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Vol 14 No. 4 Fall 2017

Fall 2017

Pharmacy Journal of New England

Updates for Influenza Vaccine Balancing Safety and Efficacy with Anticoagulants Insurance Coverage for New Advances: Rx and the Law How Much Will You Spend When You Retire? Financial Forum

University of St. Joseph takes the Pepto Bowl in this year’s New England Pharmacists Convention. More Convention details inside!


See what our tomorrow looks like at: phmic.com/tomorrow2

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Pharmacy Journal

Vol 14 No. 4 Pharmacy Journal of New England • Fall 2017

of New England

State Associations and DQSA Coalition Send Letter to State Boards of Pharmacy and Medicine

Editors

Dear Readers,

Design & Production

State pharmacy associations, along with the DQSA Coalition, a broad cross-section of organizations representing varied healthcare providers, sent a letter to all state Boards of Pharmacy and Medicine expressing concern regarding the Food & Drug Administration’s (FDA) implementation of the Drug Quality & Security Act (DQSA) without following Congressional intent. The letter stressed that FDA’s actions are affecting patient access to compounded medications, and causing confusion for the states, providers, patients, and pharmacists. “Our organizations urge the members of your Board to delay consideration of any regulatory or policy decisions on the ability of practitioners to obtain and use office-use compounded preparations until such time as the Agency issues its guidance in a manner that is consistent with Congressional intent and that preserves patient access,” according to the letter. View the full letter here.

Lindsay De Santis Margherita R. Giuliano, R.Ph., CAE

Managing Editor Ellen Zoppo CPA

Kathy Harvey-Ellis

The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher. Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619. Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org

Submitting Articles to the Pharmacy Journal of New England™

Sincerely,

The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication.

Lindsay De Santis Executive Vice President Massachusetts Pharmacists Association

Margherita R. Giuliano, RPh Executive Vice President Connecticut Pharmacists Association

All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.

Please submit manuscripts to:

Contents:

2 01US News 4 New England States 11 2017 New England Pharmacists Convention Coverage 14 Feature: Codeine and Tramadol in Children, Adolescents, and

PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: ezoppo@ctpharmacists.org

Breastfed Infants; Balancing Safety and Efficacy with Anticoagulatnts

19 21

Pharmacy Marketing Group: Rx and the Law, Financial Forum From the Colleges

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U.S. News DEA Collects Record Number of Unused Pills on Take Back Day An announcement made on Nov. 7 by the Drug Enforcement Administration (DEA) shows the impact that National Prescription Drug Take Back Day has made on patients nationwide. During the 14th Prescription Drug Take Back Day this year, the DEA and its more than 4,200 local and tribal law enforcement partners brought a record-setting 912,305 pounds, or 456 tons, of potentially dangerous expired, unused, and unwanted prescription drugs for disposal at more than 5,300 collection sites. That marks nearly six tons more than was collected at last spring’s event. Since the fall of 2010, the DEA has now collected a total of 9,015,668 pounds, or 4,508 tons of prescription drugs. Complete results for DEA’s fall Take Back Day are available at www.deatakeback.com.

In November, the FDA approved a medication embedded sensor that can tell doctors when patients take their medication. The sensor containing copper, magnesium, and silicon generate an electric signal when in contact with stomach fluids. Thus, only data on administration of the medication will be taken. A patch changed weekly, worn on the rib cage, detects the signal. Data from the patch is transmitted via bluetooth to a smartphone app before being sent off to a database. In order to view the data, consent forms must be signed allowing their doctors and up to four others to receive the data, including family members. Patients can block recipients at any time through the app. This paves way for new avenues of monitoring patient adherence and future reiterations and products may eliminate the need for a patch.

Pressure Builds to Cut Medicare Patients in on Prescription Deals

Senators Introduce Bill to Reduce ‘Completely Preventable Waste’

Pharmacists have been monitoring the PBM industry and its impact on pharmacy for years. PBMs have long contended that they help contain costs and are improving drug availability. However, pressure has been building for federal agencies to explore how Medicare patients could get a share of certain behind-the-scenes fees and discounts negotiated by insurers and PBMs. Supporters say this could help enrollees by reducing the cost of their prescription drugs and slow their approach to the coverage gap in the Part D program, according to an article published by Kaiser Health News on Nov. 10. The Centers for Medicare & Medicaid Services (CMS) could disclose the fees to the public and apply them to what enrollees pay for their drugs. However, there’s no guarantee that this approach would be included in a proposed rule change that could land any day, according to several experts familiar with the discussions.

Two U.S. senators introduced legislation requiring federal agencies to create a solution to the waste caused by oversized eyedrops and single-use drug vials, citing a ProPublica story published in November.

Federal officials described these fees in a January fact sheet as direct and indirect remuneration, or DIR fees. https://khn.org/news/pressure-builds-to-cut-medicare-patients-inon-prescription-deals/

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FDA Approves First “Digital Pill”

The bipartisan effort by Sens. Amy Klobuchar, D-Minn., and Chuck Grassley, R-Iowa, calls for the Food and Drug Administration and the Centers for Medicare and Medicaid Services to develop a plan to reduce the waste, which is estimated to cost billions of dollars a year. ProPublica’s story showed how drug companies force patients to pay for expensive liquid medications, such as eyedrops and cancer drugs, which are produced or packaged in ways that lead to waste. Drug companies have known for decades that eyedrops are larger than what the eye can hold. This has resulted in excess medication overflowing the eye and running down users’ cheeks. Some patients then run out of medicine before their insurers allow them to refill their prescriptions. https://ctmirror.org/2017/11/05/senators-introduce-bill-toreduce-completely-preventable-waste/


Pharmacy Journal of New England • Fall 2017

Is Amazon Getting into the Pharmaceutical Business? by Lubna Dala PharmD Candidate 2018, Jennifer Donato PharmD Candidate 2018, Kenny Ha PharmD Candidate 2018 Amazon has now received approval for wholesale pharmacy licenses in 12 states, according to an article published by the St. Louis Post-Dispatch on October 27. These states include Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, New Hampshire, Idaho, Tennessee, and Oregon. Now Maine is considering joining the group. A spokesperson from Amazon has yet to comment on the matter, but it is becoming more apparent that the online giant is aiming for new revenue streams in the pharmaceutical industry.

drug supply chain, aside from manufacturing, is to control a pharmacy benefits manager (PBM). By partnering up, or more likely integrating with an established PBM, this would set them up to compete with the leaders such as CVS Caremark and Express Scripts. If they disrupt this market like they have with others in the past, this might lead to the possibility of a transparent PBM with enough resources to truly disrupt the current market. As of now, Amazon has not officially revealed its intentions. Currently, the e-commerce giant is utilizing the newly acquired Whole Foods locations to push existing consumer products such as their Amazon Echo. Speculation will continue, but it seems only a matter of time until Amazon steps onto the stage.

Currently, Amazon cannot start shipping prescription drugs or devices directly to consumers without a pharmacy license. However, Amazon has the resources and experience in managing massive delivery networks. With Amazon’s acquisition of Whole Foods closed back in August, it now has brick-and-mortar locations to establish pharmacies. These locations would provide the link between the physical and virtual portions of Amazon. This also opens up the possibility of mail order fulfillment centers for chronic medications while also providing prescriptions immediately. One of the largest weaknesses of mail order pharmacies is providing essential prescriptions in a timely fashion, where Amazon could utilize Amazon Prime Now for delivery within a couple hours. This is currently done in Japan with a number of medications that must first be approved by a pharmacist from a partnering entity.

Did You Know? That the Connecticut Pharmacists Association offers a 2-Week Online Course for CT Law? www.ctpharmacists.org

Amazon not only has the ability to utilize the mail order business model, but it also has the ability to target a specific population, which are patients who are paying for prescription drugs by cash. This will then give them the opportunity to push further beyond the realm of retail pharmacy and into pharmacy benefit management. The competition from Amazon may push current pharmacies into becoming more creative, as Amazon has always been providing quality consumer experiences and pushing boundaries into their markets. With wholesaler licenses and potential brick-and-mortar locations, the only part left in the 3


New England Connecticut

President’s Message It is my pleasure to be taking over the helm of the Connecticut Pharmacists Association at a pivotal time for our profession. From patient-centered care to being on the front lines for the opioid public health crisis, we know that we have a critical role to play.

Gillian Kuszekski, PharmD CPA President, 2017-18

The Connecticut Pharmacists Association is always at the forefront of issues and we appreciate those of you who consistently invest and renew your membership to assist in

supporting us support YOU. Another way to support the CPA Is to attend the CE Live Programs. There is no better forum than our ACPE accredited events, and we have our signature event coming up on Thursday, February 1, 2018 at the Aqua Turf. We have already booked Dan Hussar for his very popular “New Drugs 2016.” Many of you may be aware that Ellen Zoppo, our Communications Director, was recently elected as Mayor of Bristol and has left the CPA as of November. Ellen has championed having a community plan for opioid abuse prevention as one of her platforms and we are so excited that there is a Chief Executive of a large city who is interested in taking on this issue, and also recognizes the role of the pharmacist. We wish her the best, and hope to see her at the Mid-Winter!

Sincerely, Gillian Kuszekski,, PharmD President, CPA

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Pharmacy Journal of New England • Fall 2017

Massachusetts Dear Readers, Greetings from the Massachusetts Pharmacists Association Board of Directors! We’ve had a busy Fall so far at the organization, and it is my pleasure to provide you with some insight on how your Association is working to support all of you in the Profession.

Paul Larochelle Jr.,, PharmD MPhA President, 2017-18

In September, we welcomed new members to the MPhA Board of Directors, and were excited to recognize a number of fantastic pharmacists and technicians who are making a significant difference in the lives of patients at the Annual New England Pharmacists Convention. I was also honored to officially start my term as President, and cannot adequately express the gratitude and appreciation I have for the opportunity to serve in this capacity and I am energized by the enthusiasm I see in our membership and our Board. 2017 brought several changes to our organization, including the arrival of our new Executive Vice President, Lindsay De Santis. Lindsay brings significant association management experience with her, and she has been a phenomenal leader to date. The organization also unveiled its new logo in over 35 years this fall, with over 23 logo concepts reviewed by our sub-team before finalizing the design. We wanted to ensure that the logo embodied what our organization stands for and represents, so we looked to include those values in the logo. We should all be proud that MPhA has served as the voice of pharmacy for 134 years, so we also integrated the traditional mortar and pestle into the logo with our founding year. Finally, we must remember that this organization represents all pharmacists in the entire Commonwealth, so we felt it was vital to bring in a representation of the state as part of our logo.

