August 2014 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association AUGUST 2014

THE AFFORDABLE CARE ACT AND ITS IMPLICATIONS

FOR THE PRACTICE OF PHARMACY

THE WALKWAY OF RECOGNITION

FPA OFFICE

YOUR NAME HERE

Have you been searching for just the right gift or thought of placing your name in perpetuity? If so, then consider purchasing an engraved brick for you or someone else. The main sidewalk at the Florida Pharmacy Association needs replacing. The Florida Pharmacy Foundation has undertaken the project to repair and beautify the sidewalk with engraved personal bricks purchased by pharmacists or friends of pharmacy. Engraved 4x8 bricks can be purchased for $250.00 each with the donor’s name engraved (3 lines available) or you could also purchase an engraved brick for someone you feel should be honored or remembered. The monies earned from this project will be used to fulfill the goals and future of the Foundation. There are a limited number of bricks available – so, it is first come first served.

ORDER FORM

The Walkway of Recognition

❑ YES, I want to order _______ concrete brick/s at $250.00 each. (Please copy form for additional inscriptions). PL E A S E P R INT I NSC RIP TION

The concrete bricks are 4x8 and can be engraved with up to 14 characters per line, three lines available, spaces and punctuation count as one character. Please find enclosed my check for $_________ for _________ bricks. PLEASE PRINT: Please charge my

❑ Master Card

CARD #

Contributions to the Florida Pharmacy Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details. Fed Emp. I.D. #59-2190074

❑ Visa EXP. DATE

AUTHORIZED SIGNATURE NAME ADDRESS CITY

STATE

PHONE (W)

(H)

Send to Florida Pharmacy Foundation, 610 N. Adams St., Tallahassee, FL 32301, or fax to (850) 561-6758.

ZIP

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE.

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 22 Buyer’s Guide

VOL. 77 | NO. 8 AUGUST 2014 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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David Laven Honored with James H. Beal Award OPINION: The Affordable Care Act and its Implications for the Practice of Pharmacy Find Your Pharmacy Passion: A Student’s Perspective DBPR Issues Statement on Prescription Transfers

AUGUST 2014

FPA Calendar 2014

AUGUST 23-24 Council and Committee Meetings Orlando

NOVEMBER 1-2

Committee and Council Meetings Orlando

SEPTEMBER 7-14

FPA CE at SEA 2014 Port of Canaveral

20-21 Ft. Lauderdale Clinical Conference Fort Lauderdale OCTOBER 7-8

DECEMBER 2-3

Florida Board of Pharmacy Meeting

6-7

Law and Regulatory Conference Sarasota

25-26 FPA Office Closed

Florida Board of Pharmacy Meeting Kissimmee

11-12 2014 Midyear Clinical Conference Lake Buena Vista 11-12 2014 Midyear Nuclear Pharmacist Conference Lake Buena Vista 18-22 NCPA Annual Meeting Austin Texas

For a complete calendar of events go to www.pharmview.com Events calendar subject to change CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2015 or prior to licensure renewal. Consultant pharmacists and technicians will need to review their licenses and registrations by December 31, 2014. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www.pharmview.com

Mission Statements: of the Florida Pharmacy Today Journal

The Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the Florida Pharmacy Today Board of Directors

The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the

Journal in its goal of self-support.

Advertisers EPC...................................................................... 20 THE HEALTH LAW FIRM.............................. 13 KAHAN HEIMBERG, PLC............................. 14 PPSC.................................................................... 11

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 U/F — Art Wharton (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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FLORIDA PHARMACY TODAY

E-MAIL YOUR SUGGESTIONS/IDEAS TO dave@fiorecommunications.com

The President’s Viewpoint SUZANNE KELLEY, FPA PRESIDENT

Is Your Profession Worth More Than Your Latte?

n my mind, it is never too early or too late for a cup of coffee. When on a trip, whether on the road or in the air, I always look forward to a good cup of coffee, maybe even a latte. It has become a joke to those who travel with me that stops are determined by the location of a Starbuck’s or other specialty coffee shop. Some of you can relate with me. You spend the money for this special drink and enjoy it. So where am I going with this? We pay for what we want. We spend the extra money for those things we enjoy, such as this latte, and we don’t mind paying that higher price. How much is your profession worth to you? We all have spent quite a bit of time in school to achieve a place in the profession of pharmacy. Some of you are still in school and are eagerly looking forward to getting that pharmacy degree and passing the Naplex as well as the “Law Exam.” Then come the expenses and they never seem to end: exams, licenses, insurance, school loans, professional dues and political advocacy. Yes, political advocacy is important. How important is it? Your vote and personal contributions or donations have a direct influence on your elected officials who represent you as well as make many decisions that affect your profession’s future. Their decisions, along with the laws they pass, will tell you how to practice your profession and how to care for your patients. In addition, how health care costs affect our state budget are a result of these decisions and laws. This past year, along with our new legislative advocacy team at Adams St. Advocates, we were successful in accomplishing all four of our legislative

priorities: fair and uniform pharmacy audit practices, mail order reform, pharmacy-technician ratio and funding for the Prescription Drug Monitoring Program. Unfortunately, some compromise was necessary but, as we found

So how can you help? Contribute to the Florida Pharmacist Political Committee (FPPC). Suzanne Kelley 2014-2015 FPA President

out, that is the nature of politics. So how can you help? Contribute to the Florida Pharmacist Political Committee (FPPC). This is a good way for us to pool our resources and have a greater impact in this political arena. We have to reach those candidates who have or will have an understanding of what is best for the practice of pharmacy. Our patients and how we provide that patient care are most important. How much do you need to contribute? It is very important to know that the political candidates get the majority of our contributions. This money helps to support their campaigns. When it comes to making their decisions and voting on bills, they remember us. Regrettably, money speaks and the more money that is contributed, the louder the voice. I have heard Michael Jackson say many times, “If only every pharmacist would contribute $5.” Is that a lot of money? Is your pharmacy profession worth more than $5?

For those of you who have heard Mr. Jackson talk about advocacy, you probably remember that slide, which should shame you. It certainly embarrassed me! Why do the Florida Medical Association, the Florida Hospital Association and the Florida Dental Association all have higher political contributions than the Florida Pharmacy Association? Why do the nurses contribute three times more than the Florida Pharmacy Association? Is your profession worth the cost of a latte? Of course it is! Well, I am assuming that it is. You can start by just contributing $5. But, let me challenge you. Don’t be satisfied with that amount and go ahead and contribute more. Your donation can be made in many ways. You can contribute directly to the FPPC. You can make donations toward the Florida Pharmacists Legislative Days, which will help to pay the many expenses that are incurred to hold this event. You can also donate directly to the health fair. AUGUST 2014

2014 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work diligently all year long on behalf of our members.

