Pharmacy News

Entries for January 2020

Clinical Implications of HIV PrEP in Community Pharmacy

By Adam King, CPhT, PRS, Master of Public Health student - Western Michigan University

The rate of new Human Immunodeficiency Virus (HIV) diagnoses is rising in Michigan.1 As of 2018, over 16,000 Michigan residents live with the disease.1 The six county region surrounding the City of Detroit is particularly hard hit with this illness, with over 65 percent of the diagnosed population in Michigan residing in that area.2 With no vaccine in sight, the public health best practice for preventing new illness is the use of pre-exposure prophylaxis (PrEP) used along with condom use.3 The population particularly at risk of contracting HIV is African American males who have sex with males.2 There are several clinical implications in community pharmacy when using this approach.

Current Pre-Exposure Prophylaxis Methods

The current accepted PrEP method is the use of older generation antiretroviral therapy along with barrier protection.4 Truvada was the first medication to receive this indication in 2018.5 In October 2019, Descovy was approved for the indication.6 It should be noted that the PrEP indication for these medications only applies to sexual transmission of HIV, use of PrEP for intravenous drug use is only partially effective and not widely studied.5–7

Insurance Coverage for PrEP

Many insurances still designate HIV therapy as specialty drugs and will often restrict access to select pharmacies. As of Oct. 1, 2019, Michigan Medicaid will only cover Truvada under the fee-for-service common formulary.8(p66) Each Medicare Part D formulary has its own criteria for PrEP coverage.

Since there are not currently generics for the PrEP medications, these medications do carry a considerable cost. The average price for a one-month supply of PrEP is around $2,000.9

Clinical Considerations

Since HIV medication often comes from a different pharmacy than other medications a patient may take, drug interactions may become hard to detect. Common medications that interact with PrEP medications include hepatitis B and C medications, verapamil, chemotherapy, diuretics, immune modulators, immunosuppressants and some seizure medications.5,6,10 St. John’s wort should be avoided in patients using Descovy, as the herb will reduce the antiviral effectiveness.6 Drugs that impact renal function should be avoided in patients taking Truvada to avoid renal failure.5

Side effects of antiviral therapy should be conveyed to the patient when starting PrEP. Common adverse reactions include headaches, respiratory infection, sinusitis and diarrhea.5 These side effects occur in about 10 percent of patients. Patients with a diabetes diagnosis should be aware of potential kidney damage with these medications.5

While researchers continue to develop a vaccine for HIV, a rise in prescriptions for PrEP will be expected. With a low chance of developing drug-resistant strains of HIV, this intervention is currently the gold standard in HIV prevention. The use of the medications though is not a silver bullet as PrEP medications alone do not prevent all sexually transmitted infections. Barrier protection in the form of condoms must also be used to avoid potential co-morbid infections such as chlamydia, gonorrhea and hepatitis C.3

References:
1. Michigan Department of Health and Human Services. HIV & STD’s in Michigan - an overview. July 2019. https://www.michigan.gov/documents/mdhhs/2018_HIV__STD_overview_660409_7.pdf. Accessed Nov. 10, 2019.
2. Division of Communicable Diseases. Epidemiologic Profile of HIV in Michigan 2018. Lansing: Michigan Department of Health and Human Services; 2018:44. https://www.michigan.gov/documents/mdhhs/2018HIV-Epi-Profile_620033_7.pdf. Accessed Nov. 10, 2019.
3. Kokolo MB, Fergusson DA, Cameron DW. HIV Pre-Exposure Prophylaxis (PrEP)—A Quantitative Ethics Appraisal. PLoS One; San Francisco. 2011;6(8):e22497. doi:http://dx.doi.org.libproxy.library.wmich.edu/10.1371/journal.pone.0022497
4. Patel RR, Mena L, Nunn A, et al. Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS One; San Francisco. 2017;12(5):e0178737. doi:http://dx.doi.org.libproxy.library.wmich.edu/10.1371/journal.pone.0178737
5. Gilead Sciences. Truvada package insert. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=54e82b13-a037-49ed-b4b3-030b37c0ecdd. Published May 18, 2018. Accessed Nov. 10, 2019.
6. Gilead Sciences. Descovy package insert. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=06f66e98-e6ee-4538-9506-6c1282cc14c1. Published Oct. 11, 2019. Accessed Nov. 10, 2019.
7. Guise A, Albers ER, Strathdee SA. ‘PrEP is not ready for our community, and our community is not ready for PrEP’: pre-exposure prophylaxis for HIV for people who inject drugs and limits to the HIV prevention response. Addiction. 2017;112(4):572-578. doi:10.1111/add.13437
8. Michigan Department of Health and Human Services. Managed Care Common Formulary Listing. Michigan Medicaid. https://www.michigan.gov/documents/mdhhs/Managed_Care_Common_Formulary_Listing_506275_7.pdf. Published Oct. 1, 2019. Accessed Nov. 10, 2019.
9. GoodRx, Inc. Truvada Prices, Coupons & Savings Tips. GoodRx. https://www.goodrx.com/truvada. Published Nov. 10, 2019. Accessed Nov. 10, 2019.
10. Liverpool Drug Interaction Group. Interactions with NRTIs. November 2019. https://liverpool-hiv-hep.s3.amazonaws.com/prescribing_resources/pdfs/000/000/079/original/NRTIs_2019_Nov.pdf?1572877409. Accessed Nov. 10, 2019.

