November 2013 Florida Pharmacy Today by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association NOV. 2013

y p p a s H y a d i l o H FROM THE FPA

Healthcare Clinic nurse practitioner, Margaret McKenna and Walgreens pharmacist, Mellisa Gray , help patients get, stay and live well by promoting a culture of wellness. Their collaboration combines best practices in healthcare and the expertise and personal care of our trusted providers to deliver access to high-quality, affordable and convenient healthcare.

florida PHARMACY TODAY

Features

Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 23 Member Profile 27 Buyer’s Guide

VOL. 76 | NO. 11 NOVEMBER 2013 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

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Pharmacy in Crisis? Two Views of an Evolving Job Market

FPA Official 2014 Election Ballot Call for Nominations FPA Awards 2013-2014

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FPA Calendar 2013 - 2014 12

20-22 ASCP Annual Meeting Seattle, Washington

FPA Strategic Planning Retreat Orlando

28-29 Thanksgiving Holiday FPA Office Closed

Martin Luther King Day FPA Office Closed

FPA Law and Regulatory Conference Sandestin Last day to submit election ballots

NOVEMBER

DECEMBER 3-4

Florida Board of Pharmacy Meeting Gainesville

7-8

FPA Regulatory and Law Conference Sarasota

APhA Immunization Certificate Program Sarasota

25-26 Holidays - FPA Office Closed JANUARY 1

FPA Office Closed

Young Pharmacist Leadership Conference Orlando

FEBRUARY Awards Nomination Deadline MARCH Legislative Session Begins

10-11 Florida Pharmacy Health Fair and Legislative Days Tallahassee 15

Deadline to Submit Resolutions

28-31 APhA Annual Meeting Orlando

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. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2015 or prior to licensure renewal. Consultant pharmacists and technicians will need to review their licenses and registrations by December 31, 2014. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www.pharmview.com

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 EPC........................................................................ 9 HCC...................................................................... 3 KAHAN HEIMBERG, PLC............................... 9 PPSC...................................................................... 9 Rx OWNERSHIP............................................... 28 WALGREENS...................................................... 2

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

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FLORIDA PHARMACY TODAY

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

The President’s Viewpoint TERRY GUBBINS , FPA PRESIDENT

The Numbers Tell the Story

n September 1, 2011, mandatory data reporting to the Electronic Florida Online Reporting of Controlled Substance Evaluation Program (E-FORCSE) began. E-FORCSE is our state’s prescription drug mon-

purpose of a PDMP is to provide information collected in the database to healthcare practitioners to guide our clinical decisions in dispensing controlled substances. With 11,497 pharmacists having registered to receive

E-FORSCE has helped many pharmacists identify “doctor shoppers,” and this has led to fewer drugs on the street and to fewer deaths in Florida. itoring program (PDMP). How have things gone in the past two years? The numbers tell the story: ■■ ■■ ■■ ■■ ■■

85 million dispensing records 11,188 prescribers with access 11,497 pharmacists with access 6,997 pharmacies/dispensers have reported data Over 6 million queries to the system

What have been the benefits of EFORSCE? According to the 2012 Drugs Identified in Deceased Persons Report by Florida Medical Examiners, deaths caused by oxycodone plunged by 41 percent in 2012, and overall occurrences of prescription drug deaths fell by 10 percent. The report also shows fewer people in Florida died in 2012 from methadone, hydrocodone and cocaine as well. Was this decrease in deaths solely due to E-FORCSE? No. But it certainly has been a vital component, and a useful tool in our pharmacies. The

