the kentucky pharmacist vol. 10, no. 1

Vol. 10, No. 1 January 2015

TTTHEHEHE KKKENTUCKYENTUCKYENTUCKY

PPPHARMACISTHARMACISTHARMACIST

News & Information for Members of the Kentucky Pharmacists Association

Membership

Matters

in YOUR

KPhA

Get

Involved

Stay

Involved

January 2015

THE KENTUCKY PHARMACIST 2

Table of Contents

Table of Contents

Table of Contents— Oath— Mission Statement 2 President’s Perspective 3 2014 Bowl of Hygeia Winners 4 Retirements and New Beginnings 5 From your Executive Director 6 APSC 8 Technician Review 9 Jan. 2015 CE — Diabetes Care Update 10 January Pharmacist/Pharmacy Tech Quiz 16 KPhA Emergency Preparedness 17 Advocating for Our Profession: A Student Perspective 18 Continuing Education Article Submission Guidelines 19

2015 KPhA Professional Awards 20 Pharmacy Time Capsules 23 Hub on Advocacy 24 In Memoriam 25 2015 Kentucky Legislative Session 26 Kentucky Renaissance Pharmacy Museum 27 KPhA New and Returning Members 28 Pharmacy Law Brief 32 Pharmacy Policy Issues 34 Pharmacists Mutual 36 Cardinal Health 37 KPhA Board of Directors 38 50 Years Ago/Frequently Called and Contacted 39

Oath of a Pharmacist

At this time, I vow to devote my professional life to the service of all humankind through the profession of

pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy

outcomes for the patients I serve.

I will keep abreast of developments and maintain professional competency in my profession of pharmacy.

I will embrace and advocate change in the profession of pharmacy that improves patient care.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

Kentucky Pharmacists Association

The mission of the Kentucky Pharmacists

Association is to promote the profession of

pharmacy, enhance the practice standards of the

profession, and demonstrate the value of pharmacist

services within the health care system.

Editorial Office:

© Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association.

Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email [email protected]. Website http://www.kphanet.org.

The Kentucky Pharmacy Education and Research

Foundation (KPERF), established in 1980 as a non-profit

subsidiary corporation of the Kentucky Pharmacists

Association (KPhA), fosters educational activities and

research projects in the field of pharmacy including career

counseling, student assistance, post-graduate education,

continuing and professional development and public health

education and assistance.

It is the goal of KPERF to ensure that pharmacy in Kentucky

and throughout the nation may sustain the continuing need

for sufficient and adequately trained pharmacists. KPERF will

provide a minimum of 15 continuing pharmacy education

hours. In addition, KPERF will provide at least three

educational interventions through other mediums — such as

webinars — to continuously improve healthcare for all.

Programming will be determined by assessing the gaps

between actual practice and ideal practice, with activities

designed to narrow those gaps using interaction, learning

assessment, and evaluation. Additionally, feedback from

learners will be used to improve the overall programming

designed by KPERF.

January 2015


It is hard to believe that

2014 has come to a close.

Where did the year go? I

think this is a good time to

give thanks for our blessings

from the past year, focus on

the present and look forward to the new year and new be-

ginnings.

The past year has been a significant one for me and one to

give many thanks, both on a personal and professional lev-

el. In June, I was installed as the President of YOUR KPhA.

It is a significant honor. It is hard to believe that I am half

way through my term as President. October saw the cele-

bration of my one year anniversary as Corporate Director of

Pharmacy at Baptist Health after having served as Director

of Pharmacy at Baptist Health Louisville for more than 25

years. In November, my wife (Janice) and I became first

time grandparents with the birth of Robert Shelton Oakley

III (We will call him Shelton.). By the time this article is pub-

lished, our son Rob and his wife Amanda will have complet-

ed their move from Baltimore to Louisville, which is even

more exciting! Just as I have had reason to be thankful for

these many blessings in the past year, I think each of you

will be able to find similar significant events in your life this

past year for which to give thanks. I would hope that each

of you would take time from your busy lives to pause for

your own moment of personal reflection. I hope that you will

be able to consider yourself as blessed as I find myself to

be. I also believe that this is a good time for reflection and

remembrance of those who are no longer with us, but they

were a special part of our lives.

The present sees the start of a new calendar year and a

new legislative year. YOUR KPhA once again will be look-

ing to champion legislation that advances the profession of

pharmacy. We will be introducing a bill again this year to

make changes to the Collaborative Care Agreement to the

Pharmacy Practice Act. We came very close to getting this

legislation passed last year. KPhA has developed a new

strategy for 2015, which we hope will succeed. Once the

bill is filed, KPhA will be sending out contact information for

the members of the legislature. It is important to our suc-

cess that you personally contact your representative and

senator to let them know you support this bill. On the na-

tional level, a new Congress will start as well. Congress-

man Brett Guthrie from Kentucky has again filed his bill to

give health care provider status to pharmacists. Through

the efforts of YOUR KPhA and its members, five out of the

six Congressmen from Kentucky signed on as co-sponsors

of the bill in 2014. There were over 120 co-sponsors of the

bill in 2014. Hopefully, this momentum will carry into 2015.

As the Protector of the Pharmacy Act, YOUR KPhA will

continue to monitor proposed legislative and regulatory pro-

posals, including but not limited to work on compliance is-

sues with the previously enacted MAC transparency legis-

lation, to support efforts to advance medication synchroni-

zation initiatives for patients and to support naloxone pre-

scribing by pharmacists.

Looking forward into 2015, there are many exciting activi-

ties besides legislative initiatives that YOUR KPhA is work-

ing on. First, Bob McFalls and I have started a dialogue

with the presidents of the local associations to see what

KPhA can do to help them. The goal is to create stronger

local associations, which in turn will help to make KPhA a

stronger state wide organization. Secondly, our member-

ship committee, led by KPhA President-Elect Chris Clifton,

continues to focus on new ways to attract new members to

KPhA and retain existing members. If you have an idea that

you would like to share with us on how KPhA can better

serve YOU, our member, please let us know.

The third area to look forward to in the coming year is the

subject I first mentioned in the November issue of The Ken-

tucky Pharmacist, our KPhA Rebuilding for the Future

Campaign. In my article, I looked back at the first 50 years

of YOUR KPhA building and the efforts of the members to

get the job done. I think we benefit when looking forward by

looking back first to see where we have been. Now it is

time to look to the future and to start planning for the next

50 years. The key insight for me so far has been that if we

want to be successful in our campaign, we have to take

time to do it right. The first step is to contact other state

PRESIDENT’S

PERSPECTIVE

Robert Oakley

KPhA President

2014-2015

President’s Perspective

Continued on Page 7

Past, Present Future

January 2015


2014 Bowl of Hygeia Recipients

January 2015


Retirements and New Beginnings

Congrats on Retirement!

Long-time Board of Pharmacy inspector Phil Losch

retired at the end of 2014. He was recognized by

2014 Board President Cathy Hanna and Executive

Director Mike Burleson at the Board’s December

meeting. His son, Andrew, and wife, Julie, helped

celebrate.

Also at the Board’s January meeting, Burleson

announced he will retire, effective August 1.

Pharmacy TAC

orientation

YOUR KPhA provided

orientation materials to the

members of the reinstated

Pharmacy Technical Advisory

Committee. Members are: Rob

Warford, Cindy Gray, Suzanne

Francis, Christopher Betz and

Jeff Arnold (not pictured).

President Bob Oakley and

Roamey welcomed the group.

Information will be added to

the Event Listing at

www.kphanet.org soon!

Hotel information is online now at

www.kphanet.org/?page=AnnualMeeting

January 2015


From Your Executive Director

MESSAGE FROM YOUR

EXECUTIVE DIRECTOR

Robert “Bob” McFalls

It’s hard to believe that not only is it January 2015, but the

month and year are already moving far too quickly. As we

begin a new year, I like to pause and to hear the words of

T.S. Eliot ringing out:

What we call the beginning is often the end, and to

make an end is to make a beginning. The end is

where we start from… For last year's words belong

to last year's language and next year's words await

another voice (Little Gidding).

The advent of a new year brings a time of resolve whereby

we sort the “old” and ponder the “new” as we reflect on

what has passed and think about what we might possibly

accomplish in beginning a new chapter of our life’s journey.

For many of us, it is a time for “new” resolutions accompa-

nied by equal determination to improve ourselves either

personally and/or professionally. And these principles are

easily adaptable to renewing our commitment to causes we

care about as we endeavor to serve our patients as well as

to help others. History informs us that one can trace the

origins of resolutions back to the ancient Babylonians who

made promises at the start of each year. Likewise, during

the medieval period, knights would reaffirm their “peacock

vows” at the end of the Christmas season as they renewed

their commitment to chivalry. Various cultures over time

have adapted the resolution process accordingly, and our

media-driven culture has certainly done its share to engage

us in looking at how we might improve ourselves as we en-

ter into a new year and its cycle of life.

Resolutions, promises and oaths come in a number of

forms in terms of eliciting our response, commitment and/or

covenant. Our forefathers believed so much in honor that

they mutually pledged to each other in the Declaration of

Independence “…our Lives, our Fortunes and our Sacred

Honor.” Reflections during the recent holiday season led

me on a personal journey to my Scouting days with Lincoln

County BSA Troop 91. As a Scout, Assistant Scoutmaster

and Scoutmaster, I learned and taught others to do our best

at all times and in all places — indeed it is our honor and

duty as a part of our oath — and in so doing to leave the

world a better place than we found it. I find strong parallels

here to the work that pharmacists do on a daily basis, and

to your oath, in terms of devoting one’s self to a lifetime of

service to others.

Gallup released its annual Honesty and Integrity Survey in

December, and we all read with humility and gratitude how

pharmacists continue to maintain your high ranking of trust-

worthiness. Pharmacists continue to hold the second posi-

tion — behind only nurses and tied with medical doctors.

The exact question asked by Gallup is as follows: “Please

tell me how you would rate the honesty and ethical stand-

ards of people in these different fields – very high, high,

average, low or very low?” For pharmacists and medical

doctors, 65-percent said “very high” or “high.” The survey

measures the public’s trust of diverse professions, including

but also well beyond healthcare, and the findings reaffirm

the remarkable trust that patients have with their pharma-

cists. It is central to your oath; moreover, being accessible

and providing meaningful service is highly valued by your

patients and/or their caregivers.

During the holiday season, we also were reminded about

how our giving can help others at all levels — whether we

give through charitable donations, direct assistance or with

our one-on-one volunteer efforts, we are often the ones

who receive the benefit. Indeed, in this spirit of giving, we

are reminded that giving also is beneficial for the giver’s

well-being, mentally and physically. The giver finds his or

her own reward in giving. As cited by the Health Hub from

the Cleveland Clinic (12/2/14), studies find these health

benefits associated with giving: lower blood pressure; in-

creased self-esteem; less depression; lower stress levels;

greater happiness; and, longer life overall. The Health Hub

goes on to report, “Biologically, giving can create a “warm

glow,” activating regions in the brain associated with pleas-

ure, connection with other people and trust. In a 2006

study, researchers from the National Institutes of Health

The Rewards of Giving

January 2015


From Your Executive Director

The Kentucky Pharmacist is online!

Go to www.kphanet.org, click on Communications

and then on The Kentucky Pharmacist link.

Would you rather receive the journal electronically?

Email [email protected] to be placed on the Green list for electronic delivery.

Once the journal is published, you will receive an email

with a link to the online version.

Watch eNews and

subsequent editions

of The Kentucky

Pharmacist for more

information on ways

YOU can help

rebuild YOUR KPhA

Headquarters!

associations and learn from their fund raising efforts. We

have received information from Ohio and Virginia, who had

recent campaigns to build new offices. We have learned a

significant amount of information in a short period of time.

