MINNESOTA PHARMACIST

WINTER 2020 INSIDE THIS ISSUE

Minnesota Legislature: Hot Issues for the 2020 Session

MPhA’s ALNE Celebrates Another Success

Updates to Gender-Affirming Pharmacotherapy: A Summary of Guideline Recommendations

...and more! WINTER 2020 Volume 74, Number 1 INSIDE

UPFRONT VIEWS AND NEWS

A Message from the MPhA President...... 4

Message from the Executive Director...... 5 ON THE COVER

MINNESOTA NEWS The Winter issue of the Minnesota Pharmacist includes a report about some Update from the Dean...... 6 of the topics of interest to pharmacists at the Minnesota Legislature as well as a resource guide to help you reach out Minnesota Legislative Preview: Hot Issues for the 2020 Session...... 7 to your state and federal level elected officials. It’s more important now than ever to let them know how you and your MPPS Seeks and Welcomes New Members ...... 8 pharmacy are being affected by outside forces. Pharmacy Time Capsule...... 8 Find us on Facebook MPhA NEWS MINNESOTA PHARMACISTS Help Us Recognize Today’s Leaders in Pharmacy...... 9 ASSOCIATION You’ll find quick updates about what is MPhA’s ALNE Celebrates Another Success...... 12 happening at MPhA and more photos from our events! MPhA News & Notes...... 32 Find us here.

NATIONAL NEWS Follow us on Twitter

National and State Associations Submit Joint Comments to CMS on Scope of Practice. 14 Follow us @MinnPharmAssoc

CLINICAL NEWS Network on LinkedIn

You can find us here. Updates to Gender-Affirming Pharmacotherapy: ...... 15 View photos on Insatgram 2020 Prescription Drug Prices: Growing Slower, but Not Going Lower...... 22

Follow us @minnpharmassoc MPHA RESOURCE GUIDE Share your pharmacy-related Legislative Directory ...... 26 photos using #minnpharm

DO THE WRITE THING Has your pharmacy created an innovative practice idea that benefits your patients? Are you doing research or have special interest or knowledge about some aspect of pharmacy that you are ready to share with your fellow MPhA members? Do you have news to share about MPhA members and their achievements? Help us spread the news about the good work that our members are doing across Minnesota! We are always on the lookout for articles for our Small Doses weekly e-newsletter as well as our quarterly Minnesota Pharmacist journal. Articles for the e-newsletter are typically 75-200 words, while articles for the journal can be up to 1,500 words. Send material to Communication Director Laurie Pumper at [email protected]. Laurie can also answer questions about topics, format and deadlines. MPHA BOARD OF DIRECTORS

President: Craig Else Upcoming Events Past President: Jason Varin President-Elect: Michelle Johnson Secretary-Treasurer: Tim Affeldt Central Minnesota Resident MPhA Leadership Summit and Speaker: Alison Knutson Clinical Pearls – MSHP and MPhA House of Delegates Meeting Rural Board Members: Joint CE Event June 10, 2020 Reid Smith April 2, 2020 Roseville, MN Jason Miller St. Cloud, MN

Metro Board Members: APhA’s Delivering Medication MPhA Annual Learning Networking Amanda Brummel Sarah Westberg Therapy Mgmt. Services – Twin Event Cities October 1-2, 2020 At-Large Board Members: Ann Byre May 8, 2020 Brooklyn Park, MN Ross Fishman St. Paul, MN Rebecca Pickler Anoji Punjabi Register Today! Visit the MPhA website for more details about all these events! Christel Svingen

Student Representation: Duluth MPSA Liaison: Brandon Anderson Minneapolis MPSA Liaison: Kris Nemitz The Minnesota Pharmacists Foundation Ex-Officio collaborates with and supports the profession Vice Speaker: Luke Slindee of pharmacy for the enrichment of public MN ASCP Representative: Jordan Wolf health. MCCP Representatives: Andrea Larson, President VISIT MNPHARMACISTS.ORG FOR MORE Marjan Khazaeli, President Elect INFORMATION. College of Pharmacy Representative: Bruce Benson Your Amazon.com purchases can help raise Pharmacy Technician Representatives: funds for the Foundation. Simply choose Deena Ayoub “Minnesota Pharmacists Foundation” at Max Blanchard Amazon Smile, and 0.5% of the purchase will Matt Winans be donated to the Minnesota Pharmacists Minnesota Pharmacist Foundation. Official publication of the Minnesota Pharmacists Association. MPhA is an affiliate of the American Pharmacists Association, the American Society of Consultant Pharmacists, the Academy of Managed MPhA Mission: Serving Minnesota pharmacist providers to advance patient care. Care Pharmacy, and the National Community The Minnesota Pharmacists Association is a state professional association, whose Pharmacists Association. membership is made up of pharmacists, student pharmacists, pharmacy technicians, Editor: and those with a business interest in pharmacy. MPhA will be the place where Laurie Pumper, CAE pharmacists go first for education, information and resources to become empowered to provide optimal patient care. MPhA will be the recognized and respected voice of Managing Editor, Design & Production pharmacy with legislators, regulators, payors, media and the public. Jessie Austin

The Minnesota Pharmacist journal is published quarterly by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469. Phone: 651-697-1771 or 1-800-451-8349, 651-290-2266 fax, [email protected]. Send email address changes to Minnesota Pharmacist, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469 or email [email protected] Article Submission/advertising: For writer’s guidelines, article submission, or advertising opportunities, contact Laurie Pumper at the above address or email [email protected]. Copyright 2019-2020. Bylined articles express the opinion of the contributors and do not necessarily reflect the position of the Minnesota Pharmacists Association. Articles printed in this publication may not be reproduced in any manner, either in whole or in part, without specific written permission of the publisher. Acceptance of advertisement does not indicate endorsement.

Minnesota Pharmacist • Winter 2020 • 3 UPFRONT VIEWS AND NEWS

President’s Desk A Message from the MPhA President

By Craig Else, PharmD

I want to thank everyone who attended our Annual Learning The MPhA Board will be working with our various and Networking Event (ALNE) in October. It was great to committees to advance our strategic plan. This includes see so many enthusiastic and engaged pharmacists and four pillars: Advocacy, Membership Engagement, Practice students getting together to share stories, learn new skills Implementation and Financial Advancement. I believe each around leadership, clinical and operations, and partner in of these areas will work synergistically to support our future helping create the future of our profession. I also appreciate success. In 2019, we were very successful in our Minnesota the strong support of our many vendor partners. We had Pharmacy Alliance (MPA) partnership with the Minnesota great participation and discussions in the hallways between Society of Health-System Pharmacists (MSHP) and the sessions. Thank you finally to Sarah Derr, our executive College of Pharmacy in advancing our legislative priorities. director, and the Ewald staff (Siri Livdahl, Jill Tichy, Jenna We want to build upon this success, but also feel we need Luedtke and many others) for putting on such a great event. to increase our focus on implementation. Pharmacy practice I heard many compliments about the food and facilities and in Minnesota has not taken full advantage of past legislative everything ran smoothly. changes to improve care — and we hope to engage our membership to create education and toolkits to help our Sarah and I attended a number of Town Hall events all members succeed. over Minnesota, last fall. Meetings in St. Cloud, Duluth, Alexandria, Rochester, Braham, and Grand Rapids provided Finally, I want to thank all of you for everything you do for an opportunity for continued education and to continue your patients, your families, and yourselves. I am proud discussions on how to improve the care of our patients and to be part of this wonderful profession which has a proud ourselves. I hope to see many of you at future events. history and a bright future. I am confident our brilliant, passionate and caring members will help lead us forward.

APHA’S DELIVERING MEDICATION THERAPY MGMT. SERVICES – TWIN CITIES Friday, May 8, 2020

Facilitators: Jordan Wolf, PharmD, and Michelle Johnson, PharmD, BCACP • St. Paul

Join us for the next MTM certificate program in May. This program qualifies you to register as a provider with MN Medicaid and conduct and receive payment for Medication Therapy Management services. APhA’s Delivering Medication Therapy Management Services Certificate training program (3rd Edition) presents a systematic approach for developing, implementing, delivering, and sustaining MTM services.

REGISTER AT MPHA.ORG

4 • Minnesota Pharmacist • Winter 2020 UPFRONT VIEWS AND NEWS

Message from the Executive Director Minnesota: The Pharmacy Innovators

By Sarah Derr, Pharm D

Innovation. Collaboration. Partnership. Minnesota Public Health Partnerships pharmacies and pharmacists have prided themselves on During my short time back in Minnesota, I have also had the being innovative for decades now. I am proud to say I went pleasure of seeing pharmacists partner with the Minnesota to school in Minnesota and noticed this innovation during Department of Health. Multiple pharmacies have partnered that time at national meetings and when I worked at the on a Memorandum of Understanding around immunizations regional level for both Phi Delta Chi and the American and emergency medications should there ever be an Pharmacists Association. Minnesota is truly ahead of other outbreak in our state. states in the country. Pharmacists are also on several task forces to evaluate Moving to Iowa, I also saw innovation, but in a different way. billing codes and add pharmacists into the health care team. I am excited to see Minnesota adopting some of the new innovative work that is spreading across the country and Department of Human Services (DHS) making it their own. As I traveled the state for Town Halls Pharmacists have also been involved in the change to a in fall 2019, it was apparent that Minnesota pharmacists uniform Preferred Drug List (PDL) within both fee for understand the importance of changing the way we practice service and managed care organizations. This has been a to keep the community pharmacy doors open. smoother roll-out than initially anticipated. MPhA will work with DHS to create a survey for any issues that may arise Collaborations and partnerships continue to flourish if we see large numbers. and allow Minnesota pharmacy to continue to grow and innovate. Without these partnerships, we would not be able Medical Billing continue to be the best in pharmacy. During the 2019 legislative session, a bill was passed to allow pharmacists to administer long-acting injectables for Flip the Pharmacy and Community Pharmacy Enhanced substance use and mental health issues. These injections Services Network must be billed through the medical benefit. This provides a A new initiative in Minnesota is the Community Pharmacy great opportunity for pharmacists to have a new way to bill Enhanced Services Networks (CPESN). This initiative has for our services and opens the door to opportunities in the been funded by Flip the Pharmacy through the Community future. Pharmacy Foundation and has been successful particularly in North Carolina and Iowa. This work does look different With all of this innovation, MPhA is working hard to identify in Minnesota as we have more retail chain-based and and/or create resources to assist pharmacists in practice less independently-owned pharmacies. The Luminaries, efforts and initiatives. Please reach out if you have identified or leaders of CPESN-Minnesota, are hard at work. a gap that MPhA can help fill with education, implementation The Minnesota Luminaries include Paul Iverson, Laura or other support. Schwartzwald, Mike Schwartzwald, Jessica Astrup and Steve Simenson. There are still many areas where we can continue to innovate — including elevating technician roles, shifting to More information will be included in the next edition of the more clinical pharmacist roles, and utilizing our interns and MPhA Journal. technicians at the top of their scope. Please continue your innovative efforts and thank you for all of the work you have done already. MPhA is here to support you as we continue to innovate in pharmacy.

Minnesota Pharmacist • Winter 2020 • 5 MINNESOTA NEWS Update from the Dean Twenty Years Later — Our Time Is Now

Lynda S. Welage, PharmD, FCCP, University of Minnesota College of Pharmacy, [email protected]

Almost 20 years ago, a report to Congress indicated that there was We have not reached our goal of providing medication an imbalance of supply and demand management services in our current health care models. that had created a national shortage However, the model of value-based health care is slowly of pharmacists.1 At the time, this becoming a reality. This gives us, as pharmacists, the shortage was based on multiple chance to seize opportunities that further expand our factors including a decrease in influence. While there is a broad appreciation for the the graduation cohort due to the negative impact of suboptimal medication use, we must transition from the BS degree to work together to capitalize on solutions that will drive the entry-level PharmD degree, and demand for pharmacists’ services in a sustainable manner. a societal focus on patient safety, that had in part been At the same time, we need to address challenges in our stimulated by To Err Is Human and Crossing the Quality profession (i.e., lack of adequate reimbursement, DIR fees, Chasm, reports issued by the U.S. Institute of Medicine. the unfortunate closing of some community pharmacies, Subsequently, David Knapp launched the Pharmacy pressures to increase the volume of prescriptions processed Manpower Project (now Pharmacy Workforce Center) and which may then jeopardize quality, concerns regarding estimated that 417,000 pharmacists would be needed in lack of breaks, and burnout of pharmacists and their staff). 2020 (a deficit of ~157,000 pharmacists at that time).2 Bottom line: patients and communities need us.

Fast forward to today and 2020 is here. Recent reports from Benjamin Mays once said, “The tragedy of life is often not the Bureau of Labor Statistics (BLS) project that there will in our failure, but rather in our complacency; not in our be little or no change in the overall need for pharmacists doing too much, but rather in our doing too little; not in through 2028.3 Did the reports of the early 2000s get it our living above our ability, but rather in our living below wrong? Well, not completely. One must look closely at both our capacities.” We must not be complacent. We have to reports to better understand the situation. Twenty years work with our professional organizations, with other health ago, we predicted that the need for order fulfillment would care providers and our patients to change the profession. I decrease substantially over time because of changes in encourage everyone to become involved, participate in state technology. The recent report by the BLS draws similar and national pharmacy organizations that work to address conclusions with an estimated decline of 5.9 percent in the these issues, advocate for changes in our profession and retail pharmacy sector through 2028.2,3 The initial Pharmacy our scope of practice, and/or be creative in developing new Manpower Report predicted growth in patient care services models of care that improve the health of the people we and the most recent report by the BLS also predicts growth serve. in multiple sectors including hospitals, ambulatory care, and outpatient care centers. While we have seen substantial 1. Report to Congress on pharmacist shortage. growth (~117,600) in the pharmacy workforce, it is less 2. Knapp DA. Professionally determined need for pharmacy services in 2020. Am J Pharm Educ. 2002;66(4):421-429. http://archive.ajpe.org/ than predicted 20 years ago. This is in large part due to legacy/pdfs/aj660414.pdf the multiple pressures facing our profession and the slow 3. Bureau of Labor Statistics, U.S. Department of Labor, Occupational growth in building demand for patient care services in a Outlook Handbook, Pharmacists, financially sustainable manner. on the Internet at https://www.bls.gov/ooh/healthcare/pharmacists.htm (visited October 26, 2019).

