Missouri Pharmacist Spring Issue 2025

THE LEADING VOICE FOR THE MISSOURI PHARMACIST

Your name here

MPA membership

WHAT’S YOUR WHY?

Take a look inside to find heartfelt testimony from MPA members sharing their Why. Discover how MPA advocates for you, fosters lasting friendships, and offers enriching opportunities. We’re more than just a membership, we are a supportive network dedicated to advancing pharmacy practice and enhancing our members’ lives.

Mistakes Happen PQC+

CAN HELP

The PQC+ program provides tools to improve efficiency and patient safety, and helps your pharmacy meet accreditation, Part D, and state quality assurance requirements.

C O N N E C T W I T H U S

The Alliance for Patient Medication Safety is a federally recognized Patient Safety Organization.

TABLE OF CONTENTS

MPA Staff

Ron Fitzwater, MBA, CAE, Chief Executive Officer

Robyn Silvey, CMP, MBA, Chief Operating Officer

Annie Eisenbeis, PharmD, MBA, Director of Practice Development

Henrio Thelemaque, Director of Government Affairs

Sarah Mengwasser, Director of Communications

Lauren Eichelberger, Membership Coordinator

Drew Oestreich, Pharmacy Provider Relations

Ashley Stone, PharmD, Education Coordinator

Carson Von Alst, PharmD, MBA, Executive Fellow

Board of Directors

President – Kendall Guthrie, PharmD, BCACP

UMKC School of Pharmacy, Kansas City, MO

President Elect – Roxane Took, PharmD, BCACP

SSM St. Louis University Hospital, St. Louis, MO

Treasurer – Pawel Sierbinski, PharmD, BCACP

Gateway Apothecary, St. Louis, MO

Secretary – Erica Mahn, PharmD, BC-ADM

Alps Pharmacy, Springfield, MO

Immediate Past President – Koby Prater, PharmD Prater’s Pharmacy, Seneca, MO

Members At Large

Laura Butkievich, PharmD, MHA, BCPS, BCACP, FASHP

University of Missouri Health Care, Columbia, MO

Lacy Epperson, PharmD

Mitchell’s Drug Stores on the Blvd. Neosho, MO

Tyler Taylor, PharmD

St. Louis Hills Pharmacy, St. Louis, MO

Caleb Witt, PharmD Pharmax Pharmacy, Leadington, MO

Ex-Officio Members

Russell Melchert, PhD, RPh

UMKC School of Pharmacy, Kansas City, MO

Terri Warholak, PhD, RPh, CPHQ, FAPhA

Remembering Your Why: A Call to Action pg. 4

CEO Update: You’ve Got A Friend pg. 6

Financial Forum pg. 9

Focus Topic: Why MPA? MPA Members Share Their Why pg. 10

Perfect Storm: Looming Crisis for Missourians Needing Pharmacy-Based Health Care Services Pg. 26

Free CE | 1 Contact Hour Hedva Barenholtz Levy, PharmD AGS Beers Criteria® and STOPP/START: Tools to Enhance Medication Safety Pg. 34

St. Louis College of Pharmacy at University of Health Sciences & Pharmacy, St. Louis, MO Missouri Pharmacy Association | 211 East Capitol Avenue | Jefferson City, MO 65101 Phone: (573) 636-7522 | Fax: (573) 636-7485 | morx.com

Missouri Pharmacist is sent to MPA members, non-member pharmacists, pharmacy educators, pharmacy technicians, and pharmacy students in Missouri. All views and opinions expressed in articles are those of the writer and are not necessarily the official position of the Missouri Pharmacy Association. Missouri Pharmacist is owned and published by the Missouri Pharmacy Association. To advertise or for editorial inquiries email Sarah Mengwasser at sarah@morx.com or call (573) 636-7522. Missouri Pharmacist Magazine | Spring Issue

MISSOURI PHARMACY ASSOCIATION MISSION: The Missouri Pharmacy Association promotes and protects the role of pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team.

REMEMBERING YOUR WHY A CALL TO ACTION

KENDALL GUTHRIE

PharmD, BCACP, UMKC School of Pharmacy, Kansas City, MO

As the year progresses, I often find myself caught up in the demands of daily life-balancing professional responsibilities, personal commitments, and ensuring my girls have a multitude of core memories to look back on someday. I am guilty of forgetting to slow down, appreciate the journey, and savor the moments that will one day be cherished memories. I often have to remind myself to stop, breathe, and reflect on the things that give me purpose and fulfillment.

Similarly, in the fast-paced world of pharmacy, pharmacists and pharmacy teams are constantly juggling ever-growing workloads, patient care responsibilities, keeping up with the latest healthcare developments, and advocating for the profession. The demands can at times feel constant, leaving little time for reflection. It is important to intentionally reconnect with our “why” and take inventory of the things we are grateful for in our careers.

For those of us in the pharmacy profession, our “why” is often rooted in a passion for helping others, a commitment to advancing healthcare, and a desire to better the communities we serve. When I think about what I am grateful for in my professional journey, the list is extensive. However, the experiences I’ve had and the relationships I’ve built through my involvement with MPA are among the top of the list. There are many tangible benefits to being a member of the Missouri

Pharmacy Association: real-time industry updates, readily accessible continuing education, discounted pricing for live events, and getting a free subscription to this magazine. But for me, the true value of membership in the association goes far beyond these perks. Here are just a few reasons why the association has been such a meaningful part of my career:

1. Mentorship and Networking

Being part of MPA opens the door to a wealth of networking and mentorship opportunities, allowing you to meet peers who share your passion and can offer valuable advice. Whether it’s a quick conversation at the annual conference or a long-term mentorship relationship, these connections can be career-changing. I vividly remember my very first MPA Annual Conference, surrounded by unfamiliar faces. Fast forward to this year’s conference, I looked around the room surrounded by friends that in many cases feel like family. This professional “family” has been invaluable for sharing experiences, celebrating successes, and navigating challenges together.

2. Professional Development

MPA has played a pivotal role in my growth as a leader. Through the various committees, task forces, working groups, and the Board of Directors, I’ve been able to sharpen my leadership skills while making meaningful contributions to the profession of pharmacy. Has it always been easy? Of course not. Do I still have a lot to learn? Absolutely. But the supportive culture fostered by MPA encouraged me to step outside my comfort zone, take on new challenges, learn from inspirational colleagues, and gain valuable insights into my personal leadership style and areas for growth.

3.Advocacy for the Profession

One of the most powerful aspects of association membership is the collective voice it provides. A mentor of mine once said when discussing advocacy, “If not you, then who?” Membership in the association has provided an outlet for me to advocate for the changes I want to see in the profession. I have had the opportunity to work alongside the movers

and shakers in the industry to protect and advance pharmacy practice in the state and nationally. I have said it once, and I will say it a million times. MPA is one of the strongest pharmacy associations in the country and fights tirelessly for its members and the profession we all cherish.

Although I could write endlessly about the impact MPA has had on my career, I want to take a moment to focus specifically on the advocacy aspect.

“Think back to your professional “why”. Why did you want to pursue a career in the pharmacy profession? What aspects of the profession do you value and want to protect?”

January 8th was the first day of the 2025 Missouri Legislative Session. Leading up to that date, the MPA staff and Board of Directors, together with a dedicated PBM Task Force of members, spent months preparing for the busy session ahead focused on fair business practices and advancing the practice of pharmacy in Missouri. As we laid the foundation for the legislative agenda, we knew the success of these efforts would rely heavily on the voices and actions of the MPA membership. We knew we needed a committed membership, representative of all facets of pharmacy, ready to mobilize and act when the time came to advocate.

And I am here to tell you, THE TIME HAS COME!

When it comes to advocacy, the math is simple: more voices equal a stronger collective voice. So, I am calling on all of you, the MPA members, to help us amplify our voice and recruit others to join the cause. Think back to your professional “why”. Why did you want to pursue a career in the pharmacy profession? What aspects of the profession do you value and want to protect? We have laid the groundwork for impactful legislation that has the potential to bring meaningful change to the pharmacy profession. Through diligence, strategy, networking, and ongoing discussions with key stakeholders and policymakers, we have positioned ourselves for success. However, we need your help to turn these efforts into reality. We need our members to get involved and advocate. Through this shared commitment, MPA members become powerful partners in the fight to ensure this profession, our profession, remains viable and impactful in the years to come. Your voice and engagement are critical for the success of these bills. If you are in the pharmacy profession and have not yet contacted your legislators to support pharmacy legislation (PBM reform, vaccine authority expansion, 340B regulation), please do so as soon as possible. I will leave you with this, “If not you, then who?” Thank you for your dedication to the profession. I look forward to a successful, connected, and impactful year ahead!

“You’ve Got a Friend ”

RON

FITZWATER MBA, CAE, CEO, Missouri Pharmacy Association

First, if you are currently a member of the Missouri Pharmacy Association – thank you. We are working hard to make sure we are representing your profession at every table and in every meeting where health care is discussed. I know that many feel like your profession is going through some extreme challenges right now. I can assure you that your Board of Directors and staff are laser focused on those issues – and more importantly, on solutions to address those issues.

Like most successful associations, your board adheres to a carefully crafted Mission Statement and Vision Statement that help guide the organization through all board and committee deliberations. Those statements are as follows:

Mission: The Missouri Pharmacy Association (MPA) promotes and protects the

role of pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team.

Vision: Pharmacists at the forefront of care and community.

Through the work of the Missouri Pharmacy Association and our subsidiary organizations (Missouri Pharmacy Foundation; Pharmacist Political Action Committee of Missouri; MO Pharmacist Care Network; CPESN Missouri and Pharmacy Agent Corporation), your association is uniquely positioned to address issues across the health care spectrum. The boards of these individual organizations in combination with the MPA staff, work tirelessly on your behalf. We appreciate your support.

If you are not a member, I hope that I can help build the case for why you may want to join your colleagues. As I was preparing to write this article, I came across a video of

Vince Gill from several years ago when he did a eulogy at the funeral for Arnold Palmer. In addition to telling a few of his golfing stories about the legend, he sang a song that he had sung at another event for Mr. Palmer earlier in his career. The song that Mr. Gill sang was “You’ve Got a Friend.” This is a song that wasn’t written by him, but instead by Carole King (a prolific songwriter in the later part of the 20th Century). The song was made popular by singer James Taylor. Following is a few of the lines from the song:

“You just call out my name

And you know, wherever I am I’ll come runnin’

To see you again

Winter, spring, summer or fall

All you have to do is call

And I’ll be there

You’ve got a friend”

The song obviously doesn’t totally represent the seriousness of the issues the pharmacy profession faces today. But the message is clear in that in most of life’s situations, we all need a friend. Someone to help us sort out the issues and discuss options to address them. Someone who has our back in those extremely difficult situations. Someone to be in all the places we can’t be in to look out for our best interest when we can’t be there ourselves.

MPA is that association! MPA is a true friend of pharmacists and your patients. We work with the Missouri Legislature, MO HealthNet, the Missouri Board of Pharmacy, BNDD, the U.S. Congress, Missouri schools of pharmacy, national pharmacy associations and many others to address issues of importance to Missouri pharmacists. And we do it all for about 50 cents per day for individual members.

The last verse of the song is:

“Ain’t it good to know you’ve got a friend

Ain’t it good to know, ain’t it good to know

Ain’t it good to know

You’ve got a friend

Oh, yeah, now, you’ve got a friend

Yeah baby, you’ve got a friend

Oh, yeah, you’ve got a friend”

I encourage you to join thousands of your colleagues and join the Missouri Pharmacy association. Please let me know if I can answer any questions for you.

Thank you.

Student Perspective

“I would encourage every pharmacy student to do a rotation with the Missouri Pharmacy Association, no matter what area of pharmacy you are interested in.” •

CAITLIN AHEARN

2025 PharmD Candidate, UMKC School of Pharmacy (Columbia)

As I walked into the Missouri Pharmacy Association (MPA) on my first day, I was nervous and unsure of what to expect. I was immediately given a warm welcome and was introduced to Annie Eisenbeis, who quickly briefed me on her initiative to implement pharmacy scope of practice into Missouri state legislation. Without hesitation, we jumped right into action and one quick google search turned into a whole day’s worth of research. I quickly learned that MPA’s impact was far greater than I had originally thought.

