minnesota pharmacist journal january-february 2013

2 Minnesota Pharmacist n January-February 2013

How does your

measure up?Professional Liability

808 Highway 18 W | Algona IA 50511

Coverage BenefitsOur Professional Liability Policy is

specifically designed as excess coverage, yet it can become your first line of defense when

no other coverage is available.

• Additionalprotection for you above that provided by your employer.

• Covered 24hoursaday anywhere in the United States, its territories and possessions, Canada or Puerto Rico.

• Coverscompoundingandimmunizations(if legal in your state).

• On-staff pharmacist-attorneysareavailabletocounsel policyholders.

• Riskmanagementassistance that may reduce pharmacy professional exposure.

ApplyOnline!Go to www.phmic.com,

and choose the Pharmacist Liability Application under

the Online Services tab.

For more information, please contact your local representative:

*Compensated EndorsementNot licensed to sell all products in all states.

Form No. PM PhL 196

Endorsed by*:

Tom Nilsson, CIC, LTCP800.247.5930 ext. 7115

952.949.0617

Sheila Welle, CIC, LUTCF, LTCP800.247.5930 ext. 7110

218.483.4338

Lee Ann Sonnenschein, LTCP800.247.5930 ext. 7148

605.372.3277

Minnesota Pharmacist n January-February 2013 3

Upfront Views and newsPresident’s desk: Transitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

executive’s rePort: Change is Good . . . . . . . . . . . . . . . . . . . . . . . 7

Viewpoint Dandelions and Other Wildflowers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Mail-order pharMacysaving Money — But at what price to the patient? . . . . . . . . . . . . . . 18

clinical issUesFungal Meningitis outbreak: Background and Lessons Learned about Compounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

case-Based clinical Pearls: A Schizophrenic Case Study . . . . . . . . . . 21

Ask the Pharmacist: Frequently Asked Questions about

Continuing Pharmacy Education (CPE) Monitor . . . . . . . . . . . . . . . . . . . . 23

report of drug insert labeling revisions . . . . . . . . . . . . . . . . . . . . . . 25

indUstry newsMarketing the community pharmacist . . . . . . . . . . . . . . . . . . . . . . . . . 27

Pharmd Life: Musings on the Life of a PharmD Candidate . . . . . . . . . . 30

Minnesota newsPharmacy Legislative day: Details and Registration . . . . . . . . . . . . . . . 14

Mpha newsAWARxE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

MPhA Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Pharmacy Time Capsules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Member Profile: Amanda Maderich, PharmD . . . . . . . . . . . . . . . . . . . . . 12

Academy news: Pharmacy Technician Continuing Education . . . . . . . . 33

MPhA Announces Exciting Transitions For 2013 . . . . . . . . . . . . . . . . . . . 35

January-February 2013 Volume 67. Number 1, ISSN 0026-5616INSIDE

On the Cover: Mail-order pharmacySaving Money — But at What Price to the Patient? page 18

Find us on Facebook...Minnesota Pharmacists Association

Must-readfungal Meningitis outbreak: Background & Lessons Learned about Compounding page 16

How does your

measure up?Professional Liability

808 Highway 18 W | Algona IA 50511

Coverage BenefitsOur Professional Liability Policy is

specifically designed as excess coverage, yet it can become your first line of defense when

no other coverage is available.

• Additionalprotection for you above that provided by your employer.

• Covered 24hoursaday anywhere in the United States, its territories and possessions, Canada or Puerto Rico.

• Coverscompoundingandimmunizations(if legal in your state).

• On-staff pharmacist-attorneysareavailabletocounsel policyholders.

• Riskmanagementassistance that may reduce pharmacy professional exposure.

ApplyOnline!Go to www.phmic.com,

and choose the Pharmacist Liability Application under

the Online Services tab.

For more information, please contact your local representative:

*Compensated EndorsementNot licensed to sell all products in all states.

Form No. PM PhL 196

Endorsed by*:

Tom Nilsson, CIC, LTCP800.247.5930 ext. 7115

952.949.0617

Sheila Welle, CIC, LUTCF, LTCP800.247.5930 ext. 7110

218.483.4338

Lee Ann Sonnenschein, LTCP800.247.5930 ext. 7148

605.372.3277


Visit www.mpha.org for more information and registration

Minnesota pharMacists foUndation GoUrMet dinner and wine tastinG eVent

February 9, 2013 | Crowne Plaza, Plymouth

leGislatiVe day February 19, 2013 | Embassy Suites, St . Paul

2013 Mpha annUal conferenceMay 17-18, 2013 | Marriott Minneapolis Northwest, Twin Cities

Mpha Board of directorsExecutive/Finance Committee:

President: Martin Erickson Past-President: Scott Setzepfandt

President-Elect: Jill Strykowski Secretary-Treasurer: Bill Diers

Speaker: Meghan Kelly Executive Vice President: Julie K . Johnson

Rural Board Members: Eric Slindee Jeff Lindoo

Metro Board Members: Cheng Lo

Brittany SymondsAt-Large Board Members:

Tiffany Elton Tim Cernohous

Keri Hager Amy Sapola Jason Varin

Student Representation: Duluth MPSA Liaison: Brittany Novak

Minneapolis MPSA Liaison: Amy HerbransonEx-Officio:

Rod Carter, COP Julie K . Johnson, MPhA MSHP Representative

Pharmacy Technician Representative: Barb Stodola

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

Editor: Julie K . Johnson

Managing Editor, Design and Production: Anna Wrisky

The Minnesota Pharmacist (ISSN # 0026-5616) journal is published quarterly by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St . Paul, MN 55114-1469 . Phone: 651-697-1771 or 1-800-451-8349, 651-290-2266 fax, info@mpha .org . Periodicals postage paid at St . Paul, MN (USPS-352040) .PostMAster: Send address changes to Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St . Paul, MN 55114-1469 .ArticLe suBMission/Advertising: For writ-er’s guidelines, article submission, or advertising opportunities, contact the editor at the above address or email julie@mpha .org . Bylined articles express the opinion of the contribu-tors and do not necessarily reflect the position of the Minnesota Pharmacists Association . Articles printed in this publication may not be reproduced in any manner, either in whole or in part, without specific written permission of the publisher.Acceptance of advertisement does not indicate endorsement .

Upcoming Events

Moved, graduated, or have a name change?

Update your profile through your online MPhA Member Portal page to continue receiving important association updates.

MPhA Mission: serving Minnesota pharmacists to advance patient care. The Minnesota Pharmacists Association is a state professional association, whose membership is made up of pharmacists, pharmacy students, pharmacy technicians, and those with a business interest in phar-macy. MPhA will be the place where pharmacists go first for education, information and resources to become empowered to provide optimal patient care. MPhA will be the recognized and respected voice of pharmacy with legislators, regulators, payors, media and the public .

correctionsIn the Fall 2012 issue, we incor-rectly listed the firm that employs President Martin Erickson . It should have been listed as Fagron .

Also in the Fall 2012 issue, we included an incorrect e-mail address for Cheryl Hetland; Cheryl’s correct e-mail is chet-land2002@yahoo .com .

Finally, the Fall 2012 issue includ-ed the incorrect place of employ-ment for David Q . Hoang, PharmD, MBA . The correct information is Minnesota Multistate Contracting Alliance for Pharmacy, St . Paul .


It is with a mixture of sadness, joy and pride that I inform you Julie Johnson has accepted an offer to become associate dean for professional and external relations for the University of Minnesota’s College of Pharmacy; Julie will leave her position at MPhA effective Feb . 1, 2013 . Julie has been our executive vice president for more than 12 years, nearly twice the aver-age tenure of an association CEO; she leaves behind a strong, vibrant organi-zation that will bear the marks of her leadership for years to come .

Julie accomplished much during her tenure with MPhA. She served in her role during one of the most difficult decades in the American economy . Even with this challenge, Julie’s lead-ership contributed significantly. Here are just a few of her accomplishments:

• She led MPhA’s legislative team to successfully expand and improve pharmacist ser-vices including immunizations, medication therapy manage-ment, collaborative practice, and rural loan forgiveness .

• Julie implemented corporate membership opportunities, nearly tripling membership numbers in six months .

• She developed and maintained strong relationships with phar-macy groups and other stake-holders both at the state and national levels .

President’s Desk

transitions by Martin A. Erickson, III, RPh, Director of Professional Services and Regulatory Affairs, Fagron

Upfront Views and news

MPhA has a history of long-serving leaders . The past three EVPs together served more than 50 years . The board of directors is committed to continuing the tradition of carefully selecting lead-ers who will make long-term, lasting impacts . A search committee, com-prised of the executive committee, has been organized to coordinate the dif-ficult job of finding Julie’s replacement. An initial meeting was held to lay the groundwork for a successful search. In the weeks ahead, work will be done to identify the characteristics and qualifications of our next leader. The executive committee and the Board of Directors are confident we will be able to find the next excellent leader to carry on the work of Julie and her predecessors .

Transitions in an organization can be difficult — and that is especially true when it loses the leadership of someone who has been so important for so long. Transitions are wonderful opportunities, as well. This transition provides us with a significant oppor-tunity to bring in the next new leader who will help steer our organization successfully in the years ahead . One of Julie’s significant accomplishments is that she helped build an organi-zation that can continue to thrive, even in her absence. The decision two years ago to engage staff support from Minnesota’s leading association man-agement company, Ewald Consulting, means that in her absence, a staff of 52 professionals is available to provide continuity for our organization dur-

ing a careful and thorough leadership search .

To reiterate, your board is committed to a thorough and transparent process leading to the selection of MPhA’s next leader . Membership input is an important part of this process; there-fore I invite you to send your thoughts and suggestions to me as your Board works toward finding the best can-didate. I will continue to keep you informed of our progress; specific time frames and action steps in the deci-sion-making process are forthcoming .

Martin A . Erickson, III, RPh, MPhA President

Call for ArticlesThe Minnesota Pharmacist accepts articles for publication from its members and from non-members . All content is subject to review by the MPhA Editorial Advisory Committee and MPhA Staff, who will determine wheth-er material is of interest to our readers . To submit an article or an idea/abstract, please send an email to Communication Director Laurie Pumper at [email protected] .


The AWARxE campaign was founded by the Minnesota Pharmacists Foundation in 2009, in order to educate communities and individuals on the dangers of abuse or misuse of prescription medications .

the Minnesota focused initiatives include awarxe school and corpo-rate presentations, which directly align with the following goals:

P Inform parents and children about prescription drug abuse and misuse dangers .

P Inform people of safe and proper medication disposal options .

P Alert parents and children to the danger of online pharma-cies. Let people know there is a chance they could get coun-terfeit medications .

P Help people understand the importance of their relationship with their pharmacist in obtain-ing their prescription drugs .

P Address the public perception gap – medicine is more than a commodity and individuals must take personal responsibil-ity for their health care .

Progress to date:

P During the 2011-2012 school year, student pharmacists delivered 99 presentations about prescription drug use and abuse to 20 different middle schools in Minnesota, reaching more than 5,000 stu-dents .

P AWARxE billboards can be found on major highways across Minnesota, and the campaign’s commercials and radio spots are broadcast on major stations . Educational brochures are distributed to students during presentations .

P AWARxE has created a guide for the safe disposal of medication that can be used at “take back” events across the country . Keeping old pre-scriptions may lead to misuse, and disposing of the drugs by flushing them down the toilet can be harmful to the environ-ment .

P AWARxE has created a com-prehensive curriculum for prescription drug safety that is available for nationwide use. South Dakota and Arizona have replicated Minnesota’s AWARxE campaign with the help of this curriculum .

how can you help?

Minnesota pharmacists are urged to join us in changing and saving lives through education about prescription drug use and abuse by donating to the Minnesota Pharmacists Foundation (MPF) . To learn more about the Minnesota Pharmacists Foundation, please visit: www.mpha.org/display-common .cfm?an=1&subarticlenbr=11 .

Mpha news


For 12 years, I have enjoyed shar-ing this space in the Minnesota Pharmacist Journal with you. This time, I am excited to share a new chap-ter in my pharmacy career . Beginning Feb.1, 2013, I will leave MPhA to join the University of Minnesota College of Pharmacy as the associate dean for Professional and External Relations. The position will allow me to be involved in leadership, outreach and public relations for the college; coordinate and promote community engagement initiatives; act as a liai-son for internal and external groups to the college; establish and fos-ter relationships with other health care and industry professionals; and serve as the Global Education and Research director for the college and liaison to the Academic Health Center and University wide global programs advisory groups. I will also have the opportunity to teach first-year phar-macy students . Many of you prob-ably knew that I gave up teaching 12 years ago when I joined MPhA. So in a way, it is like going back to where I started. I am grateful for this wonderful opportunity to contribute to pharmacy in another position .

