Friday, August 25, 2017

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In the State:
Hurricane Harvey: Governor Greg Abbott has declared a state of disaster. What should you know if you’re a pharmacist in the affected areas?
Association News:
Tarrant County Pharmacy Association Induction of New Officers

National News:
FDA is evaluating prescription opioid medications approved to treat cough in children
Most U.S. teens are getting cancer-preventing vaccine
Trending News:
Fewer antibiotic prescriptions are being filled, a new analysis finds
Hospital pharmacy: New study highlights value of pharmacist prescribers in hospitals
Breakthrough cancer drug could be astronomical in price
States take on drug price transparency, gouging
So-called 'Canadian' pharmacies are a danger to consumers, NABP reports
Express Scripts research shows significant benefit of adherence to diabetes medications
More than 90% of Americans live within 2-miles of a pharmacy


In the State

Hurricane Harvey: Governor Greg Abbott has declared a state of disaster. What should you know if you’re a pharmacist in the affected areas?
Governor Greg Abbott has declared a state of disaster in the following counties: Aransas, Austin, Bee, Calhoun, Chambers, Colorado, Brazoria, DeWitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Harris, Jackson, Jefferson, Jim Wells, Karnes, Kleberg, Lavaca, Liberty, Live Oak, Matagorda, Nueces, Refugio, San Patricio, Victoria, Waller, Wharton and Wilson.

The laws and rules governing the practice of pharmacy in Texas, allow pharmacists to provide emergency refills when the prescriber cannot be reached. Specifically, in an emergency, a pharmacist may use his/her professional judgment in refilling a prescription drug order for a drug (other than a Schedule II controlled substance) provided failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

In the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

  • failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering;
  • the natural or manmade disaster prohibits the pharmacist from being able to contact the practitioner;
  • the governor has declared a state of disaster under Chapter 418, Government Code; and
  • the board, through the executive director, has notified pharmacies in this state that pharmacists may dispense up to a 30-day supply of a prescription drug.

Accordingly, Gay Dodson, R.Ph., Executive Director/Secretary of the Texas State Board of Pharmacy (TSBP), has authorized ALL pharmacists in Texas to dispense up to a 30-day supply of medication (other than a Schedule II controlled substance) for patients affected by Hurricane Harvey.

We are wishing our colleagues, family and friends who may be impacted by Hurricane Harvey the very best. We hope you are safe and taking all the precautions you can.

TSBP: Emergency Dispensing of Prescription Medications
(PDF link)
TSBP: Information for Pharmacies that Sustain Damage Due to Hurricane Harvey
(PDF link)
Natural Disasters and Severe Weather information from the CDC
https://www.cdc.gov/disasters/hurricanes/index.html
Federal Emergency Management Agency, Hurricane Harvey
https://www.fema.gov/hurricane-harvey

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Association News


Tarrant County Pharmacy Association Induction of New Officers

TPA CEO Debbie Garza and Justin Hudman, Division Director of Public Affairs, attended the Tarrant County Pharmacy Association meeting last evening in Fort Worth. The event was highly attended with nearly 100 pharmacists, pharmacy technicians, and pharmacy students. Debbie had the pleasure to install the new officers of the organization. These new officers were chosen because of their abilities, their willingness to serve, and their interest in the profession. The new officers are: president - Lisa Killam-Worrall; vice president - Carter High; secretary/treasurer - Ron Jencopale; and directors – Theresa Day, Vivian Poff, Mary Hicks, Catherine Parra, Avery Tomberlin, Adam Tomberlin, Sara Robison, Jennifer Barnett, Renee Hart, and Jake Daggett. There was also recognition of the retiring officers, who are directors – John Bailey, Ellen Church, Greg Elko, Jennifer Fix, and Carol Reagan, for their the devotion to duty and untiring efforts on behalf of the pharmacy profession. Justin Hudman presented a legislative update and session wrap-up for the attendees. Dr. Charles Taylor, the Dean at the University of North Texas System College of Pharmacy, also attended and provided remarks.

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National News

FDA is evaluating prescription opioid medications approved to treat cough in children
FDA announced Monday that the upcoming meeting of the Pediatric Advisory Committee will focus on the use of prescription opioid products containing hydrocodone or codeine for the treatment of cough in children. At the meeting, to be held September 11–12, the panel of independent experts will supply valuable input to help inform FDA's decision-making processes related to these drugs. FDA Commissioner Scott Gottlieb, MD, noted: "It is vital we understand the potential complications that can occur when using opioid-containing medications in children, even according to labeled instructions. This is an area that the agency is continuing to evaluate." In April, FDA announced required changes to the labeling of prescription codeine products to help better protect children from the serious risks associated with these opioid medications, including life-threatening respiratory depression and death. Among the changes were adding a contraindication to drug labels warning that codeine should not be used for any reason, including treatment of cough, in children younger than age 12 years.
FDA News Release (August 21, 2017)

