Greetings Readers of the MPhA Blog

My name is Zachary Wyman, I am a 4^th year student from the University of Minnesota College of Pharmacy. I am originally from Lakeville, the best city in Minnesota.

I have had a great time on this rotation so far, meeting the new staff that is supporting MPhA. Everyone is so friendly around here and it has been great having wonderful conversations about why J.Crew is better than Banana Republic and why the Lakeville South Ski team that I coach is going to beat the Minnetonka skippers this year.  Okay, enough about the getting to know the people. You can tell that this is a great environment to work in and after only one week, I am excited to have a rotation where you get to do some many interesting things and experience so many opportunities that are unique to pharmacy that you usually do not experience in other settings.

I was excited to be able to work on AWARxE while I am here at MPhA.  We had a meeting with the Minnesota Pharmacists Foundation (MPF) and we were able to update MPF on where we are at with our middle school presentations and it was great to have the support from MPF and where we are going with the student lead presentations. It was also fun that I was given the opportunity to speak at MPSA (Minnesota Pharmacy Student Alliance) at the College of Pharmacy. It is great to see that so many students are excited to join the campaign and offer help. If you would like more information about the AWARxE Campaign or would like to help give a presentation, go to AWARERX.org for more information.  AWARxE is a huge passion of mine and I hope that others will be passionate about it also or find something else within pharmacy that gives then passion. 

One thing that was eye opening to me this week was the breakfast that we had at the Town and Country Club with new elected legislative members Amy Koch, Senate Majority Leader-Elect and Kurt Zeller, Speaker of the House-Designate. I am not the smarted when it comes to politics and the legislature so it was really interesting to me to be able to participate in the breakfast and listen to the speakers about the upcoming legislative session. I hope to learn more about the process next week and hope to blog about my experiences. I am looking forward to being able to learn how to be a better advocate at the capital and to my representatives in my district.  

Thanks for reading my blog, more to come next week, Thanksgiving Edition. There will be more things about AWARxE also. 

Hi, I'm Michelle Korpela

Hello MPhA readers!  My name is Michelle Korpela and I will be spending the next five weeks on rotation here with Julie Johnson.  To tell you a little about myself, I am originally from Stillwater, MN.  I am currently a fourth year pharmacy student at the U and have pharmacy experience in both community and home infusion pharmacy.

This rotation is considered one of my electives, but I wasn’t sure what exactly I would be doing with my time here.  I’d talked with former students who all seemed to have diverse experiences with MPhA, depending on what time of year they had this rotation.  Now that the elections are over (almost…if you don’t count the new Supreme Court case to see who will be governor), it looks like I will be spending the majority of my time preparing for the upcoming legislative session starting early next year. 

I don’t know about everyone else, but I was grateful for November 3, when I would finally be able to get a break from all the campaign ads!!  Well, all that work those candidates put in just to be elected will seem like nothing once they get started on the real work.  We went to a breakfast meeting at the Town and Country Club in St. Paul to meet with some of the newly elected members of the legislature.  If all our meetings involve breakfast, I think I will really like this rotation!  I even got to have breakfast with my local House member, Carol McFarland, from White Bear!  Anyone who says they can’t approach their representatives about issues just hasn’t tried to talk to them.  They are real people from your neighborhood who are actually interested in what you have to say.

The thing that surprised me most during this meeting was how young these people were!  I guess I expected a bunch of old men smoking cigars in a formal parlor, but was pleasantly surprised to see they were pretty normal.  We listened as the newly elected Speaker of the House, Kurt Zellers, and Senate Majority Leader, Amy Koch, talked about their plans for this next year.  It should be pretty interesting to see how the new system with about 35% fewer committees affects the passage of new legislation.  

Later in the week, we met with the MPhA Public Affairs Committee to get an update from our lobbyist.  It’s interesting to hear from someone who knows these people pretty well and can figure out where pharmacy might stand on their radar.  It looks like it should be an interesting year coming up for the pharmacy world.  We think our issues are pretty important, but it sounds like the legislature will be focusing all of their energy on creating jobs and helping the economy make a comeback.  I just hope pharmacists can come together to show them that some of these proposed changes will be necessary to KEEP pharmacists’ jobs!

Week 5: My Last Week!