Posted in: Professional Practice
Membership Brings You Value

Penney M. Aiken, membership development manager, Michigan Pharmacists Association, Lansing

As a member of MSHP you have access to valuable resources to help you. You have access to educational programs like the MSHP Annual Meeting held in the fall each year designed specifically to address health-system related issues, as well as MPA conferences like the MPA Annual Convention & Exposition occurring Feb. 21-23 in Detroit. You receive complimentary subscriptions to the monthly MSHP Monitor written by health-system practitioners on topics ranging from transitions of care to ambulatory care and antimicrobial stewardship as well as the MPA quarterly journal and bimonthly PRN (Pharmacy Related News) to keep you up-to-date on industry news.

Some of the other great benefits you receive by joining the only state-based pharmacists association in Michigan include:

  • Member-only access to our expert staff who can assist you with practice-related questions or refer you to additional resources to help you find answers to your questions
  • Access to members-only content hosted on our website including the latest legislative and regulatory news
  • Representation and action at the state and federal level to promote pharmacy-friendly legislation through Michigan Pharmacy PAC and MPA's Pharmacy Advocacy Response Team (PART)
  • Professional discounts on educational programs, references and events
  • Group rates on insurance with PSI Insurance Agency, the only agency in Michigan owned by a pharmacy association who specializes in providing you with the best coverage to meet your needs

To find out more about these great member benefits, and learn what it means to be part of the strongest state pharmacy association in the nation, visit www.MichiganPharmacists.org/MemberBenefits

Posted in: Member News
Five Tips for Future Residents

Francesca Bignasci, Pharm.D. and Darene Moqbel, Pharm.D., PGY-1 Residents at Henry Ford Macomb Hospital

After pharmacy graduation and residency match-day, you are preparing to start a new chapter in your career. With a lot of unknowns and eager days, the transition into residency can be daunting. Here are some tips to help you get through your residency year as smoothly as possible.

  1. Time management - master your time
    After graduating from pharmacy school, one of the biggest transitions is developing an efficient time management system. The common phrase, “there aren't enough hours in the day” very much relates to residency. There will be days you feel you have so much to do, and not enough time to complete the tasks or projects. The best way to manage your time is to keep track of your meetings and deadlines in a calendar. Make it a habit to check your calendar frequently to stay on top of all the projects and prioritize which task should be completed first.
  2. Stay positive - this too shall pass
    During your residency year, certain days will be grueling and often feel like a marathon. It is important to stay positive and remember it is temporary. Staying positive allows you to stay focused on the goals you have set for the year and will make you a happier person. If you maintain a positive attitude you will be surprised by how much you can accomplish.
  3. Precept - be a role model
    Now that you are a resident, you can precept students and give back to the pharmacy profession. This is the time to reflect on past preceptors and think about what characteristics you liked and disliked. You can then determine what kind of preceptor you would like to be and come up with a style that fits you. It is also important to tailor your precepting style based on students learning style. Also, ask for regular feedback from your student so you can improve on your precepting skills. Don’t expect to be perfect but expect that you will get better with practice.
  4. Take care of yourself - you can’t pour from an empty cup
    Feeling stressed and overwhelmed is normal, but it is important to remember that you can’t take care of others if you can't take care of yourself first. When you take care of yourself, you have more energy to give to your patients and to your job. Whether it is spending time with friends, exercising, maintaining a balanced diet or participating in a hobby, it is important to set aside time for you! 
  5. Confidence - strive for progress, not perfection 
    With residency starting, it is easy to feel as if you do not know enough. It is important to not be too hard on yourself and develop more confidence in your pharmacist abilities. Just know that it is impossible to know everything, especially when coming straight from pharmacy school. Generate a mental snapshot of where you are at the beginning of a rotation and at the end and recognize the great strides you have made to get where you are. Being successful this year does not mean being perfect but make the most out of residency and take advantage of this opportunity, so you improve upon yourself. 
Posted in: Member News
Achievements to Advance PAI in Michigan: Final Summary of the Ambulatory Care Pharmacy Practice Leadership Workshop

