Elements Magazine Vol. 13 Iss. 3 September 2024

Vaccine Overview 2024-25 What’s next in your pharmacy

CYBERSECURITY IN YOUR PHARMACY How to protect yourself from cyberattacks

A NEW DIRECTION FOR CONTINUOUS GLUCOSE MONITORS Help patients manage their blood sugar VOL. 13 ISS. 3 | SEPTEMBER 2024

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Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA and its affiliates.

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CONTENTS ON THE COVER

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FEATURE | Vaccine Overview 2024-25 What’s next in your pharmacy

DEPARTMENTS

07

NEWS | Diagnosing Alzheimer’s Disease

08

TRENDS | Patient Medication Reviews

10

ETAIL | A New Direction for Continuous R Glucose Monitors

Blood tests are simpler, faster, and more accurate

The importance of deprescribing

Help patients manage their blood sugar

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SOLUTIONS | The Prevalence of Osteoarthritis Improve patients' lives with your support

26

SPOTLIGHT | Peripheral Artery Disease

28

MONEY | PBMs Exposed

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Tips to keep patients' symptoms at bay

Executives pressed by lawmakers for driving up drug prices

OUTLOOK | Cybersecurity in Your Pharmacy How to protect yourself from cyberattacks

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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ELEMENTS

ON THE WEB

The business magazine for independent pharmacy

VOLUME 13, ISSUE 3 SEPTEMBER 2024 PUBLISHER & EDITORIAL DIRECTOR Matthew Shamet EDITOR Gina Klein

Your In-Store Event Your patients enjoy feeling a part of your community pharmacy, and you love that they keep your pharmacy on its toes. However, don’t forget to find new ways to draw in even more customers.

GRAPHIC DESIGNER Logan Whetzal CONTRIBUTING WRITER Cecilia Vigliaturo

Finding Your Pharmacy’s Niche

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In the eyes and minds of customers, most pharmacies tend to look and feel alike. Therefore, they’re not very loyal to any one store. This is why it’s important that you make your community pharmacy unique to improve your profitability.

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Taking Charge of Obesity As the rates of obesity continue to rise, modern lifestyles are stuck in a harmful cycle of eating unhealthy foods and living a sedentary lifestyle.

However, the American Society of Health-System Pharmacists is stepping in and recommends that community pharmacists counsel and help obese patients manage lifestyle modifications.

Elements magazine is published quarterly by PBA Health. ©2024 PBA Health. All rights reserved.

Neither this publication nor any part of it may be reproduced without written permission by PBA Health.

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NEWS

DIAGNOSING ALZHEIMER’S DISEASE Blood tests are simpler, faster, and more accurate

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lzheimer's disease affects more than 6 million people in the U.S. and millions more around the world, with dementia being the most common form. The revealing biomarkers are brain-clogging amyloid plaques and abnormal tau protein.

However, new blood tests have been found to detect the characteristics of Alzheimer’s disease more accurately.

Two new drugs, Kisunla and Leqembi, can remove the gooey amyloid from the brain. This can modestly slow symptoms as they worsen. However, they only work in the earliest stages of Alzheimer’s. Therefore, proving your patients qualify in time can be a challenge. It’s invasive to measure amyloid in spinal fluid; using a PET scan to spot plaques is costly; and getting an appointment can literally take months.

While blood tests have been used mostly in carefully controlled research settings, it’s been shown that they can also work in doctors’ offices, thanks to a new study in Sweden of around 1,200 patients.

As part of the study, patients who visited a primary care doctor or a specialist for memory issues were initially diagnosed using traditional examinations, had blood work done, and were sent for a spinal tap or brain scan for confirmation.

The blood testing was significantly more accurate, according to Lund University researchers. According to the findings, the initial diagnosis from primary care doctors was 61% accurate. The specialists’ was 73%. But the blood test was 91% accurate, according to the findings, which were published in the Journal of the American Medical Association.

It's not easy to tell if Alzheimer’s causes memory issues. The only way to know is to confirm buildup of a sticky protein

known as beta-amyloid with a brain scan or uncomfortable spinal tap. Instead, a lot of patients are diagnosed based on their symptoms and cognitive tests.

There are a variety of tests today, and each one measures different biomarkers in different ways. According to the Alzheimer’s Association, only blood tests proven to have a greater than 90% accuracy rate should be used by doctors and researchers. The tests most likely to meet that benchmark are called p-tau217. They measure a form of tau that correlates with how much plaque buildup someone has.

A high level signals a strong likelihood the person has Alzheimer’s. A low level indicates it’s probably not the cause of memory loss.

ALZpath Inc., Roche, Eli Lilly, and C 2N Diagnostics are some of the companies that are developing p-tau217 tests. However, only doctors can order the tests from the labs. The p-tau217 blood test seems to be the front-runner for Alzheimer’s and with the most validity.

The peptide p-tau217 is unique because it can only be detected when amyloid plaques are present in the brain.

That means when p-tau217 is being measured, the neuron damage from tau is being measured very early on in Alzheimer’s, but only when amyloid is already present.

The Alzheimer’s Association is working on guidelines and several companies plan to try for FDA approval, which would define proper usage. In the meantime, doctors should use blood testing only in patients who have memory problems, after checking the accuracy of the type they order.

According to mathematical models based on the aging of the U.S. population, wait times for testing are going to get worse. If in 10 years a primary care doctor is still only using the current cognitive assessments to determine dementia, people will have to wait an average of about six years.

There aren’t tests for people who don’t have symptoms just yet, partly because amyloid buildup can begin two decades before the first sign of memory issues. So far, there aren’t any preventive steps other than basic advice to eat healthy, exercise, and get enough sleep.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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TRENDS

PATIENT MEDICATION REVIEWS The importance of deprescribing

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edications can drastically improve people’s lives, especially those with chronic conditions, such as high blood pressure, diabetes, mental illness, high cholesterol, cancer, and chronic pain. But taking too many prescribed medications can be dangerous.

When your patients take more than five medications, it’s called polypharmacy. With this, there are risks, such as harmful effects, drug interactions, and an increase in hospitalizations. Overall, 13% of people in the U.S. take five or more prescription drugs. For people who are 65 or older, that number is 42%.

When one pill leads to a side effect, it can lead to another pill and another side effect. This is known as a “prescribing cascade.” If taken for years, some drugs can cause harm while others stop working or interact badly with a new medication. Even though a drug can be tolerated well at first, it can later cause side effects and lead to cognitive decline and possible injuries from falls.

This is why deprescribing is crucial to patient care. With it, there’s a systematic review and reduction of medications that are either unnecessary or have the potential to be harmful. Here is what it can do for patients: • Lessen side effects. Some medications have side effects that can make health conditions worsen or cause new issues.

• Prevent drug interactions. Taking multiple medications runs the risk of harmful drug interactions. Deprescribing can help minimize the risk of drugs not mixing well.

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• Simpler regimens. The fewer medications your patients take, the simpler their regimens. This can improve their adherence and ensure they take their medications as prescribed.

• Better quality of life. With fewer medications to take, your patients will have less physical and mental burden (especially with complex medication schedules).

• Functionality improvements. Deprescribing can improve a patient’s overall functional status, especially if some of their medications impair cognitive or physical function.

