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MINNESOTA PHARMACIST
Fall 2017
Inside this Issue
ALNE Recap
New School year, New Dean
Current Treatment Modalities and Clinical Standards for HIV Patients
...and more!
INSIDE
Fall 2017
Volume 71, Number 4
UPFRONT VIEWS AND NEWS
A Message from the MPhA President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Message from the Interim Executive Director. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
NATIONAL NEWS
Pharmacists and the War on Opioid Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
CLINICAL NEWS
Current Treatment Modalities and Clinical Standards for HIV Patients. . . . . . . . . . . . 16 On the Cover
MPhA NEWS
Congratulations to our 2017
Member Spotlight: Allyson Schlichte, PharmD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
award winners!
2017 MPhA Annual Learning Networking Event & MTM Symposium a Success! . . . 13
Fourth Quarter 2017: Pharmacy Time Capsule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
MPhA News & Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Get Smart about Your Student Loan Repayment Options . . . . . . . . . . . . . . . . . . . . 26
Technicians: Get a Discount on Power-Pak Continuing Education. . . . . . . . . . . . . . . 26
MINNESOTA NEWS
New School Year, New Dean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Socks n’ Sandwiches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Find us on Facebook...
Going Above and Beyond For Mom, Daughter With Rare Disease . . . . . . . . . . . . . . 15 Minnesota Pharmacists Association
GLOBAL PERSPECTIVE You’ll find quick updates about what is
International Spotlight: FIP Provides Opportunity for Pharmacists to Expand Their happening at MPhA and more photos
from our events!
Horizons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
MPhA RESOURCE GUIDE ...or Follow us on Twitter
MPhA Resource Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
You can find us at
www.twitter.com/minnpharmassoc
Network on LinkedIn
You can find us at
www.linkedin.com/groups/
MPhA-Minnesota-Pharmacists-
Association-4268388
MPhA Board of Directors
President: Michelle Aytay
Upcoming Events
Past President: Molly Ekstrand
President-Elect: Jason Varin Southwest Minnesota Minnesota Pharmacy Legislative
Secretary-Treasurer: Doug Lobdell Pharmacists/MPhA Town Hall Day
Speaker: Tony Olson November 30, 2017 February 27, 2018
Rural Board Members: New Ulm Country Club, New Ulm Capitol Ridge Best Western Plus, St.
Reid Smith Register Today! Paul
Michelle Johnson Save the Date!
Metro Board Members: MPhA Virtual Coffee Break:
Tim Affeldt Medicare Part D Enhanced MTM APhA’s Delivering Medication
Ann Byre
December 20, 2017 Therapy Management Services
At-Large Board Members:
Online Webinar May 4, 2018
Sarah Anderson
Amanda Brummel
Register Now! Ewald Conference Center, St. Paul
Cheng Lo Register by April 9!
Rebecca Pickler Pharmaceutical Care Lyceum
Sarah Westberg January 3-5, 2018 MPhA Leadership Summit and
Student Representation Deep Portage Learning Center, House of Delegates
Duluth MPSA Liaison: Jorgen Kvaal Hackensack May 31, 2018
Minneapolis MPSA Liaison: Apply Today! Midland Hills Country Club, Roseville
Lauren Lemke Save the Date!
Ex-Officio
Vice Speaker: Alison Knutson
College of Pharmacy Representative: Bruce
Benson
Pharmacy Technician Representative: Cheryl
Hetland
Minnesota Pharmacist
Official publication of the Minnesota Pharmacists
Association. MPhA is an affiliate of the American Pharmacists
Association, the American Society of Consultant Pharmacists,
the Academy of Managed Care Pharmacy, and the National
Community Pharmacists Association. The Minnesota Pharmacists
Foundation collaborates with
Editor:
and invests in the profession
Laurie Pumper, CAE
Managing Editor, Design & Production:
of pharmacy for the
Jillian Blanc enrichment of public health.
The Minnesota Pharmacist journal is published quarterly by
VISIT MNPHARMACISTS.ORG
the Minnesota Pharmacists Association, 1000 Westgate Drive,
Suite 252, St. Paul, MN 55114-1469. Phone: 651-697-1771 or FOR MORE INFORMATION.
1-800-451-8349, 651-290-2266 fax, info@mpha.org.
Send address changes to Minnesota Pharmacist, 1000
Westgate Drive, Suite 252, St. Paul, MN 55114-1469.
ARTICLE SUBMISSION/ADVERTISING:
For writer’s guidelines, article submission, or advertising
MPhA Mission:
Serving Minnesota Pharmacists
opportunities, contact Laurie Pumper at the above address or
email lauriep@mpha.org.
to advance patient care.
Copyright 2017. Bylined articles express the opinion of the
contributors and do not necessarily reflect the position of the
Minnesota Pharmacists Association. Articles printed in this
The Minnesota Pharmacists Association is a state professional
publication may not be reproduced in any manner, either in association, whose membership is made up of pharmacists,
whole or in part, without specific written permission of the pharmacist students, pharmacy technicians, and those with a business
publisher. Acceptance of advertisement does not indicate
endorsement. interest in pharmacy. MPhA will be the place where pharmacists go
first for education, information and resources to become empowered
to provide optimal patient care. MPhA will be the recognized and
respected voice of pharmacy with legislators, regulators, payors,
media and the public.
