe sees this as one of the most valuable benefits MPA offers. “I’ve said before that I view MPA membership as insurance for our profession,” Crowe said.

— ON THE COVER —

From left, Melissa Crowe, daughters Joslyn (top) and Jolene (bottom) and Mike Crowe enjoy family time with their newest member in February 2021.

Crowe became a Student MPA member during pre-pharmacy while attending Ferris State University College of Pharmacy, where he would eventually earn his Doctor of Pharmacy degree. “I continued to be involved on campus and even attended an Annual Convention a couple times, but I didn’t really get involved with MPA until my residency year,” he said. Crowe had joined the local pharmacy association in Grand Rapids at the end of his fourth year, which motivated him to reach out to the chair of MPA’s Local Association Development Committee (LADC), who invited him to attend a meeting. Eventually, he served on the committee and was elected vice-speaker and then speaker of the MPA House of Delegates. He went on to serve on other MPA committees and task forces, reactivated his local association in Genesee County and coadvocated for pharmacy through MPA’s governmental initiatives.

From left, Mike Crowe and wife Melissa, with daughters Jolene and Joslyn, enjoy time together in February 2021.

a great job market, and good pay,” Crowe added. “As I expanded my experience in pharmacy practice settings and saw the various opportunities to help people, I continued to be encouraged by my decision to pursue a career in pharmacy.” As Crowe faces the beginning of 2022 and his year as MPA’s president, his goal is to unite and protect the profession he has come to love. One of the major strengths of the profession is the vast number of practice settings in which pharmacy professionals can serve – whether that be at a university, training pharmacy technicians, working at the corner drug store or a community hospital, seeing patients by appointment for cognitive services, consulting, or working in industry. But that strength can have a downside. “There are certainly many options in pharmacy, but that sometimes divides our efforts,” Crowe said.

“Through my involvement, not only did I learn that networking was an incredible value facilitated by MPA, but also that advocacy by MPA was almost invaluable,” Crowe said. “Every day, MPA makes sure our profession’s and our patients’ interests are heard, understood and acted on by decision makers in Lansing. Every additional member gives more clout to MPA’s advocators, and I decided early on that I would help MPA make our voice louder simply through being a member.”

Some problems may only affect one segment of pharmacy, which may lead those professionals to feel underrepresented. Conversely, those unaffected by an issue may believe MPA is dedicating too many resources to that particular concern.

Crowe first considered the profession of pharmacy as a junior in high school, when a series of small happenstances converged – an article recommended by his mom’s friend, meeting a local pharmacy chain representative at a high school career day, and then the opportunity to work as a pharmacy technician.

“My goal is that your association would be nimble enough to act at the optimal time, yet discerning enough to solicit and respond to member feedback whenever able and necessary. The Association needs to be both proactive and reactive. With this strategy, I hope we can view our challenges as chances to improve our profession, and the care it provides our patients.”

“A few other pieces that helped tip the scale were my love of science,

Mike Crowe, Pharm.D., celebrates the grand opening of Community, A Walgreens Pharmacy, in Flint, Mich. in November 2018. He is cutting the ribbon with Flint Mayor Karen Weaver (right of Crowe) and several Walgreens employees.

“The truth is that we are one profession, and we are all eventually affected by each pharmacy issue,” Crowe said. “Working together with a united voice is the only way we will move the mountains ahead of us.

Left to right, Nikkia Washington, Pharm.D.; Crowe, Pharm.D.; and Dr. Stephen Durst, dean of Ferris State University College of Pharmacy, celebrate the grand opening of Community, A Walgreens Pharmacy, in Flint in November 2018.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— ON THE COVER — Melissa, Joslyn and Mike celebrate Ferris State University Homecoming Weekend in fall of 2019.

“We all have different capacities to engage professionally, which are constantly changing with the demands of family, work and other aspects of life.” — MIKE CROWE Crowe said he would like to thank the members of MPA for the opportunity to serve as their president, as well as for their membership in MPA. He also asked that they consider, in the coming year, committing to remaining a member of MPA throughout their pharmacy career.

“We all have different capacities to engage professionally, which are constantly changing with the demands of family, work and other aspects of life,” Crowe said. “Even if you’re limited now, don’t rule out finding a way to engage in the future.”

“That alone will make a great difference in what MPA is able to accomplish moving forward,” Crowe said.

No one can account for the way sometimes the “stars align,” when it comes to picking a career, finding a new job, making a lifelong friend, or finding that extra bit of help right when needed. But the benefits of joining MPA and sharing in the “insurance” provided by advocacy, networking and more, can add more “stars” and open more doors.