During my rotation, I also had the opportunity to dive deep into their Vaccine Gap Closure program - an initiative I wasn’t initially familiar with. This program, in partnership with CPESN MO pharmacies, focuses on tackling vaccine hesitancy, improving community outreach, and making sure underserved populations have access to vaccines. I was able to attend multiple conferences with Annie Eisenbeis and Carson Von Alst where we networked with other healthcare professionals and promoted the Vaccine Gap Closure program.

This rotation has been the most unique one I have been on thus far. It was extremely eye opening to see the ideas that we brainstormed in the MPA office implemented and put into practice. I would encourage every pharmacy student to do a rotation with the Missouri Pharmacy Association, no matter what area of pharmacy you are interested in. The MPA team is approachable, well-informed, and always ready to assist. This rotation not only expanded my understanding of MPA’s impactful work but also strengthened my appreciation for the intersection of pharmacy practice and public health advocacy. It was a truly eye-opening experience that highlighted how pharmacists can make a tangible difference in the health of our communities. Thank you again to MPA for a great experience! It’s one that I won’t forget.

A New Year, A New Financial Plan: A Guide for Pharmacists

STEPHEN RODEWALD, CRCP, WEALTH ADVISOR

816-548-4113 ext.120 | fax: 816-548-4115 | cell: 913-271-8844 | stephen.rodewald@lpl.com | RxWealthSolutions.com

2025 is the perfect time for pharmacists to reassess and organize their financial strategy. Whether you’re just starting your career or have been in the field for years, a well-thought-out financial plan can make a significant difference in achieving your long-term goals. Here’s a step-by-step guide to help you start the year on the right financial track.

1. Reflect on the Past Year

Start by evaluating your financial achievements and challenges from the previous year. Were you able to meet your savings goals? Did unexpected expenses impact your budget? Understanding these factors will help you set more realistic and achievable goals for the upcoming year.

2. Set Clear Financial Goals

Define what you want to achieve financially this year. Your goals might include paying off student loans, saving for a down payment on a house, or building an emergency fund. Ensure that your goals are Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) to keep you focused and motivated.

3. Create a Detailed Budget

A budget is the foundation of any financial plan. Track your income and expenses to understand where your money is going. For pharmacists, this includes not only your salary but also additional income from overtime, consulting, or side gigs. Allocate your funds wisely, prioritizing essential expenses, savings, and discretionary spending.

4. Manage Your Debt

Pharmacists often graduate with considerable student debt. Prioritize paying off high-interest loans first, as they can significantly impact your financial health.

Consider refinancing options to reduce interest rates and monthly payments. If your loans are eligible, explore incomedriven repayment plans that align with your current financial situation.

5. Build and Maintain an Emergency Fund

An emergency fund is essential to cover unforeseen expenses, such as medical emergencies or sudden job loss. Aim to save at least three to six months’ worth of living expenses. This fund should be liquid and easily accessible, but separate from your daily checking account to avoid unnecessary spending.

6. Plan for Retirement

It’s never too early to start planning for retirement. Take advantage of employersponsored retirement plans like a 401(k) and maximize your contributions, especially if your employer offers matching contributions. Additionally, consider opening an Individual Retirement Account (IRA) for more retirement savings options.

7. Invest Wisely

Investing is a critical component of growing your wealth. Consider speaking with a financial advisor to develop a strategy that aligns with your risk tolerance and financial goals. Regularly review and adjust your investments as needed.

8. Review Your Insurance Coverage

Ensure you have adequate insurance coverage, including health, disability, and life insurance. As a healthcare professional, you understand the importance of health insurance, but don’t overlook disability insurance, which can replace a portion of your income if you’re unable to work. Life insurance is also crucial, especially if you have dependents.

9. Automate Your Finances

Automation can simplify your financial management. Set up automatic transfers to your savings and investment accounts to ensure consistency. Automate bill payments to avoid late fees and maintain a good credit score. Automation helps you stay on track even when life gets busy.

10. Seek Professional Advice

If managing your finances feels overwhelming, don’t hesitate to seek professional advice. A financial advisor who understands the unique challenges faced by healthcare professionals can provide valuable insights and personalized strategies to help you pursue your financial goals.

11. Stay Informed and Adapt

The financial landscape is constantly changing. Stay informed about economic trends, tax laws, and investment opportunities. Regularly review and adjust your financial plan to adapt to changes in your income, expenses, and financial priorities.

By following these steps, pharmacists can build a robust financial foundation that addresses immediate needs and secures their future. Starting the new year with a clear financial plan can help you pursue your goals and enjoy greater financial freedom.

The opinions voiced in this material are for general information only and are not intended to providespecific advice or recommendatons for any individual. Investing involves risk including loss of principal. No strategy assures success or protects against loss.

Planning for your financial future? Securities and advisory services offered through LPL Financial, a Registered Investment Advisor, Member FINRA/ SIPC.

WHY ?

What’s Your Why?

In the next few pages, we turn the spotlight on the heart of our organization: the ‘Why of the Missouri Pharmacy Association’ (MPA). Why are you a member, and what does your membership truly mean for you? We invite you to explore the many benefits of being part of our vibrant community. What do you love most about MPA?

Within these pages, you'll find heartfelt testimonies from fellow members sharing their own Why. Discover how MPA champions advocacy on your behalf, fosters lifelong friendships, and hosts enriching conferences that elevate our profession. Our organization is more than just a membership; it’s a supportive network dedicated to advancing pharmacy practice and enhancing the lives of our members.

As you read through these inspiring stories, we encourage you to reflect: What’s your Why?

FOSTERING INNOVATION: MPA’S UNIQUE NETWORKING POWER

TAYLOR & KRISTEN MIZE

PharmD, Co-owners of Mize Drug Wellness & Compounding, Garden City, MO

TAYLOR’S EXPERIENCE

s I completed rotations during my fourth year of pharmacy school, I was fortunate enough to have a rotation with Annie Eisenbeis, MPA’s Director of Practice Development. I graduated pharmacy school in 2021, which means that I was completing my rotations during the peak of the COVID-19 pandemic. Rather than coming to Jefferson City for my rotation, I completed my rotation virtually. While I was saddened to miss out on some aspects of the MPA rotation experience at the Capitol, I gained a unique perspective on how much MPA does to impact the health of Missourians. The COVID-19 vaccine was beginning to be rolled out during my rotation, and I saw firsthand how involved Annie and many others at MPA were in the distribution process. I saw the problemsolving skills of pharmacists and technicians come to life as MPA figured out ways to get vaccines to Missouri pharmacies so that their communities could be vaccinated.

A D DAfter I graduated pharmacy school, I went on to complete a community pharmacy residency. As a component of the residency program, I joined the MPA legislative committee and attended the legislative day and the annual conference for the first time. It was during these experiences that I began to understand the impact that MPA has on the legislative process in Missouri and how our organization is constantly advocating for us to be able to find new and innovative ways to serve our patients. Since then, I’ve continued to stay involved in the organization through committee

involvement, attending the Pharmacy Leadership Program, and attending various events, and I continue to be grateful for the work our organization does on our behalf every day in Jefferson City.

KRISTEN’S EXPERIENCE

uring pharmacy school, I joined MPA but had never fully taken advantage of the great opportunities through the organization until I was a community pharmacy resident in 2022. One of my residency learning experiences involved joining a pharmacy organization and becoming involved with the field of pharmacy beyond my daily duties as a pharmacist. Taylor had encouraged me to consider MPA for this particular learning experience and I am so glad that he did! I joined the continuing education committee and have continued to be a member of this committee since. I attended my first MPA Annual Meeting in 2022 and learned a lot from the amazing speakers, but it was the networking and relationship building that has continued to stand out to me year after year and event after event that I have attended from legislative day to the Pharmacy Leadership Program to annual meetings.

A COMMON THEME

espite all the amazing events and awesome experiences that we have been able to be a part of because of MPA, we would argue that none of them define our “why MPA.” When we think about why MPA, the thing that comes

to top of mind for us is relationships. MPA has allowed us to build professional relationships with people who are innovators and challenge the current way of thinking. Being around these people makes us expand our horizons, elevates our practice of pharmacy, and allows us to take better care of our patients. The perspective that some of these individuals provide helps us to better understand the issues facing Missouri pharmacy.

While the professional relationships that we have formed are important, we have also had the privilege to call some of these colleagues friends. These are people who have mentored us, encouraged us, and supported us throughout our lives as pharmacists. Kristen and I recently remodeled a building and opened a brand-new pharmacy – quite the learning curve for two relatively new pharmacists who were both working fulltime elsewhere until about two weeks before the pharmacy opened! Friends from MPA were with us through every step of this process. Whether they were giving us business advice, serving as a sounding board for our crazy ideas, or encouraging us when things were hard, they were consistently there for us. There were several times during another 60-hour workweek that we would hear a ding on one of our phones and there would be a text from one of our connections that we have developed through MPA just checking in to see how things were going. MPA is full of these types of people – people who are bright, caring, and always willing to lend a listening ear. In our opinion, these types of relationships are important for

“The next time you sign up for an MPA event – whether it’s legislative day or the annual conference – make it a point to reach out to a colleague who isn’t yet a member. Invite them to join you and show them firsthand what makes MPA special. By bringing in new faces and adding to our membership, we can continue to grow our network and amplify our voice.”

personal and professional development, and MPA can help provide that network. We have tried to explain our “why MPA.” What is yours? We challenge you to think about your why for being a member of this organization. Whether it’s the professional and leadership development, the advocacy efforts, or – like us – the friendships that

have made a lasting impact, we all have our reasons for involvement in MPA. Let’s share that experience with others. The next time you sign up for an MPA event – whether it’s legislative day or the annual conferencemake it a point to reach out to a colleague who isn’t yet a member. Invite them to join you and show them firsthand what makes

MPA special. By bringing in new faces and adding to our membership, we can continue to grow our network and amplify our voice. So, take a moment today to think of a friend or coworker who could benefit from joining MPA and be sure to reach out the next time the opportunity presents itself.

Note about the Authors: Taylor and Kristen both graduated from UMKC School of Pharmacy on the Springfield, MO campus in 2021 and 2022 respectively. They are currently co-owners of Mize Drug Wellness & Compounding in Garden City, MO. Taylor is the Pharmacist-in-Charge at Mize Drug and Kristen works as a clinical pharmacist at Tria Health in Kansas City, MO.

Taylor Mize Kristen Mize

Maximizing Membership: Your Effort Defines Your Experience

LACY EPPERSON PharmD, Director of Pharmacy Clinical Services, Mitchell’s Drug Stores

When I think of membership, I think of belonging to a group. Though it is often an elected choice to be included in said group, the actual effort or requirements may even be minimal just to call yourself a “member.” A member is guided by leaders of the group. A member can be as active or involved as they wish to be. I am a member of various organizations within the pharmacy profession, I am a member of my church, and I am even a member of my family. These are all groups that I have chosen, and continue to choose, to be part of and involved in. The next aspect to dissect is why we choose to be a member of a group. We often

individual. I gained experience at my local independent pharmacy when I was 18 years old, and I began learning about some of the challenges I would face as a future community pharmacist, which I truly believe ignited my passion to be part of the change. What I lacked when I began my journey as a pharmacy student was mentorship in the industry. I distinctly remember the first MPA Annual event that I attended. As a poor pharmacy student, I was eager to attend because it was located close to my campus (resulting in less travel expenses), my owner was the current president, and I had already started meeting some pharmacists in our state, so I felt like I may

specific individuals risks me forgetting someone or offending others, so I am going to stick to a very select few that made an impact on my early years as a student when I decided that I wanted to continue to be a part of this organization beyond graduation. I will never forget when Melody Savley brought me to a Board meeting with her in Jeff City, or when Tim Mitchell spent a very generous amount of time conversing with me at a social event at MPA Annual about my future plans, or when Daniel Good continued to remember my name at each and every event and acknowledge the importance of the role of students. I also will never forget how Heather Lyons-Burney continued to

“I truly feel like each MPA Annual Event is similar to a family reunion within our profession.”

associate as members of a group because we have an aligned interest or goal. Admittedly, we also often join a group for our own personal (or personal professional) benefit. None of these reasons are invalid justification for membership, but to be committed to being a member, you often have a purpose for why you became a member in the first place. Now, I do want to acknowledge the understanding of the difference between membership and involved membership. As much as I would love to see all MO pharmacists be actively involved in state organizations that are making a difference, namely the Missouri Pharmacy Association, the first step is actually becoming a member. I am a first generation pharmacist, let alone first generation healthcare professional. I’ve always had the best support system and have had the importance of work ethic instilled in me from a young age by both of my hard-working parents, who are now retired teachers from public education. If you know me, you also likely know that I am often described as a passionate

know a few faces. I will never forget when I was invited and included to dinner with a group of pharmacists, including some of my professors, invited to network and had the opportunity to meet pharmacists all across the state, and even sit in a session next to what would later become my future employer. After attending MPA Annual, I decided I would attend MPA Legislative Day. As an extrovert, it truly made me feel valued as a student being remembered by many pharmacists and owners that I had the opportunity to meet at the MPA Annual event in the months prior. Of course Legislative Day is also very unifying for pharmacists in our profession, so that was affirmation that I truly was a member of this group, and the work being conducted in this organization would indefinitely affect my future.

