Harrisburg, PA – Today, Secretary of the Commonwealth Al Schmidt highlighted the Department of State’s work to ensure Pennsylvanians retain access to life-saving medications despite the closure of hundreds of community and national pharmacies, demonstrating the Shapiro Administration’s commitment to cutting bureaucratic red tape and speeding up processing times for professional licenses.

“At Governor Shapiro’s direction, the Department of State has strengthened the Commonwealth’s pharmacy workforce by streamlining licensing processes for pharmacies and their professional staffs, which has helped protect Pennsylvanians’ timely access to the medications they need,” Schmidt said. “Collectively, these measures have helped ensure that new pharmacy counters have been able to open quickly so that patient care could continue uninterrupted.”

Previously, pharmacists in Pennsylvania had to wait 20 days on average to receive a license, and it similarly took the Department 20 days to process a pharmacy facility license. Today, it takes only four days to process a pharmacy facility license and just one day to process a pharmacist license. Taken together, these improvements have helped more pharmacists get on the job sooner – and more pharmacies open their doors to patients.

Since 2024, the Department has issued 1,644 pharmacist licenses – 764 of those licenses were granted to professionals who transferred to the Commonwealth from out of state – reflecting the Shapiro Administration’s success in streamlining the licensing process to get Pennsylvanians on the job quicker.

Read the full article here. 

ASHP’s nominating committees have named the following ASHP members as candidates for ASHP elected offices:

President (2026-2027)

• Kim W. Benner, PharmD, BCPS, FALSHP, FASHP, FPPA
  Professor of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, AL
• Vivian B. Johnson, BS, PharmD, RPh, MBA, FASHP
  Senior Vice President of Community Health Services and Senior Pharmacy Advisor, Parkland Health, Dallas, TX

Treasurer (2025-2028)

• John A. Armitstead, MS, RPh, CPEL, FASHP
  Vice President Pharmacy Services, Lee Health, Fort Myers, FL
• Lisa M. Gersema, BSPharm, PharmD, MHA, BCPS, CPEL, FASHP
  System Director for Clinical Pharmacy Services, Allina Health, Minneapolis, MN

Board of Directors (2026-2029)

• Davey P. Legendre, PharmD, MBA, BCPS, BCIDP, FASHP
  Vice President, Pharmacy Management, PharmD on Demand, Watkinsville, GA
• Christy M. Norman, PharmD, MS, BCPS, CPEL, FASHP
  Senior Vice President, Pharmacy Services, Emory Healthcare, Atlanta, GA
• Christopher M. Scott, PharmD, BCPS, FASHP, FCCM
  Chief Clinical Operating Officer, Eskenazi Health, Indianapolis, IN
• Martin J. Torres, PharmD, FCSHP
  Director of Pharmacy, UC Irvine, Orange, CA

Information about the backgrounds and perspectives of the candidates for President, Treasurer, and Board of Directors will be available in May. Online voting will begin on June 12th.

The nominating committees for the ASHP pharmacy practice sections recently approved candidates for Executive Committee chairs and directors-at-large.

Section of Clinical Specialists and Scientists

Chair (2026–2027)

• Calvin J. Ice, PharmD, BCPS, BCCCP, FASHP
  Clinical Pharmacy Manager, Training and Education, Corewell Health, Grand Rapids, MI
• Brian A. Potoski, PharmD, BCPS, BCIDP
  Antimicrobial Stewardship/Infectious Diseases Pharmacist, University of Pittsburgh School of Pharmacy, Pittsburgh, PA

Director-at-Large (2026–2028)

• Snehal H. Bhatt, PharmD, BCPS, AACC, FASHP
  Professor, Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA
• Zahra C. Nasrazadani, PharmD, BCEMP, BCPS, DPLA
  Pharmacy Clinical Manager, University Health Truman Medical Center, Kansas City, MO

Section of Pharmacy Practice Leaders

Chair (2026–2027)

