MO Pharmacist August 2022

August 2022 Volume 96, Issue II

IMMUNIZING KIDS: WHAT TO KNOW

PARTY IN MARGARITAVILLE pg. 16

pg. 28

Oddities In LawMaking pg. 16 pg.10

Little fish in a big pond? Not anymore!

Join AAP, where we're stronger together.

Learn More at RxAAP.com/BigFish (877) 797-9227

Missouri Pharmacist Magazine, Volume 96, Issue II THE TABLE OF CONTENTS

Download the App

RON FITZWATER, MBA, CAE, Chief Executive Officer ROBYN SILVEY, CMP, MBA, Chief Operating Officer ANNIE EISENBEIS, PharmD, MBA, Director of Practice Development HENRIO THELEMAQUE, Director of Government Affairs LAUREN EICHELBERGER, Membership & Programs Coordinator DREW OESTREICH, Pharmacy Provider Relations TRAVIS FITZWATER, Director of Strategic Initiatives JOSH BERRY, PharmD, Executive Fellow CYNTHIA HICKS, PharmD, Executive Fellow Board of Directors President – CURT WOOD, RPh, CGP, FASCP Elder Care Pharmacy Consultants, LLC, New London President Elect – JERRY CALLAHAN, RPh Elsberry Pharmacy, Elsberry Treasurer – KOBY PRATER, PharmD Prater’s Pharmacy, Seneca Secretary – KENDALL GUTHRIE, PharmD, BCACP UMKC School of Pharmacy, Kansas City Immediate Past President – DANIEL GOOD, MS, RPh, FASHP

FROM THE PRESIDENT pg. 2 CEO UPDATE pg. 4 REDLETTERDATES pg. 6 END OF SESSION REPORT pg. 10 CHWGRANTMONEY pg. 15 2022MPACONFERENCE pg. 16 ACADEMIA NEWS pg. 26 NOW& THEN pg. 31

Mercy Health, Springfield Members At Large SHELLY BADER, PharmD Key Drugs, Poplar Bluff BRYAN KIEFER, PharmD Jones Drug Store, Jackson

PAWEL SIERBINSKI, PharmD Beverly Hills Pharmacy, St. Louis ROXANE TOOK, PharmD, BCACP SSM Saint Louis University Hospital, St. Louis Ex-Officio Members RUSSELL MELCHERT, PhD, RPh UMKC School of Pharmacy, Kansas City GIOVANNI PAULETTI, MPharm, PhD St. Louis College of Pharmacy at University of Health Sciences & Pharmacy, St. Louis

MISSOURI PHARMACY ASSOCIATION | 211 EAST CAPITOL AVENUE | JEFFERSON CITY, MO 65101 PH: (573) 636-7522 FAX: (573) 636-7485 MoRx.com MISSOURI PHARMACYASSOCIATIONMISSION: The Missouri Pharmacy Association promotes and protects the role of pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team. Missouri Pharmacist is mailed toMPAmembers, non-member pharmacists, pharmacy educators, pharmacy technicians, and pharmacy students in the state of Missouri. All views and opinions expressed in articles are those of the writer and are not necessarily the official position of the Missouri Pharmacy Association. Layout and design by wetsuCREATIVE Marketing. To advertise email Kim Neidert at kim@MoRx.com or call (573) 230-1953. For editorial inquiries, contact Travis Fitzwater at travis@MoRx.com or call (573) 636-7522.

Missouri Pharmacist, Volume 96, Issue II is owned and published biannually by the Missouri Pharmacy Association, 211 East Capitol Avenue, Jefferson City, MO 65101. Postage paid at Fulton, MO and additional mailing offices. Postmaster: send address changes to Missouri Pharmacist, 211 E. Capitol Avenue, Jefferson City, MO 65101-3001

FROM THE PRESIDENT

by CURTWOOD, RPh, BCGP, FASHP Time Flies

W ow, time sure flies by! Especially as we get older! As we are quickly approaching autumn, it feels like it may be appropriate to reflect on my time as MPA President. My previous article focused on the often-overwhelming stress and burnout of pharmacists across the country and in Missouri. I am proud that the MPA has been able to establish a fantastic series of webinars in It is time to unite as a profession, across all practice sites, to fight against unfair business practices by the PBMs. This is essential not only for our personal finances but also for the success of the profession of pharmacy! " ~ Curt Wood helping pharmacists cope with these issues. The series, which was set up by theMPAWorking Conditions Task Force, has been led by Brent Reed, a pharmacist who is also a Ph.D. candidate inOrganizational Psychology. That Task Force was responsible for establishing and setting up these webinars. If you have not yet signed up for one of the webinars, I highly encourage you to do so! While the 2022 Legislative Session was a bit disappointing, I would like to commend theMPA staff, the Legislative Committee, and all of our members that participated in Legislative Day, ESPECIALLY to those that made contact with their local legislators, both Senators and Representa tives. Remember, NOONE FIGHTS HARDER FOR THE PHARMA CISTS AND THE PROFESSION OF PHARMACY IN MISSOURI THAN THE MISSOURI PHARMACY ASSOCIATION AND ITS MEMBERS! This year we had GREAT participation from our members and students from both UHSP and UMKC at Legislative Day. It felt like our members and students were more engaged and determined to get our message to the legislators than ever before! Although we may not have gotten our PBM bill across the finish line, I am confident that both Sen ators and Representatives heard our message and concerns louder and clearer than ever before. On a positive note, however, the MPA was able to make progress in advancing pharmacists participation in PrEP and further vaccine administration. Again, thank you for your efforts and

participation.

In my opinion, pharma cists have often been our own worst enemy. We have sold products at a loss, we have giv en away valuable services for free. And, nowwe are fighting to overcome these past hab its in order to stay afloat. It is time to unite as a profes sion, across all practice sites, to fight against unfair business practic es by the PBMs. This is essential not only for our personal finances but also for the success of the pro fession of pharmacy!

Curt Wood, RPh, BCGP, FASCP, Elder Care Pharmacy Consultants, LLC, New London, Missouri, is President of the Missouri Pharmacy Association.