Minnesota Pharmacist Fall 2017 3
• •
UPFRONT VIEWS AND NEWS
President’s Desk
A Message from the MPhA
President
By Michelle Aytay
A MPhA President’s Agenda Then (1978) and Now The PATF, which is co-chaired under the leadership of
MPhA Past President Jill Strykowski, has served as a
The Minnesota Pharmacists Association’s (MPhA) mission body that represents “one voice” for pharmacy at the
is to serve Minnesota pharmacists to advance patient legislature. Although we are joined together as “one voice”
care. Throughout the years, the health care landscape has for pharmacy, we heard loud and clear last legislative
evolved and pharmacists have become more engaged in session that pharmacy needs to expand its stakeholders
providing direct patient care. As an association, MPhA has and collaborate with others. This year MPhA continues to
lead and supported pharmacists through our profession’s co-lead the PATF and has been working tirelessly to reach
changes and although much has changed, much has also additional stakeholders. We have already had discussions
stayed the same. with the Minnesota Medical Association (MMA), physician
stakeholders, key groups such as project Clear Way, big
Former MPhA President Lowell Anderson shared his Pharma, the Board of Pharmacy and many legislators
president’s agenda from 1978 with me. As I read through interested in advancing patient access to medications.
his pages of wisdom and guidance, I was amazed by how
much had changed in our profession; but then again, I was Another goal from 1978 was to “develop an allegiance
amazed by how much had stayed the same. I am going to of students to the practice and the association” so that
share a glimpse of some of the similarities with you as well students could understand MPhA and the importance of
as how much has changed since 1978! I hope you enjoy being involved. This brings us to our second goal this year,
this journey as much as me! which is to develop future pharmacy leaders. Once again,
a lot has changed since 1978; for example we now have
Lowell began his president’s agenda by mentioning that it the Minnesota Pharmacy Student Alliance (MPSA), which
was an extremely busy time for pharmacy; this definitely is a strong voice for student pharmacists. MPhA is working
sounds familiar to today’s landscape! His agenda was closely with MPSA. Recently, along with Past Presidents
11 pages long and laid out 14 goals, so I will only share Molly Ekstrand and Jill Strykowski, I presented at an MPSA
the “Cliff’s Notes” version. I will illustrate how MPhA’s meeting. This meeting was planned by MPSA Policy and
agenda from 1978 parallels our agenda for this year. To Advocacy Liaison (PAL) Kyler Anderson, and it provided
do this, I will focus on the three goals that I presented in an opportunity to share MPhA’s legislative agenda with
my president’s agenda for MPhA this year which are: 1. the students. I am also presenting on behalf of MPhA at
Continue and expand collaboration with stakeholders. 2. meetings in October and December. MPhA continues to
Develop future pharmacy leaders. 3. Advance pharmacy work with pharmacy students to engage them in action and
practice by expanding the role of the pharmacist in patient provide opportunities that show the importance of being
care. I think you will be amazed at how similar they are. involved and becoming future leaders. A great example of
this is Legislative Day, which highly leverages the work of
Let’s start with the first goal for this year, “continuing our students. The students develop the written materials to
and expanding collaboration with stakeholders.” MPhA’s educate our legislators. Mark your calendars now for this
goal in 1978 looked very similar, “to have regular year’s Legislative Day on February 27, 2018.
discussions between the profession and the college and
the State Board.” A quick look back shows us that a lot Our third goal this year for MPhA is to advance pharmacy
has happened since 1978 — including the formation of practice by expanding the role of the pharmacist in patient
the Pharmacy Advocacy Task Force (PATF), which is care. This looks very familiar to a goal in 1978, which
comprised of stakeholders from the profession, the college, was “to create a positive public image of the practice of
and consists of regular communication with the state pharmacy.” When Lowell wrote this goal, he stated that
board. one of the most significant professional problems was the
Message From the President continued on page 5
4 Minnesota Pharmacist Fall 2017
• •
Message from the President continued from page 4 UPFRONT VIEWS AND NEWS
abuse or misuse of prescription drugs. self-administered contraceptives, travel medications, and
smoking replacement. In addition, we are supporting
Today, the national opioid epidemic is on the forefront of pharmacists as mental health professionals and pharmacist
everyone’s minds. Only two years ago, naloxone became administration of injectable medications.
available in Minnesota pharmacies. MPhA is continuing to
lead the charge when it comes to working with legislators The successes of associations, as of people, are the
and stakeholders to help pharmacists be part of the sum of previous decisions. I will continue to build on the
solution to the opioid epidemic. The third goal of MPhA this programs of previous leaders of the association while also
year is to advance pharmacy practice by expanding the providing leadership that respects the rapidly evolving
role of the pharmacist in patient care. MPhA continues to health care delivery marketplace.
work with PATF on this initiative and our priorities this year
include pharmacist prescribing privileges for Naloxone,
Message from the Interim Executive
Director
By Marsha Millonig
Did you miss the MPhA Annual Learning Networking I’ve just finished summarizing all the comments we
Event/MTM Symposium on September 7-8, 2017? If received from our participants and the feedback is
so, then you also missed a fantastic lineup of speakers, extremely positive, from the content to the new Thursday-
interactive sessions, networking opportunities and the Friday format and the capstone luncheon with new
chance to develop a personal/professional/practice action University of Minnesota College of Pharmacy Dean Lynda
plan! The meeting emphasized continuing professional Welage. I want to sincerely thank all our volunteers who
development for the more than 250 pharmacists, student provided input to the event’s planning under the leadership
pharmacists, pharmacy technicians and other industry of our Education and Events Committee Co-chairs Michelle
professionals. The popular MTM symposium drew a Johnson and Denise Frank.
great crowd of participants and the Pharmacy Practice/
The meeting’s first day capped off with the Great
Management and Clinical Interest Tracks were also well
Minnesota Pharmacy Event raffle and wine pull that raised
received.
funds for the Minnesota Pharmacists Foundation (MPF)
Pharmacists’ involvement in team-based care was evident to support student scholarship and other activities. Anjoli
throughout the two-day program — starting with Dr. Mark Punjabi worked closely with a team of volunteers under
Loafman’s inspiring look from a physician’s point of view the co-leadership of MPF President Michelle Aytay and the
of how we can best contribute to team-based care and event was a success. More to come on the Foundation
become members of the team. That continued with the in the near future as we look at holding a wine tasting to
afternoon general session that was led by University of round out our newly energized MPF.
Minnesota Pharmaceutical Care Leadership Resident
I’d also like to point out our celebration of recognition for
Anjoli Punjabi, who was joined by Southern Prairie’s
our many well-deserved award winners at the Awards
Medical Director Norris Anderson. Finally, on Friday,
Reception prior to the MPF event. Congratulations to all of
MPhA Past President Molly Ekstrand, Dr. Rajiv Shah and
them. I encourage you to read more about the event and
pharmacy technician and former MPhA Board member
our winners in this issue of the Minnesota Pharmacist.
Barb Stodola had an entertaining and educational look at
creating the dream team.
