OBJECTIVE:Federal bill H.R.1 eliminates Grad PLUS loans and changes borrowing limits for Direct Unsubsidized loans for professional students, including student pharmacists. The study evaluates the total gap in pharmacy school cost of attendance (CoA), which would previously have been addressed by a Grad PLUS loan after applying the new federal Direct Unsubsidized loan limit. METHODS:A secondary data analysis was conducted using publicly available CoA data for colleges of pharmacy (COPs) in the US. 2025-26 tuition and fees and indirect expenses were collected from the American Association of Colleges of Pharmacy and each COP's university website, respectively, to calculate CoA for each COP. Annual cost gap (difference between annual CoA and the annual Direct Unsubsidized loan limit of $50,000) for each year of each program was summed to calculate total cost gap. The Kruskal-Wallis one-way analysis of variance was conducted to assess the effects of program classification (public in-state, public out-of-state, private 4-year, and private 3-year) on total cost gap. RESULTS:A total of 133 COPs were included. The median total cost gap for public in-state PharmD programs ($17,948) was significantly lower than that for public out-of-state ($68,214), private 4-year ($102,087), and private 3-year ($132,609) programs. The median total cost gap for public out-of-state programs was significantly lower than that for private 4-year and 3-year programs. CONCLUSION:Loss of Grad PLUS loans may pose a significant financial barrier to pharmacy education. COPs should use multiple strategies to address students' financial challenges, including federal and state advocacy, private loan options, tuition reduction, philanthropy, financial assistance partnerships, and loan repayment and forgiveness programs.

Background: Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives: This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods: This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results: Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99). Discussion: The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions: Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's dis- ease and related dementia care.

There are critical shortages in donor organs available for transplantation in the United States, with some racial and ethnic groups facing disparities in access. Xenotransplantation is currently an experimental approach, but has the promise of significantly increasing organ supply. Here, we discuss inequities in access to transplantation and the potential role of xenotransplantation in alleviating these inequities. Chisholm-Burns et al. discuss the substantial shortage of organs available for transplantation, with disparities in access amongst some racial and ethnic groups. The authors suggest that while xenotransplantation can potentially increase organ availability, it also has the potential to further embed inequities in transplant care.

Objective: Given the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017-2022 period. Methods: A retrospective analysis of 2017-2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. Results: With the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017-2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. Conclusion: Debt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals' postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Purpose:The 2024 ASHP Pharmacy Forecast identifies and contextualizes emerging issues and trends that will influence healthcare, health systems, and the pharmacy profession and provides recommendations to inform long-term strategic planning that should prompt action by pharmacists and health-system leaders.Methods:Drawing on the “wisdom of crowds” concept, a survey was constructed with 6 general themes, each with 6 to 9 focused statements and a seventh theme on preparedness (58 survey items in total). The size of and representation within the survey panel were intended to capture opinions from a wide range of pharmacy leaders. The survey instructed panelists to consider the likelihood of the events/scenarios described in the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Then, survey panelists assessed the preparedness (from very unprepared to very prepared) for 12 of the statements.Results:The 6 survey themes identified were Urgent Public Health Priorities, Responding to the Mental Health Crisis, Achieving Care Equity, New Disease Paradigms and Treatment Innovations, Workforce: Focus on Culture for the Future, and Artificial Intelligence: Can Ethics and Regulators Catch Up? The survey was completed by 250 respondents, yielding an 88% response rate. Analysis of survey results was provided by chapter authors along with strategic recommendations to guide actions for each theme.Conclusion:The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence healthcare and the pharmacy profession over months and years and not on day-to-day situational dynamics. The report provides insight to stimulate thinking and discussion and provides a starting point to proactively position leaders, their teams, and departments for potential future events and trends.