The first step will be the formation of a Building Fund De-

velopment Committee. This committee will help determine

funding needs, help set a fund raising goal and recognition

for those who contribute to our Rebuilding for the Future

fund. Once we have established these basic steps, we can

proceed to the next phase of the campaign. If you are inter-

ested in serving on this Committee, please contact KPhA

and let us know. We would love to have you serve. Thank

you for your efforts to Get Involved/Stay Involved through-

out the New Year!

Continued from Page 3

studied the functional MRIs of subjects who gave to various

charities. They found that giving stimulates the mesolimbic

pathway, which is the reward center in the brain, releasing

endorphins and creating what is known as the ‘helper’s

high.’ And like other highs, this one is addictive, too.”

The heart of any resolution is our individual resolve. As we

continue to advance the profession, in this new year and in

the years to come, let’s recommit to do so, remembering

the words of a fellow Kentuckian, Muhammad Ali, who said,

“Service to others is the rent you pay for your room here on

earth.” We thank you for all that you do with and for your

profession. If you would like to get more involved with

YOUR KPhA, President Bob Oakley and I would love to

hear from you!

January 2015


APSC

January 2015


Technician Review

KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost.

FREE

CE

KPhA Member Pharmacy Technicians

The mission of the KPhA Academy of Pharmacy Technicians is:

To unite the pharmacy technicians throughout the Commonwealth to have one

voice toward the advancement of our profession.

To follow what is currently happening with your profession please read our

newsletter articles and become involved.

For more information contact Don Carpenter via email at [email protected]

Technician Review From the KPhA Academy of Technicians

Happy New Year from the Academy members. We hope

that everyone had a safe and happy holiday season.

During the New Year, the Academy will continue to recruit

new members to increase our foot print in the Common-

wealth and strengthen our voice. We look forward to anoth-

er year of growth within our KPhA organization.

Currently, we are attending the Kentucky Board of Pharma-

cy’s Advisory Council meetings to try and advance the

pharmacy technician profession. We have requested that

KPhA change the membership fee requirements for stu-

dents attending a pharmacy technician education program

and will hear something back from them very soon. Our

members continue to be eligible for up to 10 hours of on-

line technician specific continuing education provided by

the Collaborative Education Institute.

National changes to be aware of this year include the deci-

sion for PTCB requiring technician specific continuing edu-

cation for 2015. The PTCB also has decided not to require

a mandatory criminal background check, but does still re-

quire full disclosure during the application process. Addi-

tional changes for 2015 include the reduction of permitted

CE’s obtained through in-services from 10 to 5 hours and

will decrease to zero hours in 2018. Upcoming changes for

2016 include a reduction in the college/university course-

work hours from 15 to 10 hours. PTCB is still on track to

require completion of an ASHP/ACPE accredited pharmacy

technician education program before applying for the certifi-

cation exam by 2020.

A quick review of what it will take to recertify. Any certified

pharmacy technician recertifying in 2015 must have one

hour of continuing education in law and one hour in medi-

cation safety as part of the 20 hours. Any CE’s acquired in

2015 must be technician specific.

If you have any questions for the KPhA Pharmacy

Technician Academy or if you are interested in joining

the Academy please contact Don Carpenter

at [email protected].

mailto:[email protected]

January 2015


Jan. 2015 CE — Diabetes Care Update

Diabetes Care Update By: Heather M. Bryan, Pharm.D candidate, Irina Yaroshenko, Pharm.D candidate, and Holly L. Byrnes, Pharm. D.,

BCPS, Jonathan S. Hayes, Pharm.D., BCPS, Sarah Raake, Pharm.D., LDE Sullivan University College of Pharmacy

There are no financial relationships that could be perceived as real or apparent conflicts of interest.

Universal Activity # 0143-0000-15-001-H01-P&T

2.0 Contact Hours (0.2 CEU)

Goal: To aid pharmacists in distinguishing and understanding the updates in diabetes care to deliver optimal evidence-based care for diabetic patients.

Objectives

At the conclusion of this article, the reader should be able to:

1. Discuss the recent main updates in diabetes care. 2. Define the rationale for the revisions in the clinical practice recommendations for diabetes care. 3. Describe the impact of the major updates on clinical practice. 4. Discuss the place in therapy for the new and emerging medications for the treatment of diabetes.

KPERF offers all CE

articles to members

online at

www.kphanet.org

Introduction

Diabetes care is continuously advancing as new evidence

emerges. It is imperative for pharmacists to stay informed

on the most up-to-date information to provide ideal diabetes

care. This past year, information and guidelines surround-

ing diabetes were updated and this article provides an

overview of the updates in diabetic care. Some of the topics

that will be discussed within the diabetes realm include: a

review of obesity management, antihyperglycemic thera-

pies, glycemic control goals and new antidiabetic agents.

Obesity Management

In the spring of 2013, the American Association of Clinical

Endocrinologists (AACE) published a new Comprehensive

Diabetes Management Algorithm.1 The AACE stresses the

importance of managing obesity because of the immense

prevalence in the United States. According to the Centers

for Disease Control and Prevention, more than 1/3 of adults

in the United States are clinically obese, and their medical

costs are over $1,400 higher than those of normal weight.2

The AACE has provided a thorough, step-by-step approach

to managing obesity instead of looking at BMI by recom-

mending management for overweight or obese patients that

focuses on obesity-related comorbidities which are classi-

fied into two categories: cardiometabolic disease and bio-

mechanical complication. The AACE classifies a BMI of

27kg/m2 to <30 kg/m

2 overweight and a BMI of ≥30 kg/m

2

clinically obese.1

Along with the AACE, The American Heart Association

(AHA)/American College of Cardiology (ACC) Task Force

on Practice Guidelines and The Obesity Society (TOS)

published guidelines for the Management of Overweight

and Obesity in Adults in November of 2013. These guide-

lines still use BMI and waist circumference to classify over-

weight and obese patients while also identifying the risks of

CVD, type 2 DM and all-cause mortality that is associated

with obesity. The AHA/ACC/TOS classifies a BMI of >25.0-

29.9kg/m2 as overweight.

3

As in previous guidelines, lifestyle modifications are recom-

mended for all overweight and obese patients. Also phar-

macological and surgical interventions can be considered

for patients with comorbidities. Orlistat was the only drug

approved when the AHA/ACC/TOS obesity guidelines were

developed so only a general statement is discussed stating

that FDA-approved medication for weight loss can be rec-

ommended for individuals with a BMI ≥30 kg/m2 or ≥27 kg/

m2 with at least one obesity-associated comorbidity.

3 These

therapeutic interventions for obesity management should

overall be considered and recommended for the treatment

of all levels of diabetes severity including pre-diabetes, dia-

betes and metabolic syndrome.

Currently, in terms of pharmacological options, there are

four medications available for weight loss (Table 1): orlistat

and phentermine for short-term treatment (<3 months) and

lorcaserin and phentermine/topiramate extended release

for chronic use which are considered the newer anti-obesity

agents becoming FDA-approved for weight management in

2012. Orlistat is available both as an over the counter and

prescription while phentermine is only available by prescrip-

tion. Although both have been approved by the FDA, their

use has been less than anticipated due to their side-effect

profiles while both lorcaserin and phentermine/topiramate

ER have their place in diabetes therapy recognized by the

AACE obesity algorithm. It is important to note that locaser-

in and phentermine/topiramate ER are recommended as

adjuncts to lifestyle modification (reduced-calorie diet and

January 2015



increased physical activity).4

Lipid Management

In November 2013, the ACC/

AHA published new guide-

lines on the treatment of

blood cholesterol with some

major changes.7 The old lipid

guidelines, the Adult Treat-

ment Panel III (ATP III) of the

National Cholesterol Educa-

tion Program, recommended

a specific LDL-C and/or non-

HDL-C goals for different risk

groups.8 The new ACC/AHA

lipid guidelines recommend

the removal of the treat-to-

target approach for multiple

reasons. One, because the

treat-to-target paradigm does

not consider the potential ad-

verse effects from multidrug

therapy required to achieve

the lipid target. Also, the AC-

C/AHA used randomized con-

trol trials (RCTs) and found

that CVD events were re-

duced by using the maximum

tolerated statin therapy but

there were no RCTs proving

that the titration of drug thera-

py to specific LDL-C and/or

non-HDL-C goals led to im-

proved CVD outcomes.7

Instead of the treat-to-target

approach, the ACC/AHA lipid

guidelines have identified four

statin benefit groups (Table 2)

and categorized statins into

different intensities (Table 3).

The ACC/AHA lipid guideline

recommends moderate-

intensity statin therapy for

most patients with diabetes and high-intensity statin thera-

py for patients with diabetes and estimated 10-year CVD

risk ≥7.5 percent.7 Please note that it is important to choose

an appropriate intensity of statin therapy as patients with

diabetes have shown high residual CVD risk due to inade-

quate intensity of statin therapy. In addition, non-statin drug

therapies such as fibrates, ezetimibe, niacin and bile acid

sequestrants are not recommended for CVD prevention.

These lipid lowering agents provide no significant benefit

when compared to the risk from adding these therapies.

Glycemic Goals

The 2013 AACE algorithm continues to support an A1C

goal of ≤6.5 percent for patients who are young, healthy

and without comorbid disease states who have a low hypo-

glycemic risk. In patients with a comorbid disease state

Table 1

Name Lorcaserin (Belviq) Phentermine/topiramate ER (Qsymia)

Dosing/ Administration

10 mg ORALLY twice daily Discontinue at week 12 if 5 percent weight loss has not been achieved; Max 20 mg/day

Initially: phentermine 3.75mg/ topiramate 23mg orally once daily for 14 days Maintenance: phentermine 7.5mg/ topiramate 46mg orally once daily; after 12 weeks at maintenance dose, if weight loss is not at least 3 percent of baseline, discontinue or escalate dose

Contraindica-tions/ Precau-tions

Pregnancy Avoid in patients with severe renal impairment (CrCl <30 ml/min)

Concomitant use with MAOI therapy or within 14 days of discontinuation of MAOI Glaucoma Hyperthyroidism Pregnancy

Side Effects Headache, back pain, nausea, dry mouth, constipation, hypoglycemia, cough and fatigue

Constipation, Xerostomia, Insomnia, paresthesia, Nasopharyngitis, upper respiratory infection

Clinical Teaching Advise patient to avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, confusion and somnolence

Drug may cause decreased visual acuity and/or cognitive impairment. Patient should avoid driving or other activities requiring clear vision, mental alertness or coordination until drug effects are realized

Source 5,6

Table 2

High- Intensity Statin Therapy (Lowers LDL-C by ~ ≥50 percent)

Moderate- Intensity Statin Therapy (Lovers LDL0C by ~30 to <50 percent)

Atorvastatin 40-80mg Atorvastatin 10mg

Rosuvastatin 20mg Rosuvastatin 10mg

Simvastatin 20-40mg

Pravastatin 40mg

Lovastatin 40mg

Fluvastatin XL 80mg

Fluvastatin 40 mg BID

Pitavastatin 2-4mg

** Once-daily doses unless otherwise specified. Source 7

January 2015



who are at risk for hypoglycemia are recommended to have

an individualized A1C goal which can be >6.5 percent.1

This along with patient preference and life expectancy are

other ways that the AACE algorithm uses the complications

-centric approach to the care of overweight/obese patients.

These in addition to BMI assessment and obesity severity

have proven to be beneficial.

