December 2016 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association DEC. 2016

TOPICAL AGENTS New Treatments for Onychomycosis

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 17 FPA News & Notes 20 Buyer’s Guide

VOL. 79 | NO. 12 DECEMBER 2016 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

10 15

Efinaconazole and Tavaborole, New Topical Treatments for Onychomycosis Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing

DECEMBER 2016

Mission Statements:

FPA Calendar 2016-17

JANUARY 2

New Year Holiday FPA Office Closed

Forward Your Profession Through Leadership Orlando

28-29 Clinical Conference Destin 31

Last day to submit election ballots FEBRUARY

Florida Pharmacy Today Journal Board Conference Call

7-8

Florida Board of Pharmacy Meeting

Award Nominations Due MARCH

Legislative Session Begins

11-12 FPA Committee and Council Meetings Orlando

14-15 Health Fair and Legislative Days at the Capitol Tallahassee 24-27 APhA Meeting San Francisco, CA APRIL 14

Good Friday - FPA Office Closed

22-23 FPA Law and Regulatory Conference Grand Hyatt Tampa Bay 26-27 NCPA Flyin Washington, DC MAY 5

Last day of legislative session

7-9

NASPA Leadership Conference

Last Day to Submit Resolutions

20-21

FPA Continuing Education Conference Jacksonville

Memorial Day - FPA Office Closed

For a complete calendar of events go to www.pharmview.com Events calendar subject to change CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours’ LIVE Continuing Education as part of the required 30 hours’ general education needed every license renewal period. There is a new 2 hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2017 or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by December 31, 2016. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For more information on CE programs or events, please contact the Florida Pharmacy Association at (850) 222-2400 or visit our website at www.pharmview.com

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 EPIC..................................................................... 12 THE HEALTH LAW FIRM............................... 13 KAHAN HEIMBERG, PLC............................... 14 PHARMACISTS MUTUAL................................ 2 PHARMACY QUALITY COMMITMENT....... 9

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 UF — Kristin Weitzel (352) 273-5114 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 is 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. 4 |

FLORIDA PHARMACY TODAY

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

The President’s Viewpoint SCOTT TOMERLIN, FPA PRESIDENT

Reflections Upon the Past Year, and the Year Ahead!

s I look back upon 2016, it certainly has been an eventful one as a profession. This past year in January, there was a special Legislative session during which we held our 2016 Legislative Days at the Capitol, with over 300 participants. What an impressive sight it is to see our pharmacists, student pharmacists and technician members take the Capitol by storm in Tallahassee, as we advocate for our profession. I cannot wait until our next Legislative Days, which will be held March 14-15, 2017. Please mark your calendar now, so you can be a part of this historic event. My challenge to our Association is for us to bring at least 100 pharmacists to the Capitol for this event. And most exciting, we will once again have the Health Fair on the second floor of the Capitol Rotunda! Speaking of Health Fairs, what a grand time we had at the 2016 Miami-Dade College Health Fair this past February. Special thanks go out to Region 8 Board of Director Bert Martinez for his continued coordination of this special event. And a special thanks to Nova APhA-ASP Chapter President Jessica Greenwood-Castillo, pharmacy technician member Lydia Mayoral, and the more than two dozen students from the Nova Southeastern School of Pharmacy that attended and participated in the over 200 health screenings that we completed that day at the health fair. It was a huge success, and we undoubtedly helped many there! The Pirates were about at this past Summer’s FPA Convention, held June 30-July 3 in Fort Lauderdale. We even held our very own first karaoke night, which raised over $700 to help benefit the Florida Pharmacy Foundation

and the support that it provides our student pharmacists through scholarships. We are excited to bring back this event by popular demand in 2017 at the FPA Convention, to be held in Orlando at the J.W. Marriott on July 13- July 16, 2017. You do not want to miss out on this!

What an impressive sight it is to see our pharmacists, student pharmacists and technician members take the Capitol by storm in Tallahassee, as we advocate for our profession. And, how amazing was our first Council and Committee meeting held in Orlando this past August? We had a record crowd in attendance, filling the room with nearly 80 attendees. It is invigorating and exciting to see so much energy in the room and the wonder-

Scott Tomerlin 2016-2017 FPA President

ful work that each of the council and committees have been working on this year. Stay tuned to see some of their exciting progress in 2017! As I pen this article, we are approaching what will be the first FPA event on the 2017 calendar, the 2017 “Launch Your Profession Forward” Leadership Conference, to be held in Orlando at the Renaissance Orlando Airport hotel on Saturday, January 7. We have searched far and wide, and have secured some of the top speakers in the industry with regard to leadership and career advancement. Those speakers will include Angela Garcia, Pharm.D., assistant professor at the University of South Florida, Norm Tomaka, past FPA president and consultant pharmacist for Health First, Christopher Lynch, retired U.S. Navy pharmacist, and Suzanne Kelley, consultant pharmacist for Covenant Hospice. I hope you will make plans to attend this event, you surely will not DECEMBER 2016

2016-17 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work diligently all year long on behalf of our members.

