Strong A Decade PMP InterConnect Serves as Vital Tool for Providers, Regulators to Protect Public Health - NABP
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September 2021 | Volume 50 | Number 8
A Decade
Strong
PMP InterConnect
Serves as Vital Tool for
Providers, Regulators to
Protect Public Health
CONTENTS
05 06 01 Letter From the Chairperson
02 Policy Perspectives
Federal, International Shipping
Regulation Changes Paramount
as Opioid Epidemic Intensifies
04 Interview With a Board
Executive Officer
David Sencabaugh, RPh
09 Association News
09 Board Staff Learn About
NABP Programs and
Services at Annual Program
Review and Training
1 0 In Memoriam: NABP Mourns
Passing of Past President and
Past Honorary President
11 Interview With a Board Member
Jeenu Philip, RPh
12 State Board News
California Prepares for New
Electronic Data Transmission
Prescription Rules
Association News Feature News 13 Professional Affairs Update
NABP’s Redesigned Innovations A Decade Strong: PMP InterConnect Study Shows Access to
and Website Honored With Serves as Vital Tool for Providers, Naloxone Decreased During
2021 EXCEL Awards Regulators to Protect Public Health COVID-19 Pandemic
NABP Executive Committee
(ISSN 2472-6850 — print; ISSN 2472-6958 — Amy Sanchez Timothy D. Fensky Fred M. Weaver
online) is published 10 times a year by the National Publications and Editorial Manager Chairperson Member, District 4
Association of Boards of Pharmacy® (NABP®)
©2021 National Association of Boards of Pharmacy. Caroline D. Juran Shane R. Wendel
to educate, to inform, and to communicate the
All rights reserved. No part of this publication may President Member, District 5
objectives and programs of the Association and its
be reproduced in any manner without the written
65 member boards of pharmacy. Reginald B. “Reggie” Deborah C. Mack
permission of the executive director/secretary of the
Dilliard Member, District 6
The opinions and views expressed in this National Association of Boards of Pharmacy.
President-elect
publication do not necessarily reflect the official Nicole L. Chopski
NABP Mission Statement
views, opinions, or policies of NABP or any board Lenora S. Newsome Member, District 7
NABP is the independent, international, and
unless expressly so stated. The subscription rate is Treasurer
impartial association that assists its member boards Kamlesh “Kam”
$70 per year. Bradley S. Hamilton Gandhi
in protecting the public health.
National Association of Boards of Pharmacy Member, District 1 Member, District 8
1600 Feehanville Drive, Mount Prospect, IL 60056 Tejal J. Patel
847/391-4406 | www.nabp.pharmacy Member, District 2 NABP Executive
help@nabp.pharmacy Committee elections
Jeffrey J. Mesaros are held each year
Lemrey “Al” Carter Member, District 3 at the Association’s
Executive Director/Secretary Annual Meeting.
2 | APRIL 2020
LETTER FROM THE CHAIRPERSON
Fellow Members,
As regulators and pharmacists, we know programs and services and view presentations
that the importance of supply chain security from all the Association’s departments. I’d like
cannot be overstated. While the country has to extend my personal thanks to those board
made great strides in addressing prescription of pharmacy staff members who were able to
drug misuse and opioid abuse in general, attend this year’s session. As an unexpected
many prescription drugs continue to be but welcome side effect of holding the
highly sought on the black market. Further, meeting virtually, over 100 people were able
the resurgence of opioid overdoses during to participate. Because of this success, NABP
the COVID-19 pandemic demonstrates the has decided to keep a virtual format for these
need for continued vigilance in this matter. events moving forward. I invite any boards
One vital service that the Association that are interested in learning more about the
provides to assist its member boards in next Program Review and Training event to
these areas is NABP PMP InterConnect®, contact NABP. In the meantime, recordings
which helps connect state prescription of the training are available for anyone who
monitoring programs (PMPs) nationwide. missed it on the Board Resources page in
Timothy D. Fensky, This year marks the 10th anniversary of the Members section of the NABP website.
RPh, DPh, FACA PMP InterConnect, and I am pleased to As a final note, I’m pleased to share that
NABP Chairperson report that this program’s strength has NABP received two Association Media
continued through the pandemic and & Publishing EXCEL Awards. NABP
beyond. With 52 states and jurisdictions received a Gold Award for its efforts with
now connected and securely exchanging the latest redesign of the newsletter you’re
data, PMP InterConnect is providing an reading now, and a Bronze Award for its
effective means of combating drug diversion work in redesigning the NABP website,
and abuse throughout the United States. which is now looking better than ever.
Appropriate regulation and monitoring of Whether through NABP’s publications
various entities such as wholesale distributors or through services such as PMP
is another important part of keeping the InterConnect, quality, accuracy, and
drug supply chain safe and secure for accessibility of information are extremely
patients. NABP’s accreditations can play a important to everyone at NABP. These
vital role in helping state boards of pharmacy awards help to confirm that we are
ensure patient safety. These include delivering on those priorities.
accreditations for drug distributors, many
different types of pharmacy practice, and the Sincerely,
.Pharmacy Verified Websites Program, which
grants use of the .pharmacy domain to safe
and legal websites.
One thing I have come to understand over
my years with the Executive Committee is the
importance of communicating high-quality, Timothy D. Fensky, RPh, DPh, FACA
accurate information with our member NABP Chairperson
boards. The Association does that through a
number of channels, including the newsletter
you’re reading now. Another great resource
for our member boards is the annual Program
Review and Training session held in June.