I debated deleting this section out numerous times, but I think the impactfulness is necessary, and may just inspire someone else across the state, so I decided to leave it. I hesitate because naming

ignite my passion and cheer me on with my involvement, as well as connect me with the individuals that I would later be so fortunate to serve on organizational leadership teams with, or when Annie Eisenbeis would include me in clinical initiatives and grant projects even as a student (although she may have thought I was a pharmacist already… inside joke.) Since these early impressions almost 8 years ago, I have been so fortunate to have this list grown astronomically through memories made at the Young Pharmacist Leadership Retreat, getting to reconnect with pharmacists across the state at one or more events throughout the year, and serving on committees with many different members. I truly feel like each MPA Annual Event is similar to a family reunion within our profession. I value collaborating with individuals who work in different practice demographics, I look forward to going to dinner with groups of colleagues turned friends who I typically otherwise only see on Zoom or via phone call, and I am appreciative of the many mentors who have

supported me and the networking circle that I am so proud to be a member of in the state of Missouri.

As with any membership, you get out of it what you put into it. As an individual who has remained actively involved with this organization, I would encourage those that have been passive members to look into the opportunities that are currently available. There truly are opportunities for all members involved. Once I graduated from pharmacy school, I initially remained actively involved in MPA through serving on the Membership Committee. Through the Membership Committee, I was able to meet and converse with so many other pharmacists and leaders across the state that helped develop my mindset and practice innovation. This also allowed me to reflect on opportunities that could be created for our members as well as created my buy-in for the sustainability of our organization. Since then, I have been fortunate to have been involved with leaders in our state who have developed and implemented clinical initiatives, grant programs, helped advocate for the Missouri Medicaid carve out, created a partnership with CPESN MO, and helped develop the infrastructure and funding for training pharmacy technicians as Community Health Workers. I believe each of these items affect all practice settings in MO, whether directly or indirectly. Additionally, there are opportunities for resource sharing, perks and benefits for employees and pharmacy teams, and legislative efforts and advocacy, which affects each and every one of us. I have enjoyed meeting new faces across the state through these opportunities as well as getting to know those practicing in my region even better. I’ve developed relationships with local pharmacists that I know I can reach out to with questions or bounce ideas off of. I have enjoyed getting to meet students through MPA and witness many of my colleagues become mentors to these students that are eagerly starting their careers. I’ve had pharmacy technicians from across the state come to my practice site to collaborate with our technicians and Community Health Workers. There are many opportunities to find ways to get involved within an organization that offers such a variety of activities. For me, each of these steps has progressed to the next opportunity and has even allowed me to further my leadership in the state by now serving on the

“I’ve developed relationships with local pharmacists that I know I can reach out to with questions or bounce ideas off of.”

Board of Directors. You never know where involvement may take you in your career journey.

Regardless of the practice setting that you are in, I believe that we all have lifelong learning to participate in, I believe that we all can learn something from our peers, and I believe that we all have practice issues that could be better identified and resolved if we worked together as one body of Missouri Pharmacists as members of this one distinct organization that represents all pharmacists and pharmacy teams. One unique factor of this organization is the locality of the state level and being governed by the same legislation. Whether it’s reconnecting with pharmacy owners, former professors, former classmates, or meeting new members of the organization, I always look forward to the relationships that are fostered through this organization and know I will always have colleagues that I can reach out to. When asked why I am a member of the Missouri Pharmacy Association, I have many different angles that circulate in my mind including advocacy, practice advancement opportunities, sustainability pathways, and of course networking opportunities. I don’t know that I can prioritize one area over another, but I do believe that it’s essential to support state associations that are exerting efforts for ALL pharmacists and pharmacy teams. We all get to choose where we spend our time, membership dues, and efforts, and I would challenge each one of you to choose to be a member where you will be recognized, remembered, and valued.

Empowered by Advocacy and Leadership: The Value

DANIEL GOOD

MS, RPh, FASHP, Past President MPA, Past President MSHP, Vice President Mercy

Leadership has always been a central part of my journey. From my earliest days in school, through college, and into my professional life, I’ve been actively involved in organizations that fostered growth, collaboration, and advocacy. In pharmacy, those experiences have translated into leadership roles that not only shaped my career but have also allowed me to contribute meaningfully to the future of the profession. The Missouri Pharmacy Association (MPA) has been an integral piece of that puzzle, enhancing my ability to advocate for pharmacy practice, build consensus across diverse groups, and push for impactful change.

A Lifelong Commitment to Leadership

My leadership path began during my youth, where I learned the value of community involvement and public service. In college, I was drawn to professional organizations. We only had three choices at the University of Washington: the Student American Pharmacists Association (SAPhA), Kappa Psi, and Lambda Kappa Sigma (LKS). Membership and leadership in SAPhA and Kappa Psi allowed me to develop my leadership abilities, deepen my understanding of the pharmacy profession, and connect with like-minded peers. These early experiences laid the groundwork for my future in pharmacy and public service.

As I progressed through pharmacy school, residency, and my early career, I stayed deeply involved in state pharmacy associations, serving in leadership roles in Kansas, Washington, Texas, and Missouri. Whether I was working on continuing education initiatives or legislative advocacy, I learned firsthand that leadership in pharmacy goes beyond managing teams; it’s about making an impact on the profession

and advocating for improvements that benefit patients and practitioners alike.

A Turning Point: Missouri and the MPA Experience

When I moved to Missouri over a decade ago, Joel Hennenfent, the president of the Missouri Society of Health-System Pharmacists (MSHP), asked me a pivotal question: “Where do you want to get plugged into association work?” His question was the starting point for my involvement in public policy and legislative advocacy, an area I had not yet fully explored. Under his guidance, I joined MSHP’s committee structure, eventually becoming a member of its Board of Directors.

This was the beginning of what I would later recognize as a transformative career path. After my time as the MSHP President, I was invited by Christian Tadrus, of the Missouri Pharmacy Association (MPA), to run for the MPA Board of Directors. Christian had a vision of broadening the board’s membership to include more hospital, long-term care, and health system pharmacists, and he wanted to foster greater cooperation across different sectors of the pharmacy community.

I joined the MPA Board as a health system representative, with the goal of bringing about consensus among diverse pharmacy practice settings. The MPA provided the perfect platform for me to help unite hospital, retail, and long-term care pharmacists in Missouri. By engaging in focus groups, hosting combined meetings, and encouraging collaboration, I saw firsthand how working together toward shared goals can have a powerful impact. This effort not only helped MPA grow its membership but also strengthened our collective voice in advocacy, which ultimately

supported MPA’s mission to be the unifying voice for pharmacy in Missouri.

Advocacy, Action, and Achievements

One of the greatest strengths of the MPA is its organizational structure, which enables the association to effectively advance pharmacy practice, advocate for the profession, and defend against external threats like declining reimbursement and increased regulation. The MPA provides a framework that allows us to take tangible action and make real progress.

During my presidential year in 2021, I had the honor of seeing the MPA work come to fruition with the landmark achievement: the passage of the Missouri Prescription Drug Monitoring Program (PDMP) into law. This was a major victory in the fight against opioid abuse and was the result of years of advocacy from MPA members, volunteers, and staff.

Furthermore, my work with MPA has been central in advocating for the continued advancement of pharmacy practice. We’ve fought for increased transparency in Pharmacy Benefit Manager programs (PBM), as well as reforms in how pharmacy practice is regulated. The pandemic years presented new challenges, but they also showcased the strength and resilience of the MPA. During the COVID-19 crisis, MPA led efforts to ensure that all patients, including those in long-term care and rural areas, had access to vaccines. The professionalism of the MPA staff and the commitment of its volunteers ensured that vaccine clinics were wellorganized and that no one was left behind.

The Power of Networking and Collaboration

MPA is more than just an advocacy organization; it’s a community. Through

Value of MPA in My Pharmacy Career

my involvement, I’ve forged invaluable relationships with fellow pharmacists, technicians, and other healthcare professionals. The networking and personal interactions within MPA have not only helped advance our shared goals but have also cultivated lasting friendships that have enriched both my personal and professional life.

Thanks to advancements in technology, like video calls and virtual committee meetings, MPA has also adapted to build strong relationships across distances. These tools have allowed us to bring consensus to complex issues, collaborate more effectively, and stay connected even during challenging times.

The MPA’s commitment to networking doesn’t stop at meetings and virtual calls. In my most recent initiative with MPA, I’ve teamed up with Tim Mitchell to co-create the Pharmacy Frontiers Podcast. This podcast, sponsored by MPA, serves as a platform to share valuable information with pharmacy professionals. We’ve recorded over a dozen episodes to date, and there are many more planned, as we continue to provide relevant and timely content to our members.

The Value of MPA Membership: A Call to Action

If there’s one thing I’ve learned through my extensive involvement in MPA, it’s that every pharmacist, pharmacy technician, and friend of pharmacy should find a professional home where they can contribute, grow, and have their voices heard. Whether it’s MPA or another organization that aligns with your practice, being part of a professional association is crucial to advancing your career and the pharmacy profession as a whole.

MPA has given me countless opportunities

to lead, advocate, and collaborate with others who share a passion for pharmacy. It’s not just about the formal meetings or the advocacy efforts—it’s about being part of something bigger than yourself, working together toward common goals, and helping shape the future of the profession.

I encourage every pharmacist to get involved. MPA has been an invaluable part of my journey, and it can be a powerful force for you, too. Whether you’re just starting your career or are looking for ways to deepen your impact, MPA offers the resources, support, and opportunities to help you succeed.

“It’s not just about the formal meetings or the advocacy efforts - it’s about being part of something bigger than yourself, working together toward common goals, and helping shape the future of the profession.”

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DAPHNE BOGGS

PharmD Candidate 2025, UMKC

my passion for pharmacy began during my junior year of high school after I shadowed a very influential pharmacist at Mercy Hospital in Springfield. Following this experience, I began preparation for pharmacy school and completion of all of my prerequisites. I gained work experience in a small retail pharmacy in my hometown of Marshfield, Missouri at 16 years old and started as a pharmacy technician at a chain pharmacy once moving to college. I gained acceptance to the University of Missouri - Kansas City (UMKC) School of Pharmacy in October of 2020. I was so excited! I have always known that organizational involvement was one of my favorite parts about school, and I looked forward to how that would carry through into pharmacy school.

Like many P1 students, I was overwhelmed with the idea of jumping into organizational involvement when I already felt in over my head trying to navigate a doctoral program. This all changed at the end of my P1 year when I applied to be the Policy Vice President for our American Pharmacists Association - Academy of Student Pharmacists (APhA-ASP) Chapter. It was through this role that I became the liaison between my school of pharmacy and Missouri Pharmacy Association (MPA). I believe that my involvement in MPA strengthened my connections throughout pharmacy school and gave me a new outlook on how I can influence my profession as both a professional student and a future pharmacist.

