2014 Q1 Missouri Pharmacist

Missouri

Vol. 88, No. 1 First Quarter 2014

Pharmacist United to Improve Health Care

“It is not in the stars to hold our destiny but in ourselves.” ~ William Shakespeare

In this issue: • Understanding Medicare Star Ratings and the Pharmacy Impact • Making a Difference • Back to Basics: Good Old Common Sense Tips • Medication Synchronization • How Pharmacies are Using Facebook • And much more

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The Missouri Pharmacy Association promotes the role of pharmacists in patient care relationships as the medication expert.

contents Advocacy‌ It Doesn’t Have to be Overwhelming............ 5

Association Staff Ron Fitzwater, CAE Chief Executive Officer Phone extension: 222 Email: ron@morx.com

Travis Fitzwater

Chief Operating Officer Phone extension: 233 Email: travis@morx.com

Cheryl Hoffer

Retail Politics............................................................................. 6 New MPA Career Center ....................................................... 8 ISMP Safe Medication Management Fellowships ........... 8 When a Small Reminder Makes a Big Difference............ 9 Pharmacist EHR for Community Practice......................... 9 Making a Difference..............................................................10

Vice President, Pharmacist Program Initiatives Phone: 314-249-2840 Email: cheryl@morx.com

New and Milestone Members............................................. 12

Director of Member Services Phone extension: 227 Email: robyn@morx.com

Understanding Medicare Star Ratings and the Pharmacy Impact................................................................... 20

Robyn Silvey

Sarah Luebbert

Director of Communications Missouri Pharmacist, Managing Editor Phone extension: 225 Email: sarah@morx.com

Back to Basics: Good Old Common Sense Tips..............16

Patients Benefit from Pharmacy-Provided Medication Synchronization Programs .................................................. 24 Synchronization Programs................................................... 25

Drew Oestreich

Emerging Ideas in Medication Synchronization............. 26

Brittiany Turner

UMKC School of Pharmacy Update..................................35

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My MPA Experience: Prescription Drug Monitoring Program....................................................................................38

Pharmacy Provider Relations Phone extension: 230 Email: drew@morx.com

How Pharmacies are Using Facebook...............................30

Administrative Assistant Missouri Pharmacist, Assistant Editor Email: brittiany@morx.com

St. Louis College of Pharmacy Partners with University in Ethiopia............................................................36

Missouri Pharmacist (ISSN 0026 6663) is owned and published quarterly by the Missouri Pharmacy Association, 211 E. Capitol Avenue, Jefferson City, MO 65101.

Missouri Pharmacist is emailed to MPA members. All views expressed in articles are those of the writer and not necessarily the official position of the Missouri Pharmacy Association. Advertising rates furnished upon request.

The Drug Quality and Security Act...................................40 Featured Free CE for MPA members:................................41 A Better Cost of Goods Guaranteed.................................. 42 How Impatience Hurts Retirement Saving......................45

Missouri Pharmacist 211 E. Capitol Avenue | Jefferson City, MO 65101 Phone: 573-636-7522 | Fax: 573-636-7485

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Advocacy… It Doesn’t Have to be Overwhelming President’s Letter The whole idea of advocacy can be overwhelming to people. It can be time consuming. It requires patience and persistence. And, it sometimes requires us to step out of our comfort zone. But if we want to truly expand our practice options – to be recognized as part of the patient care team and achieve provider status with payers - then each of us must be actively engaged in advocacy efforts in some form each and every day.

Professional advocacy comes in many forms. It can be as simple as a 5-minute counter discussion with a patient about the nuances of how reimbursement methodologies and health care regulations affect our ability to care for them. Or, it can be as complex as a multi-year commitment to a leadership role in a professional organization that actively works to craft new statues and regulations that support our goals. Regardless of how one engages, it’s all important and it all makes a difference.

If you’re hesitant to speak with decisions-makers such as legislators or regulators, don’t be. They want to know what is important to you and to your patients. They need your expertise to be able to craft fair and relevant laws that facilitate the use of your skills to improve care for your patients. They’re really just like you and me… people trying to do the right thing for people.

Christian S. Tadrus, Pharm.D., R.Ph., FASCP, AE-C President, Missouri Pharmacy Association

name or your address).

all available on the legislator’s state website (www.house.mo.gov or www.senate.mo.gov, search by legislators

If you are more comfortable on your turf, invite your legislators in to your pharmacy while they are home or during the off-season. Most legislators will return to their districts on Friday and be home for the weekend. Providing them with a quick tour will help them to better understand what pharmacists do and may help you to better explain the issues.

If you prefer face-to-face, attend the MPA Legislative Day on April 9 or sign up for an MPA Pharmacist of the Day slot. Both of these settings are a great opportunity for you to get your feet wet under the wings of experienced members and staff advocates that will work to help set up legislator visits, brief you prior to your Capitol visit and be by your side the whole time.

I encourage you to take an active role in advocating for our profession – especially when it comes to leg- Bring a friend, patient or colleague along. As they islative initiatives. If you’re hesitant on how to en- say, there is power in numbers. It can provide comfort as well as help to reinforce the importance of gage, here are a few tips: the message being presented to legislators.

The two most important steps in advocacy are to know your discussion topics, and to keep your mes- Visits to the Capitol don’t have to be scheduled in sage short and sweet. Make sure your message is advance but don’t be discouraged if your legislator easy to understand and provide examples so legis- is not available to speak with you. They have very lators know how the issue will affect their constitu- busy schedules. But they also have very knowledgeable legislative assistants whose job it is to be aware ents. of constituent’s issues and to keep the legislators inCommunications with legislators aren’t restricted formed. So don’t hesitate to speak with them about to face-to-face meetings at the Capitol. Email ad- your concerns and make sure to leave behind your dresses, phone numbers, and mailing addresses are See President, page 42

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Retail Politics CEO’s Letter Over the years, we have spent a lot of time talking about the political process and how to get our members involved in the battles we are fighting on your behalf. 2014 is a prime example of our need.

Those who have watched the process over the years know there are a number of ways to address legislative issues. Some are brought on by public sentiment and move through the legislative process with relative ease. These types of issues usually get a lot of press and you see a number of legislators jump into the fray trying to offer solutions to address the issue. Often times these issues move relatively quick and fall outside the regular legislative track. Unfortunately, few, if any, of our issues fall into this category.

Other issues are more narrow in focus and require a considerable amount of finesse to get them through the political process. They are issues that may be for the ultimate good of the public, but are complicated to explain and typically end up being championed by a small group or profession that is intimately involved in the issue, and therefore has the best resources to actually address and explain the issue. These issues need effective “retail politics” to be moved through the process. The Missouri Pharmacy Association is involved in a number of these issues in 2014 – both on the federal level and the state level.

Retail politics simply means the issue or the campaign is addressed primarily on a local, one-to-one basis with legislators or Members of Congress. It is based on relationships and partnerships. Trust is a big part of retail politics if it is to be successful.

Ron L. Fitzwater, CAE, MBA Chief Executive Officer Missouri Pharmacy Association

bated and resolved in the marketplace. Therefore, pharmacists are going to have to step up and help us educate Members of Congress and CMS about the positive aspects of the Proposed Rules. If we don’t do it – no one is going to do it for us.

On the state level, we also have these type of issues.

The Missouri Pharmacy Association has worked with legislators in both the House and Senate to file legislation to address MAC pricing problems in Missouri and to expand immunization opportunities for pharmacists. But we must have the assistance of practicing pharmacists to help get these issues adopted and finalized into law.

Here is how you can assist. First, meet with and build a business relationship with your legislators (Missouri House Member, Missouri Senator and your Member of Congress) back home. Invite them into your store and show them firsthand how the issue affects you and your patients. Remember, these folks are the constituents of the legislator. Second, participate in the MPA Legislative Day (in 2014 – it will be on April 9 in Jefferson City). This will give you a way to interact directly with your legislators. Finally, respond to the Action Alerts that are sent out by MPA. We will give you all the tools that you need to contact your legislator(s). These one-on-one contacts are critical to the success of any legislative issue we deal with at the Capitol.

The pharmacy profession has a number of political issues that are going to have to be presented and discussed at the ”retail” level if they are going to make it through the political process. On the federal level, one key example is the proposed new rules that were promulgated regarding the Part D Prescription Drug Plan. There were a number of issues The 2014 MPA Legislative Day will be held on Wednesin those proposed rules that would be very positive day, April 9. I hope to see you there. We will be pracfor pharmacists. But there is too much opposition by ticing “retail politics.”

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Are You “Achieving” Every Reward You Can? Not long ago, MPA announced our partnership with AchieveLinks®, the unique rewards program created exclusively for associations.

If you’ve already activated your account, you already know how fast your Links® Reward Points can add up. Just by making the same purchases you already make for your business and personal life, you’ve been earning valuable Links toward must-have merchandise, valuable gift cards, and once in a lifetime experiences.

If you haven’t activated yet, don’t wait another minute! Go to MORx.achievelinks.com and browse through the hundreds of merchants available for you to earn your Links.

Also now available for free download, the LinksReminder toolbar allows you to shop directly on the web without first visiting the AchieveLinks mall. Any time you’re shopping a merchant partner’s site, the toolbar will display featured coupons and Links earning opportunities. It’s easier than ever to get all the Links you deserve! Simply look for the toolbar banner on the AchieveLinks home page.

Remember, there is no cost, no risk, and no obligation. You’ve already earned all the benefits and privileges of your AchieveLinks account, just by being a member of the Missouri Pharmacy Association Your friends and colleagues are already reaping the rewards of AchieveLinks. Join them now by visiting MORx.achievelinks.com and activating your account today!

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Pharmacy Tidbits

Information You Won’t Want to Miss New MPA Career Center The Missouri Pharmacy Association is pleased to announce the launch of our new Career Center with JobTarget, an industry leader in job board development and management. The career center will focus on connecting employers in the pharmacy profession with eligible, qualified candidates.

pany profile and logo with a posting, and a pay-peruser resume bank.

Job seekers will also find the new Career Center to be easy to use. Do you have a Linked In profile? If so, most of the work of posting your resume is already done with the interconnectivity between your Linked In profile and the resume builder. Candidates can post their resumes anonymously, search through job postings and set up personal job alerts.

One of the many highlights of the center is the availability of niche-specific candidates. By using the MPA Career Center, an employer’s job posting will reach a large number of highly skilled passive and active job Go to MORx.com and click on the Career Center to seekers. Additional benefits to the Career Center infind your next employee or employer today. cludes pre-screen filters, the option to include a com-

ISMP Safe Medication Management Fellowships Despite our best efforts, medication errors happen every day, to every kind of practitioner in every kind of healthcare setting. Very often, the margin of safety depends heavily on the dedication and ability of healthcare professionals. Fellows of the Institute for Safe Medication Practices (ISMP) can be an important part of that safety margin; their work is an instrumental part of ISMP’s efforts to expand knowledge about medication errors and prevention methods.

cation errors.

ISMP’s Safe Medication Management Fellowship programs are unique 12-month learning experiences beginning each July that educate a healthcare practitioner in error prevention and safe medication use methods. Applications for the 2014-2015 fellowship are due March 31, 2014.

The ISMP Safe Medication Management Fellowships are challenging, rewarding experiences that are a clear enhancement to career growth. Fellows have the unique opportunity to make a real difference in medication safety.

