The Official Publication Of The Florida Pharmacy Association AUG. 2010
2010-2011 FPA President Humberto Martinez PRSRT STD US POSTAGE PAID TALLAHASSEE, FL PERMIT NO. 801
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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 20 Buyer’s Guide
VOL. 73 | NO. 8 AUGUST 2010 the official publication of the florida pharmacy association
Features
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Pharmacists’ Immunization Activities in Florida, 2008-09
FPA Membership Benefits
AUGUST 2010
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FPA Calendar 2010
August 28 – 29 FPA Council, Committee and Board Meetings Marriott Orlando Airport September 1
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Deadline for Nomination for FPA President Elect, Regional Director and Treasurer Offices Labor Day FPA Office Closed
11 – 12 FPA Clinical Consultant Conference PGA National Resort, Palm Beach Gardens
November 6 - 7
10 - 12 ASCP Senior Care Pharmacy Meeting Orlando, Florida
FPA Midyear Clinical Conference Renaissance Orlando Airport
12-13 Board of Pharmacy Meeting Residence Inn - Tallahassee 23 – 27 NCPA Annual Meeting Philadelphia, Pennsylvania
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 is-
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Veterans Day FPA Office Closed
sues bearing on pharmacy and newsworthy items
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Florida Pharmacy Council Meeting Orlando, Florida
journal, it solicits and accepts advertising congru-
25 – 26 Thanksgiving Day Holiday FPA Office Closed
October 2 - 3
FPA Committee and Council and Board Meetings (By conference call)
Mission Statements:
December 2010 4 – 5
5 – 9
FPA Law and Regulatory Conference Hyatt Regency Sarasota Sarasota, Florida ASHP Midyear Clinical Meeting Anaheim, California
14-15 Board of Pharmacy Meeting Gainesville, Florida 24 - 27 Christmas Holiday
For a complete calendar of events go to www.pharmview.com 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, 2011 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in 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
of interest to the profession. As a self-supported ent 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 Associa-
tion members to secure appropriate advertising to assist the Journal in its goal of self-support.
Advertisers Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L............................................ 9 mckesson.......................................................... 2 PPSC.................................................................... 11 Rx RElief............................................................ 9
CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (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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E-mail your suggestions/ideas to dave@fiorecommunications.com
The President’s Viewpoint HUMBERTO MARTINEZ, FPA President
Exciting Year Will Focus on Four Key Areas of FPA Strategic Plan Editor's Note: The following is a transcript of the presidential address at the 120th FPA Annual Meeting and Convention in Marco Island, Florida. Good morning. Thank you all for being here this early in the morning to see your officers being installed. This year promises to be another exciting year in MTM services, pharmacist’s immunizations, and member recruitment. It is amazing that we are wide awake this early in the morning after the partying that we did last night. A good number of us stayed late after dinner and we closed the dance floor. The pharmacy students were great with their energy and we tried to keep up as best we could. We will continue to work with our strategic plan and the four key focus areas: ■■ Membership services, recruitment and retention ■■ Public policy, politics and advocacy ■■ Transitioning role of the profession ■■ Financial viability of the association ■■ And also to continue to keep our vision of the FPA: “To be the premier organization representing pharmacy stakeholders in their endeavors to provide quality healthcare.” I have the pleasure to have in front of you the chairs of the FPA’s standing councils and committees. For Public Affairs Council, the chair is Suzanne Kelly. Her council will be in charge of both state health fairs and under her direction the council will organize, recruit and coordinate our efforts in this area.
For Organizational Affairs Council, the chair is Kim Murray. Her council will be working on the FPA’s bylaws and constitution changes. Under her direction, these changes will go for approval to the Board of Directors and
This year promises to be another exciting year in MTM services, pharmacist’s immunizations, and member recruitment. the House of Delegates and then on to the ballot for final approval from the members. This council will continue to oversee the FPA awards selection process and coordinate the process for the local unit’s awards. For Educational Affairs Council, the chair is Jennifer Pytlarz. She will coordinate and work to continue to maintain and produce the quality continuing education programs that the FPA is already well- recognized for. For Professional Affairs Council, the chair is Eric Alvarez. This council has
Humberto Martinez, 2010-2011 FPA President
been charged to develop, refine, and implement changes to our practice act. They will focus on making the pharmacist more centralized in the delivery of primary health care as well as address the House of Delegates directives that have been referred and work closely with the Board of Directors and the Legislative Committee for the implementation of new practice standards. For Legislative Affairs Committee, the chair is David Andrews. He will oversee the prioritization of our legislative agenda with the feedback from our membership. This committee will coordinate our grass- roots efforts with the state Legislature and keep in constant communication with our lobbyist and our membership during the legislative session. During legislative days at the Capitol, we had great participation from our members and students. One company in particular, Walgreens, was very active at the Capitol. They AUGUST 2010
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2009/2010 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 deligently all year long on behalf of our members.
