The Official Publication Of The Florida Pharmacy Association AUG. 2011
Helping Children Manage Diabetes at School
Employer Based Technician Training Program for all Florida Pharmacies The FPA has made it easy for you to file for approval for your employer based training program with the Board for approval. Once approved you can enroll your technicians in the comprehensive modules.
training
The cost per
technician
is
$290.
Technicians who join the FPA as members only pay 250. It should take about 160
hours
technician
to
for
your
complete
the program.
The Florida Pharmacy Association partnering with PassAssured of Orange Texas is pleased to present a web based employer based technician training program for Florida pharmacies. Florida Statutes 465.014 requires pharmacy technicians to register with the Florida Department of Health. To be eligible for registration technicians must complete a Board approved training program as defined under rule 64B16-26.351.
This program is designed to supplement your on-site training program for pharmacy technicians.
All employer based technician training programs must be approved by the Florida Board of Pharmacy. The FPA is offering assistance to pharmacies in their efforts to get their training programs approved. Simply follow the steps published on the FPA web site in the shopping cart where the program’s information is published. There is no cost to apply to the Board. Send us your contact information and we will be glad to help you. Name _______________________________ Address _________________________________
610 North Adams Street Tallahassee, Florida Phone: (850) 222-2400 Fax: (850) 561-6758 E-mail: fpa@pharmview.com
City _________________________ State _______________ Zip Code ____________________ E-mail address ________________________________________________________________ Phone ______________________________ Fax _____________________________________ Name of Pharmacy _____________________________________________________________
florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 9 Executive Insight 17 Buyer’s Guide
VOL. 74 | NO. 8 AUGUST 2011 the official publication of the florida pharmacy association
Features
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A Pharmacist Motivated by Inspirational Women
Helping Children Manage Diabetes at School
Dentists, Pharmacists Raise Awareness of Medication-Induced Dry Mouth
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FPA Calendar 2011
AUGUST 27-28 FPA Committee and Council Meetings SEPTEMBER
November 12-13 Board of Directors and Budget and Finance Committee Meetings 11
Veterans Day FPA Offices Closed
1
Deadline to receive nominations for FPA elected office
17-20 NASPA Fall Meeting
5
Labor Day FPA Office Closed
24-25 Thanksgiving FPA Offices Closed
10-11 FPA Law Conference Ft. Lauderdale 17-24 FPA CE at SEA OCTOBER 8-12
NCPA Annual Meeting Nashville Tennessee
14
APhA Immunization Training Program
15-16 FPA Midyear Clinical Conference 18-19 Florida Board of Pharmacy Meeting Tallahassee, Florida
DECEMBER 3-4
FPA Law Conference Sarasota, Florida
13-14 Florida Board of Pharmacy Meeting Gainesville, Florida January 2, 2012 - FPA Office Closed for New Year’s Day JANURAY 2
FPA Office Closed for New Year’s Day
10
Legislative Session Begins
16
FPA Office Closed for Martin Luther King’s Birthday
20
Journal Board Conference Call
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
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...................................................................... 15 Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L............................................ 8 PPSC...................................................................... 8 Rx RElief.......................................................... 15
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 BOB PARRADO, FPA President
FPA is Leading National Fight on Challenges to Profession of Pharmacy
I
had the pleasure of attending the 41st Annual Southeastern Pharmacy Officers Conference in Biloxi, Mississippi, earlier this month. Also in attendance were Michael Jackson, EVP/ CEO of the Florida Pharmacy Association, Bert Martinez, chairman of the Board and Goar Alvarez, presidentelect. This conference is held annually to bring the officers from all the pharmacy associations in the Southeastern United States together to discuss issues that are common to pharmacy and pharmacists everywhere. There were speakers from the National Community Pharmacists Association (NCPA), American Pharmacists Association (APhA) and the National Association of Chain Drug Stores (NACDS). The moderator was Rebecca Snead, EVP/ CEO of the National Alliance of State Pharmacy Associations (NASPA), of which our very own Michael Jackson is currently serving as the president. There were many important issues discussed, but the one issue that hit closest to home with me was the issue of PBM audits. NCPA discussed their survey of community pharmacists concerning the impact of auditing practices on patient care. The data concerning the state of Florida reflected what I, and the FPA staff, have been hearing. There is legislation currently being developed in Washington that would require PBMs to disclose greater information to pharmacies regarding MAC reimbursement for generics. This is known as transparency. Other concerns regarding PBMs surrounded the auditing process used and the appeal process. Seventy-one percent of Florida pharmacists who responded to the survey said the appeal