Terry Gubbins 2013-2014 FPA President

access to E-FORSCE, I would say pharFPA has been pro-active and has macists are using E-FORSCE in making proposed legislation for state funding their professional decisions. E-FORSCE of the PDMP. Senator Aaron Bean has has helped many pharmacists identify agreed to be our sponsor. Currently, “doctor shoppers,” and this has led to with the efficiencies in the Florida Defewer drugs on the street and to fewer partment of Health, the excess funds deaths in Florida. from licensures of healthcare profesWhen the PDMP was created by the Florida Legislature, the bill prohibited state funding of the program. It also prohibited funding from pharmaceutical companies. E-FORSCE is funded through federal and private grant money, and funds raised by the Florida PDMP Foundation. Earlier this year when funding for the PDMP was running low, the leadership of FPA donated personal funds to the PDMP Foundation, and urged pharmacists statewide to do the same. We want to make sure we don’t run into this situation Bob Parrado and Terry Gubbins present a check to the Florida PDMP Foundation. again. NOVEMBER 2013

2013 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.

Goar Alvarez............................................................................. Chairman of the Board Terry Gubbins...............................................................................................FPA President Suzanne Kelley......................................................................................... President Elect Alexander Pytlarz................................................................................................Treasurer Gary Koesten.............................................Speaker of the House of Delegates Bob Parrado....................................Vice Speaker of the House of Delegates Tim Rodgers, Director........................................................................................... Region 1 Michael Hebb, Director ......................................................................................Region 2 Stephen Grabowski, Director .......................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 Jason Beattie, Director ....................................................................................Region 5 Scott Tomerlin, Director.....................................................................................Region 6 Kimberly Jones, Interim Director................................................................ Region 7 Raul Gallo, Director.................................................................................................Region 8 Nadine Seabest, Interim Director...............................................................Region 9 Richard Kessler...................................................................................... President FSHP Michael Jackson........................................Executive Vice President and CEO

Florida Pharmacy Today Journal Board Chair......................................................Jennifer Pytlarz, jlc_rxdoc@hotmail.com Vice Chair......................................................... Don Bergemann, don@bceinfo.com Treasurer....................Stephen Grabowski, sgrabowski@seniormmc.com Secretary...................................................................Stuart Ulrich, Stuarx@aol.com Member.................................................Joseph Koptowsky, docjik1215@aol.com Member........................Rebecca Poston, rebecca_poston@doh.state.fl.us Member....................................................... Carol Motycka, motycka@cop.ufl.edu Member........................................................Cristina Medina, cmmedina@cvs.com Member................................................................Norman Tomaka, FLRX9@aol.com Member................... Verender Gail Brown, brownvgrx4304@hotmail.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com

sionals go into the stateâ&#x20AC;&#x2122;s treasury. It is these excess funds that we are asking to be directed to fund the PDMP. Soon, the PDMP funding bill will be filed. Then, we will need your help. Weâ&#x20AC;&#x2122;ll need you to contact your legislators in Tallahassee and urge their support of the bill. Share with them how E-FORSCE has been beneficial in your practice and in your community. Let them know it is a valuable tool in our profession, and we want to make sure it has sustainable funding. Let the numbers tell the story: Deaths caused by oxycodone are down by 41 percent in 2012, and overall occurrences of prescription drug deaths are down 10 percent.

Earlier this year when funding for the PDMP was running low, the leadership of FPA donated personal funds to the PDMP Foundation, and urged pharmacists statewide to do the same.

JOIN TODAY! See "Viewpoint", continued on page 6 6 |

FLORIDA PHARMACY TODAY

Florida Pharmacy Association

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

Time for Another Tea Party?

while back I wrote an article in Florida Pharmacy Today sharing with our members a little history in colonial America related to taxation. In that article, I described the events that led up to the Boston Tea Party. For those of you who aren’t his-

nesses to 21-hour filibusters and a prolonged government shutdown that fortunately was resolved prior to this issue of Florida Pharmacy Today going to press. Whether you agree or not with the tactics of the Tea Party, it is interesting to see how public policy is being

