March 2016 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association MAR. 2016

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florida PHARMACY TODAY Departments

VOL. 79 | NO. 3 MARCH 2016 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 19 FPA News & Notes 29 Buyer’s Guide

12 14 18 21

The Disruption of Pharmacy Practice

The Story of the Market FPA Participates in USF Pizza and Policy Night FPA Member Profile: Ron Clayton

MARCH 2016

Mission Statements:

FPA Calendar 2016

MARCH 27

Easter - FPA Office Closed

of the Florida Pharmacy Today Journal 24 - 25 NCPA Congressional Summit 30

APRIL 4-6

Florida Board of Pharmacy Meeting Altamonte Springs

Memorial Day - FPA Office Closed JUNE

Last day for convention pre-registration

15 - 17 FPA Clinical Conference Tampa

APhA Diabetes Certificate Program

6/30 - 7/3 FPA Annual Meeting and Convention Ft. Lauderdale, Florida

Advisory Council on Pharmacy Practice MAY

1 - 3

NASPA Leadership Retreat

Deadline for FPA Resolutions

Deadline for Vice Speaker and Director nominations

FPA Leadership Retreat

JULY 17 - 24 FPA CE at SEA Barcelona Spain 29 - 31 SE Officers Conference Williamsburg, Virginia

21-22 FPA CE Conference Jacksonville

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 review their licenses and registrations by December 31, 2016. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For more information on CE programs or events, please contact the Florida Pharmacy Association at (850) 222-2400 or visit our website at www.pharmview.com

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 BENZER PHARMACY........................................ 9 EPIC PHARMACY............................................. 12 THE HEALTH LAW FIRM............................... 12 KAHAN HEIMBERG, PLC............................... 15 PHARMACISTS MUTUAL.............................. 13 PHARMACY QUALITY COMMITMENT..... 27 Rx OWNERSHIP.................................................. 2

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 U/F — Art Wharton (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 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 |

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

The President’s Viewpoint TIM ROGERS, RPh, FPA PRESIDENT AND JESSICA GONZALEZ, PHARMD

March 2016 Mission: Lac Azuei, Haiti

e all have opportunities to volunteer and serve others. I would like everyone to share the priceless services they perform, so others may be inspired to donate their time and efforts. This is one of the issues I wrote about in last month’s FPA Journal that makes pharmacists one of the most respected professionals. During the past few years, I have had the pleasure to help others in many ways. One of my passions has been helping others through medical mission trips to other countries with Trinity Methodist Church and the University of Florida. I have logged around 15 mission trips to Chile, Nicaragua, the Dominican Republic and, most recently, to Haiti. I would like to share our most recent trip to Haiti, Feb. 27 to March 6, 2016. This year’s trip was our fifth to Lac Azuei, Haiti. On previous medical mission trips with Dr. Harvey Rohlwing, we would hold clinics and see whoever showed up. The problem with this approach is that we had no follow-up with patients, may never see these patients again on subsequent trips, and maintained no patient records on who we saw. We changed this approach for the Lac Azuei, Haiti, medical trip by selecting three villages, Lilet, Fond Bayard and Bethel (formerly Fond Belizaire), to see on each subsequent trip. We started and maintained electronic health records on each patient evaluated and developed a method of follow-up with our chronic disease state patients every six months. We began by working through a non-governmental organization, Caribbean Harvest, who was in the process of teaching fish farming to the people living around

Lac Azuei. Later on, during the years of our third, fourth and fifth trips to Lac Azuei, Caribbean Harvest began building more than 100 homes, a school and churches for the people in the three villages. Next year, we are planning to expand our scope to four additional vil-

One of my passions has been helping others through medical mission trips to other countries with Trinity Methodist Church and the University of Florida. lages, if our resources permit. Our team this year consisted of: four pharmacists, six pharmacy students, five physicians, five medical students, a nutritionist, a nutrition student and a nurse. We would see patients with conditions ranging from tinea corporis to spina bifida. Each patient would go through the following stations: 1. Triage: Patients were checked-in with our medical records and evaluated for their vital signs, medical history and complaints. 2. Nutrition: Children and women were assessed for nutritional health and growth and counseled regarding nutrition if needed; all patients would receive up to a six-month supply of vitamins.

Tim Rogers, RPh 2015-2016 FPA President

3. Medical: All patients were evaluated, diagnosed and treated by a physician. 4. Pharmacy: All patients would get a final evaluation by the pharmacist, who verifies and decides on appropriate medications. Patients would then receive their medications and be counseled on their use. We would also give each patient ibuprofen or acetaminophen to use as needed. We also had with our team four Haitian medical students and two Haitian pharmacy students from the Université d’Etat d’Haïti. These students helped us get valuable medical insight into the patient population as well as assisting in filling any language barriers when speaking to our patients. In order for our team to provide medical care to these three villages in five days, it takes a year to fully prepare the team, the supplies and the medicaMARCH 2016

2015-16 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.

Suzanne Kelley..................................................................................................Board Chair Timothy Rogers..........................................................................................FPA President Alexander Pytlarz.................................................................................... FPA Treasurer Scott Tomerlin...........................................................................................President-Elect Jackie Donovan........................................................................Speaker of the House Carol Motycka................................................................Vice Speaker of the House Thomas Johns......................................................................................... FSHP President Jennifer Raquipo................................................................................. Region 1 Director Michael Hebb.........................................................................................Region 2 Director Tom Cuomo.............................................................................................Region 3 Director Linda Lazuka.........................................................................................Region 4 Director Robert Parrado...................................................................................Region 5 Director Luther Laite IV.....................................................................................Region 6 Director David Mackarey.................................................................................. Region 7 Director 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....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary.............. Verender Gail Brown, brownvgrx4304@hotmail.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member.............................. Rebecca Poston, Rebecca.Poston@flhealth.gov Member.................................................Patricia Nguebo, notablep@hotmail.com Member................................................................Norman Tomaka, FLRX9@aol.com Member........................................................................Stuart Ulrich, Stuarx@aol.com Member............................................................. Don Bergemann, don@bceinfo.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

tions. We tried to get as many medications and supplies donated as possible. Vitamin Angels donated about 75,000 vitamins. All the students on this trip also spent endless hours coordinating fundraiser events throughout the year to help support medication and supply purchases. For items we could not get through donations, the team members paid out of pocket. This year long preparation served as additional training for the students in state regulations, project funding, teamwork and system operations. Every day, while in Haiti, the team needs to travel one to two hours to reach the rural areas where the villages are located and depart late in the evening. Every evening after dinner, the students present a discussion on topics ranging from resource options in family planning to treatment options in infectious diseases. Before the end of each night, all medications and supplies are prepared, stored and readied for transport with us for the next clinic day. From this trip, there are many opportunities to encounter pediatric care, infectious disease treatment, chronic disease treatment and acute emergency procedures. There is an average of three children per mother; in some cases, mothers have up to eight children. We were able to treat and counsel on medications for use as needed in pediatrics, but also cases treating pneumonia, scabies, asthma and malnutrition. We were able to treat various ages for a variety of sexually transmitted infections, urinary tract infections and skin and soft tissue infections. For specific patients with chronic disease states such as diabetes and hypertension, Dr. Rohlwing returns to Haiti every six months to follow up on their treatment plan. There have been several emergency incidents in which our medical physicians and students were called into acute surgical action. One year, a young boy nearly severed his thumb while working in the fields with a machete. Our emergency physicians were able to save the childâ&#x20AC;&#x2122;s thumb. This year, a villager had a motorcycle accident in which a large wound needed suturing. This year, on top of medical care, we See Presidentâ&#x20AC;&#x2122;s Viewpoint continued on p. 10

6 |

FLORIDA PHARMACY TODAY

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

Should Government Rule Pharmacist Decision Making?

n nearly 20 years of advocacy service to the profession of pharmacy here in Florida, and with hundreds of editorials published in journals and newsletters, nothing I have written compares to the message I am sharing with our readers in this article. There is a very interesting and compelling case being considered by the U. S. Supreme Court worthy of sharing with our members. The case simply is a dispute between a pharmacy provider affected by a regulation of a governmental agency in the state of Washington. The Washington State Pharmacy Commission, which is the equivalent of our state Board of Pharmacy, implemented a rule requiring pharmacists to sell the morning-after pill regardless of their religious beliefs.1 Needless to say, this issue created quite a firestorm across the pharmacy community. I am presuming that, because this issue is before the nation’s Supreme Court, a decision here would have far-reaching implications on the practice of pharmacy nationwide, and perhaps here in Florida as well. While the argument in this case is centered in the religious beliefs of health care providers, this editor will acknowledge the diversity of our membership in recognizing how polarizing the discussions could be. I can, however, remind our membership that the Florida Pharmacy Association has a long-standing policy that supports the right of pharmacists to appropriately exercise conscience beliefs. In 1998, during our House of Delegates meeting, the FPA adopted a policy statement supporting the Pharmacist’s Right of Conscience, such that: 1. The FPA recognizes the individual

pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal; and 2. The FPA shall serve as a resource for the profession of Pharmacy in Florida in addressing and understanding ethical issues in pharmacy practice.

The Washington State Pharmacy Commission, which is the equivalent of our state Board of Pharmacy, implemented a rule requiring pharmacists to sell the morning-after pill regardless of their religious beliefs. We believe that our pharmacist colleagues in the state of Washington who are affected by this ruling and who are a subject in this case warrant the unconditional support of the Florida Pharmacy Association as members of the FPA have adopted this as policy. The Washington pharmacy affected by this issue regularly referred patients who requested these medications to other pharmacy providers in their market area. This

Michael Jackson, B.Pharm

is consistent with the policy statement adopted by the FPA. This governmental rule in Washington appears to force a pharmacy to provide services whether they are unwilling or unable to perform those services or risk sanctioning. For our members, the issue is actually much deeper than simply a pharmacist provider exercising their conscious beliefs. There are economic and logistical issues as well. What is the effect of a governmental agency putting into public policy a mandate that a health care provider must make available a product or service? What is the relief to the pharmacy provider should the product or service be beyond the skills, scope and abilities of providers or the product not be commercially available to the pharmacy business? It is very clear that the government has very little influence on the price of preMARCH 2016 |

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

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

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

FLORIDA PHARMACY TODAY BOARD Chair..................................... Carol Motycka, St. Augustine Vice Chair................................Cristina Medina, Hollywood Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Verender Gail Brown, Orlando Member..................................... Joseph Koptowsky, Miami Member..............................Rebecca Poston, Tallahassee Member.............................................. Patricia Nguebo, Ocala Member................................. Norman Tomaka, Melbourne Member..............................Stuart Ulrich, Boynton Beach Member.......................Don Bergemann, Tarpon Springs Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer-reviewed publication. ©2016, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. FLORIDA PHARMACY ASSOCIATION

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: http://www.pharmview.com 8 | FLORIDA PHARMACY TODAY

scription or nonprescription medications outside of those in certain government health plans, and even that influence is limited. Why should government have the authority to require a pharmacy business to place into inventory a product that may be prohibitive in costs or may not be available through the pharmacy’s contracted

lieved to be the purpose of government. While one may argue that this type of rulemaking by government is improving access to time-sensitive medications, what about the many issues related to prescription drug benefits that are being ignored? There are more issues in those areas that need new laws and rulemaking that are

Should the government have the authority to write rules requiring a pediatrician to treat geriatric patients? supplier? While this may not be the issue in the drug in the Washington Supreme Court case, such policymaking could expand to other costly or onerous products and services. Let’s look at this from the prospective of other provider types. Should the government have the authority to write rules requiring a pediatrician to treat geriatric patients? A dentist whose primary practice is focused on orthodontia may not want to be in the general dentistry space. Probably a more direct question to ask is: Should all gynecologists be required to perform abortions, even if there are contraindications and the procedure could cause problems to the patient’s general health? Would you want your podiatrist performing heart transplants because the government said so? Should a pharmacy specializing in a niche practice of dermatologic services be required to stock and inventory biologic drugs when their patient population is never going to use or request those products? There is no doubt that government rulemaking is an important fact of our profession. It sets the standards for quality of care and ensures that providers are competent to deliver the services they are authorized to perform. This kind of policy making is extending too far into practice decision making and is not what is be-

causing far more problems than this issue. The Florida Pharmacy Association is proactively involved in this issue and has signed on as an Amicus Curiae supporting petitioner in this Supreme Court case. We are joining more than 30 other state pharmacy associations and many of our national associations supporting this effort. No doubt you will read about this issue in the pharmacy press in the months ahead. You will know that your association is supporting the fight. We will share more information as it becomes available in Stat News and our upcoming CE conferences and annual meeting. References

1 The Becket Fund for Religious Liberty

http://www.becketfund.org/ stormans-case/

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PRESIDENT’S VIEWPOINT

2013 Fond B

continued from p. 7

fed an entire village lunch. In closing, I’d like to answer the question of “Why?” It’s easy. Every person should have a built-in voice telling them to help others. If I was a carpenter, I would build housing, schools and churches. It is a very rewarding feeling to help others. I particularly enjoy teaching and sharing this feeling with the young people we take with us. Many times this ignites the desire in a person to help others, and this feeling lasts a lifetime. n

Pharmacy station in Lilet. Jessica Gonzalez, bottom right, with pharmacy and medical students

2013 Village of Lilet: A Bowlegged child, one of the reasons nutrition joined the team in future trips

Medical Station in Lilet hosted at local’s home. Chairs brought in by Caribbean Harvest.

FLORIDA PHARMACY TODAY

Belizaire before it was moved and transformed into Bethel

2016 New homes in Bethel (previously Fond Belizaire)

Child with spina bifida

TOP: Pharmacy station. Jessica Gonzalez, far right, with Tim Rogers to her left ABOVE: 2016 Lac Azuei Team on our way to a village. Tim Rogers front and center. LEFT: Nutrition station. Tim Rogers with Vitamin Angel donation of vitamin A and prenatal vitamins

MARCH 2016 |

PRESIDENT’S VIEWPOINT

continued

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MARCH 2016

THE DISRUPTION OF PHARMACY PRACTICE AN OPINION FROM A PHARMACY STUDENT By Karl Marcellus, PharmD Candidate and FPA Intern “Pharmacy is changing.” Unless you have been living under a rock in the past decade, it is likely that you have heard this phrase, or something to the same effect, numerous times – perhaps many times more than you can or wish to remember. This is especially true if you have had the opportunity to work in a pharmacy as a technician, intern or pharmacist, in which case you can even attest to many of these changes. One of the most noticeable changes in my journey as student pharmacist – even more so than the constant assertions of the importance of clinical residencies – is the high rate at which graduates are joining the ranks of the profession. Back in 2012, the job outlook in pharmacy was projected to grow a substantial 14 percent in all of the nation for the next decade.1 Today, however, a surge in the number of prospective and practicing pharmacists has significantly decreased the outlook to 3 percent for the next eight years, which is lower than average.2 While job security is a concern, I cannot help but think that this change is good! This type of growth can serve to highlight pharmacists’ high care accessibility, which is a quality that is not stressed enough. In 2014, there were an estimated 20,180 working pharmacists in the state of Florida, with an estimated 3,964 pharmacies employing many of them.3,4 The significance of this lies in the fact that as many as 56 million Americans lack adequate access to primary care.5 Moreover, it is difficult to ignore the benefit if you take into account that 93 percent of all Americans live within five miles of a community retail pharmacy.6 This kind of growth could very well turn pharmacists into health vanguards against the increased demand due to the physician shortages (somewhere between

At the moment, pharmacists in Florida possess the numbers and the proper clinical qualifications to act beyond dispensing and counseling; nevertheless, they still remain underutilized. 85,000 and 200,000) that are expected to result from Medicare and the Patient Protection and Affordable Care Act (PPACA) in the next two decades.7 In addition, in a nation where 86 percent of prescriptions are for chronic care, pharmacists are essential, as they provide useful services for these conditions, such as health screenings and testing for diabetes, high blood pressure and lipids – strategies needed to counteract chronic illnesses responsible for killing 7 in 10 Americans and contributing to 75 percent of all health spending.5,8 With all that said, perhaps pharmacy is not changing in all of the right places. At the moment, pharmacists in Florida possess the numbers and the proper clinical qualifications to act beyond dispensing and counseling; nevertheless, they still remain underutilized. Our willingness to rise to higher levels of health practice are often stifled on legislative and inter-professional levels. For example, advocacy efforts to make the healthcare system less fragmented have made slow progress, while legislation attempting to make greater strides at once have been mostly shut down. Case in point, a bill that would have made the role of the Florida pharmacist more pronounced in collaborative efforts with physicians was recently withdrawn due to last minute changes in its language. The ability to be more proactive in regard to medication therapy management in community settings would not only benefit the patient but would also empower the pharmacist. Because about 76 percent of all physician office visits are for post-diagnostic care, there is am-

While job security is a concern, I cannot help but think that this change is good! This type of growth can serve to highlight pharmacists’ high care accessibility, which is a quality that is not stressed enough. 14