• Decrease healthcare costs. Taking fewer medications reduces costs for patients and the healthcare system.

This includes lower expenses for purchasing drugs and managing side effects.

• Support personalized care. By deprescribing, treatment plans can be better tailored to the patient’s current health status, goals, and preferences.

Performing patient medication reviews is vital for multiple reasons. First of all, you’re trained to identify issues such as side effects, drug interactions, and inappropriate dosages.

Reviewing your patients’ medications helps detect and resolve any problems. If a medication on their list isn’t needed anymore, here are steps you can take to deprescribe effectively: • Review the medication list. Assess the current medications your patient is taking. Are they still effective and relevant? Decide which medications are still necessary.

Pay attention to drugs that may cause adverse effects, interactions, or have outdated indications.

• Assess the patient’s condition. Check their health status.

Review the patient’s overall health, including their medical history, current conditions, and any new health issues.

Make sure the medication plan aligns with the patient’s goals and preferences.

• Make medications a priority. Determine risk vs. benefit.

Decide the medications with the highest risk or least benefit. Prioritize them for potential discontinuation.

• Speak with the patient and healthcare team. Talk about options. Chat with the patient about the risks and benefits that come with continuing vs. stopping each medication.

Invite family members if appropriate. Team up with other healthcare providers to secure a coordinated approach, especially for medications managed by different specialists.

• Make a deprescribing plan. Develop a gradual schedule for tapering if needed, rather than an abrupt discontinuation.

This way, you’ll avoid withdrawal symptoms or rebound effects. Plan to closely monitor your patient’s response to the medication changes and adjust the plan as needed.

• Educate your patient. Inform your patient why you’re stopping the medication, potential side effects, and any signs to watch for. Make sure they understand the plan and know who to contact for any questions or concerns.

• Monitor regularly. Schedule follow-up appointments to monitor your patient’s health status and response to the changes in medications. Be ready to make further adjustments based on your patient’s clinical outcomes and feedback.

Document all changes. Be sure to record all decisions and changes made. This includes patient discussions and clinical

rationale. Be sure the patient’s medication records have also been updated with recent changes.

Common causes of hospital readmissions are due to medication errors and adverse drug reactions. But your regular reviews can help prevent issues like these, especially if you collaborate with other healthcare professionals to consider all aspects of a patient’s health and treatment. This leads to better patient outcomes and reduced costs.

You give personalized advice and education that helps your patients understand their treatments better and can adhere to their medication regimen with confidence. And with regular reviews of your patients’ medications, you’re able to see that they’re used safely and effectively with the ability to adjust prescriptions as needed, whether it’s from changes in a patient’s health or to new evidence-based guidelines.

Educating your patients provides valuable tips on how to take their medications correctly, what potential side effects they may notice, and the importance of adherence. It also empowers them to take on an active role in managing their health.

When your patients feel empowered, they experience many benefits, such as confidence in health decisions and improved management of their chronic conditions.

They engage more with their healthcare providers, asking questions and expressing concerns. Empowered patients are also more likely to seek and utilize support networks, and more likely to report a greater quality of life and sense of control over their health.

You have the power to empower your patients. So, keep going; they need your support to build their confidence in managing their health.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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RETAIL

T A NEW DIRECTION FOR CONTINUOUS GLUCOSE MONITORS

he first continuous glucose monitors (CGM) were approved by the U.S. Food and Drug Administration (FDA) in 1999. The first device could record glucose values for three days, and then the information was downloaded in the healthcare provider’s office for the patient to review.

Help patients manage their blood sugar

While CGM has been accessible over the past two decades, the most recent trend has been the FDA’s approval of the first over-the-counter (OTC) continuous glucose biosensors (CGM) on March 5. The device is intended for people with type 2 diabetes who don’t take insulin to manage their condition. However, the biosensor can also be used by those without diabetes who simply want to know how their diet and exercise affect their blood glucose levels.

A wearable sensor on the monitor is paired with a smartphone app that measures, records, displays real-time glucose levels, and helps support behavior modification.

One of the benefits of the OTC biosensor is that it can help people who need to track their glucose levels but are unable to access a CGM through insurance. What’s more, it also has the potential of undiagnosed diabetes and prediabetes.

For the use of CGM for those using insulin or at risk of hypoglycemia, real-time CGM can help your patients manage their glycemia, and depending on the state you live in, you can practice under medication therapy management (MTM), comprehensive medication management (CMM), or collaborative drug therapy

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management (CDTM). Also determined by state regulations, pharmacists can prescribe CGM devices based on guideline recommendations and provide adequate training to patients and caregivers.

People with type 2 diabetes who are managing it with oral medications and lifestyle changes might benefit from CGM; especially if they don’t want to stick their finger multiple times a day to check blood sugar.

“There are two components to the product,” said Keri Leone, Sr. Director, Global Medical Affairs with Dexcom. “It comes in a box, and you basically untwist it and pop a sensor on your arm. It literally takes a second to do. Then, in 30 minutes, it warms up and starts reading your glucose. Your glucose can be read to a specific handheld receiver or to your smartphone.”

There’s also a feature called Urgent Low Soon. If the feature is turned on, it will tell the patient that their numbers will be low soon, thus reminding them to not take more medicine or to go eat something to avoid a severe hypoglycemic event.

“This feature is unique to Dexcom. It looks at what your glucose is and then predicts if your glucose will be at or below the severe hypoglycemic level (<55mg/dL) in the next 30 minutes. So, if you give yourself too much insulin, that 30 minutes can turn a 150 on its way down quickly,” Leone said.

“If it notices you may have a glucose value of 55 or lower in the next 30 minutes, it’ll warn you to eat something.

This is the best feature for Medicare patients because sometimes they don’t actually feel the lows because they’ve had diabetes over a longer period.

Most of our patients are choosing to use it on their smart device. But for Medicare to cover it, it needs to have a durable aspect, which is the receiver.”

The use of CGM in the management of diabetes has been shown to decrease A1C and can provide much deeper insight into glucose patterns than a single value like a blood glucose meter or A1C level. The ability to gather information about whether a patient’s glucose level is high or low makes it much easier to identify and act upon patterns.

1. CMS Documentation Requirements In Non-insulin Treated Diabetes with Problematic Hypoglycemia CMS Recurrent Level 2 Hypoglycemic Events Must document at least one of the following: • Glucose <54mg/dL; or, • Classification as level 2 events; or, • BGM testing log with glucose, 54mg/dL; and, More than one previous medication adjustment and/or modification to the treatment plan prior to the most recent level two event.

Documentation Needs: Level 3 Hypoglycemic Event Must document at least one of the following: • Glucose <54mg/dL; or, • Classification as level 3 event; or, • BGM testing log with glucose, <54mg/dL; and, Required third party assistance for treatment.

2. CGM Accessibility Through Pharmacy and DME Channel • Centers for Medicare & Medicaid (CMS) classifies CGMs as Durable Medical Equipment (DME), covered under Part B. • Access: Individuals with FFS Medicare or Medicare Advantage can obtain Dexcom through a durable medical equipment vendor if they meet any insulin criteria and/or experience level 2 or level 3 hypoglycemia.

