the kentucky pharmacist vol. 10, no. 1
DESCRIPTION
January 2015 issue of the peer reviewed journal of the Kentucky Pharmacists AssociationTRANSCRIPT
Vol. 10, No. 1 January 2015
TTTHEHEHE KKKENTUCKYENTUCKYENTUCKY
PPPHARMACISTHARMACISTHARMACIST
News & Information for Members of the Kentucky Pharmacists Association
Membership
Matters
in YOUR
KPhA
Get
Involved
Stay
Involved
January 2015
THE KENTUCKY PHARMACIST 2
Table of Contents
Table of Contents
Table of Contents— Oath— Mission Statement 2 President’s Perspective 3 2014 Bowl of Hygeia Winners 4 Retirements and New Beginnings 5 From your Executive Director 6 APSC 8 Technician Review 9 Jan. 2015 CE — Diabetes Care Update 10 January Pharmacist/Pharmacy Tech Quiz 16 KPhA Emergency Preparedness 17 Advocating for Our Profession: A Student Perspective 18 Continuing Education Article Submission Guidelines 19
2015 KPhA Professional Awards 20 Pharmacy Time Capsules 23 Hub on Advocacy 24 In Memoriam 25 2015 Kentucky Legislative Session 26 Kentucky Renaissance Pharmacy Museum 27 KPhA New and Returning Members 28 Pharmacy Law Brief 32 Pharmacy Policy Issues 34 Pharmacists Mutual 36 Cardinal Health 37 KPhA Board of Directors 38 50 Years Ago/Frequently Called and Contacted 39
Oath of a Pharmacist
At this time, I vow to devote my professional life to the service of all humankind through the profession of
pharmacy.
I will consider the welfare of humanity and relief of human suffering my primary concerns.
I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy
outcomes for the patients I serve.
I will keep abreast of developments and maintain professional competency in my profession of pharmacy.
I will embrace and advocate change in the profession of pharmacy that improves patient care.
I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.
Kentucky Pharmacists Association
The mission of the Kentucky Pharmacists
Association is to promote the profession of
pharmacy, enhance the practice standards of the
profession, and demonstrate the value of pharmacist
services within the health care system.
Editorial Office:
© Copyright 2014 to the Kentucky Pharmacists Association. The Kentucky Pharmacist is the official journal of the Kentucky Pharmacists Association published bi-monthly. The Kentucky Pharmacist is distributed to KPhA members, paid through allocations of membership dues. All views expressed in articles are those of the writer, and not necessarily the official position of the Kentucky Pharmacists Association.
Editorial, advertising and executive offices at 1228 US 127 South, Frankfort, KY 40601. Phone 502.227.2303 Fax 502.227.2258. Email [email protected]. Website http://www.kphanet.org.
The Kentucky Pharmacy Education and Research
Foundation (KPERF), established in 1980 as a non-profit
subsidiary corporation of the Kentucky Pharmacists
Association (KPhA), fosters educational activities and
research projects in the field of pharmacy including career
counseling, student assistance, post-graduate education,
continuing and professional development and public health
education and assistance.
It is the goal of KPERF to ensure that pharmacy in Kentucky
and throughout the nation may sustain the continuing need
for sufficient and adequately trained pharmacists. KPERF will
provide a minimum of 15 continuing pharmacy education
hours. In addition, KPERF will provide at least three
educational interventions through other mediums — such as
webinars — to continuously improve healthcare for all.
Programming will be determined by assessing the gaps
between actual practice and ideal practice, with activities
designed to narrow those gaps using interaction, learning
assessment, and evaluation. Additionally, feedback from
learners will be used to improve the overall programming
designed by KPERF.
January 2015
THE KENTUCKY PHARMACIST 3
It is hard to believe that
2014 has come to a close.
Where did the year go? I
think this is a good time to
give thanks for our blessings
from the past year, focus on
the present and look forward to the new year and new be-
ginnings.
The past year has been a significant one for me and one to
give many thanks, both on a personal and professional lev-
el. In June, I was installed as the President of YOUR KPhA.
It is a significant honor. It is hard to believe that I am half
way through my term as President. October saw the cele-
bration of my one year anniversary as Corporate Director of
Pharmacy at Baptist Health after having served as Director
of Pharmacy at Baptist Health Louisville for more than 25
years. In November, my wife (Janice) and I became first
time grandparents with the birth of Robert Shelton Oakley
III (We will call him Shelton.). By the time this article is pub-
lished, our son Rob and his wife Amanda will have complet-
ed their move from Baltimore to Louisville, which is even
more exciting! Just as I have had reason to be thankful for
these many blessings in the past year, I think each of you
will be able to find similar significant events in your life this
past year for which to give thanks. I would hope that each
of you would take time from your busy lives to pause for
your own moment of personal reflection. I hope that you will
be able to consider yourself as blessed as I find myself to
be. I also believe that this is a good time for reflection and
remembrance of those who are no longer with us, but they
were a special part of our lives.
The present sees the start of a new calendar year and a
new legislative year. YOUR KPhA once again will be look-
ing to champion legislation that advances the profession of
pharmacy. We will be introducing a bill again this year to
make changes to the Collaborative Care Agreement to the
Pharmacy Practice Act. We came very close to getting this
legislation passed last year. KPhA has developed a new
strategy for 2015, which we hope will succeed. Once the
bill is filed, KPhA will be sending out contact information for
the members of the legislature. It is important to our suc-
cess that you personally contact your representative and
senator to let them know you support this bill. On the na-
tional level, a new Congress will start as well. Congress-
man Brett Guthrie from Kentucky has again filed his bill to
give health care provider status to pharmacists. Through
the efforts of YOUR KPhA and its members, five out of the
six Congressmen from Kentucky signed on as co-sponsors
of the bill in 2014. There were over 120 co-sponsors of the
bill in 2014. Hopefully, this momentum will carry into 2015.
As the Protector of the Pharmacy Act, YOUR KPhA will
continue to monitor proposed legislative and regulatory pro-
posals, including but not limited to work on compliance is-
sues with the previously enacted MAC transparency legis-
lation, to support efforts to advance medication synchroni-
zation initiatives for patients and to support naloxone pre-
scribing by pharmacists.
Looking forward into 2015, there are many exciting activi-
ties besides legislative initiatives that YOUR KPhA is work-
ing on. First, Bob McFalls and I have started a dialogue
with the presidents of the local associations to see what
KPhA can do to help them. The goal is to create stronger
local associations, which in turn will help to make KPhA a
stronger state wide organization. Secondly, our member-
ship committee, led by KPhA President-Elect Chris Clifton,
continues to focus on new ways to attract new members to
KPhA and retain existing members. If you have an idea that
you would like to share with us on how KPhA can better
serve YOU, our member, please let us know.
The third area to look forward to in the coming year is the
subject I first mentioned in the November issue of The Ken-
tucky Pharmacist, our KPhA Rebuilding for the Future
Campaign. In my article, I looked back at the first 50 years
of YOUR KPhA building and the efforts of the members to
get the job done. I think we benefit when looking forward by
looking back first to see where we have been. Now it is
time to look to the future and to start planning for the next
50 years. The key insight for me so far has been that if we
want to be successful in our campaign, we have to take
time to do it right. The first step is to contact other state
PRESIDENT’S
PERSPECTIVE
Robert Oakley
KPhA President
2014-2015
President’s Perspective
Continued on Page 7
Past, Present Future
January 2015
THE KENTUCKY PHARMACIST 4
2014 Bowl of Hygeia Recipients
January 2015
THE KENTUCKY PHARMACIST 5
Retirements and New Beginnings
Congrats on Retirement!
Long-time Board of Pharmacy inspector Phil Losch
retired at the end of 2014. He was recognized by
2014 Board President Cathy Hanna and Executive
Director Mike Burleson at the Board’s December
meeting. His son, Andrew, and wife, Julie, helped
celebrate.
Also at the Board’s January meeting, Burleson
announced he will retire, effective August 1.
Pharmacy TAC
orientation
YOUR KPhA provided
orientation materials to the
members of the reinstated
Pharmacy Technical Advisory
Committee. Members are: Rob
Warford, Cindy Gray, Suzanne
Francis, Christopher Betz and
Jeff Arnold (not pictured).
President Bob Oakley and
Roamey welcomed the group.
Information will be added to
the Event Listing at
www.kphanet.org soon!
Hotel information is online now at
www.kphanet.org/?page=AnnualMeeting
January 2015
THE KENTUCKY PHARMACIST 6
From Your Executive Director
MESSAGE FROM YOUR
EXECUTIVE DIRECTOR
Robert “Bob” McFalls
It’s hard to believe that not only is it January 2015, but the
month and year are already moving far too quickly. As we
begin a new year, I like to pause and to hear the words of
T.S. Eliot ringing out:
What we call the beginning is often the end, and to
make an end is to make a beginning. The end is
where we start from… For last year's words belong
to last year's language and next year's words await
another voice (Little Gidding).
The advent of a new year brings a time of resolve whereby
we sort the “old” and ponder the “new” as we reflect on
what has passed and think about what we might possibly
accomplish in beginning a new chapter of our life’s journey.
For many of us, it is a time for “new” resolutions accompa-
nied by equal determination to improve ourselves either
personally and/or professionally. And these principles are
easily adaptable to renewing our commitment to causes we
care about as we endeavor to serve our patients as well as
to help others. History informs us that one can trace the
origins of resolutions back to the ancient Babylonians who
made promises at the start of each year. Likewise, during
the medieval period, knights would reaffirm their “peacock
vows” at the end of the Christmas season as they renewed
their commitment to chivalry. Various cultures over time
have adapted the resolution process accordingly, and our
media-driven culture has certainly done its share to engage
us in looking at how we might improve ourselves as we en-
ter into a new year and its cycle of life.
Resolutions, promises and oaths come in a number of
forms in terms of eliciting our response, commitment and/or
covenant. Our forefathers believed so much in honor that
they mutually pledged to each other in the Declaration of
Independence “…our Lives, our Fortunes and our Sacred
Honor.” Reflections during the recent holiday season led
me on a personal journey to my Scouting days with Lincoln
County BSA Troop 91. As a Scout, Assistant Scoutmaster
and Scoutmaster, I learned and taught others to do our best
at all times and in all places — indeed it is our honor and
duty as a part of our oath — and in so doing to leave the
world a better place than we found it. I find strong parallels
here to the work that pharmacists do on a daily basis, and
to your oath, in terms of devoting one’s self to a lifetime of
service to others.
Gallup released its annual Honesty and Integrity Survey in
December, and we all read with humility and gratitude how
pharmacists continue to maintain your high ranking of trust-
worthiness. Pharmacists continue to hold the second posi-
tion — behind only nurses and tied with medical doctors.
The exact question asked by Gallup is as follows: “Please
tell me how you would rate the honesty and ethical stand-
ards of people in these different fields – very high, high,
average, low or very low?” For pharmacists and medical
doctors, 65-percent said “very high” or “high.” The survey
measures the public’s trust of diverse professions, including
but also well beyond healthcare, and the findings reaffirm
the remarkable trust that patients have with their pharma-
cists. It is central to your oath; moreover, being accessible
and providing meaningful service is highly valued by your
patients and/or their caregivers.
During the holiday season, we also were reminded about
how our giving can help others at all levels — whether we
give through charitable donations, direct assistance or with
our one-on-one volunteer efforts, we are often the ones
who receive the benefit. Indeed, in this spirit of giving, we
are reminded that giving also is beneficial for the giver’s
well-being, mentally and physically. The giver finds his or
her own reward in giving. As cited by the Health Hub from
the Cleveland Clinic (12/2/14), studies find these health
benefits associated with giving: lower blood pressure; in-
creased self-esteem; less depression; lower stress levels;
greater happiness; and, longer life overall. The Health Hub
goes on to report, “Biologically, giving can create a “warm
glow,” activating regions in the brain associated with pleas-
ure, connection with other people and trust. In a 2006
study, researchers from the National Institutes of Health
The Rewards of Giving
January 2015
THE KENTUCKY PHARMACIST 7
From Your Executive Director
The Kentucky Pharmacist is online!
Go to www.kphanet.org, click on Communications
and then on The Kentucky Pharmacist link.
Would you rather receive the journal electronically?
Email [email protected] to be placed on the Green list for electronic delivery.
Once the journal is published, you will receive an email
with a link to the online version.