Purpose To evaluate income trends among pharmacists and other select health professions (dentists, nurse practitioners, registered nurses, and physicians) in the US for the 10-year period of 2012 to 2021, with special attention given to the first 2 years of the COVID-19 pandemic (2020 and 2021). Methods A retrospective analysis was conducted of 2012 to 2021 income data for select health professions, collected from the American Community Survey. Univariate time series analysis was conducted using exponential smoothing to examine income patterns over the 10-year study period and forecast income for the next 5-year period (2022 to 2026) for each health profession. Additionally, time series regression models were constructed for each health profession. Descriptive statistics (mean percent change in income and SD) were calculated for each health profession for the prepandemic era (2012 to 2019) and the first 2 years of the pandemic (2020 and 2021). Results Goodness-of-fit statistics for each forecast model indicate highly accurate forecasts. The model for each health profession indicates a significant positive trajectory in income (P < 0.001), although pharmacists are projected to have a lower rate of income growth among the 5 health professions for the next 5-year period, 2022 to 2026. During the first 2 years of the pandemic, pharmacists had the lowest mean percent change in income (mean, 2.0%; SD, 2.0%) among the 5 health professions. Conclusion Growth in pharmacist income is projected to lag behind that in other health professions in the near future. Individual-, organization-, and profession-level strategies may facilitate opportunities for income growth among pharmacists.

In April 2023, the New York Times published an opinion piece by author and heart transplant patient, Amy Silverstein [1]. Ms. Silverstein's perspective provoked an array of responses, some of which were angry because of the perception that she lacked gratitude for the second and third chance at life she was given. However, as professionals in the transplant field, Ms. Silverstein's story resonated with us, particularly her description of what she called the "gratitude paradox" wherein solid-organ transplant patients are expected to be grateful for what they have—a new, functioning organ—and are either implicitly or explicitly discouraged from asking for more and better posttransplant treatment options [1]. While her observations were personal for us, we see parallels that are relevant for the entire healthcare community. Ms. Silverstein pointed to the conflicting emotions of her own gratitude for her two heart transplants in the wake of her terminal cancer diagnosis, a diagnosis she states likely resulted from long-term use of immunosuppression medications meant to preserve her transplanted organ, and her desire to have more life. She wasn't ungrateful in expressing that desire; she was simply being human. While the specifics of Ms. Silverstein's life are relevant to the field of transplantation, we believe the human desires she expressed should cause the entire healthcare community to pause and reflect about why we chose this calling and our inherent responsibilities. The concept of the gratitude paradox is not new. The BBC correspondent Kate Morgan explored this issue in a 2021 piece examining the complexities of gratitude for being employed in the wake of the COVID-19 pandemic [2]. She discussed the dilemma many individuals experienced between being grateful to have a job during a time of rising unemployment and feeling underpaid, undervalued, and overburdened by employers [2]. Another, more historical example is the "separate but equal" laws, colloquially known as Jim Crow laws, that pervaded American life in the post-Civil War era through the Civil Rights movement of the 1960s. Under Jim Crow, Black Americans experienced and were expected to be grateful for (or as Davis [3] describes, "agreeable and non-challenging"), segregated conditions that proved to be anything but equal. There is a prevailing attitude that certain populations, in particular those who are vulnerable, such as patients with chronic medical conditions, racial and ethnic minority groups, or individuals from poorer socioeconomic backgrounds, should be thankful for whatever benefits of progress made in achieving a better life. They are viewed as troublemakers who lack gratitude whenever they suggest the bare minimum is not enough. In our society, there is an expectation that disadvantaged and vulnerable populations should be grateful for having something that is one step above having nothing. When they qualify their gratitude by asking for more and better, there is often a backlash from those who have more because this ask provokes a defensive response: What more can we do? We submit that it is a reasonable expectation to want better outcomes from a healthcare system as advanced as the one in the United States. This viewpoint is reinforced by the emotions expressed in Amy Silverstein's opinion piece. Let us consider why we have these expectations of gratitude in the first place. As healthcare providers, our duty is to provide our patients with the best possible care available and to continually strive to do better. For example, the best medical therapy for many patients with end-stage organ disease is transplantation [4]. However, when a patient receives a solid-organ transplant, they are confronted with the lifelong burden of immunosuppression and its varied risks and adverse outcomes [5]. The uncomfortable truth for the transplant profession is that for the past 25 years, there has been only incremental progress toward improving the fate of transplant recipients. Therefore, is it really a surprise when gratitude for the miracle of transplant is tempered by a desire for better, less deleterious posttransplant treatment options? We ask our colleagues in other disciplines to be just as uncomfortably honest with themselves about where their efforts, while vigorous and well-intentioned, are not meeting the aspirations of their patients. As empathetic healthcare providers in all disciplines, we must validate the conflict patients experience; joy and gratitude for the benefits of treatment, frustration and fear when adverse effects occur, and desire for more and better care options. We must strive to offer our patients more and better life-saving and life-enhancing treatment options. The status quo simply is not good enough. We ask all of our colleagues to reflect on why it is so much easier to impose expectations of gratitude on our patients rather than offering empathy and collaboration when the desire for more and better is expressed. Moreover, we ask that the healthcare community speak in a unified voice to expose when the rigid adherence to political ideology and regulatory and policy frameworks impede progress toward improving the lives of our patients. We challenge our colleagues to reflect on the emotions experienced when reading Ms. Silverstein's article. We suggest that as a society, we project our expectations of gratitude onto others because receiving accolades for what is done is easier than confronting the limitations, inadequacies, and inequities of what is not achieved. Inherent to the profession of medicine is a sense of frustration and hopelessness because the challenges our patients face exceed our individual capacity to relieve their suffering. Therefore, we retreat behind the safe wall that is our expectation of gratitude for the minimum that is offered. The question becomes: how do we stop retreating and start relinquishing these burdensome expectations? Do we accept the status quo, or do we resist it? The profession of medicine is now at a crossroads, with external political and societal forces poised to destroy the core values of a profession whose foundation is providing service to others. We believe it is time to shift the paradigm of the gratitude paradox within our profession and to resist the larger societal forces that seek to minimize the innate desire of all people to have a better, healthier, longer life. To do so, we as individuals need to realize and accept that the experiences of those who are vulnerable and marginalized are not about the feelings their aspirations provoke within us, our expectations of gratitude, our fears of criticisms and failures. As healthcare professionals, our only task is honoring their experiences and supporting their desires for more and better. We must actively listen and work every day to become more aware and accepting of the lived experiences of our patients and their desire for a life unique to them. Our responsibility is to be their allies, advocates, and partners. It is our time to step up, rectify inequities and injustices, and overcome the gratitude paradox that is hampering progress to better healthcare for everyone. While there are many challenges to being a healthcare provider today, we are fortunate that each day we serve a higher purpose. Each day, we have the opportunity and privilege of helping our patients achieve a better life. Ms. Silverstein has done a service to all healthcare professionals, because she has reminded us that we are not here to just do enough. We are here to do the best for every patient every day. The authors have no conflicts to report. None. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