• William Kernan, PharmD, MBA, FASHP
  Director of Pharmacy Services, Orlando Health, Orlando Regional Medical Center, Orlando, FL
• Rebecca A. Taylor, PharmD, MBA, BCPS, FASHP
  Vice President, Pharmacy Service Line, Health Services Division, UPMC Corporate Services, Pittsburgh, PA

Director-at-Large (2026–2028)

• Travis B. Dick, PharmD, MBA, BCPS, CPEL, FASHP
  Director, Clinical Pharmacy Practice, Research and Education and Director, PGY1 Pharmacy Residency Program, University of Rochester Medical Center, Rochester, NY
• Meghan D. Swarthout, PharmD, MBA, BCPS, CPEL, FASHP
  Executive Director, Pharmacy Patient Care Services and Population Health, Johns Hopkins Health System, Baltimore, MD

ASHP is urging Centers for Medicare & Medicaid Services (CMS) to take immediate action to ensure that implementation of the Inflation Reduction Act (IRA) negotiated drug pricing framework does not threaten patients by undermining the financial stability of hospitals, pharmacies, and other community providers. PSHP has signed onto the ASHP letter, adding support in asking the Trump administration to revisit how IRA drug prices will be implemented.

As stated by Tom Kraus, Vice President of Government Relations at ASHP, the proposed IRA framework would actually increase prices for providers and pharmacies, and increase bureaucratic red tape, without benefiting patients. The IRA was supposed to lower drug prices. Instead, the program raises drug purchasing costs by:

• Forcing providers to purchase medications at an inflated price (wholesale acquisition cost);
• Requiring providers to finance the higher carrying cost of inventory purchased at inflated prices until rebates are received from the manufacturer;
• Creating a system where rebates may be significantly delayed or denied at the manufacturers’ discretion; and
• Saddling providers with inflated administrative costs to comply with rebate programs that vary from manufacturer to manufacturer and drug to drug.

Providers are forced to purchase medications at inflated prices: CMS’s proposed approach places drug manufacturers in full control of whether patients, providers, and pharmacies can purchase products at the lower discounted price negotiated by the government, or if they must buy these medications at higher prices and then wait for the manufacturer to provide a retrospective rebate. If, as expected, most manufacturers’ IRA plans will require providers to purchase medications at higher up-front prices, hospitals will face increased financial strain from drugs purchased under this program.

Hospitals must incur financing costs on the inventory purchased at elevated prices: A retrospective discount program for IRA pricing will require hospitals to come up with significant cash to purchase drugs at these higher prices. As a result, many hospitals will need to access financing through the bond market or a loan. Hospitals will be required to pay interest on such financing from the time of purchase until the rebates are received from manufacturers. This financing cost will further erode the operating margin of already cash-strapped safety-net hospitals.

As one hospital explained based on an analysis of converting just two common drugs to a rebate model, even if all claims for the two drugs were validated and nothing denied, a 30-day delay to get rebates would require a $2 million in working capital just to fund purchasing two of the IRA negotiated drugs at upfront WAC pricing. If this model were to apply to all IRA and 340B drugs, hospitals would face millions in additional financing costs – in some cases, the cost would be enough to wipe out a hospital’s margins, threatening their financial viability.

Rebates will be significantly delayed or unpaid for some portion of drugs: Retrospective rebates will significantly delay access to negotiated prices. As a result, providers will not only need to purchase drugs at significantly increased prices (wholesale acquisition cost versus the negotiated price), they will also need to wait to receive the rebates, with no guarantee that a rebate will actually be paid.

Providers will need to anticipate that some portion of rebates will be disputed and never paid, or at best significantly delayed, by manufacturers. Every time a rebate remains unpaid or is significantly delayed it lowers the operating margin of safety-net hospitals. This threat to provider’s financial health would be easily addressed by requiring manufacturers to provide prices upfront, rather than as a rebate, because providers would realize the reduced cost of a drug immediately, rather than facing higher purchasing costs without any guarantee that a rebate will be received in the future.