The session provides board members and staff
with the opportunity to learn about NABP
SEPTEMBER 2021 | 1
POLICY PERSPECTIVES
Federal, International Shipping Regulation Changes
Paramount as Opioid Epidemic Intensifies
Over the past year, as policymakers moved with
unprecedented speed to address the coronavirus
disease 2019 (COVID-19) pandemic, another
accelerating public health emergency also
prompted congressional attention – the opioid
epidemic. In 2020, the number of opioid
overdose deaths not only continued to climb
but markedly worsened. Consistent with recent
trends, synthetic opioids, such as illicit fentanyl
and fentanyl analogs, are involved in the vast
majority of opioid-related deaths, with most of
these illicit drugs being shipped into the United
States from overseas.
According to a January 2020 Drug
Libby Baney, JD Jillian K. Brady, MS
Enforcement Administration (DEA) report, Faegre Drinker Biddle & Reath LLP Faegre Drinker Biddle & Reath LLP
while the origins of fentanyl coming into the
US have diversified in recent years, China 300 US-based customers totaling $230,000. EMS is an international network of each
remains the primary source of fentanyl and They also found seven individuals who member country’s postal operations, including
fentanyl-related substances trafficked through died from fentanyl-related overdoses after USPS, which cooperate to ship letters and
receiving packages from one of these sellers. parcels internationally. Unlike ECOs, EMS
international mail and express consignment
All of these international online sellers is governed by the Universal Postal Union
operations. India has also recently become
explicitly indicated their preference to ship (UPU), of which all 192 members, including
a source for finished fentanyl powder and
purchases through Express Mail Service (EMS), the US, agree to universal service obligations
fentanyl precursor chemicals, which are often
a network that includes USPS, rather than mandating the acceptance of packages and
shipped to clandestine laboratories in Mexico
through commercial operators, such as DHL other mail items from other countries’
where cartels use sophisticated processing International GmbH, FedEx Corporation, and postal operators. In addition to UPU service
methods (ie, unregulated chemicals and UPS, Inc. A separate investigation conducted obligations, foreign postal operators are
industrial-size tablet presses) to produce by the USPS Office of Inspector General also subject to their own country’s laws and
wholesale quantities of illicit fentanyl pills. (OIG) also found that out of 104 illicit drug regulations. USPS, for example, cannot open and
Alarmingly, the majority of these illicit drugs websites it identified that disclosed their inspect mail without a federal search warrant.
arrive in the US through the same system that shipping methods, 92% indicated using USPS. Regardless of the system or carrier by which
most Americans use for their local mail – the they enter the US, all packages are subject to
US Postal Service (USPS). Shipping System Loopholes inspection by the US Customs and Border
Allow Illegal Drugs to Enter US Protection (CBP). Both USPS and ECOs
Illegal Drug Sellers Exploit To understand why illegal drug sellers prefer are required to accommodate CBP officials’
Vulnerabilities in USPS EMS over commercial services, it is important requests to locate and hand over suspicious
According to a 2018 bipartisan congressional to understand the differences between the two letters and packages for inspection before
investigation by Senators Rob Portman and the resulting vulnerabilities. they enter the US mail stream. However,
(R-OH) and Tom Carper (D-DE), it is easy Commercial entities, otherwise known the following vulnerabilities in USPS have
for Americans to purchase fentanyl from as express consignment operators (ECOs), historically hampered its ability to effectively
online sellers and have it shipped into the control letters and packages in closely integrated comply with CBP’s requests.
US, predominantly by way of USPS. networks from acceptance to delivery. This
1. U
SPS does not require advance
Using common internet search tools, means they own and operate private processing
electronic data (AED) – AED is
subcommittee members identified dozens facilities and control how they screen for
information about a package provided
of websites offering to sell synthetic opioids, hazardous materials. And because ECOs are
by the shipper at the time of drop-off,
on both the open and dark web. Through in the private sector, they enter into individual
including the sender name and address,
payment information related to six of the contracts with their customers, which often recipient name and address, and a
online sellers, the subcommittee identified include terms allowing them to open and inspect description of the package contents.
more than 500 financial transactions with over mail at any time. This data is provided to CBP prior to
2 | SEPTEMBER 2021
POLICY PERSPECTIVES
the package entering the US, thereby that CBP has to screen, coupled with packages contain documents. This is a
allowing it to identify which “suspicious USPS’ lack of advance information and near certainty as evidenced by DEA’s
packages” it would like to request to efficient processes for locating “suspicious 2020 report, which found that seizures of
inspect in advance. US ECOs have packages,” makes it highly unlikely that fentanyl sourced from China average less
been required to collect AED on all packages will be subject to inspection. than 1 kg in weight, and often test above
packages shipped into the US through 90% concentration of pure fentanyl.
their networks since the passage of The STOP Act of 2018
xemption of countries from AED
2. E
the Trade Act of 2002. In contrast, Recognizing that the vast majority of illegal
requirements without limitations on
according to UPU service terms, EMS online drug sellers shipping drugs into the US
how many countries and how long
members are not required to collect do so by way of USPS, Congress passed the
While the IFR allows for the exclusion
AED. Consequently, of the nearly 500 Synthetics Trafficking and Overdose Prevention
of certain low-risk countries that do not
million packages that USPS received from (STOP) Act in 2018. The STOP Act called
have the capacity to collect and transmit
foreign posts in 2017, only 36% had an for USPS and CBP to issue regulations
AED, in December 2020, USPS and
associated AED. requiring AED on all international packages
CBP reported an excess of 130 countries
2. USPS package location processes and shipments from foreign countries, no later
currently on their exception list, including
inefficient and ineffective – Since ECOs than one year from the date of enactment.
