1) When did you realize that you wanted to be a Pharmacist?
I always knew I wanted to help people but was unsure in what capacity. In my first year of undergrad, I took an overview course and learned the basics of various health professions. Once the course was finished, I decided a career in pharmacy was the path for me.
2) When you were in pharmacy school, did you consider pharmacy entrepreneurship to be an option?
I did not consider entrepreneurship until after I graduated pharmacy school. Once I realized my purpose, I knew pharmacy entrepreneurship was the path I needed to take to fulfill that purpose.
3) Who are the Pharmacists that have influenced you the most and why?
I have been most influenced by Mr. Punk Walker and Dr. Pilar Murphy. Mr. Walker is the first pharmacist I remember. He worked for Eckerd Drugs in my hometown. My mother was the Assistant Manager and when we would visit her store, Mr. Walker was always extra kind. My mother spoke of him in high regard and that was the first time I remember being introduced into the world of pharmacy. I reconnected with him during my third year of undergrad. I interviewed for a job with a pharmacist in my hometown and Mr. Walker was there! He wasn’t physically working but I think he may have been there in a consultant capacity. Dr. Pilar Murphy was one of my preceptors in pharmacy school. After graduation she became one of my go-to pharmacists for advice. She showed so much compassion and kindness to me as a student and after graduation. She is the epitome of going above and beyond for her patients and people. Since the first night I heard her speak at a PERC conference, I’ve aspired to emulate the same level of compassion and kindness.
4) What would you like the readers to know about you? And what would you like readers to know about your pharmacy practice and the services you are currently providing to the community?
I enjoy reading and hiking and my new hobby (thanks to the COVID-19 pandemic) is gardening. I am the owner of A² Pharmacy Solutions LLC, a boutique pharmacy that offers healthcare conference consulting and speaking services and community education. I love creating digital content on social media, YouTube and on my podcast, The Rx Factor. You can find me on all social media: @doctorlany. New episodes every Saturday of The Rx Factor Podcast on Anchor, Spotify and Apple Podcast apps. New videos every Friday on the Doctor Lany YouTube page.
5) What would you tell students currently in pharmacy school? What services do you foresee these students offering in the years to come?
Don’t be afraid to take the road less traveled and create your own niche in pharmacy. Also, the pharmacy world is very small so don’t forget the golden rule!
6) Freestyle question… Tell us the readers what you want us to know.
Life is not a dress rehearsal. It is the grand finale. Live life for yourself and be content with your decisions for the day. You won’t always win but do not be afraid to try. Be open-minded. Read a book. Beyond what you know to be “right” and “true” is a sea of other “rights” and “truths”.
The course will be completed using your standard textbooks and my lesson manual.
I will upload my personal lecture audio under this post throughout our 8 weeks together.
The lesson manual includes content covering 8 lessons, quizzes, previous final exams, and information pertaining to how to conduct yourself on externship. Please use this manual as your guide to complete this course. It will take both in class and out of class studying to complete each of the 8 lessons. Each lesson should take you at least 4 hours to cover.
Please refer back to the lessons as needed.
I will not print lessons, it is up to you to follow the material accordingly. The links are below.
Quiz 1 will be given on May 14, 2019. You will have 45 minutes to complete the quiz (9am – 945am). There will be a brief break and then a review of the quiz by your instructor for the remainder of the class.
Quiz 2 for May 15, 2019 will be rescheduled. We will instead cover Lesson 3 and go into more depth review of the material thus far. We will also have a lab to get hands on knowledge of the material covered.
Homework — please continue to keep studying the top 200 drugs from your text. You should now be memorizing pages 4, 5, and 6 of the top 200 from your workbook.
Quiz 2 will be next Wednesday May 22, 2019 over the top 200. Use previous quizzes from last year to study for Quiz 2. There will be 75 questions on quiz 2 and you will have 1 hour to complete the quiz.
To receive extra credit on quiz 2, please look over the top 200 and type up a summary on 25 drugs of your choice. For each medication — list the brand name of the drug, the generic name of the drug, the classification of the drug, and the body part the drug acts on.