6 • Minnesota Pharmacist • Winter 2020 MINNESOTA NEWS Minnesota Legislative Preview: Hot Issues for the 2020 Session

MPhA’s Public Affairs Committee, led by Co-chairs Tony Provider Status Post and Jeff Lindoo, has been meeting every month to While the Minnesota Pharmacy Alliance (MPA) has seen prepare for this year’s session of the Minnesota Legislature. some victories related to provider status, it is agreed More information was provided at our Minnesota Pharmacy that much remains to be addressed. The Public Affairs Legislative Day. Here are some of the issues that are being Committee will do more national research on what has discussed by legislators: been done in other states around provider status. It is likely that MPA will seek prescribing authority for pharmacists for Insulin Access and Shortages Naloxone, contraceptives and smoking cessation. Other On Dec. 18, MPhA Executive Director Sarah Derr and items related to provider status include: MPhA Public Affairs Committee co-chair Jeff Lindoo testified • Lowering or eliminating the vaccine age limit, before the Minnesota House and Senate Insulin Working • Removing the disease-specific and route-specific Group (WG) meeting. The WG is made up of three senators language in last year’s legislation allowing med and three representatives and is chaired by Rep. Michael administration, Howard (DFL) and Senator Eric Pratt (R). The December • Removal of parameters around refills and the 30-day meeting was the first public meeting held by the group. limitation in last year’s opioid legislation. The Legislature has been trying since the 2019 legislative • Considering how telemedicine/telepharmacy could look session to help patients be able to afford their insulin. in the future compared to the current state. There was no agreement last session on how to solve • Prescriptive authority for opiod antagonists, smoking the affordability problem for a subset of patients who use cessation and hormonal contraceptives insulin. Medication Repository Several legislators worked over the summer and into the During the 2019 legislative session, a bill passed and fall to craft a legislative solution. The WG is discussing both was signed into law allowing for a medication repository an emergency and a long-term insulin patient assistance to be set up in Minnesota. In the coming session of the program. The program would be set up to resolve the issue legislature, financial support will be pursued. The Alliance of patients being unable to afford their insulin medication. will seek $250,000 per year to subsidize establishment of Derr and Lindoo spoke about the importance of keeping and operation of medication repository that was created by the dispensing of medications in the pharmacy rather than the legislature last year. at the clinic, as is envisioned in the Senate’s long-term program language. Lindoo spoke about the systems that Pharmacogenomics pharmacies have set up and why pharmacists are best This initiative from the University of Minnesota College positioned to dispense insulin. Several patients focused of Pharmacy would establish a pharmacogenomics their testimony during the public commentary portion of the task force to explore the development of a statewide meeting on the importance of keeping dispensing in the pharmacogenomic database to be used by all health care pharmacy. providers to customize/personalize medication therapy.

COMPLIMENTARY ON-DEMAND VIRTUAL COFFEE BREAK WEBINARS AVAILABLE TO MPHA MEMBERS

VISIT WWW.MPHA.ORG TO LISTEN TODAY!

Minnesota Pharmacist • Winter 2020 • 7 MINNESOTA NEWS MPPS Seeks and Welcomes New Members The Minnesota Professional Pharmacists Society (MPPS) include lunch (pay for your own) and a presentation typically is an organization for senior pharmacists to meet, share eligible for State Board CE credit. Meetings are held the camaraderie and maintain old friendships. The roots of third Tuesday of each month with members gathering at MPPS go back to the early 1930s (and likely earlier) 11:30 a.m. for sign-in and menu selection, lunch is served when two organizations (Minneapolis Veteran Druggists around noon, and the program starts about 12:30 p.m. Association and the St. Paul Veteran Druggists Association) Current officers are: Bob Nordin, President; Dick Mandt, were active. MPPS welcomes pharmacists and others who Administrator; and Sandra Newhouse/Leslie Prahl sharing worked in the broad pharmacy industry to join the group. Treasurer duties. Dues are $35 per year. Please join us! The organization meets monthly at the Knights of Columbus Hall/Bloomington Event Center in Bloomington (1114 It is suggested you confirm the meeting date before your American Blvd W, near I-494 and Lyndale). Our meetings first visit. [email protected] Pharmacy Time Capsule

By Dennis B. Worthen, PhD, Cincinnati, Ohio 1994 1944 The average price for a generic prescription was $14.18 Gamma globulin used as a preventive for measles was and brand name was $37.37. Payors for prescription were: made available to civilians for the first time through the Red 19.6% government programs, 30.5% private insurance, Cross and health departments. 49.4% out of pocket. Experiments were undertaken using whole communities in Oklahoma Congressman and pharmacist Bill Brewster controlled large-scale experiments to determine whether introduced the Pharmacy Compounding Preservation Act tooth decay can be prevented by adding minute amounts of of 1994 to guarantee the ability of licensed pharmacists to fluorine to the drinking water. conduct the practice of compounding subject to applicable State and Federal laws. No action was taken but attention One of a series contributed by the American Institute of the was drawn to the need to protect the traditional duty to History of Pharmacy, a unique non-profit society dedicated prepare medicines. to assuring that the contributions of your profession endure as a part of America’s history. Membership offers 1969 the satisfaction of helping continue this work on behalf of Initiation of the Drug Efficacy Study Implementation (DESI) pharmacy, and brings five or more historical publications to by the National Research Council’s Division of Medical your door each year. Sciences, to evaluate the medical effectiveness of 3,000- 4,000 drugs introduced between 1938 and 1962. To learn more, check out: www.aihp.org

MPHA UPCOMING WEBINARS

April 15, 2020 - Payment Opportunities for Pharmacists Delivered Patient Care, CPESN MN Clinically Integrated Patient Care - Presenter: Steve Simenson, BPharm, FAPhA, FACA, DPNAP

8 • Minnesota Pharmacist • Winter 2020 MPhA NEWS Help Us Recognize Today’s Leaders in Pharmacy

The Minnesota Pharmacists Association continuously hears • Participation in national pharmacy associations, of pharmacy professionals who go above and beyond professional programs, state association activities and/ in advancing the profession and patient care. Help us or community service. recognize the profession’s leaders and by nominating a colleague for one of these awards. Nominations may be Excellence in Innovation Award submitted any time before July 1. Take a few minutes now Sponsored by Upsher-Smith Laboratories, Inc., the to think about a member who does outstanding work and Excellence in Innovation Award recognizes innovative start to formulate your nomination. pharmacy practice resulting in improved patient care. This award is presented at the MPhA Annual Learning Ideal nominations include a statement of support from the Networking Event. nominator and any additional supporting letters from other peers, co-workers, or community members. Recipients Demonstrates innovative pharmacy practice resulting in should be MPhA members and not have previously been improved patient care. awarded in the category in which they are being nominated. Pharmacy Advocate Award Bowl of Hygeia Award Presented by MPhA, the Pharmacy Advocate Award Sponsored by the American Pharmacists Association recognizes a pharmacist, student pharmacist, or pharmacy Foundation and the National Alliance of State Pharmacy technician in any practice setting who demonstrate Associations with support from Boehringer Ingelheim, leadership through participation in community service, or the Bowl of Hygeia recognizes pharmacists who possess by developing procedures that contribute to patient safety, outstanding records of civic leadership in their own or though other contributions that are significant to the communities. This award is presented at the MPhA Annual profession of pharmacy. This award is presented at the Learning Networking Event. MPhA Annual Learning Networking Event.

The Bowl of Hygeia symbol derives from Greek mythology Pharmacy Technician Award and is the most widely recognized international symbol Presented by MPhA, the Pharmacy Technician Award of pharmacy. Hygeia was the daughter and assistant of recognizes pharmacy technicians in any practice setting Aesculapius (sometimes spelled Asklepios), the God of who demonstrate leadership in their work and in their Medicine and Healing. Her classical symbol was a bowl community. This award is presented at the MPhA Annual containing a medicinal potion with the serpent of Wisdom Learning Networking Event. (or guardianship) partaking it. This is the same serpent Currently practices as a pharmacy technician in any of Wisdom that appears on the caduceus, the staff of pharmacy practice setting in the year selected. Aesculapius, which is the symbol of medicine. Demonstrates professionalism by participation in pharmacy Outstanding record of community service, from which their association, professional programs and/or community specific identification as a pharmacist reflects well on the service. profession. Promotes teamwork within the pharmacy, provides Cannot be currently serving (or served in past two years) as leadership and serves as a role model for coworkers. an officer of the association other than ex-officio. Develops or assists development of efficient safe procedures that support the provision of pharmaceutical Distinguished Young Pharmacist Award care. Sponsored by Pharmacists Mutual Companies, the Harold R. Popp Award – Sponsored by MPhA, the Popp Distinguished Young Pharmacist Award recognizes a young award was established in 1969 in honor of the late Senator pharmacist who has distinguished themself in the field of Harold R. Popp to recognize one pharmacist annually for pharmacy. This award is presented at the MPhA Annual their outstanding service to the profession of pharmacy. Learning Networking Event. This is the highest honor bestowed by the association. This award is presented at the MPhA Annual Learning • Entry level degree in pharmacy received less than ten Networking Event. years ago. • Practice community, institutional, managed care or consulting pharmacy in the year selected.

Minnesota Pharmacist • Winter 2020 • 9 Now In patients who have T2D and diabetic nephropathy (ie, DKD*) Approved INVOKANA® 100 mg is the only SGLT2i proven to slow the progression of DKD by the FDA and reduce the risk of HHF1-4 Reduced the primary composite endpoint Reduced the risk of hospitalization in the landmark CREDENCE trial5: for heart failure:

• End-Stage Kidney Disease† • Hospitalization for || 30% (dialysis, transplant, or eGFR <15) 39% Heart Failure • Doubling of § RRR Serum Creatinine RRR HR=0.70 • Renal Death‡ HR=0.61 (95% CI: 0.59, 0.82); (95% CI: 0.47, 0.80); P=0.00001 • CV Death P<0.001 INVOKANA® is the only SGLT2i to demonstrate a proven safety profile in patients with an eGFR of 30 to <901 • Similar overall adverse events were seen in the CREDENCE trial with INVOKANA® vs placebo (35.1 vs 37.9 per 100 patient years), except for DKA and male GMI. No imbalance in fracture or amputation. Hypotension incidence was 2.8% vs 1.5%, respectively • INVOKANA® 100 mg can be initiated in patients with an eGFR as low as 30* In the CREDENCE trial, patients with an eGFR <30 continued until dialysis INVOKANA® (canagliflozin) is the only T2D therapy approved by the FDA to reduce the risk of end-stage kidney disease (ESKD), doubling of serum creatinine, cardiovascular (CV) death, and HHF in adults with T2D and diabetic nephropathy with albuminuria >300 mg/day.1