developed countries such as the United
have complete control of the letters and And to ensure that these regulations could be
Kingdom. Critics rightfully contend that
packages that move through their system, enforced, following passage of the STOP Act,
allowing any country to remain on the
from point of origin to destination, the US Secretary of State negotiated with the
exception list for an extended period of
they generally have efficient systems for UPU to secure reforms requiring foreign posts
time introduces a loophole that shippers of
locating letters and packages. In contrast, to provide AED and permitting countries to
narcotics and illegal prescription drugs can
USPS has no control of international deny entry of packages that do not meet these
easily exploit by transshipping.
packages at its point of origin and requirements. Still, recognizing that certain
is obligated under the UPU service countries may need time to build the capacity Conclusion
terms to accept all packages it receives to collect and transmit AED information to Now that the public comment period has
from foreign posts. Further, according USPS, the STOP Act allowed CBP to exclude concluded, the revisions CBP makes to its
to a 2018 USPS OIG report, there is certain “low-risk” countries. However, it required regulations, if any, will dictate how effective
currently no process in place at USPS CBP to reevaluate any determination made on it is in stemming the flood of illegal online
to automatically locate and redirect the exclusion of countries at least once annually. drugs coming into the US via USPS. The
suspected packages in the mainstream On March 15, 2021, after several years requirements promulgated by the STOP Act,
for inspection. Almost all international of missed deadlines and repeated pressure if implemented in full, would create a major
mail packages shipped through EMS from Congress, Homeland Security Secretary roadblock for criminals who have far too long
are received by one of five International Alejandro Mayorkas signed an interim final exploited weaknesses in the US postal system.
Service Centers (ISCs) in New York, rule (IFR) to promulgate regulations enabling And requiring AED from foreign posts is
Chicago, Los Angeles, San Francisco, CBP to implement the provisions required in a critical tool that will allow CBP to more
and Miami. And up until recently, CBP the STOP Act. effectively screen the hundreds of millions of
agents at ISCs would manually sort
pieces of international mail that it receives
through millions of suspicious packages Where CBP’s Regulations each year for illicit drugs. But allowing
originating from “countries of interest” May Fall Short exemptions for certain countries and packages
to look for illegal items. The release of the IFR comes at a time when will undoubtedly introduce weaknesses to
USPS receives a much higher volume
3. some argue that the following conditions which international drug dealers will quickly
of mail compared to ECOs – There outlined in the IFR introduce weaknesses adapt and exploit. One thing is for sure, as
is a vast difference in the volume of that could be exploited by shippers of illegal the opioid epidemic continues to intensify,
packages that ECOs and USPS received medicines and illicit drugs, thus significantly bold action is needed to enable US law
annually. In 2016, USPS handled more diminishing the effectiveness of the STOP Act. enforcement to stem the tide of synthetic
than 275 million international packages, 1. E xempting certain shipments from opioids that continues to flow across the
which is over four times the amount AED requirements US border through the mail system.
handled by three of the largest ECOs The IFR states that AED is not required This article was written by Libby Baney, JD,
combined (65.7 million). In 2017, for letter class mail or for packages and Jillian K. Brady, MS, with Faegre Drinker
the number of international packages containing documents weighing up to Biddle & Reath LLP. Please note, the opinions
that USPS received almost doubled to 7 kg. Excluding packages according to and views expressed by Faegre Drinker Biddle
498.27 million. Thus, international weight, shape, or contents will allow & Reath do not necessarily reflect the official
drug sellers have had a huge advantage nefarious actors to circumvent CBP views, opinions, or policies of NABP or any
when shipping into the US through scrutiny not only by shipping in smaller member board unless expressly stated.
EMS. The sheer volume of packages batches, but also by declaring that their
SEPTEMBER 2021 | 3
INTERVIEW WITH A BOARD EXECUTIVE OFFICER
David Sencabaugh, RPh
Executive Director, Massachusetts Board of Registration in Pharmacy
How long have you served in the form of an approval or an order of the
as executive director of the commissioner of public health, we immediately
Massachusetts Board of posted frequently asked questions and orders
Registration in Pharmacy? on our website.
I began my work as executive director of In addition, we changed our inspection
the Board in September 2013. Prior to this and investigation procedures to protect our
position, I worked exclusively in the chain inspectors and the staff members of the
pharmacy industry, where I held various pharmacies we visited. We conducted some
positions in different organizations. inspections virtually for a time, until we
could establish protocols for our team to
What is one of the most significant follow and procure the appropriate personal
challenges or issues your Board protective equipment.
addressed in the past year or so?
Massachusetts Board of When considering the most significant What other key issues has the
Registration in Pharmacy challenges to our Board, nothing comes Board been focusing on?
close to the impact of the coronavirus disease We have been focusing on the Food and
2019 pandemic. For those of us working Drug Administration memorandum of
Number of
for the Massachusetts Department of Public understanding issue and revisions to our
Board Members
8 pharmacist members Health, the changes involved everything from regulations, which are works in progress. Two
2 public members teleworking to virtual Board meetings. other major issues that continue to challenge us
1 pharmacy technician In addition, we all had to handle major are sterile compounding safety and the opioid
1 physician changes in our personal lives at the same time. crisis. During the pandemic, I feel it has been
1 nurse more important than ever to remain dedicated
What actions were taken by the to those items, while always being ready for
Number of
Board to address the issue? new concerns that will show up.
