Pharmacy News

Entries for April 2019

New Report Highlights Role of Pharmacy Benefit Managers in Manipulating Drug Costs for Michigan Patients, Pharmacists and Taxpayers

Michigan Pharmacists Association, along 3 Axis Advisors, released a report to shine a light on the role of Pharmacy Benefit Managers (PBMs) in Michigan, specifically the extent to which these companies have unfairly profited off of pharmacists, patients and taxpayers.

 

The study collected data from 451 community pharmacies across Michigan, representing nearly 20% of the 2,356 retail/community pharmacies in the state to analyze PBM spread pricing – the difference between what a PBM pays a pharmacy for a medication and what it charges Michigan Medicaid. The spread pricing analysis is based on nearly two million prescriptions dispensed for generic drugs by pharmacies to Michigan Medicaid managed care beneficiaries over a two-year period.

As Michigan Pharmacists Association CEO Larry Wagenknecht says, “This report demonstrates the dire need for reforms in our health care system.”

 

“Based on this data, we can infer that our state has spent at least $64 million more than necessary on prescriptions. This money was funneled back to PBMs, rather than helping poor, underserved, or disabled patients receiving Medicaid managed care. We need to address the spread pricing problem and ensure that these large, Fortune 500 companies can no longer take advantage of pharmacists and patients who depend on a fair system.”

To read the full press release, click here.

To read report, click here.



Posted in: Member News
Coming Soon! Members in the Spotlight
Kali VanLangen, Pharm.D., BCPS, co-chair, MSHP/MPA Membership Committee
 
We've all heard the saying "happy wife, happy life".  The same sentiment holds true for members! When our members are happy the organization continues to thrive.  In an effort to improve member satisfaction, this year's MSHP/MPA Membership Committee was tasked with implementing technology-driven recruitment and retention strategies along with developing methods to highlight member accomplishments.  As a result, the Committee is working on developing a member spotlight initiative.
 
The goal of the member spotlight initiative is to share the story of a different member each month and highlight their professional journey. We want to highlight individuals that make a lasting impact on the people they work with day to day. All types of members will be featured including pharmacists from different practice settings, as well as residents, pharmacy technicians and students. Member spotlights will be shared on MPA's social media accounts and may also be featured in the MSHP Monitor or MPA E-news publications.
 
While the Membership Committee will be collaborating with MPA staff to identify the first few member spotlights, all members will have the opportunity to recognize a colleague for their hard work and dedication to the profession. A member spotlight submission form is being developed and a call for nominations will be posted on social media to ensure everyone has an opportunity to be recognized!
 
Our first member we would like to put in the spotlight is Katie Axford, Pharm.D., BCPS. Dr. Axford was the recipient of this year's Distinguished New Pharmacist Practitioner Award. Read on to learn more about her professional journey.
 
Where did you complete your training?
I earned my Pharm.D. from Ferris State University College of Pharmacy in 2010. I then moved to Indianapolis where I completed a two-year pharmacotherapy residency at Indiana University Health.
 
How did you first get involved in MSHP? 
Shortly after returning to Michigan in 2012, I started regularly attending monthly meetings of our regional society (WMSHP) and ended up joining the WMSHP Executive Board in 2013. While I have always identified MSHP as my section through MPA, I wouldn't say I was actively involved until 2017 when I was president of WMSHP and served as the regional delegate to the MSHP Board.  As part of that experience, I began participating in MSHP committees and decided to run for a board position the following year.

What do you value most about being involved in MSHP?
The most valuable things I've gained from my involvement with MSHP are probably the relationships that I've been able to form with colleagues across the state - many of whom I now consider friends and mentors.  I'm also incredibly thankful for the opportunity to develop my leadership skills and contribute to advancing our profession at the state level.
 
Share something non-pharmacy related about yourself.
I am currently pursuing my Masters in Public Health through Ferris and am really enjoying digging deeper and broadening my understanding of this area!
 