Terry Gubbins.......................................................................... Chairman of the Board Suzanne Kelly...............................................................................................FPA President Tim Rogers................................................................................................... President Elect Alexander Pytlarz................................................................................................Treasurer Bob Parrado................................................Speaker of the House of Delegates Jackie Donovan...........................Vice Speaker of the House of Delegates Jennifer Raquipo..............................................................Interim Director, Region 1 Michael Hebb........................................................................................ Director, Region 2 Stephen Grabowski........................................................................ Director, Region 3 Linda Lazuka........................................................................................ Director, Region 4 Jason Beattie...................................................................................... Director, Region 5 Luther Laite IV.................................................................................... Director, Region 6 Kimberly Jones................................................................Interim Director, Region 7 Humberto Martinez......................................................................., Director, Region 8 Mitchell Fingerhut......................................................... Interim Director, Region 9 Christine Gegeckas............................................................................. President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair...........................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary.............. Verender Gail Brown, brownvgrx4304@hotmail.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Member........................................................Cristina Medina, cmmedina@cvs.com Member................................................................Norman Tomaka, FLRX9@aol.com Member........................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com Journal Reviewer....................... Dr. Melissa Ruble, mruble@health.usf.edu Journal Reviewer....................................Dr. Angela Hill, ahill2@health.usf.edu

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FLORIDA PHARMACY TODAY

By doing this, we can purchase some of the many supplies that are needed for the health screenings the students perform during this affair. Our annual Florida Pharmacists Legislative Days and Health Fair are quite costly to hold, but the results are always very successful. We showcase what all pharmacists can do as health care providers. In order to achieve our legislative initiatives this year, your contributions are needed. My contributions are, also, needed. Write your check and mail it to the FPA. You can donate either online or by phone. It does not matter how you donate, just do it! We are very fortunate to have the Adams Street Advocates as our lobbyists. Come to Tallahassee and meet them as well as your legislators. We need you to call your legislators and invite them to your pharmacy. Invite your legislators to visit your unit association during a meeting. As you can see, there are many ways you can help to advocate for our pharmacy profession. Before I stop to get another cup of coffee, I want to take a minute to invite you to come join us in Tallahassee for the Florida Pharmacists Legislative Days and Health Fair next March. We will need volunteers in Tallahassee to work the health fair and visit legislators. Whether you are a student or a pharmacist, we need you. Unfortunately, we never have enough pharmacists to supervise the many students who come. Please come join us! As you can see, your contributions are important to us. Even if you only will donate the price of a latte, we can use it. The more money that is contributed, the louder our voice will be. It does take donations to persuade legislators to be pharmacy-friendly. Their votes make a difference in whether or not a bill passes. We will be busy this year, and you are most definitely needed! So as I close, I want to remind you that we pay the price for what we want: a latte, a specialty drink or even more expensive things. How much is your pharmacy profession worth to you? Are you willing to make that contribution to ensure that your profession is what you want it to be and not what legislators want it to be? n

Executive Insight BY MICHAEL JACKSON, RPH MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION

Should Pharmacists be Considered Health Care Providers?

hat an interesting question to ask, and of course, the answer is: absolutely, without a doubt. During the 2014 legislative session, a visit with Senator Greg Evers that included pharmacists and pharmacy students created an opportunity to dialogue on a variety of issues. Of course, provider status was on the list of things to talk about. We had previously spent a lot of time with Senator Evers on various pharmacy issues over the years and had briefed him on our public policy interests. Senator Evers raised an interesting question to each one of us that did not give him the response he was looking for right away. His question simply was, “What are you?” He received various responses such as pharmacy student, hospital pharmacist, community pharmacist and, in my case, pharmacist advocate and association manager. What is interesting is that these responses did not seem to be what he expected. The Northwest Florida legislator, whose district includes Escambia, Santa Rosa and parts of Okaloosa counties, helped us with the answer to his question simply by saying that each of us is a health care provider. Quite naturally, that put things into perspective with the kind of thinking that should be the core of our industry. Our practice settings may be unique; however, the common denominator is that we are all health care providers. A massive campaign is underway both nationally and within many states to get pharmacists recognized as providers. At the center of our discussions is the advocacy effort surrounding support for H.R. 4190. What does 4190 do?

Under certain sections of the Medicare Part B program, there is a list of health care providers. What is interesting is that this list amazingly does not include pharmacists. H.R. 4190 is a bill filed to enable Medicare beneficiaries to have access to pharmacist-provided services under the Part B program by amending

A massive campaign is underway both nationally and within many states to get pharmacists recognized as providers. 1861(s)(2) of the Social Security Act. Members of the U.S. House of Representatives are signing up as cosponsors, and our members should be making phone calls and visits to urge those who represent them in Washington to do the same. As I am preparing this article for you, there are 94 cosponsors on this bill, but only four members from Florida are listed. They are Representatives Thomas Rooney, Frederica Wilson, David Jolly and Joe Garcia. Florida has 27 congressional seats. If your con-

Michael Jackson, B.Pharm

gressman is not listed, you have some work to do. The state with the most cosponsors is Illinois with 11, followed by California with nine. FPA will build a special advocacy page to assist you with connecting with your congressman on this issue. Be on notice as you talk with members of Congress that this is not a discussion on scope of practice. Pharmacist patient-focused professional services are already within our scope. We are simply looking to get the critical patient care functions recognized that you do every single day. Currently, there is no Senate version; however, this should not deter you from having conversations with Senator Bill Nelson or Senator Marco Rubio’s offices. Perhaps they may want to take the lead on sponsorship of this important legislation. The national initiative is not the only AUGUST 2014 |

FPA STAFF Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200

Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall, ext. 211

Educational Services Office Assistant Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110

FLORIDA PHARMACY TODAY BOARD Chair..................................... Carol Motycka, St. Augustine Vice Chair.........................Jennifer Pytlarz, Herndon, Va. Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Verender Gail Brown, Orlando Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Member....................................Cristina Medina, Hollywood Member................................. Norman Tomaka, Melbourne Member..............................Stuart Ulrich, Boynton Beach Member.......................Don Bergemann, Tarpon Springs Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2014, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. FLORIDA PHARMACY ASSOCIATION

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web 8 Address: | F L O Rhttp://www.pharmview.com IDA PHARMACY TODAY

work that is being done to recognize pharmacists as health care providers. This summer we heard an inspiring message from Dr. Dan Buffington at the annual meeting and convention of the FPA on provider status and the incorporation of our industry into the national medical reimbursement models. Pharmacists are trained today to do a number of things within the health care system including, but not limited to, patient education, drug regimen review problem intervention, physical assessment and comprehensive medication management. Every pharmacist should have a national provider identification number (NPI). For the past two years, the FPA has set up a help desk at the annual meeting to show you how to get one. The Florida Pharmacy Association is also working with the Florida Society of Health-System Pharmacists on this provider status initiative by engaging in collaborative dialogue and looking at what changes here in Florida may be needed to achieve this status at the state level. The FPA also testified at a recent Board of Pharmacy meeting to inform the panel of the dis-

cussion in this area. The Board indicated an interest in this issue and may allow an opportunity for public testimony at future meetings. The health care market is growing significantly, especially with the implementation of the Affordable Care Act and efforts to expand Medicaid. It is possible that the current health care provider pool will not be able to keep up with the demand. With pharmacists being the most accessible health care provider, it just makes sense to include on the team the skills that we can bring to the table. It is not necessary to prove pharmacists can make a difference because that has already been done. We just need to revise the public policy to catch up to the practice. With all this in mind, the next time someone looks at you and asks what you do, your answer should be that, in addition to being a pharmacist, you are also a health care provider. n

