Christine Blank, Contributing Editor

A new campaign that has the support of several pharmacy organizations will educate consumers about the value of pharmacists.
	The American Association of Colleges of Pharmacy (AACP), which represents the 143 accredited schools of pharmacy, recently launched the Pharmacists for Healthier Lives public awareness campaign.

“This is a critical time for healthcare in the United States. People are concerned about access, coverage, and medication management. Pharmacists play a vital role on the healthcare team, and yet most people are not aware of all they do to promote healthier, better lives. We need to change this,” Maureen Thielemans, AACP’s director of communications, tells Drug Topics.
	Most people are familiar with their local community pharmacist, but are unaware that many pharmacists hold doctorates and are important members of a patient’s healthcare team, Lucinda Maine, PhD, RPh, executive vice president and CEO of AACP, says in a statement. “They work in a variety of settings such as hospitals and clinics, and make tremendous contributions in the advancement of medicine.”

ASHP, the Academy of Managed Care Pharmacy, the Accreditation Council for Pharmacy Education, the National Alliance of State Pharmacy Associations, the Georgia Pharmacy Association, and PrescribeWellness, are partnering with AACP.
	While groups like NCPA and APhA are not yet involved, “as the campaign builds, we anticipate that other pharmacy and related organizations will join the coalition,” says Thielemans. The campaign will last several years.

Partner organizations have access to an online toolkit of key messages and branding resources to use in personal and professional communications. The general public can also engage with Pharmacists for Healthier Lives on its Facebook page and through the campaign’s website. AACP is encouraging the use of the hashtag, #Indispensable to promote the campaign on social media.

Pharmacists for Healthier Lives will also be supported with earned media outreach nationally and in key markets. “Next year, we anticipate exploring additional media outlets to include online, transit, print, and broadcast,” Thielemans says.

A new partnership between Walgreens and Kroger could mean Kroger will eventually sell its pharmacy business to Walgreens, according to an analyst.

The two massive retail chains recently announced that customers in 13 initial stores in northern Kentucky can order Kroger grocery items online and pick up orders at participating Walgreens locations. Plus, Kroger’s Our Brands grocery items will be available at participating Walgreens locations. “The diversified shopping assortment will complement Walgreens products and services across health and wellness, pharmacy and beauty,” according to the companies.

Edward Kelly, retail analyst for Wells Fargo, believes the partnership will have various effects. “Opportunity for future collaboration could include the cross-selling of each company’s leading own brands, sourcing agreements, supply chain efficiency, proprietary preferred/restrictive pharmacy networks, or possibly even the sale of [Kroger’s] pharmacy business to [Walgreens],” Kelly says in a research note he provided to Drug Topics. “We recommend investors pay careful attention to the evolution of this partnership and other potential avenues of value creation.”

Kelly believes an in-store pharmacy arrangement, similar to Target and CVS Pharmacy’s partnership, is likely for Walgreens and Kroger. “Pharmacy is particularly tough for anyone other than the key scale players as preferred/limited networks are becoming more prevalent, the generic cycle has slowed, reimbursement rates are getting squeezed, and more complex specialty pharmacy is the growth driver,” Kelly wrote. “The front-end of the drugstore is also challenged given its lack of differentiation and poor value proposition. Now that we know [Kroger] and [Walgreens] have been talking, it’s obvious to us that future collaboration is possible.”

Jim Cohn, a spokesperson for Walgreens, however, tells Drug Topics that the current partnership has “no impact to pharmacy,” In addition, a partnership such as Target and CVS’ arrangement “is not a part of the pilot project, and our plans at this time are … to continue to listen to customer feedback in the coming months, while also gathering learning and insights to help determine any future steps.”

This new concept is an opportunity to test and learn, as the companies determine how to best work together to further elevate their customer offering, Stefano Pessina, executive vice chairman and CEO of Walgreens Boots Alliance, said in a joint statement from the companies. “We continue to evolve our offerings to meet the changing needs of our customers and provide a more differentiated shopping experience.”

Opioid abuse prevention legislation, signed into law by President Donald Trump, is being praised by pharmacist organizations.

Both NCPA and NACDS say they are pleased with the passage of the SUPPORT for Patients and Communities Act (HR 6) by the House of Representatives and its companion Senate bill that was also passed. The legislation was signed into law on October 24.

Requires electronic prescribing for Schedule II through V controlled substances prescriptions covered under Medicare Part D starting January 1, 2021. In addition, the use of electronic prior authorization for covered Part D drugs will be required starting January 1, 2021, Ronna Hauser, PharmD, vice president of pharmacy policy and regulatory affairs at NCPA, tells Drug Topics.

