July 2017 Florida Pharmacy Today by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association JULY 2017

2017-2018 FPA PRESIDENT

SUZY WISE

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florida PHARMACY TODAY Departments

VOL. 80 | NO. 7 JULY 2017 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

4 Calendar

Handbook of Association Information

4 Advertisers

Take part in the full benefits of Florida Pharmacy Association membership. Included is information you can use to participate in legislative activities and information you need to contact association leadership.

5 President’s Viewpoint 7 Executive Insight 36 Buyer’s Guide

Executive Committee ........................... 6 Address ............................................................8 Staff ....................................................................8 Mission Statement ................................10 Past Presidents .......................................10 Organization ................................................11 CE Calendar .................................................12 CE Requirements ....................................12 Code of Ethics ...........................................14

Unit Associations ................................... 17 History ............................................................. 17 #1 Club ..............................................................18 FPA Officer and Director Nominations.......................19 Mission Statement and Strategic Plan of the FPA.............18 FPA By Laws.............................................. 20 FPA Constitution..................................... 28

The Opioid Epidemic: Naloxone in the Community Setting: A Great Opportunity for Pharmacist Intervention

JULY 2017

FPA Calendar 2017

OCTOBER

JULY 28-29 Southeastern Officers Conference Sandy Springs, Ga.

3-4

Florida Board of Pharmacy Meeting

7-8

Midyear Clinical & Nuclear Conference Kissimmee

AUGUST 4

FPA Governmental Affairs Committee Meeting Orlando

6-9

Southeastern Education Gatherin’ Destin

14-16 Florida Board of Pharmacy Meeting Ft. Lauderdale 26-27 FPA Committee, Council and Board Meetings SEPTEMBER 1

Deadline to submit nominations for FPA President-Elect and Regional Directors

Labor Day - FPA Office Closed

9-10

Regulatory & Law Conference Miami

14-18 NCPA Annual Convention Kissimmee NOVEMBER 23-24 Thanksgiving FPA Office Closed DECEMBER 9-10

Regulatory & Law Conference Sarasota

12-13 Florida Board of Pharmacy Meeting

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, 2018. 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

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 EPIC..................................................................... 14 THE HEALTH LAW FIRM............................... 13 KAHAN & ASSOCIATES................................. 13 PHARMACISTS MUTUAL................................ 9 PQC...................................................................... 16 RX OWNERSHIP................................................. 2

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 SUZY WISE, PHARMD/MBA CPH

The Importance of Connecting Health Care

uccessful organizations have much in common: They are innovative, have a clear vision and strategy for the future, and weave clearly defined goals and action plans into all aspects of their operations. Perhaps one of the most important common characteristics is their ability to make connections. Connecting people. Connecting technology. Connecting ideas. These organizations are able to leverage the talent, knowledge, innovation and skill of their teams to build connections with stakeholders and customers. The FPA membership and leadership share many of these qualities and I am honored to work beside these talented and experienced members as we work toward our vision of being United to Advance Health Care and Pharmacy Practice. I am honored to serve as the 20172018 president of the Florida Pharmacy Association and look forward to working together to implement the Connecting Health Care theme. Connecting pharmacists in all practice settings. Connecting pharmacists with other health care providers. Connecting pharmacists with legislators. Con-

necting the FPA with other health care organizations. Connecting the past, present and future of the association. The landscape of health care is constantly evolving and through leveraging our connections we can continue to strengthen the association and advance health care. As we approach the 2017-2018 Leadership year, I reflect on the history of the FPA and the amazing accomplishments of the association. I am honored to follow in the footsteps of the past FPA presidents, and look forward to continuing their great work to move the profession forward. By leveraging the strengths of our councils and committees, a few of the foundational focus areas will be: ■■ Continuing our momentum toward provider status ■■ Engaging new practitioners ■■ Connecting past, current and future leadership to ensure continuity of our strategic plan ■■ Showcasing pharmacists with innovative practice models ■■ Exploring and implementing new ways of delivering content to members

I am honored to serve as the 20172018 president of the Florida Pharmacy Association and look forward to working together to implement the Connecting Health Care theme.

Suzy Wise, PharmD/MBA CPh 2017-2018 FPA President ■■

■■ ■■

■■

Strengthen and highlight our relationships with other health care professionals Engage more pharmacists around the state to strengthen our voice Create a process to evaluate the financial viability of new ideas and technologies Continuing the momentum to ensure a unified voice in legislation for pharmacy

With rapid advancements in technology and the ability for people to connect instantly, our association must remain nimble to serve the changing needs of our membership. The committees will be working this year to evaluate and implement technologies and platforms for delivery of content that meets the needs of our diverse membership. I challenged the committee chairs to embrace the disruptive forces in health care and technology to our advantage so we can easily shift our trajectory to continue advancing See Viewpoint, continued on p. 9 JULY 2017

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.

Scott Tomerlin....................................................................................................Board Chair Suzanne Wise...............................................................................................FPA President Ashley Huff.................................................................................................... FPA Treasurer Angela Garcia............................................................................................President-Elect David Mackarey........................................................................Speaker of the House Jeanette Connelly.......................................................Vice Speaker of the House Kathy Baldwin.......................................................................................... FSHP President Joyanna Wright................................................................................... Region 1 Director Neil Barnett............................................................................................Region 2 Director Dean Pedalino.......................................................................................Region 3 Director Linda Lazuka.........................................................................................Region 4 Director Melissa Ruble........................................................................................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

health care and the pharmacy profession. These efforts should be guided in part by the words of Ralph Waldo Emerson, â&#x20AC;&#x153;do not follow where the path may lead, but go instead where there is no path and leave a trail.â&#x20AC;?

This year we will build upon our successes and focus on strengthening connections to deliver on our mission and vision. Lastly we must ensure our continued success by leveraging the knowledge and experience of our members to connect with and support our new practitioners. Thinking back to my first years in pharmacy school, I was fortunate to cross paths with an active FPA leader who fueled my interest in the association. After graduation, it was FPA mentors who guided me through my first years as a pharmacist. Having these connections and mentors were extremely valuable experiences for me as a new practitioner. Continuing on this idea, connecting new graduates with mentors will only help to connect the past, present and future leaders of our association. This year we will build upon our successes and focus on strengthening connections to deliver on our mission and vision. I am truly humbled by the opportunity to serve the members of the Florida Pharmacy Association as president. I am excited for the great things we will accomplish together this year and in the years to come. I hope that you will join me in Connecting Health Care. n

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

FPA Conventions Rock!

s the 127th Annual Meeting and Convention of the Florida Pharmacy Association comes to a close, you would be amazed to learn that planning for the 128th has already begun. The next meeting will be at the Hyatt Regency Coconut Point in Bonita Springs, Fla. We are extremely excited to visit this region of Florida and are looking forward to another great turnout. Mark your calendars for July 12 – 15, 2018, and join hundreds of your colleagues for a lot of quality networking and connectivity. The FPA is known for its annual conferences, which include educational content for nearly every practice environment, whether you are a managing or clinical pharmacist. Our goal is to have you leave an annual meeting with much more than you came with, and based upon our postconvention surveys, we have not disappointed you. The 127th conference in Orlando delivered a lot of great content from pearls on the management of treating pain, to the treatment of Alzheimer’s disease, substance abuse and innovations in pharmacy practice. We also provided a legislative update, as well as heard a report from the Board of Pharmacy on new legislation that pharmacists and pharmacy technicians need to be aware of. Added to the 2017 annual convention were certificate training programs on pharmacy-based immunizations and diabetes care. FPA conventions are not all academic sessions, rather each conference is packed with non-continuing education events, such as our exhibition hall, social receptions, awards banquet and the President’s Breakfast. It is at the banquet where we honor those FPA members who have gone beyond the call of

duty to help society become healthier and also recognize their contributions to the Florida Pharmacy Association. The highest awards given to FPA members are the James H. Beal Pharmacist of the Year award and the Technician of the Year award. There are even friendly competitive events between the schools with our Jeopardy style game show, patient counseling competition and post-

Mark your calendars for July 12 – 15, 2018, and join hundreds of your colleagues for a lot of quality networking and connectivity.

er presentation program. Students also have designated sessions that they attend, customized for their specific learning needs. Our Adopt-A-Student program is an extensive investment by the FPA in the future practitioners of our profession. Many of our convention’s pharmacist attendees volunteer to serve as mentors to help our student participants navigate our conference and prepare them for future leadership in the FPA. Don’t forget the passion and debate within the FPA’s House of Delegates. This is where the FPA’s policy on the issues is given birth and the work plan for our organization is initiated. This year the House entertained 18 policy statements. A final report on these issues will be published by Speaker David Mackarey in a future issue of Florida Pharmacy Today. Last year we introduced new tech-

Michael Jackson, B.Pharm

nology during the 2016 annual convention in the form of an app. This allowed our convention’s participants to have access to everything related to the convention at their fingertips. This tool was well received and was brought back again for the 2017 convention. Did you miss the annual meeting this year? No worries, because the FPA will be hosting educational conferences throughout Florida over the next 12 months. We will be in Sandestin in August, Miami in September, Kissimmee in October for our clinical and nuclear conference and Sarasota in December. In January of 2018 we will return to Sandestin and we will be in Tampa in April. Our final continuing education (CE) session before the 2018 convention will be in Jacksonville in May. Don’t forget that we will be sailing the Southern Caribbean for our next CE at Sea program. Visit www.pharmview.com for more details. n JULY 2017 |

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

Director of Continuing Education Tian Merren-Owens, ext. 120

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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JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