Advocacy may be guided by the MPA, but the real message and weight of that message is carried by YOU, our members. We must continue to build relationships with our local legislators. This takes time, effort, and money. Please do not forget to give to the MPA Political Action Committee. Even a small donation of $10 a month helps!This can even be set up as an automatic charge on your credit card by the MPA staff. Set it and forget it! I would also like to reflect on the great work that our Continuing Education Committee has done in arranging the programming at this year’s Annual Conference. I am quite confident that the quality and content of the Continuing Education available at this Conference will be of first-rate quality! I sure hope that we see you there! I am also proud of the fact that this year, we were able to give students a free room and registration to the Conference! I really look forward to seeing the next group of pharmacy leaders there. Finally, I would like to thank the Membership Committee for their work on membership retainment. They have been diligently working to contact lapsed members for dues renewal. While it is always important to gain new members and grow our membership numbers, it is likewise just as important to keep the members that we have! This year theMPA also revamped its website and implemented a new phone app! It really is impressive. If you have not downloaded it yet, you should. To get the app download at bit.ly/mpa-app-google. I am proud of what the MPA has accomplished this past year. My time as President may be quickly coming to an end, but great things will continue to happen at the Missouri Pharmacy Association! I know that the incoming President Jerry Callahan and the other officers on the Board of Directors will continue to provide outstanding leadership for our state and our profession!

2 Missouri PHARMACIST | Volume 96, Issue II | August 2022

P L A Y . D I N E . The Lodge at Old Kinde S T A Y . G A T H E R .

P L A Y . S T A Y . The Lodge G H E R . D I N E .

at Old Kinderhook

L I V E .

MEETINGSAREPRIORITY#1 Aproductiveandfunmeetingenvironment iswhatwestrive toprovideyourattendees, frombeautifulmeetingspaces tooutdoor functionspace,OldKinderhookprovidesaretreat-like atmosphere intherollinghillsofLakeof theOzarks. www.OldKinderhook.com PRIORITY #2? Enjoy our immaculate amenities. • Five minutes from the Square in Camdenton • Tom Weiskopf Signature Championship Golf • Destination Weddings...We Do! • Seasonal Outdoor Ice Rink • Master Planned Community Living • Award Winning Dining • Indoor/Outdoor Salt Water Pools • Seasonal Sand Volleyball Courts • Enhanced Spa • Lake Access - 12MM on Big Niangua • Boat Ramp on Property • Trailer Parking and Electric Hookups for Boat Charging • Conference Facilities for 250+

• NewlyRemodeledTheHookCafé • 84GuestRooms / 20VacationRentals • 11,000+SquareFeet of FlexibleMeetingSpace and8, 000SquareFeet ofOutdoor Space • TomWeiskopf SignatureGolf Course • TrophyRoomLounge andDiningHolds Exquisite Dinner SettingwithPatioViews of theGolf Course • Spa 54 atOldKinderhook • Five minutes from the Square in Camdenton • Tom Weiskopf Signature Championship Golf • Destination Weddings...We Do! • Seasonal Outdoor Ice Rink • Master Planned Community Living 678 Old Kinderhook Dr., Cam Email: info@ 573.317.4314

• Award Winning Dining • Indoor/Outdoor Salt Water Pools • Seasonal Sand Volleyball Courts • Enhanced Spa • Lake Access - 12MM on Big Niangua • Boat Ramp on Prop rty • Trailer Parking and Electric Hookups for Boat Charging • Confer nce Facilities for 250+

Missouri PharmacyAssociationhas frequentedOld Kinderhook facilities formany years only to experience the utmost qualityof services.Theywere very attentive toour needs. - RobynSilvey, CMP,MBA, ChiefOperatingOfficer Missouri PharmacyAssociation

www.OldKinderhook.com

678 Old Kinderhook Dr., Camdenton, MO 65020

PLAY. STAY. GATHER. DINE. LIVE. 678 O l d K i nd e r ho ok Dr i ve C amd en t on , MO 65 0 2 0 573 . 317. 4 4 47

2

2

Email: info@oldkinderhook.com 573.317.4314 m

www.OldKinderhook.co

CEO UPDATE

One Last Summer Conference (and Party) by RON FITZWATER, CAE, MBA

A s I sit here to write this article, we are going through a series of days with 100+ degree weather. It is hard to believe that we are planning for the end of summer already. But the heat and humidity have us all thinking about the beach, lake and cooler locales. And what would be better to do when we are there but to throw a party? Or at least host a confer ence where a party might pop up at any time.

are conducted. It was a frustrating two years as we had tomake significant adjustments to our Annual Conference because of the Covid pandemic. As we break out of the restrictions caused by the pandemic and after careful thought and discussion, our staff and Board of Directors decided to go back to the basics and return to the Lake of the Ozarks area for the 2022 Annual Conference. MPAmembers have had a lot of fun at meetings there over

"Reading departure signs in some big airport Reminds me of the places I’ve been Visions of good times that brought so much pleasure Makes me want to go back again" ~ Jimmy Buffet

Ron Fitzwater, CAE, MBA, is the CEO of the Missouri Pharmacy Association.

is, “Changes in Latitudes, Changes in Atti tudes” which is also the theme for the MPA 2022 Annual Conference & Expo. A few lines from the song express thoughts about the 2022 meeting: “Reading departure signs in some big

Health Mart is proud to support Missouri State

When I first came to the Misso ri Phar macy Association, we had hosted a number of Annual Conferences at Tan-Tar-A Resort in Osage Beach, MO. Over the past 15 or so years, we have moved the Annual Conference around the state of Missouri to try to take advantage of the facilities and activities that are available in other areas of our state as well as to try to make the meeting convenient to members across the state. In addition, we have taken the opportunity to host joint meetings with pharmacy associations from Kansas, Oklahoma andmost recently Illinois. These joint meetings have been well received and a lot of fun as we have interacted with pharmacists and their families from across the Midwest. Like many things in our daily life, the pandemic changed meetings and how they