Well over 100 pharmacists and technicians from various practice settings, as well as students representing all Colleges of Pharmacy in the Commonwealth, participated in the event to learn more about the important legislative efforts for which we are advocating. Senator Moore, sponsor of our Pharmacists as Health Care Providers bill, also attended the event to share his appreciation of all that the Profession does for health care. I was truly impressed by the showing, and it was exciting to see groups of pharmacists, technicians, and students spreading throughout the State House to advocate for our profession with their local representatives. As the Association looks to finish the year with success, the Board of Directors will be meeting to review our strategic imperatives so that we can ensure that the Association is well aligned to advocate for your needs. We are also developing a series of initiatives to engage with membership, including opportunities to participate in numerous projects and efforts to help move our profession forward. If you would like to get involved, please reach out to us and let us know what types of activities you would like to take part in. Before I close, I’d like to leave you all with a little story. I was driving with my family recently and we were having a conversation with our 5-year old, Ethan, who was sitting in the back seat. In that discussion, I asked Ethan what he wanted to be when he grows up. He thought about it for a few seconds and then he said “I think I want to do what you do, Dad.” I asked him, “well, what do I do bud?” He said, “you are a pharmacist and pharmacists help make people feel better.” When I heard that I was really touched, because whether or not he actually pursues that path, I knew he at least understood why I do what I do. This was a really exciting moment for me. Then Ethan spoke up and said, “that, or maybe I will be the superhero Flash.” I have never compared being a pharmacist to being a superhero, but maybe to some people we serve, it’s almost at that same level. We should all be proud of what we can accomplish in our jobs, even if it feels routine. Thank you for all you do for our profession and patients. We at MPhA will do all we can to represent you over the course of the next year.

In October, we jointly sponsored the 2017 Face of Pharmacy day at the Massachusetts State House with MIPA and MSHP. 5


New England States

continued

Massachusetts Pending Legislation HB 3582, An Act Prohibiting Certain Pharmacy Claims Fees. Sponsor: Representative Carmine Gentile. Current Status: Committee on Health Care Financing (6/2017) This legislation defines certain fees imposed on pharmacists or pharmacies by health insurance companies (i.e. DIR fees) or pharmacy benefit managers as unfair and deceptive trade practices, including any fees that are not apparent, that are not reported on remittance advice or which are imposed after claim adjudication. SB.583, An Act to Ensure Access to Generic Medications. Sponsor: Senator Michael J. Rodrigues. Current Status: Referred to the Committee on Financial Services (1/2017) Prescription Benefit Managers are employed by health insurance plans and large self-insured employers to manage the prescription benefit piece of the plan. Among their responsibilities is reimbursement to pharmacies who dispense medications to a plan’s or employer’s covered members. The PBM maintains lists of covered medications for each plan and employer and the maximum amount that will be reimbursed to the pharmacy for each drug. The price of generic medications can swing dramatically for a number of reasons, and in recent years the swings have included sharp price spikes in the range of 600-1,000%. Therefore, to ensure that a fair price is being reimbursed the price list must be updated regularly. In addition, PBMs rarely make these lists available to the pharmacy, essentially preventing the pharmacy from knowing the level of reimbursement for any particular drug on any given day. In a survey of its members conducted by the National Community Pharmacy Association (NCPA), almost 90% of the respondents reported that it took the PBM or other third-party payer between two and six months to update their reimbursement rate. As a result, pharmacies have endured significant losses. On appeals, protesting gross underpayment, 57% of those surveyed said the appeal was rejected by the PBM and 26% said they received no response at all. Centers for Medicare & Medicaid Services (CMS) now requires Part D plans to update their price list every seven days and also requires that PBMs divulge how they arrived at these prices. 19 states 6

have also passed generic drug pricing laws to protect their pharmacies and patient access to generic medications. SB.1240/HB.1214, An Act Recognizing Pharmacists as Healthcare Providers. Sponsors: Senator Michael Moore/ Representative Angelo Puppolo, Jr. Current Status: Joint Committee on Public Health hearing held on June 27, 2017 According to the CDC, about half of all adults, 117 million people, have one or more chronic health conditions. One of four adults has two or more chronic health conditions. For those patients with complex medical conditions on multiple medications, a pharmacist’s clinical services can be invaluable. Although an individual has the right to consult with a pharmacist free of charge, many patients require a comprehensive medication review and the counseling to ensure that they are receiving the optimal medication therapy. Incorrect dosing, preventable side effects, and polypharmacy are some of the many problems that lead to poor health outcomes and higher costs. Currently, under a collaborative care agreements with a physician, a pharmacist can manage a patient’s drug therapy. However, pharmacists are not compensated for this service, and the pharmacist’s most important skills - as the medication expert - remains an untapped resource for patient care. This bill could bring about the most important change in chronic disease management in decades. SB.523, An Act to Ensure Access to Medications. Sponsor: Sen. James B. Eldridge. Current Status: Referred to the Committee on Financial Services (1/2017) This legislation amends the “Any Willing Provider” law to allow community pharmacies to fill prescriptions for “specialty medications” as long as they can provide the required administrative, handling, and monitoring services required by the drug. Insurers and pharmacy benefit managers have been getting around the “Any Willing Provider Law” by designating a medication a “specialty medication” even when the drug requirements are minimal (e.g., Humira). This legislation will close that loophole. This will also assist patients by allowing them to obtain all their medication from one pharmacy instead of trying to coordinate mail shipments from a specialty pharmacy located in another state.


Pharmacy Journal of New England • Fall 2017

Rhode Island

President’s Message It is a great honor to address you as the 143rd President of the Rhode Island Pharmacists Association, and join the ranks of great leaders that came before me. I am very excited at the prospect of leading a group of such dedicated and hardworking individuals, Lucrezia Finegan, PharmD especially our Officers, Council RIPA President, 2017-18 and Committee Chairs. I look forward to a very productive year for our Association. I thank you for this incredible opportunity and I will serve our profession and our Association faithfully, and to the best of my ability.

It is both an exciting and frightening time for our profession. Pharmacy is moving forward; pharmacists are practicing in new and exciting settings, and performing in truly innovative

Thank you for this opportunity to lead our professional association this year. Thank you to all of the incoming Officers and Committee leads for joining me in leading this organization. And I’d like to especially thank Sarah Thompson and Lynn Pezzullo for your support and mentorship, and for preparing me to take on this responsibility. I look forward to all of the fun and exciting opportunities for growth, advocacy and collaboration that are waiting for us, and to help move our profession forward. Respectfully, Lucrezia Finegan, RPh, MBA, President, RIPA

Pharmacy Time Capsule 1992 • For fiscal 1992, the total amount Medicaid spent on drugs in 1992 approached $6.8 • National health care spending was $854.1 billion or $3287/person • There were 75 accredited colleges of pharmacy (compared to 130 in 2015) 1967

ways. Our traditional role as the dispenser of medications is growing, and pharmacists are evolving into so much more. At the same time, our reimbursement model hasn’t caught up with our capabilities.

• For fiscal year 1967, the total amount Medicaid spent on drugs exceeded $182 million.

It’s our job as the state’s professional association to educate the public as well our legislators, and even other health care providers, as to what our role is, and what it could be. Pharmacists add value to the health care team. We can have a significant impact on the patient’s health and well-being, and it’s critical that we are seen as such.

1942

I am confident in the group of dedicated and passionate pharmacists that make up our organization, and am excited to think of what we can achieve this coming year. Together, we can ensure that we can advance the mission of the Rhode Island Pharmacists Association: to elevate the practice of pharmacy, to disseminate relevant scientific and professional information, and to encourage collaboration between all health professionals towards the improvement of public health.

• Dean Rufus Lyman of the University of Nebraska calls for the formation of a national pharmacy honor society that is eventually realized with the founding of the Rho Chi Society.

• National health care spending was $51.6 billion or $253/person

• Marijuana was removed from the US Pharmacopeia in 1942. It had been included since 1854. • Premarin first marketed by Ayerst. 1917

By: Dennis B. Worthen, PhD, Cincinnati, OH. One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America’s history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org

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New England States

continued

New Hampshire Legislative Update Below is the status of some key bills that were introduced in the NH Legislature this session that affect the practice of pharmacy. House Bill 264 - (New Title) Establishing a commission to study allowing pharmacists to prescribe or make available via protocol oral contraceptives and certain related medications. Sponsored by Rep. Murphy, this bill was amended in its final form to create a commission to study allowing pharmacists to prescribe oral contraceptives and certain other medications. NHPA has a seat on the Commission. Signed by the Governor on April 25, 2017. The study commission has been meeting this fall. They are having a robust discussion around prescriber authority, collaborative practice, and the standing order. They are also looking at the states of California, Colorado and Oregon. They have taken testimony from the NH Insurance Department, NH Department of Health and Human Services, Planned Parenthood of Northern New England and others. A final report is due December 1st, 2017. Draft legislation has already been filed for the next legislative session (January 2018) anticipating the commission will support oral contraceptives being made available to the public.

SB 64 – Establishing a committee to study medication synchronization. Sponsored by Senator Carson, this bill would establish a committee to study medication synchronization. The general court notes that medication synchronization is increasingly being recognized as a tool that can improve adherence when patients are on a regular chronic medication regimen. NHPA signed in support of this bill. The Study Committee has been meeting this fall. The goal of Medication synchronization is to save time for patients by reducing the number of visits to the pharmacy to one trip per month. Representatives from pharmacy and insurance companies have been working through the issues which include allowing a partial fill to sync the schedule and also, the types of medication that would be included in the program. A final report is due November 1, 2017. Senate Bill 150 - Relative to pharmacist administration of vaccines. Sponsored by Senator Soucy, at the request of the students at Massachusetts College of Pharmacy and Health Sciences, this bill would allow pharmacy student interns to immunize, under the supervision of the pharmacist, the vaccinations currently allowed by state law. NHPA testified in support of this bill. Signed by the Governor on May 12, 2017. Effective Date: July 11, 2017. The signing ceremony was held at the governor’s office on September 18, 2017.

House Bill 455-FN - Relative to the practices of pharmacy benefit managers. Sponsored by Rep. Hennessey, this bill prohibits pharmacy benefit managers from requiring providers to attain accreditation, credentialing, or licensing other than by the pharmacy board or other state or federal entity. NHPA testified in support of this bill. This law will automatically be repealed on May 1, 2018. New legislation has already been filed, so the issue to be debated in January, 2018.

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From left to right: Kaylie Love, Jessica McKenna, Kristine Willette, Cheryl Durand,Senator Donna Soucy (sponsor of the bill) and Lorraine Radick. Seated is Governor Christopher T. Sununu.


Pharmacy Journal of New England • Fall 2017

In Memoriam

grandchildren.

Gerald E. Goodwin, 86, died in Penacook on August 30, 2017. He was born in Laconia and was raised in Lakeport and Lebanon. He graduated from Massachusetts College of Pharmacy in Boston in 1952.

Dearborn Wingate, 90, a lifelong resident of Nashua, NH, passed away peacefully on July 26, 2017 at Aynsley Place in Nashua. He was widowed in 1996, having been married to Fern (Chomard) Wingate for 46 years. He also leaves behind several children including Gary Wingate, also a pharmacist, his grandchildren, nieces and nephews as well as many friends and colleagues.

From 1970 until 1990, he owed and operated Griffin Drug Co. in Franklin and Tilton Pharmacy. He later worked at LaVerdiere’s Super Drug in Franklin and Rite Aid in Bristol. He was a former member and officer of the NH Pharmacists Association, MCP Alumni of NH, and a member of the NH Sociaty of Health System Pharmacists, Inc. He was recognized by the State of NH Board of Pharmacy for 50 years of service to the Profession in 2002. He was also awarded the AH Robbins Bowl of Hygeia in 1978. He leaves his wife of 33 years May (Foster) Goodwin, five children, and seven grandchildren. Patrick J. Mahoney, Jr., 70, died on July 18, 2017. He was a resident of Derry, NH for 39 years. He went on to discover his lifelong passion at Hamden School of Pharmacy, Boston, MA. His career as a pharmacist began in the Boston and Lowell, MA area. He retired from the Manchester VA Medical Center several years ago. For over 25 years, he was deeply devoted to his patients and especially the veterans. He leaves behind his wife of 41 years, Kathleen (Fuller) Mahoney, and his daughters Jennifer and Meghan. Robert (Bob) Theriault, Sr. 79, passed away on August 8, 2017. Bob was born on October 15, 1937 in Nashua, NH. He graduated from Nashua High School in 1955 and the University of Connecticut in 1959 with a Bachelor’s degree in Pharmacy. He worked at Southern New Hampshire Medical Center in Nashua for 44 years as the Director of Pharmacy and retired to Ogunquit, ME in 2000. Bob is survived by his wife of 59 years Patricia (Smith) Theriault of Ogunquit, a daughter and three sons (including Robert Theriault, Jr. also a pharmacist) and eight

Deaborn Wingate

Dearborn was born and raised in Nashua, NH graduating from Nashua Senior High in 1945. He then attended the Massachusetts College of Pharmacy in order to carry on the family legacy. Wingate’s Pharmacy was established in 1900 by grandfather Frank Wingate. Dearborn assumed ownership of the pharmacy from his father, Homer, in 1951 until 1984, when his son, Gary, took over the family business.

2017 Continuing Education Conferences NHPA 2017 Fall CE Conference at the LaBelle Winery On September 10, 2017, NHPA hosted our 2nd annual LaBelle Fall CE Conference. We had a great line up of speakers. Presentations included pharmacy informatics, substance misuse/abuse, veterinary compounding and 2-hour Pharmacy Law on Advanced Practice Pharmacy Technicians. The NHPA Scholarship Foundation had its second annual silent auction at this CE event. We have been providing scholarship for over 100 years. The NHPA Scholarship Foundaiton seeks to assist deserving students of pharmacy in their education and career paths. Scholarship recipients are residents of the state and the future of New Hampshire pharmacy. We had 30 items up for bidding and all were sold. Many thanks to the attendees for making this event a huge success.

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New England States

continued

Vermont

President’s Message Dear Colleagues, The VPA presented a successful Fall meeting with continuing education on October 15th at Rutland Regional Medical Center. The profession was well represented with pharmacists and technicians from independent, chain, and hospital settings all in attendance. Jim Godfrey, RPh Treatments for Rheumatoid Arthritis, Opioid Dependence Drugs, and Update on Immunization were featured topics. Our Fall Social was held November 2nd at the Lincoln Inn On Tap Bar and Grill in Essex Junction, and provided a chance to relax and meet colleagues and future pharmacists. Up next is Vermont Pharmacists Day at the Statehouse in Montpelier on Friday January 26, 2018. Along with a delegation of pharmacy students, we will take the day to visit

with our elected officials, attend and testify at committee meetings, and be recognized by legislative leadership. The contacts we forge in this setting have been invaluable in furthering our legislative goals. We not only have a voice with our lawmakers, but also find they will seek us out for input on healthcare issues they are considering. The VPA Spring meeting will be held on Sunday, February 25, 2018 at the Colchester, VT campus of Albany College of Pharmacy and Health Sciences. It will feature an all-day Diabetes Seminar for continuing education credit, exhibitors, and a chance to meet and network with your fellow professionals and VPA board members. For those of you who are not already members, the VPA invites you to participate in our organization whose mission is to unite pharmacists and advance the profession by promoting relationships among pharmacists and other healthcare providers, advocating for pharmacy in legislative and rule-making arenas, providing continuing education, and supporting scholarships. Visit our website at http://www.vtpharmacists.com/index.php . Enjoy the upcoming holidays, and help keep our patients and community healthy and safe. Jim Godfrey, RPh, President

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New England Pharmacists Convention 2017

Experience a yoga practice capsule: Jay Gupta, RPh, gives the keynote speech.

President’s Award winner Diane Martin and MPhA President 2016-17 Alicia Mam daCunha enjoy a moment together with their husbands.

2017 Pepto Bowl winner, University of St. Joseph (above)

At left, pictured L to R: Meghan Wilkosz, past CPA president, Cynthia Huge, Past Foundation president, and Foundation board member Jenn Dizney

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New England Pharmacists Convention 2017

Above, pictured at the CPA installation of Officers and Awards Banquet from L-R: Gillian Kuszewski, newly installed President, Bahar Matusik, Past President, Laura Craven, Cardinal Health Gen Rx recipient, Ellen Jones, Innovations recipient and Distinguished Young Pharmacist recipient Colleen Teevan. Above, pictured L to R: MPhA President Paul Larochelle, Jr. and Bowl of Hygeia recipient Anita Young.

One of the CT 2017 scholarship recipients, Ambrose Fynn, USJ Class of 2019, pictured with USJ Dean Josef Ofosu (L) and Foundation President Emmett Sullivan (R)

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Above, MPhA award winners, L to R: Edward Leahy, Pharmacy Industry Award; Allison Burns, Upsher Smith Excellence in Innovation; Diane Martin, MPhA President’s Pharmacist of the Year; Dennis Lyons, Nathan Goldberg Award; Deborah Brown, Pharmacy Technician of the Year; Maggie DeLeo, Pharmacists Mutual Distinguished Young Pharmacist; Anita Young, Bowl of Hygeia; Kimberly Lenz, Cardinal Health Generation Rx Champion; Alicia Mam DaCunha, MPhA Outgoing President.


Features Updates for Influenza Vaccine by Kailynn DeRonde, PharmD, and Jennifer Girotto, PharmD This article will provide a summary of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) consensus recommendations for the 2017-2018 influenza season in the United States.1,2 The 2017-2018 seasonal influenza vaccine is recommended for all patients, six months of age and older who do not have any contraindications.1,2 ACIP continues to suggest that healthcare providers should begin offering influenza vaccination to patients by the end of October.1 This timeline has been established to vaccinate patients prior to the onset of significant seasonal influenza virus circulation in the community, while maintaining efficacy for most of the season even in the elderly population who may have a shorter duration of protection.1 Both trivalent and quadrivalent vaccines are available for the 2017-2018 season, and are comprised of stains A/Michigan/45/2015 (H1N1) pdm09-like virus, A/Hong Kong/4801/2014 (H3N2)-like virus, and B/Brisbane/60/2008like virus (Victoria lineage). The quadrivalent vaccine will contain the additional strain of B/Phuket/3073/2013-like virus (Yamagata lineage).1,2 The only component of this year’s vaccine that is different than that used in the 2016-2017 season is the H1N1 strain. The A/California/7/2009 (H1N1) pdm09-like virus included for the past many years has been replaced with the A/Michigan/45/2015 (H1N1) pdm09-like virus strain.3 Although the 2016-2017 and 2017-2018 H1N1 strains are similar as noted by them both being considered pdm09-like, the CDC notes they do have slight differences that are expected to improve the patient’s response against circulating H1N1 viruses. Specifically, the majority of the analyzed A/California/7/2009 (H1N1) pdm09-like viruses collected early in the 2016-2017 influenza season were identified as part of the phylogenetic clade (a group of lineages from a common ancestor) 6B. More recently, however, circulating H1N1 viruses have been classified as part of the subclade 6B.1. While these are similar, circulating viruses were identified to be poorly inhibited in

Pharmacy Journal of New England • Fall 2017

some post-vaccination adult human serum pools after the patients received the 2016-2017 A/California/7/2009 (H1N1) pdm09-like virus strain.4 ACIP has reiterated that it is not recommending the live attenuated influenza vaccination (LAIV; Flumist) for any patient for the 2017-2018 influenza season.1 This is due to continued uncertainty surrounding the vaccine’s low efficacy against the 2009 influenza A H1N1 pandemic strain during 2013-2014 and the 2015-2016 seasons.1 ACIP did not feel that sufficient explanation and evidence were provided to confidently assess the effectiveness against H1N1 from 2016-2017 season nor can they predict when the next H1N1 predominant season will occur to provide sufficient data. Therefore, it is not recommended for at least the 2017-2018 season.1,2 ACIP has again not provided a preference of any one inactivated influenza product over another. Instead they recommend any licensed, age-appropriate inactivated influenza vaccine be administered to patients.1,2 Specifically, children 6 months through 8 years old will require two doses of influenza vaccine, separated by 28 days if they have not received 2 doses of influenza vaccine prior to July 2017. The first dose this year can be administered once the vaccine is available, while the second dose should be offered by the end of October. Children 6 months through 8 years old who have received at least 2 doses of influenza vaccine and all patients 9 years and older, should receive one dose of seasonal influenza vaccine this season.1 A summary of influenza vaccines that will be available for the 2017-2018 season are summarized in Table 1. ACIP has highlighted some changes to available recommended vaccines which are summarized here. First, FluLaval Quadrivalent (IIV4, ID Biomedical Corp. of Quebec) was FDA approved in November 2016, to include patients as young as 6 months of age at a dose of 0.5mL. This is the first vaccine to be provided at this dose in patents less than 3 years of age.1, 5 Therefore, when vaccines are being administered to patients 6 months through 35 months, the healthcare provider should verify which product is being used, as the dose differs based on the product will determine what dose is recommended. Another change in 2017-2018 ACIP influenza 13


Feature

continued

recommendations affecting children, includes an alteration in the manufacturing process of Afluria trivalent (IIV3, Seqirus). This change reduce the likelihood of adverse reactions, specifically febrile seizures. ACIP now recommends that Afluria trivalent, can be used in patients as young as 5 years, in line with its FDA approval.1,2 In addition to the changes affecting children, a few new quadrivalent vaccines have also been added for adults this season. Afluria Quadrivalent (IIV4, Seqirus), approved in August 2016, and Flublok Quadrivalent (RIV4, Protein Sciences), approved October 2016, are included in the recommended options for adult patients 18 years old and older.6,7 Note the RIV4 replaces the previously approved trivalent formulation.1 Although no vaccine is being recommended over another, ACIP summarized studies that showed that the high dose influenza vaccine, adjuvented influenza vaccine, and RIV4 all have shown to have improved efficacy in older adult populations. To date, most of the data have been reported for the high dose and there have been no head to head clinical trials comparing the three vaccines.1 Therefore, ACIP does not recommend one product over another, but one of these, if available, maybe good to consider for the older adult population. In addition to the approvals, ACIP also clarified their recommendations regarding pregnancy. ACIP continues to reinforce that pregnant women are a focus group for influenza vaccination. They have now specified that similar to other patients, any licensed, age-appropriate, inactivated influenza vaccine, including RIV4, can be used for pregnant patients.1 It is always important to review and understand true vaccination contraindications. For influenza vaccine the only true contraindication is a history of severe allergic reaction to any vaccine component or prior dose of an influenza vaccine.

14

Precautions for administration for both formulations include moderate to severe illness or a history of Guillain-Barré syndrome within six weeks of receiving a prior dose of an influenza vaccine.1,2 In summary, the 2017-2018 influenza season brings some minor changes to influenza vaccination products and recommendations. The only change to the vaccine components is that the H1N1 strain has been updated and includes A/Michigan/45/2015 (H1N1) pdm09-like virus strain. It is still recommended to vaccinate all patients 6 months of age and older without valid contraindications. Again for the 2017-2018 season, only inactivated vaccine should be used as LAIV is not recommended for any patient.