Tim Rogers............................................................................................................Board Chair Scott Tomerlin..............................................................................................FPA President Alexander Pytlarz.................................................................................... FPA Treasurer Suzy Wise ...................................................................................................President-Elect Carol Motycka............................................................................Speaker of the House David Mackarey............................................................Vice Speaker of the House Kathy Baldwin.......................................................................................... FSHP President Jennifer Chen........................................................................................ Region 1 Director Neil Barnett............................................................................................Region 2 Director Tom Cuomo.............................................................................................Region 3 Director Linda Lazuka.........................................................................................Region 4 Director Robert Parrado...................................................................................Region 5 Director Luther Laite IV.....................................................................................Region 6 Director Paul Delisser.................................................................... Region 7 Director (Interim) Humberto Martinez..........................................................................Region 8 Director Mitchell Fingerhut.............................................................................Region 9 Director

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair....................................................Cristina Medina, cmmedina@cvs.com Treasurer...............................Don Bergemann, don.bergemann@verizon.net Secretary................................................................... Stuart Ulrich, stuarx@aol.com Member.............................. Rebecca Poston, Rebecca.Poston@flhealth.gov Member.................................................Patricia Nguebo, notablep@hotmail.com Member................................................................Norman Tomaka, FLRX9@aol.com Member............................................Greta Pelegrin, gretapelegrin@yahoo.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com Journal Reviewer....................... Dr. Melissa Ruble, mruble@health.usf.edu Journal Reviewer....................................Dr. Angela Hill, ahill2@health.usf.edu

6 |

FLORIDA PHARMACY TODAY

regret it! So, what you might ask is on the radar for 2017. Certainly, we have much ahead in the form of opportunities. I like to refer to these as opportunities, rather than challenges. Those include working to modify the Pharmacy Practice Act to bring it more current to todayâ&#x20AC;&#x2122;s practice as pharmacists are being trained, holding PBMs accountable for the actions they are enforcing on our pharmacies, working with the Legislature on the problems associated with restricted networks with regard to the Medicaid HMOs, and educating our Legislature on how pharmacists can play a critical role in improving patient health care in Florida and across the country. Throughout the past year, we held several local town hall sessions in Orlando and most recently Sarasota, where we hosted our members to share their concerns that they are seeing in the workforce on these issues. We canâ&#x20AC;&#x2122;t fight this battle alone. We believe our strength lies in the collaboration of all of us working together in this battle. I am optimistic and excited for 2017. At the Florida Pharmacy Association, there is always a place for you to get involved. We look forward to the upcoming year, the opportunities for growth that it may present, and are ready and willing to fight for our profession and your patients. I have crisscrossed this state over this past year, visiting numerous pharmacy schools and associations, and the message is loud and clear, we are ready to Launch our Profession Forward. Join us in this mission, together we will work hard to make 2017 the best year we have seen. n

Executive Insight BY MICHAEL JACKSON, RPH MICHAEL JACKSON, B.PHARM, EVP & CEO, FLORIDA PHARMACY ASSOCIATION

A Stellar Year for Member Services

ou may not be aware of this, but the Florida Pharmacy Association is entering its 130th year of service to the membership. It was in 1887 that our organization was created in a meeting room in Jacksonville. Here we are in the 21st century and still going strong in our efforts to build on the foundation that began so many years ago. We are pleased to report that 2016 included a lot of new and reoccurring services that we have been able to bring to our member stakeholders. Continuing Education One of the most active and highly utilized services of the FPA is our vast offerings of continuing education programs. This year there were seven live conferences available that offered Board of Pharmacy approved consultant recertification services in various regions across Florida. These programs included the required medication errors CE as well as the new two-hour CE requirement on prescription validation. We also have a wide variety of home study CE programs of which many are approved for consultant recertification, medication errors and a program based on the new controlled substance prescription validation requirements. Programming has been available for pharmacy technicians as well as special networking sessions for pharmacy students. The FPA even traveled to the Mediterranean Sea and provided over 10 hours of continuing education on board Royal Caribbean’s newest cruise ship, Harmony of the Seas. In addition, FPA staff and leadership delivered CE program content at various local association meetings throughout Florida. In the near future we will be offering continuing education by webinars, where you can get your CE without having to travel.

Advocacy The core of the work of the FPA includes fighting on behalf of the profession and business of pharmacy. It is clear that in this area we will never run out of things to do. Our battles for this year, in addition to the Florida Legislature, have been before the Agency for Health Care Administration, Florida Board of Pharmacy, the Congress of the United States, the Center for Medicare and Medicaid Services, the Florida Attorney General’s Office and the Food and Drug Administration. This included, but was not limited to, discussions with policy makers, submission of comment letters and also the publishing of editorials in the print media of Florida. We also published a number of member advocacy messages and action alerts on issues that we were monitoring. We are pleased to share with the members the following successful campaigns: ■■

■■

Advocated for and succeeded in getting the Legislature to increase the threshold for which wholesalers must review orders for controlled substances from 5,000 to 7,500 dosage units Worked with the Legislature to align Florida’s pedigree laws with federal track and trace laws Worked to expand the types of services that pharmacists could provide for patients whose prescription refills for maintenance medications have been exhausted and the prescriber cannot be contacted Succeeded in expanding the ability of pharmacists to provide the inhaled and autoinjected form of narcotic antagonists by standing order Revised Florida laws that created a pathway for pharmacists to dispense medications to the partner of

Michael Jackson, B.Pharm

■■

patients with sexually transmitted diseases. Supported legislation that created a pathway for registration or licensure of the health care provider spouses of military personnel Monitored the removal of a requirement for pharmacist and technician licensure candidates from having to complete a two-hour medication safety program and maintained the CE requirement after licensure Supported the change in PDMP laws that would allow for a pharmacy technician to query the database on behalf of the pharmacist Monitored legislation that required prescription drugs with abuse deterrent and those without abuse deterrent properties to be covered similarly under insurance plans Monitored legislation that restricted the sale of dextromethorphan to persons who are younger than 18 years of age DECEMBER 2016 |

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

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

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

FLORIDA PHARMACY TODAY BOARD Chair..................................... Carol Motycka, St. Augustine Vice Chair................................Cristina Medina, Hollywood Treasurer...................Don Bergemann, Tarpon Springs Secretary.........................Stuart Ulrich, Boynton Beach Member..............................Rebecca Poston, Tallahassee Member.............................................. Patricia Nguebo, Ocala Member................................. Norman Tomaka, Melbourne Member..............................................Greta Pelegrin, Hialeah Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer-reviewed publication. ©2016, 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

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Monitored legislation that would give ARNPs and PAs controlled substance prescribing authority Worked with the Board of Pharmacy on controlled substance dispensing issues as well as a number of other proposed rule changes Worked with the national associations on the federal provider status initiatives and got the majority of the Florida congressional delegation to sign on as cosponsors.