That doesn’t mean every member has to join a committee or run for a position on a board, he explained, but that they consider when might be the best fit for them to change their level of involvement. Whether that be next year or 10 years from now, whether it’s attending a local association meeting or getting involved in an MPA task force, there are many opportunities and varying levels of commitment.

Mike and Melissa Crowe take a selfie in the hotel room before heading down to the Banquet and Awards Ceremony at the 2019 MPA Annual Convention & Exposition.

MichiganPharmacists.org

“Though I usually refer to volunteering as ‘serving,’” Crowe said, “I find that I always get way more out of the service than I put in.”

Crowe presents research at the 2017 National Association of Specialty Pharmacy Annual Meeting.

— LEGAL INSIGHTS —

THE ANNOYING, CHILLING AND SOMETIMES HORRIFYING CONSEQUENCES OF NOT HAVING A

WORKING COMPLIANCE PROGRAM

ederal law makes the existence and implementation of a compliance program a mandatory condition of enrollment (CoE) for providers in Medicare and other federally funded healthcare programs, including Medicaid.1 But what can happen if a pharmacy doesn’t have one and the government comes knocking and wants to have a good look around?

BY JULIE JANEWAY, MSA, JD; Associate principal, Foley, Baron, Metzger and Juip, PLLC

“The importance of a quality, comprehensive and operational compliance program cannot be overstated.”

When a pharmacy enrolls to bill Medicare, and then later does the same to bill other federal healthcare programs like Tricare or Medicaid, a representative signs an attestation on the Medicare application that certifies that the pharmacy meets, continues to meet and complies with all applicable Medicare regulations.2 With that signature, the representative also agrees the pharmacy would immediately inform the Centers for Medicare and Medicaid Services (CMS) if that situation were to change, which is a CoE. That attestation and agreement is the foundation on which almost all CMS non-criminal enforcement authority is built. If a pharmacy also applies to bill Medicaid, Tricare or any other federally funded healthcare program, those programs all use the Medicare screening and eligibility approval as the basis for their program’s approval as well. They all require, per federal law, a working compliance program. Pharmacists may note that many private programs and pharmacy benefit managers (PBMs) also enforce these compliance program requirements as a Condition of Participation (CoP). Federal regulations authorize CMS to revoke a provider’s Medicare billing privileges for, among other things: 1) noncompliance with enrollment requirements, 2) providing false or misleading information on the enrollment application, or 3) evidence of noncompliance at an onsite review.3 How would CMS find out that a pharmacy didn’t have or meticulously follow a proper compliance program? Let us count the ways: Health Insurance Portability and Accountability Act (HIPAA) investigations; private program audits; whistleblower reports; tips from agencies like the Department of Justice (DOJ), Food and Drug Administration (FDA), Federal Trade Commission (FTC), Internal Revenue Service (IRS), or state or local law enforcement; discovery that an excluded individual is employed there; reports from vendors; claims issue self-reports; licensing authorities; National Practitioner Data Bank (NPDB) reports from licensing authorities; other violations of CoPs; and more. Pharmacies cannot live in obscure noncompliance for long before a mistake catches the attention of an auditor or investigator. If a violation is found, they may feel the situation warrants CMS notification. Pharmacies without an operational compliance program could face the following consequences – in order from annoying to chilling to horrifying:

• Imposed corrective action plan through CMS, private insurance programs or state licensing inspections, which will cost money, time and closer monitoring. • HIPAA/ Health Information Technology for Economic and Clinical Health (HITECH) breaches, which must be reported to CMS, and depending on the size and nature, may have to be reported to the state and media. The cost range is $100 to $50,000 per violation, with an average minimum of at least $1,000.4 • De-participation from private insurance programs, likely leading to further investigation and de-participation by other programs. • The CMS Office of the Inspector General (OIG) is authorized to order Civil Monetary Penalties (CMPs) against violators.5 The relevant provision states that CMPs may be imposed for “knowingly making or causing to be made any false statement, omission, or misrepresentation of a material fact in any application, agreement, bid, or contract to participate or enroll as a provider of services or supplier under a federal healthcare program.” The cost starts at $100,000 for a false statement on the application. Other violations are additional. • The CMS OIG can order exclusion of individuals and businesses from Medicare, Medicaid and all federal healthcare programs.6 This does not require a criminal conviction. Simply making the attestation on the application, failing to remain in compliance and failing to notify CMS of the noncompliance can be coupled with other violations and result in exclusion. For more on the horrifying effects of exclusion, see https://oig.hhs.gov/ exclusions/effects_of_exclusion.asp. • Preclusion – after any exclusion is completed, CMS can place an individual or entity on the preclusion list for any period of time. • Prison time – some violations have mandatory prison sentences. The importance of a quality, comprehensive and operational compliance program cannot be overstated. All related requirements – including training, an active compliance officer, and appropriate internal monitoring– must be rigorously met, and compliance should always be a top priority. References available upon request from the MPA office. 2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— PROFESSIONAL DEVELOPMENT —