process was very unsatisfactory and burdensome. Eighty-two percent of survey respondents said that the PBM reimbursement and auditing practices were affecting their ability to provide patient care and to remain in business. We are all aware of the aggressive auditing practices that are attempting to recoup monies for prescriptions that were filled in good faith. The patients properly received the benefit of the needed medication yet the auditors found a clerical error and demanded refunds. These clerical errors included a clinic’s NPI number instead of the prescriber’s NPI number or a physician’s DEA number on the back of the prescription instead of the front. A very egregious example discussed was an auditor that refused to provide documentation that he was working for a PBM and had HIPPA authority to do the audit. When the pharmacist refused to let him inspect the files, he marked all the prescriptions included in his audit package as non-compliant and charged the pharmacy back $33,000. It is because of practices such as these by auditing companies that pharmacists are wary of filling prescriptions for certain insurance companies. This can cause a delay in the patient receiving his medication in a timely fashion, possibly causing a negative impact on patient care. It is because of practices like this from auditing companies that the FPA is actively considering legislation to regulate Prescription Benefit Managers. I believe that there is a need for auditing to determine if fraud is being committed. If fraud is found, then the person and pharmacy committing that fraud should be severely punished. It is because of this fraud that we are all being penalized.
Bob Parrado, 2011-2012 FPA President
John O’Brien, a Nova almunus, is currently working for CMS in Washington. His area of expertise is being utilized in the Partnership for Patients. This $1 billion program is funded to prevent hospital readmissions due to hospital-acquired infections. Their goal is to reduce these readmissions by 40 percent by 2013 resulting in a $35 billion savings over a three-year period. His presentation on this topic was very informative, and he recognizes the importance of the pharmacist being responsible for positive medication therapy outcomes in this program. The most compelling topic discussed was the fact that pharmacists are great at telling ourselves our own story. We don’t share these concerns with other members of the health care team. There was a lot of lively debate on this subject, but the bottom line is that we need to get out of our comfort zone and discuss the problems we are having regarding our ability to fill prescriptions with other appropriate AUGUST 2011
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2011/2012 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.
Humberto Martinez............................................................. Chairman of the Board Robert Parrado .........................................................................................FPA President Goar Alvarez............................................................................................... President Elect Betty Harris ............................................................................................................Treasurer Suzanne Wise............................................Speaker of the House of Delegates Eric Alvarez.....................................Vice Speaker of the House of Delegates Preston McDonald, Director............................................................................ Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Eva Sunell, Director ..............................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jeffrey Parrado, Director ...............................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Paul Rohrbaugh, Director.................................................................................. Region 7 Raul Gallo, Director.................................................................................................Region 8 Paul Elias........................................................................................................................Region 9 Venessa Price.......................................................................................... 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 Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com
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health care providers. Errors on e-prescriptions are causing pharmacy staff to spend hours every day getting the correct information needed, not only to get the patient the correct medication but also to prevent auditors from recouping the precious few dollars we were paid to get that patient their medication. We need to share our concerns with our colleagues in medicine and nursing if we are to be that positive influence on medication therapy outcomes. Lastly, we need to understand that there will be an opportunity for pharmacists to be recognized as “providers� and become involved in multidisciplinary teams as care coordinators and direct clinical providers. There will be 17 million patients added to the Medicaid rolls in 2014 and 2015. This population has very little medical management history. The costs to manage these new patients are unknown. Primary care provider resources are limited and stretched thin now, so we have to explore an expanded scope of practice in the future to meet this critical patient care need for medication therapy outcomes. The Florida Pharmacy Association leadership and staff are committed to exploring these challenges to our profession. We need your help to address these challenges. There are fewer than 10 percent of the pharmacists licensed in Florida who belong to their professional association. I realize that I am speaking to the choir here because if you are reading this you are a member of the FPA. We all need to get out and share these concerns with the non-members and educate them on the importance of membership. With everyone getting just one pharmacist to join, we can double the number of members. This increase in membership will enable our lobbyists to get out and show the legislators who regulate our profession and business that pharmacists really do care about current pharmacy issues. Up to now, we have been perceived as a non-interested and fragmented group. We need to change that perception and show the legislators that we are one professional voice -- and we vote. n
MEMBERSHIP MATTERS! Email 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.