JOIN TODAY! Florida Pharmacy Association

Measuring Success

By Richard Boyd

It seems that we are endlessly measuring things in pharmacy. Business figures (such as daily prescription counts and annual sales) must be measured to assess performance. Patient health figures (such as blood pressure and glucose levels) must be measured much for the same reasons. Only by measuring are we able to assess a baseline value, and from there we can strive for improvement. So why shouldn’t this concept hold true for patient medication adherence? There are many ways that medication adherence can be measured. Patient medication diaries, pill counting, refill rates, and simply asking the patient are all valid methods. Typically once an adherence issue is recognized, the patient is alerted and told to “get back on track” (typically in more professional, empathetic terms!). Instead of constantly taking the “eat your vegetables!” approach to improving adherence, however, some pharmacists may choose to step back and let the patient assess themselves. A number of medication adherence surveys have been developed that can be quickly and easily administered in the community pharmacy setting. These surveys have been validated in multiple disease states, and are a great way to get patients to think about their own behavior. No guidelines currently exist as to which survey is best, but each has its own benefits. The major surveys of interest to the community pharmacist include the Medication Adherence Questionnaire (MAQ), the Self‐efficacy for Appropriate Medication Use Scale (SEAMS), and the Brief Medication Questionnaire (BMQ). The survey validated in the broadest range of disease states (including hypertension, dyslipidemia, HIV, Parkinson’s disease, type 2 diabetes, heart failure, and coronary artery disease) is the MAQ. This survey is only four items long, consists of simple yes or no questions, and has been shown to consistently detect non‐

adherence at the point of care. The SEAMS (validated in chronic disease states including coronary artery disease, hypertension, dyslipidemia, and diabetes) and BMQ (used in patients with diabetes, depression, and other chronic diseases) are 13 and 9 items long (respectively), and attempt to gauge other barriers to medication adherence. However, both of these scales are difficult to score at the point of care. Given national averages that put medication adherence at 50–60 percent, patient surveys are yet another useful tool in the pharmacist’s arsenal of improving patient care. The MAQ is the briefest, easiest to score, and most widely validated survey, although there are advantages of using other surveys in various patient populations. Given the type of patient and the time available, an appropriate survey can be selected and discussed with the patient at the point of care. Give it a try and see if you can make a difference in your patient’s adherence. Medication Adherence Questionnaire (MAQ) (Morisky, et al. 1986) 1. Do you ever forget to take your medicine? ❑ Yes ❑ No 2. Are you careless at times about taking your medicine? ❑ Yes ❑ No 3. When you feel better do you sometimes stop taking your medicine? ❑ Yes ❑ No 4. Sometimes if you feel worse when you take the medicine, you stop taking it? ❑ Yes ❑ No Reprinted with permission from National Community Pharmacists Association in the June 2011 issue of America’s Pharmacist. For more information about NCPA, visit www.ncpanet.org.

AUGUST 2014

FPA Officer and Director Nominations Although we have just finished the election for a President-Elect and Directors for the even numbered regions to be installed at the 2014 annual meeting, it is time to start thinking about nominees for the 2015 election since the nomination deadline is September 1 of this year (9/1/14). As the form below indicates, this year we will need candidates for President-Elect, Treasurer and Directors for the odd numbered regions. Please note that you may nominate yourself. CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2015 Elections The FPA By-Laws specify that any subdivision or any member in good standing may nominate one person for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The Treasurer shall serve a two-year term and may succeed to one consecutive term of office in that capacity. Nominees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for President-Elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for Treasurer should have good analytical skills and experience and ability in financial management and budget preparation. There are nine regional Board Directors who shall serve two year terms. Nominees must be a Florida registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, Board Directors must be a member of at least one the FPA Unit Associations within their region. Board Directors terms are staggered such that even numbered regions shall be elected in even numbered years and odd numbered regions shall be elected in odd numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annual meeting of the second ensuing year.

FPA CANDIDATE NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION: NAME: ADDRESS:

FOR THE FOLLOWING OFFICE:

(Nomination Deadline September 1, 2014)

q President-Elect q Treasurer q Board Director Region 1 Region 3 Region 5 Region 7 Region 9 NOMINATED BY: NAME: DATE SUBMITTED: SIGNATURE:

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2014

FLORIDA PHARMACY TODAY

David Laven Honored with James H. Beal Award

David Laven receives the Pharmacist of the Year Award from FPA President Terry Gubbins.

During the Florida Pharmacy Association’s 124th Annual Meeting & Convention held July 9-13, 2014, at the Harbor Beach Marriott Resort and Spa in Broward County, David L. Laven, RPh, NPh, CPh, FASHP, FAPhA, CDR, was named the 2014 recipient of the James H. Beal Award – “Pharmacist of the Year.”

The James H. Beal Award is given annually to recognize a pharmacist who has rendered outstanding service to pharmacy within the past five years. It is the Florida Pharmacy Association’s most prestigious honor to a Florida pharmacist. David Laven is a 1981 alumnus from the University of New Mexico – College of Pharmacy, and is a Florida registered pharmacist as well as a licensed nuclear pharmacist and consultant pharmacist. Since 2005, David has served Florida’s public sectors as a Drug Inspector with the Division of Drugs, Devices and Cosmetics – Florida Department of Business & Professional Regulation. The Longwood, Fla., resident was the recipient of this prestigious award in recognition of his numerous accomplishments and contributions to pharmacy and public health at the local, state, national, and international level over a 37-year career in health care services. David is a specialist in the area

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of radioactive drugs and the practice of nuclear pharmacy. He was recently recognized as an Emeritus Member of the Society of Nuclear Medicine & Molecular Imaging and has been involved in innumerous cutting edge events involving our industry’s first recognized specialty area involving nuclear pharmacy. His involvement with state, national and international organizations and agencies in the development of policy and regulations has been extensive. As an author/editor his endeavors have led to four books, 10 proceedings books for various state and international symposiums on nuclear pharmacy and nuclear medicine, eight book chapters, nine state and national newsletters in pharmacy and nuclear pharmacy. David has given over 160 presentations on topics in pharmacy, nuclear pharmacy and nuclear medicine to various local, state, national and international organizations throughout his career.