However, expanding knowledge and developing strategies is only half the picture--communication and education are the other half. ISMP fellows also work on broad-based communication and education initiatives that reach healthcare professionals and the public with crucial information about the nature of medication errors, what must be done to prevent them, and how to manage errors that do occur.

More information on the fellowships, including a course outline, description of duties, and application. are available on the ISMP website.

Fellows are based in ISMP’s Horsham, PA, office near Philadelphia, and learn and work collaboratively with leading experts to develop and implement interdisci- Please note: The course outline, description of duplinary error-prevention strategies that focus on sys- ties, and application are the same for both fellowtem analysis and effectively reduce the risk of medi- ships.

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When a Small Reminder Makes a Big Difference Have you ever had one of those little warning icons light up on your car’s dash and you don’t know what it means? You know that some signals require attention right away and others can wait. The thing is, most of the time you have to look up the icon to make that decision.

sages – for example, “Warning – Paralyzing Agent” or “Dilute Before Using” – are the only markings that should appear on ferrules and cap overseals of injectable drugs. The ferrules and cap overseals must remain clear of any markings, including logos, except for markings intended to prevent an imminent lifethreatening situation. The standard goes on to say When it comes to medicines and people’s lives, there that warnings must be printed in contrasting color is no substitute for being clear about a warning, and and clearly visible under ordinary conditions of use. for injectable drugs the stakes are particularly high.

Finally, products that do not require cautionary As of December 1, 2013, manufacturers of injectstatements should be free of information, so that able drugs now have to comply with new labeling those with cautionary statements are immediately standards that help ensure that important warnings apparent.

— warnings that can help prevent life-threatening situations — are obvious and clear. The standards With the new USP labeling standard, if a healthcare were established by the U.S. Pharmacopeial Conven- provider sees a warning on a ferrule or cap overseal, tion (USP). USP is a scientific nonprofit organization he or she will know immediately that it is a vital, posthat sets standards for the identity, strength, qual- sibly life-saving piece of information that must be ity, and purity of medicines, food ingredients, and observed and acted upon before administering the dietary supplements manufactured, distributed and drug to the patient. consumed worldwide. USP’s mission is to improve Warning messages on ferrules and cap overseals global health through public standards and related may go a very long way to helping practitioners proprograms that help ensure the quality, safety, and tect their patients from harm. benefit of medicines and foods.

In short, this USP standard states that warning mes-

Reprinted with permission from the U.S. Pharmacopeial Convention, www.USP.org

Pharmacist EHR for Community Practice The Pharmacy HIT Collaborative (Collaborative), of which MPA, through the National Alliance of State Pharmacy Associations, is a proud member, has recently worked with Health Level Seven (HL7) to post the “Pharmacist Electronic Health Record (EHR) Implementation Guide for Community Practice” on the EHR Functional Profile page of the HL7 website.

tive Director Shelly Spiro, BSPharm, RPh, FASCP, the Collaborative formed several workgroups, all composed of volunteers, to enable pharmacists to better document the clinical exchange of information.

“I want to commend and thank the workgroup cochairs, volunteers, and staff members who worked on this guidance document. Working with HL7 to add this guidance document marks an important step for the Collaborative and pharmacy system vendors to move toward adoption and implementation of the Pharmacist EHR,” said Rebecca Snead, CEO of the National Alliance of State Pharmacy Associations.

Pharmacist Electronic Health Record (EHR) Implementation Guide for Community Practice: as pharmacists prepare to electronically collect, document and exchange clinical information, the pharmacy management systems need the appropriate functionality to capture these functions. This guide will help EHR certification organizations develop certifi“Now that this document is available on the HL7 and cation criteria for Pharmacist EHRs. Collaborative websites, we hope community pharFounded in 2010, the Collaborative was formed to fo- macists will work with their pharmacy system vencus on improving patient care quality and outcomes, dors to encourage adoption of this Pharmacist EHR through the integration of pharmacists’ patient care standard functional profile,” said Shelly Spiro, Execservices in the national health information technol- utive Director, Pharmacy HIT Collaborative. ogy infrastructure. Under the leadership of Execuwww.MORx.com

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Making a Difference Imagine driving two hours to work each day for a week in an area where the roads are dirt paths, there are no street signs, and somebody on a motorcycle meets you to take you through a maze that leads to hundreds of patients waiting for your arrival.

Jim Weissler, BS Pharm, doesn’t have to imagine this; he has experienced it for the past four years on his annual Project H.O.P.E. Nicaragua trip, from which he just completed in January. “Universally it is an overwhelming, life-changing experience for all who have experienced such human poverty. I now have empathy for what I previously only read about from such people as Mother Teresa or Pope Francis,” said Weissler.

As the only pharmacist on a forty-nine-person team that assists around 4,000 people during their trip, Weissler stays very busy. Other medical professionals that make up the team include a cardiologist, internist, emergency medicine, family practice, dentist, dental hygienist, oral surgery, registered nurses, and optician. Some of the team members are Nica-

raguan, but the majority come from the Springfield, Mo. area, the home base of Project H.O.P.E. A friend of Weissler’s, also in the medical profession, is the one that introduced him to the idea of traveling to Nicaragua on the medical mission trip. “I knew the mission trip must be credible because I was also

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acquainted professionally with several of the other highest quality providers who make the annual trip,” Weissler explained. While many would be hesitant to remove themselves from their modern day technologies and comforts, Weissler believes that the more you give of yourself in service to others to make the world a better place, the more you will receive in return. This is the same reason he joined the pharmacy profession.

Each day, the Project H.O.P.E. team would travel approximately two hours from their home base of Suyapa, to a community where they would set up their clinic sites. The pharmacy was set up in a variety of locations, but the main priority in choosing a location is to select a shaded area. “I have set up the pharmacy in a barber shop that was an extension of a home, a small retail store, also an extension of a home, and on the shaded side of a community center,” Weissler explained.

Skin infections, COPD/asthma, internal and external parasites, scabies, ear infections, hypertension, respiratory infections, GERD, erosive esophagitis, sinusitis, and chlamydia are just a few of the common conditions seen at each location. The pharmacy also did all the pregnancy and glucose tests. The pharmacy tech, a registered nurse, was responsible for

cleaning and bandaging all the wounds. While this may seem stressful, Weissler noted, “It is great to practice pharmacy the way I started in 1976. There is the patient, the doctor and the pharmacist, no third party telling you how to provide health care.”

The medications provided during this trip are purchased, with funds raised through Project H.O.P.E., from a permanent medical clinic in Managua, NI. One U.S. dollar is equal to 20 Nicaraguan Cordoba’s so you get a lot of medicine for the money. The Nicaraguan clinic used is inspected and licensed by the Nicaraguan government. In addition, each member of the team that travels brings a 50-pound tote of supplies, including cases of reading glasses. All medications brought to Nicaragua must be FDA approved and in-date, nothing expired is allowed in the coun-

Memorable Moments An unknowing patient had significant diabetes that was causing peripheral diabetic neuralgia to the point of apparent leg venous stasis, which is now being treated.

The treatment will save his legs and improve his quality of life.

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termelons,” Weissler said.

try. “Quite often, the medications are personally purchased by the providers knowing from experience what medications the patients will require when we get there. I personally brought oral syringes and a scale from home to establish the proper does of medications based on weight,” said Weissler.

“If you want to make a lot of new friends in Nicaragua, bring a bag of suckers! At the clinics, through an interpreter, I was able to explain each prescription given out to the patients, and handed out stickers and candy to the children,” said Weissler. He also noted that most of the homes are the size of an average master bedroom in the United States. They have dirt floors and wood burning stoves (a common cause of COPD), with walls made out of plastic or scrap metal sheets. The fences are barbwire and nothing flushes in Nicaragua, outhouses are the standard.

“They take excellent care of what little they possess.

It was not unusual to see a mom or dad sweeping the dirt floor of their house. Everything was immaculate when we arrived in each clinic location. They also dressed in their best clothes to come see us. By the end of the day everything was covered in dust.

The children would continually throw water on the streets to limit how much dust would be blowing into the pharmacy.”

The trip doesn’t come without some risk for those that exist in this foreign land during their week stay. “I would only eat what Dr. Bob Scott would eat,” explained Weissler. “Dr. Scott has done this annually for 21 years. I would say that 25 to 50 percent of our staff is infected with some kind of bug while we are there. Knock on wood, I have never been sick. I loved eating their pineapple, watermelon, papaya and cantaloupe. Most meals included rice and beans. I missed clean water to drink, as I never drank anything that was not sealed by a manufacturer. I never drank their delicious looking fresh tropical fruit drinks and I never ate salad because they wash the lettuce with their water. I lost five pounds while I was there.”

The experience and gratitude far outweigh the risks on the trip for those that participate in Project H.O.P.E. “The Nicaraguans are very patient people,” Weissler explained. “There would be 600 people waiting in a single file line in their best clothes to see us. It is also part of their everyday conversation to include God. I cannot count how many times a patient blessed me after giving them their prescription. They would say ‘Dios Le Bendiga, May God Bless You.’ And at the end of each clinic day we would gather with the local Nicaraguans who had organized the clinic and the leader would say a prayer and thank us from the bottom of their hearts.

“Our bus rides back to our base camp each day were

The team for Project H.O.P.E. remains very busy while in Nicaragua, but there is a little time during the day to venture out and explore local culture. “Each day the clinic would close for about an hour to eat lunch. During lunch I would walk around the area and I encountered many things including people walking with large stacks of items on top of their heads, a monkey, an alligator, tropical birds, boys playing soccer in bare feet on the hot ground, a casket manufacturer, and fields of papaya, mango, bananas and wa12 | Missouri Pharmacist | First Quarter 2014

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filled with lively conversations of what we witnessed that day during clinic. By the time dinner was finished it was time for bed.

I always slept like a rock and woke up early for another adventurous day of making a difference in someone’s quality of life, and being appreciated for my effort.”

If you are interested in learning more about Project H.O.P.E., go to www.PJHope.org. In addition to the medical mission trip, they offer construction and children ministry trips, agriculture and water project programs, social programs and adult education programs.

Jim Weissler, BS Pharm, is a pharmacist at the Jordan Valley Community Health Center Pharmacy in Springfield, Mo., and an active member of the Missouri Pharmacy Association.

A small child, who could not walk due to a congenital disease, was being carried everywhere by her mother for the past several years.

Within two hours a staff member was able to deliver to her the absolute “coolest” pink wheel chair that you could ever imagine. They both left with huge smiles on their faces.

Project H.O.P.E. • Since March of 1999, Project H.O.P.E. has built 1,096 homes in 32 communities around Nicaragua.

• Over 10 water wells have been drilled to ensure clean water to the people in the surrounding communities.

• Five schools have been constructed and four schools have received additional repairs and expansions.

• Every year, over 9,000 people receive medical and dental care.

• For more information on Project H.O.P.E., go to www.pjhope.org.

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“i’M AlWAyS WAtChing Out fOr My PAtientS, but whO’s watChiNg Out fOr Me?”

we are.

We are the Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization.

Our Pharmacy Quality Commitment (PQC) program helps you implement and maintain a continuous quality improvement program that offers strong federal protection for your patient safety data and your quality improvement work. PQC also helps you comply with quality assurance requirements found in network contracts, Medicare Part D, and state regulations. We offer flexible and powerful tools, ongoing training and support to keep your pharmacy running efficiently, and most importantly, to keep your patients safe.