Karen Whalen.......................................................................... Chairman of the Board Humberto Martinez..................................................................................FPA President Robert Parrado........................................................................................ President Elect Don Bergemann.....................................................................................................Treasurer William Riffee.............................................Speaker of the House of Delegates Suzanne Wise............ Vice Speaker of the House of DelegatesPreston McDonald, Director.................................................................................................. Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Al Tower, Director ..................................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Kim Murray, Director............................................................................................ Region 7 Joy Marcus, Director...........................................................................................Region 8 Ayala Fishel, Director...........................................................................................Region 9 Alissa Fuller................................................................................................ President FSHP Michael Jackson........................................Executive Vice President and CEO
had all of their pharmacy supervisors from the state of Florida in Tallahassee and were actively participating in our health fair and legislative visits. I would like to thank Terry Gubbins for coordinating them with the FPA for successful health fair and legislative visits. And, I challenge the other pharmacy chains in the state to do the same with our efforts to keep our profession at the forefront of patient care. In closing, I would just like to say that if my actions inspire others to Dream More, Learn More, Do More and Become More, then I will be satisfied that I have done a good job as your president. Thank you for having the confidence in electing me your president. I am here to serve. Thank you again. n Your 2010-2011 FPA President, Humberto “ Bert� Martinez
Florida Pharmacy Today Journal Board Chair................................................................. Betty Harris, beejpharm@gmail.com Vice Chair...........................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com
JOIN TODAY! Florida Pharmacy Association
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Executive Insight By Michael Jackson, FPA Executive by michael jackson,Vice RPhPresident/CEO
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Understanding Florida Technician Regulations
f you are confused by the new laws and rules related to pharmacy technicians, you certainly are not alone. New laws and subsequent rules published by the Florida Board of Pharmacy have created sweeping new standards and a regulatory identification for Florida’s pharmacy technicians. We have published information on these changes in Stat News and also this journal as well as presented them at various Association continuing-education programs on several occasions. In some cases, our own members have struggled to grasp this new concept. Hopefully, in this article we can help you understand the new changes and what pharmacists and pharmacy technician obligations are. Unfortunately, those who are not members of the Florida Pharmacy Association will likely not receive this and will have to discover what to do on their own. To understand these changes, let us visit Senate Bill 1360 from the 2008 legislative session. That bill created the FPA-supported changes to Florida Statutes 465 requiring pharmacy technicians in this state to become registered. This issue goes even farther back to 1995 with the FPA House of Delegates meeting in Boca Raton. At this meeting, resolution 95-25 was placed into policy by the affiliated and invited pharmacy organizations in this state. It mandated that the Legislature should require pharmacy technicians to be certified. This issue was revisited in 2007 during the 117th Annual Meeting and Convention of the FPA in Marco Island where the members and delegates advocated for the Association to seek legislative changes that call for the mandatory registration of pharmacy
technicians in Florida. Senate Bill 1360, as signed into law by the governor of Florida, created the following new standards for anyone holding themselves out to be a pharmacy technician in this state: ■■ Requires the Board of Pharmacy to adopt rules on registration ■■ Requires registered technicians to be at least 17 years old
Hopefully, in this article we can help you understand the new changes and what pharmacists and pharmacy technician obligations are. ■■
■■
■■ ■■ ■■
Requires 20 hours of continuing education (4 hours live, 2 hours med errors and pharmacy law) Registration must be available to the public as well as board inspectors Pharmacy interns are exempt from registration as a technician Technician students are exempt from registration as a technician Pharmacists who have received disciplinary action are not eligible to register as technician
Also included in this law was the following grandfather clause for indi-
Michael Jackson, B.Pharm
viduals currently working as technicians: By January 1, 2011, Registered Technicians must have: ■■ Completed a Board-approved training program or ■■ Have completed a certification program approved by the National Commission for Certifying Agencies (NCCA) or ■■ Have worked a minimum of 1,500 hours under a licensed pharmacist So what does all this mean and what are my obligations as a technician or supervising pharmacist? Let us try to answer this with some frequently asked questions. Registered Pharmacy Technician Frequently Asked Questions Question: Why do I have to register as a pharmacy technician? AUGUST 2010 |
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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
Membership Coordinator Ranada Simmons , ext. 110
Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chair..................................Betty Harris, Lighthouse Point Vice Chair.................................. Jennifer Pytlarz, Brandon Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member................. Don Bergemann, don@bceinfo.com Member..................................... Joseph Koptowsky, Miami Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee
This is a peer reviewed publication. ©2010, 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 Address: http://www.pharmview.com 8 |
Florida Pharmacy TodaY
Answer: Section 465.014, Florida Statutes (F.S.) was amended during the 2008 legislative session requiring all pharmacy technicians performing the duties as described in Rule 64B1627.420, Florida Administrative Code (F.A.C.) to be registered to work in the state of Florida. Question: What happens if my registration application was not approved on January 1, 2010, and I do not have a registration number? Answer: You should not be working as a registered pharmacy technician. Once your application has been approved and a registration number issued, you will be able to work as a registered pharmacy technician in Florida. Question: May I register online? Answer: Beginning October 1, 2009, pharmacy technician registration may be completed using an online process by visiting http://www.flhealthsource. com. You will need a valid email address, valid mailing and physical address, and payment by credit, debit card or other payer code. Question: Where can I get an application form? Hard copy applications are available on the http://www.doh.state.fl.us/mqa/ pharmacy website and may be mailed to Florida Board of Pharmacy, P.O.B 6320, Tallahassee, FL 32314-6320 along with appropriate fees and supporting documents. Question: What is the initial fee for registration? Answer: A person who wishes to register as a pharmacy technician must submit a completed application and a $105 fee to the Board of Pharmacy. The fee is composed of the following: ■■ Application processing fee of $50 ■■ Initial registration fee of $50 ■■ Unlicensed activity fee of $5.00 ■■ Cashier checks or money orders are to be made payable to the “Department of Health.” The application will be reviewed within 30 days.