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AUGUST 2014 |

OPINION: The Affordable Care Act and its Implications for the Practice of Pharmacy Julienne Pauly, Pharm.D. Candidate 2015, Palm Beach Atlantic University The transition to a healthcare reform through President Obama’s implementation of the Patient Protection and Affordable Care Act (PPACA), or the “Affordable Care Act” (ACA), has come with important implications for both patients and practitioners with provisions that could directly impact pharmacists. This article serves as a brief review of the impact the new law will have through the discussion of pharmacy practice expansion and insurance reform, with emphasis on positions taken by national pharmacy organizations. The first important discussion point includes the “Centers for Medicare and Medicaid Innovation Center,” which supports the development of a new health care payment and delivery model.1 This statue includes “Medication Therapy Management,” or MTM, a special service provided by pharmacists. MTM is the process of managing a patient’s medication regimen to avoid medication errors such as duplication of therapy, dosing errors or drug interactions.2 The service includes adjustment of regimens through the refining, ordering and/or removal of medications, and the interaction allows the pharmacist to ensure patient adherence and management of chronic disease states. According to the National Community Pharmacists Association (NCPA) and American Pharmacists Association (APhA), pharmacists “add value to the healthcare system” through these services, where their role is “critical to

Health care reform has established “Integrated Care Models” which include pharmacists and their services. Examples of such models include the “Independence of Home Demonstration Program,” “Community-Based Interdisciplinary Teams” and the “State Option to Provide Health Homes for Enrollees with Chronic Conditions.”3 12

FLORIDA PHARMACY TODAY

the model’s success.”3,4 The ACA provides grants for the implementation of these MTM services, and is defined by 10 specific MTM service components, which are further incorporated into service models.2 An example of such a service model includes the Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model, Version 2.0, which includes medication therapy review, personal medication record, a medication-related action plan, intervention and/or referral, documentation and follow-up.2 The American College of Clinical Pharmacy (ACCP), notes that these MTM grant programs ensure the testing of “patient-centered self-management programs, that improve patient outcomes through team-based collaborations between prescribers and pharmacists.”5 To be provided government grants for MTM would be an appreciated reward for services that pharmacists already provide but without substantial payment. Health care reform has established “Integrated Care Models” which include pharmacists and their services. Examples of such models include the “Independence of Home Demonstration Program,” “Community-Based Interdisciplinary Teams” and the “State Option to Provide Health Homes for Enrollees with Chronic Conditions.”3 Accountable Care Organizations (ACO) are another integrated care model allowing for the collaboration of care between healthcare providers. These models capitalize on using specialized skills of clinicians in their respective practices and sharing cost responsibility for the care provided.6 ACO Medicare programs include the “Shared Savings Program,” “Advance Payment ACO Model” and “Pioneer ACO Model.”6 The Shared Savings Program provides incentive when innovative care is delivered with the maintenance of low healthcare costs. This Medicaid program shares profits with successful, cost-effective and innovative providers. As analyzed in a statement paper by the Academy of Managed Care Pharmacy (AMCP), pharmacists’ roles within ACOs include drug utilization reviews, medication adherence clinics, medication reconciliation, drug therapy management clinics and identification of gaps in therapy.7 ACCP feels that pharmacists, as the experts in pharmacotherapy, are warranted in this team-based approach.5 APhA is interested in participating within ACO entities to prove that pharmacists can help save costs while also improving patient care, and the American Society of Health-System Pharmacists (ASHP) sees working within ACO entities as the opportunity for hospital pharmacists to prove their “clinical and econom-

ic” value in a healthcare team.3,8 Another integrated care model is the “Patient-Centered Medical Home” (PCMH), which is defined through the Agency for Healthcare Research and Quality (AHRQ) as a model of organization of primary care.9 This medical home encompasses comprehensive care from a variety of healthcare providers, including pharmacists.9 Other functions of the model include patient-centered and -coordinated care, accessible services, quality and safety.9 ASHP makes mention of this medical home as being an opportunity for pharmacists to work within a team to provide care to the patient with chronic disease states.8 The success of these PCMHs will be contingent upon rewards for ensuring adequate counseling, following preventative measure strategy and achievement of established therapeutic goals.10 Unfortunately, innovative models such as these have not gone mainstream, but, where implemented, benefit is seen when pharmacists are part of the healthcare team. The Connecticut Medicaid Transformation project is an example of this, where a correlation between cost improvements in Medicaid patient outcomes and one-on-one MTM counseling with a pharmacist was established.11 “Transitional Care Models” are another product of the ACA; the intent here being testing of payment and service models in current programs to review expenditures and quality initiatives.3 Two projects included within the initiative can impact pharmacy: the “Community Based Care Transitions Program” (CCTP) and the “Partnership for Patients.”3 Pharmacists here have the potential to reduce hospital re-admissions through direct involvement in medication-related transitions of care.12 In Section 3026 of the ACA, the CCTP was created in an effort to test models for improving transitions of care between institutions and other settings, while also reducing re-admission rates for high-risk Medicare beneficiaries.13 This program also strives to document the savings to Medicare with said implementations.13 Rationale of the program stems from high re-admission rates. One in five Medicare patients who are discharged from the hospital are readmitted within a month, equating to a cost of more than $26 billion per year.13 The ACCP notes that pharmacists play an important role in transitions of care, where activities could range from medication reconciliation and discharge planning, to better use of patient medication records.5 In a statement to the HHS, NCPA shared the same sentiment, stating that pharmacists help promote improved medication utilization when patients change facilities.4 Aforementioned is the Partnership for Patients project, which has similar motives as the CCTP.3 An Ohio pharmacy has already implemented this program, in which community pharmacists follow discharged patients and have direct communication with hospital pharmacists.14 Expected outcomes include an increase in patient safety, a decrease in medication errors and an increase in patient satisfaction score.14 On January 1, 2014, the ACA made healthcare insurance mandatory. The increase in insurance holders will lead to an increase in the number of individuals receiving primary care and prescription drugs. According to National Association of Chain Drug Stores (NACDS), this creates an opportunity to

I stand with APhA and ASHP in support of the Affordable Care Act implications for pharmacists because I can appreciate the opportunities that it creates for the pharmacy profession. expand the role of pharmacists and other non-physician professionals to meet the needs of the now-insured patients.15 There is also a greater opportunity for pharmacy chains to increase business through their clinic, vaccination and medication-filling services. Some are hopeful that the increased need for prescription medications will in turn cause an increase in demand for pharmacists, making it easier to penetrate the already saturated job market. Retail chains have begun extrapolating upon the ACA through establishment of patient-aid programs. For example, the CVS Pharmacy Corporation has created an outreach program allowing customers to gain information about health insurance plans with the new healthcare changes.16 This program will be launched into those populations that are less likely to be insured and will also encompass healthcare screenings. CVS Pharmacy has also invited specialists in the insurance field to give patients the information they need for selection of the most appropriate place to cater to their needs.16 Walgreens Pharmacy has

Representing Health Care Professionals

• DOH Investigations • Licensure Discipline • Medicare/Medicaid Defense • Administrative Hearings • Contract Litigation George F. Indest III, J.D., M.P.H., LL.M.