Our political committee has been very active this year both with fundraising as well as supporting political candidates. We were able to hit our fundraising goal and even raised the bar for the next 12 months. We also supported a number of political candidates and over 90 percent were successful during the general election. The FPA has been the primary host of the annual Florida Pharmacists Legislative Day event in Tallahassee for the past several years. We had close to 400 participants at the Capitol with a number of visits to legislators educating them on pharmacy issues. Member Services The FPA is pleased to share with the membership that we are continuing a number of popular member services as well as introducing new member programs. Our technician training program has been very popular and has been helpful in assisting technician candidates in becoming eligible for registration status. We are also continuing our member rewards program available through our Pharmview.com website, and those members who are actively involved in recruiting nonmember pharmacists receive valuable benefits for their efforts. The FPA also entered into a relationship with SoFi on a student loan refinancing program in which those members who have student loans can get their costs reduced. There are also changes underway to add students and technicians to the FPA Board of Directors. This year, we introduced a new app for those attending the annual meeting and convention. The app, which made it easier for members to navigate the convention

and report their CE participation, was well received. What’s new for 2017 is a member payment program that allows current and new pharmacist members who would be paying $195 for their dues annually to elect to make monthly payments of $18. The payment program would be automatic and will be done by credit card. Included in our regular member services is the monthly publication of Florida Pharmacy Today. This magazine includes various articles of interest to the profession and is provided electronically along with regular issues of Stat News. Stat News is sent by email monthly and more frequently during the legislative session. Our social media sites, such as our Facebook and Twitter accounts, are getting a considerable amount of activity. The FPA will also be changing its option to support the Foundation through the dues payment option. The Foundation has its own website and has requested that the FPA refer donor members there rather than processing contributions through Pharmview.com. This new process will begin in January of 2017. We are also pleased to announce that we have revamped our career center on Pharmview.com. This new tool is helpful for those members seeking employment and also for those who may be looking to bring on new staff. Our student outreach has been exemplary, with FPA staff and leadership visiting with each of Florida’s seven pharmacy school campuses. We have student representatives on nearly all of FPA’s committees and councils, and they have played an active role in helping to shape our policies and working our strategic plan. We are excited about the future of our organization with the recent strong growth in our membership. The momentum that was created during this leadership year will carry over into 2017. We have a very aggressive political campaign planned with coordinated efforts to fight for a number of pharmacy issues. Stay tuned for announcements of new initiatives that your association will be undertaking. n

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DECEMBER 2016

Efinaconazole and Tavaborole, New Topical Treatments for Onychomycosis: What Practicing Pharmacists Need to Know

Lindsey Childs-Kean, PharmD, MPH, BCPS Clinical Assistant Professor Department of Pharmacotherapy and Translational Research University of Florida College of Pharmacy Seminole, FL Lchilds-kean@cop.ufl.edu

(727) 394-6213 9200 113th St N PH 102 Seminole, FL 33772 Primary and Corresponding Author

Zuzana Blackwood PharmD Candidate University of Florida College of Pharmacy Seminole, FL zblackwood@ufl.edu 9200 113th St N PH 102 Seminole, FL 33772 10

FLORIDA PHARMACY TODAY

Mark Kennedy PharmD Candidate University of Florida College of Pharmacy Seminole, FL mark.kennedy@ufl.edu 9200 113th St N PH 102 Seminole, FL 33772 Lindsey Childs-Kean, PharmD, MPH, BCPS is a Clinical Assistant Professor in the Department of Pharmacotherapy and Translational Research with the University of Florida College of Pharmacy at the St. Petersburg campus. She earned her PharmD degree from University of Florida and completed a PGY1 residency at Tampa General Hospital and a PGY2 Infectious Diseases residency at the South Texas Veterans Healthcare System. Her teaching, research, and practice interests include infectious diseases and professional development of students and new practitioners. Keywords: Efinaconazole, Tavaborole, Onychomycosis, Fungal Infections

Disclosures: The authors report no financial or commercial relationships in regard to this article. Abstract Introduction: Onychomycosis is a fungal infection of the finger or toenail that is often accompanied by pain, embarrassment, and diminished quality of life. Treatment options include systemic antifungals, which pose the risks of drugdrug interactions and adverse events, and topical antifungals, which have questionable efficacy. New prescription topical agents efinaconazole and tavaborole are now available for onychomycosis treatment. Discussion: Efinaconazole and tavaborole were each evaluated for safety and efficacy in two phase III multicenter, randomized, double-blind, vehicle-controlled studies. Both drugs showed significantly improved complete cure rates over vehicle-treated patients (p<0.001 for each drug). Adverse events were mild to moderate, topical in nature and required few treatment discontinuations. Practical considerations for the practicing pharmacist to assist in the optimal use of these new agents include assisting patients in accessing copay assistance programs and counseling on appropriate administration techniques. Conclusion: Efinaconazole and tavaborole present a viable but costly alternative to currently used oral and topical treatments. Introduction Onychomycosis is a fungal infection of the finger or toe nail(s) that has historically limited treatment options. The disease can infect any part of the nail, including the matrix, bed, and/or plate.1 It typically presents as a yellowing, thickening and deformity of the nails.2 This condition accounts for approximately 50% of nail diseases,1 and its prevalence is increasing in developed countries.3 Several studies have correlated age over 50 with increasing prevalence.4,5,7 In addition to increasing age, other factors contributing to the risk of developing onychomycosis include diabetes, immunosuppres-