Compliance
Officers/Inspectors Massachusetts Governor Charles Baker, Jr,
1 compliance officer issued an emergency declaration in March What insights do you have
and 12 inspectors 2020 that included the approval for certain for other states that may be
state employees to work remotely and the facing similar challenges?
ability to hold Pharmacy Board meetings Work hard and keep all channels of
Rules & Regulations
virtually. The Massachusetts Department communication open. Do not be afraid to reach
Established by
Board of Registration of Public Health quickly gave the Board out to other states or stakeholders that may
in Pharmacy the tools necessary to work remotely and offer insight and ideas not yet contemplated.
a robust plan to rotate staff. Since travel Information must flow quickly and in
and parking were no longer an issue, we multiple directions. Even if you do not have
Number of decided to have a Board meeting with an answer immediately, or if your answer is
Pharmacist Licensees
our 13 volunteer members every week, so not a popular one, the trust and respect you
13,936
that we could react quickly to the many can earn by showing that you care, getting
unprecedented issues that were evolving. back to people quickly, and being honest will
Number of Pharmacies Internally, our staff began to meet virtually ultimately lead to success and satisfaction.
1,124 (includes home daily to keep the lines of communication Throughout it all, we have been blessed
infusion, mail-order, open with our stakeholders, the public, and all to have a strong, knowledgeable, and
and nuclear pharmacies) the agencies we work with closely. Our Board focused staff dedicated to public safety.
created an all-inclusive spreadsheet to track We are also blessed with a wonderful and
the many varied questions that were pouring diverse group of Board members, who
Number of Wholesale in from our licensees and the public. Our graciously adjusted their schedules to
Distributors
37 staff worked practically day and night getting accommodate the needs of the state and,
the answers to these questions and turning as such, the public. I am so proud and
around responses quickly. When answers came honored to be associated with them.
4 | SEPTEMBER 2021
ASSOCIATION NEWS
NABP’s Redesigned Innovations and Website
Honored With 2021 EXCEL Awards
NABP received two 2021 EXCEL Awards during Association Media & Publishing’s
(AM&P’s) 41st Annual EXCEL Awards Celebration, held virtually on June 16, 2021.
AM&P’s prestigious EXCEL Awards program recognizes excellence and leadership in
nonprofit and for-profit association media, publishing, marketing, and communications.
NABP received the following honors: AM&P’s 2021 EXCEL Awards program
April 2020 Innovations drew 575 entries in nine broad categories
GOLD ranging from diversity and inclusion
Newsletter Redesign initiatives to digital publishing and magazines
to books and promotional campaigns. levels for each of the awards (Gold, Silver, and
NABP Website Redesign Of those, the judges selected 240 entries to Bronze). The 2021 EXCEL Awards winners
BRONZE receive EXCEL Awards. During the Awards will be featured in the September/October
Website (Redesign) Celebration, AM&P announced the award issue of AM&P’s Signature magazine.
SEPTEMBER 2021 | 5
WHOLESALE DRUG
IMPORTATION
UNDER THE
SPOTLIGHT
as NABP, Member
Boards Act to Ensure
Patient Safety
6 | SEPTEMBER 2021
A DECADE STRONG
PMP InterConnect Serves as Vital Tool for
Providers, Regulators to Protect Public Health
At the height of the prescription drug abuse
epidemic, NABP was approached by several
states to develop a solution that would
make it possible to share vital information
from prescription monitoring programs
(PMPs) across state lines.
As a culmination of this request and months of shared effort, NABP PMP
InterConnect® was launched in 2011, allowing participating state PMPs
throughout the United States to share PMP information. This service enhances
existing PMPs and allows physicians, pharmacists, and other authorized users
to better identify patients whose prescription history may indicate issues with
prescription drug misuse and diversion, particularly in cases where patients are
crossing state lines. Despite the coronavirus disease 2019 (COVID-19) pandemic,
PMP InterConnect is now stepping into its second decade of serving the states
(at no cost to them) in a position of strength. Now a comprehensive, fully
integrated option for reviewing patient prescription history, PMP InterConnect
is expected to soon reach the significant milestone of more than 1 million users.
Combating a Historic Epidemic
In 2011, the health care community was starting to recognize the full scope of
the opioid epidemic and the role that prescription drug abuse and diversion were
playing. Centers for Disease Control and Prevention (CDC) data showed that
more than seven Americans per 100,000 were dying of opioid overdoses, and more
than half of those overdoses (4.9 per 100,000) involved commonly prescribed
opioids. An estimated 21,088 people died of opioid overdoses in 2010 alone.
Eager to find ways to fight the rapidly increasing number of overdose deaths,
many states developed PMPs and passed laws that required prescribers and
pharmacists to use PMPs to watch for patients who might be in danger of
developing an opioid use disorder or diverting opioids. As PMP technology
was developed, expectations increased. However, a significant blind spot was
identified when it became clear that some of these activities were happening
across state lines.
“We weren’t able to share information,” explained Mark J. Hardy, PharmD,
RPh, executive director of the North Dakota State Board of Pharmacy. “That
was the problem we were looking to solve. It was the height of the prescription
drug abuse epidemic, and a lot of individuals we identified were moving
between states. Data wasn’t flowing between practitioners in those states, and it
became clear that something like PMP InterConnect was needed.”
NABP and its technology provider, Appriss, Inc, developed and deployed
the necessary technology and infrastructure for PMP InterConnect in just
seven months. At launch, PMPs in Ohio and Indiana had started to share
data, and Connecticut, Kansas, North Dakota, South Carolina, Virginia, and
SEPTEMBER 2021 | 7
West Virginia were in the process of implementing the technology. “Our instances of doctor shopping have fallen 93% since 2011,”
In total, 15 states had already agreed to take the steps necessary to said Schierholt. “That is directly attributable to our PMP,
participate in the program. PMP InterConnect, PMP Gateway, and the prescriber community.
