Georgia Pharmacy Journal - February 2014

Keynote Speaker: Th omas E. Menighan, CEO American Pharmacists Association

An Update On Provider Status Nationwide

Plus:

GPhA Named One Of the Top 5 Georgia Association Lobbyists

FDA Recommends Discontinuing Products Th at Contain 325mg or More of Acetaminophen

Th e ABCs of Star Quality

Mark Parris Named to BOC Executive Committee

Thursday, February 27, 2014 - Georgia Railroad Freight DepotThursday, February 27, 2014 - Georgia Railroad Freight Depot

VOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVIP DAY

February 2014VOLUME 36, ISSUE 2

Editor: Jim [email protected]

Th e Georgia Pharmacy Journal® (GPJ) is the offi cial publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, offi cers or members of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose interested in writing for this publication are encouraged to request the offi cial “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email [email protected].

SUBSCRIPTIONS AND CHANGE OF ADDRESSTh e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

Th e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offi ces.

POSTMASTER: Send address changes to Th e Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

ADVERTISINGAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at [email protected].

GPhA Headquarters50 Lenox Pointe, NE

Atlanta, Georgia 30324t 404-231-5074 f 404-237-8435

www.gpha.org

February 2014

1Th e Georgia Pharmacy Journal

ContentsMessage from Pamala Marquess .................

Message from Jim Bracewell .........................

Welcome New Members.................................

Member News ..................................................

24

55

.........................................

1617

Th e ABCs of Star Quality ...............................

Mark Parris Named to BOC Executive Committee ..........................

FDA Recommendation - Discontinue Prescribing Products Containing More Th an 325mg of Acetaminophen ................................................ 14

12

PharmPAC Supporters .................................18Continuing Education ................................21GPhA Board of Directors .........................28

......................................... VOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVIP DAY

Editor: Jim [email protected]

Th e Georgia Pharmacy Journal® (GPJ) is the offi cial publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2014, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor.

All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, offi cers or members of the Georgia Pharmacy Association.

ARTICLES AND ARTWORKThose interested in writing for this publication are encouraged to request the offi cial “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email [email protected].

SUBSCRIPTIONS AND CHANGE OF ADDRESSTh e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia.

Th e Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offi ces.

POSTMASTER: Send address changes to Th e Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

ADVERTISINGAdvertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at [email protected].

GPhA Headquarters50 Lenox Pointe, NE

Atlanta, Georgia 30324t 404-231-5074 f 404-237-8435

www.gpha.org

February 2014


ContentsMessage from Pamala Marquess .................

Message from Jim Bracewell .........................

Welcome New Members.................................

Member News ..................................................

24

55

.........................................

1617

Th e ABCs of Star Quality ...............................

Mark Parris Named to BOC Executive Committee ..........................

FDA Recommendation - Discontinue Prescribing Products Containing More Th an 325mg of Acetaminophen ................................................ 14

12

PharmPAC Supporters .................................18Continuing Education ................................21GPhA Board of Directors .........................28

......................................... VOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVOICE IN PHARMACY DAYVIP DAY

Pamala MarquessGPhA President

The Georgia Pharmacy Journal2

MESSAGE from Pamala Marquess

Committee Work Moves Pharmacy Forward

The Committees of the Georgia Pharmacy Association put forth an amazing amount of effort in advancing the practice of pharmacy. I would like to thank the committee members for their dedication and contributions to the profession of phar-macy in the state of Georgia.

Why is the practice of pharmacy innovative in Georgia? GPhA has a group of ded-icated pharmacist members working on pharmacy issues through committee work on

a monthly basis.We met for our January Committee meetings and below is a summary of their yearly charges and

initiatives.

The following are the Charges for the Continuing Pharmacy Education Committee:1. Collaborate with the Convention Planning Committee to plan and promote the convention CPE.2. Assess the needs of GPhA members in relation to CPE.3. Plan & Promote education and training to establish patient care services for Pharmacists in GA.4. Provide CPE which supports the Pharmacist Provider status initiative.5. Provide CPE which supports the ACO Pharmacist initiative.6. Discuss Leadership CPE for the Women’s Leadership Retreat.7. Discuss CPE to enhance pharmacist provided patient care services utilizing multi-disciplinary teams.8. Discuss APhA Certificate Programs and the offerings for 2013-2014.

The following are the Charges for the Governmental Affairs Committee:1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day. (Coordinate with Student & Academic Affairs Chair).2. Set Legislative Strategy to accomplish Legislative Agenda.a. Provider Statusb. MACc. Immunization expansiond. Accreditation/Board of Pharmacy3. Involve, Invite, Engage!!!! Involve members across the state to Invite Legislators to learn about our issues and Engage their support!!!

The following are the Charges for the Third Party Policy Committee:1. MAC pricing. Collect MAC pricing prescription losses and submit to GPhA for documentation. Goal: 100 documentations of MAC losses.2. Create a simple MAC description/explanation for use with legislators to explain MAC.3. Discuss strategy for obtaining Provider Status for Pharmacists with 3rd party providers.

“This work not only contains short term goals but also long

term goals to promote the

pharmacist’s servic-es, improve patient outcomes, and the pharmacists pro-

vider status.”

Pam

4. Discuss strategy for ACO’s with 3rd party providers.5. Discuss Accreditation requirements from 3rd party providers. 6. Discuss new HIPAA rules for 3rd party providers. How can GPhA assist?7. Discuss new tactics of 3rd party audits.

The following are the Charges for the Public Affairs Committee:1. Establish a public service campaign that promotes pharmacist provider status.2. Coordinate at least 2 volunteer opportunities for GPhA members with a health cam-paign, (ie. Diabetes University, or Susan Komen). Build a GPhA Team of volunteers to attend the event.3. Identify opportunities for GPhA members to volunteer for public service around the state.4. Identify opportunities for GPhA awareness/promotion through media outlets.5. Collaborate with other Health Care Providers in Public Affairs events.6. Involve New Practitioners and students in volunteer events.

The following are the Charges for the Student & Academic Affairs Committee:1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day.2. Work with student leaders to attend meetings on campus to promote GPhA, con-

vention, and New Practitioner Leadership Conference involvement.3. Invite students to attend region meetings and share student activities with the group.4. Invite Residents and students to publish research in the GPhA Journal.5. Engage members through Facebook and website.6. Collaborate and Organize for GPhA volunteers to be present at major events on campus, (ie. gradua-tion, white coat, pinning ceremony, with a booth).7. Develop a “Navigational Packet” for GPhA targeted at New Practitioners.8. Conduct a seminar on “how to register for the GA Boards” targeted at 4th year students.

I know you will agree that we have many volunteers who are critical to the progress and enrichment of GPhA. This work not only contains short term goals but also long term goals to promote the phar-macists services, improve patient outcomes, and the pharmacist provider status.

I hope that you will consider joining a committee that you can share your talents with! n

Pamala S. Marquess

3The Georgia Pharmacy Journal

Pamala MarquessGPhA President


MESSAGE from Pamala Marquess

Committee Work Moves Pharmacy Forward

The Committees of the Georgia Pharmacy Association put forth an amazing amount of effort in advancing the practice of pharmacy. I would like to thank the committee members for their dedication and contributions to the profession of phar-macy in the state of Georgia.

Why is the practice of pharmacy innovative in Georgia? GPhA has a group of ded-icated pharmacist members working on pharmacy issues through committee work on

a monthly basis.We met for our January Committee meetings and below is a summary of their yearly charges and

initiatives.

The following are the Charges for the Continuing Pharmacy Education Committee:1. Collaborate with the Convention Planning Committee to plan and promote the convention CPE.2. Assess the needs of GPhA members in relation to CPE.3. Plan & Promote education and training to establish patient care services for Pharmacists in GA.4. Provide CPE which supports the Pharmacist Provider status initiative.5. Provide CPE which supports the ACO Pharmacist initiative.6. Discuss Leadership CPE for the Women’s Leadership Retreat.7. Discuss CPE to enhance pharmacist provided patient care services utilizing multi-disciplinary teams.8. Discuss APhA Certificate Programs and the offerings for 2013-2014.

The following are the Charges for the Governmental Affairs Committee:1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day. (Coordinate with Student & Academic Affairs Chair).2. Set Legislative Strategy to accomplish Legislative Agenda.a. Provider Statusb. MACc. Immunization expansiond. Accreditation/Board of Pharmacy3. Involve, Invite, Engage!!!! Involve members across the state to Invite Legislators to learn about our issues and Engage their support!!!

The following are the Charges for the Third Party Policy Committee:1. MAC pricing. Collect MAC pricing prescription losses and submit to GPhA for documentation. Goal: 100 documentations of MAC losses.2. Create a simple MAC description/explanation for use with legislators to explain MAC.3. Discuss strategy for obtaining Provider Status for Pharmacists with 3rd party providers.

“This work not only contains short term goals but also long

term goals to promote the

pharmacist’s servic-es, improve patient outcomes, and the pharmacists pro-

vider status.”

Pam

4. Discuss strategy for ACO’s with 3rd party providers.5. Discuss Accreditation requirements from 3rd party providers. 6. Discuss new HIPAA rules for 3rd party providers. How can GPhA assist?7. Discuss new tactics of 3rd party audits.

The following are the Charges for the Public Affairs Committee:1. Establish a public service campaign that promotes pharmacist provider status.2. Coordinate at least 2 volunteer opportunities for GPhA members with a health cam-paign, (ie. Diabetes University, or Susan Komen). Build a GPhA Team of volunteers to attend the event.3. Identify opportunities for GPhA members to volunteer for public service around the state.4. Identify opportunities for GPhA awareness/promotion through media outlets.5. Collaborate with other Health Care Providers in Public Affairs events.6. Involve New Practitioners and students in volunteer events.

The following are the Charges for the Student & Academic Affairs Committee:1. Collaborate with the four schools of Pharmacy to promote, attend, and involve the students in VIP Day.2. Work with student leaders to attend meetings on campus to promote GPhA, con-

vention, and New Practitioner Leadership Conference involvement.3. Invite students to attend region meetings and share student activities with the group.4. Invite Residents and students to publish research in the GPhA Journal.5. Engage members through Facebook and website.6. Collaborate and Organize for GPhA volunteers to be present at major events on campus, (ie. gradua-tion, white coat, pinning ceremony, with a booth).7. Develop a “Navigational Packet” for GPhA targeted at New Practitioners.8. Conduct a seminar on “how to register for the GA Boards” targeted at 4th year students.

I know you will agree that we have many volunteers who are critical to the progress and enrichment of GPhA. This work not only contains short term goals but also long term goals to promote the phar-macists services, improve patient outcomes, and the pharmacist provider status.

I hope that you will consider joining a committee that you can share your talents with! n

Pamala S. Marquess


Jim Bracewell Executive Vice President

Th e Georgia Pharmacy Journal

“...their homes destroyed, their buff alo gone, the last band of free Sioux submitted to white authority at Fort Robinson, Nebraska. Th e great horse culture of the plains was gone and the American frontier was soon to pass into history.”

- Epilogue from, “Dances With Wolves”

The neighborhood pharmacy was permanently closed. Now the pharmacists’ ability to deliver patient care in the community was also gone. Th e last remnants of the state associa-tion disbanded and the practice of pharmacy was soon to pass into history under the author-ity of government run healthcare.

Like the spirit predicted the future for Scrooge in the famous Dickens tale “A Christmas Carol”, so can the future of pharmacy. But just as Scrooge questioned the ghost, do these things have to be? Or can the future that is predicted be changed?

I have good news for every pharmacist in Georgia. Th is does not need to be the future of your career or your profession. On February 27, 2014, you can band with your fellow phar-

macists at the State Capitol and hear Tom Menighan Executive Vice President of the American Pharmacists Association predict a bright future for pharmacy when pharmacists are recognized as healthcare providers by CMS (the Federal Government), because then and only then will pharmacy be on the level of reim-bursement with physicians, nurses, dentists and other healthcare providers.

Government is of the people, by the people and for the people that participate. Our state and federal government virtually controls healthcare and especially pharmacy. Our elected representatives cry out for pharmacists to participate in creating their future but all too oft en pharmacists have been too busy to get involved. Too busy to participate, too tired to attend a meeting, too little money

to pay their association dues so they abdicate their responsibility to their profession and leave it to non-pharmacists to create their future.

Th is is not the case with the leadership of the Georgia Pharmacy Association, but without active members that follow, leadership just becomes a walk in the park. Whether you are an active voice in pharmacy by being a long time active member, a strong contributor to PharmPAC, or have never joined your association nor supported your profession, you create your future in pharmacy either way it goes. I hope to see you February 27, 2014 at Voice In Pharmacy Day.

If for some real reason you cannot be there on February 27th, do the next best thing and ask a friend to join GPhA for the future you want in pharmacy. n

Jim

4

“Our state and federal government

virtually controls healthcare and

especially pharmacy.”

You Control Your Professional Future By Creating Your Professional Future


M E M B E R N E W S

As a pharmacist, the most impor-tant aspects of my profession are the re-lationships I have with customers and keeping up to date so I can give them the best service possible. Taking care of the customers’ needs is my fi rst tenet.

Medicare Part D plans are a way peo-ple over 65 can aff ord medications they might otherwise not. Although the pa-tients pay premiums, the cost is largely supported by taxes we all pay.

Most Part D plans have two levels of participation for pharmacies — network and preferred. Customers usually have a lower co-pay at a preferred pharmacy, but their premiums are the same. Th e plans decide if a pharmacy can be network or preferred. Th is year, most independent pharmacies were denied preferred status by the plans.

Large health care plans and chain pharmacies are engaging in confusing and misleading tactics to steer customers away from their current pharmacy. Th ey make calls and send mail encouraging customers to change to chain or mail or-der pharmacies. Th ey may even put their logo on the insurance card. Th is can cause the customer to believe they have no choice but to go to the plan’s pharma-cy.

You do have a choice. You can go to a network pharmacy. Th e diff erence in cost can be justifi ed by better personal service. Pharmacists want to give good customer service, but large corporations oft en put demands on pharmacists that make personal service diffi cult, if not impossible. Smaller community phar-macies emphasize customer service and developing a relationship with the cus-tomer. Th is leads to better patient adher-ence and better outcomes. Patients need to have ready access to their pharmacist.

If you and your taxes are paying for

your pharmacy plan, you should be free to choose any participating pharmacy without having to pay a penalty. Any pharmacy willing to participate in a government or corporate-funded plan should be given the opportunity to do so under the same rules as any other phar-macy. A larger pool of providers means

Medicare Part D Participants Being Nudged Toward Chain Pharmacies

By Ed Dozier, GPhA Region 2 President

WELCOME

Th e Georgia Pharmacy Association strives to be the leading voice for pharmacy in the state of Georgia. We aggressively advocate for the profession by shaping public policy and scope of practice to enhance the value of pharmacy. We take pride in our presti-gious history and value our membership for its diversity in all practice settings as well as its dedication to health care. GPhA provides its members with the resources and support needed to advance our profession. As healthcare changes, so do job responsibilities and career tracks may be refocused. GPhA is your career develop-ment partner as you address your future in pharmacy. Professional networking, skills training and continuing pharmacy educa-tion are key benefi ts of your GPhA member-ship. Whether you are a recent Pharmacy school grad or an established pharmacist, there is a place for your voice at GPhA.

New Members

Have you considered GPhA’s new Sustaining Membership? ..........only $14.58 per month Never get another renewal notice! Visit gpha.org and sign up today!

50 Lenox Pointe, NE, Atlanta, GA 30324 | tf: 888.871.5590 | ph: 404.231.5074 | f: 404.237.8435 | www.gpha.orgTHE GEORGIA PHARMACY ASSOCIATION

Your Voice in Pharmacy

greater choices for customers and in-creased access to pharmacists.

Please write your legislators and let them know you support pharmacy com-petition in Medicare Part D. n Ed Dozier has been a community phar-macist in Albany since 1972. He current-ly works with U-Save-It Pharmacy.

PharmacistsSteve Freeman - Atlanta, GA

Aquila Ingram - Pooler, GA

Edie Swaggard-Green - Douglasville, GA

Vasavi Th omas - Tucker, GA

John Richey - Columbus, GA

Elizabeth Carroll - Americus, GA

Associate

Kenneth Barngrover - Columbus, GA

Jim Bracewell Executive Vice President


“...their homes destroyed, their buff alo gone, the last band of free Sioux submitted to white authority at Fort Robinson, Nebraska. Th e great horse culture of the plains was gone and the American frontier was soon to pass into history.”

- Epilogue from, “Dances With Wolves”

The neighborhood pharmacy was permanently closed. Now the pharmacists’ ability to deliver patient care in the community was also gone. Th e last remnants of the state associa-tion disbanded and the practice of pharmacy was soon to pass into history under the author-ity of government run healthcare.

Like the spirit predicted the future for Scrooge in the famous Dickens tale “A Christmas Carol”, so can the future of pharmacy. But just as Scrooge questioned the ghost, do these things have to be? Or can the future that is predicted be changed?

I have good news for every pharmacist in Georgia. Th is does not need to be the future of your career or your profession. On February 27, 2014, you can band with your fellow phar-

macists at the State Capitol and hear Tom Menighan Executive Vice President of the American Pharmacists Association predict a bright future for pharmacy when pharmacists are recognized as healthcare providers by CMS (the Federal Government), because then and only then will pharmacy be on the level of reim-bursement with physicians, nurses, dentists and other healthcare providers.

Government is of the people, by the people and for the people that participate. Our state and federal government virtually controls healthcare and especially pharmacy. Our elected representatives cry out for pharmacists to participate in creating their future but all too oft en pharmacists have been too busy to get involved. Too busy to participate, too tired to attend a meeting, too little money

to pay their association dues so they abdicate their responsibility to their profession and leave it to non-pharmacists to create their future.