Watch eNews and
subsequent editions
of The Kentucky
Pharmacist for more
information on ways
YOU can help
rebuild YOUR KPhA
Headquarters!
associations and learn from their fund raising efforts. We
have received information from Ohio and Virginia, who had
recent campaigns to build new offices. We have learned a
significant amount of information in a short period of time.
The first step will be the formation of a Building Fund De-
velopment Committee. This committee will help determine
funding needs, help set a fund raising goal and recognition
for those who contribute to our Rebuilding for the Future
fund. Once we have established these basic steps, we can
proceed to the next phase of the campaign. If you are inter-
ested in serving on this Committee, please contact KPhA
and let us know. We would love to have you serve. Thank
you for your efforts to Get Involved/Stay Involved through-
out the New Year!
Continued from Page 3
studied the functional MRIs of subjects who gave to various
charities. They found that giving stimulates the mesolimbic
pathway, which is the reward center in the brain, releasing
endorphins and creating what is known as the ‘helper’s
high.’ And like other highs, this one is addictive, too.”
The heart of any resolution is our individual resolve. As we
continue to advance the profession, in this new year and in
the years to come, let’s recommit to do so, remembering
the words of a fellow Kentuckian, Muhammad Ali, who said,
“Service to others is the rent you pay for your room here on
earth.” We thank you for all that you do with and for your
profession. If you would like to get more involved with
YOUR KPhA, President Bob Oakley and I would love to
hear from you!
January 2015
THE KENTUCKY PHARMACIST 8
APSC
January 2015
THE KENTUCKY PHARMACIST 9
Technician Review
KPhA Technician members are eligible for Free CE modeled on PTCB standards by becoming a member of the KPhA Pharmacy Technician Academy. All KPhA Technician Members are eligible for Academy Membership at no additional cost.
FREE
CE
KPhA Member Pharmacy Technicians
The mission of the KPhA Academy of Pharmacy Technicians is:
To unite the pharmacy technicians throughout the Commonwealth to have one
voice toward the advancement of our profession.
To follow what is currently happening with your profession please read our
newsletter articles and become involved.
For more information contact Don Carpenter via email at [email protected]
Technician Review From the KPhA Academy of Technicians
Happy New Year from the Academy members. We hope
that everyone had a safe and happy holiday season.
During the New Year, the Academy will continue to recruit
new members to increase our foot print in the Common-
wealth and strengthen our voice. We look forward to anoth-
er year of growth within our KPhA organization.
Currently, we are attending the Kentucky Board of Pharma-
cy’s Advisory Council meetings to try and advance the
pharmacy technician profession. We have requested that
KPhA change the membership fee requirements for stu-
dents attending a pharmacy technician education program
and will hear something back from them very soon. Our
members continue to be eligible for up to 10 hours of on-
line technician specific continuing education provided by
the Collaborative Education Institute.
National changes to be aware of this year include the deci-
sion for PTCB requiring technician specific continuing edu-
cation for 2015. The PTCB also has decided not to require
a mandatory criminal background check, but does still re-
quire full disclosure during the application process. Addi-
tional changes for 2015 include the reduction of permitted
CE’s obtained through in-services from 10 to 5 hours and
will decrease to zero hours in 2018. Upcoming changes for
2016 include a reduction in the college/university course-
work hours from 15 to 10 hours. PTCB is still on track to
require completion of an ASHP/ACPE accredited pharmacy
technician education program before applying for the certifi-
cation exam by 2020.
A quick review of what it will take to recertify. Any certified
pharmacy technician recertifying in 2015 must have one
hour of continuing education in law and one hour in medi-
cation safety as part of the 20 hours. Any CE’s acquired in
2015 must be technician specific.
If you have any questions for the KPhA Pharmacy
Technician Academy or if you are interested in joining
the Academy please contact Don Carpenter
January 2015
THE KENTUCKY PHARMACIST 10
Jan. 2015 CE — Diabetes Care Update
Diabetes Care Update By: Heather M. Bryan, Pharm.D candidate, Irina Yaroshenko, Pharm.D candidate, and Holly L. Byrnes, Pharm. D.,
BCPS, Jonathan S. Hayes, Pharm.D., BCPS, Sarah Raake, Pharm.D., LDE Sullivan University College of Pharmacy
There are no financial relationships that could be perceived as real or apparent conflicts of interest.
Universal Activity # 0143-0000-15-001-H01-P&T
2.0 Contact Hours (0.2 CEU)
Goal: To aid pharmacists in distinguishing and understanding the updates in diabetes care to deliver optimal evidence-based care for diabetic patients.
Objectives
At the conclusion of this article, the reader should be able to:
1. Discuss the recent main updates in diabetes care. 2. Define the rationale for the revisions in the clinical practice recommendations for diabetes care. 3. Describe the impact of the major updates on clinical practice. 4. Discuss the place in therapy for the new and emerging medications for the treatment of diabetes.
KPERF offers all CE
articles to members
online at
www.kphanet.org
Introduction
Diabetes care is continuously advancing as new evidence
emerges. It is imperative for pharmacists to stay informed
on the most up-to-date information to provide ideal diabetes
care. This past year, information and guidelines surround-
ing diabetes were updated and this article provides an
overview of the updates in diabetic care. Some of the topics
that will be discussed within the diabetes realm include: a
review of obesity management, antihyperglycemic thera-
pies, glycemic control goals and new antidiabetic agents.
Obesity Management
In the spring of 2013, the American Association of Clinical
Endocrinologists (AACE) published a new Comprehensive
Diabetes Management Algorithm.1 The AACE stresses the
importance of managing obesity because of the immense
prevalence in the United States. According to the Centers
for Disease Control and Prevention, more than 1/3 of adults
in the United States are clinically obese, and their medical
costs are over $1,400 higher than those of normal weight.2
The AACE has provided a thorough, step-by-step approach
to managing obesity instead of looking at BMI by recom-
mending management for overweight or obese patients that
focuses on obesity-related comorbidities which are classi-
fied into two categories: cardiometabolic disease and bio-
mechanical complication. The AACE classifies a BMI of
27kg/m2 to <30 kg/m
2 overweight and a BMI of ≥30 kg/m
2
clinically obese.1
Along with the AACE, The American Heart Association
(AHA)/American College of Cardiology (ACC) Task Force
on Practice Guidelines and The Obesity Society (TOS)
published guidelines for the Management of Overweight
and Obesity in Adults in November of 2013. These guide-
lines still use BMI and waist circumference to classify over-
weight and obese patients while also identifying the risks of
CVD, type 2 DM and all-cause mortality that is associated
with obesity. The AHA/ACC/TOS classifies a BMI of >25.0-
29.9kg/m2 as overweight.
3
As in previous guidelines, lifestyle modifications are recom-
mended for all overweight and obese patients. Also phar-
macological and surgical interventions can be considered
for patients with comorbidities. Orlistat was the only drug
approved when the AHA/ACC/TOS obesity guidelines were
developed so only a general statement is discussed stating
that FDA-approved medication for weight loss can be rec-
ommended for individuals with a BMI ≥30 kg/m2 or ≥27 kg/
m2 with at least one obesity-associated comorbidity.
3 These
therapeutic interventions for obesity management should
overall be considered and recommended for the treatment
of all levels of diabetes severity including pre-diabetes, dia-
betes and metabolic syndrome.
Currently, in terms of pharmacological options, there are
four medications available for weight loss (Table 1): orlistat
and phentermine for short-term treatment (<3 months) and
lorcaserin and phentermine/topiramate extended release
for chronic use which are considered the newer anti-obesity
agents becoming FDA-approved for weight management in
2012. Orlistat is available both as an over the counter and
prescription while phentermine is only available by prescrip-
tion. Although both have been approved by the FDA, their
use has been less than anticipated due to their side-effect
profiles while both lorcaserin and phentermine/topiramate
ER have their place in diabetes therapy recognized by the
AACE obesity algorithm. It is important to note that locaser-
in and phentermine/topiramate ER are recommended as
adjuncts to lifestyle modification (reduced-calorie diet and
January 2015
THE KENTUCKY PHARMACIST 11
Jan. 2015 CE — Diabetes Care Update
increased physical activity).4
Lipid Management
In November 2013, the ACC/
AHA published new guide-
lines on the treatment of
blood cholesterol with some
major changes.7 The old lipid
guidelines, the Adult Treat-
ment Panel III (ATP III) of the
National Cholesterol Educa-
tion Program, recommended
a specific LDL-C and/or non-
HDL-C goals for different risk
groups.8 The new ACC/AHA
lipid guidelines recommend
the removal of the treat-to-
target approach for multiple
reasons. One, because the
treat-to-target paradigm does
not consider the potential ad-
verse effects from multidrug
therapy required to achieve
the lipid target. Also, the AC-
C/AHA used randomized con-
trol trials (RCTs) and found
that CVD events were re-
duced by using the maximum
tolerated statin therapy but
there were no RCTs proving
that the titration of drug thera-
py to specific LDL-C and/or
non-HDL-C goals led to im-
proved CVD outcomes.7
Instead of the treat-to-target
approach, the ACC/AHA lipid
guidelines have identified four
statin benefit groups (Table 2)
and categorized statins into
different intensities (Table 3).
The ACC/AHA lipid guideline
recommends moderate-
intensity statin therapy for
most patients with diabetes and high-intensity statin thera-
py for patients with diabetes and estimated 10-year CVD
risk ≥7.5 percent.7 Please note that it is important to choose
an appropriate intensity of statin therapy as patients with
diabetes have shown high residual CVD risk due to inade-
quate intensity of statin therapy. In addition, non-statin drug
therapies such as fibrates, ezetimibe, niacin and bile acid
sequestrants are not recommended for CVD prevention.
These lipid lowering agents provide no significant benefit
when compared to the risk from adding these therapies.
Glycemic Goals
The 2013 AACE algorithm continues to support an A1C
goal of ≤6.5 percent for patients who are young, healthy
and without comorbid disease states who have a low hypo-
glycemic risk. In patients with a comorbid disease state
Table 1
Name Lorcaserin (Belviq) Phentermine/topiramate ER (Qsymia)
Dosing/ Administration
10 mg ORALLY twice daily Discontinue at week 12 if 5 percent weight loss has not been achieved; Max 20 mg/day
Initially: phentermine 3.75mg/ topiramate 23mg orally once daily for 14 days Maintenance: phentermine 7.5mg/ topiramate 46mg orally once daily; after 12 weeks at maintenance dose, if weight loss is not at least 3 percent of baseline, discontinue or escalate dose
Contraindica-tions/ Precau-tions
Pregnancy Avoid in patients with severe renal impairment (CrCl <30 ml/min)
Concomitant use with MAOI therapy or within 14 days of discontinuation of MAOI Glaucoma Hyperthyroidism Pregnancy
Side Effects Headache, back pain, nausea, dry mouth, constipation, hypoglycemia, cough and fatigue
Constipation, Xerostomia, Insomnia, paresthesia, Nasopharyngitis, upper respiratory infection
Clinical Teaching Advise patient to avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, confusion and somnolence
Drug may cause decreased visual acuity and/or cognitive impairment. Patient should avoid driving or other activities requiring clear vision, mental alertness or coordination until drug effects are realized
Source 5,6
Table 2
High- Intensity Statin Therapy (Lowers LDL-C by ~ ≥50 percent)
Moderate- Intensity Statin Therapy (Lovers LDL0C by ~30 to <50 percent)
Atorvastatin 40-80mg Atorvastatin 10mg
Rosuvastatin 20mg Rosuvastatin 10mg
Simvastatin 20-40mg
Pravastatin 40mg
Lovastatin 40mg
Fluvastatin XL 80mg
Fluvastatin 40 mg BID
Pitavastatin 2-4mg
** Once-daily doses unless otherwise specified. Source 7
January 2015
THE KENTUCKY PHARMACIST 12
Jan. 2015 CE — Diabetes Care Update
who are at risk for hypoglycemia are recommended to have
an individualized A1C goal which can be >6.5 percent.1
This along with patient preference and life expectancy are
other ways that the AACE algorithm uses the complications
-centric approach to the care of overweight/obese patients.
These in addition to BMI assessment and obesity severity
have proven to be beneficial.
In relation to the AACE algorithm, The American Diabetes
Association (ADA) provides more detailed guidelines on
A1C goals. Their recommendation is an A1C of <7 percent
for most patients, <6.5 percent for lower-risk patients with a
short disease duration, long-life expectancy and absence of
CVD, and <8 percent for higher-risk patients with a short-
life expectancy, history of severe hypoglycemia, serious
complications and multiple comorbid conditions.9 Since
these medical organizations have some differences in rec-
ommendations, it’s important to recognize them and apply
them in clinically appropriate settings where one recom-
mendation may fit better than the other. Something else
that is important to note, all organizations (ADA, AACE al-
gorithm, and AHA/ACC/TOS) recommend that each patient
should be managed with individualized goals that take the
patients age, comorbidities and hypoglycemia risk into con-
sideration.
