June 2011 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association JUNE 2011

Key Issues Facing Pharmacists and Technicians

A work-life survey from the Florida Society of Health-Systems Pharmacists in collaboration with the Florida Pharmacy Association.

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

STATEWIDE REPRESENTATION

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561-999-5999 bkahan@kahanshir.com 1800 N.W. Corporate Blvd., Suite 200 Boca Raton, FL 33431 The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 8 Executive Insight 20 Buyer’s Guide

VOL. 74 | NO. 6 JUNE 2011 the official publication of the florida pharmacy association

Features

SPECIAL REPORT: Key Issues Facing Pharmacists and Technicians

National Adverse Drug Event Network Launched

JUNE 2011

FPA Calendar 2011

June 22 - 26 FPA Annual Meeting and Convention Aventura, Florida July 4

Independence Day FPA Office Closed

Legislative Committee Meeting Orlando, Florida AUGUST

5-7

SE Officers Conference Biloxi Mississippi

7-8

28th Annual Southeastern Gatherin

of the Florida Pharmacy Today Journal SEPTEMBER

Deadline to receive nominations for FPA elected office

10-11 FPA Law Conference Ft. Lauderdale 17-24 FPA CE at SEA OCTOBER 8-12

Mission Statements:

NCPA Annual Meeting Nashville Tennessee

15-16 FPA Midyear Clinical Conference 18-19 Florida Board of Pharmacy Meeting Tallahassee, Florida

16-17 Florida Board of Pharmacy Meeting Orlando 27-28 FPA Committee and Council Meetings

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.

For a complete calendar of events go to www.pharmview.com CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2011 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www. pharmview.com

Advertisers EPC...................................................................... 11 Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L............................................ 2 PPSC...................................................................... 2 Rx RElief............................................................ 2

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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E-mail your suggestions/ideas to dave@fiorecommunications.com

The President’s Viewpoint HUMBERTO MARTINEZ, FPA President

FPA: A Year in Review

t has been a great privilege and a humble honor to serve as president of the Florida Pharmacy Association during the 2010-2011 year. The theme for my presidency was “A Strong Foundation for Positive Outcomes.” We have accomplished great things for the FPA and our profession by being this strong foundation for pharmacy. Our work for the 2010-2011 year began in early June when the FPA held its leadership retreat. There, our strategic plan was reviewed and revised. Goals were set and assignments were made to continue with our strategic plan. Also, new charges were given to the councils and committees for their work throughout the year. We reviewed our mission statement as follows, “FPA is the professional society representing Florida pharmacists, united to improve public health and patient care, enhance professional development and advocate for the interest of the profession. The Association is organized to preserve and advance the practice of pharmacy and to serve the professional needs of all pharmacists, pharmacy students, and pharmacy technicians.” We also developed action plans to carry on this mission. Our vision statement was also reviewed as follows, “To be the premier organization representing pharmacy stakeholders in their endeavors to provide quality healthcare.” Ideas were shared and implemented to carry forth this vision throughout the year. The Educational Affairs Council, chaired by Jennifer Pytlarz, was charged with developing a CE program in Tallahassee during the health fair/legislative days. This would help get more pharmacists to get out of work for some additional CE hours. There were over 200 people there during those days and it was the most suc-

cessful of all of our health fairs. The council was also charged with developing and presenting educational programs in the area of innovative quality pharmacy healthcare and coordinating the planning of all CE programs for the FPA. I am happy to report that all was accomplished by this council. This

There were over 200 people there during those days [Health Fair/ Legislative Days] and it was the most successful of all of our health fairs. year, we had a greater number of FPA programs, throughout the state, than ever before. The Public Affairs Council, chaired by Suzanne Kelley, was charged with coordinating the Tallahassee and Miami health fairs. Both events were a success, and we received a lot of positive comments from the attendees. Many attendees were not aware of the health screenings that can be done and are being done by pharmacists in many practice locations throughout the state. We had about 60 pharmacists and over 150 students in attendance. This year, we collaborated with FSHP and had representation from both associations at the legislative days in Tallahassee. The council was also instrumental in informing the community in October that it was Pharmacist’s month. Several proclamations were made by public officials honoring pharmacists.

Humberto Martinez, 2010-2011 FPA President

One charge was to show your community the value of their pharmacist. This was accomplished by the various health fairs that were held throughout the state. The last charge was to coordinate a list of names for PERT- Pharmacist Emergency Response Team. This was accomplished at the FPA convention by the manning of tables by council members and getting people to sign up for the list. The Organizational Affairs Council, chaired by Kimberly Murray, was charged with several FPA constitution and by-laws changes to clear up some directions the association had on policy issues. After these changes, the FPA Board of Directors will be approving all policy issues for the association and be the only entity able to speak for the FPA. Also, the membership on our councils and committees was cleared up in the by-law changes. They also finished the revised membership applications specific to each category. We now have specific FPA membership applications for pharmacists, students JUNE 2011