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. We also have available a fraud, waste and abuse manual which includes a section on Board of Pharmacy required procedures for handling fraudulent prescriptions. Please call FPA Members Services for more information: 850222-2400 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.
Is your technician enrolled in the FPA employer based technician training program? If so encourage them to consider becoming certified through the Pharmacy Technician Certification Board (PTCB) when they finish the program. For more information, contact the FPA at (850) 222-2400 or visit the PTCB website at www.ptcb.org.
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A Pharmacist And A Lawyer Board of Pharmacy Licensure Disciplinary Proceedings Chapter 499 Violations, Pharmacy Audit Disputes Mergers and Acquisitions Commercial, Civil and Criminal Proceedings KAHAN ◆ SHIR, P.L.
Pharmacist Attorney Brian A. Kahan, R.Ph., J.D. Licensed Florida Pharmacist and Attorney
STATEWIDE REPRESENTATION
Florida Pharmacy Association
561-999-5999 bkahan@kahanshir.com 1800 N.W. Corporate Blvd., Suite 200 Boca Raton, FL 33431 The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.
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Executive Insight Michael Jackson, BPharm, EVP & CEO, Florida Pharmacy Association by michael jackson, RPh
A
Do You Believe in the Freedom to Choose?
s far as I can remember, the fundamental principles of freedom that allow us to make our own decisions has always been the framework behind the strength and appeal of our nation. Wars have been fought and blood spilled on both American and foreign soil to ensure the integrity of that freedom. These wars are chartered by those individuals who are voted into office by the people. It is perplexing to me that those who craft health care policy are choosing to disregard the will and concerns of the people who put them in the position of crafting that policy. No, I am not talking about the budget fight in Washington, D.C. I don’t want this article to get into that debate. I am talking specifically about efforts to fix the costs of Florida’s health care challenges by turning the entire program over to those entities that are not the ones providing the health care. For example, in Medicaid reform, the theory is that costs can be contained and quality improved by adding an entity between those who deliver health care and those who pay for health care. To achieve savings under this model means that you have to either deny services, decrease utilization or reduce payments -- or a combination of all three. In some cases, the patient may be fortunate enough to keep their current provider. For pharmacy, since we are a business model built on providing the service and then billing in hopes of getting paid, we may find ourselves at risk. Initially, the service is billed and paid only to find that a retrospective “audit” discovered a technical issue with record-
keeping. This could result in a withholding of payment for future services or perhaps even a coerced offer to accept an invitation to resign from the provider network. All this could be happening without knowledge of the
It is perplexing to me that those who craft health care policy are choosing to disregard the will and concerns of the people who put them in the position of crafting that policy. patient or even the entity that pays for health care services. When this occurs, patient choice becomes restricted. Consider the proposed merger of America’s two largest pharmacy benefit managers. Congressman Don Young of the state of Alaska has written a letter to Jon Leobowitz, chairman of the Federal Trade Commission, raising serious concerns over how this merger would affect choice. Congressman Young even suggested that such an arrangement would unlikely result in cost savings for patients. Also, it could be possible that a considerable amount of servic-
Michael Jackson, B.Pharm