Antihyperglycemic Therapy
In terms of A1C goals for patients with diabetes, the AACE
algorithm is very adaptable to make sure each patient has
individualized care. When discussing recommendations on
antihyperglycemic pharmacotherapy, the AACE algorithm
is much more specific. Four goals are identified, in addition
to lifestyle modifications that should be considered in re-
gards to hyperglycemic therapy.1
1. Avoid hypoglycemia
2. Avoid weight gain in persons who are obese and assist
them with weight loss
3. Achieve clinical and biochemical glucose targets; and
4. Reduce or avoid increasing CVD risk
With these goals in mind, AACE established a Glycemic
Control Algorithm and Profiles of Antidiabetic Medications.1
A1C is divided into three categories (<7.5 percent, 7.6 - 9
percent, >9 percent) with a correlation of progression in
disease state with worsening A1C levels. These also are
considered AACE’s recommended starting points for thera-
py. In brief, antihyperglycemic therapy advances from sin-
gle drug therapy to dual therapy, triple therapy and insulin
therapy with or without additional agents. To clarify from
the previous statement, patients do not have to go through
three oral therapies prior to starting insulin. For example,
insulin will almost always be initiated with an A1c of >9 with
symptoms because the patient will not obtain a 3+ drop in
A1C with oral therapies alone. Also, the risk associated
with the endpoint is always considered so if the patient’s
A1C goal is higher than others with <8, insulin may not be
needed.
The AACE algorithm recommends metformin as first-line
therapy, which is in agreement with the ADA.9 After metfor-
min, incretin-based therapies (GLP-1 agonists and dipep-
tidyl peptidase-4 (DPP-4) inhibitors are placed above oth-
ers in the hierarchy because they are widely accepted in
diabetes care because of their effectiveness but their use is
still limited in certain populations because of cost and route
of administration. GLP-1 agonists also have shown to have
more of an A1C-lowering effect and weight loss benefit
compared to DPP-4 inhibitors making them prioritized over
DPP-4 inhibitors in the AACE algorithm.8.
Both have mech-
anisms of action that are favorable compared to other
agents such as stimulating insulin secretion, reducing glu-
cagon secretion and promoting satiety while also being rel-
atively safe with regards to side-effect profiles compared to
sulfonylureas or glinides. Sulfonylureas and glinides have
common side effects such as weight gain and increased
hypoglycemia risk which makes them disadvantageous and
are thus considered to be the last line of therapy in the
AACE algorithm.1 Although, all these appealing characteris-
tics lean toward GLP-1 agonist, as pharmacists, we need to
consider they are injectable while DPP-4 inhibitors are tab-
lets which can effect medication adherence and gastroin-
testinal side effects (nausea/vomiting) are more commonly
seen with GLP-1 agonists.10
Although sulfonylureas and glinides have fallen out of fa-
vor, the TZD class is holding steady in the hierarchy. Their
mechanism of improving insulin sensitivity without stimulat-
ing insulin release and increasing risk of hypoglycemia
helps them to hold their own. The ADOPT trial tested the
glycemic durability of rosiglitazone, metformin and gly-
buride as monotherapy. The trial concluded that TZDs
seem to be more durable in controlling glycemic levels in
Table 3
Statin Benefit Groups
Individuals with clinical Arteriosclerotic cardiovascular disease (ASCVD)
Individuals with primary elevvations of LDL-C ≥190 mg/dL
Individuals 40-75 years of age with diabetes with LDL-C 80-189 mg/dL
Individuals without clinical ASCVD or diabetes who are 40-75 years of age with LDL-C 70-189 mg/dL and an estimated 10-year ASCVD risk of 7.5 percent or higher Source 7
January 2015
THE KENTUCKY PHARMACIST 13
Jan. 2015 CE — Diabetes Care Update
comparison of the other two, giving the TZD class another
incentive for use.9 In November 2013, the FDA officially
required the removal of prescribing and dispensing re-
strictions on rosiglitazone after finding out that the recent
data showed no increased risk of heart attack compared to
metformin and sulfonylureas.12
The side effect profile of
TZDs including weight gain, fluid retention leading to wors-
ening or inducing heart failure and increased risk of bone
fractures are all reasons limiting the use of TZDs in clinical
practice.1
The 2013 AACE algorithm gives specific guidelines on the
addition or intensification of insulin in patients with type 2
diabetes. For patients with A1C >9 percent, the presence of
diabetic symptoms usually determines whether or not to
initiate insulin therapy. A symptomatic patient along with
whether or not the patient is experiencing these while al-
ready on two non-insulin antidiabetic agents also are con-
sidered because adding a third or fourth antidiabetic agent
is less likely to bring down a patients A1C to target range.
As stated earlier, patients with an A1C >9 who are sympto-
matic are generally started on insulin therapy. Also, AACE
guidelines suggest that non-insulin antidiabetic therapies
be continued while initiating basal insulin with the exception
of sulfonylureas and glinides. These increase the risk of
hypoglycemia in conjunction with insulin and should be dis-
continued.1 The ADA/EASD statement differs reading that
when basal insulin is initiated, sulfonylureas and glinides be
continued or reduced to prevent loss of control during the
titration period.9
The algorithm also recommends basal insulin at a starting
dose of 0.1-0.2 unit/kg for patients with A1C ≤8 percent and
a dose of 0.2-0.3 unit/kg for patients with A1C >8 per-
cent.This starting dose of basal insulin can be titrated up
every two to three days to achieve a fasting blood glucose
<110 mg/dL. If hypoglycemia occurs, the basal insulin can
be reduced by 10 – 20 percent for glucose levels <70 mg/
dL and by 20 – 40 percent for severe hypoglycemia with a
blood glucose level of <40 mg/dL.1
Hypoglycemia and weight gain are associated with insulin
therapy. Intensifying the regimen in patients with sympto-
matic hyperglycemia and an A1C that is not at goal to a
basal-bolus insulin regimen is an option but the AACE algo-
rithm recommends strong consideration be given to a regi-
men of basal and incretin-based therapy to avoid these
serious adverse effects. This recommendation is based off
a clinical trial that showed the addition of a GLP-1 agonist,
exenatide, to basal insulin decreased A1C by 1.74 percent
while the placebo group only decreased A1C by 1.04 per-
cent and the addition of a DPP-4 inhibitor showed great
A1C reduction compared to the placebo group (difference:
0.41 percent, P <0.0001) with neutral effects on hypoglyce-
mia and weight gain.13,14
The New Kids in Town
In March 2013, the US Food and Drug Administration
(FDA) approved canagliflozin (Invokana) for the treatment
of Type 2 Diabetes. It is the first drug approved in the Unit-
ed States belonging to a new class of drugs called sodium-
glucose cotransporter 2 (SGLT2) inhibitors. The SGLT2
inhibitors lower the renal threshold for glucose and in-
crease urinary glucose excretion by interfering with the re-
absorption of renally-filtered glucose. Compared to
glimepiride (Amaryl), a 100 mg dose of canagliflozin
worked as well as glimepiride. Also, in patients already tak-
ing metformin and a sulfonylurea, 300 mg daily of canagli-
flozin lowered A1C as well as sitagliptin (Januvia) which is
commonly prescribed.15,16
The usual starting dose of
canagliflozin is 100 mg daily, taken before the first meal of
the day. For people who tolerate the drug well with few side
effects and who generally have good kidney function, the
dose can be increased to 300 mg daily if necessary. With
that being said, people with severe kidney dysfunction
should avoid canaglifozin entirely.
In addition to better diabetes control, there are several oth-
er advantages with the use of canagliflozin. Weight loss is
one of the positive attributes with patients losing 2 – 4 per-
cent of their body weight while taking 300 mg of canagli-
flozin daily for six months in clinical trials. Another benefit
during the clinical trials was that the drug lowered systolic
blood pressure between 2 mmHg and 8 mmHg along with
the rarity of hypoglycemic episodes. The most commonly
seen adverse effects of canagliflozin (occurring in more
than 5 percent of patients) are related to the genitourinary
tract. Vaginal yeast infections occur in approximately 10
percent of women who took canagliflozin and urinary tract
infections occurred in more than 5 percent of study partici-
pants. Other common negative side effects seen were vagi-
nal itching, thirst, constipation, nausea and abdominal
pain.15
As of June 2014, the U.S. Food and Drug Administration
approved a rapid-acting inhaled insulin to improve glycemic
control in adults with diabetes mellitus: Afrezza (insulin hu-
man) Inhalation Powder.17
Afrezza is administered at the
beginning of each meal and is not a substitute for long-
acting insulin. Afrezza must be used in combination with
long-acting insulin in patients with type 1 diabetes, and it is
not recommended for the treatment of diabetic ketoacido-
sis, or in patients who smoke. It should not be used in pa-
tients with asthma or chronic obstructive pulmonary dis-
January 2015
THE KENTUCKY PHARMACIST 14
Jan. 2015 CE — Diabetes Care Update
ease (COPD) because of the acute bronchospasm that has
been observed in patients with those disease states.17
A total of 3,017 participants – 1,026 participants with type 1
diabetes and 1,991 patients with type 2 diabetes – were
evaluated on the drug’s safety and effectiveness.17
The
Afrezza efficacy at mealtime was compared to mealtime
insulin aspart (fast-acting insulin) and both in combination
with basal insulin (long-acting insulin) in a 24 week study.
The treatment provided for type 2 diabetes patients in com-
bination of Afrezza with oral antidiabetic drugs showed a
mean reduction in HbA1c that was statistically significantly
greater compared to the HbA1c reduction observed in the
placebo group. Unfortunately, Afrezza provided less HbA1c
reduction than insulin aspart in type 1 diabetes patients,
and the difference was statistically significant. Four more
post-marketing studies are required by FDA on Afrezza.17
Conclusion
Diabetes care will forever be changing as new drugs and
guidelines continue to emerge with the new evidence found
from clinical trials. It is important as a pharmacist to stay up
to date with these guidelines so that we can effectively
practice evidence-based medicine with our diabetic patient
base.
References
1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE
comprehensive diabetes management algorithm 2013.
Endocr Pract. 2013;19:327-336.
2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence
of obesity in the United States, 2009-2010. NCHS Data
Brief. 2012 Jan;(82):1-8.
3. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/
ACC/TOS guideline for the management of overweight
and obesity in adults: a report of the American College
of Cardiology/American Heart Association task force
on practice guidelines and The Obesity Society. Circu-
lation. Published online November 12, 2013.
4. Colman E, Golden J, Roberts M, et al. The FDA’s as-
sessment of two drugs for chronic weight manage-
ment. N Engl J Med. 2012;367:1577-1579.
5. Belviq (lorcaserin)[package insert]. Woodcliff Lake, NJ:
Eisai Inc; 2012.
6. Qsymia (phentermine and topiramate extended-
release) [package insert]. Mountain View, CA: VIVUS,
Inc; 2012.
7. Stone NJ, Robinson J, Lictenstein AH, et al. 2013 AC-
C/AHA Guideline on the Treatment of Blood Cholester-
ol to Reduce Atheroscleotic Cardiovascular Risk in
Adults. Journal of the American College of Cardiology
(2013), doi: 10.1016/j.jacc.2013.11.002.
8. Grundy SM, Cleeman Jl, Merz CN, et al; National
Heart, Lung, and Blood Institute; American College of
Cardiology Foundation; American Heart Association.
Implications of recent clinical trials for the National
Cholesterol Education Program Adult Treatment Panel
III guidelines. Circulation. 2004;110:227-239.
9. Inzucchi SE, Bergenstal RM, Buse JB, et al. Manage-
ment of hyperglycemia in type 2 diabetes: a patient-
centered approach: position statement of the American
Diabetes Association and the European Association for
the Study of Diabetes. Diabetes Care. 2012;35:1364-
1379.
10. Deacon CF, Mannucci R, Ahrén B. Glycemic efficacy
of glucagon-like peptide-1 receptor agonists and dipep-
tidyl peptidase-4 inhibitors as add-on therapy to sub-
jects with type 2 diabetes- a review and meta analysis.
Diabetes Obes Metab. 2012;14:762-767.