To help govern the system and ensure responsible use and rollout Today, health care providers are all working diligently to be a part of
of the technology, a PMP InterConnect Steering Committee was the solution, and interconnectivity is a huge part of that.”
created, composed exclusively of representatives of the PMPs that Although efforts to combat the opioid crisis have seen great strides
were participating in the system. During the early meetings of the since 2011, the COVID-19 pandemic and emergency measures taken
committee, the group engaged in many discussions about security, to slow the spread of the disease may have complicated the situation.
methods for auditing access to PMP data, and ways to integrate As reported in previous issues of Innovations, CDC and other
PMP InterConnect into clinical workflows of health care providers. authorities report that the opioid crisis in recent years has been driven
As a result of these discussions, a software solution known as PMP by the proliferation of illegally manufactured fentanyl being sold
Gateway was developed to allow PMP InterConnect integration into through various methods. In addition, CDC has reported significant
electronic health records (EHRs), making it possible to view PMP increases in overdose deaths over the last two years, and evidence
data without having to manually access a separate website. suggests that this resurgence can be attributed, at least in part, to
“PMP InterConnect and Gateway facilitate integration – the pandemic, as detailed in the October 2020 issue of Innovations.
integrating the PMP into the clinical workflows through [EHR] In summary, increased isolation and greater economic stresses may
systems and pharmacy management systems,” said Steven W. have led to a resurgence of opioid overdoses. As the pandemic-related
Schierholt, Esq, executive director of the State of Ohio Board of isolation has eased over the last year, vigilance regarding prescription
Pharmacy. “That has been huge – honestly, a game changer. Ohio opioids continues to be important. More information about the
was the first state in the country to provide that feature to its current state of the opioid crisis will be available in the October 2021
hospitals, doctors, and pharmacies free of charge. It has driven our issue of Innovations.
use exponentially, and it was probably the biggest step in turning our
PMP into an indispensable health care tool here in Ohio.” Health Care Providers Benefit From
“In 2016, Indiana started integrating PMP data directly into PMP InterConnect Integration
[electronic medical records],” said Kara Slusser, director of the As of press time, 52 states and jurisdictions are participating in PMP
Indiana Scheduled Prescription Electronic Collection and Tracking InterConnect. Of the nearly 1 million users of PMP InterConnect,
Program, Indiana’s PMP. “In 2017, we launched a statewide approximately 900,000 are physicians and prescribers, and 100,000
integration project with the added benefit of allowing practitioners are pharmacists. In fact, in the last five years, the volume of information
to access multistate data using PMP InterConnect. This was all made requests sent through the system has increased more than 7,000%.
possible because of NABP’s work and the PMP InterConnect system. According to Appriss, PMP InterConnect regularly delivers information
Over the last decade, NABP has worked so diligently to develop to one out of every three prescribers in the US, and over 132,000
connections with nearly all 50 states. Without that ability to view facilities have integrated PMP Gateway into their workflows.
patient data from multiple states, our integration efforts would not Another important metric for PMP InterConnect is the amount
have been as successful as they are today.” of time it saves providers, particularly when fully integrated to EHR
systems and health care system workflows. Appriss estimates that PMP
Pandemic Surge Shows Vigilance Is Still Needed InterConnect saves providers between two and five minutes per patient
In the decade since PMP InterConnect was introduced, PMPs have encounter. Because the system now processes over 1 billion annual
become a vital tool in helping to reduce prescription drug misuse. patient encounters per year, PMP InterConnect is saving PMP users a
Although the opioid crisis continues to be an important priority minimum of 33 million hours each year.
for NABP and its member boards of pharmacy, overdoses related to Schierholt believes that PMP Gateway integration has been
prescription opioids have declined significantly. Similarly, dangerous an important part of improving participation in his state’s PMP.
pain clinics run by unscrupulous prescribers and problematic patient “Seven years ago, I heard that our PMP was slow and cumbersome,”
behaviors such as “doctor shopping” (visiting multiple prescribers to Schierholt said. “Now, it is seamless. With a click of a button, providers
seek the same or similar controlled substances) have also declined. can get a prescription history from Ohio or any other participating
“I don’t think it’s a coincidence that a decrease in these metrics state. Integration is a game changer, and we would encourage any state
occurred after PMP InterConnect started to see widespread use,” to work toward it. It is also helping prescribers get time back – time
Hardy commented when discussing the impact PMPs have had once used to log into a system, enter data, and make queries can be
on the pandemic in North Dakota. “It fostered sharing between used to have more meaningful conversations with patients.”
jurisdictions, addressed major problems we had 10 years ago, and Enhancements to PMP InterConnect continue to be developed and
made PMPs into a high-level tool. It’s been built on a lot of successes.” implemented, with several new technical improvements underway.
“Once sharing through PMP InterConnect began we saw These developments will continue to make it easier for users to
significant decreases in the number of people crossing state lines to monitor the system, get reports and other vital information when they
obtain controlled substances as part of illegal activity,” added Joe need it, and enable stronger, secure connections between PMPs. The
Fontenot, RPh, assistant executive director of the Louisiana Board of future of PMP InterConnect will also be discussed at a forthcoming
Pharmacy. “To my knowledge, there was no mechanism in place to Steering Committee meeting in October 2021. More information on
share information across state lines before PMP InterConnect.” this meeting will be provided in future communications.
