spring 2011 minnesota pharmacist

2 Minnesota Pharmacist n Spring 2011

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Minnesota Pharmacist n Spring 2011 3

in this issuePresident’s desk Many Organizations, One Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

executive’s rePort Pharmacists and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

features What’s in it for Me? Why Buy from You? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8AWARxE Campaign: What’s in the Pitcher? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10MTM Marketing Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Developing MTM Marketing Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Pharmacy and the law You’ve Been Served! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

featureSpeak to Be Remembered and Repeated: 7 Rules to Remember . . . . . . . . . . . . . . .17

financial forum Take Advantage of the Saving Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

features MPCA Revisiting Rules for Pharmaceutical Reverse Distribution . . . . . . . . . . . . . .19 Bariatric Surgery Meets Pharmaceutical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Emergency Preparedness: Lessons Learned and Future Direction Pharmacists’ Role in Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

association Presidential candidates . . . . . . . . . . . . . . . . . .26

student PersPective Student Pharmacists Join the Battle Against Cancer: Duluth Becomes “Where Leukemia Meets its Match” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

mPha 127th annual meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Join the PartnershiP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

advertisersDakota Drug Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36McKesson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Outcomes Pharmaceutical Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 21PACE Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Pharmacists Mutual Companies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Pharmacy Quality Commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Spring 2011 Volume 65. Number 2, ISSN 0026-5616

mPha Board of directorsExecutive/Finance Committee: President: Brent Thompson

Past-President: Bruce Thompson President-Elect: Scott Setzepfandt

Secretary-Treasurer: Bill Diers Speaker: Meghan Kelly

Executive Vice President: Julie K . Johnson

Rural Board Members: Ted Beatty

Mark Trumm

Metro Board Members: Cheng Lo

James Marttila

At-Large Board Members: Tiffany Elton Randy Seifert Eric Slindee

Jill Strykowski Jason Varin

Student Representation: Duluth MPSA Liaison: Alicia Mattson

Minneapolis MPSA Liaison: Brittany Alms

Ex-Officio: Rod Carter, COP

Julie K . Johnson, MPhA MSHP Representative

minnesota PharmacistOfficial publication of the Minnesota Pharmacists Association. MPhA is an affiliate of the American Pharmacists Association, the American Society of Consultant Pharmacists, the Academy of Managed Care Pharmacy, and the National Community Pharmacists Association.

Editor: Julie K . Johnson

Managing Editor, Design and Production: Anna Wrisky

The Minnesota Pharmacist (ISSN # 0026-5616) journal is published quarterly by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St . Paul, MN 55114-1469 . Phone: 651-697-1771 or 1-800-451-8349, 651-290-2266 fax, info@mpha .org . Periodicals postage paid at St . Paul, MN (USPS-352040) .

Postmaster: Send address changes to Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St . Paul, MN 55114-1469 .

article submission/advertising: For writer’s guidelines, article submission, or advertising opportuni-ties, contact the editor at the above address or email julie@mpha .org .

Bylined articles express the opinion of the contribu-tors and do not necessarily reflect the position of the Minnesota Pharmacists Association . Articles printed in this publication may not be reproduced in any manner, either in whole or in part, without specific written permission of the publisher .

Acceptance of advertisement does not indicate endorsement .

Upcoming EventsVisit www.mpha.org

for more information and to register

Technician conference MShP/MPha evenT,

July 21, 2011 Crowne Plaza, Plymouth

127Th annual MeeTing, June 10-12, 2011

Madden’s Resort, Brainerd

Moved, graduated, or have a name change? Update your profile through your online

MPhA Member Portal page.

mPha office1000 Westgate drive

suite 252 st. Paul, mn 55114

phone: 651-697-1771 fax: 651-290-2266

Visit us online at www.mpha.org!


Pharmacy Time caPsules2011 (Second Quarter)

By: Dennis B. Worthen, Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH

1986—TwenTy-five years ago:Reye’s Syndrome warning required to be added to all aspirin labels .

The American Association of Pharmaceutical Scientists (AAPS) was formed with almost 3,000 charter members .

Human Genome Project launched with the object to understand the human genome and therefore provide the continuing progress of medicine .

1961—fifTy years ago:President Kennedy signed Public Law 87-319 designating the third week in March as National Poison Prevention Week .

1936—sevenTy-five years ago:The use of radiopharmaceuticals began when John Lawrence administered a radioactive isotope of phosphorus-32 to treat chronic leukemia .

1911—one hundred years ago:The US Supreme Court ruled against Dr . Miles Medical Co ., which had sued a distributor for selling its products at cut rate prices .

1886—one hundred TwenTy-five years ago:The University at Buffalo School of Pharmacy and Pharmaceutical Sciences opened .

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


Minnesota really is a special place to be . Living here makes me extremely proud; yet, I’m a bit embarrassed to be smiling while looking at piles of snow on April 1 . There’s some-thing to be said for the strength and endurance of Minnesotans and how that is reflected to the rest of the world . People say we are nuts . People won-der how we do it . But, people are always quick to point out the good folks that live here .

We just got home from the APhA Annual meet-ing in Seattle and it truly was a celebration of good folks in Minnesota . We had many of our amazing Minnesota pharmacists receive awards at the meeting, which you will see in this journal . These recipients are long-standing, committed, and very appreciated members of MPhA . I want to congratulate and thank one of these incredible people for once again representing Minnesota pharmacy in a spe-cial way . Julie Johnson, executive director of MPhA, received the Gloria Niemeyer Francke Leadership Mentor Award . This award was established to recognize an individual who has promoted and encouraged pharmacists to attain leadership positions through example, acting as a role model and mentor . This is certainly reflective of why myself and many many others in MPhA have sought certain accomplishments in the pharmacy profession . I’m personally very grateful for her gentle guidance and encourage-ment . As always, it felt good to be a Minnesota pharmacist at our national association meeting .

Back to the message I promised you throughout the year — pro-fessional involvement . Hopefully, my ramblings have been useful for some and no one has tired of the message . Pharmacy is a com-mitment to a life of service to our families, our friends, the public, the profession and our patients . I’ve shared with you ways to get involved, how being too humble might stop you from taking an active role in advancing the profession, and how even the easy little commitments can play a huge role in our involvement .

I haven’t shared with you in these pages as yet what I believe deserves some time — is my personal vision for the profession: “We will someday carry one voice, united as a profession with the single goal of serving our patients better .” Currently, I rec-ognize about nine major national pharmacy organizations and I’m sure there are several I’m missing: the American Pharmacists Association (APhA), the National Alliance of State Pharmacy Associations (NASPA), the American Society of Health-System Pharmacists (ASHP), the Academy of Managed Care Pharmacy (AMCP), the Accreditation Council for Pharmacy Education

(ACPE), the American Association of Colleges of Pharmacy (AACP), the American College of Clinical Pharmacy (ACCP),

the American Society of Consultant Pharmacists (ASCP), and the National Community Pharmacists Association (NCPA) . There are nearly as many at the local level in each state . I’m a member of several . I believe the missions of every one of them are good, solid, heartfelt and necessary . What concerns me most is the perception that we don’t agree as a profession . I worry that policymakers, other healthcare col-leagues, and our patients might see that we are divided and work only to serve ourselves . A few

years back, I heard Bob Osterhaus say something in his Melendy Lecture that struck hard at the core of my vision . He said “We should all be able to agree, if it ain’t right for our patients, it ain’t right for the profession .” It’s really that simple . If there are dif-fering opinions in the profession, we should ask ourselves which best serves our patients and have a united voice as a profession .

This will likely not be my last opportunity to share with you, but will be my last commentary in Minnesota Pharmacist as president of MPhA . The year has been filled with exciting opportunities and changes for MPhA . From moving offices and expanding the asso-ciation’s operational ability, squeezing some “Pharmacy Nights” into morning events so our messages would get to all corners of the state in a timely manner, to development of an entirely new strate-gic plan this summer, with health care reform in the spotlight . I’m honored to have been asked to serve you as president of MPhA . I’m appreciative of all those who have chosen to be involved and give their time, and pleased to know MPhA continues to remain strong in serving Minnesota pharmacists to advance patient care .

Dr . Brent Thompson MPhA President

Please remember this:

“Every man owes a part of his time and money to the business or industry in which he is engaged. No man has a moral right to with-hold his support from an organization that is striving to improve conditions within his sphere.” Pres. T. Roosevelt - 1908

Many organizationS

one visionby Brent Thompson, Pharm.D., MPhA President

We will someday carry

one voice, united as

a profession with the

single goal of serving

our patients better.


Pharmacists’ contributions to patient health and the health care system are not new to any of us . But we continue to demonstrate ways to provide examples of our value to others in the system . In another article, I talked about how it’s not about us but rather what we can do to better the health of our patients . In other words, in what ways can we contribute to the total health of the patients we serve?

In the Fall Minnesota Pharmacist, the contents of my “perspec-tive” article proved to be useful information for MPhA as we were asked by the Minnesota Department of Health to join them in an MDH/Pharmacists Engagement Collaborative . The proj-ect and efforts culminated as a program to prepare and engage pharmacists to support community emergency preparedness efforts by participating in Minnesota’s Medical Reserve Corps or other established, event-responder groups . Kevin Sell engaged the MPhA leadership to set the effort in motion by expressing inter-est from the MDH to reach out to pharmacists because of the growth of pharmacist-delivered immunizations .

The goals of the initiative include: assessment of current par-ticipation by pharmacists and other community providers in emergency response, review of state and national responses to the 2010 H1N1 threat, identification of strengths and improvements necessary to coordinate effective efforts between pharmacists and public health to meet needs of future events, to educate phar-macists and other community providers on the roles, opportuni-ties and capabilities necessary to respond to public health needs relating to immediate and anticipated health threats — and most importantly, to engage pharmacists and other community provid-ers in the preparation necessary to respond to future public health threats by enlisting them in ongoing networks so that they have the tools to respond when called .

A summary of the information presented is included in this issue on page 25 by Alison Knutson, Pharm .D ., a University of Minnesota Leadership Resident who worked with MPhA during her time with our organization to develop the program content . By the time this issue is printed, six of these programs were presented during the Spring Pharmacy Night events and will be offered again during the MPhA Annual Meeting at Madden’s in Brainerd on Friday, June 10 and the MPhA/MSHP Technician Conference on July 21 . Webinars of this presentation (includ-ing continuing education credits for pharmacists and nurses) will soon become available on the MPhA Web site at mpha .org . And thanks to the support of MDH, this journal is provided to

all pharmacists in Minnesota in the hope that more pharmacists become aware of the opportunities and continued need for their involvement in public health initiatives .

Julie K . Johnson, Pharm .D . MPhA Executive Vice President/CEO

executive’S report

PharmacisTs and Public healThby Julie K. Johnson, Pharm.D., MPhA Executive Vice President/CEO

Learn, Relax, Enjoy in Northern Minnesota with MPhA!

127th Annual Meetingof the Minnesota Pharmacists Association

See page 32 for details.Visit www.mpha.org to register online!


viewPoint

What’S in it for Me?

why buy from you?by Lowell J. Anderson, D.Sc., FAPhA

Does it matter what our profession’s brand is? What your prac-tice’s brand is? What your personal brand is? Does it really matter what people think of us as a profession and you as a member of the profession?

I think it matters greatly . Our brand contributes to our status in the health delivery system, product reimbursement and service compensation, our inclusion in developing delivery concepts and ultimately the long-term viability and success of our practices .

