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Contributing Editor Christine Blank is a freelance writer based in Florida.
Easy-to-swallow bits of news and studies for the busy pharmacist.
Sometimes, despite your best efforts, you can't stay up on the latest news. Staying up on local and national politics is hard enough, but what about the latest pharmacy news? Almost impossible.
That's why every month we bring you Small Doses. They're easy-to-swallow little pills (candy-coated!) of information tailored for the busy pharmacist. There's a lot happening out there, but here's the short version of what we think you need to know.
This month, read more on depression in the pharmacy, vaccine errors, naloxone, and more. And when you're done, hopefully you'll be well-versed enough to share the news around the water cooler-assuming you even have time for a water break.
Up next: More pharmacy residents depressed than medical residents.
Pharmacy residents typically carry a high stress load and can become depressed, but more accurate data on depression rates are needed. “We haven’t really studied this a lot,” says Janet A. Silvester, PharmD, vice president of accreditation services for ASHP. “On the medical side, they have been looking at [the impacts of stress on residents] longer.”
To obtain more accurate data on pharmacy resident stress, Evan Williams, PharmD, BCPS, assistant professor of pharmacy practice at Roseman University of Health Sciences in Henderson, NV, along with pharmacists who work for Albertsons and Rite Aid, surveyed more than 1,900 pharmacy residents using the depression screening component of the Patient Health Questionnaire (PHQ-9).
The study, published in the March 2018 issue of the American Journal of Health-System Pharmacy, found 39% reported moderate to severe depressive symptoms during March 2016. Rates among medical residents have been reported to be about 30%. In the general population, the depression rate ranges from 6.6% to 7.6%.
“The rate was higher than what I expected,” says Williams.
Now, he and his colleagues are working to reproduce the results in a two-year study, surveying pharmacy residents about their depression rates at various times of the year. “Hopefully, we are able to publish this and get more of a cluster of data, to describe how frequently we think this is happening,” Williams says.
The school’s pharmacy residents and pharmacists are supplying the city’s police and firefighters with naloxone, and training them to use the opioid overdose reversal medication.
“The Auburn pharmacy faculty and students are working to be proactive, and prepare the Auburn community to react and respond if and when the United States opioid epidemic extends to the Auburn community,” says Kimberly Braxton-Lloyd, PharmD, assistant dean in Auburn’s Department of Pharmacy Health Services. “We want to increase awareness and preparedness among our students, faculty, advisors, and first responders, so we can act quickly and decisively in emergencies and potentially save lives.”
Braxton-Lloyd is working to raise funds for additional training and education. “We would like to continue to expand this program to further educate and equip others who may be in a position to respond during an opioid overdose,” Braxton-Lloyd says. “We believe the more people who are trained and equipped throughout campus, the more likely it will be that we are prepared when an overdose situation does occur on our campus.”
Alabama leads the country in opioid prescribing, according to the CDC, with an estimated 96 to 142 prescriptions per 100 people per year.
Specialty drugs will contribute all of the growth in drug spending in 2018. In fact, these medicines are expected to reach 48% of total spending in developed markets by 2022, according to a new study from the IQVIA Institute for Human Data Science.
This year, the $318 billion specialty medicines market will represent 41% of developed market spending, up from $172 billion in 2013, IQVIA said in its 2018 and Beyond: Outlook and Turning Points study. However, the growth of spending on specialty medicines will be constrained by cost and access controls and a greater focus on assessments of value, IQVIA notes.
Related article: Considering Specialty Pharmacy? Make Your Move
Biosimilar drugs will also have a much bigger impact on drug spending in 2018 and beyond. In 2018, $19 billion of current biotech spending in developed markets will have competition from biosimilars for the first time. “That amount is significantly greater than the $3 billion in biosimilar revenue that became exposed in 2017, and it adds to the $26 billion already facing competition,” IQVIA says. “The new exposure to competition in 2018 is the largest single-year change to date and signals the start of the next large wave of biosimilars.”
The study also found that real net per capita spending on medicines in the United States will decline in 2018 and continue almost unchanged at roughly $800 per person through 2022. “Spending will remain flat after factoring in the robust pipeline of new drugs, moderating brand price increases of 2% to 5% on a net basis (7% to 10% on a list price basis) and the impact of brand losses of exclusivity, which will be greater in the next five years than the last five,” according to an IQVIA statement.