We’re committed to providing conference, our first choice was to go back to a familiar site. That’s what we’re doing. But when you arrive, you will fin that the resort has changed names. It is no longer Tan Tar-A – it's now Margaritaville Lake Resort. That name creates thoughts about the beach, fun times and Jimmy Buffett music. I have been a Jimmy Buffett fan s nce he first hit the charts several decades ago. Certainly, one of his biggest hits is the song Margaritaville. “Strumming his six-string on his front porch swing ...” But my favorite Jimmy Buffet song the years. Some of our current members had a chance to attend our meetings at the Lake during their childhood. It was the summer vacation for some. We want to recreate that atmosphere of education and a little beach/ lake relaxation. In looking for a location for the 2022

PharmacyAssociation airport, Reminds me of the places I’ve been, Visions of good times that brought so much pleasure, Makes me want to go back again ” I invite you and your family to join us Health Mart® celebrates your independence. in Osage Beach for the 2022 MPA Annual Conference. I have talked about the social aspects of the meeting because after the past couple of years, I think everyone could use some fun and relaxation. However, theMPA Continuing Education Committee has put together a great conference program as well. We will be offering sessions on some of the following topics: Transitions of Care; Mental Health; Addiction and Recovery; Geriatrics; ImmunizationUpdate; LawUpdate; Leading Your Pharmacy; Pharmacy Value to Health Plans; Gender-Affirming Care; Smoking Ces- 855.458.4678 | join.healthmart.com the solutions and support that enable you to grow your business, your way. Learn how you can benefit from our best-in-class pharmacy services, together with the strength of McKesson’s distribution network.

Health Mart is proud to be a member of the McKesson family, sharing in the collective industry knowledge and

4 Missouri PHARMACIST | Volume 96, Issue II | August 2022

more at mckesson.com.

experience residing within all of the McKesson corporate affiliates. Learn ©2021 Health Mart Systems, Inc. All rights reserved. HM-656400-0721

sation and Best practices for Cyber Access and DCPro. It is a great lineup of educational opportunities. I think the chorus for “Changes in Lat itudes, Changes in Attitudes” sums it up the best: “It’s these changes in latitudes, changes in attitudes, Nothing remains quite the same, With all of our running and all of our cun ning, If we couldn’t laugh, we would all go insane ” I hope to see you at Margaritaville in Osage Beach September 15-18 for some out standing educational opportunities as well as some laughs and relaxation. Best wishes. Send me an email at ron@MoRx.com to tell us how we're doing leading your profession in Jefferson City. We want to hear from you as we fight to keep pharmacy at the forefront of legislators, and administration officials' minds. MPA promotes and protects the role of the Missouri pharmacists as the medication expert in patient care relationships, and as an integral part of the health care team.

Ways to Interact & Improve Your

Pharmacy Profession Join Today It's never been more important for you to be a member of the MPA, as we advocate. Receive the weekly update MPA Insider email newsletter, Continuing Education offerings, the earliest news on the vaccine distribution plans from the state, and much, much more. For as little as $150/year, join and impact your profession. bit.ly/mpa-membership

Get the App! Download our new MPA app and be in the know on all things within your Missouri pharmacy profession. Download at: bit.ly/mpa-app-google apple.co/394bgW7 MPA Podcast You can find some of our best content on the Missouri Pharmacy Podcast. bit.ly/mpa-podcast

Health Mart is proud to support Missouri State PharmacyAssociation Health Mart® celebrates your independence. We’re committed to providing the solutions and support that enable you to grow your business, your way. Learn how you can benefit from our best-in-class pharmacy services, together with the strength of McKesson’s distribution network.

855.458.4678 | join.healthmart.com

Health Mart is proud to be a member of the McKesson family, sharing in the collective industry knowledge and experience residing within all of the McKesson corporate affiliates. Learn more at mckesson.com. ©2021 Health Mart Systems, Inc. All rights reserved. HM-656400-0721

RED LETTER DATES

August 22, 2022 University of Health Sciences & Pharmacy Classes Begin St. Louis, Missouri The UHSP School of Pharmacy begins their classes for the 2022-23 school year. www.uhsp.edu/events/_files/academic calendar-2022-23.pdf August 22, 2022 UMKC School of Pharmacy Classes Begin Kansas City, Missouri The UMKC School of Pharmacy begins their classes for the 2022-23 school year. www.calendar.umkc.edu/all/categories/ Academic%20Calendar September 14, 2022 Missouri State Legislature Veto Session Jefferson City, MO In mid-September every year, the Missouri legislature meets to consider the vetoes made by the Governor. Find out what the legislature did with Governor Parson’s vetoes by visiting our mobile app for updates or check out the link for info on the Governor’s actions on legislation. www.governor.mo.gov/actions/legislative-actions September 15-18, 2022 MPA Annual Convention Osage Beach, Missouri The Missouri Pharmacy Association’s Annual Conference and Trade Show takes place at Margaritaville Lake Resort. Join hundreds of your Missouri based pharmacy connections for a weekend of education and networking. www.morx.com/Web/Events/Event_Display.aspx? EventKey=AC2022&WebsiteKey=d4c31fa4-467a 4959-b48b-cae3ea93e516

October 1-4, 2022 NCPA Annual Conference Kansas City, Missouri The National Community Pharmacists Association will be coming to Kansas City for their Annual Convention. Join pharmacy friends from around the country for NCPA’s premier yearly conference. ncpa.org/annual-convention October 16-18, 2022 APhA Joint Federal Pharmacy Seminar (JFPS) Cleveland, Ohio Join pharmacy colleagues from across the country for American Pharmacists Association joint seminar on readiness in national emergencies. https://www.eventscribe.net/2022/JFPS2022/ aaStatic.asp?SFP=QkpLWVhMVlpAMTIyMzM Any Date For additional information and current calendar listings visit MoRx.com.

Enjoy the FINEST luxuries at the NEWEST hotel in the Capital City. 610 Bol ivar St , Jef ferson City, MO 65101 www.marriott.com/coucj 573/761-1400

Enjoy Your Stay at Parker’s Place E stablished in 1905 — just steps away from the old Missouri State Penitentiary and 3 blocks from the State Capitol — Parker’s Place provides the great gathering place to socialize and rest, whether it’s business or pleasure. Our rooms are fully furnished — complete with full kitchen. Come experience the history of Jefferson City, Mo. www.ParkersPlaceJC.com 624 E. Capitol Avenue † Jefferson City, Mo. (573 ) 301-5987

Want a digital version of the Missouri Pharmacist emailed or sent to you via text? Click bit.ly/mpa-digital to receive your digital, & interactive version for FREE!