11. Kahn SE, Haffner SM, Heise MA, et al; ADOPT study
group. Glycemic durability of rosiglitazone, metformin,
or glyburide monotherapy. N Engl J Med.
2006;355:2427-2443.
12. US Food and Drug Administration. FDA Drug Safety
Communication; FDA requires removal of some pre-
scribing and dispensing restrictions for rosiglitazone-
containing diabetes medications. http://www.fda.gov/
drugs/drugsafety/ucm376389.htnm.Published Novem-
ber 25, 2013. Accessed July 15, 2014.
13. Buse JB, Bergenstal RM, Glass LC, et al. Use of twice-
daily exenatide in Basal insulin-treated patients with
type 2 diabetes: a randomized, controlled trial. Ann
Intern Med. 2011; 154:103-112.
14. Barnett AH, Charbonnel B, Donovan M, et al. Effect of
saxagliptin as add-on therapy in patients with poorly
controlled type 2 diabetes on insulin alone or insulin
combined with metformin. Curr Med Res Opin.
2012;28:513-523.
15. Cefalu WT, Leiter LA, Yoon KH, et al. Efficacy and
safety of cangliflozin versus glimepiride in patients with
type 2 diabetes inadequately controlled with metformin
(CANTATA-SU): 52 week results from a randomized,
double-blind, phase 3 non-inferiority trial. Lancet. 2013
Sep 14;382 (9896):941-50.
16. G Schernthaner, JL Gross, J Rosenstock, et al.
Canagliflozin compared with sitaglitin for patients with
January 2015
THE KENTUCKY PHARMACIST 15
Jan. 2015 CE — Diabetes Care Update
tpe 2 diabetes who do not have adequate qlycemic
control with metformin plus sulfonylurea: a 52-week
randomized trial. Diabetes Care. 2013;10:2337-2344.
17. US Food and Drug Administration. FDA approves
Afrezza to treat diabetes. June 27, 2014; modified June
30, 2014. http://www.fda.gov/newsevents/newsroom/
pressannouncements/ucm403122.htm Accessed Au-
gust 11, 2014.
January 2015 — Diabetes Care Update
1. Which statin listed below is considered a high-intensity statin and can lower a patient’s LDL-C by about ≥ 50 per-cent? A. Rosuvastatin 10mg B. Rosuvastatin 20mg C. Simvastatin 20mg D. Simvastatin 40mg 2. Which of the following is NOT a contraindication for the use of Qsymia? A. Pregnancy B. Hyperthyroidism C. Glaucoma D. CrCl <15ml/min 3. The recommended A1C for higher-risk patients with a short-life expectancy, history of severe hypoglycemia and multiple comorbid conditions is ______. A. < 7 percent B. < 6.5 percent C. < 8 percent D. < 5 percent 4. Which of the following medications is associated most with side effects of constipation, xerostomia, insomnia, paresthesia, nasopharyngitis and upper respiratory infec-tion? A. Qsymia B. Atorvastatin C. Belviq D. Lovastatin 5. Afrezza is NOT recommended for the treatment of dia-betes in which of the following patients? A. A patient with a history of COPD B. A patient just diagnosed with type 1 diabetes currently
on a long-acting insulin C. A type 2 diabetic patient with gout D. A healthy type 2 diabetic patient
6. Which side effect is most commonly associated with canagliflozin? A. Vaginal itching B. GI side effects C. Dizziness D. Fatigue 7. Which class of medications below does the AACE algo-rithm recommend after metformin for the treatment of dia-betes? A. Insulin B. DPP-4 C. Sulfonylureas D. Glinides 8. Which class of medications works by lowering the renal threshold for glucose and increasing urinary glucose ex-cretion by interfering with the reabsorption of renally-filtered glucose? A. Sulfonylureas B. GLP-1 agonists C. SGLT2 inhibitors D. Insulin 9. Orlistat and phentermine are approved for use up to ___ months. A. 3 B. 6 C. 9 D. 12
The February 2015 continuing education article will
be in the March issue of The Kentucky Pharmacist.
January 2015
THE KENTUCKY PHARMACIST 16
Jan. 2015 CE — Diabetes Care Update
This activity is a FREE service to members of the Kentucky Pharmacists Association. The
fee for non-members is $30. Mail completed forms to: KPERF, 1228 US 127 South,
Frankfort, KY 40601. Credit will be applied to your CPE Monitor Profile.
The Kentucky Pharmacy Education & Research Foundation is
accredited by The Accreditation Council for Pharmacy
Education as a provider of continuing Pharmacy education.
Quizzes submitted without NABP eProfile
ID # and Birthdate cannot be accepted.
PHARMACISTS ANSWER SHEET January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-P Name ________________________________________________ KY Lic. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D Information presented in the activity: Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No Unmet Objectives:______________________________________________________________________________ I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________
Personal
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD)
Expiration Date: January 30, 2018 Successful Completion: Score of 80% will result in 2.0 contact hour or 2.0 CEU.
Participants who score less than 80% will be notified and permitted one re-examination.
TECHNICIANS ANSWER SHEET. January 2015 — Diabetes Care Update (2.0 contact hours) Universal Activity # 0143-0000-15-001-H01-T Name _______________________________________________KY Cert. # __________________________________ Address ______________________________________________Email_____________________________________ PLEASE CIRCLE THE APPROPRIATE ANSWERS: 1. A B C D 3. A B C D 5. A B C D 7. A B C D 9. A B C D 2. A B C D 4. A B C D 6. A B C D 8. A B C D Met my educational needs ___Yes ___No Figures and tables were useful ___Yes ___No Achieve the stated objectives ___Yes ___No Posttest was appropriate ___Yes ___No Was well written ___Yes ___No Commercial bias was present ___Yes ___No Is relevant to my practice ___Yes ___No I hereby certify that I completed this self-study program independently and without assistance from any other party. Signature ____________________________________________Completion Date___________________________ Personal
NABP eProfile ID #_____________________________ Birthdate ___________________(MM/DD)
January 2015
THE KENTUCKY PHARMACIST 17
KPhA Pharmacy Emergency Preparedness
KPhA Pharmacy Emergency Preparedness Initiative Interest Form
Name: ______________________ Status (Pharmacist, Technician, Other): ___________________
Email: ______________________________ Phone: ___________________________
Interest in serving as a volunteer: Yes____ No ____
Interest in serving as a Volunteer District Coordinator: Yes____ No _____
You also may join the Medical Reserve Corps by following the KHELPS link on KPhA Website to register
(www.kphanet.org under Resources)
Please send this information to Leah Tolliver, KPhA Director of Pharmacy Emergency Preparedness via email at
[email protected], fax to 502-227-2258 or mail at KPhA, 1228 US 127 South, Frankfort, KY 40601.
For more Emergency
Preparedness Resources, visit
www.kphanet.org, click on
Resources and Emergency
Preparedness.
Emergency Preparedness Training YOUR KPhA has developed two emergency preparedness
training programs for the KPhA Pharmacy Volunteers that
will be available online in the next few weeks. Watch
eNews for more information on these programs.
Also, KPhA Director of Pharmacy Emergency Prepared-
ness, Leah Tolliver, is developing a new CE program that
will roll out this winter and spring at our local organizations
about preparing your pharmacy in the event of a disaster.
These tips and procedures will be relevant to all pharma-
cies including retail, hospital, long term care and com-
pounding. If you are interested in seeing this program at
your local organization meeting, contact your local leader
or KPhA! Please contact Leah to present at your district
meeting, or to schedule a meeting in your area if there is
no active district.
This program also will be offered at the 137th KPhA Annual
Meeting and Convention June 25-28, 2015 in Bowling
Green!
January 2015
THE KENTUCKY PHARMACIST 18
Advocating for our Profession
My name is Caroline Beaulieu, and I am a third-
year pharmacy student at the University of Ken-
tucky College of Pharmacy. I have been a mem-
ber of the Kentucky Alliance of Pharmacy Stu-
dents since my first semester in pharmacy
school, and I continue to value my professional
membership with various pharmacy organizations, includ-
ing the Kentucky Pharmacists Association. I am eager for
new opportunities to advance the professional practice of
pharmacy and promote pharmacists’ role as direct patient
care providers.
This past summer, I had the honor to be selected to com-
plete the American Society of Health-System Pharmacists
(ASHP) Summer Internship. As a member of the Patient
Access to Pharmacists’ Care Coalition (PAPCC), ASHP is
one of the national professional associations actively in-
volved in the pursuit of Provider Status, with headquarters
located in our nation’s capital. Supporting patient access to
pharmacists’ services and expanding pharmacists’ role in
healthcare represent a few of their priorities. I participated
in a 10-week long training program designed to provide
experience in various aspects of pharmacy including pro-
fessional and public affairs, medication information, publi-
cations and governmental affairs.
Throughout my internship, I had the opportunity to work on
several projects related to pressing issues currently faced
by the profession of pharmacy. I participated in collabora-
tive efforts aimed at advancing patient care. I worked
alongside leaders to develop various resources for stu-
dents, residents and residency program directors, create a
classification scheme to rank states according to their de-
gree of provider status, work on the Pharmacy Practice
Model Initiative (PPMI) and participate in a visit with Con-
gressional staff to advocate for provider status. In an effort
to help implement the latest philosophies of pharmacy lead-
ership, I also wrote an article for the AJHP student column
to help pharmacy students maximize their potential to
PPMI.
I highly value the experience I gained throughout my intern-
ship. Not only did it expand my understanding of provider
status but it also motivated me to start advocating for our
profession. After I realized the impact I could have as a
student in supporting the expansion of pharmacists’ role, I
became determined to take another step forward. In Sep-
tember, I decided to go back to Washington, D.C. to partici-
pate in ASHP’s legislative day with the Kentucky delega-
tion. I was able to meet with Congress members and their
staff to speak about the education that we receive as stu-
dents and how it qualifies us to offer a broader range of
clinical services upon graduation.
My experience at the national level was an incredible eye-
opener. It made me realize part of what I can do as a stu-
dent to help expand the role of pharmacists and have the
services we provide recognized under Medicare Part B. I
now have a better appreciation for the importance of advo-
cating for our profession to promote what pharmacists can
offer to improve patient outcomes. As I move forward with
my career, I plan on continuing to apply what I learned to
keep pharmacy unified and help take our place on the
health care team. I will remain politically active both
throughout the remaining of my time in pharmacy school
and beyond graduation to keep advancing the professional
practice of pharmacy. I highly encourage everyone in our
profession to join political efforts aimed at advancing col-
laborative care in Kentucky and provider status at the Fed-
eral level. Together, we can help others understand our
essential role on the healthcare team and help optimize
patient care.
Advocating for
Our Profession: A
Student’s
Experience at the
National Level
While in Washington, DC, Caroline (far right) met with U.S. Rep. Andy
Barr from Kentucky. Also pictured are Dr. Kelly Smith, Dr. Michelle
Fraley and Alexis Kjellsen (PY4).
January 2015
THE KENTUCKY PHARMACIST 19
The following broad guidelines should guide an au-
thor to completing a continuing education article for
publication in The Kentucky Pharmacist.
Average length is 4-10 typed pages in a word pro-
cessing document (Microsoft Word is preferred).
Articles are generally written so that they are per-
tinent to both pharmacists and pharmacy techni-
cians. If the subject matter absolutely is not perti-
nent to technicians, that needs to be stated clearly
at the beginning of the article.
Article should begin with the goal or goals of the
overall program – usually a few sentences.
Include 3 to 5 objectives using SMART and meas-
urable verbs.
Feel free to include graphs or charts, but please
submit them separately, not embedded in the text
of the article.
Include a quiz over the material. Usually between
10 to 12 multiple choice questions.
Articles are reviewed for commercial bias, etc. by
at least one (normally two) pharmacist reviewers.
When submitting the article, you also will be
asked to fill out a financial disclosure statement to
identify any financial considerations connected to
your article.
Articles should address topics designed to narrow
gaps between actual practice and ideal practice in
pharmacy. Please see the KPhA website
(www.kphanet.org) under the Education link to see
previously published articles.
Articles must be submitted electronically to the KPhA
director of communications and continuing education
([email protected]) by the first of the month pre-
ceding publication.
YOUR KPhA Needs YOU! Have an idea for a continuing education article? WRITE IT!