• Pharmacy Access: Some Medicare Advantage plans, such as the list below, allow access to Dexcom at the pharmacy (still under the medical benefit, not Part D).

• CGM is available for pickup at pharmacies for beneficiaries enrolled in Medicare Advantage plans, such as those provided by United Healthcare, Aetna, Cigna, and Humana— making it easier for patients to get their CGM to send scripts to the pharmacy.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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Hypoglycemia can also be dangerous, though many people can be asymptomatic. That’s where CGM can be especially helpful. It can also identify hypoglycemia and alert patients to predicted low glucose levels so they can intervene early to minimize its severity. CGM can also alert patients when their glucose is high. However, if the alert level for hyperglycemia isn’t set appropriately for the patient, it may alert the patient more often. This can be seen as a nuisance. With diabetes, it’s normal to see incidences of hyperglycemia, so setting alerts to a level that’s attainable to the patient is important.

To improve access to CGM and reduce the administrative burden for HCPs to document the need for CGM, on October 1, new ICD-10 codes will come out. So, for pharmacists who code for their time with those patients and get reimbursed, there is going to be a much more effective and efficient way of documenting for those with hypoglycemia.

A collaboration between Dexcom and other entities went to CMS in May and made it known that there wasn’t a great way to document severe hypoglycemia. They asked if they could work together and make it easier for providers, prescribers, and pharmacists to code for these people. The two main brands of CGM that you can now get through CMS are the Abbott Libre 2 or 3 and Dexcom G7.

“CMS approved, and as of October 1st, there will be three codes now instead of having to write it in your notes and then have to submit your notes to CMS for review,” Leone said.

“You can just code e16.a1, e16.a2, or e16.a3, and that one code tells CMS this patient has hypoglycemia, severe hypoglycemia, or needs third-party assistance.”

“What’s exciting specifically for Medicare Advantage plans is now they can access CGM through their pharmacy. So, they can get CGM sent right to their local pharmacy. Their pharmacist would have to order the product, but in some cases, the pharmacy carries them on the shelf. Once it’s prescribed, they hand it over to a patient with their copay, which can be through their normal pharmacy channel,” Leone said. “And specifically, with Medicare Advantage plans, like United Healthcare, Aetna, Cigna, and Humana, there is a growing availability through the pharmacy channel, making it easier for patients to get their CGM.” If you come across patients whose glucose alerts and readings from their CGM don’t match their symptoms or expectations, Dexcom recommends using a blood glucose meter to make their diabetes treatment decisions. You can find a list of compatible devices at dexcom.com/compatibility.

UPDATED MEDICARE COVERAGE CRITERIA FOR CGM Updates to the coverage criteria for CGM allow many more Medicare beneficiaries to qualify.

The patient’s medical record should show they meet the following eligibility requirements: 1. Treated with insulin; or 2. Documented history of problematic hypoglycemia with at least one of the following: - Recurrent level 2 hypoglycemic events (glucose <54 mg/dL) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or - A history of one level 3 hypoglycemic event (glucose <54 mg/dL) requiring thirdparty assistance (Source: Centers for Medicare and Medicaid Services, LCD)

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SOLUTIONS

THE PREVALENCE OF OSTEOARTHRITIS Improve patients' lives with your support

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illions of adults suffer from chronic joint pain and stiffness known as osteoarthritis (OA). It’s the most common type of arthritis both in the U.S. and around the globe, and it’s affecting more than 32.5 million Americans alone.

OA is a degenerative joint disease that typically develops as a result of injury or overuse. It involves the bone, cartilage, ligaments, fat, and tissues lining the joints. It breaks down cartilage, misshapes bones, and creates inflammation that leads to pain, swelling, stiffness, and a loss of mobility. OA will also affect a person’s hands, knees, hips, neck, and lower back. While it most often occurs in older adults, it can also affect those who are younger. Unfortunately, the damage caused by OA is irreversible.

Gender can also affect a person’s chances of developing OA. It’s more common in males aged 50 and younger. But in people 50 and older, it’s more common in females, especially after menopause.

It’s important that you are aware of OA signs and symptoms so you can provide your patients with advice on pain management. With your advice and support, you can improve their quality of life. Noticing patients who have difficulty walking, hip or knee pain, or the appearance of stiffness and pain in their hands should alert you to the possibility of OA and the need for a referral to a physician to be diagnosed.

The first step in helping a patient with OA is asking the following osteoarthritis screening questions from the Osteoarthritis Action Alliance: • Have you ever been told by a doctor that you have inflammatory arthritis?

• Did your joint pain start suddenly or abruptly?

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• Does your pain or stiffness last longer than 30 minutes after rising from a sitting position?

• Do you have any of the following? º Recent history of trauma (fall, car wreck, sports injury) º History of osteoporosis (fragile bones) º Fever º Rash º Muscle weakness º Burning, stinging, tingling, numbness around the painful joint(s) º Red, swollen joint(s) • Do you have more than 2 or 3 painful joints? º History of inflammatory arthritis (i.e. rheumatoid or gout) º Fibromyalgia If they answered “yes” to any of the questions, their symptoms could be something other than osteoarthritis. It’s recommended they talk to a physician about the symptoms.

In the meantime, you can connect your patients to community programs, such as recreation centers, YMCAs, residential communities, or senior centers. The CDC Arthritis Program recommends programs that are evidence based and proven to improve the quality of life of people with arthritis, also known as Arthritis-Appropriate Evidence-Based Interventions (AAEBIs). Here are a couple of online OA exercise programs you can refer to your patients to get them started: • AEA Arthritis Foundation Exercise: aeawave.org/Arthritis/Arthritis-Foundation-Programs • My Knee Exercise Program: mykneeexercise.org.au

NONPHARMACOLOGICAL TREATMENT OPTIONS

• Arthritis education • Weight loss (if overweight) • Increase physical activity

Certain types of fish are good sources of inflammationfighting omega-3 fatty acids, especially salmon, tuna, sardines, herring, anchovies, scallops, and other cold-water fish. Nuts and seeds are also great for inflammation. According to studies, we should consume 1.5 ounces of nuts daily. One study found that over a 15-year period, men and women who consumed the most nuts had a 51% lower risk of dying from an inflammatory disease compared to those who ate the fewest nuts. Nuts are jam-packed with inflammation-fighting monounsaturated fat. While relatively high in fat and calories, however, studies show that eating nuts promotes weight loss due to their protein, fiber, and monounsaturated fats.

Adding supplements to the diet is also a popular choice.

However, supplements aren’t suitable for everyone with OA, and many doctors don’t recommend them to their OA patients due to a lack of clear evidence that they’re beneficial. However, the following supplements have been investigated by researchers to help in treating OA. Curcumin. The active component of turmeric is curcumin, and it possesses potent anti-inflammatory and antioxidant properties. It can help reduce pain and inflammation in OA, which improves joint function.