As the liaison between UMKC and MPA, I attended monthly meetings with MPA staff. These meetings gave me insight into what a state pharmacy association does day-to-day and how beneficial they are to our practice. It was also through my time in these meetings that I was able to gain appreciation for all of the preparation that goes into planning a state-wide event, such as Legislative Day or their Annual Conference. I also had the opportunity to make connections

The Benefits of MPA for PharmD

with individuals who were on the front lines of advocating for pharmacy. The MPA lobbyists and pharmacists work tirelessly to push our practice forward, which is so meaningful to see as a future medical professional.

The experiences I gained at gatherings such as the MPA Annual Conference, Legislative Day, and Regional Meetings cannot be overstated. Not only did they provide a free meal (which is a very big deal as a doctoral student), but my knowledge of pharmacy and the policies that protect our practice was deepened. It was through these meetings that I met outstanding pharmacists such as Daniel Good and Lacy Epperson, both of whom continue to amaze me with their work ethic and expertise. Daniel Good is an exemplary pharmacist who demonstrates that state pharmacy associations are about all pharmacists, not just those working in an outpatient or retail setting. His involvement as the Vice President of Mercy Pharmacy and past president of MPA highlights the role that inpatient-based pharmacists can have within state pharmacy associations. During Legislative Day 2024, I shadowed Lacy and watched her advocate for herself and her patients with our legislators. This experience was extremely empowering and provided a great example of how to follow suit for my future patients.

Though it can be daunting to manage organizational involvement alongside schoolwork, it is so worth it! The experiences and networking gained through involvement in MPA will last a lifetime; they provide skills that extend past the pharmacy counter. MPA is instrumental in helping build the future leaders and pharmacy advocates, but you have to take the first step! I urge all of my fellow pharmacy students to not only join MPA, but to also be an active participant in learning how to advocate for our profession and future patients.

“The experiences I gained at gatherings such as the MPA Annual Conference, Legislative Day, and Regional Meetings cannot be overstated. Not only did they provide a free meal (which is a very big deal as a doctoral student), but my knowledge of pharmacy and the policies that protect our practice was deepened.”

DAPHNE BOGGS

MPA Membership Candidates

Being a student member of the Missouri Pharmacy Association (MPA) has opened so many doors throughout my career as a professional student.

Some of the experiences that I have been able to take part in thanks to MPA start with the Annual Young Pharmacist Leadership Retreat where I was able to network with Pharmacists, Owners, Students, Technicians, and Interns. This was a weekend filled with opportunities to expand and reflect on my leadership skills. The objectives of this session were to provide the necessary tools and strategies to challenge us as overall leaders, providing guidance on how to apply that to our daily lives. A few key points that I took away from this retreat is the power of perception, the need to have crucial conversations, how to champion change, and the importance of being cognizant of emotional intelligence: self-awareness, social awareness, self-management, and relationship management.

I have attended the MPA state legislative day at Missouri’s Capitol in Jefferson City for the past two years, as well as had the opportunity to travel to Washington D.C. to continue in my advocacy journey on a national level with the National Association of Chain Drug Stores (NACDS) RxIMPACT Day.

At this year’s Annual Conference, I was awarded the 2024 Student of the Year for St. Louis College of Pharmacy at the University of Health Sciences and Pharmacy. I am honored to have been a recipient as this award encompasses what I have strived to be as a student pharmacist, showing a commitment to the profession of pharmacy and to the community. As a former President of our schools National Community Pharmacist Association (NCPA) student chapter, community involvement is something I tried to implement and encourage.

PharmD Candidate 2025, UHSP

Why be a member?

Why not? By becoming a member, you gain exposure to other pharmacy associations, ample networking opportunities, and education that keeps you updated on important topics happening within pharmacy.

How to join & get involved

It starts with you! Only you know your story and experiences. By joining MPA and being an active member, you can share those stories with others within the association who can then provide resources and guidance on how to reach out and contact state legislators and other government officials.

What keeps me involved?

I believe it is up to us as Pharmacists, Student Pharmacists, Technicians, Interns, and Owners to advocate for our profession and our patients. By attending the MPA Legislative days and the NACDS RxIMPACT day in Washington D.C. I had first-hand experience speaking with and educating state representatives on important topics within pharmacy and what impact certain bills could have for the future of pharmacy and healthcare.

We need to invest in ourselves and our patients. By advocating, that is exactly what we are doing. If we don’t let our government officials know what is really happening within the world of pharmacy, then who will?

That is why I plan to continue to advocate on behalf of patients and the profession of pharmacy.

Remember: You are your own best advocate.

“Only you know your story and experiences. By joining MPA and being an active member, you can share those stories with others within the association who can then provide resources and guidance on how to reach out and contact state legislators and other government officials.”

FAITH OLIVER

From Association Hesitancy to Active Membership: My Journey with MPA

TOM GREENLEE

PharmD, Senior Director of Pharmacy Services, MU Health Care

For the majority of the last three decades, I would have been the last person to write an article advocating for membership in an organization like the Missouri Pharmacy Association (MPA). In high school, I joined just enough clubs to enhance my college applications—though I couldn’t tell you which ones without consulting my yearbook and wading through some rather embarrassing photos showcasing my evolving hairstyles. My undergraduate years at the University of Missouri were no different; I often questioned the motivations behind peers’ involvement in multiple student organizations. You might think my perspective shifted upon entering pharmacy school at the University of Iowa, but that was not the case. I merely nodded along and smiled as professors and classmates extolled the virtues of organizations like APhA-ASP and the Iowa Pharmacy Association.

Fast forward to present day, where I am an active member of Missouri Pharmacy Association, serving on the Legislative Committee and recently concluding two years of service on the Immunization Expert Advisory Board. I look forward to association meetings, I read every word of Ron’s weekly newsletter, and I try to answer calls for volunteers whenever there is a need I feel equipped to meet.

While we’ve all heard of “vaccine hesitancy,” my experience for nearly two decades could be aptly termed “association hesitancy.” So, what changed my perspective on association membership? More importantly, what insights can my journey provide to help you convey the value of joining MPA to your fellow pharmacists?

Passion for Pharmacy

As I prepared for graduation from pharmacy school, my career path was an easy choice. I wanted to be a community pharmacist. I wanted to be on the frontlines of our profession, serving patients where they were at and earning their trust. There’s nothing quite like the pride of a patient insisting they’ll only speak to you when they call the pharmacy or approach the counter.

I took my first pharmacy technician job at a grocery store pharmacy in 2000. I quickly grew to love the profession. I loved the fast pace. I loved that pharmacy was positioned at the intersection of science, healthcare delivery, and compassionate service to others. I loved the camaraderie that develops between members of a highfunctioning pharmacy team. Yet, my focus remained narrowly fixed on my individual pharmacy. Changes that affected my work environment stemmed from staff turnover, corporate policy shifts, or new performance metrics, and it was easy to blame distant corporate offices or unsympathetic supervisors.

Connecting the Dots

Years passed and I accepted my fate, and the fate of the profession. After all, what power did I have? I was just one pharmacist in one pharmacy trying to do right by my patients. At the end of the day I evolved with the profession, becoming more efficient filling prescriptions and finding that I had less time to do what I truly loved, which was spending time with my patients. What I failed to do was connect the dots between changes in my beloved profession, external forces negatively impacting my employer,

“The moment I connected the dots between my passion and MPA’s advocacy on the issue, membership was a no-brainer.”

and that there were groups out there fighting to defend the profession I love.

It turns out I had an issue I was passionate about, and that was payment reform. The moment I connected the dots between my passion and MPA’s advocacy on the issue, membership was a no-brainer. I joined MPA in 2019 and by that time had assumed a leadership position at MU Health Care. I was ready to join an association with voices across the state advocating for the changes I envisioned for my team and for our profession.

MPA’s Value to My Career

After two decades of association hesitancy, I initially assumed that the primary benefit of my membership would be advocacy. However, I soon realized that MPA is far more than an advocacy association; it is a vibrant, diverse community of pharmacy professionals from various practice settings, all united in the mission to defend and advance pharmacy practice in Missouri. Through MPA events, I’ve forged friendships, expanded my professional network, and embraced new opportunities to contribute.

Beyond the expected association benefits, I have been impressed with MPA’s commitment to advancing pharmacy practice and connecting available resources with the healthcare needs of Missouri residents. When MPA announced the formation of an Immunization Advisory Board in 2021 to bolster vaccination efforts among high-risk and underserved populations, I felt an immediate connection. Having co-led MU Health Care’s COVID-19 mass vaccination initiatives, I saw this as a

unique opportunity to serve patients beyond the walls of my health system.

Steps to Overcome Association Hesitancy

Now that I recognize the myriad benefits of MPA membership, it’s clear why I was initially resistant. I was preoccupied with the challenges of my job and life outside of pharmacy, viewing association membership as an additional commitment that offered little value to my everyday work experience. You may know someone in your professional circle who mirrors this mindset. Drawing from my experience, here are three actionable steps to help transform this colleague from association hesitant to active membership:

1. Educate yourself on the benefits of joining MPA - You take advantage of certain benefits of MPA membership, but do you know all that MPA has to offer? Visit morx. com for the full list of member benefits.

2. Listen and Learn - Payment reform was my passion. What is your colleague passionate about? Is it expanding the pharmacist scope of practice, immunizations, critical care, sterile compounding, leadership?

3. Connect the Dots - MPA likely supports this passion through advocacy, educational programming, or service opportunities, as well as by fostering connections with those who share similar interests.

Strength in Numbers

The Missouri Pharmacy Association represents pharmacists and technicians from all practice settings. There is undeniable

strength in numbers. Since becoming an active member, I’ve witnessed the dedication of MPA staff, who genuinely seek to understand and address the concerns of each member. My active participation has amplified my voice, revealing that my passions are shared by pharmacists across the state. Together, through the voice of MPA, we are stronger.

While discussions about professional association membership may feel awkward, I often reflect on how beneficial it would have been if someone had taken the time to help me connect those crucial dots two decades ago. Let’s work together to ensure others don’t miss out on the opportunities that active membership in MPA can provide.

“However, I soon realized that MPA is far more than an advocacy association; it is a vibrant, diverse community of pharmacy professionals from various practice settings, all united in the mission to defend and advance pharmacy practice in Missouri.”

VOICES OF MPA What’s Your Why?

“I am a proud member of the Missouri Pharmacy Association (MPA) because of their unwavering commitment to advocating for crucial pharmacy legislation. MPA’s strong presence at the state Capitol and their active role in shaping policies ensures that the voices of pharmacy professionals and patients are heard. Their leadership in advancing and protecting the industry makes them a key partner in driving positive change for our communities.”

Michael Burgard RPh.,

Supervisor, Hy-Vee Inc.

Member Since: 2018

“MPA has given me so much more understanding of the legislative process and how to best get involved to make sure our practice rules give us the opportunity to maintain viability. They also are about the most welcoming people I have ever been around, starting from the very first annual meeting cocktail hour when I knew no one. Through MPA, I have made amazing professional contacts and, more importantly, friends.”

Sarah Oprinovich, PharmD,

BCACP, Clinical Associate Professor, UMKC Member

Since: 2016

“I’ve been a proud member of the MPA throughout my entire career, and it’s been such a rewarding experience. It’s given me opportunities to learn, build meaningful friendships, and actively advocate for our profession.

MPA has been my go-to resource, keeping me informed and supported, even as I balanced growing my career and my family.”

Heather Lyons-Burney, PharmD,

Clinical Associate Professor, UMKC

Member Since: 1994

“In 2017 a few of us proposed an off the wall idea to MPA leadership. That idea was for MPA to charter a Missouri chapter of CPESN USA’s Clinically Integrated Network. That chapter is now called CPESN Missouri. Ron, Robyn, and the MPA board took a chance on CPESN Missouri back then, and today it has become one of the top performing networks in the country.

I’m a member of MPA because MPA is supporting the creation of practice changing opportunities for it’s members. Opportunities that keep the doors open in Missouri pharmacies like ours.”

Tripp Logan, PharmD, Vice President, SEMO Rx Pharmacies & SEMO Rx Care Coordination COO, Seguridad, Inc.