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Most U.S. teens are getting cancer-preventing vaccine
The annual National Immunization Survey-Teen report shows that 60% of teenagers aged 13–17 years received one or more doses of human papillomavirus (HPV) vaccine last year. That figure is a 4 percentage point increase from 2015. In addition, the report found that HPV vaccination is becoming more common among boys, with 56% of boys receiving the first dose in 2016—a 6 percentage point increase from the previous year. The rate for girls is about 65%, similar to the rate reported in 2015. Still, CDC notes there is room for improvement, as only 43% of teens are up-to-date on all the recommended doses of HPV vaccine. Furthermore, HPV vaccination rates were lower in rural and less urban areas compared with more urban areas. "I'm pleased with the progress, but too many teens are still not receiving the HPV vaccine—which leaves them vulnerable to cancers caused by HPV infection," said CDC Director Brenda Fitzgerald, MD. "We need to do more to increase the vaccination rate and protect American youth today from future cancers tomorrow." CDC last year updated its HPV vaccination recommendations to reflect evidence that two doses of HPV vaccine in younger adolescents provided similar levels of protection to those seen for three doses in older adolescents and young adults. Adolescents who receive the first dose of HPV vaccine before turning age 15 years should get two doses of HPV vaccine to be protected against cancers caused by HPV, while three doses are recommended for individuals who start the series at age 15–26 years. CDC News Release (August 24, 2017)

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Trending News

Fewer antibiotic prescriptions are being filled, a new analysis finds
The use of antibiotics among Americans with commercial health insurance has decreased during the past several years, according to a new analysis that nevertheless shows lingering variations for different ages and in different parts of the country. The study released on Thursday provides the latest evidence of how doctors and patients have begun to heed warnings that excessive antibiotic use breeds dangerous drug resistance and “superbug” bacteria. The analysis is based on 173 million insurance claims from people under age 65 with Blue Cross Blue Shield coverage who filled prescriptions between 2010 and 2016. It is a sequel of sorts to research by the federal Centers for Disease Control and Prevention, which found a smaller decline and comparable age and geographic variations. The CDC reported a 5 percent decrease overall between 2011 and 2014 in antibiotic prescriptions written in outpatient settings such as doctors’ offices, clinics and hospital emergency rooms. The study by the Blue Cross Blue Shield Association found that 9 percent fewer antibiotics prescribed in outpatient settings were filled in 2016, compared with 2010. Washington post (August 24. 2017)

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Hospital pharmacy: New study highlights value of pharmacist prescribers in hospitals
Pharmacist prescribing evaluated in three critical care units was found to be safe, with a very low error rate. Pharmacist prescribing makes a positive contribution to patient care in hospital settings, an evaluation of one UK teaching hospital has found A new study has highlighted the value and safety of services provided by pharmacist independent prescribers to hospital patients, including those in critical care. Published online in the European Journal of Hospital Pharmacy, the paper, ‘Pharmacist prescribing in critical care: an evaluation of the introduction of pharmacist prescribing in a single large UK teaching hospital’, found that pharmacists contributed to a “significant proportion of total prescribing”.
The Pharmaceutical Journal (August 17, 2017)

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Breakthrough cancer drug could be astronomical in price
A new leukemia drug from Novartis is being hailed by doctors as a breakthrough, but it could prove among the most expensive therapies ever on the market. For a single treatment, the price is expected to reach hundreds of thousands of dollars. "From what we're hearing, this will be a quantum leap more expensive than other cancer drugs," said Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center in New York. Novartis has not announced a price for the medicine, but British health authorities have said a price of $649,000 for a one-time treatment would be justified, given the significant benefits. The cancer therapy was unanimously approved by an FDA advisory committee in July, and its approval seems all but certain. The treatment, CTL019, belongs to a new class of medications called CAR T-cell therapies, and has been tested in patients whose leukemia has relapsed in spite of chemotherapy or a bone-marrow transplant. In a clinical trial, 83% of those treated with CAR T-cell therapy have gone into remission. FDA is scheduled to decide on approval by October 3. The agency is also considering a CAR T-cell therapy from Kite Pharma. A third company, Juno Therapeutics, halted the development of one of its CAR T-cell therapies after five patients died from complications of treatment.
USA Today (August 22,2017)

