Patients taking oral antineoplastic agents (OAAs) expressed a satisfaction with a pharmacy-led adherence and symptom monitoring program, according to the results of a recent study.

The findings were presented as late breaking research at the Hematology/Oncology Pharmacy Association Annual Conference, which is being held virtually April 13 to 17.

In a virtual presentation, Stefan Allen, PhD candidate, University of Texas (UT) Austin College of Pharmacy/UT Health San Antonio (PERC), noted that although OAAs can be beneficial in reducing office visits and avoiding infusion-related complications, many of these regimens are challenging for patients and can cause significant adverse reactions.

For the study, the research team aimed to evaluate the feasibility and physician and patient perceived benefit of a pharmacist-delivered adherence and symptom monitoring program for patients taking OAAs through patient participation in a pilot program.

The study was conducted at the Mays Cancer Center, a University of Texas outpatient cancer clinic, over a time period of 6 months. Enrolled patients were receiving any of 6 OAAs: capecitabine, sorafenib, regorafenib, osimertinib, afatinib, or erlotinib. A pharmacist contacted enrolled patients twice each cycle or month, between clinic visits, for symptom or adherence monitoring over a 3-month follow-up. In collaboration with physicians, pharmacists managed or triaged symptoms such as diarrhea, mucositis, rash, nausea, and vomiting. Physicians and patients completed satisfaction surveys.

According to the results, 47 patients were eligible for participation. Patients had a median age of 59 and were predominantly male and Hispanic.

Of the 252 expected encounters with patients, 231 were performed. The pharmacy administered the Edmonton Symptom Assessment Scale (ESAS-FS) 102 times with the average total severity score decreasing over time. With an acceptance rate of 98%, 48 symptom management recommendations were made to patients and physicians by pharmacists. Ninety-six percent of patients and 90% of physicians agreed the program was beneficial and easy to use. Additionally, 97% of patients indicated they would recommend the programs to others, but only 45% agreed it improved communication with their physicians.

Overall, this pilot project suggests that a pharmacist monitoring program for patients newly prescribed OAAs is both feasible and perceived to be beneficial, according to Allen. 

“The methods utilized in this program are easily scalable to include more OAAs, more pharmacists with greater scope of practice through collaborative practice agreements, and more clinic physicians,” he concluded. However, further research is needed to evaluate whether this program improves safety, adherence, and outcomes.

Allen S, Cervantez S, Tenner L, et al. A retrospective cohort study of patients on oral antineoplastic agents. Presented at: HOPA Annual Conference 2021; April 13-17; virtual. 

https://www.eventscribe.net/2021/HOPAAnnualConference/searchbyposterbucket.asp?f=PosterCustomField17&pfp=Topic

Articles

Research presented at the HOPA Annual Conference 2021 supported the benefit and feasibility of a pharmacy-led adherence and monitoring program for oral antineoplastic agents. 

High Patient, Physician Satisfaction With Pharmacy-Led Monitoring Program for Oral Antineoplastic Agents

As the United States nears the 200 million mark for the total number of COVID-19 vaccine doses administered, with 23.5% of Americans fully vaccinated against the virus as of April 15, coronavirus-related news is not slowing down. 

Here’s a roundup of the latest coronavirus-related news, including a recent survey from the National Community Pharmacists Assocation (NCPA) and the CDC recommendation to temporarily pause the Johnson & Johnson vaccine.

NCPA: Independent Pharmacies Can Improve Vaccine Uptake in Vulnerable Communities

According to a new survey from the National Community Pharmacists Association (NCPA), independent community pharmacists are key to vaccinating socially vulnerable populations, including minority populations, but many are receiving inadequate vaccine supply.

Guillain-Barré Syndrome in COVID-19 Vaccine Trial Does Not Imply Causality, Experts Say

In a COVID-19 vaccine trial, an individual who received the vaccine subsequently developed Guillain-Barré syndrome; however, authors of a recently published paper are cautioning that this does not prove that the vaccine was the cause.

FDA, CDC Recommend Temporary Pause for Johnson & Johnson COVID-19 Vaccine

US health officials are recommending a pause in the administration of the single-dose Johnson & Johnson COVID-19 vaccine following 6 reports of a rare and severe type of blood clot, according to a joint statement issued on Tuesday by the CDC and FDA.