Lead Luminary, CPESN Health Equity Member Since: 1997

“Joining MPA has been an incredible opportunity to build lasting friendships and expand my network! Leading the state’s first Charitable Pharmacy is an exciting challenge that inspires innovative thinking and fresh ideas to drive our mission forward. I truly appreciate the amazing support from everyone at MPA—they’re always ready to share strategies, brainstorm together, and help bring our vision to life.

I’m genuinely optimistic that the relationships we’re nurturing will lay a strong foundation for the organization’s future success!”

Henry Irvin, PharmD, Executive Director, My Neighbor’s Charitable Pharmacy Member Since: 2022

“Being a member of MPA inspired me to pursue leadership and advocacy roles at both the state level and national levels. Had I never joined, I would not be in the position to inform and influence as I am today.”

Christian Tadrus, PharmD, Tadrus Advisory Group Member Since: 1996

That’s a wrap!

The Missouri Pharmacy Association (MPA) is vital for pharmacy professionals, offering advocacy and a strong presence at the Capitol. Membership fosters lasting friendships and provides essential resources to support individual needs. With a commitment to keeping members informed, MPA creates networking opportunities that lead to mentorship and career growth. Joining MPA means being part of a dedicated community focused on advancing the pharmacy profession. If you or someone you know is thinking about joining - there is no better time than NOW!

jim@shugart.com

PHARMACIST POLITICAL ACTION COMMITTEE OF MISSOURI

WHY GIVE TO PPAC?

When you’re dealing with legislators whose decisions affect Missouri Pharmacy’s business and professional climate, you should do everything possible to ensure pro-pharmacy candidates are elected. Your vote is essential, but these candidates need your financial backing as well.

Through the Pharmacist Political Action Committee of Missouri (PPAC), you can help elect legislators who support pharmacy on professional and business issues. Next to your vote, contributing to the PPAC of Missouri could be the single most important thing you do this election cycle.

HOW CAN THE PPAC HELP MY BUSINESS/PROFESSION?

By supporting candidates who will promote a good business and professional climate in Missouri. It is essential that the Missouri House and Senate are pro-pharmacy!

PERFECT STORM:

Looming Crisis for Missourians Needing Pharmacy-Based Health Care Services

“No doubt, Missourians are facing a significant decline in access to pharmacy-based health and wellness services that will get far worse in the near future.”

RUSSELL B. MELCHERT

Dean and Professor, School of Pharmacy

University of Missouri - Kansas City

Introduction

Meteorologists described it as a “perfect storm” off the coast of New England in 1991 when two very powerful weather fronts converged with a hurricane unfortunately resulting in devastating consequences for a fishing boat and its crew [1]. When hurricanes strike, meteorologists can model potential damage based on leading indicators such as the storm surge and wind speeds. Yet, the overall damage from the storm can be difficult predict, especially when flooding, tornados, and other off shoots of the storm occur on land. Leading indicators are helpful to model potential damage, for sure, but some level of uncertainty always remains, and often those indicators are subtle then ignored or debated then forgotten. Indeed, “seeing around corners” can be difficult, but we should certainly pay attention to leading indicators to best prepare for the future [2].

Here, we present leading indicators strongly suggesting imminent significant negative consequences for pharmacy-based health and wellness services. Two years ago [3], we predicted an imminent shortage of pharmacists, a shortage which has arguably already arrived, especially in community pharmacies. While we may have done a reasonable job of modeling numbers of graduates, we failed to consider other factors that could exacerbate the shortage creating even further damage, especially here in Missouri. Using data available to member organizations of the American Association of Colleges of Pharmacy (AACP), we updated

our predictive model to show the rapidly declining number of pharmacy graduates through 2026 using the latest national enrollment data. We also provide additional leading indicators in Missouri such as an aging pharmacist population and a more exaggerated decline in aspiring pharmacists compared to bordering states which suggests that Missouri may be hit harder by this storm than in surrounding states. Further, we highlight data from the National Association of Boards of Pharmacy (NABP) demonstrating a significant increase in the percentage of graduates who have not sought licensure in their graduation year. All these leading indicators demonstrate that a perfect storm is heading right for our state.

No doubt, Missourians are facing a significant decline in access to pharmacybased health and wellness services that will get far worse in the near future. Closures of community pharmacies are already happening at an alarming rate [4], so the rapid decline in licensed practicing pharmacists in Missouri will no doubt continue to contribute to further closures. Ultimately, services provided by pharmacists in health systems, ambulatory care centers, specialty pharmacies, public health organizations and the like will be hit hard by this perfect storm. And, of course, pharmacy schools are already hurt by the low enrollment as revenue declines affect our ability to hire and retain faculty and staff. Some would claim this is an academic problem created by rising tuition and fees, unsustainable increases in enrollment, and

TERRI L.WARHOLAK

Dean and Professor, St. Louis College of Pharmacy

University of Health Sciences and Pharmacy

failure to react quickly enough to changing market demands. We acknowledge that as pharmacy school deans, we rely on enrollment for the viability of our programs, our schools, and our universities. Yet, we argue that this is not an academic problem, this is a problem for all of us in every domain of pharmacy, and most importantly, a problem for the public at large and our patients. While current pharmacy school enrollment data demonstrates that we cannot stop this perfect storm from hitting Missouri, we believe there are some things we can do now to hopefully create an inflection point if Missouri pharmacists, K-12 educators, career counselors, and policy makers work together.

Enrollment Numbers

Figure 1 (pg. 30) demonstrates clearly the rapid increase and subsequent rapid decrease in pharmacy school enrollments from 2000-present. A significant demand for pharmacists in the 1980’s-1990’s stimulated a growth in the number of seats available for pharmacy students nationwide. Those available seats were increased in historically long-standing programs such as the University of Missouri-Kansas City (UMKC) and the St. Louis College of Pharmacy (STLCOP) at University of Health Sciences and Pharmacy, but also through a rapid rise in the number of universities offering professional pharmacy degrees. We currently have 140 fully accredited pharmacy programs in the United States [5], that at the peak of pharmacist supply in 2018 or 2019 produced

about 14,000 new pharmacists nation-wide. Using AACP data, we estimated attrition rates at approximately 11% over the next 3 years which was the average attrition rate nationally over the past 5 years. Combining enrollment with attrition, our model suggests that the number of pharmacist graduates will drop below 8,000 by 2026.

An Aging Pharmacist Population in Missouri

We downloaded the list of licensed pharmacists in Missouri from the State Board of Pharmacy website [6], and sorted licensees based upon initial year of licensure in the state. We created an estimate of the age of the licensees based upon the high likelihood that pharmacists licensed before approximately 2000 would most likely have been at least 23 years of age upon licensure as they likely completed 5-year bachelor’s degree programs. Then, following the year 2005, nearly all graduates would have been coming from Pharm.D. programs as that became the entry level degree for licensure. Those Pharm.D. graduates would most likely be at least 24 years of age upon graduation as they likely completed 6-year Pharm.D. programs, save the occasional “Doogie Howser” protégé who is obviously quite rare. As shown in Table 1 (pg. 30), approximately 25.9% of Missouri-licensed pharmacist would have to be at least 50 years old in 2026, while 14.8% would have to be at least 59 years old in 2026. While we do not have access to average retirement ages, we do know that practicing health care providers including dentists, nurses, pharmacists and physicians have physically and mentally demanding and yes sometimes very stressful jobs that can lead to earlier retirement or career changes. Eligibility for social security benefits for retirement is age 62, so we speculate that nearly 15% of Missouri licensed pharmacists would be social security eligible in 2028.

Fewer Graduates Seeking Licensure

Dr. Al Carter, Executive Director of the National Boards of Pharmacy, presented to AACP members at the Annual Meeting in Boston in July 2024. Among the most interesting data he presented was the percentage of pharmacy graduates who are NOT sitting for the NAPLEX during

the year they graduated. Table 2 (pg. 30) demonstrates that the percentage of nontest-takers rose from 1.9% in 2018 to 8.3% in 2023. On the one hand, these data should not be a surprise and in some ways we could potentially be satisfied that it supports our long-standing contention that there are many careers that graduates can pursue with their pharmacy degrees. And, indeed, many of those careers do not require licensure as a pharmacist. Such jobs could include positions in pharmaceutical industry, insurance companies, and medical writing to name a few. However, we find the data quite alarming for multiple reasons, not the least of which is the fact that more than 600 new drugs have been approved by the FDA since one of our authors graduated from pharmacy school, and he claims that he would have difficulty passing the NAPLEX if he sat for it today. People often choose to change careers at some point in their lifetime, but not having the license to practice pharmacy severely limits options in the pharmacy profession. But, the most alarming aspect of this data is that the number of pharmacists entering practice is clearly going to be lower than our models predicted in 2022 [3], and indeed what we predict with updated numbers here. Our model in Figure 1 (pg. 30) does not include percentages of graduates who choose not to sit for the NAPLEX, but if it did, we would predict the number of licensed pharmacists entering the market in 2026 could be 14% lower if the trend continues. That is to say, instead of approximately 8,000 pharmacy graduates in 2026, perhaps the number would be 6,880 pharmacy graduates sitting for the NAPLEX. Apply also the national average pass rate for first time NAPLEX test takers (77.5% in 2023 [7]) and the number drops to 5,332 licensed pharmacy graduates.

Pharmacist Demand

Even at the peak of the number of graduates (Figure 1) (pg. 30) in 2018-2019, we argue that the number of new pharmacists produced was perhaps just getting close to meeting demand for pharmacists rather than flooding the market, as some have claimed. Evidence in support of this contention is the United States Bureau of Labor and Statistics (USBLS) data estimating a need

for approximately 13,500 new pharmacists yearly to make up for those who change careers or retire, and the need is estimated to grow at a rate of 3% over the next 10 years [8]. While the exact methodology used by USBLS to estimate these numbers is difficult to track down, we strongly believe that the USBLS underestimates the number of pharmacy graduates needed because it most likely does not consider the variety of pharmacy careers our students take. For example, in addition to health systems, community pharmacies, and ambulatory care centers, we see our graduates taking positions in pharmaceutical industry, regulatory agencies such as state boards of pharmacy and others, public health organizations, insurance companies, research organizations, military and many others [9]. Further evidence in support of our contention are the very high placement rates that graduates from our pharmacy programs in Missouri have enjoyed. For example, we survey at the time of graduation (as required by ACPE) and typically find placement rates of 85-95% in full-time employment or postgraduate residency training at the time of survey. We do not believe this means that 5-15% were unable to find jobs, but rather that number reflects graduates who do not answer the question or have not yet found the exact job they wanted when we survey in April or May. We have tried to do follow-up employment surveys later, but the response rate is understandably low, so the actual placement rate is not known.

Need for More Recruitment Efforts

Clearly, the number of licensed pharmacists entering practice in Missouri will plummet over the next 3 years, and the impact this will have on reducing already low access to health and wellness services and pharmacist-provided primary care will be dramatic. Due to reductions in enrollment, and subsequent revenue, both schools of pharmacy are operating on minimal faculty and staff levels. However, both schools are trying to invest in advertising and recruitment efforts, including efforts in Missouri high schools and universities. But, we simply do not have enough people to get out to all locations where students interested in health careers may reside. We believe that we need more recruitment efforts, especially

here in Missouri. Table 2 (pg. 30) shows that Missouri currently ranks 8 out of 9 states, including all bordering states, based on the number of pharmacy applicants this year. In contrast, Nebraska, Kentucky and Arkansas have far more applicants when normalized for state population. While we do not know what those states are doing for recruitment, it seems logical to ask Missouri pharmacists to help in recruitment efforts whenever possible. A few suggestions that might be helpful include participating in career days, reaching out and providing information to high school guidance counselors, reaching out to community colleges, referring students who might be interested in health professions, and helping to spread a positive word about the many careers available for pharmacy graduates.