Interim Executive Director continued on page 6
Minnesota Pharmacist Fall 2017 5
• •
Interim Executive Director continued from page 5 UPFRONT VIEWS AND NEWS
We also realize not all pharmacists are able to participate to learning to networking and connecting. MPhA is truly
in the ALNE/MTM Symposium, especially our Greater a volunteer-driven organization and one that I am so
Minnesota friends. We have an active member outreach fortunate to work with. Given the excellent team efforts we
effort underway through our reenergized Town Halls. We have made with our volunteer leaders and staff the past
just completed a hugely successful Southeast Minnesota few years, I know we will continue to move MPhA forward
Pharmacists event in Rochester with nearly 40 participants in meeting its mission to serve Minnesota pharmacists to
coordinated by Sherwood Peterson. Dean Welage and advance patient care.
President Aytay were both on hand to share insights
We look forward to your feedback on the website and
and our agendas. Please mark your calendars for Town
MPhA. Feel free to call me at any time or email me with
Hall events being planned Nov. 30 with the Southwest
any input you may have for YOUR association. My number
Minnesota Pharmacists, and Jan. 24, 2018, in St Paul. We
is 651-366-6094 and my email is marsham@mpha.org.
hope to see you all there!
My personal goal is to ensure your needs are met in a
Finally, MPhA committees are working on the themes responsive and positive manner and we can direct you
echoed in President Aytay’s column in this issue. Serving to the right resources in an easy to access way. I look
on an MPhA committee is a great way to meet new people forward to being on the Minnesota pharmacy team this
while furthering your professional development. Most year and to your calls and input!
committees meet once a month for an hour and provide
Best regards,
the ability to phone in for convenience. More information
can be found at MPhA’s website, www.mpha.org. Marsha
I can tell you as an MPhA member, I’m so impressed with
and proud of all the volunteers who give their time, talent
and energy to all that is part of MPhA — from advocacy
SAVE THE DATE!
FEBRUARY 16-18, 2018
Holiday Inn Des Moines-Airport
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Highlights (so far) for the 2018 Midwest Pharmacy Expo include:
High Quality Live CE: Up to 16.5 hrs for pharmacists Keynote by Jacques Turgeon, BPharm, PhD:
and 10 hrs for pharmacy technicians Dr. Turgeon is the chief scientific officer at Tabula
Rasa HealthCare and will give the Saturday keynote on
Clinically Intensive Program: Friday, Feb. 16, will precision medicine.
feature high-level clinical programming designed for
those who have or are seeking advanced certification ...And More!
Agenda & Registration Coming in November!
•
www.MidwestPharmacyExpo.com
6 Minnesota Pharmacist Fall 2017
•
MPhA Pharmacy Advocacy Fund
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Fax: 651.290.2266
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ph. 651-697-1771 | fax 651.290.2266
Minnesota Pharmacist Fall 2017 7
• •
MPHA NEWS
Member Spotlight: Allyson Schlichte, PharmD
Allyson Schlichte, PharmD, is the When discussing why her membership to MPhA is a value
Medication Therapy Management to her career, Allyson said, “I’ve met some amazing and
Provider and Operations Lead at the supportive people within the MPhA community. I keep
Fairview Specialty Services Pharmacy up my membership because it’s always fun to meet new
in Minneapolis. “I work at our company pharmacists, technicians, students and other pharmacy
offices three days a week, and then two friends as well as catch up with the ones I’ve known quite
days per week I take care of patients at a while.” She also noted that a topic worth exploring within
the Fairview Uptown Clinic.” the association and its membership is pharmacist burnout,
saying, “I would love to see MPhA start discussions and
Allyson studied at Drake University in Iowa, where she dialogue about pharmacist burnout. We hear so much
received her Doctor of Pharmacy degree. Originally upon about physician burnout and now nursing burnout, but no
enrolling in postsecondary school she wanted to become a one is talking about pharmacists. We have to start taking
dentist, saying, “I really wanted to help people and thought better care of ourselves!”
being a dentist would be a great way to get to know
patients, but then I started learning more about drugs and When she isn’t working with patients at the Fairview clinics,
found them to be absolutely fascinating. Thank goodness Allyson likes to bike (weather and seasons permitting). “I
for that very wise admissions counselor!” spend a lot of time on a bicycle; during the summer out
on the lovely trails in Minneapolis and St. Paul, usually
With 11 years’ experience working in the pharmacy sampling some local craft brews along the way. In the
profession, Allyson started her career at Walmart winter you’ll find me in cycle class at Lifetime Bloomington
pharmacy. She ultimately worked her way to Fairview South.”
Health Services in Minneapolis. When asked what she
likes most about her profession, she responded, “I get to The last movie she saw was HBO’s The Immortal Life of
work one-on-one with patients and their medications. It’s Henrietta Lacks. “I understand it’s a book many U of MN
so rewarding to watch patients reach their health goals. It’s students read. It was definitely a difficult, but enthralling
also really fun to help people whittle down their medication watch.”
lists — I watched one of my patients go from high doses of
basal and bolus insulin, down to just 500mg of metformin Allyson’s favorite meal is a culinary classic: “My favorite
over the course of a year while he made substantial food is still Kraft Macaroni and Cheese (only the kind in
changes to his diet and exercise. He feels so much better shapes, no elbow macaroni for me). I’m not sure there is
and is so much happier — that’s what is so great about even anything one would consider real food in there, but
what I get to do. I love building the relationships with it’s awesome!”
people as they go through their own health care journeys.”
Have You Visited the MPhA Website Recently?
You can find information to become a more effective advocate for pharmacy and get
the latest news about state and federal legislation affecting pharmacy!
www.mpha.org
8 Minnesota Pharmacist Fall 2017
• •
MINNESOTA NEWS
New School Year, New Dean
By Lynda Welage, PharmD, FCCP, Dean, University of Minnesota College of Pharmacy, pharm@umn.edu
I’m very excited for this school year, my We are also excited to be a part of the largest philanthropic
first as Dean of the University of Minnesota initiative in U of M history, Driven: The University of
College of Pharmacy. Minnesota Campaign. Our college-specific campaign focus
is on our innovation and impact. You can learn more at
Throughout my career (most recently as www.pharmacy.umn.edu/alumni/give
dean and professor at the University of
New Mexico, and prior to that as faculty I would also like to share that we recently welcomed
and associate dean for Academic Affairs another exceptional class of incoming students.
at the University of Michigan College of Pharmacy and
associate director in the Michigan Institute for Clinical Our Class of 2021 is made up of 168 students – 60
and Health Research), I heard great things about the students in Duluth and 108 students in the Twin Cities.