Th is is not the case with the leadership of the Georgia Pharmacy Association, but without active members that follow, leadership just becomes a walk in the park. Whether you are an active voice in pharmacy by being a long time active member, a strong contributor to PharmPAC, or have never joined your association nor supported your profession, you create your future in pharmacy either way it goes. I hope to see you February 27, 2014 at Voice In Pharmacy Day.

If for some real reason you cannot be there on February 27th, do the next best thing and ask a friend to join GPhA for the future you want in pharmacy. n

Jim

4

“Our state and federal government

virtually controls healthcare and

especially pharmacy.”

You Control Your Professional Future By Creating Your Professional Future


M E M B E R N E W S

As a pharmacist, the most impor-tant aspects of my profession are the re-lationships I have with customers and keeping up to date so I can give them the best service possible. Taking care of the customers’ needs is my fi rst tenet.

Medicare Part D plans are a way peo-ple over 65 can aff ord medications they might otherwise not. Although the pa-tients pay premiums, the cost is largely supported by taxes we all pay.

Most Part D plans have two levels of participation for pharmacies — network and preferred. Customers usually have a lower co-pay at a preferred pharmacy, but their premiums are the same. Th e plans decide if a pharmacy can be network or preferred. Th is year, most independent pharmacies were denied preferred status by the plans.

Large health care plans and chain pharmacies are engaging in confusing and misleading tactics to steer customers away from their current pharmacy. Th ey make calls and send mail encouraging customers to change to chain or mail or-der pharmacies. Th ey may even put their logo on the insurance card. Th is can cause the customer to believe they have no choice but to go to the plan’s pharma-cy.

You do have a choice. You can go to a network pharmacy. Th e diff erence in cost can be justifi ed by better personal service. Pharmacists want to give good customer service, but large corporations oft en put demands on pharmacists that make personal service diffi cult, if not impossible. Smaller community phar-macies emphasize customer service and developing a relationship with the cus-tomer. Th is leads to better patient adher-ence and better outcomes. Patients need to have ready access to their pharmacist.

If you and your taxes are paying for

your pharmacy plan, you should be free to choose any participating pharmacy without having to pay a penalty. Any pharmacy willing to participate in a government or corporate-funded plan should be given the opportunity to do so under the same rules as any other phar-macy. A larger pool of providers means

Medicare Part D Participants Being Nudged Toward Chain Pharmacies

By Ed Dozier, GPhA Region 2 President

WELCOME

Th e Georgia Pharmacy Association strives to be the leading voice for pharmacy in the state of Georgia. We aggressively advocate for the profession by shaping public policy and scope of practice to enhance the value of pharmacy. We take pride in our presti-gious history and value our membership for its diversity in all practice settings as well as its dedication to health care. GPhA provides its members with the resources and support needed to advance our profession. As healthcare changes, so do job responsibilities and career tracks may be refocused. GPhA is your career develop-ment partner as you address your future in pharmacy. Professional networking, skills training and continuing pharmacy educa-tion are key benefi ts of your GPhA member-ship. Whether you are a recent Pharmacy school grad or an established pharmacist, there is a place for your voice at GPhA.

New Members

Have you considered GPhA’s new Sustaining Membership? ..........only $14.58 per month Never get another renewal notice! Visit gpha.org and sign up today!


Your Voice in Pharmacy

greater choices for customers and in-creased access to pharmacists.

Please write your legislators and let them know you support pharmacy com-petition in Medicare Part D. n Ed Dozier has been a community phar-macist in Albany since 1972. He current-ly works with U-Save-It Pharmacy.

PharmacistsSteve Freeman - Atlanta, GA

Aquila Ingram - Pooler, GA

Edie Swaggard-Green - Douglasville, GA

Vasavi Th omas - Tucker, GA

John Richey - Columbus, GA

Elizabeth Carroll - Americus, GA

Associate

Kenneth Barngrover - Columbus, GA

Mercer College of Pharmacy Names New Department Chair


M E M B E R N E W SM E M B E R N E W S

Call for GPhA Awards!The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the 139th GPhA Con-vention in 2014. A brief description and cri-teria of each award is included below. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 1, 2014. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at the 139th GPhA Convention at the Wyndham Bay Point Resort in Panama City Beach, FL.

Bowl of Hygeia Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by the GPhA and all state phar-macy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee;

5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist Created in 1987 to recognize the achieve-ments of young pharmacists in the profes-sion, the Award has quickly become one of the GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) To encourage new pharmacists to participate in association and community activities, and 2) To annually recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in phar-macy association programs or activities and community service projects.

2014 Awards Nomination Form Bowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Generation Rx Champions

Nominee’s Full Name Nickname Home Address City State Zip Practice Site Work Address City State Zip College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

Supporting Information:

Submitted By: Submit this form completed by March 1, 2014 to:

GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

Innovative Pharmacy Practice This Award is presented annually to a prac-ticing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.

Generation Rx Champions AwardThis award is presented annually to a phar-macist who has demonstrated work with prescription drug abuse. This award gives honor to the recipient with a plaque and donates $500 to the charity of the recipients choice.Selection Criteria: 1) Nominee must a have demonstrated a committed effort to reduce prescription drug abuse;2) Nominee must be a licensed Georgia Pharmacist; 3) Nominee must be a member of the Geor-gia Pharmacy Association in the year of the selection.

The Georgia Pharmacy Journal

GPhA member Dr. Susan Miller, Pharm.D., named chair of the Department of Pharmacy Practice.

A long time supporter of the Geor-gia Pharmacy Association, Dr. Susan Miller was recently named chair in the Department of Pharmacy Practice at Mercer. She also teaches and conducts research in the areas of the practice of pharmacy, geriatric pharmacotherapy, senior care pharmacy, and medical and

professional ethics. She also conducts pedagogical research in areas relevant to pharmacy education.

Her previous administrative positions in Mercer’s College of Pharmacy include vice-chair of the Department of Phar-macy for curriculum, associate dean for administration, vice-chair of the De-

partment of Clinical and Administrative Sciences, and chair of the curriculum committee.

Dr. Miller is a frequent presenter at pharmacy and academic meetings, and she has authored over 100 publications including 18 book chapters, 32 original research articles, and numerous con-tinuing education publications. Dr. Mill-er has received teaching awards includ-ing the Distinguished Educator Award from the Mercer College of Pharmacy.

As well as being a member of The Georgia Pharmacy Association (GPhA) she is a member of the American Asso-ciation of Colleges of Pharmacy, a grad-uate of the Academic Leadership Fellow Program of AACP, and a Fellow in the American Society of Consultant Phar-macists.

The Georgia Pharmacy Association would like to say congratulations to Dr. Susan Miller, Pharm.D. n

Dunaway Shows School Spirit as UGA Cheerleader

This past year, GPhA member and former GPhA President and Board Chairman Bill Dunaway was part of the group.

Bill graduated from Marietta High in 1957 and cheered at UGA from 1958 to 1961. “Yep, I started cheering at UGA 55 years and 25 lbs. ago,” Dunaway said.

With each UGA score Dunaway did the required push-ups for each point. Unfortunately UGA had another bad day. The good news was that Bill only had to do 21 push-ups.

In 1973, alumni of the Redcoat Band started performing in a pregame show. Dunaway also performed in 1973 and 1974 since he played in the band also.

Not only is Bill an active UGA Alumni and a past president of the GPhA he is also a former Mayor of Marietta (serving two terms), a registered Pharmacist and former owner of Dunaway Drug Stores, an adjunct faculty member and Trustee

Emeritus at Kennesaw State University, and past president of the Georgia Phar-macy Advisory Board. n

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It means having real strategies for all your � nancial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their

families and their practices. It means working with an independent � rm you can trust.

Michael T. Tarrant, CFP®• Speaker & Author• PharmPAC Supporter• Creating Real Financial

Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • [email protected]

Rah! Rah! Rah! In 1976 the University of Georgia started a tradition of inviting alumni cheerleaders back to cheer on the field for the first half of Homecoming.

Mercer College of Pharmacy Names New Department Chair


M E M B E R N E W SM E M B E R N E W S

Call for GPhA Awards!The GPhA Awards Committee is seeking nominations for the following awards which will be presented at the 139th GPhA Con-vention in 2014. A brief description and cri-teria of each award is included below. Please select the award for which you would like to nominate someone and indicate their name on the form below. Deadline for submitting the completed nomination form is March 1, 2014. Nominations will be received by the Awards Committee and an individual will be selected for presentation of the Award at the 139th GPhA Convention at the Wyndham Bay Point Resort in Panama City Beach, FL.

Bowl of Hygeia Recognized as the most prestigious award in pharmacy, the Bowl of Hygeia is presented annually by the GPhA and all state phar-macy associations. Selection Criteria: 1) The nominee must be a licensed Georgia pharmacist; 2) The Award is not made posthumously; 3) The nominee is not a previous recipient of the Award; 4) The nominee is not currently serving nor has served within the immediate past two years as an officer of GPhA other than ex-officio capacity or its awards committee;

5) The nominee has an outstanding record of service to the community which reflects will on the profession.

Distinguished Young Pharmacist Created in 1987 to recognize the achieve-ments of young pharmacists in the profes-sion, the Award has quickly become one of the GPhA’s most prestigious awards. The purpose of the Award is two-fold: 1) To encourage new pharmacists to participate in association and community activities, and 2) To annually recognize an individual in each state for involvement in and dedication to the pharmacy profession. Selection Criteria: 1) The nominee must have received entry degree in pharmacy less than ten years ago; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a GPhA member in the year of selection; 4) Nominee must be actively engaged in pharmacy practice; 5) Nominee must have participated in phar-macy association programs or activities and community service projects.

2014 Awards Nomination Form Bowl of Hygeia Distinguished Young Pharmacist Innovative Pharmacy Practice Generation Rx Champions

Nominee’s Full Name Nickname Home Address City State Zip Practice Site Work Address City State Zip College/School of Pharmacy List of professional activities, state/national pharmacy organization affiliations, and/or local civic church activities:

Supporting Information:

Submitted By: Submit this form completed by March 1, 2014 to:

GPhA Awards Committee, 50 Lenox Pointe, Atlanta, GA 30324 or complete this form online at www.gpha.org.

Innovative Pharmacy Practice This Award is presented annually to a prac-ticing pharmacist who has demonstrated innovative pharmacy practice which has resulted in improved patient care. Selection Criteria: 1) The nominee must have demonstrated innovative pharmacy practice which has resulted in improved patient care; 2) Nominee must be a licensed Georgia pharmacist; 3) Nominee must be a member of the GPhA in the year of selection.

Generation Rx Champions AwardThis award is presented annually to a phar-macist who has demonstrated work with prescription drug abuse. This award gives honor to the recipient with a plaque and donates $500 to the charity of the recipients choice.Selection Criteria: 1) Nominee must a have demonstrated a committed effort to reduce prescription drug abuse;2) Nominee must be a licensed Georgia Pharmacist; 3) Nominee must be a member of the Geor-gia Pharmacy Association in the year of the selection.


GPhA member Dr. Susan Miller, Pharm.D., named chair of the Department of Pharmacy Practice.

A long time supporter of the Geor-gia Pharmacy Association, Dr. Susan Miller was recently named chair in the Department of Pharmacy Practice at Mercer. She also teaches and conducts research in the areas of the practice of pharmacy, geriatric pharmacotherapy, senior care pharmacy, and medical and

professional ethics. She also conducts pedagogical research in areas relevant to pharmacy education.

Her previous administrative positions in Mercer’s College of Pharmacy include vice-chair of the Department of Phar-macy for curriculum, associate dean for administration, vice-chair of the De-

partment of Clinical and Administrative Sciences, and chair of the curriculum committee.

Dr. Miller is a frequent presenter at pharmacy and academic meetings, and she has authored over 100 publications including 18 book chapters, 32 original research articles, and numerous con-tinuing education publications. Dr. Mill-er has received teaching awards includ-ing the Distinguished Educator Award from the Mercer College of Pharmacy.

As well as being a member of The Georgia Pharmacy Association (GPhA) she is a member of the American Asso-ciation of Colleges of Pharmacy, a grad-uate of the Academic Leadership Fellow Program of AACP, and a Fellow in the American Society of Consultant Phar-macists.

The Georgia Pharmacy Association would like to say congratulations to Dr. Susan Miller, Pharm.D. n

Dunaway Shows School Spirit as UGA Cheerleader

This past year, GPhA member and former GPhA President and Board Chairman Bill Dunaway was part of the group.

Bill graduated from Marietta High in 1957 and cheered at UGA from 1958 to 1961. “Yep, I started cheering at UGA 55 years and 25 lbs. ago,” Dunaway said.

With each UGA score Dunaway did the required push-ups for each point. Unfortunately UGA had another bad day. The good news was that Bill only had to do 21 push-ups.

In 1973, alumni of the Redcoat Band started performing in a pregame show. Dunaway also performed in 1973 and 1974 since he played in the band also.

Not only is Bill an active UGA Alumni and a past president of the GPhA he is also a former Mayor of Marietta (serving two terms), a registered Pharmacist and former owner of Dunaway Drug Stores, an adjunct faculty member and Trustee

Emeritus at Kennesaw State University, and past president of the Georgia Phar-macy Advisory Board. n

Registered Representative of INVEST Financial Corporation, member FINRA/SIPC. INVEST and its a� liated insurance agencies o� er securities, advisory services and certain insurance products and are not a� liated with Financial Network Associates, Inc. Other advisory services o� ered through Financial Network Associates, Inc. ad.10040.110749

Real Financial Planning.No Generics.

It means having real strategies for all your � nancial issues, not just insurance and investments. It means working with a real planner who is experienced with the needs of pharmacists, their

families and their practices. It means working with an independent � rm you can trust.

Michael T. Tarrant, CFP®• Speaker & Author• PharmPAC Supporter• Creating Real Financial

Planning for over 20 Years

1117 Perimeter Center West, Suite N-307 • Atlanta, GA 30338 • 770-350-2455 • FNAplanners.com • [email protected]

Rah! Rah! Rah! In 1976 the University of Georgia started a tradition of inviting alumni cheerleaders back to cheer on the field for the first half of Homecoming.

M E M B E R N E W S

Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to

use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.

There is not a singlePharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/

With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

SUPPORT BUDDY CARTER R.Ph FOR CONGRESS

PAID FOR BY BUDDY CARTER FOR CONGRESSCARLTON HODGES, TREASURER

GPhA Named One of the Top Five Georgia Association Lobbyists

#1. Georgia Hospital Association #2. Georgia Chamber of Commerce #3. Medical Association of Georgia #4. Georgia Poultry Federation #5. Georgia Pharmacy Association Georgia Beverage Association (Tie) #6. Georgia Association for Career & Technical Education #7. Georgia Association of Realtors #8. Georgia Credit Union Affi liates Georgia Association of Educators (Tie) #9. Metro Atlanta Chamber #10. Georgia Association of Convenience Stores County Commissioners of Georgia (Tie)

Top Five Association Lobbyists James MAGAZINE, Georgia’s only monthly magazine providing readers with in depth political news coverage, has named Th e Georgia Pharmacy As-sociation as the number fi ve association lobbyist in the state.

“Th e quality lobbyists on the list aren’t just about quality. Th ey’re about excel-lence,” said James.

Th e GPhA maintains a strong pres-ence on the political scene on behalf of pharmacy, not only during the legis-lative session but also throughout the

year. Th e association also works to build relationships with policy makers on a state and national level.

Go to www.insideradvantage.com to read more. n

M E M B E R N E W S

Corporate contributions and contributions by foreign nationals are prohibited. Individuals may contribute a maximum of $5,200 to the campaign- $2,600 for the primary election and $2,600 for the general election. PACS may contribute $10,000 to the campaign - $5,000 for the primary election and $5,000 for the general election. Federal law requires us to

use our best efforts to collect and report the name, mailing address, occupation, and name of employer of each individual whose aggregate contributions exceed $200 in an election cycle.

REAL SOLUTIONS. CONSERVATIVE PRINCIPLES.

There is not a singlePharmacist serving in Congress. It’s time to change that. Please support Buddy Carter R.Ph for Congress. buddycarterforcongress.com/donate/

With all of the major changes taking place in the health care industry, now more than ever, we pharmacists must have our voices heard.

SUPPORT BUDDY CARTER R.Ph FOR CONGRESS

PAID FOR BY BUDDY CARTER FOR CONGRESSCARLTON HODGES, TREASURER

GPhA Named One of the Top Five Georgia Association Lobbyists

#1. Georgia Hospital Association #2. Georgia Chamber of Commerce #3. Medical Association of Georgia #4. Georgia Poultry Federation #5. Georgia Pharmacy Association Georgia Beverage Association (Tie) #6. Georgia Association for Career & Technical Education #7. Georgia Association of Realtors #8. Georgia Credit Union Affi liates Georgia Association of Educators (Tie) #9. Metro Atlanta Chamber #10. Georgia Association of Convenience Stores County Commissioners of Georgia (Tie)

Top Five Association Lobbyists James MAGAZINE, Georgia’s only monthly magazine providing readers with in depth political news coverage, has named Th e Georgia Pharmacy As-sociation as the number fi ve association lobbyist in the state.

“Th e quality lobbyists on the list aren’t just about quality. Th ey’re about excel-lence,” said James.

Th e GPhA maintains a strong pres-ence on the political scene on behalf of pharmacy, not only during the legis-lative session but also throughout the

year. Th e association also works to build relationships with policy makers on a state and national level.

Go to www.insideradvantage.com to read more. n


M E M B E R N E W S

11

This year’s South University APhA-ASP Chapter has been inspired! Twen-ty-one students attended the 2013 APhA-ASP Midyear Regional Meeting (MRM) in Birmingham, AL. Students enjoyed debating proposals on policies submit-ted from other chapters, and all gained a passion for advocating for the future of the profession. After returning from MRM, the chapter is energized for this next year, and optimistic that we might contribute to our profession and com-munity positively.