My life has been blessed with many such chances . Each time, it has meant giving up something to grow and experience another avenue . Each time, it has been difficult to leave a position where I have devel-oped strong relationships and friend-ships I have come to enjoy . But I

have found that pharmacy is like a tapestry into which we are all woven. We will always be a part of it, no mat-ter where we go.

The Minnesota Pharmacists Association is a strong organization because of the leadership of your board of directors . This group has guided our work, made good and sometimes tough decisions, and has always worked together for the same mission: Serving Minnesota pharma-cists to advance patient care .

The MPhA was established in 1856 by pharmacists who got together to collectively accomplish things that they could not do alone . It exists today for the same reasons . Thank you for supporting our profession by supporting this association .

Julie K . Johnson, PharmD, MPhA Executive Vice President/CEO

Executive’s Report

change is Goodby Julie K. Johnson, PharmD, MPhA Executive Vice President/CEO

Upfront Views and news

I have found that pharmacy is like a tapestry into which we are all woven.

We will always be a part of it, no matter

where we go.


Please provide a letter of support for each award nominee describing in detail the reasons for the MPhA Awards Committee to consider your nominee. Include specific examples and/or details. Attach your nomination letter and any supporting docu-ments to this form, including a current CV of nominee if possible. Nominations that do not include adequate information will not be considered until missing information is submitted. Nominators will be notified when nominations are received by the MPhA office and if additional information is required. Please see the MPhA Website for additional award information and forms: www.mpha.org.

harold r. popp award

Sponsored by MPhA, the Popp Award recognizes one pharmacist annually for outstanding services to the profession of pharmacy. This is the highest honor bestowed by the association. nominee’s name: ______________________________________ Workplace: ________________________________

Bowl of hyGeia award Sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations with support from Boehringer Ingelheim, the Bowl of Hygeia recognizes pharmacists who possess outstanding records of civic leadership in their own communities, from which their specific identification as a pharmacist reflects well on the profession. nominee’s name: ______________________________________ Workplace: _______________________________

distinGUished yoUnG pharMacist award

Sponsored by Pharmacists Mutual Companies, the Distinguished Young Pharmacist Award recognizes a young pharmacist within his/her first ten years of practice who has distinguished himself/herself in the field of pharmacy. This pharmacist is also a participant in national pharmacy associations, professional programs, state association activities and/or community service . nominee’s name: ______________________________________ Workplace: _______________________________

excellence in innoVation award

Sponsored by Upsher-Smith Laboratories, Inc., the Excellence in Innovation Award recognizes innovative pharmacy prac-tice resulting in improved patient care . nominee’s name: ______________________________________ Workplace: _______________________________

pharMacy technician award

Presented by MPhA, the Pharmacy Technician Award recognizes pharmacy technicians in any practice setting who dem-onstrate leadership in their work and in their community. This includes demonstrating professionalism by participation in pharmacy association, professional programs and/or community service, promoting teamwork within the pharmacy, provid-ing leadership and serving as a role model for coworkers, developing or assisting development of efficient safe procedures that support the provision of pharmaceutical care .nominee’s name: ______________________________________ Workplace: _______________________________

NoMiNator’S iNforMatioN:

NaMe (please print): ____________________________________________________________

PhoNe: _______________________ eMaiL: ________________________________________

addreSS: ______________________________________________________________________

City: _________________________________________ State: ______ ZiP: ______________

Mpha award nomination form

Recognizing members who

are an inspiration to the field of pharmacy!

Please return all noMInatIons by March 15, 2013 to the MPha offIce.


Recognize those making a difference in the profession of pharmacy.

The association annually recognizes leaders in the field of pharmacy . Please help us identify pharmacy leaders by submitting a nomination form(s) and letters of support to the MPhA office. More information can be found on the MPhA Website. Following are descriptions of each award, and past recipients . A full listing of past recipients can be found at mpha .org .

harold r. popp award

Sponsored by the Minnesota Pharmacists Association, the Popp Award was established by MPhA in 1969 in honor of the late Senator Harold R . Popp to recognize one phar-macist annually for outstanding services to the profession of pharmacy. This is the highest honor bestowed by the association. This award is presented at the MPhA Annual Meeting .

Bowl of hyGeia

Sponsored by the American Pharmacists Association Foundation and the National Alliance of State Pharmacy Associations with support from Boehringer Ingelheim, the Bowl of Hygeia recognizes pharmacists who possess out-standing records of civic leadership in their own communi-ties, from which their specific identification as a pharmacist reflects well on the profession. This award is presented at the MPhA Annual Meeting .

distinGUished yoUnG pharMacist

Sponsored by Pharmacists Mutual Companies, the Distinguished Young Pharmacist Award recognizes a young pharmacist within his/her first ten years of practice who has distinguished himself/herself in the field of phar-macy . This pharmacist is also a participant in national pharmacy associations, professional programs, state asso-ciation activities and/or community service. This award is presented at the MPhA Annual Meeting .

excellence in innoVationsponsored by Upsher smith, the Excellence in Innovation award recognizes innovative pharmacy practice resulting in improved patient care. This award is presented at the MPhA Annual Meeting .

pharMacy technician award

Presented by MPhA, the Pharmacy Technician Award rec-ognizes a pharmacy technician in any practice setting who demonstrates leadership in workplace and community. This includes demonstrating professionalism by participation in pharmacy association, professional programs and/or community service, promoting teamwork within the phar-macy, providing leadership and serving as a role model for coworkers, developing or assisting development of efficient safe procedures that support the provision of pharmaceu-tical care. This award is presented at the annual MPhA/MSHP Technician Conference .

Please provide a letter of support for each award nomi-nee describing in detail the reasons for the MPhA Awards Committee to consider your nominee. Include specific examples and/or details. Attach your nomination letter and any supporting documents to the form on page 8, includ-ing a current CV of nominee if possible. Nominations that do not include adequate information will not be considered until missing information is submitted. Nominators will be notified when nominations are received by the MPhA office and if additional information is required. Please see the MPhA Website for additional award information and forms: www.mpha.org.

Please return all noMInatIons by March 15, 2013 to the MPha offIce.

Past Recipients: 2012: William diers 2011: rod Carter 2010: Marilyn eelkema

Past Recipients: 2012: Stacy Steber 2011: Sarah Leslie2010: dan rehrauer

Past Recipients: 2012: Conrad o. thompson 2011: Camille Kundel 2010: amanda Brummel

Past Recipients: 2012: Barb Stodola2011: robbin Leach 2013: Carole Lentz

Past Recipients: 2012: Larry Leske 2011: John hoeschen 2010: Gregory trumm

2012 Mpha award categories


dandelions and other wild flowersby Lowell J. Anderson, D.Sc., FAPhA

The year just ended – 2012 – was a dry year. Certainly we experienced a drought. It was also a dry year for lucid political thinking, and rational financial and economic management. It was a year of uncertainties! Or as the Queen once called such a year: annus horribilus.

It was probably made more horrible because with TV and social media, everything was with us 24/7. There was little escape – other than mowing the lawn.

I wrote this article in September of 1990 for the “Minnesota Pharmacist” journal. I think after 22 years it may still have relevance. Here it is again. Enjoy.

Summer 1990 was the year I became reacquainted with my lawn. After three years of drought, mowing once a week somehow seemed to signify a return to normalcy .

When viewed from the detached per-spective of the passerby, lawns are expanses of green, categorized by degree of imperfection . Most fall short of the perfection of the 18th green at the golf club .

Lawns are similar to pets in that they seem to take on the personal-ity of their owners. There are lawns that are so perfectly maintained that even a wild flower would wilt at the prospect of invading these suburban Gardens of Eden . These types of lawns seem to be owned by either corporate accountants, people who

Viewpoint

vote independent or people who hire a lawn service.

There are lawns that seem to look almost like patches of prairie . They have a broad representation of living things: dandelions, creeping Charlie, a clump of daisies here and there . These are the people that I want to get to know. They seem to understand that perfection is a character flaw; and that diversity and lack of total control are virtues . These people have dis-covered that everything inherently has something to appreciate – something of value: even a weed.

To do your own mowing causes you to eventually begin to appreciate that in everything there can be beauty . When you mow a lawn each week for an entire summer you become intimately aware of each part of it. Each micro-climate, weed-would-be-flower, each bald spot becomes a landmark to be given consideration with each mowing. You begin to plan: fertilize this part a bit heavier this fall, and seed that part . Lawn mowing, in this respect, is a lot like running a business or a life . Paying attention to parts of things is important and rewarding because it will eventu-ally be reflected in the whole.

I marvel that the plants purchased from the nursery can grow so slowly. Yet, in just the period between mow-ings, a plant that has gone unnoticed in our lawn can shoot up to a foot in height and bloom . I have had young employees like that – blossoming in the most surprising ways.

I sometimes wonder if we delight in cutting these assertive plants down because we take offense at their assault on our sense of uniformity and propriety . There is a story of a Russian Tsar who liked to ride his horse through fields of wheat and with his sword cut off the heads of the taller wheat stalks. This Tsar ran his country so as to assure uniformity . To stand above the crowd was an assault to his order of things. Excellence was discouraged.

Much of the present philosophy in our country seems to increasingly advo-cate “lopping off the heads” of the

Lawn mowing ... is a lot like running a business

or a life. Paying attention to parts of

things is important and rewarding because it will eventually be

reflected in the whole.

dandelions and other wild flowers continues on page 11

people who stand above the crowd — those who are striving for excel-lence. A good example is how corpo-rate America and government, through various controls and reimbursement schemes, discourage health practitio-ners who attempt to provide a level of care above the average . Uniformity and average have become goals of our system and in our lives and profes-sion, just as in many of our lawns.

We have a cat at home named Guido . (After he was “fixed,” we named him for one of the great seventeenth-cen-tury Italian castrati.) Guido will sit and look out a window for hours. I think his mind is on test pattern . Maybe he is recharging his psychic batteries after a tough evening of consulting!

Mowing a lawn has similar psychic rejuvenating properties for me . The drone of the mower is monotonous and blocks out most other sounds . The endless back and forth of side-by-side straight lines, the sameness of which is only punctuated by that which wasn’t there last week, becomes a kind of sensory deprivation – much like a long shower. I do some of my most cre-ative thinking while mowing the lawn (some of it even useful) . Just consider dedicating three hours every week to creative thinking. Whew! Think about the stress if one felt compelled to act on the results of that much creative thinking .

Senator John Brandl, in his April 1990 retirement speech from the Minnesota Senate, said: “In politics one must struggle to maintain a normal private life. Busyness can crowd out reflec-tion . The attention of others can sub-stitute for an inferior life . The thought flickers in the back of the politician’s mind: I shouldn’t have to carry out the trash, make the bed, and mow the lawn. The grand responsibilities and acclaim that come with holding public office can unhealthily substitute for inti-

macy, ordinary friendships, and meet-ing the simple responsibilities of life .”

The life of a politician, as Senator Brandl describes it, bears some simi-larity to the life of a health practitio-ner . We, too, get caught up in busy-ness: The busyness of running our practice and dealing with third parties or the busyness of trying to deliver excellence in a system that does not reward excellence. The gratitude of a patient oftentimes compensates for the forever-missed gratitude of a child or a spouse when we again miss just spending time with them. The grati-tude of a patient is nice – but not the same .

The grand responsibility of being a health practitioner does not absolve us from the need to “take out the trash, or mow the lawn,” or nurture our families and friends . Instead, the grand responsibility of being a health practitioner requires us to meet these simple responsibilities of our own life.

In 1990 (and 2013) it is so easy to get involved in – to become obsessed with – the big problems of politics, economics and health care . In reality, the times demand that as real people we spend time mowing our lawns.

Not only our own lawns, but those of our profession as well.

Lowell J. Anderson, DSc, FAPhA, prac-ticed in community pharmacy for most of his career. He is a former president of MPhA, the Minnesota Board of Pharmacy and APhA. In addition, he has held positions in the Accrediting Council on Pharmacy Education, National Association of Board of Pharmacy and the United States Pharmacopeia. Currently he is co-director of the Center for Leading Healthcare Change at the University of Minnesota, and co-editor of the International Pharmacy Journal. He is a Remington Medalist. If you have feedback about this article, we would like to hear it! Send your comments to MPhA at [email protected].

1987—twenty-five years ago:

• Clinical Sciences Section formed within the American Pharmaceutical (now Pharmacists) Association Academy of Pharmaceutical Research and Science .

1962—Fifty years ago:

• Legislation introduced (unsuccess-fully) to allow the FDA to inspect pharmacy prescription files.

• Paul Parker at the University of Kentucky established first formalized Drug Information Service .

• Merrell removes Mer-29 (triparanol) from market for adverse eye events .

1937—seventy-five years ago:

• More than 100 people were poisoned by S. E. Massengill Company’s Elixir of Sulfanilamide . This led to 1938 legislation requiring proof of safety as a condition for marketing .

