Q2 2015 Missouri Pharmacist

Missouri THE MISSOURI PHARMACY ASSOCIATION

VOL. 89, NO. 2, SUMMER 2015

Compounding Interest

Mixing Tradition into the Formula for Success

2016 Star Measures Update

NEW: TECHNICIAN'S CORNER Tips to Diffuse the Angry Patient Math Reference Guide

The 3 Bills that Matter to Pharmacists ISSUE 2014 1

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Missouri THE MISSOURI PHARMACY ASSOCIATION

Missouri Pharmacy Association Staff RON FITZWATER, MBA, CAE, Chief Executive Officer ROBYN SILVEY, Chief Operating Officer Missouri Pharmacist Managing Editor CHERYL HOFFER, Vice President Pharmacist Program Initiatives TRAVIS FITZWATER, Director of Strategic Initiatives DREW OESTREICH, Pharmacy Provider Relations BRITTIANY TURNER, Communications Coordinator LAURA STIEFERMAN, Meetings and Membership Coordinator Missouri Pharmacist Magazine Publisher GREG WOOD Editor in Chief DANITA ALLEN WOOD Sales Manager MIKE KELLNER Advertising Director MARYNELL CHRISTENSON Advertising & Marketing Consultant BRENT TOELLNER Sales Account Executive GRETCHEN FUHRMAN Advertising Coordinator JENNY JOHNSON Art Director SARAH HERRERA Custom Projects Editor NICHOLE BALLARD Associate Editor JONAS WEIR Graphic Designer and Staff Photographer HARRY KATZ Circulation Manager AMY STAPLETON

Board of Directors President ERICA HOPKINS-WADLOW, Pharm.D. D&H Drug, Columbia President-Elect JUSTIN MAY, Pharm.D. Red Cross Pharmacy, Sedalia Treasurer MARTY MICHEL, R.Ph., MBA, CDE Key Drugs, Poplar Bluff Secretary MELODY SAVLEY, B.S. ALPS Pharmacy, Springfield Immediate Past President CHRISTIAN TADRUS, Pharm.D., R.Ph., FASCP, AE-C Sam’s Health Mart Pharmacies, Moberly Member at Large SCOTT CADY, Pharm.D. Pharmacist Consultant, Chillicothe Member at Large CHRIS GERONSIN, Pharm.D. Beverly Hills Pharmacy, St. Louis Member at Large DANIEL GOOD, M.S., R.Ph. Mercy Health, Springfield Member at Large LISA UMFLEET, R.Ph., CGP Parkland Health Mart Pharmacy, Desloge Ex-Officio Member RUSSEL MELCHERT, Ph.D., R.Ph. UMKC School of Pharmacy, Kansas City Ex-Officio Member JOHN PIEPER, Pharm.D., FCCP St. Louis College of Pharmacy, St. Louis

Missouri Pharmacist is produced for the Missouri Pharmacy Association by MissouriLife 501 High Street, Ste. A, Boonville, MO 65233 660-882-9898 l MissouriLife.com Missouri Pharmacy Association www.MoRx.com 211 E. Capitol Avenue, Jefferson City, MO 65101 phone: 573-636-7522, fax: 573-636-7485 Missouri Pharmacist is mailed to MPA members. All views expressed in articles are those of the writer and are not necessarily the official position of the Missouri Pharmacy Association.

Advertising rates are furnished upon request.

Missouri Pharmacist, Vol. 89, No. 2, Summer 2015, (ISSN 0026 6663, application to mail at periodicals postage prices is pending) is owned and published quarterly by the Missouri Pharmacy Association, 211 E. Capitol Avenue, Jefferson City, MO 65101. Postage paid at Jefferson City, MO and additional mailing offices.

Postmaster: send address changes to Missouri Pharmacist, 211 E. Capitol Ave., Jefferson City, MO 65101-3001.

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Missouri

IN THIS ISSUE THE MISSOURI PHARMACY ASSOCIATION

SUMMER 2015

8 > I nvol ve me n t MPA president asks for members to get involved in pushing for pharmacy-friendly legislation.

10 > B as e b al l Me cca MPA CEO looks forward to the future of pharmacy and the baseball season. Both are promising.

12 > M PA Me mb e r N e ws Pharmacist Timothy Mitchell gets recognition from his alma mater for his work in Joplin. Red Cross Pharmacy receives an ethics award, and Fred Gattas is named a fellow.

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14 > T i db i ts ACH partners with MPA and MO-PCN to institute a program modeled after the Asheville Project.

Also, Pharmacist Mutual profits, and MO-PCN now offers chain contracting.

17 > Automate I t Learn about PennTech’s automated vial washing machines for compounding pharmacists.

Get to know Eldon Drug Company owner Miranda Henley and how she is getting back to her roots.

24 > Kn ow Your Stars Read up on what’s new for the 2016 Star Quality Ratings and how they affect pharmacy.

29 > Qui ck M ath for P h armacy Te c hs If you ever find yourself trying to remember how to convert from standard to metric on the fly, don’t worry. Our handy math reference and refresher guide for pharmacy technicians is all you need.

36 > Te ch n i ci an ’s Corn e r Learn the best way to overcome a situation with an angry patient in our new technician column.

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38 > P h armacy an d th e L aw NCPA Vice President discusses three bills that are vital to the future of pharmacy.

40 > Sch ool Up date Get the latest news from the UMKC and St. Louis schools of pharmacy.

44 > B oot Camp Pharmacy students attend a new, satellite compounding boot camp put on by the experts.

46 > M i le s ton e s , Ne w Me mb e rs , a nd C a le nd a r Celebrate members’ anniversaries, welcome new members, and visit statewide events.

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COVER PHOTO BY HARRY KATZ; NCPA, 123RF, COURTESY OF TIMOTHY MITCHELL; HARRY KATZ

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President’s Letter

INVOLVEMENT

ERICA HOPKINS-WADLOW PHARM.D., MPA PRESIDENT

Involvement. Dictionary.com defines it as: “to include as a necessary circumstance, condition, or consequence.”

That is an appropriate description of what the Missouri Pharmacy Association needs from our members: involvement in the critical issues your board is advocating for on your behalf.

In the past issue, I wrote about the importance of membership and being a part of your profession. This month, I want to talk to you about not just being a member but being an active, involved member.

There are a lot of exciting things going on at MPA that directly impact your practice and profession. As I sit here writing, we are in the process of finalizing the 2015 Missouri Legislative Session. We still have a few issues moving through the final stages of the legislative process, but we are confident this has been a very productive year in the legislature for pharmacists. A special thank you is in order for Representatives Lynn Morris and Travis Fitzwater and Senator David Sater for all their hard work on our behalf. We will provide a full wrap-up in the next issue of Missouri Pharmacist.

In mid-May, I joined a number of our colleagues in Washington, DC, at the 2015 NCPA Legislative Conference to meet with members of the Missouri Congressional Delegation to discuss federal legislative issues that impact our patients and our profession—issues such as

8 MISSOURI PHARMACIST

H.R. 793/S. 1190, the Ensuring Seniors Access to Local Pharmacies Act, which creates and protects opportunities for us to participate in preferred networks. We also worked on MAC Pricing issues, the federal provider status bills (H.R. 592/S. 314), TRICARE issues, and longterm care issues, to name a few.

I want to thank the MPA members who took the time to participate in our Legislative Day in Jefferson City, who have participated in the MPA Pharmacist of the Day Program, those who work with their members of congress and travel to Washington, DC, to push the message of pharmacy, and all the volunteers who have worked on pharmacy issues across our state. Your participation—your involvement—has been critical to our ability to move issues forward.

It will require all of our members to take our efforts to the next level. The forces against our profession from local, state, and national sources have never been stronger.

We need your involvement as we continue to push issues.

This fall, at our regional meetings, we will lay out our legislative vision for 2016. I encourage you to be involved with our committees and board over the next few months as we create that strategy.

Thank you in advance for all you do. It is a privilege to serve as your president and to work with you on these critical issues.

MPA

2015 Legislative Day

SUMMER 2015 9

CEO News What's more exciting than baseball? The schools of pharmacy graduating classes of 2015.