For example… ProAir HFA is an inhaler and is classified as a respiratory agent, the generic name is Albuterol HFA and the body part that the drug acts on is the lungs. The drug acts in a manner to open the airways so that a person can breath normally.
If you type up 25 drugs and do it as I’ve asked you, you can receive up to 25 points extra credit on quiz 2. Remember, it must be typed!!! And you must turn this in on Tuesday May 21, 2019 to receive credit.
Please continue to look over the externship material. Sign the final page of the agreement, informing me that you’re committed to a 40 hour externship, and please talk to DHR and/or JCCEO to inform them of your intentions to become a registered pharmacy technician — you need to be registered prior to going on externship. This costs $103.
Tuesday May 21, 2019 we reviewed Lesson 3 and began covering Lesson 4. We finished the first problem in Lesson 5. Please work on the second question in Lesson 5 and read Chapter 6.
Audio from Tuesday May 21, 2019:
Wednesday May 22, 2019 the second quiz for this session was administered.
After taking into account the 25 point bonus — the class average for quiz 2 was 77.8%
A review of Chapter 6 continued during this lecture post quiz. Please continue to work on Chapter 6 and review Lesson 1-Lesson 5 for class next week.
Tuesday May 28, 2019 the third quiz was administered by Janiece. All those present received a 100% on the quiz.
Wednesday May 29, 2019 we completed Lesson 7 — please continue to review Lesson 7. We reviewed Lesson 5.
Lecture Audio May 29, 2019:
For Quiz 4 prepare in this way:
Memorize section A conversions from Lesson 5
Be prepared to answer multiple choice questions that relate to prescription examples Baby Girl Roberts, Janet Jackson, and Henry Ford from Lesson 5.
Lastly, review the Alligation Hydrocortisone example that can be found on page 184 in your text. This example will be used for your quiz.
June 4, 2019 the quiz will be 25 questions. We will then review Quiz 4 –> proceed to a lab on compounding –> and review Lesson 8.
Please review your syllabus, our time together is nearing the end.
June 4 — Quiz 4 and practical compounding lab
June 18 — Final Exam
June 19 — Review of the Final Exam administered on the 18th and Final Grades
Please continue to study, work diligently on your pharmacy technician registration, work on your resume’, and begin submitting applications to local pharmacies
If you find a job as a pharmacy technician or as a pharmacy cashier prior to externship, you will not have to complete an externship.
50 point extra credit!!!!!!
Write two paragraphs describing each lesson that we have completed thus far. We have completed Lessons 1, 2, 3, 4, 5, 7.
Give 2 examples from each lesson and why each example is important in becoming a pharmacy technician.
For example in your paragraph you describe Pharmacy Technician Registration in the State of Alabama…
In Lesson 1 we discussed how to become registered as a pharmacy technician. It is important that pharmacy technicians know that in the State of Alabama we register by using albop.com. The annual fee is $103 with renewals occurring in odd years.
Remember 2 examples from each lesson, each example should be 1 paragraph in length. This must be typed. 12 point font. Times New Roman. Double spaced.
If anytime remains we will begin covering Lesson 8.
Externships will be emailed out this Friday June 8, 2019. It is your responsibility to contact the Pharmacy Managers/Lead Technicians to setup days that you can complete your 40 hours of training. You will have 3 weeks to complete training. You are exempt from externship if you have found a job in Pharmacy.
June 11 2019 — Janiece will cover Lesson 8/Discuss Externship
June 12 2019 — Practice Final Examination/Discuss Externship
Link to practice final exam — please use your books and internet to study
In this edition of Profiles in Pharmacy — Tim Lacey and I discuss his career and journey as a Practicing Pharmacist.
Tim has been a Pharmacist for over 40 years, and has plenty to share about the profession. To the young Pharmacist and Pharmacy Students that have an opportunity to meet and talk with Tim Lacey, please take advantage of that opportunity. Ask questions about the profession and learn from his perspective and memories.
In order for us to realize the potential of our future as Pharmacists, we must first pay respect to those that helped to lay the foundation for which we stand upon. I often tell folks that my triumphs in life are just reflections of the parenting, mentoring, coaching, and praying that I received from individuals that cared enough to teach me right from wrong.