8 | SEPTEMBER 2021ASSOCIATION NEWS
Board Staff Learn About NABP Programs and Services at
Annual Program Review and Training
One hundred and three board of pharmacy e-Profile Connect system, licensure transfer, forward as it allowed for more board of
staff representing 25 boards of pharmacy Clearinghouse, examinations, accreditation pharmacy staff to attend. Information about
attended the virtual 2021 NABP Program and inspection programs, and more. the 2022 training, which will take place in
Review and Training session on June 15, Due to the success of last year’s virtual summer 2022, will be provided in future
2021. The live, interactive session provided training, NABP has made the decision to NABP communications.
information about the Association’s hold this annual training virtually moving
Participants’ Comments on the 2021 Program Review and Training
“The information “This was my first,
was well presented
in an orderly
but hopefully not my
manner. Presenters “I enjoyed how last, Program Review
were knowledgeable
interactive and Training session. I
at the field or area
of expertise.” the training enjoyed all the topics and
was and that presenters very much.”
it included
multiple polls
“I enjoyed the and quizzes.”
virtual aspect
since it gave “I really enjoyed the training
presentations. I was very
me a better
“This was a good tool impressed by how efficient and
opportunity for beginning users clear all the presenters were
to attend.” of the NABP platform with the training being virtual.”
and will be used to
train new employees.”
Missed the Training? • NABP Examinations • CPE Monitor®
Access a Recording Online! • Examination Eligibility • harmacy and Distributor
P
Did you miss the 2021 Program Review Accreditations and Inspections
and Training, or attend but want to view
• Performance Reports
a specific segment from the training • oreign Pharmacy Graduate
F • ember Relations and Government
M
Examination CommitteeTM Affairs, Federal Affairs, Professional
again? This year’s training was recorded Affairs, and Communications
and edited for quick and easy viewing on Certification
the NABP website at any time. • Licensure Transfer To access the videos, visit the Board
The training has been segmented into • NABP Clearinghouse Resources page in the Members section of
videos, each ranging in length from four
• Licensure Warehouse and the NABP website. Each video includes
minutes to 34 minutes, which cover the Data Exchange an email address at the end to receive
following NABP programs and services: more information on the topic.
• Licensure Verification
SEPTEMBER 2021 | 9ASSOCIATION NEWS
In Memoriam: NABP Mourns Passing of Past
President and Past Honorary President
Llyn A. Lloyd
Past NABP President Llyn A. Lloyd passed
away on June 13, 2021. Lloyd served as
the Association’s president from 1992 to
1993. Under Lloyd’s leadership as president,
NABP began the development of single-
issue task forces to promptly address critical
practice, licensure, and regulatory issues,
and to give the state boards of pharmacy a
voice in Association change. Lloyd served as
executive director of the Arizona State Board
of Pharmacy for more than 17 years. He was
a strong advocate for recovering pharmacist
treatment programs, and a recipient of the
Llyn A. Lloyd William “Buck” Stevens
A.H. Robins Bowl of Hygeia Award.
William ‘Buck’ Stevens Compliance Advisory Committee and the was instrumental in enabling pharmacists to
Past Honorary NABP President William Task Force on the Expanded Use of the administer immunizations and to provide
“Buck” Stevens passed away on May 22, Internet in Pharmacy Practice and Regulation. disease management services. He was
2021. From 2004-2005, Stevens served Because of Stevens’ efforts while serving as also the major force behind the Disease
as NABP’s honorary president. An active executive director, the Mississippi Board of State Management examination program
member of NABP, Stevens played an integral Pharmacy received the 1999 Fred T. Mahaffey and the National Institute for Standards
role in many of NABP’s committees and task Outstanding Board of Pharmacy Award at in Credentialing and was an outspoken
forces, including the Bureau of Voluntary the 95th NABP Annual Meeting. Stevens advocate for pharmacists nationally.
NABP Accreditations and Verifications
NABP awarded a total of 76 accreditations and verifications from April 1 to May 31, 2021. The breakdown by program is as follows:
Drug DMEPOS Digital Compounding .Pharmacy
Distributor Pharmacy Pharmacy Pharmacy Verified
Accreditation: Accreditation: Accreditation: Accreditation: Websites:
47 6 1 3 19
To see the names of businesses accredited and verified by NABP, visit the
Programs section of the Association’s website at www.nabp.pharmacy.
10 | SEPTEMBER 2021INTERVIEW WITH A BOARD MEMBER
Jeenu Philip, RPh
Member, Florida Board of Pharmacy
When were you appointed to understand the value pharmacists can bring
the Board of Pharmacy? What to the health care team. During a meeting,
type of member are you? we were able to hear from pharmacists who
I was appointed to the Board in 2013 as a work in such collaborative teams and are
pharmacist member and served as chair in 2018. able to make a difference in patients’ lives
because their understanding of drug therapy
What steps should a board member is different from that of physicians or nurses.
take to be successful in their role?