* With albuminuria >300 mg/day. Initiate INVOKANA® 100 mg once daily for patients with DKD* and T2D¹ † End-stage kidney disease was defined as dialysis for≥ 30 days, kidney transplantation, or an eGFR <15 mL/min/1.73 m2 sustained for ≥30 days. Initiate ‡There were not enough events to evaluate the risk of renal death (placebo, n=5; INVOKANA®, n=2). INVOKANA® is not indicated to reduce the risk of renal death. §RRR was calculated using the following formula: 100 x (1–HR). eGFR ≥30 with albuminuria >300 mg/day || 100 mg Prespecified secondary endpoint. once daily Patients already on INVOKANA® whose eGFR is less than 30 with albuminuria >300 mg/day can continue on Study design 100 mg once daily. CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) was a randomized, double-blind, parallel group, multicenter, event-driven clinical trial. The trial compared the effects of INVOKANA® (canagliflozin) 100 mg vs placebo in 4401 men and women with type 2 diabetes and diabetic kidney disease (described as chronic kidney disease In the CREDENCE trial, patients continued on INVOKANA® 100 mg until initiation of dialysis. 2 with eGFR 30 to <90 mL/min/1.73m and albuminuria [ratio of albumin to creatinine >300 to 5000 INVOKANA® is contraindicated in patients with an eGFR <30 who are being treated for glycemic mg/g]), who were already taking a stable, maximum-tolerated or labeled dose (for ≥4 weeks prior control and in patients on dialysis. to randomization) of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). The mean eGFR of patients was 56.2 mL/min/1.73 m2 and the median urinary In patients with an eGFR ≥60 needing additional glycemic control, the dose can be increased to 300 mg 1 albumin-to-creatinine ratio was 927 mg/g. The primary efficacy outcome for these analyses was the once daily. composite of end-stage kidney disease (dialysis, transplant, or eGFR <15 mL/min/1.73 m2), doubling CI=confidence interval; CV=cardiovascular; DKA=diabetic ketoacidosis; DKD=diabetic kidney disease; of serum creatinine, or renal or cardiovascular (CV) death. Prespecified secondary outcomes eGFR=estimated glomerular filtration rate; ESKD=end-stage kidney disease; FDA=U.S. Food and Drug included a composite of CV death or hospitalization for heart failure; a composite of heart attack, Administration; GMI=genital mycotic infection; HHF=hospitalization for heart failure; HR=hazard ratio; stroke, or CV death; hospitalization for heart failure; and a composite of end-stage kidney disease, RRR=relative risk reduction; SGLT2i=sodium-g|ucose co-transporter 2 inhibitor; T2D=type 2 diabetes. doubling of the serum creatinine level, or renal death. INVOKANA® (canagliflozin) is indicated: • as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus • to reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease (CVD) • to reduce the risk of end-stage kidney disease (ESKD), doubling of serum creatinine, cardiovascular (CV) death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria >300 mg/day INVOKANA® is not recommended in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. IMPORTANT SAFETY INFORMATION WARNING: LOWER-LIMB AMPUTATION • An increased risk of lower-limb amputations associated with INVOKANA® use versus placebo was observed in CANVAS (5.9 vs 2.8 events per 1000 patient-years) and CANVAS-R (7.5 vs 4.2 events per 1000 patient-years), two large, randomized, placebo-controlled trials in patients with type 2 diabetes who had established cardiovascular disease (CVD) or were at risk for CVD. • Amputations of the toe and midfoot were most frequent; however, amputations involving the leg were also observed. Some patients had multiple amputations, some involving both limbs. • Before initiating, consider factors that may increase the risk of amputation, such as a history of prior amputation, peripheral vascular disease, neuropathy, and diabetic foot ulcers. • Monitor patients receiving INVOKANA® for infection, new pain or tenderness, sores, or ulcers involving the lower limbs, and discontinue if these complications occur. CONTRAINDICATIONS WARNINGS and PRECAUTIONS • Serious hypersensitivity reaction to INVOKANA® • Lower-Limb Amputation: An increased risk of lower-limb amputations associated with INVOKANA® use versus placebo was observed in CANVAS (5.9 • Patients with severe renal impairment (eGFR <30 mL/min/1.73 m2) who are being vs 2.8 events per 1000 patient-years) and CANVAS-R (7.5 vs 4.2 events per 1000 treated for glycemic control patient-years), two randomized, • Patients on dialysis placebo-controlled trials evaluating Please see additional Important Safety Information and accompanying full Prescribing Information, including Boxed WARNING, and Medication Guide, or visit www.InvokanaHCP.com/PI. IMPORTANT SAFETY INFORMATION (cont’d) WARNINGS and PRECAUTIONS (cont’d) • Bone Fracture: Increased risk of bone fracture, occurring as early as 12 weeks after patients with type 2 diabetes who had either established cardiovascular disease treatment initiation, was observed in patients using INVOKANA®. Prior to initiation, or were at risk for cardiovascular disease. The risk of lower-limb amputations was consider factors that contribute to fracture risk. observed at both the 100-mg and 300-mg once-daily dosage regimens. DRUG INTERACTIONS Amputations of the toe and midfoot (99 out of 140 patients with amputations • UGT Enzyme Inducers: Co-administration with rifampin lowered INVOKANA® receiving INVOKANA® in the two trials) were the most frequent; however, exposure, which may reduce the efficacy of INVOKANA®. For patients with eGFR amputations involving the leg, below and above the knee, were also observed ≥60 mL/min/1.73 m2, if an inducer of UGTs (eg, rifampin, phenytoin, phenobarbital, (41 out of 140 patients with amputations receiving INVOKANA® in the two trials). ritonavir) is co-administered with INVOKANA®, increase the dose to 200 mg (taken Some patients had multiple amputations, some involving both lower limbs. as two 100 mg tablets) once daily in patients currently tolerating INVOKANA® 100 mg. The dose may be increased to 300 mg once daily in patients currently Lower-limb infections, gangrene, and diabetic foot ulcers were the most common tolerating INVOKANA® 200 mg and who require additional glycemic control. precipitating medical events leading to the need for an amputation. The risk of For patients with eGFR <60 mL/min/1.73 m2, if an inducer of UGTs is co-administered amputation was highest in patients with a baseline history of prior amputation, with INVOKANA®, increase the dose to 200 mg (taken as two 100 mg tablets) once peripheral vascular disease, and neuropathy. daily in patients currently tolerating INVOKANA® 100 mg. Consider adding another Before initiating, consider factors in the patient history that may predispose antihyperglycemic agent in patients who require additional glycemic control. to the need for amputations, such as a history of prior amputation, peripheral • Digoxin: There was an increase in the AUC and mean peak drug concentration of vascular disease, neuropathy, and diabetic foot ulcers. Counsel patients about digoxin when co-administered with INVOKANA® 300 mg. Monitor appropriately. the importance of routine preventative foot care. Monitor patients for signs and symptoms of infection (including osteomyelitis), new pain or tenderness, sores, or • Positive Urine Glucose Test: Monitoring glycemic control with urine glucose tests ulcers involving the lower limbs, and discontinue if these complications occur. is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control. • Hypotension: INVOKANA® causes intravascular volume contraction. Symptomatic hypotension can occur after initiating INVOKANA®, particularly in the elderly, and • Interference With 1,5-Anhydroglucitol (1,5-AG) Assay: Monitoring glycemic in patients with impaired renal function, low systolic blood pressure, or on diuretics control with 1,5-AG assay is not recommended in patients taking SGLT2 inhibitors. or medications that interfere with the renin-angiotensin-aldosterone system. Use alternative methods to monitor glycemic control. Before initiating INVOKANA®, volume status should be assessed and corrected. USE IN SPECIFIC POPULATIONS Monitor for signs and symptoms after initiating. • Pregnancy: INVOKANA® is not recommended in pregnant women, especially • Ketoacidosis: Ketoacidosis, a serious life-threatening condition requiring urgent during the second and third trimesters. hospitalization, has been identified in patients with type 1 and 2 diabetes mellitus • Nursing Mothers: INVOKANA® is not recommended while breastfeeding. receiving SGLT2 inhibitors, including INVOKANA®. Fatal cases of ketoacidosis have been reported in patients taking INVOKANA®. Before initiating INVOKANA®, • Pediatric Use: Safety and effectiveness in patients <18 years of age have not been consider factors in patient history that may predispose to ketoacidosis. Monitor for established. ketoacidosis and temporarily discontinue in clinical situations known to predispose • Geriatric Use: Patients ≥65 years had a higher incidence of adverse reactions to ketoacidosis. related to reduced intravascular volume, particularly with the 300-mg dose; more • Acute Kidney Injury: INVOKANA® causes intravascular volume contraction prominent increase in the incidence was seen in patients who were ≥75 years. and can cause acute kidney injury. Acute kidney injury, requiring hospitalization Smaller reductions in HbA1c relative to placebo were seen in patients ≥65 years. and dialysis, has been reported. Initiation of INVOKANA® may increase serum • Renal Impairment: The efficacy and safety of INVOKANA® for glycemic control creatinine and decrease eGFR. Before initiation, consider factors that may were evaluated in a trial that included patients with moderate renal impairment predispose patients to acute kidney injury. Consider temporarily discontinuing (eGFR 30 to <50 mL/min/1.73 m2). These patients had less overall glycemic efficacy, INVOKANA® in any setting of reduced oral intake or fluid losses; monitor patients and patients treated with 300 mg per day had increases in serum potassium, which for signs and symptoms of acute kidney injury. If it occurs, promptly discontinue were transient and similar by the end of the study. Patients with renal impairment and treat. Evaluate renal function prior to initiation and monitor periodically using INVOKANA® for glycemic control may be more likely to experience thereafter. hypotension and may be at a higher risk for acute kidney injury. INVOKANA® is • Urosepsis and Pyelonephritis: Serious urinary tract infections, including urosepsis contraindicated in patients with ESKD on dialysis. and pyelonephritis, requiring hospitalization have been reported in patients • Hepatic Impairment: INVOKANA® has not been studied in patients with severe receiving SGLT2 inhibitors, including INVOKANA®. Treatment with SGLT2 inhibitors hepatic impairment and is not recommended in this population. increases this risk. Evaluate for signs and symptoms and treat promptly. OVERDOSAGE • Hypoglycemia With Concomitant Use With Insulin and Insulin Secretagogues: • In the event of an overdose, contact the Poison Control Center and employ the INVOKANA® can increase the risk of hypoglycemia when combined with insulin usual supportive measures. or an insulin secretagogue. A lower dose of insulin or insulin secretagogue may be required. ADVERSE REACTIONS • The most common adverse reactions associated with INVOKANA® (5% or greater • Necrotizing Fasciitis of the Perineum (Fournier’s Gangrene): Necrotizing incidence) were female genital mycotic infections, urinary tract infections, and fasciitis of the perineum, a rare but serious and life-threatening necrotizing increased urination. cp-68813v3 infection requiring urgent surgical intervention, has been identified in postmarketing surveillance in female and male patients with diabetes mellitus Please see accompanying full Prescribing Information, including Boxed WARNING, and Medication Guide, or visit www.InvokanaHCP.com/PI. receiving SGLT2 inhibitors, including INVOKANA®. Serious outcomes have included hospitalization, multiple surgeries, and death. If suspected, start References: 1. INVOKANA® [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc. 2. Jardiance® [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. 3. Farxiga® treatment immediately with broad-spectrum antibiotics and, if necessary, surgical [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP. 4. SteglatroTM [prescribing debridement. Discontinue INVOKANA®. information]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. 5. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. • Genital Mycotic Infections: INVOKANA® increases risk of genital mycotic N Engl J Med. 2019;380(24):2295-2306. infections, especially in uncircumcised males or patients with prior infections. Monitor and treat appropriately. • Hypersensitivity Reactions: Hypersensitivity reactions, including angioedema and anaphylaxis, were reported with INVOKANA®; these reactions generally occurred within hours to days after initiation. If reactions occur, discontinue INVOKANA®, treat, and monitor until signs and symptoms resolve.

Janssen Pharmaceuticals, Inc. Canagliflozin is licensed from Mitsubishi Tanabe Pharma Corporation.

© Janssen Pharmaceuticals, Inc. 2019 September 2019 cp-103427v1 MPhA NEWS MPhA’s ALNE Celebrates Another Success

Many thanks to everyone who attended the 2019 Annual Our exhibit hall was busy with more than 30 exhibit tables. Learning Networking Event! We welcomed more than 160 We greatly appreciate the support of our sponsors and people and more than 30 sponsors and exhibitors. Our exhibitors! deep appreciation to all of the presenters who provided valuable information and kept attendees engaged. Don’t forget to follow us on Instagram @minnpharmassoc and on Facebook for more photos!

The Roundtable sessions are a popular part of the ALNE agenda. Here, Paull Rukavina is shown leading a session on the changing landscape of diabetes therapy to reduce cardiovascular risk.

Our opening keynote session brought together a diverse mix of student pharmacists and those further along the career path, and from varied pharmacy settings, to share Thanks to the following sponsors and perspectives. Thanks to President Craig Else for leading the exhibitors! session! Educational Grant Sponsor: Pfizer

Lunch Sponsor: University of Minnesota College of Pharmacy

Coffee Sponsor: National Association of Chain Drug Stores

Silver Sponsors: Amgen • Anda • Arkray USA, Inc. • AstraZeneca Diabetes • Janssen Pharmaceutical Companies • Lilly USA, LLC • Merck Vaccines • Novo Nordisk • Upsher Smith Laboratories MPhA’s ALNE brings together pharmacists, student pharmacists, pharmacy technicians and others from all parts Exhibitors: Abbvie • Allergan • AmeriSourceBergen of Minnesota. • Amgen • Boehringer Ingelheim Pharmaceuticals • Bristol-Myers Squibb • Gilead Sciences • IntegraDose Compounding • Janssen Neuroscience/Johnson & Johnson • McKesson • Merck & Co., Inc. • Minnesota Board of Pharmacy • Minnesota Department of Health • Minnesota Pharmacy Student Alliance • Mylan • Pfizer Vaccines • Pharmacists Mutual Companies • Sage Therapeutics • Sharps Free • SpartanNash • Tabula Rasa Healthcare • Teva Pharmaceuticals

12 • Minnesota Pharmacist • Winter 2020 MPhA NEWS

MPhA Celebrates Award Recipients at Pharmacy Technician Award – Julie Schumacher of Welia Health in Pine City was honored for exhibiting ALNE professionalism both in the pharmacy and in her community The tradition of recognizing pharmacists who contribute their every day. She’s worked as a pharmacy technician in her time and expertise to their profession is near and dear to hometown for 20 years, and her passion for athletics has MPhA. We were honored to present the following awards as also led her to volunteer her time to help shape youth part of our Annual Learning Networking Event: athletics. Her nominator states, “she holds the profession to a high standard few can compete with and does this Distinguished Young Pharmacist Award (sponsored willingly without expectation of recognition.” by Pharmacists Mutual) – Tony Olson of the University of Minnesota College of Pharmacy, Duluth, was recognized for Harold R. Popp Award – Patricia Lind of Welia Health in his service to MPhA as a board member, Speaker and Vice Mora (formerly with the University of Minnesota College of Speaker of the House, and committee co-chair. Tony also Pharmacy) received the 50th annual Popp award for her has served APhA in multiple capacities, going back to his unmatched mix of pharmacy leadership, mentoring and time as a student. community service. She’s also been recognized as Teacher of the Year and Teacher of the Semester at the COP, as an Excellence in Innovation Award (sponsored by Upsher MPhA Bowl of Hygeia recipient, for Innovations in Teaching Smith Laboratories) – Joe Dvorak of Welia Health in Pine by the American Association of Colleges of Pharmacy, and City was honored for his innovations that ensure valuable by APhA for her innovations in medical coding. resources are going to patients in need and create an avenue for underserved patients to receive needed Distinguished Service Award – Jim Alexander of the medications. He is in charge of two community pharmacies Pharmacists Recovery Network in Minneapolis received that provide services that are rarely offered in rural areas. this new award from MPhA to recognize his many years Joe is working alongside other influential pharmacists on of service in mentoring pharmacy students and as an expanding the Community Pharmacy Enhanced Services advocate for preventing chemical dependency and abuse in Network to bring a higher level of pharmacy services pharmacists. For two decades, he has annually organized through independent pharmacies in Minnesota. recovering pharmacist presentations for pharmacy classes. Congratulations to all of our award recipients! Pharmacy Advocate Award – Rowan Mahon, a student at the University of Minnesota College of Pharmacy, Twin Cities was recognized for her tireless work during the 2019 session of the Minnesota Legislature to ensure that legislation was passed into law to allow Minnesota to operate a medication repository. She brought together students, pharmacists, professional organizations and legislators to create positive change for our profession.

SAVE THE DATE! The 2020 ALNE will be held Oct. 1-2 at the Minneapolis Marriott Northwest

Minnesota Pharmacist • Winter 2020 • 13 NATIONAL NEWS National and State Associations Submit Joint Comments to CMS on Scope of Practice From National Alliance of State Pharmacy Associations, published Jan. 2, 2020

In January, 47 state pharmacy associations and the National on optimizing medication use and health outcomes as part Alliance of State Pharmacy Associations (NASPA) joined of coordinated care delivery including pharmacists. several other national associations (including the American Ensure pharmacists can engage in remote patient Pharmacists Association, the American Association of monitoring and other telehealth services. Colleges of Pharmacy and the National Community Pharmacists Association) and state health-system Specific Recommendations pharmacy societies in submitting comments regarding Implement a general supervision requirement vs. direct the Centers for Medicare and Medicaid Services’ request supervision for services delivered by highly trained for input on Executive Order #13890, “Protecting and pharmacists. Improving Medicare for our Nation’s Seniors.” The signing Align Medicare service requirements with the most robust organizations requested CMS include the following changes pharmacist state scopes of practice. in agency regulations, programs, and policies to implement Clarify physicians and other qualified practitioners can bill the charges outlined in the Executive Order: for “incident to” services provided to Medicare beneficiaries by pharmacists at levels higher than E/M code 99211. General Recommendations Address challenges for pharmacists and pharmacies to Use inclusive provider language in rulemakings, programs, deliver DSMT services and continuous glucose monitoring and policies to ensure pharmacist inclusion to support services. medication optimization and improve patient outcomes. Allow pharmacist-initiated electronic prior authorization. Issue a Center for Medicaid & CHIP Services Information Allow pharmacists to be DATA-waived providers by including Bulletin where payers could utilize pharmacists to better as qualified practitioners. address needs for patients. Attribute and promote significant contributions of Read the final joint comments document. pharmacists to health outcomes of Medicare beneficiaries. Expand service models utilizing pharmacist-provided patient care services using CMS Center for Medicare and Medicaid Innovation data, including in value-based payment models by employing CMMI’s waiver authority. Incorporate and/or test an alternative model at CMMI in rural and medically underserved areas/populations focusing

ALLIED AGAINST OPIOID ABUSE NATIONAL CONSUMERS LEAGUE TOOLKIT

The AAOA-NCL Consumer Toolkit addresses common questions that patients may have about their rights, risks and responsibilities associated with prescription opioids, and highlights facts about opioid medications to raise awareness about misinformation and prevent misuse before it occurs. The toolkit includes the following materials: • “Ten Things Consumers Should Know About Opioids” • “Myths and Facts About Opioids” • “Frequently Asked Questions About Opioids” • “What You Can Do to Prevent Opioid Misuse and Abuse.”

