June 2014 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association JUNE 2014

AFPASUCCESSFUL SESSION Accomplishes All Four Legislative Priorities

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 23 FPA News & Notes 25 Buyer’s Guide

VOL. 77 | NO. 6 JUNE 2014 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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Florida Pharmacy Association 2014 Legislative Update Drilling Down on Drug Errors House of Delegates Speakers Report The Term “Organic Impurities” Is Not an Oxymoron

JUNE 2014

FPA Calendar 2014

JUNE 13

Convention Registration Deadline

Convention Hotel Registration Deadline

12-13 Florida Board of Pharmacy Meeting Deerfield Beach 23-24 Council and Committee Meetings Orlando

JULY 4 11

9-13

7-14

2014 Exhibitor Information FPA Annual Meeting and SE Gatherin’ Ft. Lauderdale

20-21 Ft. Lauderdale Clinical Conference Fort Lauderdale

124th Annual Meeting and Convention Ft. Lauderdale Government Affairs Committee Orlando AUGUST

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SEPTEMBER

Independence Day FPA Office Closed

31st Southeastern Gatherin’ Destin

FPA CE at SEA 2014 Cape Canaveral

OCTOBER 7-8

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

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...................................................................... 10 KAHAN HEIMBERG, PLC............................. 10 PPSC.................................................................... 11 Rx OWNERSHIP................................................. 2

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — (850) 906-9333 U/F — Dan Robinson (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 TERRY GUBBINS , FPA PRESIDENT

What a Year! What a year! What a great year for the Florida Pharmacy Association! We had perhaps our best legislative year ever in Tallahassee with multiple bills passed to advance our profession of pharmacy. It was also a great year for building a better, stronger relationship with our pharmacy student members. We updated our Mission Statement to “United to Advance Healthcare and Pharmacy Practice.” We created a new Strategic Plan that will allow us to execute our Mission Statement. And, we created our new logo: bright, crisp and colorful. First, let me tell you how we started on our legislative mission. After our annual convention in Orlando last July, only a few weeks passed before we started working for you. Our Governmental Affairs Committee (GAC), chaired by Shannon Wedekind, met on August 9, 2013, to plan and set our legislative priorities. Shannon presented the GAC’s recommendations to our Board of Directors on August 25, 2013. Those priorities included: 1. Advocate for pharmacist provider status 2. Advocate to remove “on the face of the prescription” language found in F.S. 893.04 and F.S. 456 3. Support efforts to fund the Prescription Drug Monitoring Program 4. Remove mandatory mail-order prescription requirements for state employees 5. Support efforts to expand pharmacist immunization services 6. Support efforts to revise auditing standards I’m proud to say we had success with all six items! Two days after the introduction of

H.R. 4190 in Washington D.C., which would amend title XVII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services, more than 400 pharmacists and students from 40 states participated in the NACDS RxImpact Day on Capitol Hill. Included in the 400 participants were eight members of the

Two days after the introduction of H.R. 4190 in Washington D.C., which would amend title XVII of the Social Security Act to provide for coverage under the Medicare program of pharmacist services, more than 400 pharmacists and students from 40 states participated in the NACDS RxImpact Day on Capitol Hill. Florida Pharmacy Association: Rizwan Khaliq, Georgia Lehoczky, Wesley Rohn, Sandra Vazquez, Ziad Ghanem, Shawn Rice, Chris Christopoulos and myself. After just completing Legislative Days in Tallahassee, we packed our bags and headed to Washington, D.C. It was an exciting time to be there, and

Terry Gubbins 2013-2014 FPA President

it was great to see a united pharmacy coalition having success at the Capitol. All of our visits with our legislators consisted of us introducing H.R. 4190 to them, since it was just introduced in the House. The initial responses were all positive! Just recently, one of the legislators that we met with, Representative Thomas Rooney, became a cosponsor of H.R. 4190. We lived our slogan this year, and were successful to Unite Pharmacy! We worked with the Florida Society of Health System Pharmacists and the Florida Independent Pharmacists Network, and negotiated a technician ratio bill that all could accept (HB 323). Included in the legislation was the provision that removes the requirement that information on controlled substance prescriptions must be “on the face of the prescription.” Another priority achieved! We advocated for legislation to fund the Prescription Drug Monitoring Program, with bills in the House and in JUNE 2014

2013 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.

Goar Alvarez............................................................................. Chairman of the Board Terry Gubbins...............................................................................................FPA President Suzanne Kelley......................................................................................... President Elect Alexander Pytlarz................................................................................................Treasurer Gary Koesten.............................................Speaker of the House of Delegates Bob Parrado....................................Vice Speaker of the House of Delegates Tim Rodgers, Director........................................................................................... Region 1 Michael Hebb, Director ......................................................................................Region 2 Stephen Grabowski, Director .......................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jason Beattie, Director ....................................................................................Region 5 Scott Tomerlin, Director.....................................................................................Region 6 Kimberly Jones, Interim Director................................................................ Region 7 Raul Gallo, Director.................................................................................................Region 8 Nadine Sebest, Interim Director..................................................................Region 9 Richard Kessler...................................................................................... President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair......................................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Vice Chair......................................................... Don Bergemann, don@bceinfo.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Member....................................................... Carol Motycka, motycka@cop.ufl.edu Member........................................................Cristina Medina, cmmedina@cvs.com Member................................................................Norman Tomaka, FLRX9@aol.com Member................... Verender Gail Brown, brownvgrx4304@hotmail.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

the Senate. We could not get these to the finish line. However, after the conclusion of the legislative session, during the next business day, Florida Attorney General Pam Bondi announced that her office would fund the PDMP for the next four years! Another priority achieved! For the past few years, state employees have been forced to get refills for their maintenance prescriptions by mail order only. One of our legislative priorities was to get this mandate removed