ObjectiveMedicare Part D Star Ratings are instrumental in shaping healthcare quality improvement efforts. However, the calculation metrics for medication performance measures for this program have been associated with racial/ethnic disparities. In this study, we aimed to explore whether an alternative program, named Star Plus by us that included all medication performance measures developed by Pharmacy Quality Alliance and applicable to our study population, would reduce such disparities among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia.MethodWe conducted an analysis of a 10% random sample of Medicare A/B/D claims linked to the Area Health Resources File. Multivariate logistic regressions with minority dummy variables were used to examine racial/ethnic disparities in measure calculations of Star Ratings and Star Plus, respectively.ResultsAdjusted results indicated that relative to non-Hispanic Whites (Whites), racial/ethnic minorities had significantly lower odds of being included in the Star Ratings measure calculations: the odds ratios (ORs) for Blacks, Hispanics, Asians, and Others were 0.68 (95% confidence interval [CI] = 0.66-0.71), 0.73 (CI = 0.69-0.78), 0.88 (CI = 0.82-0.93), and 0.92 (CI = 0.88-0.97), respectively. In contrast, every beneficiary in the sample was included in Star Plus. Further, racial/ethnic minorities had significantly higher increase in the odds of being included in measure calculation in Star Plus than Star Ratings. The ORs for Blacks, Hispanics, Asians, and Others were 1.47 (CI = 1.41-1.52), 1.37 (CI = 1.29-1.45), 1.14 (CI = 1.07-1.22), and 1.09 (CI = 1.03-1.14), respectively.ConclusionsOur study demonstrated that racial/ethnic disparities may be eliminated by including additional medication performance measures to Star Ratings.