CONQUER E D H E IGH T S H E RE AND ON T HE ROPES COURSE

CONQUER E D H E IGH T S H E RE AND ON T HE ROPES COURSE

CONQUER E D H E IGH T S H E RE AND ON T HE ROPES COURSE

NEXT UP - ONE MI LK SHAKE, T WO S T RAWS

NEXT UP - ONE MI LK SHAKE, T WO S T RAWS

B EF OR E T HIS, BRAV E D SHAR CANYON

B EF OR E T HIS, BRAV E D SHARK CANYON

B EF OR E T HIS, BRAV E D SHARK

B EF OR E T HIS, BRAV E D SHARK CANYON

B EF OR E T HIS, BRAV E D SHARK

CANYON

CANYON

See Where It Takes You stlouisunionstation.com Discover The St. Louis Wheel, The St. Louis Aquarium, Ropes Course and Carousel, The Soda Fountain and more!

THE FELLOWS CORNER

by JOSH BERRY, PharmD, Executive Fellow P h a r m a c i s t P r e s c r i b i n g P a x l o v i d : now what? On July 6, the FDA put another foot forward for pharmacy advancement and the important role we play in the Covid 19 pandemic by authorizing pharmacists to prescribe Paxlovid through the Emergency Use Authorization (EUA). This advances our patient care, reducing the time between diagnosis and treatment, especially when pharmacies are often open longer hours than physician offices. While it is usually simple to access a patient’s medication list, lab work is much more difficult. Implementing

Paxlovid prescribing will be easiest for the patients that can look at their patient portal to find their own lab work. Those who don’t have access we can request that information from the patient’s doctor. While this may slow things down, it can often be faster than the patient waiting for an appointment.

Paxlovid is nirmatrelvir 150 mg tablets co-packed with ritonavir 100 mg. Patients take the medication twice daily for 5 days, with dose adjustments based on renal function. State-licensed pharmacists are able to prescribe under the following circumstances: • Positive SARSCoV-2 tested. Home test is sufficient. • Electronic or printed health records less than 12months old withmost recent lab work to verify kidney or liver problems. Informationmay also be provided by the patient's provider. • A list of medications, prescription andOTC, the patient is taking to screen for potential serious interactions. Ritonavir is a strong CYP3A4 inhibitor and P-glycoprotein inhibitor. Whether prescribing or receiving a prescription order from an office, pharmacists play an important role in safe Paxlovid use. Lisa Cillessan, Clinical Associate Professor at UMKC and Clinical Pharmacist at Jordan Valley CHC, has verified many Paxlovid orders and notes that drug-drug interactions are a key factor to review closely before approving. “The Paxlovid fact sheet has all the interactions listed, but requires some interpretation. I typically utilize the NIH’s Paxlovid interaction guidance, as they do a better job stating if you need to hold a medication, decrease, monitor the patient, or if a different Covid therapy would be recommended,” Lisa said. She also adds that knowing the availability of other treatment options in your local community is important to ensure your patients get the care they need.

Josh Berry, PharmD, is a Executive Fellow at the Missouri Pharmacy Association.

Just as we have capitalized on the momentum of widespread pharmacy vaccination, the ability to prescribe Paxlovid highlights how the sharing of health records, especially lab work, would be beneficial in the pharmacy. While I would love to have access to all labs, one that would be most helpful is kidney function. For instance, if the office sends creatinine clearance with Mr. Smith’s new gabapentin prescription then we could alert the office the dose is too high. We could also find out that Mr. Smith’s Januvia 100 mg that he has been on for years now needs to be reduced.

RK

Paxlovid prescribing is not just a win, but also an opportunity for the profession to show that there are more ways we can be utilized.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 9

End of Session Report: Oddities Abound in 2022 by HENRIO THELEMAQUE

The 2022 legislative session adjourned on Friday, May 13 with 45 non-appropriations bills and resolutions passed and sent to the Governor. Over the past 40 years, the average number of bills passed each sessionhas been about 150.This session’s legislative output was diminished by infighting, especially among Republican Senators. The year was marked by frequent filibusters, a months-long stalemate on congressional redistricting, and personal attacks between Senators on the floor and in social media. Despite these challenges to productivity, the General Assembly passed a historic $49 billionbudget aswell as substantial policy changes, such as reinstating photo IDrequirements to vote and increasing funding for charter schools. In many ways, this session is most notable for what did not advance. Many of the conservative issues stalled, including initiative petition reform, limitations on transgender student athletes, employer vaccine mandate bans, and school curriculum restrictions. This report provides an overview of major policies addressed by the General Assembly specific to the Missouri Pharmacy Association. Following this is an overview of other major pieces of legis lation this session. Missouri Pharmacy Association Issues 2022 Ivermectin and Hydroxychloroquine This legislative session, various legislative provisions regarding Ivermectin and Hydroxychloro quine were filed regarding the profession of pharmacy. The extent to which proposals would impact pharmacists varied, andmany of these bills mandated that a pharmacist dispense thesemedications without any questions for either the patient or physician. During debate on HouseBill 2149 , Senators added language that would restrict a pharmacist’s ability to consult a patient for these medications. Due to a majority of Senators supporting this measure, and the nature of the Missouri Senate, the Missouri Pharmacy Associationworked to find a compromise that would not impede the practice of pharmacy nor restrict a pharmacist’s ability to use their clinical skills that they’ve cultivated for years. The language that was Truly Agreed and Finally Passed does the following: • Nothing requires you to dispense, nor carry Ivermectin andHydroxychloroquine. • The Missouri Board of Pharmacy can’t punish a pharmacist for LEGALLY dispensing Ivermectin and Hydroxychloroquine. • A pharmacist cannot call the prescribing physician to dispute the safety of ivermectin FOR HUMAN USE. The provision in HB 2149 does not constrict a pharmacist’s ability to dispute the efficacy Ivermectin or Hydroxychloro quine to treat Covid-19 or any other disease state. Nothing in this provi sion constricts a pharmacist’s ability to consult a patient that shouldn’t take these medications due to certain health conditions or contraindi cations to other drugs.