Question: How can my employer pay for my registration? Answer: Instead of the employee providing their own credit card for payment when completing the online registration application, they will have the option to enter the ‘Other Payer Code’ to complete the application process. The application will be uploaded for processing and will stay in pending status until the employer makes the payment. Interested employers will need to register with the Florida Board of Pharmacy as an Other Payer and receive an Other Payer Code. Question: Who is responsible if my employer fails to pay my registration? Answer: The applicant is responsible for submitting the required fees. Question: How do I know if the Board has approved a training program? Answer: Approved training programs may be identified by checking the Board of Pharmacy website at http://www.doh.state.fl.us/mqa/pharmacy or by visiting www.CEBroker. com. Question: Am I required to take a state exam or national certification exam to register as a pharmacy technician? Answer: No, a state or national certification exam is not required to be a registered pharmacy technician through December 31, 2010. However, any person wishing to provide proof of their national certification before December 31, 2010, will meet the educational requirements for registration. Question: Can I work in a pharmacy as a technician if I plan to take the national certification exam in the future? Answer: Applying to take the Pharmacy Technician Certification Board (PTCB) or Institute for the Certification of Pharmacy Technicians (ICPT) is not considered enrollment in a Board approved training program. You may not work as a pharmacy technician unless you are registered or enrolled in a Board approved training program. If you want to work while waiting for the certification by an agency accredited by the National Commission for Certify-
ing Agencies, you must be enrolled in a Board approved training program. Question: How do I submit my previous work experience as a technician to apply for the 1500 hours work experience credit? Answer: The experience must be recorded on the Pharmacy Technician Work Experience Form. This form is available in the Pharmacy Technician application packet or in the online application if you are applying by this method. At the end of your online application process, after you input your payment method, you can download the form and return to the Board of Pharmacy. Question: Is work experience as a technician in other states acceptable Answer: Yes, as long as it is documented on the Pharmacy Technician Work Experience Form. This form is available on the website at www.doh.state.fl.us/mqa/pharmacy.
Question: What laws and rules govern registered pharmacy technicians? Answer: Florida registered pharmacy technicians are governed by Section 465.014, Florida Statutes, and Rule 64B16-26.103, 64B16-26.350, 64B16-26.351, 64B16-27.410, 64B16-27.420, F.A.C. The FPA has available as a member benefit the laws and rules governing the practice of pharmacy. To access this information, sign into www.pharmview.com with your username and password. Question: Does a person newly hired to be a pharmacy technician have a “grace period” before they need to be registered with the Board of Pharmacy? Answer: No. However if the person is enrolled in an approved pharmacy technician training program, that person can work as a pharmacy technician without registering with the Board. Once the person has completed the training program, they must register with the Board in order to continue practicing as a pharmacy technician. Pursuant to Rule 64B16-26.351(2), F.A.C.
student technicians must complete a board approved training course. Question: If I am a registered intern, will I need to register as a pharmacy technician? Answer: No, a registered intern may work as a pharmacy technician and is exempt from being registered with the Florida Board of Pharmacy only during their internship. Question: I am a foreign-trained pharmacist. Will I need to register as a technician? Answer: Yes. Question: Will any technician certificate program be approved for technician registration in Florida? Answer: Approved pharmacy technician training programs include those approved by American Society of Health-System Pharmacists, Southern Association of Colleges and Schools, Florida Department of Education or Florida Commission for Independent Education, programs provided by a branch of the federal armed servic-
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es that provide a certificate of completion as well as Board approved employer based training programs. Members need to note that this rule is still under revision as you read this. Please refer to Rule 64B16-26.351(2), F.A.C.
days prior to the expiration.
Question: Can I work if I am not a registered pharmacy technician in Florida? Answer: No, pharmacy technicians must be registered before starting to work in Florida.
Question: What are the requirements for continuing education? Answer: Registered Pharmacy Technicians are required to obtain a minimum of 20 contact hours of continuing education (CE) per biennial renewal period of which 4 hours must be via live presentation and 2 hours must be related to the prevention of medication errors and the law.
Question: Will a pharmacy techniciantraining program taken in another state be accepted in Florida for registration? Answer: Yes, if you have taken a pharmacy technician training program approved by the Florida Board pursuant to Rule 64B16-351, F.A.C. You will be required to submit an application, fees and supporting documentation.
Question: Do I have to obtain credits from any particular providers? Answer: Yes. In order to meet the CE requirements, courses must be either ACPE approved or approved by the Florida Board of Pharmacy. Any credits taken that do not meet these requirements cannot be used to satisfy CE hours.
Question: Am I required to report a change of address when I move? If so, how do I do this? Answer: Yes, you may update your address online at www.flhealthsource. com.
Question: What crimes or licensure discipline must be reported on the application? Answer: All convictions, guilty pleas, and nolo contendre pleas must be reported, except for minor traffic violations not related to the use of drugs or alcohol. This includes misdemeanors, felonies, “driving while intoxicated (DWI)” and “driving under the influence (DUI).” Crimes must be reported even if they are a suspended imposition of sentence. All prior disciplinary action against any other professional licenses must be reported, whether it occurred in Florida or another state or territory.