Study: Some Individuals Report Long-Term Effects Following Mild COVID-19

Although it is known that many patients hospitalized with COVID-19 report persistent long-term symptoms, there is not much knowledge regarding long-term outcomes among individuals with mild COVID-19.

What Contributes to Severe COVID-19 in Kids

COVID-19 may be mild in most cases for children, but severe cases do happen. An investigation offers insight into what factors may contribute to those cases.

Here's a roundup of the latest coronavirus-related news.

Coronavirus News Roundup: Pharmacists Can Improve Vaccine Uptake; FDA and CDC Recommend Pause for Johnson & Johnson Vaccine

In October 2020, I started a new position as director of clinical services at Nickman’s Drug Store in Fayette County, Pennsylvania. Fayette County shares the border with West Virginia, our new home. Our goal was to live closer to our daughter and son-in-law, and especially our adorable 4-year-old grandson. We are also 1 hour closer to Pittsburgh, where our son’s family, including our 2 granddaughters, lives. However, in April 2021, I am making another career change.

One sacrifice I have to make is resigning from my teaching position at St Francis University, which is now 2.5 hours away. I will miss my Thursday mornings with the students and our interactions. Most of all, I will miss the spirit of St Francis University. Their tagline is “Become That Someone,” which is attributed to Jack Twyman, who cared for their most renowned graduate, Maurice Stokes, class of 1955.

In the final game of the 1957-58 regular season, Stokes fell and suffered a subsequent brain injury. Three days later, on a flight to a playoff game in Detroit, Stokes suffered a series of seizures on the plane, leaving him paralyzed and unable to speak. Stokes and Twyman played for the National Basketball Association’s (NBA) Cincinnati Royals. The league provided no health insurance or pension plan.

Twyman began raising money for Stokes’ care by enlisting the help of the NBA’s stars. The first charity basketball game organized by Twyman was in 1958 and attracted 65 of the 90 players in the league. In 1964, the NBA players threatened to boycott the All-Star game in Boston, Massachusetts, forcing the owners to finally consider health and pension benefits. This act of defiance led to the riches the game enjoys today.

However, none of this was to benefit Stokes. For the next 12 years, Twyman took care of him, acting as his guardian. Stokes died in 1970 at the age of 36. When asked about providing care to Stokes, Twyman was quoted as saying, “Maurice was on his own, something had to be done, and somebody had to do it. I was the only one that was there, so I became that someone.” 

On Thursday mornings I drive past the Stokes Athletic Center on my way to Sullivan Hall to teach pharmacology to a class of 55 physician assistant science students. I often think of the Twyman-Stokes relationship, and how helpless Stokes felt, because he could never repay Twyman for all his efforts. I am sure that after every hospital visit (12 years’ worth), Twyman got his payment in knowing he helped someone who truly needed him. I hope for the morning that I teach that my overwhelmed students see me as that someone who not only teaches this most difficult subject, but who cares deeply about them and their knowledge base needed to practice their profession.

What I will truly miss most after my 16-year teaching career at St Francis is the ability to affect future physician assistants. I taught them year-round from the beginning of June until the beginning of May for at least 3 hours on Thursday mornings. During that time slot, I strived to become that someone that they needed.

In the lifesaving profession of pharmacy we are given opportunities to become that someone daily. Whether we volunteer at a COVID-19 vaccination clinic, teach a newly diagnosed patient with diabetes how to use a blood glucose meter, or teach an Advanced Pharmacy Practices Experience student how to give compassionate care, we become that someone. More than ever with the disjointed health care so prevalent in our nation, our patients need us.

The next time you are doing medication synchronization to promote adherence, counseling a new mother on dosing of an antibiotic for otitis media, or giving a shingles or flu shot, for that space in time you have an opportunity to become that someone. As for me, the satisfaction of knowing I made a difference in their health care is what keeps me so energized with this amazing profession, even in this disjointed health care system.

More than ever with the disjointed health care so prevalent in our nation, our patients need us.

Become That Someone for Your Patients

The FDAhas approved the drug, which is a new combined oral contraceptive (COC) with 3 mg drospirenone (DRSP) and 14.2 mg estetrol (E4). Developed by Mithra Pharmaceuticals, it is the first and only contraceptive pill containing E4. That means it is the first new estrogen introduced in the US in more than 50 years. Its commercial launch is anticipated by the end of June 2021.