FPA Past Presidents 1887-88 Dr. Hy Robinson

1928-29 F. B. Stephens

1888-89 Dr. J. D. Palmer

1929-30 William Emrich

1889-90 H. C. Cushman

1930-31 H. W. Childs

1890-91 W. A. Rawls

1931-32 J. H. Haughton

1891-92 A. E. Philips

1932-33 E. O. Purcell

1892-93 N. Woolridge

1933-34 John K. Clemmer

1893-94 T. S. Chalker

1934-35 Don S. Evans

1894-95 F. P. McElory

1935-36 Victor Wray

1895-96 W. I. Woodman

1936-37 George O. Taylor

1896-97 J. A. Conover

1937-38 R. Q. Richards

1904-05 J. C. Abernathy

1938-39 George Moore

1905-06 Thomas Clarke

1939-40 S. F. Harris

1906-07 J. M. Stansfield

1940-41 L. H. Penberthy

1907-08 D. W. Ramsaur

1941-42 J. Emmett Brown

1908-09 W. S. Oppenheimer

1942-46 H. B. Douglas

1909-10 J. W. Bodiford

1946-47 C. G. Hamilton

1910-12 W. D. Jones

1947-48 A. B. Ware

1912-13 Macon Thornton

1948-49 D. M. Weaver

1913-14 Leroy Cotter

1949-50 E. E. Bludworth

1914-16 M. M. Taylor

1950-51 Ed J. Pierce

1916-17 H. H. Dâ&#x20AC;&#x2122;Alemberte

1951-52 Euless Watford

1917-18 W. A. Rawls

1952-53 Clyde Morris

1918-19 Marshall Bize

1953-54 A. Wm Morrison

1919-20 J. S. Jewett

1954-55 John L. McDonald

1925-26 J. R. West

1955-56 Francis Walpole

1926-27 J. K. Atwood

1956-57 Wesley D. Owens

1927-28 Cliff Smith

Jacksonville, FL

FLORIDA PHARMACY TODAY

1957-58 Grover F. Ivey* Orlando, FL

1958-59 James Love*

Delray Beach, FL

1959-60 Rufus I. Thomas*

New Smyrna Beach, FL

1960-61 Lucien W. Watson Marianna, FL

1961-62 L. W. Harrell* Palatka, FL

1962-63 Dan Davis* Miami, FL

1963-64 Walter Griffin* Jacksonville, FL

1964-65 Freeman Oikle* Miami, FL

1965-66 Felix Donatelli Lakeland, FL

1966-67 Arnold Albert*

Orlando, FL

1967-68 Harold S. Osteen Jacksonville, FL

1968-69 John W. White* Tallahassee, FL

1969-70 Neil Bitting* Ocala, FL

1970-71 Sidney Simkowitz* Miami, FL

1971-72 Mark Sullivan* Tallahassee, FL

1972-73 George B. Browning Melbourne, FL

1973-74 John W. Davies Orlando, FL

1974-75 Bernard J. Cimino* Tampa, FL

1975-76 William Nestor

Palm Beach Gardens, FL

1976-77 Gilbert N. Weise, Sr. Jacksonville, FL

1977-78 Robert T. Showerman* St. Petersburg, FL

1978-79 John Stadnik*

Miami Springs, FL

1979-80 Lawrence A. Diaz Gainesville, FL

1980-81 Joe Cuellar*

Temple Terrace, FL

1981-82 Peter C. Demro Ocala, FL

1982-83 John C. King

Mission Statement United to Advance Health Care and Pharmacy Practice

Bartow, FL

1983-84 Michael W. Stamitoles Pensacola, FL

1984-85 George B. Browning Melbourne, FL

1985-86 Max A. Lemberger* St. Augustine, FL

1986-87 Robert Fishman Hollywood, FL

1987-88 Kenneth R. Norfleet Brooksville, FL

1988-89 Allen Nichol

Coral Gables, FL

1989-90 Red N. Camp Titusville, FL

1990-91 Ed L. Hamilton Lake Alfred, FL

1991-92 Betty J. Harris

Delray Beach, FL

1992-93 S. Mark Hobbs

Merritt Island, FL

1993-94 M. Peter Pevonka Gainesville, FL

1994-95 Allen David Knee Sunrise, FL

1995-96 James Koivisto Jacksonville, FL

1996-97 James Powers

2009-10 Karen Whalen

1997-98 Paul Ackerman

2010-11

1998-99 Rebecca R. Poston

2011-12

1999-2000 Eric M. Alvarez

2012-13

2000-01 Robert Wilson

2013-14

2001-02 Joy Marcus

North Miami, FL

2014-15 Suzanne Kelley Pensacola, FL

2002-03 Tom Cuomo

2015-16 Tim Rogers

2003-04 Theresa W. Tolle

2016-17 Scott Tomerlin

Tallahassee, FL

Palm Beach Gardens, FL Winter Springs, FL Miami, FL

Pensacola, FL

Cape Coral, FL Grant, FL

2004-05 Glenn Boyles Wellington, FL

2005-06 Kathy Petsos

Cape Canaveral, FL

2006-07 Lee Fallon

The Villages, FL

2007-08 Don Bergemann

Tarpon Springs, FL

2008-09 Norman Tomaka Melbourne, FL

Gainesville, FL

Humberto Martinez Miami, FL Bob Parrado Tampa, FL Goar Alvarez Cooper City, FL Terry Gubbins Riverview, FL

Newberry, Florida Rockledge, Florida

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

FPA ORGANIZATIONAL CHART

FPA Member

House of Delegates

Board of Directors

President’s Committee of the Board of Directors

ACPP

(Advisory Council on Pharmacy Practice)

Invited and Affiliated Organizations

EVP and CEO

AD Hoc Committees

FPA Staff Governmental Affairs Committee

Budget and Finance Committee

Standing Councils Public Affairs Professional Affairs Organizational Affairs Educational Affairs Membership Affairs Student Affairs

JULY 2017 |

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

Continuing Education Requirements for Florida Pharmacists and Pharmacy Technicians 2017-18 LIVE FPA CONTINUING EDUCATION CALENDAR AUGUST 6-9, 2017 34th Annual Southeastern Gatherin’ Sandestin Golf & Beach Resort Room Rate: $159 and up plus tax Call (800) 320-8115 by July 14, 2017 General & Consultant Recertification Credit available plus 2 hr med error and CS Exhibit and Sponsorship Opportunities Available** Destin, Florida SEPTEMBER 9-10, 2017 Regulatory & Law Conference Marriott Miami Biscayne Bay Room Rate $109 plus tax Call (305) 374-3900 by August 18, 2017 16 hrs total GCE of which 12 hrs for RC Plus 2 hour med error & controlled substance CE Miami, Florida OCTOBER 7-8, 2017 Midyear Clinical & Nuclear Conference Embassy Suites Lake Buena Vista South Room Rate $143 plus tax Call (407) 597-4000 by September 15, 2017 16 hrs total GCE of which 12 hrs for RC plus 2 hour med error & controlled substance CE Kissimmee, Florida DECEMBER 9-10, 2017 Regulatory & Law Conference Hyatt Regency Sarasota Room Rate $149 and up plus tax Call (888) 421-1442 by November 17, 2017 16 hrs total GCE of which 12 hrs for RC

Plus 2 hour med error & controlled substance CE Sarasota, Florida JANUARY 27-28, 2018 Regulatory & Law Conference Hilton Sandestin Golf & Beach Resort Room Rate $139 and up plus tax Call (850) 267-9500 by January 12, 2018 16 hrs total GCE of which 12 hrs for RC Plus 2 hour med error & controlled substance CE Destin, Florida APRIL 21-22, 2018 Clinical Conference Grand Hyatt Tampa Bay Room Rate $174 plus tax Call by March 30, 2018 16 hrs total GCE of which 12 hrs for RC Plus 2 hour med error & controlled substance CE Tampa, Florida MAY 19-20, 2018 Regulatory & Law Conference Marriott Hotel Room Rate $94 plus tax Call (800) 962-9786 by April 27, 2018 16 hrs total GCE of which 12 hrs for RC Plus 2 hour med error & controlled substance CE Jacksonville, Florida

General Continuing Education Requirements Florida licensed pharmacists are required to obtain thirty (30) hours of approved courses of continued professional pharmaceutical education the 24 month period prior to the expiration date of the license. For example approved continuing education courses will need to be completed between October 1, 2015 and September 30, 2017 before the “PS” license expires on September 30, 2017. (64B16-26.103) Ten (10) of the thirty (30) hours of approved courses of continued professional pharmaceutical education must be LIVE continuing education hours. LIVE continuing education is defined as either a live seminar, a live video teleconference, or through an interactive computer |

FLORIDA PHARMACY TODAY

JULY 21-28, 2018 Southern Caribbean Royal Caribbean’s Freedom of the Seas 10 hrs General Credit available Departure and returning port: San Juan, Puerto Rico Ports: Charlotte Amalie, St. Thomas; Willemstad, Curacao; Oranjestad, Aruba; Bassseterre, St. Kitts ONLINE HOME STUDY COURSES 3 Hour Consultant Credit Hypertension 3 Hour Consultant Credit Diabetes 3 Hour Consultant Credit Lipids 3 Hour Consultant Credit IBS/IBD 6 Hour Consultant Credit Geriatric 3 Hour Immunization AMA PR1 Course 2 Hour Board Approved Medication Errors 2 Hour Board Approved Validation of CS 1 Hour Board Approved HIV/AIDS Update Register @ www.pharmview.com

JULY 11-15, 2018 128th Annual Meeting & Convention Hyatt Regency Bonita Springs Room Rate $199 plus tax

Continuing Education Requirements for Florida Pharmacists and Pharmacy Technicians

Call (888) 421-9432 by June 20, 2018 General & Consultant Recertification Credit available plus 2 hr med error and controlled substance CE Exhibit and Sponsorship Opportunities Available** Bonita Springs, Florida

based application. (64B16-26.103) Medication Error Continuing Education Requirements As a part of the biennial renewal, pharmacists are required to complete a two (2) hour Florida Board of Pharmacy approved course on Medication Errors. The course must contain the following components: (a) root-cause analysis; (b) error reduction and prevention; (c) patient safety. The two-hour program may be applied towards the thirty-hour continuing education requirement. (64B16-26.103) Validation of Prescriptions for Controlled Substances Requirements As a part of the biennial renewal, pharmacists are required

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. to complete a two (2) hour Florida Board of Pharmacy approved course on Validation of Controlled Substance Prescriptions. The course must contain the following components: (a) Ensuring access to controlled substances for all patients with a valid prescription; (b) Use of the Prescription Drug Monitoring Program’s Database; (c) Assessment of prescriptions for appropriate therapeutic value; (d) Detection of prescriptions not based on a legitimate medical purpose; and (e) The laws and rules related to the prescribing and dispensing of controlled substances. The two-hour program may be applied towards the thirtyhour continuing education requirement. (64B16-27.831 F.A.C.)

3 hour CE program must be done once each biennial renewal period ending September 30 and must be offered by a Florida statewide professional association of physicians; The statewide association must be accredited to provide AMA PRA Category I CME; The program must cover the safe and effective administration of vaccines and epinephrine auto-injection; A distance learning format allowed for the 3 hour CE program; The 3 hours required to meet immunization “recertification” can be included within the 30 hour CE biennial requirement for pharmacists; Failure to get the recertification CE will result in the pharmacist’s immunization registry being revoked.

HIV/AIDS Continuing Education Requirements Effective July 1, 2006, applicants for licensure are no longer required by Chapter 456, FS, to show proof of a course on HIV/ AIDS as part of the initial licensure process. You will, however, be required by Chapter 456, FS, to take an HIV/AIDS course approved by the board for your first renewal. This includes pharmacy technicians as well. As of July 1, 2006 licensees will no longer be required by Chapter 456, FS, to take an HIV/AIDS course for each renewal.

Registered Pharmacy Technician Beginning January 1, 2011 technicians interested in working in Florida permitted pharmacies will need to complete a Florida Board of Pharmacy approved training program. Upon successful completion of that program technicians can then submit an application to the Board for full registration status. Registered pharmacy technicians must complete 20 hours of appropriate CE (4 hours live, 2 hours med errors and 1 hour HIV for initial renewal) by December 31, 2018. See rule 64B16-26.355 and Florida Statutes 465.014.