• Information regarding community-based resources • Exercise (non-weight bearing on the affected joint(s)) • Assistive walking devices (e.g. cane) • Corrective footwear

CHECKLIST FOR PHARMACOTHERAPY CONSIDERATION

• Hot or cold therapy

• Patient has tried non-Rx (e.g. weight loss, increased activity, thermal modalities), but pain persists

• Referral to physical therapy and/or occupational therapy

• Arthritis education has been provided

(Source: Osteoarthritis Action Alliance)

• Current medications and supplements have been reviewed

MANAGING OA THROUGH DIET Many people with OA adapt their diet to include antiinflammatory foods, such as fruits and vegetables, beans, whole grains, fish, and nuts. Also known as the Mediterranean Diet, studies confirm that eating these foods have the following benefits:

• Medication allergies have been discussed

• Lower blood pressure • Protection against chronic conditions, such as cancer and stroke

• NSAIDS (OTC) – Assess patient for appropriate use and risk factors (GI, renal, CV, asthma)

• Helps curb inflammation

• Recommend referral to PCP for further evaluation

• Benefits joints as well as the heart • Leads to weight loss, which lessens joint pain

• Medical history has been discussed • Acetaminophen (mild-moderate pain): Maintain <4 grams per 24 hours from all sources

(Source: Osteoarthritis Action Alliance)

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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However, curcumin might interact with blood thinners, resulting in the risk of bleeding. It can also affect the absorption of iron, and when taken in high doses, it can cause digestive issues, such as stomach upset and nausea.

Boswellia serrata. It’s been reported by a 2020 study that a particular composition of Boswellia serrata, a gum resin extract known for its anti-inflammatory properties, can reduce pain and improve mobility in rats.

Boswellia is generally safe but can cause gastrointestinal symptoms such as acid reflux, nausea, and diarrhea in some people. It might also interact with anti-inflammatory and autoimmune medications.

Vitamin D. Crucial for bone health, vitamin D may help people manage symptoms of OA. Having adequate levels of vitamin D is associated with lower risk of progression in OA. However, vitamin D can interact with many medications, including steroids and weight loss drugs. When taken in excessive amounts, it can also lead to hypercalcemia (high calcium levels). Hypercalcemia can cause nausea, weakness, and kidney problems.

Omega-3 fatty acids. Found in supplements such as fish oil and flaxseed, they have anti-inflammatory effects that can reduce joint pain and stiffness in arthritis. High doses, however, can cause gastrointestinal symptoms, such as bloating, indigestion, and diarrhea.

S-Adenosyl-L-Methionine (SAMe). Research from 2020 shows that SAMe may have anti-inflammatory, pain-relieving, and tissue-healing properties. It may improve joint health and reduce the symptoms of OA. However, SAMe can interact with antidepressant medications and may not be suitable for those with bipolar disorder. The most common side effects are nausea, diarrhea, and headache.

Glucosamine. This supplement may promote the formation and repair of cartilage. Some studies suggest it can reduce OA pain and improve joint mobility, particularly in the knees.

There have been numerous studies on glucosamine and OA, and they’ve produced conflicting results. So, doctors now recommend against using glucosamine for knee, hip, and hand OA. Glucosamine may interact with blood thinners and insulin

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medication. Side effects are mild, but may include GI issues and allergic reactions, especially in people allergic to shellfish.

Pycnogenol. Extracted from French maritime pine bark, pycnogenol has anti-inflammatory and antioxidant effects.

It may help reduce pain and stiffness in OA. However, pycnogenol can interact with immunosuppressants and diabetes medications. Side effects are rare, but they can include dizziness, gut problems, and headaches.

Avocado-soybean unsaponifiable, (ASU). ASU is known to reduce inflammation and prevent cartilage breakdown.

Collagen. Taking collagen supplements may help improve OA symptoms by supporting cartilage repair and reducing inflammation. Collagen is considered safe for most people, although some may experience mild digestive side effects. Allergic reactions can’t be ruled out, especially if the collagen comes from a source a person is sensitive to such as beef, pork, and fish.

It is possible for your patients to slow down the progression of osteoarthritis. They can do this by making healthy lifestyle changes. Keeping a healthy weight, getting exercise regularly, eating anti-inflammatory foods, and staying hydrated will help fight inflammation and pain.

DEPRESSION AND SOCIAL ISOLATION • One-third of people with arthritis over the age of 45 suffer from depression or anxiety.

• People with OA are likely at greater risk for depression because of increased disability and fatigue associated with their pain.

• People with doctor-diagnosed arthritis report more days in the last month of poor mental health (5.4 days vs 2.8 days for people without arthritis).

• Social isolation and loneliness are often evident among people with osteoarthritis and other chronic musculoskeletal diseases. There appears to be a bi-directional relationship with pain impacting social isolation and loneliness and vice versa.

(Source: Osteoarthritis Action Alliance)

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FEATURE

VACCINE OVERVIEW D

2024-25

What’s next in your pharmacy

uring the pandemic, you stepped up and provided access to COVID testing in your community; and in other communities, the ability to partner with providers for test and treat. That’s a big deal.

By continuing to work with community partners, you can strategize and address challenges and needs of the community while increasing vaccine access and immunization rates. Here’s how: KNOW THE REGULATIONS IN YOUR STATE While all 50 states allow pharmacists to administer immunizations, some have limitations. For instance, some states might have certain types of vaccines that can be administered or age limitations for patients. Check to see if your state requires pharmacists to have a collaborative practice agreement, protocol, or standing order. If they don’t, you can find model standing orders available at the Immunization Action Coalition’s website, immunize.org.

TAKE COURSES AND BECOME CERTIFIED If you want to administer immunizations, you’ll need to be certified by an Accreditation Council for Pharmacy Education (ACPE) accredited immunization and delivery course. You can find these courses at: • Your state pharmacy association • A local university or school of pharmacy • American Pharmacists Association (APhA) • Other pharmacy organizations Be aware that you’ll also need to be CPR/BLS certified. You can receive your certification through the American Heart Association’s or American Red Cross’ Basic Life Support for Healthcare Providers course, and then maintain your current certification.

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OBTAIN A STANDING ORDER FROM A LICENSED PHYSICIAN Whether it’s required by your state or not, standing orders are encouraged because they allow you to administer vaccines according to a physician-approved protocol without a direct prescription or order. You can refer to the Immunization Action Coalition’s document on Using Standing Orders for Administering Vaccines: What You Should Know.

Your state may require that you complete and submit a state board application. You might also be required to submit your application and required documents to your state board. You can find state-specific guidelines at naspa.us/blog/resource/pharmacist-authority-to-immunize.

COVID-19 vaccines will target the JN.1 variant instead of the KP.2 strain, according to the Food and Drug Administration (FDA).

Advisers from the FDA follow the European and World Health Organization recommendations, and their advisers agreed upon targeting the older JN.1 variant over the newer KP.2 strain.

Now in its fifth year, subvariants of the Omicron strain continue to drive infections in the U.S. The vaccines are still expected to be effective at preventing hospitalization, severe disease, and death.

There are three COVID-19 vaccines that will be in use in the U.S. in 2024-2025: PFIZER COMIRNATY COVID-19 VACCINE (mRNA) (12 YEARS AND UP): DO NOT FREEZE Earlier this year, the FDA approved Comirnaty. Then, on August 22, the new mRNA Covid-19 vaccines (2024-2025 formula) were approved to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. The mRNA COVID-19 vaccines are updated with this formula to more closely target the current variants that are circulating and provide better protection against serious consequences of COVID-19.