Need for More Incentive Programs

Some states, including Missouri, have offered grant programs to assist with recruitment of health professionals. Last year, two bills were proposed in the Missouri House of Representatives to assist with recruitment of health professionals. House Bill 1925 would have provided grants to health care professionals if they agreed to reside and practice for at least 5 years in a rural Missouri county (defined as a county with a population <35,000). House Bill 1898 was a loan repayment program for health care professionals who agreed to practice in “areas of defined need”. Both programs included a variety of health care professionals in addition to physicians and nurses, such as chiropractors, counselors, dentists, nurses, psychologists, social workers and other therapists. However, pharmacists were not included in these proposed programs. believe that Missouri pharmacists could assist here by contacting their state legislators to let them know of the imminent crisis shortage of pharmacists, closure of pharmacies, and need to attract more students to the profession.

Assist with Training Pharmacy Technicians

While much of what we propose will require long-term commitment and results would not be expected for many years, we believe there are other things we can do to help Missouri pharmacists in the more

immediate future. Both STLCOP and UMKC are involved with pharmacy technician training programs, including programs residing in Missouri high schools. Not only would these technicians be potential recruitments to pharmacy school, but more importantly in the near term, most pharmacists would agree that highly skilled and knowledgeable technicians can make their day much easier and less stressful. Pharmacy technicians can start work at age of 18 and begin contributing to the overall workload involved in caring for the public and our patients.

Get the Aid of Influencers

Today’s marketing environment is a lot more complicated than when we went to pharmacy school. In addition to mainstream television and radio channels, we now contend with multiple streaming paths and multiple browser and social media platforms. Both schools are currently using social media channels to the best of our ability to recruit potential pharmacy students. While they do allow the advantage of specifically focusing on certain age groups, these platforms are also expensive and short-lived. We believe that our efforts would be tremendously assisted if we had a well-known influencer willing to speak about their positive experiences with pharmacists and pharmacy teams. Do you know someone famous who would willing to help us out? If you do, let us know.

Continue to Fight for Patient Access to Pharmacists and Pharmacies

Finally, another key factor in getting students to consider careers in pharmacy is make sure the profession itself is seen as viable, sustainable, and rewarding to younger generations. Transformation of the profession continues at a pace slower than we would like, but we need to maintain efforts to ensure that the public and our patients have access to pharmacists and pharmacy teams to get health and wellness primary care services they need. This means that pharmacists and pharmacy organizations need to continue to fight for appropriate payment for services and fair practices regarding managed care and medication management. With a reduction in the number of pharmacists, it

is possible that pharmacists will continue to see more workload; therefore, efforts focused on pharmacist well-being are critical [10]. Pharmacy is not alone in health care professions in experiencing burnout in practitioners as certainly our colleagues in medicine and nursing are dealing with this as well. But every effort aimed at improving working conditions for pharmacists is time well-spent for the long-term survival of our profession.

Conclusion

Unfortunately, our nation is facing a crisis-level shortage of pharmacy graduates within the next couple of years, and this shortage comes on top of a current shortage of pharmacists working in the community pharmacy sector. While there is nothing we can do to stop the imminent shortage, we can raise awareness and try to get people to work with us to solve this problem. Through the generous work of organizations like AACP, the American Pharmacist Association, the American Society of Health-Systems Pharmacists, as well as our two Missouri schools of pharmacy, we have plenty of resources to share that highlight the exciting plethora of careers possible with a pharmacy degree.

The Missouri Society of Health-System Pharmacists, The Missouri Pharmacy Association, The Missouri Borad of Pharmacy, STLCOP and UMKC have formed the Coalition to MOve Pharmacy Forward to ensure we are addressing pharmacy challenges together. We believe that if we work together, we can create an inflection point soon that would begin to reverse the trend and get more highly educated and trained pharmacists and pharmacy technicians into the health care workforce in Missouri. Are you willing to help us? If so, please feel free to reach out to either one of us at any time. We welcome your assistance.

CONTACT US melchertr@umkc.edu terri.warholak@uhsp.edu

References

1. Junger, S. The Perfect Storm. W.W. Norton & Company, New York, NY. 1997.

2. McGrath, R. Seeing Around Corners: How to Spot Inflection Points in Business Before They Happen. Harper Collins Publishers, New York, NY. 2019.

3. Melchert, R.B., Stoner, S.C., and Graham, M.R. Storm on the horizon: a looming lack of access to pharmacy care services. Missouri Pharmacist. 96(III):2324, 2022.

4. https://www.actforpharmacy.com/ pharmacy-closures

5. https://www.acpe-accredit.org/ accredited-programs-by-status/

6. https://www.pr.mo.gov/pharmacists.asp

7. https://nabp.pharmacy/news-resources/ data-research/#passing-rates

8. https://www.bls.gov/ooh/healthcare/ pharmacists.htm

9. https://www.aacp.org/sites/default/ files/2020-10/Pharm4Me2020Brochure. pdf

10. https://www.pharmacist.com/ wellbeing

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Advancing Pharmacy Practice Through Tailored Continuing Education: The MPA Difference

ASHLEY STONE

PharmD, Clinical Pharmacist, Burrell Pharmacy

In Missouri, pharmacists and certified pharmacy technicians are familiar with the concept of continuing education (CE) and the regulatory requirements necessary for license renewal. However, CE represents far more than a mere regulatory check-box. Its core purpose is to support growth, maintain professional competency, and keep pharmacists and pharmacy technicians current with the latest developments in their field. Moreover, CE is an essential element of an individual’s continuing professional development (CPD) plan—a self-directed, lifelong learning approach that helps professionals identify improvement areas, set meaningful goals, and select CE activities that align with these objectives. CE opportunities for pharmacists and pharmacy technicians are plentiful, various, and often accessible for free or for a fee. This begs the question: What makes the Missouri Pharmacy Association (MPA) a valuable and distinct provider of CE, making it a sought-after benefit of membership?

Tailored Education for MPA Members

What truly distinguishes the MPA’s CE program is its membercentered approach, customized to meet the unique needs of pharmacists and pharmacy technicians across Missouri. MPA understands that the pharmacy landscape is diverse and constantly changing, shaped by advances in medication therapies, new technologies, and evolving patient care strategies. With this understanding in place, each year MPA conducts comprehensive landscape surveys to gather insight and feedback from its members on the topics, challenges, and skills that are most valuable and

“What truly distinguishes the MPA’s CE program is its member-centered approach, customized to meet the unique needs of pharmacists and pharmacy technicians across Missouri.”

relevant to the practice of pharmacy. These survey results drive the development of CE programs and are key to crafting an agenda for the MPA’s annual conference, ensuring that offerings align closely with member priorities. The result? Presentations that resonate with participants, addressing real-world issues that Missouri’s pharmacy professionals face daily. By engaging directly with members, MPA creates a CE program that speaks to their needs, making education more engaging and impactful.

A Diverse CE Committee for a Well-Rounded Program

Another element that sets MPA’s CE program apart is its commitment to inclusivity and diversity within its CE committee. This committee comprises pharmacists and pharmacy technicians from various backgrounds, representing multiple practice settings such as hospital, retail, compounding, specialty pharmacies, and

more. This diversity translates directly into the quality and scope of MPA’s CE offerings. By bringing together voices from all corners of the pharmacy profession, MPA can develop programming that covers the complexity of the field, providing education that is relevant to members at all career stages and practice settings. Through this well-rounded approach, MPA ensures that its CE offerings are comprehensive, catering to the unique needs of Missouri’s pharmacy community. Pharmacists and technicians from different settings may encounter vastly different challenges, and a CE program that addresses these varied experiences offers a more complete view of the industry. For MPA members, this approach to CE means exposure to topics beyond their immediate expertise, broadening their knowledge and fostering a deeper understanding of the profession as a whole.

A Commitment to Excellence

At the core of MPA’s CE offerings is a commitment to high-quality, relevant, and forward-thinking education. This dedication ensures Missouri’s pharmacy professionals are equipped to meet the demands of new healthcare practices, advancing technologies, and evolving patient care models. MPA membership is an investment in lifelong learning—a foundation for professional growth that keeps members both competitive and confident in a shifting landscape. By focusing on targeted, member-driven CE, MPA supports its members in

staying compliant with regulatory requirements while also pushing the boundaries of their professional knowledge. With MPA’s support, pharmacy professionals across Missouri can continue to elevate their practice, deliver enhanced patient care, and make meaningful contributions to the communities they serve.

What makes MPA a valuable and distinct provider of CE? By offering a CE program that goes beyond regulatory compliance, emphasizing growth, enriching the careers of its members, and elevating the practice of pharmacy in Missouri. Through tailored, member-driven education, MPA meets the unique needs of Missouri's pharmacists and pharmacy technicians, keeping them at the forefront of an ever-evolving field. With a diverse CE committee, ongoing member engagement, and a commitment to high-quality content, MPA supports its members in broadening their expertise, meeting new challenges, and enhancing the quality of care they deliver. For those dedicated to advancing their practice and making a meaningful impact, MPA membership and its CE offerings are invaluable resources on the path to professional excellence.

AGS Beers Criteria® and STOPP/START: Tools to Enhance Medication Safety

ABSTRACT:

HEDVA BARENHOLTZ LEVY

PharmD, BCPS, BCGP, Director, HbL PharmaConsulting

Disclosure Statement:

Dr. H. B. Levy has no actual or potential conflicts of interest in relation to this activity.

AGS Beers Criteria® and STOPP/START identify drugs or drug classes that are considered potentially inappropriate medications (PIMs) in older adults and should be avoided when safer options are available. START uniquely addresses potential prescribing omissions. These tools were both updated in 2023 and are important resources to help pharmacists optimize drug therapy for older adults. There are many commonalities between the tools including drugs that affect bleeding risk and fall risk, drugs that require renal dose adjustments, and drugs with anticholinergic activity. Many differences make the tools highly complementary. Both serve as educational tools to drive shared decision making with patients.

The US is more than halfway through the long-anticipated population age wave. 73 million baby boomers are turning 65 years old between 2011 and 2029.1 In the next five years, an estimated 14 million people who make up the tail end of that generation will become older adults.2 Pharmacists can anticipate that by 2050, 22% of the US population—more than one in five persons—will be 65 and older.2 Geriatrics is the medical specialty that focuses on the care of patients who are over 64 years of age. This population is notable for disproportionate spending on healthcare and medications: while currently comprising about 17% of the population, it accounts for 41% of major healthcare expenditures in the US.3 Medication use is an important component of this. 42% of older adults experience polypharmacy,4 commonly defined as the use of five or more medications. The presence of multiple comorbidities is a large driver of increased medication use among older adults. 64% of Medicare beneficiaries are diagnosed with at least two chronic conditions.5 Over 40% of beneficiaries have four or more chronic conditions.6 Unfortunately, older adults often are excluded from clinical trials regarding drug therapy, especially if they have multiple chronic conditions or already are taking other medications.7 This results in a dearth of information to guide safe and appropriate medication use in this population. Additionally, most clinical guidelines fail to address how to optimize drug therapy for the older, more complex patient.

There is truth to the statement that with few exceptions, all pharmacists will be involved in the care of older patients at some point in their careers. Older adults are more vulnerable to adverse drug events (ADEs) compared to younger individuals and are at increased risk of experiencing medication-related problems (MRPs).

Among older adults in the community setting, 30 to 45% of ADEs are deemed preventable.8,9 Thus, the anticipated increase in sheer number of older adults through 2030 is a stark reminder that pharmacists must be stewards of safe and appropriate medication use to prevent MRPs.

Two valuable tools to bolster pharmacists’ geriatric pharmacotherapy knowledge are the American Geriatrics Society (AGS) Beers Criteria® and Screening Tool of Older Person’s Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START).10,11 The AGS Beers Criteria® and STOPP/START are internationally respected drug lists of explicit criteria that identify potentially inappropriate medications (PIMs) in older adults. Both were updated in 2023; thus a review of these tools is timely and relevant for pharmacists.

HISTORY AND OVERVIEW OF PIMS

The term PIM refers to medications that generally should be avoided in older individuals because the risks outweigh clinical benefits and when safer options are available. Older individuals are more susceptible to adverse drug reactions (ADRs) and/or diminished benefits from PIMs for multiple reasons. The most obvious reason is pharmacodynamic and pharmacokinetic changes associated with age. Other factors include polypharmacy, multiple comorbidities, greater medical complexity, and the exclusion of older adults from clinical research trials.7

There is no objective definition of what makes a drug “potentially inappropriate.” Thus, both the AGS Beers Criteria® and STOPP/ START rely on expert consensus to determine which drugs warrant inclusion as PIMs. Note that these medications are deemed potentially inappropriate, not definitely so. In some situations, a PIM might be the best choice for an individual, and the PIM criteria should never be used in a punitive manner.10 Fortunately, both tools have become more evidence-based over the years, commensurate with the increased availability of published research and safety data pertinent to geriatric pharmacotherapy.