Michael Jackson, B.Pharm

tory aficionados, this was a protest of citizens in Massachusetts against taxation policies of the British government. These events led to a massive revolt that triggered a significant milestone in American history. My article described how growing dissent triggered action by affected stakeholders who felt that something needed to be done. I closed that article suggesting that, with all the things affecting health care, the time was probably right for a new revolt. Less than a year after I published that article in Florida Pharmacy Today, the Tea Party was given birth in modern American politics. We are now wit-

crafted in Washington, D.C. Still, with all the chatter along the Potomac River, we still have issues related to pharmacy practice that need to be addressed. For example, I received a call from a pharmacist who was working through an auditing issue. This pharmacist was told by a PBM auditor that refills for schedule III oral prescriptions were not allowed for purposes of payment. What is really amazing is that this auditor incorrectly presumed this pharmacy was violating Florida law. Florida statutes 893.04 (2) (e) states the following: “A pharmacist may not dispense more than a 30-day supply of a controlled substance listed in Sched-

ule III upon an oral prescription issued in this state.” This statute says absolutely nothing about refills and is not referenced anywhere in this section. To this author, this simply is a method used to deny patient medications that have been properly prescribed by a Floridalicensed practitioner. Perhaps one may suggest that the statute is not clear in its intent and that it could be interpreted to have some kind of vague effect on whether refills are permitted. Well, my answer to that is simply a phrase quoted to me by my kids when they don’t agree with something I said: WHATEVER! This issue had become so aggravating that a pharmacy had to file a petition to the Board for a declaratory statement to authenticate the correct posture on refills for schedule III prescription drugs that are called into a pharmacy by the prescribing practitioner. A declaratory statement is a means for reNOVEMBER 2013 |

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

This is a peer reviewed publication. ©2013, 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 8 Address: | F L O Rhttp://www.pharmview.com IDA PHARMACY TODAY

Florida statutes 893.04 (2) (e) states the following: “A pharmacist may not dispense more than a 30-day supply of a controlled substance listed in Schedule III upon an oral prescription issued in this state.” This statute says absolutely nothing about refills and is not referenced anywhere in this section. To this author, this simply is a method used to deny patient medications that have been properly prescribed by a Florida-licensed practitioner. solving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders of the Board of Pharmacy. That declaratory statement was issued September 19, 2008, clarifying that refills on called-in prescriptions are permitted, yet we have PBM auditors today that still can’t seem to figure that out. This means that someone or some entity other than the Board of Pharmacy and the Florida Legislature is creating and enforcing public health care policy. I wrote in my May 2009 Florida Pharmacy Today journal article that it is time for a tea party. I don’t think that we need the type of revolution we have going on in Washington, D.C., but we really need to look

at who is governing health care with things like maximum allowable cost, restricted networks and unfair and vague auditing and practice standards. For now I think the health care policy makers are those sitting in cubicles with sharpened pencils and adding machines. They don’t get to see you say no to a patient in need of critical medications and essential pharmacist medication management services. These are services that could keep patients out of hospitals or long-term care facilities. Do you think that we need another pharmacist tea party? Come to our law conference in Sarasota in December and let’s talk about it.

I don’t think that we need the type of revolution we have going on in Washington, D.C., but we really need to look at who is governing health care with things like maximum allowable cost, restricted networks and unfair and vague auditing and practice standards.

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Pharmacy in Crisis? Two Views of an Evolving Job Market THE OPINION: Daniel L. Brown, PhD, PharmD, Professor/Director of Faculty Development, Professor of Pharmacy Practice, Director of Faculty Development, Palm Beach Atlantic University