es provided by Florida licensed pharmacists and paid for by Florida taxpayers could be relocated to other states should such a joint venture move forward. Have you discussed this new development with your congressman? If you believe in choice, you should. Both the National Association of Chain Drugs Stores and the National Community Pharmacists Association have weighed in on this issue and are raising serious concerns through a joint published statement. The driving force behind such a merger arrangement in theory is to create better negotiating arrangements with prescription drug manufacturers and pharmacy providers. How can you negotiate down pharmacy reimbursement when pharmacy net profits are hardly more than 2 or 3 percent? The Florida Pharmacy Association has also been actively engaged in the Florida Medicaid managed care deAUGUST 2011
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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 Howard, ext. 110
bate. Members have testified before the Agency for Health Care Administration (AHCA) to recommend careful scrutiny of efforts to reform the Medicaid program. We have also facilitated press releases and press conferences and have partnered with an organization called Pharmacy Choice and Access Now (PCAN). This campaign is also underway in Texas, California and Illinois. A website has been created that describes
what your practice setting may be. Remember that the federal government pays for over 50 percent of pharmacy services in this country. They are going to balance the budget with or without your input, and the tools they will be using will be YOUR reimbursement. On January 24 – 25, 2012, we will be gathering again in Tallahassee, Florida, for our annual legislative days and health fair. Clear your calendars
Educational Services Office Assistant Stacey Brooks , ext. 210 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 Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee
This is a peer reviewed publication. ©2011, 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 10
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How can you get involved? The easiest thing for you to do now is to talk to your colleagues out there and urge them to catch the advocacy fever. this campaign and also includes a petition that your patients can sign. Please visit their web site at www.rxchoiceandaccess.com. Recommendations include transparency so that taxpayers are aware of how their dollars will be used to care for the indigent. FPA advocates also urged AHCA to screen the health plans’ efforts to facilitate and allow for mandatory mail-order programs similar to the one ordered by the Florida Legislature for state employees. We have even prepared written comments on our concerns to the Center for Medicare and Medicaid Services. If you are concerned over some of the things in this article, you are not alone. The email and telephone call volume into the FPA office on these and many issues related to the practice and business of pharmacy have increased significantly over the last 12 months. How can you get involved? The easiest thing for you to do now is to talk to your colleagues out there and urge them to catch the advocacy fever. These challenges are not going away. With Washington, D.C., engaged in intensive debate over the cost and size of government, your business and profession will be under attack no matter
for those days and join us as we walk the halls of public policy development. The legislative session for Florida begins January 10, 2012, and will end on March 9, 2012. The first six weeks or so of the session include a number of committee meetings where pharmacy issues may be placed on the table. If you cannot be there for pharmacists legislative days, then try to come to Tallahassee during the committee hearings. You may have an opportunity to provide oral comment to some of these committees as they grapple with Florida’s health care challenges. Remember: THE PRICE OF APATHY IS TO BE RULED BY EVIL MEN. n
A Pharmacist Motivated by Inspirational Women Source: Centers for Disease Control and Prevention
Fredrick Ochenge in the Tabitha clinic pharmacy