Monday evening was my first experience visiting the MN Board of Pharmacy.  Julie and I attended the Prescription Monitoring Program (PMP) Meeting – for which she is on the Advisory Committee.  For those of you not familiar with PMP, it is an online database that went “live” on 4/15/10 where pharmacies report the dispensing of controlled substances.  To date, over 5 million prescriptions have been reported and the database has 3,397 users – most of which are physicians.

Presentations at the meeting were given by Virginia Ghafoor, a PharmD specializing in pain management from UMMC Fairview and Sergeant Matthew St. George, from the Financial Crimes Unit at the Minneapolis Police Department specializing in pharmaceuticals investigations. Both presenters explained the importance of using the PMP database in their practice.  Physicians are more comfortable treating pain when they know the patients true prescription history, especially in the emergency room setting.  Also, the system is obviously very useful in crime investigations at the Police Department when suspects are found with prescription drugs to find out if they truly had a legitimate prescription for them or not.

New legislative issues coming about from the PMP program include adding Methadone, Tramadol, and Schedule V drugs to the list of medications monitored.  Currently, PMP can only be used by healthcare professionals for prescribing or filling purposes.  There is discussion about expanding the list of appropriate uses to include queries in the ER for an unresponsive patient, intake in a pain clinic or methadone clinic, prospective transplant patients, and use by family members for cause of death.

So far, all feedback from healthcare professionals regarding PMP has been all positive except for a single comment stating, “The online system was confusing.” It seems that the program thus far has been a great success and will continue to grow in this direction. 

Tuesday night in the Twin Cities was our last pharmacy night for the year! There was a wonderful turnout exceeding 150 pharmacists, students, and technicians. Again, I learned about asthma for the 7^th time and even got a demo Advair inhaler!

Wednesday was our AWARxE strategic planning meeting.  During the meeting we mainly discussed goals for the next 3 years to facilitate in writing grant proposals.  We are hoping to expand the amount of school presentations, add faith stories to video presentations, and create a package to market nationwide.

My 5 weeks at MPhA has taught me aspects of pharmacy that the College of Pharmacy curriculum hasn’t.  I have seen a new span of opportunities that has opened my eyes to new career choices I had not considered in the past.  MPhA has shown me that being involved in your profession has benefits in any stage or field of pharmacy.  I had never considered becoming a member of MPhA before this rotation, but will undoubtedly join immediately after graduation and sign up with the MTM Academy.  I have unlimited gratitude for Julie, who’s passion for teaching students is incredible.  Thanks Julie and Ewald staff!!

Week 4: AWARxE and MTM Symposium

At the start of rotation week 4, Julie and I attended an AWARxE marketing meeting with HealthPartners to discuss what it means for them to become a sponsor.  AWARxE initially came about from a father whose teenage son had died from an overdose from prescription medications.  He approached his legislator and has strongly advocated in starting a program that can prevent future situations like his.  Before the meeting, I had only thought of the program as preventing prescription drug abuse from medications such as pain meds, anxiolytics, etc. but it also seems to be a promotion for MTM services!  The program looks at helping patients better understand their medications so they don’t abuse, overuse, or underuse ANY type of medication in ANY age group. 

While at HealthPartners, we were informed they recently posted a new MTM video which can be found at: http://www.youtube.com/watch?v=2d1ZWJyesXg.  I think this specific video is an exceptionally great patient education tool because it gives real life examples of drug therapy problems that patients can relate to and understand instead of just explaining what a drug therapy problem is.  For example, “This patient was on two meds that are very similar from different doctors, which was dangerous so we stopped one and the patient feels much better.” 

Tuesday was my “try to figure out MTM at Ridgeview” day.  I met with the pharmacy director and billing department out at Ridgeview Medical Center which felt more like a roundtable discussion of confusion.  The billing department wants to pursue MTM contracts this spring – leaving time for me to graduate and get licensed and all.  Documentation and Billing still seems a blur, but I thought maybe this would become clear at my afternoon meeting with Medication Management Systems (MMS).  It was SO refreshing to talk to people that know exactly how to bill for MTM and explain the millions of benefits MTM has to offer!  Next steps are trying to get Ridgeview and MMS to meet.  At this point, I am going to push to include MTM as an employee benefit at Ridgeview. 