While attending MRM, the APhA-ASP Chapter President, Tiffany Gallo-way, delivered a presentation to the re-gion on the chapter’s work with Parent University. Parent University is a collab-orative within the community with the purpose of educating parents and their children on a range of topics including Cough, Cold and Flu, and Heartburn. The presentations prepared by members of APhA-ASP and ASHP were given at Savannah High School followed by a question and answer session. We feel our work with Parent University helps us to inform the parents and young people of our community.

This past October during National Pharmacist Month, over 40 ASP students and alumni attended the American Dia-betes Association Step Out Walk for Dia-betes. Many members walked in support of the cause, while others performed health screenings on over 100 attendees. Students screened participants’ blood glucose, blood pressure, and BMI while educating the public on healthy lifestyle choices to reduce their risk for diabetes. ASP participates in this event every year, and awaits this opportunity to serve the community in such a positive way while

By: Kari Nemenz and Stephanie Wilcox South University School of Pharmacy Savannah, GA

promoting the profession of pharmacy.Coming up in 2014 are more events

the chapter will participate in. Many of our members will be attending GPhA’s VIP Day at the capitol in Atlanta, which is always a very popular event for our members. Later in March, a group of our students will be attending APhA’s Annual meeting and exposition in Or-lando. ASP will continue to partner with

Reflecting on the Past & Awaiting a New Year with New Opportunities

local YMCAs to offer health screenings for members of our community through-out the year. The chapter is looking for-ward to partnering with students in the Physician’s Assistant program at South University for the first time in order to better develop our inter-professional re-lationships.

As we set our sights on 2014, we antic-ipate a busy and rewarding year. n

Twenty-one students attended the 2013 APhA-ASP Midyear Regional Meeting (MRM) in Birmingham, AL.

10 The Georgia Pharmacy Journal The Georgia Pharmacy Journal

Melvin M. Goldstein, P.C.AT T O R N E Y AT L AW___

248 Roswell StreetMarietta, Georgia 30060

Telephone 770/427-7004Fax 770/426-9584

www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters

n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency

n Former Administrative Law Judge for the Office of State Administrative Hearings

CPE Monitor™ integration is well underway and soon all Accredita-tion Council for Pharmacy Edu-cation (ACPE)-accredited provid-ers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing phar-macy education (CPE) credit. In fact, many providers have already integrat-ed their systems and are requiring this information.As of press time, more than:• 950,000 CPE activity records are now stored in the CPE Monitor system• 120 ACPE-accredited providers are actively transmitting CPE data electronically• 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles

CPE Monitor is a national collabo-rative service from NABP, ACPE, and ACPE providers that will allow licens-ees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

April 26-28, 2013 Legacy Lodge & Conference Center

Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference.

Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria:

(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations;(3) Community activities; (4) Clarity and vision in response to application questions.

I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print)

Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For: ______________________________________________________________________________________Preferred Mailing Address: ______________________________________________________________________________

_______________________________________________________________________________ _______________________________________________ State: ______ ZIP: _____________ Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________ E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________

Address: [ ] Home or [ ] Work?________________________________________________________________________________ _________________________________________________________ State: _______ Zip: ___________________

Tel. (____) __________________ E-mail: ___________________________________________________________

Please return this Nomination Form to: Georgia Pharmacy Foundation Attn: Regena Banks 50 Lenox Pointe, NE Atlanta, GA 30324

Or, you may FAX this Nomination Form to: 404.237.8435Or, submit online at WWW.GPHA.ORG

If you have questions, please contact Regena Banks at GPhF: 404.231.5074 Email: [email protected]

20th Year Please return by January 18, 2013

This address is [ ] Home [ ] Work

licensees, eventually eliminating the need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Mon-itor.

Reprinted with permission from The National Association of Boards of Pharmacy® (NABP®), October 2012 issue of the NABP Newsletter: ©2012, National Association of Boards of Pharmacy®, Mount Prospect, Illinois.

- CORRECTION -In the November edition of the

Georgia Pharmacy Journal, Bent Gay’s name was spelled

incorrectly. We sincerely apologize and again would

like to congratulate Mr. Gay on being named the Next

Generation Long-term Care Pharmacist of the Year.

2014

Nomination Form for the 2014 New Practitioner Leadership Conference

May 2 - 4, 2014

Please return this Nomination Form to: The Georgia Pharmacy Foundation

Attn: Jim Bracewell 50 Lenox Pointe, NE

Atlanta, GA 30324

If you have any questions, please contact Jim Bracewell: 404-419-8119 - email: [email protected]

21st Year

Please Return by

Feb. 14, 2014

I would like to nominate the following individual to attend the 2014 New Practitioner Leadership Conference:


M E M B E R N E W S

11

This year’s South University APhA-ASP Chapter has been inspired! Twen-ty-one students attended the 2013 APhA-ASP Midyear Regional Meeting (MRM) in Birmingham, AL. Students enjoyed debating proposals on policies submit-ted from other chapters, and all gained a passion for advocating for the future of the profession. After returning from MRM, the chapter is energized for this next year, and optimistic that we might contribute to our profession and com-munity positively.

While attending MRM, the APhA-ASP Chapter President, Tiffany Gallo-way, delivered a presentation to the re-gion on the chapter’s work with Parent University. Parent University is a collab-orative within the community with the purpose of educating parents and their children on a range of topics including Cough, Cold and Flu, and Heartburn. The presentations prepared by members of APhA-ASP and ASHP were given at Savannah High School followed by a question and answer session. We feel our work with Parent University helps us to inform the parents and young people of our community.

This past October during National Pharmacist Month, over 40 ASP students and alumni attended the American Dia-betes Association Step Out Walk for Dia-betes. Many members walked in support of the cause, while others performed health screenings on over 100 attendees. Students screened participants’ blood glucose, blood pressure, and BMI while educating the public on healthy lifestyle choices to reduce their risk for diabetes. ASP participates in this event every year, and awaits this opportunity to serve the community in such a positive way while

By: Kari Nemenz and Stephanie Wilcox South University School of Pharmacy Savannah, GA

promoting the profession of pharmacy.Coming up in 2014 are more events

the chapter will participate in. Many of our members will be attending GPhA’s VIP Day at the capitol in Atlanta, which is always a very popular event for our members. Later in March, a group of our students will be attending APhA’s Annual meeting and exposition in Or-lando. ASP will continue to partner with

Reflecting on the Past & Awaiting a New Year with New Opportunities

local YMCAs to offer health screenings for members of our community through-out the year. The chapter is looking for-ward to partnering with students in the Physician’s Assistant program at South University for the first time in order to better develop our inter-professional re-lationships.

As we set our sights on 2014, we antic-ipate a busy and rewarding year. n

Twenty-one students attended the 2013 APhA-ASP Midyear Regional Meeting (MRM) in Birmingham, AL.

10 The Georgia Pharmacy Journal The Georgia Pharmacy Journal

Melvin M. Goldstein, P.C.AT T O R N E Y AT L AW___

248 Roswell StreetMarietta, Georgia 30060

Telephone 770/427-7004Fax 770/426-9584

www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters

n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency

n Former Administrative Law Judge for the Office of State Administrative Hearings

CPE Monitor™ integration is well underway and soon all Accredita-tion Council for Pharmacy Edu-cation (ACPE)-accredited provid-ers will require pharmacists and pharmacy technicians to submit their NABP e-Profile ID and date of birth (MMDD) in order to obtain ACPE-accredited continuing phar-macy education (CPE) credit. In fact, many providers have already integrat-ed their systems and are requiring this information.As of press time, more than:• 950,000 CPE activity records are now stored in the CPE Monitor system• 120 ACPE-accredited providers are actively transmitting CPE data electronically• 188,000 pharmacists have created e-Profiles • 103,500 pharmacy technicians have created e-Profiles

CPE Monitor is a national collabo-rative service from NABP, ACPE, and ACPE providers that will allow licens-ees to track their completed CPE credits electronically. It is anticipated that in 2013 the boards of pharmacy will be able to request reports on their

Pharmacists and Technicians Encouraged to Register Now for CPE Monitor

NOMINATION FORM FOR THE 2013 NEW PRACTITIONER LEADERSHIP CONFERENCE

April 26-28, 2013 Legacy Lodge & Conference Center

Lake Lanier Islands Resort Lake Lanier Islands, GA

The 2013 New Practitioner Leadership Conference is an exceptional opportunity for new practitioners in Georgia to spend time together in a retreat setting to develop organizational skills that will enable both personal and professional growth. A select group of no more than 20 practitioners will be chosen to attend the Conference.

Any pharmacist who is in his/her first 10 years of professional practice is eligible to apply for participation in the Conference. Applicants need not be members of GPhA to apply. Participants are selected by Foundation Board members based on the following criteria:

(1) Leadership potential; (2) Involvement in college student activities and/or professional organizations;(3) Community activities; (4) Clarity and vision in response to application questions.

I would like to nominate the following individual to attend the 2013 New Practitioner Leadership Conference: (Please Print)

Nominee’s Name: __________________________________________________________ Designation: __________________ (R.Ph., Pharm.D., etc.)

Works For: ______________________________________________________________________________________Preferred Mailing Address: ______________________________________________________________________________

_______________________________________________________________________________ _______________________________________________ State: ______ ZIP: _____________ Telephone: (Work) (____) __________________ (Home) (____) ___________________ (Cell) (____) _______________________ (Fax) (____) _______________ E-mail: __________________________________________________________

NOMINATED BY: _________________________________________________________________ Designation: _________________ Company: ____________________________________________________________________________________________

Address: [ ] Home or [ ] Work?________________________________________________________________________________ _________________________________________________________ State: _______ Zip: ___________________

Tel. (____) __________________ E-mail: ___________________________________________________________

Please return this Nomination Form to: Georgia Pharmacy Foundation Attn: Regena Banks 50 Lenox Pointe, NE Atlanta, GA 30324

Or, you may FAX this Nomination Form to: 404.237.8435Or, submit online at WWW.GPHA.ORG

If you have questions, please contact Regena Banks at GPhF: 404.231.5074 Email: [email protected]

20th Year Please return by January 18, 2013

This address is [ ] Home [ ] Work

licensees, eventually eliminating the need for printed statements of credit for ACPE-accredited CPE. To obtain an e-Profile ID, licensees may visit www.MyCPEmonitor.net, create an e-Profile, and register for CPE Mon-itor.

Reprinted with permission from The National Association of Boards of Pharmacy® (NABP®), October 2012 issue of the NABP Newsletter: ©2012, National Association of Boards of Pharmacy®, Mount Prospect, Illinois.

- CORRECTION -In the November edition of the

Georgia Pharmacy Journal, Bent Gay’s name was spelled

incorrectly. We sincerely apologize and again would

like to congratulate Mr. Gay on being named the Next

Generation Long-term Care Pharmacist of the Year.

2014

Nomination Form for the 2014 New Practitioner Leadership Conference

May 2 - 4, 2014

Please return this Nomination Form to: The Georgia Pharmacy Foundation

Attn: Jim Bracewell 50 Lenox Pointe, NE

Atlanta, GA 30324

If you have any questions, please contact Jim Bracewell: 404-419-8119 - email: [email protected]

21st Year

Please Return by

Feb. 14, 2014

I would like to nominate the following individual to attend the 2014 New Practitioner Leadership Conference:

Th e Georgia Pharmacy Journal12 13Th e Georgia Pharmacy Journal

Keynote Speaker: Th omas E. Menighan, CEO, American Pharmacists Association

An Update On Provider Status NationwideJoin the GPhA on Thursday, February 27, 2014 The Freight Room at The Georgia Railroad Freight Depot

65 Martin Luther King, Jr. Drive, Atlanta, GA 30334


A wise man once said, “It matters not the issue, social, economic, or politi-cal. Our constitution grants and protects our right to assemble and address our common issues before our government.” Tim Russert, the legendary host of Sun-day’s Meet Th e Press liked to oft en repeat a great quote from his father – “What a country!”

Many pundits like to neg-atively label associations as “those powerful special interest groups”, as though uniting for a common cause is detrimental to our form of government.

Th e Keynote Speaker at this year’s VIP Day Event is Tom Menighan, CEO of the American Pharmacists Association.

Mr. Menighan received his bachelor of science in pharmacy (BSPharm) in 1974 from West Virginia University School of Pharmacy and master of business administration (MBA) in 1990 from Averett College. Prior to his current lead-ership roles at APhA, he was founder and president of SynTegra Solutions, Inc., founded SymRx, Inc., and developed CornerDrugstore.com©.

Th roughout his career, Menighan has served advocacy roles within the profession of pharmacy, including president of APhA from 2001 to 2002 and a member of the APhA Board of Trustees between 1995 and 2003. He was a se-nior staff member of APhA from 1987 to 1992. While on staff as senior director of external aff airs, he managed state aff airs, public relations, new business de-velopment, and practice management issues. His other professional experiences include management of the PharMark Corporation, creator of RationalMed©, and licensor of systems for states to conduct drug utilization review for millions of state Medicaid enrollees. Menighan also founded and was a 20-year Medicine Shoppe owner in Huntington, West Virginia. He is a current partner in Phar-macy Associates, Inc.

Mr. Menighan will speak on the important issue of Provider Status and how the legislation aff ects the pharmacy profession nationwide. n

Where would our country be without such associations as the NAACP, the NRA, the Tea Party, and the Sierra Club? With each group I named, you may ap-

plaud or oppose their ideas but in what other country would those people have the protected right to assemble and peti-

tion their government on behalf of their cause?

Th e late United States Supreme Court Justice Th urgood Marshall said: “Mil-

lions of Americans speaking in unison is not a corruption of the democratic political process, it is the democratic political process.”

In the state of Georgia, the General Assembly pass-es the laws that allow the practice of the profession

of pharmacy in our state. Th e Georgia Board of Pharmacy is provided the pow-er to regulate and license the profession.

But who advocates for the profession of pharmacy in Georgia before the General Assembly and the Board of Pharmacy? Th e Georgia Pharmacy Association does.

GPhA’s legislative team have their hands full this ses-sion working on MAC pricing, more immunizations by phar-macists under physician proto-col, and laying the groundwork for getting healthcare provider status for pharmacists.

Fixing the problems of MAC pricing will take up most of our time during the session as strong opposition is expected from the PBMs that benefi t fi nancial-ly for reimbursing pharmacies at lower prices than what prescriptions can be purchased.

Besides working on MAC pricing and

“Do you want to impact the practice of pharmacy? Do you want to assure the economic viability of

your degree for the future? Do you want your profession to be valued as part of the future

of healthcare delivery in our state?”

other pro-pharmacy legislation, every session the GPhA has to fi ght off legis-lation that is harmful to the practice of pharmacy. Th is year will probably be no

diff erent but we will remain vigilant in our eff orts to continue defeating harmful legislation.

Weekly GPhA Legislative Pharm-O-Grams to members will continue this ses-

sion informing you of what is going on at the Capitol and what you can do to help.

Do you want to impact the practice of pharmacy? Do you want to assure

the economic viability of your degree for the future? Do you want your profession to be valued as part of the future of healthcare delivery in our state? Th en resolve today to be an ac-tive advocate for your profes-sion through the contribution of your time, talent and re-sources to that common cause of advocacy.

What a country! And what a privilege it is for pharmacists to be able to accept the responsibility for the gover-nance of their profession through mem-bership and involvement in the Georgia Pharmacy Association. n

Pharmacists and pharmacy students from across the state will convene at the Georgia Freight Depot for breakfast, a speaker, and

a chance to visit with their legislators. Don’t miss your BIGGEST chance to be

heard along with your peers at the Capitol! Remember to wear your white coat.

PharmPAC is GPhA’s Political Action Committee, providing the resources for the association to lobby and advocate on behalf of pharmacy.

Please help protect the pharmacy profession by donating at www.gpha.org/pharmpac

Th e Georgia Pharmacy Journal12 13Th e Georgia Pharmacy Journal

Keynote Speaker: Th omas E. Menighan, CEO, American Pharmacists Association

An Update On Provider Status NationwideJoin the GPhA on Thursday, February 27, 2014 The Freight Room at The Georgia Railroad Freight Depot

65 Martin Luther King, Jr. Drive, Atlanta, GA 30334


A wise man once said, “It matters not the issue, social, economic, or politi-cal. Our constitution grants and protects our right to assemble and address our common issues before our government.” Tim Russert, the legendary host of Sun-day’s Meet Th e Press liked to oft en repeat a great quote from his father – “What a country!”

Many pundits like to neg-atively label associations as “those powerful special interest groups”, as though uniting for a common cause is detrimental to our form of government.

Th e Keynote Speaker at this year’s VIP Day Event is Tom Menighan, CEO of the American Pharmacists Association.

Mr. Menighan received his bachelor of science in pharmacy (BSPharm) in 1974 from West Virginia University School of Pharmacy and master of business administration (MBA) in 1990 from Averett College. Prior to his current lead-ership roles at APhA, he was founder and president of SynTegra Solutions, Inc., founded SymRx, Inc., and developed CornerDrugstore.com©.

Th roughout his career, Menighan has served advocacy roles within the profession of pharmacy, including president of APhA from 2001 to 2002 and a member of the APhA Board of Trustees between 1995 and 2003. He was a se-nior staff member of APhA from 1987 to 1992. While on staff as senior director of external aff airs, he managed state aff airs, public relations, new business de-velopment, and practice management issues. His other professional experiences include management of the PharMark Corporation, creator of RationalMed©, and licensor of systems for states to conduct drug utilization review for millions of state Medicaid enrollees. Menighan also founded and was a 20-year Medicine Shoppe owner in Huntington, West Virginia. He is a current partner in Phar-macy Associates, Inc.

Mr. Menighan will speak on the important issue of Provider Status and how the legislation aff ects the pharmacy profession nationwide. n

Where would our country be without such associations as the NAACP, the NRA, the Tea Party, and the Sierra Club? With each group I named, you may ap-

plaud or oppose their ideas but in what other country would those people have the protected right to assemble and peti-

tion their government on behalf of their cause?