sion, poor peripheral circulation, trauma and tinea pedis.4,7 It is estimated by podiatrists that onychomycosis affects up to 35 million people in the United States.4 Despite being a non-life threatening condition, if left untreated, complications such as discomfort, pain, as well as secondary complications like skin ulceration and systemic infections may develop, particularly in the immunodeficient and diabetic population.7 The stigma and the embarrassment accompanying this condition can lead to social and workplacerelated matters. Patients may fear spreading the disease to others, and the embarrassment stemming from perceived disfigurement may go hand in hand with feelings of low self-esteem, inadequacy, depression and social isolation that result in a reduction of productivity and quality of life.8 Current standard of care options include oral agents such as itraconazole and terbinafine.9 These oral agents have been first line treatment for years, yet they have many drug-drug interactions and serious side effects including hepatotoxicity.10 This limits the use of an oral antifungal in patient populations such as the elderly and immunocompromised. Available topical agents like ciclopirox (Penlac) have offered relief from the concerns of drug-drug interactions and side effects at the cost of questionable efficacy, even with up to 48 weeks of treatment.11 Two new topical antifungal agents, efinaconazole (Jublia) and tavaborole (Kerydin), recently approved for onychomycosis, try to fill the gap between side effects of oral agents and limited efficacy of older topical agents.2,10 Efinaconazole is an azole antifungal agent that works by inhibiting the fungal lanosterol 14-Îą-demethylase, which is required for ergosterol synthesis.12 Tavaborole is a novel antifungal in the oxaborole class, halting fungal protein synthesis by inhibiting an aminoacyl-transfer ribonucleic acid synthetase.13 This article will discuss the clinical evidence supporting the use of the new topical agents and other considerations for the practicing pharmacist. Clinical Studies The safety and efficacy of efinaconazole and tavaborole were investigated in four phase III multicenter, randomized,

Table 1. Efficacy of Efinaconazole and Tavaborole for the treatment of Onychomycosis Drug or Vehicle

Study 1

Study 2

Complete cure

Mycologic cure

Complete cure

Mycologic cure

Tavaborole

6.5%

31.1%

9.1%

35.9%

Vehicle

0.5%

7.2%

1.5%

12.2%

p Value2

p =0.001

p <0.001

Efinaconazole

17.8%

55.2%

15.2%

53.4%

Vehicle

3.3%

16.8%

p Value10

p <0.001

53.4% p <0.001

p<0.001 DECEMBER 2016 |

double-blind, vehicle-controlled studies. The primary outcome in each study was complete cure, defined as a combination of clear affected toenail and mycologic cure at 52 weeks. Mycologic cure was defined as negative KOH wet mount and negative fungal culture.2,10 Participants in these trials had a diagnosis of mild to moderate toenail onychomycosis involving at least 1 great toenail.2 Table 1 summarizes the efficacy data for the two agents. The two studies investigating the safety and efficacy of efinaconazole 10% solution enrolled 1,655 participants (n=870 for study 1 and n=785 for study 2) between 18 to 70 years of age with a clinical diagnosis of mild to moderate toenail onychomycosis affecting at least 1 great toenail.10 White participants represented the majority of the study population (64.9% and 87.8% in study 1 and study 2 respectively), and the majority were male (74.4% and 80.4% respectively).10 Enrolled participants were randomized 3:1 to receive efinaconazole 10% solution or vehicle (placebo).The topical agents were self-applied to the affected toenail once a day for 48 weeks without any nail debridement. The 48-week treatment period was fol-

THE PRIMARY OUTCOME IN EACH STUDY WAS COMPLETE CURE, DEFINED AS A COMBINATION OF CLEAR AFFECTED TOENAIL AND MYCOLOGIC CURE AT 52 WEEKS.

lowed by 4 treatment-free weeks of follow-up. Safety and efficacy assessments were done at baseline, then at 12-week intervals, and at the final visit at week 52. These assessments included monitoring and recording of adverse events as well as vital sign measurements and laboratory parameters.10 The results of the two studies showed that complete cure was significantly higher in the efinaconazole groups (17.8% and 15.2% versus 3.3% and 5.5%, p<0.001).10 Mycologic cure was also achieved in more efinaconazole-treated patients (55.2% and 53.4% versus 16.8% and 16.9%, p<0.001).10 Adverse events associated with the use of efinaconazole were generally mild or moderate. The most common treatment-related adverse effects were application site dermatitis and vesicles. The discontinuation rate of efinaconazole was 3.2% in study 1 and 1.9% in study 2, compared with 0.5% and 0% for vehicle in the respective studies.10 Tavaborole 5% solution was investigated for safety and efficacy in two trials that enrolled 1,198 participants (study 1: 594, study 2: 604) who were between 18- and 88-years-old.2 The majority of the study population comprised of white (78.8% and 89% in study 1 and study 2, respectively) male participants (81.1% and 82.3% respectively).2 A 2:1 randomization into tavaborole and vehicle (placebo) groups was performed. The topical agents were self-applied once a day to the affected toenail for 48 weeks without nail debridement. An assessment of disease involvement was done on day 1, week 2, week 6, and then at 6 week intervals. Participants were assessed for adverse reactions, vital signs, electrocardiogram (ECG), and laboratory parameters throughout the study.2 Significantly more patients treated with tavaborole achieved complete cure 6.5% and 9.1% versus 0.5% and 1.5% in the vehicle group (p<0.001).2 Mycologic cure was achieved more frequently in the tavaborole groups (31.1% and 35.9% versus 7.2% and 12.2%, p<0.001).2 Treatment-related adverse reactions were generally mild to moderate and included application site exfoliation and ingrown toenail;13 they generally resolved without a sequelae.2 The discontinuation rates were 0.3% and 0.5% (study 1 and study 2 respectively).2 Efinaconazole and tavaborole present a viable alternative for the treatment of onychomycosis; however, there are significant limitations to the phase III trials. The two agents have not been studied head-to-head against each other or against other antifungal therapy, so direct efficacy comparisons are not possible.2,10 Furthermore, the safety and efficacy of these agents remains unknown if they are used beyond 48 weeks.10 Persons with severe onychomycosis, coinfection with nondermatophyte fungi, as well as those with uncontrolled diabetes, immunocompromising conditions, moccasin tinea pedis, those less than 18 years of age, or those with other conditions

