PHARMACY

Navajo pharmacist fills patient education gap

BY Alaric DeArment

TSAILE, Ariz. — Some people enter the twilight years of college without a clue of what they want to do, only to decide at the last minute. Others, like pharmacist Terry Teller, know early on.


For Teller, a member of the Navajo Native American tribe originally from Lukachukai, Ariz., helping to heal people is part of his heritage, with multiple generations of medicine men and women on both sides of his family.


Teller had several healthcare-related jobs, including research and working as a nurse’s aid. He considered medical school before working with a pharmacist at an Indian Health Service facility in Tsaile, Ariz., which inspired him to go to pharmacy school at the University of New Mexico, where he earned his doctor of pharmacy degree in 2007.


“From all of those, I found I really didn’t want to do the direct patient care a doctor would provide,” Teller told Drug Store News. He now divides his time between work as a staff pharmacist at Tsaile and as a weekend relief pharmacist at Walmart stores in Farmington and Gallup, N.M.


At Walmart, Teller often finds himself using a skill uncommon among pharmacists: his ability to speak the Navajo language, which his parents speak and he studied in high school and college. As the only pharmacist in his area who speaks the language, he’s often in high demand, particularly among elderly customers. 
“Once they know I speak Navajo, once they know I can explain things, I get held up on the floor for a while,” Teller said.


One issue that accompanies speaking in a different language is cultural attitudes. “One of the challenges is having [the customers] understand that these medications will work, because there is a struggle to tell them, especially if they’re very traditional in thought. A lot of them have the mindset that they need a ceremony, and their high blood pressure or blindness will disappear,” Teller said, noting that patients often will attend ceremonies and use traditional herbal 
remedies, creating a need to consult references to Navajo herbal medicines and online databases to prevent potential drug interactions.


Another issue is the way illness is discussed in Navajo culture. Teller can’t tell a patient directly that he or she has a disease and will encounter certain symptoms, but instead must frame it in indirect terms, such as saying that if “a person” had a disease, he or she might encounter this or that symptom. “If I tell them [directly], in the traditional Navajo mindset, it’s like cursing them,” Teller said.


According to the Centers for Disease Control and Prevention, Native Americans and Alaska Natives have the highest rates of diabetes in the 10- to 19-year-old age category. Apache County, where Lukachukai is located, and neighboring McKinley County, N.M., have diabetes prevalence rates greater than 10.6%, according to the CDC.


Most diabetes patients strive to keep their A1c levels below 7%, but Teller sometimes encounters patients with levels of 14%. Heart disease rates among Native Americans and Alaska Natives also are among the highest in the country, with the CDC reporting hypertension rates of 28% and high cholesterol rates of 30%.


Any program working to reduce those rates requires public awareness, but that’s part of what got Teller into pharmacy in the first place. “For me, why I wanted to get into pharmacy was that I didn’t like direct patient care, but where I get a lot of my enjoyment is with 
patient education,” he said.

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PHARMACY

Retail pharmacy can rest easy with unequivocal AMP victory

BY Jim Frederick

ALEXANDRIA, Va. — It’s a battle that raged for more than three years. But in mid-December, the retail pharmacy industry was able to declare a clear, unequivocal victory.


We’re talking, of course, about the struggle to head off what would have been a devastating change in the way Medicaid pays community pharmacies to dispense generic drugs to low-income patients. On Dec. 14, the chain and independent pharmacy lobbies announced they had reached a landmark agreement with the 
Centers for Medicare and Medicaid Services that effectively ends the threat.


In short, the National Association of Chain Drug Stores and the National Community Pharmacists Association refer to the proposed changes as AMP, which stands for average manufacturer price. CMS had proposed AMP as a new method for calculating the market price of generics as a new basis for establishing the federal upper limit of reimbursements to pharmacies for dispensing those generics to Medicaid patients.


CMS unveiled the new reimbursement guidelines as a way to cut Medicaid costs in line with the Deficit Reduction Act of 2006. But pharmacy leaders have long argued that it’s a flawed approach to cost-saving by the government. AMP doesn’t reflect the true acquisition cost of the generic for retail pharmacies, they argued, since it takes into account the lower costs paid by other types of purchasing entities, such as hospitals and institutions. What’s more, the feds’ definition of a multiple-source drug itself was flawed, pharmacy 
advocates asserted.


Together with the low rate of markups CMS was proposing for generic Medicaid payments, the new AMP rule drastically would have cut pharmacy reimbursements and made it all but impossible to dispense medicines to low-income patients without incurring a loss, pharmacy leaders have long argued. To head off the change, NACDS and NCPA filed a suit in federal district court in 2007 to halt the new AMP guidelines from taking effect.


The resulting court-imposed injunction has kept AMP from taking effect, and it has saved chain and independent pharmacies an estimated total of $5.5 million a day ever since. Now that CMS finally agreed to withdraw its reimbursement plan and go back to the drawing board, NACDS and NCPA, along with their members, are breathing a sigh of relief. The fact that they’ve also agreed to drop the suit signals the end of a long — and ultimately victorious — battle for respect, and a decent return on their business.

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Travel clinics, immunizations take flight at Bartell Drugs

BY Alaric DeArment

SEATTLE — You can say Bartell is getting into the travel business.


Bartell, which had an estimated $353.4 million in sales in 2009, began operating travel clinics eight years ago and now has them at 10 of its 59 stores. They were the brainchild of pharmacists Jolene Kalmbach and Sharon Woodward, who got the idea after noticing that patients’ doctors often lacked necessary expertise in travel medicine and that commercial travel clinics were overbooked.


Customers can pay $50 for a consultation with the pharmacist and then pay individually for immunizations. In particular, Bartell’s clinics benefit from a provision in Washington state’s pharmacy regulations that gives pharmacists limited power to prescribe medicines and vaccines under special agreements with physicians.


“Seattle has emerged as a business-and-leisure travel hub to Asia, Latin America and Europe,” said Bartell Drugs clinical care coordinator Rachel Allen. “The international travel clinics have become a signature service that not only supports awareness of our overall vaccination program but [also supports] sales of travel-related items throughout the entire store.”

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