2011/2012 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Humberto Martinez............................................................. Chairman of the Board Robert Parrado .........................................................................................FPA President Goar Alvarez............................................................................................... President Elect Betty Harris ............................................................................................................Treasurer Suzanne Wise............................................Speaker of the House of Delegates Eric Alvarez.....................................Vice Speaker of the House of Delegates Preston McDonald, Director............................................................................ Region 1 Marcus Dodd-o, Director .................................................................................Region 2 Al Tower, Director ..................................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director...............................................................................................Region 6 Kim Murray, Director............................................................................................ Region 7 Raul Gallo, Director.................................................................................................Region 8 Paul Elias........................................................................................................................Region 9 Alissa Fuller................................................................................................ President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair......................................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Vice Chair......................................................... Don Bergemann, don@bceinfo.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com

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and pharmacy technicians. And I am glad that all their strategic plan incentives were accomplished. These by-laws changes will be voted on at the FPA annual convention in the House of Delegates and hopefully be approved. This council accomplished a lot of hard work for the association. The Professional Affairs Council was charged with the expansion of pharmacy standards of practice and MTM services. Also, I proposed them a question of “How to make the pharmacist indispensable to the employer.” And they worked with this and have come up with some very good ideas. A new resolution will be presented by them at the HOD to address this question. Several resolutions from last year’s HOD were given to them for implementation. Council Chair Eric Alvarez has worked relentlessly to get his council to accomplish these many things. He has traveled to Tallahassee to speak before the Board of Pharmacy to implement one of the resolutions assigned to his council and he has represented the FPA at many events throughout the state. Eric was hospitalized for a short time and he still got his council to finish all of their charges. I would like to congratulate him for a job well done. The Ad Hoc Membership Committee was co-chaired by Tom Coumo and Al Tower. They were charged with coming up with some ideas on how to increase membership and to come up with a golden handcuff that would retain our members after they join. They talked to several members throughout the state and a compilation of all those conversations was presented in the annual report from their committee. FPA leadership traveled to all the pharmacy schools in the state and offered free membership in the FPA for six months after graduation. Hopefully, we will be able to retain them after they start practicing pharmacy. Members are the backbone of this association and we need increased numbers to be a strong foundation to be able to accomplish positive outcomes for the FPA. There are over 25,000 registered pharmacists in this state and about 2000 find it beneficial to be a member of their pro-

fessional association. That is less than 7 percent of the Florida pharmacists, and it amazes me that we can accomplish what we are charged to do for our profession. I would like to thank the core team of members that have helped us move forward and accomplish the many things that our members ask of us. And I would like to challenge any pharmacy stakeholder to join the FPA and help us to be the premier organization representing them in their endeavors to provide quality healthcare. The Governmental Affairs Council (formally Legislative Affairs) was chaired by David Andrews. The council met in July of last year and set our legislative agenda with input from our members. We had eight issues to advocate for in this legislative session. ■■ Advocate for a process for intern immunization administration under the supervision of a pharmacist and expansion of immunization authority. ■■ Advocate for PBM transparency. ■■ Monitor Medicaid reform and advocate for open networks and mandatory MTM services. ■■ Advocate for moving 499 back to the Department of Health. ■■ Advocate expansion for Medicaid audit standards to other third party programs. ■■ Monitoring and defense from Medicaid reimbursement cuts. ■■ Look for opportunities to expunge disciplinary records for minor violations through referring to FPA lobbyist to assess the viability of successful advocating this program. ■■ Monitoring for opportunities to revise the self-care consultant act which would allow the prescribing of vitamins, minerals, etc. by pharmacists if the federal laws change. Work with the naturopathic association. Many thanks go to out lobbying team of Prieguez and Weems and our own EVP, Michael Jackson, for their tireless efforts to get our issues heard and passed by the Legislature. They fought extensively against the hardships on our profession in HB7095.

This bill has generated a lot of concern among pharmacists throughout the state and I hope that we have sent the message that there is strength in numbers and we need members to represent you. Our lobbyist team coordinated the visits of over 30 legislators during our Tallahassee health fair and legislative day. They also coordinated the visit of a “Pharmacist a Week” during the legislative session. Not too many pharmacists could take the time off to be in Tallahassee for a week at a time. But, I am hopeful that we will find more pharmacists next year to respond to be there to help our profession. I very much like this quote from Plato: “Apathy can lead you to be lead by evil men.” We cannot be apathetic and let our legislature make laws that will affect our profession adversely. We have to be involved and engaged with our association that will help prevent some of these things from happening. I will not go into the details of what was passed and not passed, for Michael will be giving a more extensive legislative update. Over all, we were successful in stopping and minimizing some adverse legislation to our profession. This year, FPA leadership and especially our EVP, Michael Jackson, have traveled to many meetings being held throughout the state on the issues coming out of the legislative session. Many people found out about the issues after they passed both houses and were waiting for the governor’s signature to become law. They received the message that if they were a member of the FPA, then they would have been informed about these issues before they were passed. We also advocated for donations to our Political Action Committee of Continuous Existence (PACCE). Many new members joined and we collected more than double our total donations to the PACCE from the previous year. The continued support of our members is essential to the success of our association and the future of pharmacy in Florida. As your president, I have traveled throughout the state and represented the FPA at many national events. I will go anywhere I can to be there and advo-