There are significantly greater administrative costs for a rebate program compared to up-front discounts: Rebate models also impose significant administrative complexity, which raises the costs for providers, reducing money that would otherwise be spent on patient care. Because the IRA guidance puts drug companies in the driver’s seat when structuring IRA negotiated rebate models, including product-specific models, each manufacturer will likely have their own model. Multiple inconsistent models further increase expenses and add to confusion relating to tracking rebate data submitted to manufacturers, validating/auditing whether rebates were received and pursuing payment for denied rebates. These concerns are compounded by the fact that CMS has indicated that hospitals and dispensers will not have access to the models until September 2025, leaving very little time for input and/or necessary revisions. With drug companies driving the process, it seems unlikely that models will adequately address the practical needs of other stakeholders.

PSHP greatly appreciates ASHP urging the Trump administration to take immediate action to prevent the current proposed IRA drug negotiation framework from taking effect and to adopt an upfront discount model to ensure patients, providers, and our healthcare system benefit from lower drug prices.

On Feb. 13, the White House released an executive order establishing the Make America Healthy Again Commission to address the rising rates of chronic diseases. The executive order follows the recent Senate confirmation (52-48) of Robert F. Kennedy, Jr. as secretary of the Department of Health and Human Services (HHS).

The commission is tasked with studying the prevalence and causes of chronic diseases, considering factors such as diet, environmental exposures, medical treatments, and lifestyle. Specifically, within the first 100 days from the order, the commission will conduct an assessment on the potential overuse of medications, with an emphasis on prescriptions for selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs. In addition, the commission will provide government-wide recommendations to address and mitigate the identified causes of childhood chronic diseases.

January 15, 2025, the U.S. Food and Drug Administration is amending its color additive regulations to no longer allow for the use of FD&C Red No. 3 in food and ingested drugs.

Drug manufacturers who use FD&C Red No. 3 in ingested drugs will have until January 18, 2028, to reformulate their products.

FDA intends to issue guidance to provide drug manufacturers with recommendations regarding replacing color additives used in approved and marketed drugs, including recommendations for reformulation when a color additive regulation is revoked.

The FDA is revoking the authorization for the use of FD&C Red No. 3 based on the Delaney Clause of the Federal Food, Drug, and Cosmetic Act (FD&C Act). The Delaney Clause, enacted in 1960 as part of the Color Additives Amendment to the FD&C Act, prohibits FDA authorization of a food additive or color additive if it has been found to induce cancer in humans or animals.

The FDA determined that the data presented in a 2022 color additive petition show that this ingredient causes cancer in male laboratory rats exposed to high levels of FD&C Red No. 3 because of a hormonal mechanism that occurs in male rats. Studies in other animals or in humans did not show the same effect and there is no evidence showing FD&C Red No. 3 causes cancer in humans.

FD&C Red No. 3

Delaney Clause

Color Additive Petitions

State Advocacy Wins
Last year, we continued to see the power of state-level advocacy. ASHP’s efforts, in partnership with state affiliates, resulted in new legislation that’s already driving change in our country.

In 2024, six more states passed laws aligned with ASHP’s model legislation to protect 340B contract pharmacy arrangements. Five states passed laws to prohibit insurers and pharmacy benefit managers (PBMs) from reducing reimbursements to 340B-covered entities. These efforts are critical as we work to enable patient access to needed care supported by the 340B

Drug Pricing Program
Fourteen states also expanded scope of practice, allowing more pharmacists to provide services such as HIV pre-and post-exposure prophylaxis, immunizations, and medications for opioid use disorder. Three additional states passed laws requiring insurers to reimburse pharmacists for providing all covered services within their scope of practice. In total, 30 states now permit pharmacists to prescribe at least one medication, and 17 require Medicaid reimbursement of all or nearly all services within pharmacists’ scope of practice. We are pleased that ASHP’s model laws assisted our state affiliates and grateful to these members for their dedication and advocacy to expand patient access to pharmacist care.

Federal Advocacy Progress
At the federal level, ASHP led several successful efforts on pharmacy residency funding, drug shortages, and site-neutral payment provisions in 2024.