For the past few years, state employees have been forced to get refills for their maintenance prescriptions by mail order only. One of our legislative priorities was to get this mandate removed and allow state employees to get their refills through community pharmacies or by mail order. and allow state employees to get their refills through community pharmacies or by mail order. We achieved this priority with an amendment added to HB 5003 that describes how community pharmacies may also serve state employees and compete directly with mail order. Another priority achieved! We also were successful in supporting efforts to expand pharmacist immunization services. HB 323 allows pharmacists to administer the meningitis vaccine under protocol. The legislation also removes a requirement for a written prescription prior to the shingles vaccine being administered by a pharmacist and instead allows administration by protocol consistent with the standards of other vaccines. Another priority achieved! See Viewpoint, continued on p. 8

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FLORIDA PHARMACY TODAY

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

Convention is Where Pharmacy Practice Changes Begin

he practice of pharmacy is constantly changing with new drugs and new patient-care services delivered by our state’s licensees and registrants. The learning only begins when a professional degree is earned and a license to practice becomes a reality after passing state regulatory boards. The Florida Pharmacy Association has been a valuable resource for new information on emerging issues, and the annual meeting and convention of the FPA has been a buffet of practice-building tools. Pharmacists from all practice settings have found a number of programs relevant to their practice site including, but not limited to, long-term care, hospital ambulatory care, consulting and compounding. Even those not involved in direct patient care, such as those in pharmacy management and administration, find our extensive workshops and educational sessions to be valuable career-building resources. At the convention next month, some of the many issues we will be exploring include health management tips on diabetes, arthritis, natural medications, pneumonia, skin and soft tissue infections, antimicrobial agents, cystic fibrosis and asthma management. We will even be providing a program on new drug updates as well as a legislative and regulatory recap on items of interest to pharmacists, pharmacy owners and pharmacy technicians. Our goal with the 124th Annual Meeting and Convention is to have you leave with much more than you came with. If you spend four or five days with us, we believe that you will be able to reengineer your practice to meet today’s new quality standards.

Our convention is not just educational programs. This unique meeting gives participants the opportunity to network with each other face-to-face and to exchange new ideas and concepts. New practitioners learn from our seasoned members. Our experienced members get recharged through the energy of our young pharmacists and pharmacy students. Even after the convention is

Mark your calendar for July 9 – 13, 2014, for the 124th Annual Meeting and Convention of the FPA. over, our website has the tools to continue the networking connection virtually through Pharmivew.com. The Florida Pharmacy Association is asked all the time where we stand on various pharmacy practice issues. No one member gets to make that decision. The genesis of FPA policies and positions are discussed and decided on at the House of Delegates meeting during the convention. Invited and affiliated organizations have this one opportunity to place on the policy-discussion table items on which the FPA should take a stance. This is the one place where members can get their voices heard. While any member can submit a resolution, only those who can qualify as a delegate can actively participate in the House discussions. Of course, to be a delegate in the House you have to be an active FPA member and have a connection with your local pharmacy association. If you do not have a local pharmacy association, you can form one in your community. If you are not sure

Michael Jackson, B.Pharm

how to do that, you can receive guidance at the annual meeting from those who have local organizations and learn their process. While we are at the convention, we will take the time to acknowledge and recognize those within our profession who have done exceptional things and award excellence in service. The most prestigious of all awards is the James H. Beal Pharmacist of the Year award. The FPA has given this award to 75 pharmacists over the years. Come to the annual meeting to see who will be No. 76. Don’t forget it is at this meeting that the FPA will transition its leadership for 20142015. If you have questions or concerns, the new members of the FPA Board of Directors will be happy to hear from you. Mark your calendar for July 9 – 13, 2014, for the 124th Annual Meeting and Convention of the FPA. n JUNE 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............................................. Jennifer Pytlarz, Brandon Vice Chair...................Don Bergemann, Tarpon Springs Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Member.............................. Carol Motycka, St. Augustine Member....................................Cristina Medina, Hollywood Member................................. Norman Tomaka, Melbourne Member..............................Verender Gail Brown, Orlando 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

"Viewpoint" continued from page 6

We have all lived through numerous third-party pharmacy audits. Our legislative priorities included supporting efforts to revise auditing standards. Well, SB 702 does just that! Nine specific revisions were included in the legislation that will make audits more fair to pharmacists. Third-party audits will now be less aggravating for us. Another priority achieved! We replaced our lobbyist this year with Claudia Davant, Chelsea d’Hemecourt and the team from Adams Street Advocates. I cannot thank our new friends enough! The Adams Street Advocates team was there with us in the fall, planning and creating strategy, and there with us at the end as multiple pharmacy bills were passed. A banner year! Thank you, Adams Street Advocates! Even though the legislative session in Tallahassee took a lot of our time, we were able to achieve other successes for FPA: specifically, creating more engagement with our pharmacy student members. Last fall, we held a student membership drive. The University of South Florida won our $1,000 prize for having the highest percentage of student members in FPA (48%). In January, we held our first annual Young Pharmacist Leadership Conference in Orlando. Over 200 students and pharmacists attended. And at our 2014 Florida Pharmacists Legislative Days and Health Fair, I had the pleasure of presenting our first FPA Student Leadership Award to Ashley Rowand from the University of Florida. Ashley received a plaque and a $1,000 scholarship. The FPA Student Leadership Award was not our only investment in our student members. In May, the Florida Pharmacy Foundation awarded an additional $9,000 in scholarships. One student from each of the six Florida pharmacy schools received a $1,500 Walgreens/Florida Pharmacy Foundation scholarship. Our Organizational Affairs Committee, headed by Jackie Donovan, submitted a new Mission Statement to our Board of Directors, which was approved unanimously. “United to Advance Healthcare and Pharmacy Prac-

Even though the legislative session in Tallahassee took a lot of our time, we were able to achieve other successes for FPA: specifically, creating more engagement with our pharmacy student members. tice” eloquently states our mission. I applaud the committee for the many hours of work and discussion it took to create the Mission Statement, and I thank each of them. Members of our Board of Directors met this past winter to create a new Strategic Plan for our association. The 13-page plan is very thorough, sets goals that will truly advance healthcare and pharmacy practice and will make our association stronger. The Strategic Plan is available on our website. To go along with our new Mission Statement and Strategic Plan, we created a new logo. In our logo, the word PHARMACY stands out in our name. We used bright colors, a mortar and pestle emblematic of our history and a rising sun to represent our future. We also included an outline of Florida to show our state pride. My year as president of the Florida Pharmacy Association has flown by. I want to thank everybody for giving me this opportunity, and everybody who has helped us achieve our goals this year. We accomplished a lot. I’m very proud of the success of our association! It has been a pleasure. What a year! What a great year for the Florida Pharmacy Association! n