cate for our profession. I was at a meeting in Austin, Texas, and the speaker said that out of most association memberships, only 10 percent are doers, 5 percent are donors, 5 percent are door openers, and 80 percent are dues payers. In my first speech as your president, I said that I would like my actions to inspire others to Dream More, Learn More, Do More and Become More. I will be satisfied that I have done a good job as your president if I have increased the number of doers in this association by my actions. In closing, I would like to thank the members of the President’s Committee and the Board of Directors for all of their hard work and dedication this year. I would especially like to thank our hard working, committed and devoted executive vice president and CEO, Michael Jackson. We all appreciate his dedication to our association. Also, I would like to thank the staff of the FPA. Without them in the back office, our association would not run smoothly. I wish incoming president, Bob Parrado, and incoming president-elect, Goar Alvarez, the best of luck during their year. I am confident that our association will be in good hands and continue to grow and move forward under their leadership. I will still be serving as the chair of the Board of Directors and will continue to serve our association in whatever capacity is needed. Thank you for your confidence in me for the last year, and I shall continue to serve this association and profession that I love. n Your 2010-2011 FPA President Humberto “Bert” Martinez

JUNE 2011 |

Executive Insight Michael Jackson, BPharm, EVP & CEO, Florida Pharmacy Association by michael jackson, RPh

2011 Legislative Report and Advocacy Program

uring the course of the 2011 legislative session, we again experienced the ongoing impacts of term limits caused by legislators having less and less legislative experience. The 2011 Legislature passed fewer than 300 bills – the lowest number of total bills passed in recent memory. Yet the magnitude of the issues taken on by the Legislature was great and will have huge impacts on our state’s financial resources and health care system for years to come. The Florida Pharmacy Association actively advocated, monitored and offered input on numerous legislative proposals that will be impactful on our profession and business models. Unfortunately, there continue to be no pharmacists serving in the Florida House of Representatives, the Florida Senate or any cabinet level positions. This means that much of the policymaking affecting professional pharmacy is being driven by pro- and anti-pharmacy advocacy organizations, other professional medical organizations and legislative staff. To a great extent – and largely because of the challenges we faced during this year’s legislative session – the responses to our calls for support of the Florida Pharmacy Political Action Committee of Continuous Existence and the Florida Pharmacy Association legal defense fund has been phenomenal. Many of you have poured thousands of dollars into our political and legal accounts. Decisions and laws are being made that directly determine how you will practice your profession of pharmacy, run your pharmacy business, and care for your patients, as well as how health 8 |

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care costs affect our state budget. Your contributions have a direct impact on electing candidates who can and will represent you effectively and will make decisions allowing for the continuation and growth of the future of your cho-

Unfortunately, there continue to be no pharmacists serving in the Florida House of Representatives, the Florida Senate or any cabinet level positions. This means that much of the policymaking affecting professional pharmacy is being driven by proand anti-pharmacy advocacy organizations, other professional medical organizations and legislative staff. sen profession. The Florida Pharmacy Political Action Committee of Continuous Existence (FP-PACCE) is a means for us to “pool” our political contribution re-

Michael Jackson, B.Pharm

sources to allow for a greater reach to political candidates who have or will have an understanding of what’s best for the practice of pharmacy and each aspect of patient care. When the Legislature is in session we are prohibited from making political contributions. When the session is over, this gives us all an opportunity to support those campaigns that are friendly to pharmacy issues. So far in calendar year 2011, the PACCE has raised over $18,000. Much of that has come in within the last two months in response to some very onerous decisions under consideration here in Tallahassee. The PACCE Board extends many thanks to those of you who are supporting our fundraising campaign. It is not hard to do. Just think of it as making an investment in your profession. A bottle of water may cost around $1.00. If you buy two each week, that will add up to about $100 per year. Just imagine if each of Florida’s

25,000 licensed pharmacists matched what he or she pays for bottled water with an equal amount of a PACCE contribution. We would have a political war chest of over $2.5 million of which could bring a tremendous amount of pharmacy political muscle to our efforts in Tallahassee. Where do your PACCE funds go? According to PACCE Treasurer Theresa Tolle, nearly all of it (approximately 90%) is used to support political campaigns. Of the political candidates that we supported with contributions, over 80% were successful in their campaigns. Funds that are not used to directly support political campaigns are used to help raise additional money such as direct mailing expenses, PACCE brochure printing, post office box fees and the PACCE golf tournament and reception fundraising events. A healthy PACCE fundraising program makes it much easier to bring to the forefront of elected policymakers the challenges that you face in providing patient care services on a daily basis. Some of these challenges include abuses by pharmacy benefit managers and their auditors, outdated practice act standards that restrict you from providing the care that you have been trained for and the pressure to increase volume driven by declining pharmacy reimbursements. Below are the issues that we are monitored on your behalf this session. This year’s legislative session saw very few bills get passed for presentation to the governor. As this report is being prepared, the governor had not signed any pharmacy-related bills. A final report was made available at the 2011 annual meeting and convention in Aventura, Florida. HB 7095 Approved by Legislature (Pharmacy Permit Requirements and Controlled Substances) – This legislation, as filed, sought to control pain clinics and physician dispensing. The original bill was only 31 pages and then took on a strike all 91 page amendment restricting pharmacies from dispensing controlled drugs under many circumstances. The FPA launched a massive advocacy campaign to create awareness on how this version of