Henrio Thelemaque is the Director of Government Affairs of the Missouri Pharmacy Association.

Get in touch with Henrio to ask questions or to get information about session. Contact Henrio at henrio@MoRx.com

10 Missouri PHARMACIST | Volume 96, Issue II | August 2022

Licensure System Upgrade $21millionwas appropriated this session to aid theDepartment of Commerce and Insurance inupdating the state’s professional licensure sys tem.This will aid in bringingMissouri forward inhow the state’s licensing happens, andmitigate the current headaches the system has. The House approved HJR 117 , sponsored by Representative Cody Smith (R-Carthage), a proposed constitutional amendment to subject coverage for theMedicaidExpansionpopulation to annual appropriations. This is in response to theMissouri Supreme Court decision directing the administration to complywith the Expansion language in the constitution even though the Legislature declined to allocate additional funds last year. HJR117would also enact work or com munity engagement requirements for able-bod ied adultMedicaid participants.This resolution passed the SenateAppropriations Committee in mid-April. It was never approved by the Senate GAFO Committee, chaired by Senator Lincoln Hough (R-Springfield), meaning it could not come to the Senate floor for debate. MoRX Program Legislation passed this year to extend the durationof theMORXprogram, whichprovides prescription drug assistance to dual eligible se niors, to 2029. It was set to expireAugust of 2022. This provision passed on SB 710 and HB 2400 . Pharmacy Benefit Managers HB1677 and SB921 , sponsoredbyRepresen tativeDaleWright (R-116) andSenatorBillWhite (R-Joplin), respectively, sought to bring greater transparencyandregulatoryoversight to theprac ticesofpharmacybenefitmanagers (PBMs).These contained provisions that would prevent a PBM from requiring patients to use mail-order phar macies, rather thana pharmacy of their choosing, andcontainedprovisions tocreate reimbursement parity for non-PBM affiliated pharmacies. These bills also codified the definition of a rebate, estab lished thefiduciarydutyof PBMs, andprohibited categorizingbrandnamemedications as generics. The House passed HB 1677 by a vote of 113-31. While therewas support for thesebills intheSenate, bothHB 1677 and SB 921 ultimately did not get a vote in the Senate Insurance Committee. Medicaid Expansion

Statewide Standing Order for Naltrexone HCL Legislation that permits theDepartment of Health and Senior Services to issue a statewide standing order to authorize pharmacists to dis pense naltrexone, anopioid antagonist, without the need passed this legislative session.This pro vision is similar to legislationpassed to authorize pharmacists to dispense Naloxone. Scope of Practice Expansion HB2452 and SB1126 , sponsored byRepre sentative BennieCook (R-142) and SenatorHolly Rehder (R-Scott), respectively, were pieces of leg islation filed to expand the scope of Pharmacy. Bothbillswould allowpharmacists to administer all vaccines and create a framework for statewide standing orders. Acompromisewasworked out between various stakeholders to allow pharma cists to administer all vaccines to those who are seven years and older.This languagewas amend ed onto various senate and house bills but was met by threats of a filibuster andultimately could not make it through the process. Vaccine Mandates Limiting the ability of employers to enact Covid-19 vaccination requirements was amajor issue coming into this session, and numerous bills were filed and started moving early in the House. Compromise language passed theHouse on HB 1686 , sponsored by Representative Bill Hardwick (R-Waynesville), to ensure religious and medical exemptions for employees. How ever, this language was blocked in the Senate by conservative caucus members who said it did not go far enough. Far-right proposals to punish businesses with vaccine requirements were defeated by Senate Democrats and mod erate Republicans. The only provisions sent to the Governor’s desk prohibit Covid-19 vaccine mandates for state and other public employees. This language passed on HB1606 , sponsored by Representative PeggyMcGaugh (R-Carrollton), and HB2090 , sponsored byRepresentativeDave Griffith (R-Jefferson City). Both bills exempt fa cilities governed by CMS.

The 2022 Legislative Session began January 5th and concluded May 13th. Republicans hold supermajorities in both Chambers and all but one statewide office. Over the past 40 years, the average number of bills passed each session has been about 150. This session, only 45 non-appropriations bills and resolutions passed and were sent to the Governor. Quick Points: Session Overview

Looking Ahead

The MPA would like to take this time to thank our members for your continuous sup port throughout the 2022 Legislative Session. Your passion and stories allow theMPA to be the voice for all ofMissouri pharmacy.With session over, we ask that you continue to educate your legislators on the impact that you have in your community, especially given that this is an elec tion year. As we gear up for the 2023 Legislative Session, it is crucial that pharmacy plays a role in setting the agenda for the healthcare battles that will take place in the state capitol. With the headwinds we face, due to a robust legislative agenda for 2023 as well as this year being an election year, your support by donating to the Pharmacist Political Action Committee of Mis souri will play a crucial role in ensuring that the voice of pharmacy is heard.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 11

Backed by Science, Proven by Research: Clinical Pharmacists Impacting Patient Outcomes with MedWise® Science and MedWise Risk Score™ Executive Summary