• Loronzo L. Skaggs opened the first store of a new chain chain of self-service drugstores in the Midwest. Original name was “Pay-Less” later changed to Osco Drug .

1912—one hundred years ago:

• Phenobarbital (Luminal) first mar-keted by Bayer in 1912 .

1887—one hundred twenty-five years ago:

• International Pharmaceutical Federation (FIP) established as an international federation of national pharmacy organizations .

• The Journal of the American Medical Association (JAMA) reports the first diagnosis of death by heart attack .

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

Pharmacy Time CapsulesBy: Dennis B. Worthen, Lloyd Scholar, Lloyd Library and Museum, Cincinnati, OH

dandelions and other wild flowers continued from page 10


Enhance your coordination and communication with community physicians

Your peer, Dennis Stanley, BSPharm, provides tips on how to collaborate with local physicians in an effort to enhance coordination of adult vaccination, including

• Reaching out to local providers

• Creating collaborative practice agreements

• Engaging in follow-up conversations with physicians, and more

Pharmacy Insider is your behind-the-scenes look at ways to help increase access to vaccines and tips to help protect more adult patients in your community.

Watch Dennis’ video today, and remember to check back for upcoming videos focusing on other pharmacy topics.

Dennis was honored with a 2012 APhA Immunization Champion Award. He received the Lifetime Achievement Recognition and was called a “model vaccination partner.”

Hear what Dennis has to say at www.merckvaccines.com/PharmacyInsider

Dennis Stanley, BSPharm, Virginia

Copyright © 2012 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. VACC-1026261-0008 11/12

Member Profile: Amanda Maderich, PharmDwalgreens, superior, wi

“I grew up in Missouri; I came to Minnesota because I love the win-ter!” Amanda Maderich, PharmD, said . She lived in the North Country as a

young child; it called her back home from the milder mid-section of the Midwest. Her grandparents reside in the Upper Peninsula of Michigan, and they are anoth-er draw, she said. “Many people wouldn’t know that about me, but the northern states offer great outdoor activities, and I enjoy many of them .”

Amanda is a graduate of the University of Minnesota-Duluth. She began working as an intern in 2007 at Walgreens and gradu-ated in 2010 . She completed undergradu-ate work at Minnesota State University, Moorhead. After graduation she worked in the Twin Cities for a few months until job opportunities opened in the Duluth area .

Amanda works as an MTM specialist and staff pharmacist at Walgreens, in Superior, Wisc., near the border with Duluth. The opportunity to work with patients one-on-one captivated her interest early on, leading her to leave her chemistry major in favor of

pharmacy. “It’s a good feeling when many patients ask for me, because I know then that I have made a difference in their lives,” Amanda said . “It could be something as simple as helping a patient become more comfortable using an inhaler, or it could be as complex as helping patients understand the importance of compliance, and helping them work out a medication schedule that works in their daily lives.

“I do have another challenge aside from my consulting services, and that is help-ing other pharmacists believe that MTM services are possible in a busy, retail phar-macy setting,” she said. When asked what she would like covered in the Minnesota Pharmacist, she said articles showing how MTM is working in various community pharmacies; that could encourage those who doubt they can, in fact, move toward MTM .

“Currently, my store is remodeling to pro-vide a more ideal setting for patient care activities including MTM,” she said . As more insurance carriers are offering MTM to seniors, the demand for that service is growing. “Patients and insurers are real-izing the value of MTM services, not only from improved health outcomes but from savings in medication dollars spent .”

“In some outstate locations, there are not as many MTM options for pharmacists wanting to provide those services and for patients needing to receive medication management advice . Although all phar-macists have the knowledge, many are hesitant to provide that service for reasons not thoroughly explored .”

It’s also true that in very busy urban phar-macies, she said, pharmacists who want to provide MTM services become discour-aged by perceived barriers . “MTM can be done in these situations – it is happening,” she said .

Leisure time is spent on various home improvement projects, she said, “with my pharmacist husband, Jake Maderich, who is a Walgreens manager .” Building (i .e ., taking the house apart and putting it back together), painting and decorating take up much time . “Being an outdoor person, I enjoy gardening and cooking with fresh Minnesota produce .”

So we asked, when you’re not being a pharmacist, a carpenter or a gardener, what are you reading? “I’m reading a very good series: Game of Thrones .”


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TUESDAY, FEBRUARY 19EMBASSY SUITES | ST. PAUL, MINN.

“

PHARMACY LEGISLATIVE DAY2013

With a strong United voice,we make ourselves Heard

Be an advocate for your profession! Hear briefings on targeted state and federal issues and remarks from key public policymakers. The day is bro-ken into a morning session and an evening reception. Pharmacists will have the opportunity to meet with their representatives and senators at the Capitol in the afternoon. The event concludes with a roundtable discus-sion with public policy makers.

EMPOWER YOURSELF!

MORNING SESSION - BOP # 2-010-147-30-000 (2.75 credit hours)CE for Pharmacists AND Pharmacy TechniciansEMBASSY SUITES: 175 East 10th Street, Saint Paul

8:30 am REGISTRATION

9:00 am WELCOME & STATE ISSUES BRIEFINGMichelle Aytay, Public Affairs Committee Chair, MPhA; Patrick Lobejko, MPhA Lobbyist

10:00 am PHARMACISTS‘ ROLE IN AFFORDABLE CARE: HOW DO I IMPACT HEALTH OUTCOMES AND QUALITY OF CARE?Educational Session sponsored by Century Mortar Club

Steve Schondelmeyer, PharmD, PhD, Head, Department of Pharmaceutical Management & Health Systems Endowed Chair in Pharmaceutical Management & Economics Professor and Director, PRIME Institute

10:45 am BREAK

11:00 am ROUNDTABLE DISCUSSIONS

The issues to be discussed include:• Biosimilars• Practice Act Changes• Pseudoephedrine Reporting• Immunizations• Compounding• Board of Pharmacy Changes

Noon ADJOURN

LEARNING OBJECTIVES:Upon completion, the participant will be able to:

1. Define accountable care organizations (ACO) and patient-centered medical homes (PCMH).

2. Describe the pharmacist’s roles in ACOs and PCMHs.

3. Identify pharmacist interventions that will improve star ratings through better health outcomes and quality of care.

4. Review the keys to advocacy.

12:30-4:30 pm CAPITOL VISITS Schedule a visit with your legislators between 12:30-

4:30pm. Free van shuttles to/from capitol for attendees

Pharmacists & Pharmacy Students: Wear your white coats to the Capitol to enhance the professional image of pharmacy!

5:30 pm REGISTRATION & SOCIAL

6:30 pm WELCOME & GREETINGSDeborah Klein, MSHP President

Martin Erickson, MPhA President

7:00 pm INVITED PUBLIC OFFICIALS PANELOfficials TBD

8:30 pm CLOSING COMMENTSMartin Erickson, MPhA President

EVENING SESSION - BOP # 2-010-147-31-000 (2.0 credit hours)CE for Pharmacists AND Pharmacy TechniciansEMBASSY SUITES: 175 East 10th Street, Saint Paul


1. Review how to effect policy changes which are positive to the practice of pharmacy and the advancement of patient care.

2. Describe the Minnesota Senate and House of Representatives Health Policy Legislation as it relates to pharmacists’ role in general as well as initiatives specific to pharmacy.

Participating Organizations: MINNESOTA PHARMACISTS ASSOCIATION

MINNESOTA RETAILERS ASSOCIATION

MINNESOTA SOCIETY OF HEALTH-SYSTEM PHARMACISTS

MINNESOTA GROCERS ASSOCIATION

NATIONAL ASSOCIATION OF CHAIN DRUG STORES

CE FOR PHARMACISTS AND PHARMACY TECHNICIANSEDUCATIONAL SESSIONS SUPPORTED BY CENTURY MORTAR CLUB

PHARMACY LEGISLATIVE DAY REGISTRATION YES I will schedule my appointment and visit my legislator

*Register early — space is limited for the Morning Session.

Name: ________________________________________________________________________________________________Organization: ___________________________________________________________________________________________Please provide your home address so we can correctly identify your legislative district

Home Address: _________________________________________________________________________________________City: ____________________________________________________________State: _________ Zip: ___________________Phone: ___________________________________________________Fax: __________________________________________Email: _________________________________________________________________________________________________NABP ePID number: __________________________________ Date of Birth (in MMDD format, no year) ________________

I will be available for a Capitol Visit I will not be available for a Capitol Visit

FULL DAYContinental breakfast and hors d’oeuvres buffet

PHARMACIST/RESIDENT ..................... $75 STUDENT/TECHNICIAN ........................ $25

MORNING ONLYContinental breakfast


EVENING ONLYHors d’oeuvres buffet and cash bar


TOTAL DUE: $_________

PAYMENT BY: Check Visa Mastercard DiscoverIf paying by credit card, all fi elds are required.

Card Number: ___________________________________________________Exp. Date: ____________ Security Code: _________________

Cardholder Name (Print): _____________________________________________________________________________________________

Billing Address: _____________________________________________________________________________________________________

City/State/Zip: ______________________________________________________________________________________________________

Cardholder Signature: ________________________________________________________________________________________________Please do not email credit card information. Fax or mail your registration form to protect this information.

The Minnesota Pharmacists Association is accredited by the Minnesota Board of Pharmacy as a provider of continuing pharmacy education. Following attendance, completion and submission of evaluation forms, certificates will be available on the MPhA website. Certificates will be sent by email to all paid

attendees within one week of the event.SATISFACTORY COMPLETION FOR CREDITS: All attendees must have signed in as required, completed and turned in a course evaluation form prior to leaving the confer-ence. Each session claimed for credit must be attended in its entirety.

LATE REGISTRATION: All registrations received after February 1, 2013 will be charged a $10 late fee.CANCELLATIONS/NO SHOWS: Cancellations received prior to February 1, 2013 will be charged a $25 administration fee. No refunds will be given after February 1, 2013. No refunds will be given to those registered who do not attend the meeting. Those registered who have not prepaid will be invoiced for the full registration amount.

MNBOP

Mail registration and payment to:

MINNESOTA PHARMACISTS ASSOCIATION1000 Westgate Drive, Suite 252St. Paul, MN 55114651-697-1771 • 651.290.2266 faxwww.mpha.org

*Pharmacists are encouraged to invite their legislators to the evening recep-tion. However, under Minnesota Ethics laws, it is illegal for associations to pay for legislators’ meals. Therefore, legisla-tors must pay for their food cost. The cost for the evening reception is $45.

MINNESOTA PHARMACISTS FOUNDATION STUDENT EDUCATION FUND

Your 100% tax free donation provides financial assistance to pharmacy students attending MPhA sponsored events. A donation in any amount is appreciated:

$25 $50 $75 $_____

MPF PAYMENT: I am enclosing an additional check payable to MPF. Please charge the same card for my Student Fund donation.

initialsdate

CK/CCamt. paid

bal. due

fin.(For office use only)

TUESDAY, FEBRUARY 19EMBASSY SUITES | ST. PAUL, MINN.

“

PHARMACY LEGISLATIVE DAY2013

With a strong United voice,we make ourselves Heard

Be an advocate for your profession! Hear briefings on targeted state and federal issues and remarks from key public policymakers. The day is bro-ken into a morning session and an evening reception. Pharmacists will have the opportunity to meet with their representatives and senators at the Capitol in the afternoon. The event concludes with a roundtable discus-sion with public policy makers.

EMPOWER YOURSELF!

MORNING SESSION - BOP # 2-010-147-30-000 (2.75 credit hours)CE for Pharmacists AND Pharmacy TechniciansEMBASSY SUITES: 175 East 10th Street, Saint Paul

8:30 am REGISTRATION

9:00 am WELCOME & STATE ISSUES BRIEFINGMichelle Aytay, Public Affairs Committee Chair, MPhA; Patrick Lobejko, MPhA Lobbyist

10:00 am PHARMACISTS‘ ROLE IN AFFORDABLE CARE: HOW DO I IMPACT HEALTH OUTCOMES AND QUALITY OF CARE?Educational Session sponsored by Century Mortar Club

Steve Schondelmeyer, PharmD, PhD, Head, Department of Pharmaceutical Management & Health Systems Endowed Chair in Pharmaceutical Management & Economics Professor and Director, PRIME Institute

10:45 am BREAK

11:00 am ROUNDTABLE DISCUSSIONS

The issues to be discussed include:• Biosimilars• Practice Act Changes• Pseudoephedrine Reporting• Immunizations• Compounding• Board of Pharmacy Changes

Noon ADJOURN


1. Define accountable care organizations (ACO) and patient-centered medical homes (PCMH).

2. Describe the pharmacist’s roles in ACOs and PCMHs.

3. Identify pharmacist interventions that will improve star ratings through better health outcomes and quality of care.

4. Review the keys to advocacy.

12:30-4:30 pm CAPITOL VISITS Schedule a visit with your legislators between 12:30-

4:30pm. Free van shuttles to/from capitol for attendees

Pharmacists & Pharmacy Students: Wear your white coats to the Capitol to enhance the professional image of pharmacy!