Minnesota pharmacy community. I am very excited to now The class has an average PharmCAS GPA of 3.4, which
be a part of it. is typical of our high-quality students we accept each
year. Approximately 77 percent are Minnesota residents,
Over the past several months, I’ve had the pleasure while others come from 17 states and 35 other countries,
of meeting with many of you and learning more about including Ethiopia, Kenya, China, the Philippines, Thailand
pharmacy practice in Minnesota. I am very eager to meet and Mexico, to name a few. This year, we again welcomed
with more practitioners and hear your thoughts on the two students from China through a partnership program
college and the practice in the state. between the College of Pharmacy and several Chinese
universities.
Over the next several months, I will travel around
the state to meet as many people as I can. I was Additionally, our incoming class has a well-rounded
at MPhA’s Southeast Minnesota Pharmacist Night education. Approximately 92 percent have Bachelor’s
Extravaganzapalooza in Rochester on Oct. 12, and have degrees with majors in more than 35 disciplines. Five
tentatively scheduled an event in Duluth for later in the students have a Master’s degree, and one already has a
month. I will share the dates of other get-togethers as the doctoral degree.
details are confirmed. Please watch for an invitation soon
in your inbox, and join us if your schedule allows. Our students were busy prior to matriculating into the
College of Pharmacy. They have work experience as a
One of my top goals as Dean is to work with you to pharmacy technician, soccer coach, dietary assistant,
develop new and enhance existing partnerships to further server, research assistant, lifeguard, medical scribe, nanny
practice transformation and meet the health care needs of and more. Collectively, they have dedicated more than
all Minnesotans, particularly those in rural and underserved 300,000 hours to volunteer and extracurricular activities.
areas. I’d also like to continue to build momentum in
advancing our innovative models of education, and new The Class of 2021 has much to offer each other, the
discoveries and translational research. College of Pharmacy and the profession of pharmacy.
Please join me in welcoming them.
Looking ahead, we at the college are excited to launch our
new five-year strategic plan that includes these goal areas: Once again, thank you for your kind welcome. I am
education (professional and graduate), research, practice, honored to have been selected to serve as Dean of this
people and diversity, outreach/community engagement/ great College of Pharmacy. I look forward to becoming part
global, resources and alumni affairs. We are now working of the Minnesota pharmacy community.
to develop and implement specific strategies and tactics to
meet these goals.
Minnesota Pharmacist Fall 2017 9
• •
MINNESOTA NEWS
Socks n’ Sandwiches
By Vu Ha, APPE Pharmacy Student, University of Minnesota, College of Pharmacy
In the practice of pharmacy, we truly never know what and influenced me to strive for more. Those around me
to expect on a daily basis as there are always obstacles have inspired me to do more for those who cannot help
that challenge our mental and emotional capabilities. themselves.
Pharmacists continually face adversity in their practice
setting whether it be inpatient or outpatient, and yet they During this past year, I began a volunteer initiative known
always manage to find their way through for the sake of as Socks n’ Sandwiches after developing a strong passion
the patient. At times, it may seem that too much focus for community work and volunteering in underserved
may be spent on drug therapy problems and insurance communities for many years at the College of Pharmacy.
issues at the expense of recognizing our own patients’ For this campaign, I aim to create 60 sandwiches monthly
personal adversity. Some have gone through numerous and deliver them on the fourth Thursday of every month to
hardships in their lives while others may come from difficult local homeless shelters around the Minneapolis-St. Paul
backgrounds that have affected their views on medication metro area. Each sandwich is affixed with a positive saying
experience. or quote on a notecard for the individual to read once they
open their sandwich bags. Socks are fundraised monthly
Since 1991, Wilder Research has published a study every as well, and there has been an outpouring of support
3 years regarding the state of the homeless population in from the world of pharmacy. The College of Pharmacy –
Minnesota in terms of demographics and factors affecting Pharmaceutical Care and Health Systems Department,
the population. Their researchers interview members of the Park Nicollet Medication Therapy Management Team,
population in order to gauge numerous variables, such as Mayo Clinic Austin Pharmacy, Walgreens Specialty St.
family status and nights spent without a place of stay. The Cloud and many more have helped me each month to
most recent publication in 2015 showed a 9% decrease create these sandwiches and donated socks on their
in the number of homeless individuals in Minnesota own behalf. Although the process is meant to help
compared to the 2012 report, but highlighted the those who cannot help themselves, I have found that
unfortunate truth that many are afflicted with mental health coming together for this activity promotes team building
conditions and lack the basic needs to access health and brings awareness for the cause. Pharmacists and
care services. There is an alarming need to bring more pharmacy students alike have offered countless hours
awareness to the homeless population and help bring and their services to Socks n’ Sandwiches to demonstrate
resolution to a patient subset that tends to be overlooked our profession’s ability to understand the culture of our
by even the most astute health care professionals. underserved patients and continue our philanthropic ways.
As a whole, we have fundraised over 200 pairs of socks
My name is Vu Ha. I’m currently a fourth-year pharmacy and more than 300 sandwiches have been passed out this
student from the University of Minnesota. I am a first past year thanks to our efforts.
generation Asian American and the first to receive an
actual college education in my family. I am not originally Pharmacy is an ever-changing field that is filled with
from the United States; I was born in a refugee camp in obstacles that challenge us mentally, physically, and
Thailand as my parents sought out a clear passage to sometimes emotionally almost every single day. Our
the U.S. When we finally came to America, our family profession demonstrates resilience and aptitude to adapt to
had zero dollars to our name. With no house, no job, any given situation. My challenge to you is this — join me
no sense of belonging anywhere just yet, it would be an in making a sandwich one day in the near future or donate
understatement to say that my family struggled initially. a pair of socks and help bring awareness to the campaign
I can recall sleeping as a cozy family of 5 on the floors against hunger in the homeless patient population.
of our family friends’ apartments and using coupons to
get free lunches at my elementary school. My grandpa Thanks for reading.