Another issue I investigated during the week was regarding the “Cancer drug repository act”.  Don’t know what this is?  You can check it out here: http://www.phcybrd.state.mn.us/forms/cdrguidelines.pdf.  Basically it is a law that allows pharmacies to “reuse” expensive cancer drugs.  After talking with the MN Board of Pharmacy, no pharmacies have used this to date.  Why not?  Pharmacies cannot guarantee the storage or contamination of any products that have left the pharmacy, and thus feel it is too risky to dispense them again.  Also, pharmacies can’t charge for the re-dispensed product, so there is no incentive.  However, I talked with Pharmacists Mutual and participation would not increase one’s liability insurance since the law includes immunity for participating pharmacies as long as the guidelines are followed.

On Thursday, Julie and I attended the MPSA meeting at the College of Pharmacy to listen to a presentation from the Immunization Action Coalition.  The presentation included discussions about the flawed arguments of those who are anti-immunizations.  I learned that the National Vaccine Information Center, a common website referred to by patients, is an anti-immunization group!  Beware…….the name is deceiving! 

Friday was the long awaited MTM symposium!  I was able to sit in on roundtable discussions including an “Update on Part D requirements” by Tom Albers (MMS) and “Documentation Systems” by Stacy Steber (Goodrich).  After the roundtables, I learned about a new free documentation program available: Medication Pathfinder.  Several practitioners recommended using this program to me as a new practitioner.  Others questioned the cost-effectiveness of some other systems, such as Assurance.  If anyone has input, please comment!  Unfortunately, even after talking with many of the “brightest bulbs” in MTM, I still feel confused about billing!  Why do I feel like I am reinventing the wheel?

This week I am looking into the possibility of contracting with Outcomes so I can provide MTM to Medica and Humana patients at Ridgeview.  I need to find out if they only contract with retail pharmacies.  They have an “Alternative location contract” as a consultant pharmacist, but I am not sure if this would include a pharmacist at a doctor’s office/clinic. 

Billing for MTM Services – What a …. Headache!

As mentioned in my first blog, I am currently working on implementing MTM services at Ridgeview Medical Center (Waconia hospital) and their associated outpatient clinics.  I think each person I talk to and each answer I get, I am left with 20 more questions!

A concern right now is that Ridgeview is not contracted with Medicare Part D, so I need to find out how to do this and make sure it is “worth it” to them!  Completely at a loss of ideas, I contacted various faculty and residents at the U of MN College of Pharmacy and other pharmacists that have started up MTM services at other locations.

The location of Ridgeview has only about a 5% Medicaid population, meaning billing the state for MTM services will not be a meaningful way to sustain this service.  We need other payers!  It is my understanding that Ridgeview may be able to contract with individual private payers to cover this service, but I still need to find out.  It seems that we need to work directly with the Part D providers to contract for this service.  In this area, the only Part D plans contracting for MTM services are Humana, Medica, and Health Partners.  Humana and Medica are already contracted through Outcomes, but I am not sure if they also will contract with others for MTM services or if pharmacists must use Outcomes to bill.  If pharmacists must use Outcomes, this might not fit with the Ridgeview MTM model since they don’t have outpatient retail pharmacies. 

Next week I have a meeting with Medication Management Systems (MMS), a company that specializes in helping health plans and PBMs to implement MTM programs.  This could be just what we need, and I will keep my blog updated with any findings so future pharmacists implementing MTM programs can have some guidance!

Another topic I have researched this week is the benefits of a having a pharmacist in pay-for-performance healthcare settings. It seems to be an opportunity and a way to help justify clinical pharmacy services.  However, since pay-for-performance is really just emerging it is likely that no one has had enough experience with it yet to evaluate this very well. It has been difficult to find anything significant published on this yet. If anyone has any helpful resources, please comment!

I visited the Minnesota State Capitol on Wednesday for a tour.  I got to hear about the capitol’s history, art, and architecture and see the different chambers where our government makes decisions.  It was the first time I had been there since middle school, and it was truly stunning to see the beautiful architecture. I ended the week working on excerpts for MPhA’s November CAPS newsletter.  Please be sure to read the newest CAPS on the website!