5:30 pm REGISTRATION & SOCIAL

6:30 pm WELCOME & GREETINGSDeborah Klein, MSHP President

Martin Erickson, MPhA President

7:00 pm INVITED PUBLIC OFFICIALS PANELOfficials TBD

8:30 pm CLOSING COMMENTSMartin Erickson, MPhA President

EVENING SESSION - BOP # 2-010-147-31-000 (2.0 credit hours)CE for Pharmacists AND Pharmacy TechniciansEMBASSY SUITES: 175 East 10th Street, Saint Paul


1. Review how to effect policy changes which are positive to the practice of pharmacy and the advancement of patient care.

2. Describe the Minnesota Senate and House of Representatives Health Policy Legislation as it relates to pharmacists’ role in general as well as initiatives specific to pharmacy.

Participating Organizations: MINNESOTA PHARMACISTS ASSOCIATION

MINNESOTA RETAILERS ASSOCIATION

MINNESOTA SOCIETY OF HEALTH-SYSTEM PHARMACISTS

MINNESOTA GROCERS ASSOCIATION

NATIONAL ASSOCIATION OF CHAIN DRUG STORES

CE FOR PHARMACISTS AND PHARMACY TECHNICIANSEDUCATIONAL SESSIONS SUPPORTED BY CENTURY MORTAR CLUB


Fungal Meningitis Outbreak:Background and Lessons Learned about CompoundingBy Alyssa Ferrie, PharmD Candidate 2013, University of MN-Twin Cities

The mortar and pestle is the longstanding symbol of pharmacy . This symbol rep-resents the historical roots of pharmacy — going back thousands of years, long before medications were commercially manufactured . From our first days as stu-dent pharmacists we are taught how to make suspen-sions, capsules, supposi-tories and compounded IV medications . Compounding pharmacy is as old as the profession itself .

Up until the 1920s, compounding knowledge was essential for up to 80% of all prescriptions . By the 1970s, less than 1% of all prescriptions were compounded . Today, there are an estimated 40 million compounded prescriptions per year . As pharma-cists, we know the simple definition of compounding: combining, mixing, or altering of ingredients to create a cus-tomized medication for an individual patient in response to a licensed prac-titioner’s prescription. We also under-stand complexity and necessity of compounded prescriptions . Hospitals rely on sterile compounding every day . Compounding serves critical patient needs in the wake of drug shortages, discontinued dosage forms and spe-cial patient populations and situations such as pediatrics and excipient aller-gies. We have always respected the essential relationship between physi-

cian, patient and pharmacist to work together for maximum patient benefit.

On September 26, 2012, an investiga-tion was launched at the New England Compounding Center (NECC) in Framingham, Mass ., that resulted in the recall of three suspected con-taminated lots of methylprednisolone acetate injection . On October 4, 2012, after observing black particulate mat-ter believed to be fungal contamina-tion in an individual vial from one of the suspected lots, the U .S . Food and Drug Administration (FDA) recom-

mended that all health care profes-sionals cease use and remove from inventory any material produced by NECC and reported that NECC’s phar-macy license had been voluntarily sur-rendered. NECC went on to volun-tarily recall all products and the recall expanded to products produced by Ameridose, a company that shares ownership and leadership with NECC. As the horrific story unfolded, it became apparent that contamination was pres-ent in several other NECC products and investigators identified multiple serious health and safety deficiencies

clinical issUes


related to their practices . Hoods and tacky mats were noticeably soiled, a leaking boiler created a pool of poten-tially contaminated water in the phar-macy, and adequate sterility testing and proper product sterilization prac-tices were not performed according to practice standards . The use of these products have, to date, caused 656 cases of fungal meningitis, stroke due to presumed fungal infection, other central nervous system infections, or peripheral joint infection . This outbreak has reached 19 states and resulted in the death of 39 patients . The investiga-tion continues as additional affected products and potential infections and patient complications are identified.

This is an extremely unfortunate cir-cumstance that has brought the area of pharmaceutical compounding into the limelight and subsequently under the microscope . Pharmacists, like any other health care practitioners, view patient safety and welfare as our num-ber one priority. We — along with the public — question our practice and safeguards when patients are harmed. We recognize and understand the desire for change and call to action by our communities, pharmacy prac-tice regulators and the government in the wake of this disaster. This has affected all areas of pharmacy practice as patients and other health care pro-viders become concerned about the safety and quality of all medications .

As we move forward, we need to advo-cate for our profession — but review our own practices. We need to be the experts when potential changes are suggested . As the legislative session approaches, we will no doubt see com-pounding pharmacy on the agenda . As we review our practices and weigh the potential regulatory options, it is important to consider the facts about compounding pharmacy practice, cur-rent laws and regulation governing pharmacy practice and the specific circumstances surrounding the NECC .

Compounding serves an essential

role in quality patient care . The intention of compounded prescrip-tions is to meet spe-cific patient needs in the absence of com-mercially manufac-tured products to meet that need . There are many reasons why compounded products are preferred such as absence of a product stable enough to be manufactured, shipped, stored and distributed . Prescriptions are often compounded due to national short-ages of commercially available prod-ucts. Physicians and pharmacists work together to customize a compounded prescription when specific patient char-acteristics require a medication tai-lored to their individual needs, whether it is in response to patient allergies or inability to safely use the commercially available dosage forms or concentra-tion .

Minnesota state law requires all com-pounded prescriptions to follow the United States Pharmacopeia 795 and 797 standards for non-sterile and ster-ile compounding in all pharmacy prac-tice settings. Seventeen states specifi-cally identify these requirements in law or statute . The Board of Pharmacy in each state works to ensure that these standards are upheld in order for the pharmacy practice to be licensed . The Boards of Pharmacy in these states have the authority to inspect these pharmacies and issue appropriate cita-tions or warnings and revoke licenses when necessary.

The FDA has the authority to inspect, regulate and issue warnings to any pharmacy that is suspected of using products from a non-FDA registered facil-ity or that is operating outside of its licensure as a pharmacy . The FDA has guides and standards that contain scenarios in which the FDA would consider a phar-macy to be manufacturing under

the guise of compounding including wholesaling and bulk production not in response to a prescription written by a licensed prescriber for an individual patient . Manufacturers are required to follow FDA good manufacturing prac-tices and the FDA has authority to determine whether or not a pharmacy is operating in this way.

NECC had multiple and blatant vio-lations of state and federal laws. NECC appears to have exceeded its scope of authority as a pharmacy and engaged in the manufacture and dis-tribution of drugs without registering as a manufacturer with either the FDA or the Massachusetts State Board of Pharmacy . The company had been issued warnings and concerns had been noted . One can argue that the FDA and Board of Pharmacy had rea-son to pursue action against NECC prior to the fungal meningitis outbreak . It is apparent that NECC’s alleged behavior had clear, known violations and was not operating under the fun-damentals of pharmacy practice to do

As the legislative session approaches, we will no doubt see compounding phar-macy on the agenda. As we review our

practices and weigh the potential regula-tory options, it is important to consider

the facts about compounding pharmacy practice, current laws and regulation gov-erning pharmacy practice and the specific

circumstances surrounding the NECC.

Meningitis continues on page 24


By Julie K. Johnson, PharmD, Executive Vice President/CEO, Minnesota Pharmacists Association

It is estimated that one in six companies have made mail-order drugs mandatory for employees — and others are opting for incentivized plans in which patients get a discount on co-pays for choosing to use mail order . The summer session of the MPhA House of Delegates and the spring 2012 Board of Directors meeting both brought lively discussion regarding mail-order pharmacy . MPhA has been charged with addressing the topic .

News reports from two other states, New York and Pennsylvania, high-lighted recent laws passed intended to address mail-order pharmacy. New York’s statute, said to have “banned mail order,” requires pharmacy con-tracts to offer the same pharmacy reimbursement to mail order and com-munity outlets, theoretically leveling the planning field. Pennsylvania’s lan-guage (passed in October 2012 and scheduled to take effect on March 1, 2013) addresses the same . Its impact remains to be seen . A bill in committee in the U .S . House of Representatives would prohibit pharmacy benefit man-agers (PBMs) from offering cheaper prices for one method of filling pre-scriptions . But until such legislation is

passed, companies and workers will continue to make choices and inno-vate .

Before plans are made to follow suit here in Minnesota, leaders and staff are carefully studying the facts about mail order and current legislation to evaluate the most efficient and effec-tive means to address the concerns pharmacists have brought forward. Scanning the literature, surveys, and interviews with numerous interested parties have contributed to the con-tent of this piece, likely not to be the last published on mail-order pharmacy . This article attempts to provide a fac-tual summary of issues related to this contentious topic .

Mail-Order PharMacySaving Money — But at What Price to the Patient?

The number of prescriptions filled by mail jumped from 222 .9 million in 2005 to 237 .5 million in 2009, according to IMS Health, a health care information and consulting company . In 2009, the three big mail-order pharmacy compa-nies reported millions of dollars in net income. For Express Scripts, it was $827.6 million, Medco was $1.3 billion, and Caremark was $3.7 billion.

Critics say mail-order drugs reduce the quality of care patients receive and increase frustration . Proponents say the system is more efficient and saves money at a time when health care costs are spinning out of control . Not only does it change the way millions of Americans get their prescriptions, but if it continues, it may further jeop-ardize the health of some independent pharmacies . The system ultimately pits mail-order companies against local pharmacies . As employers push to save money on health care expenses, more patients are getting their medica-tions from the postal carrier instead of the pharmacist . While mail-order com-panies are considered more efficient because of economies of scale, many argue that the cost to a patient’s well-being is high .

Following are interviews from Minnesota pharmacists reporting their experience with the service.

MArk truMM:

The most prevalent complaint with mail order is “I didn’t get it in time.” I often contact physicians to get a one-week supply of medication for a patient until a mail order arrives . Patients have

to pay cash because mail order has already been processed . This elimi-nates any convenience or savings to the patient . Some patients go off medi-cations until the mail order arrives .

I often hear from patients they would prefer to get their medications from us, but they are either required to, or receive incentives to get from mail order .

We had a PBM mail-order pharma-cy contact one of our nursing home patients and talk her into switching to mail order . Imagine the surprise of the nursing staff when three months of her meds showed up — not in the two-week dosing system used by the nursing home. Now imagine the prob-lem we had in getting the mail-order pharmacy to reverse its claim so we could provide the service the patient and nursing home expected . Was the mail-order pharmacy really acting in the best interest of the patient?

At the last pharmacy night in Alexandria, the hospital pharmacists told me horror stories of admits bringing in bags full of unused/un-needed mail order meds . This is saving the insurers money?

cheng Lo:

I have worked in retail long enough to experience what it was like before mail order came into pharmacy and to also witness some of the issues that patients have had to endure . When a major employer forced many of its employees to switch to mail order back in the early 2000s, many patients came to me to express their concerns

and disappointments . Most of these patients I had known for many years and had built long-lasting relationships with them. I knew their medical condi-tions, their medication lists, the names of their family members, and what kind of pets they had. It was rather sad to see that our patient/pharmacist rela-tionships had to be severed because someone wanted to save money by outsourcing pharmacy benefits.

After a few months, many of these patients came back to me and expressed their frustrations . There were many occasions when medicine did not arrive on time . These patients ended up buying 3 to 7 day supplies of multiple medications to hold them over . I have done this several times for old customers as well as people who were not our regular customers . Many times, the cost for 3 to 7 days of prescriptions easily exceeded their copays from mail order and people would sigh in disgust. For some whom I have known a long time, I sold them their medications at cost because I felt bad .

Because we had such good relation-ships with our patients, they did not want to utilize the mail-order pharmacists when they had questions . In

Mail order pharmacy contin-ued on page 20

As employers push to save money on health care expenses, more patients are getting their medications from the postal carrier instead of the pharmacist. While mail-order companies

are considered more efficient because of economies of scale, many argue that the cost to

a patient’s well-being is high.


the beginning, my colleagues and I answered all questions. As the months went on, it was more difficult to field questions when we were unsure of our old patients’ med-lists. Also, the time we were spending with them on the phone or in person was becoming too great and making it unfair for our pay-ing customers . The problems started to unfold and become clearer: our ex-patients informed me that it was nearly impossible to get a real pharmacist on the phone at the mail-order pharma-cies. The phone menus were compli-cated and the hold times were ridicu-lously long. To make things worse, the mail-order pharmacies closed earlier than us, so patients still kept calling us for help .