TREATMENT WITH THE NEW TOPICAL ANTIFUNGALS WAS PROVEN TO BE EFFECTIVE WHEN COMPARED TO PLACEBO; HOWEVER, COMPLETE CURE RATES DID NOT EXCEED 17.8%. 12

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that may have caused toenail abnormalities were excluded from these trials; therefore, the efficacy and safety of efinaconazole and tavaborole in these patients remain unknown.2,10 Since the above trials did now allow for nail debridement along with the use of the topical agents, it remains undetermined if this combination would lead to better efficacy.2,10

OTHER COUNSELING POINTS FOR PATIENTS INCLUDE NAIL POLISH USE, MISSED DOSES AND DRUG STORAGE. THE MANUFACTURERS RECOMMEND AGAINST USING NAIL POLISH WHILE TREATING WITH EFINACONAZOLE OR TAVABOROLE, BECAUSE THE EFFECT OF NAIL POLISH ON THE CLINICAL EFFICACY OF THESE AGENTS HAS NOT BEEN EVALUATED. Practical Considerations Treatment with the new topical antifungals was proven to be effective when compared to placebo; however, complete cure rates did not exceed 17.8%.2,10 When informing patients about these new antifungal options, it is important to counsel on the potential efficacy, as well as the duration of treatment and the cost.2,10 Both new agents require a daily topical application for 48 weeks even if results are seen earlier.2,10 The cost for a course of treatment with efinaconazole can exceed $2000.14 Tavaborole has a price of $645.43 per 4 ml bottle, and at least three bottles are likely to be needed for the full 48week treatment course.13 In comparison, ciclopirox has a cash price of about $100 per 6.6mL bottle, and multiple bottles are needed for a full treatment course.15 Efinaconazole and tavaborole both offer cost relief to patients through discount cards available on the manufacturers’ websites.16,17 The manufacturer of efinaconazole reports that most patients will pay a $0 copay for either the 4 ml or 8 ml size bottles for up to 12 fills.16 The same number of refills apply to both insured and cashpaying patients with a reported cost of $125 for the 4ml bottle and $200 for the 8ml bottle.16 The manufacturer of tavaborole also offers a discount card through their website, and according to the manufacturer’s customer support department (personal communication, March 2016) insured patients can pay as little as $0 with 11 total fills of the medication.17 The tavaborole discount card does not apply to cash-paying customers.17 Neither of the programs offer benefits for non-commercial insurance holders including Medicaid and Medicare recipients.16,17 Proper application technique is vital to ensuring optimal use of the product. Patient counseling is crucial to assure compliance and appropriate refill time in order to avoid gaps in therapy. Patients should be instructed to wait at least ten minutes after washing, bathing, or showering before apply-

ing efinaconazole.12 One drop should be applied on each affected toenail, with 1 additional drop to the end of each big toenail involved.12 The drops should then be spread over the tops and under the fronts of the infected toenails using the brush attached to the bottle.12 After application, the drug should be allowed to dry for several minutes.12 The number of days that one bottle will last depends on how many and which toenails are involved. Efinaconazole comes in a 4 ml and 8 ml size, and patients may benefit from procuring the larger size to reduce the number of refills and copays.12 For tavaborole, one drop should be placed on the clean and dry toenail with an additional drop allowed if more product is needed for full coverage of the nail.13 The drops should be spread over the entire nail including under the front of the toenails using the tip of the dropper.13 Any excess drug on the skin after application can be removed with a tissue.13 After application, drug should be allowed to dry for several minutes.13 Instructions for tavaborole estimate the use of one to two drops per nail as needed for full coverage; this can result in different quantities of bottles needed for the duration of treatment based on number of affected nails and patient variability.13 Tavaborole is available in 5 ml and 10 ml size bottles and the bottle should be discarded after three months of inserting the dropper.13 Other counseling points for patients include nail polish use, missed doses and drug storage. The manufacturers recommend against using nail polish while treating with efinaconazole or tavaborole, because the effect of nail polish on the

Representing Health Care Professionals

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

1101 Douglas Avenue Altamonte Springs, FL 32714 Telephone: (407) 331-6620 www.TheHealthLawFirm.com

DECEMBER 2016

clinical efficacy of these agents has not been evaluated.12,13 If the patient misses a dose for either one of these medications, a dose should be applied as soon as they remember it.12,13 If it is close to the next dose, patient should be instructed to skip the missed dose and go back to their regular dosing schedule.12,13 These medications should be stored at room temperature in a dry place, away from children and pets.12,13 Counseling patients about the proper application and storage of efinaconazole and tavaborole can help ensure that patients use the products correctly for the full treatment time and they are aware of the costs of the drug therapy. Conclusion Onychomycosis is a fungal infection that can affect the productivity and quality of life of a large number of individuals. Current oral treatment options come with significant drug-drug interactions in addition to a possibility of hepatotoxicity. These characteristics make oral agents less than desirable for patients on multiple concomitant medications or those with impaired liver function. Older topical agents come with a more favorable toxicity profile, however, they lack significant efficacy.11 The new topical agents, tavaborole and efinaconazole, present viable alternatives to established oral and topical treatments.2,10 Manufacturers of both products offer programs to help reduce the financial burden that these newer agents may present. However, despite several currently available treatment options, the optimal cure for this disease remains elusive. Treatments that offer high efficacy with low