Fredrick Ochenge moves quickly and efficiently around Tabitha clinic’s small pharmacy, filling up bottles, counting out pills, and chatting happily with everyone he encounters. When he calls a patient’s name, they are met at the dispensary window by his wide smile and a warm greeting, as he carefully explains each medication’s use, dose, and precautions. It is instantly clear to all who meet him: this is not your typical pharmacist. For the last seven years, Ochenge has worked at the Tabitha clinic, flagship project of Carolina for Kibera, a nonprofit working to effect positive change among the residents of Kibera, Africa’s largest urban slum. Having joined the clinic during its early stages, Ochenge’s institutional memory paints a picture of a thriving grassroots project: ‘I have seen the clinic grow from a staff of two, to more than forty; from a one-room shanty to a beautiful building.’ How Ochenge ended up in that ‘beautiful building’ is a story marked by tragedy and triumph, and the incredible influence of two inspirational women. The second youngest of eight children, all boys, Ochenge grew up in a rural village in Nyanza Province, where the disease burden is high and access to education is low. His mother died when he was only six years old, followed two years later by his father’s untimely death. The newly orphaned brothers were taken in by various family members, but struggled to overcome
the significant challenges they now had to face. Ochenge was the only one who made it out of the village, thanks in large part to his paternal grandmother, whom he calls his greatest inspiration. ‘She was a traditional healer,’ says Ochenge, ‘and she is the reason I became a pharmacist.’ Though there were several other healers in the area, ‘she was the top one,’ he says. ‘I used to accompany her when she collected plants and bark for her medicines, which she taught me how to make and use.’ Besides encouraging his life-long fascination with medicine, Ochenge’s grandmother also instilled in him a strong sense of compassion and community responsibility. ‘Many people came for her services,’ he recalls. ‘Sometimes she would charge something small, but often she would treat them for free.’ Her kindness and work ethic made a lasting impression on the young Ochenge, who went on to pass Form 4 and complete his Diploma in Pharmacy Studies. Not long after graduating, he met Tabitha Festo, a woman who shared his passion for helping others and who would quickly become like a mother to him. ‘We met at church,’ says Ochenge. ‘Tabitha heard me giving testimony in which I mentioned being a pharmacist. After the service, she pulled me aside and told me about her work. She asked if I would come for a visit, so we arA view of the Tabitha clinic in Kibera
ranged to meet the following week.’ From the moment he stepped inside Rye Medical Clinic (renamed Tabitha clinic in 2005), Ochenge knew he had found something worthy of his time and skills. ‘The pharmacy,’ he says, ‘was a real mess. At that time, the clinic relied entirely on donations, so there were boxes of donated medications scattered everywhere.’ The clinic did not yet have a pharmacist, and upon inspection, ‘I found that many of the medications were expired.’ Ochenge threw out the bad drugs, organized the good ones, and started dispensing what remained to Tabitha’s patients. From that first visit, he began working in the clinic 7 days a week. ‘I worked every day, without leave, for almost three years,’ he says. ‘There was no one else working in the pharmacy, so how could I take a vacation and allow people to suffer?’ Even more remarkable, however, is that for the first two years, Ochenge worked full time as a volunteer. Yes, without a salary. It wasn’t until the CDC arrived that the clinic had enough funding to officially hire Ochenge. He initially worked as a CDC Community Interviewer, but soon returned to his first love, the pharmacy, where he has remained as Chief Pharmacist until today. A few months after their first meeting, Tabitha Festo passed away, but her legacy continues to influence Ochenge’s life. The experience of working for a successful development project has inspired him to return to school, where he is currently studying for a Bachelor of Healthcare System Management, and hopes to later complete a Master of Public Health. His goal is to someday manage, not just the pharmacy, but the whole clinic. ‘I knew Tabitha,’ he says. ‘I knew what she wanted. She wanted people to have free medical care. This was her dream. I want to fulfill the dream she had.’ AUGUST 2011 |
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Helping Children Manage Diabetes at School Source: Centers for Disease Control and Prevention
and also may need to eat snacks in the classroom. For more information, visit Helping the Student with Diabetes Succeed: A Guide for School Personnel.