Continuing Education Article Guidelines
CE Article Guidelines
January 2015
THE KENTUCKY PHARMACIST 20
2015 KPhA Professional Awards
2015 KPhA Professional Awards Bowl of Hygeia Award Criteria – To recognize an individual who has demonstrated outstanding community service in pharmacy. Eligibility – The recipient must be an Active or Honorary Life member of the Association. The recipient must be a pharmacist with a current valid license to practice in Kentucky. The recipient must be living, awards are not present-ed posthumously. The recipient has not previously received the award and is not currently serving nor has he/she served within the past two years on the selection committee or as an officer of the Association in other than ex-officio capacity. The recipient has compiled an outstanding record of community service that apart from his/her specific identifications as a pharmacist reflects well on the profession. Bowl of Hygeia Previous Recipients Jerry White 2014 Leon Claywell 2013 George F. Hammons 2012 William I. McMakin, III 2011 Kim Croley 2010 Patricia Thornbury 2009 Dave Peterson 2008 Charles Fletcher 2007 Gloria Doughty 2006 Larry Hadley 2005 Harold Cooley 2004 Brian Fingerson 2003 Simon Wolf 2002 Richard Ross 2001 Tom Houchens 2000 Phil Losch 1999 Lucy Easley 1998 Nick Schwartz 1997 Michael Cayce 1996 Bill Borders 1995 Gerald Deom 1994 Kenneth Calvert 1993 Joseph G. Bessler 1992 Michel A. Burleson 1991 Lynn Harrelson 1990 William A. Conyers, Jr. 1989 Daniel R. Kovar, Jr. 1988 Martin W. Nie 1987 Ralph Schwartz 1986 Dwaine K. Green 1985 W. Vance Smith 1984 Richard L. Roeding 1983 William J. Farrell, Sr. 1982 Joseph L. Scanlon 1981
Joseph T. Elmes, Jr. 1980 H. Joe Russell 1979 Alvin R. Bertram 1978 Norman C. Horn 1977 H. Joseph Schutte 1976 D.H. "Sonny" Ralston 1975 Arthur G. Jacob 1974 James M. Brockman 1973 Richard E. Murray 1972 Randolph N. Smith 1971 Oliver E. Mayer 1970 Donald C. Morwessel 1969 James Phillip Arnold 1968 William D. Morgan 1967 Ernest M. Davis 1966 W.F. Bettinger 1965 Arvid E. Tucker 1964 Vernon B. Hager 1963 Sidney Passamaneck 1962 John H. Voige 1961 E. Crawford Meyer 1960 James J. Hamilton 1959
Distinguished Service Award Criteria- To recognize individual mem-bers who have made significant contri-butions to the Association or the pro-fession at large over an extended peri-od of time. Eligibility – Only Active or Honorary Life members of the Association shall be eligible for the award. No individual shall be a recipient of the award more than once. Distinguished Service Award Previous Recipients William Grise & Judy Minogue 2014 Catherine Hanna 2013 Glenn Stark 2012 Kenneth Roberts 2011 Ann Amerson & Lynn Harrelson 2010 Larry Hadley 2009 Dwaine Green 2008 John Brislin 2007 Donnie Riley 2005 Gloria Doughty 2004 Coleman Friedman 2003 Joe Fink III 2002 Melinda Joyce 2002 David Jaquith 1999 R. Paul Easley & Jeff Osman 1998 Ralph Bouvette 1997 Pat Chadwell 1996 Jordan Cohen and Marty Nie 1995 Mike Montgomery 1994 Richard Ross 1993 Thomas Weisert 1991
R. David Cobb 1990 Joseph G. Bessler & Arthur G. Jacob 1989 Paul E. Davis 1988 Norman Horn & Robert E. Lee Sandlin 1987 Joseph V. Swintosky 1986 J.H. (Jack) Voige 1985 Charles T. Lesshafft, Jr. 1984 Jerry Budde 1983 William H. Nie 1982 R.N. (Randy) Smith 1981
Pharmacist of the Year Award Criteria – To recognize a pharmacist for outstanding professional activities undertaken during the current or previ-ous calendar year, which resulted in demonstrable benefit to the profession of pharmacy. Eligibility – Only Active or Honorary Life members of the Association shall be eligible for nominations and receipt of this award. Pharmacist of the Year Previous Re-cipients Jill Rhodes 2014 Trish Freeman 2013 Alyson Schwartz 2012 William Grise 2011 Holly Byrnes 2010 Dave Sallengs 2009 Kelly Smith 2008 Joseph Bickett 2007 Paul Easley 2006 John Anneken 2005 Kim Croley 2004 Ralph Bouvette 2003 David Jaquith 2001 Melinda Joyce 1999 Michael Wyant 1998 Phil Losch 1997 Tom Houchens & Bob Kuhn 1996 Don Ruwe 1995 Mark Edwards 1994 C. Dave Peterson 1993 Brian Fingerson 1992 Martin W. Nie 1991 Judy Minogue 1990 Paul Ruwe 1989 Joseph L. Fink III 1988 Steven R. Adams 1987 William J. Farrell 1986 Harold G. Becker 1985 Dwaine K. Green 1984 R. David Cobb 1983 Richard E. Murray 1982
January 2015
THE KENTUCKY PHARMACIST 21
2015 KPhA Professional Awards
Richard Rolfsen 1981 Gloria H. Doughty 1980 Joseph G. Bessler 1979 Emil Baker 1978 Robert L. Barnett 1977 Joseph L. Scanlon 1976 John B. Anneken 1975 Alvin R. Bertram 1974 Patricia A. Donahue 1973 H. Joseph Schutte 1972 Willard Alls 1971 Joe D. Taylor 1970 Richard L. Ross 1969 Ralph J. Schwartz 1968 George W. Grider 1967 Robert J. Lichtefeld 1966 E.M. Josey 1965 Julius T. Toll 1964 Charles E. Otto 1963 Charles F. Rosenberg 1962 R.N. Smith 1961 E. Crawford Meyer 1960 Charles A. Walton 1959 Ernest C. Williams 1958 George W. Grider 1957 Ray Wirth 1956 Nathan Kaplin 1955 Marion Hardesty 1954
Professional Promotion Award Criteria – To recognize individuals or organizations who have exhibited out-standing efforts to demonstrate the importance of pharmacy as a health care profession, and which promote proper application of pharmacists’ pro-fessional services. Eligibility – Open to persons or organ-izations. Professional Promotion Previous Recipients Cassandra Beyerle 2014 Julie N. Burris & Walgreens Corporation 2013
Sullivan University College of Pharmacy student chapter of APhA-ASP 2012 Lynne Eckmann 2011 Gloria Doughty & Lynn Harrelson 2010 Jordan Covvey 2009 Jeff Mills 2008 Trish Freeman 2007 Sherry DeCuir 2006 Pete Orzali 2005 John Armistead, Don Kupper & Willie Newby 2004 Kroger Pharmacy Mid South Division, Holly Divine, Randy Gaither, Bill Grise & Laura Jones 2003 Jefferson County Academy of Pharmacy, Dean Ken Roberts 2002 Paul Easley, Bob Oakley and Michael Wyant 2001 Judy Minogue 2000 Ralph Bouvette 1999 Rodger Smith, Barbara Woerner, Mary Ann Wyant, and Rick Vissing 1998 Larry Spears 1997 John B. Anneken 1996 Phil Losch 1995 Jordan Cohen 1994 Judy Minogue 1994 Kentucky Academy of Student of Pharmacy 1993 Celeste Flick & Clarence Sullivan III 1988 William H. Nie 1987 Student Kentucky APhA 1986 Northern KY Pharmacists Association 1986
Young Pharmacists of the Year Award sponsored by Pharmacists Mutual Insurance Company Criteria – To recognize a young phar-
macist’s outstanding contribution to the profession and/or community. Eligibility – The recipient must be an Active member of the Association. The recipient must be licensed to prac-tice for nine years or less. The recipi-ent must have a valid, active license to practice in Kentucky. The recipient must have demonstrated participation in a national pharmacy association, professional program(s) and/or com-munity service. Distinguished Young Pharmacist Award Previous Recipients Chris Harlow 2014 Brooke Hudspeth 2013 Stacy Rowe 2012 Aimee Ruder 2011 Karen Hubbs 2010 Matt Martin 2009 Tiffany Self 2008 Angela Parrett 2007 Janet Mills 2006 Alyson Schwartz 2005 Nancy Horn 2004 Jennifer O’Hearn 2003 Karen Altsman 2001 Kim Wilson 1999 Kim Harned 1998 Michael Box 1997 Dan Yeager 1996 Dan Minogue 1995 Pan Haeberlin 1994 Kim Croley 1993 Phillip Sandlin 1992 Jeffrey W. Danhauer 1991 Mark S. Edwards 1990 Susan Murray Kathman 1989 Melinda Cummins Joyce 1987
Nominate your peers today! Email your letter of nomination with any supporting
documents to [email protected] or submit to:
KPhA Awards
1228 US 127 South
DEADLINE IS
MARCH 31!
January 2015
THE KENTUCKY PHARMACIST 22
2015 KPhA Professional Awards
Kentucky Pharmacists Political Advocacy Contribution Form
Name: _________________________________ Pharmacy: ___________________________
Address: _______________________ City: ________________ State: _____ Zip: ________
Phone: ________________ Fax: _________________ E-Mail: __________________________________
Contribution Amount: $_________ Check ____ (make checks payable to KPPAC)
Mail to: Kentucky Pharmacists Political Advocacy Council, 1228 US Highway 127 South, Frankfort, KY 40601
CONTRIBUTION LIMITS
The primary, runoff primary and general elections are separate elections. The maximum contribution from a PAC to a candidate or slate of candidates is $1,000 per election.
Individuals may contribute no more than $1,500 per year to all PACs in the aggregate.
In-kind contributions are subject to the same limits as monetary contributions.
Cash Contributions: $50 per contributor, per election. Con-tributions by cashier’s check or money order are lim-ited to $50 per election unless the instrument identi-fies the payor and payee. KRS 121.150(4)
Anonymous Contributions: $50 per contributor, per elec-tion, maximum total of $1,000 per election.
(This information is in accordance with KRS 121. 150)
Excellence in Innovation Award Sponsored by Upsher-Smith Laboratories Criteria – To recognize a pharmacist who has demonstrated innovative pharmacy practice resulting in im-proved patient care in the previous year or over an extended period of time. Eligibility – A recipient must be a pharmacist who is an Active or Honor-ary Life member of the Association. A recipient may receive the award more than once. Innovative Pharmacy Practice Award Previous Recipients Brooke Hudspeth 2014 Buddy Wheeler 2013 Lynn Harrelson 2012 James Nash & BC Childress 2011 Lynne Eckmann & Cathy Hanna 2010 Ann Albrecht 2008 Lisa Short 2005 Holly Divine, Amy Nicholas 2004 Judy Minogue 2003 Trish Freeman 2002 Mary Ann Wyant 2001 Joyce Korfhage Rhea 2000
Cathy Edwards 1999 Celeste Flick 1998 Jeanne Zeis 1997 Dave Wren 1996 Preston Art 1995 W. Michael Leake 1994
Technician of the Year Award Criteria – To recognize a Certified Pharmacy Technician for outstanding professional activities. Eligibility – Only active Pharmacy Technician members of the Associa-tion shall be eligible for nomination and receipt of this award. Don Carpenter 2014 Leslie Lochner & Robin Lillpop 2013 Patricia Robinson 2012 Jessica Salmons 2011 Gwen Otter 2010 Lisa Sawvel 2008 Margaret Sinkhorn 2007 Charlotte Bowling 2006 Mary Jane Wathen 2005 Kent Williams 2004 Tammy Newsome 2003 Frank Ray 2002 Jane Woerner 2001
Cardinal Health Generation Rx Champions Award Criteria – This award program recog-nizes excellence in community-based prescription drug abuse prevention at state pharmacy associations. This award honors a pharmacist who has demonstrated outstanding commitment to raising awareness of the dangers of prescription drug abuse among the general public and among the pharma-cy community. The award is also in-tended to encourage educational pre-vention efforts aimed at patients, youth and other members of the community. In addition to the award, to honor the pharmacist’s work to fight prescription drug abuse, APMS, state pharmacy associations and the Cardinal Health Foundation will donate $500 to a chari-ty of the award recipient’s choice. Cardinal Health Generation Rx Champions Award Past Recipients Amber Cann 2014 Raymond Float 2013 Brian Fingerson 2012
January 2015
THE KENTUCKY PHARMACIST 23
Pharmacy Time Capsules
By: Dennis B. Worthen, PhD,
Cincinnati, OH
One of a series contributed by the
American Institute of the History of
Pharmacy, a unique non-profit society
dedicated to assuring that the contribu-
tions of your profession endure as a
part of America's history. Membership
offers the satisfaction of helping contin-
ue this work on behalf of pharmacy, and
brings five or more historical publica-
tions to your door each year. To learn
more, check out: www.aihp.org
1990 OBRA 1990 passed. States required to offer prospective and retro-spective DUR. Patient counseling mandatory for Medicaid patients. Society of Infectious Diseases Pharmacists founded. 1965 Title XVIII and XIX (Medicare and Medicaid) passed. Quaalude (methaqualone Rorer) named to invoke the phrase “quiet interlude” was approved. The drug was discontinued in 1985 because of its addictive-ness and recreational use. 1940 Ida M. Fuller became the first person to receive an old-age monthly benefit check under the new Social Security law. 1915 Abraham Flexner refused to do a study of pharmacy similar to his study of medical education. He describes pharmacy as “nonprofessional because it is unintellectual, highly profit motivated, without a technique of its own and with-out a primary responsibility.”