“These requirements may change some pharmacy work flow aspects,” Hauser says. In addition, pharmacists may see Medicare Part D lock-in programs grow, as lock-in provisions for Medicare patients that are at-risk for opioid abuse will be required by 2022, and will be an option for plans starting January 1, 2019, according to Hauser.

The Medicare Part D provision “maintained provisions to exempt long-term care patients in nursing facilities and to ensure that patients’ choice of pharmacy is respected,” NCPA says in a statement.

Provides federal grants to states to assist drug disposal authorized collectors with the cost to purchase, install, and maintain drug take-back kiosks; the cost to dispose of collected unwanted prescription drugs; and the cost to train staff in operating the kiosks with the goal of improving take-back programs and participation in the states, NACDS says in a statement.

Enhances eligibility for the Medicare Part D Medication Therapy Management program to include at-risk beneficiaries.

Requires federal agencies to develop and distribute materials to train pharmacists on the circumstances in which they are allowed by law to decline to fill a prescription for a controlled substance, NCPA says. These circumstances may include the suspicion of fraud, forgery, or other forms of modification.

“Pharmacists will soon have access to HHS materials/training that can be a resource to determine when to decline to fill a controlled substance prescription,” Hauser says.

Strengthens prescription drug monitoring programs. The legislation takes “important technical steps to facilitate a collaborative and interconnected system that provides meaningful prescribing information to healthcare providers that can help prevent fraud, waste, and abuse,” NACDS says.

Social media sites often lead consumers to websites that sell prescription drugs illegally, according to a new report.

During a recent four-week study, the National Association of Boards of Pharmacy (NABP) performed keyword searches on multiple social media sites and easily found posts leading to websites selling commonly counterfeited and/or abused medications. Keywords and terms used included “Viagra,” “ciprofloxacin” (Cipro), and “Xanax for sale online.”

On Pinterest, for example, NABP found 66 posts promoting sale of medications; 38% provided links to websites selling prescription medicines illegally. Similar keyword searches on Instagram, Facebook, Twitter, Reddit, and eBay garnered similar results.

Characteristics of these sites include selling products not FDA approved, not requiring a prescription, and selling controlled substances.

“This review of social media sites was a subset of NABP’s ongoing study of online drug sellers, which has found that 95% of websites selling prescription drugs online are doing so illegally,” says NABP in a statement.

Twitter and Snapchat require that advertisers of pharmacies and pharmacy products be verified by NABP. Pinterest executives say they are taking steps to further reduce the number of illicit “pins” that slip through their filters, according to NABP.

“As Americans’ reliance on social media platforms for news and information has grown in recent years, it is expected that the prevalence of rogue online pharmacies in these spaces will also increase. The goal is for social media companies to take steps and use available resources to screen and monitor their platforms for harmful content linking to illegally operating websites,” NABP says.

Articles

Small Doses: November News

Atrial fibrillation (AFib) patients with a history of cancer are less likely to see a cardiologist or fill anticoagulant prescriptions, compared to AFib patients who had never had cancer, a recent study notes. But those who are treated by a cardiologist are more likely to stick with their anticoagulant regimens

These patients are potentially putting themselves at increased risk of stroke by not filling and taking prescribed medication, according to the 

Journal of the American College of Cardiology

Researchers at Emory University School of Medicine examined the relationship between early cardiology involvement after an AFib diagnosis in patients with a history of cancer and how that affected outcomes. After reviewing records of more than 64,000 AFib patients with a history of cancer, they found that cancer patients were less likely to see a cardiologist after AFib diagnosis and less likely to fill prescriptions for oral anticoagulants.

Prostate and breast cancers were the most common types of cancer in the reviewed records. The study found that patients with a history of cancer were also older and more likely to have other cardiovascular conditions, according to a 

from the American College of Cardiology (ACC).

However, after about a year of followup, cancer patients who visited a cardiologist were more likely to fill their prescriptions, showed a reduced risk of stroke, and did not show an increased risk of bleeding, the study found. These patients were also more likely to be hospitalized, which may be due to more aggressive treatments, ACC states.

“Although AF patients with cancer were less likely to see a cardiologist, or fill anticoagulant prescriptions, cardiology involvement was associated with increased anticoagulant prescription fills and favorable AF-related outcomes in AF patients with cancer,” writes Wesley T. O'Neal, MD, lead author of the study and a cardiology fellow at Emory University School of Medicine in Atlanta, in the study.