Me and Tim often joked that he was my Pharmacy Daddy. Because when it came to Pharmacy, he taught me right from wrong…
I met Tim, while he was floating at the Walgreens on Greensprings Ave in Birmingham, AL circa 2009. I transferred stores later that year and began working for him when he was the Pharmacist in Charge for the Walgreens located on Richard Arrington Jr. Blvd. I was still finding my way in pharmacy when we met. I still looked at Pharmacy like it would be a good job to have. Under his direction, I began to realize that Pharmacy was more than a job — it truly was a calling. Under his tutelage I began to realize what it meant to be part of a Profession…
I think about Tim often because he practices Pharmacy in the the trenches like a good offensive lineman. He hasn’t always gotten the recognition for the great work that he does, but he still keeps plugging away daily — 40 plus years later he’s still providing each individual with appropriate pharmaceutical care.
Sam: What year did you graduate from Auburn? Since you’re a local Birmingham native, where did you attend HS?
Tim: I attended Phillips High School (now Phillips Academy) and graduated from Auburn in 1976.
Sam: How did you learn about pharmacy? I remember you telling me about your mom working at a local drug store when you were growing up, how did that impact your decision to pursue a career in pharmacy?
Tim: I was influenced by the two pharmacists that worked at Cowgill Drug in North Birmingham, where my mother worked as a clerk. The owner, Franklin Little, was classy and professional, highly respected by everyone in the community. Everyone called him “Doctor Little”. The staff pharmacist, George Thompson, was a happy-go-lucky guy that seemed to enjoy his job immensely. I admired both very much and decided that I wanted to be a combination of the two.
Sam: There are foundational lessons I learned from watching you practice. Things like keeping appropriate eye contact with customers, how to keep the pharmacy lighthearted with a few jokes, knowing your patients name when they come to the counter, and always being the early shift pharmacist on Monday mornings when you’re the manager…. Who are some of the men and women in pharmacy that taught you the way of doing things the right way? And in what way did each person influence your practice of pharmacy?
Tim: In addition to the two already mentioned, I had the privilege of working a number of years for Jimmy Harrison, president of Harco Drugs, and Jerry Thomas, vice president of Harco. They made working for Harco seem like a family business, where everyone was important. When I decided to go back to work for Harco after Big B Drugs was bought out by CVS, I received a personal phone call from Mr. Harrison, telling me how excited he was that I was back. When he made the difficult decision to sell Harco to Rite Aid, he personally hand wrote a letter of apology to each of his pharmacy managers, explaining why he made the decision. It meant so much to all of us. He taught us the right way to treat employees and patients.
Sam: Can you describe your career path — I know about Big B Drugs and helping to open the Walgreens in Pelham, have there been any other stops you would like to discuss? How have your jobs in pharmacy impacted your outlook of the profession?
Tim: In addition to working at Cowgill as a teenager, I worked at Campus Drugs in Auburn (a Harco store) while in school. After graduation, I did my internship with K-Mart Pharmacy in Huntsville. After I received my license in 1977, I returned to Harco, working briefly in Talladega before opening a new store in Alexander City. I became homesick for my family and friends in Birmingham, and started working for Big B in 1979. I stayed with them for 17+ years until they were bought by Revco, then eventually CVS. By then, Harco had locations in Birmingham and I received an offer from them in 1997. I was glad to be back with the Harco family, but the Rite Aid deal was not long after. I stayed with Rite Aid for about another year. I began hearing rumors about Walgreens coming to Alabama, and started checking about possible employment. I had been told many years before “if you ever get a chance to work for Walgreens, take it!” I had the honor of being one of 3 pharmacists hired to open their first Alabama store, in Pelham. I now have 20+ years with Walgreens.
Sam: In your opinion what have been the differences in curriculum when you compare the Bachelors Degree in Pharmacy to the Doctor of Pharmacy degree? It seems that when we talked about your curriculum (BS degree) you told me about having to work a full year as an intern after graduation prior to being allowed to register as a pharmacist… In your opinion what were the strengths and weaknesses of the BS in Pharmacy and what are the strengths and weakness of the Doctor of Pharmacy? Has the transition been what you thought it would be — and does the BS in Pharmacy receive enough respect from the younger generations of Pharmacist?