Consultant Re-Certification Continuing Education Requirements Florida licensed consultant pharmacists must complete no less than 24 hours of Board approved consultant continuing education (see rule 64B16-26.302) with in the 24 month period prior to the expiration date of the consultant license (see 64B16-26.103). For example Florida approved consultant CE programs must be completed between January 1, 2017 and December 31, 2018 for consultant licenses that expires December 31, 2018. Course content for consultant re-certification programs must consist of at least three (3) hours of training in specified subjects. Duplicated courses are not acceptable. (see rule 64B16-26.302). Ordering and Evaluation of Laboratory Tests Florida Consultant pharmacists and pharmacists holding the Doctor of Pharmacy degree that wish to order and evaluate laboratory tests and who are practicing under the provisions of Florida Statute 465.0125* are required to complete at least a three (3) hour initial certification course and at least a one (1) hour recertification course. Successful completion of the course will certify the pharmacist for this practice for two (2) years from the date of completion. (64B16-26.320) *Florida Statute 465.0125 defines practice settings as nursing homes or licensed home health agencies for Consultant Pharmacists and only licensed home health agencies for the Doctor of Pharmacy. Nuclear Pharmacy Continuing Education Requirements Florida Nuclear Pharmacists must complete no less than twenty-four (24) additional hours of coursework each two year period designed to provide in-depth treatment of nuclear pharmacy practice. (64B16-26.304) Immunizing Pharmacists Pharmacists wishing to provide immunizations must take a Board approved immunization training program. The program must be at least 20 hours in length and include a review of immunization laws and CPR training. (64B16-26.1031). During the 2012 legislative session, House bill 509 passed that created a new requirement for pharmacists who wish to maintain their immunization registry. Those requirements include the following: The

C r e d it f o r a ny C o n t i n u i n g E du c a t i o n C o u r s e may not be used more than once in any given year. The above information should only be used as a guide and cannot be considered advice. This information is subject to change. Revised 2/9/2017

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JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

Code of Ethics for Pharmacists PREAMBLE Pharmacists are health professionals who assist individuals in making the best use of medications. This Code, prepared and supported by pharmacists, is intended to state publicly the principles that form the fundamental basis of the roles and responsibilities of pharmacists. These principles, based on moral obligations and virtues, are established to guide pharmacists in relationships with patients, health professionals and society. I. A pharmacist respects the covenantal relationship between the patient and pharmacist. Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust. II. A pharmacist promotes the good of every patient in a caring, compassionate and confidential manner. A pharmacist places concern for the well-being of the patient at the center of professional practice. In doing so, a

pharmacist considers needs stated by the patient as well as those defined by health science. A pharmacist is dedicated to protecting the dignity of the patient. With a caring attitude and a compassionate spirit, a pharmacist focuses on serving the patient in a private and confidential manner. III. A pharmacist respects the autonomy and dignity of each patient. A pharmacist promotes the right of self-determination and recognizes individual self-worth by encouraging patients to participate in decisions about their health. A pharmacist communicates with patients in terms that are understandable. In all cases, a pharmacist respects personal and cultural differences among patients. IV. A pharmacist acts with honesty and integrity in professional relationships. A pharmacist has a duty to tell the truth and to act with conviction of conscience. A pharmacist avoids discriminatory practices, behavior or work conditions that impair professional judgment, and actions that compromise dedication to the best interests of patients. V. A pharmacist maintains professional competence. A pharmacist has a duty to maintain knowledge and abilities as new medications, devices and technologies become available and as health information advances. VI. A pharmacist respects the values and abilities of colleagues and other health professionals. When appropriate, a pharmacist asks for the consultation of colleagues or other health professionals or refers the patient. A pharmacist acknowledges that colleagues and other health professionals may differ in the beliefs and values they apply to the care of the patient.

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VII. A pharmacist serves individual, community and societal needs. The primary obligation of a pharmacist is to individual patients. However, the obligations of a pharmacist may at times extend beyond the individual to the community and society. In these situations, the pharmacist recognizes the responsibilities that accompany these obligations and acts accordingly. VIII. A pharmacist seeks justice in the distribution of health resources. When health resources are allocated, a pharmacist is fair and equitable, balancing the needs of patients and society. Approved by: FPA House of Delegates and APhA Active and Life members October 1994.

34TH ANNUAL

SE Gatherinâ&#x20AC;&#x2122; Conference Management of Pulmonary Disorders AUGUST 6 - 9, 2017

Sandestin Golf and Beach Resort 9300 Emerald Coast Pkwy W. Destin, FL 32550

SAVE THE DATE

FPA LAW AND REGULATORY CONFERENCE Offering General, Consultant, Med Errors and Controlled Substance Continuing Education

September 9 - 10, 2017 Marriott Miami Biscayne Bay 1633 North Bayshore Drive Miami, FL 33132 (305) 374-3900

JULY 2017

“I’M ALWAYS WATCHING OUT FOR MY PATIENTS, BUT WHO’S WATCHING OUT FOR ME?”

WE ARE. We are the Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization. Our Pharmacy Quality Commitment (PQC) program: • • • •

Helps you implement and maintain a continuous quality improvement program Offers federal protection for your patient safety data and your quality improvement work Assists with quality assurance requirements found in network contracts, Medicare Part D, and state regulations Provides tools, training and support to keep your pharmacy running efficiently and your patients safe

Call toll free (866) 365-7472 or visit www.pqc.net PQC IS BROUGHT TO YOU BY YOUR STATE PHARMACY ASSOCIATION 16

FLORIDA PHARMACY TODAY

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

UNIT ASSOCIATIONS REGIONAL MAP History of The Florida Pharmacy Association Established in 1887, The Florida Pharmacy Association (FPA) has been serving the pharmacists and pharmacy technicians of the state of Florida for over a century. FPA encompasses all aspects of pharmacy (hospital, independent and chain, nursing home, consulting home health care, managed care, etc.) and strives to stay abreast of the needs of a rapidly changing pharmacy practice community.

The Florida Pharmacy Association Needs Your Involvement. The Florida Pharmacy Association is currently filling positions for its 2018-2019 Standing Councils. If you are interested in serving as a member of an FPA Council, please fill out the form below.

Florida Pharmacy Standing Councils The Florida Pharmacy Association (FPA) has created six standing councils to assist in the development of Association policy and activities as well as to better serve the FPA membership. The councils have also been formed to provide members with a mechanism for representation. FPA's councils include Educational Affairs, Organizational Affairs, Professional Affairs, Public Affairs, Membership Council and Student Affairs Council. EDUCATIONAL AFFAIRS: The Educational Affairs Council proposes policy and programs designed to provide quality continuing education to the pharmacists and technicians of Florida. ORGANIZATIONAL AFFAIRS: The Organizational Affairs Council considers issues pertaining to the structure, function and development of the Association, including membership issues. PROFESSIONAL AFFAIRS: The Professional Affairs Council monitors issues of interest to the profession of pharmacy, including legislative changes and Florida Board of Pharmacy law changes, and interfaces with other professions as they relate to pharmacy. PUBLIC AFFAIRS: The Public Affairs Council disseminates material relating to the practice of pharmacy to the public, in order to enhance the image of the profession of pharmacy.

MEMBERSHIP COUNCIL: The council was formed to facilitate the Association’s membership recruitment and retention programs, as well as to oversee the activities of the #1 Club or any other matters referred to it for consideration. STUDENT AFFAIRS : The Student Affairs Council promotes and encourages student involvement in the FPA, and serves as a liaison between the FPA and Florida Colleges of Pharmacy. Council meetings are held three times a year in central Florida. Meetings are held on Saturdays from 10 a.m. to 3 p.m. allowing members to drive in and out the same day. As a member of a Council, the FPA will assist in your travel expenses. Council members will serve two-year terms.

Please complete the form today and return by April 1, 2018, to: Florida Pharmacy Association, Attn: Christopher Heil, 610 N. Adams St., Tallahassee, FL 32301 or FAX (850) 561-6758. YES, I am interested in serving on an FPA Council. The council I am most interested in is:  Educational Affairs  Organizational Affairs  Professional Affairs  Public Affairs  Membership Council  Student Affairs Council

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JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

The Officers and Executive Committee of the Florida Pharmacy Association cordially invite you to join the

#1 CLUB This exclusive organization recognizes outstanding

contributors to membership development within the Florida Pharmacy Association. The Florida Pharmacy Association’s (FPA) prestigious #1 Club, established in 1985, recognizes those members who demonstrate extraordinary commitment to increasing membership in the FPA. You are challenged to become one of the select few who achieve #1 Club membership. Eligibility requirements and benefits of membership are described below. Each new member sponsored brings you a step closer to becoming a part of this elite organization, and increases the strength and influence of the entire pharmacy profession.

Eligibility Requirements:

Membership in the #1 Club may be attained by sponsoring 10 new active regular members to the FPA and participation in one retention program. The 10 recruited member records shall be current and active just prior to the annual meeting of the FPA, as determined by FPA staff. Active membership in the #1 Club must be maintained by sponsoring three (3) new regular members to the FPA each year following that of your installation and participation in two membership retention programs per year, or preparation of a Journal article on the advantages of membership. Students can also participate in the #1 Club recruitment program and will be eligible to receive a #1 Club T-shirt upon recruiting 3 new pharmacist members. These recruited pharmacist members can be included in the #1 Club red jacket designation should the number of member pharmacists recruited get to the 10 member level.”

Benefits of Membership:

1. One complimentary registration for you to the FPA Annual Meeting and Convention EACH YEAR that active membership in the #1 Club is maintained. 2. Engraved membership plaque to be awarded at the FPA Annual Meeting and Convention when installed into the #1 Club. 3. Distinctive red jacket with #1 Club crest indicating membership in the #1 Club.