In November, Congress introduced the bipartisan Rebuild America’s Health Care Schools Act of 2024 to protect critical federal funding for pharmacy and nursing residency programs. ASHP worked closely with Congress and a coalition of health systems and colleges of nursing to develop this legislation, and we will keep working to get it passed in 2025. ASHP continued our longstanding advocacy supporting solutions to reduce drug shortages. When Hurricane Helene in September damaged the nation’s leading IV fluid manufacturing facility, ASHP worked closely with federal officials and other stakeholders to mitigate the resulting shortages. Earlier last year, the Department of Health and Human Services released a policy paper that incorporated many proposals from our most recent set of drug shortage recommendations, and the Senate is also developing legislation aligned with these recommendations.

We also remained steadfast in our advocacy for much-needed PBM reforms, which were a top issue for many in Congress last year. We were careful, however, to push for reform proposals that did not also include policies that would reduce Medicare reimbursement for administration of medications in hospital outpatient clinics, sometimes referred to as site-neutral payment. We believe such policies are detrimental to health-system pharmacy and our patients, and this year we will continue to make sure they are not included in PBM reforms.

2025 ASHP Advocacy Agenda
Our advocacy is anchored to an agenda that supports our mission of helping people achieve optimal health outcomes. As part of this work, we remain committed to advancing seven key priorities:

• Expand the scope of pharmacist-provided patient care services in acute and primary care settings
• Secure payment for pharmacist-provided patient care
• Advocate for solutions to pharmacy workforce challenges
• Promote the role of qualified pharmacy technicians
• Protect patient access to safe and affordable medications
• Address societal barriers to patient care
• Protect the sustainability of health-system pharmacy

We have already begun engaging the new Congress and administration on our efforts to carry out these priorities. In the year ahead, we will push to further advance provider status legislation, the Equitable Community Access to Pharmacist Services Act, through key committees in Congress. That legislation was the result of our enduring advocacy and partnership with 190 pharmacy, health systems, and patient organizations. We will devote significant time and effort to protect the 340B program and to pass legislation safeguarding and expanding pharmacy residency programs. We will also urge Congress to finalize PBM reforms that started last year while ensuring the legislation does not undermine medication administration services in hospital outpatient clinics. At the state level, our state affiliates will continue to drive change by advancing policies that expand pharmacist scope of practice and reimbursement for pharmacist clinical services in their communities. We are ready for the work ahead. Please explore the details of our 2025 advocacy agenda and join us in championing these critical initiatives.

Applications are open through Sept. 3 for ASHP Foundation’s Pharmacy Resident Research Grant, which awards up to $50,000 to support quality research on practice advancement conducted by pharmacy residents in ASHP-accredited postgraduate year 1 and 2 programs.

The virtual Pharmacy Executive Leadership Alliance (PELA) conference, held in May, provided pharmacy executives from more than 200 health systems the chance to discuss strategies for managing high-cost medications and system-wide Pharmacy and Therapeutics Committees. Get details on the proceedings and key takeaways in this conference report here.

ASHP members have elected the incoming individuals to serve on the Executive Committees of ASHP’s Pharmacy Practice Sections. The terms for the section Chairs-Elect will begin immediately; the two-year terms for Directors-at-Large will start in June 2025. Click here to view the new executive committee members.

ASHP recently published the results of the “ASHP National Survey of Pharmacy Practice in Hospital Settings: Operations and Technology-2023” on May 23, 2024, and available through AJHP.

Overall the survey results concentrated in four areas:

(1) demonstrated a shift to more decentralized models for drug distribution,

(2) detailed automated dispensing cabinets level of usage, with both bar code and auto-verification technology

(3) pharmacy services working to optimize patient care transitions

(4) the traditional and the emerging expanded use of pharmacy technicians

For a complete review of the information and article, an ASHP membership subscription is required and may be accessed here.

President (2025-2026)

Board of Directors (2025-2028)

The ASHP Elections also include all ASHP Section Leaders, Practitioners, and Educators.  Please review and vote in the appropriate section you have selected as your area(s) of interest.  This is the time to advocate for us and join the process. Vote by 7/12/24.