Question: Am I required to report change of employment location each time? Answer: Yes, you are required to notify the Department within 10 days of a practice location change. Question: What happens to my registration if I cease employment as a registered pharmacy technician? Answer: The registration remains active until the registration expires or renewed for the next biennial. Question: What is required to maintain pharmacy technician registration? Answer: A pharmacy technician must submit a $55 biennial renewal fee and complete 20 hours of pharmacy continuing education appropriate for pharmacy technicians as required in Rule 64B16-26.103, Florida Administrative Code (F.A.C.).
Question: Can a person obtain registration as a pharmacy technician if they have a misdemeanor or felony crime on their record? Answer: Each application is evaluated on a case-by-case basis. The board considers the nature, severity, and date of offenses, as well as rehabilitation and other factors. The board cannot make a determination for approval or denial of licensure without evaluating the entire application and supporting documentation.
Question: How will the Department notify me when my registration is about to expire? Answer: Renewal cards will be sent to the last mailing address of record 90
Question: Do I have to report charges if I completed a period of probation and the charges were dismissed or closed? Answer: Yes. Offenses must be re-
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ported to the board even if you received a suspended imposition of sentence and the record is now considered closed. Question: What type of documentation do I need to submit in support of my application if I have a prior criminal record or licensure discipline? Answer: (1) Certified official court document(s) relative to your criminal record, showing the date(s) and circumstance(s) surrounding your arrest(s)/conviction(s), section(s) of the law violated, and disposition of the case. This would normally consist of the Complaint or Indictment, the Judgment, Docket Sheet or other documents showing the disposition of your case. This may also be referred to as the Order of Probation. The clerk of court must certify these documents. (2) Certified copy of document(s) relative to any disciplinary action taken against any license. The documents must come from the agency that took the disciplinary action and must be certified by that agency. (3) A detailed description of the circumstances surrounding your criminal record or disciplinary action and a thorough description of the rehabilitative changes in your lifestyle since the time of the offense or disciplinary action, which would enable you to avoid future occurrences. It would be helpful to include factors in your life, which you feel may have contributed to your crime or disciplinary action, what you have learned about yourself since that time, and the changes you have made that support your rehabilitation. Members need to be aware that this is an obligation for pharmacy technicians to fulfill. This is a new concept for these individuals who will most likely need your guidance and support. There is a perception that completing a technician “certification” program such as passing the Pharmacy Technician Certification Board (PTCB) examination will satisfy Florida requirements. Remember that this is currently one of three options available to “grandfather” current pharmacy technicians into full registration status. These options are available only until the end of this year.
Beginning January 1, 2011, the only way to become registered in Florida as a technician is to successfully complete one of the Board approved technician training programs as defined by rule. It is recommended that you verify the registration status of your pharmacy technicians. You can do so by visiting a link at the bottom of the www. pharmview.com homepage and doing a licensure search. Technicians who are fully registered should have an expiration date of December 31, 2012. Technicians who are conditionally registered will have an expiration date of December 31, 2010, and will need to submit to the Board evidence of either having passed the PTCB exam, worked 1,500 hours under a licensed pharmacist or have completed a Board approved training program. To keep their registration status they will need to do the required CE each biennium and “renew” their registration just like each of us have to renew our pharmacist license.
Change in Journal Printing Schedule Due to the importance and timeliness of the immunization study released this month, the Journal board decided to print this issue in addition to posting it online as scheduled. Next month's issue, which will feature the award-winners and festivities from the FPA Annual Convention in Marco Island, will be printed and posted as scheduled. This schedule change will result in the October, November and December issues of the Florida Pharmacy Journal to be posted online and not printed.
Finally, encourage your pharmacy technicians to become members of the Florida Pharmacy Association. They can join online for $30 or they can call our office at (850) 222-2400 and our staff will be very happy to assist them. With their new registration status they will need to be informed on pharmacy issues just as you are. See you in Aventura in 2011. n
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Pharmacists’ Immunization Activities in Florida, 2008-09 Earlene Lipowski, RPh, PhD Bingcao Wu, BS Karen Whalen, PharmD, BCPS, CDE
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BIOGRAPHIES Earlene Lipowski, PhD, Professor, Pharmaceutical Outcomes & Policy, University of Florida. Bingcao Wu, BS, Graduate Student, Pharmaceutical Outcomes & Policy, University of Florida. Karen Whalen, PharmD, BCPS, CDE, Clinical Associate Professor, Distance, Continuing & Executive Education, University of Florida; and President, Florida Pharmacy Association Declaration of funding interests: This study was self-funded. The authors have no conflicts of interest to declare. ABSTRACT Objective: To describe immunization practices of Florida pharmacists during the 200809 flu season. Participants: all certified pharmacist immunizers registered by the Florida Board of Pharmacy as of May 30, 2009 (N=1,467) Method: Survey. Main outcome measures: Self-reported training and vaccination activities of Florida pharmacists for the 2008-09 flu season, the type and characteristics of their practice settings, and the opportunities and challenges of providing immunizations in pharmacy settings. Results: Most certified pharmacist immunizers (86%) received immunization training through their employer and the vast majority of those certified (89%) administered influenza vaccine during the 2008-09 flu season. Nearly all of the survey respondents worked in a community-chain pharmacy (74%) or a pharmacy located within a grocery store (21%). The pharmacists reported that customers frequently asked about
the availability of other vaccines, such as pneumococcal pneumonia vaccine, which pharmacists are not allowed to administer under current Florida law. Restricting vaccine administration to adults also limited immunizations requested by the public. Pharmacists cited the availability of time, lack of staff support, and inadequate third party reimbursement as the top 3 barriers to providing immunization services. However, 71% of pharmacists in all practice settings predicted that they would administer more influenza vaccination next season. Pharmacist managers and owners were even more likely to anticipate an increase in demand for pharmacist immunizations in the upcoming year. Conclusion: Florida law permitted certified pharmacists to administer influenza vaccine for the first time in 2008-09. Pharmacists working in chain and grocery settings availed themselves of employer sponsored training and became active immunizers. The pharmacists reported that customers frequently asked for other vaccinations which are beyond the scope of current law. Pharmacists cited lack of time, insufficient staff support and inadequate reimbursement as the primary impediments to pharmacybased immunizations but generally an-