the legislation would harm pharmacy businesses. There were some minor modifications to the pharmacy provisions that were applied in a House Appropriations Committee. While the bill passed unanimously, several members of the committee expressed concern with the pharmacy provisions. A number of independent pharmacy owners testified on the issues found in the original version of the bill. This legislation ultimately bounced back and forth between the Florida Senate and the House. Major troublesome issues in the bill that the FPA began fighting against included the following: ■■ Restrict wholesalers from shipping 5,000 dosage units each of hydrocodone, morphine, oxycodone, methadone or any benzodiazepine or derivative of benzodiazepine to any retail pharmacy in any given month. ■■ Require community pharmacies to apply for a new permit under the bills revised permitting standards by March 1, 2012, in order to be eligible to dispense Schedule II or III controlled substances at all. (One version of this bill would have required pharmacies to get this permit by January 1, 2012. This is something that the FPA believed the Department of Health could not achieve.) ■■ Created an unlawful act for pharmacists to fail to report fraudulent prescriptions to the sheriff’s office within 24 hours of believing a fraudulent activity had taken place. ■■ One version of this bill would have restricted entirely the dispensing of controlled substances by pharmacies that: • Were not publically traded; • Were not operational for at least 10 years; or • Did not have over $100 million in assets. We worked tirelessly on this legislation to remove these burdens on small pharmacy businesses and to assure that patients with legitimate needs for controlled substances had access to the drugs they needed. Published in the enrolled version of the bill (approved

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

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

Membership Coordinator Ranada Howard, ext. 110

Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chair............................................. Jennifer Pytlarz, Brandon Vice Chair...................Don Bergemann, Tarpon Springs Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member..................................... Joseph Koptowsky, Miami Member.............................................................Rebecca Poston Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2011, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: http://www.pharmview.com JUNE 2011

by the House and Senate and signed by the governor) are the following changes or additions to Florida law: ■■ Creates additional penalties for inappropriate prescribing of controlled substances and non-compliance with F. S. 456.44. ■■ Requires physical examination prior to prescribing controlled substances in pain clinics. ■■ Requires written controlled substance prescriptions to be on counterfeit-proof prescription blanks. ■■ Prohibits physician dispensing of Schedule II and Schedule III controlled substances and creates penalties if a physician dispenses such controlled substance in violation of dispensing practitioner laws. ■■ Provides following exceptions to ban on physicians from dispensing Schedule II & Schedule III controlled substances: ■■ A labeled sample; ■■ Within the Department of Corrections; ■■ After an approved surgical procedure (not to exceed 14 day supply); ■■ Pursuant to a clinical trial; ■■ Through licensed opiate treatment facilities; or ■■ Through licensed hospices. ■■ Grants authority for the Department of Health to deny or to revoke a license for prescription processing errors. ■■ Create new grounds for denying a pharmacy permit (including being on the OIG list). ■■ Requires all community pharmacies to have a new permit issued by 7/1/2012 in order to dispense Schedule II and Schedule III controlled substances and establishing new standards so as to significantly restrict the issuing of this permit only to those persons who are qualified to receive one. ■■ Further defines precisely who a pharmacy permit may be issued to. ■■ Establishes new policies, procedures and penalties to minimize dispensing based upon fraud. ■■ Provides that the department “may” deny a permit for violations of sections 465, 499, 893, etc., by the pharmacy owners. This may also include 10

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denying the pharmacy permit application if the prescription department manager or consultant of record has a “disqualifying offense” as specified by the statute. ■■ Requires comprehensive reports to be filed when wholesaling drugs listed under F. S. 893.02. ■■ Makes it unlawful for a pharmacist to fail to report to the sheriff within 24 hours (or after the close of the next business day whichever is later) after learning of a person attempting to obtain a controlled substance from a pharmacy fraudulently. ■■ Clarifies that law enforcement and the Department of Health shall have access to controlled substance dispensing records upon request and that a subpoena or search warrant is not required to obtain access to, or copies of, records related to controlled substances. ■■ Adds consultant pharmacist of record to the list of those who must be fingerprinted as part of the pharmacist and pharmacy background check procedures. ■■ Requires the permittee to notify the Department of a change in prescription department manager within 10 days of any such change. ■■ Defines certain duties of the prescription department manager. ■■ Requires prescription department managers to notify the Board of Pharmacy of significant theft or loss of controlled substances by the business day following any such theft or loss. ■■ Increases recordkeeping requirements for controlled substance prescription and dispensing records from two years to four years. ■■ Prohibits the transferring of pharmacy permits. ■■ Require pharmacy controlled substance records to be immediately retrievable. ■■ Requires wholesalers to undergo and conduct background screening and credentialing of customers and clients. ■■ Requires wholesalers to review and analyze controlled substance orders greater than 5,000 unit doses per month.

■■

Requires wholesaling data to be collected and reported to the governor, Senate president and House speaker by November 1, 2011. Enhances possession and trafficking offenses relating to controlled substances. Retains the prescription drug monitoring program that was objected to by the governor and the Florida House of Representatives leadership early in the session and enhances the reporting and functionality requirements. Reduces the deadline for a pharmacy’s reporting to the prescription drug monitoring program of controlled substances drugs dispensed by a pharmacy from 15 days to 7 days Creates buy-back and returns program for Schedule II and Schedule III drugs in physician offices so that physicians who are no longer permitted to dispense such drugs will be able to return unused inventory. Provide a $3 million in budgetary funding to facilitate the buy-back program Grants authority for law enforcement to “quarantine” and “seize” Schedule II & III controlled substance inventory in physician offices that is not returned.

