Pharmacy News

Entries for November 2019

MPA intervenes in letter to JCAR; LARA rescinds rule and removes item from agenda

By Brian Sapita, government affairs manager, Michigan Pharmacists Association

The administrative rules process can be a lengthy process. In short, state agencies draft rules in consultation with the respective Board. The draft rules are then presented to the public during a public hearing, allowing the public to comment on the proposed rules. Workgroups are held that take all the public comments under consideration and stakeholder groups are able to give additional input. Finally, the draft rules are presented to the Joint Committee on Administrative Rules (JCAR) for approval. The Committee (JCAR) is made up of 10 legislators, responsible for the legislative oversight of administrative rules proposed by state agencies.

The Committee has the authority to approve or deny any set of rules presented and historically, the committee has always approved the rules, believing that the department and its boards had done their due diligence and was sending the rules in good faith. Unfortunately, sometimes that is not always the case. In early September, a rule change in the Controlled Substance Rules (R 338.3162b) was proposed to JCAR by the Department without the support of the public or the Board of Pharmacy. 

The proposed rule (R 338.3162b) made changes to the reporting requirements of pharmacists and dispensing prescribers to the Michigan Automated Prescription System (MAPS), including submitting information about persons unrelated to the prescriber-patient relationship to MAPS when picking up a prescription for a patient. Note that the information collected and reported will include the name of the person picking up a prescription, his or her ID number and the relationship to the patient.

Those proposed changes would have required pharmacies throughout the State of Michigan to make necessary, costly, programmatic changes to comply with the rule, thus placing unnecessary economic burden on Michigan small businesses. MPA strongly opposed the proposed rule since there is not data that supports a decrease in diversion with the proposed increase in reporting requirements. 

MPA and other individuals wrote letters to JCAR and spoke with legislators on the committee to implore them to deny the rules. On the day of the committee hearing LARA rescinded their rules and took them off the agenda. They have not announced what they plan to do with the rules or if they will continue to work on them, but MPA will continue to monitor the situation on all administrative rules that affect the profession. 

Posted in: Member News
Dashboard Updates and Revisions with New Metrics

By Laura Hencken, Pharm.D., BCCP, clinical pharmacist, Henry Ford Hospital

In 2018, the Michigan Society of Health-System Pharmacists (MSHP) Board of Directors charged the Residency Committee to develop dashboard content for the Michigan Pharmacists Association (MPA) website that could be used to measure the quality of Michigan residency programs and to promote Michigan residency training programs. The Residency Committee consists of residency program directors, preceptors and residents. The committee identified quality metrics, collected data from Michigan residency programs, and shared the data. The metrics described residency program graduates and current preceptors. Aggregate, statewide data from participating programs was displayed on a poster at the MSHP Annual Meeting and posted on the MPA website with a list of the participating residency programs. This was used to promote residency training in Michigan. Additionally, individual data along with statewide aggregate markers were sent to each participating residency program to facilitate quality improvement at individual programs. A several year plan was developed to allow for continued improvement and expansion of the Michigan residency program data.

In 2019, the Residency Committee was charged to update and revise dashboard content for the MPA website to measure the quality of Michigan residency programs, to promote Michigan Residency training and to facilitate quality improvement. The Committee decided to use the same metrics as the previous year to describe residency program graduates and current preceptors. However, the Committee also developed new metrics to describe the training opportunities at Michigan residency programs. The new metrics included PGY2 residency programs, code blue response, documentation in the electronic medical record, emergency department pharmacy services and various dosing services. Data was again collected from voluntarily participating PGY1 pharmacy residency programs across Michigan. Seventeen out of 24 (71 percent) of PGY1 programs responded. Participating programs included:

  • Ascension Borgess
  • Ascension St. John
  • Ascension Genesys Hospital
  • Beaumont Hospital Dearborn
  • Beaumont Hospital Royal Oak
  • Bronson Battle Creek Hospital
  • Bronson Methodist Hospital
  • Detroit Medical Center
  • Henry Ford Hospital
  • Henry Ford Macomb
  • McLaren Oakland
  • Mercy Health Saint Mary’s
  • Michigan Medicine
  • Munson Medical Center
  • Saginaw VAMC
  • Sparrow Hospital
  • Spectrum Health

The 2019 aggregate data was updated on the MPA website and can be found by clicking here and navigating under Michigan PGY1 pharmacy residency program site and outcome data.