In relation to the AACE algorithm, The American Diabetes

Association (ADA) provides more detailed guidelines on

A1C goals. Their recommendation is an A1C of <7 percent

for most patients, <6.5 percent for lower-risk patients with a

short disease duration, long-life expectancy and absence of

CVD, and <8 percent for higher-risk patients with a short-

life expectancy, history of severe hypoglycemia, serious

complications and multiple comorbid conditions.9 Since

these medical organizations have some differences in rec-

ommendations, it’s important to recognize them and apply

them in clinically appropriate settings where one recom-

mendation may fit better than the other. Something else

that is important to note, all organizations (ADA, AACE al-

gorithm, and AHA/ACC/TOS) recommend that each patient

should be managed with individualized goals that take the

patients age, comorbidities and hypoglycemia risk into con-

sideration.

Antihyperglycemic Therapy

In terms of A1C goals for patients with diabetes, the AACE

algorithm is very adaptable to make sure each patient has

individualized care. When discussing recommendations on

antihyperglycemic pharmacotherapy, the AACE algorithm

is much more specific. Four goals are identified, in addition

to lifestyle modifications that should be considered in re-

gards to hyperglycemic therapy.1

1. Avoid hypoglycemia

2. Avoid weight gain in persons who are obese and assist

them with weight loss

3. Achieve clinical and biochemical glucose targets; and

4. Reduce or avoid increasing CVD risk

With these goals in mind, AACE established a Glycemic

Control Algorithm and Profiles of Antidiabetic Medications.1

A1C is divided into three categories (<7.5 percent, 7.6 - 9

percent, >9 percent) with a correlation of progression in

disease state with worsening A1C levels. These also are

considered AACE’s recommended starting points for thera-

py. In brief, antihyperglycemic therapy advances from sin-

gle drug therapy to dual therapy, triple therapy and insulin

therapy with or without additional agents. To clarify from

the previous statement, patients do not have to go through

three oral therapies prior to starting insulin. For example,

insulin will almost always be initiated with an A1c of >9 with

symptoms because the patient will not obtain a 3+ drop in

A1C with oral therapies alone. Also, the risk associated

with the endpoint is always considered so if the patient’s

A1C goal is higher than others with <8, insulin may not be

needed.

The AACE algorithm recommends metformin as first-line

therapy, which is in agreement with the ADA.9 After metfor-

min, incretin-based therapies (GLP-1 agonists and dipep-

tidyl peptidase-4 (DPP-4) inhibitors are placed above oth-

ers in the hierarchy because they are widely accepted in

diabetes care because of their effectiveness but their use is

still limited in certain populations because of cost and route

of administration. GLP-1 agonists also have shown to have

more of an A1C-lowering effect and weight loss benefit

compared to DPP-4 inhibitors making them prioritized over

DPP-4 inhibitors in the AACE algorithm.8.

Both have mech-

anisms of action that are favorable compared to other

agents such as stimulating insulin secretion, reducing glu-

cagon secretion and promoting satiety while also being rel-

atively safe with regards to side-effect profiles compared to

sulfonylureas or glinides. Sulfonylureas and glinides have

common side effects such as weight gain and increased

hypoglycemia risk which makes them disadvantageous and

are thus considered to be the last line of therapy in the

AACE algorithm.1 Although, all these appealing characteris-

tics lean toward GLP-1 agonist, as pharmacists, we need to

consider they are injectable while DPP-4 inhibitors are tab-

lets which can effect medication adherence and gastroin-

testinal side effects (nausea/vomiting) are more commonly

seen with GLP-1 agonists.10

Although sulfonylureas and glinides have fallen out of fa-

vor, the TZD class is holding steady in the hierarchy. Their

mechanism of improving insulin sensitivity without stimulat-

ing insulin release and increasing risk of hypoglycemia

helps them to hold their own. The ADOPT trial tested the

glycemic durability of rosiglitazone, metformin and gly-

buride as monotherapy. The trial concluded that TZDs

seem to be more durable in controlling glycemic levels in

Table 3

Statin Benefit Groups

Individuals with clinical Arteriosclerotic cardiovascular disease (ASCVD)

Individuals with primary elevvations of LDL-C ≥190 mg/dL

Individuals 40-75 years of age with diabetes with LDL-C 80-189 mg/dL

Individuals without clinical ASCVD or diabetes who are 40-75 years of age with LDL-C 70-189 mg/dL and an estimated 10-year ASCVD risk of 7.5 percent or higher Source 7

January 2015



comparison of the other two, giving the TZD class another

incentive for use.9 In November 2013, the FDA officially

required the removal of prescribing and dispensing re-

strictions on rosiglitazone after finding out that the recent

data showed no increased risk of heart attack compared to

metformin and sulfonylureas.12

The side effect profile of

TZDs including weight gain, fluid retention leading to wors-

ening or inducing heart failure and increased risk of bone

fractures are all reasons limiting the use of TZDs in clinical

practice.1

The 2013 AACE algorithm gives specific guidelines on the

addition or intensification of insulin in patients with type 2

diabetes. For patients with A1C >9 percent, the presence of

diabetic symptoms usually determines whether or not to

initiate insulin therapy. A symptomatic patient along with

whether or not the patient is experiencing these while al-

ready on two non-insulin antidiabetic agents also are con-

sidered because adding a third or fourth antidiabetic agent

is less likely to bring down a patients A1C to target range.

As stated earlier, patients with an A1C >9 who are sympto-

matic are generally started on insulin therapy. Also, AACE

guidelines suggest that non-insulin antidiabetic therapies

be continued while initiating basal insulin with the exception

of sulfonylureas and glinides. These increase the risk of

hypoglycemia in conjunction with insulin and should be dis-

continued.1 The ADA/EASD statement differs reading that

when basal insulin is initiated, sulfonylureas and glinides be

continued or reduced to prevent loss of control during the

titration period.9

The algorithm also recommends basal insulin at a starting

dose of 0.1-0.2 unit/kg for patients with A1C ≤8 percent and

a dose of 0.2-0.3 unit/kg for patients with A1C >8 per-

cent.This starting dose of basal insulin can be titrated up

every two to three days to achieve a fasting blood glucose

<110 mg/dL. If hypoglycemia occurs, the basal insulin can

be reduced by 10 – 20 percent for glucose levels <70 mg/

dL and by 20 – 40 percent for severe hypoglycemia with a

blood glucose level of <40 mg/dL.1

Hypoglycemia and weight gain are associated with insulin

therapy. Intensifying the regimen in patients with sympto-

matic hyperglycemia and an A1C that is not at goal to a

basal-bolus insulin regimen is an option but the AACE algo-

rithm recommends strong consideration be given to a regi-

men of basal and incretin-based therapy to avoid these

serious adverse effects. This recommendation is based off

a clinical trial that showed the addition of a GLP-1 agonist,

exenatide, to basal insulin decreased A1C by 1.74 percent

while the placebo group only decreased A1C by 1.04 per-

cent and the addition of a DPP-4 inhibitor showed great

A1C reduction compared to the placebo group (difference:

0.41 percent, P <0.0001) with neutral effects on hypoglyce-

mia and weight gain.13,14

The New Kids in Town

In March 2013, the US Food and Drug Administration

(FDA) approved canagliflozin (Invokana) for the treatment

of Type 2 Diabetes. It is the first drug approved in the Unit-

ed States belonging to a new class of drugs called sodium-

glucose cotransporter 2 (SGLT2) inhibitors. The SGLT2

inhibitors lower the renal threshold for glucose and in-

crease urinary glucose excretion by interfering with the re-

absorption of renally-filtered glucose. Compared to

glimepiride (Amaryl), a 100 mg dose of canagliflozin

worked as well as glimepiride. Also, in patients already tak-

ing metformin and a sulfonylurea, 300 mg daily of canagli-

flozin lowered A1C as well as sitagliptin (Januvia) which is

commonly prescribed.15,16

The usual starting dose of

canagliflozin is 100 mg daily, taken before the first meal of

the day. For people who tolerate the drug well with few side

effects and who generally have good kidney function, the

dose can be increased to 300 mg daily if necessary. With

that being said, people with severe kidney dysfunction

should avoid canaglifozin entirely.

In addition to better diabetes control, there are several oth-

er advantages with the use of canagliflozin. Weight loss is

one of the positive attributes with patients losing 2 – 4 per-

cent of their body weight while taking 300 mg of canagli-

flozin daily for six months in clinical trials. Another benefit

during the clinical trials was that the drug lowered systolic

blood pressure between 2 mmHg and 8 mmHg along with

the rarity of hypoglycemic episodes. The most commonly

seen adverse effects of canagliflozin (occurring in more

than 5 percent of patients) are related to the genitourinary

tract. Vaginal yeast infections occur in approximately 10

percent of women who took canagliflozin and urinary tract

infections occurred in more than 5 percent of study partici-

pants. Other common negative side effects seen were vagi-

nal itching, thirst, constipation, nausea and abdominal

pain.15

As of June 2014, the U.S. Food and Drug Administration

approved a rapid-acting inhaled insulin to improve glycemic

control in adults with diabetes mellitus: Afrezza (insulin hu-

man) Inhalation Powder.17

Afrezza is administered at the

beginning of each meal and is not a substitute for long-

acting insulin. Afrezza must be used in combination with

long-acting insulin in patients with type 1 diabetes, and it is

not recommended for the treatment of diabetic ketoacido-

sis, or in patients who smoke. It should not be used in pa-

tients with asthma or chronic obstructive pulmonary dis-

January 2015



ease (COPD) because of the acute bronchospasm that has

been observed in patients with those disease states.17

A total of 3,017 participants – 1,026 participants with type 1

diabetes and 1,991 patients with type 2 diabetes – were

evaluated on the drug’s safety and effectiveness.17

The

Afrezza efficacy at mealtime was compared to mealtime

insulin aspart (fast-acting insulin) and both in combination

with basal insulin (long-acting insulin) in a 24 week study.

The treatment provided for type 2 diabetes patients in com-

bination of Afrezza with oral antidiabetic drugs showed a

mean reduction in HbA1c that was statistically significantly

greater compared to the HbA1c reduction observed in the

placebo group. Unfortunately, Afrezza provided less HbA1c

reduction than insulin aspart in type 1 diabetes patients,

and the difference was statistically significant. Four more

post-marketing studies are required by FDA on Afrezza.17

Conclusion

Diabetes care will forever be changing as new drugs and

guidelines continue to emerge with the new evidence found

from clinical trials. It is important as a pharmacist to stay up

to date with these guidelines so that we can effectively

practice evidence-based medicine with our diabetic patient

base.

References

1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE

comprehensive diabetes management algorithm 2013.

Endocr Pract. 2013;19:327-336.

2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence

of obesity in the United States, 2009-2010. NCHS Data

Brief. 2012 Jan;(82):1-8.

3. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/

ACC/TOS guideline for the management of overweight

and obesity in adults: a report of the American College

of Cardiology/American Heart Association task force

on practice guidelines and The Obesity Society. Circu-

lation. Published online November 12, 2013.

4. Colman E, Golden J, Roberts M, et al. The FDA’s as-

sessment of two drugs for chronic weight manage-

ment. N Engl J Med. 2012;367:1577-1579.

5. Belviq (lorcaserin)[package insert]. Woodcliff Lake, NJ:

Eisai Inc; 2012.

6. Qsymia (phentermine and topiramate extended-

release) [package insert]. Mountain View, CA: VIVUS,

Inc; 2012.

7. Stone NJ, Robinson J, Lictenstein AH, et al. 2013 AC-

C/AHA Guideline on the Treatment of Blood Cholester-

ol to Reduce Atheroscleotic Cardiovascular Risk in

Adults. Journal of the American College of Cardiology

(2013), doi: 10.1016/j.jacc.2013.11.002.

8. Grundy SM, Cleeman Jl, Merz CN, et al; National

Heart, Lung, and Blood Institute; American College of

Cardiology Foundation; American Heart Association.