PHARMACIST-LED

MEDICATION THERAPY MANAGEMENT

harmacists today are actively participating in direct patient care activities due to the increasing complexities of modern medication therapies. Medication therapy management (MTM) services are pharmacist-led consultations that optimize drug therapy and improve therapeutic outcomes of patients. All Michigan Medicaid beneficiaries (including both fee-for-service and managed care and excluding Medicare Part D) have been eligible for MTM services since April 1, 2017. These activities go beyond saving healthcare dollars; they improve and even save patients’ lives. MTM services focus on the patient rather than the product. Medication management services strive to improve collaboration among the various healthcare professions while optimizing medication usage and patientcentered outcomes.

BY FARAH JALLOUL,

Pharm.D., MBA, director of professional development, Michigan Pharmacists Association

THE BENEFITS OF MEDICATION THERAPY MANAGEMENT Clinical Service: Pharmacists help patients effectively manage all their medications and treatments through one-on-one counseling, collaboration with other healthcare professionals and follow up. Safety: MTM keeps patients safe by minimizing interactions and ensuring all medications are appropriate. Patient-centered: MTM aids pharmacists in enabling their patients to take control of their medication(s), therapy goals and overall health with confidence. Cost Savings: MTM is proven to help patients reduce their healthcare costs, because improving patient health prevents future healthcare issues.

“Pharmacists help patients effectively manage all their medications and treatments through one-on-one counseling, collaboration with other healthcare professionals and follow up.” MichiganPharmacists.org

— PROFESSIONAL DEVELOPMENT — Eligible patients: A beneficiary is eligible for MTM services if they are receiving at least one medication used to treat or prevent one or more chronic conditions as identified in the Chronic Conditions for Medication Therapy Management Benefit Eligibility list. Note: at least one diagnosis code on an MTM claim must be a diagnosis code from the list of chronic conditions for MTM eligibility. Eligible MTM providers: To be eligible for MTM services reimbursement, pharmacists must first complete an MTM program approved by the Accreditation Council of Pharmacy Education (ACPE), such as the Michigan Pharmacists Association’s (MPA’s) ACPE-approved program “Delivery of MTM Services for Michigan Medicaid Beneficiaries” or complete the American Pharmacists Association’s “Delivering Medication Therapy Management Services” certificate program.

Telephonic MTM Services: Once enrolled in CHAMPS, pharmacist-led MTM services can be provided in an ambulatory care outpatient setting, a clinic, a pharmacy or the beneficiary’s home if the beneficiary does not reside in a non-covered service setting. MTM services are intended to be provided face-to-face, however, due to COVID restrictions, Medicaid Medical Services Administration (MSA) bulletin 20-12 and MSA 20-13 authorize the telephonic delivery of the service. CHAMPS Billing: Note that a “02” must be used as a place of service identifier along with a GT interactive modifier code of GT0780 for telephonic MTMs. In addition, the claim notes section must state that the “service was provided telephonically.” Pharmacists can bill Medicaid’s CHAMPS system using the current procedural terminology (CPT) billing codes identified under Table 1. Note that each CPT Code is billed for a 15-minute increment. CPT Code 99607 allows for additional 15-minute increments that can be dual billed with either CPT Code 99605 or 99606.

Enrolling in CHAMPS: After completing the MTM training, pharmacists must enroll in the Community Health Automated Medicaid Processing System (CHAMPS). CHAMPS is the web-based Michigan Department of Health and Human Services (MDHHS) Table 1: Billing Codes for MTM Services Medicaid claims processing system. To bill for MTM services rendered, pharmacists must CPT Code Service Rate Limitations enroll in CHAMPS using their pharmacist Initial assessment performed face-to-face in Only one CPT 99605 will be covered per national provider identifier (NPI) number and 99605 $50 a time increment of up to 15 minutes provider per beneficiary in a 365-day period. affiliate themselves with the Billing NPI of a Follow-up assessment in a time increment of Up to seven CPT 99606 will be covered per pharmacy, Federally Qualified Health Center 99606 $25 up to 15 minutes provider per beneficiary in a 365-day period. (FQHC), Tribal Health Center (THC) or a rural Additional increments of 15 minutes of time Up to four CPT 99607 will be covered per 99607 $10 health clinic (RHC). To begin the CHAMPS for 99605 or 99606 provider per beneficiary per date of service. enrollment process, visit www.Michigan.gov/ MedicaidProviders and click on Provider Enrollment. For additional For questions regarding Medicaid MTM, membership can contact assistance regarding enrollment, providers may contact the CHAMPS MPA Director of Professional Development Farah Jalloul at Farah@ Provider Support at 1-800-292-2550 or ProviderSupport@michigan.gov. MichiganPharmacists.org.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— MSPT PRESIDENT —