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States take on drug price transparency, gouging
States are increasingly addressing the issue of drug price transparency. In California, an Assembly committee on Wednesday moved forward a bill (SB 17) that would put a spotlight on what the state spends on the most expensive prescription drugs, as well as which drugs have seen the highest year-over-year spending increases. States are increasingly addressing the issue of drug price transparency. In California, an Assembly committee on Wednesday moved forward a bill (SB 17) that would put a spotlight on what the state spends on the most expensive prescription drugs, as well as which drugs have seen the highest year-over-year spending increases. The bill, which passed the state Senate in May, also would require manufacturers to provide written notification prior to a price increase of more than 10% to each state purchaser, health plan or insurer, and PBM. Ohio, meanwhile, is debating a November ballot measure, known as Issue 2, that would require the state and state agencies, including the Department of Medicaid, to pay the same or lower prices for prescription drugs as the U.S. Department of Veterans Affairs, which typically pays 20%–24% less than other agencies for prescription drugs. State House and Senate Democrats in Michigan earlier this week proposed a plan to create a Prescription Drug Consumer Protection Board that drug manufacturers would be required to submit documentation to justify price increases above 10% in 1 year, or 30% over 5 years. Louisiana, Nevada, Maryland, North Carolina, and Vermont have all adopted measures aiming to increase transparency on drug prices or stop price gouging. APhA (August 24, 2017)

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So-called 'Canadian' pharmacies are a danger to consumers, NABP reports
A new report from the National Association of Boards of Pharmacy (NABP) reveals how rogue online pharmacies take advantage of the perception in the United States that Canadian pharmacies provide safe and cheaper medication. NABP found in a recent study that of more than 100 pharmacy websites that used "Canada" or "Canadian" in their name or URL or included a Canadian contact address, approximately three-quarters source their drugs from countries outside of Canada. According to the data, one-half of the "Canadian" websites source their drugs from India or a combination or countries where counterfeit products are known to originate. In addition, 20% dispense drugs from unspecified foreign locations. None of the websites studied require a valid prescription, researchers found. NABP last year teamed up with Canada's National Association of Pharmacy Regulatory Authorities to verify online pharmacies located or doing business in Canada. The partnership was established as part of the Pharmacy Verified Websites Program. NABP's Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators: August 2017 is available here. APhA (August 22, 2017)

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Express Scripts research shows significant benefit of adherence to diabetes medications
People with diabetes who were nonadherent to their oral diabetes medications had higher medical costs and higher total health care costs compared with those who were adherent, according to new research. The study, from Express Scripts, found that nonadherent diabetes patients last year had 1.3 times higher medical costs and 4% higher total health care expenses compared with adherent patients. Furthermore, the report noted that patients who were adherent to their medications had 235 fewer emergency department visits and 50 fewer inpatient hospitalizations per 1,000 patients. Health care costs for adherent patients with diabetes-related complications were 9% lower than those for individuals who were not adherent to their oral diabetes drugs. "Medication adherence pays off in a meaningful way for patients, in both better health and lower total health care costs," said Glen Stettin, MD, senior vice president, clinical, research and new solutions at Express Scripts. "Continued efforts to improve medication adherence, particularly for diabetes, should be a priority for employers seeking to lower cost and improve care." A separate analysis found that adherence to oral diabetes drugs rose 3.6% between 2014 and 2016. The research showed that medication adherence to oral diabetes drugs was highest among commercially insured individuals aged 65 years and older at almost 75%, while those aged 20–44 years had the greatest room for improvement, with slightly less than 50% reporting adherence to oral diabetes drugs in 2016. PR Newswire (August 25, 2017)

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More than 90% of Americans live within 2-miles of a pharmacy
The number of community pharmacies increased by 6.3% from 63,752 (2007) to 67,753 (2015). Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively, while the remainder were comprised of mass retailer (12%), food store, (10%), clinic-based (3%) or government (<1%) pharmacies. With the exception of e-prescribing, there was no substantial change in pharmacy characteristics over time. While the number of pharmacies per 10,000 people (2.11) did not change between 2007 and 2015 at the national-level, it varied substantially across counties ranging from 0 to 13.6 per-capita in 2015. We also found that the majority of pharmacies do not offer accommodations that facilitate access to prescription medications, including home-delivery, with considerable variation by pharmacy type and across counties. For example, the provision of home-delivery services ranged from less than <1% of mass retailers to 67% of independent stores and was not associated with county demographics, including ambulatory disability population and percent of the population aged ≥65 years. Click here to see the study

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Monthly Free Member CE:



Stress Management Skills for Pharmacy Practice

This activity will introduce pharmacists to evidence-based approaches for managing stress. Attendees will practice mind-body skills known to short-circuit the “fright, fight, or flight” response to stressful situations. Attendees also will learn cognitive practices for changing their thinking about potentially stressful situations. Attendees will leave with a personal toolkit of strategies for controlling the amount of stress they experience both in and out of the workplace. More


TPA Educational Opportunities
TPA offers other education programs on a wide range of topics. For information on all of TPA’s upcoming educational events, visit the TPA Event Calendar & Online CE Calendar


Wildfire Defense Systems
If a fire threatens an insured property, Pharmacists Mutual Insurance Company may dispatch an engine and crew to the property for pre-fire and post-fire mitigation services. Learn more about this special service at http://wildfire-defense.com/.


Texas Pharmacy Association
Debbie Garza, CEO, TPA • 512.615.9170