BETHESDA, Md — Blockbuster growth in weight-loss drugs was the main driver of a 13.5% increase in spending on prescription medications in the U.S. in 2023, according to ASHP’s report, National Trends in Prescription Drug Expenditures and Projections for 2024. By contrast, hospital drug spending dipped slightly as the pandemic ended and remdesivir injections were replaced by less-costly oral COVID treatments.

Spending on weight-loss drugs — originally marketed as diabetes treatments —will likely continue to climb as supplies catch up with the huge demand, the report predicted. The trend will escalate further as additional similar drugs come to market and as the FDA approves the medications for more conditions, said the report's lead author Eric Tichy, Pharm.D., M.B.A., division chair, supply chain management at Mayo Clinic, Rochester, Minn.

Expenditures for semaglutide doubled last year, making it the new top-selling drug in the U.S., replacing adalimumab, which treats autoimmune diseases like rheumatoid arthritis and Crohn’s disease. Sales of adalimumab continued growing despite the availability of less costly biosimilars. Adding to the weight- loss category, spending on the diabetes drug tizepatide grew an astounding 373% even though its approval for weight loss came late in 2023.

Meanwhile, hospital drug spending decreased by a modest 1.1%, extending a long relatively steady period of expenditures that was interrupted only by a spike during COVID. The report said the decrease was caused by the continued decline in the use of expensive COVID medications, the adoption of lower- cost biosimilars, and the growth of the 340B program, which allows some hospitals to purchase drugs at a reduced price.

“Hospitals and health systems are doing a commendable job using available tools to manage drug expenditures, which typically represent about 10% of their budgets,” Tichy said. “Pharmacy and health- system leaders should persist in their proactive management and continue to anticipate disruptions that may affect drug spending.”

The Inflation Reduction Act, in its second year, influenced 2023 spending, but the full effect of its savings won’t be felt until 2026 for retail and mail order pharmacy and 2028 for hospitals and clinics. While price negotiations required under the law will reduce prices on certain drugs, it could drive up spending on some medications as more people use them, Tichy said.

Other key findings:

• Drug expenditures in clinics grew 15% driven by increased use of high-cost injectable medications for cancer, immunology, and neurology.
• At 2.9%, inflation in drug prices was lower than consumer price inflation for the fourth consecutive year. Consumer price inflation was 3.4%.
• Uptake of biosimilars in hospitals and clinics continues to be strong, helping contain total expenditures; biosimilar uptake in retail and mail-order pharmacies was more limited.

“Policymakers, pharmacy leaders, and hospital and health-system decision makers can benefit greatly from this report,” said Daniel J. Cobaugh, Pharm. D., FAACT, DABAT, senior vice president of professional development and publishing at ASHP and editor-in-chief of AJHP, which published the paper. “The drug expenditures report provides an opportunity for a deeper understanding of the complex factors influencing the costs of medications to inform strategic decisions about allocating resources to support appropriate use of these complex agents.”

Since 2019, CMS has used a change in its auditing procedure to fundamentally shift the requirements for allied health residency programs, but it has never updated its regulations or provided guidance on how residencies can comply.

Specifically, auditors have begun using a so-called “direct control” requirement (42 C.F.R. §413.85) to disallow funding for everything from off-site clinical rotations at other hospitals within a health system, to the use of a health system’s name on a pharmacy residency program, to use of shared educational resources, and even for use of shared human resources and payroll across a health system, despite the fact the program regulations explicitly allow for such shared services and CMS has provided no guidance to the contrary.

As a result, programs have no way to determine if they will have their funding clawed back, despite long previous histories of clean audits. Residency programs should not be left guessing how to comply and should not be punished because CMS has failed to communicate compliance requirements.

A rise in audits threatening federal funding for postgraduate year 1 (PGY1) residency programs had led to the creation of a new ASHP toolkit mentioned in last month’s newsletter.

ASHP recently released a Controlled Substances Diversion Prevention Program (CSDPP) Assessment Tool. This practical, web-based resource helps conduct a gap analysis against best practices described in the ASHP Guidelines on Preventing Diversion of Controlled Substances.