(at the age of 56) was laying tiles and bricks, my mom
worked at a nail salon, and my uncle cut hair. My unique YouTube Video Promotional Video – Socks n’ Sandwiches
background taught me this — that hardships of any sort
ultimately teach you the value of hard work. I am forever
thankful for those who have changed my life for the best
10 Minnesota Pharmacist Fall 2017
• •Minnesota Pharmacist Fall 2017 11
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12 Minnesota Pharmacist Fall 2017 TRAVEL SOMETHING
MORE
• • TM
AUTOMOTIVEMPHA NEWS
2017 MPhA Annual Learning Networking Event
& MTM Symposium a Success!
More than 200 pharmacists, technicians, pharmacy insurance products and risk management solutions to
students and sponsors gathered in September for MPhA’s pharmacy professionals.
biggest event of the year. From the compelling keynote
presentation by Dr. Mark Loafman to open the event to a Bowl of Hygeia award:
closing presentation from new College of Pharmacy Dean Denise Frank of Frank
Lynda Welage, our speakers kept everyone engaged and Consulting in Princeton,
sparked new ideas and conversations. Minn. The “Bowl of Hygeia”
Award is presented
annually by participating
pharmacy associations
in each of the 50 states, the District of Columbia, and
Puerto Rico. The recipients are selected by their respective
associations for their outstanding record of community
service. The Bowl of Hygeia award is sponsored by the
American Pharmacists Association Foundation and the
National Alliance of State Pharmacy Associations.
Cardinal Generation Rx
A packed room of intrigued participants greeted Dr. Mark award: Laura Palombi
Loafman for his presentation on integrating medication of the University of
management into primary care. Minnesota College of
Pharmacy in Minneapolis.
The Cardinal Health
Generation Rx
Champions Award recognizes a pharmacist who has
demonstrated excellence in community-based prescription
drug abuse prevention. The award is intended to recognize
outstanding efforts within the pharmacy community to
raise awareness of this serious public health problem.
It is also intended to encourage educational prevention
efforts aimed at patients, youth, and other members of the
community.
Our round table sessions, including this one on COPD
(led by Lisa Krohn of Park Nicollet MTM in St. Louis Park) Excellence in Innovation
were very well attended and generated thought-provoking award: Anjoli Punjabi
discussion. of the University of
Minnesota College
Congratulations to Our Award Winners! of Pharmacy in
Distinguished Young Minneapolis. The
Pharmacist award: Kati Excellence in Innovation
Dvorak of FirstLight award is a national
Health System in Mora, award coordinated by the National Alliance of State
Minn., received the award Pharmacy Associations, and generously sponsored by
that recognizes one Upsher-Smith Laboratories, Inc. to recognize and honor
pharmacist in each state a qualified pharmacist who has demonstrated significant
for individual excellence and outstanding contributions. The innovation in their respective practice, method or service
prestigious award is presented by Pharmacists Mutual
Companies, nationally recognized as a leader in providing ALNE Recap continued on page 14
Minnesota Pharmacist Fall 2017 13
• •ALNE Recap continued from page 13
directly or indirectly resulting in improved patient care and/ Many thanks to our sponsors for ALNE! We couldn’t enjoy
or advancement of the profession of pharmacy. this continued success without their support.
Pharmacy Technician of Platinum Sponsors
the Year award: Baron McKesson Drug Pharmacists Mutual
Tisthammer of Fairview
Specialty Pharmacy Gold Sponsor
in Minneapolis. The Novartis
Pharmacy Technician Award
recognizes pharmacy technicians in any practice setting Silver Sponsors
who demonstrate leadership in their work and in their AmeriSourceBergen
community. AstraZeneca
Charterpoint Wealth Strategies
Harold R. Popp Award: Todd HealthEast Pharmacy
Sorensen of the University Novo Nordisk
of Minnesota, the current Nutri-Dyn
Executive Director for Sanofi
AIMM and a co-investigator Upsher Smith Laboratories
on the ACCP grant. This
recognition, sponsored by MPhA, was established in 1969 Bronze Sponsor
in honor of the late Senator Harold R. Popp who was Smart-Fill
known to support the profession tremendously during his
lifetime. This award recognizes one pharmacist annually Specialty Sponsors
for their outstanding service to the profession of pharmacy Friday Lunch Sponsor
and is the highest honor bestowed by this association, and University of Minnesota College of Pharmacy
has been presented yearly since 1969.
Coffee Sponsor
For additional photos from ALNE, visit the MPhA Facebook NACDS
page.
Fourth Quarter 2017: Pharmacy Time Capsule
By Dennis B. Worthen, PhD, Cincinnati, OH
Pharmacy Time Capsules are written by Dennis Worthen, who 1942 – 75 years ago
makes them available for state pharmacy associations to share • Marijuana was removed from the US Pharmacopeia in 1942.
with their members. It had been included since 1854.
• Premarin first marketed by Ayerst.
1992 – 25 years ago
• For fiscal 1992, the total amount Medicaid spent on drugs in 1917 – 100 years ago
1992 approached $6.8 billion. • Dean Rufus Lyman of the University of Nebraska calls for
• National health care spending was $854.1 billion or $3287/ the formation of a national pharmacy honor society that is
person. eventually realized with the founding of the Rho Chi Society.
• There were 75 accredited colleges of pharmacy (compared
to 130 in 2015). One of a series contributed by the American Institute of the
History of Pharmacy, a unique non-profit society dedicated to
1967 – 50 years
Thanks to OuragoSponsors assuring that the contributions of your profession endure as a
• For fiscal year 1967, the total amount Medicaid spent on part of America’s history. Membership offers the satisfaction of
drugs exceeded $182 million. helping continue this work on behalf of pharmacy, and brings five
• National health care spending was $51.6 billion or $253/ or more historical publications to your door each year.
person.
To learn more, check out: www.aihp.org
14 Minnesota Pharmacist Fall 2017
• •MINNESOTA NEWS
Going Above and Beyond For Mom, Daughter
With Rare Disease
By Fairview Health Services
Even so, Nancy wanted Rachel to start treatment for the
disease early in hopes that it would keep the symptoms at
bay and lead to a longer lifespan. As she started seeking
treatment for her daughter, Nancy decided that it was the
right time to start her own treatment as well.