A KINDNESS ANTIDOTE

The Power of Small Acts in Difficult Times

BY LISA AUSMUS,

president, Michigan Society of Pharmacy Technicians

ife has changed a lot over the last year and a half, and it has affected how we relate to one another. We have been more socially distant from one another, both family and strangers alike. We have wondered if someone near us could make us ill or if we could make them ill. As essential workers, we have wondered if we will bring illness home to our families. Most of us continued to work through this changing landscape of daily living, but many others did not. These changes have left many people feeling isolated and alone during a difficult, unprecedented time in our history. Many wonder how to maintain their health, both physically and mentally. I remember a saying growing up: “It takes a village...” While I know that refers to raising a child, I think it can also apply to life in general. Even putting the pandemic aside, with advances in technology, we have lost some of the social norms of the past: the neighborhood picnics, sending a “thinking of you” note, talking with strangers at the beach. The way neighbors looked out for one another and helped each other with small things. I remember how adults in my neighborhood taught us children life lessons we needed to learn when our own parents could not be around to witness our shenanigans. Today, so much of that “village” has changed or fallen by the wayside. I wonder about those of us who have no family nearby, and now with the restrictions and enforced distance, are feeling truly alone. It is easy to imagine how

some of the humanity we all ought to show one another can sometimes get put on the back burner. Daily in our profession – which most of us have chosen to be able to help others – we dispense medications to treat physical ailments. We often overlook, however, the benefit that a simple act or kind word can have on a patient to augment the effects of that medication. My parents taught me to treat others as I wanted them to treat me. That is a life lesson I continue to remember. While we all get caught up in the hustle of daily living, sometimes we need a nudge to take a moment and just breathe, to look around and imagine what a great world we could have. Those of us with life experience and wisdom to share can help younger generations learn about some of the “old ways of thinking.” A kind gesture can mean a lot to someone who is struggling. A simple wave to a neighbor as we drive past might lift their spirits in ways we can’t know or predict. Saying, “Hi, it’s nice to see you,” might be the only live conversation that person has had in a while. Telling the cashier to “have a wonderful day,” or holding a door open for the next person can make them feel seen or cared about, even just a little bit. These are just small things that can have a significant effect toward making society a better place, and they do not cost any money. Afterall, happiness is contagious, and that’s a pandemic I would love to be a part of.

“A simple wave to a neighbor as we drive past might lift their spirits in ways we can’t know or predict. Saying, “Hi, it’s nice to see you,” might be the only live conversation that person has had in a while. Telling the cashier to “have a wonderful day,” or holding a door open for the next person can make them feel seen or cared about, even just a little bit.”

MichiganPharmacists.org

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— TECHNICIAN FOCUS —

Cassandra Kingsford is pictured with her son, Joseph, and daughter, Junie, as well as at work in these photos. Also pictured is her husband, Tom, with their cat, Lumberg.

UP CLOSE AND TECHNICAL

One Technician’s Experience During COVID-19 A Q&A with Cassandra Kingsford When was the first time you considered pharmacy as a career?

When/how did you become certified to provide immunizations?

I was actually in school to become a physical therapist when I was asked to work in the Kmart pharmacy. I had been with Kmart for five years at the time.

I had heard through the grapevine that certified pharmacy technicians can become immunizers, and that it went toward the advanced certification for technicians, so when I was asked if I wanted to take the course, I jumped in feet first.

Why pharmacy? I love helping people and what better way than helping patients understand their medications? By CASSANDRA KINGSFORD, CPhT, pharmacy technician, Munson Medical Center

Did you stumble into it, or was it something you knew you wanted to do from the start? I stumbled into it, but after about two weeks of working in the pharmacy, I knew it was the career for me.

What was your educational/career path? After about a month of working in the pharmacy, I started looking into online universities, found Rasmussen University, which had a program to become a pharmacy technician, and I graduated from the program.