Florida Pharmacy Association 2014 Legislative Update

During the 2014 Legislative Session, the Legislature passed a $77.1 billion state budget and filed 1,812 bills while only passing 264. The number of bills passed this session is almost 22 percent fewer than the 10-year average of 338 bills. The Florida Pharmacy Association, along with their legislative advocacy team Adams St. Advocates, were successful in accomplishing all four of FPA’s legislative priorities: fair and uniform pharmacy audit practices, mail-order reform, pharmacy technician ratio and funding for the Prescription Drug Monitoring Program. SB 70 (Pharmacy Audits), requiring fair and uniform pharmacy audit rules by pharmacy benefit managers’ (PBMs), passed both chambers. This new law will provide predictability and common sense business practices for pharmacies to prepare and respond to audits by increasing efficiency and productivity.

Through budget proviso language, state employees will now have the option to purchase their 90-day maintenance drugs from retail pharmacies, instead of being required to only use mail order. This ability to visit and purchase from a retail pharmacy will allow employees better access to care and proper medication counseling. HB 323 (Pharmacy Technician Ratio), removing an arbitrary cap and allowing the Board of Pharmacy to approve the proper ratio, passed both chambers. The Board of Pharmacy makeup was also revised by increasing the number of actively practicing pharmacists to ensure patient safety is a priority in this process. The Board will now include two community pharmacists (currently practicing), two institutional pharmacists (currently practicing), four at-large pharmacists (any type of practice setting) and two consumers (in no way connected to pharmacy). Due to political dynamics, the House and Senate differed in their approach on how the Prescription Drug Monitoring Program (PDMP) should be accessed. The House and Senate both agreed to fund the PDMP program, however the vehicles in which the funding was included did not pass in the final hours of session. The Attorney General did announce that she will be using $2 million from a past settlement with Caremark to fund the PDMP for four years! Session began with a series of bills that would have addressed the physician shortage reported across the state. Two separate bills, SB 1352 and HB 1275 (Health Care Practitioners), would have expanded the powers of nurses and physician assistants to allow more independence from supervising physicians. Two other bills, SB 1646 and HB 751 (Telemedicine), would have provided regulation to the state’s budding telemedicine industry, and health-

care companies with ways to charge for it. In the last days of the session, the House incorporated all three lower chamber companions into HB 7113 (Health Care Trauma Train), which would have settled a legal dispute that could lead to the closure of three trauma centers. The massive health-care train bill cleared the House and was heavily amended by the Senate to remove any changes to the roles of nurses, physician assistants or the state’s telemedicine industry. Time ran out before the House could take up an amended HB 7113. In the last hours of the session, the House placed a trauma center provision in an amendment of HB 7105 (Health Care Services Rulemaking), but it was rejected in the last moments by the Senate. The trauma centers dispute will now be addressed by the state Department of Administrative Hearings later this month. OTHER BILLS OF INTEREST THAT WERE ADOPTED BY THE FLORIDA LEGISLATURE: HB 7177 - Relating to OGSR/Department of Health Passed unanimously in both House and Senate Chambers Open Government Sunset Review Act (OGSR)/Prescription Drug Monitoring Program: Revises provisions relating to public record exemption for certain information held by DOH pursuant to the prescription drug monitoring program; specifies that certain entities may disclose confidential and exempt information in certain instances if such information is relevant to active investigation; requires certain steps to ensure continued confidentiality of non-relevant confidential and exempt information before disclosure of such information; authorizes DOH to disJUNE 2014

close relevant information, rather than requiring DOH to disclose confidential and exempt information; saves exemption from repeal Effective Date: October 1, 2014 HB 7077 - Relating to Nonresident Sterile Compounding Permits Passed unanimously in both House and Senate Chambers Nonresident Sterile Compounding Permits: Expands penalties to apply to injury to nonhuman animal; deletes requirement that Board of Pharmacy refer regulatory issues affecting nonresident pharmacy to state where pharmacy is located; provides that pharmacy is subject to certain health care fraud provisions; requires registered nonresident pharmacies and outsourcing facilities to obtain permit in order to ship, mail, deliver or dispense compounded sterile products into this state; authorizes board to deny, revoke or suspend permit, or impose fine or reprimand for certain actions; provides dates by which certain nonresident pharmacies

must obtain permit; authorizes board to adopt rules; authorizes department to inspect nonresident pharmacies and nonresident sterile compounding permittees; requires such pharmacies and permittees to pay for costs of such inspections Effective Date: October 1, 2014 SB 360 - Relating to Sentencing for Controlled Substance Violations Passed unanimously in the Senate and with 113 yeas and 2 nays in the House Sentencing for Controlled Substance Violations: Providing that a person who knowingly sells, purchases, manufactures, delivers or brings into this state, or who is knowingly in actual or constructive possession of, specified quantities of hydrocodone, or any salt, derivative, isomer or salt of an isomer thereof, or any mixture containing any such substance, commits the offense of trafficking in hydrocodone; providing that a person who knowingly sells, purchases, manufactures, delivers or

brings into this state, or who is knowingly in actual or constructive possession of, specified quantities of oxycodone, or any salt, derivative, isomer or salt of an isomer thereof, or any mixture containing any such substance, commits the offense of trafficking in oxycodone, etc. Effective Date: 7/1/2014 HB 517 - Relating to Fraudulent Controlled Substance Prescriptions Passed unanimously in both House and Senate Chambers Fraudulent Controlled Substance Prescriptions: Revises provisions prohibiting possession of incomplete prescription forms; provides enhanced criminal penalties for violations involving incomplete prescription forms Effective Date: October 1, 2014 SB 836 - Relating to Medical Gas Passed the House with 115 yeas and 1 nay, and in the Senate with 36 yeas and 0 nays The bill creates part III of ch. 499,