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

STATEWIDE REPRESENTATION 561-392-9000 bkahan@kahanlaw.com 2300 N.W. Corporate Blvd., Suite 123 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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risk of side effects and drug-drug interactions remain a major interest of further research. References:

1 Scher RK. Onychomycosis is more than a cosmetic problem. British Journal of Dermatology. 1994 Apr;130 Supplement 43:15. 2 Elewski BE, Aly R, Baldwin SL, et al. Efficacy and safety of tavaborole topical solution, 5%, a novel boron-based antifungal agent, for the treatment of toenail onychomycosis: Results from 2 randomized phase-III studies. Journal of American Academy of Dermatology. 2015;73:62-69. 3 Aly R. Ecology and epidemiology of dermatophyte infections. Journal of American Academy of Dermatology. 1994 Sep;31(3):S21–S25. 4 Ghannoum MA, Hajjeh RA, Scher R, et al. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. Journal of American Academy of Dermatology. 2000;43(4):641-648. 5 Elewski BE, Onychomycosis: Treatment, quality of life, and economic Issues. American Journal of Clinical Dermatology. 2000;1(1)19-26. 6 Gupta AK, Jain HC, Lynde CW et al. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. Journal of American Academy of Dermatology. 2000;43:244-248. 7 Thomas J, Jacobson GA, Narkowicz CK, et al. Toenail onychomycosis: and important global disease burden. Journal of Clinical Pharmacy and Therapeutics. 2010;35:497-519. 8 Drake LA, Patrick DL, Fleckman P, et al. The impact of onychomycosis on quality of life: Development of an international onychomycosis-specific questionnaire to measure patient quality of life. Journal of the American Academy of Dermatology.1999;4(2):189-196. 9 Westberg DP, Voyack MJ. Onychomycosis: Current trends in diagnosis and treatment. American Family Physician. 2013;88(11):762-770. 10 Elewski BE, Rich P, Pollak R, et al. Efinaconazole 10% solution in the treatment of toenail onychomycosis: Two phase III multicenter, randomized, double-blind studies. Journal of American Academy of Dermatology. 2013;68(4):600-608. 11 Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. Journal of Clinical and Aesthetic Dermatology. 2014;7(7):10-18. 12 Jublia (efinaconazole) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America; March 2015. 13 Kerydin [package insert]. Palo Alto, CA: Anacor Pharmaceuticals, Inc; 2014. 14 Mikhailov A, Cohen J, Joyce C, et al. Cost-effectiveness of confirmatory testing before treatment of onychomycosis. JAMA Dermatology. 2016;152(3):276-281. 15 Penlac prices. (n.d.) Retrieved December 9, 2016 from https:// www.goodrx.com/penlac. 16 Valeant Access Program. (n.d.). Retrieved March 18, 2016 from http://www.valeantaccessprogram.com/. 17 Kerydin discount program. (n.d.). Retrieved March 18, 2016 from http://www.kerydin.com/instant-savings.html?gclid=C MWPxfvU18sCFckehgodJJILeg#prescription-savings.

Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing By Martin R. Dix, J. D., Florida State University College of Law During the 2016 legislative session, Florida granted authority to both advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) to prescribe controlled substances, subject to approval by their supervising practitioner. This change brings these professionals’ authority in line with what most other states allow. However, this was not a complete grant of prescribing authority and, as explained below, leaves these professionals with a few restrictions to track. ARNPs: ARNPs are now allowed to “prescribe, dispense, administer, or order any drug” under a supervisory arrangement with a practitioner. However, in order to dispense a controlled substance, the ARNP must have “graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills.” It is not known if this leaves some ARNPs without the authority to prescribe controlled substances. The Florida Board of Nursing is required to establish a committee to recommend a formulary of controlled substances that ARNPs can and cannot prescribe or only prescribe for specific uses or in limited quantities, or to limit the prescribing of certain drugs to certain types of ARNPs. The formulary must restrict the prescribing of “psychiatric mental health controlled substances” for children younger than 18 years of age to ARNPs who are also psychiatric nurses. With the exception of “controlled substances that are psychiatric medications” prescribed by ARNPs who are psychiatric nurses, ARNPs cannot prescribe more than a sevenday supply of a Florida Schedule II con-

trolled substance. It is not clear whether “psychiatric mental health controlled substances” are the same as “controlled substances that are psychiatric medications.” These requirements are set forth in the ARNP rules (Rule 64B9-4.016, F.A.C.). The formulary applies to prescribed drugs, but not those “dispensed for administration” (presumably drugs administered directly to the patient). ARNPs practicing in facilities licensed under Chapter 395 and Part II of Chapter 400, FS, (generally hospitals and nursing homes) may, within their protocol arrangements, order any medication for administration to a patient. PAs: PAs were likewise granted Florida controlled substance dispensing authority effective January 1, 2017, subject to the protocols with their supervising physician and subject to certain limitations in the PAs’ formulary: Physician Assistants may not prescribe psychiatric mental health controlled substances for children younger than 18 years of age Physician Assistants may only prescribe a seven-day supply of Schedule II controlled substances as listed in Section 893.03, FS PAs may order any medication for administration to the supervising practitioner’s patients allowed by the supervising practitioner in any facility licensed under Chapter 395 and Part II of Chapter 400, FS, (generally hospitals and nursing homes). Where does this leave pharmacies and pharmacists? When ARNPs and PAs were first granted prescribing authority, pharmacists had been concerned that when they received prescriptions from PAs or ARNPs that they would not know whether the supervising physician had allowed the prescribing. To address this concern, in 2004, legislation was passed that allowed the pharmacies and phar-