Th e late United States Supreme Court Justice Th urgood Marshall said: “Mil-

lions of Americans speaking in unison is not a corruption of the democratic political process, it is the democratic political process.”

In the state of Georgia, the General Assembly pass-es the laws that allow the practice of the profession

of pharmacy in our state. Th e Georgia Board of Pharmacy is provided the pow-er to regulate and license the profession.

But who advocates for the profession of pharmacy in Georgia before the General Assembly and the Board of Pharmacy? Th e Georgia Pharmacy Association does.

GPhA’s legislative team have their hands full this ses-sion working on MAC pricing, more immunizations by phar-macists under physician proto-col, and laying the groundwork for getting healthcare provider status for pharmacists.

Fixing the problems of MAC pricing will take up most of our time during the session as strong opposition is expected from the PBMs that benefi t fi nancial-ly for reimbursing pharmacies at lower prices than what prescriptions can be purchased.

Besides working on MAC pricing and

“Do you want to impact the practice of pharmacy? Do you want to assure the economic viability of

your degree for the future? Do you want your profession to be valued as part of the future

of healthcare delivery in our state?”

other pro-pharmacy legislation, every session the GPhA has to fi ght off legis-lation that is harmful to the practice of pharmacy. Th is year will probably be no

diff erent but we will remain vigilant in our eff orts to continue defeating harmful legislation.

Weekly GPhA Legislative Pharm-O-Grams to members will continue this ses-

sion informing you of what is going on at the Capitol and what you can do to help.

Do you want to impact the practice of pharmacy? Do you want to assure

the economic viability of your degree for the future? Do you want your profession to be valued as part of the future of healthcare delivery in our state? Th en resolve today to be an ac-tive advocate for your profes-sion through the contribution of your time, talent and re-sources to that common cause of advocacy.

What a country! And what a privilege it is for pharmacists to be able to accept the responsibility for the gover-nance of their profession through mem-bership and involvement in the Georgia Pharmacy Association. n

Pharmacists and pharmacy students from across the state will convene at the Georgia Freight Depot for breakfast, a speaker, and

a chance to visit with their legislators. Don’t miss your BIGGEST chance to be

heard along with your peers at the Capitol! Remember to wear your white coat.

PharmPAC is GPhA’s Political Action Committee, providing the resources for the association to lobby and advocate on behalf of pharmacy.

Please help protect the pharmacy profession by donating at www.gpha.org/pharmpac

Seeking Executive Vice President The Georgia Pharmacy Association is seeking an Executive Vice President. Below is a summary of qualifications, knowledge, and skills. • Bachelor’s degree or higher or equivalent education and experience is re-quired Business administration, pharmacy, or other healthcare related degree is desired. • Certified Association Executive (CAE) designation is desired. • Minimum of three years of experience in association management or equiv-alent pharmacy leadership experience.• Minimum of five years of experience in a supervisory or management role. • Possess an understanding of and strong interest in the health care industry. • Demonstrable skills in the areas of financial and policy management, strate-gic planning and project management, and an understanding of the legisla-tive and regulatory process. • Clear, compelling and articulate communicator, both verbal and written, with a variety of internal and external stakeholders. • Experience in mentoring and developing staff and volunteers. • Flexibility to work weekends and evenings as required/needed.

To request a full job description and to apply contact Charles Hall, President, Association Services Group: P.O. Box 2945, LaGrange, GA 30241 v. 706-845-9085, f. 706-883-8215, [email protected] Interested applicants should not directly contact The Georgia Pharmacy Association staff or members of the Board of Directors.

Application DEADLINE – 5:00pm - February 28, 2014

Cordially Invited! You are


RSVP

www.gpha.org

To the Georgia Reception at the APhA Annual Meeting


I N D U S T R Y N E W S

FDA Recommendation - Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen

The FDA recommends health care professionals discontinue prescribing and dispensing prescription combina-tion drug products with more than 325 mg of acetaminophen to protect con-sumers

[1/14/2014] FDA is recommending health care professionals discontinue

prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acet-aminophen1 per tablet, capsule, or other dosage unit. There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the

added risks for liver injury. Further, lim-iting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetamin-ophen overdose, which can lead to liver failure, liver transplant, and death.

We recommend that health care pro-viders consider prescribing combination drug products that contain 325 mg or less of acetaminophen. We also recom-mend that when a pharmacist receives a prescription for a combination product with more than 325 mg of acetamino-phen per dosage unit that they contact the prescriber to discuss a product with a lower dose of acetaminophen. A two tablet or two capsule dose may still be prescribed, if appropriate. In that case, the total dose of acetaminophen would be 650 mg (the amount in two 325 mg dosage units). When making individ-ual dosing determinations, health care providers should always consider the amounts of both the acetaminophen and the opioid components in the prescrip-tion combination drug product.

In January 2011 we asked manufac-turers of prescription combination drug products containing acetaminophen to limit the amount of acetaminophen2 to no more than 325 mg in each tablet or capsule by January 14, 2014. We request-ed this action to protect consumers from the risk of severe liver damage which can result from taking too much acetamino-phen. This category of prescription drugs combines acetaminophen with another ingredient intended to treat pain (most often an opioid), and these products are commonly prescribed to consumers for pain.

More than half of manufacturers have voluntarily complied with our request. However, some prescription combina-tion drug products containing more than 325 mg of acetaminophen per dos-

age unit remain available.In the near future we intend to with-

draw approval of prescription combi-nation drug products containing more than 325 mg of acetaminophen per dos-age unit that remain on the market.

Cases of severe liver injury have oc-curred in patients who:• took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period;• took more than one acetamino-phen-product at the same time; or• drank alcohol while taking acetamino-phen products.

Inadvertent overdose from prescrip-tion combination drugs containing ac-etaminophen accounts for nearly half of all cases of acetaminophen-related liver failure in the United States, some of which result in liver transplant or death.

Health care providers and pharma-cists who have further questions are en-couraged to contact the Division of Drug Information at 888.INFO.FDA (888-463-6332) or [email protected]. n

•E M P L OY M E N T O P P O R T U N I T Y•

Seeking Executive Vice President The Georgia Pharmacy Association is seeking an Executive Vice President. Below is a summary of qualifications, knowledge, and skills. • Bachelor’s degree or higher or equivalent education and experience is re-quired Business administration, pharmacy, or other healthcare related degree is desired. • Certified Association Executive (CAE) designation is desired. • Minimum of three years of experience in association management or equiv-alent pharmacy leadership experience.• Minimum of five years of experience in a supervisory or management role. • Possess an understanding of and strong interest in the health care industry. • Demonstrable skills in the areas of financial and policy management, strate-gic planning and project management, and an understanding of the legisla-tive and regulatory process. • Clear, compelling and articulate communicator, both verbal and written, with a variety of internal and external stakeholders. • Experience in mentoring and developing staff and volunteers. • Flexibility to work weekends and evenings as required/needed.

To request a full job description and to apply contact Charles Hall, President, Association Services Group: P.O. Box 2945, LaGrange, GA 30241 v. 706-845-9085, f. 706-883-8215, [email protected] Interested applicants should not directly contact The Georgia Pharmacy Association staff or members of the Board of Directors.

Application DEADLINE – 5:00pm - February 28, 2014

Cordially Invited! You are


RSVP

www.gpha.org

To the Georgia Reception at the APhA Annual Meeting



FDA Recommendation - Discontinue Prescribing Products Containing More Than 325mg of Acetaminophen

The FDA recommends health care professionals discontinue prescribing and dispensing prescription combina-tion drug products with more than 325 mg of acetaminophen to protect con-sumers

[1/14/2014] FDA is recommending health care professionals discontinue

prescribing and dispensing prescription combination drug products that contain more than 325 milligrams (mg) of acet-aminophen1 per tablet, capsule, or other dosage unit. There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the

added risks for liver injury. Further, lim-iting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetamin-ophen overdose, which can lead to liver failure, liver transplant, and death.

We recommend that health care pro-viders consider prescribing combination drug products that contain 325 mg or less of acetaminophen. We also recom-mend that when a pharmacist receives a prescription for a combination product with more than 325 mg of acetamino-phen per dosage unit that they contact the prescriber to discuss a product with a lower dose of acetaminophen. A two tablet or two capsule dose may still be prescribed, if appropriate. In that case, the total dose of acetaminophen would be 650 mg (the amount in two 325 mg dosage units). When making individ-ual dosing determinations, health care providers should always consider the amounts of both the acetaminophen and the opioid components in the prescrip-tion combination drug product.

In January 2011 we asked manufac-turers of prescription combination drug products containing acetaminophen to limit the amount of acetaminophen2 to no more than 325 mg in each tablet or capsule by January 14, 2014. We request-ed this action to protect consumers from the risk of severe liver damage which can result from taking too much acetamino-phen. This category of prescription drugs combines acetaminophen with another ingredient intended to treat pain (most often an opioid), and these products are commonly prescribed to consumers for pain.

More than half of manufacturers have voluntarily complied with our request. However, some prescription combina-tion drug products containing more than 325 mg of acetaminophen per dos-

age unit remain available.In the near future we intend to with-

draw approval of prescription combi-nation drug products containing more than 325 mg of acetaminophen per dos-age unit that remain on the market.

Cases of severe liver injury have oc-curred in patients who:• took more than the prescribed dose of an acetaminophen-containing product in a 24-hour period;• took more than one acetamino-phen-product at the same time; or• drank alcohol while taking acetamino-phen products.

Inadvertent overdose from prescrip-tion combination drugs containing ac-etaminophen accounts for nearly half of all cases of acetaminophen-related liver failure in the United States, some of which result in liver transplant or death.

Health care providers and pharma-cists who have further questions are en-couraged to contact the Division of Drug Information at 888.INFO.FDA (888-463-6332) or [email protected]. n

•E M P L OY M E N T O P P O R T U N I T Y•

Parris Named to Second Term on Board of Certification Executive Committee



In the December 2013 issue of The Georgia Pharmacy Journal, Elliot Stogol and Jake Galdo discussed star ratings and how they affect community phar-macy practice. In order to understand these star measures and their effect on practice, we first need to discuss the ac-ronyms of quality measures.

The Pharmacy Quality Alliance (PQA), established in 2006, is a “consen-sus-based, multi-stakeholder member-ship organization committed to improv-ing health care quality and patient safety with a focus on the appropriate use of medications.” 1Members include whole-salers, chain pharmacies, health technol-ogy corporations, schools of pharmacy, pharmacy benefits managers (PBMs),

health insurance plans, pharmaceutical companies, and others. The mission of PQA is to improve patient health with higher quality medication management throughout multiple healthcare settings.

The Centers for Medicare and Med-icaid Services (CMS) have partnered with PQA to develop qual-ity measures, known as star ratings, to evaluate Medicare Part D plans. There are seventeen measures of quality used to evaluate insurance plans, five of which are related to medication use. All quality measures are not weighted equally, with


Mark L. Parris, Chairman Elect of AIP and a GPhA member, has recently been named to the Board of Certifica-tion/Accredition Executive Committee.

Dr. Parris enthusiastically accepted his second term as Member-at-Large, stat-ing, “I’m honored to be chosen by my col-leagues to represent both pharmacy and DME in a unique dual role as this year brings many challenges facing both phar-macy and DME. I believe pharmacy ac-creditation is something we will need in the near future. I’m privileged that BOC is leading the implementation process and assuring the transition ease for each enrolled pharmacy. I look forward to the continued success of BOC as we embark

on the evolving changes in the healthcare industry.”

Parris has served BOC as a test de-velopment committee volunteer and has been on the Board since 2010. He also serves as Chairman-Elect of the Board of Directors for the Academy of Indepen-dent Pharmacy Association in Georgia, where he sits on the Committee of Gov-ernmental Affairs. He is President of Par-ris Medical Services in Blue Ridge, Geor-gia, a BOC-accredited pharmacy.

James L. Hewlett, BOCO, who has served two terms as Vice Chair of the Board, assumed the role of Chair begin-ning January 1, 2014.

Congratulations Mark. n

The ABCs of Star QualityBy: Bobby Newsome, Pharm.D., PGY-1 Graduate Resident, UGA/Barney’s PharmacyEmily Murphy, Pharm.D., PGY-1 Resident, SCCP/Barney’s PharmacyJake Galdo, Pharm.D., BCPS, CGP, Barney’s Pharmacy/UGA

medication use being triple weighted (highest impact). Therefore, it is expect-ed that these star measures will quickly impact community pharmacies due to pharmacy benefit managers searching

for ways to improve their quality mea-sures. Please refer to the previous article, The CMS Star Rat-ings, for definition of these quality mea-sures.

Electronic Qual-ity Improvement Platform for Plans & Pharmacies (EQuIPP) is a data based portal that allows for a neutral per-formance measurement of medication use, which can be used by health in-surance plans and community pharma-cies. EQuIPP is supported by Pharmacy Quality Solutions (PQS), collaboration between PQA and CECity. For a fee, EQuIPP allows community pharmacies to access their star ratings for the five medication related quality measures and provides a national and state compara-tor.

Succinctly, PQA developed quality measures, which CMS enforces through PBMs. As a community pharmacist, we can access our star ratings through EQuIPP, operated by PSA, owned by PQA.

The upcoming GPhA annual conven-tion will feature more information on star ratings, including CE opportuni-ties discussing the pharmacotherapy of many disease states that are currently being measured and ways to improve your pharmacy’s star measures. n

References:1. PQA Mission Statement. http://pqaal-liance.org/about/default.asp. Accessed 1/24/2014.

The Georgia Pharmacy Journal 17

By Andy Miller, Georgia Health News

Pharmacy officials say robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state. Pill mills are clinics or doctor’s offices that prescribe oxycodone and other powerful narcotics without a legitimate medical purpose.

A tall man wearing a green baseball cap recently entered a CVS pharmacy in intent on robbery. The man was not look-ing for cash. Instead, according to police, he demanded that the pharmacist give him Lortab and Percocet painkillers. He then grabbed drug bottles and prescrip-tion bags belonging to customers before fleeing the store, police said.

Pharmacy officials say such robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state.

Last year, the Georgia General As-sembly passed legislation to get rid of pill mills, requiring pain clinics to be licensed by the state medical board and owned by physicians. The state also launched a prescription drug monitor-ing program, aiming to cut down on the abuse of opioid painkillers.

A spokeswoman for state Attorney General Sam Olens said this month that the pain clinic licensing and the drug monitoring program “have reduced the number of rogue pain pill clinics by making such clinics more difficult to op-erate.’’

The abuse of opioid painkillers is a major national problem. The federal gov-ernment says prescription painkillers are the nation’s No. 1 drug epidemic. More than 16,000 people die annually in the United States from opioid painkillers

— more than from heroin and cocaine combined.

Laws in Florida and Georgia have made a difference. But unfortunately, when pill mills are eliminated, people who have addictions will look elsewhere for drugs, pharmacy officials say.

State Sen. Buddy Carter (R-Pooler), a pharmacist, says the robbery increase is connected to the progress made on the pill mill crackdown. And it’s not just conventional pharmacies. Carter cited an armed robbery of a company in Co-nyers that provides pharmacy services to nursing homes, among other customers.

The increase in robberies, in fact, led the Georgia Drugs and Narcotics Agen-cy in November to issue guidelines to

pharmacists on what to do during such incidents.

Pharmacies are keeping lower quan-tities of controlled drugs on the prem-ises, says Jim Bracewell of the Georgia Pharmacy Association. Anecdotally, he says, armed robberies of pharmacies are increasing.

“Hopefully we have driven [pill mills] somewhere else,’’ adds Brace-well. He compares the fight against ille-gal painkiller abuse to a Whac-a-Mole game, where each time an adversary is “whacked” it only pops up again some-where else.

One solution, he says, is to identify people with addictions and get them into treatment. n

Drug Thefts Rising After Georgia’s Pill Mill Crackdown

“There are seventeen measures of quality used to evaluate insurance plans, five of which are related to

medication use.”

Parris Named to Second Term on Board of Certification Executive Committee



In the December 2013 issue of The Georgia Pharmacy Journal, Elliot Stogol and Jake Galdo discussed star ratings and how they affect community phar-macy practice. In order to understand these star measures and their effect on practice, we first need to discuss the ac-ronyms of quality measures.

The Pharmacy Quality Alliance (PQA), established in 2006, is a “consen-sus-based, multi-stakeholder member-ship organization committed to improv-ing health care quality and patient safety with a focus on the appropriate use of medications.” 1Members include whole-salers, chain pharmacies, health technol-ogy corporations, schools of pharmacy, pharmacy benefits managers (PBMs),

health insurance plans, pharmaceutical companies, and others. The mission of PQA is to improve patient health with higher quality medication management throughout multiple healthcare settings.

The Centers for Medicare and Med-icaid Services (CMS) have partnered with PQA to develop qual-ity measures, known as star ratings, to evaluate Medicare Part D plans. There are seventeen measures of quality used to evaluate insurance plans, five of which are related to medication use. All quality measures are not weighted equally, with


Mark L. Parris, Chairman Elect of AIP and a GPhA member, has recently been named to the Board of Certifica-tion/Accredition Executive Committee.

Dr. Parris enthusiastically accepted his second term as Member-at-Large, stat-ing, “I’m honored to be chosen by my col-leagues to represent both pharmacy and DME in a unique dual role as this year brings many challenges facing both phar-macy and DME. I believe pharmacy ac-creditation is something we will need in the near future. I’m privileged that BOC is leading the implementation process and assuring the transition ease for each enrolled pharmacy. I look forward to the continued success of BOC as we embark

on the evolving changes in the healthcare industry.”

Parris has served BOC as a test de-velopment committee volunteer and has been on the Board since 2010. He also serves as Chairman-Elect of the Board of Directors for the Academy of Indepen-dent Pharmacy Association in Georgia, where he sits on the Committee of Gov-ernmental Affairs. He is President of Par-ris Medical Services in Blue Ridge, Geor-gia, a BOC-accredited pharmacy.

