While at the 2018 APhA Institute on Substance Use Disorders in Salt Lake City, UT, I heard many reasons why people wanted to attend. Some expressed an interest in working within the field of substance use disorder, while others referenced personal experiences with addiction affecting family members, friends, or even themselves.

According to the U.S. Surgeon General’s Report on Alcohol, Drugs, and Health, there are 20.8 million people with a substance use disorder living in the United States. That means substance use disorder is 1.5 times more common than all cancers combined and has a prevalence similar to diabetes. During your pharmacy career, you will be expected to counsel patients with diseases such as hypertension, heart failure, diabetes mellitus, and many more; but you will be prepared for this because this knowledge is part of the PharmD curriculum. However, these patients may also be struggling with addiction, and you will need to consider complications that may arise due to an active substance use disorder or substance withdrawal.

“36-year-old female, 27 weeks pregnant with multi-drug resistant tuberculosis. Resistant to isoniazid, ethionamide, pyrazinamide and rifampin. What can we administer? Additionally, she is an undocumented immigrant with no insurance coverage.

“Yes, the diagnosis code. We cannot bill to Medicare Part B without the diagnosis code on the script.”

“The new shingles vaccine. Do you have it?”

“Only one dose of patiromer was given. The potassium didn’t lower fast enough, so we lost her.”

Caregiver. Problem solver. Advocate. Learner. Educator. Leader. Provider.

Hi, “Ami”! As a preceptor and a new practitioner in community pharmacy, I truly resonate with your rotation reflection. I, too, fell in love with the fully accessible provider role of pharmacists that inspires unique relationships with patients. I have experienced the powerful impact of that very tangible relationship with many of my patients in my practice. When I was a student pharmacist, I also fell in love with the dedicated advocacy of the pharmacy profession to advance legislation that improves patient care. Finally, I echo the earnest desire of your preceptor to facilitate a rotation experience of mutually beneficial learning.

Hi all! I am a final-year student pharmacist at Drake University College of Pharmacy & Health Sciences in Des Moines, IA. Signing up for APhA–ASP 5 years ago was one of the greatest decisions of my college experience, and I feel so fortunate to serve as your APhA–ASP National President. I became involved in Generation Rx as a first-year pre-pharmacy student. APhA–ASP became my home because it offered me the opportunity to grow as a young professional, serve patients in my community, be a change agent for the profession, and discover my career path. Since then, I have had the privilege to serve APhA–ASP on a local, regional, and national level, and met some of my best friends along the way. My roots are in the small town of Monticello, IA, where I grew up with my parents and four younger siblings. My favorite pastimes with my family include going to church on Saturday evenings, boating at Lake Delhi, and driving cross-country in the RV while blasting Cher and Johnny Cash. I am always on the hunt for the perfect dark roast, and I find my peace in practicing hot yoga and making chocolate chip pancakes.

In the 15-year timespan from 2003 to 2018, one in six rural independent pharmacies had closed their doors for the last time.¹ Speculation may point to many potential reasons, but there is one practice that undeniably hinders small pharmacy operations: direct and indirect remuneration (DIR) fees. 

Imagine you are selling candy bars at a local food stand, and you are dealing with Company X, which helps certain groups of people buy chocolate bars. You are given $2 by Company X through selling a candy bar to a man named Billy. A few months later, Company X comes to your shop and takes 75 cents in fees for that sale because of administrative costs and changing chocolate prices. Your shop ends up making only $1.25 for that chocolate bar you sold to Billy. Imagine even further that your price for chocolate bars from the wholesaler is $1.30 a bar. Because these fees are recouped by Company X, you end up losing 5 cents on that sale to Billy. This is a simplified explanation of what PBMs are doing to pharmacies across the nation in the form of DIR fees.