For the medical profession, being known as a “doctor” or “physi-cian” defines a person who takes care of people’s health, and, of course, has reserved parking spaces at the hospital!

Our brand is not that concise . There is no similar perception of what pharmacy is, or what a pharmacist does . Actually our brand is pretty schizoid . Who we are is determined by where we practice . We are known as a chain, community, hospital, clinical and con-sultant pharmacist, or whatever . Each has a different value to the public that is determined in part by the consumer’s opinion of the facility that we use to define ourselves . And, in fact, we encourage that perception because we label ourselves that way, even though we talk among ourselves as health-care professionals . Our allied health professionals also see each “modifier-pharmacist” as a differ-ent type of professional with different competencies .

Unfortunately, there is also a consumer perception of different levels of competence that comes with these workplace definitions, which I believe is largely related to accessibility of the practitioner . The more accessible a pharmacist is to the consumer of services, the more competent he or she is judged to be . Spending your time behind the dispensing counter barrier does not lead to accessibility and a heightened perception of competence .

Marketing professionals talk in terms of “value proposition” – the functional benefit of a brand that relates directly to the service . Consider FedEx dependability – “We Deliver .” Or, Jiffy Lube with a “30 minute oil change .”

What is the functional benefit of going to a pharmacy and talk-ing with a pharmacist? Is there an overarching consumer image of pharmacists and pharmacist services that is independent of the setting where we work? We can certainly say that part of our value proposition is that you can get a prescription accurately filled at a licensed pharmacy . Community pharmacies are a good place to get over-the-counter medicines, greeting cards, toothpaste and

other consumer goods that people forget to buy at the grocery or the dollar store . These are important, but they are all product related! At one time the Value Proposition for many pharmacists was “Quick, Cheap and Accurate .” That is now expected and no longer resonates with the consumers of our services .

In hospitals, medicines magically appear just–in-time and the patient never sees the dispensing pharmacist – much less interact with him or her . Still product related!

The core “value proposition” that seems to be missing is that phar-macists “take care of people’s health by managing their medication therapy .” Unfortunately it is not part of our brand .

Professionals skilled in marketing also talk about “emotional bene-fit .” Emotional benefits are the feelings that consumers have when they make a purchasing choice . As examples, think about the good feeling you get about a new car or the purchase of ice cream . Emotional benefits are beyond the functional benefits because of their psychological nature .

Although we can get warm fuzzies over our new car or the pros-pect of an ice cream cone on a summer day, I think it is probably very difficult for a consumer to have a similar emotional reaction to the pretty pink pills in a prescription package — covered with warning labels . The emotional benefit comes when there is a social interaction: in our case, between the consumer and the pharma-cist .

Quite simply, each of us who practices in a patient-care setting is the “face of pharmacy .” Each of us contributes to the brand of a caring profession and the value proposition of our profession . The pharmacist who spends time with consumers beyond the trans-actional demands or the requirements of the board of pharmacy contributes to the emotional benefit that in combination with our value proposition creates our brand .

Conversely, the practitioners who do not interact at a personal level also create an emotional benefit and value proposition judg-ment in the minds of consumers . Unfortunately . Those judgments all too often are negative: “If all I am getting is a prescription, it doesn’t make any difference where I get it .” Consumers not only want to know “What’s in it for me?” but “Why buy from you?”

Why buy from You? continued on page 9


As pharmacist practitioners, we are busy professionals . Each one of us has many reasons to not leave the security of the hospital or community-pharmacy dispensing counter . Some reasons are valid . But we need to realize that not a lot of care occurs when there is a spatula in one hand and an Abbott Counting Tray in the other!

It does take a conscious effort to put a face on your practice and your profession . I think that independent pharmacists are pretty good at this . It is just the nature of independent practice: the CEO is the practice, a member of the community and sees the results daily in a very personal way .

Lowell J. Anderson, D.Sc., FAPhA, practiced in community pharmacy for most of his career. He is a former president of MPhA, MN Board of Pharmacy and APhA. In addition he has held positions in the Accrediting Council on Pharmacy Education, National Association of Board of Pharmacy and the United States Pharmacopeia. Currently he is co-director of the Center for Leading Healthcare Change, University of Minnesota and co-editor of the International Pharmacy Journal. He is a Remington Medalist.

The Minnesota Pharmacists Foundation works to create a strong future for pharmacy by investing in pharmacists of tomorrow . The Foundation backs this commitment by providing annual scholarships to pharmacy students attending the University of Minnesota campuses in Duluth and Minneapolis .

Visit our page on Facebook or the MPhA site to learn more about how you can help us achieve our goals!

coMMitMent to exceLLence and tpL SaLeS Leader

awarded To sheila welle

Pharmacists Mutual Companies awarded Sheila Welle the 2010 Commitment to Excellence Award . This award recognizes the field repre-sentative who has displayed dedication to excel-lence in service to customers based on several areas of measurement . She also earned the 2010 Pharmacists Life Insurance Company Sales Leader Award . Welle earned this award by hav-ing the highest Pharmacists Life production of the most life insurance policies sold last year .

Welle was recognized at the 2011 Annual Sales and Marketing Meeting in Las Vegas, Nev .

Sheila Welle, CIC, LUTCF, LTCP is a field representative for North Dakota and Northern Minnesota . Before joining Pharmacists Mutual in 1996, Welle was employed at Pioneer Mutual in Fargo, No . Dak . She is originally from Emerado, No . Dak ., attended Larimore High, and graduated from Wahpeton College . Welle and her husband, Steve, currently reside in Hawley, Minn . Welle has one son, Casey, and two stepsons, Ray and Chris .

Why buy from You? continued from page 8


student PersPective

whaT’s in The PiTcher? By Heather Dekan, University of Minnesota Pharmacy Student

are you aware of the decisions kids face today when it comes to prescription drugs? More than three in five teens say that prescription drugs are easy to get their hands on.

Well, as student pharmacists, we weren’t aware of the wide avail-ability of these drugs until we partnered with AWARxE, a national program with the purpose of educating people on the dangers of abusing and misusing prescription and OTC drugs . AWARxE has specific, ongoing efforts in the state of Minnesota that have been designed with middle school students in mind . Currently, student pharmacists give an AWARxE presentation in a small class-room setting . The message presented to the students is that drugs aren’t bad, but the misuse and abuse of drugs is . As University of Minnesota pharmacy students, we feel compelled to do our part in educating middle school students on medication misuse and abuse . Our goal is to leave students with the ability to make the right decisions when it comes to prescription drug use, especially in a social situation .

Student pharmacists didn’t know a whole lot when it comes to teaching 7th and 8th graders, so we looked for help . An 8th grade health teacher and the school district’s prevention specialist were able to provide the following tips:

1 . Keep it casual — presenters wear jeans and a nice shirt .

2 . Sit with the kids — presenters sit on desks to show that they are talking with the kids, not at them .

3 . Make the presentation funny and interactive .

It is common knowledge that sometime in the past teens have been told drugs are bad . The presenter’s first question for the students is: “Are drugs bad?” Most students answer “yes,” some say “no .” However, the best answer is, “it depends .” The presenters start a discussion by reinforcing that prescription drugs are not bad, it is the abuse and misuse of drugs that is dangerous to their immediate and long-term health .

Then, to verbally and visually explain the dangers of mixing a variety of medications — what typically happens at a “Skittles party” — the presenters conduct an engaging demonstration for the students . A middle school student volunteer is asked to drink or eat individual healthy items, such as juice, milk, water, crack-ers, oatmeal, and cheese . The presenters then unveil a cocktail of all the contents combined in a pitcher and ask who would put this in their body . Not only does this combination look disgusting, but who would have any idea what was in the pitcher . The kids

understand the analogy and how it can be related to drugs: Don’t consume handfuls of unknown drugs!

We have found that humor and raw factual truth are integral to appeal to this age group . Teenagers can be a tough audience, but not unreachable . Candor relates well with the teens and allows for a connection to be made during presentations .

So, are these presentations successful? Yes . The students are engaged, eager to volunteer, entertained, and interactive . Does the message stick? Yes . Jim, a health teacher, stated, “I was standing in the back of the room and one of my students who talks every day in class was sitting there with her eyes glued to the presentation . She came up to me afterwards and said ‘You know what I learned today? Drugs aren’t bad; it is bad to abuse them .’”

If you are interested in an AWARxE presentation at your school, please contact Julie Johnson at Julie@mpha .org .

Pictured are Heather Dekan, AWARxE Coordinator, Marilyn Eelkema, Minnesota Pharmacists Foundation President, and Zach Wyman, also an AWARxE Coordinator


Call toll free (866) 365-7472 or go towww.pqc.net for more information. PQC is brought to you by your state pharmacy association.

Is a QA Program Missing From Your Checklist?Pharmacy Quality Commitment™ (PQC™) is what you need!

Reduction of medication errors and implementation of a QA program are no longer options. A growing number of pharmacy network contracts require a process in place and no matter what it is called, QA, CQI,safe medication practices, or medication error identification and reduction program – PQC™ is the answer.

The PQC™ Program: • Legally protects reported data through a federally listed Patient Safety Organization (PSO) • Helps increase efficiency and improve patient safety through a continuous quality improvement (CQI) process • Provides easy-to-use tools to collect and analyze medication near miss and error data • Presents a turnkey program to help you meet obligations for QA and CQI requirements • Includes simple method to verify compliance • Offers excellent training, customer service and ongoing support

Not all programs are the same, make sure your pharmacy and your data is protected. Pharmacies that license PQC™ andreport patient safety events are provided federal legal protection to information that is reported through the Alliance for Patient

Medication Safety (APMS) – a federally listed PSO. To learn more about PSOs, visit www.pso.ahrq-gov/psos/fastfacts.htm.

TM

Fraud and Abuse TrainingPseudoephedrine Log

OSHA RequirementsHIPAA Privacy and SecurityPolicies and Procedures

Quality Assurance (QA)Program

44

4

4


mTm markeTing research: LeSSonS Learned froM focuS groupS in MinneSota coMMunity pharMacieS

by Nate Chandler, Classs of 2011, University of Minnesota Duluth College of Pharmacy

develoPing mtm marketing strategies

What do we need to do in order to effectively market our skills as MTM providers? How can we relay the concept of MTM to patients and practitioners in Minnesota? Why do patients tend to not participate in the service? Can we gain insight from the patient perspective to help improve our efforts?

On March 15, 2011, the University of Minnesota hosted an event that focused the spotlight directly on these and other questions . The answers have been a long-standing source of mystery, and perhaps frustration, for those practitioners who are delivering or attempting to deliver MTM services to patients . When trying to build the base for a widespread acceptance of MTM services in any practice setting, understanding the perspectives of patients can give some useful insights for improvement opportunities . That was the goal of some recent research completed around the state by a mar-keting specialty company .

Mark It!, a Rochester, Minn .-based marketing firm, conducted six focus groups consisting of MTM-eligible patients in retail phar-macy settings . The focus group participants were identified, deemed eligible for MTM service coverage, and then recruited by each indi-vidual site . Sessions were about two hours in length and included a short educational video shown about halfway through the encoun-ter to explain MTM more clearly .

Focus groups were designed to gather the patients’ opinions, expec-tations and insights on their pharmaceutical and medical care . Patients were asked to explain their current views on the roles held by their pharmacist, their physician, and any issues or concerns they had with their current medication regimen . Next, participants were asked about MTM and asked to explain the extent of their previous awareness . After watching the video explaining the major concepts of the MTM service, participants also shared their reactions .