MichiganPharmacists.org

What motivated you to achieve this certification? What motivated me to become certified in immunizations was the fact that we, as a nation, were and still are in a crisis. Knowing that I can be part of helping the community overcome the COVID-19 pandemic was a big motivator. This was at the time when Pfizer and Moderna’s COVID-19 vaccines had just come out.

Would you recommend other technicians get this certification? Yes, I would. There is just something about giving immunizations at a time like this that makes me feel that I made a difference in someone’s life. What better feeling is there than that?

— TECHNICIAN FOCUS — What are the benefits to you and/or the profession? I think the main benefit is that we are helping people. Whether it’s the flu, shingles or the COVID-19 shot, we are helping in the long run. Another benefit is that we are helping the pharmacist free their hands, so they can check a prescription or consult a little longer with a patient without feeling rushed, even though I think we all feel that from the time we start the work day until the end of the work day. But if you have a great team and work well with each other, it can be a productive day.

How would you describe your workflow before and after adding immunizations to it? To be honest, I didn’t notice a difference! If you are good at multi-tasking, it will not be an issue.

How has COVID-19 changed your work experience? What is the biggest lesson or growth opportunity you have learned from COVID?

Luckily, most patients make an appointment, so it’s easy to see what my day is going to be like and work with that.

The biggest lesson is never take anything for granted. I have been able to go to clinics at nursing homes to give the vaccine, and the people there were so grateful. They were excited that they might be able to give their kids and grandkids a hug, to be able to stay in one room and not talk to their loved ones through a window or on the phone.

What are the challenges this has presented?

How has this experience affected you or your family personally?

The challenge is when you have walk-ins, the phone ringing off the hook and a line of 10 patients waiting for their medications. It can get pretty hectic, but with the help of my other co-workers, it always works out in the end. Plus, it makes the time go by faster!

COVID took a toll on my whole family. My parents, my sister and her family moved to Tennessee a few weeks before the state shut down, and it was hard that we could not be together. Growing up in the Army, when the tough got going, you had your family there. It was really rough when they all got COVID and I could not be there to help them through it. Luckily, none of them got so sick they needed to go to the hospital, just to their doctors. It was really rough on my children. My son was graduating high school in 2020, and I felt so bad for him. His last year of high school

How do you incorporate immunizations into your workflow?

should not have gone the way it did. For my daughter, it was horrible doing virtual school. My husband could not work for three months, since his job was deemed nonessential. That put a lot of stress on him since he owns his own company. As for me, there were days I got to work and cried before heading in. No amount of encouragement or thank-you’s from the community could make it better, though it helped a little. I just never knew if I was going to bring COVID home to my family. That was the scariest part for me and a lot of my co-workers – the what-ifs.

What do you consider your proudest moment or greatest accomplishment from the COVID-19 pandemic? Knowing I made a difference in people’s lives. Knowing that I can walk into work and help more patients.

What are your goals or next moves as you continue to grow in your career and personal life? One of my goals is to get my advanced certification. The other is to keep helping as many people as I can.

“The biggest lesson is never take anything for granted. I have been able to go to clinics at nursing homes to give the vaccine, and the people there were so grateful. They were excited that they might be able to give their kids and grandkids a hug, to be able to stay in one room and not talk to their loved ones through a window or on the phone.“ 2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— COVER YOUR ASSETS —

Stay Safe this School Year Simple Precautions Make A Difference

As fall sets in and kids get back into the swing of the school year, it’s important to remember the simple ways we can keep ourselves and our families safe from unexpected accidents and injuries. This couldn’t be more true now, with the many changes families face and have faced in recent months. Most of us do what we do for the good and welfare of our loved ones, and keeping our families safe is an everyday, all-year, around-the-clock job. Here are some ideas for keeping our families safe in this back-to-school time.

Tips for walkers: • Walk on the sidewalk when one is available. When there is no sidewalk, walk on the side of oncoming traffic to maintain increased awareness of approaching vehicles. BY RON DEVERS,

CIC, CPIA, director, PSI Insurance Agency

• Stop and look! Left, right and left again before crossing the street. • Make eye contact with drivers before crossing, and always cross at crosswalks or intersections. • Stay alert and avoid distracted driving.

Tips when driving kids to school: • Obey school zone speed limits and follow drop-off/pick-up procedures. • Make eye contact with children crossing in front of your vehicle. • Never pass a school bus picking up or dropping off children. • When stopping near a bus, keep enough distance to allow children to safely enter and exit the bus.