In it Together
In searching for the right place to receive treatment, Nancy
found her way to Fairview Home Infusion, part of Fairview
Pharmacy Services, where she had a special request: she
wanted to be able to receive her treatment together with
Rachel.
Whereas many infusion centers offer only pediatric or adult
Fairview Home Infusion recently celebrated an important infusions, Fairview Home Infusion serves people of all
milestone: reaching a patient census of 1,000 IV patients! ages and was able to make a few special arrangements so
This achievement was made even more special by the that Rachel and Nancy could get their first treatments side
exceptional work the Fairview Pharmacy Services team by side.
did to make the patient—or rather, the patients—feel
comfortable and cared for. “I knew Rachel wouldn’t be comfortable by herself because
she doesn’t like needles,” says Nancy. “This way she could
Meet Nancy and Rachel see what they were doing to me first and know it was OK.”
Nancy Larkey and her 11-year-old daughter Rachel have
many things in common—their brunette locks, their quiet Home Sweet Home
nature and their love of movies, to name a few. The two After being monitored on-site during their first treatment,
also share Fabry disease, a rare genetic disorder caused Nancy and Rachel have been able to start receiving
by a defective gene. infusions from Fairview in their own home.
“I tested Rachel when she was two months old,” says Not having to travel for treatment gives the family more
Nancy. “I was really hoping she wouldn’t have it.” time for the things they love to do together, like playing
cards and having family dinners at their grandparents’
For Nancy, the disease manifests in a burning sensation in house.
her hands and feet, decreased ability to sweat and muscle
pain. Rachel hasn’t had many symptoms yet, other than an “Fairview was helpful and nice,” says Nancy. “I’m happy
occasional migraine. about it.”
Minnesota Pharmacist Fall 2017 15
• •CLINICAL NEWS
Current Treatment Modalities and Clinical
Standards for HIV Patients
By Daniel Jude, PharmD, AAHIVP, CSP, Manager of Specialty Clinical Services, Fairview Specialty Services Pharmacy,
Minneapolis
The world of HIV medicine is complex and can be Table 1 (adapted from the guidelines)2
intimidating, but there are good reasons for this. What sets Recommended Regimen Options
HIV apart from other complex disease states are the many
Recommended regimens are those with demonstrated durable
advances in research, drugs for treatment and delivery
virologic efficacy, favorable tolerability and toxicity profiles, and
systems. Even though most of us are not working in
ease of use.
settings where HIV disease state management programs
To improve readability, the ‘anchor’ ARV has been bolded,
are warranted, pharmacists still have an obligation to
boosting agents have been italicized, and the active NRTI has
recognize areas where we can improve outcomes and
been underlined.
patient care. My goal is to provide a high-level review
of current treatment guidelines and products, dig into INSTI plus 2-NRTI Regimen:
prevention strategies, and describe new medications • Triumeq
expected in the near future. • Dolutegravir/abacavir/lamivudinea—only for
patients who are HLA-B*5701 negative (AI)
Current Guidelines and Treatments • Tivicay + either Truvada or Descovy
The United States DHHS Guidelines continue to be the • Dolutegravir plus either tenofovir disoproxil
gold standard for care of people living with HIV/AIDS fumarate/emtricitabinea (AI) or tenofovir
(PLWHA) in the U.S. The guidelines can easily be found alafenamide/emtricitabine (AII)
by typing “HIV Guidelines” into a search engine or visiting • Genvoya or Stribild
https://aidsinfo.nih.gov/guidelines. The guidelines were • Elvitegravir/cobicistat/tenofovir alafenamide/
recently given a facelift and have a much more modern emtricitabine (AI) or Elvitegravir/cobicistat/
online interface.1 The PDFs are still available on the tenofovir disoproxil fumarate/emtricitabine (AI)
site, should you want to download a copy for reference • Isentress + either Truvada or Descovy
offline. A few notable tools within the guidelines include 1) • Raltegravir plus either tenofovir disoproxil
drug:drug interaction tables that address Area Under the fumarate/emtricitabinea (AI) or tenofovir
Curve (AUC) changes for both antiretrovirals (ARVs) and alafenamide/emtricitabine (AII)
the interacting medication; 2) co-infection considerations Boosted PI plus 2 NRTIs:
for Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and • Prezista + Norvir + either Truvada or Descovy
tuberculosis (TB); 3) detailed ARV dosing for renal/hepatic • Darunavir/ritonavir plus either tenofovir
insufficiency; 4) very in-depth review of perinatal data and disoproxil fumarate/emtricitabinea (AI) or
recommendations on use of ARVs before, during and after tenofovir alafenamide/emtricitabine (AII) a
pregnancy. A helpful “Tables Only” link also provides a fast • Lamivudine may substitute for emtricitabine or
way to get to key information without the full discussion vice versa.
included.
INSTIs have offered generally increased tolerability
Current data support the long-held standard starting over PIs and NNRTIs while offering comparable efficacy
treatment-naïve patients on two nucleoside/nucleotide and durability.1 INSTIs as a class can interact with
reverse transcriptase-inhibitors (NRTIs) along with one aluminum and/or magnesium-containing antacids if
other “anchor” ARV.1 You might remember non-nucleoside given concomitantly; it is critical to counsel patients and
reverse transcriptase inhibitors (NNRTIs) and protease- re-educate as necessary to prevent an easily avoided
inhibitors (PIs) as being popular in the past, but that is no Rx:OTC interaction.1 Because of dolutegravir and
longer the case. Integrase strand transferase-inhibitors elvitegravir’s hepatic clearance, drug:drug interactions
(INSTIs or integrase-inhibitors) now account for four out of are still plentiful especially since elvitegravir is given with
the five “Recommended Regimens” (see table 1).1 a pharmacokinetic boosting agents, such as ritonavir or
cobicistat.1 For all INSTIs a single resistance mutation is
clinically significant. If resistance is suspected or proven,
HIV Treatments... continued on page 17
16 Minnesota Pharmacist Fall 2017
• •HIV Treatments continued from page 16
dolutegravir is approved for twice daily dosing.1 This of “undetectable,” it means that their most recent viral load
could mean a patient could be prescribed a single tablet assay showed a level below the limits of detection. Studies
regimen (STR) of dolutegravir/abacavir/lamivudine along have shown that patients with undetectable levels of virus
with another tablet of dolutegravir 12 hours later, leading have a very low risk of transmitting HIV to an uninfected
to confusion for the pharmacy and patient. partner.1 The CDC released a letter in September 2017
stating this perspective, and many organizations have
Tenofovir disoproxil fumarate (TDF) has been common- begun educational campaigns equating “undetectable” to
place in HIV regimens. A new prodrug form was recently “untransmittable”.8 Pharmacists can help patients achieve
approved: tenofovir alafenamide.3 The new form has a the goal of “undetectable” through supportive adherence
longer plasma half-life, allowing the target cells to gather services and removing access and clinical barriers to the
up the medication over a longer period of time. This allows patient therapy.