Recently, a transplant patient came to my pharmacy to transfer his medica-tions from mail order . I believe he had a total of six or seven medications . The phone menu at the mail-order facility was in either English or Spanish only, so this particular patient had to rely on his children to help him reorder prescriptions . He said he often missed doses because he just didn’t plan well enough in advance to get his orders on time. In addition, he really wanted to be able to speak to a pharmacist in person about his medication concerns . He asked me if I could write his instruc-tions in Hmong so that he could read what each medication was “really for.” I replied, “of course!” He was shocked because in the many years he has had to endure mail order, he has never seen his own language on his bottles, let alone have a pharmacist counsel him on all his medications . It took me about 40 minutes to transfer and fill all his medications. When I went to ring him up, he was quickly disappointed. His copays were significantly higher than through the mail . He told me that I had to charge him the same or else he would have to go back to mail order. I apologized and said that I could not afford to discount his copays to match the mail-order company .

The patient expressed that one or two medications would not be a big deal — but to pay a higher amount for six or seven medications would be very difficult for him each month. I told him that I understood if he were to transfer his medications back to mail order . We then calculated how much it would be to buy seven days of each medication, it was a no-brainer to pay the copays and transfer back the following month. This is a classic example of patients receiving sub-optimal pharmacy ser-vices via mail order for the sake of the employer or PBM to profit by cutting costs . Most of us agree that health care costs are out of control . I believe that if we can level the playing field between mail order and retail phar-macy by giving all patients the right to choose from whom they get their pre-scriptions, we can make a significant impact in saving health care dollars and also improving the health of our fellow Americans.

AnonyMous PhArMAcist:

“I know that some out-patient clin-ics offer mail order to patients who aren’t local but it’s at the same cost as they would pay at a retail phar-macy (whatever their copay would be). Often patients come and fill at a walk-up pharmacy site, then continue to receive their meds via mail .”

Why have the plethora of criticism from pharmacists, physicians and patients about mail service pharmacy not stopped businesses from moving their employees to health care plans that encourage patients to use a mail-order system?

Does mail order have a place for peo-ple who enjoy the convenience and are familiar with their medications? Is forced participation detrimental to some patients? How does this service save money? Who saves the money brought by the efficiencies of mail order? Should patients have the right to choose? Is it all about the money?

Mail order pharmacy continued from page 19

“The J.D. Power and Associates Survey from 2009 says customers have the same level of satisfaction with mail order as with their pharmacy experiences . The National Community Pharmacists Association released its own report on Sept. 18 of the same year. NCPA’s survey found 48 percent of respondents who were mail-order customers had to go without their medications because of late delivery,” according to NCPA .

The Pharmaceutical Care Management Association came out against the NCPA survey, saying the two surveys couldn’t both be right.

There are more questions than answers. Many of our members are deeply concerned about losing their patients to mail order . Some of our members work for companies who provide these mail-order plans . The likelihood is that pharmacy benefit managers won’t change the way they do business anytime soon .

The most important thing is patient access to pharmacists .

Pharmacists are urged to continue to market aggressively and educate patients on pharmacy services .

case-Based clinical Pearls: a schizophrenic case study

O. Greg Deardorff, PharmD, Adjunct Clinical Assistant Professor, UMKC School of Pharmacy, Adjunct Clinical Faculty, St. Louis College of Pharmacy, Adjunct Clinical Faculty, MU School of Medicine, Clinical Manager, Fulton State Hospital, Fulton, Missouri, and Stephanie A. Burton, PharmD Candidate, University of Missouri-Kansas City School of Pharmacy at MU, Columbia, Missouri

introductionForensic psychiatry is a subspecialty in the field of psychiatry in which medi-cine and law collide. Practiced in many facilities such as hospitals, correctional institutions, private offices and courts, forensic psychiatry requires the coop-eration of health care and legal pro-fessionals with the common goal of helping patients become competent of their legal charges and returning to a productive life in the commu-nity . In contrast to general psychiatric patients, the clients in this field have been referred through court systems instead of general practitioners and are evaluated not only for their symptoms but also their level of responsibility for their actions .

These patients can be some of the most challenging to treat because of factors such as non-compliance, an extensive history of failed medica-tion trials, and the severity of their mental illness . Some of the patients with the most severe mental illnesses reside in forensic psychiatric hospitals and have spent much of their lives institutionalized . Treatment refractory schizophrenia, defined as persistent psychotic symptoms after failing two adequate trials of antipsychotics, is a common occurrence in forensic psy-chiatric hospitals and often requires extensive manipulation of medication regimens to obtain a desired thera-peutic response . Like other patients, these patients may present with bar-riers to using the most effective treat-ment such as agranulocytosis, inabil-ity to obtain and maintain therapeutic

clinical issUes

drug levels due to fast metabolism, or bothersome adverse effects such as hyperprolactinemia . In treatment resistant patients, it may still be nec-essary to use these medications even when barriers are present due to a lack of alternative therapeutic options not previously exhausted . In addition to complex regimens, treatment plans for these patients often require trials of multiple medication combinations or unique exploitation of interactions and biological phenomena .

caseWe report a forensic case study that exemplifies multiple clinical pearls that may be useful in patients with treatment refractory schizophrenia . A 31-year-old African American female presented to the emergency room escorted by law enforcement after stabbing a cab driver with a pencil. The patient stated she was raped by the cab driver and while in the emergency room stated that “dirty cops brought me here .” She was admitted to the inpatient psychi-atric unit to determine competency to stand trial for the assault of the cab driver . She had been in many previous correctional institutions with a known history of schizophrenia and additional diagnoses of amenorrhea, hyperpro-lactinemia, and obesity .

The patient’s history was significant for auditory hallucinations and para-noid delusions beginning by age 14 with a diagnosis of major depression with psychotic features. By age 18, she was diagnosed with schizophre-nia, paranoid type . She had multiple

previous hospitalizations and a his-tory of poor compliance as an outpa-tient. There was no known history of tobacco, alcohol, or illicit drug use . Her family history was significant for schizophrenia, diabetes mellitus, and drug use . The patient reported abusive behavior by her grandmother, who was her primary caretaker as a child.

During hospitalization, the patient con-tinued to report sexual assaults, accus-ing both patients and staff of rape, and declined to participate in groups . She denied any visual or auditory halluci-nations but continued to exhibit para-noid delusions. The patient was later found to be permanently incompetent to stand trial and was committed to the state’s department of mental health for long term treatment of her psychiatric illness .

• clinical pearl i – pharmacokinetics

• clinical pearl ii – clozapine and agranulocytosis

• clinical pearl iii – hyperprolactinemia and associated complications

editor’s note: this article is reprinted with permis-

sion. deardorff, oG. Case Based Clinical Pearls: a

schizophrenic case study. the Mental health Clinician

(MhC). 2012 february. available at: http://cpnp.org/

resource/mhc/2012/02/case-based-clinical-pearls-

schizophrenic-case-study.

The rest of this article is available at www.mpha.org, under the Communications tab > Minnesota Pharmacist Journal .



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what is cpe Monitor?

CPE Monitor is a national, collaborative effort by the Accreditation Council for Pharmacy Education (ACPE) and the National Association of Boards of Pharmacy (NABP) to provide an elec-tronic system for pharmacists and pharmacy technicians to track their completed con-tinuing pharmacy education (CPE) credits. It will also offer state boards of phar-macy the opportunity to elec-tronically authenticate the CPE units completed by their licensees, rather than requir-ing pharmacists and techni-cians to submit their proof of completion statements upon request or for random audits .1

how does cpe Monitor work?Pharmacists and pharmacy tech-nicians will need to log in to CPE Monitor through the NABP Website using this link: http://www.nabp.net/programs/cpe-monitor/cpe-monitor-service/index .php . From the CPE Monitor page, pharmacists and phar-macy technicians will need to create an NABP e-Profile. You will receive a unique ID after setting up your e-Pro-file with NABP and registering for CPE

Ask the PharmacistFrequently Asked Questions about

Continuing Pharmacy Education (CPE) MonitorBy David Q. Hoang, PharmD, MBA, Minnesota Multistate Contracting Alliance for Pharmacy, St. Paul

Monitor . As ACPE-accredited provid-ers have been transitioning their sys-tems to CPE Monitor throughout 2012, you will need to begin to provide your NABP e-Profile ID and date of birth to the providers when you register for CPE or submit a request for credit . The system will then direct electronic data from ACPE-accredited providers to ACPE and then to NABP, ensur-ing that CPE credit is officially verified by the providers . Once information is received by NABP, you will be able to log in to access information about your completed CPE .2

is cpe Monitor able to track non-acpe accredited cpe?Currently, CPE monitor is not able to track non-ACPE accredited CPE . In Phase 2 of the CPE Monitor initiative, CPE Monitor will add a function to track CPE from providers not accred-ited by ACPE in addition to CPE from ACPE-accredited providers . Until Phase 2 is completed, pharmacists and technicians will need to submit proof of non-ACPE accredited CPE directly to the board of pharmacy when required to do so .2

is the Minnesota Board of pharmacy currently using cpe Monitor?No, the Minnesota Board of Pharmacy is not currently using CPE Monitor in any way. Minnesota Board of Pharmacy will take a closer look at how it will be able to use CPE Monitor in the future. The problem right now is that CPE Monitor only tracks ACPE-approved CE programs and our state

allows pharmacists to use non-ACPE approved experiences for CPE .3

if the Minnesota Board of pharmacy is not currently using cpe Monitor, why do i have to be concerned with it?Even though the Minnesota Board of Pharmacy is not currently using CPE Monitor, ACPE-accredited pro-viders have been transitioning their systems to CPE Monitor throughout 2012 . MPhA is an ACPE-accredited provider and is investing resources to transition its systems to CPE Monitor . All MPhA members (both pharma-cists and pharmacy technicians) were asked to sign up by Dec . 31, 2012, as the new reporting period began. If pharmacists and technicians do not submit the NABP e-Profile ID to the CPE provider when the CPE activity is completed, then the provider cannot award the credit. It is the responsibility of the pharmacists and technicians to obtain and submit the correct ID to the CPE provider, as the CPE provider will not have the mechanism to look up ID numbers . Individual pharmacists and technicians will also be responsible to assure that the information in their profile is accurate.2

will acpe-accredited cpe provid-ers continue to issue paper state-ments of credits?ACPE does not require ACPE-accredited CPE providers to issue

clinical issUes

ask the pharmacist continues on page 24


no harm and to put patient safety and wellbeing before financial profit and gain . In this instance, it seems that regardless of the law, NECC would not have followed it.

Going forward, it is important to remember that compounding occurs in almost all pharmacy practice set-tings; therefore any changes to state or federal law would affect all pharma-cies . It is safe to say that as pharma-cists, we want to work with patients, professionals, regulators, government officials and boards of pharmacy to assure that any gaps or regulatory gray areas that may result in patient harm are identified and corrected. Stricter oversight and clearly defined practice standards may be necessary . Areas worth exploring may be clear definitions of bulk compounding and medications intended for office use. Universal guidelines and standards such as USP 795 and 797 should be considered . If jurisdiction and regula-tion falls on either the FDA or boards of pharmacy, it is essential that these entities are adequately funded in a manner sufficient to provide educated and specially trained personnel to conduct regular inspections . Boards of pharmacy need to review how they rely on each other when licensing non-resident pharmacies . Individual pharmacies and health systems need to review their practices in identifying reputable wholesalers and distributors as well as verifying appropriate licen-sure and current standing in following best practices of any other pharmacy from which they may acquire drugs.

It is unfortunate that it takes a cri-sis of this magnitude to bring about change, but it is essential that phar-macists, lawmakers and regulators work together to ensure the integrity of the practice of pharmacy and the area of compounding while keeping patient safety and protection at the forefront . Compounding pharmacy is a lasting foundation of the profession and serves a vital role for patients . In this crisis, we have the opportunity to make change to prevent future trag-edies. Protecting patient safety with-out hindering legitimate compounding practice is the ultimate goal .

references:The Commonwealth of Massachusetts Executive Office of Health and Human Services, New England Compounding Center Preliminary Investigation Board of Registration in Pharmacy Report, http://www.mass.gov/eohhs/docs/dph/quality/boards/necc/necc-prelimi-nary-report-10-23-2012 .pdf

USP U .S . Pharmacopeial Convention: USP Compounding Standards and Resources, http://www.usp .org/usp-healthcare-professionals/compounding

Kate Douglass, Eric S . Kastango, MBA, RPh, Peter Cantor, State Regulations Impact USP 797 Compliance, Pharmacy Purchasing and Products, April 2012, http://www.pppmag.com/article/1113/April_2012_State_of_Pharmacy_Compounding/State_Regulations_Impact_USP_797_Compliance/

David L. Cowen and William H. Helfand, Pharmacy: An Illustrated History 186 (1990) .