Here are some key pre-video perceptions raised by patients:

1 . Pharmacists are commonly viewed as the coach or advisor on medications .

2 . Pharmacists are viewed as more available than the physicians, and often spend more time than the physicians .

3 . Physicians and pharmacists are both viewed as part of the care team, though people said the pharmacist probably lacked the intimate knowledge that is possessed by physicians .

4 . Physicians are viewed by many patients as the medication experts in educating, checking interactions and follow-up .

5 . Patient awareness of MTM — both the concept as well as avail-ability — is very low .

Patients also revealed concerns about their current drug regimens such as:

1 . Timing and administration techniques,

2 . Overdosing risks,

3 . Mail-order pharmaceuticals taking away personal relationships, and

4 . Notifications when dosages or formulations change .

In the middle of the session, the video describing MTM was shown . The patients were then re-surveyed after viewing the video . Some of the key points from patients after the video were:

1 . Patients reacted very positively to the concept of MTM, and wanted pharmacists to be a part of their healthcare team .

2 . The main perceived benefits from the patient perspective result-ing from an MTM visit included optimizing medication use, improving treatment outcomes, and improving quality of life .

3 . In general, patients felt that any medication management visits should be covered by insurance .

4 . The name medication therapy management is not a clear enough title for most patients to grasp . A suggestion that was mentioned multiple times was to simply drop the “therapy” and just call it “medication management .”

5 . Another universal theme highlighted by patients was collabora-tion . The entire team must subscribe to the concept for it to work — from the physician to the pharmacist to the patient . Patients showed more willingness to attend an MTM visit if their physician was the driving force behind the encounter and provided endorsement of the service .

In conclusion, the marketing team provided a few recommenda-tions as we move forward into an ever-evolving landscape of health-care in the United States . First, patients need to clearly understand the difference between MTM and counseling on prescriptions . Second, focus your marketing efforts towards the top three benefits patients mentioned: optimizing safe and effective medication use, improving treatment outcomes and improving quality of life . These are key messages and may help increase the uptake and utilization

mtm marketing research continued on page 14



creating a SuStainabLe coMpetitive advantage:

develoPing mTm markeTing sTraTegiesby Gina Rozinka, Classs of 2011, University of Minnesota Duluth College of Pharmacy

What is a sustainable competitive advantage (SCA)? How does SCA relate to marketing medication therapy management (MTM)? I had the opportunity to attend the “Marketing MTM Strategies” seminar sponsored by the UPlan to discuss past, present and future marketing strategies to expand the practice of MTM . Dr . Rajiv Vaidyanathan, professor of Marketing from the Labovitz School of Business and Economics, University of Minnesota Duluth, pre-sented basic marketing concepts to current MTM practitioners . He provided definitions, raised thought provoking questions and discussed segmentation, targeting and positioning to develop a sus-tainable competitive advantage .

market segmentation is a principle that helps us to more accurate-ly identify our patient base . It is roughly defined as a group of con-sumers with similar needs that utilize services for similar reasons . Consumers can be broadly categorized based on geographic loca-tion and demographic information . Market segmentation allows MTM practitioners to evaluate who our patients are and who we want as our patients . This concept also requires us to evaluate our resources, objectives and current marketing strategies to determine if we are meeting the needs of our patient base and if not, how we can improve it . Defining a market segment will help you find new patients and serve a need not currently being met, as well as more effectively use marketing resources and develop a niche for your service .

targeting a specific patient population allows practitioners the opportunity to offer a distinctive and beneficial product, identify competitors, as well as match the needs of those individuals identi-fied in segment population . The key to targeting is to highlight the “benefits” of your service and not focus on the “features .” Provide potential patients with concrete benefits, for example, evaluate all drug therapies to ensure safety and efficacy, help patients receive maximum benefit while minimizing financial output, improve patient understanding and education on medication therapy and collaboration with the patient’s physician to provide tailored and optimal treatment options .

To understand the concept of positioning, ask yourself the ques-tion: How do your potential patients view and perceive your service? For individuals who decide to utilize MTM, they need to clearly perceive the tangible benefit provided by your service . One key step to developing your position is determining your potential patient’s perceptions and preferences . Positioning allows you to create an identity in the market that is congruent with what your target audience would like . A key point Dr . Rajiv emphasized was ensuring that your service appeals to your patient’s emotions . Consumers have a tendency to find greater value and are more like-

ly to purchase (or utilize) your service if they can find emotional value in your services .

So when you combine the concepts of segmentation, targeting and positioning, you arrive at the concept of sustainable competitive advantage . Sustainable competitive advantage asks the question: What can you do better than your competitors that they cannot copy and that customers care about? This concept allows you to uniquely identify yourself as an MTM practitioner, providing cog-nitive pharmacy services to ensure the safety and efficacy of all your patient’s medications . By evaluating your market segment, your target audience and how you plan to position yourself in the mar-ket, then you have successfully created a foundation for marketing MTM services!

dr. raJiv vaidyanathan’s overview of the stP ProcessFollowing is a list of questions each MTM provider was given dur-ing the UPlan Marketing MTM Strategies workshop . Each provid-er was encouraged to take these questions back to their pharmacy, health system or office to develop and refine their current MTM marketing plan .

1 . Define market segments .

2 . Assess and evaluate segments (size, growth, attractiveness) .

3 . Evaluate your pharmacy’s/facility’s resources and objectives .

4 . Select most appropriate segment(s) as target market(s) .

5 . Develop marketing and positioning strategy for each target market .

6 . Develop marketing mix (tactics) for each target market .

implementation steps for Positioning:

1 . Identifying competitors,

2 . Assessing customer perceptions of self and competitors (what benefits are important to customers?),

3 . Determining your own and your competitors’ positions (how does each competitor compare on the key benefits?),

4 . Analyzing customer preferences (determine segments and the requirements of each segment),

5 . Selecting a positioning strategy for the target market (where do consumer values match benefits offered?), and

6 . Monitoring the positioning strategy (must know if positioning is successful, customer needs changing, etc .) .


of the MTM concept from the patients . Finally, the creation of a visible, open collaborative relationship with the physicians is essen-tial . Physicians are generally viewed as the leaders of the healthcare team, and having their endorsement appears to be an important piece to building a successful practice .

While the ultimate structure of healthcare in the U .S . is more unclear than ever, it appears that MTM may indeed be a part of its future . Legislation is moving through the state and national level, which is an attempt to increase eligibility . Healthcare homes may provide a new and reliable market for MTM services . Even the pri-vate sector is beginning to slowly expand into providing MTM as a benefit of their prescription drug plans, with a bit of focused mar-keting and simply talking to patients, we can keep the ball rolling in the right direction . We have a great start . And with a bit more exposure, the word-of-mouth advertising will likely be more pow-

erful than anyone expected . In the meantime, build a marketing plan, talk to your patients and their physicians, and get out there and do what you know as the medication experts: Manage medica-tions and improve your patients’ lives!

Mark It! Contact Info:

http://www .yourmarkit .com

507-529-9000

mtm marketing research continued from page 12


The articles, “MTM Marketing Research: Lessons Learned from Focus Groups in Minnesota Community Pharmacies” and “Creating a Sustainable Competitive Advantage: Developing MTM Marketing Strategies”, underscore the need for dialogue among perscribers, pharmacists and patients .

When patients agreed to participate in focus groups held at the University of Minnesota, they had little knowledge of medica-tion therapy management (MTM); they didn’t understand what the service provided; and they were not aware of value to their personal medication regimen . Nate Chandler, author of the article covering patient perceptions, made it clear that once patients understood how this service could improve their personal medica-tion outcomes, they were very enthusiastic regarding the possibili-ties of having pharmacists more involved in their healthcare team -- if the service is physician driven .

Pharmacists’ task at hand is to educate prescribers and patients about MTM; changing perceptions is not as easy as it sounds.

Gina Rozinka attended the seminar sponsored by UPlan, as men-tioned in her article . This seminar covered the how to aspect of building an MTM practice . She emphasized that the first step is to identify the market segment, and then develop market strate-gies for each segment in your population . Rozinka learned that the MTM service you provide must appeal to the patient’s emotions . In her conclusion, Rozinka urges pharmacists to begin talking to patients and their physicians about MTM .

Pharmacists’ task at hand is to become marketing experts; defining your market is not as easy as it sounds.

“The need for continued support for pharmacists to make these important services available to their patients is clear,” said Julie Johnson, Pharm .D ., executive vice president and CEO, MPhA . “Much work is yet to be done in educating legislators, prescrib-ers, patients, and last but not least, in supporting an environment where pharmacists create medication management services their patients will demand .”

Rita Tonkinson is a contracted staff writer for the association, who provides insightful looks into the field of pharmacy for our readers.

Pharmacy sTudenTs Provide a look aT mTm: What’S happening noW and What happenS nextby Rita Tonkinson


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Run with the bulls.


you’ve been served!by Don McGuire, R.Ph., J.D.

PHARMACY MARKETING GROUP, INC. • PHARMACY ANd THE lAw

The day that you had hoped would never come has come . The sheriff makes his way through the store, with papers in his hand, heading towards the prescription counter . The sheriff says, “Chris, I’ve got something for you .” The sheriff hands you the summons and complaint and walks out of the store . A summons is the notice that a suit has been filed against you . A complaint is the actual lawsuit . Now what do you do?

The most important thing is to not ignore it . This event, service of process, is the start of a procedure that is very time-sensitive . Unfortunately, some defendants read through the complaint and conclude that it is either a bogus case or just a ploy to extract money from them . The worst thing you can do is to toss it aside or throw it in a drawer and forget about it . This is not something that is going to go away . Ignoring it will only cause you more problems . In fact, the clock started when the sheriff handed Chris the summons .

Court rules prescribe the time frame within which some sort of response to the summons must be made . Depending on the juris-diction, this is typically 20 or 30 days, although there are some other limitations out there . If nothing is filed with the court before this time expires, the plaintiff may be able to file for a default judgment . A default judgment essentially says, “You failed to respond, you lose .” If the plaintiff gains a default judgment, they can then begin to try to collect the money from you . The worst thing about a default judgment is that there is no deliberation on the facts or the issues of the case . You might end up paying on that bogus case that you tossed into the desk drawer .

The most typical response to a summons and complaint is to file an answer . The answer addresses all of the allegations made by the plaintiff . The response is usually one of three possibilities: admis-sion, denial, or not enough information . With an admission, you admit that the allegation is true . With a denial, you deny that the allegation is true . The third response is used when you don’t know enough about the allegation to admit or deny it . For litigation purposes, this is treated as a denial . A response needs to be made for each and every allegation in the complaint . The answer is also the place where affirmative defenses are raised . These are legal defenses that counteract the allegations against you . For example, raising truth as a defense to slander or libel .

However, there are circumstances when other filings are made instead of an answer . These are generally motions that raise a

particular issue to the court . The purpose of these motions is to contest certain issues prior to actually working on the substance of the case via the answer . If you are successful on these issues, many times the case is thrown out and there is no need to work on the substance of the case . The issues contested can include a lack of jurisdiction by the court, the case was filed in the incorrect venue, the summons and complaint were improperly served, the case failed to name the proper parties, or the case is a duplicate of a previously filed case in another court .