Florida Pharmacy Association Retention Programs:

1. Call 20 members who have not renewed their membership dues. 2. Coordinate bringing a group of local pharmacists to Florida Pharmacy Association’s Legislative Days. 3. Serve on the Membership Council to develop new retention programs, discuss membership issues or to develop membership satisfaction surveys. 4. Call and welcome 20 new members who were not sponsored in the #1 Club program. 5. Use the online “Refer a Friend” tool to invite 10 pharmacists to become members. 6. Visit a graduating class with an invitation to FPA membership. For more information on the #1 Club, contact: Chris Heil, 610 North Adams Street Tallahassee, FL 32301 850-222-2400 18

FLORIDA PHARMACY TODAY

#1 CLUB MEMBERS Carmen Aceves Paul Ackerman Ann Marie Aldrich Eric Alvarez Goar Alvarez Eli Berkofsky Glenn Boyles Joseph Burghardt Leonard “Red” Camp Tom Cuomo Ana De La Huerta Paul Delisser*** Art Diaz Marcus Dodd-O Jackie Donovan Leo “Lee” Fallon*** Raul Gallo Mayra Gonzalez-Abreu Terry Gubbins*** Ed Hamilton Betty Harris Carl “Fritz” Hayes S. Mark Hobbs Thomas Isbon Michael Jackson*** Alan Katz Suzanne Kelley David Laven Georgia Lehoczky David Mackarey*** Joy J. Marcus Humberto Martinez Robert Miller Tian Merren Owens*** Allen Nichol Mary Kay Owens Bob Parrado Kathy Petsos Rebecca Poston James Powers Michael Stamitoles Theresa Tolle Norman P. Tomaka*** Scott Tomerlin Alton Tower Robert H. Wilson

*** Denotes active #1 Club Members

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

FPA Officer and Director Nominations Although we have just finished the election for a President-Elect and Directors for the odd-numbered regions who were installed at the 2017 annual meeting, it is time to start thinking about nominees for the 2018 election, since the nomination deadline is September 1 of this year (9/1/17). As the form below indicates, this year we will need candidates for President-Elect, Treasurer and Directors for the even-numbered regions. Please note that you may nominate yourself. CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2018 Elections The FPA bylaws specify that any subdivision or any member in good standing may nominate one person for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The Treasurer shall serve a two-year term and may succeed to one consecutive term of office in that capacity. Nominees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for President-Elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for Treasurer should have good analytical skills and experience and ability in financial management and budget preparation. There are nine regional Board Directors who shall serve two-year terms. A nominee must be a Florida registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, each Board Director must be a member of at least one the FPA Unit Associations within their region. Board Directorsâ&#x20AC;&#x2122; terms are staggered such that even-numbered regions shall be elected in even-numbered years and odd-numbered regions shall be elected in odd-numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annual meeting of the second ensuing year.

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

FOR THE FOLLOWING OFFICE:

(Nomination deadline: September 1, 2017)

q President-Elect q Board Director q Region 2 q Region 4 q Region 6 q Region 8 NOMINATED BY: NAME: DATE SUBMITTED: SIGNATURE:

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2017

JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

FLORIDA PHARMACY ASSOCIATION BYLAWS Article I Name & Location Section 1 - Name. The name of the Association shall be the Florida Pharmacy Association, hereinafter referred to as the Association. Section 2 - Location. Offices for transaction of business of the Association shall be located at such places as the Board of Directors shall from time to time determine and direct. Article II Membership Section 1 - Qualifications. Any person may be admitted to membership of the Association, who shall qualify for membership pursuant to the Constitution and by making application to the Executive Vice President of the Association, together with the appropriate annual dues. Section 2 - Certificates. A suitable certificate showing the memberâ&#x20AC;&#x2122;s name, membership classification and a membership card showing the term for which membership fee has been paid shall be furnished to all members by the Executive Vice President. Article III Annual Membership Fee Section 1 - Due Date. The annual membership fee shall be an amount as hereinafter set forth and shall be due and payable on January 1 or July 1 of each calendar year in accord with the appropriate membership cycle. Section 2 - Dues Amount. A. The dues for Regular Members shall be determined by the Budget and Finance Committee and shall be approved by the Board of Directors. B. The dues for Regular Associate Members shall be the same as dues for Regular Members. C. The dues for Associate Pharmacy Technician Members shall be determined by the Budget and Finance Committee and shall be approved by the Board of Directors. D. The dues for Student Members shall be determined by the Budget and Finance Committee and shall be approved by the Board of Directors. 20

FLORIDA PHARMACY TODAY

E. The dues for Retired Pharmacists shall be one-half the dues for Regular Members. F. The dues for Joint Membership with a spouse paying the Regular Member rate shall be one-half the dues for Regular Members. G. The dues for New Practitioners following graduation from pharmacy school shall be one-half the dues fee for Regular Members for the first year out of school and the Regular Members rate the second year after graduation from pharmacy school. H. The dues for Honorary or Lifetime members shall be waived. Section 3 - Grace Period. Any member not paying their annual dues within ninety (90) days after the due date shall have their services discontinued until said annual dues are paid in full. During times of national military service, established members shall have no less than a six (6) month grace period upon return to civilian status to pay their annual dues. Such members shall retain all rights and privileges of membership during the service and grace periods. Section 4 - Joint Billing of Membership Fees. The Association shall bill jointly for the membership fee of the Association, as defined in these Bylaws, and for the membership fee of each affiliated county or local Association, hereinafter referred to as Unit Associations, if so requested. The membership fee for each Unit Association shall be determined by their own membership, and the amount collected shall be returned to the Unit Association. Section 5 - Budget Related Increases. The Association with the recommendation of the Budget and Finance Committee may increase the dues amount in any or all membership categories, as listed in Section 2, by an amount not to exceed 3% annually. Any dues increase greater than 3% must be approved by the House of Delegates. Article IV Subdivisions Section 1 - Unit Associations. The term Unit Associations shall be the term used to describe all local or county associations. The Unit Associations can best represent the local pharmacists in items of local interest and concern but should also be the means of communication with pharmacy, state and nationwide.

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. Any organized group of pharmacists within Florida may request to be designated an affiliated unit association of the Florida Pharmacy Association. Any such request must be made in writing and must be accompanied by the following: 1) a copy of the organization’s current constitution and bylaws 2) a list of the names, addresses and phone numbers of the organization’s officers 3) a list of the organization’s members of which no fewer than 10 must be FPA members 4) a written statement signed by the officers of the association, which documents the organization’s support for the FPA Mission Statement and the organizations’ desire to participate fully and actively in the FPA House of Delegates. The Organizational Affairs Council shall certify in writing to the Board of Directors that the unit associations’ constitution and bylaws are consistent with the objectives and organizational characteristics of the Florida Pharmacy Association. Upon a majority vote by the Board of Directors the unit association may become affiliated. The Board of Directors shall establish geographical areas comprised of approximately equal numbers of pharmacists within the State to be termed Regions, and will periodically re-evaluate the number and size of these Regions. Each region will have an elected regional director that will serve on the Board of Directors of the Association. Section 2 - Advisory Council on Pharmacy Practice. There shall be an Advisory Council on Pharmacy Practice which should educate the FPA Board of Directors on emerging issues impacting pharmacy through written communications, formal presentations and discussion of these issues. The Advisory Council on Pharmacy Practice should meet with the FPA Board of Directors at some specified point in time in conjunction with a planned weekend gathering of the FPA Councils and Committees, as well as the FPA Board of Directors, so that presentation of issues (and any recommendations for action pertaining thereto) can be presented to the FPA Board of Directors and other interested FPA Councils and Committees. Section 3 - Foundation. There shall be a foundation, the purpose and functioning of which shall be as described in the foundation’s constitution and bylaws. The Chief Executive Officer of the foundation shall report on the foundation’s activities at each meeting of the Board of Directors. Section 4 - Florida Pharmacy Today Corporation. There shall be a Florida Pharmacy Today Corporation, the purpose and functioning of which shall be as described in the Florida Pharmacy Today Corporation constitution and bylaws. The Chairperson of the Florida Pharmacy Today Corporation shall report on the Journal Board’s activities at each meeting of the Board of Directors.

Article V House of Delegates Section 1 - Establishment of Rules. The Association shall recognize, through its Board of Directors, all organizations entitled to representation in the House of Delegates. Section 2 - Apportionment. Each organization officially recognized by the Association as being entitled to representation in the House of Delegates shall be entitled to two (2) delegates. Each affiliated Unit Association shall be entitled to these two (2) delegates plus one (1) additional delegate for each fifty (50) members or major fraction thereof, provided that no such association may be entitled to more than seven (7) delegates. The officers of each individual organization shall make a report to the Speaker of the House of Delegates once each year in order to verify the identity and address of the officers and number of members in each organization. An amended report may be made up to thirty (30) days prior to the Annual Conference if a change in membership will change the number of delegates to which the organization is entitled. Section 3 - Delegates. The name and address of each official delegate shall be sent to the Speaker of the House of Delegates by the officers of the organization he represents. Each official delegate shall be a member in good standing of the Florida Pharmacy Association. Each delegate shall maintain their membership in the Association during their term of service as a delegate. The usual term of service of all delegates shall coincide with the usual term of office of the President of the Association. Section 4 - Meetings. The House of Delegates shall meet during a meeting of the Association in order to act upon resolutions presented to the Association. Section 5 - Rules of the House of Delegates. The House of Delegates shall adopt rules and regulations for the functioning of the House of Delegates which shall not conflict with the Constitution and Bylaws of the Association. Section 6 - Association Policy. The official policy positions of the Florida Pharmacy Association shall be determined by the House of Delegates. Interim policy decisions may be made by the Board of Directors of the Association or the President’s Committee, subject to review and approval at the next meeting of the House of Delegates. Section 7 – Who May Submit a Resolution. All resolutions emanating from an individual member or group of members must conform to the resolutions format prescribed by the House of Delegates and bear the name(s) of the sponsor(s) at least one (1) of whom must be present at the House of Delegates session to introduce their resolution by reading. JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. Article VI Quorum & Proxy Vote Section 1 - Annual and Special Meetings of the Association. Fifty (50) voting members shall constitute a quorum for the transaction of business at any annual or special meeting of the Association. Section 2 - Board of Directors Meetings. Attendance by more than 50% of the voting members of the Board of Directors shall constitute a quorum for the transaction of business at any meeting of the Board of Directors. Section 3 - Proxy Vote. Any member of the Board of Directors who is unable to attend a meeting of said Board of Directors may, by giving written notice to the chairman of the Board of Directors, specify a proxy to cast his vote at the meeting. Regional Directors must designate as proxy an FPA member in good standing from the same region. Organization directors must designate another FPA member from the same organization. The Chairman must inform the membership present of all written notices of proxy he has received as the first order of business. Representation by proxy may not be counted to make a quorum. Article VII Committees/Councils Section 1 - Appointment of Committees/Councils. The President shall appoint committees/councils as listed in this article unless otherwise provided and such other committees/ councils as the President shall deem necessary. The President shall appoint only members in good standing as members of all committees/councils and shall serve as an ex-officio member of each committee/council he appoints. The chairs of the standing councils should file reports with the President and President-elect. Any recommendations contained in those reports must include an indication of how many committee members were present. Any member of a Florida Pharmacy Association Council or Committee is not authorized to speak on behalf of the Association, either verbally or in writing without the approval of the Board of Directors.1 Section 2 - President’s Committee. There shall be a President’s Committee composed of the President, as Chairman, the President-Elect, the Treasurer, the Immediate Past President, the Speaker of the House of Delegates, Vice Speaker of the House of Delegates and the Executive Vice President. This committee shall be charged with making the decisions 1 This revision to the bylaws approved by the 2011 House of Delegates required a change to Article V, Section 2 of the FPA Constitution during the 2011-2012 election cycle. The FPA membership approved the constitution change during the fall elections of 2011. 22