Centers for Disease Control and Prevention: Multistate Fungal Meningitis Outbreak Investigation, http://www.cdc .gov/hai/outbreaks/meningitis .html

US Food and Drug Administration: Multistate outbreak of fungal meningitis and other infections, http://www.fda .gov/Drugs/DrugSafety/FungalMeningitis/default .htm

paper statements of credits . It is up to each provider to distribute paper state-ments if it wishes to do so.2

will pharmacists be able to print their transcripts?Yes, pharmacists and technicians will be able to print their transcripts and individual statements of credit from their e-Profiles.2

since some pharmacists have two license numbers, do they register twice in the nABP e-profile?No, the pharmacist with multiple licenses will only need to complete the profile one time. The ID number the pharmacist receives will accommodate all licenses .2

Beginning January 1, 2013, MPhA and all other American Council of Pharmacy Education (ACPE) providers are required to electronically upload CPE credits earned . In order for MPhA or any other provider to upload your CPE credits, you must set up an NABP e-Profile, obtain your NABP e-Profile ID, and register for CPE .

references & resources1 . CPE Monitor . Accreditation Council for Pharmacy Education Website. https://www.acpe-accredit.org/pharmacists/cpemonitor .asp

2 . CPE Monitor Service . National Association of Boards of Pharmacy Website. http://www.nabp.net/programs/cpe-monitor/cpe-monitor-service/index .php

3 . Personal communication (email) . Executive Director, Minnesota State Board of Pharmacy . October 30, 2012 .

Do you have a question?Ask the Pharmacist by emailing your questions to info@mpha .org .

Meningitis continued from page 17

DID YOU KNOW...A working group at the Center for Leading Healthcare Change at the College of Pharmacy has completed its report on

recommendations for the modernization of MN Statutes, Chapter 151, “Enabling the Pharmacists to Respond to the Health Needs of Minnesota Communities .”

Much of the current act dates back to a rewrite from 1937. The intent of the recommendations is to provide increased opportunities for pharmacist practitioners to fully participate in the changes occurring in the delivery of health in

Minnesota and the U .S .See the full report here: http://tinyurl .com/987upu4

ask the pharmacist continued from page 23

report of drug insert labeling revisions Based Upon New Efficacy Information

By Kent T. Johnson, MSPharm

Recent revisions to drug product insert labeling that might be of interest and importance to pharmacists are noted in the accompanying Table of Efficacy Supplements . The entries are selected from the many supplements to approved drug applications approved each month by FDA for marketed drugs and biologics . Specifically, entries to this table are largely based upon supplements categorized: “Efficacy supplement with clinical data to support.” These would typically be the type to provide new or revised: Indications and Usage and/or Dosage and Administration changes in the professional labeling . The entries chosen for inclusion are the major-ity of, but not all, efficacy supplements. It is also important to note that the short descriptions of the changes provided in the table may not provide all information associated with the revision. Additional supporting changes may also be in the revised labeling (for example, new safety information) . Readers should consult the new labeling when the changes cited are important to their specific need.

Different presentations and extent of restat-ing the revised information are noted in this report . Variation comes about by extent of the change and ease of understanding the changes in different presentations . It is anticipated that format and description of the changes will be refined in future reports . Consult the FDA Website to obtain or review FDA’s approval letter and/or revised insert labeling:

www.accessdata.fda.gov/scripts/cder/drugsatfda/index .cfm?fuseaction=Reports .ReportsMenu

If you have questions about this article, please contact the author at kenttjohn-son@usfamily .net .

DATE PROPRIETARY NAME

ACTIVE INGREDIENT(S)

NEW INFORMATION

Oct . 26 Avastin bevacizumab Indications and Usage: (1) Includes a Limitations of Use statement: Avastin is not indicated for the adjuvant treatment of colon cancer . (2) Metastatic Breast Cancer – removed .

Oct . 18 Rituxan rituximab Dosage and Administration = Provide for the use of Rituxan as a 90 minute infusion for previously untreated follicular non-Hodgkin’s lymphoma (NHL) and diffuse large B-cell lymphoma (DLBCL) patients who have tol-erated the standard infusion of Rituxan at Cycle 1 .

Oct . 17 Alimta pemetrexed Dosage and Administration = Greater detail on requirements for vitamin supplementa-tion and concomitant corticosteroid use with Alimta administration; and dosage recom-mendations for patients with hepatic impair-ment .

Oct . 10 Taclonex calcipotriene & betamethasone dipropionate

New Indication: For plaque psoriasis of the scalp and body in patients 18 years and older .

Oct . 12 Baraclude entecavir Revision of “Use in Specific Populations” section to include data from studies of post-liver transplant population and Black/African American population .

Oct . 12 Humalog insulin lispro Provides for intravenous administration .Oct . 11 Actemra tocilizumab Revision of Indications and Usage section

on R .A .; …for the treatment of adult patients with moderately to severely active rheuma-toid arthritis who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs (DMARDS), …

Oct . 4 Tracleer bosentan Provides revised details of patient popula-tions establishing effectiveness .

Sept . 28 Humira adalimumab New Indication: For inducing and sustaining clinical remission in adult patients with mod-erately to severely active ulcerative colitis who have had an inadequate response to immunosuppressants such as corticoste-roids, azathioprine, or 6-mercaptopurine .

Sept . 21 Eyelea aflibercept Provides for treatment of macular edema following Central Retinal Vein Occlusion (CRVO) .

Sept . 20 Prolia; Xgeva denosumab New Indication: Treatment to increase bone mass in men with osteoporosis at high risk of fracture .

Sept . 18 Besivance besifloxacin Indications and Usage = Provides for the addition of four pathogens to the current labeling .

table of efficacy supplements, september and october, 2012

clinical issUes

labeling revisions continues on page 26


pronUnciation of actiVe inGredient naMes of recently approVed drUG prodUcts

This column provides a guide to pronunciation of the nonproprietary name of active ingredients in drug products recently approved by FDA under a new drug application (NDA) or a biologics license applica-tion (BLA) . The list is not exhaustive for every recent approval. For example, some newly approved drug products have active ingredients found in previously approved products . Also, there is some editorial privi-lege exercised to not include selected products in this list because the product may not have great impact upon traditional pharmacy services, e.g., a new radio-pharmaceutical, or for other reasons . The pronuncia-tion guide comes from: 2012 USP Dictionary of USAN and International Drug Names . Additional information on how pronunciation is established will be seen in future editions of the Minnesota Pharmacist .

labeling revisions continued from page 25proprietary

naMenonproprietary naMe of actiVe inGredient(s)

pronUnciation date approVed

Synribo omacetaxine mepe-succinate

oh” ma se tax’ een mep” e sux’ i nate

Oct . 26

Fycompa perampanel per am’ pa nel Oct . 22

Jetrea ocriplasmin ok” ri plaz’ min Oct . 17

--- nepafenac ne pa’ fen ak Oct . 16

Nucynta tapentadol ta pen’ ta dol Oct . 15

Cystaren cysteamine sis tee’ a meen Oct . 2

Stivarga regorafenib re” goe raf’ e nib Sept . 27

Aubagio teriflunomide ter” i floo’ noe mide Sept . 12

Bosulif bosutinib boe sue’ ti nib Sept . 4

FURTHERING PHARMACY

ADVANCINGCAREERS

Find the best jobs and highly qualifiedpharmacists Minnesota has to offer.

ONLINE CAREER CENTERwww.mpha.org

PHARM.MN_print_half_7.5x4.75.indd 1 12/13/12 5:00 PM


Marketing the Community PharmacistBy Robert Mueller, PharmD, and Jason Varin, PharmD, Cub Pharmacy

Pharmacy is defined as “the art, prac-tice, or profession of preparing, pre-serving, compounding, and dispensing medical drugs .”1 While this definition describes the profession in a very traditional sense, the role of the com-munity pharmacist encompasses more than just compounding and dispens-ing medications . Pharmacists have a long history of identifying, preventing, and resolving drug-related problems, encouraging appropriate medication use, and being the trusted, accessible source of health information and edu-cation .2,3 Over the past few decades the profession at large has evolved away from the traditional pharmacist stereotype . Rather than preparing or providing a product, pharmacists have focused more on providing health-related services while working closely with other health care providers and the public as evidenced by pharmacist roles in hospital and clinic care teams, in skilled nursing facilities as consul-tants, and in the community as medica-tion therapy management (MTM) prac-titioners .2,4 As a result of this realign-ment and expansion in the practice of pharmacy, society holds misconcep-tions of what community pharmacists actually do . Associate Professor at the University of Tennessee College Of Pharmacy, Lawrence Brown, PharmD, PhD, states,

“patients think far less of pharma-cists than what we think. and i am not saying that as a negative. i am saying that means we need to do a better job of helping them under-stand what it is that we can do. Because their stereotypical view was, the community pharmacist fills the prescriptions, and any-thing outside of that was beyond [the patients’] understanding.”5

While there are many obstacles (such as staff shortages, lack of time, and poor reimbursement) that impede pharmacists from expanding their role in health care even further, Dr. Brown’s research demonstrates one sizeable barrier is actually the patient .4,5 Many patients do not express support for expanded pharmacy services, likely due to the fact that patients are large-ly unaware of what pharmacists can do . Therefore, a proposed solution is to market community pharmacists as trusted and accessible health care pro-viders who improve clinical outcomes, and reduce health care costs .

trusted and convenient (location, location, location!)The community pharmacist has a long pedigree of being a trusted and easily accessible health care provider . In a recent Gallup poll, pharmacists ranked second (after nurses) for being the most trusted profession regarding hon-esty and ethical standards .6 In addi-tion to being trustworthy, pharmacists are the most accessible health care professionals . On average, there is a pharmacy within 2.36 miles of any resident in the United States, and 92% of all Americans live within 5 miles of a community pharmacy . This ubiquity typically allows patients convenient access to a pharmacist without an appointment or fee .7

Many community pharmacists provide health monitoring and preventive care services including, but not limited to, tobacco cessation programs, blood pressure checks, screenings for cho-lesterol, osteoporosis and blood glu-cose, diabetes counseling, and immu-nization services .8 In communities with little or no access to primary care, the provision of these monitoring and

preventative services by pharmacists allows patients to receive services they might otherwise forego. Pharmacist-provided care does not and should not replace that of a physician, nurse, or any other member of the health care team. We do, however, provide our own unique benefit as drug experts and synergize the net effect of the health care team to become more than the sum of the individual practitioners .

The advent of pharmacist-delivered immunizations has been particularly important in providing convenient, pre-ventative care to patients . In 1995, pharmacists were allowed to admin-ister vaccinations in only five states.9

Today, all 50 states allow pharmacists to vaccinate, and out of the 94 million adults vaccinated during 2010-2011, an estimated 17 million doses were administered by pharmacists .10 A CDC report during that same time period estimated 18 .4% of all immunizations were administered in pharmacies, supermarkets, and other retail set-tings, making them the leading alterna-tive locations to the doctor’s office for receiving immunizations .10

clinical outcomes: We have Walked the walkPharmacists and the services they provide have a large impact on patient care by improving clinical outcomes and aiding in disease prevention . Pharmacists can optimize appropriate medication use by improving medica-tion adherence, reducing medication related problems and improving health outcomes through health promotion, disease prevention, chronic care man-agement activities, administration of

indUstry news

Marketing the community pharm-acist continues on page 28


immunizations, and delivery of MTM services .

Studies have shown that com-munity pharmacist involvement in patient care (beyond that of dispensing medications) can positively impact inhaler use, smoking cessation, blood pressure, and medication adherence.11,12,13,14 Intensive community pharmacist inter-vention consisting of identify-ing, assessing, educating and referring patients with a high cardiovascular risk has been shown to reduce baseline LDL by 13.4% and sustain these beneficial results for more than a year.15

MTM (a systematic care process, the roots of which were fertilized here in Minnesota more than 20 years ago16) has been shown to provide positive benefits to patients. Since this specific nomenclature was developed, MTM has demonstrated great potential for increasing quality of care, reducing health expenditures, and generating a positive return on investment .3,4 For example, a year-long evaluation of an MTM program in Minnesota demon-strated that pharmacists identified and resolved 789 drug therapy problems in 259 patients (an average 3 .1 drug therapy problems per recipient) .17

the societal Value of pharmacist provided care Proper use of medications improves quality of life and health outcomes . Conversely, drug-related morbidity and mortality (DRMM) creates a significant problem for the health care system . It is estimated that the improper use of medications by patients costs the health system roughly $290 billion per year .18 A 2006 Institute of Medicine

report estimated that at least 1 .5 mil-lion preventable ADEs (adverse drug events) occur in the United States each year, costing the health system an estimated $3 .5 billion per year .19

As medication experts, pharmacists in the community are in a unique posi-tion to help lower the cost of health care related to DRMM . Pharmacists can reduce health care related costs by encouraging medication adherence, by providing education on medication usage and potential adverse drug reac-tions, and by identifying and correcting medication errors before they reach the patient . The cost savings second-ary to pharmacist interventions are sig-nificant; as one study noted, the direct cost of medical care that is avoided as a result of pharmacists’ interventions was estimated to be $122.98 per prob-lematic prescription .20

MTM has demonstrated cost sav-ings by reducing out-of-pocket and third-party expenses through several interventions such as generic substitu-tion and therapeutic interchange, and may have a favorable effect on overall medical costs by reducing office visits, emergency room visits, and hospital admissions .4 One study found that a health care system avoided an aver-age estimated cost of $93 .78 for every $8 .44 reimbursed to community phar-macists for providing MTM .9,21

now Let’s talk the talkThe hard work of planting the field, harvesting the yield, and packaging the year’s produce is complete and our shelves are bursting with quality inven-tory. Now we need to sell it to patients, to other health care team members, to politicians, to society, and perhaps the biggest challenge, to ourselves . One member of a Special Issues Board offered a harsh critique stating, “The profession lacks good management and organization to market pharma-cists’ skills.”22 Fortunately, marketing the role of pharmacists and the ser-vices we provide does not have to be difficult. Perhaps the easiest and most

powerful way to market our “wares” to patients is to allow them to experience the value of a pharmacist firsthand.