can lead to ADEs. Identifying Patients with

Healthcare costs are rising in the U.S. According to the Centers for Medicare & Medicaid Services (CMS), National Health Expenditure increased 4.6% in 2019, reaching $3.8 trillion, with Medicare spending climbing 6.7% to $799.4 billion.1Meanwhile, U.S. Census Bureau estimates show a growing 65-and-older age group, which increased 34.2%between 2010 and 2019.2 Among this group, the Lown Institute reports that 42% take at least five prescription medications.3 Rising healthcare costs and a growing elderly population could have significant implications when it comes to adverse drug events (ADEs). ADEs occur when an individual is harmed by medication, even when that medication is used appropriately. They are responsible for around 1.3 million emergency department visits a year, and roughly 350,000 individuals require hospitalization for additional treatment.4 Tabula Rasa HealthCare’s (TRHC) MedWise Risk Score™ is a novel approach to help clinical pharmacists target patients at risk for ADEs. Used together with TRHC’s clinical decision support technology, MedWise® Science, pharmacists can identify those patients with high risk scores and target them for risk-mitigating interventions. TRHC has found these pharmacist-led interventions to result in better patient outcomes, including reduced falls, hospital admissions, emergency department visits, medical expenditures, and deaths. Pharmacists and other healthcare providers working with TRHC clinical pharmacists can use these technologies to effectively pinpoint risk, identifymedication related problems, andmake recommendations that advance patient outcomes and ultimately save lives. The impact of clinical pharmacist-driven interventions, under the scope of medication safety reviews, using these technologies is further illustrated in a newpeer-reviewed research series inThe American Journal of Managed Care. Understanding MedWise and the MedWise Risk Score TRHC’s MedWise Risk Score helps pharmacists determine which patients are at risk for ADEs5 by analyzingmedication-related risk factors through proprietary algorithms.6 Unlike traditional medication therapy management offerings, which evaluate a number of chronic diseases, number of medications, and Medicare Part D costs, the MedWise Risk Score evaluates pharmacokinetic and pharmacodynamic characteristics of active medication ingredients.7This evaluation incorporates over-the counter medications, herbals, and supplements to illuminate simultaneous, multi-drug interactions.5 Based on the data, patients are assigned a risk score ranging from 0 to 50, where 0–9 indicates minimal risk, 10–14 in dicates low risk, 15–19 indicates intermediate risk, 20–29 indicates high risk, and 30 and above indicates severe risk.6 In the CMS Innovation Center’s Enhanced Medication Therapy Management (EMTM) model, TRHC clinical pharmacists used the MedWise Risk Score with MedWise Science, a clinical decision support technology, to optimize patient outcomes.7TheMedWiseMatrix creates a visualization of a patient’s complete medication regimen and enables pharmacists to identify and address medication-related problems that

Higher Risk for Negative Outcomes Research has proven that MedWise Risk Scores can help pharmacists successfully identify patients whose medications—when used together— put themat greater risk for negative outcomes including ADEs, falls, higher medical expenditure, emergency department visits, hospitalizations, and death. A study byMichaud et al. included over 200,000 participants who were prescribedmedication in 2018.6 AMedWise Risk Score was calculated for the year 2018 and, according to the data, there was a greater percentage of intermediate, high, and severemax scores among participants who had at least one ADE. Specifically, 18.6% of participants with one or more ADE had an intermediate score, 26.5% had a high score, and 9.9% had a severe score.The results also showed a strong link between theMedWise Risk Score and falls. Compared to participants with aminimal max score, participants with a severe max score were most likely to experience a fall, followed by participants with a highmax score, then an intermediatemax score. Data trended similarly for medical expenditures. Fifty percent of participants with a minimal max score had a mean yearly medical ex penditure of $1,297. This cost escalated to $2,964 for participants with a low score; $4,532 for participants with an intermediate score; $6,514 for participants with a high score; and $10,352 for participants with a severe score (see Figure 1). In addition, the data revealed associations between the MedWise Risk Score and emergency department visits, hospitalizations, and deaths. For example, the data showed a greater number of participants with high and severe max scores among those who died compared to those who remained living. These results confirm the MedWise Risk Score’s ability to identify which patients have the greatest risk for negative outcomes.

12 Missouri PHARMACIST | Volume 96, Issue II | August 2022

Pinning Down Medication-related Problems By identifying patients with the greatest risk, a MedWise Risk Score helps to prioritize individuals forMedWise Safety Reviews.These reviews enable pharmacists to leverage the clin ical decision support tools to detect medica tion-related problems and make recommenda tions to prevent dangerous drug interactions.8 Pharmacists used MedWise Risk Scores and MedWise Science to effectively lower patient risk for multi-drug interactions in a study by

Bankes et al.7 During the study, analyzing MedWise Risk Scores helped pharmacists prioritize 22,696 high-risk participants for their first-ever review. Guided by MedWise Science, pharmacists detected 36,455 clini cally actionablemedication-related problems, roughly 85%of whichwere adverse drug reaction, drug interaction, and unnecessarymedication use. MedWise Science also informed pharmacist recommendations to address themedication-related problems, with start alternative therapy, discontinue medication, change time of medication administration, and change dose topping the list. According to the study’s results, pharmacist recommen dations could reduce the average MedWise Risk Score by 4.7 points. Improving Patient Outcomes Insight from MedWise Safety Reviews can optimize prescribing practices and impact patient outcomes. This impact was proven by Stein et al., who studied the impacts of MedWise Safety Reviews on medical expenditures, hospitalizations, emergency department visits, and mor tality.9 The research included two groups totaling 11,436 participants: 4,384 individuals who received their first-ever review in 2018 and at least one review in 2019, and 7,052 individuals who did not receive a review. According to the data, participants who received MedWise Safety Reviews benefitted from less total medical expenditure as well as fewer hospitalizations and emergency department visits, comparatively. While mean total medical costs (Medicare Part A and Part B) in creased for both groups from 2018 to 2019, participants with MedWise Safety Reviews saved in comparison. In fact, the findings revealed an 8.5% increase for those who received MedWise Safety Reviews versus a 16% increase for those who did not, resulting in 7.5% cost savings for those who completed reviews. Similarly, emergency department visits increased in both groups, but this increase was less among participants with MedWise Safety Reviews. According to the data, the change from 2018 to 2019 was 2.3% for those who received MedWise Safety Reviews and 12.6% for those who did not, marking a 10.3% decrease for the in tervention group (see Figure 2). Meanwhile, the hospitalization rate decreased among participants who hadMedWise Safety Reviews, but increased among participants who did not. Hospitalizations climbed 6.6% for those who did not complete reviews but dropped 3.4% for those who did, resulting in an overall 10% reduction for those who completed reviews (see Figure 2). The data also demonstrated impact in terms of mortality. While 6.8% of participants who had their first-ever review in 2018 died by the end of 2019, 8.9% of participants who did not have a review died by the end of 2019. This marks a 2.1% difference between the groups (see Figure 2). Putting Results in Perspective With over 6 billion prescriptions dispensed in 2020, the safe use of medication is critical.10 Advanced tools like MedWise Science and