One of the updated mRNA COVID-19 vaccines includes Comirnaty, a full FDA-approved vaccine for use in people 12 years of age and older. Those who are 12 and up are eligible to receive a single dose of the updated and approved Comirnaty.

If previously vaccinated, the dose is administered at least 2 months after the initial dose of any COVID-19 vaccine.

PFIZER-BioNTech COVID-19 VACCINE (5 TO 11 YEARS OF AGE), EUA The FDA approved a single dose of Pfizer-BioNTech COVID-19 vaccine for individuals ages 5 to 11 years old. This is a messenger RNA (mRNA) vaccine, which uses a relatively new technology.

Therefore, it must be stored in freezer-level temperatures, which can make it harder to distribute than some other vaccines.

Who can get it: • Anyone who is 6 months and older can get the vaccine, including those who are pregnant, breastfeeding, or might become pregnant. However, anyone who recently had COVID-19 may need to consider waiting to get their vaccination by 3 months.

• Children ages 6 months to 4 years need 2 to 3 doses of COVID-19 vaccines. This includes at least one dose of the 2024-2025 updated vaccine.

• Those who are 6 months or older and have a weakened immune system need at least one dose of the updated COVID-19 vaccine. They may get additional doses depending on the number of doses they’ve previously received. Those who are immunocompromised and 65 or older should get an additional dose.

• Ages 5 years and older should have one dose of the 20242025 Pfizer COVID-19 vaccine.

• Adults 65 and older who are not moderately or severely immunocompromised need one dose of the 2024-2025 Pfizer COVID-19 vaccine.

PFIZER-BioNTech COVID-19 VACCINE (6 MONTHS THROUGH 4 YEARS OF AGE), EUA • Individuals who are unvaccinated need three doses of Pfizer-BioNTech COVID-19 Vaccine (2024-2025 formula) administered: The first two doses are administered three weeks apart. The third dose is administered at least 8 weeks after the second dose.

• Those who have received one previous dose of any Pfizer BioNTech COVID-19 Vaccine that’s no longer authorized for use in the U.S.: Two doses of Pfizer-BioNTech COVID-19 Vaccine (2024-2025 formula) are administered. The first dose of Pfizer-BioNTech COVID-19 Vaccine (2024-2025 formula) is administered three weeks after receiving the previous dose and the second dose is administered at least 8 weeks later.

• Individuals who have received two or more previous doses of any Pfizer BioNTech COVID-19 vaccine that’s no longer authorized for use in the United States: A single dose of Pfizer-BioNTech COVID-19 vaccine (2024-2025 formula) is administered at least 8 weeks after receipt of the last previous dose.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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Moderna COVID-19 vaccines, including at least one .25 mL dose of the 2024-2025 updated vaccine.

• Those who are 6 months or older and moderately or severely immunocompromised need at least one dose of the updated vaccine and may get additional doses depending on the number of doses they’ve previously received. Those who are immunocompromised and 65 or older should get an additional dose at least two months after their first dose.

• People between 5 and 64 (including those who are pregnant, breastfeeding, or might become pregnant) may get one dose of the 2024-2025 updated Moderna COVID-19 vaccine.

• Adults who are 65 and older and not moderately or severely immunocompromised need one dose of the 2024-2025 updated vaccine.

MODERNA: SPIKEVAX (mRNA) Full approval was granted by the FDA for the 2024-2025 Moderna vaccine, Spikevax, for people 12 and older.

Moderna uses the same mRNA technology as Pfizer and a similar high efficacy at preventing symptomatic disease.

Be aware that it does need to be shipped and stored in freezer-level temperatures. After it’s shipped, it needs to be refrigerated for up to 60 days.

Moderna’s COVID-19 vaccine has been updated over time to target new virus variants. In September 2022, the vaccine was replaced by bivalent vaccines that are designed to prevent both the original virus and the Omicron variants BA.4 and BA.5. In September 2023, updated vaccines replaced the bivalent shots with vaccines targeting the SBB lineage of the variant Omicron.

While the original and bivalent vaccines are no longer used, a decision hasn’t yet been made whether updated shots will be administered yearly like flu shots.

Who can get it: Moderna’s Spikevax vaccine can be given to people ages 12 and older. However, the CDC has specific recommendations for the following groups, noting that anyone who recently had COVID-19 may need to consider delaying their vaccination by 3 months.

• Children ages 6 months to 4 years who are not moderately or severely immunocompromised need two doses of the

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NOVAVAX The Novavax vaccine is a protein adjuvant and had 90 percent efficacy in its clinical trial. It performed almost as well as the mRNA vaccines in their early trials. It’s much simpler to make compared to some of the other vaccines.

It can also be stored in a refrigerator at a temperature between 36 and 46 degrees, which makes it much easier to distribute.

The earlier Novavax authorization was amended by the FDA to allow for a new adjuvanted 2024-2025 Novavax vaccine for ages 12 and older to target the XBB.1.5 strain in October 2023, which was a few weeks after the updated mRNA shots were approved. The Novavax vaccine is the only non-mRNA updated COVID-19 vaccine that’s available in the U.S. since the previous Novavax vaccine is no longer authorized.

Who can get it: • Novavax can be given to anyone who is 12 or older and who was previously vaccinated with any COVID-19 vaccine.

They can get one dose of the 2024-2025 updated vaccine and may need more depending on the number of previous COVID-19 vaccines they’ve received.

• Those who haven’t ever been vaccinated with any COVID-19 vaccine may get two doses of the Novavax updated vaccine (administered eight weeks apart).

• Anyone who is moderately or severely immunocompromised needs at least one dose of the 2024-2025 updated Novavax vaccine and may need more depending on their COVID-19 vaccination history.

MANUFACTURER

CATEGORY

TRADE NAME

AGE RECOMMENDATION

PRESENTATION

MODERNA

COVID

Spikevax

12yr & older

1 pre-filled syringe/ Paperboard box of 10

MODERNA

COVID

Spikevax

12yr & older

1 pre-filled syringe/ Blister carton of 10

MODERNA

COVID

Covid-19 Vaccine

6mos to 11yr

1 pre-filled syringe/ Paperboard box of 10

MODERNA

RSV (new)

mRESVIA

60yr & older

1 pre-filled syringe/ Box of 10

NOVAVAX

COVID

Covid-19 Vaccine, Adjuvanted

12yr & older

1 pre-filled syringe/ Box of 10

PFIZER

COVID

COMIRNATY

12yr & older

1 pre-filled syringe/ Box of 10/Do not freeze

PFIZER-BioNTech

COVID

Covid-19 Vaccine

5yr to 11yr

1 pre-filled syringe/ Box of 10

PFIZER-BioNTech

COVID

Covid-19 Vaccine

6mos to 4yr

MDV/3 doses per vial/ Box of 10 (30 doses)

PFIZER

RSV

ABRYSVO

60yr & older/ pregnant women 32-36 weeks gestation

1 kit (1 dose)

PFIZER

RSV

ABRYSVO

60yr & older/ pregnant women 32-36 weeks gestation

5 kits (5 doses)

PFIZER

RSV

ABRYSVO

60yr & older/ pregnant women 32-36 weeks gestation

10 Act-O-Vials

PFIZER

PNEUMOCOCCAL

Prevnar 20

6 weeks & older

1 pre-filled syringe (1 dose)