RON L. FITZWATER MBA, CAE

Missouri has baseball teams on both sides of the state lead their divisions. The St. Louis Cardinals started off hot out of the gate and are on a record pace for their storied franchise. And the Kansas City Royals picked up right where they left off last year.

As my good friend Harvey Tettlebaum keeps reminding me—it is a long, 162-game season. But it’s fun to watch the in-state rivalry. I hope it lasts. In addition, the Missouri State University Bears in Springfield and Missouri Tigers in Columbia are playing great baseball.

But baseball isn’t the only exciting thing happening in Columbia, Kansas City, and St. Louis. Recently the schools of pharmacy in each of those communities held commencement programs for the 2015 graduates.

I would like to extend my congratulations to each of the graduates and wish you the best of luck as you begin your pharmacy career or residency program. These are indeed exciting times for you.

And it is an exciting time for the pharmacy profession.

I have had an opportunity to interact with a number of students over the past several years at MPA annual conventions, MPA legislative days, NCPA meetings, APhA meetings, and other events.

I am confident that the future of pharmacy is in good hands here in Missouri. Some of our graduates will leave

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our state, but most will begin their practice right here.

Students: Obviously, it will take a brief period to get your bearings and your career off to a start. I encourage you to take advantage of your year of free membership with MPA and to entrench yourself in the activities of the association. We have many exciting activities and opportunities right now. Your input and participation will be invaluable as we work to create the pharmacy practice of the future while maintaining the current base of the profession.

St. Louis College of Pharmacy and the University of Missouri-Kansas City School of Pharmacy provide the foundation for the practice of pharmacy. MPA works to complement that education by working with the Missouri Legislature, Congress, the Missouri Board of Pharmacy, Bureau of Narcotics and Dangerous Drugs, and others to help create and expand practice opportunities.

As the esteemed business consultant Peter Drucker said, “The best way to predict the future is to create it.”

I invite our new members to join with our established members, the board, and MPA leadership to create that future here in Missouri. It will be even more thrilling than a Cardinals versus Royals World Series.

Please let me know how you would like to be involved with MPA.

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Member News

MPA MEMBERS MAKE NEWS

FRED GATTAS, FELLOW OF THE AMERICAN PHARMACISTS ASSOCIATION

MITCHELL RECOGNIZED AT UMKC ALUMNI ASSOCIATION AWARDS

Timothy G. Mitchell (B.S.P. ‘96), University of Missouri-Kansas City School of Pharmacy, is among the 17 alumni recognized at the annual alumni awards luncheon April 23. Mitchell was selected by the UMKC Alumni Association and the campus as the 2015 School of Pharmacy Alumni Achievement Award recipient.

He is a strong supporter of the Neosho community and of independent pharmacy. After the 2011 Joplin tornado, Mitchell was among the first responders, setting up emerTimothy Mitchell was one of the first gency dispensaries, giving tetanus shots, and responders in Joplin when a providing medications. Mitchell has estabtornado devastated the city. lished two annual scholarships through the UMKC Pharmacy Foundation.

His community is served by not one but four of Mitchell’s pharmacy facilities: Family Pharmacy of Neosho, Country Care Pharmacy, Advantage Health Care, and Mitchell’s Downtown Drug Store.

RED CROSS PHARMACY RECOGNIZED FOR STELLAR ETHICS

Red Cross Pharmacy was selected as the recipient of the Ethics in Action Award given by the MVC ENACTUS class. The annual award recognizes a business for having high ethical standards and practices. Numerous students, faculty, and professors came out to celebrate the pharmacy’s achievement.

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Left to right: (front row) Kathy McGuire, Tara Eddy, Andy Roehrs, Jessica Allen, Aislinn Jasper, (back row) Scott Hartwig and Steve Hartwig.

Fred Gattas, Pharm.D., BCNP, was named a fellow of the American Pharmacists Association in April.

He is the director of quality and safety at Triad Isotopes Inc. and serves as an assistant professor at the University of Tennessee Health Science Center College of Pharmacy (UTHSC), clinical assistant professor at Southern Illinois University-Edwardsville, and adjunct assistant professor at the St. Louis College of Pharmacy.

Gattas has held previous positions with Covidien, formerly Mallinckrodt Inc., including staff pharmacist, radiation safety officer, and quality assurance associate.

He has served in several leadership positions with APhA, including chair of the New Practitioner Network and coordinator for the Academy of Pharmacy Practice and Management Nuclear Pharmacy Practice Special Interest Group. He received his Pharm. D. from UTHSC and is a Board Certified Nuclear Pharmacist.

A fellow of the American Pharmacists Association is a member of the APhA Academy of Pharmacy Practice and Management or the APhA Academy of Pharmaceutical Research and Science with a minimum of 10 years of professional experience and achievements in professional practice.

An APhA Fellow has rendered outstanding service to the profession through activities in APhA and other organizations.

Gattas received MPA’s Pharmacists Making a Difference award in 2010.

COURTESY OF RED CROSS PHARMACY, TIM MITCHELL, AND FRED GATTAS

Timothy Mitchell received an alumni association award and an achievement award from UMKC for his work in Joplin in 2011.

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Pharmacy Tidbits

PHARMACY TIDBITS

Learn about developments in the pharmaceutical industry.

Pharmacists Mutual CEO Ed Yorty and COO Jon Grether.

Pharmacists Mutual Insurance Company has reported a net income of more than $2.5 million for the first quarter of 2015, its 106th year of operation. That figure is up from $1.5 million for the same period in 2014. Increases in premiums written and surplus were also reported.

According to Chief Operating Officer Jon Grether, the profitable first quarter is due, in part, to minimal weather events and realized capital gains from the company’s investment portfolio.

Policyholder surplus increased 1.3 percent to $99.1 million. Direct premiums written increased to $31 million from $29.8 million in 2014, according to the unaudited report.

Pharmacists Mutual shows $1 million “We also concluded an 18-month project increase in first quarter. by implementing our new policy administration system on March 2,” Grether said in a press release. “This new system is designed to improve policyholder service while helping to keep operating expenses in check.”

CHAIN CONTRACTING NOW AVAILABLE THROUGH MO-PCN Whether a smaller multi-store owner or the owner of a larger regional chain, the Missouri Pharmacist Care Network (MO-PCN) can support pharmacists becoming MO-PCN providers through chain contracting.

MO-PCN works in conjunction with healthcare partners to expand pharmacist-delivered patient care services and seeks to develop and facilitate sustainable models of compensation for pharmacists across all practice settings.

MO-PCN’s partners include the American Health Care and National Community Pharmacists Association population health management pilot, Department of Health and Senior Services in conjunction with the Centers for Disease Control and Prevention, St. Louis College of Pharmacy, and University of Missouri School of Pharmacy.

To contract as a chain, contact Brittiany Turner at 573-636-7522 or Brittiany@MoRx.com or Cheryl Hoffer at 314-249-2840 or Cheryl@MoRx.com.

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MISSOURI PHARMACISTS LAUNCH EFFORT TO REDUCE COSTS FOR LOCAL EMPLOYERS

BY MELISSA JACOBSEN AND EMILY CRANE

WHILE CAPITOL HILL DEBATES how to best control rising healthcare costs, Missouri pharmacists are doing it.

Launching a program that has been proven to reduce healthcare costs up to as much as $4,000 per participant per year, the Missouri Pharmacy Association and Missouri Pharmacist Care Network (MOPCN) are reaching out to employer groups across the state to implement a population health management program based on the Asheville model.

The program is administered by American Health Care (AHC)—a national leader in population health management—in partnership with MPA, MO-PCN, and the National Community Pharmacists Association (NCPA).