Implications of recent clinical trials for the National

Cholesterol Education Program Adult Treatment Panel

III guidelines. Circulation. 2004;110:227-239.

9. Inzucchi SE, Bergenstal RM, Buse JB, et al. Manage-

ment of hyperglycemia in type 2 diabetes: a patient-

centered approach: position statement of the American

Diabetes Association and the European Association for

the Study of Diabetes. Diabetes Care. 2012;35:1364-

1379.

10. Deacon CF, Mannucci R, Ahrén B. Glycemic efficacy

of glucagon-like peptide-1 receptor agonists and dipep-

tidyl peptidase-4 inhibitors as add-on therapy to sub-

jects with type 2 diabetes- a review and meta analysis.

Diabetes Obes Metab. 2012;14:762-767.

11. Kahn SE, Haffner SM, Heise MA, et al; ADOPT study

group. Glycemic durability of rosiglitazone, metformin,

or glyburide monotherapy. N Engl J Med.

2006;355:2427-2443.

12. US Food and Drug Administration. FDA Drug Safety

Communication; FDA requires removal of some pre-

scribing and dispensing restrictions for rosiglitazone-

containing diabetes medications. http://www.fda.gov/

drugs/drugsafety/ucm376389.htnm.Published Novem-

ber 25, 2013. Accessed July 15, 2014.

13. Buse JB, Bergenstal RM, Glass LC, et al. Use of twice-

daily exenatide in Basal insulin-treated patients with

type 2 diabetes: a randomized, controlled trial. Ann

Intern Med. 2011; 154:103-112.

14. Barnett AH, Charbonnel B, Donovan M, et al. Effect of

saxagliptin as add-on therapy in patients with poorly

controlled type 2 diabetes on insulin alone or insulin

combined with metformin. Curr Med Res Opin.

2012;28:513-523.

15. Cefalu WT, Leiter LA, Yoon KH, et al. Efficacy and

safety of cangliflozin versus glimepiride in patients with

type 2 diabetes inadequately controlled with metformin

(CANTATA-SU): 52 week results from a randomized,

double-blind, phase 3 non-inferiority trial. Lancet. 2013

Sep 14;382 (9896):941-50.

16. G Schernthaner, JL Gross, J Rosenstock, et al.

Canagliflozin compared with sitaglitin for patients with

January 2015



tpe 2 diabetes who do not have adequate qlycemic

control with metformin plus sulfonylurea: a 52-week

randomized trial. Diabetes Care. 2013;10:2337-2344.

17. US Food and Drug Administration. FDA approves

Afrezza to treat diabetes. June 27, 2014; modified June

30, 2014. http://www.fda.gov/newsevents/newsroom/

pressannouncements/ucm403122.htm Accessed Au-

gust 11, 2014.

January 2015 — Diabetes Care Update

1. Which statin listed below is considered a high-intensity statin and can lower a patient’s LDL-C by about ≥ 50 per-cent? A. Rosuvastatin 10mg B. Rosuvastatin 20mg C. Simvastatin 20mg D. Simvastatin 40mg 2. Which of the following is NOT a contraindication for the use of Qsymia? A. Pregnancy B. Hyperthyroidism C. Glaucoma D. CrCl <15ml/min 3. The recommended A1C for higher-risk patients with a short-life expectancy, history of severe hypoglycemia and multiple comorbid conditions is ______. A. < 7 percent B. < 6.5 percent C. < 8 percent D. < 5 percent 4. Which of the following medications is associated most with side effects of constipation, xerostomia, insomnia, paresthesia, nasopharyngitis and upper respiratory infec-tion? A. Qsymia B. Atorvastatin C. Belviq D. Lovastatin 5. Afrezza is NOT recommended for the treatment of dia-betes in which of the following patients? A. A patient with a history of COPD B. A patient just diagnosed with type 1 diabetes currently

on a long-acting insulin C. A type 2 diabetic patient with gout D. A healthy type 2 diabetic patient

6. Which side effect is most commonly associated with canagliflozin? A. Vaginal itching B. GI side effects C. Dizziness D. Fatigue 7. Which class of medications below does the AACE algo-rithm recommend after metformin for the treatment of dia-betes? A. Insulin B. DPP-4 C. Sulfonylureas D. Glinides 8. Which class of medications works by lowering the renal threshold for glucose and increasing urinary glucose ex-cretion by interfering with the reabsorption of renally-filtered glucose? A. Sulfonylureas B. GLP-1 agonists C. SGLT2 inhibitors D. Insulin 9. Orlistat and phentermine are approved for use up to ___ months. A. 3 B. 6 C. 9 D. 12

The February 2015 continuing education article will

be in the March issue of The Kentucky Pharmacist.

January 2015



This activity is a FREE service to members of the Kentucky Pharmacists Association. The

fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South,

Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.

The Kentucky Pharmacy Education & Research Foundation is

accredited by The Accreditation Council for Pharmacy

Education as a provider of continuing Pharmacy education.

Quizzes submitted without NABP eProfile

ID # and Birthdate cannot be accepted.

PHARMACISTS ANSWER SHEET January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________

Personal

NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD)

Expiration Date: January 30, 2018 Successful Completion: Score of 80% will result in 2.0 contact hour or 2.0 CEU.

Participants who score less than 80% will be notified and permitted one re-examination.

TECHNICIANS ANSWER SHEET. January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________ Personal

NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD)

January 2015


KPhA Pharmacy Emergency Preparedness

KPhA Pharmacy Emergency Preparedness Initiative Interest Form

Name: ______________________ Status (Pharmacist, Technician, Other): ___________________

Email: ______________________________ Phone: ___________________________

Interest in serving as a volunteer: Yes____ No ____

Interest in serving as a Volunteer District Coordinator: Yes____ No _____

You also may join the Medical Reserve Corps by following the KHELPS link on KPhA Website to register

(www.kphanet.org under Resources)

Please send this information to Leah Tolliver, KPhA Director of Pharmacy Emergency Preparedness via email at

[email protected], fax to 502-227-2258 or mail at KPhA, 1228 US 127 South, Frankfort, KY 40601.

For more Emergency

Preparedness Resources, visit

www.kphanet.org, click on

Resources and Emergency

Preparedness.

Emergency Preparedness Training YOUR KPhA has developed two emergency preparedness

training programs for the KPhA Pharmacy Volunteers that

will be available online in the next few weeks. Watch

eNews for more information on these programs.

Also, KPhA Director of Pharmacy Emergency Prepared-

ness, Leah Tolliver, is developing a new CE program that

will roll out this winter and spring at our local organizations

about preparing your pharmacy in the event of a disaster.

These tips and procedures will be relevant to all pharma-

cies including retail, hospital, long term care and com-

pounding. If you are interested in seeing this program at

your local organization meeting, contact your local leader

or KPhA! Please contact Leah to present at your district

meeting, or to schedule a meeting in your area if there is

no active district.

This program also will be offered at the 137th KPhA Annual

Meeting and Convention June 25-28, 2015 in Bowling

Green!

January 2015


Advocating for our Profession

My name is Caroline Beaulieu, and I am a third-

year pharmacy student at the University of Ken-

tucky College of Pharmacy. I have been a mem-

ber of the Kentucky Alliance of Pharmacy Stu-

dents since my first semester in pharmacy

school, and I continue to value my professional

membership with various pharmacy organizations, includ-

ing the Kentucky Pharmacists Association. I am eager for

new opportunities to advance the professional practice of

pharmacy and promote pharmacists’ role as direct patient

care providers.

This past summer, I had the honor to be selected to com-

plete the American Society of Health-System Pharmacists

(ASHP) Summer Internship. As a member of the Patient

Access to Pharmacists’ Care Coalition (PAPCC), ASHP is

one of the national professional associations actively in-

volved in the pursuit of Provider Status, with headquarters

located in our nation’s capital. Supporting patient access to

pharmacists’ services and expanding pharmacists’ role in

healthcare represent a few of their priorities. I participated

in a 10-week long training program designed to provide

experience in various aspects of pharmacy including pro-

fessional and public affairs, medication information, publi-

cations and governmental affairs.

Throughout my internship, I had the opportunity to work on

several projects related to pressing issues currently faced

by the profession of pharmacy. I participated in collabora-

tive efforts aimed at advancing patient care. I worked

alongside leaders to develop various resources for stu-

dents, residents and residency program directors, create a

classification scheme to rank states according to their de-

gree of provider status, work on the Pharmacy Practice

Model Initiative (PPMI) and participate in a visit with Con-

gressional staff to advocate for provider status. In an effort

to help implement the latest philosophies of pharmacy lead-

ership, I also wrote an article for the AJHP student column

to help pharmacy students maximize their potential to

PPMI.

I highly value the experience I gained throughout my intern-

ship. Not only did it expand my understanding of provider

status but it also motivated me to start advocating for our

profession. After I realized the impact I could have as a

student in supporting the expansion of pharmacists’ role, I

became determined to take another step forward. In Sep-

tember, I decided to go back to Washington, D.C. to partici-

pate in ASHP’s legislative day with the Kentucky delega-

tion. I was able to meet with Congress members and their

staff to speak about the education that we receive as stu-

dents and how it qualifies us to offer a broader range of

clinical services upon graduation.

My experience at the national level was an incredible eye-

opener. It made me realize part of what I can do as a stu-

dent to help expand the role of pharmacists and have the

services we provide recognized under Medicare Part B. I

now have a better appreciation for the importance of advo-

cating for our profession to promote what pharmacists can

offer to improve patient outcomes. As I move forward with

my career, I plan on continuing to apply what I learned to

keep pharmacy unified and help take our place on the

health care team. I will remain politically active both

throughout the remaining of my time in pharmacy school

and beyond graduation to keep advancing the professional

practice of pharmacy. I highly encourage everyone in our

profession to join political efforts aimed at advancing col-

laborative care in Kentucky and provider status at the Fed-

eral level. Together, we can help others understand our

essential role on the healthcare team and help optimize

patient care.

Advocating for

Our Profession: A

Student’s

Experience at the

National Level

While in Washington, DC, Caroline (far right) met with U.S. Rep. Andy

Barr from Kentucky. Also pictured are Dr. Kelly Smith, Dr. Michelle

Fraley and Alexis Kjellsen (PY4).

January 2015


The following broad guidelines should guide an au-

thor to completing a continuing education article for

publication in The Kentucky Pharmacist.

Average length is 4-10 typed pages in a word pro-

cessing document (Microsoft Word is preferred).

Articles are generally written so that they are per-

tinent to both pharmacists and pharmacy techni-

cians. If the subject matter absolutely is not perti-

nent to technicians, that needs to be stated clearly

at the beginning of the article.

Article should begin with the goal or goals of the

overall program – usually a few sentences.

Include 3 to 5 objectives using SMART and meas-

urable verbs.

Feel free to include graphs or charts, but please

submit them separately, not embedded in the text

of the article.

Include a quiz over the material. Usually between

10 to 12 multiple choice questions.

Articles are reviewed for commercial bias, etc. by

at least one (normally two) pharmacist reviewers.

When submitting the article, you also will be

asked to fill out a financial disclosure statement to

identify any financial considerations connected to

your article.

Articles should address topics designed to narrow

gaps between actual practice and ideal practice in

pharmacy. Please see the KPhA website

(www.kphanet.org) under the Education link to see

previously published articles.

Articles must be submitted electronically to the KPhA

director of communications and continuing education

([email protected]) by the first of the month pre-

ceding publication.

YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT!