Michigan residency program directors who participated this year have received emails with their programs’ individual data as well as statewide aggregate markers for 2018 and 2019 of participating programs. A breakdown of the data by hospital size (greater than 500 beds and less than 500 beds) was included as well. This data can be used to help facilitate internal quality improvement at residency programs. Residency program directors are encouraged to share information about the data with the program preceptors to identify areas of strengths and areas for improvement. The data can also be used to promote the benefit and quality residency training experience in Michigan to pharmacy students seeking residency program training.

The Committee hopes to continue to improve and expand Michigan residency program data. Potential future directions include the addition of PGY2 program data and increased distribution of data across the country. 

Posted in: Professional Practice
Role of the Specialty Pharmacy Industry

By Heba Sobh, Pharm.D., specialty pharmacist, AllianceRx Walgreens Prime, Canton

As we progress in the world of medicine and lean toward individualized health, the idea of specialty medications becomes more appealing. Specialty medications were first established in the 1970s as temperature-controlled medications to treat cancer, hemophilia, HIV and infertility.1 By the mid-1990s, there were less than 30 specialty drugs on the market. Today that number has increased more than 1,200% as there are over 500 specialty drugs spanning 40 therapeutic categories.2 This growth seems promising for many as new treatments are more focused on rare diseases and patients’ individual needs.

Generally speaking, medications are classified as specialty medications due to their high cost. Specialty medications are also those used to treat complex, chronic diseases and may require special handling and administration.3 The complexity associated with these medications may be attributed to the monitoring of side effects, the disease state being treated, limited access to the drug or financial barriers. Many of these medications also require special handling and storage conditions and, as a result, specialty medications are not commonly dispensed at a typical community pharmacy; rather, at a properly equipped specialty pharmacy.4

Specialty pharmacies require supplementary features to suitably store, handle and monitor these high-risk medications. To do so accurately and efficiently, specialty pharmacies may be divided into teams to provide the best care for patients. Each team handles a stage of that prescription and individuals from these teams may be grouped together to concentrate on disease states. Team tasks may be focused on intake and clarification of prescriptions, enrolling patients and scheduling mediation delivery, verifying insurance benefits, reviewing appropriateness of therapy, or even physically packaging the medication and supplies. These dedicated tasks allow for meticulous efforts to ensure a prescription is appropriately managed. Because of this comprehensive cycle, one can imagine that a specialty prescription is not processed as quickly as a non-specialty one at the local community pharmacy. This is important to explain to both patients and prescribers to ensure timeliness when ordering medications.

Specialty pharmacies have proactive standards in play to ensure medications are handled in a timely manner. In an ideal setting, all patients would receive their medications as scheduled without interruption in therapy; however, delays still occur due to unforeseen circumstances. These include unexpected weather conditions affecting delivery, necessary prescription clarification, prior authorization mismatch or even internal processing errors. In situations as such, teams work together diligently to warrant no further delay as many of these medications are time sensitive. Pharmacists are accountable for counseling these patients on missed doses, resuming therapy and monitoring. Additional clinical tasks for specialty pharmacists include drug dosing, drug interactions and patient education. Pharmacists work with prescribers to recommend alternative therapies after medications have been found ineffective or not listed on payer drug formularies. Pharmacists are also responsible for ensuring the specialty medications are compatible with patients’ concomitant non-specialty medications. As a result, specialty pharmacists must remain updated on non-specialty medications that may not be dispensed at their pharmacy.

Reports state that the growth in drug spending can be largely attributed to specialty medications.5 This can be expected as specialty medications, as previously mentioned, may be geared toward smaller populations or even individualized therapy. This focused therapy requires resources such as additional funding and knowledgeable specialists for research, production and monitoring. Pharmacists contribute to the safety and efficacy before, during and after medication approval. They provide hope to all patients, irrespective of their condition complexity or disease severity. 


1. Cortez, M. and Lauerman, J. (2015). Valeant's Favorite Pharmacy Made Life Easy for Doctors, at a Price. [online] Available at: [Accessed Oct. 19 2019].
2. Raper, A. (2019). The Rise of Specialty Medications: Hope for Patients, Hurdle for Health Care. [online] Available at: [Accessed Oct. 18 2019].
3. (2019). What is a specialty Drug? [online] Available at: [Accessed Oct. 14 2019].
4. (2016). NASP Definitions of Specialty Pharmacy and Specialty Medications. [online] [Accessed Oct. 15 2019].
5. Bell, J. (2018). Drug spending growth to come solely from specialty meds, report says. [online] BioPharma Dive. Available at: [Accessed Oct. 18 2019].