a smaller milligram dose of the alafenamide to achieve
similar efficacy. In clinical studies, the lower exposure In 2014 the FDA approved tenofovir disoproxil fumarate/
appears to prevent two notable adverse effects of the emtricitabine (TDF/FTC) for pre-exposure prophylaxis
TDF form: decrease in bone-mineral density, and renal (PrEP) to prevent HIV acquisition in high-risk HIV-negative
toxicities.4,5 The DHHS guidelines have included the new patients. You might recognize TDF/FTC as a common
prodrug in recommendations at the same strength (A) but NRTI backbone for treating HIV infection. The FDA also
admittedly with less evidence (II).1 mandated a REMS program with only “Elements to Ensure
Safe Use” component be created for TDF/FTC when
While the DHHS guidelines list which regimens a naïve- used for PrEP.9 Health care provider educational material,
patient should be offered, many patients encountered screening checklists and training are available online
in the pharmacy will be on older and sometimes much through the FDA’s and manufacturer’s websites. Of note,
more complex regimens. Switching a patient’s ARV a prescription for TDF/FTC for PrEP should never contain
regimen is a complex process, is not always appropriate, more than a total of a 90-day supply; this is due to the
and includes multiple factors: resistance mutations, viral requirement that the patient have an HIV test performed
response, immune response, adverse effects, renal and by their provider at least every 2-3 months.
hepatic function, experience with previous regimens, etc.1 Post-exposure prophylaxis (PEP) can be broken
A pharmacist should consult with an HIV specialist before into two sections: occupational (oPEP) and non-
offering alternative therapies. occupational (nPEP). Both scenarios are detailed in
DHHS guideline documents.10,11 Of note, oPEP is much
Prevention Strategies more straightforward due to occupational health laws
Prevention of new HIV infections is multifaceted and and requirements. Timing is important in both, with 28-30
includes syringe-exchange/access programs, treatment- days of ARV regimens that need to be initiated within
as-prevention strategies, pre-exposure prophylaxis (PrEP) 48-72 hours after the time of exposure. Difficulties with
and post-exposure prophylaxis (PEP). Each of these nPEP include timing of presentation to care (often on
concepts can benefit from the inclusion of pharmacists. weekends), insurance coverage (unexpectedly high costs
with high deductible plans), psychosocial needs of patient
The Minnesota Pharmacy Syringe/Needle Access Initiative (sexual assault victim, “blackout” situations), provider lack
allows pharmacies to voluntarily sell up to 10 syringe/ of knowledge (unfamiliar with urgency, order requirements)
needles to a patient at a time without a prescription.6 and system barriers (lack of care coordination in the ER).
Providing unused and clean syringes to a population While some health systems and clinics have processes
decreases the sharing of syringes and helps decrease HIV in place, they can be inconsistent. Pharmacists can help
and HCV transmission. In response to the HIV outbreak support by providing emotionally supportive and expedient
in Scott County, Indiana, in 2015 that included 190 new care to nPEP patients.
cases, a syringe-access program was initiated to help
stem the overwhelming growth of new infections due to Future Treatment Options
syringe sharing while connecting people to substance- Long-acting injectables are currently being explored for
abuse treatment resources.7 Minnesota pharmacists can treatment and prevention of HIV. Cabotegravir, a new
help decrease the risk of HIV transmission by providing INSTI, given with rilpivirine in a long-acting injectable form
clean syringes at all outpatient or ambulatory care
pharmacies. To learn more, please visit: http://www.health.
HIV Treatments... continued on page 18
state.mn.us. When a PLWHA is able to achieve the goal
Minnesota Pharmacist Fall 2017 17
• •HIV Treatments continued from page 17
has shown to maintain 87-94% of patients virologically practice offers unique opportunities to support prevention
suppressed after an oral lead-in period.12 Both 4- and and treatment of HIV-infection. Though it might seem
8-week intervals of the injectable were studied along with intimidating, knowing where to find quality information,
an oral comparator, as well as the acceptability of the such as DHHS guidelines, that can aid in treatment
different regimens. Cabotegravir has also been studied on decisions is key to supporting optimal patient outcomes.
its own for PrEP use and will continue into phase III
studies.13 Oral lead-ins will need to occur to ensure safe Citations
use of long-acting injectable formulations once approved; 1. Panel on Antiretroviral Guidelines for Adults and Adolescents.
pharmacists are in a position to ensure optimal outcomes Guidelines for the use of antiretroviral agents in HIV-1-infected
when patients transition dosage forms. adults and adolescents. Department of Health and Human
Services. Available at http://aidsinfo.nih.gov/contentfiles/
The first single-tablet regimen containing a PI is expected lvguidelines/AdultandAdolescentGL.pdf Accessed 2017 October
in the near future. Darunavir boosted by cobicistat with 8.
emtricitabine and tenofovir alafenamide (TAF) has been
part of a switch study where patients were switched 2. Panel on Antiretroviral Guidelines for Adults and Adolescents.
to this regimen after suppressed on a boosted PI plus Guidelines for the use of antiretroviral agents in HIV-1-infected
emtricitabine and tenofovir disoproxil fumarate (TDF).14 adults and adolescents. Department of Health and Human
There was no statistical difference between rates of Services. Available at http://aidsinfo.nih.gov/contentfiles/
success for those who switched versus those who did not lvguidelines/AdultandAdolescentGL.pdf Accessed 2017 October
switch. With the change from TDF to TAF in the regimen 8. Table 6.
backbone, an expected increase in cystatin c-based eGFR
occurred in the TAF arm. 3. Descovy Prescribing Information. Gilead Sciences. Available
at https://www.descovy.com/ Accessed on 2017 October 8.