References: 1. Goshskopf LA et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices – United States, 2017-2018 Influenza Season. MMR Recomm Rep. 2017; 66(2): 1-17. 2. Grohskopf LA. Influenza WG considerations and proposed recommendations. Advisory Committee on Immunization Practices June 2017 Meeting, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/vaccines/acip/ meetings/downloads/slides-2017-06/flu-06-grohskopf.pdf on July 19, 2017. 3. Grohskopf LA et al. Prevention and control of seasonal influenza with vaccines recommendations of the Advisory Committee on Immunization Practices – United States, 2016-2017 Influenza Season. MMWR Recomm Rep. 2016; 65(5): 1-52. 4. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2017-2018 northern hemisphere influenza season. Retrieved from http:// www.who.int/influenza/vaccines/virus/recommendations/201703_recommendation. pdf on July 25, 2017. 5. FLULAVAL QUADRIVALENT [Package Insert] Research Triangle Park, NC. GlaxoSmithKline, 2016. 6. Grohskopf LA. Influenza summary and WG considerations. Advisory Committee on Immunization Practices February 2017 Meeting, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/vaccines/acip/meetings/downloads/ slides-2017-02/influenza-07-grohskopf.pdf on July 19, 2017. 7. Hachey WE. Flublok Pregnancy Data. Advisory Committee on Immunization Practices February 2017 Meeting, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/vaccines/acip/meetings/downloads/ slides-2017-06/flu-05-hachey.pdf on July 19, 2017.


Pharmacy Journal of New England • Fall 2017

Table 1: Available Vaccines for the 2017-18 Vaccine Season Brand Name (Manufacturer) Afluria (Seqirus)

Route

Vaccine Category

Recommended Ages

Dose

IM

IIV3

> 5 yearsa

0.5mL

IIV4

> 18 yearsa

0.5mL

> 65 yearsb

0.5 mL

Fluad (Seqirus)

IM

aIIV3

Fluarix (Glaxo Smith Kline)

IM

IIV4

> 3 years

0.5 mL

Flublok (Protein Sciences)

IM

RIV4

> 18 years

0.5 mL

RIV3

> 18 years

0.5 mL

> 4 years

0.5 mL

Flucelvax (Seqirus)

IM

ccIIV4

FluLaval (ID Biomedical Corporation of Quebec)

IM

IIV4

> 6 months

0.5 mL

Fluvirin (Seqirus)

IM

IIV3

> 4 yearsb

0.5 mL

Fluzone High-Dose (Sanofi Pasteur)

IM

IIV3

> 65 years

0.5 mL

Fluzone (Sanofi Pasteur)

IM

IIV4

6 - 35 months

0.25 mL

> 3 years

0.5 mL

18-64 years

0.1 mL

Fluzone (Sanofi Pasteur)

ID

IIV4

Abbreviations: IIV3 = trivalent inactivated influenza vaccine; IIV4 = quadrivalent inactivated influenza vaccine; aIIV3 = adjuvanted trivalent inactivated influenza vaccine; RIV4 = recombinant, quadrivalent inactivated influenza vaccine; RIV3 = recombinant, trivalent inactivated influenza vaccine; ccIIV4 = cell cultured-based quadrivalent inactivated influenza vaccine; IM = intramuscular; ID = intradermal a 18-16 may receive via needle/syringe or via jet injector b syringe cap of prefilled syringe may contain natural rubber latex

15


Feature

continued

Balancing Safety and Efficacy with Anticoagulants: Where Are We Now? by M. Cardinalea The direct oral anticoagulants (DOACs) represent a major advancement for patients requiring oral anticoagulant therapy. Use of these agents is rapidly expanding due to randomized controlled trials demonstrating improved efficacy and similar or decreased bleeding rates compared to warfarin. This rapid increase in utilization highlights the importance of ensuring appropriate patient, agent, and dose selection when prescribing these high-risk medications. This article will discuss the role of DOACs in several special populations that may be particularly sensitive to inappropriate use, and the outcomes that may be associated with off-label dosing of DOACs.

Introduction In 2016, 17.6% of all ED visits for outpatient adverse drug effects were associated with anticoagulants, more than any other class of drugs.1 Of these, almost 50% resulted in hospitalization.1 As the superior efficacy and ease of use of the DOACs lead to greater patient exposure to these agents, caution should be used when prescribing these high-risk medications to ensure appropriate patient selection and dosing according to the labeling.

Key Points • DOACs are increasingly preferred over warfarin due to their attractive safety and efficacy. • Certain special populations require careful consideration when selecting a DOAC for anticoagulation. • Surgical patients receiving oral anticoagulant therapy represent a unique challenge for clinicians and require special consideration. • One in eight patients receiving a DOAC agent may be receiving an inappropriate dose based on the package insert, and this may be associated with poor outcomes. 16

Commentary The ease of use of the DOACs has the potential to result in overuse of these agents. Patient-specific factors that influence the potential risks or benefits of DOAC therapy must be considered with selecting an oral anticoagulant. For example, in elderly patients apixaban seems to exhibit the safest profile most consistently, and dabigatran seems to increase gastrointestinal bleeding risks.2,3 Unfortunately, however, all of the available data in the elderly population is limited to indirect comparisons from meta-analysis or observational data, making it difficult to draw solid conclusions.2,3 If a DOAC is used in these vulnerable patients, renal function should be monitored very closely, and the DOAC should be discontinued if severe renal impairment occurs. In patients with renal impairment, care should be exercised when selecting the correct dose according to indication. For rivaroxaban and dabigatran, it should be noted that the creatinine clearance calculation is performed using actual body weight. The reliance of drug elimination on the kidney should also be taken into account, as 80% of dabigatran is eliminated unchanged by the kidney, compared to 27% of apixaban. In patients undergoing hemodialysis, dosing should be based on the package insert or these drugs should be avoided, since a large study on patients in a dialysis database demonstrated higher bleeding rates when unadjusted doses of dabigatran or rivaroxaban were used.4 In patients with morbid obesity defined as a BMI >40 kg/m2 or body weight > 120 kg, DOACs should be avoided until more data is available.5 If they are used, calibrated anti-Xa assay monitoring should be performed to ensure therapeutic levels are within an expected level.5 However, these assays are currently not readily available. Lastly, more studies are needed to characterize the role of DOACs in patients with malignancy. In the treatment of venous thromboembolism associated with cancer, low molecular weight heparin (LMWH) should be offered first, and DOACs can be used if LMWH is refused.6 In patients on DOACs requiring surgical intervention, careful consideration should be made to determine the risk of interrupting anticoagulation therapy in relation to the risk of bleeding based on both patient-specific factors and surgery-


Pharmacy Journal of New England • Fall 2017

specific factors.7 In patients requiring interruption of DOAC therapy, the DOAC should be held for 2-3 half lives for low bleeding risk procedures, and 4-5 half lives for high bleeding risk procedures.7 In patients on warfarin, bridge therapy with a parenteral anticoagulant should be reserved for patients with an exceptionally high thrombotic risk and relatively low risk of bleeding.7 Mounting evidence suggests that DOACs are often prescribed in doses that are not consistent with the FDA-approved dosing.8,9 In one major registry study, 13% of patients were dosed inappropriately according to the package insert.9 Importantly, in these studies, off-label dosing resulted in negative outcomes, including increased stroke or cardiovascular hospitalization in underdosed patients and increased bleeding and all-cause mortality in overdosed patients.8,9 These results suggest that off-label dosing may worsen outcomes and special attention should be given to ensure DOACs are dosed according to FDA-approved labeling.

Conclusions

on the safety and efficacy of the DOACs in special populations. In addition, inpatient and outpatient anticoagulation stewardship efforts should focus on ensuring appropriate patient selection and appropriate dosing according the FDA-approved labelling, especially given the high-risk profile of the DOACs.

Acknowledgements None.

Notes and References 1 ISMP Medication Safety Alert. July 27, 2017;22(15). http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1172. Accessed August 2, 2017. 2 Sharma M, Cornelius V, Patel J, et al, Circulation, 2015, 132(3), 194. 3 Sardar P, Chatterjee S, Chaudhari S, et al, J Am Geriatr Soc, 2014, 62, 857. 4 Chan K, Edelman E, Wenger J, Circulation, 2015, 131(11), 972. 5 Martin K, Beyer-Westendorf J, Davidson B, et al, J Thromb Haemost, 2016, 14(6), 1308. 6 Kearon C, Akl E, Omelas J, et al, Chest, 2016, 149(2), 315. 7 Doherty J, Gluckman T, Hucker W, et al, J Am Coll Cardiol, 2017, 69, 871. 8 Yao X, Shah N, Sangaralingham L, et al, J Am Coll Cardiol, 2017, 69, 2779. 9 Steinberg B, Shrader P, Thomas L, et al. J Am Coll Cardiol, 2016, 68, 2597.

Further studies are needed to provide additional information

17


Pharmacy Marketing Group

Rx and the Law By: Don R. McGuire Jr., R.Ph, JD

This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

Insurance Coverage for New Advances An earlier article in this series talked about preparing to enter the exciting period of change that is occurring in the pharmacy profession. Recent changes in a number of states have broadened the clinical and patient care activities that can be undertaken by pharmacists. These changes take many different forms. Ohio passed a bill that authorizes pharmacists to provide a large number of patient care activities, including ordering and analyzing the results of blood and urine tests, ordering up to a 30 day supply of life saving medication when a physician is unavailable, and modifying drug therapy (including ordering new drugs). Many other states also allow pharmacists to order and interpret laboratory tests. Most states allow pharmacists to participate in Collaborative Practice Agreements (CPA). The activities allowed under a CPA vary tremendously from state to state. These can include initiation of drug therapy, modification of drug therapy and/ or discontinuation of drug therapy. Another development is the use of statewide protocols to allow pharmacists to prescribe certain medications. The leaders in this area are New Mexico, Idaho, California, and Oregon, but other states are beginning to follow their lead. Among the medications that pharmacists are allowed to prescribe are emergency contraception, smoking cessation, oral hormonal contraceptives, and preventative prescription medications recommended by the CDC for people traveling outside the US. A question that should come to mind for every pharmacist involved is whether they are covered by their insurance policy for these activities. This is a very important and challenging question because the coverage provided by each insurance company is different. You cannot just assume that new practices are covered. Each insurance company can determine what they do and do not want to cover in a policy, regardless of what constitutes your state’s scope of practice. For example, there are policies available in the marketplace that 18

exclude damages resulting from patient counseling – whether or not the counseling is required by law. Whether the services you provide are required or optional, you will want to be sure you are adequately protected. It is never safe to assume that you have coverage for something that you cannot find in your policy without first asking and validating it with your insurance company. So how do you go about examining your insurance coverage? Remember that under the law, insurance is a contract. The terms of that contract or agreement are spelled out in the insurance policy. While every provision is important, three parts of the policy are key to our question. They are the definitions, the insuring agreement, and exclusions. Make sure that the activity in question is included in the definitions and/or the insuring agreement of the policy and that it is not included in the exclusions. In a situation like we have in these states, new activities recently authorized likely will not be found in the policy yet. There is a time lag due to the requirement that insurance policies be approved by the Department of Insurance in each state. Because of this lag, coverage will depend on the insurance company’s interpretation of its existing policy language. Some policies carry a broad definition of what activities are covered. For example, the policy may say that you are covered for your acts as a pharmacist or for your acts within the profession of pharmacy. For cutting edge advances, you may not know how your insurance company will interpret what acts they are intending to cover. Another insurance company includes the phrase, “and other services of a professional nature legally performed by ‘you.’” This phrase picks up newly authorized activities until policies can be rewritten to specifically include them in the policy language. It is important to note that the phrase also includes the words “legally performed.” The pharmacist would need to complete any required training program or certifications prior to providing these services for the coverage to apply. It is also important to comply with all procedures and recordkeeping required by the law. Pharmacists will need to verify what activities they are legally allowed to provide in their state. Once they have chosen the activities that they wish to add to their practice, pharmacists need to verify coverage with their insurance company because every insurance company is different.