14 • Minnesota Pharmacist • Winter 2020 CLINICAL NEWS Updates to Gender-Affirming Pharmacotherapy: A Summary of Guideline Recommendations Megan Waibel, 4th Year Student Pharmacist – University of Minnesota College of Pharmacy

In light of the recent addition of compendia indications Table 1. Long-acting GnRH analogs for pubertal for puberty-suppressing and sex hormone therapies to suppression in adolescents (bolded drugs have adolescent Micromedex, increased coverage for pharmacotherapy is indications in Micromedex for gender dysphoria).1,2,7,8 imminent for persons with gender dysphoria. A review of Agent Dosing Recommendation these therapies is warranted to best serve our patients who Histrelin acetate (Supprelin Subcutaneous (SC) implant may now have means to pursue gender confirmation. This LA)7,8 Children ≥ 2 years old article is an integrated compilation of the leading guidelines • 50 mg implant inserted and recommendations in pharmacotherapy for transgender/ surgically every 12 months non-binary care (Endocrine Society [ES] 2017, World (releasing about 65 mcg/ Professional Association for Transgender Health [WPATH] day) 2012, and UCSF Center for Excellence 2016). Leuprolide acetate (Lupron Intramuscular (IM) depot CARE FOR ADOLESCENTS WITH GENDER DYSPHORIA/ Depot-Ped)1,5,8 injection every 4 weeks NON-CONFORMITY Initial dosing: • Patients weighing ≤ 25 kg: Pubertal Suppression 7.5 mg Pubertal suppression is the first stage in pharmacotherapy • Patients weighing > 25 kg: for adolescents with gender dysphoria/non-conformity. This 11.25 mg Titrate by 3.75 mg every 4 stage is also fully reversible and allows the adolescent weeks (about 10 mcg/kg/ and parent(s) and/or guardian(s) time to halt endogenous day) as needed to achieve puberty before reaching a decision to begin the gender adequate suppression transition. Endocrine Society, WPATH, and UCSF guidelines IM depot injection every 12 all recommend starting pubertal suppression at Tanner weeks Stage 2, which can be as early as age 9 and as late as • 11.25 mg age 14. Pubertal suppression has the greatest efficacy at • 22.5 mg this stage in preventing the development of secondary sex • 30 mg characteristics and promoting psychological well-being; No established recommen- however, suppression started at later stages may still dations for dosage prevent some unwanted effects of endogenous puberty.1,2,3 Goserelin acetate (Zola- SC implant (anterior ab- 6,8 Pubertal suppression is ideally achieved through the use dex) dominal wall) of gonadotropin-releasing hormone (GnRH) analogs, • 3.6 mg every 4 weeks which suppress luteinizing hormone (and downstream • 10.8 mg every 12 weeks sex hormone) secretion.1,2,3 In the United States, these More frequent injections may be needed in some include drug products containing histrelin, leuprolide, patients goserelin, and triptorelin. Table 1 outlines the dosing recommendations for each agent. It is important to note that Triptorelin pamoate (Trel- IM depot injection only triptorelin has a listed adolescent compendia indication star)4 • 3.75 mg every 2 weeks x for pubertal suppression in gender dysphoria, although 3 doses -> 3.75 mg every goserelin and leuprolide have this indication in adults as 4 weeks thereafter adjunct therapy.4,5,6 The recommendations listed below for histrelin, leuprolide, and goserelin are the same for central precocious puberty, for which they have historically been Other alternatives for pubertal suppression include depot 1,2,8 used. Doses should be titrated to clinical effect based on and oral progestins, and other anti-androgens (such as 1,2 physical examination and lab monitoring. spironolactone). These agents are not as effective as Minnesota Pharmacist • Winter 2020 • 15 Updates to Gender-Affirming... continued CLINICAL NEWS

GnRH analogs, but will still somewhat suppress pubertal is accomplished with testosterone esters. Intramuscular hormones. Progestins may potentially cause depression, (IM) injectable formulations are recommended due to weight gain and unfavorable lipid changes; they may cost and available safety data.1,2 However, many patients also increase the risk of breast cancer and adverse have been self-injecting IM formulations subcutaneously cardiovascular events (especially medroxyprogesterone). (SC) with great success.1,2 Caution should be used when Spironolactone has the potential for hyperkalemia due to its prescribing injectable testosterone as patients may have potassium-sparing diuretic effect.1,2 allergies to the specific oils used for suspension.2 It should be noted that the testosterone undecanoate formulation, Although these agents are often initiated as pubertal specifically, has an associated REMS program and patients suppression, they are also useful in suppressing must be administered the injection in a health care facility endogenous hormones throughout the life of transgender/ and monitored for 30 minutes following injection.10 There non-binary persons. Their continued role will be discussed are also transdermal and SC auto-injectable formulations further in the “Pubertal Induction” section. available. The SC auto-injection hides the needle and is easier to dose than traditional IM formulations.9 Transdermal Side effects of pubertal suppression may include: products (such as gels and patches) avoid the needle slowed bone mineralization, compromised fertility (if altogether, but it should be noted that testosterone patches subsequently treated with sex hormones), increased fat can cause adverse skin reactions.1,2 mass and decreased lean body mass, weight gain, arterial hypertension, irregular vaginal bleeding, hot flashes, fatigue Whether administering estradiol or testosterone, it is and mood alterations. Due to the risk for osteoporosis/ recommended to carefully titrate therapy to best mimic osteopenia, adequate supplementation with calcium endogenous puberty.1,2,3 There are a variety of viewpoints and vitamin D3, as well as weight-bearing activity, is that support titrating doses every six months to mimic recommended. The Endocrine Society and UCSF Center for Tanner Stages, or as little as every 8-12 weeks to help get Excellence guidelines provide specific recommendations for patients up to speed with their pubertal peers.1,2 Titration adolescent monitoring during pubertal suppression in three timelines should be carefully considered in partnership main categories: growth/development, lab values and bone with the patient, especially because some secondary sex health.1,2 characteristics can take years to fully develop.1,2,3 ES and UCSF guidelines provide detailed titration schedules based Pubertal Induction (Sex Hormone Therapy) on specific sex hormone formulations, as seen in Table Pubertal induction is partially reversible and is the next 2.1,2 Use of testosterone gel has also been studied in the step in therapy for adolescents with gender dysphoria. adolescent population by Gomez, et al., as seen in Table While some effects of hormone therapy may be reversed, 2.11 Maintenance doses should be adjusted and titrated to some effects may not (such as lowered vocal resonance mimic desired physiologic testosterone and estrogen levels or gynecomastia). In addition, if sex hormone therapy (400-700 ng/dL and 100-200 pg/mL, respectively).1 For is started late in puberty or post-puberty, already- recommendations once adult doses have been reached, developed secondary sex characteristics may not be see Table 3. reversed. This step normally takes place by the age of 16 (or sooner). Prolonging pubertal suppression without As previously discussed, pubertal suppression therapy initiating sex hormone therapy increases social anxieties of should be continued to smooth transition and prevent maintaining a pre-pubertal physical appearance and also the use of supraphysiologic sex hormone doses. This increases the risk of bone disease (as sex hormones are decreases the risk of adverse events such as VTE (from essential for increasing bone mineral density throughout long-term high-dose estrogen use) or erythrocytosis (from development).1,2,3 long-term high-dose testosterone use). Estrogen, especially, is not sufficient (at physiologic doses) to suppress Estradiol (E2) and testosterone (T) are the primary endogenous testosterone levels. Therefore, in patients with agents in pubertal induction. Induction of female puberty male genitalia, it is recommended to continue endogenous is accomplished with estradiol. Oral or transdermal hormone suppression via GnRH analogs (or spironolactone) formulations are recommended due to ease of until gonadectomy. In patients with female genitalia, administration and titration; however, injectable formulations it is recommended to continue endogenous hormone are also available.1,2 Ethinyl estradiol is not recommended suppression until sufficient levels of testosterone are due to an elevated risk of VTE.1,2 Induction of male puberty reached (with about three months of overlap), and possibly

16 • Minnesota Pharmacist • Winter 2020 Updates to Gender-Affirming... continued CLINICAL NEWS continued for menstrual suppression. Progesterone may be and aggression.1,2 Patients taking spironolactone should continued, as indicated, in order to suppress menstruation, be monitored for nocturia, polyuria and hyperkalemia.1,2 prevent pregnancy, and relieve dysphoria. Figures 1 and 2 The Endocrine Society guidelines provide specific outline the desired timeline for initiation and discontinuation recommendations for adolescent monitoring during of agents for male-to-female and female-to-male transitions, pubertal induction in generally the same three categories respectively.1,2,3 of monitoring as seen with pubertal suppression: growth/ development, lab values and bone health.1 Side effects of pubertal induction are similar to the effects of endogenous puberty. For estrogen, these may tenderness and swelling.1,2 For testosterone, these may include: injection site reactions, headache, hyperlipidemia,

Figure 1. Male-to-female standard therapy.

Figure 2. Female-to-male standard therapy.

Updates to Gender-Affirming... continued on page 19

Minnesota Pharmacist • Winter 2020 • 17 A continuous quality improvement program can be a lifesaver! MAKE YOUR PATIENTS AND YOUR PHARMACY SAFER.

FOR LESS THAN A DOLLAR A DAY ... • Increase patient safety – learn from collected safety data and online resources • Maintain compliance – meet accreditation, credentialing, PBM and state QA requirements • Reduce costs – increase operations efficiency, reduce potential risk and cut down on “re-do” Rxs • Safeguard your data – Patient Safety Organizations offer confidentiality and legal protection

Learn more at www.medicationsafety.org or call us at (866) 365-7472. The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO). 18 • Minnesota Pharmacist • Winter 2020 Updates to Gender-Affirming... continued from page 17 CLINICAL NEWS

CARE FOR TRANSGENDER ADULTS Pharmacotherapy for Transgender Females Gender-affirming therapy for transgender females includes For many transgender adults, initiation of pharmacotherapy estradiol, as well as GnRH analogs or other anti-androgens is a much more difficult transition than for their adolescent (like spironolactone) to suppress endogenous testosterone peers. At this stage, patients are transitioning from an that physiologic doses of estradiol alone cannot accomplish already completed (or mostly complete) endogenous (Table 3).1,2,3 Ethinyl estradiol is associated with an puberty to their affirmed gender. This involves not only increased risk of VTE and are therefore not recommended hormones consistent with the patient’s gender identity, but for hormone therapy.1,2 Maintenance doses should also adjunct therapies to diminish endogenous secondary be titrated to clinical effect and within premenopausal sex characteristics.1,2,3 These regimens are outlined in physiologic estradiol and testosterone levels (100-200 pg/ Table 3. Because long-term sex hormone therapy has its mL and < 50 ng/dL, respectively).1 If a gonadectomy is own risks, it is recommended to evaluate and address any performed, discontinuation of estradiol may be considered medical conditions that could be exacerbated (see Table 4) at age 50, the mean age of menopause in the United before beginning pharmacotherapy.1 States.2 Transgender women who choose to stop estradiol therapy without undergoing gonadectomy may experience

Table 2. Sample pubertal induction protocols (bolded doses are listed in Micromedex).1,2,10 Pubertal Sex Hormone Formu- Induction Protocol (peri-pubertal) Accelerated Induction Protocol Induction lation (post-pubertal) Female Estradiol (oral, sublin- ES1 ES1 gual)1,2 Increasing the dose every 6 months: Increasing the dose over 6 5 mcg/kg/day -> 10 mcg/kg/day -> 15 mcg/kg/day -> 20 mcg/kg/day months: -> Adult dose: 2-6 mg/day 1 mg/day -> 2 mg/day -> Adult UCSF2 dose: 2-6 mg/day -0.25 mg daily -> gradual increase to -> Adult dose: 6-8 mg/day

Estradiol valerate (IM)2 ES1 Increasing the dose every 6 months (new system placed twice weekly or every 3.5 days): 6.25-12.5 mcg/24 hr -> 25 mcg/24 hr -> 37.5 mcg/24 hr -> Adult dose 50-200 mcg/24 hr UCSF2 6.25 mcg/24 hr twice weekly -> gradual increase to -> Adult dose: 400 mcg/24 hr

Estradiol valerate (IM)2 UCSF2 5-20 mg every 2 weeks -> Adult dose: 30-40 mg every 2 weeks

Estradiol cypionate (IM)2 UCSF2 2-10 mg weekly

Male Testosterone cypionate ES1 ES1 (IM), testosterone enan- Increasing the dose every 6 months: Increasing the dose over 6 thate (IM, SC), testoster- 25 mg/m2 every 2 weeks -> 50 mg/m2 every 2 weeks -> 75 mg/m2 months: one undecanoate (IM)1,2 every 2 weeks -> 100 mg/m2 every 2 weeks -> Adult dose: 100-200 75 mg/m2 every 2 weeks -> mg every 2 weeks 125 mg/m2 every 2 weeks *Note: doses can also either be halved and administered weekly *Note: doses can also either OR doubled and administered every 4 weeks, dependent on patient be halved and administered preference weekly OR doubled and UCSF2 administered every 4 weeks, SC administration: dependent on patient prefer- 12.5 mg weekly x 8-12 weeks -> 25 mg weekly x 3 months -> Check ence levels and adjust in 12.5 mg intervals -> Adult dose: 50-75 mg weekly IM administration: 25 mg weekly x 8-12 weeks -> 50 mg weekly -> Check levels and adjust in 25 mg increments -> Adult dose: 50-100 mg weekly *Note: IM doses can be doubled and administered every 2 weeks, dependent on patient preference