In 3 clinical trials conducted in 3725 women, Nextstellis proved to be safe, effective, and demonstrated outstanding cycle control, bleeding control, safety and tolerability, according to reports.

“When speaking with patients about their contraceptive options, one of the most common concerns is side effects,” said Mitchell Creinin, Professor and Director of Family Planning at the University of California in a 

. Clinical results showed a desirable bleeding profile and minimal impact on triglycerides, cholesterol and glucose, and on weight and endocrine markers. Nextstellis also produced significantly lower increases in sex hormone-binding globulin (SHBG) compared to two other contraceptives containing the synthetic estrogen ethinyl-estradiol (EE).

Nextstellis (drospirenone; estetrol) now is approved as a combined oral contraceptive for birth control.

FDA OKs New Combined Oral Contraceptive

The field of specialty pharmacy is exactly what it sounds like—it is a unique, rapidly growing segment of the pharmacy industry that primarily focuses on the dispensing of high-cost, high-touch medications.

High cost, in this instance, typically refers to therapies that cost upwards of $700 per month for a patient—simple enough, right? Defining “high touch” is a little bit more obscure. Think of it as analogous to being considered “high maintenance”. For our purposes, this translates to medications that require extra time, attention, and/or resources from most or all the stakeholders associated with it from production to consumption, namely manufacturers, wholesalers, prescribers, payers, pharmacies, and patients. Specialty medications are also “special” in that they often tend to treat disease states that affect smaller patient populations than those most often seen at traditional retail pharmacies. For example, according to the American Heart Association, in 2020 an estimated 918 million individuals globally are living with a diagnosis and/or are being treated for hypertension. Conversely, according to the National Multiple Sclerosis Society, only 2.8 million people worldwide suffer from multiple sclerosis, a common disease state targeted by specialty medications. Additionally, therapies 

 also be considered specialty medications when they are prescribed only by specialists and/or are restricted from a distribution standpoint. Other specialty medications may include biotech products, medications that require special handling, products with unique administration routes such as injectables, or drugs that are included and restricted by a Risk Evaluation and Mitigation Strategy program and require extra monitoring. There is no exhaustive drug list or 1 set of criteria that specifically defines which medications are considered specialty medications. Different organizations or companies may have completely different lists or criteria from one another for the medications that they require to be dispensed in a specialty pharmacy, thus making this industry even more complex and tricky to define and conceptualize. 

As we know, the concept of pharmacies, drug stores, and apothecaries have existed since ancient times with traditional pharmacies operating in most cities, towns, and villages for many, many decades. The concept of specialty pharmacies, however, has only come into existence in much more recent times, beginning in the 1970s, and has been in much more focus over the last decade or so. 

Specialty pharmacy models first originated from the need to better support and manage the medication therapy of primarily transplant and HIV patients. The relatively new-to-market, complex medications used to treat these disease states were generally higher cost and required more patient counseling regarding proper use, the importance of compliance, and the adverse effects compared with typical new-to-market medications. Dispensing these medications in pharmacies specifically equipped and trained to handle this new level of complexity resulted in a higher level of care for patients and, often, better outcomes. From there, specialty pharmacy has continued to grow over the years to include hundreds of additional drugs for similarly complex disease states such as pulmonary hypertension, immune disorders, and many more. This niche industry also began to add a focus on drugs for exceedingly rare and orphan diseases to facilitate a higher level of expert care for patients from pharmacists specially trained and educated on these smaller groups of medications than a traditional retail or mail order pharmacist.

Helping Retail and Specialty Pharmacies Use the Right Analytics to Unlock Value Beyond Prescription Reimbursements 

As the specialty model has gained more volume, attention, and success, this newer branch of the pharmacy industry has grown tremendously over the past few decades. This is no surprise as these licensed, accredited pharmacies offer a traditional, yet unique service to patients by dispensing medications when needed while also providing much more personalized medication counseling, adherence coaching, and third-party support – something today’s retail pharmacies are not structured to routinely provide at such a high level. This is not to suggest that retail pharmacists are not capable of providing quality patient care and experiences, but simply that the time associated with these processes for specialty drugs often exceeds the typical time required or allotted for a similar process in the community setting, referring back to the “high-touch” concept. 