“Pharmacists are ideal health coaches for people with chronic conditions because in addition to talking with them about how medications work and their potential side

COURTESY OF PHARMACISTS MUTUAL INSURANCE COMPANY

PHARMACISTS MUTUAL PROFITS

123RF

effects, they’re able to spend significant time collaborating with them about nutrition, exercise, weight management, and other self-care that not only helps improve their chronic condition but also enhances quality of life,” said Cheryl Ann Hoffer, Vice President, Pharmacist Program Initiatives for the MPA, MO-PCN. Currently used in other states across the country, the program’s specific process and methodology focuses on people with chronic conditions including diabetes, high blood pressure, and high cholesterol. Pharmacists regularly meet with patients to discuss medication adherence and lifestyle goals (including diet and exercise) and collaborate with physicians to make sure patients are taking the most efficacious medications. The program enables pharmacists to provide patients with additional time to help manage their conditions and keep them on the treatment plan prescribed by their physician.

“NCPA is strategically focused on catalyzing new revenue opportunities for community pharmacies across the country,” said William Popomaronis, P.D., Vice President of Strategic Initiatives for NCPA. “We are proud of the network we have been able to put together working with

MPA and MO-PCN to demonstrate the impact pharmacists on the care team can have to improve outcomes for AHC’s employer clients.”

AHC’s program is similar to the nationally recognized Asheville Project. Dr. Barry Bunting, DSNAP, Vice President of Clinical Services for AHC and one of the architects and original health coaches with the Asheville Project, leads the newly improved program.

“This program is a win-win for employers and employees,” Bunting said. “Employers see reduced healthcare costs and healthier, more-productive employees, while employees This program is a win-win for employers and employees. have reduced prescription costs and experience better health.”

Events have been held in St. Louis and are anticipated in Kansas City later this summer to bring together Missouri pharmacists and local employer groups to learn more about how this program is guaranteed to reduce healthcare costs for their employees and dependents.

For more information, contact AHC National Sales Director Victoria Martinez at 916-316-9709 or v.martinez@americanhealthcare.com.

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2014 Recipients of the “Bowl of Hygeia” Award

Mike Mikell Alabama

Scott Watts Alaska

Crane Davis Arizona

Eric Shoffner Arkansas

Walter Cathey California

Wendy Anderson Colorado

Philip Bunick Connecticut

Donald Holst Delaware

Norman Tomaka Florida

Robert Bowles Georgia

Jeani Jow Hawaii

Susan Cornell Illinois

Sean McAlister Indiana

Craig Clark Iowa

Richard Bieber Kansas

Jerrold White Kentucky

Robert Hollier Louisiana

Mark Polli Maine

Donald Taylor Maryland

Erasmo Mitrano Massachusetts

Joseph Leonard Michigan

Brent Thompson Minnesota

Carter Haines Mississippi

Kenneth Michel Missouri

Mark Donaldson Montana

Christopher Shea Nevada

Lawrence Routhier New Hampshire

Maria Leibfried New Jersey

Stephen Burgess New Mexico

Karl Fiebelkorn New York

Ronald Maddox North Carolina

Charles Peterson North Dakota

James Liebetrau Ohio

Henry Roberts Oklahoma

Larry Cartier Oregon

Julie Gerhart-Rothholz Pennsylvania

Blanca Delgado-Rodriguez Puerto Rico

Katherine Kelly Orr Rhode Island

Gene Reeder South Carolina

Earl Hinricher South Dakota

Robert Shutt Tennessee

May Jean Woo Texas

Brent Olsen Utah

Cynthia Warriner Virginia

Patricia Slagle Washington

Wallene Bullard Washington D.C.

Arlie Winters West Virginia*

Nicole McNamee West Virginia

Terry Maves Wisconsin

Ardis Meier Wyoming

The “Bowl of Hygeia”

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.

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* 2013 recipient not previously pictured.

Tech Spotlight

PENNTECH AUTOMATES IT

COURTESY OF PENNTECH

Technology plays a key role in keeping compounding pharmacists and their patients safe.

Ensuring the safety and effectiveness of customized medications is a key priority of compounding pharmacists for the protection of patients. However, there are still more than half a million adverse medication-related events reported every single year to the Federal Drug Administration. This is estimated to be only 10 percent of all actual adverse events, according to estimates published by the FDA and Adverse Events Inc. As a result, federal and state regulators have strengthened their oversight of compounding pharmacies and their methods of enforcement. Now more than ever, it is vital for compounding pharmacies to evaluate their current processes. The fact is doing as good as or better than current standard practices is becoming the expectation of federal and state offices.

A compounding pharmacy does not have to be doing something wrong or be out of compliance to change current practices. For many years, hand-washing vials or using some sort of a dishwasher has been the standard practice in most compounding pharmacies. Washing vials manually is not only time consuming, it is inconsistent. It often fails to remove contaminants and yields results that cannot be validated. How does one achieve a process that can be validated? Automate it.

Machines are consistent; they repeat the same process over and over again, and they guarantee that vials have been cleaned for the safety of patients and within the FDA standards and requirements.

PennTech Machinery Corporation was founded in 1992 as a manufacturer of vial washing and tray loading machines. With this foundation, PennTech has designed and manufactured its aseptic solution to help keep compounding pharmacies USP 797 and cGMP compliant.

For more than 20 years, PennTech has optimized and perfected the art of vial washing.

The objective of vial washing is to remove particulate matter and microorganisms. Traditional vial washers have many moving parts in the washing chamber. Not only do these all generate particulates, but often they also cause glass chipping and vial breakage. PennTech washers are designed with minimal moving parts and use servo motors rather than gears, belts, and chains.

At PennTech, a special emphasis is put on simplistic, yet robust design, adherence to cGMP guidelines, and

quality, not only of the machines, but also of the supporting validation documents.

Since its founding, PennTech Machinery Corporation has become a world leader in manufacturing complete aseptic vial production lines. The company's success in performance and reliability has led to an ever increasing and diverse product line that PennTech’s specialty lies in includes not only vial washers and low-to-medium speed applications; tray loaders but also sterilization but they also offer many machines tunnels, filling/stopper-inserting exceeding 400vpm. machines, automatic lyophilizer loading machines, capping machines, and external decontamination machines.

PennTech’s specialty lies in low-to-medium speed applications (less than 200 vials per minute); but they also offer many machines exceeding 400 vpm.

PennTech's automated vial washing machines are USP 797 and cGMP compliant.

SUMMER 2015 17

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SUMMER 2015 19

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TOUCHING THE PAST

Eldon Drug Company owner Miranda Henley is committed to preserving the charm of her independent pharmacy but is making bold moves toward the future.

BY MARTIN W. SCHWARTZ AND PHOTOS BY HARRY KATZ

Someone once observed, “The secret to getting ahead is getting started.” Miranda Henley, Pharm.D., discovered that secret at a very young age.

Growing up in Eugene, a town of about 1,400 and 28 miles northeast of Lake of the Ozarks, Henley said she always knew she wanted to do something in the medical field. “After a lot of thought and exploring different career options,” she said. “I decided that pharmacy would be a good choice.”

In 2002, while still in high school, she landed a job at Eldon Drug Company. She continued working at the drug store after graduating from high school and on breaks from classes at the University of MissouriKansas City School of Pharmacy. In 2009, Henley graduated from UMKC as a Doctor of Pharmacy and returned to Eldon Drug as a full-time staff pharmacist.

Four short years later, she bought the store.

Eldon Drug Company has a rich history in the small community known as The Gateway to the Lake. According to the Miller County Museum, Eldon Drug Company was founded in 1894 by Dr. J. W. Temple, who later sold the business to E.G. Hawthorne and C.B. Whitney.

Henley purchased the drug store from Dennis Bond, who bought the store from Whitney and was lead pharmacist for the 30 years he owned it.

Given its small-town roots, Eldon Drug Company looks like an old-fashioned neighborhood drug store.

There’s a soda fountain: a drug store staple that started disappearing in the late 1960s. The remnant of days gone by doesn’t mean Eldon Drug is mired in the past.

Since purchasing the business, Henley has worked to keep the store relevant to the needs of its small community base. In addition to the full service pharmacy, the store offers gifts, greeting cards, beauty products, immunizations, medication therapy management, durable medical equipment, and more. “Patients see

Miranda Henley began working at Eldon Drug while still in high school with the hopes of owning her own pharmacy. Today she owns the store.

their pharmacist a lot more than they see their physician,” she said. “We’re often the person they come to with minor things they don’t want to bother their doctor with.”