It takes time to evaluate the allegations, decide whether to file an answer and/or a motion and to decide what allegations need to be admitted or denied . Timeliness is your most valuable asset . Don’t be an ostrich when you are served . Sticking your head in the sand won’t make it go away and ignoring it could result in some serious negative ramifications for you . Call your attorney and/or insurance company as soon as possible . The more time they have to work on your response, the better it will be .

© Don McGuire, R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company.

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

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


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Speak to be reMeMbered and repeated

7 rules To remember By THE Executive Speech Coach Patricia Fripp, CSP, CPAE

“Speak to be remembered and repeated” is the advice i give my executive speech-coaching cli-ents. isn’t that the goal of every executive, profes-sional speaker and sales professional — to be remembered and repeated?

However, it’s easier said than done . Here are some tips .

1. speak in short sentences or phrases. Edit your sentences to a nub . Jerry Seinfeld said, “I will spend an hour taking an eight word sentence and editing it down to five .” In comedy, the fewer the words between the set-up and the punch word, the bigger the laugh . In business communications, change the punch word or phrase to impact phrase .

2. don’t step on your punch word. It should be the final word or idea in the sentence . (Yes, this works for Jerry Seinfeld and his comedian brethren, and it also works for business communicators .)

The otherwise-powerful word “today” can also be the biggest impact-diluting word in business communications if you use it wrong . For example, in the sentence, “You have to make an impor-tant decision today,” your punch word should be “decision .” So switch it around and change the noun “decision” to the active verb “decide .” “Today, you have to DECIDE!”

3. Perfect your pause. Deliver your punch word and then pause . . . and pause . . . and pause . Give your listeners time to digest what you’ve just said . Get comfortable with silence, and don’t be tempt-ed to rush on or fill it with “um’s .”

4. repeat your key ideas more than once. Do not be afraid of being redundant . Instead, worry that tomorrow your audience members will not remember your key ideas .

5. never read your speech. Remember, the audience wants to hear from you . If someone is simply going to read a script or the titles off a PowerPoint slide presentation, you could have stayed home . (PowerPoint is a magnificent visual aid, but not a scripting aid .)

6. use stories. Help your listeners to “see” your words. Statistics and facts are fine, but sell your message and make yourself unfor-gettable by getting listeners to make the movie in their heads . For

example, you might say, “Drunk driving is a bad idea . Let me share with you some statistics on the loss of control drivers experience after even one beer .” Instead say, “Never, never, never drive drunk! Not even after one beer . I know . My friend Eliot Kramer was absolutely positive that two drinks couldn’t affect his timing and judgment .” (Hold up a single shoe, dangling from its shoelaces .) “Six months ago, he died .” Farther on, add some statistics and then conclude with a reference to your powerful story .

7. say something memorable. Presidents have gifted speech writ-ers to coin ringing phrases for the history books . You can be just as memorable in your field when you think about what you want to say and why . Here’s an example from the memorial for 60 Minutes’ Ed Bradley . Fellow reporter Steve Kroft said, “I learned a lot from Ed Bradley, and not just about journalism . I learned a lot about friendship, manners, clothes, wine, freshly cut flowers (which he had delivered to his office every week) and the importance of stop-ping and smelling them every once in awhile .”

Another example, from Mike Powell when he was a senior scientist at Genentech, giving a speech to the Continental Breakfast Club: “Being a scientist is like doing a jigsaw puzzle, in a snow storm, at night, when you don’t have all the pieces, or the picture you are trying to create .”

Remember to try out these seven key ideas as you prepare your next presentation so your words will be remembered and repeated . Why else would you go to all that effort?

about the author Patricia Fripp is an executive speech coach, sales presentation trainer, and keynote speaker on sales, customer service, promoting business, and communication skills. She works with companies large and small, and individuals from the C-Suite to the work floor. She builds lead-ers, transforms sales teams and delights audiences. She is the author of Get What You Want!, Make It, So You Don’t Have to Fake It!, and is a past-president of the National Speakers Association. To learn more about having Patricia do her magic for you, contact her at www.Fripp.com, (415) 753-6556, or [email protected].


take advantage of the

saving years

Preparing for retirement requires a plan, and that plan should con-sist of two important phases: the saving years and the retirement years . To achieve the goal of a financially secure retirement, you will have to make wise decisions during the saving phase of your plan .

For starters, if you plan to use IRAs to help you save, you need to decide what type of IRA you’re going to use . Traditional and Roth IRAs have different eligibility requirements, and each has its own advantages . More than likely, your unique financial needs will make one kind of IRA better-suited for you than the other, so it’s a good idea to evaluate your options .

The main difference between traditional and Roth IRAs is the way their earnings are treated for tax purposes, so it’s important you understand the concepts of tax-deferred and tax advantaged accumulation . With tax deferral, you only owe taxes when you withdraw money from the account . A traditional IRA lets you make contributions and pay taxes when you take withdrawals . Withdrawals prior to age 59½ may be subject to a 1070 IRS pen-alty .

On the other side of the coin, tax-free growth means you don’t have to pay federal taxes on your earnings . A Roth IRA offers the potential for tax-free growth on the after-tax dollars you invest, as long as you meet a few specific requirements . To avoid paying taxes on your Roth IRA earnings, you must have held the IRA for five years and you must be age 59½ or older at the time of with-drawal . Nonqualified withdrawals may be subject to income taxes and a 10% IRS penalty .

In addition to the difference in how earnings are taxed, another important consideration is the tax deduction possibilities of a traditional IRA . As long as you meet certain conditions, you may be able to claim a deduction on your income taxes based on the amount of your IRA contributions .*

To help illustrate our objective, let’s consider an example . Suppose Kim, age 30, is thinking about investing for her future retirement security . Even before considering her IRA options, her first smart move would be to invest in her employer’s 401(k) plan . Assuming she’s already done that, let’s think about her IRA options . With a modified adjusted gross income (MAGI) of $30,000, she is eligible for either a tax-deductible contribution to a traditional IRA or a nondeductible contribution to a Roth IRA . To help her decide, she should think about her answers to a few key questions .

For one thing, how would she handle the immediate tax ben-

efit (i .e . tax deduction) of a traditional IRA contribution? If she chooses to invest the money she would otherwise pay in taxes, her savings could get an additional boost . But if she chooses to spend it elsewhere, the deduction a traditional IRA offers may not help in building her retirement assets .

Kim also needs to ask herself how soon she will need to access her retirement savings . Any traditional IRA withdrawals before age 59½ will be taxed as ordinary income and may also incur a 10% IRS penalty . So if she expects to need access to her retirement savings before age 59½, tax- and penalty-free access to Roth IRA contributions would probably prove valuable .

Additionally, Kim needs to think about whether her tax bracket during retirement will be higher or lower than what it is currently . This could provide valuable insight as to which account would be better suited for her, given the taxation of traditional IRA with-drawals versus the tax-free withdrawals from a Roth IRA .

Like our example, it’s important for you to think about retirement savings well before you approach the time when you’ll actually need the funds . Take steps now to get your savings started, and make the most of the years you have to add to that savings .

*This example is for illustrative purposes only and does not reflect the perfor-mance of any particular investment.

Provided by courtesy of Pat Reding, CFPTM of Pro Advantage Services Inc., in Algona, Iowa. For more information, please call Pat Reding at 1-800-288-6669.

Registered representative of and securities offered through Berthel Fisher & Company Financial Services, Inc. Member NASD & SIPC.

Pro Advantage Services, Inc./Pharmacists Mutual is independent of Berthel Fisher & Company Financial Services Inc. Berthel Fisher & Company Financial Services, Inc. does not provide legal or tax advice. Before taking any action that would have tax consequences, consult with your tax and legal professionals. This article is for informational purposes only. It is not meant to be a recommendation or solicitation of any securities or market strategy.

This series, Financial Forum, is presented by Pro Advantage Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company, and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

PHARMACY MARKETING GROUP, INC. • FINANCIAl FORUM


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Mpca reviSiting ruLeS for

PharmaceuTical reverse disTribuTionby Rita Tonkinson

The Minnesota Pollution Control Agency (MPCA) has revised its regulatory approach to reverse dis-tribution of unusable undispensed pharmaceuticals .

“Minnesota has one of the most aggressive programs of enforcement with health care providers in the nation,” said Jeff Lindoo, executive vice president of Long-term Care Services at Thrifty White Pharmacies . “Hospitals have been under scrutiny for the past several years . Particularly, hospi-tal pharmacies have been following waste regulations rigorously . Although technically full enforcement began for all health care facilities on October 1, 2010, there are still pharmacies, long-term care facilities, and clinics working to understand the rules and come into full compliance .”

Pharmacies that are licensed as hazardous waste generators and are attempting to follow the hazardous waste rules remain unclear about what can be sent to a reverse distributor .

“The Environmental Protection Agency (EPA) has adopted a posi-tion that if a product has value or potential value, it is not waste,” Lindoo said . So federally, outdated pharmaceuticals may be sent to a reverse distributor because if there is a potential for credit to be received they are still considered products .

The Minnesota Hazardous Waste Rules are different than the fed-eral position . In Minnesota, once a product can no longer be used for its intended purpose (dispensed to a patient), even if it has or may have value, it is waste . That makes an expired pharmaceutical a waste in Minnesota .

According to Brandon Finke, a hazardous waste inspector with the MPCA, the hazardous waste rules start with the assumption that all pharmaceutical waste generated by businesses is hazard-ous waste unless documentation (product inserts, MSDS sheets, etc .) shows that it is not listed (P- or U-list) and does not possess a hazardous chemical characteristic (ignitable, oxidizer, corrosive, reactive, toxic, or lethal) .

Unless evaluated and shown to be non-hazardous, pharmaceutical waste is subject to all applicable hazardous waste requirements . There are three options for a business to dispose of hazardous waste (including unevaluated) pharmaceuticals:

1 . Have it picked up by licensed hazardous waste transporter,

2 . Drop it off at a Very Small Quantity Generator Collection Program, or

3 . Pour it down the drain to a sanitary sewer with prior approval from the local wastewater treatment authority .

The MPCA’s new decision represents a limited alternative to the full hazardous waste requirements . It allows a pharmaceutical in a closed, original manufacturer or dispensing container that will not be used for its intended purpose and has not yet been dispensed to continue to be managed through reverse distribution .

In order to use this alternative and manage pharmaceutical waste through reverse distribution a pharmacy must:

1 . Document agreement with the reverse distributor that waste received from the pharmacy will be managed appro-priately,

2 . Maintain a plan including the names and locations of facilities used by reverse distributor to dispose of waste received from the pharmacy, and

3 . Retain disposal records provided by the reverse distributor for three years .

The new requirements have been worked out through the cooper-ation of the Minnesota Pollution Control Agency and the MPhA Public Affairs Committee . Although the hazardous waste laws have been on the books since the late 1970s, until recently they have not been enforced with regard to waste pharmaceuticals in community pharmacies in Minnesota . Additional assistance with understanding the rules as well as leniency with regard to usable in-date pharmaceuticals and legitimately useable expired pharma-ceuticals would be helpful .

How is this new decision by the MPCA different from the Minnesota Hazardous Waste Rules?

1 . Reverse distributed pharmaceuticals may be excluded from the determination of hazardous waste generator size . However, a pharmacist who does not generate any other fully regulated hazardous waste must maintain an active status Hazardous Waste Identification Number by sub-

reverse distribution continued on page 23


Medication Therapy Management Services

As a provider of Outcomes MTMS, you will:

• Promote effective medication use• Enhance professional satisfaction• Generate new revenue for your pharmacy• Build patient loyalty• Demonstrate the value of community pharmacists

Over 2.5 MilliOn paTienTS naTiOnwide have received Outcomes MTM coverage, a number that will continue to grow.