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F.S., which separates the regulation, including permit requirements, of manufacturers and wholesale distributors of medical gases, as well as medical oxygen retail establishments, from the provisions of part I and part II of the chapter, which regulate the manufacturers and distributors of other drugs, devices and cosmetics. The bill includes many provisions governing medical gases that are substantially similar to existing provisions in part I, but revises those provisions for applicability to medical gases. The provisions of new part III require: ■■ Permits for medical gas manufacturers and wholesale distributors and medical oxygen retail establishments; ■■ Minimum qualifications for obtaining a permit to deal in medical gases; ■■ Certain procedures to change a permit; ■■ Security and storage of medical gases; ■■ Returned, damaged and outdated

medical gases to be handled in a certain manner; ■■ Penalties for committing prohibited and criminal acts associated with medical gases; and ■■ Inspections of facilities that manufacture medical gases The bill requires rules adopted under part III to be consistent with the law and rules governing the possession and use of medical oxygen by emergency medical service providers in part III of ch. 401, F.S. SB 1030 - Relating to Cannabis Passed the House with 111 yeas and 7 nays, and the Senate with 30 yeas and 9 nays SB 1030 names the act, the “Compassionate Medical Cannabis Act of 2014.” This bill changes the definition of lowTHC cannabis to mean a plant of the genus Cannabis, the dried flowers of which contain 0.8 percent or less of tetrahydrocannabinol (THC) and more than 10 percent of cannabidiol (CBD) weight for weight; the seeds thereof; the

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resin extracted from any part of such plant; or any compound, manufacture, salt, derivative, mixture, or preparation of such plant or its seeds or resin that is dispensed only from a dispensing organization. The bill expands who may be ordered low-THC cannabis under the act to include a patient suffering from cancer. As a condition of prescribing low-THC cannabis, the physician must determine that no other satisfactory treatment options exist and obtain a voluntary informed consent. The final version of the bill does not include the Senate’s requirement that the physician must have treated the patient for at least two months and does not provide for the issuance of a patient identification card. Criminal misdemeanor penalties are created for a physician who orders lowTHC cannabis for a patient without a reasonable belief that the patient is suffering from a qualifying condition and for any person who fraudulently represents himself or herself as having a qual-

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ifying condition for the purpose of obtaining an order for low-THC cannabis. A dispensing organization is required to employ a medical director, who must be a physician and have successfully completed a course and examination that encompasses appropriate safety procedures and knowledge of low-THC cannabis. One dispensing organization is authorized in northwest Florida, northeast Florida, central Florida, southeast Florida and southwest Florida, for a total of five statewide. Additional criteria for approval as a dispensing organization include: possessing a certificate of registration for the cultivations of more than 400,000 plants that is issued by the Department of Agriculture and Consumer Services, be operated by a nurseryman, have been operating as a registered nursery in this state for at least 30 years, and provide certified financials. Upon approval, a dispensing organization must post a $5 million performance bond. The bill excludes “low-THC cannabis from the definition of cannabis in s. 893.02, F.S. Additional emphasis is placed on research in the final version. Medical centers that are recognized as a Cancer Center of Excellence are authorized to conduct research on CBD and low-THC cannabis. The Department of Health’s Office of Compassionate Use is directed to enhance access to investigational new drugs for Florida patients through approved clinical treatment plans or studies, with specific authorities to accomplish this directive. One million dollars is appropriated in nonrecurring general revenue to the James and Esther King Biomedical Research Program for research of CBD and its effect on intractable childhood epilepsy. A constitutional amendment allowing doctors to prescribe marijuana to ease the side effects of some debilitating illnesses will be up to Florida voters in November. The ballot initiative is unrelated to SB 1030.

FLORIDA PHARMACY TODAY

BILLS OF INTEREST THAT WERE NOT ADOPTED BY THE FLORIDA LEGISLATURE: SB 1014/ HB 765 - Relating to Pharmacy Benefit Managers (MAC Pricing) SB 1014 passed through three of the four committees unanimously. There was great discussion and we hope to have this brought up again in the 2015 legislative session. Pharmacy Benefit Managers; Specifying contract terms that must be included in a contract between a pharmacy benefit manager and a pharmacy; providing restrictions on the inclusion of prescription drugs on a list that specifies the maximum allowable cost for such drugs; requiring a contract between a pharmacy benefit manager and a pharmacy to include an appeal process, etc. Effective Date: 7/1/2014 SB 1266/HB 1361 - Relating to State Employees’ Prescription Drug Program Although SB 1266 and HB 1361 failed, we were successful in accomplishing changing the requirement for state employees to use mail order to making it an option between retail pharmacies or mail order through budget proviso language. CS/SB 1266 amends s. 110.12315(2), Florida Statutes, relating to the state employees’ prescription drug program, to allow the Department of Management Services to negotiate a dispensing fee for 90-day maintenance drugs at retail, and to authorize a 90-day supply of maintenance prescriptions to be filled at retail. The bill also limits the reimbursement for retail and mail order purchases to the amount contracted by the department for prescriptions fulfilled by mail order. SB 1646 - Relating to Telemedicine / HB 751 - Relating to Telehealth Both SB1646 and HB 751 failed. CS/SB 1646 would have created the Florida Telemedicine Act (the act) and defined the key components for the practice of telemedicine. The act establishes telemedicine as the practice of medicine through advanced commu-

nications technology by a telemedicine provider at a distant site. A telemedicine provider would be a physician or physician assistant licensed under ch. 458 or ch. 459, F.S., an advanced registered nurse practitioner licensed under ch. 464, F.S., or a pharmacist licensed under ch. 465, F.S., who provides telemedicine services or an out-of-state physician who meets the specific requirements for an exemption from Florida licensure. The standard of care for telemedicine service coincides with health care services provided in-person. A controlled substance may not be prescribed through telemedicine for chronic non- malignant pain. Regulatory boards, or the Department of Health (DOH) if there is not an applicable board, may adopt rules to administer the act. Rules prohibiting telemedicine that are inconsistent with this act must be repealed. The bill’s fiscal impact was indeterminate. SB 1384- Relating to Pharmaceutical Services SB 1384 was referred to three committees: Banking and Insurance; Governmental Oversight and Accountability; Appropriations, and later withdrawn from consideration. SB 1384 would have created provisions relating to health insurers, and amended provisions relating to health maintenance organizations, to provide that an insured or subscriber may not be required to obtain pharmaceutical services from a mail order pharmacy; providing that a pharmacy that is not a mail order pharmacy is subject to the same terms and conditions as a mail order pharmacy, etc. Effective Date: 7/1/2014