LearN MOre: Call toll free (866) 365-7472 or visit www.pqc.net is brought to you Quarter by your state PharmaCy assoCiation 14 | MissouriPQC Pharmacist | First 2014

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New Members

Milestone Members

Jamie Barton, Pharmacist

50 Years Joseph Tuley, RPh

Ana Dale, New Graduate Chad Day, Associate member

25 Years Gary Fox, BS Pharm

Susan Duffett, Pharmacist Suu Duong, Pharmacist

10 Years Rita Barnes, Technician

Stephanie Hawkins, Pharmacist Katelyn Lutz, Student Erik Martinez, Student

5 Years Daniel Blakeley, BS Pharm, MBA

Kensy Maxwell, Student

Michael Burns, RPh

Kimberly Nolte, Pharmacist

Beth Hall, PharmD

Babette Schilling, Pharmacist

Adrienne Klingsmith, PharmD

Stephanie Seaton, Pharmacist

Matt Montgomery Julia Moser

Jamie Shelly, Pharmacist

Michael Schultz, RPh

Sandra Tooley, New Graduate Tom Trussell, Technician Kathleen Voltz, Student

PAAS Membership Benefits

• Expert Third-Party Audit Assistance • Monthly Third-Party Newsline • PAAS Member Manual & Third-Party Guide • PBM Resource/Advice & Contract Information • Valuable Forms & Reference Tools

Be Proactive. Be Protected. Be Prepared.

JOIN PAAS TODAY! 888.870.7227 | PAASnational.com

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Back to Basics: Good Old Common Sense Tips If your mother taught you any manners at all, you know how you are supposed to properly act in public and politely to others.

And if you were taught all of these wonderful tips, you probably realize that you don’t always use them like you should. So here are a few short, simple, and straight to the point reminders to help you put your best foot forward everyday with coworkers and customers. Here we go:

1.

“Please” and “thank you” always have been, and always will be, powerful words. Seldom overused.

2.

3.

“Sorry ‘bout that” is not an apology. It’s a cliché. “My apologies” is much better.

4.

5.

“You’re welcome” is the best replacement for “no problem.”

A frown is a smile upside down. Stand on your head if you must; but SMILE, darn it!

You cannot do two things well at once. Pay attention to the call or the customer.

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One word answers on email or in person are considered cold and rude. Three words make a sentence.

6.

7.

Learn what phrases frustrate your customers. They’re probably the same ones that bother you.

8.

9.

Drop a personal handwritten note to a customer and just say “thanks for being a good customer.”

10.

11.

Email manners? The same as phone and in person.

The old “don’t tell ‘em what you can’t do; tell ‘em what you can do” applies to most, if not all, customer interactions.

14.

15.

“Hey how ‘ya doing?” is not a great way to start up a conversation.

Out with friends or family? Put the cell phone away. Talk for 30 minutes. (If you remember how.)

12.

13.

When was the last time you sent flowers to someone just because?

Get excited!

Oh, and smile. That needed to be said twice.

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Reprinted with permission of Telephone Doctor Customer Service Training. Nancy Friedman is a featured speaker at association & corporate meetings. She has appeared on OPRAH, Today Show, CNN, FOX News, Good Morning America, CBS This Morning & many others.

For more information, call 314-291-1012 or visit www.nancyfriedman.com.

Missouri Pharmacist | First Quarter 2014 | 17

THE PTCB

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Certification by PTCB is the gold standard for pharmacy technicians. Many employers now require their employees to be PTCB-Certified Pharmacy Technicians (CPhTs).

PTCB has a new website, a streamlined application process, sponsorships, and free verifications. The Pharmacy Technician Certification Exam (PTCE) reflects current knowledge areas demanded across all practice settings. PTCB’s requirements to become a CPhT include a high school diploma and a passing score on the PTCE. Learn more and apply at www.ptcb.org.

Get the

PTCB ADVANTAGE Become a

PTCB CPhT TODAY

SETTING THE STANDARD 18 | Missouri Pharmacist | First Quarter 2014 www.ptcb.org CONNECT ONLINE: www.MORx.com

Remember learning about contract negotiation in pharmacy school?

Maybe it’s because you were busy learning to be a pharmacist. But what you didn’t learn then, doesn’t have to hold your pharmacy back now.

Because now there’s ProfitGuard. ProfitGuard utilizes a team of expert negotiators to secure

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better pricing, rebates and terms on your supplier contract. Guaranteed. Securing chainlike pricing is possible, if you’re backed by the expert negotiators at ProfitGuard. www.pbahealth.com/profitguard

6300 Enterprise Road Kansas City, MO 64120 800-333-8097

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Understanding Medicare Star Ratings and the Pharmacy Impact Written by: Heather Worthington PharmD Candidate 2014 University of Missouri - Columbia School of Pharmacy how do star ratings impact pharmacy?

The Centers for Medicare and Medicaid Services (CMS) developed the Five Star Quality Rating System to help educate Medicare beneficiaries (members) on quality and provide transparent Medicare plan information, as well as improve the overall quality of services the Medicare plans provide.

• Member experience with drug plan • Drug pricing and patient safety.

CMS gives the different quality measures a “star” rating based upon information from member satisfaction surveys, plans, and healthcare providers. CMS then takes all the individual ratings and summarizes them into a single star rating for the plan.

If a member does not choose “traditional” Medicare, there are several other plan options. For example, a Ratings are displayed as 1 to 5 stars Medicare Advantage Plan is a type of Medicare plan 5 STARS = Excellent offered privately that then contracts with CMS and 4 STARS = Above Average provides the member with all Part A and Part B bene3 STARS = Average fits (Note: Part A & Part B combined = Medicare Part 2 STARS = Below Average C). Most Medicare Advantage Plans offer prescrip1 STAR = Poor tion drug coverage (Medicare Part D) and then are referred to as a Medicare Advantage – Prescription Pharmacies do not directly receive a star rating from Drug Plan (MA-PD).

CMS. However, they certainly impact a plan’s star A stand-alone prescription drug coverage plan is re- rating, providing collaborative opportunity to work ferred to as a Medicare Prescription Drug Plan (PDP). together as a healthcare team. Plans are interested in collaborating and contracting with pharmacies MA-PDs and PDPs are plans that provide opportuni- that perform well on specific medication manageties for community pharmacies to positively, or neg- ment quality measures. atively, impact a plan’s star ratings.

These plans are rated across four different catego- The FIVE star2 measures related to medication management ries, including: Out of the multiple quality measures, five are spe• Plan customer service • Member complaints, problems getting services, cifically related to medication management. The following measures are where pharmacies have the choosing to leave the plan Sources: 1. Jackie Green, Pharmacy Quality Alliance. PQA measures used by CMS in the star ratings. Retrieved from http://pqaalliance.org/measures/cms.asp

2. Medicare.gov. Star ratings. Retrieved from http://www. medicare.gov/find-a-plan/staticpages/rating/planratinghelp.aspx?AspxAutoDetectCookieSupport=1

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most impact on a plan’s star rating:

hibitors, INSULIN NOT INCLUDED)

1. High Risk Medication—Percent of plan members 4. Medication Adherence for Hypertension who received prescriptions for certain drugs with (RASA)—Percent of plan members with a prea high risk of serious side effects, when there may scription for a blood pressure medication who be safer drug alternative choices. (Based off the fill their prescription to cover 80% or more of the Beer’s List.) time they are supposed to be taking the medication. (Note: Includes ACE-I, ARB, or a direct renin 2. Diabetes Treatment—Percent of patients with inhibitor drug.) diabetes who received one of the recommended types of blood pressure medications. (Note: 5. Medication Adherence for Cholesterol (Statins)— When people with diabetes also have high blood Percent of plan members with a prescription for pressure, there are certain types of blood presa statin drug who fill their prescription often sure medications recommended, an ACE-I/ARB.) enough to cover at least 80% or more of the time they are supposed to be taking the medication.

3. Medication Adherence for Diabetes—Percent of plan members with a prescription for diabe- These five measures are weighted so heavily in the tes medication who fill their prescription often star score summary that they make up almost half of enough to cover 80% or more of the time they the total star rating score provided by CMS. are supposed to be taking the medication. (Note: What are the 2014 star rating cut-offs?

Includes biguanide, sulfonylurea, TZD, DPP-IV inBenchmarks are determined through previous years’ data.

Medicare Advantage Plans3 Medication Adherence for Hypertension

Medication Adherence for Cholersterol

< 67%

< 68%

< 63%

≥ 82% to < 85%

≥67% to < 71%

≥ 68% to < 72%

≥ 63% to < 68%

> 5% to ≤ 8%

≥ 85% to < 86%

≥ 71% to < 74%

≥72% to < 75%

≥68% to < 71%

4 STARS

> 3% to ≤ 5%

≥ 86% to < 87%

≥ 74% to < 77%

≥ 75% to < 79%

≥ 71% to < 75%

5 STARS

≤ 3%

≥ 87%

≥ 77%

≥ 79%

≥ 75%

Medication Adherence for Hypertension

Medication Adherence for Cholersterol

Diabetes Treatment

Number of Stars

High Risk Medication

1 STAR

> 11%

< 82%

2 STARS

> 8% to ≤ 11%

3 STARS

Medication Adherence for Diabetes Medications

Medicare Part D Plans3 Diabetes Treatment

Medication Adherence for Diabetes Medications

Number of Stars

High Risk Medication

1 STAR

> 11%

< 80%

< 73%

< 73%

< 70%

2 STARS

> 8% to ≤ 11%

≥ 80% to < 82%

≥73% to < 76%

≥ 73% to < 76%

≥ 70% to < 72%

3 STARS

> 5% to ≤ 8%

≥ 82% to < 83%

≥ 76% to < 79%

≥76% to < 79%

≥72% to < 74%

4 STARS

> 3% to ≤ 5%

≥ 83% to < 84%

≥ 79% to < 82%

≥ 79% to < 81%

≥ 74% to < 76%

5 STARS

≤ 3%

≥ 84%

≥82%

≥81%

≥ 76%

Source: 3. Centers for Medicare and Medicaid Services, (2013). 2014 part c & d medicare star ratings data. Retrieved from website: http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html

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How are medicare plans responding to these changes?

• Plans are aligning with the star measures by4: • Changing formularies • Forming clinical strategies • Reviewing network contracts Why do plans care about star ratings?

• Plans can receive quality bonus payments from the federal government when they have good star ratings.6 • These bonuses must be used to improve the care delivery system • $3.1 billion of quality bonus payments in 20128

agement quality measures. Plans will use contract strategies with pharmacies to improve these ratings through: • Pharmacy Preferred Network4—Health plans will contract with pharmacies that have higher performance ratings • Pay-for-Performance4—Pharmacies may position themselves to be eligible for future bonus payments based on performance

What does this mean for your pharmacy?

Community pharmacies must change to continually thrive. To contract with a plan’s preferred network and to capitalize on payment for patient care services delivered, pharmacies need to demonstrate they can positively impact patient outcomes, keep • Patients can choose to leave their current patients adherent to their medications, identify gaps plan for a 5-star plan at any point during De- in care, and identify inappropriate medication use.

Pharmacists’ ability to engage patients with their cember 8th to November 30th6 own healthcare will impact both the patients’ health • 5-star plans can market year-round outcomes and the pharmacies’ performance meas• Patients will not be allowed to enroll in a ures. plan if it received low scores for 3 straight With adherence making up 3 of the 5 medication years6 management quality measures, plans will focus • More patients are likely to choose a plan with a higher star rating5 • Plans with higher star ratings tend to have higher premiums • The difference in payment between a 3-star and a 5-star plan averages $16/ member/month7 • If a plan has 1 million members, this equates to $192 million per year of added revenue7

Where do pharmacies play a role?