Parents need to make a plan to help their child manage diabetes at school. They should start by meeting with school staff and by making sure their child has the necessary supplies for routine care and blood sugar emergencies. Parents may already have bought the basic school supplies for sending their child back to school, but if their child has diabetes, they need to make additional preparations. A person with diabetes must manage this chronic illness all the time, including during the school day. Staff such as nurses, teachers and coaches can work with the parent and child on managing diabetes. This assistance may include helping the child take medications, check blood sugar levels, choose healthy foods in the cafeteria, and be physically active. Of course, you as a pharmacist, can be of great assistance in both preparation and patient care. The following are some tips for parents that you might want to pass along. How to Prepare To help your child get ready for the first day of school and for the rest of the school year, here are a few key tips: Create a diabetes management plan with the school. Meet with staff early in the school year to learn more about how the school helps students care for diabetes and handles any diabetes-related emergencies. Public schools and schools that receive federal funding are prohibited from discriminating against people with diabetes by the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. You can work with your child’s doctor and school staff to create a Diabetes Medical Management Plan. Having a plan helps your child and school workers with managing diabetes in school and during extracurricular activities. Be sure to include information on services the school will provide and how to recognize high and low blood sugar levels. Your child may need assistance with giving insulin and checking blood sugar levels,
Check for necessary diabetes supplies. Your child must have access to supplies needed to manage diabetes and to treat any episodes of high or low blood sugar. You and your child can work together to create a care package to bring in his or her backpack. Supplies should include: ■■ blood glucose meter, testing strips, lancets, and extra batteries for the meter ■■ ketone testing supplies ■■ insulin and syringes/pens ■■ antiseptic wipes ■■ glucose tablets or other fast-acting glucose snack ■■ water ■■ for children who wear an insulin pump, backup insulin and syringes/pens in case of pump failure Also, be sure school workers have a glucagon emergency kit and know how to use it if your child experiences a low blood sugar emergency. Make sure your child can manage diabetes at a level appropriate for his or her age. If your child is going to monitor his or her blood sugar, ensure that he or she feels comfortable doing so. If a trained school employee will do the monitoring, be sure your child knows where and when to go for testing. Also, make sure your child knows who to go to for help with high or low blood sugar episodes. The actions to be taken should be in the Diabetes Medical Management Plan. Encourage your child to eat healthy foods. Prepare a healthy breakfast, which will help your child stay focused and active. If you send a lunch with your child, pack a healthy meal that contains whole grains and fresh fruits and vegetables. Replace high-fat foods with low-fat options, such as low-fat turkey, reduced-fat cheese, and skim milk. Include healthy snacks, such as fruit, nuts or seeds, which your child can eat later in the day to help avoid the vending machine and keep blood sugar under control. If your child buys meals at school, look at the cafeteria menus together to help him or her make choices that fit into a healthy meal plan. Many schools post their menus online, or you can request this information from school workers.
Make sure your child gets at least 60 minutes of physical activity every day. Having diabetes does not mean that your child cannot be physically active or participate in physical education classes. In fact, being active can help your child improve his or her blood sugar control. Also, limit screen time – TV, videogames and the internet – to one to two hours a day. Being active at an early age establishes good habits for a lifetime and is a lot of fun. Encourage your child by being active together, doing such things as walking the dog, riding bicycles or playing basketball, and you will get the health benefits too.
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Help prevent sick days. Check to be sure your child has had all recommended vaccinations, including the flu shot. If children with diabetes get sick, they can take a longer time to recover than children without diabetes. Talk to your child’s doctor to see if your child needs any vaccinations before starting the school year. Also, encourage your child to wash his or hands regularly, such as before eating and after using the bathroom. Diabetes does not have to get in the way of your child’s good experience at school. Remember, parents and schools have the same goal: to ensure that students with diabetes are safe and that they are able to learn in a supportive environment. Make sure school staff have the information and resources they need for your child’s safety and health. Help prepare your child to manage diabetes when he or she goes back to school.