Introducing ourselves to our patients is an incredibly easy and effective means (although rarely used) of starting a relationship . After the introduction, ask some questions (non-medical) and get to know the people inside the patients, remember their names, put notes such as the names of their children or pets in their profile, or note their hobbies for reference on subsequent visits . Build a relationship with them, and when the time is appropriate, personally invite them to take advantage of the pro-fessional services you can provide . Patients will likely realize on their own that their pharmacist is trustworthy, convenient, helps improve their health, and saves them time and money .

Pharmacists could also resort to other common strategies used in marketing such as advertising, sales promotion, or publicity . The depth and importance of pharmacist-provided services could be promoted on posters or prescription fliers. These vehicles could contain information such as “Blood Glucose Screening Oct. 14,” or “Did you know you can get your flu shot right here right now? If you have Plan X, Y or Z, there is no charge to you .” More than likely you have several patients who are employed at a local business or reside in an assisted-living complex . Find out whom to talk with about pro-viding a flu-shot clinic or other health care related service at these facilities . Not only will you provide a valuable service to the community and improve your bottom line, you will acquire a captive audience and an opportunity to promote your other professional ser-vices . Pharmacy services could also be advertised through local media such as television, newspaper, billboards, radio, or through social media outlets such as Facebook and Twitter.

Ensuring medications are used in a safe and effective manner to improve patient outcomes remains at the core

Marketing the community pharm-acist continued from page 27


of our profession . The profession has transitioned from a largely product-based environment to a hybrid of pro-viding products and professional ser-vices. This transition, while beneficial for the profession, has been difficult for the public to comprehend . Change has been, and will continue to be, a constant within the profession of pharmacy . We need to embrace and proactively direct change, which will surely provide opportunities . When an opportunity does arise, take the class, complete the training or whatever action is required to enable you to pro-vide professional services . Take time to do a professional inventory includ-ing all of the services that you can provide to your patients, then speak to others about these services and the benefits they provide with the same zeal as you would a favorite musical group or beloved movie, and with the same pride as if your child was walk-ing across the stage to receive their diploma . It is time for us, as a profes-sion, to “blow our own horn!”

Robert Mueller, PharmD, is a PGY1 resident at Froedtert Health System in Milwaukee, Wisc. He is a 2012 graduate of the U of MN College of Pharmacy. This article was created during his last APPE rotation at Cub Pharmacy in Chanhassen with Dr. Varin act-ing as his preceptor. You can contact Dr. Mueller at [email protected].

Jason Varin, PharmD, practices at Cub Pharmacy and serves as experiential coordinator for Cub Pharmacies. He also serves as Pharmacist Ambassador for the Center for Leading Healthcare Change at the University of Minnesota and as a member of the MPhA Board of Directors. Please contact him with any comments you have about this article at [email protected].

references1. “Pharmacy.” Merriam-Webster. http://www.merriam- webster.com/dictionary/pharmacy (accessed May 1, 2012) . 2 . Nkansah, Nancy, et al . “Effect of outpatient pharma-cists’ non-dispensing roles on patient outcomes and prescribing patterns .” Cochrane database of systematic reviews. 7 (2010):CD00033-CD000336.3 . Isetts, Brian J . “Pharmaceutical care, MTM, & payment: the past, present, & future .” The Annals of Pharmacotherapy 46 .4 (2012):S47-S56 .4 . Barnett, Mitchell J, et al . “Analysis of pharmacist-provided medication therapy management (MTM) ser-vices in community pharmacies over 7 years .” Journal of managed care pharmacy 15 .1 (2009):18-31 .5 . Schu, Bill . “The Next Generation of Pharmacy Practice.” Pharmacy Times. http://www.pharmacy-times.com/publications/career/2009/Careers_2009-02/Careers_2009-02_017 (accessed April 28, 2012).6 . Saad, Lydia . “Honesty and Ethics Poll Finds Congress’ Image Tarnished.” Gallup. http://www.gallup.

com/poll/124625/Honesty-Ethics-Poll-Finds-Congress-Image-Tarnished .aspx (accessed April 15, 2012) . 7 . NACDS . “Community Pharmacists One Of Most Trusted Health Care Professionals.” Medical News Today . MediLexicon, Intl ., Sep . 29, 2007 . Web . Aug . 8, 2012. <http://www.medicalnewstoday.com/releas-es/83978 .php>8 . Radford, Andrea; Richardson, Indira; Mason, Michelle; Rutledge, Stephen . “The Key Role of Sole Community Pharmacists in Their Local Health care Delivery Systems .” Findings Brief . March 2009 . http://www.shepscenter.unc.edu/rural/pubs/finding_brief/FB88 .pdf (accessed April 28, 2012) .9. Grosch Jr, Stephen. “Four ways pharmacists will make a big impact in 2010 .” RxTimes . February 4, 2012. http://www.rxtimes.com/4-ways-pharmacists-will-make-a-big-impact-in-2010/ (accessed March 27, 2012) .10 . Egervary, Alex . “CDC: Pharmacists increasingly popular alternative for flu vaccination.” Pharmacist.com. http:// www.pharmacist.com/cdc-pharmacists-increasingly-popular-alternative-flu-vaccination (accessed March 29, 2012) .11. Bosnic Anticevich, Sinthia Z, et al. “Metered-dose inhaler technique: the effect of two educational inter-ventions delivered in community pharmacy over time .” The Journal of asthma 47 .3 (2010):251-256 .12 . Sinclair, H K, C M M Bond, and L F F Stead . “Community pharmacy personnel interventions for smoking cessation .” Cochrane database of systematic reviews. 1 (2004):CD003698-CD003698.13 . Lau, Rosalind, et al . “Evaluation of a commu-nity pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised con-trolled trial .” BMC health services research 10(2010):34-34 .14 . Carter, Barry L, and J W Foppe van Mil . “Comparative effectiveness research: evaluating phar-macist interventions and strategies to improve medica-tion adherence .” American journal of hypertension 23 .9 (2010):949-955 .15 . Yamada, Carol, et al . “Long-term impact of a com-munity pharmacist intervention on cholesterol levels in patients at high risk for cardiovascular events: extended follow-up of the second study of cardiovas-cular risk intervention by pharmacists (SCRIP-plus) .” Pharmacotherapy 25 .1 (2005):110-115 .16 . Strand LM, Cipolle RJ, Morely PC, Perrier DG . Levels of pharmaceutical care: a needs-based approach . Am J Hosp Pharm . 1991 Mar:48(3):547-50 . 17 . Evaluating Effectiveness of the Minnesota Medication . Therapy Management Care Program . Final Report. Submitted December 14, 2007. http://www.dhs.state.mn.us/main/groups/business_partners/docu-ments/pub/dhs16_140283.pdf (accessed May 1, 2012). 18 . Engleberg Center for Health Reform at Brookings and the Dartmouth Institute for Health Policy and Clinical Practice . Brookings-Dartmouth Accountable Care Organization Toolkit . Washington, DC: The Brookings Institution 2011:119 . 19 . Institute of Medicine . “Preventing Medication Errors.” July 2006. http://www.iom.edu/~/media/Files/Report%20Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf (accessed June 1, 2012) .20. Rupp, M T. “Value of community pharmacists’ inter-ventions to correct prescribing errors .” The Annals of pharmacotherapy 26 .12 (1992):1580-1584 .21 . Barnett MJ, Frank J, Wehring H, et al . J Manag Care Pharm . 2009;15:18-3122 . Kelly, H W . “The role of pharmacists in the evo-lution of health care: an open forum discussion .” Pharmacotherapy 26 .9 (2006):200S-202S .

Pharmacists Rank in Top

Three in Integrity

For the tenth consecutive year, Gallup’s annual Honesty and Ethics survey reveals that pharmacists have ranked among the top three professions for integrity. In the most recent survey, released on Dec. 3, 2012, pharmacists ranked second only to nurses and ahead of doctors. The annual survey measures the public’s trust of professionals across diverse disciplines.

Source: News release from National Association of Chain Drug Stores, Dec. 3, 2012. Accessed at www.nacds.org.


By Kandace Schuft, PharmD Candidate

indUstry news

What a whirlwind of events!

In September, I finished my fourth block of Advanced Pharmacy Practice Experience (APPE) rotations, on the oncology unit at Fairview-UMMC. This rotation allowed me to learn new clinical skills, use the knowledge we learned in class in regards to chemo-therapy, and manage complications of these drugs. Applying what I learned in pharmacotherapy during our third year of school was a rewarding feeling, knowing my decisions and consults directly affected patient care .

In addition to using clinical skills on the oncology unit, I embraced being part of a team. Even as a student, I was able to assist in answering consults and drug information questions, enter-ing warfarin and vancomycin notes, and following patients throughout their stay in the hospital. Not only was I a part of these activities, but I was also acknowledged by other health-care professionals during rounds and throughout the floor by nursing staff, mid-level practitioners, fellows, and the attending physicians . Throughout my rotation, I worked with a variety of pharmacy staff as well, including team leaders, clinical pharmacists, and resi-dents. Working with each and every person allowed me to build commu-nication skills and learn clinical pearls they had learned throughout their own career experiences .

Working as a part of the “team” allowed me to also observe when a pharmacist can really shine through as a positional

and non-positional leader. It was bene-ficial to observe and experience this in action because it has been a focus of my Leadership Emphasis Area (LEA) track available at the University of Minnesota-College of Pharmacy . In addition to the concept of differentiat-ing between types of leaders, I have learned a great deal about leader-ship styles, management vs . leader-ship, my personal strengths, Kotter’s 8-step process for leading change throughout the Leading Change in Pharmacy courses, Leadership APPE rotations, and the Leadership Best Sellers course . All of these experi-ences have increased my awareness and self-reflection in regards to being a leader within my professional or per-sonal life. I couldn’t have asked for a better way to learn more about myself, including my personal strengths using StrengthsFinder, which opened my eyes to why and how I work with others to accomplish tasks and projects . This type of self-reflection has helped me to realize and organize my thoughts surrounding my future short- and long- term career goals .

As I started my fifth block, a leadership/management rotation with John Pastor at Fairview-UMMC, I can recall him stating, ”This is a pivotal time in your life,” as we discussed career plans and goals . This statement resonated with me and I am sure other PharmD candidates couldn’t agree more! This is the moment we, as students, have been waiting for: to “figure out” what we want to do with our lives. At the same time, I think we never really can

answer this question. As pharmacists we will always continue to learn, grow, change, and progress, whether it is changing positions with one organiza-tion or moving across the nation .

As graduation and residency/job appli-cation deadlines grow closer, there are important lessons we have learned from working, rotations, and classroom experiences. As students, we have learned what we do and do not enjoy, helping to guide our decision on our future . The options are endless, but the real goal is to enjoy each day and give 100% to what we do every day. In a few weeks, the ASHP Midyear Clinical Meeting will take place in Las Vegas. I am confident it will be an enor-mous amount of fun! Not only because Midyear is in Las Vegas but also because we, as a class, will be able to reconnect. It is unreal how motivated and re-energized I feel after attending a professional pharmacy conference with my colleagues, whether it is the MPhA Annual Meeting or the ASHP Midyear Clinical Meeting. Amazing how time flies! Soon after the meeting, it will be time to turn in our PharmD papers and present them in January . This is something I am sure we are working on, day in and day out … right!?