the MedWise Risk Score are important to shed unparalleled light on medication regimens and prescribing practices. Research has proven the MedWise Risk Score effective in identifying patients whose medication regimens put them at greater risk for negative outcomes. For high-risk patients, pharmacists can pinpoint medication-re lated problems and recommend measures that reduce risk through pharmacist-led consultations, which leverage MedWise Science. As research demonstrates, this strategy ultimately leads to im proving the safety of medication use and better patient outcomes. Given overarching trends surrounding healthcare costs, the elderly, and ADEs, wider use of advanced clinical decision support technology, such as MedWise Science, can help clinicians significantly improve the healthcare landscape. Copyright © 2021, Tabula Rasa HealthCare, Inc., All Rights Reserved. These materials are confidential and proprietary information of Tabula Rasa HealthCare, Incand may not be reproduced in whole or in part without the written consent of Tabula Rasa HealthCare, Inc. References 1 NHE fact Sheet. CMS.gov. https://www.cms.gov/Research-Statistics-Da ta-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/ NHE-Fact-Sheet. Published December 16, 2020. Accessed August 19, 2021. 2 65 and older population grows rapidly as baby boomers age. United States® Census Bureau. https://www.census.gov/newsroom/press-re leases/2020/65-older-population-grows.html. Published June 25, 2020. Accessed August 19, 2021. 3 Medication overload and older Americans. Lown Itnstitute. https://lown institute.org/projects/medication-overload-how-the-drive-to-prescribe-is harming-older-americans. Accessed August 19, 2021. 4 Adverse drug events in adults. Centers for Disease Control and Prevention. https://www.cdc.gov/medicationsafety/adult_adversedrugevents.html. Published October 11, 2017. Accessed August 19, 2021. 5 MedWise Risk Score™. Tabula Rasa HealthCare. https://www.tabularasa healthcare.com/our-technology/medication-risk-score. Accessed August 19, 2021. 6 Michaud V, Smith M, Bikmetov R, et al. Association of a MedWise Risk Score with health care outcomes. Am J Manag Care. 2021;27(suppl 16):S280-S291 7 Bankes D, Pizzolato K, Finnel S, et al. Medication-related problems iden tified by pharmacists in an Enhanced Medication Therapy Management model. Am J Manag Care. 2021;27(suppl 16):S292-S2999. 8 Discover the next frontier of medication safety. Tabula Rasa HealthCare. https://www.tabularasahealthcare.com/medwise-msr. Accessed August 20, 2021. 9 Stein A, Finnel S, Bankes D, et al. Health outcomes from an innovative Enhanced Medication Therapy Management model. Am J Manag Care. 2021;27(suppl 16):S300-S308. 10 The use of medicines in the U.S. IQVIA. https://www.iqvia.com/insights/ the-iqvia-institute/reports/the-use-of-medicines-in-the-us. Published May 27, 2021. Accessed August 19, 2021.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 13

Community Health Workers (CHWs) are people from the community, a pharmacy technician for ex ample, who connects individuals with organizations to fulfill their needs. This includes addressing social determinants of health (SDoH), which includes helping someone get transportation to their healthcare appointments, connecting themwith food banks, or many other solutions to support nonclinical needs. Community pharmacists are already an information, education and health care hub re ceiving information, such as prescriptions fromall of the various doctors and specialists for each patient. Similar to pharmacy services, many community resources are being underutilized due to lack of awareness. Pharmacy technicians who are trained and serve in a dual role as CHWs serve as a referral hub and effectively determine what support their fellow community members need. to incorporate CHWs into the pharmacy workflow. There is an other element to pharmacy technicians becoming CHWs that is valuable, and that is their proximity to a clinician, the pharmacist. This powerhouse team of patient advocates, community support, and health care professionals has public health organizations taking notice. Through a collaboration among MPA, L&S Pharmacy, and CEimpact, the first virtual CHWcourse for pharmacy technicians was developed and is now being offered in Missouri and several other states. This course is specifically designed with pharmacy workflows and processes in mind and utilizes relevant case studies specific to pharmacy. The Missouri Department of Health and Senior Services has partnered with MPA to provide grant funding to cover scholarships for pharmacy technicians to complete the course. In addition, for MPA business members, pharmacies can receive implementation and onboarding stipends to support the integration of the CHW activities into the pharmacy after the technician becomes a credentialled CHW. You can now get your Community Health Worker training paid for, for free! free! free! Ultimately, incorporating CHWs into the pharmacy workflow provides extensive care coordination be yond the pharmacy walls to help bridge gaps in care, expand access to care, and improve health outcomes for patients and communities. While your pharmacy technicians who become CHWs may never end up in a superhero comic book, they’ll definitely be heroes to your patients! • Organizations supporting: MPA and the MO DHSS • What are the grant details? $3,000/month stipend for 6 months Community HealthWorkers (CHWs): A Favorite Topic in PublicHealth and How Pharmacies Can Get Involved by DR. ANNIE EISENBEIS, PharmD, MBA CHWs currently work in settings like clinics, nursing homes and health systems. Because pharmacies provide an ideal setting for routine as sessments, monitoring and follow-up for patients, it makes sense

Register to get started.

What's the day-to-day like? Check it out.

Listen to learn how.

• What is required? Collect data, train 1 pharmacy tech, and attend trainings either offline or online • Application information: Contact Dr. Annie Eisenbeis for more information by email at annie@morx.com. You must be a licensed pharmacy in the state of Missouri to participate.