macists to presume that ARNP and PA prescriptions were valid (Section 456.0392, FS). The Legislature excluded controlled substances from this presumption since, at that time, ARNPs and PAs lacked controlled substance prescribing privileges. Unfortunately, this law was not amended during the 2016 legislative session to address any presumption as to controlled substance prescriptions. So, while a pharmacy or pharmacist may legally presume that prescriptions written by ARNPs and PAs are valid if the medications are not controlled substances, they may not legally presume that controlled substance prescriptions written by ARNPs and PAs are valid. A pharmacy may wish to confirm that a PA or ARNP has a protocol with the prescribing physician and the ARNP has the required educational training before filling controlled substance prescriptions. Pharmacies and pharmacists should also confirm that an ARNP is a psychiatric nurse for those mental health and psychiatric drug prescriptions that only such an ARNP may prescribe. Hopefully, the Legislature will address this gap in the law in a future session. This same statutory provision required pharmacists to list on the label of prescriptions the name and professional license number of a “practitioner who is authorized under the laws of this state to write prescriptions for drugs that are not listed as controlled substances in chapter 893 but who is not eligible for a federal Drug Enforcement Administration number.” Since this section no longer applies, it should be addressed by the Legislature in a future session as well. Martin Dix, Board Certified by The Florida Bar in Health Law, practices healthcare law at Akerman, with his primary focus on pharmacy law. DECEMBER 2016

CALL FOR RESOLUTIONS TO THE 2017 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in May 2017 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is May 19, 2017. PLEASE NOTE THIS DEADLINE. The last day to submit items of new business is June 16, 2017. The following information will be needed when submitting resolutions: 1. Name of organization: The name of the organization submitting the resolutions(s); 2. Name and telephone number of individuals: A contact in the event clarification or further information is needed; 3. Problem: A statement of the problem addressed by the resolution; 4. Intent: A statement of what passage of the resolution will accomplish; 5. Resolution Format: Please type and use double spacing. TITLE OF RESOLUTION NAME OF ORGANIZATION WHEREAS , AND

WHEREAS :

THEREFORE BE IT RESOLVED (THAT THE FPA OR SUBDIVISION OF FPA)

CONTACT NAME AND PHONE #: PROBLEM: INTENT:

Return this form to: Membership Coordinator, Florida Pharmacy Association, 610 North Adams Street, Tallahassee, Florida 32301 or fax (850) 561-6758

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FPA News & Notes FPA Continues Open Network Advocacy FPA advocates recently met with the House Health and Human Services Committee Chair to discuss Medicaid network closure issues that are happening across Florida. Under the current Florida Medicaid managed care program health plans have the ability to limit the size of their pharmacy networks based upon credentials, quality indicators and price. This is articulated in Florida Statutes 409.975 implemented by AHCA and approved by the 2011 Florida Legislature. The Medicaid program and the legislature must revisit this policy statement that allows for the indiscriminate exclusion of highly qualified pharmacy providers. There is an “Action Alert” posted on the Pharmview.com website where members can message members of the Florida House and Senate to brief them on this issue. This alert system works best if you customize it to how it is affecting your pharmacy. Your senator or representative may ask if there is a bill number and for the moment one has not been filed yet. The FPA has hosted two town hall meetings and there will be likely others in the near future. Pharmacy Practice Act Needs to Change Today’s pharmacists are taking on many new roles in the health care industry. This includes medication therapy management, preventative immunization services, diabetes counseling, and general health and well-being services. The curriculums in our seven colleges of pharmacy are preparing their candidates for the next 40 years of service. Our Pharmacy Practice Act, however, was written during a different time. It is safe to presume that what we are allowed to do has not caught up with what we are trained to do. We are beginning to have conversations with policy makers on the need for revisions to F. S. 465 to make some long overdue changes. This may include revisions that would allow pharmacists to play a greater role in drug therapy decision making and closer collaboration with our prescribing colleagues. The pharmacy industry is having discussions with the medical community and at that same time we need to begin having similar conversations with members of the Florida House and Senate. While there is no bill number at this time, it is recommended that you use the break between now and the start of the March legislative session to talk about a higher role for pharmacists. Here are some talking points that can help you as we prepare for the 2017 Legislative Session.

Surgeon General Releases Report on E-Cigarettes U.S. Surgeon General Vivek H. Murthy published a new report this week, “E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General” to address the growing public health threat. Dr. Murthy’s report confirms that there is “no acceptable level of nicotine when it comes to our kids,” and that “aerosol form e-cigarettes is not harmless.” The report, as well as tools for parents and a PSA from Dr. Murthy, can be found online at e-cigarettes.surgeongeneral.gov. Professional Liability Insurance – Is It Necessary This is a curious question to ask these days. If you travel across Florida you will find an ample inventory of billboards advertising resources that consumers can go to if there is an injury regardless of whether it is by an automobile accident, product or even through medical mistakes. Some of our colleagues may rely upon their employers to provide professional liability coverage but is that enough for you in today’s busy pharmacy practices? You would not dare risk driving your automobile on today’s busy highways without your own insurance coverage and you should feel the same way about your “professional superhighway.” For more information contact Pharmacist Mutual Insurance Company for both professional liability and other insurance services.

DECEMBER 2016

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APhA Foundation and NASPA Bowl of Hygeia Awarded to a pharmacist for outstanding community service above and beyond professional duties. The use of the following selection criteria is required: ■■ The recipient must be a Florida licensed pharmacist and a member of FPA. ■■           ■■ T recipient has not previously received the award. ■■               two  on its award committee or an officer of the association other than in an ex officio capacity. ■■   has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession. James H. Beal Award Awarded to the "Pharmacist of the Year." The criteria established for this award is that the recipient be a Florida registered pharmacist and a member of FPA, who has rendered outstanding service to pharmacy within the past five years. Criteria: ■■   must be a Florida registered pharmacist and a member of the FPA. ■■   has rendered outstanding service to pharmacy within the past five years. Technician of the Year Award Awarded annually to a Florida pharmacy technician who is recognized for his/her outstanding performance and achievement during his/her career. Criteria: ■■ Candidate must be a member of the Florida Pharmacy Association for at least two years. ■■ Candidate must have demonstrated contributions and dedication to the advancement of pharmacy technician practice.