James L. Hewlett, BOCO, who has served two terms as Vice Chair of the Board, assumed the role of Chair begin-ning January 1, 2014.

Congratulations Mark. n

The ABCs of Star QualityBy: Bobby Newsome, Pharm.D., PGY-1 Graduate Resident, UGA/Barney’s PharmacyEmily Murphy, Pharm.D., PGY-1 Resident, SCCP/Barney’s PharmacyJake Galdo, Pharm.D., BCPS, CGP, Barney’s Pharmacy/UGA

medication use being triple weighted (highest impact). Therefore, it is expect-ed that these star measures will quickly impact community pharmacies due to pharmacy benefit managers searching

for ways to improve their quality mea-sures. Please refer to the previous article, The CMS Star Rat-ings, for definition of these quality mea-sures.

Electronic Qual-ity Improvement Platform for Plans & Pharmacies (EQuIPP) is a data based portal that allows for a neutral per-formance measurement of medication use, which can be used by health in-surance plans and community pharma-cies. EQuIPP is supported by Pharmacy Quality Solutions (PQS), collaboration between PQA and CECity. For a fee, EQuIPP allows community pharmacies to access their star ratings for the five medication related quality measures and provides a national and state compara-tor.

Succinctly, PQA developed quality measures, which CMS enforces through PBMs. As a community pharmacist, we can access our star ratings through EQuIPP, operated by PSA, owned by PQA.

The upcoming GPhA annual conven-tion will feature more information on star ratings, including CE opportuni-ties discussing the pharmacotherapy of many disease states that are currently being measured and ways to improve your pharmacy’s star measures. n

References:1. PQA Mission Statement. http://pqaal-liance.org/about/default.asp. Accessed 1/24/2014.

The Georgia Pharmacy Journal 17

By Andy Miller, Georgia Health News

Pharmacy officials say robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state. Pill mills are clinics or doctor’s offices that prescribe oxycodone and other powerful narcotics without a legitimate medical purpose.

A tall man wearing a green baseball cap recently entered a CVS pharmacy in intent on robbery. The man was not look-ing for cash. Instead, according to police, he demanded that the pharmacist give him Lortab and Percocet painkillers. He then grabbed drug bottles and prescrip-tion bags belonging to customers before fleeing the store, police said.

Pharmacy officials say such robberies are occurring with greater frequency in Georgia. Ironically, the officials link the increase to the state’s recent success in cracking down on the scourge of “pill mills’’ in the state.

Last year, the Georgia General As-sembly passed legislation to get rid of pill mills, requiring pain clinics to be licensed by the state medical board and owned by physicians. The state also launched a prescription drug monitor-ing program, aiming to cut down on the abuse of opioid painkillers.

A spokeswoman for state Attorney General Sam Olens said this month that the pain clinic licensing and the drug monitoring program “have reduced the number of rogue pain pill clinics by making such clinics more difficult to op-erate.’’

The abuse of opioid painkillers is a major national problem. The federal gov-ernment says prescription painkillers are the nation’s No. 1 drug epidemic. More than 16,000 people die annually in the United States from opioid painkillers

— more than from heroin and cocaine combined.

Laws in Florida and Georgia have made a difference. But unfortunately, when pill mills are eliminated, people who have addictions will look elsewhere for drugs, pharmacy officials say.

State Sen. Buddy Carter (R-Pooler), a pharmacist, says the robbery increase is connected to the progress made on the pill mill crackdown. And it’s not just conventional pharmacies. Carter cited an armed robbery of a company in Co-nyers that provides pharmacy services to nursing homes, among other customers.

The increase in robberies, in fact, led the Georgia Drugs and Narcotics Agen-cy in November to issue guidelines to

pharmacists on what to do during such incidents.

Pharmacies are keeping lower quan-tities of controlled drugs on the prem-ises, says Jim Bracewell of the Georgia Pharmacy Association. Anecdotally, he says, armed robberies of pharmacies are increasing.

“Hopefully we have driven [pill mills] somewhere else,’’ adds Brace-well. He compares the fight against ille-gal painkiller abuse to a Whac-a-Mole game, where each time an adversary is “whacked” it only pops up again some-where else.

One solution, he says, is to identify people with addictions and get them into treatment. n

Drug Thefts Rising After Georgia’s Pill Mill Crackdown

“There are seventeen measures of quality used to evaluate insurance plans, five of which are related to

medication use.”


Thanks to All Our Supporters Highlight denotes new and increased contributors.

NOTICE: Contact Andy Freeman, GPhA Director of Government Affairs, to update your sup-port or if any information is incorrect. [email protected] 404-419-8118

*Denotes a monthly sustaining PAC member. (Month/Year) Denotes most recent contribution.


PharmPac Board of Directors Eddie Madden, ChairmanDean Stone, Region 1Keith Dupree, Region 2Judson Mullican, Region 3Bill McLeer, Region 4Mahlon Davidson, Region 5Mike McGee, Region 6Jim McWilliams, Region 7T.M. Bridges, Region 9Mark Parris, Region 9Chris Thurmond, Region 10Stewart Flanagin, Region 11Henry Josey, Region 12Pam Marquess, Ex-OfficioJim Bracewell, Ex-Officio

Diamond Level$4,800 minimum pledge*Scott Meeks, R.Ph.*Fred Sharpe, R.Ph

Titanium Level$2,400 minimum pledge*Ralph Balchin, R.Ph. T.M. Bridges, R.Ph. 12/14*Ben Cravey, R.Ph.*Michael Farmer, R.Ph.*David Graves, R.Ph.*Raymond Hickman, R.Ph.Ted Hunt, R.Ph. 1/14*Robert Ledbetter, R.Ph.*Brandall Lovvorn, Pharm.D. *Marvin McCord, R.Ph.*Jeff Sikes, R.Ph.*Danny Smith, R.Ph.*Dean Stone, R.Ph.*Tommy Whitworth, R.Ph.

Platinum Level$1,200 minimum pledgeJim Bracewell 9/14Thomas Bryan, Jr. 12/14*Larry Braden, R.Ph.*William Cagle, R.Ph.*Hugh Chancy, R.Ph.*Keith Chapman, R.Ph.*Dale Coker, R.Ph.*Billy Conley, R.Ph.*Al Dixon Jr., R.Ph.*Ashley Dukes, R.Ph.*Jack Dunn Jr., R.Ph.*Neal Florence, R.Ph.

*Andy Freeman*Robert Hatton, Pharm.D.Ted Hunt, R.Ph.12/14*Ira Katz, R.Ph.Thomas Lindsay, R.Ph. 5/14*Eddie Madden, R.Ph.*Jonathan Marquess, Pharm.D. *Pam Marquess, Pharm.D.*Kenneth McCarthy, R.Ph.*Ivey McCurdy, Pharm. D*Drew Miller, R.Ph.*Laird Miller, R.Ph.*Jay Mosley, R.Ph.*Sujal Patel, Pharm D*Mark Parris, Pharm.D.*Allen Partridge, R.Ph.Jeff Lurey, R.Ph. 4/14*Houston Rogers, Pharm.D. Tim Short, R.Ph. 10/14*Benjamin Stanley, Pharm.D.*Danny Toth, R.Ph.*Christopher Thurmond, Pharm.D.*Alex Tucker, Pharm.D.Lindsay Walker, R.Ph. 6/14Henry Wilson, Pharm.D. 11/14

Gold Level$600 minimum pledgeJames Bartling, Pharm.D. 6/14*William Brewster, R.Ph.*Liza Chapman, Pharm.D.Carter Clements, Pharm. D. 12/14 *Mahlon Davidson, R.Ph.*Angela DeLay, R.Ph.*Benjamin Dupree, Sr., R.Ph*Stewart Flanagin, R.Ph.

*Kevin Florence, Pharm.D.*Kerry Griffin, R.Ph.*Michael Iteogu, R.Ph.*Joshua Kinsey, Pharm.D.*Dan Kiser, R.Ph.*Allison Layne, C.Ph.TLance LoRusso 6/14*Sheila Miller, Pharm.D.*Robert Moody, R.Ph.*Sherri Moody, Pharm.D.*William Moye, R.Ph.*Anthony Ray, R.Ph.*Jeffrey Richardson, R.Ph.*Andy Rogers, R.Ph.Daniel Royal Jr., R.Ph.12/14*Michael Tarrant*James Thomas, R.Ph.Zach Tomberlin, Pharm.D. 4/14*Mark White, R.Ph.*Charles Wilson Jr., R.Ph.

Silver Level$300 minimum pledge*Renee Adamson, Pharm.D.Larry Batten, R. Ph. 11/14Lance Boles, R.Ph. 8/14Laura Coker, Pharm D 6/14*Ed Dozier, R.Ph.*Greg Drake, R. Ph.*Terry Dunn, R.Ph.*Marshall Frost, Pharm.D.*Amanda Gaddy, R. Ph.*Johnathan Hamrick, Pharm.D.*Willie Latch, R.Ph*Hilary Mbadugha, Pharm.D.*Kalen Manasco, Pharm.D.

*William McLeer, R.Ph.*Sheri Mills, C.Ph.T.Albert Nichols, R.Ph. 2/14*Richard Noell, R.Ph.*Cynthia Piela*Donald Piela, Jr. Pharm.D. Bill Prather, R.Ph. 6/14*Kristy Pucylowski, Pharm.D.*Edward Reynolds, R.Ph.*Ashley Rickard, Pharm D.*Brian Rickard, Pharm D. Flynn Warren, R.Ph. 6/14Steve Wilson, Pharm.D. 7/14*William Wolfe, R.Ph.*Sharon Zerillo, R.Ph.

Bronze Level$150 minimum pledgeMonica Ali-Warren, R.Ph. 6/14*Shane Bentley, Student *Robert Bowles*Rabun Deckle, R. Ph.Ashley Faulk, Pharm.D. 4/14James Fetterman, Jr., Pharm.D. 4/14Charles Gass, R.Ph. 1/14*Larry Harkleroad, R.Ph.Winton Harris Jr., R.Ph. 6/14*Amy Grimsley, Pharm. D*Thomas Jeter, R.Ph. *Henry Josey, R.Ph*Brenton Lake, R.Ph.*Tracie Lunde, Pharm.D.*Michael Lewis, Pharm.D.Max Mason, R.Ph. 6/14*Susan McLeer, R.Ph.Judson Mullican, R.Ph. 11/14

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800.247.5930www.phmic.com

Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment.

Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.

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• Pro Advantage Services®, Inc. d/b/a Pharmacists Insurance Agency (in California)

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404.375.7209


David F. Kisor, BS, PharmD and Angela J. Smith, PharmD Candidate, Ohio Northern University, Ada, Ohio

continuing educat ion for pharmacists

Therapeutic Actions and the Genetic Code: Examples of the Applicat ion of Pharmacogenetics

Volume XXXI, No. 12

Dr. David Kisor and Ms. Angela Smith have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on how differ-ences in genetics can affect patient response to drugs, causing both therapeutic effects and adverse reactions, to help pharmacists provide better medication therapy management.

Objectives. At the completion of this activity, the participant will be able to:

1. demonstrate an understand-ing of pharmacogenetics and its application to pharmacy practice;

2. recognize variations in genes and the nomenclature used to iden-tify variant alleles;

3. identify variation in alleles, diplotypes and metabolic pheno-types which can result in altered therapeutic response and adverse effects in patients; and

4. list examples of drug-gene interactions and interpret how these apply to patients in specific cases.

IntroductionThe term pharmacogenetics (PGt) refers to differences in a given gene that can affect an individual’s response to drugs. The variation in metabolism due to genetics can alter both the therapeutic effect of medications, as well as cause adverse effects. Drug-gene inter-actions are similar to drug-drug interactions, putting pharmacists

in a unique position to apply their extensive drug knowledge and pro-ficiently fill a new gap in medica-tion management.

DNA is composed of a sequence of nucleotides (the triphosphates of adenine [A], cytosine [C], gua-nine [G], and thymine [T]), and serves as a “production manual” for the assembly of proteins. In relation to drugs, genes of inter-est (“pharmacogenetic genes”) are the segments of DNA which code for receptors, transporters, and metabolizing enzymes. There are approximately 25,000 genes in the human genome, i.e., the entirety of DNA, with variations resulting in differences in pharmacodynamics (PD), or how individuals respond to a drug, and pharmacokinetics (PK), or how individuals “handle” a drug with respect to absorption, distri-bution, metabolism and excretion (ADME).

A variant form of a gene, called an allele, may result in altered drug response, due to altered PD or as a result of altered ADME. The most common variation in a gene is the single nucleotide polymor-phism or SNP (pronounced “snip”) which is the case where a single nucleotide is replaced in the gene DNA sequence by another nucleo-tide, such as T replacing C. For instance, the C in position 634 of a gene being replaced by T would be noted as 634C>T. As a SNP pro-duces a variant allele, the variant form of the gene is given a specific designation to differentiate it from the “common” form. The variant

form may result in altered protein function.

With reference to the cyto-chrome P450 (CYP) enzyme fam-ily, responsible for metabolizing many drugs, a “star” nomenclature has been adopted, where the most common form of a gene is typically termed the *1 form and variant forms are designated otherwise, such as *2, *3, and so on. It should be noted that a given “*” variant for one gene, such as *17, does not necessarily have the same mean-ing as a *17 variant for a different gene. For instance, the *17 form of the CYP2C19 gene is a “gain-of-function” form resulting in in-creased drug metabolism by CYP2C19, whereas the *17 form of the CYP2D6 gene is a “reduced-function” form resulting in decreased drug metabolism by CYP2D6.

Different alleles can affect protein function and, as in the case of the CYP enzyme family, this can lead to variability in drug metabo-lism. Some genetic effects are more drastic than others and, in the more extreme cases, genetic testing may make the difference between therapeutic failure and success, or safety and toxicity.

As data supporting the use of genetic testing in drug therapy decision-making accrues, more and more pharmacies are offering services that integrate pharmaco-genetics into medication therapy management (MTM) programs. Currently, pharmacogenetic-based dosing guidelines have been pub-

let our expertsdo the math

800.247.5930www.phmic.com

Now more than ever, pharmacists are learning just how important it is to have not only proper insurance coverage, but the right amount of insurance. We understand the risks involved in operating a pharmacy practice and have coverage designed to ensure that you and your business are protected. We even provide policies specifically designed for practices that offer specialty services such as compounding or home medical equipment.

Trust the experts - our representatives can help you determine the right coverage for you. We offer products to meet all your needs; everything from business and personal insurance to life and investments. We’re proud to be your single source for insurance protection.

• Pharmacists Mutual Insurance Company• Pharmacists Life Insurance Company

• Pro Advantage Services®, Inc. d/b/a Pharmacists Insurance Agency (in California)

CA License No. 0G22035

Not licensed to sell all products in all states.Find us on Social Media:

Hutton Madden800.247.5930 ext. 7149

404.375.7209


David F. Kisor, BS, PharmD and Angela J. Smith, PharmD Candidate, Ohio Northern University, Ada, Ohio

continuing educat ion for pharmacists

Therapeutic Actions and the Genetic Code: Examples of the Applicat ion of Pharmacogenetics

Volume XXXI, No. 12

Dr. David Kisor and Ms. Angela Smith have no relevant financial relationships to disclose.

Goal. The goal of this lesson is to provide information on how differ-ences in genetics can affect patient response to drugs, causing both therapeutic effects and adverse reactions, to help pharmacists provide better medication therapy management.

Objectives. At the completion of this activity, the participant will be able to:

1. demonstrate an understand-ing of pharmacogenetics and its application to pharmacy practice;

2. recognize variations in genes and the nomenclature used to iden-tify variant alleles;

3. identify variation in alleles, diplotypes and metabolic pheno-types which can result in altered therapeutic response and adverse effects in patients; and

4. list examples of drug-gene interactions and interpret how these apply to patients in specific cases.

IntroductionThe term pharmacogenetics (PGt) refers to differences in a given gene that can affect an individual’s response to drugs. The variation in metabolism due to genetics can alter both the therapeutic effect of medications, as well as cause adverse effects. Drug-gene inter-actions are similar to drug-drug interactions, putting pharmacists

in a unique position to apply their extensive drug knowledge and pro-ficiently fill a new gap in medica-tion management.

DNA is composed of a sequence of nucleotides (the triphosphates of adenine [A], cytosine [C], gua-nine [G], and thymine [T]), and serves as a “production manual” for the assembly of proteins. In relation to drugs, genes of inter-est (“pharmacogenetic genes”) are the segments of DNA which code for receptors, transporters, and metabolizing enzymes. There are approximately 25,000 genes in the human genome, i.e., the entirety of DNA, with variations resulting in differences in pharmacodynamics (PD), or how individuals respond to a drug, and pharmacokinetics (PK), or how individuals “handle” a drug with respect to absorption, distri-bution, metabolism and excretion (ADME).

A variant form of a gene, called an allele, may result in altered drug response, due to altered PD or as a result of altered ADME. The most common variation in a gene is the single nucleotide polymor-phism or SNP (pronounced “snip”) which is the case where a single nucleotide is replaced in the gene DNA sequence by another nucleo-tide, such as T replacing C. For instance, the C in position 634 of a gene being replaced by T would be noted as 634C>T. As a SNP pro-duces a variant allele, the variant form of the gene is given a specific designation to differentiate it from the “common” form. The variant

form may result in altered protein function.

With reference to the cyto-chrome P450 (CYP) enzyme fam-ily, responsible for metabolizing many drugs, a “star” nomenclature has been adopted, where the most common form of a gene is typically termed the *1 form and variant forms are designated otherwise, such as *2, *3, and so on. It should be noted that a given “*” variant for one gene, such as *17, does not necessarily have the same mean-ing as a *17 variant for a different gene. For instance, the *17 form of the CYP2C19 gene is a “gain-of-function” form resulting in in-creased drug metabolism by CYP2C19, whereas the *17 form of the CYP2D6 gene is a “reduced-function” form resulting in decreased drug metabolism by CYP2D6.