Pharmacy Time Capsules
January 2015
THE KENTUCKY PHARMACIST 24
hubonpolicyandadvocacy
In early August, Stephen Gagnon, PharmD, received a “call
to action” e-mail from APhA to contact his Member of Con-
gress.
A graduate of Albany College of Pharmacy and Health Sci-
ences, Gagnon has been an employee of CVS Health for
more than 14 years, five of those years as a pharmacist. Gag-
non also spends one day a week working at a compounding
facility, is a credentialed HIV pharmacist and is licensed in
both New York and Florida.
APhA’s e-mail was a template letter urging congressional
support for H.R. 4190, the federal bill that would amend Title
XVIII of the Social Security Act to enable patient access to,
and coverage for, Medicare Part B services by state-
licensed pharmacists in medically underserved communities.
“I forwarded it on [to my U.S. representative], not thinking
anything about it. I figured nobody is ever going to read this,
see this. It’s just spam mail, and it will be thrown out,” Gag-
non said in an interview with Pharmacy Today. “But I sent it
anyway because it was the right thing to do for the profes-
sion.”
A week later, the office of Rep. Paul Tonko (D-NY) respond-
ed to the pharmacist.
With support from CVS Health corporate, Gagnon was able
to set up a pharmacy visit from his Member of Congress. On
September 26, Tonko—by then one of the 116 cosponsors
of H.R. 4190—came to one of the busiest pharmacies in the
Albany, N.Y., area.
Community practice site
The Clifton Park CVS/pharmacy store fills 5,000 to 5,200
prescriptions a week for patients in the community. This site
offers many clinical services, including but not limited to drug
utilization reviews and immunizations. The store does not
house an automatic blood pressure machine, so pharma-
cists must manually take the reading, which offers a unique
counseling opportunity outside of the dispensing role.
Asked about the most used service at the practice site, Gag-
non replied, “Pharmacists’ knowledge. Patients take ad-
vantage of how accessible pharmacists are. I can literally be
in the middle of giving a flu shot, and I have a patient coming
up to me. I have to ask them to give me a second to finish
giving the flu shot before addressing their question. We’re so
accessible [that] patients are always coming up to ask their
pharmacist about every medical ailment. We do our best to
provide what we can.”
Interestingly, Gagnon’s answer to the question of the most
underused service was the same. “Pharmacists are overuti-
lized by patients for our knowledge, but underutilized by the
rest of the medical community for what we know and are
able to do,” he said.
Practice equals advocacy
Pharmacy visits are a very strong tool in advocating for the
profession. Pharmacy visits do not require a pharmacist to
be knowledgeable about politics or advocacy. They are an
opportunity to let the passion for patient care speak for
itself.
APhA, through its website at pharmacist.com, can help you
arrange a pharmacy visit. State-specific materials and infor-
mation, in addition to a how-to guide that offers valuable
information, are available at www.pharmacist.com/how-set-
your-pharmacy-visit.
Positive response
Always a supporter of the profession, Tonko officially signed
on to cosponsor H.R. 4190 on September 16. The Member
of Congress told Gagnon that he had been present when
the profession shifted from the 5-year BSPharm to the
PharmD.
“I was glad to have the opportunity to meet with the team at
the Clifton Park CVS and learn more about their operations
and what factors ultimately contribute to their successes,”
Tonko told Today. “Our pharmacists have an important role
to play in our mission to expand access to quality care, but
they need the tools to do so.”
Tonko continued, “That is why I value my work with local
pharmacists to pass H.R. 4190—legislation that would pro-
vide pharmacists across the nation with the tools they need
to improve outcomes, enhance quality and reduce costs in
our health care delivery system.”
hubonpolicyandadvocacy Advocacy 101: How to set up a pharmacy visit Alka Bhatt 2015 PharmD candidate and APhA Extern
Reprinted with permission from the Hub on Policy and Advo-cacy column in the November 2014 issue of Pharmacy To-day (www.pharmacytoday.org). For more information about ways for pharmacists to follow and influence the federal, state, and local processes that are defining the structure of a reformed American health care system, access the Get In-volved section of APhA’s website, www.pharmacist.com. Copyright © 2014, American Pharmacists Association. All rights reserved.
January 2015
THE KENTUCKY PHARMACIST 25
KPhA Remembers KPhA desires to honor members who are no longer with us. Please keep KPhA
informed by sending this information to [email protected].
Deceased members for each year will be honored permanently at the KPhA office.
In Memoriam
KPhA Government Affairs Contribution Name: _______________________________Pharmacy: _____________________________
Email: ______________________________________________________________
Address: _____________________________________________________________
City: ___________________________________________ State: _________ Zip: ____________
Phone: ________________ Fax: _________________ E-Mail: ______________________________
Contribution Amount: $_________ Check ____ (make checks payable to KPhA Government Affairs)
Mail to: Kentucky Pharmacists Association, 1228 US Highway 127 South, Frankfort, KY 40601
In Memoriam KPhA offers its condolences to the family and friends for longtime member Jack Carver, who passed away Jan. 3,
2015.
Save the Date
137th KPhA Annual Meeting &
Convention
June 25-28, 2015
Holiday Inn University Plaza and Sloan Convention Center
Bowling Green, KY
January 2015
THE KENTUCKY PHARMACIST 26
2015 Kentucky Legislative Session
Donate online to the Kentucky Pharmacists Political Advocacy Council!
Go to www.kphanet.org and click on the Advocacy tab for more information about
KPPAC and the donation form.
2015 Kentucky Legislative Session
The 2015 Kentucky Legislative Session began with an organizational week
in early January. This session, which is a short 30-day session,
runs through February and March, with sine die adjournment scheduled for
March 24.
YOUR KPhA will keep you abreast of all of the pharmacy related issues
before the legislature through social media and weekly email updates.
Follow KPhA’s Legislative Advocacy Twitter feed @KPhAGrassroots.
Staff live Tweets committee meetings and general sessions of the
legislature.
Not receiving the Friday Legislative Update? Send your email address to
Scott Sisco at [email protected].
January 2015
THE KENTUCKY PHARMACIST 27
In 2009 the Centers for Medicare and Medicaid Services
(CMS) implemented Surety Bond Requirements for sup-
pliers of Durable Medical Equipment, Prosthetics and
Supplies (CMS-6006-F). This ruling requires that each
existing supplier must have a $50,000 surety bond to
CMS.
Pharmacists Mutual Insurance Company, through its
subsidiary PMC Advantage Insurance Services, Inc. d/b/
a Pharmacists Insurance Agency (in California), led the
way to meet this requirement by negotiating the price of
the bond from $1,500 down to $250 for qualifying risks.
To see if you qualify for a $250 Medicare Surety Bond,
or would like information regarding our other products,
please contact us:
Call 800.247.5930 Extension 4260
E-mail [email protected]
Contact a Pharmacists Mutual Field Representative or Sales Associate http://www.phmic.com/phmc/services/ibs/Pages/Home.aspx
In Kentucky, contact Bruce Lafferre at 800.247.5930 ext. 7132 or 502.551.4815 or Tracy Curtis at 800.247.5930 ext. 7103 or 270.799.8756.
Pharmacists Mutual Insurance offers Medicare Surety Bond
Kentucky Renaissance Pharmacy Museum
The Kentucky Renaissance Pharmacy Museum offers several ways way to show support of the Museum, our state's
leading preservation organization for pharmacy.
While contributions of any size are greatly appreciated, the following levels of annual giving have been established
for your consideration.
Friend of the Museum $100 Proctor Society $250
Damien Society $500 Galen Society $1,000
Name______________________________________ Specify gift amount________________________
Address ____________________________________ City____________________Zip______________
Phone H____________________W________________ Email___________________________________
Employer name_____________________________________________________for possible matching gift.
Tributes in honor or memory of_____________________________________________________
Mail to: Kentucky Renaissance Pharmacy Museum, P.O.Box 910502, Lexington, KY 40591-0502 The Kentucky Renaissance Pharmacy Museum is a non-profit 501(c)(3) business entity and as such donations are tax deductible. A notice of your tax
deductible contributions will be mailed to you annually.
Questions: Contact Lynn Harrelson @ 502-425-8642 or [email protected]
For more information on the museum, see
www.pharmacymuseumky.org or contact
Gloria Doughty at [email protected] or
Lynn Harrelson at [email protected].
January 2015
THE KENTUCKY PHARMACIST 28
KPhA New and Returning Members
KPhA Welcomes New and Renewing Members
November-December 2014
Jamal Aboulhosn Louisville Donna Adams Sebree Matthew Andrews Fisherville John Anneken Edgewood Paul Arthur Huntington, W. Virg. Heidi Bainer Pedro, Oh Chester Baltenberger Louisville Verlon Banks Whitesburg Stephanie Bargo Lexington Jennifer Barker Morehead Jessica Baugh Shepherdsville Walter Bauman Lancaster Justin Bell Lexington Danny Bentley Russell Thomas Beringer Sparta Robert Bero New Bern, Nc Renee' Blair London Bradley Boone Marion Diana Bowles Sonora
Chris Bowling Barbourville Ngoc Anh Bradshaw Louisville Jackson “Mac” Bray Frankfort Brenda Brewer Stanton Deborah Brewer Sandy Hook Sam Brown Murray William Brown Wingo Charles Bryant Cave City Jimmy Buchanan Prospect Michael Burleson Lexington Scott Burris Partridge Robert Burton Hazard Ashley Calvert Bloomfield Mashawna Caudill Isom John Chaney Hazard Brian Cheek Louisville Janie Cheek Louisville Rebecca Cheek London William Clark Owensboro
Heather Clayton Elkton Richard Clement Cadiz Robert Clement Cadiz Kem Coe Tompkinsville Adam Coffman Nortonville Samuel Coletta Cincinnati, Oh Bonnie Collins Paris Stephanie Collins Corbin George Combs Louisville David Conyer Paducah Karen Cornelius Harrogate, Tn Charlotte Cornett London Melvin Croley Park City Matt Cull Owenton Dan Daffron Monticello William Danhauer Owensboro Marshall Davis Paducah Kecia Dawson Prospect Pamela Decker-Meadows Cynthiana
Laura Dehart Paducah James Denton Georgetown Marie Denton Georgetown John Dickerson Olive Hill Alfred Diebold Louisville Brad Doering Burlington Walter Doll Lexington Kenneth Dove Winchester Ben Doyle Nicholasville Jane Dunbar-Suwalski Longmont, Co
MEMBERSHIP MATTERS:
To YOU, To YOUR Patients To YOUR
Profession!