The FPA has also been working with the Florida Attorney General’s office that made passage of this legislation its top priority during this session. It is possible that some permit holders who have disqualifying offenses may have difficulty renewing by the July 1, 2012, deadline. We believe that the Department of Health will be required write rules for its permit application for community pharmacies. We do not know if those rules will be in place prior to the deadline. The Board of Pharmacy at its Fort Lauderdale meeting did say on the record that they are not recommending pharmacies have to pay a permit application. The FPA will continue to monitor the Department of Health’s effort to issue these new permits. If it is apparent that the July 1, 2012, deadline is not possible then we will have another opportunity during the legislative session

for 2012 to advocate for an extension. HB585, SB1268 Not Adopted by the Legislature (Pharmacist Immunization Services) – This legislation would have authorized pharmacy interns to administer the same vaccines authorized to be administered by pharmacists, under certain circumstances. The legislation would have expanded the immunization authority of pharmacists to permit – in addition to the influenza vaccination pharmacists are currently permitted to administer to adults – pneumonia and shingle vaccines for the elderly. The bill also would have granted authority for pharmacists and pharmacy interns to administer an epinephrine auto injection under certain circumstances. This bill passed one committee in the Senate but was defeated by a one vote margin in the House Health and Human Services Quality Subcommittee meeting on Wednesday, April 6. Testifying before the committee was Tallahassee immunizing pharmacist Jonathan Hickman. Jon provided the committee with extensive and comprehensive testimony on the benefits of

these services provided by pharmacists and how his practice has helped patients. You can see the video of his testimony by going to the House Health and Human Services Quality Subcommittee web page. You can Google that web page by searching “Online Sunshine”. When you find the video link, advance the slide bar to 27.00 where you will see the HB585 being introduced and debated. SB2000 and SB2144 Approved by the Legislature (Florida Budget) – The 2011-12 budget did not include the requirement that AHCA implement a mail order program for chronically diseased Medicaid patients as passed during the 2010 legislative session. The language adopted in the AHCA conforming bill gives the Agency for Health Care Administration the discretion to implement a voluntary mail order program for home delivery of maintenance pharmaceuticals. There was a proposed dispensing fee reduction of $.50 per prescription on the Senate side, however the House did not agree. Keep in mind though that Medicaid pa-

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tients are transitioning to managed care which means that reimbursement could be driven by whatever contractual agreements that the plans are offering. The current dispensing fee for Medicaid will remain at $3.73. There was an ingredient cost reduction in the budget that is estimated to save the state (and cost pharmacy providers) a little over $22 million. That reduction revised the current ingredient cost reduction “lowest-of” formula to provide that any Medicaid drugs dispensed at wholesale acquisition cost (WAC) will be reimbursed at WAC plus 1.5% instead of WAC plus 4.5%. HB39, HB1039 – Approved by the Florida Legislature (Regulation of Controlled Substances) – House bill 39 defined what a “homologue” is. Also both bills added the following to the list of schedule I controlled substances:

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JUNE 2011 |

SPECIAL REPORT:

Key Issues Facing Pharmacists and Technicians

A work - life survey from the Florida Society of Health-Systems Pharmacists in collaboration with the Florida Pharmacy Association. Â

Authors: Jennifer Williams, Pharm.D. University of Florida College of Pharmacy St. Petersburg, FL

Sandy Estrada, Pharm.D., BCPS Lee Memorial Health System Fort Myers, FL

Connie Hogrefe, Pharm.D. Lee Memorial Health System Fort Myers, FL

The authors would like to acknowledge the contributions of the 2009-2010 FSHP Administrative Affairs Council. Additional members included: Richard Kessler, David Osterberger, Earnestine Pringley, Kimberly Thorp, Renee Zawistowski and Gail Brown.

Florida Pharmacy TodaY

K e y I ss u e s F a c i n g P ha r m a c ists a n d T e c h n i c ia n s

Introduction The Administrative Affairs Council of the Florida Society of Health-Systems Pharmacists (FSHP) was charged in 2009 to develop a survey to obtain salary data and measure the general work-life satisfaction of pharmacists and technicians in the State of Florida. This survey was conducted in collaboration with the Florida Pharmacists Association (FPA). The goal of this survey is to provide pharmacy leadership in the state of Florida with information on the important issues facing pharmacists and technicians. In addition to surveying the membership in 2010, the continuing goal is to re-survey annually to trend the data collected. Methods The FSHP Administrative Affairs Council developed the questions for the survey based on past surveys and council discussions. The survey was approved by the FSHP and FPA Board of directors in 2010. A Survey Monkey ™ survey was created and sent to the membership of FSHP and FPA in December 2010. All responses were anonymous and aggregate data is reported. Results Technician Survey 118 survey responders indicated they were technicians (18% of total survey response). Table 1 shows all survey questions and the response rate for each question. The majority of technician respondents work in hospital or health systems (60.2%) or community chain pharmacies (13.6%). Technicians that chose “other” specified settings such as ambulatory, oncology/cancer center settings, contract manager, call centers and specialty pharmacies. Due to the relatively low technician response the data was not analyzed by geographic region. Amongst technicians, 33% indicated staff technician as