Tim: The PharmD degree has much more clinical component than the old Bachelors degree. In my opinion, at first, there was a shortage of practical experience with the PharmD students, but I believe that has been addressed and corrected now. When I graduated, the requirements were different in that we had to get the majority of our intern hours after graduation, which gave us about a year of practical experience under supervision. I probably learned as much in that year as I did in 3 years of pharmacy school. The PharmD students get great experience on their rotations in their final year. I think it would have been fun to do that while I was a student. For the most part, I’ve received nothing but respect from my students. They recognize that 40+years of experience counts for something, and that I know what I’m talking about (most of the time).
Sam: What pharmacy law rule do your current prescribers have the most difficulty understanding, thus leading to errors and calls for clarifications?
Tim: I think, over the years, the one rule that causes the most confusion, is the “two signature lines” rule. Technically, if a prescription blank does not have that, it’s not a valid prescription. I understand there is some talk about eliminating or modifying that rule.
Sam: What would you tell a new grad?
Tim: I would tell a new grad that patient safety is the most important thing. If something is unclear, whether it is the drug prescribed, directions for use, potential interactions or contraindications, you must get it right. If you don’t get it right, it doesn’t matter how fast you got it to the patient. Ours is one of the few, if not the only profession, you have to bat 1000, or there’s a problem.
Sam: How has being a preceptor changed for you over your career? Is it harder or easier to teach? How many students do you think you’ve taught over the years?
Tim: Student pharmacists are so well educated these days. I feel that sometimes I learn more from them than they do from me. As far as being harder or easier to teach, it depends on the student. Some come to me with no experience in retail. There is a learning curve for them. Five or six weeks is not long enough to learn everything we have to deal with. The ones with retail experience are usually the easiest. I would estimate that I have had close to 500 students, including students on rotation and students that worked part time. I often wish that I had kept a scrapbook of all my students over the years.
Sam: Is being a Pharmacist what you thought it would be?
Tim: Yes, and no. Pharmacy, especially retail pharmacy has changed so much over the last 42 years. I never dreamed that I would be administering immunizations. I never imagined the impact that third party payors would have on the profession. I never thought I would have to deal with a drive thru window.
Sam: Is there anything that you would like to add?
Tim: The profession has been good to me. It has given me a nice income, and a sense of being a part of something that helps people. I have derived much satisfaction from mentoring students that went on to be good pharmacists, and any time a patient thanks you for what you do for them, well, it doesn’t get any better than that.
October is American Pharmacist Month. Every October comes and goes, and typically I’ve never celebrated this fact when it comes to Pharmacy. I always liked Halloween parties, but never discussed Pharmacy much outside of the Pharmacy. Only in the past few years have I thought about purchasing food for my staff and/or honoring a fellow Pharmacist with kind words and acknowledgement about our shared calling and responsibilities to the communities that we serve through the practice of pharmacy. I remember discussing Pharmacist Month in school vaguely, but it never really was on my radar.
A few weeks ago, I thought — wouldn’t it be cool if I could interview some pharmacists that I respect and do a brief profile of their careers to celebrate their accomplishments and acknowledge openly my appreciation to what they’ve given to the profession. Simply stated..how can we as a profession move our profession forward if we never discuss our admiration for each other, and/or discuss openly how to create a more open dialogue about how to create a fair market for both consumers and the practicing pharmacist.
Over the next month, I hope to profile up to 8 Pharmacists. Each profile will consist of an interview and picture of the Pharmacist in their practice setting. I hope you as the reader gain an appreciation for the art and science of pharmacy and the people who encompass our profession.
Our first Profile in Pharmacy is of Brad Schmidt, PharmD
Brad graduated from the University of Minnesota in 2001 with his Doctor of Pharmacy. He earned his Bachelor of Arts in Chemistry from Gustavus Adolphus College in 1995. He is the Staff Pharmacist for Peds Rx Pharmacy Solutions and has been my work partner at the Pharmacy since we opened in September 2013.
Sam: How did you come about pharmacy?