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required to implement the actions of the Board of Directors. The President’s Committee may take actions on behalf of the Association and may make interim decisions between meetings of the Board of Directors, subject to review and approval by the Board of Directors. The President will report to the Board of Directors, at its regular meeting, the actions taken on their behalf, for their approval. Section 3 - Budget and Finance Committee. The President’s Committee shall appoint a Budget and Finance Committee composed of the: Treasurer who shall serve as Chair Immediate Past Treasurer, who shall serve as Vice Chair President of the Association Immediate Past President Speaker of the House of Delegates Two (2) members selected by the President as At-Large members who shall serve staggered terms of two (2) years and may be selected for reappointment; and President-Elect Executive Vice President Vice Speaker of the House of Delegates All members of the Budget & Finance Committee shall be voting members, except for the position of Immediate Past Treasurer. The Budget and Finance Committee shall be responsible for the: investment policy of the Association preparation of an annual budget; and development of reimbursement policies for travel and per diem expenses of representatives of the Association The Board of Directors shall ratify all decisions of the Budget and Finance Committee; however, the Executive Vice President may obtain approval of the President’s Committee to implement decisions of the Budget and Finance Committee in the interim between meetings of the Board of Directors. The members of the Budget & Finance Committee and the President’s Committee will be indemnified for all investment decisions made within the parameters of the financial guidelines approved by the Board of Directors. Section 4 –Governmental Affairs Committee. A Governmental Affairs Committee shall be formed to consider any matters or issues pertaining to rules and regulations affecting the profession of pharmacy, or any other matters referred to it for consideration. This committee shall meet at least once a year or more often as the legislative environment mandates. The membership of the Governmental Affairs Committee should consist of the following: Chair, appointed by the President The elected officers of the Association The Executive Vice President of the Association, as secretary FPA’s governmental Affairs Advisor/Lobbyist, as a non-vot-

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. ing member At-large members (not to exceed 5), appointed by the President including at least one student. Past Chair Political Committee Chair FSHP Liaison Section 5 - Standing Councils. Public Affairs. A Public Affairs Council shall be formed to consider matters or issues inherent in or arising from the interface of the profession with the public, or any other matters referred to it for consideration. Professional Affairs. A Professional Affairs Council shall be formed to consider matters or issues of interest to the pharmacy profession and arising from or inherent in the interface of the pharmacy profession with other professions, or any other matters referred to it for consideration. Organizational Affairs. An Organizational Affairs Council shall be formed to consider matters and issues pertaining to the structure, function and development of the Association, or any other matters referred to it for consideration. Educational Affairs. An Educational Affairs Council shall be formed to consider any matters or issues pertaining to the pharmacy education, or any other matters referred to it for consideration. Advisory Council on Pharmacy Practice. An Advisory Council on Pharmacy Practice shall be formed and should educate the FPA Board of Directors on emerging issues impacting pharmacy through written communications, formal presentations and discussion of these issues. Membership Council – A Membership Council shall be formed to facilitate the Association’s membership recruitment and retention programs as well as to oversee the activities of the #1 Club or any other matters referred to it for consideration. Student Affairs Council – A student Affairs Council shall be formed to promote and encourage student involvement in the FPA, and to serve as a liaison between the FPA and Florida Colleges of Pharmacy. Section 6 - Council Membership. With the exception of the Advisory Council on Pharmacy Practice and the Student Affairs Council, standing councils shall be composed of seven (7) members, one of shall be the chairman and one shall be a Pharmacy Technician. The term of office for each council member shall be for two (2) years. The terms of membership shall be staggered so that at least three (3) members will be appointed each year. In addition to

the above, there will be no more than three (3) invited Student representatives from Florida schools/colleges of Pharmacy for a one year term. The chairman, members and invited Student representative shall be selected by the President. The Advisory Council on Pharmacy Practice shall consist of, but not limited to, the following: The President’s Committee of the FPA Board of Directors consisting of the President-elect (as Chair of the Advisory Council on Pharmacy Practice), President, Immediate PastPresident, Treasurer, Speaker of the House of Delegates, ViceSpeaker of the House of Delegates, Executive Vice-President of the Association (as Secretary of the Advisory Council on Pharmacy Practice); The Deans of Florida’s Colleges of Pharmacy or their designees; The ASP Chapter Presidents from Florida’s Colleges of Pharmacy or their designees; An FPA member representing each a community, institutional, and a non-traditional pharmacy practice area; An invited representative of the Florida Chapter of the American Society of Consultant Pharmacists; An invited representative of any independent pharmacist organization in Florida; An invited representative of any pharmacy technician organization in Florida; The President of the Florida Society of Health-System Pharmacists; and Depending on the pharmacy issues under consideration, the Advisory Council’s Chair may invite additional representatives whose expertise in other areas of pharmacy practice, not otherwise noted above, is deemed of value to the discussions, with such invitations based upon the budgetary constraints of the Florida Pharmacy Association. The Student Affairs Council shall be composed of the following: Two (2) students from each Florida College of Pharmacy (to include the student chair). Three (3) pharmacists (to include the pharmacist co-chair). The term of office for each council member shall be for two (2) years. The terms of membership shall be staggered so that at least one student from each school is appointed each year. P4 students serving on the council would be encouraged to serve as a pharmacist on the council for the next year. The chairman, co-chair, and council members shall be selected by the FPA President.

JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. Article VIII Delegates Section 1 - Appointment. The President may appoint such delegates to commercial bodies, medical societies, state associations or like gatherings as he may deem necessary and shall appoint delegates and alternates to attend the annual meeting of the American Pharmacists Association as well as delegates and alternates to the annual meeting of the National Community Pharmacists Association. The priority of these appointments by the President of the aforementioned delegates shall be as follows: The current seated President and President-elect Members of the Presidentâ&#x20AC;&#x2122;s Committee Members of the Board of Directors, and Members of any Standing Council Section 2 - Expenses. The actual expenses incurred for transportation, lodging and meals by the President, the PresidentElect and the Executive Vice President while attending the annual meeting of the American Pharmacists Association and National Community Pharmacists Association shall be paid by the Association upon presentation of proper itemized statements of expenses to the Executive Vice President and approval by the Board of Directors. All money advanced to any delegates to these meetings must be accounted for by an itemized statement or returned to the general fund of the Association. The President and President-Elect of the Florida Pharmacy Association, who are in office on the first day of January shall be the proper officers to attend the annual meeting of the APhA which falls within that year. Section 3 - Reports of Meetings. Officers attending said meetings shall make a full report of the meetings of the national bodies to this Association in person or by written report filed with the Executive Vice President to be published in the Journal. Article IX Rules of Order Robertâ&#x20AC;&#x2122;s Rules of Order shall be the authority on all points of order in the conduct of meetings of the Association. These Bylaws shall not be suspended without the consent of twothirds of the members present. Article X Amendments to Bylaws Amendments to these Bylaws shall be approved by the Board of Directors and proposed by them to the House of Delegates and approved by a two-thirds vote of those voting members 24

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present at a regular meeting or special meeting called for that purpose; provided, however, that thirty (30) days notice of that meeting shall be given by the House of Delegates in a manner approved by the Board of Directors. Article XI Publishing of Proceedings Section 1 - What to be Published. The proceedings of the Association, the roll of officers, committees, and members shall be published annually under the supervision of the Executive Vice President and the Board of Directors and a copy of the proceedings sent to each member of the Association not in arrears for membership fees. Section 2 - When Published. The Publication of the Proceedings shall be made and copies thereof mailed to members within two months after the close of the annual meeting. Article XII Expulsion or Removal of Members or Officers Any member may be expelled from membership or removed from office for conduct which adversely affects the pharmacy profession the Association or the professional standing of a colleague, or for violating the Constitution or Bylaws. Any officer may be removed from office for non-residence, inability or unwillingness to perform his duties of office. No person shall be expelled or removed except by a two-thirds vote of all members of the Board of Directors present at a regular meeting or a special meeting called for such purpose and after he shall be given an opportunity to be heard in his own defense.

Article XIII Nominations & Election Section 1 - Procedure for Nomination - A Nominating Committee will be appointed by the President by September 1st of each year. The committee will consist of the immediate Past Chairman of the Board of Directors, who will serve as Chairman and a representative from each FPA standing council. No member serving on the committee shall be eligible to run for office. The committee will establish guidelines. Subdivisions or any FPA member in good standing may nominate one person for the office of President-Elect and one person for the office of Treasurer and one person for the office of Regional Director and one person for the office of Student Director and one person for the office of Technician Director. The Treasurer shall serve a two year term and may succeed to one consecutive term of office in that capacity. With the exception of the Student Director and Technician Director, a nominee must be a Florida licensed pharmacist. The

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. Student Director must be a licensed Florida Pharmacy Intern. The Technician Director must be a registered Florida Pharmacy Technician. All nominees must be in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. The election process will be conducted by mail or electronic balloting. A Board of Canvassers composed of three (3) Past Presidents of the Florida Pharmacy Association appointed by the President, together with the Executive Vice President, shall tally the ballots. Balloting will be according to the following time schedule. Nominations shall be received at the Association headquarters not later than September 1st of each year together with a biographical sketch and a picture. Section 2 â&#x20AC;&#x201C; Procedures for Election With the exception of Student Director, the Executive Vice President of the Association shall determine every active member of the Association who, as defined in the Constitution, is qualified to vote by November 30, and shall issue to every active voting member a ballot which will contain the names of the nominees for President-Elect, Treasurer, Regional Directors, and Technician Director together with a biographical sketch and a picture, no later than January 1. The ballot for the position of Student Director shall be issued to every active Florida College of Pharmacy student FPA member. A. The qualified membership shall submit an electronic ballot or mark, seal and mail a paper ballot to the address specified on the ballot by January 31. B. With the exception of the Student Director, by the end of February the Board of Canvassers shall open and tally the ballots. The nominees receiving the majority of the votes shall be declared elected. If no single nominee shall receive a majority of the votes cast for the office, a run-off election shall be held between the nominees receiving the two highest number of votes for each office in the following manner. A second ballot shall be prepared containing the names of the nominees receiving the two highest number of votes for each office affected, together with biographical sketch and a picture. The Executive Vice President shall issue these ballots to every active member of the Association who is qualified to vote, at least thirty (30) days in advance of the annual meeting. The active qualified membership shall submit an electronic ballot or mark, seal and mail an approved paper ballot to the address specified on the ballot by seven (7) days prior to the annual meeting. The ballots cast in the run-off election shall be tallied no later than the close of the first general session of the annual meet-