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AUGUST 2014

created similar efforts, disseminating information through LearnAboutReform.com and partnering with Blue Cross Blue Shield to aid patients in plan selection.16 On a larger scale, NACDS has kept its members up to speed on Medicaid expansion and the open enrollment of insurance by holding webinars lead by expert speakers in the field.15 Hospital pharmacies are hopeful for the realization of benefits in payment and quality under the ACA. The increase in insured patients will allow for a decrease in uncompensated care and hospital-acquired conditions, and will strengthen performance standards as well as rates of hospital re-admissions.8 The “Disproportionate Share Hospital” payments that cover uncompensated care costs will be lowered under the law with more people insured.8 Healthcare-acquired conditions will also have prohibited payment models under Med-

Free preventative services are now available under the ACA for Medicare patients, including exams, shots, lab tests and screenings.20 Programs for health monitoring, along with counseling and education, are also included.20

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Pharmacist Attorney Brian A. Kahan, R.Ph., J.D. Licensed Florida Pharmacist and Attorney

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icaid, and Medicare will make payment cuts when hospitals exceed a certain threshold.8 Value purchasing programs will be in effect for hospitals meeting certain performance expectations, and hospitals with re-admissions within 30 days of discharge will receive reduced payments.8 All of these new implications impact pharmacists in terms of the care they provide as well as through the compensation received for their services. The insurance reform also comes with coverage of essential health benefits (EHB) which encompass ambulatory care services, emergency services, hospitalization, maternity and newborn care, mental health services, prescription drugs, rehabilitative services, laboratory services, preventative services and pediatric services.17 APhA actively advocated for the HHS to include pharmacist services, such as MTM, to the proposed rule.18 In a statement to the HHS, APhA stated they “believe that by making pharmacists’ clinical services more widely available through [essential health benefits], patients will benefit through these [preventative] services, physicians and other prescribers will have improved access to collaborative work with pharmacists as part of the health care team and [payers] will experience cost savings.”18 The HHS has allowed each state to establish their own benefits through working with the Center for Consumer Information and Insurance Oversight’s (CCIIO) state regulators, consumers, and other stakeholders.19 The APhA is arguing for states to include pharmacist-provided services as part of these benefits, citing the report from the U.S. Public Health Service (USPHS) office of the Chief Pharmacist that stated, “pharmacy care is an acceptable model of improved health care delivery.”18 In addition, pharmacist care meets the 10 categories required as a part of these essential benefits. Free preventative services are now available under the ACA for Medicare patients, including exams, shots, lab tests and screenings.20 Programs for health monitoring, along with counseling and education, are also included.20 The HHS recently partnered with pharmacies to educate these Medicare patients on the preventive services available to them as well as the closing of the Part D coverage gap.21 The APhA notes that pharmacies are visited more than other healthcare providers, creating the opportunity for pharmacists to disseminate important information to these beneficiaries.21 NCPA supports pharmacist involvement in these wellness promotion activities, noting that “pharmacy has gone from an emphasis on medication dispensing to one of effective medication use and optimal patient outcomes.”4 Also, there are grants awarded to states for the development of immunization demonstration programs targeting the improvement of vaccinations in specific patient populations.11 According to the NCPA, this funding allows pharmacists to have an expanded role in the administration of vaccinations to consumers under the ACA.4 In addition, there now exists coverage for tobacco cessation counseling, another outlet for pharmacists to participate in these wellness-based models.20 Other important implications for pharmacy practice as defined by the Summary of Provisions in the Patient Protection and Affordable Care Act: providing adequate pharmacy re-

Patients are looking for a change in the care they receive; they want healthcare providers to do more than what has been done in the past. It is time for pharmacists to step up to the plate. imbursement (sec. 2503); exemption of certain pharmacies from accreditation requirements (sec. 3109); Pharmacy Benefits Manager (PBM) transparency requirements (sec. 6005); providing adequate pharmacy reimbursement (sec. 2503); approval pathway for biosimilar biologic products (sec. 7002); and prescription drug rebates (sec. 2501), among others.22 Just as the Medicare Modernization Act of 2003 expanded the opportunities of practice for the pharmacy profession so, too, will the Affordable Care Act have a dramatic effect on progressing us toward practicing within the full scope of our licensure. It is with changes like these that doors open for pharmacist provision in patient care, an important step as we continue on the path toward provider status. While I feel that our foundational services as a profession are important to maintain, we must take on a different way of thinking and cater our practice toward new business models that prove invaluable to this healthcare reform. In fostering MTM, the ACA allows for pharmacists to provide the service we already do so well. Congress recognized when passing this legislation that patients need additional education and support for improved medication related outcomes; this is the time that pharmacists can prove how their services will contribute to a drastic reduction in the number of adverse related drug events occurring annually. For those who feel that we will never be recognized for our skills here, I would challenge a review of innovative models much like the Connecticut Medicaid Transformation project, which provides objective data of the pharmacistâ&#x20AC;&#x2122;s worth in MTM.11 Integrated Care Models such as ACOs and PCMHs will prove valuable through the establishment of a standard of care for patients, allowing for continuity and thus better health outcomes. It was actually noted that partnerships across patients, physicians, pharmacists and other care providers are desired by patients, which is further rationale for a movement toward pharmacists as active team players in healthcare. I agree with the national pharmacy organizations that collaboration across disciplines will be of much benefit for our profession. Pharmacists have historically struggled to prove their worth as part of the healthcare team; past opposition from other professionals has caused tension across the disciplines, using energy that should be exerted into improving the quality of patient care. It was once a fight to administer flu shots in the pharmacy, but through advocating and proving our worth, pharmacists have made that a standard. So, too, will we make our practice a standard of care for all patients; it will be the norm for the pharmacists to be part of the team for the patient. It will come with challenges, but if we can continue in this pursuit, I believe that we will see the change we so desire. Results of the recent 2014 Scorecard on State Health System Performance note that improvement can