Continuing Education Article Guidelines

CE Article Guidelines

January 2015


2015 KPhA Professional Awards

2015 KPhA Professional Awards Bowl of Hygeia Award Criteria – To recognize an individual who has demonstrated outstanding community service in pharmacy. Eligibility – The recipient must be an Active or Honorary Life member of the Association. The recipient must be a pharmacist with a current valid license to practice in Kentucky. The recipient must be living, awards are not present-ed posthumously. The recipient has not previously received the award and is not currently serving nor has he/she served within the past two years on the selection committee or as an officer of the Association in other than ex-officio capacity. The recipient has compiled an outstanding record of community service that apart from his/her specific identifications as a pharmacist reflects well on the profession. Bowl of Hygeia Previous Recipients Jerry White 2014 Leon Claywell 2013 George F. Hammons 2012 William I. McMakin, III 2011 Kim Croley 2010 Patricia Thornbury 2009 Dave Peterson 2008 Charles Fletcher 2007 Gloria Doughty 2006 Larry Hadley 2005 Harold Cooley 2004 Brian Fingerson 2003 Simon Wolf 2002 Richard Ross 2001 Tom Houchens 2000 Phil Losch 1999 Lucy Easley 1998 Nick Schwartz 1997 Michael Cayce 1996 Bill Borders 1995 Gerald Deom 1994 Kenneth Calvert 1993 Joseph G. Bessler 1992 Michel A. Burleson 1991 Lynn Harrelson 1990 William A. Conyers, Jr. 1989 Daniel R. Kovar, Jr. 1988 Martin W. Nie 1987 Ralph Schwartz 1986 Dwaine K. Green 1985 W. Vance Smith 1984 Richard L. Roeding 1983 William J. Farrell, Sr. 1982 Joseph L. Scanlon 1981

Joseph T. Elmes, Jr. 1980 H. Joe Russell 1979 Alvin R. Bertram 1978 Norman C. Horn 1977 H. Joseph Schutte 1976 D.H. "Sonny" Ralston 1975 Arthur G. Jacob 1974 James M. Brockman 1973 Richard E. Murray 1972 Randolph N. Smith 1971 Oliver E. Mayer 1970 Donald C. Morwessel 1969 James Phillip Arnold 1968 William D. Morgan 1967 Ernest M. Davis 1966 W.F. Bettinger 1965 Arvid E. Tucker 1964 Vernon B. Hager 1963 Sidney Passamaneck 1962 John H. Voige 1961 E. Crawford Meyer 1960 James J. Hamilton 1959

Distinguished Service Award Criteria- To recognize individual mem-bers who have made significant contri-butions to the Association or the pro-fession at large over an extended peri-od of time. Eligibility – Only Active or Honorary Life members of the Association shall be eligible for the award. No individual shall be a recipient of the award more than once. Distinguished Service Award Previous Recipients William Grise & Judy Minogue 2014 Catherine Hanna 2013 Glenn Stark 2012 Kenneth Roberts 2011 Ann Amerson & Lynn Harrelson 2010 Larry Hadley 2009 Dwaine Green 2008 John Brislin 2007 Donnie Riley 2005 Gloria Doughty 2004 Coleman Friedman 2003 Joe Fink III 2002 Melinda Joyce 2002 David Jaquith 1999 R. Paul Easley & Jeff Osman 1998 Ralph Bouvette 1997 Pat Chadwell 1996 Jordan Cohen and Marty Nie 1995 Mike Montgomery 1994 Richard Ross 1993 Thomas Weisert 1991

R. David Cobb 1990 Joseph G. Bessler & Arthur G. Jacob 1989 Paul E. Davis 1988 Norman Horn & Robert E. Lee Sandlin 1987 Joseph V. Swintosky 1986 J.H. (Jack) Voige 1985 Charles T. Lesshafft, Jr. 1984 Jerry Budde 1983 William H. Nie 1982 R.N. (Randy) Smith 1981

Pharmacist of the Year Award Criteria – To recognize a pharmacist for outstanding professional activities undertaken during the current or previ-ous calendar year, which resulted in demonstrable benefit to the profession of pharmacy. Eligibility – Only Active or Honorary Life members of the Association shall be eligible for nominations and receipt of this award. Pharmacist of the Year Previous Re-cipients Jill Rhodes 2014 Trish Freeman 2013 Alyson Schwartz 2012 William Grise 2011 Holly Byrnes 2010 Dave Sallengs 2009 Kelly Smith 2008 Joseph Bickett 2007 Paul Easley 2006 John Anneken 2005 Kim Croley 2004 Ralph Bouvette 2003 David Jaquith 2001 Melinda Joyce 1999 Michael Wyant 1998 Phil Losch 1997 Tom Houchens & Bob Kuhn 1996 Don Ruwe 1995 Mark Edwards 1994 C. Dave Peterson 1993 Brian Fingerson 1992 Martin W. Nie 1991 Judy Minogue 1990 Paul Ruwe 1989 Joseph L. Fink III 1988 Steven R. Adams 1987 William J. Farrell 1986 Harold G. Becker 1985 Dwaine K. Green 1984 R. David Cobb 1983 Richard E. Murray 1982

January 2015



Richard Rolfsen 1981 Gloria H. Doughty 1980 Joseph G. Bessler 1979 Emil Baker 1978 Robert L. Barnett 1977 Joseph L. Scanlon 1976 John B. Anneken 1975 Alvin R. Bertram 1974 Patricia A. Donahue 1973 H. Joseph Schutte 1972 Willard Alls 1971 Joe D. Taylor 1970 Richard L. Ross 1969 Ralph J. Schwartz 1968 George W. Grider 1967 Robert J. Lichtefeld 1966 E.M. Josey 1965 Julius T. Toll 1964 Charles E. Otto 1963 Charles F. Rosenberg 1962 R.N. Smith 1961 E. Crawford Meyer 1960 Charles A. Walton 1959 Ernest C. Williams 1958 George W. Grider 1957 Ray Wirth 1956 Nathan Kaplin 1955 Marion Hardesty 1954

Professional Promotion Award Criteria – To recognize individuals or organizations who have exhibited out-standing efforts to demonstrate the importance of pharmacy as a health care profession, and which promote proper application of pharmacists’ pro-fessional services. Eligibility – Open to persons or organ-izations. Professional Promotion Previous Recipients Cassandra Beyerle 2014 Julie N. Burris & Walgreens Corporation 2013

Sullivan University College of Pharmacy student chapter of APhA-ASP 2012 Lynne Eckmann 2011 Gloria Doughty & Lynn Harrelson 2010 Jordan Covvey 2009 Jeff Mills 2008 Trish Freeman 2007 Sherry DeCuir 2006 Pete Orzali 2005 John Armistead, Don Kupper & Willie Newby 2004 Kroger Pharmacy Mid South Division, Holly Divine, Randy Gaither, Bill Grise & Laura Jones 2003 Jefferson County Academy of Pharmacy, Dean Ken Roberts 2002 Paul Easley, Bob Oakley and Michael Wyant 2001 Judy Minogue 2000 Ralph Bouvette 1999 Rodger Smith, Barbara Woerner, Mary Ann Wyant, and Rick Vissing 1998 Larry Spears 1997 John B. Anneken 1996 Phil Losch 1995 Jordan Cohen 1994 Judy Minogue 1994 Kentucky Academy of Student of Pharmacy 1993 Celeste Flick & Clarence Sullivan III 1988 William H. Nie 1987 Student Kentucky APhA 1986 Northern KY Pharmacists Association 1986

Young Pharmacists of the Year Award sponsored by Pharmacists Mutual Insurance Company Criteria – To recognize a young phar-

macist’s outstanding contribution to the profession and/or community. Eligibility – The recipient must be an Active member of the Association. The recipient must be licensed to prac-tice for nine years or less. The recipi-ent must have a valid, active license to practice in Kentucky. The recipient must have demonstrated participation in a national pharmacy association, professional program(s) and/or com-munity service. Distinguished Young Pharmacist Award Previous Recipients Chris Harlow 2014 Brooke Hudspeth 2013 Stacy Rowe 2012 Aimee Ruder 2011 Karen Hubbs 2010 Matt Martin 2009 Tiffany Self 2008 Angela Parrett 2007 Janet Mills 2006 Alyson Schwartz 2005 Nancy Horn 2004 Jennifer O’Hearn 2003 Karen Altsman 2001 Kim Wilson 1999 Kim Harned 1998 Michael Box 1997 Dan Yeager 1996 Dan Minogue 1995 Pan Haeberlin 1994 Kim Croley 1993 Phillip Sandlin 1992 Jeffrey W. Danhauer 1991 Mark S. Edwards 1990 Susan Murray Kathman 1989 Melinda Cummins Joyce 1987

Nominate your peers today! Email your letter of nomination with any supporting

documents to [email protected] or submit to:

KPhA Awards

1228 US 127 South

DEADLINE IS

MARCH 31!

January 2015



Kentucky Pharmacists Political Advocacy Contribution Form

Name: _________________________________ Pharmacy: ___________________________

Address: _______________________ City: ________________ State: _____ Zip: ________

Phone: ________________ Fax: _________________ E-Mail: __________________________________

Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)

Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601

CONTRIBUTION LIMITS

The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election.

Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.

In-kind contributions are subject to the same limits as monetary contributions.

Cash Contributions: $50 per contributor, per election. Con-tributions by cashier’s check or money order are lim-ited to $50 per election unless the instrument identi-fies the payor and payee. KRS 121.150(4)

Anonymous Contributions: $50 per contributor, per elec-tion, maximum total of $1,000 per election.

(This information is in accordance with KRS 121. 150)

Excellence in Innovation Award Sponsored by Upsher-Smith Laboratories Criteria – To recognize a pharmacist who has demonstrated innovative pharmacy practice resulting in im-proved patient care in the previous year or over an extended period of time. Eligibility – A recipient must be a pharmacist who is an Active or Honor-ary Life member of the Association. A recipient may receive the award more than once. Innovative Pharmacy Practice Award Previous Recipients Brooke Hudspeth 2014 Buddy Wheeler 2013 Lynn Harrelson 2012 James Nash & BC Childress 2011 Lynne Eckmann & Cathy Hanna 2010 Ann Albrecht 2008 Lisa Short 2005 Holly Divine, Amy Nicholas 2004 Judy Minogue 2003 Trish Freeman 2002 Mary Ann Wyant 2001 Joyce Korfhage Rhea 2000

Cathy Edwards 1999 Celeste Flick 1998 Jeanne Zeis 1997 Dave Wren 1996 Preston Art 1995 W. Michael Leake 1994

Technician of the Year Award Criteria – To recognize a Certified Pharmacy Technician for outstanding professional activities. Eligibility – Only active Pharmacy Technician members of the Associa-tion shall be eligible for nomination and receipt of this award. Don Carpenter 2014 Leslie Lochner & Robin Lillpop 2013 Patricia Robinson 2012 Jessica Salmons 2011 Gwen Otter 2010 Lisa Sawvel 2008 Margaret Sinkhorn 2007 Charlotte Bowling 2006 Mary Jane Wathen 2005 Kent Williams 2004 Tammy Newsome 2003 Frank Ray 2002 Jane Woerner 2001

Cardinal Health Generation Rx Champions Award Criteria – This award program recog-nizes excellence in community-based prescription drug abuse prevention at state pharmacy associations. This award honors a pharmacist who has demonstrated outstanding commitment to raising awareness of the dangers of prescription drug abuse among the general public and among the pharma-cy community. The award is also in-tended to encourage educational pre-vention efforts aimed at patients, youth and other members of the community. In addition to the award, to honor the pharmacist’s work to fight prescription drug abuse, APMS, state pharmacy associations and the Cardinal Health Foundation will donate $500 to a chari-ty of the award recipient’s choice. Cardinal Health Generation Rx Champions Award Past Recipients Amber Cann 2014 Raymond Float 2013 Brian Fingerson 2012

January 2015


Pharmacy Time Capsules

By: Dennis B. Worthen, PhD,

Cincinnati, OH

One of a series contributed by the

American Institute of the History of

Pharmacy, a unique non-profit society

dedicated to assuring that the contribu-

tions of your profession endure as a

part of America's history. Membership

offers the satisfaction of helping contin-

ue this work on behalf of pharmacy, and

brings five or more historical publica-

tions to your door each year. To learn

more, check out: www.aihp.org

1990 OBRA 1990 passed. States required to offer prospective and retro-spective DUR. Patient counseling mandatory for Medicaid patients. Society of Infectious Diseases Pharmacists founded. 1965 Title XVIII and XIX (Medicare and Medicaid) passed. Quaalude (methaqualone Rorer) named to invoke the phrase “quiet interlude” was approved. The drug was discontinued in 1985 because of its addictive-ness and recreational use. 1940 Ida M. Fuller became the first person to receive an old-age monthly benefit check under the new Social Security law. 1915 Abraham Flexner refused to do a study of pharmacy similar to his study of medical education. He describes pharmacy as “nonprofessional because it is unintellectual, highly profit motivated, without a technique of its own and with-out a primary responsibility.”