ASHP and the ASHP Foundation ("the Foundation") present this 11th edition of the annual Pharmacy Forecast and are pleased to disseminate it through AJHP, providing readers with easy access to the report.The Pharmacy Forecast has a long tradition of providing insightful perspective on internal and external factors that influence patient care, the health of populations, and our profession.The Pharmacy Forecast is a product of efforts from many individuals.Founding editor William Zellmer guided the report through the first 4 editions.The Pharmacy Forecast is indebted to the members of the Forecast 2023 Advisory Committee, Forecast Panelists (FPs) who responded to the survey, and the chapter authors.ASHP and the ASHP Foundation recognize those who have helped make the 2023 edition a success.The staff of AJHP has provided substantial editorial support for this publication, and we appreciate their assistance.As the philanthropic arm of ASHP, the Foundation supports the pharmacy workforce by funding research and education to improve health outcomes through optimal medication use and to demonstrate pharmacy's impact.Through the Pharmacy Forecast, ASHP and the Foundation assist pharmacy leaders as they navigate through developments in key areas of opportunity or challenge over the next 5 years.The Pharmacy Forecast provides insights into emerging trends and phenomena that have affected or could affect the practice of pharmacy and the health of patients across the health system.While the primary application of the report is for health-system pharmacists and pharmacy leaders to inform their strategic planning efforts, the report can also be useful to inform leaders about likely influencers over the next 5 years.This edition of the Forecast addresses old and new topics with new perspectives and identifies new responsibilities leading to a call for action by pharmacists and health-system leaders.The Pharmacy Forecast is not intended to be an accurate prediction of future events.Rather, the report is intended to be a provocative stimulant for the thinking, discussion, and planning that must take place in every health system for leaders to be informed and for their organizations to succeed in their mission of caring for patients, addressing the health of populations, and advancing the profession of pharmacy.Some may disagree with the opinions of the FPs or the positions taken by individual chapter authors with respect to their interpretations and extensions of the survey data.That is acceptable and desirable.Also, the report reflects a consensus of the national direction and may not reflect what is likely to occur in your geographic region or state.Reflect those differing opinions in your organization's strategic planning process and chart a course for your organization that is consistent with your institution's priorities, and the Pharmacy Forecast will have met its objective of encouraging planning efforts of health systems.We welcome your comments on the 2023 edition of the Pharmacy Forecast.Suggestions for future forecasts can be sent to any of the Forecast editors through the Foundation's Pharmacy Forecast website at https://www.ashpfoundation.org/pharmacyforecastand will be considered for future editions.

Objectives:Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data. Methods:Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017. Key Findings:Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81). Conclusions:Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.

Background: The Medicare Part D medication therapy management (MTM) program has positive effects on medication and health service utilization. However, little is known about its utilization, much less so about the use among racial and ethnic minorities. Objective: To examine MTM service utilization among older Medicare beneficiaries and to identify any racial and ethnic disparity patterns. Methods: A retrospective cross-sectional analysis of 2017 Medicare administrative data, linked to the Area Health Resources Files. Fourteen outcomes related to MTM service nature, initiation, quantity, and delivery were examined using logistic, negative binomial, and Cox proportional hazards regression models. Results: Racial and ethnic disparities were found with varying patterns across outcomes. For example, compared with White patients, the odds of opting out of MTM were 8% higher for Black patients (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.03-1.14), 57% higher for Hispanic patients (OR = 1.57, 95% CI = 1.42-1.72), and 57% higher for Asian patients (OR = 1.57, 95% CI = 1.33-1.85). The odds of continuing MTM from the previous years were 12% lower for Black patients (OR = 0.88, 95% CI = 0.86-0.90) and 3% lower for other patients (OR = 0.97, 95% CI = 0.95-0.99). In addition, the probability of being offered a comprehensive medication review (CMR) after MTM enrollment was 9% lower for Hispanic patients (hazard ratio [HR] = 0.91, 95% CI = 0.85-0.97), 9% lower for Asian patients (HR = 0.91, 95% CI = 0.87-0.94 ), and 3% lower for other patients (HR = 0.97, 95% CI = 0.95-0.99). Hispanic and Asian patients were more likely to have someone other than themselves receive a CMR. Conclusions: Racial and ethnic disparities in MTM service utilization were identified. Although the disparities in specific utilization outcomes vary across racial/ethnic groups, it is evident that these disparities exist and may result in vulnerable communities not fully benefiting from the MTM services. Causes of the disparities should be explored to inform future reform of the Medicare Part D MTM program.

Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group ( p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.