ticipated increasing demand for these services. THE RESEARCH In 2008 the Centers for Disease Control and Prevention (CDC) called for greater public awareness of immunization guidelines. One of the CDC’s aims was to increase the number of adults being immunized, and to reduce racial and ethnic disparities in the distribution of recommended vaccines for adults.1,2 Roughly two-thirds (63.6%) of Floridians aged 65 and older had a flu shot in the 2007-08 season according to the Behavioral Risk Factor Surveillance System (BRFSS).3 This level placed Florida among states with the lowest level of compliance with CDC recommendations. Vaccination rates are even lower among near elderly, minority, and lowincome populations. The goal set by Healthy People 2010 is to reach immunization rates of 90 percent or more among persons aged 65 and over.4 Immunization rates in the range of 90% create herd immunity. That is, if a sufficient proportion of individuals are immune, protection improves for the entire population. A high level of immunity lowers the probability that a susceptible person will come into contact with an infected individual. These goals stand to prevent seasonal illness, reduce absence from work and school as well as decrease hospitalization and mortality among those most likely to become seriously ill from influenza. Benefits of having pharmacists provide vaccinations have been documented. Using the community pharmacy for the delivery of seasonal influenza vaccines is cost-effective.5 The practice has provided better access and increased vaccination rates in high risk populations,6-8 with particular success among hard-to-reach populations.5,9,10 Patients express satisfaction with these services. AUGUST 2010
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In addition, expanding the pool of certified immunizers contributes to emergency preparedness in the event of a natural or man-made disaster. Increasing both the number of providers and locations for immunizations is critical to mounting an adequate response in the event of a pandemic. Legislation permitting certified pharmacists to administer influenza vaccinations to adults passed in Florida in 2007. The Florida Board of Pharmacy subsequently promulgated regulations and the first opportunity for pharmacists to contribute in closing the gap between actual and recommended vaccination rates was during the 2008-09 flu season. The objective of this study was to describe the immunization activities of certified pharmacist immunizers in Florida during the 2008-09 flu season, taking note of any challenges pharmacists experienced in providing immunization services. Having a pharmacist’s perspective represents an opportunity for additional improvements in efficiency and quality of immunization programs and contributes to emergency preparedness. METHODS A list of pharmacist immunizers certified by the Florida Board of Pharmacy was obtained from the Florida Department of Health. Pharmacists with a Florida mailing address were asked to participate in a survey. The invitation letter included an explanation of the project, the contact information for the principal investigator and a link to a web-based survey. A prepaid response card was enclosed giving potential respondents the opportunity to receive a mail survey or electronic invitation at an Internet address of their choosing. The Institutional Review Board at the University of Florida approved the study protocol. The survey posed 17 questions about their training and the immunizations they personally administered during the 2008-09 flu season. Respondents who actively immunized during the 2008-09 flu season answered four additional questions about their experience and difficulties, if any, in provid14
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ing immunization services. Responses were anonymous but pharmacists were asked six questions about their practice and demographic information. Survey responses were collected in collaboration with the Florida Pharmacy Association (FPA) from October 22, 2009 to January 6, 2010 using Survey MonkeyTM software. One reminder postcard was sent to respondents prior to ending the data collection period. Responses were summarized using descriptive statistics. We used ArcMapTM 9.3 software to map the geographic distribution of certified immunizers and survey respondents. RESULTS As of May 30, 2009 there were 1,564 pharmacists registered as certified immunizers with the Florida Department of Health. After excluding pharmacists with an out-of-state address, 1,467 pharmacists were invited to participate in the web-based survey. Seventy-three invitation letters were returned as undeliverable. Thirty-four pharmacists requested and were sent a survey by post; 28 of these were returned. Altogether there were 156 responses available, a response rate of 11.2 percent. The geographic distribution of the survey respondents is illustrated on the map in Figure 1 through color-coding of the respondents’ counties of residence. The geographic distribution of Florida’s certified pharmacist immunizers is marked on the map as well. The illustration shows survey respondents distributed among the population of certified immunizers, with the greatest number located between Jacksonville and Miami on the Atlantic coast, from Pensacola to Tampa Bay along the Gulf of Mexico and in the most densely populated areas of central Florida. Almost all of the pharmacists who responded (95%) worked in community settings, primarily traditional chain (74%) and grocery pharmacies (21%). Survey responses came from staff pharmacists (55%), managers (39%)
and pharmacy owners (1.4%). The majority (74%) received their first professional degree more than 10 years ago, while the remaining 26% graduated after 2000. Just over 40 percent of the respondents reported having a PharmD degree. Training required for the immunization certificate was largely provided by employers (86%), but only 11.5% reported that the training was required as a condition of their employment. Ninety-nine percent of the survey respondents gave influenza vaccinations during the 2008-09 flu season. The typical respondent administered up to 500 doses although others reported giving more than 1000 vaccinations. Only 1.5% reported giving intranasal influenza vaccinations and those were for relatively few patients, typically 10-20 persons. Figure 2 shows that pharmacies used a variety of delivery models for their vaccination services. In nearly 87% of cases the vaccine was available on demand to customers who walked in and requested the injection. Almost half of the respondents reported that they offered appointments during routine business hours whereas about 40% restricted appointments to specific dates or times. Specific dates and times for mass clinic also were common events reported by two-thirds of the pharmacists. Roughly 20 percent provided services at an off-site location including work sites, churches, health fairs, nursing homes and assisted living facilities, fire and police stations, civic clubs, community and neighborhood centers and schools.