JUNE 2014

Drilling Down on Drug Errors Don McGuire, R.Ph., JD, General Counsel Pharmacists Mutual One of the staples of the Pharmacists Mutual Claims Study for the last decade or so has been the listing of the top 11 drugs delivered to patients in the Mechanical Error claims. Mechanical Error claims are defined as providing the wrong drug, the wrong strength of the right drug or the wrong directions on the label. Mechanical Errors occur because of how our brains are wired and how we process information. They are not a reflection of competence or intelligence. These “human errors” are the most common, making up 85 percent of the claims in the study. With any good risk management program, techniques must be put in place to minimize the potential for error. In this article, we will go deeper into the data to help you better understand the risk potentials. The examples we will use from the top 11 drugs include warfarin, levothyroxine, insulin, oral hypoglycemics and prednisone. The inclusion on this list tells you that these drugs are problematic, but that, in and of itself, doesn’t give you much of

FLORIDA PHARMACY TODAY

a clue as to why or how they are problematic. Levothyroxine is delivered to patients in 5.7 percent of the Mechanical Error claims, making it the second most common drug on the list. Simply telling the staff to be careful when dispensing levothyroxine is not very helpful. However, looking further at the data, we find that two-thirds of the time, the wrong strength of levothyroxine is dispensed. This is not surprising considering that there are now 12 strengths available. It is also not surprising that only 3.6 percent of these claims involve the wrong directions since the oncedaily dose is so ubiquitous. While the 29 percent of patients who received levothyroxine when they should have received something else isn’t insignificant, it is more efficient to tackle the is-

sue of wrong strength first. It focuses on one issue and gives the greatest potential for a reduction in errors. This same logic holds true for warfarin. Warfarin is delivered incorrectly in 7.1 percent of the claims. Again, most of these are delivering the wrong strength of the 9 strengths available. This happens about 60 percent of the time. There is a little more variability in dosing, so we see wrong direction errors increase to just over 12 percent. Patients received warfarin instead of their intended drug in 27.5 percent of claims. As with levothyroxine, the greatest potential reduction in errors will occur by focusing on the strength dispensed. The data tells us that we don’t want to use this approach when we are dealing with insulin and oral hypoglycemics. Delivering the wrong strength of

For insulin, patients received the wrong drug 71 percent of the time. For oral hypoglycemics, the frequency was a whopping 88.6 percent!

these drugs is not that frequent, 16 percent and 9.5 percent respectively. Insulin claims account for 3.3 percent of our mechanical errors and oral hypoglycemics account for 4.5 percent. This 7.8 percent total is significant when the effectiveness of these drugs’ actions is linked to them being frequently dispensed incorrectly. For insulin, patients received the wrong drug 71 percent of the time. For oral hypoglycemics, the frequency was a whopping 88.6 percent! The focus for these two groups of drugs should be making sure that the proper drug is being dispensed. Techniques that are useful here are “Show & Tell” counseling and the “NDC Check.” Again, focusing on the one of the three possible errors that gives the biggest return on effort increases the chance for the staff to receive positive feedback. The last example is one where neither of the above approaches will work best. Prednisone is the drug delivered in 3.2 percent of our Mechanical Error claims. For prednisone, however, the types of errors involved are more scattered. Patients received the wrong drug in just under 36 percent of claims. Prednisolone, methylprednisolone, dexamethasone and other steroids contribute to these errors. Patients received the wrong dose almost 42 percent of the time. Here there are six tablet strengths and two concentrations of oral liquids that contribute to these errors. Prednisone is not a drug with an overwhelming “regular” dose like levothyroxine is. The result is that wrong directions make up 22 percent of the prednisone errors. Different factors make it so that no one category dominates the type of errors committed. So how do we pro-

ceed with prednisone? We might be able to tackle all three categories at once if it was the only drug, or one of a few drugs, that we were approaching that way. Tackling all drugs that way would be too overwhelming. We might also start with the wrong strength situations since that makes up 42 percent of the claims. Another approach is to examine the error history in your practice setting specifically. Perhaps you vary from the broad sample that contributes to the Pharmacists Mutual Claims Study and a more specific problem will identify itself within your pharmacy. The data in our Claims Study is drawn from a wide variety of pharma-

cies. The value in examining it is that it provides a head start to any pharmacy’s risk management program by allowing them to learn from others’ mistakes. Specialty pharmacies’ experiences will likely be different. It is also provides valuable information about where to attack the whole idea of dispensing errors. Telling someone to be more careful is not terribly effective alone. It is too broad. Telling them to make sure that the right strength of levothyroxine is being dispensed is more useful and effective. The key is to get started. Little victories inspire us to achieve greater victories.