ing by the Board of Canvassers. The nominee receiving the majority of votes shall be declared elected. If a tie vote should occur in the run-off election, a general election will be held at the last general session of the annual meeting with a majority vote deciding the winner. C. For the position of Student Director by the end of February, the Board of Canvassers shall tally the ballots submitted by students from each Florida College of Pharmacy. Each College of Pharmacy will have one collective vote for the Student Director as determined by majority vote from each respective school. In the event a nominee does not receive the majority of votes, the Student Affairs Council will make a recommendation to the FPA President to cast the tie-breaking vote after the ballots were counted. Section 3 - Elections of Board of Directors Regional Directors - Nine Board of Directors shall be elected according to regional requirements and shall serve a two-year staggered term. A Nominee must be a Florida licensed pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. In the event that the Board of Directors Regional Director cannot fulfill the duties of the office, the President will appoint a replacement with the approval of the Board of Directors to complete the Directorâ&#x20AC;&#x2122;s term of office or until an election is held. Elections for regional directors shall be held such that directors representing even numbered regions shall be elected in even number years, and directors representing odd numbered regions shall be elected in odd number years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting and shall continue in office until the last day of the annual meeting of the second ensuing year. Section 4 - Elections of Student Director - The Student Director shall be elected according to Article VIII Section 2 Subsection C requirements and shall serve a two-year term. A Nominee must be a Florida licensed pharmacy intern in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Section 5 - Elections of Technician Director - The Technician Director shall be elected according to Article VIII Section 2 Subsection B requirements and shall serve a two-year term. A Nominee must be a Florida Registered Pharmacy Technician in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Section 6 - Assumption of Office - All newly elected officers shall take office on the last day of the annual meeting, and shall continue in office until the last day of the annual meeting of the next ensuing year. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annual meeting of the second ensuing year. The PresJULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. ident-Elect shall assume the duties of the President on the last day of the annual meeting of the year following his election as President-Elect. Article XIV Duties of Officers. Section 1. President. The President of the Florida Pharmacy Association: Sets goals, themes and topics to be addressed by the councils/ committees and chairs. Announces appointments of council/committee members and chairs for standing councils/committees. Chairs a leadership retreat, if funding allows, with incoming council/committee chairs and leadership to serve as an introduction to the President’s theme and goals for the year. Chairs the President’s Committee that reviews and decides on issues in between Board of Directors meetings Shall form and appoint members to ad-hoc committees, on an as needed basis, to address topics of concern to the profession. Participate in the Budget and Finance Committee and appoints the one at-large member, in coordination with the President’s Committee. May appoint delegates to represent the FPA and Florida Pharmacy to other state or national associations, governmental and/or other commercial bodies. Represents the FPA by attending appropriate pharmacy-related events and activities. Uses all forms of communication to relate issues and topics to FPA membership and stakeholders. This communication includes contributions to the Florida Pharmacy Today Journal, STAT newsletter, website, or other media as issues require. Appoints the Nominating Committee. Appoints the Canvassing Committee. Presides and Chairs the annual business meeting at the convention. Presides over and inducts the Board of Directors at the President’s breakfast. Section 2. President-Elect. The President-Elect of the Florida Pharmacy Association: Chairs the Advisory Council on Pharmacy Practice meeting. Substitutes for the President in the event the President is unable to participate in activities. Reviews and approves the slate of officers of the political action committee Board of Directors. Considers selection of upcoming council/committee members and chairs for standing councils/committees. Section 3. Chairman of the Board. The Chairman of the Board of the Florida Pharmacy Association: Coordinates recommendations from Advisory Council on 26

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Pharmacy Practice. Chairs the Board of Directors meeting. Ensures the President-Elect reaches out to the chairs of FSHP L & R Committee and the FPA GAC and invites them to attend each meeting. Section 4. Treasurer. The Treasurer of the Florida Pharmacy Association: I.Will work with the Executive Vice President and President to develop an annual budget for presentation to the Budget and Finance Committee and/or President’s Committee; II.Will review the Association’s expenditures and receipts prior to each Board of Directors meeting; III.Has oversight authority of the Budget and Finance Committee and will provide written certification to the Board of Directors during each Board of Directors Meeting; IV.Will as immediate past treasurer, serve on the Nominating Committee as an Ex-Officio member to screen nominees for the position of Treasurer and President-Elect; V.Will make a written Annual Report to the membership and present an oral report at the Annual Business meeting and be prepared to respond to questions; Section 5. Speaker. Speaker of the House of Delegates of the Florida Pharmacy Association Will preside over the meetings of the House of Delegates Will ensure a quorum is established, call the meeting to order, maintain proper decorum, and proceed under Roberts Rules of Order Will be a delegate in case there is a tie breaker situation Will be responsible for producing a report of the actions of the House of Delegates to the members of the Florida Pharmacy Association Section 6. Vice Speaker. Vice Speaker of the House of Delegates of the Florida Pharmacy Association Will assist the Speaker in the performance of the Speaker’s duties and/or perform such as specified by the House of Delegates. In the event of a vacancy in the position of Speaker of the House, or in the event the Speaker is unable to perform the duties of the office during a meeting of the House of Delegates, the Vice Speaker shall assume the duties of the Speaker. Will be the FPA liaison to local affiliated units and conduct their meeting at the FPA Annual Meeting. Will be elected during the FPA Annual Meeting by the House of Delegates Revised 09/12/01, 6/24/03, 07/14/04, 08/08/06, 06/30/2007, 7/12/2008, 6/23/2011 (One Revision Requiring Constitution change), 07/05/2012, 07/11/2013, 7/10/2014, 6/25/2015, 6/30/2016, 6/13/2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership.

FPA Constitution Article I Name The association shall be called the Florida Pharmacy Association, hereinafter called the Association. Article II Object The Association shall be to unite all persons interested in the profession of pharmacy in the State of Florida for the following purposes: a. To support and encourage higher standards of pharmaceutical education at all levels of the profession in order to attract qualified personnel into the profession of pharmacy. b. To encourage and maintain relations with all healthcare professions and governmental bodies and agencies to enhance the overall quality of healthcare. c. To ensure pharmacy is practiced by properly qualified pharmacists, to protect the welfare of the public. d. To serve, represent, and assist the Florida pharmacists to advance the profession and practice of pharmacy. Article III Membership The Association shall have six types of membership: Regular, Associate, Student, Honorary, Pharmacy Technician, and Lifetime. Section 1 - Regular Members. Regular members shall be those persons who otherwise qualify as members in good standing and who are licensed pharmacists, entitled to practice pharmacy. Section 2 - Associate Members. Associate members shall be those persons who otherwise qualify as members in good standing, and are interested in pharmacy or are associated with a business or profession related to the pharmaceutical profession. Associate members shall submit an application for membership and shall comply with such requirements as may be established by the Association and its Bylaws. Section 3 - Student Members. Student members shall be those persons who otherwise qualify as members in good standing and are students in good standing, matriculated in a college or school of pharmacy. Section 4 - Honorary Members. The Association may elect to honorary membership any person interested in pharmacy or its related sciences, at any annual meeting or special meeting of the Association called for such purpose.

Section 5 - Pharmacy Technicians. Pharmacy Technician members shall be those persons who assist licensed professional pharmacists in performing their professional duties as defined in F.S. 465. Pharmacy Technician members shall submit an application for membership and shall comply with such requirements as may be established by the association and its bylaws. Section 6 - Lifetime Members. Current Association Regular members receiving the Florida Board of Pharmacy 50year certificate shall receive Lifetime membership in the Association. Article IV Officers The officers of the Association shall be the President, the President-Elect, the Treasurer, the Executive Vice President, the Board of Directors Chairman, Speaker of the House of Delegates and Vice Speaker of the House of Delegates. Section 1 - President. The President shall preside at all meetings of the Association and shall perform all other duties that may be incident to that office. Section 2 - President-Elect. The President-Elect shall perform all duties of the President in the absence or inability of the President to serve. The President-Elect shall be the official representative of the Association on the Board of Directors of the House of Delegates. Section 3 - Treasurer. The Treasurer shall perform all duties incident to the office of Treasurer. Section 4 - Executive Vice President. The Executive Vice President shall be the executive officer of the Association and shall conduct and administer the affairs of the Association in accordance with the Constitution and Bylaws and subject to the policies and directives of the Board of Directors. Section 5 - Board of Directors Chairman. The Board of Directors Chairman shall be the Immediate Past President of the Association. This chairman shall chair all meetings of the Board of Directors and shall arrange the meeting and expedite all business to be transacted by this Board of Directors. The Chairman may select another member of the Board of Directors to serve in his/her absence or, if none is selected, the President may chair a preliminary meeting to select a Board of Directors member to chair that meeting.

JULY 2017

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. Section 6 - Speaker of the House of Delegates. The Speaker of the House of Delegates shall be the person elected by the House of Delegates to serve as the Speaker. The Speaker shall be the official representative of the House of Delegates on the Board of Directors. Section 7 – Vice Speaker of the House of Delegates. The Vice-Speaker shall be the person elected by the House of Delegates to serve as Vice Speaker. The Vice-Speaker shall be installed as the Speaker in one year. Section 8 - Qualification of Officers. No person shall be elected to any office in the Association unless such person is a member in good standing. Section 9 - Inability to Serve. In the event of the death or inability of an officer to serve, the President will appoint a replacement with the approval of the Board of Directors to complete the term of the office, or until an election is held.

Article V Board of Directors Section 1 - Membership. There shall be a Board of Directors of which the Immediate Past President of the Association shall be chairman. The Board of Directors will consist of the following 19 members: ■■ The elected officers of the Association ●● Immediate Past-President, as chair ●● President ●● President-elect ●● Treasurer ●● Speaker of the House ●● Vice Speaker of the House of Delegates ■■ The Executive Vice-President of the Association, as secretary ■■ The President of FSHP ■■ Nine (9) elected directors who will serve staggered terms ■■ One (1) elected student director ■■ One (1) elected technician Section 2 - Duties. The Board of Directors is the only body that can establish and implement policy for the Association. The Board of Directors shall approve the Executive Vice President, approve his salary and other terms of his appointment; the term of office; prescribe his duties and direct his activities where such duties and activities are not specifically provided in the Constitution or Bylaws. The Board of Directors shall be responsible for arranging and expediting business during meetings of the Association. The Board of Directors shall expend the funds of the Association for such matters and things as, in the judgment of the Board of Directors, shall be for the betterment of pharmacy in the State of Florida and of value to the members of the Association, the profession of pharmacy, and the health and welfare of the citizens of the State of Florida. The Board of Directors shall audit charges against the Association. The Board of Directors shall, in their usual order of business, review the report of the President’s Committee and approve or correct actions the President’s Committee has taken on behalf of the Board of Directors. The Board of Directors shall perform such other duties as are normally incident to such a committee. Any member of a Florida Pharmacy Association Council or Committee is not authorized to speak on behalf of the Association, either verbally or in writing, without the approval of the Board of Directors. Section 3 - Meetings. The Board of Directors shall meet at least twice a year at such times that one of the meetings must occur no more than eight months and no less than one month prior to the regular annual meeting of the Association. A meeting of the Board of Directors may be called by the chairman or by petition of one-fourth of its members at other times as Association business may demand. A quorum of the members of the Board of Directors, as defined in the Bylaws, must be present in order to transact any business. All meetings of the Board of Directors shall be open to any Regular Member and the membership shall be informed

FLORIDA PHARMACY TODAY

HANDBOOK OF ASSOCIATION INFORMATION Information you need to participate and take advantage of your FPA membership. of the meeting by the Executive Vice President in advance, when time permits; however, all members of this Board of Directors must be notified. Section 4 - Voting. Only members of the Board of Directors shall be entitled to vote at a meeting of the Board of Directors. Any member of the Board of Directors may designate another member of the Florida Pharmacy Association to cast his vote by proxy as defined in the Bylaws. Section 5 - Qualifications to Board of Directors. No person shall be appointed to the Board of Directors unless such person is a member in good standing. Article VI Meetings Section 1 - Regular Meetings. There shall be an annual meeting of the Association at such time and place as the Board of Directors shall direct. Section 2 - Special Meetings. Special meetings of the Association may be held from time to time as the business of the Association may require, upon written request of fifty (50) Regular Members of the Association. In the event of such a special meeting, the Executive Vice President shall mail written notice to each voting member no less than twenty-five (25) days prior to the date of such meeting. The notice shall state the time and place of such meeting and all the matters to be brought before the Association at such special meeting unless deemed to be of an emergency nature by the Board of Directors. Section 3 - Voting. At any regular or special meeting of the Association, all members in good standing in this Association shall be entitled to vote, except for Honorary Members. Article VII House of Delegates There shall be established a House of Delegates as defined in the Bylaws of the Association. Article VIII Presidentâ&#x20AC;&#x2122;s Committee There shall be established a Presidentâ&#x20AC;&#x2122;s Committee as defined in the Bylaws of the Association. Article IX The Florida Pharmacy foundation There shall be established a foundation as defined in the Bylaws of the Association. Article X Florida Pharmacy Today Corporation There shall be established a Florida Pharmacy Today Corporation as defined in the Bylaws of the Association.