PFIZER

PNEUMOCOCCAL

Prevnar 20

6 weeks & older

1 pre-filled syringe/ 10 per package/10 doses

PFIZER

MENINGOCOCCAL

TRUMENBA

10yr to 25yr

1 pre-filled syringe/ 5 per package/5 doses

PFIZER

MENINGOCOCCAL

TRUMENBA

10yr to 25yr

1 pre-filled syringe/ 10 per package/10 doses

PFIZER

MENINGOCOCCAL

PENBRAYA

10yr to 25yr

1 kit (1 dose)

PFIZER

MENINGOCOCCAL

PENBRAYA

10yr to 25yr

5 kits/5 per carton/ 5 doses

PFIZER

MENINGOCOCCAL

PENBRAYA

10yr to 25yr

10 kits/10 per carton/ 10 doses

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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FLU VACCINE UPDATES Annual flu vaccines for 2024-2025 have also been updated, and the CDC recommends everyone 6 months and older receive an updated flu vaccine. This will reduce the risk of influenza and its potentially serious complications during the colder months.

The updated 2024-2025 flu vaccines will all be trivalent and will protect against three viruses: H1N1, H3N2, and a B/Victoria lineage virus.

Most people only need one dose of the flu vaccine each season. The CDC recommends flu vaccination as long as influenza viruses are circulating. However, September and October are still the best times for most people to get their vaccine. July and August are not recommended months for vaccination for most people, however, there are several considerations for certain groups during those months.

• Those who are pregnant and in their third trimester during those months can get a flu vaccine in July or August to protect their babies from flu after birth, when they’re too young to get vaccinated.

• Children who need two doses of the flu vaccine should get their first dose as soon as it becomes available. Their second dose, however, must wait until at least four weeks after the first.

• Giving vaccinations in July or August is considered for children who have healthcare visits during those months if they might not have another opportunity to get the vaccine.

• Vaccination in July and August should be avoided for adults (especially 65 years old and older) and pregnant people in the first and second trimester unless it won’t be possible to vaccinate in September or October.

AstraZeneca is offering FluMist Quadrivalent for the 20242025 flu season. FluMist is a vaccine that’s sprayed into the nose to help against influenza. FluMist Quadrivalent provides protection against four influenza strains in people 2-49 years of age.

CSL Seqirus began shipping out its three influenza vaccine options on July 9. The company offers Flucelvax, noted as the first and only cell-based influenza vaccine and Fluad, which is recommended by the CDC Advisory Committee on Immunizaion Practices (ACIP) for people 65 and older.

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CSL Seqirus also makes the egg-based vaccine, Afluria, for people six months of age and older.

Sanofi began its initial vaccine shipments on July 10 and has more planned through October. Sanofi’s 2024-2025 flu vaccine portfolio includes Flublock, a quadrivalent shot made using insect cells, along with standard and high-dose versions of its Fluzone.

GSK began shipping its vaccines on July 11 after a licensing and lot-release approval from the FDA. The company markets Flulaval and Fluarix and expects to distribute more than 36 million doses in the U.S. this flu season.

MULTI-DOSE VS. SINGLE-DOSE VIALS With vaccine season just around the corner, it’s always good to go over the importance of safe injection practices in your pharmacy. Knowing how to use multi-dose vaccine vials safely and correctly is crucial.

Multi-dose vaccine vials are used more than once to vaccinate multiple people, so a fresh needle and fresh

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syringe need to be used each time. A specific set of safety procedures are required and need to be used every time you prepare to give a vaccine. This helps ensure they don’t become dirty or contaminated.

How to Safely Use a Multi-Dose Vaccine Vial: • Always prepare multi-dose vial injections away from patient care spaces in a clean, designated area • Clean your hands before touching the vial • Check the label to make sure it’s a multi-dose vaccine vial

The routine vaccines recommended for adults, other than flu and COVID vaccines, include:

• Chickenpox vaccine (varicella) adults between 19 and 43

• Hepatitis B: adults between 19 and 59

• HPV vaccine (human papillomavirus): adults ages 19 to 26

• Check to make sure the vaccine is not expired or “beyond use” • Look and see if the vaccine appears the way the vaccine maker tells you it should • Use brand-new, sterile needles and syringes for every vaccine dose • Disinfect the top part of the vial (the vial stopper) with an alcohol prep pad—every time • Make sure the top is dry before inserting the needle in it • When you first put a needle into the vial, write the date and time on the label • Follow the vaccine maker’s instructions for storage • Never “pool” doses (combine partial doses from multiple vials to make one dose for a patient)

ROUTINE VACCINES It’s important for your patients to protect their health, and getting vaccinated is one of the safest ways. Vaccines help prevent catching and spreading serious diseases that can result in poor health, missing work, expensive medical bills, and the inability to care for family.

• MMR vaccine (measles, mumps, and rubella): adults ages 19 and up

• Tdap vaccine (tetanus, diphtheria, and whooping cough) or Td (tetanus, diphtheria): adults every 10 years

• Respiratory Syncytial Virus Vaccines (RSV): adults 60 and up

• Shingles (varicella-zoster): adults ages 50 and older

• Pneumococcal vaccines (PCV15, PCV20, PCV23) adults ages 65 and older

• MenB Vaccine (meningococcal disease): adults up through 23 years of age

Your authority to prescribe vaccines and administer a vaccine without a patient-specific prescription from another healthcare provider can vary by vaccine or the patient’s age for each state.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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SPOTLIGHT

PERIPHERAL ARTERY DISEASE Tips to keep patients' symptoms at bay

P

eripheral artery disease (PAD) is a common condition that affects more than 12 million people in the U.S. However, it’s more prevalent in patients who are over the age of 50, and the risk increases with age. Its main target is a person’s extremities. In fact, it typically affects the legs more than the arms, and it affects both men and women.

Risk factors for PAD include:

• Smoking • Hypertension • Diabetes • Atherosclerosis • Hypercholesterolemia • More advanced age • African American race When fatty plaque deposits build up inside the arteries that carry the oxygenated blood to the extremities, it causes stenosis of the arteries. This reduces blood flow and results in pain, numbness, cramping, and difficulty healing. It can even lead to amputation, heart attack, or stroke.

Patients with PAD can help reduce the symptoms and prevent further progression of the disease through claudication medications and lifestyle changes, such as exercise and a healthy diet. These alone are enough to slow down the progression of the disease or even reverse the symptoms.

As their pharmacist, there are things you can do to help your PAD patients manage the disease. Suggest the following tips to help stop their symptoms from getting worse:

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Don’t smoke or use tobacco A major, preventable risk factor for PAD is tobacco smoke.

Smoking damages the arteries and increases the risk of peripheral artery disease. Most people struggle with smoking cessation, but you can recommend effective tools that can help them quit, such as nicotine replacement products, behavior modification techniques, and medications that can curb cravings.

Exercise regularly An effective treatment for PAD symptoms is physical activity because exercise helps improve blood flow to the arms and legs. Healthcare professionals typically recommend supervised exercise therapy for people with PAD. A program of exercise and education can help increase the distance they can walk without pain.