be seen with coordinated efforts, but healthcare is still at a place where there is a lack of accessibility and costs are still driven upward.23 We need to use this information to drive us, to see the niche we can fill and help close the gap between mediocre and exceptional healthcare. Patients are looking for a change in the care they receive; they want healthcare providers to do more than what has been done in the past. It is time for pharmacists to step up to the plate. The Transitions of Care model is another opportunity for pharmacists to shine: their focus on medication management has proven benefits to health outcomes. Pharmacists can aid patients moving from the hospital setting to the community through ensuring no drug discrepancies exist, and from the community to the hospital to ensure no medication errors exist, which could result in worse outcomes and an extended hospital stay. In implementing programming to ensure prevention of hospital re-admissions, the CMS is recognizing that a change is warranted in that aspect of care. Through these services, pharmacists can contribute to a reduction in hospital re-admissions. Perhaps one innovative pharmacist would facilitate a hospital-to-retail-pharmacy communication program, where sharing of electronic medical records would allow for a decrease in fragmented care. The skeptic might suggest that patients would not appreciate the sharing of their health information, but recent data shows that patients feel all of their physicians should have access to their medical records.11 The insurance reform presents pharmacists with the opportunity to be included in essential health benefits. When we review all that EHB encompasses, it can be seen that pharmacists already have roles within the majority of these statutorily required service categories. Our clinical services would prove beneficial in fulfilling these requirements, but again, it will take active advocacy and proving of our worth through the other ACA programming to be recognized. The prevention and wellness healthcare movements will be key in proving the pharmacistsâ&#x20AC;&#x2122; value. It was noted in the 2014 Scorecard that better access to care is associated with improved primary and preventative services.23 Being that we are the most accessible healthcare professional, we can educate both our community and Medicare patients on how to maintain a healthy lifestyle. We have the training and expertise to discuss healthy eating, exercising, maintaining a healthy weight and smoking cessation. In addition, we already offer immunizations and screenings, and some pharmacy practice models allow for the review of laboratory values. This time of transition calls for pharmacists to be dynamic within their role and create innovative service models that become the standard of pharmacy practice. This should not be an effort to make ourselves more esteemed over our medAUGUST 2014

ical colleagues, but rather a time to work amongst them and prove the value we add to the health system, thus allowing for exceptional care for our patients. It is very exciting to explore the possibilities and new opportunities for pharmacists through the Affordable Care Act. I look forward to the potential new liberties afforded through it, and to eventually practicing to the full extent of my license. I know patience is required while the healthcare structure changes and pharmacists are recognized as providers; until then, I will maintain my zeal and advocacy for the profession as we prepare for a better tomorrow. References

1. The CMS Innovation Models. Centers for Medicare and Medicaid Services Website. A¬¬¬¬¬vailable at: http:// innovation.cms.gov/. Accessed November 26, 2013. 2. Steeb D, Webster L. Improving Care Transitions: Optimizing Medication Reconciliation. J Am Pharm Assoc (2003). 2012 JulAug;52(4):e43-52. 3. Health Care Reform- The Affordable Care Act. American Pharmacists Association Website. Available at: http://www. pharmacist.com/health-care-reform-affordable-care-act. 2012. Accessed October 3, 2013. 4. Request for Comments Regarding Exchange-Related Provisions in Title I of the Patient Protection and Affordable Care Act. National Community Pharmacists Associations. 2010. Available at: http://www.ncpa.co/pdf/leg/aug11/ patient_protection_affordable_care_act.pdf. Accessed August 24, 2014. 5. Pharmacy Practices for Healthcare Reform. American College of Clinical Pharmacists Website. 2008. Available at: http:// www.accp.com/docs/govt/advocacy/121208%20HCR%20 Principles.pdf. Accessed August 24, 2014. 6. Smith SM. The Affordable Care Act: Key Points for Pharmacists. University of New England Website. Available at: http://www.une.edu/sites/default/files/SSmith_ACA_2014_ DHK.pdf. Accessed August 24, 2014. 7. Pharmacists as vital members of accountable care organizations. Academy of Managed Care Pharmacy. Available at: http://www.amcp.org/WorkArea/DownloadAsset. aspx?id=14916. Accessed August 24, 2014. 8. The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act: Summary of Key Health-System Pharmacy Related Provisions. American Society of Health Systems Pharmacists Website. 2010. Available at: http://www.ashp.org/DocLibrary/SM2010/Health-CareReform-Reportsm2010.aspx. Accessed December 8, 2013. 9. Defining the PCMH. Agency for Healthcare and Research Quality. U.S. Department of Health and Human Services Website. Available at: http://pcmh.ahrq.gov/page/definingpcmh. Accessed August 24, 2014. 10. Matzke GR. Health Care Reform 2011: Opportunities for Pharmacists. Ann Pharmacother. 2012 Apr;46(4):S27-32. 11. Smith M, Giuliano MR, Starkowski MP. In Connecticut: improving patient medication therapy management in primary care. Health Aff (Millwood) 2011; 30: 646-54. 12. Pharmacy Organizations Launch Initiative to Improve Transitions of Care. American Pharmacists Association Website. 2012. Available at: http://www.pharmacist.com/ pharmacy-organizations-launch-initiative-improve-transitionscare. Accessed December 2nd, 2013. 13. Community-based Care Transitions Program. Centers for Medicaid and Medicare Website. Available at: http:// 16

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innovation.cms.gov/initiatives/CCTP/index.html. Accessed December 2nd, 2013. 14. Transitions of care: Taking action under the ACA. American Pharmacists Association Website. 2011. Available at http:// www.pharmacist.com/transitions-care-taking-action-underaca. Accessed August 24, 2014. 15. The Affordable Care Act is Here- and So Is NACDS. National Association of Chain Drugs Stores Website. Available at: http://www.nacds.org/Home/TabId/107/PostId/3749/ the-affordable-care-act-is-hereand-so-is-nacds.aspx. Accessed August 24, 2014. 16. Pharmacies Plan to Promote Benefits of the Affordable Care Act. Pharmacy Times Website. 2013. Available at: http://www. pharmacytimes.com/news/Pharmacies-Plan-to-PromoteBenefits-of-Affordable-Care-Act. Accessed December 8, 2013. 17. The Center for Insurance Information and Insurance Oversight. Additional Information on Proposed State Essential Health Benefits Benchmark Plans. Centers for Medicare and Medicaid Services Website. Available at: http://www.cms. gov/CCIIO/Resources/Data-Resources/ehb.html. Accessed August 24, 2014. 18. APhA to HHS: Include MTM in essential health benefits. American Pharmacists Association Website. 2012. Available at: http://www.pharmacist.com/apha-hhs-include-mtmessential-health-benefits. Accessed November 28th, 2013. 19. The Center for Consumer Information and Insurance Oversight. Centers for Medicare and Medicaid Services Website. Available at: http://www.cms.gov/cciio/index.html. Accessed on November 28th, 2013. 20. Your Guide to Medicare’s Preventative Services. Centers for Medicare and Medicaid Services Website. Available at: http:// www.medicare.gov/Publications/Pubs/pdf/10110.pdf. Accessed August 24, 2014. 21. Pharmacies partner with HHS to promote free preventative care. American Pharmacists Association Website. 2012. Available at http://www.pharmacist.com/pharmacies-teamhhs-promote-free-preventive-care. Accessed August 24, 2014. 22. Summary of Provisions of The Patient Protection and Affordable Care Act. Obama Care Facts: dispelling the myths. Available at: http://obamacarefacts.com/summary-ofprovisions-patient-protection-and-affordable-care-act.php. Accessed August 24, 2014. 23. Radley D, McCarthy D, Lippa J, et al. Aiming Higher: Results from a Scoreboard on State Health System Performance. The Commonwealth Fund Website. 2014. Available at: http://www.commonwealthfund.org/publications/fundreports/2014/apr/2014-state-scorecard. Accessed August 24, 2014.