A new oral INSTI, bictegravir, is being studied for
treatment naïve patients in two head-to-head trials 4. Arribas JR, et al. Significant Efficacy & Long-Term Safety
versus dolutegravir. Dolutegravir is paired with an Difference With Taf-Based Str In Naïve Adults. Croi 2017.
abacavir/lamivudine backbone for the first trial and Abstract 453.
tenofovir alefenamie/emtricitabine in the second trial.15,16
In both studies, the bictegravir performed similarly to 5. Orkin C, DeJesus E, Ramgopal M, et al. Switching from
the dolutegravir arms. Safety data were similar except rilpivirine/emtricitabine/tenofovir disoproxil fumarate (RPV/FTC/
for greater nausea, neuropsychiatric and sleep-related TDF) to rilpivirine/emtricitabine/tenofovir alafenamide (RPV/
symptoms in the dolutegravir/abacavir/lamivudine arm. FTC/TAF): Safety and efficacy through 48 weeks. Program and
Doravirine, the first new NNRTI in many years, is being abstracts of the 2016 International Congress of Drug Therapy in
studied along with lamivudine/tenofovir disoproxil fumarate HIV Infection; October 23-26, 2016; Glasgow, United Kingdom.
in treatment-naïve patients versus efavirenz/emtricitabine/ Abstract O124.
tenofovir disoproxil fumarate.17 The doravirine arm showed
similar virologic efficacy at week 48 but had significantly 6. Minnesota Pharmacy Syringe/Needle Access Initiative.
less neuropsychiatric adverse effects. Minnesota Department of Health. Available at http://www.health.
state.mn.us/divs/idepc/diseases/hiv/syringe/mnpharmacy.html
Regimen simplification typically means switching complex Accessed on 2017 October 8.
regimens for simpler regimens that preserve efficacy with
higher tolerability. Multiple studies are being conducted 7. Rudavsky S. An Indiana town recovering from 190 HIV cases.
examining if reducing regimens to either a dolutegravir Indianapolis Star. Available at http://www.indystar.com/story/
or boosted-darunavir along with a single NRTI is an news/2016/04/08/year-after-hiv-outbreak-austin-still-community-
acceptable regimen.1 Though the studies show hopeful recovery/82133598/ Accessed on 2017 October 8.
data, there are still not enough data at this time to
recommend this type of switch outside of a clinical trial
setting.
Summary
HIV treatment continues to evolve with each passing year,
HIV Treatments... continued on page 19
to the benefit of PLWHA and their quality of life. Pharmacy
18 Minnesota Pharmacist Fall 2017
• •HIV Treatments continued from page 18
8. McCray E, Mermin J. Dear Colleague Letter. Centers for 14. Molina JM, et al. Efficacy and safety of switching from
Disease Control and Prevention. Available at https://www.cdc. boosted-protease inhibitor plus emtricitabine/tenofovir disoproxil
gov/hiv/library/dcl/dcl/092717.html Accessed on 2017 October 8. fumarate regimens to the single-tablet regimen of darunavir/
cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in
9. Truvada for a Pre-Exposure Prophylaxis (PrEP) Indication. virologically-suppressed, HIV-1-infected adults through 24
Gilead Sciences. Available at: https://www.truvadapreprems.com/ weeks: EMERALD study. IAS 2017. Abstract. TUAB0101
Accessed on 2017 October 8.
15. Gallant J, et al. A phase 3 randomized controlled clinical
10. Kuhar DT, et al. Updated U.S. Public Health Service trial of bictegravir in a fixed dose combination, B/F/TAF, vs ABC/
guidelines for the management of occupational exposures DTG/3TC in treatment-naïve adults at week 48. IAS 2017.
to human immunodeficiency virus and recommendations for Abstract MOAB0105LB.
postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013
Nov;34(11):1238. 16. Sax PE, et al. Phase 3 randomized, controlled clinical
trial of bictegravir coformulated with FTC/TAF in a fixed-dose
11. Dominguez KL, et al. Updated guidelines for antiretroviral combination (B/F/TAF) vs dolutegravir (DTG) + F/TAF in
postexposure prophylaxis after sexual, injection drug use, or treatment-naïve HIV-1 positive adults: week 48 results. IAS 2017.
other nonoccupational exposure to HIV—United States, 2016. Abstract TUPDB0201LB.
Centers for Disease Control and Prevention. Available at https://
stacks.cdc.gov/view/cdc/38856 Accessed on 2017 October 8. 17. Squires KE, et al. Fixed dose combination of doravirine/
lamivudine/TDF is non-inferior to efavirenz/emtricitabine/TDF
12. Eron J, et al. Safety and efficacy of long-acting CAB and in treatment-naïve adults with HIV-1 infection: week 48 results
RPV as two drug IM maintenance therapy: LATTE-2 week 96 of the Phase 3 DRIVE-AHEAD study. IAS 2017. Abstract
results. IAS 2017. Abstract MOAX0205LB. TUAB0104LB.
13. Landovitz R, et al. Safety, tolerability and pharmacokinetics
of long-acting injectable cabotegravir in low-risk HIV-uninfected
women and men: HPTN 077. IAS 2017. Abstract TUAC0106LB.
ClinicalTrials.gov. NCT02178800.
Complimentary On-Demand Virtual Coffee Break Webinars
Available to MPhA Members
Listen to a presentation on HIV treatments by Daniel Jude for more information. MPhA offers educational webinars that
provide you with education from experts on best practices, trends, effective solutions, and quality resources to help you
advance your career as an pharmacy professional. E-learning is ideal for those who are unable to travel or are looking for
educational opportunities in between conferences. The program provides opportunities to obtain CEs from the comfort of
your home or office with both live and on-demand options. These webinars are free for MPhA members —
another benefit of membership! More than 20 webinars are available on a wide range of topics.
Minnesota Pharmacist Fall 2017 19
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