Brad: I grew up in a small town — thought about becoming a physician — then got more interested in chemistry when I went off to college — I ended up talking to my local pharmacist in town and got more into the profession from there.
Sam: Can you please describe your career path and what you’ve done during your career and please don’t be modest.
Brad: I got out of pharmacy school — I floated in a retail chain for a while — but, I really didn’t find that rewarding or something I enjoyed (CVS Pharmacy 1 year). So, once an opportunity to work at a pediatric outpatient pharmacy came about I took it (Children’s of Alabama 7 years). Some years went by when I wanted to try something different, so I found a job as a Clinical Pharmacist at UAB (1 year). Then I left that position and took a job doing mail order (CVS 2 years). Mail order was a nice hourly job that was family conducive, but then the facility closed down. Then I moved onto working in Home Infusion (Walgreen Home Infusion 2 years). Then in 2013 we met, and I’ve been at Peds Rx for the past 5 years (Pediatric Outpatient Pharmacy for Children’s of Alabama). So all in all, I have 12 years of pediatric outpatient pharmacy experience. I do like different things, I like changes, and I never wanted to do the same thing for 30 years — so I’ve always believed that you never know your true passion until you try something. Thus, I’ve tried different things over the years.
Sam: What does your family think you do at work
Brad: Well my wife, she’s a pharmacist, so she understands what I do. In regards to the dispensing role, she understands that we are a resource for information for the hospital, and help patients get their medications situated for discharge from the hospital, do prior authorizations and overrides, and overall increase access for patients to receive appropriate pharmaceutical care… so that’s my wife…
But Everyone else in my family thinks I just count drugs and make kids feel better.
Sam: How do you see the future of pharmacy practice in the next 20 years
Brad: I see pharmacists as being dispensers being phased out — and more medication therapy management reviews like whats being done with Medicare Part D.. I see the role of technology increasing — remote dispensing will continue to push forward — more centralization of pharmacy with Amazon and Big Chains. Less corner store drug stores — less chain stores and more automation with central pharmacies. Independents will continue to fill the void with a niche market.
Sam: Is being a Pharmacist what you thought it would be
Brad: I would probably say umm… I would say starting off yes, but after practicing for 18 years — things have changed — there’s less focus on the patients and things have become more number driven. The scope of practice ( clinical positions) isn’t what I expected. Which is good. Residencies were just starting when I was graduating but now most of the graduates look into residencies now. The thing that surprised me is that it’s become less patient focused with the financial pressures due to the market constraints that has created a barrier for entry to the little guy. Which we as pharmacists have to fight for. In school we talk about pharmaceutical care and patient wellness — and in the real world it’s more like fill 500 scripts and just get the work done..
Sam: What do you think of October being American Pharmacists Month?
Brad: Unfortunately I think that most times — maybe only a 1/4 to 1/3 of the places I’ve worked at even celebrated Pharmacists month — most of management, patients, and even the parents didn’t know about Pharmacists Month. And even within the profession there’s not a lot of recognition. Only 25 to 30 percent of the time have I received a thank you or been given recognition for Pharmacists Month.
Overall I’m glad it’s there, but in reality it’s not as recognized as some of the other professions. We’re not a very organized profession — we’re divided in some ways and because of this there’s division in how we celebrate the month. The nursing association and medical associations bring about the importance of their professions — but when was the last time our association did something to recognize the profession through something like a commercial. The month comes and goes and we go to work and go home. But hopefully as the years go forward we will become more organized and united for the month of October.
Sam: What would you tell a new grad?
Brad: Since they already graduate then it’s too late 😉 laughter…
There’s a lot of opportunities out there — the PharmD degree has many opportunities and there’s a lot of diversity within the profession — thus there’s alot of things to be involved in and ways with which you can be challenged. I tell new grads to always take your time in the final check and always go with your gut instincts and don’t get distracted during that final verification step. Pharmacy is a small world so don’t ever burn bridges. Even if you don’t like someone part peacefully. Don’t burn bridges — pharmacy is a small world.
Sam: How must pharmacy school change to keep up with the changes taking place in the workplace and the business market?