Telling someone to be more careful is not terribly effective alone. It is too broad. Telling them to make sure that the right strength of levothyroxine is being dispensed is more useful and effective. The key is to get started. JUNE 2014

House of Delegates Speakers Report Gary Koesten – Speaker, FPA House of Delegates It has been my pleasure to serve as your Speaker of the House of Delegates this past year. I have had t he plea su re to travel to the pharmac y ass o c i at io n s i n Alachua, Brevard, Escambia and Palm Beach counties as an officer of FPA. The House of Delegates is the membership’s voice. It is the forum by which YOUR VOICE, directly or through your local unit association, can bring to the table subjects that YOU consider important. These subjects are presented to the House of Delegates each year, at convention, as Resolutions. These Resolutions, once presented, are discussed under Roberts Rules and are voted on by the registered delegates at the annual convention. One important consideration is that a Resolution has to be submitted to the House prior to the published deadline. If a Resolution is submitted after the deadline, it can only be considered by the House if the majority of delegates agree to suspend the rules allowing the Resolution to be heard. These Resolutions, once passed by the House, serve as direction for the leadership of FPA for the coming year. This year, I am happy to report that there will be a decent number of Resolutions that have been submitted in a timely fashion that will be considered by the House. I’m positive there will be much discussion on some of these Resolutions. Our theme at FPA is “United to Advance Healthcare and Pharmacy Practice.” The voice of the House of Delegates exemplifies our unity in this regard. For your benefit, what follows is an update of previous Resolutions and actions that have been taken. 16

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★★★★★ 2011 Resolutions PRESCRIPTION INFORMATION:

The FPA shall pursue the change of FS 893.04 to remove the wording “on the face of the prescription (2011-3) Resolution passes Referred to Governmental Affairs Committee As of the date this report was written, there is pending legislation, that if passed, this Resolution will sunset. ★★★★★ 2012 Resolutions LIMITATION AND REVERSAL OF PHYSICIAN SCOPE OF PRACTICE EXPANSION INTO DISPENSING (2012-4)

Resolution passes Referred to Governmental Affairs Committee This is a policy statement and the Resolution was made part of the Resolution Manual. ★★★★★ 2013 Resolutions

ABOLISH THE PRACTICE OF GIFTS FOR TRANSFERRING EXISTING PRESCRIPTIONS BETWEEN PHARMACIES (2013-1)

Resolution passes Referred to Professional Affairs Council This is a policy statement and the Resolution was made part of the Resolution Manual.

PHARMACISTS TO BE RECOGNIZED AS HEALTH CARE PROVIDERS (2013-4)

Resolution passes Referred to Governmental Affairs Committee This is an action item. ■■ FPA is active in advocating for this to the Florida Legislature, AHCA and other grass-root efforts by APhA and other national organizations FPA TO OPPOSE ANY CHANGES TO CURRENT PHARMACY TECHNICIAN RATIO (2013-6)

Resolution passes Referred to Governmental Affairs Committee This is an action item. ■■ As of the date this report was written, this remains open until pending legislation is resolved FPA TO INVITE FSHP TO UNITE AS ONE SINGLE STATEWIDE PHARMACY ASSOCIATION (2013-7)

Resolution passes as amended This is an action item. ■■ FPA Ad Hoc Committee formed consisting of FPA President, Speaker of HOD and Organizational Affairs Council Chair to seek dialogue with FSHP CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) TO CLARIFY DEFINITION OF “QUALIFIED PROVIDER” IN MEDICATION THERAPY (MTM) RULES (2013-8)

Resolution passes Referred to Governmental Affairs Committee ■■ Letter to CMS in support of federal legislation pending that relates to pharmacist status

The Term “Organic Impurities” Is Not an Oxymoron We see the word “organic” all the time in supermarkets, and when we do it connotes something devoid of chemicals. Conversely, “impurities” are contaminations and pollutants. While these words may seem like opposites, it really depends on how they are used. The word organic can refer to any carbon-based substances, so for medications, organic (or carbon-based) impurities can occur – they can be found in some active pharmaceutical ingredients (API) or finished pharmaceutical products (FPP). Carbon is the foundation of all naturally occurring life, what could be so bad about having it in medication? While carbon is the foundation of all naturally occurring life, in the case of your medication it can be unwanted or even unsafe. Organic impurities in medication can result from the manufacturing process, storage processes or because ingredients change over time. Impurities, organic or otherwise, in medications have no therapeutic value and are potentially harmful if not controlled. To keep people and animals safe, impurities need to be understood, tested for and limited in medications. How can I make sure my medication doesn’t have organic impurities? You can’t, because these impurities are byproducts of making and storing drug substances and drug products. However, we all want to make sure that quality standards are used to limit impurities in medications to appropriate levels. What impurities standards are there? The United States Pharmacopeial Convention (USP) improves lives through public standards and related programs that help ensure the quality, safety and benefit of medicines and foods. Recently USP proposed new and revised standards for organic impurities in drug substances and drug products as part of a broader effort to develop modernized standards that will incorporate current scientific thinking and innovations. Basically, older standards are being updated with new insights and new technology.

and/or regulators) to their discussions. Expert Panels are not decision-making bodies, but rather serve as advisory groups to one or more Expert Committees which oversee their work. In this case, the Expert Panel is being overseen by the “Physical Analysis Expert Committee.” The volunteers serving on this Committee and all USP Expert Committees are required to serve as individual experts, using their best personal, professional, and scientific judgment, and not serve any outside interests, including that of their employers. In other words, Expert Committee volunteers (who oversee Expert Panel work) are exceptionally knowledgeable in their fields and are required to provide their unbiased expertise to draft and/or update standards. Can others provide feedback? Absolutely! Drafts of the new and revised standards appear in the May-June 2014 issue of Pharmacopeial Forum (PF) – USP’s free-access, online publication for posting proposed changes to currently official public standards. USP strongly encourages comments through the PF, particularly from industry, academia, regulatory agencies and other interested parties. The public comment period for these changes will end on July 31, 2014. To access the PF go to: www.usp.org/usp-nf/pharmacopeial-forum, register (if you haven’t already) and click on “ACCESS PF NOW.” Content for this piece was provided by United States Pharmacopeial Convention (USP). It may be freely reproduced and distributed, for non-commercial use only. The Florida Pharmacy Association is Voting Member of the USP Convention. USP is a global health organization that improves lives through public standards and related programs that help ensure the quality, safety, and benefit of medicines and foods. USP’s standards are used worldwide. For more information about USP, visit http://www.usp.org.