Article XI Bylaws The Association may establish such Bylaws, not in conflict with this Constitution, as may be deemed necessary to direct and control the affairs of the Association. Article XII Amendments This Constitution may be altered or amended provided that such proposal to alter or amend same shall be submitted to the Chair of the Organizational Affairs Council in writing. The proposed alteration or amendment to the Constitution shall be read at the annual meeting of the Association. Upon majority approval of the membership voting, the proposed amendment shall then be referred to the Board of Directors who shall cause the Executive Vice President to publish such proposed amendment in the Florida Pharmacy Today, which is placed in circulation at least thirty (30) days prior to the ballot being mailed to the membership. Upon the vote of three-fourths (3/4) of the voting members returning the ballot by the specified deadline, in favor of adoption of the amendment, it shall become a part of this Constitution. Revised 02/2006, 02/2008, 2/2011, 2/2016

A Pharmacist And A Lawyer Board of Pharmacy Licensure Disciplinary Proceedings Compounding Violations, DEA Investigations Mergers and Acquisitions Pharmacy Risk Assessment/Management Consultants KAHAN & ASSOCIATES, PLLC

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.

JULY 2017

THE OPIOID EPIDEMIC Naloxone in the Community Setting:

A Great Opportunity for Pharmacist Intervention Authors: Jessica C. Fields, Pharm.D. Robin Moorman Li, Pharm.D., BCACP, CPE Clay M. Fischer, Pharm.D. Candidate 2017 Contributing Editor: Steve Spudic, R.Ph., J.D.

FLORIDA PHARMACY TODAY

Opioid-related drug overdoses continue to be a growing problem in Florida and the United States. In 2015, there were 52,404 drug overdose deaths in the United States and of those, 33,091 (63.1%) involved an opioid.1 The drug overdose death rate in the United States has tripled from 1999 to 2014 and has steadily increased in the majority of states from 2010 to 2015.1 However, in Florida, drug overdose death rates declined from 2010 to 2013 and then increased from 2013 to 2015.1,2 This initial decline in deaths may be attributed to the numerous new laws and regulations that took effect in 2010, including efforts to close “pill mills” and the implementation of tamperresistant formulations of prescription opioids.2 While deaths due to methadone significantly decreased from 2014 to 2015, heroin and illicitly manufactured fentanyl have been identified as major contributors to the rising opioid death rates in Florida and throughout the United States.1,3 In the 2015 Florida Medical Examiner Report, deaths caused by heroin and fentanyl rose 79.7% and 77.6%, respectively, from 2014 to 2015.3

Opioid Overdoses and The Role of Naloxone Respiratory depression is the most common cause of opioid-related death.4 Opioid-induced respiratory depression is caused by opioid activity at the brainstem that results in a decline in respiratory rate and tidal volume.5 Additionally, opioids may decrease the responsiveness of the brainstem to conditions of low oxygen or high carbon dioxide.5 Drug overdose from an opioid is a life-threatening condition that can rapidly progress to severe respiratory depression and death. Restoring adequate ventilation either through ventilator support or rescue breaths is an important intervention in cases of opioid overdoses.6 Naloxone, an opioid antagonist, is used in combination with ventilation support measures to resuscitate patients experiencing an opioid overdose.6 Naloxone competitively inhibits opioid binding and through this mechanism, reverses life-threatening sedation, hypotension and respiratory depression.7 Naloxone’s Food and Drug Administration (FDA) approved routes of administration include intravenous, intramuscular, subcutaneous, and intranasal. Other routes of administration which are not FDA approved include inhalation, endotracheal, and intraosseous administration. Due to the extensive first pass metabolism of naloxone, the oral route is ineffective in the treatment of opioid overdose.8 In opioid-dependent patients, opioid reversal may precipitate acute withdrawal symptoms such as agitation, hypertension, tachycardia, piloerection, and tachycardia.6,9,10 Although these symptoms are considered uncomfortable, they are not lifethreatening in most situations.6,9,10 Naloxone will not harm or cause any major pharmacologic effects to patients that have not ingested opioids.7,10,11 Furthermore, naloxone is not effective in treating overdoses involving benzodiazepines, barbi-

ALTHOUGH THE USE OF NALOXONE TO REVERSE AN OPIOID OVERDOSE IS COMMONLY ASSOCIATED WITH A HEROIN OVERDOSE, IT IS IMPORTANT TO REMEMBER NALOXONE CAN REVERSE OVERDOSES INVOLVING OPIOID PRESCRIPTION MEDICATIONS, SUCH AS BUPRENORPHINE, CODEINE, FENTANYL, HYDROCODONE, HYDROMORPHONE, METHADONE, MORPHINE, AND OXYCODONE. JULY 2017

turates, amphetamines, and other non-opioid toxicities.10 Although the use of naloxone to reverse an opioid overdose is commonly associated with a heroin overdose, it is important to remember naloxone can reverse overdoses involving opioid prescription medications, such as buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone.10 Expanding access to opioid reversal agents, such as naloxone, to patients and caregivers has been shown to reduce opioid overdose death rates and can be a life-saving tool while waiting for law enforcement or emergency medical services to arrive.12

ON AVERAGE, REVERSAL EFFECTS ARE SEEN WITHIN TWO TO THREE MINUTES AND EFFECTS CONTINUE FOR A RANGE OF 20 TO 90 MINUTES. The FDA has approved two naloxone single-use products which are intended for distribution in the community including an intranasal delivery formulation (Narcan®) and a hand-held auto-injector (Evzio®).13,14 Narcan® nasal spray is available in a 2 mg or 4 mg per 0.1 mL formulation.13 The 4 mg nasal spray has been available since February 2016 and the FDA approved the 2 mg nasal spray in January 2017. According to the package insert, use of the 2 mg dose should be limited to patients at low risk of overdose and high risk of experiencing severe opioid withdrawal.13 The Narcan® nasal spray does not require any assembly and is designed to deliver a constant measured dose which is delivered in one nostril upon pressing firmly on the plunger device.13 Evzio® is now available as a 2 mg per 0.4 mL auto-injector system which delivers the naloxone intramuscularly.14 This auto-injector system includes an electronic voice which instructs the user on the proper steps of administration. Previously, Evzio was available in a 0.4 mg per 0.4 mL dose. However, the manufacturer website states that although the 0.4 mg strength is considered safe and effective, this strength will no longer be manufactured.15 Both Narcan® nasal spray and Evzio® contain a single dose and cannot be reused.13,14 However, both products are dispensed in packages containing two devices since users are instructed to administer a second dose if the desired response does not occur after two to three minutes following initial administration. There are two other products commercially available including an FDA approved intramuscular injectable kit dispensed with two syringes and a non-FDA approved nasal kit which includes naloxone injection vials with a mucosal atomizer device.16 The onset and duration of action of naloxone varies based on the dosage form. On average, reversal effects are seen within two to three minutes and effects continue for a range of 20 to 90 minutes.6 It is important to educate patients on naloxone’s short duration of action because patients and caregivers need to be aware that despite initial improvement, emer32

FLORIDA PHARMACY TODAY

gency services should be contacted and multiple doses of naloxone may be required. The effective dose of naloxone depends on the patient factors, such as body weight, and drug properties, such as the dose and receptor affinity of the opioid involved.6 Patient Selection for Naloxone Many organizations support providing a prescription for naloxone along with a prescription for an opioid including the American Medical Association, Centers for Disease Control and Prevention (CDC), and American Academy of Pain Medicine to name a few.17,18,19 There are many reasons for which one might overdose on an opioid including accidental overdoses from overuse, drug-drug interactions, and changes in renal function that could affect the opioid elimination. Children are also at risk of accidental ingestions of opioids. A retrospective study which evaluated data from the Nationwide Emergency Department Sample collected from 2006 to 2012 found that there were 21,928 pediatric emergency department visits for prescription opioid overdoses.20 Of those 21,928 visits, over half were unintentional overdoses and a large percentage of these patients were between the ages of zero and five years old.20 Recognizing the risks of opioid overdoses and educating the community about naloxone could save a life. The CDC Opioid Guidelines recommend that prescribers consider prescribing naloxone to patients who are at high risk for an opioid overdose.18 Examples include patients who are taking more than 50 mg of morphine equivalents per day, patients with a history of substance use disorder or a history of an opioid overdose, and patients who are currently taking a benzodiazepine with an opioid.18 Additionally, the CDC recommends prescribing naloxone to patients who are tolerant to a particular opioid but are unable to gain access to this opioid for a period of time, such as when a patient is incarcerated.18 These patients are at risk for an overdose if they restart their opioid at the same dose after a period of abstinence. The CDC Guidelines recommends readers to review Prescribe to Prevent: http://prescribetoprevent.org, which offers comprehensive information for prescribers, patients, and pharmacists about the use of naloxone. Additionally, this website suggests a broader patient population to consider naloxone use (table 1).21 These patients are considered high-risk for an opioid overdose and could include many of the patients that pharmacists commonly see in the community. For example, a patient who is prescribed oxycodone 10 mg by mouth every six hours is considered high risk for an opioid overdose based on the fact the patient is taking 60 mg of morphine equivalents

ONE BARRIER TO A PATIENT OBTAINING NALOXONE IS COST. ALTHOUGH SOME INSURANCE COMPANIES WILL PAY FOR A NALOXONE DEVICE, PATIENTS MIGHT STILL STRUGGLE TO PAY THE COPAY.

per day. Despite having support and guidance on who should receive naloxone, barriers do exist. One barrier to a patient obtaining naloxone is cost. Although some insurance companies will pay for a naloxone device, patients might still struggle to pay the copay. Patients who do not have insurance might not be able to afford these products. Although the cost is a barrier, patients who are at high risk should be educated on the necessity of obtaining a naloxone product. Additional barriers surrounding naloxone have been identified through a recently published study which examined perceptions of naloxone from patients and pharmacists.22 Patients involved in this study were concerned about the stigma of naloxone and how pharmacists would perceive them following the purchase of naloxone, which could affect the filling of future opioid prescriptions.22 Pharmacists barriers included both a concern of offending the patient and damaging the relationship, as well as logistical concerns around proper counseling on the devices and submitting for insurance reimbursement for these devices.22 Florida Naloxone Laws In an effort to improve access to emergency opioid antagonists, many states have implemented statutes which allow naloxone to be distributed to first responders and laypersons through prescriptions and standing orders.23 Furthermore, 42 states provide protection from criminal liability to laypersons and first responders administering naloxone.23 In Florida, House Bill 1241 was signed into law in 2016 allowing Florida pharmacists to dispense naloxone to patients and caregivers without a prescription through a standing order.24 The law became effective July 1, 2016, however many pharmacists remain unclear on the correct policies and procedures for implementing this process into their practice. To better understand the law, we will review the exact wording of Florida Statute 381.887(3) and then dissect the who, what, and how of the law.