Take for example billing a prescription through a patient’s insurance. In the specialty setting, approximately 85% of prescriptions require prior authorization (PA), which can take several minutes to hours between initiation, prescriber collaboration, paperwork, and follow up. This far exceeds the percentage of prescriptions that require PA at retail pharmacies by a large margin. Similarly, many contracts associated with specialty medication manufacturers require that the dispensing pharmacy ensure the highest level of patient adherence and/or provide clinical programs and support—both of which take significant pharmacist resourcing and time.

We should also consider the steep increase in specialty-type medications coming to market as the science and research on hard-to-treat conditions continues to improve year over year. It is clear how difficult and overwhelming this could quickly become in the retail setting for pharmacists to remain up-to-date and knowledgeable on each new medication hitting the market, despite rarely dispensing them. To note, overall growth in specialty pharmacy today is significantly outpacing traditional pharmacies and soon will make up approximately half of total pharmacy spend with more than half of all newly approved drugs potentially being considered specialty medications. These 2 factors, when considering the model of retail pharmacy, further highlight the need for specialty pharmacies.

Understanding Specialty Pharmacy Part 2: The Patient Journey. 

Overall growth in specialty pharmacy today is significantly outpacing traditional pharmacies and soon will make up approximately half of total pharmacy spend.

Understanding Specialty Pharmacy (Part 1)

Oncology and hematology pharmacists experience high levels of occupational burnout, according to the results of a survey presented at the at the Hematology/Oncology Pharmacists Association Annual Meeting 2021.

The findings, which were presented during a poster presentation on April 13, depicted the prevalence of burnout among hematology/oncology pharmacists in a first-of-its-kind evaluation specifically for this group of healthcare professionals. The study also assessed factors associated with a higher or lower level of burnout in this sample.

A total of 3024 pharmacist and resident HOPA members were invited to participate in an anonymous, web-based survey via email in the fall of 2020. The used the Masiach Burnout Inventory (MBI), Well-Being Index (WBI), and items that explored occupation and sociodemographic factors.

A total of 18% of pharmacists completed the WBI and were included in the analysis. According to the results, 61.8% of respondents reported symptoms of burnout, as defined by a high score on the emotional exhaustion (EE ≥27) or depersonalization (DP ≥ 10) scale of the MBI.

Additionally, 20.2% of respondents were concerned that they made a major medical error within the past 3 months. “This could have serious adverse consequences in patients receiving antineoplastics,” the study authors wrote.

Factors that were associated with a high level of reported burnout included:

concern for a major medical error within 3 months; and

decreased wellness due to the COVID-19 pandemic.

Among those who reported high burnout, 62.7% felt they would benefit from a wellness program. However, 30.5% were not aware of available awareness programs.

Higher levels of reported burnout were also associated with respondents reporting a high likelihood of leaving their position in the next 2 years. Moreover, factors that commonly increased work dissatisfaction were role conflict, quantity of work, workflow disruptions, organizational culture, and leadership support. This is particularly important because loss of clinical expertise and recruitment/onboarding costs can be detrimental for organizations, the authors reported.

Overall, the authors concluded that organization leaders should work to develop meaningful interventions to prevent and mitigate burnout among hematology/oncology pharmacists.

Golbach AP, McCullough KB, Soefje SA, Mara KC, et al. Evaluation of burnout in a national sample of hematology/oncology pharmacists. Presented at: Hematology/Oncology Pharmacy Association Annual Meeting 2021; virtual; April 13.

Findings presented at the Hematology/Oncology Pharmacists Association Annual Meeting 2021 discussed burnout and job dissatisfaction among oncology and hematology pharmacists. 

Oncology/Hematology Pharmacists Report High Levels of Burnout

Despite legal discrimination being outlawed almost 70 years ago, racism still exists today in various forms. Although it can look somewhat different from past days, its effects are similar and result in negative health disparities for minoritized groups.

During a keynote lecture at the Hematology/Oncology Pharmacy Association Annual Conference, which is being held virtually April 13 to 17, Lakesha Butler, PharmD, BCCPS, professor and director of diversity, equity, and inclusion at SIUE School of Pharmacy, in Edwardsville, Illinois, addressed how pharmacists can actively disrupt the status quo when it comes to structural racism.