Who is deciding what organic impurity standards to use? These revisions are being proposed by USP’s “Organic Impurities in Drug Substances and Drug Products Expert Panel,” a group of expert volunteers. USP’s Expert Panels are formed to provide additional expertise on a particular topic. Volunteer Expert Panel members are encouraged to bring the perspectives of the communities they represent (i.e., industry JUNE 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

Florida Pharmacy Association

2014 Summer Conferences

This year’s convention theme is UNITE PHARMACY! The profession of pharmacy is transforming and has grown from being dispensers of pills and capsules, to dispensers of knowledge and services. Pharmacists today do Medication Therapy Management, Chronic Disease Management, Diabetes Education, Prevention and Wellness Services, and other patient-education services. As a result, there has been better patient care! Continuing education courses will be offered for consultant and general licenses, as well as pharmacy technician registration. The convention will address current and emerging topics that will keep you abreast of the constant change in the practice of pharmacy. The following educational courses offered will

be offered: Immunology, Infectious Disease, Pulmonology, New Drugs, Med Errors, etc. In addition, there will be a preconvention program on Diabetes Management which will provide the most current information evolving in the world of diabetes. Let’s UNITE PHARMACY with your colleagues at the Marriott Harbor Beach Resort & Spa in Ft. Lauderdale for FPA’s 124th Annual Meeting & Convention. Get involved and become aware of the state and national issues facing the profession; expand your professional network; increase your knowledge from captivating speakers, especially the delivery of the keynote address by Dr. Daniel E. Buffington, PharmD, MBA. JUNE 2014

Florida Marriott Harbor Beach Resort & Spa Pharmacy Ft. Lauderdale, Florida Association July 9 – 13, 2014

124th Annual Meeting & Convention Room Rates

• $155 single/double occupancy for standard deluxe room. The room reservation deadline is Friday, June 20, 2014 or when room block is full. Thereafter, reservations may be taken on a space available or rate available basis. • Please be sure to ask for the Florida Pharmacy Association group rate. The check-in time is 4:00 PM and the checkout time is 11:00 AM. • Room reservations can be made by calling (888) 789-3090. • Guest self parking is $8 per day. Valet parking is $30 per day.

Dr. Daniel E. Buffington, PharmD, MBA

Keynote Speaker

Thursday thru Sunday

Originally from Clearwater, Florida, Dr. Buffington did his under graduate work in biochemistry at the University of South Florida in Tampa, Florida. He received his Doctor of Pharmacy (PharmD) and Masters of Business Administration (MBA) degrees from Mercer University in Atlanta, Georgia. He also completed his Clinical Pharmacy Practice Residency and Clinical Pharmacology Fellowship at Emory University Hospital in Atlanta, Georgia. Dr. Buffington is nationally recognized for the development of a private “Clinical Pharmacology” specialty practice model that provides Medication Therapy Management (MTM) consult services, a clinical research trial center, a national drug information center, and forensic pharmacology service. The practice also services as an active training site for pharmacists, physicians and nurses and is affiliated with several different colleges of pharmacy and medicine. His practice focuses on patients who take chronic or high-risk medication therapy and provides a common resource point between patients and their various prescribers to optimize therapy and reduce risks of adverse effects and drug interactions. He has served on many different state and national committees, task forces, and organization panels in both medicine and pharmacy organizations. He currently serves on the national collaborative called the Pharmacists Services Technical Advisory Coalition (PSTAC) and the represents all pharmacists on the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel and helped to develop the national billing codes that describe pharmacists’ services.

GEnErAl EDucAtion trAck The general education track will offer courses designed to educate pharmacists on a wide variety of important topics pertaining to the profession of pharmacy practice. Specific courses being offered are Reducing Medication Errors, HIV/AIDS, and the always-popular offering of Florida Legislative Update. There will also be a New Drug Update course which focuses on the most recently FPA approved drugs introduced into the market.

Thursday thru Saturday

conSultAnt EDucAtion trAck The consultant education track will provide pharmacists with the most current information available on various topics that pharmacists encounter in the profession of pharmacy. The specific topics being offered include Immunology, Infectious Disease, and Pulmonary Disorders. There are 15 hours available for consultant pharmacists.

StuDEnt AnD tEcHniciAn trAck Thursday thru Sunday

Students and Technicians will benefit from interacting with practicing pharmacists and attending student and technician focused continuing education programs. The technician track offers several hours of continuing education on a variety of topics, including the required courses for Florida registration and PTCB renewal: Medication Errors, Pharmacy Law and HIV/AIDS for initial renewal. The student track consists of several hours of fun and exciting continuing education, such as The Career Forum and the NASPA/NMA Game Show. Students will also have an opportunity to participate in the Patient Counseling Competition and showcase their Poster Presentations.

PrE-conVEntion EDucAtion Wednesday Only

Special Events

Our traditional Wednesday program will focus on Diabetes Management. Diabetes mellitus is a chronic disease associated with abnormally high levels of blood glucose. Pharmacists play a vital role in the management and patient education of diabetes. The program will focus on the most current information evolving in the world of diabetes. The diabetes program will offer 6 hours of live continuing education credit. Register for this outstanding program and walk away with valuable knowledge for you and your diabetic patients. A separate registration fee is required for the pre-convention program. Exhibits: Participate in our grand opening reception in the exhibit hall! Poster Presentations: Browse submissions from pharmacy students. Contact the FPA office for more information if you would like to submit a poster presentation. Awards ceremony reception: Honor outstanding practitioners during the awards presentation. President’s Breakfast: Attend the Sunday morning installation of new officers. receptions: Enjoy catching up with your colleagues as the Universities entertain their alumni and friends, and as the FPA Foundation hosts FAMILY NIGHT OUT. House of Delegates: Be a delegate or observer and see how important member participation is to the direction of the Association. Student Events: Participate in the Adopt-A-Student Mentor Social and Volleyball Tournament. Students will benefit from interacting with practicing pharmacists, attending student focused continuing education programs and learning first hand about the FPA and how involvement can improve their chosen profession. Call the FPA office and offer to mentor or sponsor a student. Florida Pharmacists Political committee (FPPc) luncheon: Purchase a ticket to this luncheon to support your Political Committee. FPA Golf Event: Join us Friday for the FPA Golf Event. Please register early to reserve your space.