To improve star ratings, plans are looking more and more to pharmacies for improving medication manSources: 4. Nau, D. (2013). CMS medicare part d star ratings 2013.

Retrieved from http://pqaalliance.org/resources/other.asp 5. Ried, Partha, Howell & Shrank. JAMA 2013; 309 (3)267274 6. Oates, V. Centers for Medicare and Medicaid Services, Division of Clinical and Operational Performance. (2013).

Cms’ star ratings program. Retrieved from website: http:// regional.nacds.org/presentations/Using_Star_Ratings.pdf 7. Lambert, W., & Nau, D. (2011, August). Medicare part d star ratings: Opportunities for community pharmacy. Pharmacy technology conference, Boston, MA. Retrieved from

With adherence making up 3 of the 5 medication management quality measures, plans will focus more attention in improving these measures. http://www.rxconference.org/presentations/Nau.Lambert.

Dimos.pdf 8. Conklin, M., Masci, K., & Chan, C. (2013, June 6). Engaging your pharmacy network for star ratings improvement.

Retrieved from http://www.pqaalliance.org/images/uploads/ files/Engaging Your Pharmacy Network for Star Ratings Improvement.pdf 9. Logan, R. & Logan, T. (2013, November). You future is in the stars. America’s Pharmacist, Retrieved from http:// www.americaspharmacist.net/issues/APNOV13-Future_is_ in_the_Stars.pdf

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more attention in improving these measures. Mailorder pharmacies might have had an advantage over community pharmacies in reaching the adherence performance measures however, CMS instated new regulations within mail-order pharmacies stating they must call and verify new prescriptions and refills with patients before mailing the medications(10).

This addresses Medicare beneficiaries’ complaints over receiving and being charged for medications they did not need or want. This also helps to level the playing field between community and mail-order pharmacies when it comes to these adherence measures.

Challenges for the community pharmacy Time9 Pharmacists need designated time to devote to patient care service delivery in the pharmacy. Patient care services include, as example, the annual Medicare Part D Comprehensive Medication Review (CMR), medication adherence and gaps in care programs, and more. Pharmacies need to streamline workflow and become more efficient at filling prescriptions, now more than ever. Tools are available to help with adjusting workflow and improving pharmacy performance, including medication adherence and medication synchronization programs.

Money9 A financial opportunity exists for pharmacies providing patient care services, including payment available through some plans and patient care documentation platforms. Pay-for-performance is the future payment model, with data supporting a payment structure reflecting pharmacists’ ability to improve patient outcomes and save health care dollars.

how to advance your pharmacy practice to achieve and maintain a high performance level.

Know your numbers!

Tools are available to help you monitor your pharmacy’s performance, in relation to medication adherence and star ratings.

Pay-for-performance is the future payment model, with data supporting a payment structure reflecting pharmacists’ ability to improve patient outcomes and save healthcare dollars.

Other available resources http://www.medicare.gov/Pubs/ pdf/11226.pdf http://www.amcp.org/QBP_framework/ http://smartretailingrx.com/regulatorypublic-affairs/star-ratings-explained/

For pharmacies, it is extremely important to understand what implications star ratings have on health plans and how they subsequently affect you. Pharmacists have a huge opportunity to positively impact the quality of healthcare as well as position pharmacies to be eligible for reimbursement through payfor-performance. Now is the time to know if you are a high-performer or a low-performer as well as know

S ources : 10. Schweers, K. (2013, October 3). [Web blog message]. Retrieved from http://ncpanet.wordpress.com/2013/10/03/ medicare-addresses-mail-order-waste-refill-synchronization-for-2014/

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Patients Benefit from PharmacyProvided Medication Synchronization Programs >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Nationwide Study Shows Higher Adherence, Persistence Among ‘Synced’ Patients

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Patients who opt in to medication synchronization programs offered through their community pharmacy average more than 100 additional days on therapy per year and are 30 percent more likely to take their medication as prescribed (or to be “adherent”) than patients not enrolled in a synchronization program, according to the results of a new study project conducted by the National Community Pharmacists Association (NCPA®).

medication therapy; and to confirm that the patient needs the medication before it is dispensed. The biggest predictor of medication adherence is patients’ personal connection (or lack thereof) with a pharmacist or pharmacy staff, according to Medication Adherence in America: A National Report Card.

“This study confirms that a personalized medication synchronization service delivered by community pharmacies is impactful, scalable, and able to be The study conducted by NCPA and technology part- replicated in any community pharmacy,” said NCPA ner Ateb involved more than 1,300 patients enrolled CEO B. Douglas Hoey, RPh, MBA. “It’s also further in medication synchronization programs at 10 inde- evidence of the positive impact that these and other pendent community pharmacies across the country. types of pharmacy-provided services can have on The pharmacy coordinated patients’ chronic pre- patient health. As trusted, accessible medication exscription medications to be filled on the same date perts, community pharmacists are ideally positioned to counsel patients and ensure they take medicaeach month. tions as prescribed and understand their importance Patients receiving synchronization services averaged to better health.” an additional 103 days on therapy than those not enrolled in such a program (337 versus 234, respec- Other key findings from the study: tively). Nearly 90 percent of patients who received • Patients enrolled in a medication synchronizasynchronized refills were considered adherent as tion program received an average of 3.4 more remeasured by the Proportion of Days Covered (PDC) fills per prescription over a 12-month period than compared to 56 percent of patients not receiving non-enrolled patients. The average enrolled pasynchronized refills. tient was taking 5.9 synchronized medications.

Moreover, these gaps in medication coverage were Participating pharmacies filled 20 more prescriptions per year on average for these patients. reduced along with the provision of adherence-supporting services from the community pharmacies • First-fill abandonment (prescriptions that are inithat patients do not typically receive through mail tially filled and never refilled despite having refills order auto-refill shipments. Patients in the medicaremaining) was reduced over 90 percent for pation synchronization program received a monthly tients enrolled in the medication synchronization call from their pharmacy to discuss medications and program. dosing instructions; to determine whether any physician visits or hospitalizations may have changed See NCPA on page 29 24 | Missouri Pharmacist | First Quarter 2014

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Synchronization Programs >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Disclaimer: 1. This chart does not provide a comprehensive list of all available synchronization programs. It is recommended you research program options and determine the right fit for your pharmacy.

2. As with any program, you are responsible for the implementation of best practices, complying with all Board of Pharmacy regulations and guidelines, as well as any third party agreements and contractual requirements.

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Emerging Ideas in Medication Synchronization Written by: Samuel Stolpe, PharmD, associate director, quality initiatives, Pharmacy Quality Alliance Elliott Sogol, PhD, RPh, FAPhA, vice president, professional relations, Pharmacy Quality Solutions Medication Synchronization We often see new ideas in the pharmacy profession that actually are not that new at all. The topic of synchronizing medications for patients is not a new idea, but one that has come to fruition. The following is a basic overview of one model for medication synchronization—an Appointment Based Model (ABM).

tion refills are aligned so that they all fall due on the same day. Patients come in once monthly to collect prescriptions on an appointment date around which the pharmacy offers clinical services, such as brief counseling, blood pressure screening, medication therapy management (MTM), immunizations and other clinical services. Using focused appointment confirmation calls, pharmacy staff replaces rushed, disruptive inbound communiqués and frenzied visits with a single, monthly outbound communication.

Why choose to move toward Medication Synchronization?

Situations where pharmacy process workflow and Three key features define the model3: continuity of care are interrupted by a patient or car1) The synchronization of patient refills. egiver’s concerns and management of medication therapy arise frequently under the traditional prac2) The use of a regular (typically monthly) tice of community pharmacy. The resulting time-inoutbound pre-appointment call to the patient tensive interruptions to normal operations can result or designated care provider to capture which in significant pharmacy inefficiencies. Studies have medications are appropriate to be filled, shown that interruptions in workflow lead to signifiincluding any changes to the patient’s cant reductions in medication dispensing rate, and medication regimen.

1,2 increases in dispensing errors . These interruptions 3) The appointment date itself. can be as simple as an inbound call from a patient to request a refill during normal operating hours.

Benefits of ABM ABM pharmacies can see increased opportunities to What is the Appointment-Based Model (ABM)? schedule ancillary clinical services beyond dispensWith ABM, the pharmacy takes responsibility for ing at the time of the patient’s appointment. When managing patients’ medications. Chronic medicapharmacy staff knows the appointment date that paS ources : 1. Flynn EA, Barker KN, Gibson JT, Pearson RE, et al. Impact of Interruptions and Distractions on Dispensing Errors in an Ambulatory Care Pharmacy. Am J Health-Syst Pharm.

1999;56:1319-25.

2. Grundgeiger T, Sanderson P. Interruptions in Healthcare: Theoretical Views. Internat J Med Info. 2009;78:293-307.

3. Pharmacy’s Appointment Based Model: A Prescription Synchronization Program that Improves Adherence. APhA Foundation Whitepaper. Aug 2013. Available at: http:// aphafoundation.org/sites/default/files/ckeditor/files/ABMWhitePaper-FINAL-20130923(3).pdf. Accessed February 9, 2014.

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tients will come in to collect their medications, they can better manage their inventory. Pharmacies using ABM have also seen increases in patient satisfaction and customer loyalty. Workflow improvements and efficiencies can be seen as staff better manages both inbound calls from patients and outbound communications to patients and prescribers3. And if the patient moves to a more adherent status, increases in ROI are seen based on increases in prescriptions being filled and clinical services rendered. Perhaps the most widely publicized benefit of ABM is its support to patients in adherence to chronic medications. Patients enrolled in an ABM program have demonstrated adherence increases by as much as an average of 84 additional days of medication on hand per medication per year4.

Getting Started The National Alliance of State Pharmacy Associations (NASPA) hosts a number of free, open-sourced resources and templates for the development of ABM materials on their webpage5. We encourage you to review this reference for much more detailed information on the ABM process. A two-hour CE course for pharmacists and technicians is available through Drug Store News6.

Participation in ABM usually occurs on an opt-in basis. If the patient agrees to participate in the synchronization program, the pharmacy staff should inform the patient’s prescriber as well. This can be accomplished by a form letter to the prescriber, along with a fax request for refills of the synchronized medications. Patient agreements are optional, but should

Basic Steps to implement the appointment based model for medication synchronization

1.

2.

Patient opts-in to synchronization program.

3.

Communicate with prescriber.

4.

Select anchor medication.

5.

Decide what medications should be included in the synchronization program.

6.

Schedule appointment date on the refill date of anchor medication.

S ources : 4. Holdford D, Inocencio T. Adherence and persistence associated with an appointment-based medication synchronization program. J Am Pharm Assoc. Nov 2013;53:576-583.

5. National Alliance of State Pharmacy Associations. “Appointment Based Model”. Available at: http://www.naspa.

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Short-fill selected medications to get to same refill date as anchor medication.

us/grants/abm.html. Accessed February 9, 2014.

6. Stolpe SF. Medication synchronization using the appointment-based model. Drug Store News. Nov 2013. Available at: http://www.cedrugstorenews.com/userapp/lessons/lesson_view_ui.cfm?lessonuid=0401-0000-13-013-H04-P. Accessed February 9, 2014.

Missouri Pharmacist | First Quarter 2014 | 27

be considered.