Background: Drug-drug interactions (DDIs) cause many preventable hospitalizations and admissions. Efforts have been made to raise DDI awareness and reduce DDI occurrence; for example, Medicare Part D Star Ratings, a health plan quality assessment program, included a DDI measure. Previous research reported racial and ethnic disparities in health services utilization and that racial and ethnic minorities, compared with non-Hispanic whites (whites), may be less likely to be targeted for a similar measure, a Star Ratings adherence measure for diabetes medications. Objective: This study aimed to investigate whether any racial and ethnic disparities are associated with the DDI measure in Part D Star Ratings among Medicare populations with diabetes, hypertension, and hyperlipidemia. Methods: This cross-sectional study analyzed a 2017 Medicare Part D data sample, including 3,960,813 beneficiaries. Because the inclusion in the denominator of the Star Ratings DDI measure was determined by the use of a list of target medications, the likelihood of using a listed target medication was compared between racial and ethnic minorities and whites. Individuals with diabetes, hypertension, and hyperlipidemia were included in the analysis owing to the high prevalence of these conditions. Patient- and community-level characteristics were adjusted by logistic regression. Results: Of the entire study sample, 26.2% used a target medication. Compared with whites, most racial and ethnic minorities were less likely to use a target medication. For example, among individuals with diabetes, blacks, Hispanics, Asians/Pacific Islanders, and others had, respectively, 14% (odds ratio 0.86 [95% CI 0.84-0.881), 5% (0.95 [0.93-0.981), 12% (0.88 [0.84-0.921), and 10% (0.90 [0.87-0.931) lower odds compared with whites. Findings were similar among hypertension and hyperlipidemia cohorts, except that Hispanics had similar odds of use as whites. Conclusion: Most racial and ethnic minorities may have lower likelihood of being targeted for the DDI measure compared with whites. Future studies should examine whether these disparities affect health outcomes and devise new DDI measures for racial and ethnic minorities. (C) 2022 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

Objective Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD). Methods Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017. Results In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD. Conclusions Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.

BACKGROUND: Policies such as Medicare Part D Star Ratings are designed to encourage medication adherence and facilitate positive health outcomes. Patients who have received a kidney transplant not included in assessment of Star Ratings measures may have worse outcomes. OBJECTIVE: To determine if criteria for inclusion in assessment of Star Ratings medication adherence measures among kidney transplant patients with diabetes, hypertension, and dyslipidemia lead to racial and ethnic disparities in who is included in this assessment. METHODS: This was a cross-sectional, secondary analysis of 94,822 adult kidney transplant patients receiving continuous coverage of Medicare Parts A/B/D and filling at least 1 prescription for diabetes, hypertension, or dyslipidemia in 2017. Utilizing 2017 Medicare claims, inclusion in assessment of Star Ratings measures was determined based on criteria for each measure concerning adherence to oral diabetes, hypertension, and dyslipidemia medication. Binary and multinomial logistic regression were conducted. RESULTS: Among kidney transplant patients with diabetes only, Black and Hispanic patients were less likely than White patients to be included in assessment of the Star Ratings adherence measure for oral diabetes medications (P < 0.0001). Among kidney transplant patients with hypertension only and dyslipidemia only, all racial and ethnic minority groups were less likely to be included in assessments of Star Ratings adherence measures for oral hypertension and dyslipidemia medications (P < 0.001). For example, among patients with hypertension, adjusted odds ratios for inclusion of Black, Hispanic, and Asian patients were 0.44 (95% CI = 0.40-0.49), 0.56 (95% CI = 0.49-0.63), and 0.55 (95% = CI 0.45-0.67), respectively. CONCLUSIONS: Disparities exist among patients who have received a kidney transplant qualifying for inclusion in Star Ratings measures, which may ultimately facilitate adverse health outcomes.

INTRODUCTION:With an underrepresented minority (URM) student population of <20%, colleges and schools of pharmacy (CoPs) in the United States (US) lag behind the national population, in which URMs account for >30%. Few tools are available to assist the >140 US CoPs in tracking progress in URM diversity among student pharmacists. Thus, the study's purpose was to address this gap by: (1) creating a "diversity index" for pharmacy programs; and (2) determining changes in diversity index scores between 2011 and 2020. METHODS:This was a secondary analysis of 2011-2020 fall URM enrollment data for CoPs and national and state population data. The annual diversity index score for 2011-2020 was calculated for each CoP. Wilcoxon signed-rank tests and Mann-Whitney U tests were conducted. RESULTS:Among all CoPs, median URM percent enrollment significantly increased from 7.7% in 2011 to 14.5% in 2020. Median diversity index scores for all CoPs increased from 0.66 in 2011 to 0.76 in 2020, but this change was not statistically significant. Historically Black Colleges and Universities (HBCUs) and Hispanic-Serving Institutions (HSIs) had significantly greater diversity index scores than non-HBCUs/HSIs. Diversity index scores of public vs. private colleges did not differ significantly. CONCLUSION:This diversity index represents an important step in tracking progress in increasing URM student pharmacist representation in CoPs. The index may be utilized as a tool to support development of diversity best practices and more inclusive environments for student pharmacists, faculty, staff, and stakeholders.