Different alleles can affect protein function and, as in the case of the CYP enzyme family, this can lead to variability in drug metabo-lism. Some genetic effects are more drastic than others and, in the more extreme cases, genetic testing may make the difference between therapeutic failure and success, or safety and toxicity.

As data supporting the use of genetic testing in drug therapy decision-making accrues, more and more pharmacies are offering services that integrate pharmaco-genetics into medication therapy management (MTM) programs. Currently, pharmacogenetic-based dosing guidelines have been pub-

The Georgia Pharmacy Journal22 23The Georgia Pharmacy Journal

lished for 10 gene-drug pairs: thio-purine methyltransferase (TPMT)-thiopurines; cytochrome P450 2C19 (CYP2C19)-clopidogrel; CYP2C9 and vitamin k epoxide reductase subunit 1 (VKORC1)-warfarin; CYP2D6-codeine; human leukocyte antigen B (HLA-B)-abacavir; solute carrier organic anion transporter 1B1 (SLCO1B1)-simvastatin; HLA-B-allopurinol; CYP2D6 and CYP2C19-tricyclic antidepressants (TCAs); HLAB-carbamazepine; and dihydropyrimidine dehydro-genase (DPYD)-5-fluorouracil and capecitabine. Additionally, another five guidelines are under develop-ment.

Guidelines are available on the pharmacogenomics knowledgebase website (www.pharmgkb.org) and are available as open access publi-cations in Clinical Pharmacology and Therapeutics.

Relating a patient’s drug response to genetics defines PGt. Genetic factors represent the un-derlying variability in response to a drug, notwithstanding environmen-tal factors, diet, pathophysiology, concomitant drug use, and other factors that introduce variability. Table 1 provides examples of drug-gene interactions and the potential outcome of each interaction. Four specific case examples of the ap-plication of pharmacogenetics will be presented.

CYP2D6-CodeineCytochrome P450 2D6 (CYP2D6) is a major drug metabolizing enzyme, responsible for metabolizing ap-proximately 20 percent of drugs. There are more than 80 different alleles of the CYP2D6 gene, which can result in a spectrum of CYP2D6 enzyme activity. As an individual receives genetic in-formation from each parent, the combination of alleles (called a dip-lotype) will impart a certain level of enzyme activity relative to drug metabolism. Each allele inherited by an individual contributes to the phenotype of enzyme activity that is expressed and allows individuals to be classified by a “metabolism phenotype,” such as ultrarapid me-

tabolizer (UM) or poor metabolizer (PM). The classification of an indi-vidual by metabolism phenotype has shown to be of consequence when considering the use of co-deine. Case Example #1 describes one of the extremes of genetic influ-ence on drug response.

This case example illustrates

a lack of drug effectiveness. Nei-ther JS nor his brother underwent simple pharmacogenetic testing relative to CYP2D6 prior to receiv-ing the codeine-containing prod-uct. Subsequent testing through a university medical center study showed that JS and his brother were in fact poor metabolizers,

Table 1Examples of drug-gene interactions and potential outcomes

Gene Drug Variant Effect on Effect on Potential Allele (SNP)a Proteinb PK/PDc Outcome

HLA-B carbamazepine 15:02 HLA-B- T-cell Stevens-Johnson altered mediated syndrome; toxic protein immune epidermal necrolysis structure response

CYP2C19 clopidogrel *17 increased increased increased (C>T) CYP2C19 clearance clopidogrel effect; rs12248560d enzyme (conversion)e bleeding activity

CYP2D6 codeine *3 nonfunction- decreased decreased codeine A deleted al CYP2D6 clearance effect; lack of pain rs35742686 enzyme (conversion)f relief

CYP2C9 warfarin *2 decreased decreased increased warfarin (C>T) CYP2C9 clearance effect; bleeding rs1799853 enzyme activity

aSNP = single nucleotide polymorphism where one DNA base (adenine (A), cytosine (C), gua-nine (G), and thymine (T)) replaces another (e.g., such as T replacing C; C>T). bPharmacoge-netic proteins include receptors, drug transporters, and drug metabolizing enzymes. cPK/PD = pharmacokinetics/pharmacodynamics. drs number = a specific and consistent identifier of the SNP as found in the SNP database (dbSNP) of the National Center for Bio-technology Information. eThe increased clearance of clopidogrel results in greater conversion to the active metabolite. f The decreased clearance of codeine results in less conversion to morphine, which is largely responsible for the analgesic effects of codeine.

Case Example #1

JS, a 19 y.o. healthy Caucasian male, is a body shop mechanic. JS visited the near-by university medical center emergency department (ED) after slicing his hand on a piece of sheet metal. Following suturing (18 stitches), the hand was bandaged and wrapped. JS was in pain and was complaining that his hand was “throbbing.” He was given acetaminophen/codeine phosphate (300 mg/30 mg) in the ED and provided a prescription for a 72-hour period with the instructions to take 1 to 2 tablets every 4 to 6 hours as needed for pain. At the pharmacy, he asked if this was the same as Tylenol #3 because his younger brother had some prescribed for him after he had his tonsils removed. JS explained that the Tylenol #3 did not help his brother at all, so they “have plenty at home.” The pharmacist explained that prescriptions are for specific individuals, and JS agreed to get the prescrip-tion filled for him and not use what was left from his brother’s prescription. The pharmacist also told JS to monitor if the pain medication was working. At 36 hours, JS was still experiencing severe throbbing pain and called the pharmacy. The pharmacist discussed the situation with JS’ family physician, who prescribed an alternative analgesic, which was used by JS with success. In discussion with JS’ family physician, the pharmacist explained that the lack of efficacy of the ac-etaminophen/codeine combination may have a genetic basis, as neither JS nor his younger brother experienced pain relief with the codeine containing product.

each with a *3/*4 diplotype (combi-nation of CYP2D6 gene variants in-herited from each parent). Having a diplotype that produced nonfunc-tional CYP2D6 enzymes, neither JS nor his brother had the meta-bolic capacity to convert codeine (a prodrug) to morphine (the active drug), which is largely responsible for the analgesia produced with acetaminophen/codeine use.

The other extreme of CYP2D6 enzyme activity, where excessive amounts of morphine are formed following codeine administration, is seen in individuals who are ultrar-apid metabolizers. These individu-als are at risk of morphine toxicity due to very efficient conversion of codeine. Additionally, infants who were breastfeeding have tragically died of morphine overdose because their mothers were UMs receiving codeine-containing products. Here, the infants received morphine that was passed onto them in the breast milk.

The Clinical Pharmacogenet-ics Implementation Consortium (CPIC) pharmacogenetic-based dosing guidelines suggest avoiding codeine use in UM and PM individ-uals due to the potential for toxici-ty and lack of efficacy, respectively. Finally, in early 2013, the Food and Drug Administration issued a black box warning for the labeling of codeine-containing products, as well as a contraindication to the use of codeine-containing products in children following tonsillectomy and/or adenoidectomy. The aim of this labeling is to try and prevent opioid toxicity and death due to codeine use in children who may be UMs. The therapeutic action, based on an individual’s genetics, would be to use an alternative opioid or a non-opioid analgesic.

HLA-B-CarbamazepineThe human leukocyte antigen (HLA) gene family is responsible for the coding of the HLA complex, a group of proteins which guide the immune system in identifying “foreign” cells. Individuals with the gene variant HLA-B*15:02 are at increased risk of a T-cell-mediated

immune response, resulting in the potentially life-threatening skin disease of Stevens-Johnson syn-drome (SJS; also called erythema multiforme majus) or toxic epider-mal necrolysis (TEN). SJS can be expressed as a mild form with the patient experiencing fever, itching, and malaise. Additionally, lesions (macular, papular, hive-like, with or without blisters) may be found symmetrically on the trunk and on upper and lower extremities. The severe form of SJS includes less than 10 percent of the patient’s body surface area (BSA) being ne-crotic skin. When necrotic lesions extend beyond 30 percent of the BSA, the diagnosis of TEN is made. In addition to mucosa and skin involvement in SJS and TEN, vital organs can also be affected and se-vere forms result in mortality rates up to 40 percent, most often due to sepsis.

It is thought that carbamaze-pine hypersensitivity is the result of the drug’s metabolites alter-ing cellular proteins. The protein alteration results in the immune system identifying cells as “foreign” and elicits a T-cell mediated im-mune response, culminating in SJS or TEN. Individuals with the vari-ant HLA-B*15:02 are at increased risk of SJS and TEN when taking carbamazepine. Case Example #2 illustrates the HLA-B-carbamaze-pine interaction.

The presence of one or two copies (one from each parent) of the variant HLA-B*15:02 al-lele imparts an increased risk of developing SJS or TEN in patients who are to receive carbamazepine. Table 2 presents the frequencies of HLA-B*15:02 in U.S. Asian popu-lations. It should be noted that oxcarbazepine has also been shown to cause skin reactions in HLA-B*15:02 positive individuals. The therapeutic action here, based on

Case Example #2

YL is a 17 y.o. Chinese male who is participating in a cultural exchange program with the United States. YL lives with his host family in South-west Ohio. While attending a col-lege baseball game, YL experiences a generalized tonic-clonic seizure. YL’s airway and head are protected, and the seizure ends after approxi-mately 90 seconds. YL is evaluated and transported by ambulance to the medical center emergency depart-ment. There is no documentation that YL has a seizure history, and it was never mentioned by YL or the exchange agency. In discussing treatment options, the pharmacist points out that the Asian population and, in particular, individuals of Han Chinese descent have been shown to have an increased risk of SJS and TEN related to the interaction of HLA-B*15:02 with carbamazepine. With this in mind, alternative treat-ment options are considered.

Table 2The frequency of occurrence of HLA-B*15:02 in U.S.

Asian populations compared to the reference population of Han Chinesea

Population Frequency (%) of Total # of indi- Approximate # of in- occurrence of viduals tested dividuals testing HLA-B*15:02b for HLA-B*15:02 “positive” for HLA-B*15:02 Han Chinesec 13 101 13U.S. Asian 5 358 18 population 1U.S. Asian 4 1772 71 population 2

aAdapted from allelefrequencies.net with the noted Han Chinese frequency for referencebRounded to approximate whole numbercExample Han population (Yunnan Province)


lished for 10 gene-drug pairs: thio-purine methyltransferase (TPMT)-thiopurines; cytochrome P450 2C19 (CYP2C19)-clopidogrel; CYP2C9 and vitamin k epoxide reductase subunit 1 (VKORC1)-warfarin; CYP2D6-codeine; human leukocyte antigen B (HLA-B)-abacavir; solute carrier organic anion transporter 1B1 (SLCO1B1)-simvastatin; HLA-B-allopurinol; CYP2D6 and CYP2C19-tricyclic antidepressants (TCAs); HLAB-carbamazepine; and dihydropyrimidine dehydro-genase (DPYD)-5-fluorouracil and capecitabine. Additionally, another five guidelines are under develop-ment.

Guidelines are available on the pharmacogenomics knowledgebase website (www.pharmgkb.org) and are available as open access publi-cations in Clinical Pharmacology and Therapeutics.

Relating a patient’s drug response to genetics defines PGt. Genetic factors represent the un-derlying variability in response to a drug, notwithstanding environmen-tal factors, diet, pathophysiology, concomitant drug use, and other factors that introduce variability. Table 1 provides examples of drug-gene interactions and the potential outcome of each interaction. Four specific case examples of the ap-plication of pharmacogenetics will be presented.

CYP2D6-CodeineCytochrome P450 2D6 (CYP2D6) is a major drug metabolizing enzyme, responsible for metabolizing ap-proximately 20 percent of drugs. There are more than 80 different alleles of the CYP2D6 gene, which can result in a spectrum of CYP2D6 enzyme activity. As an individual receives genetic in-formation from each parent, the combination of alleles (called a dip-lotype) will impart a certain level of enzyme activity relative to drug metabolism. Each allele inherited by an individual contributes to the phenotype of enzyme activity that is expressed and allows individuals to be classified by a “metabolism phenotype,” such as ultrarapid me-

tabolizer (UM) or poor metabolizer (PM). The classification of an indi-vidual by metabolism phenotype has shown to be of consequence when considering the use of co-deine. Case Example #1 describes one of the extremes of genetic influ-ence on drug response.

This case example illustrates

a lack of drug effectiveness. Nei-ther JS nor his brother underwent simple pharmacogenetic testing relative to CYP2D6 prior to receiv-ing the codeine-containing prod-uct. Subsequent testing through a university medical center study showed that JS and his brother were in fact poor metabolizers,

Table 1Examples of drug-gene interactions and potential outcomes

Gene Drug Variant Effect on Effect on Potential Allele (SNP)a Proteinb PK/PDc Outcome

HLA-B carbamazepine 15:02 HLA-B- T-cell Stevens-Johnson altered mediated syndrome; toxic protein immune epidermal necrolysis structure response

CYP2C19 clopidogrel *17 increased increased increased (C>T) CYP2C19 clearance clopidogrel effect; rs12248560d enzyme (conversion)e bleeding activity

CYP2D6 codeine *3 nonfunction- decreased decreased codeine A deleted al CYP2D6 clearance effect; lack of pain rs35742686 enzyme (conversion)f relief

CYP2C9 warfarin *2 decreased decreased increased warfarin (C>T) CYP2C9 clearance effect; bleeding rs1799853 enzyme activity

aSNP = single nucleotide polymorphism where one DNA base (adenine (A), cytosine (C), gua-nine (G), and thymine (T)) replaces another (e.g., such as T replacing C; C>T). bPharmacoge-netic proteins include receptors, drug transporters, and drug metabolizing enzymes. cPK/PD = pharmacokinetics/pharmacodynamics. drs number = a specific and consistent identifier of the SNP as found in the SNP database (dbSNP) of the National Center for Bio-technology Information. eThe increased clearance of clopidogrel results in greater conversion to the active metabolite. f The decreased clearance of codeine results in less conversion to morphine, which is largely responsible for the analgesic effects of codeine.

Case Example #1

JS, a 19 y.o. healthy Caucasian male, is a body shop mechanic. JS visited the near-by university medical center emergency department (ED) after slicing his hand on a piece of sheet metal. Following suturing (18 stitches), the hand was bandaged and wrapped. JS was in pain and was complaining that his hand was “throbbing.” He was given acetaminophen/codeine phosphate (300 mg/30 mg) in the ED and provided a prescription for a 72-hour period with the instructions to take 1 to 2 tablets every 4 to 6 hours as needed for pain. At the pharmacy, he asked if this was the same as Tylenol #3 because his younger brother had some prescribed for him after he had his tonsils removed. JS explained that the Tylenol #3 did not help his brother at all, so they “have plenty at home.” The pharmacist explained that prescriptions are for specific individuals, and JS agreed to get the prescrip-tion filled for him and not use what was left from his brother’s prescription. The pharmacist also told JS to monitor if the pain medication was working. At 36 hours, JS was still experiencing severe throbbing pain and called the pharmacy. The pharmacist discussed the situation with JS’ family physician, who prescribed an alternative analgesic, which was used by JS with success. In discussion with JS’ family physician, the pharmacist explained that the lack of efficacy of the ac-etaminophen/codeine combination may have a genetic basis, as neither JS nor his younger brother experienced pain relief with the codeine containing product.

each with a *3/*4 diplotype (combi-nation of CYP2D6 gene variants in-herited from each parent). Having a diplotype that produced nonfunc-tional CYP2D6 enzymes, neither JS nor his brother had the meta-bolic capacity to convert codeine (a prodrug) to morphine (the active drug), which is largely responsible for the analgesia produced with acetaminophen/codeine use.

The other extreme of CYP2D6 enzyme activity, where excessive amounts of morphine are formed following codeine administration, is seen in individuals who are ultrar-apid metabolizers. These individu-als are at risk of morphine toxicity due to very efficient conversion of codeine. Additionally, infants who were breastfeeding have tragically died of morphine overdose because their mothers were UMs receiving codeine-containing products. Here, the infants received morphine that was passed onto them in the breast milk.

The Clinical Pharmacogenet-ics Implementation Consortium (CPIC) pharmacogenetic-based dosing guidelines suggest avoiding codeine use in UM and PM individ-uals due to the potential for toxici-ty and lack of efficacy, respectively. Finally, in early 2013, the Food and Drug Administration issued a black box warning for the labeling of codeine-containing products, as well as a contraindication to the use of codeine-containing products in children following tonsillectomy and/or adenoidectomy. The aim of this labeling is to try and prevent opioid toxicity and death due to codeine use in children who may be UMs. The therapeutic action, based on an individual’s genetics, would be to use an alternative opioid or a non-opioid analgesic.

HLA-B-CarbamazepineThe human leukocyte antigen (HLA) gene family is responsible for the coding of the HLA complex, a group of proteins which guide the immune system in identifying “foreign” cells. Individuals with the gene variant HLA-B*15:02 are at increased risk of a T-cell-mediated

immune response, resulting in the potentially life-threatening skin disease of Stevens-Johnson syn-drome (SJS; also called erythema multiforme majus) or toxic epider-mal necrolysis (TEN). SJS can be expressed as a mild form with the patient experiencing fever, itching, and malaise. Additionally, lesions (macular, papular, hive-like, with or without blisters) may be found symmetrically on the trunk and on upper and lower extremities. The severe form of SJS includes less than 10 percent of the patient’s body surface area (BSA) being ne-crotic skin. When necrotic lesions extend beyond 30 percent of the BSA, the diagnosis of TEN is made. In addition to mucosa and skin involvement in SJS and TEN, vital organs can also be affected and se-vere forms result in mortality rates up to 40 percent, most often due to sepsis.

It is thought that carbamaze-pine hypersensitivity is the result of the drug’s metabolites alter-ing cellular proteins. The protein alteration results in the immune system identifying cells as “foreign” and elicits a T-cell mediated im-mune response, culminating in SJS or TEN. Individuals with the vari-ant HLA-B*15:02 are at increased risk of SJS and TEN when taking carbamazepine. Case Example #2 illustrates the HLA-B-carbamaze-pine interaction.