Eldon Drug is the only independently-owned pharmacy in town, It really takes you back to the roots of being a pharmacist. and it’s that smaller, more intimate setting that appeals to Henley.

She also likes the move toward pay-for-services over just filling prescriptions and sending patients on their way. It’s a more hands-on approach, she said, helping patients to understand their medication through education and consultation.

SUMMER 2015 21

Eldon Drug is one of only three PCAB accredited compounding pharmacies in Missouri.

Although passionate about retaining the level of personal attention that generations of Eldon Drug customers have come to expect, Henley is also working to provide more services to meet the growing medical needs and challenges of twenty-first century life. The recent addition of compounding services, Henley said, offered a chance to move forward by There are not a lot of pharmacies touching on the past. that do compounding, especially to The new foray into untested arthe extent that we do. eas took Henley a little out of her comfort zone. “There are not a lot of pharmacies that do compounding, especially to the extent that we do,” she said.

Henley and a technician were throwing the idea of compounding around as a way to set Eldon Drug apart.

Since then, Eldon Drug has become one of only three pharmacies in the state accredited by the Pharmacy Compounding Accreditation Board for sterile and nonsterile pharmacy compounding. The pharmacy ships compounds throughout the state.

The new service represents the kind of outside-thebox thinking that Henley said is necessary to expand 22 MISSOURI PHARMACIST

her small drug store beyond its somewhat limited service market.

According to an article by Charles E. Myers in the American Journal of Health-System Pharmacy, about 60 percent of medications from pharmacies in the 1930s and 1940s in the United States were compounded compared to less than 1 percent today. But even centuries before that, apothecaries and pharmacists were creating mixtures to treat ailments.

“It really takes you back to the roots of being a pharmacist,” she said. “It’s what we were always trained to do, it’s just not many pharmacists get the chance to actually do that in this day and age.”

Growing up near the community she now serves and working in the drug store for several years have given Henley an ability to know her patients that would be difficult, if not impossible, to duplicate. No amount of education or training could replace the experience of that one-on-one communication with her patients.

It’s that simple communication between pharmacist and patient that Henley sees as the biggest challenge to overcome—even greater than legislation,

insurance payments, and Internet prescription sales.

And with that way of thinking, Henley is a supporter of changes to Missouri’s Medicare and Medicaid services that would allow pharmacists to be listed as medical providers.

“Once that happens, you’ll see pharmacists providing more care—more immunizations, more medication therapy—and billing for their services, not just the prescription,” she said.

“A lot of the healthcare costs in the United States are related to non-adherence to medication. They quit taking it. They’re not taking it the right way. We’re getting back to that and making sure patients understand what they are supposed to do because attention to that can prevent further hospital visits down the road.”

Henley is also the vice president of the Eldon Chamber of Commerce, and when not working, she can be found at her family’s farm in Eugene or showing cattle.

Purchasing Eldon Drug in 2013 was the fulfillment of one dream, though another is still on the horizon and she is hoping to expand and purchase at least one more independent pharmacy, eventually.

Eldon Drug Company was founded in 1894 by Dr. J. W. Temple, who later sold the business to E.G. Hawthorne and C.B. Whitney. Henley purchased the independent pharmacy from the third owner, Dennis Bond, in 2013.

In the meantime, as she guides Eldon Drug into yet another century of service, Henley is keeping a close eye on the past and the tradition of personal service that she has been a part of since she was a teenager.

SUMMER 2015 23

REACHING FOR THE

XXXX

STAR

24 MISSOURI PHARMACIST

RS Pharmacies are quickly adapting to the change from Star Ratings.

BY LISA UMFLEET

The only thing constant is change. It seems the words of Greek philosopher Heraclitus have never been truer than in healthcare today. The tentacles of the Affordable Care Act (ACA) touch virtually every part of healthcare, and pharmacy is no exception.

Although physicians and health systems have been experiencing value-based payments for several years, community pharmacy is just beginning to experience this change. Community pharmacies have been adapting their practices to align with quality measures required by Centers for Medicare and Medicaid Services LISA UMFLEET RPH CGP, PARKLAND (CMS), better known as the Star Ratings.

As the quality measures adopted by CMS expand HEALTH MART into health exchanges, the private sector and managed PHARMACY care pharmacists are recognizing that their ability to add value and improve patient outcomes is here to stay.

Offering services such as Medication Therapy Management (MTM) and adherence programs, pharmacists are incorporating clinical pearls into their daily practice.

Medication Synchronization is an example of pharmacy quickly adapting to change. Med Sync was just a buzz word a few short years ago, but with Medicare Star Ratings focusing on adherence, Med Sync is now a standard of care in many community pharmacies.

Although Star Ratings are not new to the Medicare space, the dollars attached to them are a direct result of the ACA. These dollars, known as Quality Bonus Payments, are awarded to high performing Medicare Advantage plans and have provided a catalyst for change.

Pharmacy has transitioned slowly into pay-for-performance models, but with Medicare plans leaving money on the With Medicare plans leaving money on the table, the rate pharmacy is table, the rate has been accelerated. changing has been accelerated.

To better understand and prepare for the changes coming in 2016, it is necessary to start at the beginning: the creation of the Stars.

Star Ratings were developed by CMS as a quality rating system for Medicare Prescription Drug Plans (Part D) and SUMMER 2015 25

THE 5 STAR RATING MEASURES There are nearly 50 2016 Star Rating Measures for Medicare Part C and Part D. Five are important to pharmacists. CMS ratings are on a scale of one to five stars, with five stars being excellent and one star being poor. These five measures are weighted so heavily in the star score summary that they make up almost half of the total star rating score provided by CMS. 1. High Risk Medication—Percent of plan members who received prescriptions for certain drugs with a high risk of serious side effects, when there may be safer drug alternative choices (Based off the Beer’s List).

2. Diabetes Treatment—Percent of patients with diabetes who received one of the recommended types of blood pressure medications.

3. Medication Adherence for Diabetes—Percent of plan members with a prescription for diabetes medication who fill their prescription often enough to cover 80 percent or more of the time they are supposed to be taking the medication.

4. Medication Adherence for Hypertension (RASA)—Percent of plan members with a prescription for a blood pressure medication who fill their prescription to cover 80 percent or more of the time they are supposed to be taking the medication.

High Risk Medication

5. Medication Adherence for Cholesterol (Statins)—Percent of plan members with a prescription for a statin drug who fill their prescription often enough to cover at least 80 percent or more of the time they are supposed to be taking the medication.

Medicare Advantage Plans (Part C) in 2006. Although pharmacies do not receive Star Ratings, the pharmacy’s performance contributes to the plan’s ratings.

Pharmacy Quality Alliance (PQA) is a nonprofit, consensus based organization that provides guidance to CMS on the quality measures. PQA has more than 200 members, including three St. Louis College of Pharmacy faculty members who participate on measure development teams. Pharmacies can view their quality measure data on a dashboard format through Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP).

There are currently five Star Quality Measures related to medication management that pharmacies directly impact. Three measures are for Proportion of Days Covered (PDC), otherwise known as adherence measures. The PDCs measure three classes of medications: diabetes, hypertension, and cholesterol. Because 26 MISSOURI PHARMACIST

of the weighting of the adherence measures, the pharmacy’s quality measures contribute to almost 50 percent of a plan’s star score summary. The Diabetes Treatment Measure focuses on blood pressure medication (reninangiotensin system antagonists) use by diabetic patients. High Risk Medication (HRM) measures elderly patients on potentially inappropriate medications due to the high risk of side effects. The HRM list is a subset of the Beers List developed by the American Geriatric Society and targets patients 65 and older.

EVOLUTION OF THE STARS

There are three key changes for star rating measures for 2016. Comprehensive Medication Review (CMR) will move from a display measure to a star rating measure.

As a display measure, CMS has been evaluating data and setting benchmarks for this measure. The CMR Star Rating for 2016 will be based on 2014 data.

Medication Adherence for Cholesterol (Statins)

Medication Adherence for Diabetes Medications

Medication Adherence for Hypertension

Stars shine the brightest when surrounded by darkness.