Testosterone gel11 Gomez, et al.11 50 mg topically once daily

Minnesota Pharmacist • Winter 2020 • 19 Updates to Gender-Affirming... continued CLINICAL NEWS a return of virilization.2 Expected side effects are similar to The Endocrine Society and UCSF Center for Excellence those described for pubertal induction.1,2 guidelines provide specific recommendations for monitoring during hormone therapy in adults in three main categories: Pharmacotherapy for Transgender Males development of physical sex characteristics, lab values, Gender-affirming therapy for transgender males includes and routine health screening. Standards of care for testosterone, as well as progesterone or GnRH analogs routine health screening and monitoring are the same for if physiologic testosterone levels are not sufficient to transgender and non-transgender patients.1,2 suppress menses (Table 3).1,2,3 Progesterone-only contraceptives (such as LARCs or progesterone-only pills) Conclusion may also be used to prevent pregnancy.1,2,3 Combined The recent addition of therapeutic indications for puberty oral contraceptives (COCs), while effective, are not a suppression and hormone therapy in persons with gender preferred option for contraception due to the increased risk dysphoria to Micromedex will lead to an increase in of VTE with use of ethinyl estradiol.1,2 Maintenance doses coverage for many who could not access these therapies should be titrated to clinical effect and within physiologic previously. This is a golden opportunity for pharmacists to testosterone levels (400-700 ng/dL).1 Discontinuation of use their expertise in pharmacotherapy management to testosterone may be considered at age 50, the mean age of positively impact the lives of their patients. menopause in non-transgender women.2 It should be noted that discontinuation at this age will result in reduced muscle mass, body hair, and libido.2 Expected side effects are similar to those described for pubertal induction.1,2

Table 3. Gender-affirming regimens in transgender adults (bolded doses are listed in Micromedex).1,5,6

Gender Role of Therapy Agent Recommended Adult Dosage Identity Female Estrogen administration Estradiol (oral)1 2-6 mg/day Estradiol (transdermal system) 1 0.025-0.2 mg/day (new system placed every 3-5 days) Estradiol valerate (IM injection)1 5-30 mg every 2 weeks OR 2-10 mg weekly Estradiol cypionate (IM injection)1 5-30 mg every 2 weeks OR 2-10 mg weekly GnRH analog - Adjunct Goserelin acetate (SC injection)6 3.8 mg every 4 weeks in combination with estradiol valerate endogenous hormone 10 mg IM every 10 days suppression Leuprolide acetate (SC or IM 3.75 mg SC once a month1 OR injection)1,5 3.75 mg IM once a month in combination with transdermal estradiol 1-2 mg/day5 OR 11.25 mg SC every 3 months1,5 Anti-androgen – adjunct Spironolactone (oral)1,2 100-300 mg/day1 OR endogenous hormone Titrate up to 200 mg twice daily2 suppression Testosterone cypionate Testosterone enanthate (IM, SC 100-200 mg IM or SC every 2 weeks OR (IM), testosterone injection)1 Half the dose and deliver once weekly enanthate (IM, Testosterone cypionate (IM 100-200 mg every 2 weeks SC), testosterone injection)1 1,2 undecanoate (IM) Testosterone undecanoate (IM 1000 mg at 0 and 6 weeks -> THEN injection)1 1000 mg every 12 weeks

Testosterone gel 1.6%1 50-100 mg/day

Testosterone transdermal patch1 2.5-7.5 mg/day

20 • Minnesota Pharmacist • Winter 2020 CLINICAL NEWS

Table 4. Medical risks associated with sex hormone therapy.1

Risk of Adverse Estrogen Therapy Testosterone Therapy FOLLOW MPHA ON TWITTER, Outcomes (MtF) (FtM) FACEBOOK AND INSTAGRAM Very high Thromboembolic Erythrocytosis (hematocrit disease > 50%) On Twitter, follow us at @MinnPharmAssoc Moderate Macroprolactinemia Severe liver dysfunction to get updates on what’s happening at the Breast cancer (liver transaminases > 3x state legislature, MDH and DHS; federal Coronary artery ULN) government policymakers and agencies; disease (CAD) CAD Cerebrovascular Cerebrovascular disease and with affiliated organizations like APhA, disease Hypertension ASHP, NCPA and ACCP. We tweet almost Cholelithiasis (gall Breast or uterine cancer every weekday. In addition to keeping our stones) members informed, another goal of our Hypertrigylceridemia tweets is to raise the profile of pharmacy among key influencers such as legislators Acknowledgments and policymakers. You can help us by The author would like to thank Dr. Jamie Feldman, MD, PhD retweeting some of our messages, or by and Dr. Dave Hoang, PharmD, MBA for their help on this creating your own tweets during events like project. the Annual Learning Networking Event (if you mention @MinnPharmAssoc in your References 1. Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer tweets, we are likely to retweet your posts). WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab [Internet]. 2017 Nov 1 [cited 2019 Jun On Facebook, you’ll find updates about 19];102(11):3869–903. our members and from the University of 2. Deutsch, MB. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. Center of Excellence for Minnesota College of Pharmacy. We post Transgender Health. University of California, San Francisco. 2nd Edition. photos from our events — so send your June 17, 2016. 3. Coleman, E, Bockting, W, Botzer, M, et al. Standards of Care for the photos from ALNE or other events to Laurie Health of Transsexual, Transgender, and Gender-Nonconforming People. Pumper at the MPhA office to have them World Professional Association for Transgender Health (WPATH). Version 7. 2012. included! 4. Schagen SE, Cohen-Kettenis PT, Delemarre-van de Waal HA, et al: Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016; On Instagram we post photos from our 13(7):1125-1132. events and other news of interest to 5. Gava G, Cerpolini S, Martelli V, et al: Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a pharmacists and pharmacy technicians. comparison of safety and effectiveness. Clin Endocrinol (Oxf) 2016; Follow us and share your photos using 85(2):239-246. 6. Mueller A, Zollver H, Kronawitter D, et al: Body composition and bone #minnpharm mineral density in male-to-female transsexuals during cross-sex hormone therapy using gonadotrophin-releasing hormone agonist. Exp Clin Endocrinol Diabetes 2011; 119(2):95-100. 7. SUPPRELIN(R) LA subcutaneous implant, histrelin acetate subcutaneous implant. Product Information. Indevus Pharmaceuticals,Inc, Lexington, MA, 2007. 8. GnRH agonists for CPP - UpToDate [Internet]. [cited 2019 Jun 18] 9. DailyMed - XYOSTED- testosterone enanthate injection [Internet]. [cited 2019 Jun 19]. 10. Aveed (testosterone undecanoate). NDA 022219. Approved Risk Evaluation and Mitigation Strategies (REMS). U.S. Food and Drug Administration. Last updated December 19, 2018. [cited 2019 Nov 4]. 11. Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Cruz Almaraz M, et al. Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology [Internet]. 2012 [cited 2019 Jun 19];37(5):662-670.

Minnesota Pharmacist • Winter 2020 • 21 CLINICAL NEWS 2020 Prescription Drug Prices: Growing Slower, but Not Going Lower

By Stephen W. Schondelmeyer, PharmD, MPubAdm, PhD, FAPhA, FNAS, Professor & Director, PRIME Institute, Century Mortar Club Endowed Chair, [email protected]

January 2020 was the beginning of a new decade. As most Overall drug prices are growing slower, but they are not pharmacists know, the first month of the year is also a time going lower. Keep in mind—a slowed rate of inflation does when many drug products experience a change in their list not mean that a drug price decreases, but only that the price (i.e., AWP and WAC). This January (in the first five increase observed is not as much as seen in a previous days) drug companies posted price changes for more than period. 2,000 drug products (about 4.9% of active NDCs). The vast majority (96.6%) of these price changes were increases. The average 2020 brand name price increase was 5.5% According to MediSpan, there were 40,733 active NDCs for across 1,884 NDCs. The range in brand name price prescription drugs as of January 5, 2020. Just over one- changes (AWP) was from a 66.3% increase to a 98.5% third (35.5%) of these NDCs are brand name drug products decrease. In contrast, the average generic drug price and nearly two-thirds (64.5%) are generic drug products. change was a 7.3% increase. The range in generic price changes was from a 35.9% increase to a 52.0% price Figure 1.

2020 Prescription Drug Prices... continued on page 24

22 • Minnesota Pharmacist • Winter 2020 Minnesota Pharmacy Advocacy Fund

CONTACT INFORMATION:

Pharmacy Name: ______First Name: ______Last Name: ______Pharmacy Address: ______Pharmacy City: ______State: ______Zip: ______Preferred Phone: ______Preferred Fax: ______Preferred Email: ______

PAYMENT q Check (payable to MPHA) q Visa q Mastercard q Discover q AMEX

DONATION AMOUNT: $ ______

If paying by credit card, all fields are required. Card Number: ______Exp. Date: ______Security Code: ______Cardholder Name (Print): ______Billing Address (if different than above): ______City/State/Zip: ______Cardholder Signature: ______Please do not email credit card information. Fax or mail your registration form to protect this information. All contributions are welcome and fully tax deductible.

Thank you for your continued support of pharmacy! (For office use only) fin. Please mail your payment to: initials date Minnesota Pharmacists Association CK/CC Attn: Pharmacy Advocacy Fund amt. paid 1000 Westgate Drive, Suite 252 | St. Paul, MN 55114 bal. due 651-697-1771 | Fax 651.290.2266 | www.mpha.org

Minnesota Pharmacist • Winter 2020 • 23 2020 Prescription Drug Prices... continued from page 22 CLINICAL NEWS decrease. Yes, that’s right—the generic drug products If these prices do not increase again in 2020, this could be (NDCs) which had a price change, had a higher average the lowest rate of price increases in more than 15 years. change (7.3%) in early 2020 than did the brand name drug Brand name price increases hit a peak of 15.9% in 2014 products (5.5%). and had slowed to 5.8% by 2018. However, a large share of the drug products with price increases in recent years take Brand name drug companies as far back as 2016 began more than one price change per year. We’ll just have to wait making pledges to hold their brand name drug price and see how prices change during the rest of 2020. increases to 10.0% or under. As many as 12 big pharma companies have made some kind of price restraint pledge On a related note, the Minnesota Attorney General in the last three or four years. Most of these drug firms has created an Advisory Task Force on Lowering kept their pledge, mostly. Almost all (99.0%, 1,866 of 1,884 Pharmaceutical Drug Prices in Minnesota. This 15-member NDCs) of the brand name drug price changes in 2020 were group has been working since April 2019 to review past at, or below, the 10% level and 7.6% (143 of 1,884 NDCs) and current legislative and regulatory efforts to address had price changes at, or below, the rate of general inflation high drug prices. The Task Force is wrapping up its work (2.1%, CPI-All Items) in the U.S. for 2019. (See Figure 1.) and is expected to provide a Final Report with clear and Nearly one-fourth (23.8%, 31 of 130 NDCs) of the generic understandable recommendations for efforts that will help drug products that had price increases were at, or above, Minnesotans and policymakers address the problem of the 10.0% level. Interestingly, most of the generic price high drug prices. The Task Force report was released on increases above the 10.0% level were heparin (porcine) February 19. See the MPhA Small Doses Newsletter from injectable products (Pfizer & Hospira) with price increases February 21 for more details. of about 15.0%. Only 3.1% (59 of 1,884 NDCs) brand name had a price decrease in early 2020, while 6.2% (8 of 130 NDCs) of the generic drugs had a price decrease in January 2020.

UPCOMING MPHA TOWN HALLS

APRIL 7 & MAY 21 - Virtual Town Hall

A review of the FDA-approved indications and the use of long-acting injectable (LAI) antipsychotics and extended-release naltrexone in the appropriate patient populations. Mechanism of action, dosing, need for oral medication overlap, and potential adverse effects will be explored. Participants will compare and contrast the different long-acting injectable antipsychotics and identify which agent(s) may be most appropriate based on patient and product characteristics. Participants will identify patients who may benefit from extended- release naltrexone and when initiation of extended-release naltrexone is appropriate. Finally, participants will be able to list advantages and disadvantages to the use of long-acting injectable antipsychotics and extended-release naltrexone to identify possible motivations for patient acceptance of these agents.

MPhA is planning additional Town Hall events in the following locations:

JUNE 16 - Alexandria SEPTEMBER 15 - Duluth

SEPTEMBER 8 - SW Area OCTOBER 13 - Saint Cloud SEPTEMBER 13 - Mora NOVEMBER 10 - Twin Cities

VISIT MPHA.ORG TO REGISTER!

24 • Minnesota Pharmacist • Winter 2020 CONGRATULATIONS 2020 SCHOLARSHIP WINNERS

Pharmacists Mutual is proud to support students who are interested in serving in an independent or small chain community pharmacy or an underserved geographic or cultural community. Each student listed received a $2,500 scholarship.