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N O M I N A T I O N S ■■ Candidate must have demonstrated

contributions to the Florida Pharmacy Association and/or other pharmacy organizations. ■■ Candidate must have demonstrated commitment to community service. ■■ Candidate is not a past recipient of this award. R.Q. Richards Award This award is based on outstanding achievement in the field of pharmaceutical public relations in Florida. Criteria: ■■  recipient must be a Florida registered pharmacist and a member of the FPA. ■■   has displayed outstanding achievement in the field of pharmaceutical public relations in Florida. Frank Toback/AZO Consultant Pharmacist Award Criteria: ■■ Candidate must be an FPA member, registered with the Florida Board of Pharmacy as a consultant pharmacist in good standing. ■■ Candidate should be selected based on their outstanding achievements in the field of consultant pharmacy. DCPA Sidney Simkowitz Pharmacy Involvement Award Presented annually to a Florida pharmacist who has been active at the local and state pharmacy association level in advancement of the profession of pharmacy in Florida. Criteria: ■■ A minimum of five years of active involvement in and contributions to the local association and FPA. ■■ Candidate must have held office at local level pharmacy association. ■■ Member in good standing for a period of at least five years in the FPA and must have served as a member or chairman of a committee of the association. ■■ Candidate must have been actively involved in a project that has or could potentially be of benefit to members of the profession.

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Pharmacists Mutual Companies Distinguished Young Pharmacist Award Awarded to a young pharmacist for their involvement and dedication to the practice of pharmacy. Criteria: ■■ Licensed to practice for nine years or fewer. ■■ Licensed to practice in the state in which selected. ■■ Participation in national pharmacy association, professional programs, and/or community service. IPA Roman Maximo Corrons Inspiration & Motivation Award Interamerican Pharmacists Association created this award to honor the memory of Roman M. Corrons who inspired and motivated countless pharmacists to participate actively and aspire to take on leadership roles in their profession. Roman was always there with guidance and support that motivated pharmacists and encouraged visionary leadership, approachable active membership and succession planning. This award recognizes the motivators among us who inspire others to continue to advance the profession. Criteria: ■■ The recipient must be a Florida Licensed Pharmacist and a member of the FPA. ■■ Candidate should motivate others to excel within the profession by encouraging them to be leaders. ■■ Candidate is not necessarily an association officer, but guides, supports and/or inspires others. A brief description on the candidate’s motivational/inspirational skills must accompany the nomination. The Jean Lamberti Mentorship Award The Jean Lamberti Mentorship Award was established in 1998 to honor those pharmacists who have taken time to share their knowledge and experience with pharmacist candidates. The award is named in honor of long time FPA member Jean Lamberti for her effort in working with pharmacy students.

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Criteria: ■■ The recipient must be an FPA member. ■■ The recipient must serve as a role model for the profession of pharmacy. Upsher Smith Excellence in Innovation Award Awarded to honor practicing pharmacists who have demonstrated innovation in pharmacy practice that has resulted in improved patient care. Criteria: ■■ The recipient has demonstrated innovative pharmacy practice resulting in improved patient care. ■■ The recipient should be a practicing pharmacist within the geographic area represented by the presenting Association.

Qualified Nominee: A pharmacist practicing within the geographic area represented by the presenting Association. Cardinal Generation Rx Award The Cardinal Health Generation Rx Champions Award recognizes a pharmacist who has demonstrated excellence in community-based prescription drug abuse prevention. The award is intended to recognize outstanding efforts within the pharmacy community to raise awareness of this serious public health problem. It is also intended to encourage educational prevention efforts aimed at patients, youth and other members of the community. The nominee must be a pharmacist who is a member of the state association. Self-nominations are allowed. Applica-

tions will be evaluated based upon the following criteria: ■■ Commitment to community-based educational prevention efforts aimed at prescription drug abuse ■■ Involvement of other community groups in the planning and implementation of prevention programs ■■ Innovation and creativity in the creation and implementation of prevention activities ■■ Scope/magnitude of prescription drug abuse efforts ■■ Demonstrated impact of prescription drug abuse prevention efforts

DEADLINE FOR NOMINATIONS: FEBRUARY 28, 2017 FPA AWARDS NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NOMINATED BY:

Name:

Address:

Date Submitted: Signature:

FOR THE FOLLOWING AWARD: (Nomination Deadline February 28, 2017)  APhA Foundation and NASPA Bowl of Hygeia  James H. Beal Award

Please describe briefly below the nominee's accomplishments, indicating why you feel he or she should receive this award. (Attach additional sheets if necessary.)

 Technician of the Year Award  R.Q. Richards Award  Frank Toback/AZO Consultant Pharmacist Award  DCPA Sydney Simkowitz Award  Pharmacists Mutual Co. Distinguished Young Pharmacist Award  IPA Roman Maximo Corrons Inspiration & Motivation Award  The Jean Lamberti Mentorship Award  Upsher Smith Excellence in Innovation Award  Cardinal Generation Rx Award

MAIL NOMINATONS TO: Annual Awards, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS FEBRUARY 28, 2017

DECEMBER 2016

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FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 412-4166 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm DRUG INFORMATION CENTER Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 http://floridapoisoncontrol.org/ NATIONAL COMMUNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314 (703) 683-8200 (703) 683-3619 fax info@ncpanet.org

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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RECOVERING PHARMACISTS NETWORK OF FLORIDA (407) 257-6606 “Pharmacists Helping Pharmacists”