their current position and 24.3% indicated “other”. (Chart 1) The responses indicated as “other” included a wide variety of specialized technician positions such as Pyxis™ technician, chemo technicians and technician interns. Chart 2 shows the current position/title of technician respondents with the majority indicating staff technician. About half, (50.5%) indicated that they did complete a pharmacy technician program (diploma/certificate). 12.6% responded that they completed a pharmacy technician associate’s degree program. Overall, 87.4% of technicians did not complete a pharmacy technician associate’s degree program although they may have had some higher education in a different field. 82.5% of technician respondents are currently certified by the Pharmacy Technician Certification Board (PTCB). Almost one-third (32%) of pharmacy technicians indicated the intention to attend pharmacy school in the future. 73.6% indicated their employer offers tuition reimbursement and/or assistance. 36.8% indicated their employer reimburses for attendance at conferences or educational meetings. Thirty-six technicians responded to the question “Does reimbursement include travel and/or salary compensation?” with 58.3% responding affirmatively. Technicians were asked how many years of experience they had. 17.9% indicated 0-3 years, 29.5% indicated 4-10 years, 17.9% was 11-15 years, 9.5% was 16-20 years and 25.3 was greater than 20 years. When asked how many years they had been in their current position, 46.3% indicated 0-3 years, 41.1 indicated 4-10 years and the remaining indicated greater than 11 years. Less than half (42.9%) responded that they work 40 hours per week. 29.6% indicated they worked greater than 40 hours per week. 14.3% indicated that they worked less than 24 hours per week with the remainder indicating between 24 and 39 hours per week. 83.7% of respondents indicated they were paid hourly (Chart 3), 13.3% were paid by salary and 3.1% were per diem. Of the 13.3% indicating they were paid by salary 12/13 responded they made greater than $31,200. Ninety five technicians responded that they receive compensation JUNE 2011

K e y I ss u e s F a c i n g P ha r m a c ists a n d T e c h n i c ia n s Table 1. Survey Questions and Number of Responses to Each Question Question Are you a pharmacist or technician? Primary Pharmacy Practice Setting Zip Code of Primary Practice Site Position/Title Degree/Certification (check all that apply) Work Hours per Week Compensation: Salary vs. Hourly Did you complete a Pharmacy Technician Program Diploma/Certificate Did you complete a Pharmacy Technician Associates Degree Program? Do you have plans to attend pharmacy school? Are you certified? What type of certification? Average Salary Base Base pay per hour Additional payment/earnings not included in base pay Years of Experience Years in Current Position Does your employer reimburse for your attendance to conference/educational meetings? Does reimbursement include travel and/or salary compensation? Does your employer offer tuition reimbursement and/or assistance? Work Environment/Professional Activity (total% time spent= 100%) How satisfied are you with your current job at your primary place of employment? (with 1 being least satisfied and 5 being very satisfied) Work Load Assessment Have current third party program policies affected pharmacist patient care services? Gender Ethnic/Racial Background State of Initial Pharmacy License *Shadowed boxes indicate the group was not asked the question.

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Number of Pharmacist Responders 536 500 500 500 500 500 500

Number of Technician Responders 118 103 103 103 98 98 103

103

327 167 487 487 487 487

103 103 90 13 84 95 95 95 95

278 470

36 87

470 470

87 87

470 470

550 542 500

K e y I ss u e s F a c i n g P ha r m a c ists a n d T e c h n i c ia n s

The following percentage of technician responders reported 4 or 5 for the following questions: Satisfaction with the job as a whole- 66.6%, Progress towards personal/professional goals- 59.3%, Opportunities for advancement- 41.9% and Job fit to personal skill set- 62.8%. Technicians were asked if their workload had changed from previous year with the majority (75.9%) responding that the workload had increased or greatly increased.

not included in their base pay. More than one type of compensation could be selected with 49 responses for overtime, 24 retirement benefits, 19 bonuses, 10 profit sharing, 10 indicated none and 14 indicated â&#x20AC;&#x153;otherâ&#x20AC;? including shift or weekend differential. Eighty-seven technicians responded to the question regarding work environment/professional activity. Ten responses were excluded due to incomplete response to the questions, leaving 77 evaluable responses. Of the 77 responses the average amount of time technician responders spend in the following professional activities is as follows:- Dispensing/Distributions/Operation- 52.4%, Patient Medication Related Needs- 23.2%, Business Management- 10.7%, Other (research/instruction/preceptorship)- 13.6. Four questions were asked regarding job satisfaction at the primary place of employment with a response of 1 representing least satisfied and 5 representing very satisfied (Chart 4).