Pharmacy Time Capsules

January 2015


hubonpolicyandadvocacy

In early August, Stephen Gagnon, PharmD, received a “call

to action” e-mail from APhA to contact his Member of Con-

gress.

A graduate of Albany College of Pharmacy and Health Sci-

ences, Gagnon has been an employee of CVS Health for

more than 14 years, five of those years as a pharmacist. Gag-

non also spends one day a week working at a compounding

facility, is a credentialed HIV pharmacist and is licensed in

both New York and Florida.

APhA’s e-mail was a template letter urging congressional

support for H.R. 4190, the federal bill that would amend Title

XVIII of the Social Security Act to enable patient access to,

and coverage for, Medicare Part B services by state-

licensed pharmacists in medically underserved communities.

“I forwarded it on [to my U.S. representative], not thinking

anything about it. I figured nobody is ever going to read this,

see this. It’s just spam mail, and it will be thrown out,” Gag-

non said in an interview with Pharmacy Today. “But I sent it

anyway because it was the right thing to do for the profes-

sion.”

A week later, the office of Rep. Paul Tonko (D-NY) respond-

ed to the pharmacist.

With support from CVS Health corporate, Gagnon was able

to set up a pharmacy visit from his Member of Congress. On

September 26, Tonko—by then one of the 116 cosponsors

of H.R. 4190—came to one of the busiest pharmacies in the

Albany, N.Y., area.

Community practice site

The Clifton Park CVS/pharmacy store fills 5,000 to 5,200

prescriptions a week for patients in the community. This site

offers many clinical services, including but not limited to drug

utilization reviews and immunizations. The store does not

house an automatic blood pressure machine, so pharma-

cists must manually take the reading, which offers a unique

counseling opportunity outside of the dispensing role.

Asked about the most used service at the practice site, Gag-

non replied, “Pharmacists’ knowledge. Patients take ad-

vantage of how accessible pharmacists are. I can literally be

in the middle of giving a flu shot, and I have a patient coming

up to me. I have to ask them to give me a second to finish

giving the flu shot before addressing their question. We’re so

accessible [that] patients are always coming up to ask their

pharmacist about every medical ailment. We do our best to

provide what we can.”

Interestingly, Gagnon’s answer to the question of the most

underused service was the same. “Pharmacists are overuti-

lized by patients for our knowledge, but underutilized by the

rest of the medical community for what we know and are

able to do,” he said.

Practice equals advocacy

Pharmacy visits are a very strong tool in advocating for the

profession. Pharmacy visits do not require a pharmacist to

be knowledgeable about politics or advocacy. They are an

opportunity to let the passion for patient care speak for

itself.

APhA, through its website at pharmacist.com, can help you

arrange a pharmacy visit. State-specific materials and infor-

mation, in addition to a how-to guide that offers valuable

information, are available at www.pharmacist.com/how-set-

your-pharmacy-visit.

Positive response

Always a supporter of the profession, Tonko officially signed

on to cosponsor H.R. 4190 on September 16. The Member

of Congress told Gagnon that he had been present when

the profession shifted from the 5-year BSPharm to the

PharmD.

“I was glad to have the opportunity to meet with the team at

the Clifton Park CVS and learn more about their operations

and what factors ultimately contribute to their successes,”

Tonko told Today. “Our pharmacists have an important role

to play in our mission to expand access to quality care, but

they need the tools to do so.”

Tonko continued, “That is why I value my work with local

pharmacists to pass H.R. 4190—legislation that would pro-

vide pharmacists across the nation with the tools they need

to improve outcomes, enhance quality and reduce costs in

our health care delivery system.”

hubonpolicyandadvocacy Advocacy 101: How to set up a pharmacy visit Alka Bhatt 2015 PharmD candidate and APhA Extern

Reprinted with permission from the Hub on Policy and Advo-cacy column in the November 2014 issue of Pharmacy To-day (www.pharmacytoday.org). For more information about ways for pharmacists to follow and influence the federal, state, and local processes that are defining the structure of a reformed American health care system, access the Get In-volved section of APhA’s website, www.pharmacist.com. Copyright © 2014, American Pharmacists Association. All rights reserved.

http://www.pharmacytoday.org/

http://www.pharmacist.com/

January 2015


KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA

informed by sending this information to [email protected].

Deceased members for each year will be honored permanently at the KPhA office.

In Memoriam

KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________

Email: ______________________________________________________________

Address: _____________________________________________________________

City: ___________________________________________ State: _________ Zip: ____________

Phone: ________________ Fax: _________________ E-Mail: ______________________________

Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)

Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601

In Memoriam KPhA offers its condolences to the family and friends for longtime member Jack Carver, who passed away Jan. 3,

2015.

Save the Date

137th KPhA Annual Meeting &

Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center

Bowling Green, KY

January 2015


2015 Kentucky Legislative Session

Donate online to the Kentucky Pharmacists Political Advocacy Council!

Go to www.kphanet.org and click on the Advocacy tab for more information about

KPPAC and the donation form.

2015 Kentucky Legislative Session

The 2015 Kentucky Legislative Session began with an organizational week

in early January. This session, which is a short 30-day session,

runs through February and March, with sine die adjournment scheduled for

March 24.

YOUR KPhA will keep you abreast of all of the pharmacy related issues

before the legislature through social media and weekly email updates.

Follow KPhA’s Legislative Advocacy Twitter feed @KPhAGrassroots.

Staff live Tweets committee meetings and general sessions of the

legislature.

Not receiving the Friday Legislative Update? Send your email address to

Scott Sisco at [email protected].

January 2015


In 2009 the Centers for Medicare and Medicaid Services

(CMS) implemented Surety Bond Requirements for sup-

pliers of Durable Medical Equipment, Prosthetics and

Supplies (CMS-6006-F). This ruling requires that each

existing supplier must have a $50,000 surety bond to

CMS.

Pharmacists Mutual Insurance Company, through its

subsidiary PMC Advantage Insurance Services, Inc. d/b/

a Pharmacists Insurance Agency (in California), led the

way to meet this requirement by negotiating the price of

the bond from $1,500 down to $250 for qualifying risks.

To see if you qualify for a $250 Medicare Surety Bond,

or would like information regarding our other products,

please contact us:

Call 800.247.5930 Extension 4260

E-mail [email protected]

Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx

In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.

Pharmacists Mutual Insurance offers Medicare Surety Bond

Kentucky Renaissance Pharmacy Museum

The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's

leading preservation organization for pharmacy.

While contributions of any size are greatly appreciated, the following levels of annual giving have been established

for your consideration.

Friend of the Museum $100 Proctor Society $250

Damien Society $500 Galen Society $1,000

Name______________________________________ Specify gift amount________________________

Address ____________________________________ City____________________Zip______________

Phone H____________________W________________ Email___________________________________

Employer name_____________________________________________________for possible matching gift.

Tributes in honor or memory of_____________________________________________________

Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax

deductible contributions will be mailed to you annually.

Questions: Contact Lynn Harrelson @ 502-425-8642 or [email protected]

For more information on the museum, see

www.pharmacymuseumky.org or contact

Gloria Doughty at [email protected] or

Lynn Harrelson at [email protected].

mailto:[email protected]

http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx

http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx

January 2015


KPhA New and Returning Members

KPhA Welcomes New and Renewing Members

November-December 2014

Jamal Aboulhosn Louisville Donna Adams Sebree Matthew Andrews Fisherville John Anneken Edgewood Paul Arthur Huntington, W. Virg. Heidi Bainer Pedro, Oh Chester Baltenberger Louisville Verlon Banks Whitesburg Stephanie Bargo Lexington Jennifer Barker Morehead Jessica Baugh Shepherdsville Walter Bauman Lancaster Justin Bell Lexington Danny Bentley Russell Thomas Beringer Sparta Robert Bero New Bern, Nc Renee' Blair London Bradley Boone Marion Diana Bowles Sonora

Chris Bowling Barbourville Ngoc Anh Bradshaw Louisville Jackson “Mac” Bray Frankfort Brenda Brewer Stanton Deborah Brewer Sandy Hook Sam Brown Murray William Brown Wingo Charles Bryant Cave City Jimmy Buchanan Prospect Michael Burleson Lexington Scott Burris Partridge Robert Burton Hazard Ashley Calvert Bloomfield Mashawna Caudill Isom John Chaney Hazard Brian Cheek Louisville Janie Cheek Louisville Rebecca Cheek London William Clark Owensboro

Heather Clayton Elkton Richard Clement Cadiz Robert Clement Cadiz Kem Coe Tompkinsville Adam Coffman Nortonville Samuel Coletta Cincinnati, Oh Bonnie Collins Paris Stephanie Collins Corbin George Combs Louisville David Conyer Paducah Karen Cornelius Harrogate, Tn Charlotte Cornett London Melvin Croley Park City Matt Cull Owenton Dan Daffron Monticello William Danhauer Owensboro Marshall Davis Paducah Kecia Dawson Prospect Pamela Decker-Meadows Cynthiana

Laura Dehart Paducah James Denton Georgetown Marie Denton Georgetown John Dickerson Olive Hill Alfred Diebold Louisville Brad Doering Burlington Walter Doll Lexington Kenneth Dove Winchester Ben Doyle Nicholasville Jane Dunbar-Suwalski Longmont, Co

MEMBERSHIP MATTERS:

To YOU, To YOUR Patients To YOUR

Profession!