 
Thank you to Dr. Axford for being our first Member in the Spotlight! 
Posted in: Member News
Drug Spotlight on New Antibiotics Plazomicin and Omadacycline
Felda Matti, Pharm.D. 2019 candidate, Wayne State University
 
Antibiotic resistance is considered one of the major global healthcare problems today. Inappropriate use of antimicrobial therapy has led to an increase in multi-drug resistant organisms and a concern for limited treatment options, thus, the development of novel antibiotics with enhanced spectra of activity is critical. This article will highlight two recently approved antibiotics: plazomicin and omadacycline.
 
Plazomicin (Zemdri™)
 
Plazomicin is a new generation aminoglycoside FDA approved on June 26, 2018, for the treatment of complicated urinary tract infections (cUTI). Like other aminoglycosides, it is a bactericidal antibiotic that works by inhibiting bacterial protein synthesis in a concentration-dependent manner. Plazomicin is active against gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterobacter cloacae. It has some activity against Citrobacter freundii, Citrobacter koseri, Enterobacter aerogenes, Klebsiella oxytoca, Morganella morganii, Proteus vulgaris, Providencia stuartii and Serratia marcescens, though this is based on in-vitro findings, not clinical trials. Plazomicin has no activity against Enterococcus sp, Streptococcus sp, Acinetobacter sp, and anaerobes.1 Plazomicin is unique in that it has activity against CRE and ESBL+ Enterobacteriaceae. The approved dose for cUTI is 15 mg/kg (total body weight) intravenously once daily, with adjustments for obesity and impaired renal function.2,3 Per the manufacturer, the weight based dosing is considered appropriate for cUTI with target trough level less than 3 mcg/ml (notably, a trough of greater than 2 mcg/ml was still associated with an increased risk of nephrotoxicity). It is important to note that the FDA did not approve plazomicin for the indications of bloodstream infections and HAP/VAP due to small studies and lack of sufficient data. If plazomicin is approved for these indications in the future, it would be ideal to dose and monitor the medication based on peak/trough calculations, similar to the dosing of other aminoglycosides. As expected, plazomicin has boxed warnings for nephrotoxicity, ototoxicity, neuromuscular blockade and fetal harm in pregnant women.4 Due to limited safety and efficacy data, as well as for antimicrobial stewardship, use of plazomicin should be reserved for patients with limited or no alternative treatment options.
 
Omadacycline (Nuzyra™)
 
Omadacycline is an aminomethylcycline tetracycline FDA approved on Oct. 2, 2018, for the treatment of community acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI). It is a bacteriostatic antibiotic which blocks bacterial protein synthesis. Omadacycline has broad-spectrum activity against Gram-positive bacteria (including MRSA and VRE), Gram-negative bacteria, anaerobes and atypical organisms.5 Omadacycline is unique in that it retains activity against bacteria that exhibit mechanisms of resistance such as efflux pumps and ribosomal protection proteins. The dosing of omadacycline is dependent upon the indication and route of administration. Higher doses of the oral formulation are warranted due to a bioavailability of only 34.5 percent.6 No dosing adjustments are recommended in the setting of liver or renal impairment. In addition, the pharmacokinetic profile of omadacycline allows once daily dosing, differentiating it from other tetracyclines and increasing ease of administration. The most common side effects associated with omadacycline are nausea, vomiting and diarrhea. It is important to note that patients should not be counseled to take omadacycline with food to offset the GI side effects because the efficacy of omadacycline decreases with food intake.7
 
As with all antibiotics, judicious antimicrobial stewardship principles should be employed to ensure appropriate use of antibiotics and limit the development of future mechanisms of resistance.
 
References:
  1. Zemdri (plazomicin) [prescribing information]. South San Francisco, CA: Achaogen, Inc; June 2018.
  2. Shaeer KM, Zmarlicka MT, Chahine EB, et al. Plazomicin: A Next-Generation Aminoglycoside. Pharmacotherapy 2019; 39:77-93
  3. Zhanel GG, Lawson CD, Zelenitsky S, et al. Comparison of the next-generation aminoglycoside plazomicin to gentamicin, tobramycin and amikacin. Expert Rev Anti Infect Ther 2012;10:459-73
  4. Plazomicin. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed Feb. 23, 2019.
  5. Barber KE, Bell AM, Wingler MJB, et al. Omadacycline Enters the Ring: A New Antimicrobial Contender. Pharmacotherapy 2018; 38:1194-1204.
  6. Omadacycline. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed Feb. 23, 2019.
  7. Nuzyra (omadacycline) [prescribing information]. Boston, MA: Paratek Pharmaceuticals, Inc; Oct. 2018.
Posted in: Member News
The Current Use of Pharmacy Extenders in Pharmacy Practice
Krista Lobkovich, Pharm.D., 2019 candidate, Ferris State University College of Pharmacy
Tiffany Jenkins, Pharm.D., BCACP, population health pharmacy manager, Affinia Health Network
 