FPA 124th ANNUAL MEETING & CONVENTION • JULY 9 – 13, 2014 • INFO (850) 222-2400

FPA News & Notes FPA Launches New Logo The FPA leadership is pleased to announce that a new logo and brand has been adopted by the FPA Board of Directors. This new image contains a revised color palette as well as markings consistent with our industry and state. Association staff is working to transition all of our publications and media (as well as Stat News and the FPA website) to this new design. This change constitutes a tremendous amount of input from FPA leadership including elected regional directors across Florida. We hope that you like our new brand and are proud of our efforts. Medicaid Managed Care Complaint Form Online In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency for Health Care Administration (AHCA) to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components: the Managed Medical Assistance program and the Long-term Care program. There is a list of frequently-asked questions on the AHCA web site that may assist you with questions on the transition efforts. Also, members need to be aware that the FPA has been informed of a complaint process where you or your patients can file your concerns online. You can report a complaint by navigating through the link in this article, or by going to the FPA website and selecting “links of interest” on either the homepage or subpages of Pharmview.com. Go down to the section of the landing page where we have posted government links. You will see a link labeled “Agency for Health Care Administration Managed Care Complaint Form.” We understand that AHCA will be monitoring these submissions very carefully. Statewide Medicaid Managed Care (SMMC) Marketing Restrictions (from AHCA) The Agency for Health Care Administration would like to make you aware of important marketing restrictions related to the Statewide Medicaid Managed Care program. SMMC managed care plans’ contracts with network providers are required to specify that the provider shall comply with the marketing requirements specified by the Agency in the plans’ SMMC contract.

These requirements include, but are not limited to, a requirement that any marketing materials related to the SMMC program that are displayed by the provider be submitted to the Agency for written approval before use. Marketing material, per federal regulations [see 42 CFR § 438.104], means materials that 1) are produced in any medium, by or on behalf of a managed care plan, and 2) can reasonably be interpreted as intended to market to potential enrollees. This includes any of the plan’s employees, affiliated providers, agents or contractors. Additional limitations on provider-based marketing include, but are not limited to, the following: To the extent that a provider can assist a recipient in an objective assessment of his/her needs and potential options to meet those needs, the provider may do so. Providers may engage in discussions with recipients should a recipient seek advice. However, providers must remain neutral when assisting with enrollment decisions. Providers may not: 1. Offer marketing/appointment forms 2. Make phone calls or direct, urge or attempt to persuade recipients to enroll in the Managed Care Plan based on financial or any other interests of the provider 3. Mail marketing materials on behalf of the Managed Care Plan 4. Offer anything of value to induce recipients/enrollees to select them as their provider 5. Offer inducements to persuade recipients to enroll in the Managed Care Plan 6. Conduct health screening as a marketing activity 7. Accept compensation directly or indirectly from the Managed Care Plan for marketing activities 8. Distribute marketing materials within an examroom setting 9. Furnish to the Managed Care Plan lists of their Medicaid patients or the membership of any Managed Care Plan Providers are permitted to make available and/or distribute Managed Care Plan marketing materials as long as the provider and/or the facility distributes or makes available marketing materials for all Managed Care Plans with which the provider participates. The Agency does not expect providers to proactively contact all Managed Care Plans; rather, if a provider agrees to make available and/or distribute Managed Care Plan

JUNE 2014

marketing materials it should do so knowing it must accept future requests from other Managed Care Plans with which it participates. Providers are also permitted to display posters or other materials in common areas such as the provider’s waiting room. Additionally, long-term care facilities are permitted to provide materials in admission packets announcing all Managed Care Plan contractual relationships. Should providers under contract with SMMC Managed Care Plans have questions regarding marketing activities under SMMC, you should contact the Managed Care Plan(s) to inquire of provider education, outreach and monitoring resources available to the plan’s network providers to assist with complying with specified marketing requirements. Furthermore, the Medicaid Provider Agreement stipulates: “the provider agrees to comply fully with all state and federal laws, rules, regulations and statements of policy applicable to the

Medicaid program, including the Medicaid Provider Handbooks issued by the agency, as well as all federal, state and local laws pertaining to licensure, if required, and the practice of any of the healing arts.” Section 409.912(20), Florida Statutes, prohibits any entity contracting with the Agency to provide health-care services to Medicaid recipients from engaging in certain marketing practices or activities. Medicaid Fee-for-Service (FFS) providers engaging in prohibited marketing practices or activities may be subject to appropriate enforcement actions including, but not limited to, termination of participation in the Medicaid program. HHS Announces $300 Million to Expand Services Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced the availability of up to $300 million under the Affordable Care Act to help the nation’s community health centers expand service hours, hire more

medical providers and add oral health, behavioral health, pharmacy and vision services. For more information, visit the HHS website. Governor Scott Signs Budget Governor Rick Scott has signed Florida’s $77 billion budget. There were about $69 million in vetoes ordered for certain legislative projects. Of interest to the members of the Florida Pharmacy Association is our effort to advocate for state employees to have a choice of pharmacy providers. The Association, working with our lobby team, got language inserted into the state budget that removes many of the mandatory mail-order restrictions that have been problematic for state employees over the years. Once the new provisions of the state group health plan is implemented, patients will have a choice of their pharmacy provider if the pharmacy agrees to the network provider contract terms. Visit with us at the FPA annual meeting in July for more information.

The All-new FPA Website is Now Online Pharmview 3.0 offers more features, greater access and increased opportunities for member interaction. ■■ ■■ ■■

■■

Keep your dues current with the most accurate information in your membership accounts Register for conferences and educational programs Register online and you can print a receipt instantly without having to wait for one to be mailed to you Your continuing education credits earned through FPA programs will be published as transcripts and certificates in your member record

Take advantage of all the possibilities and visit your new website today at www.pharmview.com. 24

FLORIDA PHARMACY TODAY

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

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”

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.

JUNE 2014