All medications that will be included within the ABM calls to patients need to be synchronized to fall due on the same scheduled appointment date. This is accomplished by selecting an anchor medication. The anchor medication is the drug around which the synchronization is built. The pharmacist will short-fill (give less than a full refill) the patient’s other chronic medications such that they will have a sufficient medication quantity available until their next full refill, targeting the same refill date as the anchor medication. Using this method, the refill date of the anchor medication will be the patient’s appointment date.

Because medications usually are dispensed according to a set 30 or 90-day cycle, whereas the months of the year follow an entirely different and inconsistent pattern the exact date of the appointment will change month by month.

The process of synchronization begins with the pharmacist or technician considering the patient’s chronic medications to be included in the synchronization. The pharmacist documents the medications to be synchronized on a pre-appointment call sheet (http://www.naspa.us/grants/abm.html), such the one developed by NASPA. Most oral medications used to treat chronic conditions are recommended.

However, drugs that are used to treat chronic conditions that are taken on an “as needed” basis such as some anxiolytics, analgesics, sedative hypnotics, etc., shouldn’t be synchronized. The same holds true for drugs with non-standardized dosing (insulin, creams, eye drops, emergency inhalers), drugs that are on a nonstandard cycle (some bisphosphonates, oral contraceptives, Vitamin D), unit of use drugs, and acute medications.

Helpful Implementation Tips 1. Have one pharmacy technician manage the program.

2. Create a script that the technician can follow when contacting the patient and offering program participation.

3. Document the patient’s response, including medications and schedule agreed upon.

4. Remember it is easier to move a fill date forward versus back, ensuring the patient does not run out of medication.

5. Be prepared to modify the synchronization fill date monthly, as needed.

6. Define your process, which includes allowing sufficient time to contact the physician if needed, prior to the patient visiting your pharmacy.

Tips provided by Marty Michel, R.Ph., MBA, CDE, CF, Key Drugs, Poplar Bluff chor medication. These medications must be shortfilled at the pick up time when the first of such medications becomes due. The patient will get a full refill and pay a full copay for these medications at the appointment date.

Pharmacies will need to develop a daily ABM operations process that staff follow to ensure that all medications are filled according to schedule.

The majority of anchor medications will be the drug with the highest copay or out-of-pocket expense to the patient. However, there are circumstances when it makes more sense to select another medication.

Some examples include when a patient has multiple pre-written C-II medication prescriptions, has a medication that comes in “unbreakable” packaging, or if the patient prefers to have different cycle medications included in synchronization.

Addressing Challenges Implementation of the appointment-based model is not without its challenges. Building an ABM program takes planning and foresight. There are many flexibility points to the program (i.e., how many days in advance to make the pre-appointment call, how to market the program, how to keep short-fill costs low for patients, etc.) that the pharmacy leadership will need to make decisions about in advance of implementation. Technological support tools are available The patient will need to come in before the first apthrough third-party vendors that may aid a pharmacy pointment date to collect medications that were last in addressing some of the ABM challenges. filled before the most recent dispensing of the an28 | Missouri Pharmacist | First Quarter 2014

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Patients will occasionally fall out of sync for various reasons, such as vacations, emergency travel, hospitalizations, etc. Pharmacists should directly address issues of non-adherence through appropriate adherence counseling during the pre-appointment calls and the appointment itself. Corrective short-fills may be used to bring medications back into synchronization.

The pharmacist should keep in mind that not all patients will be ideal candidates for the model, and use professional judgment in selecting medications to synchronize. For example, if a patient is on a lot of medications that simply do not sync well (lots of insulins, eye drops, creams, etc.), it may make more sense to follow the traditional model entirely for such patients.

rollment. JAMA. 2013 Jan 16;309(3):267-74.

National Alliance of State Pharmacy Associations. “Appointment Based Model”. Available at: http://www.naspa. us/grants/abm.html. Accessed October 27, 2013.

McDonough RP, Doucette WD. Using Personal Selling Skills to Promote Pharmacy Services. J Am Pharm Assoc.

2003;43:363-374.

Stone D. The Business Case for Adherence. Am Pharm.

September 2010;30-32.

Understanding Medicare Part C and D Enrollment Periods.

Centers for Medicare and Medicaid Services. Available at: http://www.medicare.gov/Pubs/pdf/11219.pdf.

Accessed October 27, 2013.

Helping patients and caregivers through medication synchronization is one of a number of methods that support patient centered care focused on outcomes of care including tracking adherence rates making sure that we partner with our patients toward better medication management and use.

A dditional references Thinking Outside the Pillbox. New England Healthcare Institute Whitepaper. Aug 2009. Available at: www.nehi.net/ uploads/full_report/pa_issue_brief__final.pdf.

Accessed October 27, 2013.

NCPA, Continued from page 24

The NCPA study is the first study to look at a group of independent pharmacies that are not under common ownership and do not operate the same pharmacy management system. Pharmacies used Ateb’s Time My Meds® online adherence platform to idenCutrona SL, Choudhry NK, Fischer MA Servi A, et al. Modes tify patients for enrollment and to manage the daily of Delivery for Interventions to Improve Cardiovascular Medi- operations of the participating pharmacies’ medicacation Adherence. Am J Manag Care. 2010;16(12):929-42. tion synchronization programs.

Oldfield E. Pharmacists Rank Among Most Trusted Professionals. Pharm Times. Available at: http://www.pharmacytimes.com/news/Pharmacists-Rank-Among-Most-TrustedProfessionals. Accessed October 27, 2013.

Nau D. Executive Update on Medication Quality Measures in Medicare Part D Plan Ratings. Pharmacy Quality Alliance.

Estimates indicate that more than 1,600 community pharmacies are providing medication synchronization services to more than 70,000 patients nationwide through established medication synchronizaCenters for Medicare and Medicaid Services. “Medicare tion programs, including NCPA’s Simplify My Meds™ Plan Finder”. Available at: https://www.medicare.gov/finda-plan/questions/home.aspx. Accessed October 27, 2013. program, which is utilized by more than 1,100 independent community pharmacies nationwide. The Carnegie TC, Albert RM. Medicare Star Ratings—What new study and Simplify My Meds program are part Plan Sponsors Need to Know. Bloomberg BNA. BNA’s of NCPA’s Pharmacists Advancing Medication AdherMedicare Report, November 2012. ence (PAMA) initiative, which is sponsored by the Cardinal Health Foundation, Merck, and Pfizer.

Reid RO, Deb P, Howell BL, Shrank WH. Association Between Medicare Advantage Plan Star Ratings and En-

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Missouri Pharmacist | First Quarter 2014 | 29

How Pharmacies are Using Facebook Advertising can be costly to market small businesses but there is a resource available that is free and has an audience of more than 1.26 billion people.1 What is this seemingly impossible tool, you ask? The answer is simple, Facebook.

their page.

Jenny Brooks is the marketing director for D&H Drugstore in Columbia. She was hired in 2013, but D&H has been active on Facebook since 2009. Brooks is responsible for both the Twitter and Facebook acAs of November 2013, more than 25 million small counts for D&H. businesses had a Facebook page.2 Are you part of Q: What made you decide to take the leap to go to that 25 million? If not, you have to ask yourself why social media? you aren’t. Facebook provides a free tool to engage with your customers on a level you don’t always have Vaughn: We thought using Facebook would be a time for in person. good way to keep in touch with our customers about what was going on in our pharmacy. We are a busy Not sure how to use Facebook for your business? We pharmacy and not everyone is visible to the customasked two Missouri pharmacies for information on ers so we wanted the customers to get to know our how they are using Facebook, and this is what they employees better. had to say.

Brooks: We saw it as a way to quickly share informaGail Vaughn is the owner and manager of Hometown tion and to track responses to posts. Being able to Pharmacy in Mt. Vernon. Hometown Pharmacy bedirectly measure the response to your message is gan using Facebook about four years ago, and there something that is difficult to do with traditional meis one pharmacist and one technician that maintain Sources: 1,2 Digital Marketing Ramblings, “By the Numbers: 13 Amazing Facebook Page Statistics;” www.ExpandedRamblings. com, http://expandedramblings.com/?p=16645

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dia.

have time to maintain.

Q: What do you typically post and how do you choose what to post?

Brooks: We use Twitter but we would consider Pinterest and Instagram for product features. We haven’t gone there yet though.

Vaughn: We use RxWiki through NCPA to post daily informational pieces, and in addition, we post pictures of what is going on in the pharmacy. Occasionally we will post a link to an informative article or other pages such as the CDC. Brooks: We post about health issues, vaccination information, community events, specials and featured products, events that our company attends, gift ideas, and many other topics.

Q: How do your customers respond?

Vaughn: Most customers respond with likes and occasional comments.

Brooks: We are getting more and more engagement from customers with likes.

They love pictures of our staff and they are making more comments as we post more.

Q: What types of posts do your customers respond to most?

Vaughn: Our customers like pictures and fun posts about the pharmacy and the employees.

Brooks: They respond most to photos and people that they recognize and issues important to them.

Q: What have you enjoyed most about having a Facebook page?

Vaughn: We love hearing the comments our customers make about us. It’s nice to have positive comments in a world and industry that can seem negative at times.

Brooks: It is a great way to keep record of things that we are doing as a pharmacy, to interact with our customers, and share information.

Q: What do you feel pharmacies should avoid when posting on Facebook?

Vaughn: Since your Facebook page reflects your organization, I would make sure the posts aren’t too over the top. Customers enjoy a joke now and then, but you don’t want them wondering what kind of business you are. The idea is to show them a glimpse of the type of people that work in your organization and how great they are.

Brooks: You don’t want to post patient information, don’t post on highly political issues or offer specific Q: Do you feel you get more interaction/recognition health recommendations. We refer to articles from from customers with your employees now that you the CDC, Missouri Department of Health and Senhave the Facebook page? ior Services, plus various web articles on different Vaughn: Customers will come in and say happy birthday or congratulations to an employee that we mentioned on Facebook. We are careful as to how many A helpful hint about Twitter personal posts we use so that we don’t burn people from Jenny Brooks: out on the non-business posts.

Brooks: Yes, I feel like this has definitely increased even since I started toward the end of 2013. I think there is always room for improvement with engagement and likes though.

Q: What other social media outlets do you use?

Vaughn: We don’t use any other social media outlets.

The RxWiki service will help you with Google+ and Twitter, but as a small store Facebook is about all we www.MORx.com

Twitter is a little more difficult, but I would recommend, getting on Facebook, to get started and see what it’s like. Twitter helps with staying on top of the pharmacy, health-related issues, local networking, etc. that people are tweeting about. It’s more spur of the moment, but also a great way to make connections.

Missouri Pharmacist | First Quarter 2014 | 31

health-related topics. We don’t offer specific health recommendations other than to get the flu shot, which we back up with state and federal data.

Facebook Facts:

Q: What advice would you give a pharmacy that has not yet begun the Facebook journey?

• The amount of total possible engagement a post gets in its first 5 hours: 75%

Vaughn: It’s free and easy to use! Find someone in your organization that likes to use Facebook and can be trusted to be appropriate and let them do it. If you like getting information off the Internet, so will your patients. Link articles that you find helpful and your customers will appreciate it. This is a chance for your customers to get to know you and your organization.

Brooks: Set up a page and get started by inviting people to like you. Sometimes the best way to learn is to dive in and try something new.

• Average number of monthly posts per Facebook page: 36

• Average number of weekly local business page views: 645 million • Short Facebook page posts (under 80 characters) get up to 66% more engagement.