FLORIDA STATUTE 381.887(3):

An authorized health care practitioner may prescribe and dispense an emergency opioid antagonist to a patient or caregiver for use in accordance with this section, and pharmacists may dispense an emergency opioid antagonist pursuant to such a prescription or pursuant to a non-patient-specific standing order for an autoinjection delivery system or intranasal application delivery system, which must be appropriately labeled with instructions for use. Such patient or caregiver is authorized to store and possess approved emergency opioid antagonists and, in an emergency situation when a physician is not immediately available, administer the emergency opioid antagonist to a person believed in good faith to be experiencing an opioid overdose, regardless of whether that person has a prescription for an emergency opioid antagonist.

Table 1: Suggested Candidates for Naloxone Prescription18,21,26

History of emergency medical care involving opioid overdose

Taking > 50 mg of morphine equivalents per day Undergoing a change in opioid therapy (opioid rotation) Opioid-naïve patient starting methadone Lives in a remote area which leads to difficulties accessing medical services Specific request from patient or caregiver Opioid-tolerant patients who have limited access to opioids for a period of time (e.g., incarceration) Substance abuse disorders: • History of substance abuse or nonmedical use of an opioid • Known or suspected alcohol use • Receiving methadone or buprenorphine for addiction Concurrent use of opioids plus any of the following medical conditions: • COPD • Emphysema • Asthma • Active smoker • Sleep apnea • Respiratory infection • Renal dysfunction • Hepatic disease • Cardiac disease • HIV/AIDS Concurrent use of opioids plus any of the following medications: • Benzodiazepine (or other sedatives) • Antidepressants JULY 2017

So, what exactly does this mean? A pharmacist may dispense an emergency opioid antagonist through two mechanisms: 1) a patient-specific prescription or 2) a non-patientspecific standing order. It is important to note the law states the pharmacist may dispense naloxone to a patient or the patient’s caregiver. Section 381.887(1)(c) defines a caregiver as “a family member, friend or person in a position to have recurring contact with a person at risk of experiencing an opioid overdose.” The definition of a caregiver is broad and can likely apply to many people. Lastly, we must consider what dosage forms and devices the law applies to. The law specifically mentions auto-injection delivery systems and intranasal application delivery systems.

HE FIRST STEP IN ANY SUSPECTED OVERDOSE IS TO CALL 911. SAMHSA RECOMMENDS WHEN CALLING 911 TO REPORT THAT “SOMEONE IS NOT BREATHING” AND TO GIVE A CLEAR ADDRESS Patient Counseling Recognizing an overdose and knowing how to respond can be a matter of life and death. Pharmacists can play a crucial role in educating patients and caregivers about the proper steps for recognizing and managing an opioid overdose. The Substance Abuse and Mental Health Services Administration (SAMHSA) opioid overdose prevention toolkit outlines five essential steps for first responders. The first step in any suspected overdose is to call 911.10 SAMHSA recommends when calling 911 to report that “someone is not breathing” and to give a clear address and location.10 This is important because many patients will need medical attention following the administration of naloxone. Step two involves checking for signs and symptoms of an opioid overdose. Common signs include slow or shallow breathing, inability to arouse patient through a sternal rub, low blood pressure, decreased heart rate, blue or purple fingernails or lips, and/or pinpoint pupils.10 Pharmacists should provide education about the difference between respiratory and cardiac arrest. The American Heart Association makes no recommendations about administering naloxone during cardiac arrest.25 Opioid-overdoses associated with cardiac arrest should be managed with Advanced Cardiac Life Support procedures, including CPR.25 Step three involves providing respiratory support.10 Pharmacists should educate caregivers about the importance of ensuring adequate ventilation prior to administering naloxone. Initially, two slow rescue breaths should be given followed by one breath every five seconds. Step four involves naloxone administration.10 The goal of naloxone therapy is to restore breathing. If an adequate response is not seen within three to five minutes, an additional dose of naloxone may be given.10 The fifth and final step involves monitoring the patient’s response.10 As pre34

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viously discussed, the duration of action of naloxone is 20 to 90 minutes and the duration of action of many opioids is longer than this.6 Patients should be monitored for a minimum of four hours for recurrence of signs and symptoms and therefore it is essential to get the patient to the hospital as soon as possible.10 While waiting for emergency services to arrive, caregivers should have the patient laying in the recovery position on his or her side, supported with a bent knee with one arm under the person’s head. The recovery position will help prevent aspiration if vomiting occurs. Furthermore, caregivers can provide comfort and reassurance as the withdrawal symptoms for opioid-dependent patients can be unpleasant.10 Conclusions Drug overdoses involving opioids are life-threatening and can quickly progress to respiratory depression and death. Naloxone, an opioid antagonist, can be used in conjunction with respiratory support to reverse opioid-induced sedation, hypotension, and respiratory depression.6 Expanding access to opioid reversal agents to patients and caregivers has been shown to reduce opioid overdose death rates.12 As of July 1, 2016, pharmacists in Florida can dispense naloxone to patients and caregivers through a standing order process. Pharmacists are uniquely equipped to identify patients who are at risk of an opioid overdose and ensure the safe and appropriate use of naloxone for the treatment of opioid-related overdoses. Acknowledgment Thank you Alyssa Claudio, Pharm.D. for reviewing this manuscript. References

1 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445-1452. 2 Hall JN. Patterns and Trends of Substance Abuse Within and Across the Regions of Florida. Florida Alcohol & Drug Abuse Association website. http://www.fadaa.org/resource_center/ documents/Drug_Alcohol_Trends-Jim_Hall-FADAA_Update. pdf. December 2016. Accessed March 10, 2017. 3 Drugs Identified in Decreased Persons by Florida Medical Examiners 2015 Annual Report. Florida Department of Law Enforcement website. https://www.fdle.state.fl.us/ cms/MEC/Publications-and-Forms/Documents/Drugs-inDeceased-Persons/2015-Annual-Drug-Report.aspx. September 2016. Accessed March 9, 2017. 4 White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94(7):961-72. 5 Pattinson KT. Opioids and the control of respiration. Br J Anaesth. 2008;100(6):747-58. 6 Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012;367(2):146-55. 7 Naloxone hydrochloride [Package Insert]. Eatontown, NJ: West-Ward Pharmaceuticals Corp. April 2015. 8 Gold Standards, Inc. Naloxone. Clinical Pharmacology [database online]. Available at: http://www. clinicalpharmacology.com. Accessed April 1, 2017. 9 Buajordet I, Naess AC, Jacobsen D, Brørs O. Adverse events after naloxone treatment of episodes of suspected acute opioid

overdose. Eur J Emerg Med. 2004;11(1):19-23. 10 Opioid Overdose Prevention Toolkit. Substance Abuse and Mental Health Services Administration website. http://store. samhsa.gov/shin/content//SMA16-4742/SMA16-4742.pdf. Updated 2016. Accessed March 12, 2017. 11 Wermeling DP. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Ther Adv Drug Saf. 2015;6(1):20-31. 12 Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174. 13 Narcan nasal spray [Package Insert]. Radnor, PA: Adapt Pharm, Inc. February 2017. 14 Evzio [Package Insert]. Richmond, VA: Kaleo, Inc. October 2016. 15 Evzio Frequently Asked Questions. Evzio website. https:// evzio.com/hcp/. Updated February 2017. Accessed April 26, 2017. 16 Naloxone Formulations. Prescribe to Prevent website. http:// prescribetoprevent.org/pharmacists/formulations/. January 2016. Accessed April 26, 2017. 17 American Medical Association Resolution on Nasal Naloxone for the Reversal of Opioid Overdose. Drug Policy Alliance website. http://www.drugpolicy.org/resource/americanmedical-association-resolution-nasal-naloxone-reversalopioid-overdose. Accessed April 26, 2017. 18 Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. 2016;315(15):1624-45. 19 American Academy of Pain Medicine website. http://www. painmed.org/files/aapm-comments-on-naloxone-uptake-anduse.pdf. July 2015. Accessed April 26, 2017. 20 Tadros A, Layman SM, Davis SM, Bozeman R, Davidov

DM. Emergency department visits by pediatric patients for poisoning by prescription opioids. Am J Drug Alcohol Abuse. 2016;42(5):550-555. 21 Instructions for Healthcare Professionals: Prescribing Naloxone. Prescribe to Prevent website. http://www. prescribetoprevent.org/wp-content/uploads/2012/11/onepager_12.pdf. Accessed April 26, 2017. 22 Green TC, Case P, Fiske H, et al. Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc. 2017;57:S19-S27. 23 Naloxone Circle Chart. The White House website. http:// www.whitehouse.gov/sites/default/files/ondcp/blog/ naloxonecirclechart_january2016.pdf. December 2015. Accessed March 12, 2017. 24 HB 1241: Ordering of Medication. Florida Senate website. https://www.flsenate.gov/Session/Bill/2016/1241. March 2016. Accessed March 12, 2017. 25 Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S501-18. 26 Walley AY, Doe-Simkins M, Quinn E, Pierce C, Xuan Z, Ozonoff A. Opioid overdose prevention with intranasal naloxone among people who take methadone. J Subst Abuse Treat. 2013;44(2):241-7.

In Memory of Clay M. Fischer Clay was a third year pharmacy student at the Jacksonville Campus of the University of Florida College of Pharmacy. While completing an academic rotation at the Jacksonville campus, he contributed to this manuscript on Naloxone. Shortly after the conclusion of the rotation, Clay was killed in a vehicle-related accident. Our pharmacy family lost a great future pharmacist that had a passion for the Gators, the Pharmacy profession, and his colleagues and patients he interacted with while working as an intern at CVS. We will miss Clay every day but will remember him for his passion for life and his love for people. Photo by Nathan Pham 2018 UF PharmD Candidate

JULY 2017

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