The next few months will be filled with exciting, yet challenging, hurdles. However, just like our time at the College of Pharmacy, these too shall pass. Each and every one of us will match to a residency program, find a

pharmd life continues on page 33

Musings on the Life of a Pharmd Candidate


By Kandace Schuft, PharmD Candidate

MPhA Member Benefits

The Minnesota Pharmacists Association’s number one priority is its members . MPhA strives to provide services and benefits to our members that not only promote the profession of pharmacy in Minnesota, but the professional lives of our members as well. Ranging from advocacy and com-munication to discounted professional and business programs, we are always on the search for benefits that are valuable to you as pharmacy professionals .

Many of our benefits can be accessed eas-ily through our Website . From online dues renewal, conference registration and mem-ber searches, we strive to not only make membership valuable, but easy to use and navigate. Not able to find what you are looking for? Contact our office and we can help point you in the right direction .

MeMBershiP dues:Check with your employer to see if they cover a portion of MPhA membership . Membership dues can be renewed online and a portion of your dues are tax deduct-ible (consult your tax adviser with ques-tions) . We offer a variety of options to make payment more convenient, including a monthly debit program that will debit your credit card, checking or savings account each month (call the MPhA office to set up this feature) .

adVocacy MPhA works to provide members with a “voice” in pharmacy at the state and nation-al levels . The association puts a “face on pharmacy” through media and outreach to health care entities that rely on MPhA for information and resources related to phar-macy services .

Through legislative representation, policy planning, and lobbying, the association ensures that issues pertaining to pharmacy are not overlooked or undercut. We fight for the rights of pharmacists and pharmacy professionals to provide the highest level of care to the patients they serve . MPhA encourages members to become involved

in this process by being active in grass-roots actions and events . As a member, you will have access to important updates and resources made possible by your sup-port .

professional deVelopMent and edUcation MPhA provides a variety of events through-out the year to keep members involved in pharmacy issues while offering continuing education, networking opportunities and fun! Events are listed on the MPhA Website and are open to all . Members receive a discount on selected event program-ming, such as Annual Meeting, Fall Clinical Symposium, and Midwinter Conference.

Online pharmacy education is also avail-able through the MPhA Website . Home Studies and Learn Something offer a vari-ety of topics and timelines to fit your needs.

prodUcts and serVicesMembers benefit from discounted rates and prices on both professional and busi-ness related services .

Professional Services• Pharmacists Letter• Pharmacists Mutual Insurance• Technician Manuals

Business Services• Coupon Redemption Program• PAAS 3rd-Party Audit Services• Credit Card Processing Services• Pharmacists Financial Service• Discounted AAA Automotive

Membership

coMMUnicationCommunication is our cornerstone of keep-ing you informed of association, state and national news and action.

Minnesota PharmacistThe Minnesota Pharmacist is the asso-ciation’s journal that contains articles and features on today’s pharmacy topics. It mails to all pharmacists in Minnesota, reaching approximately 9,000 pharmacists,

technicians, and students . The journal is published six times per year .

caPsCAPS is our monthly faxed/emailed news-letter that keeps pharmacy professionals abreast of timely pharmacy issues and happenings. The newsletter is faxed to all pharmacies in the state, and is emailed to all MPhA members .

small DosesOur Small Doses email newsletter goes out to all subscribed members. Weekly e-news shares upcoming events, business topics, important legislative or regulatory issues, and other news.

Pharmacy news flashOnce a week, Pharmacy News Flash is delivered by email to members . These updates include news about national issues affecting pharmacists, along with local headlines and job openings .

career centerTailored to both our job seekers and employers, our Career Center allows you to browse openings or post opportunities at your convenience . Search for Minnesota locations, or broaden your search to out-side states . The center holds a variety of options to tailor results to your needs .

resoUrcesMembers receive special online access to pharmacy resources . From MTM templates and brochures to information on immuniza-tions, we save you valuable time by having these resources readily available to you for use in your practice .

call today or visit the Mpha website to join this leading pharmacy association!651-697-1771 or 800-451-8349www.mpha.org

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Mpha news

pharmacy technician continuing educationThe Minnesota Board of Pharmacy has expanded continuing education requirements to include pharmacy technicians . Starting in 2014, tech-nician registration renewal with the Board will not be issued unless the technician has completed 20 hours of approved continuing pharmacy tech-nician education (CPTE) during the two-year period between August 1, 2011 and July 31, 2013 . Each year, the Board will randomly select 10% of technicians for an audit of their com-pleted CPTEs .

In an effort to advance the role of pharmacy technicians in Minnesota and to ensure technicians have the tools available to succeed, MPhA has created the Pharmacy Technician Academy. The Academy’s mission is two-fold, “to promote the profes-sionalism and education of pharmacy technicians” and “to participate and engage with other pharmacy profes-sions to improve patient safety .” MPhA has served as a leader in continuing education for pharmacy technicians . MPhA programs provide ongoing career development and education on today’s pharmacy topics.

To further support Pharmacy Technician Academy members in meet-ing the Board requirements, beginning January 2013, MPhA will expand its

CPTE offerings . Technician members will have access to additional CPTE directly through the MPhA Website! This new members-only service is an exciting opportunity for technicians to receive inexpensive and convenient CPTE provided by MPhA . Member technicians will be able to access 10 credits of Accreditation Council for Pharmacy Education (ACPE) accred-ited, high quality education specifically designed for pharmacy technicians . The ACPE credits will meet the new requirements in Minnesota for ongo-ing technician registration . These 10 hours of written CPTE activities follow the PTCB’s blueprint domains and are based on established technician needs assessments . This CPTE is developed by Collaborative Education Institute (CEI) from Iowa and provided to Minnesota technicians by special arrangement .

Look for this new benefit in late January. The benefit will only be avail-able to MPhA member technicians and will be offered for $30 per year for 10 credits . Member technicians are encouraged to make sure that they have the correct email address on file in the MPhA database . If membership assistance is needed at any time, please call 651-697-1771 and MPhA’s Member Services representatives will assist you .

job, or continue our education else-where. Life will go on, but none of us will forget what it was like to fret about a “Dunham” exam, study antibiotics for months on end, and hope we didn’t add a trailing zero on that laboratory compounding assignment . It is funny to think how important these were, not so long ago, but soon we will be making decisions, impacting patient care and improving outcomes every single day; this is what I love about pharmacy! Pharmacists are one piece of the puzzle, helping to improve how our patients use and manage their medications each day .

pharmd life continued from page 30


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I agree to contribute $1,000 per store . $1,000 x _________ stores = $____________________

I wish to contribute an additional $ ____________________ to help fund MPhA’s efforts to maintain a favorable climate for community phar-macy .

I authorize my wholesaler(s) to place a one-tenth of a per-cent (0 .1%) Pharmacy Future Fund contribution on my regular pharmaceutical purchase invoices . I understand that this is a donation to the MPhA Pharmacy Future Fund .

Name: ___________________________________________ Organization: ______________________________________Address: _________________________________________ City: _______________________ State: _____ Zip: ______Phone: ___________________________________________Fax: _____________________________________________

PAYMENT BY: Check Mastercard Visa Discover

If paying by credit card, all of the following fields are required.

Card #: ___________________________________________Expiration: ________________ Sec . Code: _____________Signature: ________________________________________

BILLING ADDRESS: Same as aboveAddress: _________________________________________ City: _______________________ State: _____ Zip: ______

Alchemist General, Inc .Astrup DrugBaron’s PharmacyBreen’s PharmacyCaremark RX IncCity DrugCoborn’sDakota Drug, Inc .Erickson Drug, Inc .Fairview Health ServicesGenoa HealthcareGoodrich PharmacyHealthPartnersIverson Corner Drug, Inc .JT Hoeschen, Inc .Kemper Drug

Lake Country DrugLewis Family DrugMcKessonNACDSNorthfield PharmacyPark Nicollet Health ServicesPelican DrugPlanned ParenthoodProgressive Health Care of BemidjiRobin Drug CorporationRyan NiemeyerSetzer Pharmacy and Gift CenterThrifty White PharmacyTrumm DrugWalgreens

The Community Pharmacy Defense Fund was established by independent pharmacy owners and chain managers to develop a pool of funding that could be used to fund initia-tives to move pharmacy from a position of defending the status quo to pursuing an aggressive agenda, thus combat-ing the growing number of threats to community pharmacy, chief among them being:

• The inability to negotiate with third-party payers.

• Predatory pricing strategies and below-cost sales.

• The growing threat of mandatory mail-order plans and discriminatory co-pay incentives .

• The threat of continuing cuts in pharmacy reimbursement in the public and private sectors .

• The unrelenting drive by state officials to push the limits of personal importation of prescription drugs .

• The probable increasing difficulty for rural pharmacies to remain viable and to transition ownership.

Contributions of $1,000 per pharmacy are dedicated to the Community Pharmacy Defense Fund, and held in trust by the Minnesota Pharmacists Association . The fund is set up so that funding is directly applied to expenses associated with specific community pharmacy initiatives.

Mpha community pharmacy defense fund

thank you to our community fund supporters!those listed below contributed to the 2012 community pharmacy defense fund.

The Minnesota Pharmacists Association established the Pharmacy Future Fund more than ten years ago to raise funds that would allow MPhA to move our efforts to sup-port community pharmacy in Minnesota to a new level. This fund has provided the vehicle for MPhA to maintain full-time advocacy, to take on third-party issues, and to address the business needs of community pharmacists .

While this program has enabled MPhA to pursue many objectives on behalf of community pharmacy, there are more that have been identified as priorities that we fully intend to pursue . Our motivation to accomplish these tasks is high, and eventually we will get there – but resources behind motivation would enable a more rapid path to suc-cess .

Mpha pharmacy future fund

please sUpport Mpha to address the needs of coMMUnity pharMacy!

Mail or fax form(s) to: MINNESOTA PHARMACISTS ASSOCIATION 1000 Westgate Drive, Suite 252 | St . Paul, Minnesota 55114 651 .290 .2266 fax

Questions? 800-451-8349 or 651-697-1771


Mpha news

Mpha announces exciting transitions for 2013 Ewald Consulting to provide government relations services; Johnson taking U of M post

The New Year means exciting transi-tions for the Minnesota Pharmacists Association (MPhA). The statewide professional association recently announced a contract agreement securing Ewald Consulting to lead MPhA’s Government Affairs Team. The change was made after a meeting of the MPhA executive committee .

“This is an exciting development for MPhA as we continue to be leaders in policy advocacy for our industry at the State Capitol,” said Julie Johnson, cur-rent CEO and executive vice president of MPhA . “For a decade, our govern-ment relations needs were extremely well-served by Matthew Lemke, and we all owe him thanks for his work on MPhA’s behalf. We look forward to that policy advocacy continuing with Michael Wilhelmi and Patrick Lobejko from Ewald Consulting working on our behalf .”

MPhA’s history of strong advocacy and leadership in advancement of phar-macy practice in Minnesota includes numerous practice expansions of

immunization delivery, collaborative practice agreements, medication ther-apy management, rural loan forgive-ness, and more. Lemke, of the Twin Cities firm Winthrop and Weinstine, has taken a position as regional man-ager of government affairs for Koch Companies Public Sector .

The Ewald team brings decades of State Capitol experience to work for the MPhA and will immediately be focused on pursuing major initiatives as the legislative session begins in January . With the Minnesota Senate and House of Representatives both changing hands from Republican to Democratic majorities as a result of the last election, this is a time of great uncertainty and great opportunity for organizations like MPhA. Ewald Consulting first provided government relations work for MPhA in 1999, dur-ing the Practice Act change that result-ed in collaborative practice .

“Advocacy efforts in Minnesota with the new government relations team will begin to ramp up for the Practice

Act Changes currently on our horizon in 2014,” said MPhA President Martin Erickson, ”This move and the experi-ence and insight that the Ewald team brings to MPhA’s efforts will position the organization well.”

It was also recently announced that Julie Johnson will leave her role with MPhA to become the new associate dean for professional and external rela-tions for the University of Minnesota’s college of pharmacy in February . The MPhA congratulates Johnson on her new post. She has been with MPhA for the past 12 years and has made significant contributions to the associa-tion, leaving the MPhA in an excellent position to continue its work as the voice for Minnesota pharmacists .

A search committee, comprised of the executive committee, has been tasked with coordinating the difficult job of finding Julie’s replacement. An initial meeting has already been held to lay the groundwork for a successful search .

Wine TastingG o u r m e t F u n d r a i s e r

d i n n e r

You are cordiallY invited to the

minnesota Pharmacists Foundation’sToast to PharmacysaturdaY, FebruarY 9, 2013

crowne Plaza PlYmouth

6:30 P.m. recePtion | 7:00 P.m. dinner

$125 Per Plate or $900 Per table oF eiGhtcall 651-697-1771 to reserve a table and receive a bottle of winereGister online at www.mPha.orG

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Sponsorship and

Exhibition Opportunities

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Visit mpha.org for details.

minnesota pharmacist journal january-february 2013

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