Death, Taxes, and Tuition Increases

The US economy essentially froze for a period in 2020, with nearly 40 million Americans filing for unemployment and crippling uncertainty in many sectors, particularly in higher education.2 A global pandemic forced academic leaders to rethink education delivery, and pharmacy schools responded to meet the changing needs of the health system.3,4 The growth in pharmacy education (increased number of schools and increased enrollment for existing schools) in the United States over the past few decades has been previously documented.5-7 Additionally, costs to pharmacy students have increased through consistent tuition and fee inflation.8,9 In financial accounting terms, total revenue is a simple function of units sold and price per unit. DISCUSSION Pharmacy School Tuition From 2019 to 2022 Pharmacy school tuition data for three consecutive fiscal years (2019-2020, 2020-2021, and 2021-2022), published by the American Association of Colleges of Pharmacy (AACP) Office of Institutional Research and Effectiveness, was used to extract pharmacy school characteristics and tuition/fee information.10 This period was selected to observe cost changes before and during the COVID-19 pandemic, as 2019-2020 budgets were determined prior to any knowledge of the significant economic impact that would ultimately begin in the US in March 2020. During that same period, private school out-of-state cost increases were not statistically different than public school increases (p=.06), but more private schools increased out-of-state costs (p=.006). [...]public health needs during the pandemic required more clinicians to support testing and vaccination programs, making it more difficult for some schools to retain clinical faculty who recognized higher market demand for their skills.

Ensuring a high-quality and resilient supply chain of essential medications means paying more.

DISCLOSURES: Dr Mattingly reports consulting fees from Arnold Ventures, Pharmaceutical Research and Manufacturers of America, and research support from the US Food and Drug Administration unrelated to this article.

Short-Stay Admissions Associated With Large COVID-19 Outbreaks in Maryland Nursing Homes.

At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics.

Direct and Indirect Effects of Restrictive US Immigration Policies on Pharmacy Education

Keywords: immigration, cultural competency, policy, international students, international faculty INTRODUCTION Immigration policy and enforcement in the United States has experienced many ebbs and flows over our 244year history as an independent nation, with policies either supporting or opposing the influx ofnew citizens at different stages ofdevelopment.1 Nopoliticalparty can claimthe proverbial "high ground" when immigration policy is viewed through a greater historical lens, but the Trump Administration campaigned on a hardline anti-immigrant platform and effectively executed several actions to restrict immigration into the United States throughout his term in office.2 The nonpartisan Migration Policy Institute (MPI) cataloged more than 400 executive actions under the Trump AdministrationthateffectivelyreshapedtheUSimmigrationsystem, including actions on border protection, asylum case administration, immigration courts, and visa processes.3 While immigration policy changes in the United States have broad implications on the economy, culture, and everyday life of millions of people, leaders in pharmacy education may not always connect these larger policy actions to the specific needs of our more focused pharmacy education stakeholders (students, faculty, staff, etc). [...]whenImmigration and Customs Enforcement (ICE) announced in July 2020 that students who were enrolled in schools that were shifting to online-only educationbecause ofthe coronavirus identified in 2019 (COVID-19) pandemic would not be eligible to retain their student visas and could be subject to deportation procedures unless they were attending at least onein-personclass,immigrationpolicybecameamajorpriority for higher education leaders.4 While this rule was revoked shortly after, this action and the preceding pattern of immigration restriction raises concerns for those who are involved in pharmacy education and brings about the question of how future immigration policies could impact pharmacy schools. [...]from a patient care or public health perspective, retaining these graduates may have a positive impact on reducing health disparities in the United States, and we discuss this in more detail below under indirect effects.8-10 Another direct impact of changes in immigration policies involves the potential reduction in the number of international faculty employed by US schools of pharmacy. Considering that international faculty members are prime candidates to serve as mentors to international students, a lack of non-US-born faculty members would mean that there would be fewer mentors for international students that understand their background and may be better equippedto help guidethese students in anunfamiliar environment.12 The education of pharmacy students on cultural competency and sensitivity is an integral part of pharmacy school curriculums and is explicitly reviewed as part of the accreditation standards of the Accreditation Council for Pharmacy Education (ACPE).13 The American College of Clinical Pharmacy ' s(ACCP ' s) Task F orce on Cultural Competency developed a series of white papers in the early 2000s describing cultural competency for health professionals and how it should be viewed as a continuous process undertaken to ensure that care of diverse populations is delivered in an appropriate manner. 14 Further, the task force specifies that becoming culturally competent also requires a "conscious effort to reduce any ethnocentric biases" one may have.14 In other words, pharmacy students must demonstrate that they do not believe any one culture to be superior to another.

Pharmacy's Call for Authorities to Aggressively Enforce Laws Addressing Price Gouging.

Early reports of potential treatment for coronavirus disease (COVID-19) have raised concerns related to pharmaceutical distribution. Despite the lack of high-quality evidence, the mere hope of effectiveness of potential treatments, such as hydroxychloroquine, has led to surges in demand for these products, and many pharmacists are already informally reporting shortages through social channels. As manufacturers and wholesale distributors struggle to fulfill orders for drugs such as hydroxychloroquine, short-term price increases may seem reasonable in a free market when demand increases. However, any price increases by manufacturers, wholesale distributors, and pharmacies might be seen as exploitive gouging of consumers during a declared emergency. In addition to concerns of price gouging, increases in prescription drug utilization during the pandemic may lead to increases in spending for all payers as members may be treated for COVID-19. This article explores pharmaceutical supply chain and drug pricing nuances that may cause problems for payers and pharmacies as the country battles this global pandemic. DISCLOSURES: No funding supported the writing of this article. Mattingly reports unrelated consulting fees from the National Health Council, Bristol Myers Squibb, G&W Laboratories, Allergy and Asthma Foundation of American, and the Massachusetts Health Policy Commission. Hogue has nothing to disclose.