PH AR M ACIST OBIT UAR IES James “Jim” Mitchell Harvey

Monroe W. Mack

James “Jim” Mitchell Harvey went to be with the Lord on Monday, July 14, 2014. Jim was born March 6, 1927, in Waldo, Florida, to Brainard M. and Mamie Forsyth Harvey. Growing up in Waldo, he met and later married his high school sweetheart, Dorothy Nellita Cowart of Williston, Florida. Jim attended Riverside Military Academy, was a United States Marine and graduated from University of Florida School of Pharmacy. In 1950 he and Nell moved to Tallahassee with a birddog and cedar chest, in their Model A Ford. They became pioneer members of St. Paul’s United Methodist Church and the Burleigh Law Sunday School Class. He practiced pharmacy and co-owned Burdines Drug Store for 35 years until his retirement in 1988. One of his greatest joys was raising and training his birddogs. In 1988, Jim began a second “career” when he went to work for close friends, Janie and Cottie Davison, managing Pine Woods Plantation, Gem Land Company, in Jefferson County. Many happy years of hunting and raising birddogs followed until he retired at 84 and returned to Tallahassee. Jim was predeceased by his beloved wife of 60 years, Nell; parents “Popie” and “Mamie” Harvey; a brother, Brainard Harvey; and a sister, Murial Harvey Turner. He is survived by a daughter, Janice M. Harvey; a son, Bryce M. Harvey (Terri); seven grandchildren: Karlee H. Copeland (Jeremy), Haley H. Clifton (Kyle), Erin H. Chapman (Mike), Carson H. Smith (Kirk), Julie James, Jamie R. Bellamy (Mike) and Logan Roy Rhodes; a sister, Myrtice H. Stolz of Winter Haven, Florida; and four great grandchildren, as well as wonderful caretakers and a host of extended family and friends. A memorial service was held on Friday, July 18, 2014, at St. Paul’s United Methodist Church. In lieu of flowers, memorial contributions may be made to Big Bend Hospice, 1723 Mahan Center Boulevard, Tallahassee, Florida, 32308, or Tallahassee Teen Challenge, 4141 Apalachee Parkway, Tallahassee, Florida, 32311.

Mr. Monroe W. Mack, 82, of Tampa, Florida, passed away Saturday, August 16, 2014. A Memorial Service was held Friday, August 22, 2014, at 11:00 a.m. at Ray Williams Memorial Chapel, 301 North Howard Avenue, Tampa, Florida 33606, with Reverend Louis Jones, officiating. The repast followed immediately at the Tampa Airport Hilton, 2225 North Lois Avenue, Tampa, Florida 33607. Mr. Mack attended Florida A & M University, and was a member of Alpha Phi Alpha Fraternity. He was employed as Director of Pharmacy at Tampa General Hospital. He is survived by his loving wife of 50 years, LaVerne Mack; one son, Gregory Griffin (Kathanell); two daughters, Traci Mack and Nicole Mack; one brother, Charlie Mack, Jr.; and other relatives and friends. In lieu of flowers, please make a donation to the Diamondback Pharmacy Alumni Council, P.O. Box 1062, Brandon, Florida 33509-1062. To submit an obituary of a former Florida pharmacist, please send an email or link to flpharmjournal@ gmail.com.

AUGUST 2014

Find Your Pharmacy Passion: A Student’s Perspective By Laura Rhodes, PharmD Candidate, Palm Beach Atlantic University, Class of 2015 I first realized that I wanted to be a pharmacist when I was in high school. Choosing a career is difficult for many people, but I suppose that subconsciously I have always known that this is a profession I would enjoy. Choosing to be a pharmacist was an easy decision for me, but I have also learned that many difficult decisions remain ahead. Ever since I began pharmacy school, I have had countless people, both friends and colleagues, ask me what kind of pharmacy I want to practice. My answer has always been, “You know, I do not know. I am trying to keep my mind open.” As I continue my pharmacy education, despite not knowing precisely where I want to practice, I have found it of utmost importance to identify what my passion is within the profession of pharmacy. In my pursuit of finding this key component of my career, I believe I have discovered a way to use my specific strengths and skills to further both my education and our profession. The secret to my success in finding my pharmacy passion lies within the following.

1. Identify your strengths Identifying your strengths is a key component to being able to pursue your pharmacy passion. It is a popular practice to focus on self-improvement and fixing our flaws. While this is important, it is just as vital to utilize our strengths in everyday practice. Knowing what tasks you are best at will help direct you toward what type of pharmacy you want to practice, organizations you want to be involved in, goals you want to achieve and types of activities you want to pursue. It can also help in building strong teams and committees, allowing different perspectives to come together and provide a well-balanced plan of action. 2. Get involved Approximately one year ago, I, alongside two of my fellow students from Palm Beach Atlantic University, submitted our first abstract to present an educational poster at the 2013 Florida Pharmacy Association (FPA) Annual Convention. From this my involvement in the FPA was born. Our abstract was accepted and we set out to attend

In my pursuit of finding this key component of my career, I believe I have discovered a way to use my specific strengths and skills to further both my education and our profession. the convention. After arriving at the convention, I began to learn a great deal about the profession of pharmacy. Additionally, I was asked to continue to get involved with the FPA by joining one of their councils. Since that time, I have been immersed in the inner workings of this organization and its members. I have learned how they operate, the pas-

FLORIDA PHARMACY TODAY

sions they pursue and how deeply they care about the advancement of the ever-changing profession of pharmacy. Serving on the educational affairs council provided me with an opportunity to meet many of the staff and officers of the FPA. Each and every person welcomed me with open arms, which allowed me to continue to find my place within the organization. Additionally, I was provided a means to pursue my passion of continuing education and academia. As I began to understand the vision of the association, I also learned about many of the events they worked to coordinate. The annual Florida Pharmacists Legislative Days and Health Fair is of particular interest to me. I actually attended this event as a first-year pharmacy student in the spring of 2012. This event provided me invaluable insight into how to advocate for pharmacy by demonstrating my unique skill set at the state Capitol. I have also learned the importance of being longitudinally involved with our legislators. By doing so, our legislators will know whether or not pharmacists are in support or oppo-

sition of a bill that is pertinent to pharmacy. In the past two months, I have had to pleasure of working with Suzanne Kelley, the new FPA president. As we discussed the Florida Pharmacists Legislative Days and Health Fair, she informed me that the event costs approximately $7,000 to coordinate. Thus, my most recent endeavor within the association