Pharmacist Survey 536 survey responders indicated they were pharmacists (82% of total survey response). Refer to Table 1 for all survey questions and the response rate for each question. 59.5% of respondents were female and 40.5% were male. 71.6% were Caucasian, 9.4% were black, 7.2% were Asian, 6.8% were Hispanic and 5% were other. 326 of pharmacist responders were initially licensed in Florida. The majority of pharmacist responders work in hospital

JUNE 2011

K e y I ss u e s F a c i n g P ha r m a c ists a n d T e c h n i c ia n s or health systems (60.2%) or community (chain and independent) pharmacies (11%) (Chart 5). Pharmacists that chose “other” specified settings such as hospice and other specialties. Zip codes of primary practice site were collected and will be used for further data analysis in the future. Clinical pharmacists represented 29.8% of the respondents followed by 23.8% as staff pharmacists. (Chart 6) Residents or other pharmacy specialties including industry comprised the “other” category. The majority (67%) of respondents had a Pharm.D. degree with 46.2% holding a bachelors degree in pharmacy. Thirteen percent of pharmacist respondents indicated board certification.

42.6% of pharmacists responded that they work 40 hours per week and 47.8% indicated they worked greater than 40 hours per week. Three percent indicated that they worked less than 24 hours per week with the remainder indicating between 24 and 39 hours per week. 32.6% of responders indi16

Florida Pharmacy TodaY

cated they were paid hourly, 66.4% were paid by salary and 1% was per diem. 44.3% of the pharmacists paid hourly were paid $50-$55. Chart 7 shows the breakdown of pharmacist average salary base and Chart 8 shows the pharmacists average hourly base. 487 pharmacists responded that they receive compensation not included in their base pay. More than one type of compensation could be selected with 144 responses for overtime, 191 retirement benefits, 167 bonuses, 45 profit sharing, 126 indicated none and 41 indicated “other” including shift or weekend differential. Pharmacists were asked how many years of experience they had. 16.8% indicated 0-3 years, 22.8% indicated 4-10 years, 10.7% indicated 11-15 years, 7.4% indicted 16-20 years and 42.3 indicated greater than 20 years. When asked how many years they had been in their current position, 39.4% indicated 0-3 years, 36.1 indicated 4-10 years , 11.3% indicated 11-15 years, and 4.5% indicated 16-20 years and 8.6% indicated greater than 20 years. Over half (57.3%) indicated their employer reimburses for attendance at conferences or educational meetings. 278 pharmacists responded to the question “Does reimbursement include travel and/or salary compensation?” with 84.9% responding affirmatively. 68.1% indicated their employer offers tuition reimbursement and/or assistance. 470 pharmacists responded to the question regarding work environment/professional activity. Nineteen responses were excluded due to incomplete response to the questions, leaving 451 evaluable responses. Of the 451 responses the average amount of time pharmacist respondents spend in the following professional activities is as follows - Dispensing/Distributions/Operation: 33.8%, Patient Medication Related Needs: 30.7%, Business Management: 21.2%, Other (research/instruction/preceptorship): 14.3. Four questions were asked regarding job satisfaction at the primary place of employment with a response of 1 representing least satisfied and 5 representing very satisfied (Chart 9). The following percentage of pharmacist responders reported 4 or 5 for the following questions: Satisfaction with the job as a whole: 69.7%, Progress towards personal/professional goals: 63.3%, Opportunities for advancement: 45% and Job fit to personal skill set: 68.9%. Pharmacists were asked if their workload had changed from the previous year with 72.4% indicating workload had increased or greatly increased. Pharmacists were asked if current 3rd party program policies affected pharmacist patient care services with 17.9% responding yes, 32.8% no and 49.4% responding not applicable. Discussion One of the most striking results from the technician survey was that less than half feel they have the opportunity for advancement in their current position and approximately onethird have the longterm goal of attending pharmacy school. Overall pharmacists are satisfied with their job as a whole.

K e y I ss u e s F a c i n g P ha r m a c ists a n d T e c h n i c ia n s

Not surprisingly, both pharmacists and technicians feel their workload has increased significantly in the last year. The majority of pharmacists responding to the survey work in hospital or health-systems settings. Future surveys should focus on increasing the response rates amongst community/chain pharmacist in order to ensure a better representation of pharmacy practice in Florida. Consideration might also be given to separating pharmacy residents/fellows from the pharmacist category due to the large focus of the survey on compensation and job satisfaction. Compensation for pharmacy residents/fellows cannot be compared to that of pharmacists as a whole. Conclusions The results of this survey provide a good baseline against which future survey results can be compared.

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National Adverse Drug Event Network Launched Electronic Health Record Systems Used to Improve Drug Event Reporting and Patient Safety PDR Network and its partners today announced the launch of a new online network to collect and distribute adverse drug events in the United States. The new service, called RxEvent, is now available to all U.S. prescribers via integration into electronic health record (“EHR”) platforms and other online services, including directly at www.RxEvent.org. Roughly half a million adverse drug events are reported annually to the U.S. Food and Drug Administration (“FDA”) and the number is growing rapidly according to data from the FDA. More than 90 percent of these reports come from pharmaceutical manufacturers who receive them initially from physicians and other providers, typically via telephone. Manufacturers then triage and attempt to investigate these reports, notifying the FDA when appropriate. Published studies indicate that as few as one in ten adverse drug events are actually reported by healthcare professionals largely due to the time-consuming and inefficient processes involved in reporting adverse drug events. “RxEvent was designed to improve the convenience of adverse event reporting for physicians, the cost-efficiency for manufacturers, and the quality of information ultimately reported to the FDA,” explained Edward Fotsch, MD, CEO of PDR Network, the company providing the RxEvent service along with major EHR vendors and other partners. “RxEvent is part of the new suite of eCare Services that we are rolling out with content integrated into EHRs to increase drug and device efficacy and efficiency.” “Our network of physicians is growing rapidly and with it grows our ability to contribute to drug safety,” stated Todd Rothenhaus, Chief Medical Information Officer, athenahealth, Inc. “RxEvent integrated into athenaClinicals® supports our mission of physician convenience and patient safety.” 18