Diabetes Treatment

The Diabetes Treatment Measure has been nominated to be retired for 2017. CMS proposes to retain the measure for 2016 and then remove it in 2017. EQuIPP elected to remove this measure recently as only 2014 data will impact the Star Quality Measure in 2016. Keep in mind the treatment of hypertension and protecting the kidneys is still clinically relevant, but PQA recognizes new Joint National Committee guidelines, which include other classes of antihypertensive agents as well.

Since this measure was performing high, it seems a likely choice to be the quality measure to replace.

Statin use in persons with diabetes 40 to 75 years old is an anticipated 2017 display measure. As a display measure for 2017, based on 2015 data, the measure will continue to be evaluated.

Keep this gap in care at the forefront of your practice as you complete your CMRs and begin identifying patients driving this measure.

THE FAULT IN OUR STARS

To effectively drive our pharmacy data, we need to know which patients to focus on. Although EQuIPP provides pharmacies with quality measures data, there are limitations. EQuIPP can only provide data for the Medicare plans that send them information, and the data only drills down to the plan data. It is not patient-specific. As plans begin to send EQuIPP patient specific data, it will be visible on the Outliers tab within EQuIPP. Many pharmacies have chosen to use additional vendor solutions EQuIPP is only able to provide data for the Medicare plans that send in order to identify patients, as well information. as capture all of their patient data.

Real time information is a key for pharmacists, rather than a retrospective approach provided by EQuIPP. Some pharmacy software vendors have responded to this need by incorporating quality measure features directly into workflow.

SUMMER 2015 27

2015 MEDICARE PART D RATING CUTOFFS Star Rating

High Risk Medication

Diabetes Treatment

Medication Adherence for Diabetes

Medication Adherence for Hypertension

Medication Adherence for Cholesterol (Statins)



> 17%

< 79%

< 69%

< 72%

< 59%



> 13% to ≤ 17%

≥ 79% to < 83%

≥ 69% to < 73%

≥ 72% to < 76%

≥ 59% to < 68%



> 9% to ≤ 13%

≥ 83% to < 86%

≥ 73% to < 77%

≥ 76% to < 81%

≥ 68% to < 76%



> 7% to ≤ 9%

≥ 86% to < 90%

≥ 77% to < 81%

≥ 81% to < 85%

≥ 76% to < 83%

≥ 90%

≥ 81%

≥ 85%

≥ 83%

 ≤ 7% SOURCE: WWW.CMS.GOV

We know that stars shine the brightest when surrounded by darkness. A Medicare plan with a low score three years in a row will not be allowed to enroll patients. If the pharmacy cannot help the Medicare plans reach their desired rating, the pharmacy may be in danger of exclusion from the network or being asked to accept lower reimbursements.

In community pharmacy, pay-for-performance or an incentive-based payment model could mean highperforming pharmacies receive Pay-for-performance could bonus payments, or low-performmean high-performing pharmacies ing pharmacies could be excluded receive bonus payments. from the network or be asked to accept a lower reimbursement.

This concept has been referred to as the carrot or stick approach: reward high performers, and low performers receive negative consequences.

These carrot or stick payment models are already showing in pharmacy. SilverScript, for instance, launched a performance network in May 2014. And in April 2015, pharmacies were issued bonus payments as a reward for achieving high pharmacy quality measures.

As community pharmacist, I recognize the challenges with pharmacy quality measures. Reducing an HRM 28 MISSOURI PHARMACIST

requires action on the part of the prescriber, and many times patients are resistant to change. CMS recognized the industry was unable to reach its goal and relaxed the HRM threshold for 2015.

In addition, Medicare plans have removed some of the HRM from their formularies. Gaps in care, although easy to identify in CMRs, require the physician to issue another prescription. Newly endorsed PQA Measures address opioid misuse and abuse. This will create a new challenge for pharmacists, especially in Missouri, the only state without a prescription drug monitoring program. Med Sync, however, is a service we can offer without changing patients’ medication regimens. Knowing that Med Sync drives three PDC scores, it is the logical place to start.

Dr. David Nau, president of PQA said, “Most Medicare Part D plans could move from three stars to four stars if every pharmacy in its network could help just one more RASA patient, one more diabetes patient, and one more statin patient become highly adherent.”

Pharmacy continues to change and adapt. Some will embrace change, and some will not. As the profession of pharmacy continues to reach for the Stars, the silver lining will always come by helping one patient at a time.

PHARMACEUTICAL MATHEMATICS

Refresh your math skills with this quick guide for pharmacy technicians.

BY CHRISTOPHER FUCHS, PHARM. D. CANDIDATE, AND ILLUSTRATIONS BY SARAH HERRARA

123RF

Mathematics is commonly used in the pharmacy. While much of the math used by pharmacy technicians might not be as difficult as calculus, it must be performed accurately every single time. Improper calculations or conversions can have serious adverse effects on patients. Attention to detail is of the upmost importance.

As pharmacy technicians, it is your duty to be able to perform common pharmacy calculations accurately for the safety of the patient.

This refresher on pharmaceutical mathematics covers roman numerals, conversion factors, percentages, ratios, proportions, and common pharmacy calculations. We encourage you to use it as a quick reference guide and to brush up on your math skills.

SUMMER 2015 29

PHARMACEUTICAL MATHEMATICS

MEASUREMENTS There are several different units of measure used in pharmacy. The most common conversions will be from the metric system to the US system. The conversion of each system within itself will be discussed first, followed by conversions between each system.

• METRIC SYSTEM OF MEASUREMENT

The metric system is different than the US system because it is based on factors of 10. There are several different prefixes used to denote the measurement. The most common ones found in the pharmacy are listed below: kilo (k) = 1,000 deci (d) = 0.1 centi (c) = 0.01 milli (m) = 0.001 micro (μ or mc) = 0.0001

The prefixes above are applied to measurements of length, weight, and fluid volume. Length is measured in meters. So the measurements of length would be: 1 kilometer (km) = 1,000 meters (m) 1 decimeter (dm) = 0.1 m 1 centimeter (cm) = 0.01 m 1 millimeter (mm) = 0.001 m 1 micrometer (μm) = 0.0001 m

Another way of looking at it would be to convert one meter to the different prefixes: 1 m = 10 dm = 100 cm = 1000 mm = 10,000 μm

The unit for weight is grams (g or gm) and the unit for fluid volume is liter (L). Both of these units work the same way with the prefixes.

• US SYSTEM OF MEASUREMENT Weight:

Length:

1 pound (lb.) = 16 ounces (oz.)

1 foot (ft.) = 12 inches (in.)

Fluid Volume: 1 gallon (gal.) = 4 quarts (qt.)

1 qt. = 2 pints (pt.)

1 pt. = 2 cups (c.)

1 cup = 8 fluid ounces (fl. oz.)

1 fluid ounce (fl. oz.) = 2 tablespoons (Tbsp.)

1 tablespoon (Tbsp.) = 3 teaspoons (tsp.)

30 MISSOURI PHARMACIST

• CONVERSION BETWEEN SYSTEMS •

Length

•

Weight

1 in. = 2.54 cm 1 kg = 2.2 lb.

1 oz. = 28.3 g

•

Fluid volume 1 fl. oz. = 29.57 mL 1 Tbsp. = ~15 mL* *(This is not an exact conversion)

Measurement Examples

1. Convert a patient’s height of 5'6" to centimeters.

1 ft. = 12 in., 1 in. = 2.54 cm, 5 ft. × 12 in. = 60 in., 60 in. + 6 in. = 66 in., 66 in. × 2.54 cm = 168 cm.

2. Convert 1 liter to teaspoons.

1 L = 1,000 mL, 15 mL = 1 Tbsp., 1 Tbsp. = 3 tsp., 1 L × (1,000 mL/1L) = 1,000 mL, 1,000 mL × (1 Tbsp./15mL) = 66.67 Tbsp., 66.67 Tbsp. × (3 tsp./1 Tbsp.) = 200 tsp.

RATIOS Ratios, proportions, and percentages are frequently used in the pharmacy. Examples include drug concentrations and drug dosing by weight. A ratio compares two amounts and shows the number of times one value contains or is contained within the other. Ratios represent the relationship between parts to the whole.