Posted in: Professional Practice
Update on Pharmacy Technician Training and Standards

By Jesse Hogue, Pharm.D., BCPS, pharmacy education coordinator, Bronson Methodist Hospital, Kalamazoo

For the last several years, the Michigan Society of Health-System Pharmacists (MSHP) Organizational Affairs Committee has worked on charges revolving around technician training programs and American Society of Health-System Pharmacists (ASHP)/Accreditation Council for Pharmacy Education (ACPE) accreditation of such programs. The scope of the charges has focused on monitoring the numbers of accredited and unaccredited programs, identifying barriers to pursuing accreditation and developing strategies to encourage accreditation. The MSHP position is well-aligned with the ASHP position, supporting accredited training and Pharmacy Technician Certification Board (PTCB) certification. It is critical that we have well-trained, professional and competent pharmacy technicians as we seek to move our profession forward.

In our routine assessments of technician training programs, I think it is safe to say that we have not seen a rapid expansion of programs, accredited or not. A number of expected factors seem to have contributed, such as cost of enrollment and availability of training sites. Additionally, we believe that requiring inclusion of specialized, practice-specific skills, such as sterile compounding and retail billing, as part of the accreditation standard for training programs was a significant barrier to student enrollment and, thus, expansion of accredited training programs. Not having a uniform standard across states for technician training, education and practice has not helped, either, since it makes it harder to establish standardized training. I am pleased to report that there have been a couple developments in these areas that may help overcome some of the barriers.

In 2017, PTCB sponsored a stakeholder consensus conference in collaboration with ACPE and ASHP under the guidance of an advisory committee representing all major branches of pharmacy. The goal of the conference was to resolve unsettled issues related to pharmacy technicians. One of the main outcomes of the conference was that the group identified key points of agreement regarding entry-level requirements for pharmacy technicians. They also identified state variability in the regulation of pharmacy technicians as a risk for patients and the profession of pharmacy. The conferees agreed that a broad coalition should be created to pursue the recommendations of the conference and as a result a Stakeholder Advisory Committee was established. This committee has been working with the National Association of Boards of Pharmacy (NABP) to update the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy. At the 2019 NABP national meeting, a resolution was passed authorizing a task force of stakeholders to evaluate and make recommendations to NABP regarding the education requirements, practice responsibilities and competence assessments for pharmacy technicians – so progress is being made!

Another thing that caught our eye this year was a welcomed update to the national standards that serve as a guide for the development of ASHP/ACPE-accredited pharmacy technician education and training programs. If you are unfamiliar with these accreditation standards—in a nutshell they set the criteria for the evaluation of new and established technician training programs and they help ensure that pharmacy technicians gain the knowledge, skills and abilities needed for their important role. The revised accreditation standard that was approved in 2018 took effect for new programs this year and will apply to all accredited programs in 2020. The updated standard took into consideration a very large job analysis of technicians in the U.S. as well as over 500 public comments and was developed by a group that included educators, representatives of community, hospital and chain pharmacy practices as well as members of the Pharmacy Technician Accreditation Commission (PTAC, the collaborative of ASHP and ACPE).

The revised accreditation standard improved the emphasis on and clarity of the expected educational outcomes and the methods used to assess competency. More importantly for our charges, though, the new standards are divided into entry level and advanced, following the recommendations of the Pharmacy Technician Stakeholder Consensus Conference. This allows practice settings to have different education and training requirements based on the needs of the position, while assuring a core competency across practice settings. It also creates a framework for boards of pharmacy to develop entry level competency requirements as minimum standards with the ability to add advanced level credentials based on employer/practice setting requirements. The bottom line, in my opinion, is that the new standard will be more acceptable nationally across practice settings which will provide incentive for new programs to be started. As an added bonus, PTAC has developed a Model Curriculum for Pharmacy Technician Education and Training Programs. This tool is a great asset both for new programs, as well as existing programs, seeking to update their curriculum to meet the new standard. The Model Curriculum can actually be used as a template, since it includes the required Key Elements for each of the standards and corresponding competencies along with examples of learning activities for each portion of the program.

Having a well-trained, competent technician workforce is essential for progressive pharmacy practice. It is important to have a standard for the education requirements, practice responsibilities and competence assessments for pharmacy technicians. The newly revised ASHP/ACPE Accreditation Standards for Pharmacy Technician Education and Training Programs provides an excellent framework for the education and competency assessment for both entry level and advanced technician roles. The tools and momentum are there to overcome the previous barriers that existed; it will be exciting to see what progress is made in the near future!