Patients taking over-the-counter medications such as acetaminophen reported less pain intensity than patients taking prescription opioids such as Vicodin, during a recent study.
The study, published in the March 6, 2018, JAMA, involved Veterans Affairs patients who had moderate to severe chronic back pain, or hip or knee osteoarthritis pain, despite analgesic use.
Researchers compared patients’ pain intensity, pain-related function, and the adverse effects between opioids such as morphine, oxycodone, or fentanyl patches, versus nonopioids, including generic Tylenol, ibuprofen, and prescription nerve and muscle pain drugs.
While the two groups did not significantly differ on pain-related function over a 12-month period, pain intensity was significantly better in the nonopioid group. The Brief Pain Inventory (BPI) severity was 4.0 for the opioid group and 3.5 for the nonopioid group.
Adverse medication-related symptoms were significantly more common in the opioid group over 12 months:1.8 in the opioid group versus 0.9 in the nonopioid group.
“Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months,” the researchers wrote. “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
Confusion over the two herpes zoster vaccines on the market, has led to a “small number of error reports” involving differences between the two vaccines, the Institute for Safe Medication Practices (ISMP) reports.
Shingrix (zoster vaccine recombinant, adjuvanted) from GlaxoSmithKline, referred to as RZV by the CDC, was approved by the FDA last October. However, for more than 10 years, healthcare professionals have been accustomed to the storage and administration requirements of Merck’s Zostavax (zoster vaccine live, or ZVL).
“Shingrix and Zostavax have different storage requirements, components/diluents, and routes of administration,” according to ISMP in its February, 2018, ISMP Medication Safety Alert! Community/Ambulatory Care Edition.
Both components of the Shingrix vaccine, its lyophilized gE antigen component and its adjuvant suspension component, should be stored under refrigeration before and after reconstitution, according to ISMP. If the lyophilized component or its adjuvant suspension are improperly stored in a freezer, they must be discarded.
However, with Zostavax, the lyophilized vaccine (attenuated varicellazoster virus) should be stored in a freezer, and the Merck-supplied sterile water diluent can be stored in a refrigerator or at room temperature.
“The product components are not interchangeable. A system should be employed to ensure the Shingrix lyophilized component and adjuvant suspension vials are stored with one another to reduce the risk of using a diluent from another vaccine,” ISMP says.
Another major difference is that Shingrix is given intramuscularly, while Zostavax is given subcutaneously.
The American College of Apothecaries (ACA) recently acquired the pharmacy buying group The Compounders Group (TCG) to help independent pharmacists stay competitive in today’s marketplace, ACA says.
“The costs of running an independent pharmacy continue to escalate, especially with challenges like USP 800. It’s more important than ever that independent pharmacies work together,” says ACA Executive Vice President Donnie Calhoun, who is also a longtime member of TCG. “We will see more collaboration as TCG grows to an even larger, stronger group, leveraging its buying power and helping independent pharmacies face the challenging pharmacy landscape.”
Since the acquisition, TCG has experienced an almost 20% increase in membership and has expanded to 52 vendors.
“The founders of TCG have watched it grow over the past six years, from serving primarily compounders with an increasing number of members that own hybrid, specialty, and traditional pharmacies. With ACA at the helm, TCG’s goal of helping its members buy smarter and stronger will remain the same,” says David Rochefort, one of TCG’s five founding members.
ASHP lauded the benefits of the government’s 340B Drug Discount Program during a Senate hearing on drug pricing in mid-March.
“The increasing shift throughout healthcare toward ambulatory care, including more outpatient pharmacy services, has contributed to the growth of the 340B program and has allowed for better access to medications by low-income and uninsured patients,” Joe Hill, director of ASHP’s Government Relations Division, told the Senate Health, Education, Labor, and Pensions Committee. “It is important to note that drugs subject to the 340B drug-pricing program make up a fraction of the nation’s total drug expenditures.”
Related article: The Winners and Losers of 340B Changes
The 340B program also reduces government expenditures and lessens the burden on taxpayers who would otherwise be financing the indigent care federal 340B-participating hospitals provide, said Hill. He added that the 340B program results in savings that: