June 2017 Florida Pharmacy Today by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association JUNE 2017

LESS IS MORE: EVIDENCE FOR SHORTER COURSES OF ANTIBIOTICS

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 20 Buyer’s Guide

VOL. 80 | NO. 6 JUNE 2017 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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Less is More: Evidence for Shorter Courses of Antibiotics CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens Sebastian, Florida Pharmacist Elected to APhA Board Florida Pharmacy Association’s 127th Annual Meeting and Convention

JUNE 2017

FPA Calendar 2017

JULY 4

Independence Day FPA Office Closed

APhA Diabetes and Immunization Certificate Training Programs

12-16 Annual Meeting and Convention Orlando 28-29 Southeastern Officers Conference Sandy Springs, Ga. AUGUST 4

FPA Governmental Affairs Committee Meeting

6-9

Southeastern Education Gatherin’ Destin

15-16 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 OCTOBER

3-4

Florida Board of Pharmacy Meeting

7-8

Midyear Clinical & Nuclear Conference Kissimmee

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 THE HEALTH LAW FIRM............................... 16 KAHAN & ASSOCIATES................................. 13 PHARMACISTS MUTUAL................................ 2 PQC...................................................................... 10

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 UF — Kristin Weitzel (352) 273-5114 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association is engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use. 4 |

FLORIDA PHARMACY TODAY

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

The President’s Viewpoint SCOTT TOMERLIN, FPA PRESIDENT

A Privilege to Serve

t has truly been a pleasure serving as the president of the Florida Pharmacy Association this year. As my term comes to a conclusion, it has certainly been a whirlwind of an adventure, and I believe we have accomplished several significant milestones over the past year. It is my hope that the work and effort the leadership team has poured into our service to the FPA will lay a foundation for continued growth in the years to come. First and foremost, I would like to thank the extraordinary staff of the FPA for their hard work and efforts they put into our association, through countless hours of service and dedication to our members and stakeholders. A special thanks go out to our EVP/ CEO Michael Jackson, Tian MerrenOwens, Chris Heil, Stacey Brooks, and our recently retired staff member, Wan-

First and foremost, I would like to thank the extraordinary staff of the FPA for their hard work and efforts they put into our association, through countless hours of service and dedication to our members and stakeholders.

da Hall, for all that they have done, not only for me, but the association. We owe them a great debt of gratitude, and I appreciate all they do for us. Part of the success of a president’s year is the team that he or she is surrounded with. As it has been said before, there is no “I” in “Team.” I want to recognize and thank our President’s Committee for their hard work for our association, and the sacrifice in time from their families to help make FPA an even better association this year, and moving forward. Special thanks to our chairman of the Board, Tim Rogers, president-elect, Suzy Wise, speaker of the House, Carol Motycka, and treasurer, Alex Pytlarz, for the great job that they have done for us. Speaking of teams, I would be remiss not to recognize and thank our extraordinary council and committee chairs who have faithfully and dutifully served the FPA in their respective roles as council chairs over the past year. These chairs met the tasks that I laid forth for them at our opening leadership retreat last May, and excelled in serving our profession while introducing new and innovative ideas that I hope will be carried forth in the future to come. Suzanne Kelley Educational Affairs Chair Jennifer Chen Organizational Affairs Chair Sarah Steinhardt Professional Affairs Chair Angela Garcia Public Affairs Chair

Scott Tomerlin 2016-2017 FPA President

Kathy Petsos Membership Affairs Chair Farima Raof Student Affairs Student Chair Ashley Huff Membership Affairs Pharmacist Chair Norman Tomaka Governmental Affairs Chair Aneesh Lakhani Governmental Affairs Vice-Chair Membership is one of the key foundations of our association, in my opinion. And as such, I placed great emphasis on helping grow our membership over this past year. With the introduction of the monthly dues payment program process, partnership with student loan consolidator SoFi, a brand new recent graduate program offer for membership and the continued development of launching online CE webinar capabilities, we have accomplished JUNE 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.

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

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

a great deal this year. I look forward in seeing how this unfolds in the upcoming years ahead. One of my missions as your president-elect, and as president this year, was to visit as much of the state as possible, seeing the membership live in person. I had the opportunity to visit just about every local unit association and pharmacy school over the past two years, and have met hundreds of members in our visits, as well as help introduce and register new members to our beloved association. I believe at the conclusion of my term, I will have clocked approximately 30,000 miles on my oncenew car, but every mile has been traveled with love and enjoyment of this association. Each region I have learned is unique, and holds a special place in my heart. Thank you for the memories made. The theme of my presidential year for 2016-17 was “Launch YOUR Profession Forward.” It was a tribute to the area I reside, the “Space Coast” of Florida, where our backyard has launched the history of many space endeavors at the nearby Kennedy Space Center. It also follows our state and national theme of advancing our profession forward through our quest to achieve National Provider Status through legislation such as HR. 592/S.109 in Congress. One way that our team chose to showcase this theme was through the sales of special commemorate theme pins, with the sale proceeds going toward helping offset the cost of bringing back the 2017 Health Fair during the Legislative Days at the Capitol in Tallahassee. I am pleased to report that we were indeed successful in bringing back the Health Fair, which will be discussed later, and the sales of the theme pins generated over $2,000! My sincere appreciation to all who helped support this wonderful event! To recap our 2016-17 year, we started off with one of the most robust and well-attended council and committee meetings in recent memory, in August 2016 with close to 80 participants. It was at the meeting that our councils received their charges for the upcoming year, and they hit the ground running! See "Viewpoint", continued on page 9

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FLORIDA PHARMACY TODAY

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

Next Generation Pharmacy Practice

or years, traditional pharmacy practice has included the preparation and dispensing of medications to patients. This includes the appropriate product selection, screening for drug allergies and contraindications along with helping patients to understand their therapy through consultative services provided on a requested or as needed basis. We all know that this has been the mainstay for the practice of pharmacy for at least the past three or four decades. One thing that can be relied on with regularity and consistency of the rising and setting of the sun is that time facilitates change. Dispensing of medications will always be a major part of the practice, however, we have seen a host of efforts to ratchet down the costs of these services through the lowering of reimbursement and higher costs of dispensing. Even now, there is a campaign underway to find alternatives to the dispensing of medications by deploying automated systems where services provided by pharmacists can be scaled to provide significant cost savings. So what is the next step for pharmacy? We now have to turn on the pharmacist knowledge afterburners to launch this profession into a new era of health care services. There is a critical need in society for the wealth of knowledge that we as pharmacist providers have. That need has its share of barriers that must be broken down. For example, for the past several years we have been advocating for changes to the social security act to recognize pharmacists as health care providers. Those changes are in the proposed U.S. House

(HR 592) and Senate (S 109) bills. It is a campaign supported by not just a few, but nearly all, national and state pharmacy organizations. That is only part of a coordinated campaign to launch the next generation of pharmacy practice. Another campaign includes changing the Pharmacy Practice Act in the

So what is the next step for pharmacy? We now have to turn on the pharmacist knowledge afterburners to launch this profession into a new era of health care services. state, so when, and not if, the above mentioned Congressional bills are adopted and signed into law by the president of the United States, we can finally realize the value of pharmacist servic-

Michael Jackson, B.Pharm

es. There was an attempt this year to revise Florida statute 465 to give consultant pharmacists the ability to initiate, modify or discontinue prescription drug therapy, as well as legal authority to order and evaluate clinical testing, all in collaboration with a prescribing practitioner. Why is this necessary? The future of health care funding is moving toward models that can demonstrate quality and outcomes, not necessarily volume. Prescriber payment systems are being developed to reward the provision of good health care and practices that are penalized by poor patient behavior, such as those who are not adherent to their therapy or are struggling with a lack of comprehensive medication therapy management services. In pharmacy, it is clear that our provider model is best equipped to manage patient therapy. The next genJUNE 2017 |

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

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

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

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

This is a peer-reviewed publication. ©2017, 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.

eration of pharmacy practice means that pharmacists will be engaged in not only the proper dispensing of medications, but also on the front side of care, working with prescribers on drug product selection. For this new practice to grow, we must plant new seeds of public policy and strongly argue two points: Pharmacists must be recognized as health care providers by Congress, and our Practice Act in its current form here in Florida is not pro-

The future of health care funding is moving toward models that can demonstrate quality and outcomes, not necessarily volume. viding adequate benefit for consumers of this state. Members of the Florida House and Senate, as well as the governor, must understand the need for these changes so that our industry can be part of the health care quality revolution. It is only with these changes that the next generation of pharmacy practice can be realized. If you want to know more about this movement, the 127th annual meeting and convention can be the place where you learn how you can make a difference. See you in Orlando in July. n

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Florida Pharmacy Association

"Viewpoint", continued from page 6

I am proud that we brought back the Emerging Young Pharmacists Leadership Conference in 2017, which was held in Orlando with a record turnout. Created several years ago by then President Terry Gubbins, this event is a valuable resource in the quest to identify and develop our future leaders of the profession. We continue to receive extremely positive feedback from participants, and look forward in the continuation of this event in the years to come. One of the challenges that I laid forth during my inaugural speech to the FPA Membership during the Presidentâ&#x20AC;&#x2122;s Breakfast was my goal to bring at least 100 pharmacists to the Capitol for the 2017 Legislative Days at the Capitol. Moving forward to the 2017 Legislative Days and Health Fair at the Capitol, I am pleased to report that we indeed met that goal, were also successful in bringing over 300 student pharmacists from across the state. All seven Colleges of Pharmacy were well represented and made our profession proud! A special thanks goes out to our Legislative Days and Health Fair Ad-Hoc Planning Committees chairs Christina Laid and Preston McDonald for the Legislative Days, and Angela Garcia and Jeanette Connolly for the Health Fair. While it was apparent that this year proved to be an especially challenging year in Tallahassee, with much of the political climate out of our control, we were successful in a united front as pharmacists, student pharmacists and pharmacy technicians advocating for our profession. We will continue this spirit of collaboration moving forward, and look forward to another strong presence at the State Capitol this January and throughout the year. One accomplishment that I am very proud to bring to the membership this year is the growing spirit of collaboration that we continue to establish with our friends at the Florida Society of Health-Systems Pharmacists (FSHP). Working alongside FSHP President Kathy Baldwin has truly been a pleasure over the past two years. Dr. Baldwin and myself met at the beginning of our president-elect terms, and have

built a strong collaboration, which has benefited both associations. And most important of all, I have gained a dear friend in her. My sincerest appreciation to Kathy, her wonderful team at the FSHP Board of Directors and operations

I am proud that we brought back the Emerging Young Pharmacists Leadership Conference in 2017, which was held in Orlando with a record turnout. director Tamekia Bennett for their partnership and strong work that we have both accomplished this past year. I look forward to the fruits it will bear as we both work hard at advancing our profession forward.

I would be remiss not to express my sincerest appreciation to my wonderful colleagues at the Brevard County Pharmacy Association for their support, as well as my staff and supervisors at Walgreens for allowing me time off to do the good work of the FPA over the past two years. Your support has been generous, and I greatly appreciate it. At last, I want thank my wife, Teresa, and our three children, John, Nathan and Isabella, for sharing me with the FPA over the past two years. I know it has not always been easy, but I know you understand my passion for our profession. I am deeply in gratitude that I have a spouse who is a pharmacist and understands the importance of the work that is accomplished by associations such as the FPA in helping Launch our Profession Forward. Without your support, I would not be able to accomplish the things that I am able to do. A special thanks to my honorary father, Norman Tomaka, for his guidance, support and most important, friendship. Who would have known that new student grad you met in 2005 would eventually become the president of the FPA. Thank YOU to the Membership of the FPA for electing me as president of our beloved association. I not only have considered it an honor, but it really is a privilege serving the FPA as your president. I hope that I have made you proud, and look forward in the continued leadership of the association as we all work together to Launch YOUR Profession Forward! n

JUNE 2017

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Less is More: Evidence for Shorter Courses of Antibiotics

Alyssa Claudio, Pharm.D.

Carol Motycka, Pharm.D. BCACP

Introduction Over the last decade, there has been an increased focus on evidence to support shorter courses of antimicrobial therapy. One of the biggest advantages of reducing antibiotic use is limiting the prevalence of in-vitro resistance, or “collateral damage,” and the associated ecological adverse effects.1 Other potential advantages of shorter antibiotic courses include improved patient adherence and cost-savings.2,3 Not all infections, nor patients, are candidates for shorter durations of antibiotic therapy. However, urinary tract infections and community-acquired pneumonia are two infections with evidence for shorter durations which are commonly treated in both the inpatient and outpatient settings. There are many factors that must be taken into account when making the decision to opt for shorter treatment durations. Antibiotic Use in the United States In 2013, the Centers for Disease Control released the report, Antibiotic resistance threats in the United States, which gave the first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health.4 Owing to the rising threat, ensuring appropriate antibiotic usage in the United States (U.S.) has become a national priority. In response, The U.S. government released the The National Strategy for Combating Antibiotic-Resistant Bacteria in March 2015.1 Part of this plan included surveillance studies of antibiotic use. Despite the decrease in outpatient antibiotic prescribing from doctors’ offices, emergency departments, and other outpatient settings in the U.S. in recent years, the prescribing rates remain high JUNE 2017 |

compared to other nations. For example, in 2014, U.S. health care providers contributed to over 266 million antibiotic prescriptions, equaling 835 prescriptions for every 1,000 persons, while Sweden’s rate in the same year was only 328 prescriptions for every 1,000 persons.5 Research has shown that at least 30% of oral antibiotics prescribed in U.S. outpatient settings are unnecessary.6 An article published recently in JAMA Internal Medicine evaluated inpatient antibiotic use among U.S. hospitals from 2006 to 2012. While overall rates of antibiotic use did not change significantly from 2006 to 2012, important trends within individual antibiotic classes were identified. There were significant decreases in fluoroquinolones and first- and second-generation cephalosporin usage, but these decreases were offset by significant increases in vancomycin and agents with broad-spectrum activity against gram negative bacteria, including carbapenems, third- and fourthgeneration cephalosporins, and β-lactam/β-lactamase inhibitor combination antibiotics. Despite substantial reduction in fluoroquinolone use, this class remained the most commonly used antibiotic class in United States hospitals in 2012.7 Factors that Influence Antibiotic Duration of Therapy There are a number of factors that influence the decision to stop therapy which need to be considered including antibiotic selection, causative organism, biomarkers, and other patient specific factors. Antibiotic selection, specifically the agent’s pharmacokinetic and pharmacodynamic parameters, should be taken into account. Longer half-lives or concentrationdependent mechanisms may make some antibiotics better choices for shorter therapy. The causative organism is another important factor to evaluate. Resistant pathogens like methicillin- resistant S. aureus (MRSA) and Pseudomonas aerugi-

stop therapy in any infection.8 Urinary Tract Infections (UTI) UTIs include cystitis, which are lower urinary tract infections, and pyelonephritis which are upper urinary tract infections. Guidelines for acute uncomplicated cystitis and pyelonephritis were among the earliest to focus on optimal agents and durations of treatment to limit collateral damage in 1999.10 Of note, these guidelines only apply to young, healthy women who are not pregnant. The best management for elderly individuals, men and patients with comorbidities remains unclear. While the 2010 guideline update did not make huge changes to durations of therapy, trimethoprim-sulfamethoxazole remained as a first-line treatment option for only three days. Nitrofuration and fosfomycin gained enough clinical evidence to also become primary treatment options and are recommended for five days and one day, respectively. Fluoroquinolones are highly efficacious in three-day regimens, but have a propensity for collateral damage and should be reserved for important uses other than acute cystitis. Thus, unless the patient has a complicated case, alternative antimicrobials should be considered for acute cystitis.11 For acute uncomplicated pyelonephritis, the guidelines recommend trimethoprim-sulfamethoxazole for 14 days, fluoroquinolones for five to seven days, and oral beta-lactams with an initial intravenous dose of ceftriaxone or an aminoglycoside for 1014 days.11 A systematic review has been published since the 2010 guidelines, which evaluated eight randomized trials from 1980 – 2012. The patient population was adult women and men (>16 years old) that were either hospitalized or treated outpatient for pyelonephritis or UTI with sepsis. The comparison groups were seven or fewer days of therapy compared to fewer than seven days of therapy with any agent. The primary outcome was clinical failure, defined as a lack of resolution of fever or signs and symptoms of UTI, or modification of antibiotics at the end of the long-treatment arm. Although no difference was seen between the short and long treatment arms (RR 0.63, 95% CI 0.33 -1.18) for the primary outcome, there was heterogeneity that was due to one trial that compared fluoroquinolones in the short-treatment arm with trimethoprim/sulfamethoxazole in the long-treatment arm. That trial showed an advantage for the short-treatment arm because of the significantly higher resistance of isolated pathogens to trimethoprim/ sulfamethoxazole (18.4%) compared with resistance to fluoroquinolones (0.4%). Other studies compared fluoroquinolones in both treatment arms and in these studies clinical failure did not significantly differ between the short- and long-treatment arms and there was no heterogeneity. The investigators therefore concluded that that clinical failure did not differ significantly between the short- and long-treatment arm. A subgroup analysis of patients with bacteremia also showed no advantage to longer therapy. A recent open-label, prospective randomized control trial

THERE ARE A NUMBER OF FACTORS THAT INFLUENCE THE DECISION TO STOP THERAPY WHICH NEED TO BE CONSIDERED INCLUDING ANTIBIOTIC SELECTION, CAUSATIVE ORGANISM, BIOMARKERS, AND OTHER PATIENT SPECIFIC FACTORS. nosa, have been excluded from many of the trials on shorter durations, due to secondary complications associated with these pathogens, such as cavitary lesions in pneumonia that would be indications for longer therapy. Biomarkers, such as procalcitonin in upper respiratory infections, could take the cookie-cutter approach to durations of therapy away by making durations more patient specific, whether that be longer or shorter than the durations that are discussed in this article. Last but not least, there are patient-specific factors, like overall severity of disease, comorbid conditions, immunosuppression, inadequate source control and clinical response to therapy that have to be evaluated prior to making the decision to 12

FLORIDA PHARMACY TODAY

compared five days to 10 days of fluoroquinolone treatment with either levofloxacin or ofloxacin for acute uncomplicated pyelonephritis in females (≥18 years old) with clinical signs of urinary tract infection, fever >38 °C, and positive urinalysis. The primary outcome was cure at day 10 and day 30 after the end of treatment. The main bacterium involved was E. coli (n = 86; 97.7%). The cure rate observed after 10 and 30 days of treatment was not significantly different between the two study arms: 28 (93.3%) vs. 36 (94.7%) at day 10 (p=1.00) and 23 (100%) vs. 20 (100%) at day 30 (p=1.00), respectively, for the five- and 10-day arms. The authors concluded that efficacy of five days of fluoroquinolone treatment was non-inferior to 10 days of treatment. This evidence supports the guideline recommendations for five to seven days of treatment with fluoroquinolones for acute uncomplicated pyelonephritis. The subgroup analyses of patients with bacteremia secondary to the UTI also found no advantage with longer treatment durations. Community-Acquired Pneumonia (CAP) The American Thoracic Society published guidelines for CAP in 2001 with recommendations for durations of therapy that differed from the Infectious Disease Society of American recommendations that were published in 2003. The guidelines provided different durations according to the causative pathogen that ranged from seven days to 21 days. In response to confusion regarding differences between their respective guidelines, the IDSA and the ATS created a joint committee to develop a unified CAP guideline document. The consensus for duration of therapy was simplified to a minimum of five days, if afebrile for 48-72 hours and no more than one CAP-associated sign of clinical instability including a temperature > 37.8℃, heart rate > 100 beats/min, respiratory rate > 24 breaths/min, systolic blood pressure < 90 mmHg, and arterial oxygen saturation < 90% or pO2 < 60 mmHg on room air. These recommendations are regardless of the causative pathogen, however the guidelines state that longer duration may be needed if the initial therapy was not active against the identified pathogen or complicated by an extrapulmonary infection like meningitis or endocarditis. The evidence for a minimum of five days came mainly from a randomized, noninferiority study of adult patients (> 18 years old) with mildto-severe CAP. The comparison groups were levofloxacin 750 mg daily for five days versus levofloxacin 500 mg daily for 10 days, given intravenously or orally at the investigators’ discretion. The primary outcome was the clinical success rate at the post-therapy visit scheduled to occur seven to 14 days after receipt of the last dose of active drug for each group. This outcome was achieved in 183/198 (92.4%) of patients in the levofloxacin 750 mg group, and 175/192 (91.1%), with a 95% CI of -7.0 to 4.4 which met the non-inferiority threshold of <10%. There was a statistically significant difference in percent of patients with both subjective (67.4% versus 54.6%, p=0.006) and objective resolution of fever (49.1% vs. 38.5%, p=0.027) on day three in favor of the 750 mg short-course group. This is specifically cited by the guidelines as evidence for support of shorter duration. The investigators address that despite the in-

THE AMERICAN THORACIC SOCIETY PUBLISHED GUIDELINES FOR CAP IN 2001 WITH RECOMMENDATIONS FOR DURATIONS OF THERAPY THAT DIFFERED FROM THE INFECTIOUS DISEASE SOCIETY OF AMERICAN RECOMMENDATIONS THAT WERE PUBLISHED IN 2003. crease in daily levofloxacin dose to 750 mg, total drug exposure during the five-day CAP treatment course was reduced to 3750 mg—a 25% reduction, compared with the 10-day regimen of 500 mg per day. The 750-mg daily dose coupled with a shorter duration of therapy could optimize therapy by capitalizing on levofloxacin’s concentration-dependent properties while at the same time decreasing total drug exposure. Therefore, the authors concluded that treatment with 750 mg of levofloxacin per day for five days is at least as effective and well tolerated as treatment with 500 mg of levofloxacin per day for 10 days for the treatment of mild- severe CAP.14 The minimum of five days if clinically stable recommendation was only recently validated in a multicenter, randomized, non-inferiority study conducted from January 2012 to August 2013. The

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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.

JUNE 2017

comparison groups were those whose antibiotic therapy was stopped at day five if the guideline criteria were met. The control group included patients who were treated with durations of therapy determined by their physician. The primary outcomes included clinical success rate at day 10 and late followup (day 30) since admission, which was defined as resolution or improvement in signs and symptoms related to pneumonia without further antibiotics. The other primary outcome was CAP-related symptoms at day 10 measured with the 18item CAP symptom questionnaire, a specific and validated patient-reported outcome measure on which higher scores indicate more severe symptoms. There were no significant differences between the two groups for either primary outcome, therefore, the authors concluded that withdrawing antibiotic treatment based on clinical stability criteria after a minimum of five days of appropriate treatment is not inferior to traditional treatment schedules in terms of clinical success. It is important to note the patient populations that were excluded from this study since these patients would likely not be candidates for a five-day stop date. These patients included those who were immunocompromised (i.e. HIV, solid organ transplantation, a splenectomy, taking immunosuppressive agents or neutropenia), patients that would have met the previous health care associated pneumonia definition (those living in a nursing home or received antibiotics in last 30 days), those with more resistant causative pathogens including P. aeruginosa or S. aureus and those with extrapulmonary infections, such as meningitis or endocarditis.8 Summary Shorter courses of antibiotics could lead to less collateral damage, improved patient adherence and cost-savings. Urinary tract infections and CAP are two infections commonly treated both outpatient and in the hospital that have evidence for shorter courses of antibiotics. As pharmacists in both practice settings and during transitions of care, we can evaluate patients for clinical stability to see if they are candidates for shorter durations. We can educate providers that a five day course for CAP, five to seven days course for uncomplicated pyelonephritis, and as short as one to three days of antibiotics for uncomplicated cystitis may be sufficient in select patient populations. References:

1 United States Federal Government. National Strategy for Combating Antibiotic-Resistant Bacteria. March 2015. Accessed at www.obamawhitehouse.archives.gov/sites/default/files/ docs/carb_national_strategy.pdf Accessed on April 7, 2017. 2 Kardas P. Patient compliance with antibiotic treatment for respiratory tract infections. J Antimicrob Chemother. 2002;49(6):897-903. 3 Opmeer BC, El Moussaoui R, Bossuyt PM, Speelman P, Prins JM, de Borgie CA. Costs associated with shorter duration

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of antibiotic therapy in hospitalized patients with mildto-moderate severe community-acquired pneumonia. J Antimicrob Chemother. 2007;60(5): 1131-1136. 4 Centers for Disease Control and Prevention, US Department of Health and Human Services. Antibiotic resistance threats in the United States, 2013. 5 Antibiotic Resistance Project. Issue Brief: Trends in U.S. Antibiotic Use. The Pew Charitable Trusts. March 22, 2017. Accessed at www.pewtrusts.org/en/research-and-analysis/ issue-briefs/2017/03/trends-in-us-antibiotic-use. Accessed on April 7, 2017. 6 Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016;315(17):1864–73. 7 Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012. JAMA Intern Med. 2016 Nov 1;176(11):1639-1648. 8 Uranga A, España PP, Bilbao A, et al. Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial. JAMA Intern Med. 2016 Sep 1;176(9):1257-65. 9 Kardas P. Patient compliance with antibiotic treatment for respiratory tract infections. J Antimicrob Chemother. 2002;49(6):897-903. 10 Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial Cystitis and Acute Pyelonephritis in Women. Clin Infect Dis. 1999;29(4): 745-759. 11 Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5): e103-e120. 12 Eliakim-Raz N, Yahav D, Paul M, Leibovici L. Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection— 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2013; 68: 2183–2191. 13 Dinh A, Davido B, Etienne M, et al. Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial. Eur J Clin Microbiol Infect Dis. 2017; epub ahead of print. 14 Dunbar LM, Wunderink RG, Habib MP, et al. High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis 2003; 37:752–60.

CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent and rural practices, while ensuring fiscal sustainability and highquality care within Medicare. “We’ve heard the concerns that too many quality programs, technology requirements and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.” The Quality Payment Program, updated annually as part of MACRA, is meant to promote greater value within the healthcare system. Clinicians who participate in Medicare serve more than 57 million seniors. Clinicians can choose how they want to participate in the Quality Payment Program based on their practice size, specialty, location, or patient population. The proposed rule would amend some existing requirements and also contains new policies for doctors and

clinicians participating in the Quality Payment Program that would encourage participation in either Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Additionally, CMS has used clinician feedback to shape the second year of the program. If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to health care delivery. Moreover, CMS is making it easier for rural and small providers to participate. For a fact sheet on the proposed rule, please visit: https://www.cms.gov/ Medicare/Quality-Initiatives-PatientAssessment-Instruments/Value-BasedPrograms/MACRA-MIPS-and-APMs/

Proposed-rule-fact-sheet.pdf The proposed rule (CMS-5522-P) can be downloaded from the Federal Register at: https://www.federalregister.gov/ public-inspection/ For more information about the Quality Payment Program, please visit: qpp.cms.gov Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgovPress

JUNE 2017

Sebastian, Florida Pharmacist Elected to APhA Board FPA Past President to serve as APhA Trustee The Florida Pharmacy Association is pleased to announce that Past President Theresa Tolle has been elected to serve on the American Pharmacists Association Board of Trustees. Her term in office will begin at the 165th Annual Meeting and Exposition in Nashville, Tenn., March 1 - 19, 2018. Theresa Tolle, B.Pharm, FAPhA, has been the owner of Bay Street PharTHERESA TOLLE macy in Sebastian, Fla. for the past 19 years. Prior to owning an independent community pharmacy, she had practice experience in chain, long term care (consultant) pharmacy and hospital. Her pharmacy practice focuses on patient services such as counseling, MTM, compounding, immunizations and pharmacogenomics testing. Her professional activities have spanned local, state, and national pharmacy associations including serving

Representing Health Care Professionals

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

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

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as president of Florida Pharmacy Association in 2003, treasurer of the Florida Pharmacy Political Committee since 2009, APhA-APPM Community & Ambulatory Chair, 1995–1996, PAC Region 2 Board of Governors 2009–2012 and speaker– elect/speaker of the House, 2014–2017.

PRIOR TO OWNING AN INDEPENDENT COMMUNITY PHARMACY, SHE HAD PRACTICE EXPERIENCE IN CHAIN, LONG TERM CARE (CONSULTANT) PHARMACY AND HOSPITAL. Other APhA service includes Policy Committee chair in 2010–2011, AMCP Model Audit Guidelines Task Group, 2010–2011 and CPPA Oversight Committee 2012–2013. Additional professional involvement includes membership and committee work with NCPA, Cardinal Health National Advisory Board, Health First Health Plans P&T Committee and Creative Pharmacist Advisory Board. Activities outside the profession include Sebastian Chamber of Commerce Board chair & LGA Chair, American Cancer Society Treasure Coast Council and Sebastian River Medical Center trustee. Tolle graduated from University of Florida in 1988. She has won several professional awards including the 2017 APhA Pharmacy Management Excellence Award, Palm Beach Atlantic University Community Pharmacy Preceptor of the Year in 2015, Bowl of Hygeia in 2012, APhA Fellow in 2011, APhA Good Government Pharmacist of the Year in 2004 and Cardinal Health’s Ken Wurster Community Leadership Award in 2011. She is blessed to be the wife of Joe and the mom of three wonderful children, Taryn, TJ and Taelyn.

127TH ANNUAL

MEETING & CONVENTION

JUNE 2017

JW Marriott Grande Lakes Orlando, Florida July 12 – 16, 2017

ACCOMMODATIONS Room Rates: $159 and up based on single/double occupancy. The room reservation deadline is Friday, June 23, 2017 or when room block is full. Thereafter, reservations may be taken on a space available or rate available basis. Please be sure to ask for the Florida Pharmacy Association group rate. All reservations must be accompanied by a first night room deposit or guaranteed with a major credit card. The check-in time is 4:00pm and the checkout time is 11:00 am. Room reservations can be made by calling (800) 266-9432 or online at FPA’s website. Guest self parking is $9 per car per day. Valet parking is $25 per day/night.

KEYNOTE SPEAKER Pharmacist, entrepreneur and diabetes educator, DeAnn Mullins is devoted to keeping people well — As the owner of Mullins Pharmacy and WeCare Wellness, she inspires, educates and fights for patient rights, by empowering real people to care for themselves. DeAnn’s award-winning WeCare Diabetes Education Program has helped thousands of people gain the skills to balance their blood sugar levels — and lead longer, healthier, more joyful lives. She has published numerous articles on diabetes and was a regular diabetes care columnist for Retail Pharmacy Management magazine. Her column reached every retail pharmacy in the United States and then some—totaling more than 60,000 pharmacies—and had an estimated 120,000 readers. DeAnn received her formal training from Samford University’s McWhorter School of Pharmacy — but her role as a caregiver and wellness crusader began long before that, when her brother was diagnosed with Type 1 Diabetes, at age 9. As the current President of the National Community Pharmacists Association and Board of Directors member, she is deeply committed to the continued growth and prosperity of independent community pharmacy. DeAnn is a former member of the Florida Board of Pharmacy and is currently serving on advisory boards and committees for Cardinal Health, Samford University, Prescribe Wellness and the NCPA Innovation Center. DeAnn has been recognized for her professional and patient care efforts with awards including the Mylan Excellence in Pharmacy Award; Samford University Professional Service Award; Eli Lilly Award for Ethics, Scholarship and Leadership; ASHP Leadership Award; and the FPA Innovative Pharmacy Practice Award. Married for 29 years to husband Ken and Mom to Stevie-Marie (20) and Gracie (17), DeAnn considers her girls to be her best contribution thus far towards making the world a better place. Learn more about her story at mullinspharmacy.com

General Education Track THURSDAy - SUNDAy The general education track will offer courses designed to educate pharmacists on a wide

variety of important topics pertaining to the profession of pharmacy practice. Specific required Florida Board Approved courses being offered are Reducing Medication Errors, HIV/AIDS, and the Validation of Controlled Substances. There will also be an Innovative Pharmacy Practice Panel of pharmacists with various backgrounds who will share unique things occurring in their pharmacy.

CONSULTANT Education Track FRIDAyThe- general SATURDAy The consultant education track will provide pharmacists with the most current information available on various topics education track will offer courses designed to educate pharmacists on a wide variety of important topics pertaining that pharmacists encounter in the profession of pharmacy. The consultant track will focus on Geriatric Pharmacy and Infectious Disease. to the profession of pharmacy practice. Specific required courses being offered are Reducing Medication Errors and HIV/AIDS. The specific topics being offered include STOPP Criteria/BEERS, Pain in the Elderly, Alzheimers, Deprescribing, HIV/AIDS, Hepatitis, Antimicrobials, There will also be a Specialty Drug Update course which focuses on key trends in specialty pharmaceuticals for various health and Antibiotic Stewardship. There are 12 hours available for consultant pharmacists. conditions. 18

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STUDENT AND TECHNICIAN Track THURSDAy - SUNDAy Students and Technicians will benefit from interacting with practicing pharmacists and attending student and

technician focused continuing education programs. The technician track offers several hours of continuing education on a variety of topics, including the required courses for Florida registration and PTCB renewal: Medication Errors, HIV/AIDS, and Law. The student track consists of several hours of fun and exciting continuing education, such as The Career Forum, the NASPA/NMA Game Show and Responsibilities of a Pharmacist upon graduation. Students will also have an opportunity to participate in the Patient Counseling Competition and showcase their Poster Presentations.

SPECIAL EVENTS HOUSE OF DELEGATES: Be a delegate or observer and see how important member participation is to the direction of

the Association.

FPPC RECEPTION: Attend this reception to support your Political Action Committee. STUDENT EVENTS: Participate in the Adopt-A-Student Mentor Social and Volleyball Tournament. Students will benefit from interacting with practicing pharmacists, attending student focused continuing education programs and learning first hand about the FPA and how involvement can improve their chosen profession. Call the FPA office and offer to mentor or sponsor a student.

ExHIBITS: Participate in our grand opening reception in the exhibit hall! POSTER PRESENTATIONS: Browse submissions from pharmacy students. Contact the FPA office for more information if you would like to submit a poster presentation.

RECEPTIONS: Enjoy catching up with your colleagues as the Universities entertain their alumni and friends, and as the FPA Foundation host its reception. Also, participate in Karaoke Night!

5K FUN RUN/WALK: Exercise is good for the soul. Incorporate health and fitness while at the FPA convention. Please register early to reserve your space.

AWARDS EVENT: Honor outstanding practitioners during the awards presentation. PRESIDENTâ&#x20AC;&#x2122;S BREAKFAST: Attend the Sunday morning installation of new officers. JUNE 2017

FPA 127th Annual Meeting and Convention July 12-16, 2017 Orlando, FL

45Daily Education Registration

Participant Participant Information Information

Daily registration does not include admittance to functions or handbooks. Handouts will be posted on our website July 10.

Name: _____________________________________________________ Name _______________________________________________ Address______________________________________________ Badge Name: _______________________________________________ City, State, Zip_________________________________________ Mailing Address: ____________________________________________ Phone___ _______________________ City, State, Zip: _____________________________________________ Email________________________________________________ Phone: (W) (H)_______________________ Practice Setting________________________________________ License: PS______________ PU _____________RPT_________ Fax: ______________________________________________________ NABP Date of Birth__________ License:e-profile#__________________ PS________________ PU_________ Other State________ Emergency Contact Name/Number_______________________

After

FPA Member

$165

$185

$_______

Non Member

$215

$235

$_______

Member Technician

$65

$85

$_______

Non Member Technician

$90

$110

$_______

Handbooks

$40

N/A

$_______

June 16

Full Package Registration

Full package registration includes Educational Programs (Thurs-Sun), Exhibit Hall, Awards Event and President’s Breakfast. Handbooks are not included in full package registration. Handouts will be available on our website, www.pharmview.com, the week of the convention. Before June 16

After June 16

Amount_

$345

$430

$_______

Non Member

$525

$610

$_______

Pharmacist BEST Value

$540

$625

$_______

Member Technician

$155

$185

$_______

Non Member Technician

$175

$210

$_______

Technician BEST Value

$185

$220

$_______

Student

$150

$170

$_______

$160

$_______

3Guest (no CE) Guest Name_ Handbooks

_______ $40

__ N/A

$_______

(BEST Value includes Registration & Membership) Please indicate below which functions you will attend. Tickets will be provided upon request during the pre-registration process and placed in your packet. If no boxes are selected, we will assume you will not attend any of the events listed below and tickets will not be available onsite. Please see box 5 for additional tickets.



House of Delegates (Thursday)



Exhibit Hall (Friday and/or Saturday)

#_______



Awards Event (Saturday)

#_______



President’s Breakfast (Sunday)

#______ _



I will not attend any of these functions.

Friday

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Sunday

Additional Tickets

Exhibit Hall

@ $30

$______

Awards Event

@ $80

$______

President’s Breakfast

@ $50

$______

Special Events Registration

The events listed below must be purchased individually and are not included in any other registration packages. Quantity

Price

House of Delegates _________ (Non-convention registrants)

@ $25

Amount $_____

FPPC Reception _________ @ N/C (Complimentary event, indicate if attending) Christian RPh Breakfast

_________

@ $40

$_____

Student Luncheon

_________

@ $50

$_____

FPA Polo Shirt (Deadline is June 9, 2017) Quantity Price 

Yes

______ @ $35

Payment

M/F ______

Size ______

Amount $_______

Total Enclosed: $______

Check (To: FPA) AMEX Discover MasterCard Visa Account # ____________________________________________ Security Code _________________ Expiration Date __________ Billing Address ________________________________________ Signature ____________________________________________

Four Ways to Register

Saturday

The following events are included in the Full Registration Package if requested. However, you must purchase additional tickets for guests who are NOT registered. Quantity Price Amount

Mail: FPA, 610 North Adams Street, Tallahassee, FL 32301 Phone: 850-222-2400 Fax: 850-561-6758 Web: www.pharmview.com 20

June 16 Amount

Please select the day(s) you will attend: Thursday

2FPA Member

Before

HELP SUPPORT THE ADOPT-A-STUDENT PROGRAM Florida Pharmacy Association (FPA) 127th Annual Meeting & Convention July 12-16, 2017 JW Marriott Grande Lakes, Orlando Again this year, students from Florida Colleges of Pharmacy will be “Adopted” for the FPA Annual Meeting and Convention. Pharmacy students will benefit from the interaction with practicing pharmacists, learn first hand how FPA actually operates and how they can become involved in their chosen profession. As you remember, college students are on a tight budget and most of them cannot afford to attend the convention. Here is how you can help! Be a Bronze, Silver or Gold Sponsor! The donation amounts are Bronze ($150), Silver ($250), and Gold ($500) Level Mentor Sponsors and will help offset the costs of the AAS program. You also have the option to give any amount you prefer. The FPA offers Adopted students complimentary registration, which includes tickets to the Exhibit Hall, Student Luncheon, Awards Banquet, President’s Breakfast, hotel accommodations for three nights at the host hotel, and special programs designed for them. Your generous support of the FPA’s programs and services are keys to our success in advocating for our profession, supporting our pharmacy students and promoting quality patient care services. Thank you for giving back to your profession. Make a contribution yourself, ask your local unit association or get together with friends to Adopt-A-Student. Remember, these are the future leaders of pharmacy! Mentor Program. Each of the adopted students will be assigned a pharmacist who may invite them to attend meetings, CE programs, and share their knowledge and pharmacy experience with them. If you plan to attend the convention and would like to be a mentor, please contact the FPA office. Please donate online or complete the form below and fax or mail with your check to: Florida Pharmacy Association 610 North Adams Street Tallahassee, FL 32301 Fax: (850)561-6758 Please make your check payable to the Florida Pharmacy Foundation Sponsor Name: _________________________________________________________________________ Address: ______________________________________________________________________________ City: _______________________________________ State: __________ Zip: _______________________ Phone: ____________________________________ Amount of Contribution: _______________________ Charge to the following (please circle): AMEX

DISCOVER

MASTERCARD

VISA

Account #:_____________________________________Security Code: ________ Exp. Date: __________ Signature: _____________________________________________________________________________ q Yes, I would like to serve as a Mentor. q Contact me with more information on Mentoring. Contributions to the Florida Pharmacy Association Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details. JUNE 2017

florida BUYER’S GUIDE 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 PPSC Retail Pharmacy Purchasing Program (888) 778-9909

LEGAL ASSISTANCE Kahan ◆ Heimberg, PLC Brian A. Kahan, R.Ph., Attorney at Law (561) 392-9000 The Health Law Firm George F. Indest III, J.D., M.P.A., LL.M. (407) 331-6620

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

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

Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt. 22

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