Global pen pal education intervention among student pharmacists: A pilot project.

INTRODUCTION: Global health, a practice that prioritizes improving health and achieving health equity for all people worldwide, is a priority for pharmacists, schools, and pharmacy colleges. Several initiatives aim to enhance faculty and student exchanges while promoting projects and initiatives among thriving universities and under-resourced countries and institutions. While many organizations recognize the benefit of global collaboration, as demonstrated by the adoption of the 2012 American Association of Colleges of Pharmacy Strategic Plan, which calls for increased global experiences for faculty and students, the COVID-19 pandemic created a demand for international engagement within pharmacy practice. The objective of this study was to evaluate students' perceptions and attitudes toward incorporating a global pharmacy pen pal (PPP) exchange within the pharmacy curricula at two schools/colleges of pharmacy. METHODS: This mixed-method study included assigned engagement within a required or elective didactic course, followed by a post-experience survey. Each student was pre-assigned a pen pal from a cohort of pharmacy students residing in 11 countries for the assignment. RESULTS: In total, 184 students completed the learning experience, and across both sites, 63 students completed the post-experience survey. The students' impressions of the PPP varied by site, yet most participants reported an improved awareness of pharmacy practice in other countries.

Letter frequency analysis of proprietary prescription drug names in the United States: Minding the Zs and Qs.

Background: Proprietary or brand names of prescription drugs are generally with letters that are unusual in common English. There is little academic research exploring if this perception is true, despite the fact that manufacturers pay millions of dollars to research and develop drug names that conform to regulatory standards while remaining marketable. Objectives: To assess the extent to which letters used in prescription drug names may deviate from common English and to test if prescription drug names show measurable trends in letter frequency over time. Methods: The names of all prescription drugs approved in the United States between 1985 and 2020 were downloaded. Duplicates were removed and products without a proprietary name were excluded. Letter frequency analyses were then conducted on all letters in these names as an aggregate and year-over-year. Letter frequencies were compared to a validated academic reference, a corpus derived from all Google Books data, and the scoring system from the board game Scrabble. Results: Regardless of the comparator, prescription drug names use letters that are not common in typical English. Letters A (11.96% of all observed letters), V (3.08%), X (2.31%), and Z (1.91%) are all overrepresented in prescription drug names, while E (10.23%), H (0.90%), T (6.30%), and S (4.21%) are underrepresented. The letters C and N are becoming less common over time (frequency decrease of 0.10 percentage points and 0.12 percentage points per year, respectively), while V, Y, and Z are becoming more common (frequency increases of 0.61 to 0.86 percentage points per year). Conclusions: Proprietary prescription names use letters that are unlike words used in everyday American English, and there are measureable trends in letter selection. It remains to be seen how drug manufacturers will cope with an increasingly-narrow naming space as more products continue to be approved over time.

Evaluation of a pharmacy technician-based medication prior authorization program.

BACKGROUND: The roles of pharmacy technicians in clinical practice are being explored. Medication prior authorizations (PAs) from insurers can lead to delays in pharmacotherapy. OBJECTIVE: To assess the efficiency of our clinical pharmacy technicians in processing PAs for medications. PRACTICE DESCRIPTION: Outpatient clinics in a comprehensive health care provider group. PRACTICE INNOVATION: PA requests are routed to technicians for initial data collection. Clinical pharmacists can review their work before submission. EVALUATION METHODS: Clinical pharmacy staff in 4 clinics recorded information about PA requests from January 21, 2020, to April 21, 2020. In 3 of the clinics, PA requests were primarily processed by clinical pharmacy technicians. In another clinic, requests were processed by a clinical pharmacist. Information collected included the date the request was received, outcomes (e.g., approval, therapy change, or nonapproval), and the date of final outcome. Descriptive statistics were prepared, including number of requests that were approved, number of business days between request and decision, and final outcome. RESULTS: Overall, 720 PA requests were received. Of these, 88.6% were approved with first response, and 673 (93.5%) were eventually approved. Median time to first response was 0 business days, regardless of clinic. In 75% of cases, first response was within 1 business day. PA characteristics varied across clinics; however, PA approval percentages were comparable (91.2%-94.3%). CONCLUSION: In an assessment of clinical pharmacy technicians' efficiency in responding to pharmacy plan PA requests, more than 90% were approved, often within one business day. Our results must be interpreted in light of local factors and a virus pandemic during the study. However, results of requests handled by technicians were similar to results when the requests were handled by a clinical pharmacist. Clinical pharmacy technicians can be efficient and cost-effective in this role.

