Hot Topics: Pharmacy ACHA Annual Meeting June 4, 2010

1. Hot Topics: PharmacyACHA Annual MeetingJune 4, 2010 Deborah Hubbell, BSPharm, University of Connecticut Steve Kozel, PharmD, UCLA Greg Yeakel, BSPharm, Iowa State University Deirdre Younger, BSPharm, MS, University of Maryland, College Park

2. Disclosure • We have NO actual or potential conflict of interest in relation to this educational activity or presentation

3. Objectives List the most current clinical issues affecting college health pharmacists Describe current funding or other business-related challenges in providing college pharmacy services Describe strategies on other campuses for managing challenging pharmacy issues

4. Why are we here? • To gain a better understanding of who we are as college health pharmacists and explore what we can offer to our health centers • Presenters will share their experiences on the topic areas • Audience is invited to share their experiences also to expand the knowledge base of everyone in attendance

5. Topics for Discussion • Role of the pharmacist in immunizations • H1N1 and the role of the pharmacist • Integrating Pharmacy with the Health Center • Generating Operating Revenue • Identifying Unmet Health Services Needs • As time allows, other topics identified by the audience

6. Hot Topics: PharmacyACHA Annual MeetingJune 4, 2010 H1N1 and the Role of the Pharmacist Deborah Hubbell, BSPharm, University of Connecticut

7. Role of the pharmacist in immunizations • Campus Outreach Vaccination Clinics • Student Athlete Vaccination • Accessibility to all students and staff

8. H1N1 and the Role of the Pharmacist Mass Vaccination Effort (lessons learned at UConn) Including: • Vaccine allocation • Storage • Distribution • Recordkeeping

9. A virus emerges • First illness in Mexico and the United States in March/April 2009 • CDC lab confirms on April 15, 2009 • CDC activates EOC on April 22, 2009 • US government declares public health emergency on April 26, 2009

10. April 29, 2009 - WHO signals global pandemic of novel influenza A (H1N1) was underway (worldwide pandemic alert level to Phase 5)

11. June 11, 2009  Phase 6

12. By June 19, 2009, all 50 states in the United States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands had reported novel H1N1 infection

13. What did this mean to College Health? • CDC concluded novel H1N1 flu was causing a greater disease burden on people younger than 25 years of age • ACHA Pandemic Influenza Surveillance Project was launched in August 2009 • ACHA released “Interim Guidance for Managing On-Campus Novel H1N1 Flu Pandemic”

16. What did this mean to UConn?

17. Connecticut Department of Public Health:

18. Launch of SHS Flu Hotline and www.flu.uconn.edu

19. VPSA H1N1 Task ForceObjectives • To identify the challenges, risks and issues within Student Affairs that may arise as a result of an H1N1 outbreak • To develop and implement a detailed response plan to address those challenges • To serve as the Divisional contact for all matters related to H1N1 and a resource for other Student Affairs departments with issues or inquiries arising out of H1N1

20. VPSA H1N1 Task ForceMembership • Committee Chairs: Mike Kurland, Director of Student Health Services and Denielle Burl, SA Director of Risk Management • Clinical Staff – Mary Manton, M.D., Michele LaBonte, A.P.R.N. , Deb Hubbell, R.Ph. • Communication Representative – Beth DeRicco (Wellness & Prevention) • Residential Life – Maureen Armstrong, Scott Gallo • Dining Services – Dennis Pierce • Off-Campus Services – Jim Hintz

22. FLU KITS • Tissues • Hand sanitizer • Masks • Thermometer • Flu information card

23. CDC Guidelines for antiviral use Who may be considered for antiviral chemoprophylaxis ? • Persons at high risk for complications of influenza; • Health care workers and emergency medical personnel; • Pregnant women.

24. CDC Guidelines for antiviral use Whom not to treat chemoprophylactically • Groups of healthy children or adults based on potential exposures in the community, workplace, school, camp or other settings; • If  >48 hours have elapsed since the last close contact • The close contact did not occur during the infectious period How to prophylax • Antiviral drugs: oseltamivir (oral), zanamivir (inhaled)

25. Vaccine purchase, allocation, and distribution • FDA approved four vaccines (made by CSL, MedImmune, Novartis, Sanofi Pasteur) • Vaccine procured and purchased by US government • Vaccine allocated across states proportional to population • Vaccine sent to state-designated receiving sites – mix of local health depts & private providers

26. Delivery Model • Public health-coordinated effort that blended vaccination in public health-organized clinics and in the private sector (provider offices, workplaces, retail settings)