January 2015
THE KENTUCKY PHARMACIST 29
KPhA New and Returning Members
Paul Easley Fisherville Anna Eiler Shepherdsville Joseph Eiler Louisville Suzanne Epley Russellville Frank Facione Louisville William Farmer Henderson Lindsay Ferrell Owingsville Michael Fitch Lexington Lindsey Flanders Bowling Green Matthew Flanders Bowling Green Martha Ford Fort Thomas Larry Fortenberry Pikeville Andy France Covington Virginia France Covington Tom Frazier Salyersville Randy Gaither Louisville Judy Gallagher Madisonville Timothy Gallagher Madisonville Milton Gardner Jeffersontown Eric Gibbs Corbin
Mary Gilvin Mt. Sterling Amy Glaser Alexandria Rosemary Goble Inez Nevin Goebel Winchester Michael Goeing Melvin Wayne Gravitt Wheelwright Gina Guarino Louisville Patty Guinn Somerset Julie Hagan Paducah Cara Hale Inez Eman H. Hammad Louisville Catherine Hance Louisville Robert Haney Bedford Amanda Harding Louisville Ellen Harrison Tompkinsville Marla Helton Frenchburg Clara Herrell Lexington Whitney Herringshaw Winchester Jennifer Hibbs Louisville Linette Hieneman Flatwoods
Robin Hipps New Albany, In Jody Holland Pikeville Sara Holliday Owensboro Celina Howell Pikeville Taryn Howell Prestonsburg Travis Hudnall Smiths Grove Melissa Hudson Villa Hills John Hutchinson Lexington Gerard Hyland Manchester Bernard Hyman Louisville Arthur Jacob Louisville Kyla James Sellersburg, In Amanda Jett Louisville Ella Johnson Hazard Frederick Johnston Georgetown Linda Johnston Georgetown Constance Jones Russell Springs Kimberly Jones Williamsburg Misty Jones Aurora, Il Robin Justice Pikeville
Michael Keller Salem Diane Kelly Evarts Rene Kendrick Taylorsville Melissa Kennon Lexington Anita King Richmond Ethan Klein Louisville James Knight Berea John Knoop Louisville Don Kupper Louisville Richard Lacefield Bowling Green Randall Lange Butler Amanda Leathers Lebanon Teresa Leslie Prestonsburg Martin Likins Greenville Michael Lin Louisville James Litmer Edgewood Robert Little Berea Kay Lloyd Louisville Morris Lloyd Louisville Michelle Loos Covington
January 2015
THE KENTUCKY PHARMACIST 30
KPhA New and Returning Members
Sheri Lucas Millstone Mike Lusk Betsy Layne John Lutz Louisville Calvin Manis Barbourville Jonathan Marquess Acworth, Ga Craig Martin Georgetown Samantha Martin Greenville Tom Mattingly Olive Hill Nancy Matyunas Louisville Donald Mays Fort Thomas Thomas McCurry Harlan Leeann McDonald Dunnville Clayton McKinney Shelbyville Michael McWilliams Louisville Beverly Meeks Paducah Ross Melton Mount Sterling Paula Miller Fort Thomas Parvin Mischel Kathleen, Ga Michael Montgomery Nicholasville Jason Moore Corbin
Jennifer Morgan Manchester Megan Morgan Manchester Jerry Morris Louisville Wayne Morris Frankfort Sherri Muha Hazard Stephanie Myers Louisville Edwin Nickell Eddyville Kenneth Niemann Harrodsburg Leanne Nieters Louisville Paul Nixon Tompkinsville Donald Noble Garrison Freddie Norris Glasgow Patricia Oldis Louisville Charles Oliver Glasgow Angela Onkst Louisville Peter Orzali Cold Spring Lauren Otis Owingsville Staci Overby Paducah Yvonne Parmley Florence Duane Parsons Richmond
Kenneth Parsons Louisville Lindsey Peden Bowling Green Alfred Pence Stanford David Peyton West Liberty Ronald Poole Central City David Powers Jenkins Vicky Pulliam Bardstown Jonathon Ratley Henderson Christi Ratliff Pikeville Fran Reasor Pikeville Ronald Renfrow Bowling Green Herbert Rice Grand Rivers Jerry Rickard Madisonville Vendonna Rickard Madisonville Amber Riesselman Louisville Donald Riley Russellville James Robinette London Matthew Robinson Owensboro Lynda Romeo Louisville Jesse Rudd Salyersville
Gary Russell Madisonville Paul Ruwe Covington Wanda Salyer Flat Gap Christen Schenkenfelder Louisville Nicholas Schwartz Florence Benjamin Scott Lexington Ginger Scott Morgantown, W.Virg. Kimberly Scott Frankfort Mary Scott Robinson Creek Terrence Seiter Burlington George Shackleford Corbin Kent Shearer Albany William Shely Morehead Jennifer Shown Hopkinsville Michael Sizemore London Sharon Small Louisville William Smallwood Independence Jamie Smith Booneville Jessica Smith Booneville Sarah Smith Louisville
January 2015
THE KENTUCKY PHARMACIST 31
KPhA New and Returning Members
George Snider Bardstown Wayne Sparrow Eminence Larry Spears Crittenden Cathy Spencer Louisville Kelley Spencer Versailles Nancy Stanton Holmes Mill Janet Stephens Scottsville Quincy Stephenson Providence Doris Stone Kevil Cindy Stowe Louisville Amanda Sublett Lexington Clarence Sullivan Richmond Tracy Sullivan Paducah William Sutherland Louisville Evan Sweeney Madisonville Jessica Sweeney Madisonville Meghan Tarter-Marcum Russell Springs
Carolyn Taylor Crestwood David Taylor Crestwood Jason Taylor Pineville Mark Taylor Danville Nicole Thacker Huntington, Wv Paul Thompson Harrodsburg Rick Timmons Paducah Fred Toncray Maysville Sheryl Turley Horse Cave Geanie Umberger Lexington G Underwood Louisville Gabe Van Lahr Webster Joseph Vennari Lexington Benjamin Vice Manchester Frank Vice Flemingsburg Steven Wagers London Nancy Walker Cynthiana
Anthony Warford Clay Rob Warford Goshen Glenn Watson Crestwood Susan Weaks Paducah Stacy Wedeking Metropolis, Il Robert Weir Louisville Clayton Wells Inez Leslie Wells Mt. Sterling Sara Wells Gilbertsville Brian Wesselman Florence William Wheeler Lexington Tyler Whisman Union Jerrold White Russellville Marcia White Richmond Amy Wilder Booneville William Wiley Glasgow Christie Wilkins Lexington
Laura Willoughby Hardinsburg Carol Wills Lexington Randy Windham London Christine Windham London Jessica Wiseman Dayton Denton Wood Grand Rivers Dachea Wooten Hazard Greg Wright Paducah Joseph Wright Lucasville, Oh Navas Yoonus Elizabethtown Laban Young Huntington, W.Virg. Timothy Young Mount Vernon Arnold Zegart Prospect
Know someone who should be on this list?
Ask them to join YOU
in supporting YOUR KPhA!
KPhA Honorary
Life Members
Ralph Bouvette
Leon Claywell
Gloria Doughty
Ann Amerson
Stewart
January 2015
THE KENTUCKY PHARMACIST 32
Pharmacy Law Brief
Pharmacy Law Brief: Pharmacy and the “Alford Plea”
Author: Joseph L. Fink III, B.S.Pharm., J.D., Professor of Pharmacy Law and Policy and Kentucky Pharmacists Association Professor of Leadership, Department of Pharmacy Practice and Science, UK College of Pharmacy
Question: I have seen in news reports some refer-
ence to something called an “Alford Plea” and now a stu-
dent on rotation with me has told me that a reference to that
even appears in Board of Pharmacy regulations. What is
that and why is it important to pharmacists?
Response:
The relevant provisions in Kentucky statutes the student is
referring to are:
K.R.S. 315.121 – Grounds for acting against licensee –
Notification to board of conviction required – Petition for
reinstatement – Expungement
(1) The board may refuse to issue or renew a license, per-
mit, or certificate to, or may suspend, temporarily suspend,
revoke, fine, place on probation, reprimand, reasonably
restrict, or take any combination of these actions against
any licensee, permit holder, or certificate holder for the fol-
lowing reasons:
(c) Being convicted of, or entering an “Alford” plea or plea
of nolo contendere to, irrespective of an order granting pro-
bation or suspending imposition of any sentence imposed
following the conviction or entry of such plea, one (1) or
more of the following:
1. A felony;
2. An act involving moral turpitude or gross immorality; or
3. A violation of the pharmacy, drug or home medical
equipment laws, rules, or administrative regulations of
this state, any other state, or the federal government.
K.R.S. 315.121(4) – Any licensee, permit holder or certifi-
cate holder entering an “Alford” plea, pleading nolo conten-
dere, or who is found guilty of a violation prescribed in sub-
section (1)(c) of this section shall within thirty (30) days no-
tify the board of that plea or conviction. Failure to do so
shall be grounds for suspension or revocation of the li-
cense, certificate or permit.
The Alford plea came into being from a U.S. Supreme
Court ruling in North Carolina v. Alford, decided during
1970. An Alford plea permits a defendant to maintain his
innocence while agreeing to forego his right to a trial. The
Court said that “an individual accused of a crime may vol-
untarily, knowingly and understandingly consent to the im-
position of a prison sentence even if he is unwilling or una-
ble to admit his participation in the acts constituting the
crime.” By using an Alford plea, a defendant does not admit
guilt but concedes there is enough evidence for conviction.
Kentucky is in the majority of states that provide this option
to one charged with a crime. In fact, all states except Indi-
ana, Michigan and New Jersey have adopted it.
When used during a criminal proceeding the courts require
the plea to be of a voluntary nature and based on factual
evidence. The judge will make an effort to determine wheth-
er the defendant is entering the plea of his own choice, and
that there is a factual basis for the plea; this is accom-
plished by questioning the defendant about his choice and
the prosecution about the potential case against the de-
fendant. A court cannot accept an Alford plea unless there
is independent factual evidence of the defendant’s guilt.
Entering an Alford plea is slightly different from pleading
nolo contendere, meaning “no contest.” Under “nolo”, the
defendant neither admits nor disputes the charges but
agrees to being sentenced for commission of the crime.
Once entered, the plea is treated as a standard guilty plea.
An Alford plea is an “adjudication of guilt” and therefore
would have to be reported in response to this question of
the Kentucky Board of Pharmacy’s Pharmacist License Re-
newal Application: “Have you ever been convicted of any
law related to the practice of pharmacy, drugs or controlled
substances that you have not previously reported to the
Board?” Furthermore, an Alford plea can be counted as a
prior sentence under the U.S. sentencing guidelines.
Submit Questions: [email protected]
Disclaimer: The information in this column is intended for
educational use and to stimulate professional discussion among
colleagues. It should not be construed as legal advice. There is
no way such a brief discussion of an issue or topic for education-
al or discussion purposes can adequately and fully address the
multifaceted and often complex issues that arise in the course of
professional practice. It is always the best advice for a pharma-
cist to seek counsel from an attorney who can become thorough-
ly familiar with the intricacies of a specific situation, and render
advice in accordance with the full information.
January 2015
THE KENTUCKY PHARMACIST 33
KPhA Save the Date/Connect/ EPIC
@KyPharmAssoc
@KPhAGrassroots
Facebook.com/KyPharmAssoc
KPhA Company Page
Are you connected
to YOUR KPhA?
Join us online!
Save the Date 137th KPhA Annual Meeting & Convention
June 25-28, 2015
Holiday Inn University Plaza and Sloan Convention Center Bowling Green, KY
Visit www.kphanet.org for more information!
January 2015
THE KENTUCKY PHARMACIST 34
Pharmacy Policy Issues
PHARMACY POLICY ISSUES: The 340(B) Program Author: Ekim Ekinci is a third professional year PharmD student at the University of Kentucky College of Pharmacy and is
concurrently pursuing a Master of Science in Pharmaceutical Outcomes and Policy. Ekim is a native of Antalya, Turkey. She
earned her Bachelor of Science in Chemistry from Rice University in Houston, Texas and completed post-baccalaureate
coursework and doctoral classes in History of Medicine at University of Houston before starting pharmacy school.
Issue: I’m a community pharmacist and I keep hearing and reading about the 340(B) program, something that did not
exist when I was in pharmacy school. I had the impression that this was a hospital pharmacy issue with no relevance to
community pharmacy practitioners. But a colleague recently told me that was not the case at all. Can you shed some
light on this program, which I assume is a federal program of nation-wide application?
Discussion: The 340(B) Drug Discount Program was
established in 1992 with the enactment of a federal biparti-
san law. The program requires drug manufacturers to pro-
vide outpatient drugs to eligible health care organizations
at significantly reduced prices. The cost savings allow eligi-
ble organizations to stretch their scarce federal resources,
reach more patients in their communities and provide more
comprehensive clinical services to all individuals without
regard to ability to pay. Before delving into the details of
this complex law, it may prove useful to briefly review cer-
tain terminology. These terms include “covered entities,”
“eligible patients” and “covered outpatient drugs.”
The term “covered entities” usually refers to nonprofit
health care organizations that have certain federal designa-
tions or receive funding from specific federal programs, and
are therefore eligible to purchase drugs through the 340(B)
program at discounted prices.