Get Paid ForWhat You Know!

Getting Started is easy!

1. GeT COnTraCTedTo participate, complete an Outcomes MTM Network Participation Agreement by clicking on “Pharmacy Contracting.” 2. GeT TrainedTo be eligible to provide MTM services and receive professional fees, complete the Outcomes Personal Pharmacist training program by selecting “Pharmacist Training.” 3. GeT paidTo get paid for MTM services, view your pharmacy’s list of eligible patients and begin documenting and billing MTM claims.

Or

877.237.0050

getoutcomes.com


Outcomes Pharmaceutical Health Care® Minnesota Territory Manager Report March 2011 Eligible Patients 61,930 Contracted and Trained Pharmacies 735 Participating Pharmacies (year-to-date) 254 Missed Revenue (2010) $828,200 Top Performing Pharmacies:

Walgreens 10500 –Duluth, MN Guidepoint Pharmacy 101 –Brainerd, MN Coborn’s Pharmacy 2006 –Little Falls, MN Mayo Clinic Pharmacy –Rochester, MN Bloomington Drug –Bloomington, MN Goodrich Pharmacy –Anoka, MN

735595

254 168

1,455

551

243

240

200400600800

1,0001,2001,4001,600

Current

Goal

25% 26%

30%

35%

0%

5%

10%

15%

20%

25%

30%

35%

40%

TIP Response % TIP Success %

2010

Goal


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bariatric Surgery MeetS

PharmaceuTical careAndrew Bzowyckyj, Pharm.D., Assistant Professor Endocrinology UMKC College of Pharmacy

according to the american Society of bariatric and Metabolic Surgery, about 220,000 people with morbid obesity in the united States under-went bariatric surgery in 2008.1 this number has been increasing annually at an increasingly rapid rate (up from about 16,000 in the early 1990s and 103,000 in 2003).2 because the prevalence of this class of procedures continues to increase, it is essential for pharmacists to serve as pharmacotherapy resources for patients inter-ested in undergoing or having undergone any of these procedures. the purpose of this article is to provide some of the key details regarding how a pharmacist can assist patients through this process.

The ProceduresThe three most common types of bariatric surgery are the adjust-able gastric band (commonly referred to as “the lap band”), the Roux-en-Y gastric bypass (“gastric bypass”), and the vertical sleeve gastrectomy (“the sleeve”) . Regardless of the type of bariatric sur-gery performed, the resultant anatomical alterations will undoubt-edly impact a patient’s pharmacokinetic and/or pharmacodynamic response to his or her medication regimen . The specific changes to the gastrointestinal anatomy depend on the procedure performed:

1 . Gastric Band: an adjustable band is placed around the top of the stomach to create a small pouch making the patient feel satisfied faster and longer . This is a solely restrictive procedure .

2 . Roux-en-Y: reduces the patient’s stomach to a small pouch in addition to changing the route of the intestines (bypass-ing the stomach and duodenum which still remain intact) . This is a restrictive and malabsorptive procedure .

3 . Sleeve Gastrectomy: a patient’s stomach is stapled along its vertical curvature with about 80 percent of the stomach removed . This is a solely restrictive procedure .

formulaTion consideraTionsThe easiest way to help your patients prepare for medication administration after surgery is to have them practice taking medi-cations in split, crushed, or liquid forms beforehand . Although it is hard to predict exactly what a patient will continue taking after surgery (since many medications “fall off” due to improving metabolic conditions), the best way to be prepared is to assume that all of them will be continued post-operatively . In order to assist your patients, offer to scan their medication lists for capsules, extended/delayed release formulations, large tablets, and anything that requires acidity for dissolution/absorption, just to name a few . Tablets that are larger than the size of a pencil eraser (or too large to fit through a drinking straw) will not be able to pass through the restricted spaces resulting from the surgery and should be split or crushed if possible . Conversely, for extended/delayed release formulations or capsules, assess for other formulations of the same product available (e .g . fluoxetine capsules to tablets, venlafaxine extended release daily to immediate release three times daily), other medications in the same or similar class (i .e . pregabalin cap-sules to gabapentin tablets), or a pre-manufactured liquid of the same medication .

Compounded suspensions also prove beneficial, although pre-manufactured solutions are preferred since there is no need to break down any of the medication particles . Whenever altering formulations, remember to assess for differences in bioavailability between formulations and the impact that food has on absorp-tion since dose adjustments may be necessary . It is also advisable to avoid liquid products with high sugar and/or alcohol content if possible due to their high osmolarity which could lead to dumping syndrome . For capsules that have the recommendation “do not open,” often times a phone call to the manufacturer can be help-ful in making a more “evidence-based” recommendation regarding dosage form manipulation since they frequently have unpublished stability studies of extemporaneous compounds or may be able to provide other recommendations .

medicaTions of concernWith the decreased surface area of the stomach lining comes an increased risk of gastrointestinal bleeding . Because of this, medica-tions with a high baseline incidence of gastrointestinal bleeding such as antiplatelets (e .g . clopidogrel, prasugrel), NSAIDs (e .g . ibuprofen, naproxen, nabumetone, aspirin), and chronic oral ste-roids (e .g . prednisone, dexamethasone) should not be continued after surgery if possible . Other medications should be assessed

bariatric surgery continued on page 23


mitting a Hazardous Waste License Application every three years . The Metropolitan counties (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington) each have independent authority to determine hazard-ous waste licensing requirements and fees within their respective jurisdictions .

2 . The closed original manufacturer or dispensing con-tainer holding the pharmaceutical may itself be stored in an open container labeled with the words “reverse distribution”, “pharmaceuticals for reverse distribution”, or “expired pharmaceuticals” in place of a closed con-tainer labeled with the words “Hazardous Waste” and a description that clearly identifies its contents to employ-ees and emergency personnel .

3 . The undispensed discarded pharmaceutical may be transported, without the use of a licensed hazard-ous waste transporter or Uniform Hazardous Waste Manifest, by a common carrier, pharmaceutical whole-saler, or pharmaceutical manufacturer .

All pharmacies need to obtain a hazardous waste generator iden-tification number from the MPCA and apply for a hazardous waste generator license either through the MPCA or appropriate Metro county according to the amount and type of waste pro-duced . In addition, a pharmacy, long-term care facility, or clinic may generate other types of waste like electronics (anything with a picture tube, LCD display, or LED lights), batteries, fluores-cent lamps, and PCB ballasts and capacitors that may not be placed in the trash .

The MPCA is in the process of developing a factsheet that will explain exactly how this new decision will affect current reverse distribution practices . For more information about managing pharmaceuticals and other types of waste, visit this Web site created by the MPCA and the Minnesota Technical Assistance Program (MnTAP) at the University of Minnesota: http://www .mntap .umn .edu/healthcarehw/Pharmacies/Index .html

Rita Tonkinson is a contracted staff writer for the association, who provides insightful looks into the field of pharmacy for our readers.

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individually within the context of your specific patient for their risk of complicating conditions post-operatively while keeping in mind the patient’s perceptions and expectations .

whaT abouT suPPlemenTs?After each of these procedures, the risk for nutritional deficien-cies is very high although the extent varies depending on the procedure . The majority of supplements that are continued indefinitely after surgery are those that are heavily dependent on dietary intake or the acidic pH of the average stomach for metabolism/absorption (e .g . cyanocobalamin, iron, calcium, multivitamin – especially thiamine) . Because of the decreased GI acidity, the calcium citrate formulation is essential for absorption . With the malabsorptive Roux-en-Y procedure, daily multivitamin supplements will help ensure that all of the fat soluble vitamins are more likely to be maintained at adequate levels, especially vitamin D .

The role of PharmaceuTical careEven though the impact of a pharmacist in this area is assumed to be based solely in knowledge regarding pharmacokinetics and commercially available dosage forms, the provision of pharma-ceutical care can still play a tremendous role to benefit these patients . An in-depth discussion with your patient regarding their medication experience (including an accurate medication history) will help guide your decision making process for how much flexibility there is to change medication therapy and what possible recommendations for adjustments would be, if needed . As always, each medication should still be assessed for indication, efficacy, safety and convenience before considering manipulations/alternatives in order to find ways to optimize and streamline therapy . Only by looking at a patient’s entire medication regimen can the most efficient therapy be accom-plished . After all, what is the purpose of assisting a patient in administering a medication if it is not even indicated in the first place?

sources1 . http://www .asbs .org/Newsite07/media/asmbs_fs_surgery .pdf

2 . http://win .niddk .nih .gov/publications/labs .htm#howmany

Andrew Bzowyckyj is a second-year Pharmaceutical Care Leadership Resident with the University of Minnesota College of Pharmacy Ambulatory Care Residency Program. His current prac-tice site is in the Bariatric Surgery Center at Unity Hospital in Fridley, Minn.

bariatric surgery continued from page 22reverse distribution continued from page 19


bowl of hygeia finds new home aT aPhaby Joe Sheffer, Pharmacy Tradition Secured

The Bowl of Hygeia (replica) has a new home on the National Mall with the recent transfer of this prestigious award from the National Alliance of State Pharmacy Associations (NASPA) and Pfizer to APhA for placement in the Association’s Awards Gallery . Earlier in 2010, Pfizer transferred all rights and responsibilities of the award program to NASPA, including possession of the Bowl of Hygeia replica that was housed at the corporate headquarters of the sponsoring company . The original Bowl of Hygeia award is housed in the A .H . Robins family collection . APhA is gratified to main-tain stewardship of the Bowl replica on NASPA’s behalf . For more than 50 years, the Bowl of Hygeia has recognized pharmacists who are committed to making important contributions to their com-munities . Each year, pharmacists in all 50 states, the District of

Columbia, and Puerto Rico are eligible for the prestigious award . The award itself depicts the traditional symbol of healing through medicine — a symbol that has been associated with pharmacy for thousands of years . In Greek mythology, Hygeia was the goddess of health and the daughter of Aesculapius, the Greek god of medi-cine .

Reprinted with permission from On Your Behalf column in the February 2011 issue of Pharmacy Today (www.pharmacytoday.org). Copyright © 2011, American Pharmacists Association. All rights reserved.


James WalkerAlabama

Robert JohnsonArizona

Ronald NorrisArkansas

Horace WilliamsCalifornia

Tim MeadColorado

Jacqueline M. MurphyConnecticut

Kim RobbinsDelaware

Eric AlvarezFlorida

Flynn WarrenGeorgia

Elwin GooHawaii

Carl Hudson Jr.Illinois

Jeanne VanTyleIndiana

John ForbesIowa

Steven CharlesKansas

Kimberly CroleyKentucky

John O. LeTardLouisiana

Douglas KayMaine

David Fulton Jr.Maryland

Donna HornMassachusetts

Michael SanbornMichigan

Gregory W. TrummMinnesota

William WellsMississippi

Robert PiephoMissouri

Ernest RatzburgMontana

Charles MooreNebraska

Kathryn CravenNevada

Robert GoochNew Hampshire

Richard WeissNew Jersey

L. Kirk IrbyNew Mexico

Stephen GirouxNew York

Albert Lockamy Jr.North Carolina

Terry KristensenNorth Dakota

Jeffrey AllisonOhio

Charles BradenOklahoma

John BlockOregon

Michele MushenoPennsylvania

Marisel MenchacaPuerto Rico

Kimberly McDonoughRhode Island

Lynn ConnellySouth Carolina

Mark DadySouth Dakota

Sherry HillTennessee

Douglas ParkerTexas

Derek ChristensenUtah

Randy PraticoVermont

Brenda SmithVirginia

Holly HenryWashington

Betsy ElswickWest Virginia

Susan SutterWisconsin

Linda MartinWyoming

2010 Recipients of the “Bowl of Hygeia” Award

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community which richly deserves both congratulations and our

thanks for their high example. Over the years a number of companies have supported the continuation of this worthwhile program, including Wyeth and Pfizer.