Brad: They are definitely focusing on residency and clinical opportunities — unfortunately they have gotten away from the traditional roles which has caused a bit of a learning deficit. They’re beginning to lack some of the basic skills of pharmacy practice, like understanding dosage forms, etc.. Which causes the newly practicing pharmacist to not immediately understand how to dispense or compound.
In terms of the business side — the schools hurt the profession a bit. From 2001-2005 they added pharmacy schools and in 2009 during the recession the job market became tighter. Thus, from a business standpoint the market has become slightly over saturated with pharmacists.
Sam: Is there anything you would like to add?
Brad: Only thing I would like to add, is that I’m proud to be a Pharmacist, I’m proud to have made relationships with Patients and staff — but as far as moving forward we need to be more united as a profession and have organization and be united. The times have changed — and we must be united. If we don’t carve out our niche in the new world we could be wiped out as a profession. We need to come together so that we’re not eaten up..
The Dispense As Written Codes that I use regularly in my practice are:
DAW 0 = NO PRODUCT SELECTION INDICATED
DAW 1 = SUBSTITUTION NOT ALLOWED BY PRESCRIBER
DAW 9 = SUBSTITUTION ALLOWED PLAN REQUESTS BRAND
Why is this important?
Dispense as written codes are important in billing/filing claims correctly to a patient’s insurance plan. Claims must be billed/filed correctly so that patients receive the appropriate drug products at the correct price.
For me… DAW 0 is used most of the time (this holds true for most pharmacists), while DAW 1 is used sparingly; a drug example for those who are not Pharmacists as to when a Pharmacist uses DAW 1 is seen in the case of prescribing Brand Name Synthroid. Prescribers often write for Brand name Synthroid instead of Levothyroxine because this drug has a Narrow Therapeutic Index (NTI). Due to the NTI, formularies often include both the Brand and Generic products on their formularies so that patients receive appropriate pharmaceutical treatment for their thyroid conditions.
DAW 9 is increasingly becoming popular and being put into place by Pharmacy Benefit Managers (PBM’s). Typically generics have been dispensed because the generic product is the cheaper alternative when compared to the brand name product. However, increasingly manufacturers have been offering PBM’s rebates for the monies that they pay the pharmacies on the drugs cost.
In short…even when prescribers write a prescription and sign Product Substitution Permitted — the pharmacist must dispense the brand name product for the product to be covered by the patient’s insurance. This is done by changing the computer DAW code from a 0 to a 9.
So you may be asking, “how is it more profitable for the PBM’s to have higher priced drugs on their drug formularies?” I found a great article published by NCPA entitled “PBM Revenue Streams and Lack of Transparency”. The article is a quick read and outlines why Brand Name products continue to be on formulary even when a generic competitor enters the market.
Examples of using DAW 9 in my practice (Generic Drug — Condition Treated)
Dexmethylphenidate ER — ADHD
Diazepam Rectal Gel — Seizures
Methylphenidate ER — ADHD
Budesonide Respules — Asthma
What’s the effect on people and the market?
In my practice this leads to a major consultation point…
You and/or your family member is on a drug that insurance is requiring that Brand Name be dispensed (DAW 9). I’m not sure if your local pharmacy carries the Brand Name or Generic product. Thus, it is imperative that you contact your pharmacy days in advance to ensure this product is in stock when you attempt to refill your medication. If you don’t call ahead of time, this could potentially delay when you receive your medication, which could lead you to become non-compliant with your medication(s).
The reason that this is so important…
Finding the medication for your patient is important…but ensuring that your patient has access to this medication is just as important. If they can’t obtain or access the medication, then you can’t ensure their compliance on the medicine. And non-compliance ultimately can lead to hospital readmission.
When patient’s transition from an inpatient admission to being discharged to the outpatient setting, prescribers are often unaware of what’s on or not on the patient’s drug formularies. This can lead to confusion and delay and/or impede discharge planning which can potentially lengthen their hospital admission.
DAW 0 versus DAW 9 seems like such a trivial issue, but the increased prevalence of this small change can impact our patient’s compliance and can drive up the cost for providing healthcare.
If you have Questions related to this topic? Please feel free to leave a comment.