“Groups that have been and continue to be subject of racism have seen it, have lived it, and have in fact died from it since its inception, and even today,” said Butler, who is also the CEO and co-founder of Dr. Lakesha Butler, LLC, and an editorial advisory board member of 

Butler referred to 2020 as the “year of 2 pandemics.” The spotlighted racial injustices that have occurred over the past year brought many of these longstanding issues to the forefront. Moreover, data show that minority groups are disproportionately affected when it comes to COVID-19 outcomes. Black and African American individuals have a 2.1x higher mortality rate from COVID-19 compared with whites.

In many ways, the COVID-19 pandemic has shone a brighter light on racism today.

“However, unlike COVID-19 being a novel virus…racism is far from being novel and new,” said Butler.

According to Butler, these disproportionate health outcomes seen amid the pandemic are not simply the cause of any genetic or biological differences between groups, or individual choices made during the pandemic. Historical and contemporary racism impacting health care, housing, employment, and other social factors is to blame.

A History of Structural Racism: Understanding the “Why”

Most pharmacists and pharmacy students learn about topics in diversity, equity, and inclusion, as well as health care disparities affecting minority populations, but Butler argues that there is often a missing component to this education.

“An important piece that were oftentimes missing is the ‘why’,” Butler said. Education can often focus on the “what”: the data and statistics that represent persistent health care disparities between groups. However, according to Butler, it is crucial to peel back the layers in order to understand that these disparities are rooted in structural racism that still manifest today. Without this understanding, we run the risk of interpreting health disparities as facts unable to be changed, rather than as injustices that require interventions, she explained.

Furthermore, when we don’t recognize the why behind health care disparities affecting minorities, it can lead to associating cultural diversity with negative outcomes. “When hearing that certain groups are most likely to die from certain disease states, this further perpetuates the ideology that there’s something different about those individuals,” she explained.

The structural racism that fuels these disparities dates back to hundreds of years ago. Historically, specific laws and policies were used to separate individuals of color from those that are white. For example, Butler pointed to the subpar housing that was created for individuals of color, often built around toxic environments such as industrial plants. Minority communities were not given access to the same education, financial, or health care resources as whites. This created a system of inferiority, Butler said.

And although this discrimination is illegal today, the consequences of these policies have had lasting effects on minorities, according to Butler. She pointed specifically to continued segregation amongst minority groups in major cities, often resulting from a lack of financial means to move into certain neighborhoods. This dates back to not having the opportunities to build wealth or have certain jobs because of racist ideologies.

“Now we are about 70 years of having discrimination illegal,” Butler said. “We have a lot of work to do to dismantle the hundreds of years of structural racism.”

As it pertains to health care, the effects of structural racism on social determinants of health (SDOH) play an important role in the existing disparities.

“These differences are rooted in structural racism that are still manifested today,” Butler noted. She explained some of the social and economic factors, in addition to physical environmental factors, that affect individuals of color. 

: Employment, income, expenses, debt, medical bills, support

: Housing, transportation, safety, parks, playgrounds, walkability

: Literacy, language, early childhood education, vocational training, higher education

 Social integration, support systems, community engagement, discrimination

 Health coverage, provider availability, provider linguistic and cultural competency, quality of care

Pharmacists should continue learning about areas of SDOH and consider these factors when caring for minority patients. 

With all of this in mind, the question becomes “How do we dismantle structural racism?”

According to Butler, this starts with disrupting the status quo by getting to the root problem and working to address it. And although understanding SDOH is certainly a step in the process, it should not stop there. Addressing racism is both an organizational and individual responsibility.

Organizations can look to revise policies and practices to be more equitable, according to Butler.

“In organizations, what does your leadership look like? What about your hiring practices?” Butler said.

Engaging minoritized individuals as shared stakeholders is particularly important in creating a space for them to be heard. To do this, diversity, equity, and inclusion efforts are often employed in organizations. Butler stressed the importance of ensuring each of those terms are tied together.

For example, Butler explained that diversity can be termed as having a seat at the table, but not necessarily having your voice heard. Inclusion is the component that allows an individual to have a voice. The most important component is equity.

“Equity is where we allow the individuals to be heard,” Butler said.

When it comes to hiring practices, Butler recommends being intentional by reaching out to minorities when leadership opportunities arise. Minorities should be able to see themselves in leadership positions in organizations, she said. If the candidate pool isn’t diverse enough, Butler suggests coming up with a strategy to widen the pool and seek out proper representation before moving forward.