Today we have two well-respected documents to guide decisions regarding the use of PIMs. However, these tools have been a generation in the making and have undergone meaningful growth and adaptations since inception. While they both identify PIMs in older adults, there are many important differences in how the tools were developed and present the criteria (Table 1).10,11

AGS Beers Criteria®

In 1991, the geriatrician Mark Beers, MD, and colleagues published a list of medications to be avoided in nursing home residents because of the risks associated with those medications in a frail population.12 The list was the first of its kind and came to be known eponymously as the Beers criteria. Although intended for nursing home residents, the criteria were widely applied to other care settings because they filled a clinical void regarding risks and benefits of medications in older patients. Subsequently, a revised version was published in 1997 that expanded the focus to all settings where older adults might reside, i.e., acute care, ambulatory, and long-term care.13 Over the course of 33 years, the Beers criteria have undergone significant changes, with the 2023 update being the 7th version (Table 2).14-19

STOPP/START

The STOPP/START criteria were developed in Ireland and published in 2008.20 This new PIM tool was met with great interest and quickly emerged as a valuable resource alongside the Beers criteria. STOPP/ START is unique because it consists of two separate listings. STOPP addresses PIMs, similar to the AGS Beers Criteria®, and START addresses potential prescribing omissions (PPOs). PPOs refer to drug therapy that should be considered for use in certain medical conditions in older adults but is not prescribed. START is the first explicit criteria to address PPOs.

STOPP/START underwent revisions in 2015 and 2023.20,21 In 2015, the expert panel was expanded to include geriatricians from across Europe to broaden the reach beyond Ireland.20 Each update was notable for adding a significant number of new indicators.

2023 AGS BEERS CRITERIA® UPDATES

The expert panel for the 2023 AGS Beers Criteria® consisted of 12 interprofessional experts in geriatrics from medicine, pharmacy, and nursing. It newly included three representatives from national stakeholder agencies to participate in the process. The criteria apply to older adults in all settings except for palliative care and hospice.10 The 2023 update retains the same format as the previous iteration, with the criteria arranged in five general categories. Each category appears as a separate table in the publication:

1. Medications considered potentially inappropriate

2. Medications considered potentially inappropriate in patients with certain diseases or syndromes

3. Medications to be used with caution

4. Potentially inappropriate drug-drug interactions

5. Medications that require dose adjustment based on renal function

A separate table of drugs with strong anticholinergic properties also is provided.

Drugs with low usage or that are unavailable in the US were removed in the 2023 update to improve usability. These medications are still deemed to be PIMs and are relocated to a separate table for reference. Examples of removed drugs include disopyramide, flurazepam (low use), and ranitidine (no longer available).

The 2023 version continues the trend from 2019 to incorporate more exclusions or exceptions for the PIMs. Examples include referring to an age threshold, initial vs. continued therapy, or use as first-line agent. This allows for a more individualized use of the criteria. However, the added considerations make the criteria more challenging, because the user must have access to patient-specific information to assess if an indicator applies to a given patient.

Shared decision-making has a greater emphasis in the 2023 update.10 Users of the criteria are reminded that a recommendation to “avoid” is not an absolute statement unless specified on the medication label. Rather, the drug should be chosen infrequently and after careful consideration of the benefits and risks of the drug using shared decision-making with the patient. Cost concerns need to be considered as well.

Several of the specific changes to the criteria as highlighted here. Readers are encouraged to peruse the complete criteria for more detail. Aspirin is recommended to avoid for primary prevention of cardiovascular disease, bringing it in line with other practice guidelines. Previously, it was recommended to use with caution. Warfarin is now recommended to avoid as initial therapy for treating venous thromboembolism (VTE) or nonvalvular atrial fibrillation unless alternative options are contraindicated or there are barriers to their use. If patients have been using warfarin long-term, it is reasonable to continue it. Similarly, rivaroxaban is recommended to avoid in favor of safer anticoagulants when used for long-term treatment of VTE or atrial fibrillation. Previously it was recommended to use with caution. In the drug-drug interaction table, selective serotonin reuptake inhibitors (SSRIs) were added to the warfarin entry because of bleeding risk. Finally, in the table for dose adjustments with renal impairment, apixaban was removed,

and the recommendation for rivaroxaban now refers clinicians to manufacturer guidelines.

Among potentially inappropriate endocrine drugs, all sulfonylurea drugs are now recommended to be avoided because of hypoglycemia risks. In the 2019 version, glipizide was not included because of its shorter duration of action compared to other agents. The recommendation regarding estrogen was updated to be more specific regarding risks of hormone replacement therapy. Sodium glucose co-transporter (SGLT2) inhibitors were added to the table to use with caution because of urogenital infections and euglycemic diabetic ketoacidosis (DKA).

Opioids were added to the list of drugs to be avoided in patients with delirium, reflecting emerging data. In the drug-drug interaction table, the recommendation to avoid use of multiple anticholinergic medications was expanded to specify not only the risk of cognitive decline but delirium and falls or fractures. The recommendation to avoid use of three or more central nervous system-active drugs was clarified and now includes skeletal muscle relaxants.

STOPP/START (VERSION 3) UPDATES

The expert panel for revising STOPP/START version 3 was comprised of 11 geriatricians with academic and clinical experience, representing eight countries in Europe. STOPP/START is geared toward the clinical setting and focuses on situations that require caution in older adults with comorbidities. The developers emphasize the value of organizing the tool by body system to facilitate use, e.g., during a clinic visit.11

A minor but helpful modification in 2023 is adjustment of the sections within STOPP and START to better align, i.e., “cardiovascular system” is section B in both STOPP and START. This adaptation will be more user friendly for clinicians when searching for both PIMs and PPOs specific to a particular body system section of the listings.

A unique feature of STOPP is inclusion of three implicit criteria (i.e., they require clinical interpretation). These address (1) drugs prescribed without a clinical indication, (2) drugs prescribed beyond the recommended duration (where defined), and (3) duplicate drug class prescriptions. START version 3 added a single implicit indicator. This new indicator states that when a drug is clearly indicated and considered appropriate in a particular situation (and there is no clear contraindication) the drug should be initiated. This item is extremely broad, and no explanation is provided by the authors. However, by adding this item to the START criteria, it created a new section in START and enables the START and STOPP sections to better align, as mentioned above.

STOPP/START version 3 contains significant additions and updates from the 2015 version. The total number of indicators increased by 67%, from 114 to 190. 133 are in STOPP and 57 in START. The large increase is not unexpected and reflects the accumulation of new evidence and drug approvals in the eight-year span.

New criteria were added essentially to every section (body system category) within STOPP and START, with many sections increasing by 67% to 400%. The new items cover a wide range of

pharmacotherapy, impossible to enumerate (Tables 3 & 4).11 Readers are encouraged to peruse the revised criteria in their entirety, which are found in Appendix 1 in the published paper.11 Of note, each item in STOPP/START is identified by a letter and number, e.g., A1 or J5, with the letter indicating the section (i.e., body system) for that item. These section and item numbers from Appendix 1 correspond to the references for each item listed in Appendix 2.11

As with the AGS Beers Criteria® update, STOPP made several changes regarding drugs affecting the coagulation system. New items address warfarin, aspirin, and interactions with direct-acting oral anticoagulants (DOACs), as well as estrogen and the risk of thromboembolism.

New cardiovascular items include recommendations regarding statins for primary prevention and drugs that prolong the QTc interval. The central nervous system section added three new items about benzodiazepines (BZDs) and non-BZDs. Items addressing anticholinergic drugs were increased and expanded to be more specific. Two new items in STOPP address SSRIs and bleeding risk.

Both the renal system section, which lists drugs that are potentially inappropriate with impaired renal function, and the section on drug classes that increase fall risk are significantly expanded in version 3. The changes reflect accumulated evidence and underscore the importance of these prescribing concerns in older persons.

Of interest, STOPP added a new criteria addressing maximum dosage of acetaminophen in patients with poor nutritional status. The safe maximum dose of acetaminophen in older adults has long been a concern and a topic discussed among clinicians. However, guidelines have been lacking.

START contains new sections on coagulation and renal systems. Notably, five of the six items that were added to the cardiovascular section address heart failure. Two new criteria addressing osteoporosis were added that address initiating anti-resorptive agents following discontinuation of certain osteoporosis medications. The vaccine section now includes the Varicella-zoster and SARS-CoV2 vaccines.

COMMONALITIES

A strong familiarity with the full content of AGS Beers Criteria® and STOPP/START is necessary to optimize drug therapy for older adults and reduce PIM use. This section will focus on PIMs that are in common between the Beers criteria and STOPP. START focuses only on PPOs and will not be included.

Several cardiovascular drugs are addressed in both tools. Amiodarone and digoxin, the latter a new addition to STOPP version 3, are stated to be inappropriate when used as first-line treatment of atrial fibrillation. Alpha1 antagonists are included because of orthostatic hypotension risks. Centrally acting antihypertensives clonidine and guanfacine are included because ADRs with these drugs are particularly problematic in older individuals.

Drugs that increase bleeding risk in older adults are another common PIM theme. Both tools have similar statements regarding aspirin and warfarin as previously described. Several indicators about direct acting oral anticoagulants (DOACs) are present in each tool. Each tool addresses bleeding risks related to drug interactions or

the need for dose adjustment in renal impairment. Finally, SSRIs are found in both tools, not only because of bleeding risks, but for other concerns such as fall risk and hyponatremia.

Fall risk medications are highly prominent in both tools. STOPP has a section on drugs that increase fall risk in susceptible patients, and the Beers criteria address PIMs in patients with a history of falls. STOPP identifies 10 drugs or drug classes in its category, while Beers criteria identifies nine drug classes to avoid in persons with a history of falls. The following drug classes are included in both sets of criteria: antipsychotics, anti-epileptics, antidepressants, BZDs, non-BZD hypnotics, drugs with strong anticholinergic activity, and opioids.

Another common theme is drugs with strong anticholinergic activity. Both STOPP and AGS Beers Criteria® address the concept of anticholinergic burden, which reflects a growing body of evidence. They identify the use of two or more anticholinergic agents as PIM and recommend minimizing exposure. In addition, both sets of criteria identify drugs with anticholinergic activity throughout the documents.

Renal dosing is a key source of preventable ADEs among older adults and is another commonality. STOPP has a renal system section that identifies 10 drugs. AGS Beers Criteria® has a separate table of 24 drugs or drug classes that require dose adjustment depending on renal function. Only the following appear in common: colchicine, nitrofurantoin, selected DOACs, spironolactone, and NSAIDs. Both tools now address risks with estrogen, megestrol, and desmopressin. New to STOPP and updated in the Beers criteria, estrogen in post-menopausal women is not recommended due to VTE risks. STOPP version 3 added new indicators for megestrol and desmopressin. Thus, both AGS Beers Criteria® and STOPP now cite thrombosis risk and lack of efficacy with megestrol for appetite stimulation and risk of hyponatremia with desmopressin.

Other noteworthy commonalities that emerged in 2015 and are present in 2023 include the following: BZDs, non-BZDs, antipsychotics in patients with dementia for managing behavioral symptoms, proton pump inhibitors (PPIs) longer than 8 weeks, sulfonylureas, and NSAIDs. Readers are encouraged to review the specific recommendations for these criteria in the 2023 updates.