FLORIDA PHARMACY TODAY

ple opportunity for today’s pharmacists to use their talents in ways that can enhance collaborative care with other health professionals.5 These efforts can result in various clinical- and practice-level benefits, such as the freeing up of resources, the formation of links between family practice and the community pharmacy, secure and confident prescribing and expanded scopes of physician practice, among others.9 Large pharmacy corporations driven by the need to contain costs against declining reimbursement may indirectly contribute to barriers pharmacists face in their endeavor to provide patient care, and sometimes the reason is simple enough. Unless profitable or mandated by law, pharmacy services outside of prescription medication may not generate adequate revenue to be the funding model for services provided by pharmacists, which is unfortunate, considering that pharmacists’ satisfaction is proportionally related to the time they spend with patients.10 This reinforces the need for stronger legislative advocacy and advocacy participation. The bill mentioned previously also sought to provide compensation to pharmacists for patient care services apart from prescription services that are not covered under Medicare Part B. Such a change would perhaps incentivize further emphasis on such services at the forefront, or at least at the same level as traditional pharmacy dispensing services. Growth is occurring in pharmacy – the type of growth that is often heightened by the rise of a more eager generation filled with fresher ideas and more radical expectations. Sadly, the current reality is that those expectations are being met with barriers that limit their expression. As an advocate for change in our profession, these changes can be daunting but exciting. On one hand, they make me contemplate some of my inadequacies as I strive to meet these changes head-on. On the other hand, I cannot help but trust and seek to validate a lifetime’s worth of training. It is up to us as practitioners to be political advocates and monitor legislation making recurring rounds on federal and state levels, as they have the power to benefit or adversely affect, both directly and indirectly, the industry and the practice as a whole. We are ready.

It is up to us as practitioners to be political advocates and monitor legislation making recurring rounds on federal and state levels, as they have the power to benefit or adversely affect, both directly and indirectly, the industry and the practice as a whole. References

1 Hulliz, D and Brown, DL. (2014, April 15). The Future of Pharmacy Jobs -- Will It Be Feast or Famine? Medscape. Retrieved from http://www.medscape.com/ viewarticle/823365. 2 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition,

Pharmacists. (2015, December 17). Retrieved from http:// www.bls.gov/ooh/healthcare/pharmacists.htm. 3 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, Occupational Employment and Wages, May 2014. (2015, March 2015) Retrieved from http://www.bls.gov/oes/ current/oes291051.htm. 4 National Pharmacy Market Summary SK&A (2015). Retrieved from http://www.skainfo.com/health_care_market_reports/ pharmacy_list_national_summary.pdf. 5 Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Retrieved from http:// www.pharmacist.com/sites/default/files/files/USPHS_ Report_USSG_1%281%29.pdf. 6 NACDS Industry Profile 2011 – 2012, p. 14 7 Association of American Medical Colleges. Recent studies and reports on physician shortages in the U.S. (2012). Retrieved from www.aamc.org/download/100598/data/ 8 Bauer, UE. Chronic Disease Prevention and Control. Centers for Disease Control. Retrieved from http:// www.allhealth.org/briefingmaterials/BauerJulybriefingfinal071312PrintVersion-2330.pdf. 9 Pottie, K., Farrell, B., Haydt, S., Dolovich, L., Sellors, C., Kennie, N., Martin, C. M. (2008). Integrating pharmacists into family practice teams: Physicians’ perspectives on collaborative care. Canadian Family Physician, 54(12), 1714– 1717.e5. 10 Riemschneider, B. (2010). Pharmacy Times. Retrieved from http://www.pharmacytimes.com/publications/issue/2010/ september2010/ngp_future_of_pharmacy-0910.

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MARCH 2016

The Story of the Market

By William Garst, FPA’s Governmental Affairs Committee Chair

Chapter One The reader will note that innovations can have unintended consequences. There once was a county that had farmers and townspeople. If the people of the town needed food or other farm products, they would go out to the farms and purchase or trade for food. One day a man came to this town and settled there. He looked around and studied the town and had an idea! He bought an area of land in the town and divided it up into smaller areas. He called these areas stalls. This man went out to the farmers and offered to them each a stall, at a small price, so the townspeople did not have to go out to the farms. All the farmers decided to bring their goods to this place. The man that owned the place decided to call it a market. Everything went along very well. The towns people liked it because they did not have to travel all around to visit the farms and they could compare the quality of the farm products, as well as price, and make the best purchase for themselves. The farmers liked it because they could sell their goods and were exposed to many more of the townspeople. The market became a very busy place and all was good. One day, the man who owned the market decided that it was too much work to have all the farmers come to the market and sell their goods. The man went out to the farmers that owned the biggest farms and said to them, “If you bring all your goods to the market, I will make sure they are all purchased; in fact, I will purchase them myself and resell them to the townspeople, but I need a discount in return for purchasing all your goods.” The farmers that were offered this arrangement decided that it was good for them and agreed. The man called the agreement a contract. The smaller farmers showed up one day to the market and were told they could not sell their goods at the market. Only the large farmers who had a contract with the man could do

After a period of time, the large farmers and the man who owned the market realized that they controlled all the food and farm products available to the townspeople. 16