Butler recommends employing assessments to understand personal implicit biases. The Cycle of Socialization, for example, is an activity that can be used to understand how one helps to maintain an oppressive system based on the messages that have been taught regarding race.

“When we don’t know something, when we don’t dig deeper, we tend to fill in the blanks and make assumptions with the information we’ve been taught,” Butler said.

In addition to understanding and learning from personal biases, Butler emphasized the importance of become an active ally. This involves speaking up on behalf of minorities and becoming an educator in spaces that are often dominated by whiteness. “Allyship is a verb,” Butler stressed. “Moving from being a bystander to an ally is very important.”

As health care providers, it is also important to view patient encounters with an equity and trauma-informed care lens, according to Butler. Pharmacists should acknowledging racial injustices happening in different groups and how that is affecting the patient.

“We took an oath to make sure that we are providing the best care to all patients, all humanity,” Butler said. According to Butler, attaining equity for all patients is the ultimate goal.

“There will be times that you make mistakes…but I encourage you to get up, brush yourself off, and continue on this journey.”

Butler L. Dismantling structural racism in pharmacy: Our individual and organizational responsibility. Presented at: Hematology/Oncology Pharmacy Association Annual Conference 2021; virtual; April 14, 2021.

At the HOPA Annual Conference 2021, Lakesha Butler, PharmD, BCCPS, discussed how pharmacists can disrupt the status quo to fight racism and work toward health equity for all. 

Dismantling Structural Racism in Pharmacy

Kathryn Wheeler, PharmD, BCPS, is assistant clinical professor of pharmacy practice, University of Connecticut School of Pharmacy, Storrs, Conn.

On January 22, 2021, the FDA approved voclosporin (Lupkynis; Aurinia Pharmaceuticals) for the treatment of adult patients with active lupus nephritis (LN) in combination with a background immunosuppressive therapy regimen. Voclosporin is an oral calcineurin inhibitor immunosuppressant. Its activity results in inhibition of lymphocyte proliferation, production of T-cell cytokines, and expression of T-cell activation surface antigens. This is the first FDA-approved oral therapy for LN, a condition that can cause irreversible kidney damage and increase risk of kidney failure, cardiac events, and death.

The results of a 52-week randomized, double-blind, placebo-controlled trial (NCT03021499) demonstrate the efficacy of voclosporin in participants with a diagnosis of systemic lupus erythematosus and class III or IV LN (alone or in combination with class V LN) or class V LN. Renal biopsy was performed to classify LN based on the International Society of Nephrology/Renal Pathology Society’s standards. A total of 357 participants were randomized to receive either voclosporin 23.7 mg twice daily (n = 179) or placebo (n = 178). All participants received background immunosuppressant therapy (ie, oral mycophenolate mofetil [MMF] targeted to a dose of 1 gram twice daily and corticosteroid therapy adjusted to achieve a dose of 2.5 mg/d by week 16 of the study). The primary efficacy end point of the study is the proportion of patients achieving complete renal response at week 52; urine protein/creatinine ratio (UPCR) of less than or equal to 0.5 mg/mg and estimated glomerular filtration rate (eGFR) greater than or equal to 60 mL/min/1.73 m2 or no confirmed decrease from baseline in eGFR of greater than 20% or no treatment- or disease-related eGFR-associated event (ie, decrease in renal creatinine clearance or glomerular filtration rate, or increase in blood creatinine, serum creatinine, renal impairment, renal failure, or acute renal failure) at time of assessment. At week 52, a higher proportion of participants achieved complete renal response in the voclosporin arm than the placebo arm (40.8% vs 22.5%; OR, 2.7; 95% CI, 1.6-4.3; 

 < .001). Moreover, administration of voclosporin compared with placebo is associated with a reduction in the time to UPCR of less than or equal to 0.5 mg/mg (median time of 169 days vs 372 days; HR, 2.0; 95% CI, 1.5-2.7). Overall, a greater proportion of participants who received voclosporin for 1 year in addition to background therapy achieved a reduction in kidney inflammation in comparison with those who received background therapy alone.

Prior to initiating therapy with voclosporin, obtain a baseline eGFR and blood pressure. Monitor renal function and blood pressure regularly throughout treatment with voclosporin. The most common adverse effects (AEs) include decreased eGFR (26%), hypertension (19%), diarrhea (19%), headache (15%), anemia (12%), and cough (11%). Other potential AEs include lymphoma, serious infections, nephrotoxicity, neurotoxicity, hyperkalemia, corrected QT interval prolongation, and pure red cell aplasia.