Pharmacy practice has changed drastically over the last few decades. Transitioning from a process-based to a more clinically-based profession, pharmacy today requires many new responsibilities including medication therapy management (MTM), integration of pharmacy student and resident education, collaborative practice agreements, statewide protocols, immunizations and new legislation regarding controlled substances. With these changes and updates, one begins to wonder how a pharmacist can get everything done during an average eight-twelve hour work day. Luckily, behind every pharmacist is a team of pharmacy extenders who have been trained and integrated, to some extent, into these new responsibilities.
 
Pharmacy extenders most commonly include technicians, students and residents. A 2014 study reported that the integration of pharmacy students into a community teaching hospital improved HCAHPS scores and increased the number of pharmacy interventions per patient per day from 0.9 to 1.41. Additionally, this study reported that with the integration of pharmacy students into the workflow, the patient to pharmacy staff member ratio decreased from 30:1 to 7:11. This implies that the inclusion of pharmacy extenders allows for a decreased workload and more thorough patient interviews. An additional study from 2017 reported that the integration of pharmacy students into a level II trauma center resulted in a monthly cost avoidance of $3,739 and increased medical interventions that optimized medication regimens.2 While these two studies focused on pharmacy students as extenders, it can be extrapolated that the impact of technicians and residents would be similar since the responsibilities are comparable.
 
Pharmacy preceptors from across the state, including those from Henry Ford Hospital, Ferris State University, Harper University Hospital, Bronson Methodist Hospital, Genesys Health and Wayne State University all utilize  pharmacy students and residents in very similar ways. They are responsible for direct patient care activities including: medication reconciliation, patient history and objective data collection, education and counseling, collecting in-clinic vitals and necessary point-of-care tests, addressing drug information questions, navigating insurance complications and providing education for medical residents and pharmacy staff. Students and residents in many cases are also responsible for documenting their interactions in the patient's chart with a cosign from their preceptor. Most of the time pharmacy students and residents act independently, while still under supervision of their preceptor. This independence allows the pharmacist to engage with more patients each day and make more meaningful interventions each day.

The other common pharmacy extender is the pharmacy technician. Their responsibilities vary from those of students and residents, but are nonetheless helpful in expanding the pharmacist's clinical reach. Northern Physicians Organization, Spectrum Health, Community Care Services and Medical Advantage Group reported using their technicians outside of traditional dispensing activities such as for scheduling and documenting MTM encounters, calling patients to follow up on antibiotics, checking MCIR for immunizations, evaluating medication adherence and keeping patients on target refill dates. Some clinical sites also reported using technicians for administrative duties including: scheduling and rescheduling patient appointments, inputting billing codes, making sure practice agreements and statewide protocols are up to date and on file, management of licensure requirements, navigating insurance problems, writing schedules for the pharmacist and technicians and assisting with drug recalls and shortages.

Together students, residents and technicians work tirelessly to increase the clinical impact of the pharmacist. These pharmacy extenders directly assist the pharmacist and indirectly assist other providers working towards the Quadruple Aim focus. By extending the clinical reach of the pharmacist, the extenders work to improve healthcare outcomes, lower costs and ensure satisfaction for both patients and providers, which in this case is the pharmacist.

References:

1. Delgado O, Kernan WP, Knoer SJ. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health Syst Pharm. 2014 Nov 1;71(21):1871-6.
 2. Smith L, Samai K, Peshek S, Kimbrell B. Impact of pharmacy students on a level II trauma center: Int J Trauma Nurs. 2017;24(4):231-5.
Posted in: Member News