The presence of one or two copies (one from each parent) of the variant HLA-B*15:02 al-lele imparts an increased risk of developing SJS or TEN in patients who are to receive carbamazepine. Table 2 presents the frequencies of HLA-B*15:02 in U.S. Asian popu-lations. It should be noted that oxcarbazepine has also been shown to cause skin reactions in HLA-B*15:02 positive individuals. The therapeutic action here, based on

Case Example #2

YL is a 17 y.o. Chinese male who is participating in a cultural exchange program with the United States. YL lives with his host family in South-west Ohio. While attending a col-lege baseball game, YL experiences a generalized tonic-clonic seizure. YL’s airway and head are protected, and the seizure ends after approxi-mately 90 seconds. YL is evaluated and transported by ambulance to the medical center emergency depart-ment. There is no documentation that YL has a seizure history, and it was never mentioned by YL or the exchange agency. In discussing treatment options, the pharmacist points out that the Asian population and, in particular, individuals of Han Chinese descent have been shown to have an increased risk of SJS and TEN related to the interaction of HLA-B*15:02 with carbamazepine. With this in mind, alternative treat-ment options are considered.

Table 2The frequency of occurrence of HLA-B*15:02 in U.S.

Asian populations compared to the reference population of Han Chinesea

Population Frequency (%) of Total # of indi- Approximate # of in- occurrence of viduals tested dividuals testing HLA-B*15:02b for HLA-B*15:02 “positive” for HLA-B*15:02 Han Chinesec 13 101 13U.S. Asian 5 358 18 population 1U.S. Asian 4 1772 71 population 2

aAdapted from allelefrequencies.net with the noted Han Chinese frequency for referencebRounded to approximate whole numbercExample Han population (Yunnan Province)


an individual’s genetics, would be to use an alternative antiepileptic therapy that does not increase the risk of SJS or TEN in HLA-B*15:02 positive individuals. The CPIC has recently published guidelines related to the HLA-B*15:02-carba-mazepine interaction.

CYP2D6/CYP2C19-Tricyclic AntidepressantsMany drugs are metabolized by multiple cytochrome P450 enzymes such that specific isozyme (e.g., CYP2D6, CYP2C19) genotypes can influence the overall elimination (clearance) of a given substrate drug. Variant forms of the CYP2D6 and CYP2C19 genes produce in-creased enzyme function. Examples include multiple copies of function-al variants as seen in CYP2D6 UM; increased transcription (more RNA is transcribed from DNA, which results in increased production of the enzyme) as exhibited by the CYP2C19*17 gene variant. Con-versely, CYP2D6 and CYP2C19 alleles can also produce reduced-function or loss-of-function en-zymes. For example, CYP2D6*4 and CYP2C19*2 are non-function-al. The combinations of genetic variability relative to both CYP2D6 and CYP2C19 can influence the ADME and overall concentration versus time profile of substrate drugs and metabolites. Some ex-amples of substrates for CYP2D6 and CYP2C19 include amitripty-line, nortriptyline, imipramine, and other tricyclic antidepressants.

Amitriptyline is metabolized to nortriptyline and imipramine is metabolized to desipramine via CYP2C19. Amitriptyline and nortriptyline are metabolized by CYP2D6 to their respective 10-hydroxy metabolites, whereas imipramine and desipramine, also via CYP2D6, are metabolized to their 2-hydroxy metabolites. The hydroxy metabolites are less ac-tive than their parent compounds. The overall metabolism of these drugs requires multiple steps, and at each step a different enzyme is introduced into the process. With multiple alleles existing for each

enzyme, this adds a layer of compli-cation and can allow for increased variation in drug metabolism.

As mentioned earlier, there are numerous variant alleles of the CYP2D6 gene that contribute to various metabolism phenotypes. With respect to CYP2C19, there are 28 confirmed variant alleles, with the *2, *3, and *17 alleles being most commonly implicated in altered drug metabolism (Table 3). An individual with one “nor-mal” copy of the gene and one copy of either the *2 or *3 alleles would be considered an intermedi-ate metabolizer (IM), whereas an individual with two copies of the *2 or *3 alleles would be considered a PM. A *2/*3 individual would also be a PM, as both of the alleles are loss-of-function forms of the gene. The *17 form is considered a gain-of-function allele and individuals with the common form (*1) and the *17 allele, or two copies of the *17 allele, would be considered UM. Certainly the combination of CYP2D6 and CYP2C19 variant genes can be expected to impact drug metabolism, thus influencing an individual’s response to tricyclic antidepressants including amitrip-tyline and imipramine. Consider Case Example #3.

Recall that amitriptyline is converted to nortriptyline via CYP2C19. In this case, the patient is an IM, which is likely the cause of elevated amitriptyline concentra-tions. Additionally, the patient is a CYP2D6 PM indicating decreased conversion of both amitriptyline and nortriptyline to their respec-tive 10-hydroxy metabolites. The patient’s genetic coding for de-creased metabolism relative to the CYP2D6 and CYP2C19 pathways is likely responsible for the adverse effect noted in the above case. The interactions of CYP2D6 and CYP2C19 with tricyclic antidepres-sants have been evaluated and dis-cussed. With two genes playing an important role in the metabolism of TCAs and both having many vari-ants, predicting potential pharma-cokinetic effects and the response to a given TCA can be difficult. The

Case Example #3

JD is a 51 y.o. African American male who presents to his family physi-cian complaining of loss of appetite, fatigue, and apathy. He states he has been having difficulty at work and just “doesn’t sleep well.” He also states that he has been “irritable” and “quick to jump at people.” JD adds that he has been feeling more and more frustrated with day to day life. He confides that he started feeling this way over the past two months after the death of his father, whom he was very close to. JD’s physician makes an initial diagnosis of depression. Being older, the physi-cian is most familiar with the use of the tricyclic antidepressant agents and starts JD on amitriptyline. JD receives 25 mg of amitriptyline BID. After two weeks, JD contacts his phy-sician, complaining of confusion, lack of concentration and vomiting. JD is directed to be taken by his wife to the local hospital emergency depart-ment. At the ED, JD is examined, with the EKG showing a prolonged QRS complex with a right bundle branch block. While JD is receiving a relatively low dose of amitriptyline, the diagnosis of amitriptyline toxicity is made. As JD brought his vial of amitriptyline with him, a “pill count” indicates that JD has been following the administration directions. The ED physician calls the pharmacy to check on the generic form of the amitriptyline to see if it is the correct strength. A pharmacist confirms the strength of the tablets and suggests that pharmacogenetic testing be performed to identify the patient’s metabolic phenotype relative to CYP2D6 and CYP2C19. JD provides a cheek swab sample for DNA analy-sis. The amitriptyline is held and JD is monitored. JD is discharged from the ED with instructions to see his family physician for follow-up. After five days the pharmacogenetic test results are available, indicating that JD is a CYP2D6 poor metabolizer with a *4/*4 diplotype and CYP2C19 intermediate metabolizer with a *1/*2 diplotype. These results explain the adverse reactions being related to amitriptyline overdose, here due to decreased metabolism as compared to the actual dose being considered too high. JD is switched to a selective serotonin reuptake inhibitor (SSRI) and responds well to treatment.

recently published CPIC guidelines can help with the interpretation of such information. Based on the individual’s genetics, the thera-peutic action would be to use an alternative to a TCA for treatment of depression.

CYP2C19-ClopidogrelAs previously mentioned, CYP2C19 is a drug metabolizing enzyme which is responsible for metaboliz-ing between 5 and 10 percent of drugs. The CYP2C19 gene has been mostly discussed relative to the drug clopidogrel when considering conversion of this prodrug to its active form. The *1 form is related to normal metabolism, and is also commonly referred to as extensive metabolism. The *2 and *3 alleles, as present in heterozygous individ-uals (having two different alleles i.e., *1/*2, *1/*3) or homozygous individuals (having two of the same alleles i.e., *2/*2, *3/*3) result in decreased conversion of clopidogrel to its active form. This decreased conversion has been related to increased cardiovascular risk fac-tors in patients having undergone coronary artery stent placement during percutaneous coronary intervention for treatment of acute coronary syndrome (ACS). In 2010, FDA issued a black box warning for clopidogrel stating that it may not be effective for patients with reduced CYP2C19 metabolizing

Case Example #4MR is a 52 y.o. Caucasian male. MR is an outpatient visiting the ambu-latory care pharmacy to have his prescription for prasugrel filled. He explains that he is “very keen” about taking his prasugrel following the placement of two “tubes” in his “heart arteries.” MR was previously diag-nosed with ACS. He had gone to the ED after experiencing dizziness and chest pain. He had two stents placed to prevent coronary artery thrombo-sis and the consequences of a clot. MR was given a 60 mg loading dose of prasugrel and a prescription with the instructions to take one 10 mg tablet daily. His only other medica-tion is atorvastatin 20 mg daily, be-ing used for hyperlipidemia that was diagnosed five years ago. MR does not have prescription coverage as part of his healthcare insurance and is “shocked” at the price of prasugrel. He asks the pharmacist if there is an alternative drug he can take. The pharmacist suggests MR undergo pharmacogenetic testing, which is more expensive than a single prasu-grel prescription, but in the long run will likely save MR a great deal of money. MR agrees to have a pharma-cogenetic test done with the results indicating that he is an extensive metabolizer with a CYP2C19 *1/*1 diplotype. The pharmacist contacts MR’s family physician and the prasu-grel is changed to clopidogrel 75 mg daily.

capability. The *17 allele is associ-ated with increased conversion of clopidogrel to its active metabolite, which puts the patient at increased risk for bleeding. Case Example #4 presents an example of a CYP2C19-clopidogrel interaction.

Each CYP2C19 gene can be categorized as a gain-of-function, normal function or loss-of-function allele. The combination of two al-leles (one from each parent) results in the following expected “me-tabolizer” phenotypes: ultrarapid, extensive (normal), intermediate or poor (Table 4). The genotypes and expected metabolizer pheno-types have been evaluated relative to clopidogrel use as described by CPIC. The therapeutic action here,

Table 3Examples of CYP2C19 alleles, diplotypes, and

metabolic phenotypes

Functionality Example Diplotypea Metabolic PhenotypeFully functional: *1/*2 IMb

*1 (wild type)

Loss-of-function: *2/*2 PMc

*2, *3, others

Gain-of-function: *2/*17 IM *17 *1/*1 EMd

*1/*17 UMe

aCombination of alleles (one from each parent) bIntermediate metabolizercPoor metabolizer dExtensive metabolizer eUltrarapid metabolizer

Table 4CYP2C19 alleles as related to expected

metabolizer phenotypes

Gene from first parent gain-of-function normal function loss-of-function allele allele allele gain-of-function allele UMa UM IMb

normal function allele UM EMc IM

loss-of-function allele IM IM PMd aUltrarapid metabolizer bIntermediate metabolizer cExtensive metabolizer dPoor metabolizerG

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an individual’s genetics, would be to use an alternative antiepileptic therapy that does not increase the risk of SJS or TEN in HLA-B*15:02 positive individuals. The CPIC has recently published guidelines related to the HLA-B*15:02-carba-mazepine interaction.

CYP2D6/CYP2C19-Tricyclic AntidepressantsMany drugs are metabolized by multiple cytochrome P450 enzymes such that specific isozyme (e.g., CYP2D6, CYP2C19) genotypes can influence the overall elimination (clearance) of a given substrate drug. Variant forms of the CYP2D6 and CYP2C19 genes produce in-creased enzyme function. Examples include multiple copies of function-al variants as seen in CYP2D6 UM; increased transcription (more RNA is transcribed from DNA, which results in increased production of the enzyme) as exhibited by the CYP2C19*17 gene variant. Con-versely, CYP2D6 and CYP2C19 alleles can also produce reduced-function or loss-of-function en-zymes. For example, CYP2D6*4 and CYP2C19*2 are non-function-al. The combinations of genetic variability relative to both CYP2D6 and CYP2C19 can influence the ADME and overall concentration versus time profile of substrate drugs and metabolites. Some ex-amples of substrates for CYP2D6 and CYP2C19 include amitripty-line, nortriptyline, imipramine, and other tricyclic antidepressants.

Amitriptyline is metabolized to nortriptyline and imipramine is metabolized to desipramine via CYP2C19. Amitriptyline and nortriptyline are metabolized by CYP2D6 to their respective 10-hydroxy metabolites, whereas imipramine and desipramine, also via CYP2D6, are metabolized to their 2-hydroxy metabolites. The hydroxy metabolites are less ac-tive than their parent compounds. The overall metabolism of these drugs requires multiple steps, and at each step a different enzyme is introduced into the process. With multiple alleles existing for each

enzyme, this adds a layer of compli-cation and can allow for increased variation in drug metabolism.

As mentioned earlier, there are numerous variant alleles of the CYP2D6 gene that contribute to various metabolism phenotypes. With respect to CYP2C19, there are 28 confirmed variant alleles, with the *2, *3, and *17 alleles being most commonly implicated in altered drug metabolism (Table 3). An individual with one “nor-mal” copy of the gene and one copy of either the *2 or *3 alleles would be considered an intermedi-ate metabolizer (IM), whereas an individual with two copies of the *2 or *3 alleles would be considered a PM. A *2/*3 individual would also be a PM, as both of the alleles are loss-of-function forms of the gene. The *17 form is considered a gain-of-function allele and individuals with the common form (*1) and the *17 allele, or two copies of the *17 allele, would be considered UM. Certainly the combination of CYP2D6 and CYP2C19 variant genes can be expected to impact drug metabolism, thus influencing an individual’s response to tricyclic antidepressants including amitrip-tyline and imipramine. Consider Case Example #3.

Recall that amitriptyline is converted to nortriptyline via CYP2C19. In this case, the patient is an IM, which is likely the cause of elevated amitriptyline concentra-tions. Additionally, the patient is a CYP2D6 PM indicating decreased conversion of both amitriptyline and nortriptyline to their respec-tive 10-hydroxy metabolites. The patient’s genetic coding for de-creased metabolism relative to the CYP2D6 and CYP2C19 pathways is likely responsible for the adverse effect noted in the above case. The interactions of CYP2D6 and CYP2C19 with tricyclic antidepres-sants have been evaluated and dis-cussed. With two genes playing an important role in the metabolism of TCAs and both having many vari-ants, predicting potential pharma-cokinetic effects and the response to a given TCA can be difficult. The

Case Example #3

JD is a 51 y.o. African American male who presents to his family physi-cian complaining of loss of appetite, fatigue, and apathy. He states he has been having difficulty at work and just “doesn’t sleep well.” He also states that he has been “irritable” and “quick to jump at people.” JD adds that he has been feeling more and more frustrated with day to day life. He confides that he started feeling this way over the past two months after the death of his father, whom he was very close to. JD’s physician makes an initial diagnosis of depression. Being older, the physi-cian is most familiar with the use of the tricyclic antidepressant agents and starts JD on amitriptyline. JD receives 25 mg of amitriptyline BID. After two weeks, JD contacts his phy-sician, complaining of confusion, lack of concentration and vomiting. JD is directed to be taken by his wife to the local hospital emergency depart-ment. At the ED, JD is examined, with the EKG showing a prolonged QRS complex with a right bundle branch block. While JD is receiving a relatively low dose of amitriptyline, the diagnosis of amitriptyline toxicity is made. As JD brought his vial of amitriptyline with him, a “pill count” indicates that JD has been following the administration directions. The ED physician calls the pharmacy to check on the generic form of the amitriptyline to see if it is the correct strength. A pharmacist confirms the strength of the tablets and suggests that pharmacogenetic testing be performed to identify the patient’s metabolic phenotype relative to CYP2D6 and CYP2C19. JD provides a cheek swab sample for DNA analy-sis. The amitriptyline is held and JD is monitored. JD is discharged from the ED with instructions to see his family physician for follow-up. After five days the pharmacogenetic test results are available, indicating that JD is a CYP2D6 poor metabolizer with a *4/*4 diplotype and CYP2C19 intermediate metabolizer with a *1/*2 diplotype. These results explain the adverse reactions being related to amitriptyline overdose, here due to decreased metabolism as compared to the actual dose being considered too high. JD is switched to a selective serotonin reuptake inhibitor (SSRI) and responds well to treatment.

recently published CPIC guidelines can help with the interpretation of such information. Based on the individual’s genetics, the thera-peutic action would be to use an alternative to a TCA for treatment of depression.

CYP2C19-ClopidogrelAs previously mentioned, CYP2C19 is a drug metabolizing enzyme which is responsible for metaboliz-ing between 5 and 10 percent of drugs. The CYP2C19 gene has been mostly discussed relative to the drug clopidogrel when considering conversion of this prodrug to its active form. The *1 form is related to normal metabolism, and is also commonly referred to as extensive metabolism. The *2 and *3 alleles, as present in heterozygous individ-uals (having two different alleles i.e., *1/*2, *1/*3) or homozygous individuals (having two of the same alleles i.e., *2/*2, *3/*3) result in decreased conversion of clopidogrel to its active form. This decreased conversion has been related to increased cardiovascular risk fac-tors in patients having undergone coronary artery stent placement during percutaneous coronary intervention for treatment of acute coronary syndrome (ACS). In 2010, FDA issued a black box warning for clopidogrel stating that it may not be effective for patients with reduced CYP2C19 metabolizing

Case Example #4MR is a 52 y.o. Caucasian male. MR is an outpatient visiting the ambu-latory care pharmacy to have his prescription for prasugrel filled. He explains that he is “very keen” about taking his prasugrel following the placement of two “tubes” in his “heart arteries.” MR was previously diag-nosed with ACS. He had gone to the ED after experiencing dizziness and chest pain. He had two stents placed to prevent coronary artery thrombo-sis and the consequences of a clot. MR was given a 60 mg loading dose of prasugrel and a prescription with the instructions to take one 10 mg tablet daily. His only other medica-tion is atorvastatin 20 mg daily, be-ing used for hyperlipidemia that was diagnosed five years ago. MR does not have prescription coverage as part of his healthcare insurance and is “shocked” at the price of prasugrel. He asks the pharmacist if there is an alternative drug he can take. The pharmacist suggests MR undergo pharmacogenetic testing, which is more expensive than a single prasu-grel prescription, but in the long run will likely save MR a great deal of money. MR agrees to have a pharma-cogenetic test done with the results indicating that he is an extensive metabolizer with a CYP2C19 *1/*1 diplotype. The pharmacist contacts MR’s family physician and the prasu-grel is changed to clopidogrel 75 mg daily.

capability. The *17 allele is associ-ated with increased conversion of clopidogrel to its active metabolite, which puts the patient at increased risk for bleeding. Case Example #4 presents an example of a CYP2C19-clopidogrel interaction.