28. From: Robert L. Miller [mailto:MillerRL@ehhd.org] To: Kurland, Michael; Hubbell, Deborah; Olzinski, MikeSubject: UConn H1N1 vaccine allocation UConn SHS is authorized to administer: 1500 doses of flu mist lot# 500780P 400 doses of prefilled syringe (.5ml) lot#00249611A Robert L. Miller, MPH, RS Director of Health Eastern Highlands Health District 4 South Eagleville Road Mansfield Ct. 06268 860-429-3325

31. Initial Target Groups for SHS Clinics • Pregnant women • Household contacts and caregivers of infants less than 6 months of age • Students aged 18 and under who have a high risk medical condition • EMS personnel and healthcare workers who have direct clinical contact with patients

34. Mass Vaccination Clinics • October 30 – 100 • Nov. 9 & 10 – 800 • Nov. 16 & 17 – 800 • Nov 30/Dec 1 – 600 • Dec . 7 & 9 – 400 • December 15 – 60 • January 6 – 380 • February 9 – 260

35. In September, the original assumptions were that 75% of our students would want H1N1 vaccine. • We estimated that 10% of those would go to their home providers and 90% would use the MDA. • So we planned for 1,000 per week over a 3-4 month period. • In the end, we immunized 3,400 people.

36. 2010-2011 Influenza Vaccine • A/California/7/2009 (H1N1)–like virus • A/Perth/16/2009 (H3N2)–like virus • B/Brisbane/60/2008–like virus

37. Positioning the Pharmacy as a Revenue Center and a Value-Added Service for the Student Heath Center Steven Kozel, Pharm.D. UCLA Arthur Ashe Student Health and Wellness Center

38. ABSTRACT • College health pharmacies can fill a number of roles in the student health service from providing traditional pharmacy services, to generating operating revenue, to providing services for the students that are not met by the traditional student health center service providers. For the pharmacy to meet its potential, the pharmacy needs to integrate with the student health center, identify health center needs, and provide evidenced based support for those activities.

39. Integrating the Pharmacy with the Health Center • Pharmacy and Therapeutics Function- the pharmacy should assume a leadership role in this function • Quality Assurance Participation- the pharmacy should participate in the organization’s continuous quality assurance process. • A. Benchmark Medication Errors • B. Serve as an expert advisor to reduce the potential for medication errors

40. Integrating the Pharmacy with the Health Center • Volunteer to assist with health center outreach programs • A. Health Fairs • B. Immunizations-either as an immunization provider or an educator • Advise Student Health Advisory Committee and/or Student Health Insurance Committee • A. Advocate for Pharmaceutical Benefit plans that meet student needs

41. Integrating the Pharmacy with the Health Center • Establish the Pharmacy as the “Go To” Expert on Pharmaceutical Benefits • A. Serve at the prescriber’s proxy for prior authorizations • B. Facilitates timely medication availability • C. Free up providers to see additional patients rather than spend time on insurance issues

42. Generating Operating Revenue • Not For Profit vs For Profit Revenue Model • Determine the organization’s policy • Even a not for profit model “should generate revenue that can support operations • Non profit does not mean operating at a loss;

43. Generating Operating Revenue • Budgets • Insure that the pharmacy is recognized as a responsible fiscal partner in the organization • Participate in your financial review • Review your performance monthly--this should be data driven

44. Generating Operating Revenue • Assure insurance claims are adjudicated promptly and rejected claims are resolved in a timely manner. • Identify financial problems promptly and develop a plan of correction • Ensure that the pharmacy performance is included in the organization’s quarterly and annual financial reports

45. Identifying Unmet Health Service Needs • Collaborative Prescribing Protocols • Facilitates management of medication shortages; • Standardization of therapeutic medication classes within the organization to improve quality and minimize costs;

46. Identifying Unmet Health Service Needs • Self care partnership; OTC’s as an alternative to a clinic appointments-frees up clinic appointments and directs patients to seek an appointment with a provider when self care is not appropriate • Emergency Contraception Services partnership with Women’s Health; • Medication Special Orders • Specialty Pharmacy

47. Identifying Unmet Health Service Needs • Alternative Prescription Service Models • i. Online Refill Requests • ii. Electronic Prescription Appointments • iii. Prescription and refill drop boxes

48. Identifying Unmet Health Service Needs • Advertising Pharmacy Services • Business Cards; • OTC’s • Partnering with the clinic providers

49. Other Issues as Defined by Audience • What are the other issues that college health pharmacists face in today’s climate of poor economy, lay-offs, furloughs, changes in how the Health Center operates etc.? • How do we overcome these challenges?