Ratios can be written in many different forms. If there are 2 g of a drug in 3 mL of a liquid the ratio can be written as: •

2/3

•

2:3

•

2 grams per 3 mL

An example of a common pharmacy calculation using ratios would be dosages by weight.

Ratio Example

1. A patient weighs 110 lb., and they are supposed to get 2.5 g of drug A per kilogram. How many grams does the patient need?

Determine the ratio.

2.5 grams per kilogram = 2.5 g/kg = 2.5:1 We need to convert pounds to kilograms.

2.2 lb. = 1 kg, 110 lb./2.2 lb. = 50 kg, 50 kg x 2.5 g/kg = 125 g.

PROPORTIONS A proportion is a part, share, or number considered in comparative relation to a whole. For pharmacy calculations, a proportion is when two ratios are equal to each other. An example would be 6:10 = 3:5.

Proportion Example

1. There is a vial of drug A with a concentration of 25 mg/mL. The patient needs a dose of 250 mg. How many mL do you need to draw?

25 mg 250 mg, = 1 mL x Cross multiply.

25 mg 250 mg, = 1 mL x (25 mg)(x) = (250 mg)(1 mL), x = (250 mg)(1 mL)/25 mg, x = 10 mL. SUMMER 2015 31

PHARMACEUTICAL MATHEMATICS

PERCENTAGES There are three different types of percentages used in the pharmacy: percent weight in weight, percent weight in volume, and percent volume in volume.

•

Percent weight in weight (wt/wt) = x g/100 g

•

Percent weight in volume (wt/v) = x g/100 mL

•

Percent volume in volume (v/v) = x mL/100 mL

So 3 percent weight in weight is 3 g/100 g, 3 percent weight in volume is 3 g/100mL, and 3 percent volume in volume is 3 mL/100mL. Percent Example

1. How many grams of sodium chloride are needed to make a 1 L solution of 3 percent sodium chloride?

Convert the percentage to a ratio.

3% = 3 g/100 mL Convert 1 L to mL.

Temperature conversions are an important skill that a pharmacy technician should understand. In the United States, Fahrenheit is the most common temperature measurement. In most other countries, Celsius is used.

To convert from Fahrenheit to Celsius use this equation: [°C] = ([°F] - 32) × 5 ÷ 9

To convert from Celsius to Fahrenheit use this equation: [°F] = [°C] × 9 ÷ 5 + 32 Temperature Conversion Examples

1. 30°C is what in Fahrenheit?

1 L = 1,000 mL Then set up the proportion.

3g = x , 100 mL 1,000 mL (100 mL)(x) = (3 g)(1,000 mL), x = (3 g)(1,000 mL)/100 mL, x = 30 g.

32 MISSOURI PHARMACIST

TEMPERATURE CONVERSION

[°F] = [30] × 9 ÷ 5 + 32 = 86°F 2. What is 80°F in Celsius? [°C] = ([80] - 32) × 5 ÷ 9 = 48 × 5 ÷ 9 = 26.7 °C

FLOW RATE Flow rates are common calculations done in inpatient hospital pharmacies or any pharmacy that deals with intravenous (IV) medications. Flow rate is the rate at which an IV medication is infused. Flow rate is equal to volume divided by time (V/T). Make sure to remember which units you are solving for. Common units for flow rates are mL/h, mL/min, L/h, and mg/min.

Flow Rate = Volume/Time Flow Rate Examples

1. What would be the flow rate for an infusion (mL/h) of a 2 L bag over 5 hours?

Convert 2 L to mL. 2 L = 2,000 mL, Flow Rate = 2,000 mL/5 h = 400 mL/h.

2. How many mL of fluid are required to run an IV infusion at a rate of 75 mL/h for 24 hours?

Change the equation to solve for volume.

Volume = (Flow Rate)(Time) = 75 mL/h × 24 h = 1,800 mL. 3. How long will 1 L infusion last at a rate of 150 mL/h?

Convert 1 L to mL. 1 L = 1,000 mL Change the equation to solve for time.

Time = Volume/Flow Rate = 1,000 mL/(150 mL/h) = 6.7 h.

ROMAN NUMERALS Roman numerals are used in the writing of prescriptions usually to signify the number of tablets to be taken at a time. The roman numerals you are likely to see are: ss = 1/2 I=1 V=5 X = 10 L = 50 C = 100 M = 1,000

There are special rules for combining roman numerals.

A letter placed after another letter of greater value adds to that letter (VI or vi is 6), whereas a letter placed before another letter of greater value subtracts from that letter (XC or xc is 90).

For example, the year 2014 would be MMXIV. MM would be 1,000 + 1,000; therefore, 2,000.

The X is 10. The IV would be 5 - 1; therefore, 4.

You would then add them all together to get 2,000 + 10 + 4 = 2014.

The most common roman numerals in pharmacy are I (1), II (2), III (3), IV (4), and V (5).

SUMMER 2015 33

PHARMACEUTICAL MATHEMATICS

ALLIGATION Alligation is a method used to determine the amounts needed of two products with different concentrations needed to make one new product with a new concentration. The best way to explain an alligation is to do an example.

Alligation Examples

How many grams of 2.5 percent cream and how many grams of 10 percent cream are needed to make 100 g of 7.5 percent cream?

1. The first step is to make a table.

5. Total the parts (5 + 2.5 = 7.5).

10%

5 parts of 10% 7.5%

2.5%

2. Next, fill in the table.

Place the two concentrations you have in the left upper and lower corners like so, and place the desired concentration in the middle.

=

7.5

6. Then, divide the parts of one of the creams by the total parts.

7. To determine the amount of the 10 percent cream, multiple 0.67 by the total amount of cream (100 g).

7.5% 2.5%

3. Subtract diagonally, so 10% - 7.5% = 2.5% and 2.5% - 7.5% = -5%. Even though it will be negative, write it in the table as positive.

10%

5

2.5%

2.5

4. The numbers in the right corners tells you the parts of each cream needed.

10%

Amount of 10 % cream: = 0.67 × 100 g = 67 g.

8. Half of the problem is solved. To determine the amount of 2.5 percent cream, subtract the amount of 10 percent cream (67 g) by the total (100 g).

2.5% cream = Total Cream − 10% cream

7.5%

5 parts of 10% 7.5%

34 MISSOURI PHARMACIST

TOTAl PARTS

10% cream = 5 parts ÷ 7.5 parts = 0.67

10%

2.5%

2.5 parts of 2.5%

2.5 parts of 2.5%

= 100 g – 67 g = 33 g.

9. The complete answer is: 67 g of 10 % cream and 33 g of 2.5 % cream.

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The patient may not always be right but still deserves respect.

LET'S TALK...

Learn a new strategy on how to diffuse the dreaded angry patient.

HEATHER LYONS-BURNEY PHARM.D., CLINICAL ASST. PROFESSOR UMKC SCHOOL OF PHARMACY AT MSU

Pharmacy technicians are often the first person patients encounter at the pharmacy. The majority of patients are pleasant customers, but some can seem unreasonable.

In healthcare, we tend to expect the unexpected when it comes to patient interaction, but a difficult patient can still rattle us from time to time. By accepting and understanding patients’ or caregivers’ emotions, we can often diffuse a potentially unpleasant situation.

It is often said that communication is an art and that good communication skills can win over even the most challenging of patients. It is often said,“Kindness is the language which the deaf can hear and the blind can see.”

With that, let’s talk about angry patients.

Anger is defined as an emotion of annoyance, grievance, or displeasure. Merriam-Webster.com defines anger as “a strong feeling of being upset or annoyed because of something wrong or bad: the feeling that makes someone want to hurt other people, to shout, etc.”

I know for most of us, we are already uncomfortable just thinking about dealing with angry patients.

36 MISSOURI PHARMACIST

How should we handle an angry patient? When on the receiving end of unwarranted anger, we may not know how to handle patients or solve their problems.

The angry patient may find us reacting with anger of our own or completely avoiding interaction.

By adopting the policy that the customer always deserves respect, pharmacy technicians will maintain their professional duty to serve their patients. One of the most important things a technician can do when communicating with an upset patient is to listen.

The patient may not always be right but still deserves respect. The technician also deserves respect and should not accept disrespectful treatment by over-apologizing.

Patients may not change their behavior in response to a respectful interaction, but technicians can feel satisfaction in using a professional approach.

Bruce Berger has some excellent tips for diffusing a situation with an angry patient in Chapter 6 of the American Pharmacists Association book Communication Skills for Pharmacists.

123RF

BY HEATHER LYONS-BURNEY

SURVIVAL TIPS FOR COMMUNICATING WITH AN ANGRY PATIENT Stay calm • Our first instinct is to flee or fight when faced with an angry patient. Train yourself to stay calm.

Take slow and deep breaths while concentrating on maintaining eye contact.

Stop, look, listen, lean forward, and be responsive • Move the agitated person to a private area. Stop what you are doing and focus on what the patient is telling you. Body language is an important tool for showing a patient you are serious about resolving the issue. Nodding, eye contact, and note taking are all excellent modes of silent communication. Keep quiet and resist the urge to interrupt. Respond only when the patient is finished. Begin the conversation with agreement, even if it requires you to really dig deep to uncover some common ground. Start off your response with “I’m glad you brought this to our attention. I’d like to help solve this problem.”

Accept the anger • Do not take the anger personally.

Refer to the proper person • Once you have determined who could be the best person to solve the problem, explain that to the patient.

Don't give up until you have solved the problem.

Restate the problem and ask for confirmation • Briefly summarize the story to the patient to ensure you understood the whole complaint.

Personalize • Always address the patient by name. For example, when dealing with an irate patient, use the patient’s name in the conversation to help calm him or her down.

Exceed expectations • Don’t give up until you have solved the problem. If company policy allows, and it is appropriate, provide the patient with a token of appreciation such as a coupon.

Proper follow–up • Once the problem has been resolved, follow up with your manager, the pharmacist, and the patient to ensure that he or she is content.

SOURCE: BERGER, B.A. COMMUNICATION SKILLS FOR PHARMACISTS: BUILDING RELATIONSHIPS, IMPROVING PATIENT CARE. WASHINGTON DC: AMERICAN PHARMACISTS ASSOCIATION; 2009

Perniciaro and Associates Senior Care Consultants Paul G Perniciaro, R.Ph., CGP, FASCP President, Director of Consultant Pharmacy Services 636-391-7555 | paulrphcgp@sbcglobal.net 2209 Sycamore Drive, Chesterfield, MO

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Pharmacy and the Law

Senator Shelley Moore Capito speaks about S. 1190 at the 2015 Legislative Conference.

WORKING TOGETHER FOR RESULTS

NCPA’s vice president discusses legislation vital for pharmacies.

CHRISTIAN TADRUS PHARM.D., RPH, FASCP, AE-C, SAM'S HEALTH MART PHARMACIES, NCPA FIFTH VICE PRESIDENT

Partnerships are essential to meeting challenges and achieving professional goals. That’s why state associations like the Missouri Pharmacy Association work closely with their national counterparts to help align messages and rally pharmacists to a cause. Having been recently appointed to the position of vice president for the National Community Pharmacy Association (NCPA), an organization that represents the nation’s independent community pharmacies, I can attest to the power of such relationships—especially this year.

NCPA’s top 2015 legislative priority is closely aligned with MPA’s top 2015 legislative priority—ensuring transparency on Maximum Allowable Cost (MAC) pricing. The MAC Transparency Act, H.R. 244, was introduced by Representatives Doug Collins, R-Georgia, and Dave Loebsack, D-Iowa. If enacted, it would provide transparency and fairness to community pharmacies regarding their reimbursement for generic drugs.

This bill requires pharmacy benefit managers to disclose the rate of reimbursement in the contract and to update that rate at least once every seven days to reflect fluctuations in the market. At least 17 states have passed

38 MISSOURI PHARMACIST

similar MAC pricing bills, some having more impact than others. MPA has worked with NCPA to understand what has and hasn’t worked with regard to other states’ bills in order to refine the acceptable language for our own Missouri MAC pricing bill.

Preferred pharmacy network contracting continues to be a troublesome area for pharmacies, especially for independent pharmacies, as they restrict patients' access to their local, and likely preferred, pharmacy and pharmacist. NCPA is keenly aware of the toll preferred contracting is taking on independent pharmacies and is working to ensure fair and equal access by supporting H.R. 793, the Ensuring Seniors Access to Local Pharmacies Act. This bill was introduced by Morgan Griffith, R-Virginia, and Peter Welch, D-Vermont, and would allow independent pharmacies the ability to participate in preferred networks if one or more of their stores is located in a health professional shortage area, one or more of their stores is located in a medically underserved population, and if they can meet the terms and conditions that are offered to other in-network pharmacies.

NCPA

BY CHRISTIAN TADRUS

Bills that Matter to Pharmacists The MAC Transparency Act, H.R. 244 Sponsor: Rep. Doug Collins, R-Georgia • Introduced to the House on February 9 • This bill has 10 cosponsors (8 Republican, 2 Democrat) The Ensuring Seniors Access to Local Pharmacies Act of 2015, H.R. 793/S. 1190 Sponsors: Rep. Morgan Griffin, R-Virginia, and Sen. Shelley Moore Capito, R-West Virginia • Introduced to the House on February 5 and to the Senate on May 5 • These bills have 46 cosponsors (33 Republican, 13 Democrat) in the House and 4 (2 Republican, 2 Democrat) in the Senate Pharmacy and Medically Underserved Areas Enhancement Act, S. 314 and H.R. 592 Sponsors: Rep. Brett Guthrie, R-Kentucky, and Sen. Chuck Grassley, R-Iowa • Introduced to the House January 28 and to the Senate on January 29 • These bills have 127 cosponsors (70 Republican, 57 Democrat) in the House and 14 (6 Republican, 8 Democrat) in the Senate.

NCPA is also a member of a coalition of national and state pharmacy associations focused on achieving pharmacist provider status. As part of that coalition, NCPA is supporting two companion bills moving through congress: S. 314 and H.R. 592. Both would recognize pharmacists as providers under the Medicare Part B program. If enacted, pharmacists would be able to perform services Our profession doesn’t move itself for patients consistent with their forward, and bills don’t pass themselves. state’s scope of practice if their pharmacy is located in a medically underserved area, health professional shortage area, or medically underserved population.

Our profession doesn’t move itself forward, and these bills don’t pass themselves. It takes effort by pharmacists, such as you and me, on both state and national levels to ensure our future. Many of us make the effort to go to Washington, DC, each year in support of legislative initiatives because it’s important; some issues can’t be solved on a local level. But you don’t have to go to that extreme. You can help simply by calling your senator or representative and asking them to support these bills.

Give them examples about how these issues are affecting your patients. Ask them to join their chamber’s pharmacy caucus. The caucuses host quarterly educational sessions for staff and industry stakeholders and work with all pharmacy organizations to keep them upto-date on pharmacy issues that affect their constituents.

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SUMMER 2015 39

Student Update

UMKC APhA-ASP chapter places in top four.

RUSSELL B. MELCHERT DEAN AND PROFESSOR, UMKC SCHOOL OF PHARMACY

We have some exciting news from the University of Missouri-Kansas City School of Pharmacy: our student pharmacists have once again brought national attention to our pharmacy program with their recognition at the American Pharmacists Association meeting in San Diego.

The UMKC chapter of the APhA-Academy of Student Pharmacists won the Division AA National Chapter Achievement Award for 2013-2014. This, once again, placed UMKC in the top four out of 129 APhA-ASP chapters for impacting community health through patient care services, particularly in underserved/underinsured populations.

And, this national recognition continues a long history of significant success as our chapter was ranked in the top 10 in 2014, top four in 2013, and received the National Student Chapter of the Year award in 2012.

We are very proud of our student pharmacists and their outstanding accomplishments. Their efforts were facilitated greatly by the outstanding mentorship provid-

40 MISSOURI PHARMACIST

ed by the APhA-ASP Advisors at UMKC, including Drs. Kelly Cochran and Angela Brownfield in Columbia and Drs. Cameron Lindsey, Valerie Ruehter, and Andrew Bzowyckyj in Kansas City.

In addition to those outstanding APhA-ASP advisors, our student pharmacists are prepared and mentored by a truly remarkable group of people—the School of Pharmacy’s faculty and staff. We are fortunate to have a highly skilled, internationally recognized faculty providing instruction. Several faculty members were recently recognized by our student pharmacists as teachers of the year or runners up, including Drs. Tom Johnston, Mridul Mukherji, Mark Patterson, Steve Stoner, and Eric Wombwell. Congratulations to them and many thanks to our entire faculty and staff.

Finally, stay tuned for big news in the fall as we will be bringing on board five new faculty members. We can’t wait to introduce them to you.

Have a great summer!

UMKC SCHOOL OF PHARMACY

CAMPUS NEWS

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Student Update Phase I construction of the new six-story St. Louis College of Pharmacy, which will house the school, library, and the professional program's faculty, staff, and students, is underway.

JOHN A. PIEPER PHARM.D., FCCP, FAPHA, PRESIDENT AND PROFESSOR OF ST. LOUIS COLLEGE OF PHARMACY

This has been an exciting year for St. Louis College of Pharmacy. We are nearing completion on the first steps of a campus transformation. Our new 213,000-squarefoot, state-of-the-art academic and research building and library will be ready for the fall semester. The new six-story facility will house the School of Pharmacy; the four-year professional Doctor of Pharmacy program faculty, staff, and students; and our new library.

The second phase of construction is scheduled to include a second residence hall, a new dining and kitchen facility, student center, recreation center, and gyms. We are hoping to break ground this fall and complete construction late 2016.

Jones Hall is also undergoing minor renovations to create new classrooms and expand lab facilities for our department of basic sciences. Our new construction is enabling us to do more than just provide enhanced learning opportunities for our students. It will also allow us, for the first time, to expand our research initiatives and increase our collaboration with other institutions in St. Louis.

We are also collaborating with Washington University and Goldfarb School of Nursing to found a center for interprofessional education. The center’s new director will

42 MISSOURI PHARMACIST

be located in our new building and will lead the effort to bring together our student pharmacists with medical, occupational therapy, physical therapy, and public health students from Washington University and nursing students from Goldfarb School of Nursing to learn and practice together. The future of pharmacy will need graduates who are ready to provide patient care as essential members of collaborative teams.

To provide opportunities for our students to practice in teams with healthcare colleagues, we have identified local and international opportunities to learn these skills and to impact patients’ lives.

We’re working closely with alumna Dr. Kendra Holmes and others at the former Grace Hill Health Centers (recently renamed Affinia Health Care) as well as other federally qualified health centers in the St. Louis region to improve care for patients who have historically been denied high-quality care. In addition, four pharmacy practice faculty members provide care to underserved patient populations at the St. Louis County Department of Health North County and South County clinics.

Our future is bright, and I am very much looking forward to this next chapter in our rich history!

BRAD BROWN

CAMPUS NEWS

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SUMMER 2015 43

Student Update

The compounding lab course focused on 11 dosage forms that students took home.

PHARMACY BOOT CAMP

UMKC pharmacy students experience a new PCCA compounding course close to home.

BY HEATHER LYONS-BURNEY

44 MISSOURI PHARMACIST

University of Missouri-Kansas City School of Pharmacy students attended the first satellite compounding lab boot camp by Professional Compounding Centers of America in January.

PCCA experts also discussed various contemporary compounding topics, compounding as a career path, and examples of patient case studies.

Lawrence Drug, Family Pharmacy, Grove Pharmacy, and Convenient Care Pharmacy provided many of the necessary lab supplies for the camp.

“I think learning about different types of formulation and uses of compounding sparked an interest, not just in myself but for a great majority of the other students that attended,” Florin Iacob, UMKC Class of 2018 said.

The school plans to host the remote camp annually.

HEATHER LYONS-BURNEY

HEATHER LYONS-BURNEY PHARM.D., CLINICAL ASSISTANT PROFESSOR AT UMKC SCHOOL OF PHARMACY AT MSU

For two days, 27 students from the University of Missouri-Kansas City School of Pharmacy concocted lollipops, lip balms, lozenges, and other compounds in a pharmacy boot camp focused on compounding. While the camp mainly exercised the brain as opposed to brawn, it required a little elbow grease, too.

Pharmacy students attended the Professional Compounding Centers of America Student Introductory Compounding Lab Boot Camp at the UMKC School of Pharmacy at Missouri State University in Springfield January 10 and 11.

“The PCCA compounding camp was a great way for me to learn about a field of pharmacy I knew little about,” Kristen Taylor, UMKC class of 2018 said. “Not only did I learn about compounding, I had a great deal of fun making the preparations with my peers.”

Traditionally, students travel to PCCA’s facilities in Houston, Texas, to attend the course, which provides them with an elective credit hour upon completion. Students saved time and money in travel while being able to experience the PCCA’s expertise and training closer to home. Two full days of lecture and hands-on laboratory work provided a basic understanding of the skills, tools, and equipment used in contemporary compounding.

Students compounded 11 dosage forms they could take home, such as lollipops, lip balms, troches, suspensions, and transdermal delivery systems.

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SUMMER 2015 45

For more information on MPA events vist MoRx.com.

MILESTONE MEMBERS

Celebrate our pharmacists’ MPA anniversaries.

20

Paula Weaver, St. Louis Craig Willimann, New Haven

NEW MEMBERS

Welcome our new members.

Sarah Baker, Webb City Alloch Burton, Jefferson City Laura Butkievich, Columbia Tramaine Hardimon, Florissant Krista Hein, St. Louis Jeremy Leach, Desloge Elizabeth Lehmann, St. Louis Jane Massey, Neosho Jennifer McCoy, Cape Girardeau Sarah McLain, Parkville Phillip Moser, Jadwin Kimberly Nolte, St. Joseph Andrew Osterkamp, Elsberry Brian Oyler, Bolivar Michael Smith, Neosho Roger Sommi, Columbia

WE’VE GOT YOU

COVERED FOR

CONTINUING

EDUCATION

UPCOMING EVENTS APhA PROVIDING MEDICATION THERAPY MANAGEMENT SERVICES

June 19, 2015 > UMKC School of Pharmacy at Missouri State University, Springfield UMKC School of Pharmacy is hosting a Medication Therapy Management Services program. This certificate training program is to prepare pharmacists to improve medication use through the delivery of MTM services in a variety of practice settings.

MID-AMERICA PHARMACY CONFERENCE & EXPO AND GOLF TOURNAMENT

September 10-13, 2015 > Overland Park, KS Celebrate the pharmacy profession. The 2015 annual conference will bring together pharmacy professionals in Missouri, Kansas, and Oklahoma for networking opportunities, educational sessions, and a trade show featuring suppliers who specialize in pharmacy related products and services. The golf tournament begins on the first day of the conference at Ironhorse Golf Club. To register for the tournament or conference, visit MoRx.com.

Great news for MPA technicians! The Missouri Pharmacy Association is now partnering with the Collaborative Education Institute (CEI) to offer streamlined access to pharmacy technician education. This new opportunity offers all of the programs and the credit you need to continue your pharmacy technician education in one place.

As a MPA member and CEI partner, you now have free access to CEI’s Certified Pharmacy Technician (CPhT) Recertification Bucket. You can access these

46 MISSOURI PHARMACIST

programs on the CEI website through our partner page.

The CPhT Recertification Bucket includes CPhT recertification CPE activities in categories consistent with PTCB domains, structured as 10 one-hour written modules you can print and complete on the go. Also included: live and on demand webinars in pharmacy law and patient safety.

For a full list of instructions on how to access this new continuing education opportunity, login to MoRx.com under the Education and Continuing Education tabs.

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Benjamin Bluml, Washington, DC Bryan Hercules, Bridgeton Debra Schoen, Dallas, TX

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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.

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48 MISSOURI PHARMACIST © 2015 Health Mart. All rights reserved. HM-09424-05-15