Tips for bus riders: • Go to the bus stop with your children and teach them how to safely get on and off the bus. • Inform your kids to stand 6 feet away from the curb and stay there until the bus comes to a complete stop. • If crossing the street to get on the bus, teach them to cross 10 feet in front of the bus, so they can see the driver and the driver can see them. These tips and more come from the National Safety Council. Their website, www.nsc.org, provides tips ranging from back-to-school safety to workplace safety and many other topics. For your everyday insurance needs, be it your personal assets or protecting your business concerns, reach out to PSI Insurance Agency. You can reach us 24 hours a day at www.psiinsurance.net.

MichiganPharmacists.org

— THAT’S MY PHARMACIST —

Join the Michigan Society of Health-System Pharmacists and the Michigan Pharmacists Association in educating the public by utilizing the “That’s My Pharmacist” campaign in your pharmacy! This campaign includes various flyers focused on important health topics, relevant to health observances for each month of the year as well as additional awareness campaign resources to share with your patients. These flyers work to educate patients on the conditions that pharmacists can help with, as well as questions that patients can ask their pharmacists which can be customized with your pharmacy logos! Find all the available campaign materials for display in your pharmacy at www.ThatsMyPharmacist.com.

OCTOBER

American Pharmacists Month & Health Literacy Month

NOVEMBER

American Diabetes Month & COPD Awareness Month

DECEMBER National Influenza Vaccination Week

If you would like to participate in the campaign, have any additional questions or would like to provide a suggestion for the campaign, please contact Mary Beth Wardell, communications manager, at MaryBeth@MichiganPharmacists.org. We look forward to helping you achieve your pharmacy goals! Visit www.ThatsMyPharmacist.com to access a flyer for each of the observances above. Print off the flyer and share the key information included with your patients! The details included in these resources will help your patients further understand the importance of utilizing their pharmacist as a vital member of their personal healthcare team.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

FEEL THE BURN — CE HOMESTUDY —

What is Burnout and How to Combat it. An Update on Burnout for Pharmacy Personnel

BY TRAVIS MACFARLANE,

Pharm.D., PGY-1 community pharmacy resident, Meijer/Pfizer/ Ferris State University

Target Audience: This continuing education activity was designed for pharmacy technicians, pharmacists, and pharmacy students. Disclosure Statement: The author has indicated that he does not have any conflicts of interest, nor does he have financial relationships with a commercial interest related to this activity. Learning Objectives: At the end of this activity, participants should be able to: 1. List the common signs of burnout 2. Define different strategies to prevent burnout 3. Demonstrate when professional help is needed to treat burnout 4. Identify organizational opportunities to improve employee burnout rate

MichiganPharmacists.org

Introduction

Burnout Development

A patient presents to the pharmacy, seeming out of sorts and distressed from a medication error that caused them to end up in the hospital. Under normal circumstances, someone in the pharmacy may notice the distress and ask the patient if everything is okay. Yet, today the personnel have lost interest in their jobs and treating everyone like they are a number. All the personnel want to do is to just make a paycheck and clock out at their time to leave as this is “not their problem.” Their drive to care for patients has left them devoid of their passion to help patients. When addressing the patient’s concern over the error, the personnel treat the issue like it is no big deal and just want the patient to leave. If this sounds familiar, that is because some of the personnel working that day may be experiencing burnout. It is estimated that about 25-70% of pharmacy personnel are experiencing burnout and the incidence rate has been increasing over the last few years.1,2,3 As this has progressed, the phenomenon has become talked about more in the media and in medical literature. Society has begun to take notice of both the short- and long-term ill effects, such as medical errors. These effects have gotten the attention of ICD-11 (QD85) and they introduced the current working medical definition as a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It is characterized by three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one’s job with feelings of negativism or cynicism related to work, and reduced professional efficacy. With the new research into the consequences of burnout in the medical community, studies have begun to show that it can cause negative health outcomes on the person experiencing it and the patients that they are taking care of.4 This article will provide pharmacy personnel with information about and ideas on how to manage burnout.

To understand the effects of burnout in pharmacy, it is crucial to understand how the syndrome develops. While there is not an overt pathophysiological process, there is thought to be an overlap between pre-existing conditions, learning and work environments, and cultural or societal components taking place in most instances.5,6 Some pre-existing conditions that have been shown to put those at an increased risk of burnout are any health conditions that can affect the mind and the physiological response to stress. The burnout pathway is thought to start in the education of pharmacists rather than in the workplace. While there are only a few studies at this time addressing what causes burnout in pharmacy school or pharmacy technician education, medical school burnout has been more widely studied, and it extrapolates well to pharmacy education.8 This extrapolation can be completed because both schools are high stress environments, require a multitude of sacrifices, and have similar trainings required to be admitted. Medical school students report reasons they develop burnout are the competitive, perfectionism fostering environment that is cultivated in the educational system. In addition, when surrounded by emotionally stimulating situations, students report that they do not know what to do with their emotions. With no programs or supervisors to discuss an emotionally stimulating event like a patient death, these emotions build up and burnout can result.6 An example of this could be the student making their first medical error. The first time an error happens to someone, there can be a multitude of emotions that result and without having proper guidance, the student may no longer feel like they can treat patients. However, if given the proper direction, the student can develop resilience to perservere correctly through the situation.