FLORIDA PHARMACY TODAY

business at the market. The small farmers had to go back to their old way of doing business and try to sell their goods outside of their individual farms. Over time, the small farmers failed and had to move to another county. All their land became vacant and the large farmers bought the land very cheaply. After a period of time, the large farmers and the man who owned the market realized that they controlled all the food and farm products available to the townspeople. The farmers and the market owner decided that they could price the food and farm products as high as they wanted, so that is just what they did. Slowly at first, then increasingly as time passed. The townspeople realized that they were spending a great deal of their resources on food and farm products. They went to the smaller farmers, but they had moved and were no longer there. The townspeople finally realized that they had made a big mistake by letting the market owner and the large farmers take control of all the food and farm products. The townspeople went to the mayor and town council to ask what could be done. The mayor and town council said, “We cannot interfere with agreements (contracts) between people.” The townspeople said, “Even if the agreement hurts the town?” Chapter Two “Road blocks” ensue and more information is learned. Some of the townspeople decided to go to some surrounding counties where this situation had not happened. They found some of the farmers who used to live in their county. The townspeople tried to convince the farmers to come back to their county. The farmers refused because they did not have access to the market. But the townspeople said that they did not like the quality and variety of the food and farm products since they left. The farmers said they would consider coming back if they could get into the market. The townspeople asked, what if they could do that, or create another market in the town, would the farmers come back? The farmers said they would. The townspeople went to the market owner and asked if he would let the small farmers back in the market. The market owner refused because he said he did not have to and the arrangement he had with the large farmers was agreeable to him. The townspeople went to the large farmers and asked if they minded if the small farmers coming back to the market. The large farmers said that the agreement with the market owner was fine with them and refused. The townspeople went to the mayor and council to ask if property could be set aside for another market. The mayor and council said that there was no property left for this use

and the market seemed to serve its purpose of providing food and farm products. There was no need for another market, the mayor and council said. If the property were available, it would have to be purchased like the first market owner had done. The townspeople could not find another market owner because no one wanted the risk of the purchase due to the fact that the first market owner had made agreements with the large farmers to sell or purchase all of their food or farm products.

manded that the rental owners allow the large farmers to rent for their seasonal workers. The rental owners refused because they realized the power of the contract. If the market owner could discriminate and restrict whom they rented stalls to in the market, why couldn’t they restrict and rent living quarters to whom they wished?

Chapter Three The townspeople learn about agreements (contracts).

The mayor and council held a big meeting. They reviewed all that had happened and finally decided that there should be certain rules and conditions for agreements (contracts) that are made within their county. They decided that a contract can contain most any kind of arrangement as long as it is agreeable to both parties. However, they realized that some contracts affect the county and town more than others. It was decided that if agreements and contracts have a direct effect on the county and town, then there should be no discrimination about who can enter into an agreement or contract as long as there is agreement in the terms. In addition, the mayor and council realized that to prevent subtle discrimination, there should be not added restrictions for certain parties that may have been discriminated previously.

The townspeople had their own meeting to determine what else could be done. They decided that there was little else to do and still be law-abiding townspeople. At the meeting, there was a discussion that all their problems came from the agreements (contracts). They realized the power of a contract. Many of the townspeople decided to use contracts in their trades and businesses. They rationalized that if it worked for the market owner and large farmers, maybe contracts would work for them. Some of the townspeople owned and rented (leased) out living accommodations. These townspeople realized that a lease is like a contract. In the past, the townspeople who rented to people would not restrict who they rented to. Now they realized that if the market owner could restrict who he let into the market, then they could discriminate who they rented to. There are some people who would be better renters than others—especially the renters who would be in the living quarters for a long period of time. More turnover in a living accommodation would mean more work for the rental owner. Chapter Four The large farmers learn about being on the outside of an agreement (contract). The larger farmers would bring in seasonal workers to help during the harvest seasons. The large farmers would rent living accommodations for the seasonal workers from the townspeople. The townspeople who owned the rentals started to refuse the short term rentals and concentrated on renting for long terms because it was more beneficial to them. The large farmers objected to this, but they were told they can provide their own seasonal accommodations for their workers. The large farmers tried this, but found out it was more expensive to build and maintain their own seasonal accommodations. They especially did not like to maintain the living quarters during the times between seasons. The large farmers went to the mayor and council. They said that they would have a hard time producing food and farm products for the market. They asked the mayor and council to make the rental owners rent (contract) living quarters for their seasonal workers. The mayor and council talked to the rental owners about this new development. They de-

Chapter Five The mayor and council feel the need to intervene in contracts.