Diana Kostoff, Pharm.D., BCPS, BCOP, pharmacy coordinator, Hematology/Oncology Ambulatory Pharmacy Services, Henry Ford Hospital and Cancer Institute and co-chair, MSHP Ambulatory Care Pharmacy Practice Committee

The American Society of Health-System Pharmacists (ASHP)’s Practice Advancement Initiative (PAI), formerly the Pharmacy Practice Model Initiative (PPMI) was founded in 2010. Its main purpose is to empower the pharmacy team to take responsibility for medication use outcomes. In the early years of the initiative, many Michigan health-systems implemented the inpatient standards, but it became evident that the initiative had to be expanded to embrace more pharmacy practice settings, including ambulatory care services.

ASHP held an Ambulatory Care Conference and Summit in 2014 and subsequently, the Michigan Society of Health-System Pharmacists (MSHP) held its own summit the same year and as a result, formed the MSHP Ambulatory Care Pharmacy Practice Committee in 2015. Since the inception of this committee, all its yearly charges have been to advance ambulatory and transition of care (TOC) pharmacy practice in the state of Michigan. This commitment led to MSHP being awarded the 2018 ASHP Foundation PAI State Affiliate Workshop Grant.

The MSHP Ambulatory Care Pharmacy Practice Leadership Workshop occurred in June 2018 with an ASHP facilitator. The primary goals were to identify opportunities in using PAI to:

  • Leverage ambulatory and TOC pharmacy practice transformation in Michigan
  • Communicate MSHP’s strategic initiative for advancing these practices
  • Generate sustained interest and support for accomplishing practice development

Workshop attendees identified statewide priorities in ambulatory pharmacy practice focusing on:

  • Use of pharmacy extenders (technicians and learners)
  • Defining ambulatory pharmacy practice and its scope
  • Demonstrating value of ambulatory pharmacy services
  • Expansion of TOC services
  • Standardization of collaborative practice agreements (CPAs)

MSHP Board of Directors hosted a strategic planning session in September 2018 with pharmacy leaders around the state, many of which attended the workshop. Strategic plans were developed to solidify MSHP’s goals and objectives, including the incorporation of PAI initiatives into the 2019 MSHP Committee charges. Charges related to the PAI were distributed amongst various committees with the majority directed to the Ambulatory Care Pharmacy Practice Committee. These charges were included in the final report of the workshop that was submitted to ASHP.

As a result of the workshop, PAI influence and 2019 committee accomplishments, MSHP was able to demonstrate commitment and advancement to ambulatory and TOC practice in the state of Michigan with the following achievements:

  • MSHP obtained baseline data about ambulatory care and TOC practices as well as after residency training in the state of Michigan. This statewide data can be used to track practice advancement and help health-systems identify areas of improvement.
  • MSHP endorsed the advancement of pharmacy extenders by promoting the availability of structured technician training programs and pursued implementation of regulatory changes that will allow technician product verification in health-systems so more pharmacist resources can be dedicated to ambulatory, TOC or other PAI initiatives. In addition, the Ambulatory Care Pharmacy Practice Committee collected and disseminated examples of innovative use of pharmacy extenders in an article published in the April 2019 MSHP Monitor. The Residency Committee also conducted a Preceptor Needs Assessment survey to assess current and desired level of knowledge, skill or experience on a variety of topics, which included residents, students and technicians as practice model extenders.
  • MSHP supported the development and publication of a White Paper authored by members of the Ambulatory Care Pharmacy Practice and Residency Committees and Transitions of Care Task Force. This paper will define ambulatory pharmacy practice and its scope and value.
  • MSHP restructured educational programs to target best practices and to demonstrate value of capturing outcomes. Two sessions at the 2019 Annual MSHP meeting focused on outcomes and a TOC Summit is being planned for 2020.
  • MSHP has gathered more interest from pharmacists, residents and pharmacy technicians within our state to become engaged in these initiatives. The Ambulatory Care Pharmacy Practice Committee has grown from 12 members to 20 since the workshop.
  • MSHP continues to share all accomplishments with our members through the MSHP Monitor.