Board members should be fully engaged What advice would you give
in their committees and meetings. Identify to a new board member?
how you are different and then be prepared Gain perspective. As someone who attends
to provide input relevant to your industry board meetings throughout the country,
and perspective. In addition, to maintain I find that many board members take an
Florida Board your credibility, it is extremely important extremely conservative approach out of
of Pharmacy to be respectful of others’ opinions when unsubstantiated fear. Many do not look at
making any points you wish to make. the national landscape and see what is being
done safely across the country in a similar
Number of Board What are some recent policies, manner. As board members, our job is to
Members
legislation, or regulations your protect the public. My belief is that part of
7 pharmacist members
2 public members Board has implemented? that responsibility is to allow pharmacists
Recently, the Florida Board of Pharmacy and technicians to practice at the top of
worked with the Board of Medicine and the their licenses and not restrict the practice of
Number of Board of Osteopathic Medicine to write rules pharmacy without evidence that such practice
Compliance related to collaborative practice agreements is unsafe. This perspective can be gained by
Officers/Inspectors (CPAs), as well as the testing and treatment of attending national and district meetings and
18
influenza and streptococcus and other minor doing your own research on issues that are
ailments, as a result of the passing of House controversial in your state. Before creating a
Bill 389. The law change and subsequent rules rule that restricts practice in any way, ensure
Rules & Regulations create a pathway that allows pharmacists to that the rule has some evidence to back up a
Established by utilize their education, skills, and abilities to need for it. I applaud board members around the
Board of Pharmacy
improve health outcomes and reduce health country who use evidence-based decision making.
care costs. The Board is also reviewing existing
rules related to automated pharmacy systems Have you served as a member of any
Number of to determine if rule changes are necessary. NABP task forces or committees, or
Pharmacist Licensees attended NABP or district meetings?
34,157
Has the Board encountered any I have served on a multitude of task forces and
challenges to developing and/or committees as well as attended every interactive
implementing these new policies, forum, District 3 meeting, and NABP Annual
Number of legislation, or regulations? Meeting since 2013. I have served multiple
Pharmacies Since the CPA rules required input from times on the Committee on Resolutions and the
9,859 (in-state) the Board of Medicine and the Board of Committee on Law Enforcement/Legislation,
Osteopathic Medicine, there needed to be a which helps shape the Model State Pharmacy
consensus within the group as to which chronic Act and Model Rules of the National Association
Number of health conditions pharmacists may collaborate of Boards of Pharmacy. These committees and
Wholesale on utilizing a CPA. As the pharmacy profession meetings help provide immense perspective
Distributors attempts to advance health care initiatives with and shape your thought process as well as allow
Regulated by another
a focus on improving outcomes and driving you to participate in impactful changes to the
state agency
down health care costs, we need to work practice of pharmacy.
with our partners in medicine to help them
SEPTEMBER 2021 | 11STATE BOARD NEWS
California Prepares for New person who wants to purchase hypodermic and date when it may be filled. Health
Electronic Data Transmission syringes and needles or maintain a logbook care providers who object, for reasons of
Prescription Rules recording the name and address of the conscience, to participating in the provision
The California State Board of Pharmacy is purchaser, the quantity purchased, the date of medical aid in dying are not required to
preparing licensees for legislative changes related of the purchase, and the intended medical do so and will not be subject to criminal
to electronic data transmission prescriptions. use. Pharmacists will be able to offer liability, licensing sanctions, or professional
Beginning January 2022, authorized health hypodermic syringes and needles for sale to disciplinary action. However, health care
care practitioners will have the capability to any person who wants to purchase them if providers must inform the individual of their
send electronic data transmission prescriptions, the following are made available: decision and refer them to a provider who is
pharmacies will have the capability to receive • written or electronic educational able and willing to carry out the individual’s
the electronic data transmission prescriptions, materials on safe and proper disposal request, or to another individual or entity
and prescriptions used by health care of hypodermic syringes and needles; to assist the requesting individual in seeking
practitioners will be issued as electronic data • ritten or electronic educational
w medical aid in dying. The full text of the bill
transmission prescriptions. or referral information for syringe is available at https://nmlegis.gov.
For more details, including exempt exchange service programs and
situations and other provisions of the law, see substance use disorder treatment; and North Dakota Expands
Business and Professions Code Section 688. • a verbal, physical, or electronic offer Pharmacists’ Authority
to provide a naloxone prescription for The North Dakota Legislature recently
Iowa Updates PMP opioid overdose. passed, and Governor Doug Burgum has
Reporting Requirements These three requirements do not apply if signed into law, Senate Bill 2221, which
The Iowa Board of Pharmacy now requires the hypodermic syringes and/or needles are expands pharmacists’ authority in the
all Schedule V controlled prescriptions to be dispensed pursuant to a prescription or in following areas:
reported to the Iowa Prescription Monitoring conjunction with a prescription medication • Authorizes pharmacists to provide
Program (PMP). The newly adopted that requires reconstitution or administration immunizations, injections, and other
rulemaking also includes nonprescription sales by a syringe. administrations to patients as young as
of codeine-containing cough suppressants (eg, three years of age.
Robitussin AC®) as reportable transactions. New Mexico Bill Allows Health • xpands the pharmacist’s ability to
E
The rulemaking also requires a pharmacist Care Providers to Prescribe provide “emergency pharmacy practice”
to review a patient’s or a client’s prescription for Medical Aid in Dying dispensing. This extends the one-time
history report prior to dispensing a Schedule V Health care providers in New Mexico emergency fill from 72 hours to a 30-day
medication without a prescription. For more (doctor of medicine, doctor of osteopathic supply and allows the pharmacy to bill
details, see the Board’s June 2021 Newsletter. medicine, advanced practice nurse, or using the pharmacist’s National Provider
Identifier number.
physician assistant) may now provide
Kansas Implements New a prescription for medical aid in dying • ives the North Dakota State Board
G
Registration Requirements to a terminally ill adult who is mentally of Pharmacy the authority to establish
for Virtual Distributors and competent after meeting certain statewide protocols for public health
issues. The Board intends to establish
Manufacturers requirements. A prescription for medical
statewide protocols for pharmacists’
Recently passed legislation allows the Kansas aid in dying cannot be filled until 48 hours
ability to provide immunizations and
State Board of Pharmacy to recategorize after the prescription is written, unless the
tobacco cessation products by drafting
virtual distributors and virtual manufacturers prescribing health care provider medically and implementing rules.
as well as nonresident manufacturers in confirms that the individual may die before
Kansas. The change is meant to alleviate the expiration of the aforementioned time
several new requirements imposed on period. The prescription must include the
wholesale distributors in 2020, which are time and date written as well as the time
not applicable to virtual or manufacturing
facilities. Additional details are available in
the Board’s June 2021 Newsletter.