Florida Pharmacy TodaY

EHR use among physicians in the U.S. has grown dramatically and is approaching 50 percent, in part due to federal and industry subsidies to help cover the cost of these systems. Studies show that adverse drug event reporting integrated into EHRs increases the convenience, content and volume of adverse event reports.[1] “Through our PrimeRESEARCH™ clinical trials network integrated within Greenway’s PrimeSUITE® EHR, we know that providers are vigilant to adverse events and are seeking a streamlined reporting process,” said Greenway ® President and CEO Tee Green. “We are pleased to be working with PDR Network to further improve the efficiencies that enable our provider customers on the front lines to improve drug quality and patient safety through an EHR reporting system that will also advance our ability to enable innovative clinical trials procedures.” “Adverse drug event reporting is the tip of the spear in ensuring ongoing monitoring of prescription drugs. Drug safety requires a robust mechanism to identify, route, investigate and report adverse drug events,” noted Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, FDA. “Integration of adverse event reporting into EHR systems places this service at the prescriber’s fingertips, adding to convenience and ultimately improved drug safety. We applaud PDR Network and their partners for their efforts.” Jim Naughton, MD, an internist and EHR user who practices in the San Francisco Bay Area has had early access to the RxEvent service. He commented, “We see adverse drug events in our practice and I have reported them at times in the past. But the process has been cumbersome and certainly inhibits reporting at times. RxEvent improves both EHRs and adverse event reporting by making reporting much more physician-friendly.”

RxEvent will also be used by pharmacists who report tens of thousands of adverse events annually. “Pharmacists are actively involved in promoting and monitoring safe medication use by their patients. By supporting RxEvent, we hope to facilitate enhanced reporting by pharmacists, who see tens of thousands of adverse drug events annually,” said Thomas Menighan, executive vice president and CEO of the American Pharmacists Association (APhA). “Pharmacists represent a key contributor to drug safety and we are working closely with PDR, as well as pharmacists in all practice settings across the country, to ensure that RxEvent is immediately available to all U.S. pharmacists.” “The RxEvent service integrated into EHRs provides quick and convenient access for physicians and has been designed to include pre-population of information as well as an improved mechanism for pharmaceutical manufacturers or the FDA to contact the reporting provider when additional information is required.

“RxEvent was designed to improve the convenience of adverse event reporting for physicians, the cost-efficiency for manufacturers, and the quality of information ultimately reported to the FDA.”

Employer Based Technician Training Program for all Florida Pharmacies The FPA has made it easy for you to file for approval for your employer based training program with the Board for approval. Once approved you can enroll your technicians in the comprehensive modules.

training

The cost per

technician

$290.

Technicians who join the FPA as members only pay 250. It should take about 160

hours

technician

for

your

complete

the program.

The Florida Pharmacy Association partnering with PassAssured of Orange Texas is pleased to present a web based employer based technician training program for Florida pharmacies. Florida Statutes 465.014 requires pharmacy technicians to register with the Florida Department of Health. To be eligible for registration technicians must complete a Board approved training program as defined under rule 64B16-26.351.

This program is designed to supplement your on-site training program for pharmacy technicians.

All employer based technician training programs must be approved by the Florida Board of Pharmacy. The FPA is offering assistance to pharmacies in their efforts to get their training programs approved. Simply follow the steps published on the FPA web site in the shopping cart where the programâ&#x20AC;&#x2122;s information is published. There is no cost to apply to the Board. Send us your contact information and we will be glad to help you. Name _______________________________ Address _________________________________

610 North Adams Street Tallahassee, Florida Phone: (850) 222-2400 Fax: (850) 561-6758 E-mail: fpa@pharmview.com

City _________________________ State _______________ Zip Code ____________________ E-mail address ________________________________________________________________ Phone ______________________________ Fax _____________________________________ Name of Pharmacy _____________________________________________________________

JUNE 2011

Buyer’s Guide florida PHARMACY TODAY

ADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

PHARMACY RESOURCES Abbott Diabetes Care Michael J. Forker (239) 839-3313 Cerner Etreby Pharmacy Management Systems (800) 292-5590 PPSC Retail Pharmacy Purchasing Program (888) 778-9909

PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Dean Pedalino (800) 642-1652 Mobile: (727) 460-1855

PHarmaceutical WHOLESALER McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953

TEMPORARY PHARMACISTs – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Rx Relief (800) RXRELIEF

LEGAL ASSISTANCE Kahan ◆ Shir, P.L. Brian A. Kahan, R.Ph., and Attorney at Law (561) 999-5999

FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm Drug Information Center Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists”

Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt. 20

Florida Pharmacy TodaY