The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility from Pfizer for continuing this prestigious recognition program. The Bowl of Hygeia

is on display in the APhA Awards Gallery located in Washington, DC.

The “Bowl of Hygeia”


PREsIdENTIAl CANdIdATEs • 2011-2012 BOARd OF dIRECTORs

marTin erickson

I have more than four decades of experi-ence in a variety of pharmacy practice settings, including ownership and manage-ment of a community pharmacy, hospital pharmacy, consulting pharmacist for long-term care and hospital environs . As a third generation Minnesota pharmacist, I

learned my appreciation for the important work of the Minnesota Pharmacists Association on a daily basis from my grandfather, Edward Holland, and my mother, Jeanne Erickson, a 1943 gradu-ate of the University of Minnesota College of Pharmacy and owner and operator of the family pharmacy, Warroad Heritage Pharmacy .

I received my Bachelor of Arts in microbiology from the University of Minnesota in 1970; my second bachelor degree in pharmacy from the University in 1973, and attended the University of North Dakota Law School in the early 1980s . In 2009, I earned a Master of Divinity degree from the United Theological Seminary of the Twin Cities . Currently, I serve as director of Professional Services and Regulatory Affairs/Quality Assurance for pharmaceutical manu-facturing . I am also a columnist for Pharmacy Times, having written the “Compounding Hotline” for the past two decades .

I believe that a vital part of MPhA’s mission is to ensure not only the future of the profession, but to secure that future by instilling professional ethical practice in our current students – setting exam-ples and modeling practice excellence . Having been a preceptor of both Minnesota and North Dakota pharmacy students for many years, I see an important role of the association as an educator .

In the legislative arena, we must ensure regulations are equitable and reasonable and especially that legislation is not passed that adds further stressors to all areas of pharmacy practice, pharmacists, and technicians . We must work to ensure that our profession continues to uphold its proud tradition of professionalism and integrity in all areas of practice, from MTM to dispensing, using best practices in consultation and judgment when serving our patients and clients .

Further, through dialog with our state and federal legislators, we must work untiringly and with resolve to protect our profession from the avarice presented by formulary caprices of third-party payors . We must work at the state and federal government levels to advocate against random passage and/or enforcement of nonexis-tent, nonsensical, anti-business, and anti-patient rules by state and, especially, federal agencies .

I believe our strength as an association lies in recognizing those sources of inspiration, knowledge, and insight, including our vision-ary leaders, that can assist our individual spiritual, intellectual, and physical growth, and by extension as an association, so that we provide a strong legacy for subsequent generations of pharmacists . I am humbled by my nomination to be considered for the position of MPhA president, and would be honored to have an opportunity to serve .

James marTilla

I joined the Minnesota State Pharmaceutical Association (now Minnesota Pharmacists Association) soon after I graduated from pharmacy school . I joined because I was told that one should join his professional organization to sup-port his profession . That advice is as good

now as it was when my father said that to me 40 years ago . While the practice of pharmacy has evolved greatly since those days, the challenges seem the same . Belonging to your professional organiza-tion is crucial to the support of guiding the practice of pharmacy through these turbulent times .

I graduated with a Bachelor of Science in pharmacy in 1971 and a Doctor of Pharmacy in 1973 from the University of Minnesota College of Pharmacy . In 1984, I received a Master in Business from the College of St . Thomas . I am a recipient of awards from the American Pharmacists Association, the Veterans Health Administration and the Mayo Clinic, in addition to authoring numerous papers on pharmacy practice .

Currently, I serve as the director of the Pharmaceutical Contracting and Formulary Management area at Mayo Clinic where I have been in various pharmaceutical managerial positions for 24 years . Previously, I spent more than 15 years working in academia, long-term care and managed-care consulting, in addition to pharmacy ownership in clinic and retail pharmacy . I have served several terms on the Board of Directors of MPhA, in addition to serving on the Academy of Managed Care Pharmacy Leadership Group as a com-mittee chair . Other committee involvement over the years includes the American Pharmacists Association, the Academy of Managed Care Pharmacy, the Minnesota Society of Managed Care Pharmacy, and MPhA, in addition to being a Fellow in the American Apothecaries and American Society of Consultant Pharmacists .

We face great challenges as the delivery of health care, including pharmacy, goes through the greatest changes since the inception of Medicare in 1965 . A strong association with strong membership is needed now as much as any time in our history .

Our professional organization is dedicated to ensuring that pharma-cy remains a viable and prominent component of health care . There is much work to be done at both the state and federal levels . The fact that I am considered a candidate for president of this organiza-tion is a great honor and a tremendous opportunity to continue the legacy of this 128-year-old organization .


emergency PreParedness: LeSSonS Learned and future direction

pharMaciStS’ roLe in pubLic heaLth

by Alison R. Knutson, Pharm.D., Pharmaceutical Care Leadership Resident

feature

pharmacists possess a unique skill set and per-spective that make them vital to many aspects of public health — including delivering vaccinations, providing patient education, and promoting safe and effective medication use.

One of the most under-recognized areas for contribution to public health is emergency preparedness . The American Public Health Association (APHA) passed a policy in 2006 titled “The Role of the Pharmacist in Public Health .”1 This included provisions regarding emergency preparedness efforts, stating, “Pharmacists should be prepared to quickly assess and respond to critical situ-ations and have been a welcomed addition to the collaborative emergency team .” The responsibilities pharmacists hold to our patients and overall public health are echoed in the first line of the Oath of the Pharmacist, which states that we will consider the welfare of humanity and relief of suffering our primary concerns . The potential of pharmacists’ contributions has been seen through examples such as Hurricane Katrina, the 35W Bridge Collapse and the H1N1 Pandemic . However, there is also astounding room for growth in emergency preparedness efforts by pharmacists both state and nationwide .

hurricane kaTrinaIn 2005, Hurricane Katrina caused significant damage across the Gulf coast stretching from central Florida to Texas . The most devastating damage occurred in New Orleans, La ., where 80% of the city was flooded from the storm . Due to the damage, most residents of the city were immediately evacuated and sent to other large metropolitan areas . With the complete overturn of thousands of lives, several issues arose regarding medications . Many people were injured or acutely ill, requiring medical attention and, often, immediate medication therapy . Along with destroyed homes were destroyed possessions, including medications for chronic condi-tions . The loss of photo albums and heirlooms is devastating, but the loss of insulin and nitroglycerin can be life-threatening .

When the decision was made to transport evacuees to Houston, Texas, the Houston Astrodome was quickly organized to house an expected 25,000 evacuees . Around 11,000 evacuees were “admit-ted” to the makeshift clinic set up in the Astrodome for treatment of injuries and chronic conditions . Pharmacists were responsible for ensuring that each patient received the necessary lifesaving medica-tions .2

The pharmacy staff at a hospital in Houston immediately took over all prescription filling responsibilities . The prescriptions were filled at the hospital, then brought to the Astrodome to be dispensed by pharmacists . More than 2,000 prescriptions were filled in the first week .2 CVS, with its own crew of volunteer pharmacists and its high-volume filling capacities, took over the operation after the first week . They reported that more than 20,000 prescriptions were filled in the two weeks that followed . In addition to the dispensing role, pharmacists were also called on frequently for dosing recom-mendations and infectious disease consults, since many of the volunteer physicians were trained in orthopedics, cardiology, and many specialties other than emergency medicine . When disasters or emergencies occur, such as Hurricane Katrina, pharmacists are asked to step outside of their day-to-day practice and pull from all of the education and training they have received .

35w bridge collaPseOn August 1, 2007, the 35W bridge over the Mississippi River col-lapsed during the evening rush hour . This warranted an immediate large-scale emergency response from area hospitals to help those injured in the collapse . The main and closest hospitals accessed were Hennepin County Medical (HCMC) and the University of Minnesota Medical Center (UMMC)-Fairview .

Just months earlier, in May of 2007, the Minnesota Department of Health (MDH) organized a citywide drill simulating an emergency bioterrorism event . This allowed pharmacists to practice emergency procedures, including request of stock from the federal Strategic National Stockpile, coordinating communications among health-care teams in multiple locations, and proper reporting .

As a result of the drill, the HCMC pharmacy department updated its emergency preparedness protocol to include a list of “orange alert” drugs . This list included medications that may be in short supply in the case of a large-scale emergency . This “orange list” provided significant guidance during the 35W bridge collapse, to ensure vital medications were readily available . At UMMC-Fairview, pharmacists were stationed in the ER to assess medica-tion needs, and technicians traveled between the ER and pharmacy delivering these medications . In this case, the medications needed and used most frequently were morphine, cefazolin, lactated Ringer’s injection, and tetanus toxoids . The pharmacies at both HCMC and UMMC-Fairview worked diligently to provide these needed medications as efficiently as possible .

emergency Preparedness continued on page 28


h1n1 PandemicIn March 2009, the first two cases of Novel H1N1 influenza were confirmed in Mexico and the United States . Less than one month later, on April 21, the Centers for Disease Control and Prevention (CDC) prepared an alert for healthcare providers informing them of the growing population of patients confirmed to be infected with the Novel H1N1 influenza . On June 11, 2009, the World Health Organization declared an H1N1 pandemic .

Pharmacist involvement was essential with regards to vaccination campaigns and medication use and distribution for the prevention and treatment of the Novel H1N1 influenza . The large vaccina-tion campaigns to encourage everyone to receive the H1N1 vaccine nationwide were greatly supported by the readily available locations for vaccination, including community pharmacies . There were also mass immunization clinics that utilized pharmacists as immunizers . Many questions arose from other healthcare providers regarding appropriate use of antiviral medications, and pharmacists were and are the most accessible resource to clarify these issues .

asTho surveyOne important aspect of emergency preparedness is recognizing the need to learn from previous experiences . Following the H1N1 pandemic, the Association of State and Territorial Health Officials (ASTHO) was charged by the CDC to evaluate the response of the healthcare system to this pandemic . The ASTHO survey was distributed on April 2, 2010, to state health officers, senior depu-ties, agency-assigned public health lawyers, directors of public health preparedness, and immunization managers . Included among those surveyed were pharmacists involved in efforts during the pan-demic .3

Based on this survey, many strengths were identified . The survey responders noted that new relationships were established between pharmacies and public health departments in many states through-out the U .S . Another strength identified was that “[State] personnel were dedicated to contacting every pharmacy in the state weekly to ascertain current stock levels and projected supply replenishment .” This ensured that every region of the state contained an adequate and appropriate stock of vaccine and medication, given population size and current number of confirmed cases . From this strength, ASTHO identified a recommendation for the future . The sugges-tion was made to create a federal-level system for monitoring stock levels of a specific set of pharmaceuticals, either using national pharmacy corporate chains or coordinating with each state indi-vidually . Also, the vaccination campaigns were identified as an area for growth; suggestions included expanding the scope of healthcare providers, such as pharmacists, the ability to deliver immuniza-tions .4

vaccinaTionImmunization campaigns have been a huge area of success for pharmacists . Per Minnesota state law, a pharmacist may deliver vaccine to those eligible with a standing order from a physician, given that the pharmacist is trained in a program approved by the Accreditation Council for Pharmaceutical Education (ACPE) for the administration of immunizations, or graduated from a college of pharmacy in 2001 or thereafter . This includes any vaccine for patients 18 years or older, and influenza vaccine to those 10 years

and older . Although the law does state that vaccines can be given to any adult who is 18 years and older, the Minnesota Vaccines for Children program covers those who are 18 years old; therefore, pharmacists cannot administer to those patients unless they are an approved provider under the MnVFC .