Most articles published in State Board News are
selected from the newsletters of state boards
Kentucky No Longer Requires
that participate in the NABP State Newsletter
Identification for Purchase of
Program. Issues are posted on the NABP website
Hypodermic Syringes and Needles
on each participating state’s page.
Kentucky-licensed pharmacists are no longer
required to obtain the identification of a
12 | SEPTEMBER 2021PROFESSIONAL AFFAIRS UPDATE
conditions.” The study showed that these
individuals were more likely to have an
impairment from opioid prescription use
and misuse, medical cannabis use, and/
or prescription tranquilizer/sedative use
and misuse. The analyzed data is from the
2015-2019 National Survey on Drug Use
and Health. Read the full press release at
www.pharmacist.com/Pharmacy-News/older-
adults-with-functional-impairments-at-risk-of-
prescription-drug-misuse.
Pharmacists Urged by FIP
to Encourage Healthier
Patient Lifestyles
The International Pharmaceutical Federation
(FIP) released a toolkit for pharmacists and
other health care workers with steps for
helping patients practice healthier lifestyles
Study Shows Access to Food and Drug Administration (FDA) and increase physical activity. For example,
Naloxone Decreased During finalized two guidance documents regarding pharmacists are urged to promote nutrition
COVID-19 Pandemic compliance with applicable Drug Supply and weight management services. FIP states
A recent study conducted by clinician Chain Security Act provisions. The two that poor diets are responsible for more
researchers at Beth Israel Deaconess Medical guidances are Product Identifiers Under the deaths than any other behavioral risk factor,
Center showed that individuals with opioid Drug Supply Chain Security Act Questions and approximately 5 million deaths per year
misuse disorders may be experiencing and Answers, and Drug Supply Chain Security could be prevented if people were more
a lack of access to naloxone due to the Act Implementation: Identification of Suspect physically active.
coronavirus disease 2019 (COVID-19) Product and Notification. The guidance The toolkit is designed to support
pandemic. The study, published in the documents lay out FDA’s recommendations, pharmacists and discusses the impacts of
JAMA Health Forum, analyzed naloxone including those for enhanced drug nutrition, diseases, weight management
prescription trends during the pandemic distribution security at the package level strategies, and how physical activity is
in the United States and compared them that go into effect in November 2023. More essential for optimal health and well-
with trends in opioid prescriptions and information about the guidance documents being. Learn more by visiting www.fip.org/
overall prescriptions between May 2019 can be accessed by visiting the FDA website news?news=newsitem&newsitem=389.
and December 2020. Researchers, who at www.fda.gov/regulatory-information/search-
looked at data from national retail, mail- fda-guidance-documents. Study Explores Pharmacists’
order, and specialty pharmacies, found a Future Role in Treating
25% decrease in prescriptions filled for Prescription Drug Misuse Lung Cancer Patients
naloxone, compared to a 9% decrease More Risky in Adults With Pharmacists’ role in patient care is
in opioid prescriptions filled and a 14% Functional Impairment continuing to expand, including in the
decrease in prescriptions filled overall. New research published by the American treatment of lung cancer. A new national
Researchers noted that an increase in access Journal of Preventive Medicine suggests that study, “Molecularly Informed Lung Cancer
to naloxone could have helped reduce the adults over 50 years of age with functional Treatment in a Community Cancer
number of increased opioid overdoses that impairments may be at higher risk of Network: A Pragmatic Consortium,” will
occurred during the COVID-19 pandemic. prescription drug misuse, including the observe approximately 12,000 community-
misuse of prescription opioids and cannabis based patients with non-small cell lung
FDA Issues New Guidance to use. The Centers for Disease Control and cancer to better understand and define
Further Enhance Security of Prevention defines functional impairments as the role pharmacists will play as more
Prescription Drug Supply Chain “difficulties performing daily activities, such oral therapies receive approval. Learn
To ensure that prescription drugs in the as bathing or getting dressed, or problems more by visiting www.pharmacytimes.com/
US are identified and traced properly with concentration or decision making view/lung-cancer-study-brings-pharmacists-
while moving through the supply chain, affected by physical, mental, or emotional to-the-forefront-of-patient-care.
SEPTEMBER 2021 | 13Presorted First Class
U.S. Postage
PAID
Permit #583
Schaumburg, IL 60173
1600 Feehanville Dr
Mount Prospect, IL 60056
UPCOMING EVENTS
NABP Interactive Executive Officer Forum NABP Interactive Compliance
September 28-29, 2021 | Northbrook, IL Officer and Legal Counsel Forum
November 30-December 1, 2021 | Northbrook, IL
NABP/AACP District 3 Meeting
October 3-6, 2021 | Hilton Head Island, SC NABP Interactive Member Forum
January 26-27, 2022 | Northbrook, IL
NABP/AACP District 4 Meeting
October 20-22, 2021 | Columbus, OH
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