Review of purchases of unapproved medications by the Veterans Health Administration.

PURPOSE: Many medications that were marketed prior to 1962 but lack Food and Drug Administration (FDA) approval are prescribed in the United States. Usage patterns of these "unapproved medications" are poorly elucidated, which is concerning due to potential lack of data on safety and efficacy. The purpose of this project was to characterize purchases of unapproved medications within the Veterans Health Administration (VHA) by type, frequency, and cost. METHODS: VHA purchasing databases were used to create a list of all products with National Drug Codes (NDCs) purchased nationwide in fiscal year 2016 (FY16). This list was compared to FDA databases to identify unapproved prescription medications. For each identified combination of active pharmaceutical ingredient (API) and route of administration ("API/route combination"), numbers of packages purchased and associated costs were added. RESULTS: VHA pharmacy purchasing records contained 3,299 unapproved products with NDCs in FY16. After excluding equipment, nutrition products, compounding ingredients, nonmedication products, and duplicate NDCs, there were 600 unique NDCs associated with 130 distinct API/route combinations. The most commonly acquired product was prescription sodium fluoride dental paste (350,775 packages). The greatest pharmaceutical expenditure was for sodium hyaluronate injection ($24.5 million). Unapproved products accounted for less than 1% of overall VHA pharmacy purchasing in FY16. CONCLUSION: VHA purchased many unapproved prescription products in FY16 but is taking action to address use of such products in consideration of safety and efficacy data and available alternatives.

Receipt of Overlapping Opioid and Benzodiazepine Prescriptions Among Veterans Dually Enrolled in Medicare Part D and the Department of Veterans Affairs: A Cross-sectional Study.

Background: Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap. Objective: To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions. Design: Cross-sectional. Setting: VA and Medicare. Participants: All veterans enrolled in VA and Medicare Part D who filled at least 2 opioid prescriptions in 2013 (n = 368 891). Measurements: Outcomes were the proportion of patients with a Pharmacy Quality Alliance (PQA) measure of opioid-benzodiazepine overlap (≥2 filled prescriptions for benzodiazepines with ≥30 days of overlap with opioids) and the proportion of patients with high-dose opioid-benzodiazepine overlap (≥30 days of overlap with a daily opioid dose >120 morphine milligram equivalents). Augmented inverse probability weighting regression was used to compare these measures by prescription drug source: VA only, Medicare only, or VA and Medicare (dual use). Results: Of 368 891 eligible veterans, 18.3% received prescriptions from the VA only, 30.3% from Medicare only, and 51.4% from both VA and Medicare. The proportion with PQA opioid-benzodiazepine overlap was larger for the dual-use group than the VA-only group (23.1% vs. 17.3%; adjusted risk ratio [aRR], 1.27 [95% CI, 1.24 to 1.30]) and Medicare-only group (23.1% vs. 16.5%; aRR, 1.12 [CI, 1.10 to 1.14]). The proportion with high-dose overlap was also larger for the dual-use group than the VA-only group (4.7% vs. 2.3%; aRR, 2.23 [CI, 2.10 to 2.36]) and Medicare-only group (4.7% vs. 2.9%; aRR, 1.06 [CI, 1.02 to 1.11]). Limitation: Data are from 2013 and cannot capture medications purchased without insurance; unmeasured confounding may remain in this cross-sectional study. Conclusion: Among a national cohort of veterans dually enrolled in VA and Medicare, receiving prescriptions from both sources was associated with greater risk for receiving potentially unsafe overlapping prescriptions for opioids and benzodiazepines. Primary Funding Source: U.S. Department of Veterans Affairs.