During the H1N1 pandemic, pharmacies were provided with a stock of vaccination from the federal government . Because the costs of vaccines and supplies were federally subsidized, pharmacies were not allowed to charge a fee for the vaccine itself . However, depend-ing on insurance coverage, pharmacies were allowed to charge for the cost of vaccine administration .

medicaTion disTribuTionOne of the largest areas of confusion surrounding the H1N1 pandemic was medication distribution . Three areas are vital to understand in the wake of an emergency: The national supply of emergency pharmaceuticals; the federal laws protecting healthcare providers during an emergency; and the federal laws supporting use of necessary medication during an emergency .

The CDC and Department of Homeland Security retain a Strategic National Stockpile (SNS), which is a cache of medical supplies and medications that might be needed in the event of a regional, state or national emergency . Supplies used from this cache are free of charge to anyone who needs them . The medications utilized, mainly antibiotics and antivirals, would generally be distributed through a mass distribution center . The SNS guarantees that medi-cations required anywhere in the United States will be there within 12 hours from declaration of the emergency .

Due to policy barriers identified in the wake of September 11, 2001, two specific laws were passed that support adjustment of resources if needed in an emergency . The first policy barrier was improved by the Public Readiness and Emergency Preparedness (PREP) Act . The PREP Act is a federal law that was passed in 2005 to protect those trying to assist in emergency relief efforts, specifi-cally through drug development and distribution . This authorizes the Secretary of Health and Human Services to issue a declara-tion to protect those individuals and organizations involved in the development, manufacture, distribution, administration and use of countermeasures against pandemics, epidemics and diseases and health threats caused by chemical, biological, radiological, or nuclear agents of terrorism .5

On June 15, 2009, Health and Human Services Secretary Kathleen Sebelius extended the PREP Act declaration to H1N1 vaccines . The declaration was amended to add provisions that would help with H1N1 vaccination campaigns, through additional funding and advertising . This meant that manufacturers were given the abil-ity to expedite the process of producing vaccine in order to meet the needs of the community . For example, in the case of H1N1, some of the clinical-use data was not collected in order to speed up delivery of vaccine to the community . Importantly, this also protected those administering the H1N1 vaccine in the event there was an adverse event to occur from receiving the vaccine .

The second barrier surrounding medication distribution led to the creation of the United States Emergency Use Authorization (EUA) . The EUA provides that a timely and practical medical treatment is

emergency Preparedness continued from page 27

emergency Preparedness continued on page 29


made available under emergency conditions . It authorizes use of the best product available for treatment or prevention, even when the relevant product has not yet been approved or approved for this specific use by the FDA (for example, off-label use) . The FDA commissioner may declare an EUA for a specific device or medica-tion if the concerning agent can cause a serious or life-threatening disease or condition .6

During the H1N1 declared pandemic, three medications were given an EUA; Tamiflu (oseltamavir), Relenza (zanamivir) and peramavir . At the time, Tamiflu™ and Relenza™ were both FDA approved with specific treatment guidelines for viral infection . The EUA expanded the use of these medications beyond their FDA approvals . Tamiflu could be used in children <1 year old, and even in children < 3 months of age if the need was considered critical . Treatment guidelines do not recommend use of Tamiflu and Relenza past 48 hours of flu-like symptoms, but both were temporarily approved for use when symptoms had exceeded that 48-hour window . They were also both given extended expiration dates in order to ensure an adequate stock of antivirals was main-tained . Peramavir, an IV antiviral medication that was still in Phase III clinical trials at the time, was granted an EUA7 . The EUA was provided because there were no other adequate IV measures if a patient was unable to tolerate oral antiviral medication . Pharmacists were vital in promoting appropriate use of Peramavir™ . Very little information was known about its recommended dosing, side effects and monitoring parameters, leaving pharmacists as the primary ref-erence for this information .

The interplay between the PREP Act and a declaration for EUA caused significant confusion . The EUA granted use of medica-tions beyond their approval, and when used off-label there is lacking clinical data regarding these medications . The PREP Act protects health care professionals who are involved in use of coun-termeasures against something such as a pandemic were a negative outcome to occur such as a severe side effect (in this case, use of Peramivir for treatment of H1N1, or administration of the H1N1 vaccine) .

oPPorTuniTies for involvemenTIt is vital to be comfortable with the resources available for both planning for emergency response as well as for use during an emergency . The Minnesota Department of Health (www .health .state .mn .us/) is the best place to turn for immediate state-specific information . The CDC and FDA continually update information such as vaccine recommendations at all times and appropriate use of countermeasures (antibiotics, antivirals, vaccines) in a declared emergency .

There are many unique opportunities for pharmacists to be involved in public health efforts, especially in the area of emergency preparedness both throughout the state as well as nationwide .8 The Medical Reserve Corps (MRC) is a group of volunteers from many professions that can be called upon at any time if needed in an emergency or large public health need . These MRCs will request assistance from their pharmacist members in a time of need for any pharmaceutical products . In Minnesota there are two MRCs, the Minnesota Responds MRC (https://www .mnresponds .org/) and the University of Minnesota MRC (http://www .ahc .umn .edu/fac-

ultystaff/oer/mrc/index .htm) .

Consider becoming involved in emergency preparedness efforts at your workplace, institution, state or even nationally . The role in emergency preparedness continues to expand for pharmacists as welcome members of the healthcare team .4

references

1 . American Public Health Association . The Role of the Pharmacist in Public Health, policy statement . http://www .apha .org/advocacy/policy/policysearch/default .htm?id=1338 . Policy Date 11/8/2006 .

2 . Young, D . Pharmacists play vital roles in Katrina Response: More disaster-response participation urged . AJHP; 62, Nov 2005 . DOI 10 .2146/news050025

3 . Assessing policy barriers to effective public health response in the H1N1 influenza pandemic: Project report to the centers for disease control and prevention . June 2010 . Association of State and Territorial Health Officials .

4 . Survey of State Health Agency Staff on H1N1 Response Policy and Legal Issues: Summary and Analysis . June 2010, Logan Circle Policy Group LLC . Association of State and Territorial Health Officials .

5 . Public Readiness and Emergency Preparedness (PREP) Act . http://www .pandemicflu .gov/professional/federal/vaccineliability .html . Last Updated July, 2010

6 . Emergency Use Authorization, http://www .fda .gov/RegulatoryInformation/Guidances/ucm125127 .htm#intro

7 . Gonzalex, R .; Masoomi, F .; Neff, W . Emergency use authorization of Peramavir . AJHP . 2009; 66: 2162-3 .

8 . Woodard, L .; Bray, B .; Williams; Terriff, C . Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response . JAPhA . 2010; 50:158–164 .

11 a.m. RegistRation

12:00 pm shotgun staRt

$135/golfeR Includes Green Fees, Golf Cart,

Course Drink Tickets & Awards Drink Tickets.

Herbie CupGolf Invitational

Saturday, June 11, 2011 • Madden’s Resort • Brainerd, MN

the ClassiC golf CouRse

emergency Preparedness continued from page 28


Student pharMaciStS Join the battLe againSt cancer:

duluTh becomes “where leukemia meeTs iTs maTch”By Laura Palombi, Class of 2012, student at the College of Pharmacy in Duluth, MPSA’s Vice-President of Community Outreach

Every day, thousands of patients suffering from blood cancers like leukemia search for a bone marrow donor match . Unfortunately, six out of ten patients today do not find a donor who can save their life . For the second year in a row, pharmacy students in the Duluth chapter of the Multicultural Pharmacy Student Organization (MPSO) are working to change that — with amazing results!

Students from the College of Pharmacy in Duluth partnered with students from The College of St . Scholastica (CSS) to form the 2011 Twin Ports Bone Marrow Donor Registration Drive (BMDRD) Committee . Last year, more than 1,000 students reg-istered to become potential Bone Marrow Registry Donors at the University of Minnesota Duluth (UMD) as a result of the student pharmacists’ efforts and the help of non-profit DKMS1 . This year, the Committee organized three successful Bone Marrow Registry Drives that were held at UMD, The College of St . Scholastica, and the Miller Hill Mall .

during the first week of march they registered 1,185 bone mar-row donors!

because of the students’ efforts, three students from umd have already provided lifesaving transplants to leukemia patients!

For each new donor who registered, the cost to DKMS is $65 . In an effort to defray those costs, the students organized the “Be the

Missing Piece Gala” on Friday, February 25, 2011 . The event was hosted by Fox 21 News Anchor Nick LaFave and included a silent auction as well as presentations by cancer survivors and bone mar-row donors who could attest to the significance of the students’ efforts . The Gala helped to raise more than $5,670 .

mayor don ness, duluth, attended the gala and declared the first week of march to be “duluth bone marrow donor registration Week” in recognition of the students’ efforts and the importance of their mission.

The Bone Marrow Registry Drives at UMD were headed by PDIII Maggie Kading, who took the lead in initiating and organizing the events, in conjunction with the efforts of CSS student Bingshuo Li, experienced in organizing successful BMDRDs . Ruth Leathers, student services coordinator at the College of Pharmacy in Duluth and MPSO advisor, played a critical role in assisting the students with the considerable task of organizing three BMDRDs and the fundraising Gala . Student pharmacists who dedicated their time as members of the 2011 Twin Ports BMDRD include Kading (PDIII), Yohannes Woldemichael (PDIII), Akua Appiah-Num (PDIII), Steve Turner (PDIII), Lisa Herron (PDIII), Rachel Dugan (PDIII), Brandon Burk (PDIII), Laura Palombi (PDIII), Prasanna Narayanan (PDII), Sarah Shuster (PDII), Aklilu Beyene (PDII), and Souk Phaengkhouane (PDI) .

Thank you to everyone who volunteered, registered, donated money, or helped in any other way to make the Bone Marrow Registry Drives and the Be the Missing Piece Gala this year a suc-cess! We really appreciate your enthusiasm and support .

1DKMS (Deutsche Knochenmarkspenderdatei gGmbH) is the German Bone Marrow Donor Center established in Germany in 1991 . The orga-nization expanded to the United States in 2004 and currently 2 .7 million bone marrow donors are registered .