has involved educating members about the annual Florida Pharmacists Legislative Days and Health Fair, as well as generating donations to help sponsor the event. At the most recent FPA convention, I began a campaign called â&#x20AC;&#x153;Donate Your Latte Today for Our Health Fair Tomorrow.â&#x20AC;? Participants of the convention were urged to forgo their daily cup of coffee and donate that money toward the health fair instead. The campaign was fairly successful, raising just over $500 of donations for the 2015 Health Fair. The campaign was also held at the Florida Society of HealthSystem Pharmacists (FSHP) Annual Meeting in Orlando, in August. 3. Gain insight from others Whether on the giving or receiving end of mentorship, these relationships often prove to be of extreme value. Without having mentors to pour into my life, even from the very beginning, I would most likely not have chosen to be a pharmacist. I would not have gotten involved at my school. I certainly

am very much looking forward to mentoring new pharmacy students and even other pharmacists who need advice in one of my areas of expertise. 4. Keep pushing forward Oftentimes, especially as we are in the same position for a long period of time, it becomes easy to keep doing the same old, same old. Many of us go to work each day doing the same tasks that we did the day before. It is important, however, to continue to find ways to pursue our passion despite the dayto-day monotony. Over time our profession will change. Your interests and passions will change. For some, your strengths will even change. This is why it is so important to constantly evaluate where you are in your career and compare that to where you want to be. Always keep making new goals, re-evaluating your interests and pushing forward. Do not allow yourself or your vision to become stagnant.

Without having mentors to pour into my life, even from the very beginning, I would most likely not have chosen to be a pharmacist. I would not have gotten involved at my school. I certainly would not have chosen to present posters or join councils with a state organization. would not have chosen to present posters or join councils with a state organization. Because of my mentors, I have been pushed to do bigger and greater things and I am forever grateful. It is because I have been mentored that I have been able to make an impact within my profession. Further, because of the valuable mentors I have had in my life, I am prompted to become a mentor to others. Although I am young and relatively new to the profession of pharmacy, I still have unique strengths and skills. I

I am sharing these stories to demonstrate the importance of finding your passion, whatever it is, and pursuing it to further the profession of pharmacy. The FPA is made up of many hands, and it could not operate without the involvement of its employees and volunteers. If you havenâ&#x20AC;&#x2122;t heard it before, I am telling you now: We need you! I urge you, find your passion and let that drive you to make a difference. No matter what your interest is, there is a place for you within the various pharmacy organizations and institutions. No matter where or how you choose to get involved, get involved! You will be amazed at the difference you can make.

I am sharing these stories to demonstrate the importance of finding your passion, whatever it is, and pursuing it to further the profession of pharmacy. In many ways, we as pharmacists have the same skill set because of our extensive training. We all, however, have different interests, talents and passions. It is important to know that the Florida Pharmacy Association, in addition to other pharmacy organizations, is made up of people who have made an active choice to find their passion and use their skills to advance our profession. AUGUST 2014

DBPR Issues Statement on Prescription Transfers By John Lockwood On April 11, 2014, the Department of Business and Professional Regulation issued a declaratory statement to Publix Supermarkets clarifying the requirements for prescription drug wholesale distributor permits and maintaining pedigree papers. Publix requested the Department to determine whether the sale or transfer of a prescription between Publix pharmacies and the pharmacy warehouse was a “wholesale distribution.” Publix also requested the Department to determine whether individual Publix pharmacies can sell or transfer prescriptions to another Publix pharmacy or the chain pharmacy warehouse, without requiring the transferring pharmacy to obtain a prescription drug wholesale distributor permit and without a requirement to provide pedigree papers for those sales or transfers.

The purpose of a declaratory statement is to advise an individual or entity of the agency’s legal opinion concerning the applicability of statutes and rules to a particular factual scenario. A declaratory statement is generally considered to be binding upon the party requesting the opinion. The declaratory statement is not binding upon other individuals or entities, but agencies generally apply declaratory statements to other individuals and entities if the factual scenario is the same or substantially similar. The Department determined the sale or transfer of a prescription between Publix pharmacies was not a “wholesale distribution.” Therefore, the Department concluded that a Publix pharmacy could sell or transfer prescriptions to another Publix pharmacy without obtaining a prescription drug wholesale distributor permit. Further, a Publix pharmacy could sell or transfer a prescription to the chain pharmacy warehouse without providing pedigree papers. Based on the Department’s declaratory statement, any pharmacy can sell or transfer prescription drugs to another pharmacy or pharmacy warehouse if they are affiliates, and the sale or transfer is an intracompany transaction. There is no requirement for the pharmacies to obtain a Florida prescription drug wholesale distributor permit if the pharmacies 20

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e bl i la 7 va / A 24

This means that, until then, businesses with multiple pharmacies or a central warehouse can freely sell and transfer prescription drugs with each other.

are affiliate pharmacies. There is also no requirement to provide any pedigree papers for returns of prescription drugs to a chain pharmacy warehouse for affiliate businesses. Pharmacies and warehouses are affiliates when either one business controls or has the power to control the other business or a third party controls or has the power to control both business entities. The Publix pharmacies and chain pharmacy warehouse are affiliates because they are all businesses controlled by the same business, Publix Supermarkets, Inc. The declaratory statement is a temporary decision, and the rules may change when the secretary of the Food and Drug Administration sets the licensing standards for the recently enacted Federal Drug Quality and Security Act. This is expected by November 27, 2015. This means that, until then, businesses with multiple pharmacies or a central warehouse can freely sell and transfer prescription drugs with each other. John Lockwood is an attorney with the Lockwood Law Firm in Tallahassee.

PHARMACY CONSULTING & STAFFING SOLUTIONS Pharmacist & Technician Staffing Pharmacy Management Temporary & Vacation Coverage Open a Pharmacy (Retail & Compounding) Licensing for All States Medicaid & BOP Inspection Preparation Assistance with Insurances Policy & Procedures Buy/Sell a Pharmacy WE ARE PROVEN TO BE THE MOST RELIABLE AND TRUSTED STAFFING & CONSULTING FIRM EPC is Pharmacist Owned and Operated www.epcepc.com (855) 374-1029

AUGUST 2014

BUYER’S GUIDE florida PHARMACY TODAY

ADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

PHARMACY RESOURCES Abbott Diabetes Care Hernan Castellon (305) 220-0414 PPSC Retail Pharmacy Purchasing Program (888) 778-9909

LEGAL ASSISTANCE Kahan ◆ Heimberg, PLC Brian A. Kahan, R.Ph., Attorney at Law 561-392-9000 Fried Law Office, P.A. Dennis A. Fried, M.D., J.D. (407) 476-1427 The Health Law Firm George F. Indest III, J.D., M.P.A., LL.M. (407) 331-6620

PHARMACEUTICAL WHOLESALER

PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Bob Miller, BPharm, CPH (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPH President (855) 374-1029

TEMPORARY PHARMACISTS – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPH President (855) 374-1029 Rx Relief (800) RXRELIEF

McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953

Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.

FLORIDA PHARMACY TODAY

FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 412-4166 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm DRUG INFORMATION CENTER Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org NATIONAL COMMUNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org RECOVERING PHARMACISTS NETWORK OF FLORIDA (407) 257-6606 “Pharmacists Helping Pharmacists”