Pharmacy Journal of New England • Fall 2017

Financial Forum How Much Will You Spend When You Retire? Will you have enough money to make ends meet? You may have heard that people spend less once they are retired. Statistically, that is true. The question is whether a retiree has enough income to meet his or her expenses. Ideally, retirees should be able to live comfortably on 70-85% of their end salaries and draw their retirement fund down no more than 4-5% per year during a 30-year retirement. Are these two objectives realistic for the average retiree

When you spend more than you make in retirement, you dip into your savings. That fact takes us straight toward a larger problem. Most baby boomers are approaching retirement with a savings shortfall. The 2016 Employee Financial Wellness Survey from PwC (PriceWaterhouseCoopers) found that 50% of baby boomers had less than $100,000 in a workplace retirement plan. So, drawing down that amount by 4% a year would bring them less than $4,000 in annual retirement income. Of course, some of these employees will be able to tap IRAs, brokerage accounts, or income streams from other

sources – but when your workplace retirement plan savings are that scant after age 50, other sources must compensate household?1,2 According to the most recently published mightily. For many retirees, Social Security will not take up Bureau of Labor Statistics data, a household maintained by the slack. The average projected monthly Social Security someone 65 or older had a mean income of $46,627 in 2015 and a disposable income of $42,959 after taxes. That average benefit for 2017 is just $1,360.2 From the numbers in this retiree household spent an average of $44,664 in 2015. So, on article, you can glean that the average American retiree average, seniors spent more than they had on hand.2,3 Basic faces more than a little financial pressure. If you are a baby math tells us that 46,627 is roughly 70% of 66,500 and roughly boomer who has saved and invested for decades and wants to work longer to give your invested assets a few more years 85% of 55,000. So, a retirement income of $46,627 would of growth and compounding, you may have above-average correspond to about 70-85% of a typical middle-class salary in 2015. In other words, it appears all too easy for the middle- prospects for a comfortable retirement. class worker to transform into the financially Citations challenged retiree. Why is the average retiree household spending more than his/her net income? Three possible reasons come to mind. One, the cost of living may be rising faster for retirees than some assume. Social Security bases its cost-of-living adjustments to retiree benefits on changes in the CPI-W (Consumer Price Index for Urban Wage Earners and Clerical Workers). Some economists think Social Security should use a different yardstick. Two, annual health care costs may suddenly jump for some seniors. Three, it is not unusual for new retirees to spend more than they anticipate as they travel and enjoy life.4

1 - cbsnews.com/news/how-much-retirement-income-do-you-really-need/ [3/3/16]

2 - fool.com/retirement/2016/12/18/how-much-money-does-the-average-babyboomer-need-i.aspx [12/18/16] 3 - bls.gov/cex/2015/combined/sage.pdf [8/16] 4 - fool.com/retirement/2016/09/24/heres-why-your-social-security-check-ishardly-goi.aspx [9/24/16]

How do average retiree expenses break down? Housing costs accounted for $15,529 of that aforementioned $44,664 in 2015 household expenses. Transportation costs took another $6,846. Health care costs made up $5,756 of the total ($3,900 of that went to health insurance, $672 for medicines). Another $1,298 went for mortgage costs.2,3 19


From the Colleges

University of Connecticut School of Pharmacy Stephanie Gernant’s ‘Homegrown’ Path to a Career in Pharmacy C. Michael White, head of the Department of Pharmacy Practice says he’s delighted to welcome Assistant Professor of Pharmacy Practice Stephanie Gernant into the fold. He’s looking forward to the contribution she will

It was as a pharmacy intern in a 340B community pharmacy serving a low-income population that she was first introduced to the challenging issues of drug adherence and chronic disease management. When adding complications such as immigration status, language, and homelessness, the hurdles of delivering quality health care might have seemed insurmountable to some. Not to Gernant.

make to the Performance Improvement for Safe Stephanie Gernant, PharmD Medication Management (PRISM) team – the group within Pharmacy Practice that is devoted to integrating pharmacists into an inter-professional health care system that focuses on skills-based education, practice-based research, team-based care, and associated health policy issues.

She describes her PGY-1 Community Pharmacy Residency in Bangor, Maine as being especially valuable. Penobscot Community Health Care was a Pioneer Accountable Care Organizations (ACO). It offered primary care, a Federally Qualified Healthcare Center (FQHC), a patient centered medical home (PCMH), and a community pharmacy. “So it was a really fantastic hybrid in which to learn,” she says.

Maybe he should be thanking her grandmother.

reviewed two-year fellowship in Community Pharmacy Practice-Based Research at Purdue University, Gernant began her teaching career at Nova Southeastern and Larkin University College of Pharmacy, both in Florida. There, she focused on connecting community pharmacists to ACOs, as well as teaching.

Gernant started college as an undergraduate at the University of Missouri. She was a biology major with a particular interest in entomology. But, while bugs were interesting, she knew early on that her ultimate goal was a career in healthcare. It was her grandmother who tipped the scales towards pharmacy. Gernant was deeply connected to her grandmother and provided much of the care for the woman who she describes with a smile as having ‘a big personality.’ “My grandmother was both a lovely and very ornery woman, and she wasn’t afraid to voice her opinion. On our frequent trips to pick up her various medications, the pharmacist was so good and patient with her,” Gernant says. “It was clear they loved each other as they would banter back and forth. I said to myself ‘I want to be able to do that.’ It was their relationship that really made me consider a career in pharmacy.” Still, choosing to apply to the Ohio State’s School of 20

Pharmacy was somewhat of a risky choice for Gernart, who had no family members in the profession and who had never actually worked in a pharmacy herself. However, once her studies began, she knew she had made the right decision.

Following an American College of Clinical Pharmacy peer-

When a position in Pharmacy Practice at UConn’s School of Pharmacy became available, she jumped at the chance to apply. She says she knew that UConn would offer opportunities for her to get involved in teaching the same skills that first ignited her interest in pharmacy as a career – the skills demonstrated by her grandmother’s pharmacist back in Missouri. Gernant explains her role within PRISM as fostering a community pharmacy practice-based research network (CPRN) that integrates community pharmacy primary and preventative care with research. The network’s projects can enhance the health and well-being of patients and substantiate the value of pharmacists in community practice so it is visible to payers and policymakers. She says, “This is a fantastic route both before and after


Pharmacy Journal of New England • Fall 2017

graduation for students who want to advance the profession.” Having spent the last several weeks settling into to the routine of a new semester, Gernant is already impressed with the students in the School of Pharmacy, but she is not surprised. “They’re professional, courteous, and talented; they’re going to be advancing the field [of pharmacy] with their practices for decades to come – and I can’t wait to see what they come up with!” she says. As for White, he says that Gernant will be building on the work that has already been done with community pharmacies by her PRISM colleagues, Pharmacy Practice professors Thomas Buckley and Charles Caley. “Stephanie has a history of successfully partnering with pharmacies in Florida to provide clinical services and PRISM has the infrastructure and critical mass of expertise to generate compelling data that can influence public health officials and payers,” White says. He adds, “We’re glad she saw the promise of PRISM, bought into the concept, and was willing to move here to be part of something big.”

Rx for Success: New Pharmacy at UConn Health is Dream Come True for UConn Alum For patients, staff, and visitors to the Outpatient Pavilion at UConn Health, the shiny new Arrow Pharmacy on the first Jill St. Germain, PharmD floor is something of a treasure. Not only can people pick up prescriptions and consult with the pharmacist on staff, they can purchase over the counter meds, basic travel items, health and wellness products, and other medical and non-medical necessities. Need a flu shot or an immunization before travel? That can happen, too. Arrow Pharmacy can give the CDC adult recommended vaccines such as hepatitis, zoster, and pneumonia, without a prescription.

The manager of the pharmacy, which opened this past May, is Jill St. Germain ‘07 (PharmD), and the story of how she came to this position is a testament to her perseverance and the willingness of Angelo DeFazio ’85 (Pharm) to mentor an eager young student. DeFazio is the president and CEO of Arrow Pharmacy & Nutrition Centers, the largest independent pharmacy chain in greater Hartford. He also serves on the UConn Foundation’s Board of Directors, where he has been a frequent champion of students in UConn’s School of Pharmacy. He says, “I’ve been extremely fortunate in my career, and all of my success is based on earning my degree in pharmacy from UConn. Earning that degree and then getting my pharmacy license helped me forge a successful career path, so helping others, especially students who are seeking opportunities in pharmacy, seems natural. It is just the right thing to do. For someone who says she is inherently a shy person, it took a deep breath and a ton of initiative for St. Germain to approach DeFazio after he spoke at her white coat ceremony at the start of her first professional (P-1) year. As a fledgling pharmacy student, she was inspired by DeFazio’s charge to the incoming students and she took the opportunity to tell him that she had fallen in love with the profession when she began working at a local pharmacy in her hometown of Canterbury, CT when she was just 16 years old. “I knew from the time I was little that I wanted to do something in the medical field, and when I started working at my local pharmacy it pretty quickly became my goal to own my own store some day,” she says. “And here I was listening to someone who seemed to be living my dream.” For his part, DeFazio says that giving back to his alma mater is not an obligation, it’s a responsibility. “When Jill told me that she not only wanted to become a pharmacist but also had a dream of owning her own pharmacy someday, I knew I wanted to help her achieve her goals,” he says. And with that, the two began to work together to see that St. Germain would get everything she wanted out of her education. DeFazio says, “Jill was my first student in an elective 21


From the Colleges

continued

entrepreneur class I taught as an adjunct professor. Her questions, her willingness to devote extra time, and her intuition to be non-linear in her approach to problem solving set her apart from others. She has never been afraid to take a chance.” During a month-long business entrepreneurial rotation at the Arrow Pharmacy at 500 Farmington Avenue in Hartford, St. Germain began learning the business aspects of running a pharmacy. She went on to earn her MBA from UConn in 2015, but she stresses the importance of this early hands-on training with DeFazio in helping to focus her goals. After earning her PharmD, St. Germain began working full time at Arrow and when the company won the bid to establish the pharmacy at the Outpatient Pavilion at UConn Health, she jumped at the chance to manage it when offered the opportunity by DeFazio. “I was given the opportunity of a lifetime by Angelo,” St. Germain says, “and I worked with the architects, the builders, everyone involved. My goal was to make this a place where people would feel comfortable and get the best quality care. I wanted our image to coordinate with the rest of the building; it’s a beautiful place and I wanted to mirror the campus here at UConn.” DeFazio says that St. Germain fits right in with Arrow’s wellestablished culture of caring. “At Arrow, we really do seek out the ‘right’ people. It’s even there in our jingle, “You’ll feel better because we care!” It’s in our DNA and it’s what sets us apart.” The pharmacy is open from Monday through Friday, in keeping with the hours of the Outpatient Pavilion, and St. Germain stresses that it is a true community pharmacy. Though most of the foot traffic comes from patients, employees, family members, and medical staff, “We will take care of anyone who walks in the door. If people from the neighborhood want to use our services, we’re here for them, as well,” she says with a smile.