Pharmacists used a wide variety of methods to promote vaccination services but the most common strategies were in-house including signage in the pharmacy (95%), personal recommendations from pharmacists, technicians and clerks (81%), written reminders inserted in bags with merchandise (60%) and web-based advertisements (46%). Typical promotions were used to a lesser extent including advertisements in local newspapers (57%), on radio and television (52%) and through direct mail (21%). More than a quarter of the pharmacists reported contacting
only allowed to administer influenza vaccine under current Florida law. All respondents were asked to identify barriers that they perceived to providing immunizations during 2008-09 flu season. Eighty-three percent of respondents cited the age restriction (to those 18 years and older) as the greatest regulatory limitation on the number of immunizations that they provided. The top practice impediments to immunization services identified by respondents included: insufficient time (67%); lack of staff support (49%); inadequate third party reimbursement (31%);
local organizations and senior citizen groups. Additional promotions that were mentioned included outdoor signage, posting on local announcement boards, working in collaboration with physicians and placing announcements in medical offices and clinics. Word-ofmouth by individuals and groups also had noticeable impact. Less than 10% of respondents reported an affiliation with an immunization coalition. Ninety-five percent of the pharmacist immunizers received inquiries about the availability of vaccines in addition to seasonal influenza, with over 40% reporting that they received those requests often. According to the pharmacists, customers most frequently requested pneumococcal pneumonia (69%), herpes zoster (55%), tetanus (14%), human papillomavirus (HPV) (14%), and hepatitis B (10%). Pharmacists are
and inconsistent availability of vaccine (21%). About two-thirds of respondents reported that there was no designated vaccination area at their pharmacy. However only 23% of respondents named lack of area/space at their practice site as an impediment. Three-quarters of the pharmacists worked at locations where there was more than one certified immunizer. Generally two pharmacists were available to cover walk-in requests for vaccine. Seventy percent of the pharmacists reported that their immunization site was more than 5 miles from the nearest public health facility; 55% were 5 miles or more from the nearest retail clinic. On the other hand 97% of the pharmacies were located within 5 miles of the nearest physician office and 89% were within 5 miles of an urgent care center that could serve as alternative
vaccination site. Pharmacists estimated that approximately 58% of reimbursement for immunization services was from Medicare, which they identified as the primary payer for influenza immunizations. Another 25% of the revenue for immunization services was estimated to be from out-of-pocket payments by patients, with 12% and 5% from private third party coverage and Medicaid respectively. The revenue sources for immunizations differed from the reimbursement sources reported for prescriptions dispensed at the same pharmacies. For prescriptions, the pharmacists estimated the reimbursement mix to be 40% private third parties, 32% Medicare, 16% Medicaid, and 13% out-of-pocket. Despite any perceived obstacles or impediments to the practice, a large majority (71%) of the respondents expect to offer a greater number of immunizations in 2009-10. Pharmacy owners, managers were more likely to predict increased activities in the future. These expectations did not differ by pharmacy type or professional degree. The overall response rate of 11.2% is a limitation of this study but we believe that the results are a reasonable representation of the uptake and overall characteristics of pharmacy-based immunization practice in Florida in 200809. Of those who responded to the survey, 99% provided immunizations in 2008-09 and their geographic distribution is representative of the overall distribution of Florida certified pharmacist immunizers. We offer the results of this initial survey as a baseline description of services under this extension of pharmacy practice. DISCUSSION Starting with the 2008-09 flu season, certified pharmacists in Florida were allowed to administer influenza vaccination to adults under protocol with a supervising Florida-licensed physician or by written agreement with a county health department. This descriptive study is our attempt to examine the practice and the characteristics of pharmacists who initiated immunization services in Florida. AUGUST 2010
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This study shows evidence of pharmacist and consumer uptake in immunization services at community pharmacies. Pharmacists relied on low-cost and local methods to inform the public by making use of a community network as well as in-house messaging in 2008-09. They reported a number of promotions in addition to those that were check-off options on the survey form. Offering a gift certificate option – or “flu-gram” – deserves mention as one of the more clever suggestions for promoting awareness and access. A number of pharmacists offered immunization services at locations other than the pharmacy. In addition to the organizations and firms named by the respondents, potential locations for collaborations include community colleges, other health-related firms like physical therapy and fitness centers, or even day care providers and parents. There may be opportunities for individual pharmacists to coordinate and collaborate with other pharmacies in their area to maximize efficiency while increasing convenience for customers. However, fewer than ten percent of our respondents reported affiliation with an immunization coalition. An immunization coalition is a group of health professionals and consumers, often locally organized, who work to-
the state (http://www.immunizeflorida.org/community/partners.htm) . The same site provides links to professional associations, service organizations and state and federal agencies with resources for actively promoting vaccination. We find little or no information in the professional literature about persons who choose to get their flu shot at a community pharmacy. For example, we do not know whether the availability of this service attracts new customers to the pharmacy and the extent to which it improves customer satisfaction and loyalty among existing patrons. Valuable information may be generated by those pharmacies that record each immunization in the prescription record system. By generating management reports about the population, pharmacists might determine the percentage of new patients who become steady customers, and whether those who take advantage of the service come from the group of persons who stand to benefit based upon their concurrent use of prescription medications for treating chronic illnesses. Although 65% reported that there was no designated vaccination area in their primary practice site, only 23% designated the lack of space or designated area at the practice site as a barrier to pharmacy-based immunization