• EPC is Pharmacist Owned and Operated • NO ONE CAN PROVIDE BETTER SERVICE Empire Pharmacy Consultants 305-374-1029 office 305-357-6983 fax info@epcepc.com www.epcepc.com
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Dentists, Pharmacists Raise Awareness of Medication-Induced Dry Mouth Source: American Pharmacists Association Leading dental and pharmacy organizations are teaming up to promote oral health and raise public awareness of dry mouth, a side effect commonly caused by taking prescription and overthe-counter medications. More than 500 medications can contribute to oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications (for blood pressure), decongestants, pain medications, diuretics and antidepressants. In its most severe form, dry mouth can lead to extensive tooth decay, mouth sores and oral infections, particularly among the elderly. Nearly half of all Americans regularly take at least one prescription medication daily, including many that produce dry mouth, and more than 90 percent of adults over age 65 do the same. Because older adults frequently use one or more of these medications, they are considered at significantly higher risk of experiencing dry mouth. The American Dental Association (ADA), Academy of General Dentistry (AGD), American Academy of Periodontology (AAP) and the American Pharmacists Association (APhA) are collaborating to expand awareness of the impact of medications on dry mouth, a condition known to health professionals as xerostomia.
Nearly half of all Americans regularly take at least one prescription medication daily, including many that produce dry mouth, and more than 90 percent of adults over age 65 do the same. 14
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With regular saliva production, your teeth are constantly bathed in a mineral-rich solution that helps keep your teeth strong and resistant to decay. While saliva is essential for maintaining oral health and quality of life, at least 25 million Americans have inadequate salivary flow or composition, and lack the cleansing and protective functions provided by this important fluid. “Each day, a healthy adult normally produces around one-and-a-half liters of saliva, making it easier to talk, swallow, taste, digest food and perform other important functions that often go unnoticed,” notes Dr. Fares Elias, immediate past president, Academy of Gen-
eral Dentistry. “Those not producing adequate saliva may experience some common symptoms of dry mouth.” Signs and Symptoms At some point, most people will experience the short-term sensation of oral dryness because of nervousness, stress or just being upset. This is normal and does not have any long-term consequences. But chronic cases of dry mouth persist for longer periods of time. Common symptoms include trouble eating, speaking and chewing, burning sensations or a frequent need to sip water while eating. “Dry mouth becomes a problem
when symptoms occur all or most of the time and can cause serious problems for your oral health,” explains Dr. Matthew Messina, ADA consumer advisor. “Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection.”
of severe dry mouth. The treatment can produce significant damage to the salivary glands, resulting in diminished saliva production and extreme dry mouth in many cases. “Saliva plays an important role in maintaining oral health,” says Dr. Donald Clem, president of the American
also help those with the condition. Your dentist may recommend using saliva substitutes or oral moisturizers to keep your mouth wet. Your local pharmacist is also a helpful source for information on products to help you manage dry mouth.
According to Dr. Messina, who practices general dentistry in the Cleveland area, without the cleansing and shielding effects of adequate saliva flow, tooth decay and periodontal (gum) disease become much more common. According to Dr. Messina, who practices general dentistry in the Cleveland area, without the cleansing and shielding effects of adequate saliva flow, tooth decay and periodontal (gum) disease become much more common. “Constant dryness and the lack of protection provided by saliva may contribute to bad breath. Dry mouth can make full dentures become less comfortable to wear because there is no thin film of saliva to help them adhere properly to oral tissues,” he adds. “Insufficient saliva can also result in painful denture sores, dry and cracked lips and increased risks of oral infection.” Common Causes Once considered an inevitable part of aging, dry mouth is now commonly associated with certain medications and autoimmune conditions such as Sjogren’s syndrome. Both of these can reduce salivary production or alter its composition, but experts agree that the primary cause of dry mouth is the use of medications. Radiation treatment for head and neck cancer is also an important cause