APPLICATION TO PHARMACY PRACTICE

Worldwide prevalence of the use of one or more PIM is 37%.22 In the US, prevalence is slightly lower at 31% to 34%;23,24 however a recent study found a prevalence of 45%.25 PIMs have been associated with increased risk of hospitalization, emergency department visits, outpatient provider visits, and increased healthcare costs.23,26 Other studies support that PIMs are associated with increased ADEs, 27,28 functional decline, 28 and possibly increased mortality.27,29 An association between PIMs and increased risk of hospital readmissions is unclear.30

One would anticipate that reducing PIMs would result in an improvement in health outcomes. However, studies investigating the impact of reducing PIMs have met with mixed results.31,32 While reduced ADEs is associated with decreased PIM use, researchers have not found statistically significant improvements in other outcomes

such as quality of life, hospitalizations, or emergency department visits.31-33 It is speculated that the lack of significant findings is related to study size, duration, or not measuring outcomes that are affected by PIMs.31

Nonetheless, optimizing drug therapy remains the holy grail of geriatric care. It involves a balance of deprescribing PIMs while ensuring that drug therapy with known benefits is prescribed. The expansive nature of the updated tools makes them cumbersome to apply, depending on one’s practice setting. Studies that have embedded the criteria into computer algorithms have shown some success in reducing PIMs.31,33 AGS has developed a mobile application of the AGS Beers Criteria® to facilitate electronic access. One can search for PIMs by generic drug name, drug class, or PIM table (e.g., PIMs, drugs to use with caution, drug-drug interactions).

When applying the criteria in the community setting, it may be impractical to integrate the entirety of one set of criteria—let alone both—during every patient encounter. Thus, pharmacists need to focus on subsets of high-risk patients, e.g., patients over the age of 80, 22, 34 patients with low adherence, or patients with excessive polypharmacy (e.g., taking 10 or more drugs).35

Alternatively, pharmacists can target selected PIM categories, such as anticholinergic drugs, fall-risk drugs, or PIMs associated with a certain disease state, syndrome, or physiologic category. Patient education about PIMs, ideally verbally reinforced with written material, can empower patients to initiate deprescribing conversations with their healthcare professionals.

Clinicians can use the educational aspect of both sets of criteria and integrate them into a systematic approach for medication reviews, either comprehensive or more targeted. The tools complement each other well; thus, it is important to leverage their differences as well as similarities. Focusing on common PIM themes from AGS Beers Criteria® and STOPP, discussed above, can identify patients for focused medication reviews, e.g.36 An outline for integrating the PIM and PPO criteria into the flow of a broader medication review is provided in the accompanying Box.36

Ultimately, the criteria serve as an entry point for further evaluation in developing an overall care plan. Clinical judgment is still required to assess patient preferences, adherence, and effectiveness of drug therapy, e.g.35 Deciding whether to use a PIM

requires consideration of a person’s age, comorbidities, cognitive and physical function, as well as cost and affordability of the PIM and alternative therapies.10 Person-centered care and shared decision making are paramount.

SUMMARY

With an aging population, all clinicians, especially pharmacists, need to address the medication needs of older adults. MRPs are widespread and often preventable in this patient population. PIMs are a major cause of MRPs and play an important role in contributing to negative health outcomes and increased healthcare costs.

The AGS Beers Criteria® and STOPP/START have emerged as globally respected PIM tools. With each update, the tools have become more robust and evidence based. The new cadence of regular updates to the AGS Beers Criteria® keeps them clinically relevant. It is hoped that STOPP/START will follow suit with more frequent updates. Together, these PIM tools serve an educational purpose for clinicians, making them essential resources for drug therapy selection, medication reviews, and in deprescribing efforts for older adults.

Learning Objectives:

2. Describe significant changes to each set of criteria.

References and tables available online at LecturePanda.

1. Discuss the AGS Beers Criteria® and the STOPP/START regarding organization, development, and intended use.

3. Identify potentially inappropriate medications (PIMs) common to both AGS Beers Criteria® and STOPP/START.

4. Discuss how the knowledge of PIMs can be used to optimize drug therapy.

Access to this continuing education if free to Missouri registered pharmacists.

Setting: Home

Target Audience: Pharmacists

To receive credit you must participate and complete all the steps found in the "Complete Credit Requirements" link provided by the registration confirmation email.

After following the link, these steps will include:

• Reviewing the course learning materials.

• Confirming information provided on registration.

• Claiming participation in applicable credits.

• Completing all listed evaluations and quizzes.

Credit requirements must be completed before the expiration date of the activity. Upon completion, credit will be transmitted electronically to the ACPE. All transmitted credit will be viewable in your CPE Monitor profile within 24 hours.

Missouri Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

A Faster Way to Help Seniors with the Medicare Prescription Payment Plan

JEFF POHLER RPh, Medicare Executive, Paytient Technologies, Inc.

In my days behind the pharmacy counter, I witnessed patients backing away once they learned the price of their medication. Too often it was a senior who left without the meds their provider prescribed. I’ve been optimistic that the Medicare Prescription Payment Plan (M3P), which launched on January 1, 2025, would be a solution to allow older Americans access to their life-saving medications.

codes are—

• 056 - Likely to Benefit

• 057 - Opted in to M3P

• 058 - Terminated from the program

Anyone who opts into the program will pay $0 for their meds at the pharmacy and the plan will reimburse their full out of pocket cost to the pharmacy within 14 days. The member will then be billed by their plan with the cost spread out over the calendar year. For many seniors this can result in lower, more predictable monthly pharmacy costs.

All Part D beneficiaries are eligible, and CMS has said that beneficiaries can opt into this benefit if they prefer to manage their prescription payments under the program. They specifically require pharmacies to deliver a Likely to Benefit Notice to anyone who has a single prescription cost of $600 or more.

In addition to enhancing seniors’ access to care, the M3P has two major financial advantages for your pharmacy:

1) Fewer drugs returned to stock and hence lower fees.

2) No credit card fees on patients’ out of pocket transactions for the rest of the year after they sign up.

The challenge of M3P for pharmacies right now is the time it takes to educate Medicare beneficiaries about this option and support them in signing up for this optional program. There’s also the challenge of processing M3P claims, which requires a new workflow.

If a patient is 056 Likely to Benefit, you are required to provide the CMS approved Likely to Benefit Notice. If they are 057 opted into the program, you will submit the claim to a secondary BIN/PCN that is provided by your system with the primary submission. There are no switch fees for this secondary claim submission.

Educating patients about M3P

We all know how challenging it can be to educate patients when there’s a long line at the counter. As a leading provider of technology that powers the M3P program for many national Part D plans, we put together some resources that anyone can use to understand the program and sign up online.

Check out GetMyMeds.com and share it with your Part D customers. You can also request a free pharmacy kit with an FAQ, patient brochures and countertop signage.

If there’s anything we can do to help, please reach out to us at rx@paytient.com

Protect your license and your practice with confidence!

Pharmacists Mutual has been the trusted partner for pharmacists nationwide since 1909. Our commitment goes beyond providing insurance—we offer peace of mind through unparalleled expertise and a team of specialists who understand your unique needs. With industry-leading customer service and a proven track record, we’re here to help you protect your license, practice, and future. Visit phmic.com/choose-quality.

$430,375 $1,605,288 $8,821

of pharmacy professional claims reported in 2022 were related to defending pharmacists and pharmacies before a regulatory entity. The average loss paid for a license defense matter in 2022 was $8,821. Wrong directions/drug/strength claims accounted for $1,605,288 of the total pharmacy malpractice claims in 2022.

Compounding pharmacies incur some of the most severe claim losses, with an average loss paid of $430,375 in 2022.

From Research to Real-World Impact: Advancing Preventative Therapeutics and Public Health for At-Risk Populations

HANNAH BRENTON

P2 Pharmacy Student, UHSP

Atopic I am passionate about is preventing disease in atrisk populations through the development of preventative therapeutics and re-purposing therapeutics. My passion and interest in helping others at the population level recently motivated me to pursue the dual Master of Public Health program alongside my Pharm.D. I am part of the first cohort here at UHSP!

I’ve dedicated a lot of time and effort to research, with the overarching goal of helping others. I had the opportunity to contribute to the development of a preventative vaccine against a toxin staph. Aureus secretes, for the pediatric population. Through my work, I specifically identified an age range in which to vaccinate children by looking at antibody protection levels. This research was published this week in Nature! (see link): www.nature.com/articles/s41467-024-52714-7

There have been no successful prophylactic vaccines to prevent staph. Aureus infections and if they made it to market, they have failed. This is a public health threat due to the surge of antibioticresistant bacteria and the at-risk populations it affects. Another large issue we face in creating therapeutics for children is that the amount of resources spent on making the drug can hinder the ability of the drug to make it to market, especially if the projected profit isn’t fiscally viable. There are a lot of concerns when it comes to designing clinical trials with pediatric patients and a lot of ethical concerns

making sure the benefits outweigh the risks etc. One of my teams’ goals was to create a fiscally viable approach in designing the vaccine. The results of this vaccine are promising, and I’m interested to see how this story will continue to unfold.

After completing my project in basic research, my interests shifted to wanting to see the bigger picture of therapeutics which involved working with participants actively enrolled in a clinical trial. I joined the Department of Public Health at Wash U med, where I managed a phase II breast cancer clinical trial with the drug denosumab, a therapy already on the market to treat women with a high risk of fracture. Breast density is a major risk factor for the development of breast cancer, and denosumab could potentially reduce mammographic breast density, thus decreasing breast cancer risk. Working with participants on this trial was one of the most fulfilling experiences I have ever had. It took my passion for therapeutics and my passion for helping others to a whole new level. This experience was the catalyst for my decision to apply to pharmacy school.

With my dual MPH degree, I hope to specialize in epidemiology, explore therapeutic re-purposing, and try to understand recent trends in breast cancer. Some of these trends include an increasing number of estrogen receptor-positive cancers, which disproportionately affect black women. I’m excited to see where this program takes me, and I’m excited to have the training as a pharmacist and use this to help people.

GOLF TOURNAMENT - SECURE YOUR SPOT!

THURSDAY, SEPTEMBER 11 | THE OAKS | MARGARITAVILLE LAKE RESORT

LUNCH 12:00 PM | SHOTGUN START 1:00 PM

Fuel Exam Confidence

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Candidates using PTCB’s Practice Tools consistently report higher passing rates, giving them the confidence to soar.

Employers and educators can easily support candidates by

Now hiring pharmacists and pharmacy managers

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Pharmacy practice at Walgreens embraces an unmatched standard of quality care through focused efforts to allow greater access to patients where they need us most- in their communities. Our pharmacy micro-fulfillment sites free up our pharmacists to provide much needed healthcare services such as immunizations, medication therapy management and health testing, which allows them to practice at the highest level of their profession and impact millions of patients’ lives.

LEGISLATIVE DAY 2025

PHARMACY FIRST: LEADING WITH INTEGRITY ADVOCATING FOR CHANGE

MPA LEGISLATIVE DAY AGENDA | APRIL 2, 2025 | JEFFERSON CITY, MO

7:00 - 8:00 a.m.

Registration and Breakfast

8:15 - 8:30 a.m.

Welcome and Legislative Day Overview

Kendall Guthrie, PharmD, BCACP, President, MPA

Cassie Heffern, PharmD, BCACP, President of MSHP

Ron Fitzwater, CAE, MBA, CEO of Missouri Pharmacy Association

8:30 - 9:30 a.m.

Guest Legislator Speakers

9:30 - 10:00 a.m.

Missouri Board of Pharmacy Update

Kimberly A. Grinston, JD, Executive Director, MOBOP

10:00 - 10:30 a.m.

Josh Moore, PharmD, Director of Pharmacy – MO HealthNet

10:30 - 11:00 a.m.

Bil Schmidtknect – Patient Advocate

11:00 a.m. - 12:00 p.m.

Lunch

11:30 a.m.

Legislative Update

Jorgen Schlemeier, Lobbyist, Gamble & Schlemeier

12:00 p.m.

Transition to Missouri State Capitol – Legislative Visits

Help Us Recognize the Exceptional Contributions of Our Members

Submit nominations for the following prestigious MPA awards. (Awards presented at the MPA Annual Conference)

Pharmacist Making a Difference Traveler of the Year

Terry Mungle Excellence in Sales Award Bowl of Hygeia

Pharmacy Technician of the Year

Distinguished Young Pharmacist

Excellence in Innovation

Faculty Member of the Year

Student of the Year

Scan QR Code or visit bit.ly/4iM4lm3 to nominate

Deadline for nominations is April 21, 2025