Posted in: Professional Practice
Northern Society of Health-System Pharmacists Supports First Penicillin Allergy Assessment and Skin Testing Certificate Program in Michigan

By Nicholas P. Torney, Pharm.D., BCPS, BCIDP, infectious disease clinical pharmacist, 
Munson Medical Center, Traverse City

In the United States, roughly 30 million people are estimated to report a penicillin allergy in their medical record.1,2 However, less than 10 percent of those who report a penicillin allergy will have a positive penicillin allergy skin test.Despite the accuracy or severity of the recorded penicillin allergy, its presence in the allergy field has been associated with an increased odds for methicillin resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infections4 and an increased odds of surgical site infection.5 

These poor outcomes are driven by the receipt of alternative antibiotics such as fluoroquinolones, clindamycin, vancomycin and macrolides. Since “allergy stewardship” and antibiotic stewardship go hand in hand, the concept of de-labeling false penicillin allergies falls in the lap of antimicrobial stewardship programs, of which pharmacists play a key role.

Pharmacists can get involved in multiple ways to improve the outcomes of patients with reported penicillin allergies, some of which include:

1. Developing a standard approach to allergy reconciliation.
2. Providing in-services and education to physicians, advanced practice providers, nurses and pharmacists, regarding appropriate management of patients with penicillin allergies.
3. Implementing a penicillin allergy assessment and skin testing service.

It may appear to the reader that number three above is a large leap from number one and two; however, there are now multiple resources available to help guide pharmacists who are interested in implementing a penicillin allergy assessment and skin testing service in the inpatient or even outpatient setting, with the most robust resource being a complete certification program.

Similar to vaccine administration certification programs, there is now a nationally recognized Penicillin Allergy Assessment and Skin Testing (PAAST) Certificate Program that was developed by experts across the country in collaboration with the University of South Carolina College of Pharmacy. The program provides 15 hours of continuing education (CE) intended for all licensed practitioners (pharmacists, nurses, physicians, advanced practice practitioners), with 11 hours of recorded lectures and a four-hour live session dedicated to demonstrating how to conduct and interpret a penicillin allergy skin test.

To date, there have been eight training sessions conducted across the country. In late September 2019, the Northern Michigan Society of Health-System Pharmacists (NMSHP) supported the first PAAST certificate program in Michigan, hosted in Traverse City. The program was a success with 22 attendees receiving a certificate of completion, which included 11 pharmacists, six pharmacy residents and five student pharmacists.

More information regarding the PAAST certificate program can be found here.

If you would like to set up a live training in your area, send an email to: and a faculty member of the PAAST certificate program will help you through the process!

What are some other resources available to pharmacists looking to implement a PAAST service?

1. Early in 2019, a “How-to” guide was published in the American Journal of Health-system Pharmacists (AJHP) that describes the process for implementing a penicillin allergy skin testing service at your facility.6 This manuscript walks the reader through the current models for penicillin allergy skin testing, describes how to overcome common barriers, and provides a framework for pharmacists interested in adding this service at their facility. Click here to access the article.

2.Like podcasts? The Society of Infectious Diseases Pharmacists has you covered with a new member-created podcast called Breakpoints. For the first podcast, leaders in the field of ID pharmacy discuss all things penicillin allergy in a three-episode miniseries called The Itch: An SIDP Podcast Miniseries on Penicillin Allergy. No matter where you are at in this process, this podcast will help you get to the next step.


1. Macy E. Penicillin and beta-lactam allergy: epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014; 14:476.
2. Shah NS, Ridgway JP, Pettit N et al. Documenting penicillin allergy: the impact of inconsistency. PloS One. 2016; 11:e0150514
3. Solensky R, Khan DA, Bernstein IL et al. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010; 105:259–73.
4. Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK. Risk of methicillin resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361.
5. Blumenthal KG, Ryan EE, Li Y, Lee H, Kuhlen JL, Shenoy ES. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk. Clin Infect Dis. 2018 Jan. 18;66(3):329-336.
6. Bland CM, Bookstaver PB, Griffith NC, Heil EL, Jones BM, Ann Justo J, Staicu ML, Torney NP, Wall GC. A practical guide for pharmacists to successfully implement penicillin allergy skin testing. Am J Health Syst Pharm. 2019 Jan. 25;76(3):136-147.

Posted in: Professional Practice
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