Voclosporin is a CYP3A4 substrate. Coadministration with moderate and strong CYP3A4 inducers should be avoided. Voclosporin is a P-glycoprotein inhibitor; other medications may require a dose reduction when used in combination with voclosporin. Dose adjustments are recommended in severe renal impairment and mild to moderate hepatic impairment. Voclosporin should be avoided in pregnant patients because of the alcohol content of the drug formulation. Patients taking voclosporin should avoid live vaccines.

Voclosporin is administered as a 7.9-mg capsule. It must be swallowed whole on an empty stomach. Recommended starting dose is 23.7 mg orally every 12 hours. Voclosporin is approved in combination with MMF and corticosteroids. Concomitant administration of voclosporin and cyclophosphamide should be avoided; further study is required to establish safety and efficacy of the combination. Do not stop or change the dose of voclosporin without consulting a health care provider.

Lupkynis. Prescribing information. Aurinia Pharmaceuticals; 2021. Accessed March 8, 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/213716s000lbl.pdf

New Drug Review: Voclosporin for Lupus Nephritis

Navigating first-time pharmacy ownership can be difficult, and the process of purchasing a second or third store can be just as challenging. 

Bob Graul, business development with FFB and Drew Hegi, loan officer with FFB, joined 

 episode to discuss what it takes to succeed in pharmacy ownership.

Graul and Hegi offered their insights on pathways to first-time pharmacy ownership and expanding to multi-store ownership, including these central elements:

Factors for attractive and unattractive prospects

Distinctions between SBA loans and other types of loans

Independent pharmacies are being increasingly depended on for providing accessible patient care. Taking the next step to buy a pharmacy, begin a start-up, or expand to multiple stores may take expert guidance to help future owners fully realize their business goals.

 to hear the rundown of succeeding in pharmacy ownership from the experts at First Financial Bank – Pharmacy Lending division.

In a recent podcast with First Financial Bank (FFB), Bob Graul and Drew Hegi of the Pharmacy Lending Division share insights into the keys to success for first-time and multiple store ownership. 

Succeed in Pharmacy Ownership 

Based on the responses from 515 pharmacy owners and managers between April 1 and April 7, 42.3% described their surrounding neighborhoods as low-income. Additionally, 53% reported serving a large majority white community, 38% a mostly white with significant minority population, and 9% a mostly non-white population.

“Reaching socially vulnerable patients with vaccines continues to be a key problem that community pharmacists can solve. The administration recently announced a dramatic expansion of the number of pharmacies that will get the vaccine. That’s great news, but we need to be sure the supply can meet that demand,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA, in a 

Independent Pharmacy’s Best-Kept Secret in COVID-19 Vaccination

Of the 93% of respondents who are currently administering one of the COVID-19 vaccines, 13% and 36% described their vaccine supply as somewhat inadequate and very inadequate, respectively. The biggest obstacle for pharmacies working through their vaccine programs was not receiving any/enough vaccine (46.7%), followed by patient reluctance to get the shot (22.2%).

The NCPA survey also showed that 46.7% of respondents are either already administering, or planning to administer, COVID-19 vaccines at locations other than their pharmacy, including professional offices or work sites (68.7%), patients’ homes (57.1%) and community centers (53.0%). Pharmacists also reported giving shots in schools and places of worship.

“Americans trust their local pharmacist, and they can be very helpful educating people about COVID-19 and the vaccines,” said Hoey.

“Independent pharmacists live in the communities they serve. They are often prominent local business leaders and active in the civic life of the community. That’s especially true in communities of color, where community pharmacists often have strong ties, they and their staffs are part of the fabric of their neighborhood, and they can reach socially vulnerable populations in ways that larger pharmacies cannot,” Hoey said.

View the Report for 2021 NCPA Vaccine Survey

Survey Findings Suggest Independent Pharmacists are Key to Vaccinating Vulnerable Populations. News Release. NCPA; April 13, 2021. Accessed April 14, 2021. 

https://ncpa.org/newsroom/news-releases/2021/04/13/survey-findings-suggest-independent-pharmacists-are-key

A new survey conducted by NCPA showed that many independents are serving vulnerable populations but are not receiving adequate supplies of COVID-19 vaccine.  