AMNA PARACHA University of Maryland Eastern Shore MASON SYKES Samford University BENJAMIN HIGHTOWER University of Georgia MORGAN PLATTA University of Wisconsin–Madison BROOKE HENRIKSEN California Health Sciences University LESLIE VO University of Texas at Austin JADA JENSEN University of Wyoming ROBERTO NAVA University of California-San Diego EMILY BRUNSON University of Texas at Austin NEVIN RADECHEL Drake University LAUREN BREWER University of Georgia RAEANN KILGORE University of Missouri–Kansas City JOHNNY ALEXANDER University of Texas at Austin SARAH HENDERSON Virginia Commonwealth University JULIA ANNIS University of Rhode Island STEPHANIE MARTIN Drake University KAYLA LELAND Washington State University STEPHANIE LUKEVICH South University MICHAEL DANILOV University at Buffalo BRIANNA SMITH William Carey University

ACCEPTING APPLICATIONS FOR 2021 SCHOLARSHIP Pharmacists Mutual Insurance Company October 1, 2020 - December 1, 2020 808 Highway 18 W | PO Box 370 | Algona, Iowa 50511 P. 800.247.5930 | F. 515.295.9306 | E. [email protected] https://www.phmic.com/scholarship/ phmic.com

Minnesota Pharmacist • Winter 2020 • 25 MPHA RESOURCE GUIDE Minnesota House of Representatives Legislative Directory

Name District Office Address Phone Email Patty Acomb 44B DFL 431 State Office Building 651-296-9934 [email protected] Tony Albright 55B R 259 State Office Building 651-296-5185 [email protected] Paul Anderson 12B R 309 State Office Building 651-296-4317 [email protected] Jeff Backer 12A R 203 State Office Building 651-296-4929 [email protected] Kristin Bahner 34B DFL 525 State Office Building 651-296-5502 [email protected] Cal Bahr 31B R 321 State Office Building 651-296-2439 [email protected] Dave Baker 17B R 387 State Office Building 651-296-6206 [email protected] Jamie Becker-Finn 42B DFL 559 State Office Building 651-296-7153 [email protected] Peggy Bennett 27A R 307 State Office Building 651-296-8216 [email protected] Connie Bernardy 41A DFL 369 State Office Building 651-296-5510 [email protected] Robert Bierman 57A DFL 579 State Office Building 651-296-5506 [email protected] Greg Boe 47B R 313 State Office Building 651-296-5066 [email protected] Jeff Brand 19A DFL 501 State Office Building 651-296-8634 [email protected] Hunter Cantrell 56A DFL 421 State Office Building 651-296-4212 [email protected] Andrew Carlson 50B DFL 557 State Office Building 651-296-4218 [email protected] Lyndon Carlson Sr. 45A DFL 479 State Office Building 651-296-4255 [email protected] Michelle (Shelly) Christensen 39B DFL 577 State Office Building 651-296-4244 [email protected] Anne Claflin 54A DFL 539 State Office Building 651-296-4342 [email protected] John (Jack) Considine Jr. 19B DFL 433 State Office Building 651-296-3248 [email protected] Brian Daniels 24B R 231 State Office Building 651-296-8237 [email protected] Kurt Daudt 31A R 267 State Office Building 651-296-5364 [email protected] Greg Davids 28B R 283 State Office Building 651-296-9278 [email protected] Jim Davnie 63A DFL 443 State Office Building 651-296-0173 [email protected] Raymond Dehn 59B DFL 537 State Office Building 651-296-8659 [email protected] Lisa Demuth 13A R 223 State Office Building 651-296-4373 [email protected] Bob Dettmer 39A R 289 State Office Building 651-296-4124 [email protected] Steve Drazkowski 21B R 327 State Office Building 651-296-2273 [email protected] Rob Ecklund 03A DFL 409 State Office Building 651-296-2190 [email protected] Heather Edelson 49A DFL 549 State Office Building 651-296-4363 [email protected] Steve Elkins 49B DFL 515 State Office Building 651-296-7803 [email protected] Sondra Erickson 15A R 273 State Office Building 651-296-6746 [email protected] Dan Fabian 01A R 287 State Office Building 651-296-9635 [email protected] Peter Fischer 43A DFL 551 State Office Building 651-296-5363 [email protected] Mary Franson 08B R 303 State Office Building 651-296-3201 [email protected] Mike Freiberg 45B DFL 509 State Office Building 651-296-4176 [email protected] Pat Garofalo 58B R 295 State Office Building 651-296-1069 [email protected] Aisha Gomez 62B DFL 529 State Office Building 651-296-7152 [email protected] Steve Green 02B R 315 State Office Building 651-296-9918 [email protected] Matt Grossell 02A R 227 State Office Building 651-296-4265 [email protected] Glenn Gruenhagen 18B R 291 State Office Building 651-296-4229 [email protected] Bob Gunther 23A R 277 State Office Building 651-296-3240 [email protected] Barb Haley 21A R 239 State Office Building 651-296-8635 [email protected] Laurie Halverson 51B DFL 503 State Office Building 651-296-4128 [email protected] Rod Hamilton 22B R 337 State Office Building 651-296-5373 [email protected] Rick Hansen 52A DFL 407 State Office Building 651-296-6828 [email protected]

26 • Minnesota Pharmacist • Winter 2020 MPHA RESOURCE GUIDE Minnesota House of Representatives Legislative Directory

Hodan Hassan 62A DFL 531 State Office Building 651-296-0294 [email protected] Alice Hausman 66A DFL 453 State Office Building 651-296-3824 [email protected] John Heinrich 35A R 211 State Office Building 651-296-1729 [email protected] Josh Heintzeman 10A R 353 State Office Building 651-296-4333 [email protected] Kaohly Her 64A DFL 359 State Office Building 651-296-8799 [email protected] Jerry Hertaus 33A R 389 State Office Building 651-296-9188 [email protected] Frank Hornstein 61A DFL 545 State Office Building 651-296-9281 [email protected] Melissa Hortman 36B DFL 463 State Office Building 651-296-4280 [email protected] Michael Howard 50A DFL 451 State Office Building 651-296-7158 [email protected] John Huot 57B DFL 583 State Office Building 651-296-4306 [email protected] Brian Johnson 32A R 243 State Office Building 651-296-4346 [email protected] Sydney Jordan 60A DFL 553 State Office Building 651-296-4219 [email protected] Tony Jurgens 54B R 351 State Office Building 651-296-3135 [email protected] Debra Kiel 01B R 255 State Office Building 651-296-5091 [email protected] Ginny Klevorn 44A DFL 581 State Office Building 651-296-5511 [email protected] Erin Koegel 37A DFL 375 State Office Building 651-296-5369 [email protected] Carlie Kotyza-Witthuhn 48B DFL 567 State Office Building 651-296-7449 [email protected] Jon Koznick 58A R 229 State Office Building 651-296-6926 [email protected] Ron Kresha 09B R 207 State Office Building 651-296-4247 [email protected] Mary Kunesh-Podein 41B DFL 445 State Office Building 651-296-4331 [email protected] Sandy Layman 05B R 233 State Office Building 651-296-4936 [email protected] Fue Lee 59A DFL 485 State Office Building 651-296-4262 [email protected] John Lesch 66B DFL 563 State Office Building 651-296-4224 [email protected] Tina Liebling 26A DFL 477 State Office Building 651-296-0573 [email protected] Ben Lien 04A DFL 415 State Office Building 651-296-5515 [email protected] Leon Lillie 43B DFL 367 State Office Building 651-296-1188 [email protected] Todd Lippert 20B DFL 523 State Office Building 651-296-0171 [email protected] Dave Lislegard 06B DFL 413 State Office Building 651-296-0170 [email protected] Jamie Long 61B DFL 517 State Office Building 651-296-5375 [email protected] Eric Lucero 30B R 221 State Office Building 651-296-1534 [email protected] Dale Lueck 10B R 311 State Office Building 651-296-2365 [email protected] Tim Mahoney 67A DFL 365 State Office Building 651-296-4277 [email protected] Alice Mann 56B DFL 507 State Office Building 651-296-5387 [email protected] Carlos Mariani 65B DFL 381 State Office Building 651-296-9714 [email protected] Paul Marquart 04B DFL 597 State Office Building 651-296-6829 [email protected] Sandra Masin 51A DFL 543 State Office Building 651-296-3533 [email protected] Joe McDonald 29A R 241 State Office Building 651-296-4336 [email protected] Shane Mekeland 15B R 215 State Office Building 651-296-2451 [email protected] Tim Miller 17A R 329 State Office Building 651-296-4228 [email protected] Kelly Moller 42A DFL 569 State Office Building 651-296-0141 [email protected] Rena Moran 65A DFL 575 State Office Building 651-296-5158 [email protected] Kelly Morrison 33B DFL 429 State Office Building 651-296-4315 [email protected] Jeremy Munson 23B R 323 State Office Building 651-296-4240 [email protected] Mary Murphy 03B DFL 343 State Office Building 651-296-2676 [email protected] Jim Nash 47A R 349 State Office Building 651-296-4282 [email protected] Michael V. Nelson 40A DFL 585 State Office Building 651-296-3751 [email protected]

Minnesota Pharmacist • Winter 2020 • 27 MPHA RESOURCE GUIDE Minnesota House of Representatives Legislative Directory

Nathan Nelson 11B R 393 State Office Building 651-296-0518 [email protected] Anne Neu 32B R 261 State Office Building 651-296-5377 [email protected] Mohamud Noor 60B DFL 379 State Office Building 651-296-4257 [email protected] Bud Nornes 08A R 281 State Office Building 651-296-4946 [email protected] Paul Novotny 30A R 301 State Office Building 651-296-4237 [email protected] Tim O'Driscoll 13B R 237 State Office Building 651-296-7808 [email protected] Liz Olson 07B DFL 471 State Office Building 651-296-4246 [email protected] Marion O'Neill 29B R 357 State Office Building 651-296-5063 [email protected] Gene Pelowski Jr. 28A DFL 491 State Office Building 651-296-8637 [email protected] John Persell 05A DFL 437 State Office Building 651-296-5516 [email protected] John Petersburg 24A R 217 State Office Building 651-296-5368 [email protected] Nels Pierson 26B R 345 State Office Building 651-296-4378 [email protected] Dave Pinto 64B DFL 439 State Office Building 651-296-4199 [email protected] Jeanne Poppe 27B DFL 487 State Office Building 651-296-4193 [email protected] John Poston 09A R 317 State Office Building 651-296-4293 [email protected] Laurie Pryor 48A DFL 571 State Office Building 651-296-3964 [email protected] Duane Quam 25A R 247 State Office Building 651-296-9236 [email protected] Ruth Richardson 52B DFL 403 State Office Building 651-296-4192 [email protected] Kristin Robbins 34A R 225 State Office Building 651-296-7806 [email protected] Linda Runbeck 38A R 253 State Office Building 651-296-2907 [email protected] Steve Sandell 53B DFL 521 State Office Building 651-296-1147 [email protected] Julie Sandstede 06A DFL 411 State Office Building 651-296-0172 [email protected] Duane Sauke 25B DFL 593 State Office Building 651-296-9249 [email protected] Joe Schomacker 22A R 209 State Office Building 651-296-5505 [email protected] Jennifer Schultz 07A DFL 473 State Office Building 651-296-2228 [email protected] Peggy Scott 35B R 335 State Office Building 651-296-4231 [email protected] Zack Stephenson 36A DFL 371 State Office Building 651-296-5513 [email protected] Mike Sundin 11A DFL 417 State Office Building 651-296-4308 [email protected] Chris Swedzinski 16A R 245 State Office Building 651-296-5374 [email protected] Brad Tabke 55A DFL 377 State Office Building 651-296-8872 [email protected] Tama Theis 14A R 201 State Office Building 651-296-6316 [email protected] Paul Torkelson 16B R 251 State Office Building 651-296-9303 [email protected] Dean Urdahl 18A R 279 State Office Building 651-296-4344 [email protected] Samantha Vang 40B DFL 527 State Office Building 651-296-3709 [email protected] Bob Vogel 20A R 213 State Office Building 651-296-7065 [email protected] Jean Wagenius 63B DFL 449 State Office Building 651-296-4200 [email protected] Ami Wazlawik 38B DFL 565 State Office Building 651-296-3018 [email protected] Nolan West 37B R 331 State Office Building 651-296-4226 [email protected] Ryan Winkler 46A DFL 459 State Office Building 651-296-7026 [email protected] Dan Wolgamott 14B DFL 401 State Office Building 651-296-6612 [email protected] Jay Xiong 67B DFL 423 State Office Building 651-296-4201 [email protected] Tou Xiong 53A DFL 533 State Office Building 651-296-7807 [email protected] Cheryl Youakim 46B DFL 591 State Office Building 651-296-9889 [email protected]

28 • Minnesota Pharmacist • Winter 2020 MPHA RESOURCE GUIDE Minnesota Senate Legislative Directory

Name District Party Address Phone Email Jim Abeler 35 R 3215 MN Senate Bldg. 651-296-3733 [email protected] Bruce D. Anderson 29 R 3209 MN Senate Bldg. 651-296-5981 [email protected] Paul T. Anderson 44 R 2103 MN Senate Bldg. 651-296-9261 Use email form Thomas M. Bakk 3 DFL 2221 MN Senate Bldg. 651-296-8881 Use email form Michelle R. Benson 31 R 3109 MN Senate Bldg. 651-296-3219 Use email form Karla Bigham 54 DFL 2327 MN Senate Bldg. 651-297-8060 Use email form Jim Carlson 51 DFL 2207 MN Senate Bldg. 651-296-8073 Use email form Roger C. Chamberlain 38 R 3225 MN Senate Bldg. 651-296-1253 Use email form Bobby Joe Champion 59 DFL 2303 MN Senate Bldg. 651-296-9246 [email protected] Greg D. Clausen 57 DFL 2233 MN Senate Bldg. 651-296-4120 Use email form Richard Cohen 64 DFL 2301 MN Senate Bldg. 651-296-5931 Use email form Steve A. Cwodzinski 48 DFL 2319 MN Senate Bldg. 651-296-1314 Use email form Gary H. Dahms 16 R 2111 MN Senate Bldg. 651-296-8138 [email protected] D. Scott Dibble 61 DFL 2213 MN Senate Bldg. 651-296-4191 Use email form Rich Draheim 20 R 3227 MN Senate Bldg. 651-296-5558 Use email form Kari Dziedzic 60 DFL 2203 MN Senate Bldg. 651-296-7809 Use email form Chris A. Eaton 40 DFL 2403 MN Senate Bldg. 651-296-8869 Use email form Justin Eichorn 5 R 3213 MN Senate Bldg. 651-296-7079 Use email form Kent Eken 4 DFL 2211 MN Senate Bldg. 651-296-3205 [email protected] Melisa Franzen 49 DFL 2229 MN Senate Bldg. 651-296-6238 Use email form Nick A. Frentz 19 DFL 2415 MN Senate Bldg. 651-296-6153 [email protected] Paul E. Gazelka 9 R 3113 MN Senate Bldg. 651-296-4875 Use email form Michael P. Goggin 21 R 3203 MN Senate Bldg. 651-296-5612 [email protected] Dan D. Hall 56 R 3111 MN Senate Bldg. 651-296-5975 Use email form Foung Hawj 67 DFL 3413 MN Senate Bldg. 651-296-5285 Use email form Jeff Hayden 62 DFL 2209 MN Senate Bldg. 651-296-4261 Use email form John A. Hoffman 36 D 2231 MN Senate Bldg. 651-296-4154 Use email form Karin Housley 39 R 3217 MN Senate Bldg. 651-296-4351 [email protected] Jeff Howe 13 R 3231 MN Senate Bldg. 651-296-2084 [email protected] Bill Ingebrigtsen 8 R 3207 MN Senate Bldg. 651-297-8063 [email protected] Jason Isaacson 42 DFL 2321 MN Senate Bldg. 651-296-5537 Use email form John Jasinski 24 R 2101 MN Senate Bldg. 651-296-0284 Use email form Scott M. Jensen 47 R 3229 MN Senate Bldg. 651-296-4837 Use email form Mark Johnson 1 R 2105 MN Senate Bldg. 651-296-5782 Use email form Susan Kent 53 DFL 2227 MN Senate Bldg. 651-296-4166 Use email form Mary Kiffmeyer 30 R 3103 MN Senate Bldg. 651-296-5655 Use email form Matt D. Klein 52 DFL 2409 MN Senate Bldg. 651-296-4370 Use email form Mark Koran 32 R 3101 MN Senate Bldg. 651-296-5419 Use email form Carolyn Laine 41 DFL 2325 MN Senate Bldg. 651-296-4334 [email protected] Andrew Lang 17 R 3205 MN Senate Bldg. 651-296-4918 Use email form Ron Latz 46 DFL 2215 MN Senate Bldg. 651-297-8065 Use email form Warren Limmer 34 R 3221 MN Senate Bldg. 651-296-2159 Use email form Matt Little 58 DFL 2413 MN Senate Bldg. 651-296-5252 Use email form John Marty 66 DFL 2401 MN Senate Bldg. 651-296-5645 Use email form Andrew Mathews 15 R 3409 MN Senate Bldg. 651-296-8075 Use email form Jeremy R. Miller 28 R 3107 MN Senate Bldg. 651-296-5649 [email protected] Carla J. Nelson 26 R 3235 MN Senate Bldg. 651-296-4848 Use email form Scott J. Newman 18 R 3105 MN Senate Bldg. 651-296-4131 [email protected] Jerry Newton 37 DFL 2411 MN Senate Bldg. 651-296-2556 [email protected]