The MSHP Ambulatory Care Pharmacy Leadership workshop was an engaging and empowering one-day event with lasting implications. It identified ambulatory and TOC practices to be shared and developed for health-systems in Michigan. The impact of the workshop influenced MSHP’s committee activities for 2019 and beyond. As ASHP rolls out its PAI 2030 initiative, MSHP will continue to dedicate resources to support the PAI in our state. 

Posted in: Member News
20/20 Vision - Being Pharmacy Champions

Curtis Smith, Pharm.D., BCPS, FCCP, professor, Ferris State University College of Pharmacy, Lansing and MSHP President

Welcome to 2020 and a new decade of advancing pharmacy practice in health systems across the state. Thank you for helping the Michigan Society of Health-System Pharmacists (MSHP) accomplish many of the goals we have established over the past few years, for demonstrating the value of pharmacists in an array of practice settings and improving outcomes in the patients we care for. As I begin my term as President of MSHP I’m excited to continue implementing our 2018-2020 strategic plan, which was developed to provide focus for the organization and the committees that complete the bulk of the work throughout the year. Recent past presidents Nancy MacDonald and John Clark provided stellar leadership and laid the groundwork for the future success of MSHP.

While developing committee charges this year, it became clear that implementing our strategic plan required a strong voice from MSHP members, communicating the importance of pharmacy practice in health-systems. Because of that, my theme for the year is “Being Pharmacy Champions.” Although annual presidential themes can cause whiplash within organizations, I think this complements the themes from the past two years “Demonstrating Our Value” and “Achieving Patient Care Outcomes.” All these themes begin with a gerund. This pattern of using gerunds, which are verbs, connotes action. My hope for 2020 is a level of activity that ultimately helps us complete our goals and objectives from our three-year strategic plan.

What does it mean to be a pharmacy champion? The word champion comes from the Latin for fighter. It refers to “someone who fights or speaks publicly in support of a cause or a person who enthusiastically supports, defends or fights for a belief or principle.” It can further be defined as “a person who voluntarily takes extraordinary interest in the adoption, implementation and success of a cause, policy, program or project.” A champion will typically try to force ideas through entrenched internal resistance in order to create change and will talk passionately about how good something is throughout an organization, institution or system.

Championing health-system pharmacy practice is our goal in 2020. It matches the strategic plan and the ideas generated at our retreat in September 2019. We need to tell our story, especially related to practice advancement, credentialing, collaborative practice, improving patient outcomes, etc. Within the image accompanying this article you see words like promote, defend, fight, speak publicly, support, advocate, etc. This is what I hope we all can do in support of MSHP and health-system pharmacy practice in Michigan in 2020. Gabriel Eckert and Bob Harris in their book “Strategic Integration: Tips, Tools, and Techniques to Move Beyond Strategic Planning and Transform Your Organization” speak to how organizations implement their strategic plans. One of the most important methods to do this is by utilizing creative communication. Creative communication includes being an effective storyteller. Effective stories are attention grabbing, relatable, compelling and action oriented. Mantras, or short phrases and sentences that reflect the essence of a strategic priority or plan are another effective means of communication. The presidential themes of 2018 through 2020 are impactful mantras for MSHP. And finally, creative communication requires going beyond words to champion our cause. Visual communication, including infographics, photos, videos, data visualization, etc. helps convey information of strategic importance. Visuals are inherently more effective in helping people learn and remember what they are being told.

Being a champion also means being superior or excellent or the best. We should all strive for this in our practice and work to become or remain excellent clinicians. How are we maintaining/advancing our knowledge and skills and being the best at what we do – no matter our role in the health-system? Are we passionately driven to practice and perform at the highest level possible? An urban definition for champion is “someone who commits an act of extreme courage or extreme awesomeness.” Hopefully, you’re demonstrating extreme awesomeness in all your professional work.

Associations like MSHP are the backbone of every profession. They provide education, networking, political lobbying and opportunities to create credibility in a profession. I’m honored and look forward to being president of your most valued professional association – MSHP. Together we are stronger, louder and ultimately better. Together we can all be pharmacy champions.

Posted in: Member News
Page 1 of 2First   Previous   [1]  2  Next   Last