EDITOR’S NOTE: This short story by FPA’s Governmental Affairs Committee Chair William Garst seems to mirror what is happening in the business of pharmacy. We are all aware that many of the services provided by pharmacists are through some kind of contract, though the genesis of those contracts and their terms are not always very clear. Over time, the question may arise as to who benefits from a contractual agreement. Who may be harmed by these contracts, and is it possible that contracts could be advantageous to one party only? We believe at the Florida Pharmacy Association that there is a chasm between those that pay for or fund health care and those that provide health care, and that chasm grows with every signed agreement. Sometimes an agreement is signed without a person knowing what is in the document. The next time you download an app from the internet, install software on your desktop computer or even rent a car, take a moment to review what you are agreeing to. You may be shocked to know what rights and benefits you are giving away.

MARCH 2016

FPA Participates in USF Pizza and Policy Night On March 10, the University of South Florida (USF) American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) hosted their biannual “Pizza and Policy Night.” USF hosted student pharmacists from LECOM and the University of Florida at the event. The keynote speaker, U.S. Congressman Gus Bilirakis, discussed the state of healthcare and role of pharmacy. He expressed support of the profession and the need for pharmacists as healthcare evolves. Rep. Bilirakis reviewed his support of H.R. 592 and introduced upcoming legislatiTon. FPA President Tim Rogers emphasized the role of student pharmacists for advocating both during school and in the field. Pharmacist and FPA leader Bob Parrado outlined steps that student pharmacists may take to become actively involved in the advocacy process and the state organization. The USF APhA-ASP chapter would like to thank all students and faculty in attendance, the notable speakers and FPA for its continued support of the profession and students around the state.

FLORIDA PHARMACY TODAY

FPA News & Notes Tim Rogers to Run for State House 21st District Newberry pharmacist and current FPA president Timothy Rogers has filed to run for state representative for the 21st District. The district extends from just east of Interstate 75 in Gainesville through Gilchrist and Dixie Counties to the west. Tim is active in his community, having served as PTA president for Newberry elementary and middle schools for four years, the Boy Scouts for more than 30 years and the Rotary Club. He was also on the local March of Dimes steering committee. He has participated in various medical missions over the years and has been a member of FPA for more than 35 years. He has served many years in leadership in the Alachua County Association of Pharmacists and was the 2005 recipient of the prestigious Bowl of Hygeia award from the Florida Pharmacy Association. There has not been a pharmacist serving in the Florida Legislature since the term of Rep. Everett Kelly of Tavares ended in 2002. Mr. Roger’s campaign treasurer is Edwin M. Brown of Gainesville, Fla.

Enter here to view the rule draft. Members are to be reminded that this rule change is applicable only to Medicaid patients in the fee for service program.

Medicaid Rule on Prescribed Drug Fee Change Pending The Agency for Health Care Administration has scheduled a public hearing for 59G-4.251, Florida Administrative Code, Florida Medicaid Prescribed Drugs Reimbursement Methodology. The public hearing is scheduled for April 5, 2016, from 11:00 a.m. to noon ET at the:

DEA Schedules Another Take Back Day On April 30, from 10 a.m. to 2 p.m., the Drug Enforcement Administration (DEA) will give the public its 11th opportunity in six years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused and unwanted prescription drugs. Consumers may bring their unused medications to locations available through this web site link. (The DEA cannot accept liquids or needles or sharps, only pills or patches.) The service is free and anonymous, no questions asked. Last September, Americans turned in 350 tons (over 702,000 pounds) of prescription drugs at more than 5,000 sites operated by the DEA and more than 3,800 of its state and local law enforcement partners. When those results are combined with what was collected in its 10 previous Take Back events, the DEA and its partners have taken in over 5.5 million pounds—more than 2,750 tons—of pills.

Agency for Health Care Administration 2727 Mahan Drive Building 3 Conference Room D Tallahassee, FL, 32308 This proposed change is seeking to delete reference to average wholesale price. The change appears to include cleanup language by clarifying that the reimbursement methodology used by Florida Medicaid is universally applied rather than specifying it applicable to drugs dispensed by a pharmacy or injectable drugs administered by a medical professional or dispensed by a physician.