January 2015



Paul Easley Fisherville Anna Eiler Shepherdsville Joseph Eiler Louisville Suzanne Epley Russellville Frank Facione Louisville William Farmer Henderson Lindsay Ferrell Owingsville Michael Fitch Lexington Lindsey Flanders Bowling Green Matthew Flanders Bowling Green Martha Ford Fort Thomas Larry Fortenberry Pikeville Andy France Covington Virginia France Covington Tom Frazier Salyersville Randy Gaither Louisville Judy Gallagher Madisonville Timothy Gallagher Madisonville Milton Gardner Jeffersontown Eric Gibbs Corbin

Mary Gilvin Mt. Sterling Amy Glaser Alexandria Rosemary Goble Inez Nevin Goebel Winchester Michael Goeing Melvin Wayne Gravitt Wheelwright Gina Guarino Louisville Patty Guinn Somerset Julie Hagan Paducah Cara Hale Inez Eman H. Hammad Louisville Catherine Hance Louisville Robert Haney Bedford Amanda Harding Louisville Ellen Harrison Tompkinsville Marla Helton Frenchburg Clara Herrell Lexington Whitney Herringshaw Winchester Jennifer Hibbs Louisville Linette Hieneman Flatwoods

Robin Hipps New Albany, In Jody Holland Pikeville Sara Holliday Owensboro Celina Howell Pikeville Taryn Howell Prestonsburg Travis Hudnall Smiths Grove Melissa Hudson Villa Hills John Hutchinson Lexington Gerard Hyland Manchester Bernard Hyman Louisville Arthur Jacob Louisville Kyla James Sellersburg, In Amanda Jett Louisville Ella Johnson Hazard Frederick Johnston Georgetown Linda Johnston Georgetown Constance Jones Russell Springs Kimberly Jones Williamsburg Misty Jones Aurora, Il Robin Justice Pikeville

Michael Keller Salem Diane Kelly Evarts Rene Kendrick Taylorsville Melissa Kennon Lexington Anita King Richmond Ethan Klein Louisville James Knight Berea John Knoop Louisville Don Kupper Louisville Richard Lacefield Bowling Green Randall Lange Butler Amanda Leathers Lebanon Teresa Leslie Prestonsburg Martin Likins Greenville Michael Lin Louisville James Litmer Edgewood Robert Little Berea Kay Lloyd Louisville Morris Lloyd Louisville Michelle Loos Covington

January 2015



Sheri Lucas Millstone Mike Lusk Betsy Layne John Lutz Louisville Calvin Manis Barbourville Jonathan Marquess Acworth, Ga Craig Martin Georgetown Samantha Martin Greenville Tom Mattingly Olive Hill Nancy Matyunas Louisville Donald Mays Fort Thomas Thomas McCurry Harlan Leeann McDonald Dunnville Clayton McKinney Shelbyville Michael McWilliams Louisville Beverly Meeks Paducah Ross Melton Mount Sterling Paula Miller Fort Thomas Parvin Mischel Kathleen, Ga Michael Montgomery Nicholasville Jason Moore Corbin

Jennifer Morgan Manchester Megan Morgan Manchester Jerry Morris Louisville Wayne Morris Frankfort Sherri Muha Hazard Stephanie Myers Louisville Edwin Nickell Eddyville Kenneth Niemann Harrodsburg Leanne Nieters Louisville Paul Nixon Tompkinsville Donald Noble Garrison Freddie Norris Glasgow Patricia Oldis Louisville Charles Oliver Glasgow Angela Onkst Louisville Peter Orzali Cold Spring Lauren Otis Owingsville Staci Overby Paducah Yvonne Parmley Florence Duane Parsons Richmond

Kenneth Parsons Louisville Lindsey Peden Bowling Green Alfred Pence Stanford David Peyton West Liberty Ronald Poole Central City David Powers Jenkins Vicky Pulliam Bardstown Jonathon Ratley Henderson Christi Ratliff Pikeville Fran Reasor Pikeville Ronald Renfrow Bowling Green Herbert Rice Grand Rivers Jerry Rickard Madisonville Vendonna Rickard Madisonville Amber Riesselman Louisville Donald Riley Russellville James Robinette London Matthew Robinson Owensboro Lynda Romeo Louisville Jesse Rudd Salyersville

Gary Russell Madisonville Paul Ruwe Covington Wanda Salyer Flat Gap Christen Schenkenfelder Louisville Nicholas Schwartz Florence Benjamin Scott Lexington Ginger Scott Morgantown, W.Virg. Kimberly Scott Frankfort Mary Scott Robinson Creek Terrence Seiter Burlington George Shackleford Corbin Kent Shearer Albany William Shely Morehead Jennifer Shown Hopkinsville Michael Sizemore London Sharon Small Louisville William Smallwood Independence Jamie Smith Booneville Jessica Smith Booneville Sarah Smith Louisville

January 2015



George Snider Bardstown Wayne Sparrow Eminence Larry Spears Crittenden Cathy Spencer Louisville Kelley Spencer Versailles Nancy Stanton Holmes Mill Janet Stephens Scottsville Quincy Stephenson Providence Doris Stone Kevil Cindy Stowe Louisville Amanda Sublett Lexington Clarence Sullivan Richmond Tracy Sullivan Paducah William Sutherland Louisville Evan Sweeney Madisonville Jessica Sweeney Madisonville Meghan Tarter-Marcum Russell Springs

Carolyn Taylor Crestwood David Taylor Crestwood Jason Taylor Pineville Mark Taylor Danville Nicole Thacker Huntington, Wv Paul Thompson Harrodsburg Rick Timmons Paducah Fred Toncray Maysville Sheryl Turley Horse Cave Geanie Umberger Lexington G Underwood Louisville Gabe Van Lahr Webster Joseph Vennari Lexington Benjamin Vice Manchester Frank Vice Flemingsburg Steven Wagers London Nancy Walker Cynthiana

Anthony Warford Clay Rob Warford Goshen Glenn Watson Crestwood Susan Weaks Paducah Stacy Wedeking Metropolis, Il Robert Weir Louisville Clayton Wells Inez Leslie Wells Mt. Sterling Sara Wells Gilbertsville Brian Wesselman Florence William Wheeler Lexington Tyler Whisman Union Jerrold White Russellville Marcia White Richmond Amy Wilder Booneville William Wiley Glasgow Christie Wilkins Lexington

Laura Willoughby Hardinsburg Carol Wills Lexington Randy Windham London Christine Windham London Jessica Wiseman Dayton Denton Wood Grand Rivers Dachea Wooten Hazard Greg Wright Paducah Joseph Wright Lucasville, Oh Navas Yoonus Elizabethtown Laban Young Huntington, W.Virg. Timothy Young Mount Vernon Arnold Zegart Prospect

Know someone who should be on this list?

Ask them to join YOU

in supporting YOUR KPhA!

KPhA Honorary

Life Members

Ralph Bouvette

Leon Claywell

Gloria Doughty

Ann Amerson

Stewart

January 2015


Pharmacy Law Brief

Pharmacy Law Brief: Pharmacy and the “Alford Plea”

Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy

Question: I have seen in news reports some refer-

ence to something called an “Alford Plea” and now a stu-

dent on rotation with me has told me that a reference to that

even appears in Board of Pharmacy regulations. What is

that and why is it important to pharmacists?

Response:

The relevant provisions in Kentucky statutes the student is

referring to are:

K.R.S. 315.121 – Grounds for acting against licensee –

Notification to board of conviction required – Petition for

reinstatement – Expungement

(1) The board may refuse to issue or renew a license, per-

mit, or certificate to, or may suspend, temporarily suspend,

revoke, fine, place on probation, reprimand, reasonably

restrict, or take any combination of these actions against

any licensee, permit holder, or certificate holder for the fol-

lowing reasons:

(c) Being convicted of, or entering an “Alford” plea or plea

of nolo contendere to, irrespective of an order granting pro-

bation or suspending imposition of any sentence imposed

following the conviction or entry of such plea, one (1) or

more of the following:

1. A felony;

2. An act involving moral turpitude or gross immorality; or

3. A violation of the pharmacy, drug or home medical

equipment laws, rules, or administrative regulations of

this state, any other state, or the federal government.

K.R.S. 315.121(4) – Any licensee, permit holder or certifi-

cate holder entering an “Alford” plea, pleading nolo conten-

dere, or who is found guilty of a violation prescribed in sub-

section (1)(c) of this section shall within thirty (30) days no-

tify the board of that plea or conviction. Failure to do so

shall be grounds for suspension or revocation of the li-

cense, certificate or permit.

The Alford plea came into being from a U.S. Supreme

Court ruling in North Carolina v. Alford, decided during

1970. An Alford plea permits a defendant to maintain his

innocence while agreeing to forego his right to a trial. The

Court said that “an individual accused of a crime may vol-

untarily, knowingly and understandingly consent to the im-

position of a prison sentence even if he is unwilling or una-

ble to admit his participation in the acts constituting the

crime.” By using an Alford plea, a defendant does not admit

guilt but concedes there is enough evidence for conviction.

Kentucky is in the majority of states that provide this option

to one charged with a crime. In fact, all states except Indi-

ana, Michigan and New Jersey have adopted it.

When used during a criminal proceeding the courts require

the plea to be of a voluntary nature and based on factual

evidence. The judge will make an effort to determine wheth-

er the defendant is entering the plea of his own choice, and

that there is a factual basis for the plea; this is accom-

plished by questioning the defendant about his choice and

the prosecution about the potential case against the de-

fendant. A court cannot accept an Alford plea unless there

is independent factual evidence of the defendant’s guilt.

Entering an Alford plea is slightly different from pleading

nolo contendere, meaning “no contest.” Under “nolo”, the

defendant neither admits nor disputes the charges but

agrees to being sentenced for commission of the crime.

Once entered, the plea is treated as a standard guilty plea.

An Alford plea is an “adjudication of guilt” and therefore

would have to be reported in response to this question of

the Kentucky Board of Pharmacy’s Pharmacist License Re-

newal Application: “Have you ever been convicted of any

law related to the practice of pharmacy, drugs or controlled

substances that you have not previously reported to the

Board?” Furthermore, an Alford plea can be counted as a

prior sentence under the U.S. sentencing guidelines.

Submit Questions: [email protected]

Disclaimer: The information in this column is intended for

educational use and to stimulate professional discussion among

colleagues. It should not be construed as legal advice. There is

no way such a brief discussion of an issue or topic for education-

al or discussion purposes can adequately and fully address the

multifaceted and often complex issues that arise in the course of

professional practice. It is always the best advice for a pharma-

cist to seek counsel from an attorney who can become thorough-

ly familiar with the intricacies of a specific situation, and render

advice in accordance with the full information.

January 2015


KPhA Save the Date/Connect/ EPIC

@KyPharmAssoc

@KPhAGrassroots

Facebook.com/KyPharmAssoc

KPhA Company Page

Are you connected

to YOUR KPhA?

Join us online!

Save the Date 137th KPhA Annual Meeting & Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY

Visit www.kphanet.org for more information!

January 2015


Pharmacy Policy Issues

PHARMACY POLICY ISSUES: The 340(B) Program Author: Ekim Ekinci is a third professional year PharmD student at the University of Kentucky College of Pharmacy and is

concurrently pursuing a Master of Science in Pharmaceutical Outcomes and Policy. Ekim is a native of Antalya, Turkey. She

earned her Bachelor of Science in Chemistry from Rice University in Houston, Texas and completed post-baccalaureate

coursework and doctoral classes in History of Medicine at University of Houston before starting pharmacy school.

Issue: I’m a community pharmacist and I keep hearing and reading about the 340(B) program, something that did not

exist when I was in pharmacy school. I had the impression that this was a hospital pharmacy issue with no relevance to

community pharmacy practitioners. But a colleague recently told me that was not the case at all. Can you shed some

light on this program, which I assume is a federal program of nation-wide application?

Discussion: The 340(B) Drug Discount Program was

established in 1992 with the enactment of a federal biparti-

san law. The program requires drug manufacturers to pro-

vide outpatient drugs to eligible health care organizations

at significantly reduced prices. The cost savings allow eligi-

ble organizations to stretch their scarce federal resources,

reach more patients in their communities and provide more

comprehensive clinical services to all individuals without

regard to ability to pay. Before delving into the details of

this complex law, it may prove useful to briefly review cer-

tain terminology. These terms include “covered entities,”

“eligible patients” and “covered outpatient drugs.”

The term “covered entities” usually refers to nonprofit

health care organizations that have certain federal designa-

tions or receive funding from specific federal programs, and

are therefore eligible to purchase drugs through the 340(B)

program at discounted prices.

“Eligible patients” are those who are eligible under law to

receive 340(B) covered outpatient drugs. To be eligible, a

patient has to be receiving services from a health care pro-

fessional associated with a covered entity, such that the

responsibility of care remains with the covered entity. How-

ever, if the only health care service received by the patient

through the covered entity is the dispensing of a drug for

self-administration, the patient is not considered eligible.