"Overall, our data suggest that suboptimal antithrombotic care exists in AFib patients who have a history of cancer. The decision to initiate antithrombotic therapy or refer to a cardiology provider should be individualized to the patient, but our data suggest that cardiology providers positively influence outcomes among these patients,” adds O’Neal in the statement.

According to a related editorial published in the same issue of the 

, the number of cancer survivors in the United States is expected to rise from more than 15 million currently to more than 20 million by 2026, which could lead to an increased focus on addressing their other long-term medical and psychosocial needs.

"The management of cancer patients must extend beyond their primary malignancy and will require an interdisciplinary approach from oncologists, primary care providers and other subspecialists," said Sean T. Chen, MD, an author of the editorial and an internal medicine resident at Duke University Medical Center.

The research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, the National Institute on Aging of the NIH, and the American Heart Association.

Patients with atrial fibrillation who have had cancer are less likely to see a cardiologist and less likely to fill anticoagulant prescriptions.

AFib Patients Who Had Cancer Are Less Likely to Fill Their Anticoagulant Prescriptions

Up until now, there were no published studies, and limited real-world evidence, on the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients 80 years and older. Now, 

 on the topic, presented at the American Heart Association’s Scientific Sessions 2018 in Chicago in November, provides valuable insight.

In the study sponsored by the Bristol-Myers Squibb-Pfizer Alliance, researchers found that, among very elderly patients with nonvalvular atrial fibrillation (NVAF), apixaban (Eliquis) was associated with a lower risk of stroke/systemic embolism (S/SE) and major bleeding (MB) compared to dabigatran (Pradaxa) and rivaroxaban (Xarelto).

 spoke with Steven Deitelzweig, MD, one of the lead investigators for the ARISTOPHANES study and system chairman of hospital medicine and associate professor of medicine at Ochsner Clinical School in New Orleans about the novel research.

 Is this a first-of-its-kind study? Is it rare that NOACs are studied in very elderly patients?

 Yes, very elderly patients have been under-represented in randomized clinical trials and there are no head-to-head randomized controlled trials with direct comparisons between NOACs. In addition, limited evidence exists on the effectiveness and safety of NOACs in this population, which leaves practicing physicians such as myself making treatment decisions without population-specific clinical trial data, underscoring the importance of real-world evidence in filling these information gaps.

Studies such as ARISTOPHANES aim to provide clearer understanding of the effectiveness and safety associated with a treatment option in routine clinical practice. To date, ARISTOPHANES, is the largest real-world data study evaluating oral anticoagulants among patients with NVAF, including NVAF patients aged 80 and older.

 Why is this research important? How will it help pharmacists and physicians?

: Under-treatment with anticoagulants is frequently seen among elderly populations, perhaps due to fear of increased bleeding risks that accompany aging. The analysis of real-world data provides the opportunity to analyze anonymized historical data from this patient population and make informed inferences in lieu of data for patients 80 years of age and older with NVAF.

These results may be helpful for clinicians in evaluating the risk-benefit ratio of NOACs for elderly NVAF patients and help fill information gaps. 

Have results similar to the ones you found been verified in other studies?

: Yes, these data are consistent with findings from the pivotal Phase 3 ARISTOTLE clinical trial, which compared the effects of apixaban versus warfarin on the risk of stroke and systemic embolism in patients with NVAF. Patients included in this study were aged 75 years or older. Results of the study showed that in patients with NVAF, apixaban was superior to warfarin in preventing stroke/systemic embolism and major bleeding.

What else is important to know about this research?

: It is important for prescribers to note that, while real-world data cannot replace randomized clinical trials, they can complement clinical trial data by painting a fuller picture of a treatment option. In recent years, methodologies for analyzing real-world data have evolved, allowing for greater rigor and transparency when assessing analyses.

The fact that this real-world data sub-analysis of the ARISTOPHANES study was selected by AHA as an oral presentation underscores the increasing importance that medical professionals are placing on this type of research to help inform treatment decisions.

A new study fills in information gaps on NOAC use in patients age 80 and over.

Novel Study Shows Efficacy of Anticoagulant Treatment in Very Elderly with Nonvalvular Atrial Fibrillation

Telepharmacy’s growth has burgeoned in recent years, thanks to its ability to reduce overall healthcare costs and improve outcomes. And it shows no sign of slowing.

Use by chains such as CVS Health and Walgreens- along with hospitals and clinics for follow-up care-telepharmacy is becoming even more prevalent in rural areas.