Academy of Periodontology. “With decreased saliva flow, we can see an increase in plaque accumulation and the incidence and severity of periodontal diseases.” How to relieve dry mouth Individuals with dry mouth should have regular dental checkups for evaluation and treatment. “Be sure to carry an up-to-date medication list at all times, and tell your dentist what medications you are taking and other information about your health at each appointment,” advises Mr. Thomas Menighan, executive vice president and Chief Executive Officer, American Pharmacists Association. “In some cases, a different medication can be provided or your dosage modified to alleviate dry mouth symptoms. Talk to your pharmacist if you have any questions regarding your medication.” Increasing fluid intake, chewing sugarless gum, taking frequent sips of water or sucking on ice chips can also help relieve dry mouth symptoms. Avoiding tobacco and intake of caffeine, alcohol and carbonated beverages may AUGUST 2011
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Pharmacy Groups File Brief in U.S. Supreme Court on Right of Pharmacies to Challenge Medicaid Cuts Source: American Pharmacists Association
Pharmacy groups filed a legal brief this month with the U.S. Supreme Court supporting the right of pharmacies to challenge Medicaid cuts that violate a federal patient access law. The brief was filed by the American Pharmacists Association (APhA), National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA) and the National Alliance of State Pharmacy Associations (NASPA) in the case of Douglas v. Independent Living Center of California. The initial lawsuit – filed by pharmacies and other healthcare providers – argues that a 10 percent Medicaid reimbursement cut in California violates the federal patient access law, which provides that Medicaid reimbursement rates must be “sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area….” 16
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The proposed cuts would threaten access to care for Medicaid patients. Today’s joint legal brief filed by the four pharmacy groups further argues that a long line of Supreme Court decisions support the right to challenge state actions that are inconsistent with federal laws, and challenges to inadequate Medicaid reimbursement rates must be allowed if they threaten patient access to pharmacy care. “APhA is pleased to join with our colleague pharmacy organizations in challenging the actions of states that threaten to deprive patients of access to medications and pharmacists services that they desperately need,” said Thomas E. Menighan, BSPharm, MBA, ScD, Executive Vice President and CEO. “While we recognize the budget constraints that states face, these proposed Medicaid cuts will exacerbate our medication use crisis by forcing more pharmacies out of Medicaid and disrupting patient/pharmacist relationships that
are critical to effective medication use. The data show that poor medication use leads to higher costs in the form of Emergency Department visits and hospitalizations.” “Patients rely on their local pharmacists for expert medication counseling and advice on controlling healthcare costs, such as through the appropriate use of generic drugs,” said NCPA Executive Vice President and CEO B. Douglas Hoey, RPh, MBA. “Independent community pharmacists in particular are often located in underserved rural and urban areas where there may be few, if any, other pharmacy options. These cuts clearly jeopardize pharmacy access for underserved patients and could ultimately increase costs.” “We are deeply troubled about the impact that such a drastic cut in Medicaid pharmacy reimbursement will have on patient access to pharmacy care,” said NACDS President and CEO Steven C. Anderson, IOM, CAE. “This shortsighted proposal is not the solution to cutting spending and reducing costs. We have and will continue to urge the state to work with pharmacy and other provider groups to find cost-effective alternatives that do not jeopardize Medicaid beneficiaries’ access to healthcare services.” “We share our colleagues’ deep concern with Medicaid cuts that will dramatically impact patient access,” said NASPA Executive Vice President and CEO Rebecca Snead, RPh. “Arbitrarily implementing reductions in Medicaid reimbursement without consideration of federal law, is a disservice to its beneficiaries who rely and depend on these services. Ultimately, these drastic cuts will put their health and lives at risk.” The Supreme Court will hold a hearing in the case on October 3, and may issue a decision later this year.
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PHARMACY RESOURCES Abbott Diabetes Care Michael J. Forker (239) 839-3313 Cerner Etreby Pharmacy Management Systems (800) 292-5590 PPSC Retail Pharmacy Purchasing Program (888) 778-9909
PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Dean Pedalino (800) 642-1652 Mobile: (727) 460-1855 Empire Pharmacy Consultants Michael Chen PharmD., CPh President/CEO (786) 556-7825 Mobile (305) 374-1029 Office
PHarmaceutical WHOLESALER McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953
TEMPORARY PHARMACISTs – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPh President/CEO (305) 374-1029 Office Rx Relief (800) RXRELIEF
LEGAL ASSISTANCE Kahan ◆ Shir, P.L. Brian A. Kahan, R.Ph., and Attorney at Law (561) 999-5999
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 (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”
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