“Covered outpatient drugs” are any FDA-approved pre-

scription and over-the-counter drugs, and biological prod-

ucts (except vaccines) for which the patient has a prescrip-

tion, as well as clinic-administered drugs.

A complete list of eligible organizations, patient eligibility

requirements and covered outpatient drugs can be found

on Health Resources and Services Administration (HRSA)

webpage3.

At the time of its enactment 340(B) indeed did not apply to

community pharmacy practitioners. However, the law has

been greatly expanded over the years to now allow cov-

ered entities to contract with multiple clinic or community

pharmacies that would normally not be eligible to receive

340(B) discounted drugs. Thus a community pharmacy

practice may now dispense 340(B) covered outpatient

drugs to eligible patients so long as it has a written contrac-

tual agreement with a covered entity, remain compliant with

all federal requirements and maintain auditable records

documenting their compliance.

Contract pharmacies allow a covered entity to reach out to

a broader area. Covered entities will refer their eligible pa-

tients to contract pharmacies, which provides clinic and

community pharmacies with an incentive to become con-

tract pharmacies. While each covered entity may have their

own contract provisions, some may be willing to provide

financial incentives as well.

Both the covered entity and the contract pharmacy carry

the responsibility to ensure against illegal diversion of

drugs obtained under 340(B) pricing to ineligible patients. It

is important for contract pharmacies to ensure 340(B)

drugs are dispensed only to eligible patients of the covered

entity. This may require the pharmacy to keep two separate

inventories, one dedicated only to 340(B) discounted drugs

and the other for drugs purchased at regular market prices.

Covered entities and contract pharmacies also need to en-

sure that Medicaid rebates are not paid on drugs pur-

chased at 340(B) prices. Each state is specific in their Med-

icaid Program requirements to avoid such “duplicate dis-

counts.”

With so many stakeholders involved, it is not surprising that

the 340(B) Drug Discount Program is surrounded by con-

troversies. Stakeholders disagree on the intent of the law,

Have an Idea?:

This column is designed to address timely and practical

issues of interest to pharmacists, pharmacy interns and

pharmacy technicians with the goal being to encourage

thought, reflection and exchange among practitioners.

Suggestions regarding topics for consideration are wel-

come. Please send them to [email protected].

January 2015


Pharmacy Policy Issues

as well as on the definitions introduced by it. The main

conflict, however, seems to stem from a disagreement on

who the law is meant to serve.

According to Safety Net Hospitals for Pharmaceutical Ac-

cess, 340(B) makes safety net providers eligible for the

program, not just uninsured patients. Under the law any

patient of the covered entity may be provided the discount-

ed drugs, without regard to patient’s health insurance sta-

tus. Opponents argue that the law is meant to serve the

uninsured, and therefore 340(B) discounted drugs should

only be provided to uninsured patients of the covered enti-

ty. Opponents suggest that some hospitals use 340(B)

drugs for both insured and uninsured patients, and thus

effectively make money when insurance companies reim-

burse them for these medications at market rates.

Proponents of the law state that Congress’s intent in imple-

menting 340(B) was to reduce costs of eligible organiza-

tions in recognition of their mission to serve low-income

and vulnerable patients. According to their argument, 340

(B)’s purpose has always been to enable hospitals to

stretch their scarce resources without dictating the exact

manner in which the savings should be spent.4 On the oth-

er hand, opponents argue that more control over utilization

of savings is needed, because the intent of 340(B) was to

ensure that discounted drugs are provided to uninsured

patients who cannot afford them, not to those who are in-

sured, and certainly not to hospitals.

Another major argument focuses on taxpayer money. Pro-

ponents of the law argue that 340(B) reduces taxpayer

burden as discounted drugs and expanded clinical services

with the use of 340(B) savings help keep underserved pop-

ulations healthy. The counter argument suggests that

many hospitals do not expand their clinical services, but

rather keep the money as savings for themselves.

The 340(B) Drug Discount Program plays an important role

in supporting those institutions that serve the most vulnera-

ble patients. The law has been and still is a topic of heated

debate due to the many stakeholders involved who do not

agree on how the law should be applied. The only aspect

of 340(B) on which all parties agree is that the rules gov-

erning the program are in need of improvement. One thing

that is for certain is that unless changes are made to the

law to put an end to all the controversies, our most vulner-

able patients’ health will remain at stake.

Individuals who are interested in learning more about the

program are encouraged to check out the 340(B) Universi-

ty,2 an in-depth educational program created by a nonprofit

organization that serves as the exclusive contractor for the

Health Resources and Services Administration’s 340(B)

Prime Vendor Program.

References

1. "340B Drug Pricing Program." 340B Drug Pricing Program.

Health Resources and Services Administration, n.d. Web. 25

Aug. 2014. <http://www.hrsa.gov/opa/>.

2. "340B University." 340B PVP. Apexus Inc., n.d. Web. 10

Sept. 2014. <https://www.340bpvp.com/340b-university/>.

3. "Eligibility & Registration." Eligibility & Registration. Health

Resources and Services Administration, n.d. Web. 5 Sept.

2014. <http://www.hrsa.gov/opa/eligibilityandregistration>.

4. Setting the Record Straight on 340B: A Response to Critics.

N.p.: Safety Net Hospitals for Pharmaceutical Access, July

2013. PDF.

5. Wright, Elizabeth. "What is the 340B Program and Why You

Need to care." What is the 340B Program and Why You

Need to Care. Citizens Against Government Waste, 14 May

2014. Web. 27 Aug. 2014. <http://swineline.org/?p=8853>.

Loyal KPhA member writes from Florida:

Scott, as a follow up of the November article, “New Federal

Legislation Targets International Counterfeiting of Pharma-

ceuticals” by Claire Hafner, could it be possible to expose

those companies that have been counterfeiting, in order

that the public would not be at least dealing with them any-

more??? - Jacob Wishnia

Joe Fink responds for Claire, who is in the middle of

exams as this issue is assembled, with this: Jake's sug-

gestion is a good one but I suspect that the highly devious

individuals who operate such firms would quickly change

the company name to continue operations. The FDA has

taken an active approach, focusing on the medication ra-

ther than the firm, announced by Commissioner Hamburg

this way: "The FDA has systematically ranked more than

1,000 active pharmaceutical ingredients in order of their

respective risk of economically-motivated adulteration,

based on a multi-factorial risk-based model we developed.

A subset of these high-risk ingredients is targeted for addi-

tional sampling and testing at the border.

In addition, FDA is working to reduce the risk that counter-

feit or adulterated drug products reach consumers in the

US market by developing standards for track and trace sys-

tems that enable the identification of these products and

facilitate efforts to recall them."

This product-focused approach is probably a wise one.

We've recently seen reports of counterfeit Cialis®, a drug

product much more likely to be targeted by counterfeiters

than a medication in some other therapeutic categories.

KPhA expresses thanks to Jake for following up his reading

of the article with an insightful question.

January 2015


Pharmacists Mutual

January 2015


Cardinal Health / Generation Rx Champions Award

January 2015


KPhA BOARD OF DIRECTORS

Duane Parsons, Richmond Chair

[email protected] 502.553.0312

Bob Oakley, Louisville President

[email protected]

Chris Clifton, Villa Hills President-Elect

[email protected]

Brooke Hudspeth, Lexington Secretary

[email protected]

Glenn Stark, Frankfort Treasurer

[email protected]

Raymond J. Bishop Past President

[email protected] Representative

Directors

Matt Carrico, Louisville*

[email protected]

Tony Esterly, Louisville

[email protected]

Matt Foltz, Villa Hills

[email protected]

Chris Killmeier, Louisville

[email protected]

Mallory Megee, Nicholasville University of Kentucky

[email protected] Student Representative

Jeff Mills, Louisville

[email protected]

Chris Palutis, Lexington

[email protected]

Christian Polen Sullivan University

[email protected] Student Representative

Richard Slone, Hindman

[email protected]

Mary Thacker, Louisville

[email protected]

Sam Willett, Mayfield

[email protected]

* At-Large Member to Executive Committee

HOUSE OF DELEGATES

Ethan Klein, Louisville Speaker of the House

[email protected]

Chris Harlow, Louisville Vice Speaker of the House

[email protected]

KPERF ADVISORY COUNCIL

Kim Croley, Corbin

[email protected]

Kimberly Daugherty, Louisville

[email protected]

Mary Thacker, Louisville

[email protected]

Matt Carrico, Louisville

[email protected]

KPhA/KPERF HEADQUARTERS

1228 US 127 South, Frankfort, KY 40601

502.227.2303 (Phone) 502.227.2258 (Fax)

www.kphanet.org

www.facebook.com/KyPharmAssoc

www.twitter.com/KyPharmAssoc

www.twitter.com/KPhAGrassroots

www.youtube.com/KyPharmAssoc

Robert McFalls, M.Div.

Executive Director

[email protected]

Scott Sisco, MA

Director of Communications & Continuing Education

[email protected]

Angela Gibson

Director of Membership & Administrative Services

[email protected]

Leah Tolliver, PharmD

Director of Pharmacy Emergency Preparedness

[email protected]

Elizabeth Ramey

Receptionist/Office Assistant

[email protected]

KPhA Board of Directors/Staff

KPhA sends email announcements weekly. If you aren’t receiving: eNews, Legislative

Updates, Grassroots Alerts and other important announcements, send your email address to

[email protected] to get on the list.

January 2015


Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org

Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org [email protected]

American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org

National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 [email protected]

Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222

Frequently Called and Contacted

50 Years Ago/Frequently Called and Contacted

50 Years Ago at KPhA AROUND THE STATE WITH DISTRICT MEETINGS

The Jefferson County Academy of Pharmacy had their dinner dance and installation of of-

ficers January 24th. Joe T. Elmes, R.Ph., is the new President, succeeding William R.

Walker, R.Ph.

The First District had their installation of officers at a dinner dance January 28th. The new

President is Howard Ralston, R.Ph., of Paducah, who succeeds Walter M. Boyett R.Ph., of

Mayfield.

The Second District had their annual party in February with James Lee Gaddis, R.Ph., presiding.

The Fourth District met on January 7th in Russelville for a social hour and dinner. Attending the meeting were several

pre-pharmacy students from Western State College. Dr. William Rowlett, Bowling Green, was the guest speaker and

presented a humorous talk concerning the psychology of medicine from the time the patient enters the doctor’s office

until he receives the prescription. The group plans to meet in Bowling Green in March.

The Northern Kentucky Pharmacists Association met in January as they do every month but we do not have the infor-

mation as we go to press.

Christian County is expecting to have a meeting in Hopkinsville in March in which nearby counties will be invited to at-

tend. The purpose of the meeting is to organize the counties in the surrounding areas into a new district where travel

will not be so great.

- From The Kentucky Pharmacist, February 1965, Volume XXVIII, Number 2.

January 2015


THE

Kentucky PHARMACIST

1228 US 127 South

Frankfort, KY 40601

For more upcoming events, visit www.kphanet.org.

Save the Date

137th KPhA Annual

Meeting & Convention

June 25-28, 2015

Holiday Inn University Plaza and Sloan Convention Center

Bowling Green, KY

Show your Pharmacist Pride with a

KPhA Roamey Window Cling!

$5 — All proceeds benefit

the KPhA Building Fund

Available at the KPhA Online Store www.kphanet.org, click on About Tab, Online Store

the kentucky pharmacist vol. 10, no. 1

Documents

kentucky pharmacy education

profession of pharmacy

field of pharmacy

kentucky legislative

kpha members

pharmacists mutual

trained pharmacists

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