In 2019, the American Society of Health-System Pharmacists (ASHP) released its second edition of its Long-Range Vision for the Pharmacy Workforce in Hospitals and Health Systems. The report highlighted the agility and potential for growth in pharmacy, while affirming the rapidly evolving healthcare delivery models that drive practice. The report focused on drivers of change that would challenge and nurture pharmacy innovation. It predicted care transformation, technology advancements, and marketplace and organizational shifts influenced by global trends, as well as financial and health policy changes.1 A few months after its release, the coronavirus disease 2019 (COVID-19) pandemic took hold of the world, fundamentally changing the trajectory of healthcare. The pandemic fueled an already evolving healthcare landscape for pharmacy by influencing workforce, educational, and practice trends. The ASHP Section of Pharmacy Educators (SPE), abiding by its mission to support pharmacy educators in preparing, engaging, and advancing the pharmacy workforce to optimize health, sought forecasting among key pharmacy education leaders and influencers who shape the landscape for future practitioners. SPE's Crystal Ball project aimed to generate productive debate exploring disruption in pharmacy, the pharmacy workforce, and academia in the next 5 years. The SPE surveyed 4,232 SPE practitioner members and received 389 responses (9.2% response rate). Participants were asked to provide their opinions regarding key trends that influence the pharmacy workforce. Results are depicted in Figures 1 through 4. This commentary describes key observations based on the findings of this survey and provides recommendations to stimulate challenging conversations that influence pharmacy's scope, environment, and impact.

Community pharmacies represent a highly accessible and convenient setting for vaccination. However, setting-specific barriers exist which contribute to suboptimal vaccination rates, particularly for pneumococcal vaccinations. One proven quality improvement framework growing in use within healthcare settings is Lean Six Sigma (LSS). This paper describes the application of the LSS framework in select locations of a national pharmacy chain. The implementation of a training program for improved recommendation techniques to promote higher rates of pneumococcal vaccinations in high-risk adult populations is also addressed. A mixed-methods approach including pre/post quasi-experimental design and in-depth key informant interviews was used.

Objective. To evaluate whether the score on the Pre-Multistate Pharmacy Jurisprudence Examination (Pre-MPJE) predicts pharmacy students' performance on the MPJE, and to determine whether demographics, pre-pharmacy school factors, or pharmacy school factors affect MPJE outcomes.Methods. We performed a retrospective review of pharmacy school graduates' (N = 156) MPJE scores, Pre-MPJE scores, demographics, pre-pharmacy school academic performance factors, and pharmacy school academic performance factors. Bivariate and correlational analyses were conducted along with multiple linear regression models to determine the influence of variables on the MPJE total scaled score.Results. A total of 136 pharmacy school graduates were included, with most being female (59%) and non-Hispanic White students (75%). The score on the Pre-MPJE was not significantly correlated with students' first-attempt MPJE pass-fail outcome or total scaled score. Factors that were correlated with passing the MPJE were a younger age at graduation, a higher pharmacy law course grade, Pharmacy Curriculum Outcomes Assessment (PCOA) examination scores, specifically scaled total scores and scaled scores for content areas 1-4 and final pharmacy school grade point average (GPA). The MPJE total scaled score was correlated with a higher pre-pharmacy school GPA, pharmacy law course grade, PCOA total and content area 1-4 scaled scores, and final pharmacy school GPA. However, regression models found that the greatest variance in MPJE total scaled score was contributed by the pharmacy law course grade. The total scaled score on the PCOA contributed to some variance for all MPJE takers, but only the pharmacy law course grade significantly influenced the in-state MPJE total scaled score.Conclusion. The findings did not show that the Pre-MPJE score was a predictor for passing the MPJE or for the MPJE total scaled score. The most important determinant of the MPJE total scaled score was a student's performance in the pharmacy law course.