Opioid Abuse Bill Passes Senate with Medicare ‘Lock-In’ Provision (from NCPA) The Senate has overwhelmingly passed the Comprehensive Addiction and Recovery Act (CARA), which is aimed at addressing the opioid crisis, with an amendment that would let Medicare Part D plans lock Medicare beneficiaries at risk of drug abuse into sole prescribers and pharmacies to fill Schedule II controlled substance prescriptions. The bill passed 94-1 and now goes to the House. In the midst of debate on CARA, Sen. Pat Toomey (R-PA) offered his bill, The Stopping Medication Abuse and Protecting Seniors Act (S. 1913), as an amendment to CARA. The House has yet to schedule a hearing on companion legislation. As the next steps of the legislative process play out, NCPA will continue to educate Congress about the importance of supporting Medicare beneficiary access to essential medication and the community pharmacist they know and trust. NCPA was successful in ensuring the measure exempts LTC patients and that community pharmacists be included in the stakeholder group who will work with CMS and Part D plans to determine lock in patient criteria.

MARCH 2016

CALL FOR RESOLUTIONS TO THE 2016 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in May 2016 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is May 6, 2016! PLEASE NOTE THIS DEADLINE. The following information will be needed when submitting resolutions: 1. Name of organization: The name of the organization submitting the resolutions(s); 2. Name and telephone number of individuals: A contact in the event clarification or further information is needed; 3. Problem: A statement of the problem addressed by the resolution; 4. Intent: A statement of what passage of the resolution will accomplish; 5. Resolution Format: Please type and use double spacing. TITLE OF RESOLUTION NAME OF ORGANIZATION WHEREAS , AND

WHEREAS :

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

CONTACT NAME AND PHONE #: PROBLEM: INTENT:

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

FLORIDA PHARMACY TODAY

FPA Member Profile Ronald Clayton

THE STATS Hometown: Pensacola Employer: CVS

What do you value most about your FPA membership?

FPA keeps me informed, provides CE and advocates for my profession.

What are some thoughts you have on pharmacy as a profession right now?

What got you interested in pharmacy in the first place?

My grandfather graduated with a degree in pharmacy from Auburn in 1912, and my father from Florida in 1942, so I was destined to be a pharmacist and that was all I knew. I graduated with a degree in pharmacy from Ole Miss in 1972.

Due to the RX volume it has changed drastically, to one of numbers from one of people.

What do you think your patients would say about you and your practice?

What are you most excited about regarding the future of pharmacy?

“He cares.”

I think we are headed to a place in which pharmacy assistants will verify the physical work and pharmacists will deal with the patients and have time to do what we need to do and what we used to do before the hectic pace of today.

What do you wish everybody knew about pharmacy? How we really protect our patients and most of us really care about their health.

What is the most humorous thing that has ever happened to you? I cannot pinpoint anything. I try to make every day a joy. But I remember an elderly black lady that always wore her hose rolled down halfway down her calves—there was an antacid product called win gel that was pink. Hattie believed that helped her arthritis in her knees. I looked up and saw Hattie walking with her hose rolled down and two pink knees above them. I could not stop laughing.

MARCH 2016

CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS For Florida Pharmacy Students

FLORIDA PHARMACY ASSOCIATION 126th ANNUAL MEETING AND CONVENTION

June 29-July 3, 2016 Marriott Harbor Beach Resort & Spa ♦ Ft. Lauderdale, Florida Poster Session: Friday, July 1, 2016 ♦ 11:00AM-1:00PM

The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Friday, May 6, 2016. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to: Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association 610 N. Adams Street Tallahassee, FL 32301 tmerren@pharmview.com

PLEASE TYPE

Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________

□Entry Level Pharm.D. □ Post B.S. Pharm.D. Address: ________________________________________________________________________________________

City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________ Poster Type:

□Clinical Research □Basic Science Research □Translational Research (Basic Science and Clinical Research)

Primary Author: __________________________________________________________________________________ (Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student

□YES □NO

Awards:

Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)

Free Registration:

Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration. (Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration:

College:

□YES

□NO

_____________________________________________________________________________

ABSTRACT FORMAT The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions. Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.

Please direct all questions and concerns to:

Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com DEADLINE DATE: FRIDAY, MAY 6, 2016 22

FLORIDA PHARMACY TODAY

MARCH 2016

FLORIDA PHARMACY TODAY

MARCH 2016

FLORIDA PHARMACY TODAY

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

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

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

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

MARCH 2016

HELP SUPPORT THE ADOPT-A-STUDENT PROGRAM Florida Pharmacy Association (FPA) 126th Annual Meeting & Convention June 30-July 3, 2016 Marriott Harbor Beach Resort & Spa – Ft. Lauderdale, Florida 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 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 3 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. 28

FLORIDA PHARMACY TODAY

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 www.fpicn.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.

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

MARCH 2016