Minnesota Pharmacist • Winter 2020 • 29 MPHA RESOURCE GUIDE Minnesota Senate Legislative Directory David J. Osmek 33 R 2107 MN Senate Bldg. 651-296-1282 [email protected] Sandra L. Pappas 65 DFL 2205 MN Senate Bldg. 651-296-1802 Use email form Eric R. Pratt 55 R 3219 MN Senate Bldg. 651-296-4123 [email protected] Jason Rarick 11 R 3411 MN Senate Bldg. 651-296-1508 [email protected] Jerry Relph 14 R 3211 MN Senate Bldg. 651-296-6455 [email protected] Ann H. Rest 48 DFL 2217 MN Senate Bldg. 651-296-2889 Use email form Julie A. Rosen 23 R 2113 MN Senate Bldg. 651-296-5713 [email protected] Carrie Ruud 10 R 3233 MN Senate Bldg. 651-296-4913 [email protected] David H. Senjem 25 R 3401 MN Senate Bldg. 651-296-3903 [email protected] Erik Simonson 7 DFL 2417 MN Senate Bldg. 651-296-4188 [email protected] Dan Sparks 27 DFL 2201 MN Senate Bldg. 651-296-9248 [email protected] David J. Tomassoni 6 DFL 2235 MN Senate Bldg. 651-296-8017 Use email form Patricia Torres Ray 63 DFL 2225 MN Senate Bldg. 651-296-4274 Use email form Paul Utke 2 R 3403 MN Senate Bldg. 651-296-9651 Use email form Bill Weber 22 R 2109 MN Senate Bldg. 651-296-5650 [email protected] Torrey N. Westrom 12 R 3201 MN Senate Bldg. 651-296-3826 [email protected] Charles W. Wiger 43 DFL 2219 MN Senate Bldg. 651-296-6820 Use mail form Melissa H. Wiklund 50 DFL 2323 MN Senate Bldg. 651-297-8061 [email protected] Minnesota’s Constitutional Officers Governor Tim Walz State Auditor Julie Blaha Office of the Governor and Lieutenant Governor 525 Park Street, Suite 500 130 State Capitol St. Paul, MN 55103 St. Paul, MN 55155 Main Office: (651) 296-2551 Telephone: 651-201-3400 Toll Free: 800-657-3717 Fax: (651) 296-4755 Minnesota Relay: 800-627-3529 Minnesota Relay: (800) 627-3529 Fax: 651-797-1850 Email: [email protected] Contact information: http://mn.gov/governor/contact Website: www.auditor.state.mn.us/ Website: http://mn.gov/governor/ Twitter: @MNStateAuditor Twitter @GovTimWalz Secretary of State Steve Simon Lt. Governor Peggy Flanagan 180 State Office Building Office of the Governor and Lieutenant Governor 100 Rev. Dr. Martin Luther King Jr. Blvd 130 State Capitol St. Paul, MN 55155 St. Paul, MN 55155 Main Office: (651) 296-2803 Toll Free: (877) 551-6767 Telephone: 651-201-3400 Toll Free: 800-657-3717 Minnesota Relay:711 Minnesota Relay: 800-627-3529 Fax: (651) 297-7067 Fax: 651-797-1850 Email: [email protected] Contact information: http://mn.gov/governor/contact Website: www.sos.state.mn.us Website: https://mn.gov/governor/ Business Services Twitter @LtGovFlanagan 60 Empire Dr., Suite 100 St. Paul, MN 55103 Attorney General Keith Ellison Email: [email protected] 445 Minnesota St., Suite 1400 Twitter:@MNSecofState St. Paul, MN 55101 Main Office: (651) 296-3353 Toll Free: (800) 657-3787 Minnesota Relay: (800) 627-3529 Email: [email protected] Website: www.ag.state.mn.us/ Twitter @AGEllison

30 • Minnesota Pharmacist • Winter 2020 MPHA RESOURCE GUIDE United States House & Senate/Minnesota Please note that mail delivery to Washington, DC, can be delayed by up to 10 days due to security screening. If your message is urgent, fax your letter to Washington, contact your representative’s district office, or send an email through his/her website. Congressman Jim Hagedorn Congressman Tom Emmer Senator Amy Klobuchar First Congressional District Sixth Congressional District https://klobuchar.senate.gov https://hagedorn.house.gov/ https://emmer.house.gov Washington, DC Washington, DC Washington, DC 425 Dirksen Senate Building 325 Cannon House Office Building 315 Cannon House Office Building Washington, DC 20510 Washington, DC 20515 • 202-225-2472 Washington, DC 20515 202-224-3244 • fax 202-228-2186 Mankato 202-225-2331 • fax 202-225-6475 Toll-free 1-888-224-9043 11 Civic Center Plaza, Suite 301 Otsego Greater Metro Mankato, MN 56001 • 507-323-6090 9201 Quaday Ave. NE, Suite 206 1200 Washington Ave. S., Room 250 Rochester Otsego, MN 55330 Minneapolis, MN 55415 1530 Greenview Dr. SW, Ste 207 763-241-6848 • fax 763-241-7955 612-727-5220 • fax 612-727-5223 Rochester, MN 55902 • 507-323-6090 Twitter @RepTomEmmer Southern Office Twitter @RepHagedorn 1130 ½ Seventh St NW, Room 212 Congressman Collin Peterson Rochester, MN 55901 Congresswoman Angie Craig Seventh Congressional District 507-288-5321 • fax 507-288-2922 Second Congressional District https://collinpeterson.house.gov Northwestern/Central Office https://craig.house.gov/ Washington, DC 121 Fourth St S Washington, DC 2204 Rayburn House Office Building Moorhead, MN 56560 1523 Longworth House Office Building Washington, DC 20515 218-287-2219 • fax 218-287-2930 Washington, DC 20515 202-225-2165 • fax 202-225-1593 Northeastern Office 202-225-2271 Detroit Lakes Olcott Plaza, Room 105, 820 Ninth St N Burnsville 714 Lake Ave, Suite 101 Virginia, MN 55792 12940 Harriet Ave. S., Suite 238 Detroit Lakes, MN 56501 218-741-9690 • fax 218-741-3692 Burnsville, MN 55337 218-847-5056 • fax 218-847-5109 Twitter @AmyKlobuchar 651-846-2120 Marshall Twitter @RepAngieCraig 1420 East College Drive, SW/WC Senator Tina Smith Marshall, MN 56258 https://smith.senate.gov Congressman Dean Phillips 507-537-2299 • fax 507-537-2298 Washington, DC Third Congressional District Redwood Falls 720 Hart Senate Office Building https://phillips.house.gov/ 230 E Third St Washington, DC 20510 Washington, DC Redwood Falls, MN 56283 202-224-5641 1305 Longworth House Office Building 507-637-2270 Twin Cities Metro Washington, DC 20515 Thief River Falls District Office 60 East Plato Blvd, Suite 220 202-225-2871 13892 Airport Drive St. Paul, MN 55107 Minnetonka Thief River Falls, MN 56701 651-221-1016 13911 Ridgedale Dr., Ste 200 218-683-5405 • fax: 218-847-5109 Duluth Minnetonka, MN 55305 Willmar 515 W First St., Suite 104 952-656-5176 1700 Technology Dr., Suite 119 Duluth, MN 55802 Twitter @RepDeanPhillips Willmar, MN 56201 218-722-2390 320-235-1061 • fax 320-235-2651 Moorhead Congresswoman Betty McCollum Twitter @collinpeterson 819 Center Ave, Suite 2A Fourth Congressional District Moorhead, MN 56560 https://mccollum.house.gov Congressman Pete Stauber 218-284-8721 Washington, DC Eighth Congressional District Rochester Office 2256 Rayburn House Office Building https://stauber.house.gov 1202 ½ Seventh St NW, Suite 213 Washington, DC 20515 Washington, DC Rochester, MN 55901 202-225-6631 • fax 202-225-1968 126 Cannon House Office Building 507-288-2003 St. Paul Washington, DC 20515 Twitter @SenTinaSmith 661 LaSalle St., Suite 110 202-225-6211 St. Paul, MN 55114 Brainerd 651-224-9191 • fax 651-224-3056 Brainerd City Hall, 501 Laurel St. Twitter @BettyMcCollum04 Brainerd, MN 56401 218-355-0862 Congresswoman Ilhan Omar Cambridge Fifth Congressional District 300 Third Ave. NE https://omar.house.gov/ Cambridge, MN 55008 Washington, DC 763-552-3359 1517 Longworth House Office Building Chisholm Washington, DC 20515 Chisholm City Hall, 316 W Lake St., Room 7 202-225-4755 Chisholm, MN 55719 Minneapolis 218-355-0726 404 Third Ave. N., Suite 203 Hermantown Minneapolis, MN 55401 5094 Miller Trunk Hwy., Suite 900 612-333-1272 Hermantown, MN 55811 Twitter @Ilhan 218-481-6396 Twitter @RepPeteStauber

Minnesota Pharmacist • Winter 2020 • 31 MPhA NEWS MPhA News & Notes

Trumm Drug Featured in PioneerRx Publication From a blog post published by PioneerRx Pharmacy Software: Pharmacy ownership, let alone owning an award- winning pharmacy, was not on Aaron Finley’s mind when he began working at Trumm Drug in 2002. However, over the course of 17 years with Trumm Drug, “I kind of slowly changed the longer I was here,” Finley reflects. He is now the president and co-owner, alongside Alan Fetting.

The pharmacy staff at Trumm Drug received HealthMart’s 2019 Pharmacy of the Year award. Finley offered advice for Duluth Campus Welcomed New Students pharmacies inspired to get to the next level, “The first thing Faculty, staff and returning students at the University is to motivate or identify somebody that can champion that of Minnesota College of Pharmacy’s Duluth campus initiative and then to start small to get practice and work out welcomed first-year student pharmacists with a potluck on the kinks. Learn more about their success with patient care, August 20. hospitals, marketing and community involvement.

Article on Collaborative Relationships between Physicians and Pharmacists Kyle M. Turner, PharmD, BCACP, Cory A. Nelson, PharmD, BCACP, Deborah Pestka, PharmD, PhD, and Todd Sorensen, PharmD, are the authors of an article that appeared in the August 15, 2019, issue of the American Journal of Health-System Pharmacy. Kyle and Cory are past University of Minnesota Leadership residents, and COP Faculty Participate in Nexus Summit Deborah and Todd are current MPhA members. The article, Several professors from the University of Minnesota College “Identification of critical factors for forming collaborative of Pharmacy attended and presented at the Nexus Summit relationships between physicians and pharmacists,” 2019, a national conference hosted by the National Center reports on a study that identified and described strategies for Interprofessional Practice and Education. Presenters that have successfully achieved collaboration among included Jeannine Conway, PharmD, BCPS; Keri Hager, physicians and pharmacists providing comprehensive PharmD, BCACP; Anna Milone, PharmD, BCPS; Carolyn medication management (CMM) to support development of O’Donnell, PharmD student; Victoria Smith, PharmD CMM services. Read more. student; and Kristyn Williamson, PharmD. The conference was held in Minneapolis, Aug. 18-20. COP Researcher Helps Discover Novel Cellular Process MPhA member Hongbo Pang, an assistant professor in the University of Minnesota College of Pharmacy and a member of the University’s Masonic Cancer Center, is a corresponding author of a study published in Nature Communications. The research team discovered a novel process that can engulf nanomaterial without direct peptide functionalization, and its activity is regulated by Cysteine surrounding the cells.

“By simply mixing two types of nano-sized material, we discover a novel cellular process that offers an easy solution for nanomaterial into cells,” said Pang. “Further understanding of this process will aid in both cell biology and nanotechnology development.” Read the full news release.

32 • Minnesota Pharmacist • Winter 2020 MPhA NEWS MPhA News & Notes continued

Minnesota Team Chosen for First Flip the Pharmacy New University President Learns about Drug Repository Cohort Student Pharmacist Rowan Mahon and Associate Dean The Community Pharmacy Foundation (CPF) has Randy Seifert chatted with University of Minnesota announced that 30 Practice Transformation Teams have President Joan Gabel on Sept. 18. Mahon shared been chosen to participate in the first cohort of the multi- information about her legislative advocacy work that will year Flip the Pharmacy Program. A Minnesota team is help launch a prescription drug repository in Minnesota to part of the cohort. Flip the Pharmacy aims to transform collect and help redistribute unused medications to people community-based pharmacies away from point-in-time, who are struggling to pay for prescriptions. The College of prescription-level care processes and business models to Pharmacy had a table at the university’s weekly farmers longitudinal and patient-level care processes and business market as part of the Healthier Minnesota theme. models through the use of hands-on coaching.