Eat healthy foods Remind them to select plenty of fruits, vegetables, and whole grains. Limit fat to 30 percent of your total daily calories.

Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats, including products made with partially hydrogenated and hydrogenated vegetable oils.

Read medication labels Advise against products that contain pseudoephedrine.

These medications are often used to treat a stuffy nose due to allergies or colds. However, pseudoephedrine tightens blood vessels and may increase PAD symptoms.

Pay attention to leg position Remind patients to sleep with the head of their bed raised a few inches. That way their legs are below the level of their heart and can reduce pain. Sometimes hanging their legs over the edge of the bed or walking can also temporarily reduce leg pain.

The feet are another important part of the body to pay close attention to. PAD can make it a lot harder for cuts and sores on the lower legs and feet to heal, especially if they have both PAD and diabetes.

If you haven’t already, counsel your PAD and diabetes patients on how to keep their feet healthy. Make printouts of the information below and give them to your patients to take home as reminders.

Proper Foot Care • Wash your feet every day and dry them completely.

• Use a good moisturizer on your feet to prevent cracks that can lead to infection. Don’t moisturize between the toes because this can cause fungus to grow.

Counseling and Education • Disease Management: You can educate your patients about PAD, including symptoms, progression, and the importance of lifestyle changes, such as smoking cessation and exercise.

• Medication Information: Inform patients on how medications work, the potential side effects, and interactions with other drugs or foods.

Monitoring and Support • Blood Pressure and Blood Glucose Monitoring: Remind patients that regular monitoring of their blood pressure and glucose levels can help in managing comorbid conditions that often accompany PAD.

• Wear thick, dry socks and shoes that fit well.

• Treat any fungal infections of the feet quickly, such as athlete’s foot.

• Be careful when trimming your toenails.

• Check your feet daily for cuts, sores, or other injuries. If you find any, visit a healthcare professional.

Referral and Coordination • Healthcare Team: Work with primary care physicians, cardiologists, dietitians, and other health providers to ensure comprehensive care.

• Specialist Referrals: Help your patients find specialists if needed, such as vascular surgeons or dieticians.

• Go to a podiatrist if you have bunions, corns, or calluses.

You can also help your PAD patients with:

Preventive Care • Vaccinations: Encourage your patients to get their vaccines, such as the flu shot and COVID-19.

Medication Management • Prescriptions: You can dispense medications prescribed to manage PAD, such as antiplatelet agents (e.g. aspirin, clopidogrel) to reduce blood clot risk, and medications to manage associated conditions like high blood pressure and cholesterol.

Health Screenings • Risk Assessment: Monitor and assess risk factors like cholesterol levels and blood glucose and provide recommendations for managing these conditions.

• Adherence Counseling: Make sure your patients have guidance and education on how to take their medications safely and correctly. Ensure that your patients understand their medication regimen along with the importance of adherence.

This is vital for managing PAD and preventing complications.

Because PAD is a painful disease and can disrupt the quality of life, you can also monitor your patients for depression and anxiety. When appropriate, recommend psychotherapy or medications (or both) to help them manage their symptoms.

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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MONEY

PBMs EXPOSED Executives pressed by lawmakers for driving up drug prices

A

hearing titled, “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability,” was held by the House Committee on Oversight and Accountability on July 23. Pharmacy Benefit Manager (PBM) chief executives were pressed on their role in rising prescriptions drug costs and for collaborating to push deliberate, anticompetitive policies that weaken local pharmacies.

While the leaders of the three largest PBMs in the nation—CVS Caremark, UnitedHealth Group’s Optum Rx, and Cigna’s Express Scripts—say they’re working diligently to keep prescription drugs affordable for Americans, many of the House Committee on Oversight and Accountability members don’t believe it.

Committee Chair Rep. James Comer (R-Kentucky) opened the hearing on July 23 with a list of problematic practices:

• PBMs share patient information and data to steer patients to PBM-owned pharmacies.

• PBMs tout savings to payers and patients, but their drug utilization and spread pricing increase costs.

• PBMs force drug manufacturers to pay rebates to be placed on favorable tiers of PBM drug formularies, making it difficult for competing generics or biosimilars to get on the formularies.

• PBMs have begun creating foreign corporate entities and moving operations abroad to avoid transparency and state and federal reforms.

(Source: medicaleconomics.com)

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PBMs are supposed to negotiate lower drug prices with pharmaceutical managers on behalf of insurers and employers, along with reimbursing pharmacies for dispensing prescriptions. But according to Committee Chair Rep. James Comer (R-Kentucky), it’s not happening.

The PBMs say they lower drug costs for their clients, but more and more people are outraged over their dishonest business practices. In fact, in a recent survey by KFF, a nonprofit health policy research, polling, and news organization, about one-third of respondents reported that they did not take needed medication due to high costs.

Not only are PBMs facing numerous lawsuits from state attorneys general and independent pharmacies, they’re also feeling pressure from the federal government. Reportedly, the Federal Trade Commission is planning to sue CVS Caremark, Express Scripts, and Optum Rx because of how they negotiate drugs with pharmaceutical manufacturers.

While PBMs argue that their large size would help increase patient access while decreasing prescription drug costs, the opposite has happened. Patients are dealing with significantly higher costs with very few choices and worse care.

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As if this isn’t enough, PBMs steer patients to mail-order pharmacies they own. Then they choose the more expensive, brand-name medications that result in higher rebates that drugmakers pay them. The House committee report found 300 examples of the three PBMs selecting medications that cost at least $500 more per claim than a safe alternative medication.

To avoid transparency and proposed reforms, PBMs have also been creating foreign corporations and have moved certain operations overseas. They’ve even created group purchasing organizations (GPOs) to centralize the negotiation of rebates and fees in Ireland and Switzerland. They have also built companies in Ireland and the Cayman Islands to manufacture and market specific, highly profitable generics and biosimilars.

Representatives called for PBM reform during the hearing.

And while Congress seemed ready to take up the issue in recent months and even introduced several bills last year tackling the issue, lawmakers haven’t yet acted.

The most recent step taken was in February by the House Oversight Committee. The committee advanced bipartisan legislation to require the PBMs to unlink the fees they charge insurers from the price of drugs, among other changes.

Your legislators need to know the urgency of PBM reform for community pharmacies and their patients. It’s critical that you continue engaging them. Let Congress know how the costs of medications continue to rise, and that decisive action is needed in order to protect patients, taxpayers, and small community pharmacies.

Call or email your legislators and urge them to take immediate action on PBM reform by visiting these links: • ncpa.org/legislative-action-center • ncpa.org/finishthefight

NATIONAL CONSUMER SURVEY According to a national survey released in 2021 by the National Community Pharmacists Association, a large majority of American adults prefer getting their prescriptions drugs from a local pharmacist rather than a mail-order service. The reason? Because of the personal relationship with their pharmacist.

Invite your patients to contact their legislators to urge them to pass robust PBM reform fight back against corporate middlemen that threaten you and your pharmacy: • fight4rx.org/action-center

• 32 percent said their pharmacist answers questions and provides counsel on how to use the drugs.

You know the frustration of insurance companies and PBMs steering patients away from your pharmacy to the large retail chains or mail order.

Your patients feel it, too, as PBMs try to drive them away from the pharmacy they know and love. This is why it’s so important to help your patients fight back against unfair insurance and PBM practices. Download and print the two links below from NCPA, and hand them out to your patients. These free resources will help them fight back against PBMs interfering with access to the pharmacy of their choice.

• 15 percent worry their drugs will get lost in the mail, exposed to the elements, or stolen.

• ncpa.org/sites/default/files/2021-03/PatientSteering-Bag-stuffer.pdf

A national survey of 1,390 adults by Public Policy Polling found: • 85 percent prefer getting their prescription drugs from a local pharmacist instead of mail order.

• 36 percent said their pharmacist knows them better than a mail-order company.

(Source: ncpa.org)

• ncpa.org/sites/default/files/2021-03/PatientSteering-one-pager-pamphlet.pdf

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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OUTLOOK

CYBERSECURITY IN YOUR PHARMACY How to protect yourself from cyberattacks

T

he world relies on digital technology. Because of that, cybersecurity has become extremely important. When cybersecurity issues happen in your pharmacy, significant vulnerabilities will be exposed within specific operations.

This will cause all kinds of problems, including widespread prescription delays. This shows how sensitive digital infrastructures are in pharmacy and the potential for extensive disruption. It highlights the important need for better security measures.

Protecting your patients’ privacy is crucial. It’s your job to safeguard patient data and prevent data breaches.

If someone obtains unauthorized access to a patient’s information, it can lead to identity theft, financial loss, and compromised patient confidentiality. The reputation of your pharmacy can also be damaged, destroying your patients’ trust. Because of this, you need to be familiar with cybersecurity best practices.

Cyberattacks can take on various forms. Here are some of the most common:

• Phishing: Entails sending a scam email or text message that contains a link to a malicious website to trick people into giving sensitive data. This data can be used as leverage for a ransom or a means to disrupt or add chaos to a business organization.

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• Malware: Software that intentionally causes disruption to a computer, server, client, or computer network, leaks private information, and gains unauthorized access to information or systems. Malware includes various types of cyber threats such as viruses, adware, spyware, and ransomware.

• Denial of Service (DoS): Used to disable user access to websites. It can take down websites and entire networks.

A DoS attack is accomplished by flooding a network with traffic until it becomes overwhelmed and crashes. This prevents access for legitimate users.

If your pharmacy were to fall victim to a cyberattack, the inability to access your system and take care of your patients will be the largest toll on your business. Plus, your bottom line may be negatively affected due to patients and customers in your community no longer trusting that your pharmacy is safe to do business with. You are responsible for who gets access to the information, along with what protocols and cybersecurity safety measures you and your team put in place.

These cybersecurity tips can help you keep your pharmacy and patients safe: PROVIDE CYBERSECURITY TRAINING FOR YOUR STAFF Your most important line of defense against cyberattacks is training staff members and making them aware of potential

threats. Ongoing education and training programs are crucial to ensure that pharmacy staff are well-informed about privacy protocols, data-handling procedures, and the importance of patient confidentiality. They also need to be taught cybersecurity best practices, such as never using pharmacy systems for personal matters and not opening web links until they’ve checked them. Your staff also needs to know how to recognize a phishing attack. This is one of the most common ways outsiders can gain access to a system.

MANAGE PASSWORDS PROPERLY A key aspect in preventing potential cyberattacks is password management. Passwords need to be hard to guess but easy to remember. Always use different passwords for different accounts. This can prevent multiple accounts from being compromised if one is hacked. A way to add another layer of security is by using multi-factor authentication. It involves multiple steps to log into an account, and it’s a way to add another layer of security. Just remember to never write passwords down on paper. They can easily get stolen or lost.

BE SURE INTERNET EXPOSURE IS ADDRESSED If you want to be proactive, address internet vulnerabilities.

Use strategies like conducting regular exposure scanning and properly configuring any devices. You’ll also need to employ best practices for remote desktop services and be sure all your software is up to date.

PROTECT AGAINST CYBERATTACKS WITH SECURITY SOFTWARE Make sure that all your devices have web filtering, antimalware, and antivirus software. Be sure firewalls are in place at key points. This prevents attacks, and using encryption protocols and firewalls will lower risks of identity theft. It’s also vital to keep this software up to date.

BACK EVERYTHING UP You need to be sure that all critical data and systems in your pharmacy are backed up. That way, if you do become a victim to cyberattack, you’ll have backups that will allow you to have access to lost data. You’ll also want to regularly test backups for preparedness and effectiveness and be sure you never keep them on the same device that they’re backing up.

Lastly, don’t forget to encrypt all backups.

ENABLE MULTI-FACTOR AUTHENTICATION (MFA) This is an important security measure that verifies someone’s identity by requiring more than a username and password alone. MFA can require users to provide two or more of the following: • Something the user knows (password, phrase, PIN) • Something the user has (physical token, phone) • Something that physically identifies the user (fingerprint, facial recognition)

ELEMENTS | The business magazine for independent pharmacy | SEPTEMBER 2024

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Because most security breaches are caused by human error, it’s crucial to focus on employee education and training. Work with an IT professional to create tests for your staff. It’s also a good idea to have your team take cybersecurity assessments.

If you do suffer cyber loss, help limit the damage. In other words, immediately call your insurance company and file a claim. Get them involved. Restrain yourself from throwing away any of the computers. By filing a claim, your insurance company will bring in a team of professionals to help you. This includes legal advisors, attorneys, and the forensics teams who will help you with notifying customers and with any PR or communication strategies for your local communities.

Remember: It really isn’t enough to train your pharmacy staff to avoid phishing and other cybersecurity threats when they first join your pharmacy. These efforts must be constant as most security breaches are caused by human error. Because of this, ongoing employee education and training are extremely important.

Work with an IT professional who can help create tests for your staff. It’s also a good idea to have your team take cybersecurity assessments. This will help ensure they’re well prepared.

LEGAL, REGULATORY, AND COMPLIANCE You need to ensure that you comply with a variety of laws, regulations, and compliance considerations. This includes: • Data Protection Laws: You must comply with rigid data protection laws that are designed to protect patient information.

• Healthcare Compliance Standards: The breach raises concerns about adherence to healthcare compliance standards, emphasizing the need for rigorous security protocols.

• Legal Repercussions: You can face legal repercussions for failing to protect patient data, including fines and damage to reputation.

STEPS YOU CAN TAKE TO AVOID SUCH PROBLEMS You must, to the extent necessary, comply with HIPAA and state laws. This can include taking the following steps to ensure that your patients and systems are not inadequately vulnerable: Invest in Cybersecurity Measures: • Implement stronger encryption methods to protect data.

• Conduct regular security audits to identify and address vulnerabilities.

Staff Training: • Ensure all staff are trained in best practices for cyber hygiene.

• Foster a culture of security awareness within the pharmacy.

Develop a Breach Response Protocol: • Establish clear procedures for responding to data breaches.

• Minimize damage by acting swiftly and in compliance with legal reporting requirements.

Stay Informed: • Keep up with the latest cybersecurity trends and threats.

• Subscribe to cybersecurity newsletters and attend relevant workshops.

(Source: pharmacypodcast.com)

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