• Percentage of Facebook users that like a page to get a deal: 42% Source: Digital Marketing Ramblings, “By the Numbers: 13 Amazing Facebook Page Statistics;” www.ExpandedRamblings.com, http://expandedramblings.com/?p=16645

Tips and Tricks for Facebook: • If you still aren’t convinced of the benefits of Facebook and are worried about what others would post on your page, simply set your Facebook security to only allow comments on your posts.

• Limit the access of who can post to your account.

Pick one or two staff members that would have the knowledge and that you trust to have access to post on the page.

• Just as a safety net, it is a good idea to develop a social media plan. The plan would include what is acceptable and unacceptable to post on the page, the repercussions of improperly posting, ways to fix any mistakes that might be made, or how and when to respond to a negative comment. Have the employees with access sign the agreement stating they have read it.

• Personalize your page. Add your logo and picture of some smiling employees, or your store. Don’t leave the default images in place, you want to build recognition with your customers.

• People enjoy seeing the staff members of a business on the pages. This will help build a personality and identity for your business. Personalizing the staff allows customers to bond, or feel like they know the staff.

• Don’t be afraid to have fun with it. As Vaughn mentions, you don’t want to get carried away with the fun stuff, but you can get creative. Many Facebook users enjoy posting old pictures on “Throwback Thursday.” This is something that you can do and showcase old and current pictures of your pharmacy or recognize an employee that has been there for many years.

• Include links to your social media outlets anywhere you can. Do you have store signage, a newsletter, paid advertising? Make sure to include the Facebook logo with your Facebook address on your website, newsletters, advertising, even signage in the store. Review the Facebook logo usage policy before using their logo.

• Want to make it easy to find your Facebook page, use a QR code for people to scan, then they can like your page instantly.

• Not sure if Facebook is working for you? Create a report that tracks your engagement. Facebook provides all the statistics you need, you just have to watch over them. See what your customers are responding to most often, then move your messaging in that direction.

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Missouri Pharmacy Association

MORx.com

www.MORx.com

Missouri Pharmacist | First Quarter 2014 | 33

EXPERIENCE l e a r n i n g F U T U R E i n s p i r eknowledgeimagine e d u c a t i o n DREAM achieve

S

tudent ection UMKC School of Pharmacy Update STLCOP Partners with University in Ethiopia My MPA Experience: Prescription Drug Monitoring Program

Do you have a story or event you would like to share with fellow MPA members? Submit your story ideas and event information to Sarah Luebbert at sarah@morx.com.

34 | Missouri Pharmacist | First Quarter 2014

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UMKC School of Pharmacy Update Russell B. Melchert, Ph.D Dean, UMKC School of Pharmacy

Dear Fellow Missouri Pharmacists: Thank you for the opportunity to update the Missouri Pharmacy Association on the UMKC School of Pharmacy! I want to thank you also for the opportunity you have provided for us to work with you to advance our great profession in the state of Missouri!

First among the many updates, I have some bittersweet news to share. Many of you may already know, but Dr. Kathy Snella, our Associate Dean for the MU site of our program, has accepted a position as Associate Dean for Student Affairs at the newly established Ben and Maytee Fisch College of Pharmacy at the University of Texas at Tyler. We are happy that Dr. Snella has landed a great position and will be able to pursue her interests in student affairs more broadly at the new school. However, we are saddened to see her go and wish her the best of luck.

She has a very strong history of assisting with development of new pharmacy programs and extensions, so I am certain that UT Tyler will benefit greatly from her experience. They are lucky to get her.

During Dr. Snella’s eight year tenure with the School, we expanded our pharmacy program to our sister campus in Columbia (MU). We are very thankful for Dr. Snella’s leadership in Columbia that greatly helped our expansion. We have now graduated four cohorts of students who were able to spend all years of the program in and around central Missouri. The majority of these graduates accepted their first positions in central Missouri and other more rural parts of the state strongly suggesting that regional program extensions can help meet regional demand for www.MORx.com

pharmacists—the whole rationale for our expansion to Springfield.

As you may recall from my previous updates, we have reduced our enrollment in Kansas City by 15 students per class commensurate with the expiration of our Caring for Missourians funding. Our partners at Missouri State University have facilitated our expansion to the Springfield site which is planned to open with a cohort of 30 in fall 2014 pending accrediting body board review and site visit. Now, we are most pleased to announce that Dr. Paul Gubbins has been hired as the new Associate Dean to lead our Springfield expansion. Dr. Gubbins was previously with the University of Arkansas for Medical Sciences (UAMS) College of Pharmacy where he served for 22 years with about half of those years in significant leadership positions including chair of the Department of Pharmacy Practice, chair UAMS’s Institutional Review Board and Conflict of Interest Committee, Director of Clinical Research in the Department of Pharmacy Practice, and numerous other leadership roles. During his tenure, UAMS expanded their pharmacy program to Fayetteville, so Dr. Gubbins brings significant experience in distance education and satellite locations for pharmacy programs. As an added bonus for UMKC, Dr. Gubbins has significant expertise in infectious disease pharmacotherapy where he has published numerous primary research papers, review articles and book chapters as well as held significant research funding. On top of that, Dr. Gubbins served as President of the Society of Infectious Disease Pharmacists. So, we are very fortunate to have him join the team! Dr. Gubbins started January 13, 2014 and is now living in Springfield.

Dr. Gubbins’ new office and all the renovations to our Springfield site are nearly complete. We are most thankful for the funding the State of Missouri provided that has helped us not only begin hiring new faculty, but also complete the renovations of 15,000 sq. ft. of space in downtown Springfield (Brick City) See UMKC, page 46 Missouri Pharmacist | First Quarter 2014 | 35

St. Louis College of Pharmacy Partners with University in Ethiopia Institutions Separated by more than 7,000 Miles Come Together to Advance the Profession of Pharmacy.

St. Louis College of Pharmacy and Mekelle University in Ethiopia recently entered into an agreement which opens up new opportunities for students and faculty and expands the international reach of the College.

Sixth-year students Bryan Bridgford and David Kim were the first two students from the College to go to Ethiopia for a clinical experiential rotation.

“We saw three to four cases of tuberculosis a day,” Bridgford says. “That’s not something you’d normally see here.”

Peters says Ethiopia is in a state of transition right now. Basic infrastructure like roads and buildings are going up alongside cell phone towers. Bridgford and Kim travelled on paved, cobblestone, and dirt roads in their daily commute from their living quarters to the hospital.

“What impressed me the most was the attitude of compassion and sympathy towards the patient,” Kim says. “I’m looking to start a career in community pharmacy after I graduate, and it was a great lesson to learn and apply towards my future patients.”

Students will have another opportunity to travel to The genesis of the partnership began when a faculty Ethiopia early next year, and a faculty exchange promember from Mekelle University was visiting a colgram may also be possible. In the interim, Peters is league at Washington University School of Medicine, focusing on educational issues with his counterparts whose office was across the street from the College. in Ethiopia.

“They were walking by and saw the sign on our park“I’ve already started working with the team on their ing garage,” says Goldie Peters, Pharm.D., associate curriculum assessment and feedback, especially on professor of pharmacy practice. “The Mekelle Unitheir experiential rotations,” Peters says. “We went versity pharmacy program is pretty new, and they through some of their curriculum and compared it were looking for some assistance in establishing a with ours. They’ve made some significant progress, doctor of pharmacy program.” but now we need to figure out how to keep going.”

Peters travelled to Ethiopia three times in the last “From South Africa and Swaziland, to Saudi Arabia, to year to help establish the partnership. He says interMexico, the College is actively establishing partnernational rotations are not vacations. Students are ships with institutions around the world to establish held to the same academic and professional standor strengthen pharmacy programs,” says Ken Schaard as if they were in America. fermeyer, Ph.D., director of international programs.

“When students go over there and become attached “We’re using our experience and insights gained in to internal medicine or pediatric unit, it’s not as dif- each location to both enhance our work around the ferent as people expect,” Peters says. “That’s the globe and also give our students the knowledge and draw. The experience is something they’ll remember tools to be future health care leaders.” forever, but it’s still a similar clinical experience as if they’re in an American hospital.”

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2014

MPA Legislative Day April 9 Jefferson City

Make the Difference The world of pharmacy is changing and in order for us to move it in the direction of our choosing, we have to be at the forefront of the issues. There is no better way to be at the forefront than to build and grow relationships with the leaders of Missouri, to be educated about the issues, and to be willing to make the difference.

MPAâ&#x20AC;&#x2122;s Legislative Day is an opportunity for you to make the difference. Legislators and pharmacy professionals will present updates on the issues impacting pharmacy in the morning, and the afternoon provides opportunities for attendees to meet with their legislators. Share stories of what you do, talk about the impact pending legislation will have on your business/profession, and take your legislator to the rotunda to enjoy a sweet treat, all while building that necessary relationship.

Make the difference in one more way, by agreeing to allow pharmacy students to shadow you during your time at the Capitol. Your time speaking with the students and allowing them to shadow you is invaluable to them and the profession. www.MORx.com

Missouri Pharmacist | First Quarter 2014 | 37

My MPA Experience: Prescription Drug Monitoring Program Written by: Heather Worthington MPA Rotational Student, January 2014 UMKC School of Pharmacy at MU

The hearing got heated when arguments against the bill were made saying it violates the 4th amendment of the constitution. The 4th amendment states:

A PDMP in Missouri would help prevent abuse and diversion in the state as well as allow physicians, pharmacists, and other healthcare providers keep their patients safe from overdoses, adverse events, and interactions. One story provided by Representative Engler really puts the benefits of a program into perspective. A man was abusing fentanyl patches that he was not prescribed and getting high by placing the patch in his mouth and sucking on the patch. He overdosed and was not found for three days where he was alive but in a vegetative state. It was later discovered by the brother that he was getting his fentanyl patches from an 84-year-old woman who went to multiple doctors complaining of chronic pain where she would receive prescriptions for a fentanyl patch. She would then go to multiple pharmacies to fill these prescriptions. When patients pay cash, a pharmacy cannot tell if it’s an early refill on the prescription because there is no system in place that gives healthcare personnel access to what patients have been filling. Lives can be saved if we are able to utilize information about what our patients are filling to help prevent diversion of drugs through doctor and pharmacy shopping, missed drug interactions, and prescription drug abuse.

answer was no.

“The right of the people to be secure in their perIn January, I was able to attend a committee hear- sons, houses, papers, and effects, against unreasoning regarding House Bill 1133 on a Prescription Drug able searches and seizures, shall not be violated, and Monitoring Program (PDMP) for Missouri. With Mis- no warrants shall issue, but upon probably cause, souri being the only state, along with the District of supported by oath or affirmation, and particularly Columbia, to not have a program established, many describing the place to be searched, and the persons people are wondering why Missouri isn’t falling in or things to be seized.” line with the rest of the states. During the hearing, During questioning of this witness statement, one many people stepped forward representing multiple representative asked if any law suits have been filed health care groups and professions rising in support for violation of people’s 4th amendment rights in of this bill for one big reason. Patient safety. any of the other 49 states who have a program. The Ultimately, there are already multiple systems in place that track medication use but there is not any data sharing for the people who are in charge of protecting and providing healthcare to individuals.

For example, the state has the pseudoephedrine monitoring program that tracks the amount of pseudoephedrine purchased and caps a patient’s purchases to daily and monthly amounts. This program is in place to help keep patients safe and help to stop drug abuse. What is the difference in a prescription drug monitoring program?