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 15

CHANGES IN LATITUDES CHANGES IN ATTITUDES

Annual Conference at Margaritaville Lake Resort

Lake of the Ozarks SEPTEMBER 15 18, 2022

16 Missouri PHARMACIST | Volume 96, Issue II | August 2022

THE PERFECT BLEND OF LAKE LATITUDE AND ISLAND ATTITUDE

Friday, Sept. 16 7:30A REGISTRATION OPEN 7:30-8A MISSOURI PHARMACY FOUNDATION BOARD MEETING 7:30-8:30A BREAKFAST PRESENTATION PHARMACIST ENROLLMENT AS PROVIDERS WITH MISSOURI HEALTHNET; HOW TO GET PAID FOR THE SERVICE YOU ARE ALREADY PROVIDING

This year theMissouri Pharmacy Association (MPA) will come together at Mar garitaville LakeResort inOsageBeach,MOfor itsAnnual Conference September 15-18, 2022. Join fellow pharmacy professionals in all practice settings to get energizing education, best practices, and networking opportunities. Donyour shades, kickupyour feet, andgrab your favorite drink. Tucked awayon the banks of the Lake of the Ozarks inOsage Beach, Margaritaville Lake Resort is a refuge for endlessly fun living. Inspired by the lyrics and lifestyle of singer, songwriter andauthor JimmyBuffett, the resort invites you to live it upon the lake. Tee offon the championshipgolf courses or set out ona lake cruisewitha pontoon boat rental at the resort's full-servicemarina. Flavors and cocktails play together to form a meal you won't soon forget at one of our seven restaurants and bars. Find yourmoment of zen at Driftwood Spa and Salon. Spend the day cooling off at JollyMon IndoorWater Park or explore local trails on horseback. Waterfront surroundings, lakeside adventures, and relaxing vibes are set on420 scenic acres. There's no better paradise than right here. If that isn’t reason enough to attend, check out the education sessions and net working opportunities below. Educational Sessions THURSDAY, SEPTEMBER 15 12-4P MPA BOARD OF DIRECTORS MEETING 11A-5:30P Just as CPR helps you assist an individual having a heart attack, Mental Health First Aid helps you assist someone experiencing a mental health or substance use-related crisis. In the Mental Health First Aid course, you learn risk factors and warning signs for mental health and addiction concerns, strate gies for how to help someone in both crisis and non-crisis situations, and where to turn for help. 5:30-7P WELCOME RECEPTION MENTAL HEALTH FIRST AID (SEPARATE REGISTRATION)

8:30-9:30A This programwill show technicians, pharmacists, and pharmacy owners how to ef ficiently enroll pharmacists for a provider through Missouri Med icaid.Wewill walk staffmembers throughnavigating theCyberAc cess site, reserving interventions, preparing for the patient discus sion, completing an intervention, and what documentation to save for audit purposes, billing the in tervention, and how to reconcile payments once received. 9:40-10:40A This program will discuss a number of new statutes andBoard rules that have recently been enacted/promulgat ed that will substantially impact Missouri pharmacist practice, in cluding changes related to tech nician supervision, technology usage, and pharmacy standards of operation. MISSOURI BOARD OF PHARMACY UPDATE

REGISTER TODAY AT www.morx.com

THE LEADING VOICE FOR THE MISSOURI PHARMACIST | MoRx.com 17

CHANGES IN LATITUDES CHANGES IN ATTITUDES

START NOW! INCORPORATING SMOKING CESSATION IN YOUR PHARMACY 10:50-11:50A The program intends to provide phar macistswitha kick-start toproviding a smoking cessation servicewithin their practice setting. Areviewof the phar macological options andnon-pharmacological strategies, includingmotivational interviewing, will be utilizedwith in the patient scenarios and discussion. Pharmacists will review the current Missouri legislation for NRT, along with various business models to incorporate the service. Through the use of discussion, case scenarios, video clips, and interactive learning strategies, the audiencewill leave withanactionplan for incorporating a smoking cessation service into their pharmacy practice. MEDICATION OVERLOAD IN OLDER ADULTS: A CLOSER LOOK AT POLYPHARMACY AND DEPRESCRIBING 10:50-11:50A This programwill identifyways todefine polypharmacy, discuss the consequences of polypharmacy in older adults, progress and challenges related to depre scribing, and tools/tactics for optimizingmedicationuse in older adults. 12-1:30P AWARDS LUNCH Joinus for theMPAAwards Lunch as selected pharmacy professionals receive awards. LEADING YOUR PHARMACY WITH PURPOSE TO ACHIEVE AMAZING RESULTS 1:40-2:40P This sessionwill talkabout understanding the three reasons why your patients and employees won't listentoyouandthe three reasonswhy theydo listentoyou, and how to lead them to success. We will identify which current patients you should focus your time and energy on togrowyour business.Therewill be a discussionabout purposeful ways to attract new patients that will lead to business growth, and discussion and ideas from the audi ence, usingreal caseexampleswithaudienceparticipation. ADHERENCE: THE KEY TO SUCCESS IN SERVING THE MENTAL HEALTH POPULATION 1:40-2:40P This programwill give a background on Mental Health-oriented pharmacy practice and the chal lenges facedby this population.Therewill be a discussion on tools to help this specific population with adherence andhowthewhole pharmacy teamcan take part inmeet ing adherence goals.

ARE YOU UP TO DATE ON YOUR VACCINES? 2:50-3:50P The program will focus on recent CDC and ACIP changes to the vaccine schedules including pneumococcal diseases, zoster, dengue fever, flu vaccine, Hepatitis B, and Covid-19. The program will highlight the changes and allow active participation in reviewing patient cases and selecting the correct vaccines indicated for the patient. BUILDING A COLLABORATIVE PRACTICE AGREEMENT FROM TOP TO BOTTOM 4-5P This sessionwill reviewstate requirements regard ing collaborative practice agreements (CPAs), highlight standing pharmacy protocols that are relevant to CPAs, evaluate best practices for key components of aCPA, and describe techniques to enhance provider discussions re garding a CPA. THE BUSINESS MIND: A SPEED NETWORKING EVENT 5:10-6:10P This networking event is for all attendees to ask questions and learn fromcolleagues in a variety of practice settings. We will have round tables set up with a leader at each table from a specific practice setting to facilitate the discussion.This ismuch like a ‘speeddating’ event - every tenminutes youwill move to the next table. Bring your business cards. Saturday, SEPT. 17 7:30A REGISTRATION OPEN 7:30-8:30A PAST PRESIDENT’S BREAKFAST (INVITE ONLY) 7:30-8:30A BREAKFAST PRESENTATION BY NOVO NORDISK (ALL ATTENDEES) 8:40-9:40A THE FUTURE OF RNA AND DNA VACCINES The program will explore the history of RNA and DNA vaccines to set the stage for future implications of this technology.The audiencewill gaina better understanding of the technology anddevelopment of nucleic acid-based vaccines and explore disease states that are conducive to vaccination through RNA and DNA technologies.

18 Missouri PHARMACIST | Volume 96, Issue II | August 2022