Medicare currently is the primary payer for the pharmacist-based immunization services in Florida, while Medicaid only contributes a very small portion. gether to increase immunization rates. Coalitions attract members with a variety of talent and resources including health departments, hospitals, insurers, health maintenance organizations, private practices, nonprofit organizations, vaccine company representatives and individuals. The web site of Florida Department of Health lists coalitions and community partners that are active in 16
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services. A few respondents shared their reservations about consumer privacy and concerns about safety due to not having a designated clean room for vaccination. These concerns should be addressed if immunization services expand as anticipated. Medicare currently is the primary payer for the pharmacist-based immunization services in Florida, while Med-
icaid only contributes a very small portion. Influenza vaccine is not covered under Florida Medicaid except for beneficiaries who reside in a long term care facility. Additional subpopulations designated by CDC as candidates for annual immunizations include pregnant women and non-institutionalized elderly. Health insurance firms that cover the private sector are reportedly reviewing their administrative options and contractual obligations regarding coverage for vaccines. The trend is to shift vaccines from the medical benefit component of the policy to the prescription drug rider, and to add registered nurses, retail clinics and pharmacists as providers eligible for reimbursement for vaccine administration.11 As of December 2009 Tri-Care covers three vaccines in the retail pharmacy setting: H1N1, seasonal influenza and pneumococcal vaccine where permitted by state law.12 Cost may not be a deciding factor in an adult’s decision to obtain the influenza vaccine and customers may elect to obtain seasonal flu vaccine as an outof-pocket expense. According to a 2008 study, 50 percent of adults surveyed skipped getting vaccinated because they did not think they needed it. Only 12% chose not to get the shot because they said it cost too much.13 However, if immunizations increase in price and expand to other, more expensive preparations, insurance coverage will increase in importance. Pharmacists clearly expect to expand immunization services in the future with 71% of our survey respondents predicting that they will administer more influenza vaccinations in 200910 flu season than they administered in the initial year. Beginning in 201011 the CDC recommends that everyone 6 months of age or older should be vaccinated against seasonal influenza. The recommendation alone should increase the demand for vaccinations at pharmacies as only individuals in high risk categories were advised to receive the seasonal influenza vaccine in 200809 when this survey was conducted. CDC is also promoting immunization beyond a few months in autumn. This practice makes particularly good sense
for curbing possible outbreaks of influenza in Florida which could coincide with the mid-winter arrival of snowbirds and tourists. While expanding CDC recommendations and health reform may increase the numbers eligible for coverage of preventive services, the changes may place new emphasis on the medical home and coordination of care. It will be important for pharmacists to find ways to communicate vaccination status with members of the primary care team. Information technology, also an important feature of reform efforts, may be a reasonable means for recording and disseminating vaccination status. We are planning to conduct followup studies to create a longitudinal record of changes in the practice patterns and characteristics of pharmacist-based immunization services in Florida. Recent evidence from researchers at the RAND Corporation questions previous findings which claim that alternate immunization sites serve an important sector of the population. According to a nation-wide survey conducted in spring of 2008, alternative vaccination locations including retail clinics and work sites serve younger, working individuals in metropolitan areas, rather than minority, rural and lower income patients. The researchers speculate that while convenience may increase the number of persons being immunized, it may not be those who are most vulnerable to the morbidity associated with the influenza virus.14 Studies that evaluate the cost-effectiveness of pharmacist immunization practice and measure consumer satisfaction are of interest. Results that assess a change in vaccination rates in Florida and better health outcomes inform any legislation that would expand pharmacist-based immunization services. For any future research, it is necessary that we find ways of increasing the response rate so that these efforts generate convincing evidence about the populations of interest. CONCLUSIONS This web-based survey study marks the baseline for pharmacist immunization services by characterizing these
practices in Florida 2008-09. It documents customer interest in receiving additional vaccines at pharmacies. Although pharmacists named regulatory and practice-related impediments to immunization services, the study confirms that pharmacists fully expect immunization services to expand in the future. REFERENCES 1. Lu P, Bridges CB, Euler GL, Singleton JA. Influenza vaccination of recommended adult populations, U.S., 1989-2005. Vaccine 2008;26:1786-1793. 2. CDC. Influenza vaccination coverage among children and adults - United States, 2008-09 influenza season. MMWR Weekly. 2009; 58:1091-1095. 3. CDC. Behavioral Risk Factor Surveillance System Survey 2008. Accessed April 10, 2010 at http:// www.cdc.gov/BRFS S/. 4. Healthy People 2010. Leading health indicators. Accessed on April 10, 2010 at http://www.healthypeople. gov/Document/html/uih/uih_4. htm#immuniz 5. Prosser LA, O’Brien MA, Molinari NM, Hohman KH, Nichol KL, Messonnier ML, Lieu TA. Non-traditional settings for influenza vaccination of adults. Costs and cost effectiveness. Pharmacoeconomics 2008; 26:163-178. 6. Steyer TE, Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine 2004;22:10011006. 7. Kamal KM, Madhavan SS, Maine LL. Pharmacy and immunization services: pharmacists’ participation and impact. J Am Pharm Assoc 2003;43:470-482. 8. Vlahov D, Coady MH, Ompad DC, Galea S. Strategies for improving influenza immunization rates among hard-to-reach populations. J Urban Health 2007;84:615-631. 9. Kummer GL, Foushee LL. Description of the characteristics of pharmacistbased immunization services in North Carolina: results of a pharmacist survey. J Am Pharm Assoc 2008;48:744751. 10. Klepser ME. Seasonal and pandemic influenza: preparing pharmacists for the frontline. J Am Pharm Assoc 2008;48:312-314. 11. Sipkoff M. Should pharmacists be allowed to vaccinate their patients? Manag Care 2008;17:13-14.
