​ interview

Serving pharmacists and patients

Sarah Derr, PharmD

Minnesota Pharmacists Association

Please tell us about the history of the Minnesota Pharmacists Association (MPhA).

MPhA—formerly known as the Minnesota State Pharmaceutical Association (MSPhA)—was founded in 1883. Meeting in St. Paul that year, a group of 12 influential druggists made plans and preparations to organize a state pharmaceutical association. MSPhA later produced the other institutions of pharmacy in Minnesota: the state Board of Pharmacy, established in 1885, and the University of Minnesota’s College of Pharmacy (CoP), established in 1892. Over the last 137 years, MPhA has served all pharmacists, student pharmacists, and pharmacy technicians. MPhA continues to be the organization that represents all pharmacists in the state of Minnesota. (See DiGangi, Frank E., A Century of Service and Leadership. 2003.)

There are other associations of pharmacists in Minnesota. What can you tell us about them and how you all work together?

The other organization that is well known in Minnesota is the Minnesota Society of Health System Pharmacists (MSHP). This organization’s members are mostly comprised of pharmacists from health systems and in administrative positions within hospitals. Another smaller organization is the Minnesota College of Clinical Pharmacy (MCCP), which has members serving in clinical roles, such as those working in the clinic and those working in specialties such as renal failure, hematology, and oncology. The other major player in Minnesota pharmacy is the CoP, which not only graduates PharmD students, but also plays a large role in keeping alumni connected and serving in large leadership roles in the profession.

About a decade ago, the Practice Act Task Force was created, now known as the Minnesota Pharmacy Alliance. This brings together MPhA, MSHP, MCCP, and the CoP to discuss how we can best serve Minnesota pharmacists. The Alliance works closely together, especially on legislative issues, to ensure that we are one voice. This group works on several issues throughout the year.

​Pharmacists are the most accessible health care professionals.

Prior Authorization is an issue that impacts most physicians in many ways. How does it impact pharmacists and what are some potential solutions to these problems?

Prior Authorization can be a challenge for all health care professionals. Pharmacists are impacted when a patient brings a script to the pharmacy that requires a prior authorization that the prescriber was not aware of. In these cases, the pharmacist has to contact the clinic to get a prior authorization. This can cause a delay in the patient getting their medication. Additionally, plans change their formularies at least once a month, if not more often. This can cause the need for a new prior authorization mid-year, which then can lead to further delay in patients getting their medication.

Potential solutions are to stop health plans from changing their formulary mid-year. In addition, once a patient has had a prior authorization for a medication, we could eliminate the need to renew prior authorization each year.

Prescriptive authority for non-diagnosable conditions is an issue for the MPhA. What can you tell us about this?

MPhA has been pursuing prescriptive authority during the 2020 legislative session. We are pursuing conditions that do not require a diagnosis, such as nicotine replacement for smoking cessation, emergency opioid antagonists such as naloxone, and self-administered hormonal contraceptives. We are pursuing these three areas because they all are medications that a patient can have dispensed at the pharmacy. Pharmacists are the most accessible health care professionals, and they see patients, on average, 25 times a year. When a patient is ready to quit smoking, it is best that they get the medication and counseling that they need at that point in time, before they change their mind.

Medication administration by pharmacists is another important issue. Can you explain your work in this area?

Pharmacists are well trained to counsel and teach patients how to administer their medications. Many patients are not comfortable administering injectable medications on their own. Pharmacists are well equipped to administer these medications. In the 2019 legislative session, the Minnesota Pharmacy Alliance passed legislation to allow pharmacists to administer long-acting injectables for mental health and substance use disorders. In 2020, the Minnesota Pharmacy Alliance has efforts underway to expand this to all injectable medications so that patients have the access to the medications that they need. Additionally, pharmacists are the most accessible providers and are often closer to the patient’s home than to the clinic.

​

Several states have recently passed legislation around PBM transparency. These bills are now being challenged on the Supreme Court level as ERISA violations. Please explain why the legislation was necessary and why it is being challenged.

In the 2019 legislative session, the Minnesota Pharmacy Alliance passed legislation to regulate the PBMs through the Commerce Department. This is extremely important, as the PBMs are not well regulated and there is little transparency regarding where the dollars go. If the Supreme Court were to agree with the Pharmaceutical Care Management Association (PCMA), this would mean that all private plans would be exempt from the transparency bill that we passed in Minnesota. We will continue to monitor the Rutledge v. PCMA Supreme Court case.

Pharmaceutical prices are a major health care issue. What plans do you have to address these issues?

One of our most important plans is to pass legislation that provides transparency for PBMs and begins to regulate PBMs. This year, Minnesota Attorney General Keith Ellison worked with a group to create the “Report of the Minnesota Attorney General’s Advisory Task Force on Lowering Pharmaceutical Drug Prices.” MPhA will continue to work with Minnesota stakeholders to see how we can continue to lower medication costs.

What is your position on Minnesota’s new insulin legislation?

MPhA spent much of the 2019 session working with state legislators to ensure that the insulin legislation worked for both patients and pharmacists. The bill that was passed works well for both patients and pharmacists, as it utilizes existing programs through the manufacturer programs.

Interoperability of patient data across health system lines is an area of increasing concern. How does this impact patients on a pharmacy level, and what are some potential solutions?

Pharmacists are well trained to monitor medication and provide suggestions to changes in patients’ medications. In order to do this at the highest capacity, pharmacists need access to lab results and other information that can help pharmacists make informed decisions. Even read-only access can be helpful, although two-way communication is ideal so that the pharmacist can share any suggestions they may have.

How could health care delivery benefit from better communication between pharmacists and physicians?

Communication between pharmacists and prescribers is vital in order to provide the best patient care. By communicating with the prescriber, a pharmacist can provide the highest level of patient care. Access to the EMR is helpful for pharmacists to evaluate the effectiveness of drug therapy, as labs can assist in making medication decisions.

What have been the biggest issues your members have had to deal with related to the COVID-19 pandemic?

The biggest challenges have been access to personal protective equipment, ensuring that the patient is getting the medication for a legitimate medical reason, and payment for services. PPE is a large issue, as initially pharmacists were not considered “necessary” health care professions. This has since changed, thankfully. Medication shortages, particularly with hydroxychloroquine, have been a concern as prescribers are writing scripts before a patient is sick. This has improved, but there continue to be shortages of albuterol inhalers. Pharmacists have long fought to be paid for their services, and this continues to be an issue. Pharmacists are also concerned that they will not be paid to perform COVID-19 testing or administer a vaccine once it is available.

Sarah Derr, PharmD, is Executive Director of the Minnesota Pharmacists Association.