Diane Sobieraj Receives Prestigious New Investigator Award from AACP Diana Sobieraj, Assistant Professor of Pharmacy Practice, has been named the recipient of the New Investigator 22

Award by the American College of Clinical Pharmacy (ACCP). This prestigious honor is presented to a single ACCP member each year. The individual selected Diana Sobieraj, PharmD must be a member of the organization, have completed terminal training or a degree less than six years previously, and have established a research program with a substantial publication record. Sobieraj more than meets the criteria. Her research focuses on comparative effectiveness and health outcomes. She has published in excess of 40 papers in peer-reviewed literature, including journals such as the Annals of Internal Medicine, Journal of the American Geriatrics Society, and the International Journal of Cardiology. In fact, according to UConn School of Pharmacy’s Professor of Pharmacy Practice Craig Coleman in his letter of recommendation, “Diana Sobieraj’s accomplishments as a scholar have been nothing short of remarkable.” He cites the over $2 million in grants she has received to support her research program. This includes a recent award of $355,000 from the National Heart Lung and Blood Institute -- through the Agency for Healthcare Research and Quality’s (AHRQ) Evidence-Based Practice Center program -- to perform evidence synthesis reports related to the pharmacologic management of asthma. Sobieraj is Principal Investigator on this project, and the reports generated from her research will be used to support the forthcoming update of the Expert Panel Report Guidelines for the Diagnosis and Management of Asthma issued by the National Institutes of Health (NIH). Though her efforts are noteworthy, Sobieraj didn’t initially see herself in a research role. A 2006 graduate of the University of Rhode Island with a PharmD, she accepted a PGY-1 residency that was jointly sponsored by UConn’s School of Pharmacy and Hartford Hospital. She


Pharmacy Journal of New England • Fall 2017

followed that with a two-year fellowship in cardiovascular pharmacology and outcomes at the Evidence Based Practice Center under the auspices of the two institutions.

(HOPES) research group where our faculty at the School of Pharmacy and clinicians at Hartford Hospital use their talents, strengths, and time to support each other.”

“I had always envisioned myself primarily as a teacher,” she says, “and my post-graduate experience allowed me to teach in the classroom and in practice labs, and it confirmed my desire to go into academia. I applied for a position in ambulatory care, which had been the focus of my residency, and I thought I’d really fulfilled my dream when I was hired by the School of Pharmacy in 2007.

With an expanding track record of successful publications and research, Sobieraj still welcomes her interactions with students on their clinical rotations in adult internal medicine. Part of what she enjoys goes beyond the strictly academic.

“There, I was teaching new students and was involved with the daily clinical care of patients. I really thought I was where I was meant to be,” she adds with a smile. But, Department Chair and Professor of Pharmacy Practice C. Michael White had other ideas. White and Professor Craig Coleman had received a contract from the AHRQ – part of the U.S. Department of Health and Human Services - to conduct comparative effectiveness research. They invited Sobieraj to be a part of their team and she accepted – in a big way. “I actually welcomed the chance to do research,” she says, “because I felt that I really needed to round out my experience so that I could be the best teacher possible. But, I didn’t realize at the beginning how much I would love what I was doing as a research associate with Mike and Craig. That experience really changed my career path.”

Sobieraj says she didn’t start out to become anyone’s role model. But, because she’s a woman with a career and a family, she sometimes get asked by female student how she manages to ‘do everything.’ “The truth is, it isn’t always easy,” she says, ”but, I have two young daughters and I want them to understand that there’s nothing that’s out of reach for them. That goes for our students, as well. So if I can be a positive influence on young women, doing what I love both at home and at work, then that makes me happy.” Sobieraj delivered the annual New Investigator Award lecture during the October 8 awards ceremony at the AACP annual meeting in Phoenix.

At the end of the contract’s five-year timeline, in 2012, the School of Pharmacy had an opening in Pharmacy Practice for a tenure-track faculty member with a research focus. Sobieraj applied and was hired for the position. White says that what distinguishes Sobieraj is her tenacity and passion. He says she works exceedingly hard and wants to use her talents to make a lasting contribution to her students, post-doctoral trainees, and ultimately to patient care. He then adds, “She uses her first-hand experiences as a clinician to ask and answer questions that best impact patient care, especially in the areas of blood clotting and asthma. She fosters a longstanding family-like atmosphere in our Health Outcomes, Policy, and Evidence-Synthesis 23


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Massachusetts College of Pharmacy and Health Sciences – Boston Dear Colleagues,

Beantown Throwdown

On behalf of President Charles F. Monahan Jr. and Provost George Humphrey, I bring you greetings from the School of Pharmacy-Boston. I trust you are all well. The new academic year is well underway and our many highly motivated students, both new and return-

On October 13, a team of pharmacy students representing MCPHS University once again placed in the Beantown Throwdown, finishing in second this year after placing first in 2016. The business plan competition is a featured event during Boston’s HUBWeek conference and is hosted by MIT Enterprise Forum.

ing, have again populated the Longwood Medical area. I would like to share some recent updates and accomplishments with you involving our faculty and students. Best Wishes, Paul DiFrancesco, Dean

Faculty Updates Please join me in welcoming the following two new faculty to the School of Pharmacy-Boston: Nancy Stern Professor Stern joins us as an Assistant Professor of Pharmacy Practice and Assistant Coordinator of the Pharmacy Practice Lab. She received her BA in Biology from Brandeis University and a BS in Pharmacy from MCPHS. She had previously been an adjunct faculty member and has been involved with a number of initiatives at the school. Loriel Solodokin Dr. Solodokin is an Assistant Professor of Pharmacy Practice and her clinical site will be at the Dana Farber Institute at Brigham and Women’s Hospital. She received her BA in Chemistry and Biology Yeshiva University in New York, and her PharmD from the University of Illinois at Chicago College of Pharmacy. She has also completed a PGY-1 Residency at NYU Langone Medical Center and PGY-2 Hematology/Oncology Residency at Mount Sinai Hospital, NY. 24

Team Hear Me Now, represented by co-founders Patsy Casalino, Sarah Quirk, and Jason Navallil, presented a unique real-time app for bi-directional translation of American Sign Language using motion detection technology. They competed against 11 other prominent Boston colleges and universities including MIT and Harvard. The competition was moderated by well-known entrepreneurs and venture capitalists. In earning a second place finish, the team secured $7,500 of legal services from MBBP, a two-hour lunch and brainstorming session with CHEN PR, two tickets for a 2018 Red Sox 2018 game compliments of HBSR, a feature in the HUBweek winner’s blog post, and a guaranteed place at the MITEF Cambridge Startup Spotlight event in June 2018. It is incredibly rewarding to see pharmacy students succeed outside of their traditional roles, and it is another great accomplishment for the School of Pharmacy-Boston. Special thanks go out to Dr. Joseph Ferullo and his team of faculty for their guidance!

Student Updates White Coat Ceremony On September 12, our faculty presented white coats to the new entering professional class of PharmD students (Class of 2021) in our annual White Coat Ceremony. Class of 2019 student leader, Dareen Kanaan, addressed the new students and led them in the reciting of the Pledge of the Student Pharmacist.

Residency Showcase The ASHP student chapter at MCPHS University held their annual New England Regional Residency and Fellowship showcase October 17. Students from across New England


Pharmacy Journal of New England • Fall 2017

were invited to attend and sixty-two residency and fellowships were showcased. We had a record total of 360 students attend the showcase. The event proved to be a positive experience for all as program directors and students were able to mingle, network, and make connections. Thanks to MCPHS faculty member Dr. Trisha LaPointe for her efforts in leading the event.

APhA-ASP Chapter Wins Four Regional Awards Congratulations to our APhA-Academy Student Pharmacists (ASP) chapter on winning four Regional Awards at the Mid-regional meeting for APhA-ASP in Portland, Maine in October. APhA-ASP has five different patient care projects on topics such as immunization, diabetes, OTC, the heart, and “Generation Rx.”

Massachusetts College of Pharmacy and Health Sciences – Worcester/ Manchester Dear Colleagues,

successful Fall semester!

It was a pleasure to welcome the School of Pharmacy-Worcester/ Manchester Class of 2020 with a White Coat ceremony on September 1. The class of 2019 completed their IPPE rotations and we were happy to welcome them back to campus at the end of October. The class of 2018 has completed two APPE rotations -– only four more to go! Along with the faculty and staff, I look forward to working with and supporting our students as they continue and complete their academic journey in the profession of pharmacy. I wish you all a

Sincerely, Anna K. Morin, PharmD Dean and Professor of Pharmacy Practice

Interprofessional Education Highlights Worcester/Manchester Interprofessional Education (IPE) Day On June 28, the Worcester and Manchester campuses held the 4th Annual Interprofessional Education Day. More than 800 students and 20 faculty members from the Acupuncture, Nursing (BSN and FNP), Occupational Therapy, Optometry, Pharmacy, Physical Therapy, and Physician Assistant programs participated. This year’s topic was the opioid 25


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crisis with naloxone administration device training. Guest speakers from the community and the faculty discussed the local impact of the crisis in the Worcester and Manchester, NH areas, medical challenges encountered with treating the opioid crisis, and programs established to help those who are addicted to opioids. Students practiced assembling a demonstration naloxone pre-filled syringe/nasal atomizer.

Cancer Research Mini-Symposium In July, School of Pharmacy-Worcester/Manchester students participating in cancer research electives presented their research at the Pharmaceutical Cancer Research MiniSymposium on the Worcester campus. The theme of the symposium was multidrug resistance (MDR) and strategies used to overcome the obstacle to cancer research. Dr. Robert Campbell, Associate Professor of Pharmaceutical Sciences, mentored the students and organized the symposium. Irena Bond, Library and Learning Resources Manager, offered library database instruction as part of the experimental cancer research elective. The students acquired the database search skills necessary to complete the major course objectives, including preparation of mini-reviews and group presentations. The posters presented by the P1 students featured information on understanding the physiological basis for disease for an assigned cancer topic and the basic science, pre-clinical and clinical data used to improve treatment of drug-resistant cancer disease. The P2 students, who had participated in last year’s symposium, presented original research projects that focused on novel treatment approaches for the cancer disease topic that they presented on during the P1 year.

Orlando, Florida.

Collaborating Across Borders Professor Cheryl Babin (Doctor of Physical Therapy Program) and Dr. Karyn Sullivan (Doctor of Pharmacy Program) attended and presented at the Collaborating Across Borders (CAB) VI conference held in Banff, Alberta, Canada. CAB VI is a joint collaboration between American Interprofessional Collaborative, Canadian Interprofessional Health Collaboration, and the University of Alberta’s Health Science Council. More than 600 attendees from nine different countries participated in a variety of workshops, discussion groups, presentations, and interactive posters, all with a focus on interprofessional education and collaboration. Babin and Sullivan’s platform presentation, “Many Programs, Two Campuses, One Goal: Integrating Interprofessional Education (IPE) into Multiple Health Profession’s Curricula,” explained the development of a faculty-initiated IPE Working Group. They described IPE activities developed by the Working Group as required curricula for multiple professional health care programs and discussed the challenges and successes encountered. The unique approach established the Worcester and Manchester campuses involves more than 20 faculty from nine health profession programs. The IPE Working Group provides IPE and collaboration learning opportunities for students allowing them to actively participate and engage as healthcare team members by demonstrating mutual respect, understanding, and values to meet patient care needs.

Student Awards and Recognition ASHP Clinical Skills Competition Congratulations to Mohannad Al-Nabolsi and Ricardo Myers, Class of 2018, who won the School of Pharmacy-Worcester/ Manchester American Society of Health-System Pharmacists (ASHP) Clinical Skills Competition! Eighteen teams of two students from the Worcester and Manchester campuses entered the competition held October 4. Mohannad and Ricardo will represent the school in the national competition held in December at the ASHP Midyear Clinical Meeting in 26

Dr. Cheryl Babin and Dr. Karyn Sullivan present at the Collaborating Across Borders conference.


Pharmacy Journal of New England • Fall 2017

University of New England UNE’s Gayle Brazeau to Receive Maine Pharmacy Educator Award

Gayle Brazeau, Ph.D., professor in the College of Pharmacy, has been named as the 2017 recipient of the Douglas H. Kay Distinguished Pharmacy Educator award. This award, named after Maine’s most celebrated and nationally recognized pharmacy educator, recognizes those who have made a significant contribution to pharmacy education in Maine. It is awarded to individuals who have had a positive influence in the lives of future generations of pharmacists in the state. Nominees must have shown a commitment to the overall mission and objectives of pharmacy education with at least 15 years of experience in any type of pharmacy education, including teaching, precepting and mentoring of trainees. Brazeau was selected for her continuous efforts and commitment to the overall mission of pharmacy education. The award recognizes her teaching, mentoring and precepting of students along with her professional and public engagement. Brazeau was also chosen for her research and scholarly activities related to pharmacy, as well as her impact on pharmacy education at the local, regional and national levels. Speaking about the award, Brazeau said, “Dean Douglas Kay was an excellent mentor, colleague and friend who showed us each day how to be positively and enthusiastically committed to pharmacy education, to pharmacy and to the success of others. He was fondly remembered as the ‘Dean of Deans’ in the pharmacy academy. It was a blessing to learn and be supported by Dean Kay in the College of Pharmacy. This recognition reflects the honor of working with and learning from Dean Kay, as well as working with the many outstanding and dedicated UNE College of Pharmacy faculty, staff and students, plus the many outstanding pharmacists across the State of Maine.” Brazeau will be recognized with this award at the Maine Pharmacy Association Sesquicentennial Annual meeting. The event will take place Saturday, October 14 at Portland’s Holiday Inn by the Bay.

UNE’s Karen Houseknecht Publishes Research on Antipsychotic Induced Bone Loss Karen Houseknecht, Ph.D., professor of Pharmacology in the University of New England College of Osteopathic Medicine and interim dean of the College of Pharmacy, has published novel findings about the effects of risperidone, a widely-used antipsychotic drug, on bone loss in the July 2017 issue of BONE. Houseknecht’s laboratory focuses on understanding the links between mood and metabolism. Specifically, the lab is interested in understanding why patients with mood disorders have a higher incidence of metabolic disease and why medications used to treat mood disorders often cause metabolic disorders such as obesity, diabetes and bone loss. Atypical antipsychotic (AA) drugs, including risperidone, are FDA-approved to treat psychosis associated with schizophrenia and bipolar disorder, and some are approved to treat irritability associated with autism in children. Despite FDA warning labels relating to significant safety issues in the elderly, over 20% of nursing home residents are prescribed AA drugs. Additionally, many children, adolescents and adults are prescribed AA drugs for diagnoses with no FDA-approved indication for AA use. AA drugs have been found to cause significant metabolic side effects including obesity, type 2 diabetes, hyperglycemia, sleep disruption and cardiac arrest. Emerging research from Houseknecht and her team has shown that bone is another “off-target” site for AA side effects. Clinical studies show that patients treated with risperidone have reduced bone density and increased fracture risk. These findings are concerning in populations such as the elderly, where fracture risk is already elevated, and in adolescents who are experiencing peak bone growth. In this paper, Houseknecht and her multi-institutional, collaborative team investigated two fundamental questions: 1) are the 27


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negative effects of risperidone on bone due to drug-induced hypogonadism (diminished functional activity of the gonads) and 2) are there direct effects of risperidone on bone? It is known that risperidone can cause hypogonadism in some patients and hypogonadism is known to cause significant bone loss, as seen with menopause. Houseknecht’s team showed that hypogonadism in mice causes significant bone loss, and that adding risperidone increased the bone loss even more. This indicated that hypogonadism is not the only cause of risperidone-induced bone loss. Houseknecht then examined the novel hypothesis that antipsychotic drugs could have direct effects on bone. Her team showed for the first time that the function of bone cells that break down bone, osteoclasts, are inhibited by dopamine. The team also found that risperidone, a dopamine blocker, stimulates osteoclast function which is consistent with increased bone loss. In addition, they reported the novel finding that dopamine and risperidone are found in significant quantities in bone marrow following an oral dose of risperidone in mice, indicating that the drug accumulates in bone. “We are very excited about these findings as they shed new light on how bone biology is regulated by dopamine, a molecule that is known to be important in regulating mood, and a target for many psychiatric medications,” said Houseknecht. “Our overarching goal is to explore ways to create safer medications to treat mood disorders. Furthermore, we want to inform prescribing practices in order to optimize efficacy and safety for our most vulnerable patients.” The research team comprises: Katherine J. Motyl, Ph.D., of the Center for Molecular Medicine at Maine Medical Center Research Institute Megan Beauchemin, Ph.D., NIH funded post-doctoral fellow in UNE’s College of Osteopathic Medicine (Houseknecht lab) Deborah Barlow of UNE’s College of Osteopathic Medicine (Houseknecht lab) Phuong T. Le, of the Center for Clinical and Translational Research at the Maine Medical Center Research Institute 28

Kenichi Nagano, Ph.D., of the Department of Oral Medicine,

Infection and Immunity at the Harvard School of Dental Medicine Annika Treyball, Ph.D., of the Center for Molecular Medicine at Maine Medical Center Research Institute Anisha Contractor, Morgane Fellow and medical student in UNE’s College of Osteopathic Medicine Roland Barron, D.D.S., Ph.D., of the Department of Oral Medicine, Infection and Immunity at the Harvard School of Dental Medicine Clifford J. Rosen, M.D., of the Center for Clinical and Translational Research at the Maine Medical Center Research Institute Karen L. Houseknecht, professor of Pharmacology at UNE’s College of Osteopathic Medicine and interim dean of the College of Pharmacy This research was funded by NIH grants to Karen Houseknecht (DK095143), Katie Motyl (AR061932 and AR067858) and Cliff Rosen (AG040217). Anisha Contractor was supported by a UNE College of Osteopathic Morgane Fellowship. Deborah Barlow was supported in part by the UNE Center for Excellence in Neuroscience.

UNE’s Christian Teter Provides Training at the 2017 Annual Maine Behavior Healthcare Co-Occuring Disorders Forum Christian Teter, Pharm.D., BCPP, associate professor of Psychopharmacology at UNE, has provided his expertise on cannabinoids at the Annual Maine Behavioral Healthcare and Co-Occurring Disorders Forum. This event is jointly sponsored by Maine Behavioral Healthcare (MBH) and CCSME (Co-Occurring Collaborative Serving Maine). Teter discussed the impact of marijuana’s active ingredients, cannabinoids, on the developing brain; the harm and the benefits of recreational and medicinal uses; and what we currently do and do not understand about cannabinoids. He co-presented at the event with Debra Poulin, LCSW, CCS, director of Substance Use Treatment and Prevention Programming at MBH, who spoke about The Community Reinforcement and Family Training (CRAFT), a program developed to assist those affected by substance abuse. Poulin provided an overview of how substance use disrupts


Pharmacy Journal of New England • Fall 2017

relationships, the evidence for CRAFT model, and highlighted some of the skills needed to navigate and maintain a positive trajectory for all family members and friends. The event was a three-hour training program for MBH and partner providers, designed to further develop the co-occurring model of treatment with CCSME. It was open to clinicians, case managers, nursing staff, residential staff, medical staff and others throughout the MBH continuum of care. This program was made possible by support from the Pond Foundation and was offered through Maine Behavioral Healthcare. Contact Hours were provided through the Co-Occurring Collaborative Serving Maine.

in cost of this year’s vaccine. For those paying out of pocket in Maine, this year’s flu shot prices generally range from $30-50. Li explained that higher costs are the result of better technologies in developing the vaccine. There are different types of vaccines that protect against more strains of influenza, which are also more expensive. Li recommends that individuals speak with their doctors to find out which vaccine they should have. “The lower cost products typically do tend to sell out quicker,” said Li. “So, the longer you wait [to be vaccinated], the more likely it is that the only products out there will be the expensive ones.” Watch the story on WMTW.

Read more from MaineHealth.

UNE’s Edward Li to Speak at Hemotology Symposium Edward Li, M.P.H., BCOP, professor in the College of Pharmacy, will present a satellite symposium during the American Society of Hematology’s 59th Annual Meeting and Exposition (ASH). Li is one of three expert faculty members who will give satellite talks during the conference. Li’s presentation, Evaluating the Emerging Role of Biosimilar Agents for the Treatment of Hematologic Malignancies, will take place December 8, 2017, in Atlanta, Georgia. He will offer insight on the regulatory process associated with the approval of biosimilars by the U.S. Food and Drug Administration, along with current and emerging efficacy and safety data for biosimilar agents used in the treatment of hematologic malignancies. The satellite programs will focus on some of the most pressing issues in hematology, including the use of CAR T cells in cancer therapy and graft-versus-host disease (GvHD) pathogenesis.

UNE’s Edward Li Discusses Flu Vaccine Costs with WMTW In advance of flu season, Edward Li, M.P.H., BCOP, professor in the College of Pharmacy, spoke with WMTW about the change

UNE’s Ana and Don Olins Interviewed for ‘Active Motif’s Podcast’ Ada Olins, Ph.D., and Don Olins, Ph.D., both research professors in the College of Pharmacy, discussed their discovery of nucleosomes with ‘Active Motif’s Podcast,’ a program dedicated to epigenetics research. Above, Ada Olins PhD and Don Olins PhD The nucleosome is the fundamental first-level folding of nuclear DNA. It is vital to higher levels of chromatin packaging, highly conserved in evolution and is the site of chemical modifications that possess genetic regulatory functions. Since their discovery in 1974, the Olinses have focused their research on nuclear function and architecture, as well as chromatin structure. The Olinses’ interview coincided with the annual EMBO conference in Heidelberg, Germany, which promotes excellence in the life sciences. This year’s conference celebrated the 20th anniversary of the publication of the 29


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crystal structure of the nucleosome. During the event, the Olinses presented their current research on “Epichromatin” (nucleosomes at the surface of chromatin and chromosomes). Listen to the podcast.