— CE HOMESTUDY — While there is a lack of research about pharmacy school burnout, there is some research that has begun to address it inside a pharmacy. The pathway continues after completing education when pharmacy personnel are put into a work environment that has constant access to its employees with emails or other notifications. This leads to a feeling of constantly working and an inability to separate work and life. While at the pharmacy, staff have reported in literature that constant angry patients, lack of breaks, low reimbursement, and alert fatigue all increase their rates of burnout. Environments may also have limited staffing, underappreciation of their work from superiors, lack of peer support and a lack of mentorship. In addition, there is always the stress of attempting to be perfect so as to not make an error and harm a patient. These factors may also contribute to the burnout development pathway.6 This pathway can also be thought of like the stages of grief in that you can jump to different phases of burnout at any given point in time. The phases may have distinct times of little to no burnout where other times may be overwhelming. Moreover, no timeframe of how long a person can stay in a phase of burnout has been established.6 American culture and the sub-culture that is pharmacy has formed a stigma that is counterproductive to the process of overcoming burnout. The stigma contains the idea that an individual must always be working for advancement and if they are not working as hard as their peers, they must be lazy or have a low tolerance for high acuity jobs. People have reported that the result of the stigma has pharmacy personnel feeling if they even report being burned out, there will be negative career and societal implications. Fears of reporting burnout then develop due to anxiety over losing jobs or being demoted, being discriminated against, or being seen as unfit to be a professional.6

Signs and Symptoms of Burnout There are multiple signs of burnout that can be identified in individuals before they become aware themselves. Some signs of burnout are:6 • Lack of motivation both at and away from work • Decreased job satisfaction • Reduced mental acuity • Increased rate of illness development • Declining ability to handle stress • Higher job turnover rate • Suicide The ICD-11 diagnosis establishes that these signs and symptoms must only occur at work or as a result of work. Other diagnoses must be considered if there are other anxiety or mood disorders.10 There are a few scales that have been identified to measure burnout such as the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and the Well-Being Index (WBI). These scales have been used to identify burnout in multiple areas including for students and medical personnel. However, these scales do have their critics when it comes to utilization of the provided information for treatment purposes and the verification of the scales.7 The 15-question assessment in the WBI is free to use and the questions have been established in conjunction with American Pharmacists Association (APhA). The self-assessment takes around 15 minutes to complete and, based on the scoring of the questions, the user will be assigned a score to depict the likelihood that they will burn out, the chance of severe fatigue, the probability of medication error, satisfaction

of work-life balance, their quality of life, and how much meaning they get out of their of work. This is then tracked over time to identify trends for prevention and treatment of burnout. The types of questions range from yes or no answers to self-ranking and encompass all the factors associated with burnout.8

The Effects of Burnout Burnout can result in effects to the individual experiencing burnout, employers and patients. Individuals experiencing burnout can have both short-term and longterm complications. SHORT-TERM11

LONG-TERM11

Crippling self-doubt

Increased chance of substance abuse

Increased anxiety

Depression

Fatigue

Chronic conditions (heart disease, diabetes, hypertension) Suicide

It is important that individuals, employers and managers partake in activities that lower burnout rates to help protect individuals from the long and short-term effects of burnout.11 Employers with employees experiencing burnout can be impacted as well. An interesting aspect that employers must deal with in regard to the phenomenon is the cycling of burnout from one employee to another. This looping process develops from the chronic turnover of staff and the need to train new staff repeatedly. This can manifest itself in a higher turnover rate, decreased job satisfaction surveys, and a reduction in work productivity. All this can cause negative consequences on the financial stability of an organization and decrease profits.4 Patients can also be negatively impacted by pharmacists suffering from burnout. Staffing issues can lead to a decreased access for patients who need to be seen and a decreased quality of care due to time constraints. Medical literature has also begun to establish relationships between increased burnout rates and worsening patient outcomes from medical errors.4 Patients also report that they are less satisfied on surveys when being seen by someone Important Information Regarding Continuing Education Credit who the patient perceives as burnt out.12 Upon the completion of this activity, participants must complete an online