Duluth Mayor Don Ness joins Student Pharmacist Maggie Kading and CSS Student Bingshuo Li in declaring the first week of March “Duluth Bone Marrow Donor

Registration Week”

student PersPective


why regisTer as a bone marrow donor?While family members are usually used as bone marrow donors, only 30 to 40% of patients needing a bone marrow transplant have a compatible donor in their family. As more people become part of the registry, the chances of saving the life of someone in need of a bone marrow transplant increase.

does iT hurT?The registration process is painless. It requires some paperwork followed by an inside-the-cheek swab. If you are asked to donate, the donation method is determined by the patient’s doctor. Most bone marrow donations can be done through a blood draw.

does iT cosT anyThing?There is no cost to you to register or donate bone marrow.

who is needed?EVERYONE between the ages of 18 and 55. Individuals with these backgrounds are especially needed: Black or African Ameri-can, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Is-lander, Hispanic or Latino, and mixed race.

will i be selecTed as a donor?The chance that you will be asked to actu-ally donate bone marrow depends on your tissue type. About one out of 200 regis-trants will donate, while only four in 10 patients will receive a donation.

where can i geT more informaTion?DKMS Americas Web site: http://www.dkmsamericas.org.Information on the donation process:http://www.dkmsamericas.org/bone-marrow-donors/bone-marrow-donation-process.

Twin Ports BMDRD Commitee members Steve Turner and Yohannes Woldemichael at the Miller Hill Mall BMDRD.

Twin Ports BMDRD Committee members Aklilu Beyene and Lisa Herron at the UMD BMDRD.

student PersPective


127th Annual Meetingof the Minnesota Pharmacists Association

June 10-12, 2011 at Maddens Resort 11266 Pine Beach Peninsula • Brainerd, MN 56401

Learn, Relax, Enjoy in Northern Minnesota with MPhA!

Join us in Brainerd for the 2011 MPhA Annual Meeting and Conference!We are excited to bring to you our 127th Annual Meeting! Set in the scenic Brainerd area, this year’s meeting will take place at Madden’s on Gull Lake.

Another strong educational program! You will also find opportunities to interact with other pharmacy professionals to further develop your network connections, or reconnect with old friends.

This information can also be found on our Web site, and I encourage you to visit our Annual Meeting link for additional information and resources.

We can’t wait to see you in June — return your registration today!

Brent Thompson, Pharm.D. MPhA President

What to BringCamera • Sunscreen • Bug Spray • Comfortable Shoes

Dress for the conference is casual/resort casual. The evenings can be cool, and so can the ses-sion rooms, so pack a light sweater or jacket. For the President’s Banquet, many dress on a business/semi-formal level. Men may choose to wear a nice shirt and slacks or a suit. Women may want to consider a nice dress set or slacks and blouse. Please feel free to dress at your own comfort level.

Friday CE• Traditional and Evolving Roles of Vitamin D • Scanning the Medication Therapy Management Horizon • Update on Laws and Rules Related to Pharmacy Practice • Emergency Preparedness: Lessons Learned and Future

Direction

Saturday CE• Maximizing Your Diabetes Marketplace• Pharmacist Role in Accountable Care Organizations • The Minnesota Research and Practice Innovation Forum • Diabetes Management

∙ Self Monitoring of Blood Glucose in Patients with Diabetes

∙ Managing Infections in Patients with Diabetes ∙ Insulin Pumps and Sensors, and Continuous Glucose

Monitoring & Artificial Pancreas

Sunday CE:• Healthcare Reform: Opportunities for Pharmacy and the

Importance of Advocacy


June 10-12, 2011 at Maddens Resort 11266 Pine Beach Peninsula • Brainerd, MN 56401

mpha registration2011 annual meeting/conference

Full Weekend: Friday, Saturday & Sunday

Program/Non member $385 MPhA Member $285 Pharmacy Student Member $215

Friday only: CE, Break, Dinner & Opening Reception Program/Non member $175 MPhA Member $125 Pharmacy Student Member $90

Saturday only: CE, Break, Meals & Banquet Program/Non member $225 MPhA Member $175 Pharmacy Student Member $135

Sunday only: CE, Break & Honors Brunch Program/Non member $125 MPhA Member $100 Pharmacy Student Member $65

NAMe OrgANizAtiON

AddreSS

City StAte ziP

PhONe: hOMe wOrk Cell eMAil (required fOr eveNt CONfirMAtiON)

MPha PayMent by: Check visa Mastercard discover

If paying by credit card, all fields below are required.

CArdhOlder NAMe (PriNt)

CArd NuMber SeC COde exP

CArdhOlder SigNAture

billiNg AddreSS (if differeNt thAN AbOve)

additional gueSt(S) I will be bringing a guest(s) with me to the following events: (Do not include yourself)

friday bbq 12 & Under: $20 x ___; Adult: $40 x ___; = $_________ friday Opening reception 12 & Under: $10 x ___; Adult: $25 x ___; = $_________ Saturday breakfast 12 & Under: $13 x ___; Adult: $18 x ___; = $_________ Saturday lunch/exhibit hall 12 & Under: $13 x ___; Adult: $25 x ___; = $_________ Saturday President’s banquet 12 & Under: $20 x ___; Adult: $50 x ___; = $_________ Sunday honor’s brunch 12 & Under: $15 x ___; Adult: $30 x ___; = $_________

iF you have SPecial dietary needS, PleaSe liSt here: _____________________________________ _____________________________________________________________________________________________

MPF Student education Fund your 100% tax deductible donation to the Minnesota Pharma-cists foundation will reimburse student registration and housing costs, supporting our future pharmacists and leaders.

full ($215) day ($105) Other ____

enclosed is an additional check payable to the Minnesota Pharmacists foundation.

Session handouts will be available electron-ically on the MPhA website. Attendees will be notified one week before the conference of their availability.

if you prefer a printed set of handouts to be provided for your use at the conference, please check the box below:

i am requesting printed handouts for an additional charge of $5.

event registration = $__________

additional guests = $__________

Printed handouts = $__________

MPha total = $_________

Mail or Fax ForM back to MPha:

1000 Westgate Drive, Suite 252 • St. Paul, MN 55114 651-290-2266 fax • www.mpha.org • Questions? 651-697-1771 • 800-451-8349

initialsdate

CK/CCamt. paid

bal. due

fin.(For office use only)

Please do not email credit card information. fax or mail your registration form to protect this information.

Late Registration: All registrations received after May 20, 2011 will be charged a $25 late fee.


YOUR TWO NIGHT, LODGING ONLY PACKAGE RATES ARE: The package rates listed above include lodging, use of 3 sand beaches, 5 swimming pools, saunas, whirlpools, fitness room, business center, service charge and 6.875% MN State Sales tax. Madden’s Golf Courses; Pine Beach East, Pine Beach West and the Social 9 are offered at a special conference rate. ROOMS: Reservation and housing requests will not be accepted or honored without payment. Any reservation requests received after April 26, 2011 will be accepted on a space available basis only. Online Reservations: Go to https://reservations.ihotelier.com/crs/g_reservation.cfm?groupID=523379&hotelID=73976 Pre/Post Stays: The Association’s contracted daily rate will be honored 3 days pre conference as well as 3 days post conference for all attendees, subject to availability. Call Madden’s to make an extended reservation.

OCCUPANT 1- ADDITIONAL OCCUPANTS

Single occupancy_____Double_____Accessible_____

Name Mr/Ms_____________________________________________ Name Mr/Ms______________________________________________

Company ________________________________________________ Children’s names & ages____________________________________

Address ________________________________________________ ________________________________________________________

City ______________________________State_______Zip________ ________________________________________________________

Daytime phone___________________________________________ ________________________________________________________

Email __________________________________________________ ________________________________________________________

Credit card number VISA or MASTER ________________________________________________________

____________________________________________Exp________

Amount to be debited $__________________

PAYMENT INFORMATION: Full package payment is required at time of reservation request. When a credit card is used for a reservation request, it must be valid and will be charged the required amount when the reservation is processed. We accept VISA or MASTERCARD. Checks made out to MADDEN’S ON GULL LAKE are acceptable and must accompany the reservation request form. Vouchers and Purchase orders are not accepted for payment. All guests must present a credit card at check-in. Mail This Form To: MADDEN’S ON GULL LAKE, 11266 Pine Beach Peninsula, Brainerd, MN 56401. Call Reservations at 800-642-5363 or FAX to 218-829-7698. A credit card is required for payment on all phone and fax requests.

CANCELLATION POLICY: You are responsible for your entire stay; early departures or reservation reductions are not refundable. Package payments are refundable minus a $25.00 cancellation fee if you cancel by May 10, 2011. Any cancellations made after May 10, 2011 will not receive a refund. (Replacements are gladly accepted.) Reservations made after the deadline are non-refundable. Reservation made by _______________________________________________Phone ________________________Date _____________________

MADDEN’S RESERVATION REQUEST DEADLINE: May 10, 2011 Check in time: 4:30 PM Check out time: 11:00 AM

MN Pharmacists Assn Arrival: Friday, June 10, 2011 #7215 Departure: Sunday, June 12, 2011

Deluxe Hotel Rooms ______$390.84 Per Unit

Premium Units and Cabins ______$464.58 Per Unit

Luxury Golf Suites ______$562.90 Per Unit

Join the Partnership

i am aPPlYing as (choose one): With the exception of Associate Members, you must have completed pharmacist educational requirements. ANNUALLY MONTHLY

Active Pharmacist . . . . . . . . . . . . . . . . . . . . . . $395 . . . . . $33 Retired Pharmacist . . . . . . . . . . . . . . . . . . . . . $145 . . $12 .50 Out-of-State Member . . . . . . . . . . . . . . . . . . $230 . . $19 .50 Associate Member (non-pharmacist) . . . . . . . $295 . . . . . $25 2nd or 3rd Year Resident/Graduate Student . $130 . . . . . $11 1st Year Practitioner/Resident/Grad Student . . $25 . . . . N/A 2nd Year Practitioner . . . . . . . . . . . . . . . . . . . $200 . . $16 .70 Technician Associate . . . . . . . . . . . . . . . . . . . . $55 . . . . N/A MPSA Student . . . . . . . . . . . . . . . . . . . . . . . . . $25 . . . . N/A

Full Name (Mr/Ms/Dr): ________________________________________________

Address: ____________________________________________________________

City: __________________________________ State: ________ Zip: ___________

Phone: _________________________ Preferred Fax: _________________________

Preferred E-mail: ______________________________________________________

Birth Date: ___________________________ Male Female

College Attended: _____________________________________________________

Year Graduated: _________ Degree(s): _____________________________________

Board License Number: __________________________________________________

Please Send Mail To: Residence Business

Business Name: ________________________________________________________

Business Address: _______________________________________________________

City: ______________________________________ State: _______ Zip: ___________

Business Phone: ____________________________

www.mpha.org

PaYment: i am PaYing in full

Check Credit Card

i am PaYing bY montHlY debit Savings: Account #___________________________ Routing #___________________________ Checking: Attach voided check

i am PaYing bY credit card (All credit card fields are required) Visa Mastercard Discover

Card Number:________________________________________Expiration Date:________Security Code: _______

Cardholder Signature: __________________________________

Cardholder Address Same as above

Address: ________________________________________City: ________________ State: _____ Zip: _________

academies Your primary Academy is included in membership. Please select your setting:

Academic Chain Management Community Hospital Independent-Owner Industry Long-Term Care/Consultant Managed Care Medication Therapy Management Technician

mail or fax back to: Minnesota Pharmacists Association • 1000 Westgate Drive, Suite 252 • St. Paul, MN 55114 651 .290 .2266 fax • 800.451.8349 mn • 651-697-1771 metro

Serving Minnesota pharmacists to advance

patient care.

fin.

(For office use only)

initialsdate

CK/CCamt. paid

bal. due

the upper Midwest’s independent healthcare distributor

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fax (763) 421-0661 www .dakdrug .com

spring 2011 minnesota pharmacist

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