House Bill 1133 has passed through the Missouri House of Representatives. Follow the progress of this bill here.

38 | Missouri Pharmacist | First Quarter 2014

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Pharmacist of the Day

MPA needs your help during the 2014 Legislative Session Many issues critical to pharmacy will be addressed during the 2014 Legislative Session. These issues could have a drastic impact on Missouri pharmacists, including the pharmacy “carve-out” in Medicaid with the addition of a mailorder option. To address this issue, and many others, we are asking pharmacists to sign up and serve as the “Pharmacist of the Day” where you will pick one day to come to the Capitol and work with Ron and other MPA lobbyist to speak with legislators, attend hearings, monitor floor action, etc. We ask that you complete the registration form below, or online at MORx.com, to sign up for your day. This is your chance to help make a difference in your profession.

Please select your preferred day from the list below to be the “Pharmacist of the Day.” March 2014: 3/4

3/11

April 2014: 4/15

4/16 4/22

May 2014: 5/6

5/7

5/8

3/12

3/26 4/23

5/13

4/29

5/14

4/30

5/15

Name: Business Name: Address: Phone:

City/State/Zip: Email:

Please return completed form to: Missouri Pharmacy Association, 211 East Capitol Avenue, Jefferson City, MO; Fax: 573.636.7485, or go to MORx.com to complete the form. www.MORx.com Missouri Pharmacist | First Quarter 2014 | 39

Rx & the Law

The Drug Quality and Security Act Written by: Don. R. McGuire Jr., R.Ph., J.D. Most pharmacists are aware that the Drug Quality and Security Act (DQSA) was signed into law by President Obama on November 27, 2013. Most are also aware that the law provides additional regulatory oversight over the compounding of sterile products. This comes from the Compounding Quality Act (CQA) portion of the DQSA. However, many pharmacists are unaware of the other provision in the DQSA, the Drug Supply Chain Security Act (DSCSA).

This portion will increase the ability to track and trace products from manufacturers downstream to the ultimate users.

The CQA creates a new entity in the drug distribution model; the Outsourcing Facility. An Outsourcing Facility compounds sterile products and elects to register as an Outsourcing Facility under the act.

A facility that compounds only non-sterile preparations cannot register as an Outsourcing Facility. An Outsourcing Facility is not required to be a licensed pharmacy. In addition, the Outsourcing Facility may or may not obtain prescriptions for identified individual patients. Registration and abiding by the provisions of the CQA allow the products compounded by the Outsourcing Facility to be exempt from the requirements of the New Drug Application process.

Section 503A of the Food, Drug and Cosmetic Act contains another avenue for exemption when there is an identified individual patient who is the recipient of the compounded item, whether it is sterile or nonsterile.

The CQA provides a broad definition of compounding. Compounding includes the combining, admixing, mixing, diluting, pooling, reconstituting, or otherwise altering a drug or bulk drug substance to create a drug. The inclusion of the words diluting and reconstituting show the intent to cover everything sterile that is compounded, no matter how simple the action. Note that the inclusion of admixing shows that IV admixture programs are considered compounding.

Outsourcing Facilities will have to register with the FDA annually. The list of registrants will be public information. Outsourcing Facilities will also have to file with the FDA reports of their activities twice per year. The contents of these reports will not be public information. Outsourcing Facilities will be subject to FDA inspection on a risk-based schedule.

The CQA will also require the implementation or completion of some lists of products/components in order for Outsourcing Facilities to be able to comply with the section. An Outsourcing Facility cannot compound a product if it is on a list of drugs that have been withdrawn or removed from the market for reasons of safety or effectiveness. Also, an Outsourcing Facility cannot compound a product that is on the Demonstrable Difficulties for Compounding list. In addition, bulk substances without an USP/NF monograph must not be used unless they are on an approved list of bulk substances. None of these lists are currently complete, but the FDA will be convening a Pharmacy Compounding Advisory Committee to help compile these lists.

The second part of the DQSA is the Drug Supply Chain Security Act. This provision will impact many more pharmacies than does the CQA. This act creates a drug product history, starting with the manufacturer that must be passed on with the product as is it sold or distributed down the supply chain. This encompasses wholesalers, third party logistics providers, trading partners, repackagers, and dispensers. The drug product history is not required to be provided by the dispenser to the prescribed patient.

But the dispenser is required to have policies and procedures in place to quarantine suspect or illegitimate products, return them as necessary and notify any patients who may have received them from the dispenser.

40 | Missouri Pharmacist | First Quarter 2014

See Quality, page 47 www.MORx.com

Your On-Demand Access to Continuing Education Featured Free CE for MPA members: GLP-1 Agonists Therapy in Individuals with Type 2 Diabetes Mellitus: A Review of Safety and Tolerability ACPE UPN: 0145-9999-14-001H04-P 1.5 Contact Hours This is a knowledge-based activity.

â&#x20AC;&#x153;GLP-1 Agonists Therapy in Individuals with Type 2 Diabetes Mellitus: A Review of Safety and Tolerabilityâ&#x20AC;? is one in a series of continuing education articles authored and generously contributed to the Missouri Pharmacy Association by the Indiana Pharmacists Alliance.

Learning Objectives: 1. Explain the role of the incretin system in the development of diabetes and discuss the place in therapy for GLP-1 agonists.

2. Compare and contrast the adverse effects and safety profiles of the two FDA-approved GLP-1 agonists, exenatide and liraglutide.

3. Discuss the appropriate use and recommendations of GLP-1 agonists in terms of their safety profile.

4. Discuss the patient education that should be provided upon prescribing and/or dispensing exenatidine and liraglutide based on the REMS system.

5. Discuss the proposed mechanism and risk factors the GLP-1 agonist safety concerns.

Reviewing Diabetes Guidelines ACPE UPN: 0145-9999-14-002H04-P 0145-9999-14-002H04-T 1.5 Contact Hours This is a knowledge-based activity.

Learning Objectives: 1. Describe the treatment algorithms for type 2 diabetes from the American Diabetes Association and from the American Association of Clinical Endocrinologists.

2. Identify the goals of therapy for diabetes treatment.

3. Discuss the role of new agents to treat diabetes. www.MORx.com

Missouri Pharmacist | First Quarter 2014 | 41

A Better Cost of Goods— Guaranteed How to get the best deal every time with ProfitGuard Written by Kimberly Van Becelaere, PBA Health Photo by Aaron Newell, PBA Health

pharmacists saving.

For pharmacists like Randy Newberry, R.Ph., owner With decreasing third party reimbursements and an of The Prescription Shop in Jerseyville, Ill., getting increasingly competitive market, making the right the very best pricing is important. buying decisions matters now more than ever.

“Even though we don’t see it every day, that underBut making the right decisions—the ones that in- lying contract negotiation has a profound effect on crease your profits and keep your business thriv- our business,” Newberry said. “Your wholesaler coning—can be incredibly challenging. That’s why PBA tract can make or break you.”

Health, a pharmacy services organization, developed ProfitGuard.

Newberry decided to give ProfitGuard a try in 2008, after his wholesaler began to misrepresent purchasProfitGuard was designed specifically for community es and withhold a large amount of money in rebates. pharmacies, to secure them the best supplier pricing “We worked and worked to get that straightened available, and to provide them the tools they need out and we couldn’t. So we decided we really needto make informed, money-saving buying decisions ed to do something different,” Newberry said. “We every day. were really happy when ProfitGuard came along.”

How it works ProfitGuard forms groups of community pharmacies and uses the group’s combined purchasing volume to negotiate better pricing and terms for everyone.

ProfitGuard’s contract experts know just what to look for, and what to ask for, to get you the best deal out there.

Newberry no longer has to worry about getting the right rebates or pricing because all of that is tracked for him through ProfitGuard. He just checks his personalized website regularly to quickly see if he’s meeting his contract and to make sure his wholesaler is giving him the correct pricing. If the numbers don’t line up, PBA Health takes the discrepancy to But better supplier pricing is only the beginning. the wholesaler and ensures that a full reimburseProfitGuard also takes the time and headache out ment is issued. of improving your purchasing on a day-to-day basis. “ProfitGuard made running our business easier and Personalized online tools track your contract per- way more sophisticated,” Newberry said. “Before, formance, verify pricing and give you money-saving we did not have the data to help us understand what recommendations on products you are already pur- a certain contract might look like, or to identify what chasing. With just a few clicks, you’ll have all of the is good or bad in a contract. And then, of course, we information you need to make buying decisions that had no way to follow up after the fact to determine benefit your bottom line. whether we were getting the deal we negotiated.”

Expert contract negotiations To get the most competitive contract terms and pricing, ProfitGuard takes a different approach than most. ProfitGuard submits RFPs across multiple wholesalers to obtain the best cost of goods available, and then constantly monitors individual product pricing and offers up recommendations that keep

Today, Newberry lets other community pharmacies know how ProfitGuard can save them money and back them up if their wholesalers aren’t meeting their end of the deal. Newberry said that a lot of pharmacies are surprised when they hear how much they could be saving on their cost of goods.

42 | Missouri Pharmacist | First Quarter 2014

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“It’s amazing. As the numbers are crunched, as (other pharmacies) share some initial data with their PBA Health rep, most all of them show significant savings,” Newberry said. “It’s almost like, ‘You’ve got to be kidding me. I had no idea that I could be leaving that much money on the table or just giving that much money to my wholesaler’s profits instead of to mine.’”

saler is keeping the terms of the contract without shifting numbers or shifting the way they calculate things one way or another,” he said.

Recommendations that keep you saving While getting the best supplier pricing is important and can have a huge effect on a pharmacy’s bottom line in the long term, most buying decisions happen in the day-to-day. Prices fluctuate often, product Business tools that simplify availability changes daily, and pharmacists are left to What makes ProfitGuard different from anything else act as part-time detectives, seeking out better pricon the market is that it offers a complete solution to ing when they can with their already busy schedules. improve buying. It not only saves you money on your ProfitGuard changes that. By logging on to your cost of goods, but it also tracks your purchasing data store’s personalized website and clicking on the recfor you on a personalized, easy-to-use website. ommendations tab, you will see products you could The website gives owners, pharmacists and techs be saving money on, and the very best options to do the information and tools they need to make the so. most profitable buying decisions—all in one place.

Whether it is switching manufacturers, moving a You can easily see if you’re getting the pricing you product from your primary to your secondary wholecontracted for, where you’re sourcing your products saler (or vise versa), or choosing a different NDC, you from and if you’re meeting the generic percentage will be able to easily compare, select and print the of your contract so you don’t miss a single rebate. recommendations you want to use. And recommenFor pharmacists like Randy Meents, Pharm.D., own- dations are updated weekly, so the price comparier of Greenfield Pharmacy in Greenfield, Mo., being sons are always timely. able to access that information all in one place takes “If I was buying something and the price changed, or away the burden of doing it manually, and the worry if I was buying something and there was an alternaof not getting a fair deal. tive that was cheaper, if it was even marginally ex“Not only do ProfitGuard tools make it easier, they pensive or if I used it repeatedly, it adds up,” Newmake it possible,” Meents said. “As a small inde- berry said. “It’s just amazing how much those things pendent businessperson, I don’t have the time, the add up.” ability, or the analytical algorithms to do that kind of See Cost, continued on page 47 thing. We’d have to hash it out product by product individually and we’re unable to see a bigger picture like we can see through ProfitGuard.”

Using ProfitGuard’s tools, Meents said he is able to focus more on his patients and on the bigger picture of his business, instead of tracking down numbers and invoices.