“Eligible patients” are those who are eligible under law to
receive 340(B) covered outpatient drugs. To be eligible, a
patient has to be receiving services from a health care pro-
fessional associated with a covered entity, such that the
responsibility of care remains with the covered entity. How-
ever, if the only health care service received by the patient
through the covered entity is the dispensing of a drug for
self-administration, the patient is not considered eligible.
“Covered outpatient drugs” are any FDA-approved pre-
scription and over-the-counter drugs, and biological prod-
ucts (except vaccines) for which the patient has a prescrip-
tion, as well as clinic-administered drugs.
A complete list of eligible organizations, patient eligibility
requirements and covered outpatient drugs can be found
on Health Resources and Services Administration (HRSA)
webpage3.
At the time of its enactment 340(B) indeed did not apply to
community pharmacy practitioners. However, the law has
been greatly expanded over the years to now allow cov-
ered entities to contract with multiple clinic or community
pharmacies that would normally not be eligible to receive
340(B) discounted drugs. Thus a community pharmacy
practice may now dispense 340(B) covered outpatient
drugs to eligible patients so long as it has a written contrac-
tual agreement with a covered entity, remain compliant with
all federal requirements and maintain auditable records
documenting their compliance.
Contract pharmacies allow a covered entity to reach out to
a broader area. Covered entities will refer their eligible pa-
tients to contract pharmacies, which provides clinic and
community pharmacies with an incentive to become con-
tract pharmacies. While each covered entity may have their
own contract provisions, some may be willing to provide
financial incentives as well.
Both the covered entity and the contract pharmacy carry
the responsibility to ensure against illegal diversion of
drugs obtained under 340(B) pricing to ineligible patients. It
is important for contract pharmacies to ensure 340(B)
drugs are dispensed only to eligible patients of the covered
entity. This may require the pharmacy to keep two separate
inventories, one dedicated only to 340(B) discounted drugs
and the other for drugs purchased at regular market prices.
Covered entities and contract pharmacies also need to en-
sure that Medicaid rebates are not paid on drugs pur-
chased at 340(B) prices. Each state is specific in their Med-
icaid Program requirements to avoid such “duplicate dis-
counts.”
With so many stakeholders involved, it is not surprising that
the 340(B) Drug Discount Program is surrounded by con-
troversies. Stakeholders disagree on the intent of the law,
Have an Idea?:
This column is designed to address timely and practical
issues of interest to pharmacists, pharmacy interns and
pharmacy technicians with the goal being to encourage
thought, reflection and exchange among practitioners.
Suggestions regarding topics for consideration are wel-
come. Please send them to [email protected].
January 2015
THE KENTUCKY PHARMACIST 35
Pharmacy Policy Issues
as well as on the definitions introduced by it. The main
conflict, however, seems to stem from a disagreement on
who the law is meant to serve.
According to Safety Net Hospitals for Pharmaceutical Ac-
cess, 340(B) makes safety net providers eligible for the
program, not just uninsured patients. Under the law any
patient of the covered entity may be provided the discount-
ed drugs, without regard to patient’s health insurance sta-
tus. Opponents argue that the law is meant to serve the
uninsured, and therefore 340(B) discounted drugs should
only be provided to uninsured patients of the covered enti-
ty. Opponents suggest that some hospitals use 340(B)
drugs for both insured and uninsured patients, and thus
effectively make money when insurance companies reim-
burse them for these medications at market rates.
Proponents of the law state that Congress’s intent in imple-
menting 340(B) was to reduce costs of eligible organiza-
tions in recognition of their mission to serve low-income
and vulnerable patients. According to their argument, 340
(B)’s purpose has always been to enable hospitals to
stretch their scarce resources without dictating the exact
manner in which the savings should be spent.4 On the oth-
er hand, opponents argue that more control over utilization
of savings is needed, because the intent of 340(B) was to
ensure that discounted drugs are provided to uninsured
patients who cannot afford them, not to those who are in-
sured, and certainly not to hospitals.
Another major argument focuses on taxpayer money. Pro-
ponents of the law argue that 340(B) reduces taxpayer
burden as discounted drugs and expanded clinical services
with the use of 340(B) savings help keep underserved pop-
ulations healthy. The counter argument suggests that
many hospitals do not expand their clinical services, but
rather keep the money as savings for themselves.
The 340(B) Drug Discount Program plays an important role
in supporting those institutions that serve the most vulnera-
ble patients. The law has been and still is a topic of heated
debate due to the many stakeholders involved who do not
agree on how the law should be applied. The only aspect
of 340(B) on which all parties agree is that the rules gov-
erning the program are in need of improvement. One thing
that is for certain is that unless changes are made to the
law to put an end to all the controversies, our most vulner-
able patients’ health will remain at stake.
Individuals who are interested in learning more about the
program are encouraged to check out the 340(B) Universi-
ty,2 an in-depth educational program created by a nonprofit
organization that serves as the exclusive contractor for the
Health Resources and Services Administration’s 340(B)
Prime Vendor Program.
References
1. "340B Drug Pricing Program." 340B Drug Pricing Program.
Health Resources and Services Administration, n.d. Web. 25
Aug. 2014. <http://www.hrsa.gov/opa/>.
2. "340B University." 340B PVP. Apexus Inc., n.d. Web. 10
Sept. 2014. <https://www.340bpvp.com/340b-university/>.
3. "Eligibility & Registration." Eligibility & Registration. Health
Resources and Services Administration, n.d. Web. 5 Sept.
2014. <http://www.hrsa.gov/opa/eligibilityandregistration>.
4. Setting the Record Straight on 340B: A Response to Critics.
N.p.: Safety Net Hospitals for Pharmaceutical Access, July
2013. PDF.
5. Wright, Elizabeth. "What is the 340B Program and Why You
Need to care." What is the 340B Program and Why You
Need to Care. Citizens Against Government Waste, 14 May
2014. Web. 27 Aug. 2014. <http://swineline.org/?p=8853>.
Loyal KPhA member writes from Florida:
Scott, as a follow up of the November article, “New Federal
Legislation Targets International Counterfeiting of Pharma-
ceuticals” by Claire Hafner, could it be possible to expose
those companies that have been counterfeiting, in order
that the public would not be at least dealing with them any-
more??? - Jacob Wishnia
Joe Fink responds for Claire, who is in the middle of
exams as this issue is assembled, with this: Jake's sug-
gestion is a good one but I suspect that the highly devious
individuals who operate such firms would quickly change
the company name to continue operations. The FDA has
taken an active approach, focusing on the medication ra-
ther than the firm, announced by Commissioner Hamburg
this way: "The FDA has systematically ranked more than
1,000 active pharmaceutical ingredients in order of their
respective risk of economically-motivated adulteration,
based on a multi-factorial risk-based model we developed.
A subset of these high-risk ingredients is targeted for addi-
tional sampling and testing at the border.
In addition, FDA is working to reduce the risk that counter-
feit or adulterated drug products reach consumers in the
US market by developing standards for track and trace sys-
tems that enable the identification of these products and
facilitate efforts to recall them."
This product-focused approach is probably a wise one.
We've recently seen reports of counterfeit Cialis®, a drug
product much more likely to be targeted by counterfeiters
than a medication in some other therapeutic categories.
KPhA expresses thanks to Jake for following up his reading
of the article with an insightful question.
January 2015
THE KENTUCKY PHARMACIST 36
Pharmacists Mutual
January 2015
THE KENTUCKY PHARMACIST 37
Cardinal Health / Generation Rx Champions Award
January 2015
THE KENTUCKY PHARMACIST 38
KPhA BOARD OF DIRECTORS
Duane Parsons, Richmond Chair
[email protected] 502.553.0312
Bob Oakley, Louisville President
Chris Clifton, Villa Hills President-Elect
Brooke Hudspeth, Lexington Secretary
Glenn Stark, Frankfort Treasurer
Raymond J. Bishop Past President
[email protected] Representative
Directors
Matt Carrico, Louisville*
Tony Esterly, Louisville
Matt Foltz, Villa Hills
Chris Killmeier, Louisville
Mallory Megee, Nicholasville University of Kentucky
[email protected] Student Representative
Jeff Mills, Louisville
Chris Palutis, Lexington
Christian Polen Sullivan University
[email protected] Student Representative
Richard Slone, Hindman
Mary Thacker, Louisville
Sam Willett, Mayfield
* At-Large Member to Executive Committee
HOUSE OF DELEGATES
Ethan Klein, Louisville Speaker of the House
Chris Harlow, Louisville Vice Speaker of the House
KPERF ADVISORY COUNCIL
Kim Croley, Corbin
Kimberly Daugherty, Louisville
Mary Thacker, Louisville
Matt Carrico, Louisville
KPhA/KPERF HEADQUARTERS
1228 US 127 South, Frankfort, KY 40601
502.227.2303 (Phone) 502.227.2258 (Fax)
www.kphanet.org
www.facebook.com/KyPharmAssoc
www.twitter.com/KyPharmAssoc
www.twitter.com/KPhAGrassroots
www.youtube.com/KyPharmAssoc
Robert McFalls, M.Div.
Executive Director
Scott Sisco, MA
Director of Communications & Continuing Education
Angela Gibson
Director of Membership & Administrative Services
Leah Tolliver, PharmD
Director of Pharmacy Emergency Preparedness
Elizabeth Ramey
Receptionist/Office Assistant
KPhA Board of Directors/Staff
KPhA sends email announcements weekly. If you aren’t receiving: eNews, Legislative
Updates, Grassroots Alerts and other important announcements, send your email address to
[email protected] to get on the list.
January 2015
THE KENTUCKY PHARMACIST 39
Kentucky Pharmacists Association 1228 US 127 South Frankfort, KY 40601 (502) 227-2303 www.kphanet.org Kentucky Board of Pharmacy State Office Building Annex, Ste. 300 125 Holmes Street Frankfort, KY 40601 (502) 564-7910 www.pharmacy.ky.gov Pharmacy Technician Certification Board (PTCB) 2215 Constitution Avenue Washington, DC 20037-2985 (800) 363-8012 www.ptcb.org
Kentucky Society of Health-System Pharmacists P.O. Box 4961 Louisville, KY 40204 (502) 456-1851 x2 (502) 456-1821 (fax) www.kshp.org [email protected]
American Pharmacists Association (APhA) 2215 Constitution Avenue NW Washington, DC 20037-2985 (800) 237-2742 www.aphanet.org
National Community Pharmacists Association (NCPA) 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 [email protected]
Drug Information Center Sullivan University College of Pharmacy 2100 Gardiner Lane Louisville, KY 40205 (502) 413-8638 www.sullivan.edu Kentucky Regional Poison Center (800) 222-1222
Frequently Called and Contacted
50 Years Ago/Frequently Called and Contacted
50 Years Ago at KPhA AROUND THE STATE WITH DISTRICT MEETINGS
The Jefferson County Academy of Pharmacy had their dinner dance and installation of of-
ficers January 24th. Joe T. Elmes, R.Ph., is the new President, succeeding William R.
Walker, R.Ph.
The First District had their installation of officers at a dinner dance January 28th. The new
President is Howard Ralston, R.Ph., of Paducah, who succeeds Walter M. Boyett R.Ph., of
Mayfield.
The Second District had their annual party in February with James Lee Gaddis, R.Ph., presiding.
The Fourth District met on January 7th in Russelville for a social hour and dinner. Attending the meeting were several
pre-pharmacy students from Western State College. Dr. William Rowlett, Bowling Green, was the guest speaker and
presented a humorous talk concerning the psychology of medicine from the time the patient enters the doctor’s office
until he receives the prescription. The group plans to meet in Bowling Green in March.
The Northern Kentucky Pharmacists Association met in January as they do every month but we do not have the infor-
mation as we go to press.
Christian County is expecting to have a meeting in Hopkinsville in March in which nearby counties will be invited to at-
tend. The purpose of the meeting is to organize the counties in the surrounding areas into a new district where travel
will not be so great.
- From The Kentucky Pharmacist, February 1965, Volume XXVIII, Number 2.
January 2015
THE KENTUCKY PHARMACIST 40
THE
Kentucky PHARMACIST
1228 US 127 South
Frankfort, KY 40601
For more upcoming events, visit www.kphanet.org.
Save the Date
137th KPhA Annual
Meeting & Convention
June 25-28, 2015
Holiday Inn University Plaza and Sloan Convention Center
Bowling Green, KY
Show your Pharmacist Pride with a
KPhA Roamey Window Cling!
$5 — All proceeds benefit
the KPhA Building Fund
Available at the KPhA Online Store www.kphanet.org, click on About Tab, Online Store