Managing Your Own Burnout: Not everything to prevent and treat burnout can be done yourself, though there are best practices you can perform in your routine to decrease the likelihood of developing burnout and minimizing the impact burnout has on your life.

evaluation. Participants will receive pharmacy continuing education (PCE) credit through CPE Monitor, a national collaborative effort by ACPE and the National Association of Board of Pharmacy (NABP) to provide an electronic system for pharmacists and pharmacy technicians to track their completed PCE credits. MPA, as an ACPE-accredited provider, is required to report pharmacist and pharmacy technician PCE credit using this tracking system. Pharmacist and pharmacy technician participants must provide their NABP e-Profile identification number and date of birth (in MMDD format) when they complete a PCE activity. It will be the responsibility of the participant to provide the correct information. If this information is not correctly provided, NABP and ACPE prohibit MPA from issuing PCE credit. Online access to their inventory of completed credits will allow pharmacists and pharmacy technicians to easily monitor their compliance with PCE requirements and print statement credit. Partial credit will not be awarded. If you have not yet signed up for CPE Monitor, go to http://nabp.pharmacy/programs/ cpe-monitor/. For more home study activity options for pharmacists and pharmacy technicians, visit http://www.michiganpharmacists.org/ education/online.

Michigan Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity #0112-0000-21-005-H04-P & #0112-0000-21-005-H04-T, 1.0 contact hour, Initial Release Date: 9/20/21; Expiration Date: 9/20/24, Knowledge-based Activity. Disclosure – The author has indicated no conflicts of interest related to this topic.

Please visit www.MichiganPharmacists.org/education/online to read the rest of this article, view tables and claim CE credit.

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

— PAAS NATIONAL —

DISPENSING IVERMECTIN MAY POSE AUDIT RISKS

vermectin has been getting a lot of press as of late, from news outlets, national associations, and federal agencies, regarding the dangers of using it to treat or prevent COVID-19. While many of the reports discuss the concern about using veterinary products, there are also many reports of adverse effects when using high, and unauthorized or unapproved, doses of human products.

BY TRENTON THIEDE,

Pharm.D., MBA, president, PAAS National®, expert third party audit assistance and FWA/HIPAA compliance

In March of 2021, the U.S. Food and Drug Administration (FDA) published an article titled Why You Should Not Use Ivermectin to Treat or Prevent COVID-19 which lays out some of the reasons it is currently considered an ill-advised treatment, including not being an anti-viral drug, potential for serious patient harm when taken in large doses, and potential for patients to access via illegitimate sources and/or medications intended for animals. Subsequently, the Center for Disease Control and Prevention (CDC) issued an official health advisory on Aug. 26 to remind both clinicians and the public about the lack of evidence to support ivermectin use for COVID-19 and the potential dangers. Despite the FDA warning, the CDC advisory indicated a 24-fold increase in the number of outpatient prescriptions being prescribed, compared to the pre-pandemic baseline. Consequently, PAAS National® is seeing more pharmacy benefit manager (PBM) audits on ivermectin prescriptions. Pharmacies should be prepared to have claims looked at for potential recoupment on the basis of “clinical appropriateness.” Pharmacists should give extra scrutiny to telemedicine prescribers who may not have a valid patient-provider relationship, be prescribing outside their scope of practice, or not licensed in the state in which the patient resides. Due to the exponential increase in prescribing and dispensing, the American Medical Association (AMA), American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) issued a joint press release on Sept. 1, 2021 calling for an immediate end to the prescribing, dispensing and use of ivermectin for COVID-19 outside of clinical trials.

PAAS Tips:

• PAAS Audit Assistance members can view the July 2021 Article, Audit Risk: Ivermectin Used for Treating COVID-19 on portal.paasnational.com

• Prescriptions successfully processed at point-of-sale do not guarantee payment. PBMs, and payers, use pay and chase methods to recoup claims to avoid inhibiting potentially needed access to medications.

• Prescriptions dispensed for cash may still carry risk (outside the scope of PAAS audit services).

- While off-label prescribing is commonplace, what is atypical with ivermectin treatment for COVID is the FDA, CDC, National Institutes for Health (NIH), and national medical and pharmacy organizations recommending against its utility. Consequently, this seems to open the door for potential malpractice lawsuits to occur.

- At face value, would a prescription be considered reasonable in the face of the aforementioned opposition, or does the pandemic environment and a pharmacist’s experience and professional judgement supersede?

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. ©2021 PAAS National® LLC All Rights Reserved

MichiganPharmacists.org

2021 Oct./Nov./Dec. | Vol. 59, Issue 4

MichiganPharmacists.org