12. Office of the Secretary, Department of Defense. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/ TRICARE: Inclusion of retail network pharmacies as authorized TRICARE Providers for the administration of TRICARE covered vaccines. Fed Register. 2009; 74(236): 65436-38. Interim final rule. 13. American Institute for Research. Flu shots save lives, so why do so many fail to protect themselves. AIR News 2008; 27:1,8. 14. Lee BY, Mehotra A, Burns RM, Harris KM. Alternative vaccination locations: who uses them and can they increase flu vaccination rates? Vaccine 2009;27:4252-4256.
The 2010 survey of immunization practices by Florida pharmacists was mailed early in August to roughly 2000 certified immunizers. If you received a survey and returned your response, thank you very much! If you received a survey and did not send your response, please take a few minutes and do so today. If you received and survey and it was misplaced, contact Earlene Lipowski at 352-273-6268 or at lipowski@cop.ufl. edu and you’ll promptly receive a replacement. Florida pharmacists exerted a great deal of effort to achieve immunization status. With your help we plan to continue monitoring – and reporting - the contribution of pharmacists to public health goals and emergency preparedness in the state of Florida.
AUGUST 2010
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MEMBERSHIP MATTERS! Email/Fax Network Hotline Receive up-to-date and up-to-the-minute information on Legislative Developments, Board of Pharmacy changes and other topics affecting the profession of pharmacy. Call FPA Member Services at (850) 2222400 ext. 110 – rsimmons@pharmview. com.
Florida Pharmacy Association In keeping with a tradition of offering our members real benefits, the Florida Pharmacy Association (FPA) is proud to announce the introduction of sponsored Discount Benefits Program. These vendors are dedicated to providing an excellent value to all FPA members and associates. To take advantage of benefits contact the vendors directly at the numbers listed below and identify yourself as a FPA member and have your membership ID number handy.
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Tax Resource Provides defense and protection of your assets when you are audited. Tax Resource will defend their clients for any income tax audit, Federal or State, for any tax year. Tax Resource pioneered the tax audit service business, and is the largest audit defense firm in the United States. Call (800) 92-AUDIT (800-922-8348). Atlantic Coupon Redemption Center Receive payment in 25 working days of coupon’s face value plus a rebate of 1/6 cents based on store volume. Call Meredith McCord (800) 223-0398. Florida Commerce Federal Credit Union The chief objective of a credit union is not generating profits for stockholders, but to provide service to its member. The members benefit by getting attractive returns on savings, loans made at fair rates of interest plus enhanced and expanded services. This is probably one of the best deals around. Call (850) 488-0035. Collection Services For past due accounts call I. C. System, Inc. Call (800) 328-9595.
Other Member Benefits
Discounted Continuing Education Pro-
grams
Monthly Issues of the Florida Pharmacy
Today Journal
Hertz Now when you rent from Hertz, you can take advantage of special year-round savings through the Hertz Member Benefit Program. Florida Pharmacy Association members receive a discount off Hertz Daily Member Benefit Rates, Hertz U.S. Standard Rates; and Hertz U.S. Leisure Rates. You'll be quoted the best rate for your rental needs at the time of reservation. See the FPA web site for more details or call the FPA office. Pharmacy Resource Materials FPA provides the most recent and relevant resources necessary to meet your professional needs. This includes the Continuous Quality Improvement Manual, Controlled Substance Inventory Booklets and Pharmacy Signs. Please call FPA Members Services for more information: 850-222-2400 ext. 110. FPA Website Visit our FPA Website at ww.pharmview.com. The site, launched in December 2004 and revised in October 2008, includes a members only section. The website offers a secure server so that you can registers for CE programs, renew your membership or purchase resources materials with your credit card.
Buyer’s Guide florida PHARMACY TODAY
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PHARMACY RESOURCES
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PPSC Retail Pharmacy Purchasing Program (888) 778-9909
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FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 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 1-800-282-3171 http://ora.umc.ufl.edu/ pcc/fpicjax.htm 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. 20
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