Related article: Telepharmacy: New Jobs, Expanded Opportunities

For example, Hy-Vee, a regional supermarket chain based in West Des Moines, IA, purchased two telepharmacies in rural communities in Iowa late last year. The telepharmacies are staffed with certified pharmacy technicians-and a pharmacist is on staff 16 hours each month. Pharmacists can counsel patients at the telepharmacies using a tablet or telephone, according to Hy-Vee.

In a keynote address delivered in May at 

 (a leading industry event for innovation in healthcare that brings together key stakeholders), Troyen A. Brennan, MD, chief medical officer at CVS Health, discussed the potential for the company to “create a new, unique chassis for population health management.” This could be done by complementing the traditional use of telephonic case management with digitally-gathered information and real medical intelligence, combined with in-person visits to Minute-Clinics and CVS Pharmacies he says. Digitally gathered information would include data collected using devices such as connected glucometers.

“We are looking to narrow the distance between patients in their every-day lives and the caregiving facility by leveraging digital data and making healthcare accessible in convenient community locations,” Brennan says.

 (CPS) are expanding rapidly, and are hiring more pharmacists and pharmacy techs.

“Healthcare is transforming. New expectations on onsite staff have made it difficult to complete all of the clinical and operational expectations required,” Joe Calomo, PharmD, MBA, divisional vice president of telepharmacy for CPS, tells Drug Topics. “On top of this, there has been a shift towards ‘value-based care’, which continues to demand higher quality while com-pressing reimbursements and therefore a drive to reduce costs. Telepharmacy models can help achieve both of these outcomes.”

In a study conducted by CPS in 2015, the use of medication reconciliation and telepharmacy reduced hospital readmission rates for patients who suffered from heart failure, pneumonia, and acute myocardial infarction. The study, in cooperation with JFK Medical Center in Edison, NJ, found a 7% decline in 30-day readmission rates for Medicare patients who had suffered from heart attacks, and a nearly 5% drop in readmission rates for Medicare patients with congestive heart failure.

Related article: Is Telepharmacy Taking Pharmacy Jobs?

CPS has seen such an increasing demand for telepharmacy that it recently expanded that division. It relocated its National Telepharmacy Center from Memphis, TN, to a larger facility in Naperville, IL, and plans to hire around 60 additional pharmacists and 12 pharmacy techs over the next four years.  This is double the staffing it has now that monitors 3 million medication events annually.

More telepharmacies are opening and it appears that they are creating jobs. 

Telepharmacy Use Soars

The FDA is exploring several ways to prevent long-term drug shortages and allow more drug importation so patients have access to medically necessary drugs.

The agency is setting up a work group to explore policy frameworks that would allow for increased drug importation of “medically important” medications. This would address challenges when the drug suddenly becomes unavailable from the sole manufacturer or there are significant price increases in the medication.

“Any policy that involves the importation of drugs would be temporary until adequate competition enters these categories. Furthermore, any resulting policy would also be narrowly tailored in order not to create the same risks of counterfeits or other unsafe drugs getting into the U.S. supply chain as a broader importation policy would present,” said FDA Commissioner Scott Gottlieb, MD, in a 

The agency’s ultimate goal is to seek multiple FDA-approved and marketed versions of each medically important drug for which there are no blocking patents or other exclusivities, Gottlieb added.

Related article: Drug Shortages Remain Major Concern for Hospital Pharmacists

The agency also formed a Drug Shortages Task Force, which will be led by Keagan Lenihan, FDA’s associate commissioner for strategic initiatives. “I’m charging the shortages task force to delve more deeply into the reasons why some shortages remain a persistent challenge. The charge to this new task force is to look for holistic solutions to addressing the underlying causes for these shortages,” Gottlieb said in a 

Many of the drugs in short supply, historically, are low-profit margin generic medicines. "Many are sterile, parenteral drugs, which can be challenging to manufacture. The low-profit margins, and the significant cost of manufacturing these complex drugs, has resulted in consolidation in the industry. The only way to produce these low-margin products profitably is to manufacture them at tremendous scale. This has resulted in fewer and fewer manufacturers for certain key products,” Gottlieb said.

As a result, long-term solutions must encourage companies to invest in increased capacity to make these important medicines, “and to produce them with robust manufacturing processes that ensure consistently available quality products,” Gottlieb said. “This is one area we’ll explore. But we also need to look more broadly across the entire pharmaceutical industry, health care providers, payers and government regulators for structural solutions that keep these shortages from happening.”

The Drug Shortages Task Force will include leaders from the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs, which collectively “provide or pay for prescription medicine for millions of Americans,” Gottlieb said.