Each CYP2C19 gene can be categorized as a gain-of-function, normal function or loss-of-function allele. The combination of two al-leles (one from each parent) results in the following expected “me-tabolizer” phenotypes: ultrarapid, extensive (normal), intermediate or poor (Table 4). The genotypes and expected metabolizer pheno-types have been evaluated relative to clopidogrel use as described by CPIC. The therapeutic action here,

Table 3Examples of CYP2C19 alleles, diplotypes, and

metabolic phenotypes

Functionality Example Diplotypea Metabolic PhenotypeFully functional: *1/*2 IMb

*1 (wild type)

Loss-of-function: *2/*2 PMc

*2, *3, others

Gain-of-function: *2/*17 IM *17 *1/*1 EMd

*1/*17 UMe

aCombination of alleles (one from each parent) bIntermediate metabolizercPoor metabolizer dExtensive metabolizer eUltrarapid metabolizer

Table 4CYP2C19 alleles as related to expected

metabolizer phenotypes

Gene from first parent gain-of-function normal function loss-of-function allele allele allele gain-of-function allele UMa UM IMb

normal function allele UM EMc IM

loss-of-function allele IM IM PMd aUltrarapid metabolizer bIntermediate metabolizer cExtensive metabolizer dPoor metabolizerG

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27The Georgia Pharmacy Journal The Georgia Pharmacy Journal26

Program 0129-0000-13-012-H01-PRelease date: 12-15-13

Expiration date: 12-15-16CE Hours: 1.5 (0.15 CEU)

The authors, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

This lesson is an application-based CE activity and is targeted to pharmacists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

based on the individual’s genet-ics, would be to use clopidogrel as a less expensive alternative to prasugrel.

SummaryTesting of an individual’s pharma-cogenetics is becoming more widely available and published dosing guidelines support its application in many pharmacy settings. Addi-tionally, it is likely within the next five to 10 years that preemptive genetic testing, including partial or whole-genome (all genes) testing, will become a reality. Having the data available at the point of care will aid in the application of PGt.

Drug-gene interactions as de-scribed by the examples above can be thought of in a similar way to drug-drug interactions. The exper-tise of pharmacists calls for the profession to embrace PGt as an integral component of medication therapy management. Pharmacists need to be educated about PGt and should expect to educate other healthcare providers and patients regarding drug-gene interactions.

continuing educat ion quiz Therapeutic Actions and the Genetic Code: Examples of the Applicat ion of Pharmacogenetics

Program 0129-0000-13-012-H01-P0.15 CEU

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I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. All of the following are components of DNA EXCEPT: a. adenine. c. thymine. b. cytosine. d. uracil. 2. The most common variation in a gene is the SNP (“snip”) which refers to: a. single nucleotide polymorphism. b. single new protein. c. substituted nucleotide protein. d. slow new polymorphism.

3. With a gene variant that is a “gain-of-function” form, drug metabolism will: a. increase. c. remain the same. b. decrease. 4. Approximately what percent of drugs are metabolized by cytochrome P450 2D6 (CYP2D6)? a. 5 percent c. 20 percent b. 10 percent d. 75 percent

5. Codeine is a prodrug metabolized by what enzyme? a. CYP1A2 c. CYP3A4 b. CYP2C19 d. CYP2D6 6. Individuals who are CYP2D6 poor metabolizers are at risk of morphine toxicity when taking codeine-containing products. a. True b. False 7. When a codeine-containing product is prescribed for a child following tonsillectomy, the therapeutic action is to: a. use the normal pediatric dose. b. use an alternative opioid or a non-opioid analgesic. c. increase the dose to achieve analgesia. d. decrease the dose to avoid toxicity.

8. Following administration of carbamazepine, a patient with the HLA-B*15:02 gene variant and necrotic lesions on more than 30% of his body would be diagnosed with: a. SJS. c. TEN. b. MPE. d. erythema.

9. Genetic testing could be considered when initiating carbamazepine to avoid what potentially life-threatening condition? a. Anaphylaxis c. Stevens-Johnson syndrome b. Heart attack d. Stroke

10. What ethnicity has a higher frequency of the HLA-B*15:02 allele? a. Asian c. Native American b. African American d. Caucasian

11. Which guideline would you refer to for information about interpretation of genetic testing results? a. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) b. Infectious Disease Society of America (ISDA) c. Adult Treatment Panel III (ATPIII) d. Clinical Pharmacogenetics Implementation Consor-tium (CPIC)

12. Compared to their parent compound, how active are the hydroxy metabolites of tricyclic antidepressants? a. Same activity c. Less active b. More active

13. When considering conversion of the prodrug clopidogrel to its active form, which gene has been mostly discussed? a. CYP2D6 c. CYP3A4 b. CYP1E2 d. CYP2C19

14. Which of the following is the expected metabolic pheno-type for a patient with a normal function allele and a loss-of-function allele in regards to CYP2C19? a. Ultra metabolizer (UM) c. Intermediate metabolizer (IM) b. Poor metabolizer (PM) d. Extensive metabolizer (EM) 15. A patient with coronary artery stents who is an exten-sive metabolizer with a CYP2C19*1/*1 diplotype can be effectively treated with clopidogrel 75 mg daily. a. True b. False

To receive CE credit, your quiz must be received no later than Decem-ber 15, 2016. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to [email protected].

december 2013

27The Georgia Pharmacy Journal The Georgia Pharmacy Journal26

Program 0129-0000-13-012-H01-PRelease date: 12-15-13

Expiration date: 12-15-16CE Hours: 1.5 (0.15 CEU)

The authors, the Ohio Pharmacists Founda-tion and the Ohio Pharmacists Association disclaim any liability to you or your patients resulting from reliance solely upon the infor-mation contained herein. Bibliography for additional reading and inquiry is available upon request.

This lesson is an application-based CE activity and is targeted to pharmacists in all practice settings.

The Ohio Pharmacists Foundation Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

based on the individual’s genet-ics, would be to use clopidogrel as a less expensive alternative to prasugrel.

SummaryTesting of an individual’s pharma-cogenetics is becoming more widely available and published dosing guidelines support its application in many pharmacy settings. Addi-tionally, it is likely within the next five to 10 years that preemptive genetic testing, including partial or whole-genome (all genes) testing, will become a reality. Having the data available at the point of care will aid in the application of PGt.

Drug-gene interactions as de-scribed by the examples above can be thought of in a similar way to drug-drug interactions. The exper-tise of pharmacists calls for the profession to embrace PGt as an integral component of medication therapy management. Pharmacists need to be educated about PGt and should expect to educate other healthcare providers and patients regarding drug-gene interactions.

continuing educat ion quiz Therapeutic Actions and the Genetic Code: Examples of the Applicat ion of Pharmacogenetics

Program 0129-0000-13-012-H01-P0.15 CEU

Please print.

Name________________________________________________

Address_____________________________________________

City, State, Zip______________________________________

Email_______________________________________________

NABP e-Profile ID____________Birthdate_________ (MMDD)

Return quiz and payment (check or money order) to Correspondence Course, OPA,

2674 Federated Blvd, Columbus, OH 43235-4990

Completely fill in the lettered box corresponding to your answer.1. [a] [b] [c] [d] 6. [a] [b] 11. [a] [b] [c] [d] 2. [a] [b] [c] [d] 7. [a] [b] [c] [d] 12. [a] [b] [c] 3. [a] [b] [c] 8. [a] [b] [c] [d] 13. [a] [b] [c] [d] 4. [a] [b] [c] [d] 9. [a] [b] [c] [d] 14. [a] [b] [c] [d] 5. [a] [b] [c] [d] 10. [a] [b] [c] [d] 15. [a] [b]

I am enclosing $5 for this month’s quiz made payable to: Ohio Pharmacists Association.

1. Rate this lesson: (Excellent) 5 4 3 2 1 (Poor)2. Did it meet each of its objectives? yes no If no, list any unmet_______________________________3. Was the content balanced and without commercial bias? yes no4. Did the program meet your educational/practice needs? yes no5. How long did it take you to read this lesson and complete the quiz? ________________ 6. Comments/future topics welcome.

1. All of the following are components of DNA EXCEPT: a. adenine. c. thymine. b. cytosine. d. uracil. 2. The most common variation in a gene is the SNP (“snip”) which refers to: a. single nucleotide polymorphism. b. single new protein. c. substituted nucleotide protein. d. slow new polymorphism.

3. With a gene variant that is a “gain-of-function” form, drug metabolism will: a. increase. c. remain the same. b. decrease. 4. Approximately what percent of drugs are metabolized by cytochrome P450 2D6 (CYP2D6)? a. 5 percent c. 20 percent b. 10 percent d. 75 percent

5. Codeine is a prodrug metabolized by what enzyme? a. CYP1A2 c. CYP3A4 b. CYP2C19 d. CYP2D6 6. Individuals who are CYP2D6 poor metabolizers are at risk of morphine toxicity when taking codeine-containing products. a. True b. False 7. When a codeine-containing product is prescribed for a child following tonsillectomy, the therapeutic action is to: a. use the normal pediatric dose. b. use an alternative opioid or a non-opioid analgesic. c. increase the dose to achieve analgesia. d. decrease the dose to avoid toxicity.

8. Following administration of carbamazepine, a patient with the HLA-B*15:02 gene variant and necrotic lesions on more than 30% of his body would be diagnosed with: a. SJS. c. TEN. b. MPE. d. erythema.

9. Genetic testing could be considered when initiating carbamazepine to avoid what potentially life-threatening condition? a. Anaphylaxis c. Stevens-Johnson syndrome b. Heart attack d. Stroke

10. What ethnicity has a higher frequency of the HLA-B*15:02 allele? a. Asian c. Native American b. African American d. Caucasian

11. Which guideline would you refer to for information about interpretation of genetic testing results? a. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) b. Infectious Disease Society of America (ISDA) c. Adult Treatment Panel III (ATPIII) d. Clinical Pharmacogenetics Implementation Consor-tium (CPIC)

12. Compared to their parent compound, how active are the hydroxy metabolites of tricyclic antidepressants? a. Same activity c. Less active b. More active

13. When considering conversion of the prodrug clopidogrel to its active form, which gene has been mostly discussed? a. CYP2D6 c. CYP3A4 b. CYP1E2 d. CYP2C19

14. Which of the following is the expected metabolic pheno-type for a patient with a normal function allele and a loss-of-function allele in regards to CYP2C19? a. Ultra metabolizer (UM) c. Intermediate metabolizer (IM) b. Poor metabolizer (PM) d. Extensive metabolizer (EM) 15. A patient with coronary artery stents who is an exten-sive metabolizer with a CYP2C19*1/*1 diplotype can be effectively treated with clopidogrel 75 mg daily. a. True b. False

To receive CE credit, your quiz must be received no later than Decem-ber 15, 2016. A passing grade of 80% must be attained. CE credit for successfully completed quizzes will be uploaded to the CPE Monitor. CE statements of credit will not be mailed, but can be printed from the CPE Monitor website. Send inquiries to [email protected].

december 2013

Name PositionRobert M. Hatton Chair of the BoardPamala S. Marquess PresidentRobert B. Moody President-ElectThomas H. Whitworth First Vice PresidentLance P. Boles Second Vice PresidentLiza Chapman State At LargeTerry Forshee State At LargeDavid Graves State At LargeJoshua D. Kinsey State At LargeEddie Madden State At LargeLaird Miller State At LargeChris Thurmond State At Large Krista Stone 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentShelby Biagi 5th Region PresidentSherri S. Moody 6th Region PresidentTyler Mayotte 7th Region PresidentMichael Lewis 8th Region PresidentAmanda Westbrooks 9th Region President Flynn Warren 10th Region PresidentKalen Manasco 11th Region President Ken Von Eiland 12th Region PresidentTed Hunt ACP ChairSharon B. Zerillo AEP ChairJohn Drew AHP ChairDrew Miller AIP ChairMichelle Hunt APT ChairLeah Stowers ASA ChairJohn T. Sherrer Foundation ChairAl McConnell Board of Pharmacy ChairMegan Freeman GSHP PresidentAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeLindsey Welch UGA Faculty RepresentativeTyler Bryant ASP, Mercer University Tiffany Galloway ASP, South University Jessica Kupstas ASP, UGA Jim Bracewell Executive Vice President

2013-2014 Board of Directors

28

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ATTEND THIS YEAR’S AIP SPRING MEETING

AIP Spring Meeting Sunday, March 30, 2014

Macon Marriott & Centreplex Macon, GA

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Pharmacy Name:_______________________________________________________________________

Address:______________________________________________________________________________

E-mail Address (Please Print):_____________________________________________________________

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THE GEORGIA PHARMACY ASSOCIATION

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Mobile isn’t what it used to be, involving small screens and slow connections. Faster mobile devices like smartphones and tablets have increased the opportu-nity to utilize the mobile medium to better serve association members.

Look for GPhA’s App Release - Coming Soon!

Name PositionRobert M. Hatton Chair of the BoardPamala S. Marquess PresidentRobert B. Moody President-ElectThomas H. Whitworth First Vice PresidentLance P. Boles Second Vice PresidentLiza Chapman State At LargeTerry Forshee State At LargeDavid Graves State At LargeJoshua D. Kinsey State At LargeEddie Madden State At LargeLaird Miller State At LargeChris Thurmond State At Large Krista Stone 1st Region PresidentEd S. Dozier 2nd Region PresidentRenee D. Adamson 3rd Region PresidentNicholas O. Bland 4th Region PresidentShelby Biagi 5th Region PresidentSherri S. Moody 6th Region PresidentTyler Mayotte 7th Region PresidentMichael Lewis 8th Region PresidentAmanda Westbrooks 9th Region President Flynn Warren 10th Region PresidentKalen Manasco 11th Region President Ken Von Eiland 12th Region PresidentTed Hunt ACP ChairSharon B. Zerillo AEP ChairJohn Drew AHP ChairDrew Miller AIP ChairMichelle Hunt APT ChairLeah Stowers ASA ChairJohn T. Sherrer Foundation ChairAl McConnell Board of Pharmacy ChairMegan Freeman GSHP PresidentAmy C. Grimsley Mercer Faculty RepresentativeRusty Fetterman South Faculty RepresentativeLindsey Welch UGA Faculty RepresentativeTyler Bryant ASP, Mercer University Tiffany Galloway ASP, South University Jessica Kupstas ASP, UGA Jim Bracewell Executive Vice President

2013-2014 Board of Directors

28

Continental Breakfast & Lunch Provided

SAVE THE DATE

Network with Colleagues

Meet with Partners

Exciting Continuing Education Programs

SHOW YOUR SUPPORT

ATTEND THIS YEAR’S AIP SPRING MEETING

AIP Spring Meeting Sunday, March 30, 2014

Macon Marriott & Centreplex Macon, GA

Registration: (For Planning Purposes Please Fill Out and Return )

Member’s Name:_______________________________________ Nickname________________________

Pharmacy Name:_______________________________________________________________________

Address:______________________________________________________________________________

E-mail Address (Please Print):_____________________________________________________________

Will you be joining us for lunch (12-1pm)? Yes_____ No_____; # of additional Staff/Guests:____________

Names of Staff/Guests: ___________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

PLEASE FAX

BACK TO (404) 237-8435


The GPhA Mobile App

C O M I N G S O O N !

A V A I L A B L E F O R M A C & A N D R O I D

Contact Association

Staff.

Share this App with a friend.

Association and Industry

News.

Check out Association events and

register.

Renew your membership

- join the Association.

Receive Association

reminders and updates.

Connect with the GPhA on

facebook.

Learn about GPhA

services.

Connect with friends and associates.

Important Advocacy

links.

GPhA is soon going mobile, leveraging mobile technology to meet member’s communication, education, advocacy, and engagement needs.

Mobile isn’t what it used to be, involving small screens and slow connections. Faster mobile devices like smartphones and tablets have increased the opportu-nity to utilize the mobile medium to better serve association members.

Look for GPhA’s App Release - Coming Soon!


50 Lenox Pointe, NE Atlanta, GA 30324


139 th GPh A Con ventionJu ne 26-29, 2014

Wy ndham Bay Point R esort - Panama City Beach, FL

As healthcare changes, so do job responsibilities and career tracks. Th e Georgia Pharmacy Association is your development partner as you address your future in phar-macy. Professional networking, skills training and continuing education are key benefi ts of your GPhA membership.

Plan to attend this year’s Convention and take advantage of all the educational and networking opportunities available. Whether you’re a seasoned professional or a fi rst year student, there’s something for you at the GPhA Convention.

We’re looking forward to seeing you there.

Book your reservations at the Wyndham Bay Point Today! Room Rate: Run of House (1 King or 2 Double Beds) $189/night + tax with no resort fee. Reservation Line: (866) 269-9165 OR Visit www.gpha.org to be directed to our customized Wyndham link. Reservation Cut-Off: Wednesday, June 4, 2014

Proud Sponsor of the 139th GPhA Convention

Documents

Georgia Pharmacy Journal - February 2014