“What I like is that PBA Health is your partner and they have the tools to make sure that the whole-

www.MORx.com

Missouri Pharmacist | First Quarter 2014 | 43

ONE DIES

EVERY 19 MINUTES That’s right. Every 19 minutes, another American dies by overdosing on prescription drugs. We’re not talking street drugs. We’re talking about drugs you—and others—can find in your very own medicine cabinet. The good news?

You can do something about it.

Cardinal Health has partnered with The Ohio State University College of Pharmacy to develop the GenerationRx™ toolkit.

It empowers pharmacists and others to raise awareness about a simple truth: When used as prescribed, medications can save and improve lives. When used to get high, or without a prescription, they can be deadly.

4 · march 2011

INSPIRATION Question: What is being done to address the issue of prescription medicine abuse?

Answer: Pharmacists are partnering with the cardinal health Foundation to deliver community-based assistance programs.

Foundation launches a lifesaving awareness campaign With nearly four billion medications prescribed each year in the United States alone, it’s clear that modern medicine has dramatically improved the way human beings deal with illnesses, pain and other health issues. however, the benefits associated with innovative pharmaceutical development are being compromised by the widespread problem of medication misuse and abuse.

The “who knew?” reality In the past month alone, an estimated seven million americans have abused prescription medications—mostly painkillers, sedatives, tranquilizers, and

stimulants. The problem affects people from every age group and socioeconomic class. Every day, almost 7,000 americans start abusing some type of medication.

Their goals are usually to get high, gain competitive advantage, or to quell pain. Others misuse medications simply by not paying attention to dosing instructions, or by trying to save money by skipping doses. Unfortunately, they are often doing so at their own peril. In 16 states and the District of columbia, unintentional drug overdose is now the leading cause of unintentional death, exceeding those caused by motor vehicle accidents.

2 TIP

Pharmacists as myth busters health care services company cardinal health believes that pharmacists can play a critical role in reversing these trends.

The company is working to develop a ‘how-to guide’ to help pharmacists work with law enforcement to host medication disposal days and also helps pharmacists get trained and certified to oversee chronic disease-management programs that support long-term patient adherence.

The cardinal health Foundation has also partnered with The Ohio State University (OSU) college of Pharmacy to launch Gen-

erationrx, (www.cardinalhealth. com/generationrx), a program that provides free, user-friendly, downloadable toolkits that make it easy for pharmacists, parents and others to deliver communitybased presentations about the dangers of misusing and abusing prescription drugs.

The Generationrx toolkits have already been downloaded 1,000+ times and are being widely used

by Kroger pharmacists and hundreds of independent pharmacies nationwide.

Larry Schieber, a community pharmacist in circleville, Ohio, frequently uses the Generationrx toolkit. he says, “most americans

TAKE MEDS AS PRESCRIBED

don’t understand that prescription drugs can be harmful, even deadly, if not taken properly. That’s the heart of the message we need more americans to understand.”

Patients have easy access to information about drugs and are often nonchalant about self diagnosis and prescribing, however the consequences of using powerful medications off label, without medical supervision, is often much worse than expected.

NICOLE GRAY editorial@mediaplanet.com

Visit cardinalhealth.com/generationrx. Find out just how easy it can be to educate your friends, family and community about the deadly consequences of prescription drug abuse. Before it’s too late.

The pharmaceutical company

where innovation makes 44 | Missouri Pharmacist | First Quarter 2014 a lasting impression This program is made possible with a grant from the Cardinal Health Foundation.

© 2011 Cardinal Health. All rights reserved. CARDINAL HEALTH and the Cardinal Health LOGO are trademarks or registered trademarks of Cardinal Health. GenerationRx is a trademark of The Ohio State University, used with permission. Lit. No. 5MC6319 (03/2011)

www.MORx.com

Financial Forum

How Impatience Hurts Retirement Saving

Keep calm & carry on – it may be good for your portfolio Why do so many retirement savers underperform the market? From 1993-2012, the S&P 500 achieved a (compound) annual return of 8.2%. Across the same period, the average investor in U.S. stock accounts got only a 4.3% return. What accounts for the difference?1,2 One big factor is impatience. It is expressed in emotional investment decisions. Too many people trade themselves into mediocrity – they react to the headlines of the moment, buy high and sell low. Dalbar, the noted investing research firm, estimates this accounts for 2.0% of the above-mentioned 3.9% difference. (It attributes another 1.3% of the gap to operating costs and the remaining 0.6% to portfolio turnover within accounts.)2

What’s the takeaway here for retirement savers?

This amounts to a decent argument for dollar cost averaging – the slow and steady investment method by which you buy shares over time, a little at a time.

When the market sinks, you are buying more shares as they have become cheaper – meaning you will own more (quality) shares when they regain value.

It also shows you the value of thinking long-term.

When you save for retirement, you are saving with a time horizon in mind. A distant horizon. Consistent saving from a (relatively) early age and the power of compounding can potentially have much greater effect on the outcome of your retirement savings effort than investment selection.

Keep your eyes on your long-term retirement planImpatience encourages market timing. Some inves- ning objectives, not the short-term volatility hightors consider “buy and hold” passé, but it has cer- lighted in the headlines of the moment. tainly worked well since 2009. How did market tim- Pat Reding and Bo Schnurr may be reached at 800-288ing work in comparison? Citing Investment Company 6669 or pbh@berthelrep.com.

Institute calculations of equity account asset inflows Registered Representative of and securities and investment and outflows from January 2007 to August 2012, U.S. advisory services offered through Berthel Fisher & ComNews & World Report notes that it didn’t work very pany Financial Services, Inc. Member FINRA/SIPC. PRISM Wealth Advisors LLC is independent of Berthel Fisher & well. During that stretch, investors either sold mar- Company Financial Services Inc. ket declines or bought after market ascents 57.4% of the time. In addition, while the total return of the This series, Financial Forum, is presented by PRISM Wealth S&P 500 (i.e., including dividends) was -0.13% in this Advisors, LLC and your State Pharmacy Association through time frame, equity account investors lost 35.8% (ad- Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy justed for dividends). 3 community.

Most of us don’t “buy and hold” for very long. Dalbar’s latest report notes that the average equity account investor owned his or her shares for 3.3 years during 1993-2012. Investors in balanced accounts (a mix of stocks and bonds), held on a bit longer, an average of about 4.5 years. They didn’t come out any better – the report notes that while the Barclays Aggregate Bond Index notched a 6.3% annual return over the 20-year period studied, the average balanced account investor’s annual return was only 2.3% .2 www.MORx.com

This material was prepared by MarketingLibrary.Net Inc., and does not necessarily represent the views of the presenting party, nor their affiliates. All information is believed to be from reliable sources; however we make no representation as to its completeness or accuracy. Please note - investing involves risk, and past performance is no guarantee of future results. The publisher is not engaged in rendering legal, accounting or other professional services. If assistance is needed, the reader is advised to engage the services of a competent professional. This information should not be

See Savings, page 46

Missouri Pharmacist | First Quarter 2014 | 45

President, continued from page 5

UMKC, continued from page 35

business card and a copy of your talking points if pos- to house our expansion—truly state of the art educational space—wait ‘til you see it! We invite all of sible. you to visit this summer if you have a chance, just let Be prepared to discuss topics before your visit. You us know when you can stop by! If not, we will have already know your position on most topics of concern an official opening of the space in the early fall. to the profession but legislators get confused and frustrated when they hear different messages within The school is in the middle of revisions of strategic the same profession. So it’s important that the mes- planning and is hosting receptions for alumni and sages we present be consistent in order to get the preceptors to provide input into the new plan. The most traction. You can reinforce your knowledge on new strategic plan is the first step in our comprehenissues and learn about the message your state asso- sive accreditation self-study. The self-study officially ciation is presenting at the Capitol by visiting MPA’s kicked off February 4th with a visit and kick-off adwebsite, www. MORx. com. Just browse to the sec- dress from Dr. Greg Boyer, Director of professional tion called “Legislative Action Center”. You might Degree Accreditation with the Accreditation Council wish to check out the “Advocacy 101” section as well. for Pharmacy Education. The self-study will proceed over the next 18 months with our final study comRegardless of how you communicate with your legis- pleted and submitted to the ACPE in the fall of 2015. lators, the most important thing to remember is that you are looking to establish a lasting and beneficial Interviews are underway to fill our pharmacy Class relationship - just like you would any professional re- of 2018, and interest in our program is strong as applications remain steady. Early admitted students lationship. So take it slowly at first. have outstanding qualifications, and we are pleased Don’t expect them to fully understand the issues on with the student interest in the new Springfield site. the first visit. Let them know that you want to help We welcome your assistance with recruiting K-12 and and that you are available to provide perspective college students to not only UMKC but also to the on pharmacy issues that come before them. As you profession of pharmacy. have more contacts with them - and you should because it’s a relationship that’s being built - it will be- And finally, as always, I extend an invitation to visit come easier to speak with them. You’ll also find they us at any time at any one of our three locations. We will become more familiar with pharmacy topics and enjoy having visitors and especially the opportunity they will begin to recognize you as a trusted advisor. to catch up with alums, preceptors, and all those with an interest in UMKC Pharmacy! I wish the MPA What matters most is that you make that effort and and all of you the best for 2014! reach out to your legislators. Change is inevitable, wouldn’t you rather have a say in how those changes Sincerely, will impact your life? Advocacy is easiest when taken Russell B. Melchert one step at a time. So get out and take that first step Dean and Professor today.

UMKC School of Pharmacy

Savings, continued from page 45 construed as investment, tax or legal advice and may not be relied on for the purpose of avoiding any Federal tax penalty. This is neither a solicitation nor recommendation to purchase or sell any investment or insurance product or service, and should not be relied upon as such. All indices are unmanaged and are not illustrative of any particular investment

Citations.

1. finance.yahoo.com/news/p-fund-tops-p-500-142700129. html [5/3/13] 2. marketwatch.com/story/7-reasons-why-retirement-savers-fail-2013-06-26 [6/26/13] 3. money.usnews.com/money/blogs/the-smarter-mutualfund-investor/2012/11/05/herd-behavior-hurts-fund-investors [11/5/12]

46 | Missouri Pharmacist | First Quarter 2014

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Quality, continued from page 40

Cost, continued from page 43

Another provision of the act will require that a product identifier be affixed to the packaging of prescription drugs. This identifier will need to be readable by both humans and machines. The act also specifically outlines the content of the drug histories. Implementation of the different requirements of the act varies according to the type of entity involved, but many items will need to be implemented no later than July 1, 2015.

Newberry estimates that just by using the recommendations, he saves between $20,000 to $30,000 per year, and that’s on top of his better negotiated cost of goods.

The DQSA has been covered in the media primarily as a compounding law, but the tracking and tracing requirements will apply to all participants in the drug distribution chain. So it behooves all pharmacists to review the act and determine which provisions impact their practice and when that impact will occur.

This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community. © Don R. McGuire Jr., R.Ph., J.D., is General Counsel, Senior Vice President, Risk Management & Compliance at Pharmacists Mutual Insurance Company.

This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with policies and procedures of their employers and insurance companies, and act accordingly.

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Newberry has seen ProfitGuard work for his business, which is why he recommends it to other pharmacy owners.

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Missouri Pharmacist | First Quarter 2014 | 47

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48 | Missouri Pharmacist | First Quarter 2014

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April 26th,

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Missouri Pharmacist | First Quarter 2014 | 49

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