The Associated Press Highlights UNE’s Srinidi Mohan for Breast Cancer Research Funding The Associated Press has featured Srinidi Mohan, Ph.D., assistant professor in the University of New England College of Pharmacy, for his innovation in the field of breast cancer research. Mohan has received a $375,000 funding award from the Maine Cancer Foundation to advance the development of his early detection and disease monitoring method. Mohan has received a provisional patent for his research, which uses a marker in the blood to detect the presence of highly aggressive tumors and to help track cancer growth. Discovered while studying nutritional supplements, Mohan found that the marker Nw-hydroxy-L-Arginine (NOHA) was both a sensitive and reliable indicator for estrogen receptornegative (ER–) tumors, found in the most aggressive types of breast cancer. According to the American Breast Cancer Foundation, estrogen-negative breast cancer is diagnosed in approximately 60,000 individuals each year in the United States, with young women and African Americans most at risk. As an aggressive tumor, estrogen-negative breast cancer can grow between scheduled screenings, provides no noticeable symptoms prior to tumor cyst development, and has no readily available effective targeted therapy. Both early and advanced stage estrogen-negative breast tumors are treated predominantly by chemotherapy. Apart from poor prognosis and modest treatment options, patients with such aggressive breast cancer face twice the risk of mortality as compared to other tumor subtypes. Currently, no reliable blood-based marker exists for estrogen-negative breast tumor prognosis and/or disease monitoring.

30

Srinidi Mohan, PhD

The two-year award from Maine Cancer Foundation will focus on developing NOHA as a less-invasive, blood-based indicator for sensitive estrogen-negative breast tumor prognosis in racially distinctive populations. It will be used for early prognosis, screening and neoadjuvant tumor management. Discussing the impact of the work, UNE Director of Research Administration Nicholas Gere noted, “This research project has the potential to be one of the first at UNE to achieve successful commercialization.” As principal investigator, Mohan will be conducting the project aims of this grant in collaboration with Maine Medical Center Research Institute researchers Drs. Susan Miesfeldt, Ivette Emery, Christine Duarte, and Peter Brooks; and Mainebased company Maine Biotechnology Services. “We are thrilled to play an integral part in Mohan’s groundbreaking work,” said Tara Hill, executive director of Maine Cancer Foundation. “The development of a lessinvasive means of detecting estrogen-negative breast cancer at its earliest stages has the potential to vastly increase treatment options for women in Maine and beyond. We believe our support will help move this game-changing diagnostic out of the lab and into clinical situations where it will save lives.” Watch the story on WMTW.


Pharmacy Journal of New England • Fall 2017

University of St. Joseph Message from the Dean

convention welcomed pharmacists, pharmacy

Dear Colleagues:

England. USJ students Katherine Lee and Shafali Verma were

technicians, and pharmacy students from across New

Greetings to All!

the winners of Pepto Bowl: Student and Pharmacists Self

University of Saint Joseph School of Pharmacy’s fall semester began with the matriculation of an exuberant class of Pharm.D. students. We welcomed the Class of 2020 cohort, made up of seventy-five women and men from 11 states and Puerto Rico, to the family and supportive environment for which USJSOP is known. The academic year has taken off with a great start and we look forward to a healthy year for all.

“Jeopardy!” set up, where schools were continuously

Care Championship. This academic competition resembled a eliminated until a winner was declared. The USJ team was made up of two P3 students, Lee and Verma, and was coached by Lisa DeGennaro, Pharm.D., CDE, USJ assistant professor of Pharmacy Practice and Administration.

As always, we thank you for your continued support! Best, Joseph R. Ofosu Founding Dean and Professor

News University of Saint Joseph’s five-day Orientation culminated on August 11, 2017 with the White Coat Ceremony at Hoffman Auditorium on the West Hartford Campus. Our featured speaker was Pharmacist Jermaine Smith, Senior Director of College Relations and Professional Recruitment for Rite Aid Pharmacy. He delivered a wonderful talk on Leadership and Professionalism.

USJ Students Katherine Lee and Shafali Verma display their winning Pepto Bowl.

Awarded NEPC Scholarships Every year, the Connecticut Pharmacists Associations awards five scholarships to diligent students at the New England Pharmacists Convention. The USJ School of Pharmacy students took four out of the five awards for the 2017-2018 academic year. The University couldn’t be prouder of our students’ accomplishments.

USJ Pharmacy Students Win Pepto Bowl Championship The New England Pharmacists Convention (NEPC) was held at Foxwoods Resort Casino on Thursday, Sept. 14, and Friday, Sept. 15, 2017. This two-day annual

Award Recipients: • Mr. Jason Lew (P3) – recipient of the Henry A. Palmer Scholarship • Ms. Jennifer Donato (P3) – recipient of the Murray Abraham Memorial Scholarship 31


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• Ms. Hillary Kuzaro (P3) – recipient of the Steven J. Kruzshak Memorial Scholarship • Mr. Ambrose Fynn (P2) – recipient of the Milton S. Camilleri Scholarship

New Appointments Dr. Aaron Burton, Pharm.D., BCPS Assistant Professor, Department of Pharmacy Practice and Administration Dr. Burton joins the University of Saint Joseph School of Pharmacy as an Assistant Professor in the Department of Pharmacy Practice and Administration. Dr. Burton is a graduate of the University of Connecticut (Doctor of Pharmacy), and a present degree candidate at the University of Auburn (Masters in Business Administration). He completed his PGY-1 residency training at Moses Taylor Hospital in Scranton, Pennsylvania. He began his career as a staff pharmacist at Saint Luke’s Hospital and Health Network in Bethlehem, PA, then advanced to a clinical specialist role in internal medicine. He was promoted to Assistant Director of the Pharmacy, then Pharmacy Site Manager there, before assuming the Director of Pharmacy position at Waterbury Hospital. Dr. Burton has held adjunct faculty positions at the USP-Philadelphia College of Pharmacy, Wilkes University, and the University of Connecticut. He will be developing an internal medicine pharmacy practice at Middlesex Hospital. Dr. Morgan Comee, BS, PharmD, CDE Assistant Professor, Department of Pharmacy Practice and Administration Dr. Comee joins the University of Saint Joseph School of Pharmacy as an Assistant Professor in the Department of Pharmacy Practice and Administration. Dr. Comee is a graduate of Worcester Polytechnic Institute of Technology (BS Biology and Biotechnology) and a graduate of MCPHS University (Doctor of Pharmacy). She completed a PGY-1 residency training at Baystate Medical Center in Springfield, Massachusetts. She is a certified diabetes educator (CDE) and she is certified through APhA in medication therapy management and as an immunization trainer. Dr. Comee has held faculty appointments at MCPHS University and at the 32

University of Massachusetts Medical School. She has been in practice as the Manager of Diabetes Education at UMASS Memorial Medical Center and will be developing an ambulatory care pharmacy practice at UMASS Memorial Medical Center. Dr. Mohamed Nounou, B.Pharm., M.PSc., Ph.D Assistant Professor, Department of Pharmaceutical Science Dr. Nounou joins the University of Saint Joseph School of Pharmacy as an Assistant Professor in the Department of Pharmaceutical Science. Dr. Nounou is a graduate of Alexandria University, Egypt (B.Pharm, M.PSc.) and a graduate of University of Houston (Ph.D.) He is involved in co-teaching Pharmacokinetics, Pharmaceutical Calculations, Compounding laboratory and Pharmaceutics. He is course director of Pharmaceutics and also is expected to do research, write grants, and publish papers. Dr. Nounou discovered his interest for Pharmaceutical Science during his time at home in Egypt at Alexandria University. After completing his undergraduate and graduate work in the field, he went on to teaching globally – in Egypt, Italy, and the United States. Throughout his travels, Dr. Nounou has inspired students with his love for the field. “Pharmaceutics is a special, magical, and marvelous field,” he stated. “It unleashes creativity in the students, making them a jack of all trades.”

Publications Nounou MI, Yamin Ko, Nada A. Helal and Jeremy Boltz; “Adulteration and counterfeiting of online nutraceutical formulations in the US: Time for intervention?” Journal of Dietary Supplements, Accepted; July 25, 2017; Under Production. Szollosi DE, Manzoor MK, Aquilato A, Jackson PB, Ghoneim OM, and Edafiogho IO. “Current and Novel Anti-inflammatory Drug Targets for Inhibition of Cytokines and Leukocyte Recruitment in Rheumatic Diseases.” Journal of Pharmacy and Pharmacology. 2017, in press. Accepted August 1, 2017 DOI: 10.1111/jphp.12811. Goldstein SW, Bill A, Dhuguru J, Ghoneim OM. “Nucleophilic Aromatic Substitution – Addition and Identification of an Amine.” Journal of Chemical Education, Published July 28, 2017, DOI: 10.1021/acs.jchemed.6b00680


Pharmacy Journal of New England • Fall 2017

Terrell-Hall TB, Nounou MI, Fatema El-Amrawy, Jessica I.G. Griffith, and Paul R. Lockman; “Trastuzumab distribution in an in-vivo and in-vitro model of brain metastases of breast cancer.” Oncotarget; Accepted; July 2017; Under Production, available online.

Vitamin K Extraction Method for Management of Brodifacoum

Helal NA, Osami A, Helmy A, McDonald T, Shaaban LA and Nounou MI; “Non-Viral Gene Delivery Systems: Hurdles for Bench-to-Bedside Transformation.” Die Pharmazie; Accepted; August 2017; Under Production.

Conventional Bleach.” North American Congress of Clinical

Vadlapatla R, Wong EY, and Gayakwad SG. “Electronic drug delivery systems: an overview.” Journal of Drug Delivery Science and Tech., 41, 259-366 (2017).

Egypt”; Poster Presentation, International Conference on

Nada AA, Rajesh AM, Kronekova Z, Mosnacek J, Rudraiah S, Kumbar SG. “Bioactive Polymeric Formulations for Wound Healing.” Biomedical Materials (Under review). Nounou MI, Zaghloul TI, Ahmed NA, Eid AA and El-Khordagui LK. “Skin permeability enhancement by Bacillus subtilis alkaline protease: Application to transdermal drug delivery.” International Journal of Pharmaceutics. Accepted for publication June 15, 2017.

Toxicity.” North American Congress of Clinical Toxicology Annual Meeting, October 2017: Vancouver, BC. Laskey DA. “Treating Life’s Bleachable Moments: An Ex-Vivo Examination of Ocular Damage of Splashless vs. Toxicology Annual Meeting, October 2017: Vancouver, BC. Helal NA., AbouElfetouh A., El-Kamel A. and Nounou MI; “Over-the-Counter (OTC) Weight Loss Nutraceuticals in Pharmacoepidemiology and Therapeutic Risk Management (ICPE 2017), Montreal, Canada, August 26-30, 2017. (Travel Grant Award)

Professional Accomplishments Dr. Tamara Malm has been elected as Chair-elect for the American College of Clinical Pharmacy Clinical Administration Practice and Research Network (CADM PRN). Dr. Dayne Laskey received the Theodore Worth Award for community service to Elizabeth Park in West Hartford, CT.

Posters and Presentations Knecht J, Puia D, Riccardi M. “An Investigation of Interprofessional Education on Interprofessional Collaborative Competencies.” Saint Anselm Nurse Educators Annual Conference, North Falmouth, MA (May 2017). Laskey DA. “Common Drug Toxicities: Lithium, Valproate, and Phenytoin.” Medication Safety Continuing Education Event, Western New England University, Springfield MA, June 2017. Laskey DA. “Synthetic Cannabinoids: Update for Healthcare Professionals.” National Association of Boards of Pharmacy Annual Meeting (District 1 and 2), Groton, CT, September 2017. DeGennaro L. “The Pharmacist and Patient-Centered Diabetes Care”. New England Pharmacists Annual Convention. Mashantucket, CT. September 2017. Laskey DA, Bobea C, Slauson SR, Salinger L. “Pharmacognosy in 2017: Exploring the Feasibility of a

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Pjne fall 2017  

PJNE Fall 2017