Over the intensive two-year experience, each participating pharmacy will be served by a Practice Transformation Team that will be focused on implementing the Flip the Pharmacy Change Package with the help of the Flip the Pharmacy Coordinating Center, CPESN USA. “Each team has established key relationships with payers and transformation partners generating large in-kind support for their implementation plans, while presenting lean budgets for recruiting and coaching participating pharmacies. We are eager to watch these teams grow and begin transforming community pharmacy through the creation of replicable and sustainable care and business processes,” said CPF Board MPhA Member Shares Info on Migraine Treatment on President Phil Burgess, RPh. MPR MPhA member Natalie Roy, PharmD, a medication therapy The first cohort covers all regions of the country and the management pharmacist at M Health Fairview, and Dr. teams have committed to engaging and deploying more Abby Metzler, an assistant professor of neurology at the than 70 Practice Transformation Coaches to more than 500 University of Minnesota, joined host Angela Davis on pharmacies across the country to implement the six key Minnesota Public Radio on Oct. 22. The doctors shared transformation domains supported at the pharmacy level by information about migraine treatment options and new transformation coaches (see domains and sign up to follow treatments that can prevent migraines altogether for some the Program at www.flipthepharmacy.com). patients. Listen to the interview.

COP Class of 2023 Gets White Coats Minnesota Pharmacist Quoted in Drug Topics The University of Minnesota College of Pharmacy held its Pharmacists’ knowledge of pharmacokinetics, drug annual White Coat ceremony on Sept. 6. The class of 2023 transport, and drug metabolism make them ideally suited to are the health care leaders of tomorrow. become involved in the expanding field of pharmacogenetic testing, says Elise Durgin, PharmD, PGY1 ambulatory care resident at University of Minnesota College of Pharmacy and Goodrich Pharmacy. She’s quoted in an article published in Drug Topics, “Six New Clinical Services for Pharmacists.”

Minnesota Pharmacist • Winter 2020 • 33 MPhA NEWS MPhA News & Notes continued

MPhA Member Receives “Defining the Future” Grant MPhA Member Elected as Regional Officer for APhA-ASP MPhA student member Josiah Allen MPhA student member Morgan Olhausen was elected as has been awarded a “Defining the American Pharmacists Association Academy of Student Future” grant from the College Pharmacists (APhA-ASP) Region 5 Regional Member-at- of Psychiatric and Neurologic large in early November. Pharmacists. This grant program seeks to encourage doctor of pharmacy students and post-doctoral residents with an interest in psychiatric and neurologic disorders to investigate topics in line with the Foundation’s mission and vision. Using a competitive selection process, the Foundation annually funds three grants of up to $1,500 each.

MPhA Members Attend NCPA Conference Several MPhA members attended the annual meeting of the National Community Pharmacists Association (NCPA) in late October. MPhA Executive Director Sarah Caption: Morgan Olhausen (center) was among several new Region 5 Derr attended the National Alliance officers elected at the recent APhA-ASP meeting. of State Pharmacy Associations (NASPA) meeting, which is held Pharmacy Resident Receives APhA Foundation Grant concurrently with the NCPA Congratulations to GuidePoint meeting. Rep. Buddy Carter of Pharmacy’s resident, Ally Kingsbury, Georgia, the only pharmacist in the U.S. Congress, spoke for being awarded as one of this at the NCPA opening session and to the state executives at year’s recipients of the APhA NASPA. Foundation Incentive Grant! Way to go, Ally, and thanks to Sarah Jonjak MPhA Member Presents Poster at ACCP Annual Meeting for her help in writing the grant MPhA student member Patty Maglalang presented a poster submission. for her research group’s work on rescue therapy for seizures as part of the American College of Clinical Pharmacy Annual MPhA Participates in RALI Meeting. The meeting was held in New York City, October Minnesota Meeting 26-29. Patty is mentored by University of Minnesota The Rx Abuse Leadership Initiative (RALI) of Minnesota Experimental and Clinical Pharmacology faculty member is comprised of leaders focused on effective solutions to James Cloyd, PharmD. the opioid epidemic. MPhA Executive Director Sarah Derr participated in a meeting of the group, held on Nov. 14. MPhA is one of twenty organizations partnering on this work, along with organizations as varied as the Hennepin County Sheriff Foundation, the Minnesota Realtors Association, Minnesota Farm Bureau Foundation and Minnesota Rural Health Association.

34 • Minnesota Pharmacist • Winter 2020 MPhA NEWS MPhA News & Notes continued

GenerationRx Partners on Drug Take-back Event The Pharmacy Alumni Awards Reception On Nov. 19, the University of Minnesota College of On Dec. 3, the College of Pharmacy hosted its annual Pharmacy student organization GenerationRx partnered Pharmacy Alumni Award Reception. MPhA had the with the Hennepin County Sheriff’s office on a prescription opportunity to present two awards to recipients who were drug take-back event near the East Bank campus of the unable to attend the Annual Learning and Networking Event. university. The Bowl of Hygeia was presented to Dr. Karen Bastianelli, who has served the college on the Duluth campus, poured MPhA Editorial Committee Co-chair Takes on New Role her time into working with students on several projects and MPhA’s Long-time Editorial on an international experience, and has given back to the Committee Co-chair Dave Hoang, community in multiple ways. PharmD, MBA, stepped aside from his work on the committee as of Jan. The Distinguished Service award was presented to Jim 1, 2020. Dave has become the Board Alexander, who has been integral in work at the College of Chair of the Council on Asian Pacific Pharmacy and with those who are suffering from substance Minnesotans (a nonpartisan state use disorder. Jim has also promoted the Utah School on agency advising the governor and Drugs and Alcoholism and supported students in attending the Minnesota Legislature). Dave will continue in his position this life-changing event for decades. as Clinical Pharmacist in the Health Care Administration division at the Minnesota Department of Health. Our Congratulations to all of the award winners at this event, gratitude to Dave for his years of service to our association, many of whom are MPhA members. stretching back to 2011. • Alumni Service Award: Lowell Anderson • College of Pharmacy Above and Beyond Award: Ron MPhA Past President’s Letter Published in Star Tribune Caple and Robert Carlson MPhA Past President Jason Varin wrote a letter to the editor • College of Pharmacy Early Career Achievement of the Star Tribune regarding a recent state law that requires Award: Philip Brummond pharmacists and pharmacies to make available to patients • Spirit of the Century Mortar Club Founders’ Award: information on sources of lower cost prescription drugs. Doris Calhoun and Tom McKennell (posthumously) The letter, published on Nov. 27, points out that pharmacies • Century Mortar Club Friend of the College: Marilyn have little to no control over the price of prescription Eelkema medications. “The drug manufacturers and wholesalers • Pharmacy Alumni Society Mentors of the Year: Sarah determine the price that the pharmacy pays for the drugs, McIntosh and David Lommel and pharmacy benefit managers determine what the patient • Pharmacy Alumni Mentee of the Year: Savannah pays and what the pharmacy gets paid,” Jason writes. Read Burnside the full letter. • Pharmacy Alumni Society Distinguished Pharmacist: Jeff Lindoo Residents and Preceptors Give Back to Community • Pharmacy Society Faculty Recognition Award: Rory Residents and preceptors from the University of Minnesota Remmel College of Pharmacy came together in November to • Century Mortar Club Student Awards: Rowan Mahon support the mission of “The Sandwich Guy” (Allan Law of and Carolyn O’Donnell Minneapolis Recreation Development). They built 1,500 • Hats Off Awards: Eric and Jill Berquist and Cindy sandwiches and 1,200 shelf-stable protein packs for Singleton Minnesotans experiencing homelessness. MPhA Members Inducted to UMN Academies for Excellence On Dec. 4, the University of Minnesota inducted several faculty members to the university’s Academies for Excellence. MPhA members Lisa Coles and Anne Schull- Feulner were among the inductees. Anne Schullo-Feulnor, PharmD, BCPS, Associate Professor & Clinical Education Coordinator, Department of Pharmaceutical Care & Health Systems, was inducted to the Academy for Excellence in Clinical Practice. This is the highest recognition of

Minnesota Pharmacist • Winter 2020 • 35 MPhA NEWS MPhA News & Notes continued excellence in the practice or provision of clinical care by a MPhA Members Publish Front-Page Article on full-time faculty member. Lisa Coles, MS, PhD, Associate Comprehensive Medication Management Director of Clinical Pharmacology and Pharmacometrics, MPhA members Kyle Walburg, PharmD, Sara Massey, Center for Orphan Drug Research, was inducted to the PharmD, Kylee Funk, PharmD, BCPS, Randy Seifert, Academy for Excellence in Team Science, acknowledging PharmD, and Todd Sorensen, PharmD, wrote a front-page the valuable and significant contributions made by an article for the December 2019 issue of Minnesota Physician exemplar interdisciplinary team conducting biomedical journal. Titled “Comprehensive Medication Management: or health care research to address significant health Expanding the primary care interprofessional team,” the challenges. authors detail how adding a pharmacist to the care team can help primary care physicians avoid burnout in an environment where budgets are tight and expectations to improve health care are high.

MPhA Member Published in Science magazine From Science magazine website, accessed Jan. 10: The January issue of Science magazine includes a Perspective article co-authored by MPhA member Betsy Hirsch from the University of Minnesota College of Pharmacy. In “Tolerance to antibiotics affects response,” Hirsch and co-author Andrew D. Berti note that more than 2.8 million antibiotic-resistant infections were identified in the U.S in 2019, resulting in more than 35,000 deaths. They draw on studies showing that bacteria frequently develop enhanced MPhA Member Presents at Presidential Symposium antimicrobial tolerance prior to developing antimicrobial Angela Birnbaum, PhD, FAES, was among the presenters resistance. Read more. at the American Epilepsy Society (AES) Presidential Symposium on Dec. 7, part of the organization’s Annual Naloxone Kits Distributed to Duluth Pharmacy, Medical Meeting in Baltimore. Her presentation topic was “More Students Detailed and Individualized PK Modeling and Potential Role From Duluth News Tribune, Jan. 23: About 75 students PG Will play in the Future.” Dr. Birnbaum is a professor from the University of Minnesota College of Pharmacy and and Director of Graduate Studies in the Department of Medical School’s Duluth campus gathered in mid-January Experimental and Clinical Pharmacology. for an introduction to the opioid crisis and to learn how to use the overdose reversal drug Naloxone to save lives. MPhA Member Takes on Role of Department Head, MPhA member Laura Palombi was one of three leaders for Pharmaceutical Care and Health Systems the training session. Read the full story. University of Minnesota College of Pharmacy Dean Lynda Welage has announced that MPhA member Amy Pittenger, PharmD, MS, PhD, has accepted the position of Department Head of Pharmaceutical Care and Health Systems (PCHS), effective Jan. 21, 2020. Read more about Amy and her new appointment. SUBMIT YOUR NEWS OR ARTICLE! Do you have news to share about MPhA members and their achievements? Help us spread the news about the good work that our members are doing across Minnesota!

Contact Laurie Pumper at [email protected].

36 • Minnesota Pharmacist • Winter 2020 MINNESOTA PHARMACISTS ASSOCIATION 1000 Westgate Drive, Suite 252, St. Paul, MN 55114 p. 651.697.1771 | f. 651.290.2266 | [email protected]

MPHA MEMBERSHIP GIVES YOU... OUR MISSION You are joining a strong professional organization: Serving Minnesota pharmacist providers to advance patient care. • Empowering pharmacists to provide excellent patient care. OUR VISION • Creating communities for personal and professional growth. We will be a vital organization of engaged Minnesota pharmacy • Promoting pharmacists and the pharmacy profession with professionals. We will be recognized for leadership in advancing key stakeholders to improve health in Minnesota. patient care. • Whatever area you’re in, inspiring you to own your own practice. OUR VALUES • Engagement Keep Informed • Patient Care Professional Development • Inter-professional Collaboration Weekly Small Doses Annual Learning Networking eNewsletter, • Economic Viability of Practice Event, MTM Symposium, • Advocacy Issue Alerts, Quarterly Annual Leadership Summit MPhA Journal, eBook • Workforce & House of Delegates, • Lifelong Learning and Professional Development library, MPhA Events Minnesota Pharmacy monthly Email. • Pharmacy Teamwork Development Legislative Day, MTM & • Diversity in Membership Advocacy Immunization Certificate • Professional Collaborations and Relationships You are represented by Programs, Monthly Webinars, a strong and respected On-Demand Webinar ACCOMPLISHMENTS voice. See our recent Library, Statewide Town Hall accomplishments Meetings, Online CE from MPhA members and our lobbyist, Buck Humphrey, educated including expanded the University of Minnesota. legislators and regulatory personnel on the role pharmacists can pharmacists scope of play to be part of the solution. Be Involved Patient Fair Practices & Reimbursement practice and addressing Public Affairs, Professional reimbursement issues. & Organizational Affairs, MPhA undertook efforts on Patient Fair Practices and meaningful Networking Membership Engagement PBM reform that would address poor practices that negatively Discuss pharmacy issues Student & New Practitioners, impact patients and pharmacists’ ability to provide care. MPhA also continues to work with the Department of Human Services (DHS) and best practices at Education & Events, to pass legislation that would bring Minnesota into compliance programs and events. Make Editorial and Awards with CMS mandates to restructure the methodology for Medicaid contacts with over 2,000 Committees, MTM and other reimbursement to pharmacies. In 2019, our efforts passed pharmacy professionals. Academies. legislation that will require more transparency from Pharmacy Online member directory Resources Benefit Managers through the Commerce Department. This effort of pharmacists. Online access to will continue in the 2020 session with work to include fiduciary responsibility in the effort. resources to support Navigator Program your practice including Medication Administration A new offering with MPhA MTM, immunizations In the 2019 legislative session, legislation was passed to allow is available to help you and pharmacy practice pharmacists to administer long acting injectables for mental health navigate and get the most management, Pharmacy and substance use disorder. This is billed through the medical out of your membership! Technician CE Library benefit. MPhA will continue to advocate for billing through the Recognition discounts, APhA Pharmacy medical benefit for medication and services offered by pharmacists. Pharmacist and industry Library discounts, AAA Minnesota Pharmacy Alliance leaders recognized for discounts and more! MPhA also worked very hard to build support for legislation that their innovation, advocacy would give pharmacists the authority to prescribe naloxone, and service. hormonal contraceptives and tobacco cession products. We continue to work between sessions to build support from other stakeholders for our continued efforts on this legislation next session with the Minnesota Pharmacy Alliance (formerly the Pharmacy Advocacy Task Force). Thrifty White Pharmacy Special: To create or renew your MPhA Membership for the following year at the Thrifty White Pharmacy special membership rate of $45, please click here.

FIND OUT MORE AND FILL OUT A MEMBERSHIP APPLICATION AT WWW.MPHA.ORG