A Looming Joblessness Crisis for New Pharmacy Graduates Introduction The new millennium ushered in a period of hope and change for the profession of pharmacy. The doctor of pharmacy (PharmD) degree became the exclusive first professional degree as of 2000, bringing with it expectations for a dramatic expansion of direct patient care roles for pharmacists. Just 1 year later the pharmacy academy began a period of unprecedented growth, fueled by a longstanding shortage of pharmacists and an outstanding job market for new pharmacy graduates, making jobs for PharmD graduates easy to find and causing salaries to spiral upward. As a result, the PharmD degree became a hot commodity, generating a seemingly inexhaustible supply of applicants to colleges and schools of pharmacy. Inevitably, higher education came to see pharmacy as a “golden goose.” But no goose harbors an infinite supply of golden eggs, and the inordinate rate of academic growth that ensued has put the academy at risk, along with its students. Calls for measured academic growth, brought forth in published commentaries in 2005 and 2010, went largely unnoticed.1,2 The house of student delegates of the American Pharmacists Association-Academy of Student Pharmacists even weighed in on the subject in 2012 by approving resolution 2012:2 — Creation, Expansion, or Reductions of Schools and Colleges of Pharmacy Relative to Pharmacist Demand, which called upon current and future schools to eval10

FLORIDA PHARMACY TODAY

uate the demand for pharmacists before taking action.3 Remarkably, most leaders of pharmacy organizations and academic institutions remained relatively silent on the matter. This commentary examines the massive increase in the number of pharmacy graduates since 2001 and the vast overestimations, in the author’s opinion, made back in 2001 about the number of pharmacists that would be needed by 2020. It also identifies potential implications of the changing pharmacist job market for the pharmacy academy. Projected Manpower Needs In 2001, the Pharmacy Manpower Project sponsored a conference of 2 dozen pharmacy experts to project a vision of pharmacy services and manpower deployment for the year 2020.4 The participants envisioned a significant expansion of the pharmacist workforce and a shift in their roles and responsibilities from order fulfillment to patient care. Based on a needs forecast, they estimated that by 2020 there would be a 27% decrease in the number of pharmacist full-time equivalents (FTEs) engaged predominantly in order filling (136,400 to 100,000) and an increase in the pharmacist FTEs providing primary patient services (30,000 to 165,000). Overall, they projected a need for 417,000 pharmacist FTEs by 2020, and given the expected supply of only 260,000 pharmacist FTEs, a shortfall of

157,000 by 2020.4 However, their analysis assumed that the academy would add only 3 new PharmD programs every 10 years. Growth of the Academy The size of the academy was relatively stable during the 1980s and 1990s. In 2000, there were 80 colleges and schools of pharmacy in the United States. Since then, 48 new programs have been established and 2 schools combined into 1 college, bringing the total to 127 accredited colleges and schools as of fall 2012—a 60% increase from 2000.5 According to AACP reports, there were 7,000 first-professional PharmD degree graduates in 2001 and 11,931 in 2011, a 70% increase.6,7 Despite the rapid rate at which new pharmacy colleges and schools have been established, even greater growth of the academy has resulted from the expansion of previously existing programs. Of the increase in graduates from 2001 to 2011 by 4,931, only 1,886 (38%) can be attributed to new pharmacy programs; 62% of the increase resulted from the expansion of existing programs. Since 2001, 31 colleges and schools increased their number of PharmD graduates by more than 50%.6,7 There are now 41 satellite campuses—5 of which are in a state other than that of the parent program.[5] Growth has been widespread, affecting every region of the country. Twenty-one states are projected to increase the number of statewide graduates by 100% or

Table 1. First Professional Degree Pharmacy Graduates by State for the Years 2001, 2011, and Projected for 2016 State Alabama Arizona Arkansas California Colorado Connecticut DC Floridac Georgiac Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettsc Michigan Minnesota Mississippi Missouri Montana Nebraska Nevadac New Hampshirec,d New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Dakota South Carolinac Tennessee Texas Utahc Vermontc,d Virginia Washington West Virginia Wisconsin Wyoming TOTALe

2001 186 57 71 584 63 54 62 319 179 0 48 327 222 154 87 77 178 0 91 427 250 71 56 211 53 155 0 0 97 74 379 189 59 373 84 100 468 80 45 80 90 340 47 0 121 147 49 100 44 6948

2011 246 203 112 849 121 98 59 712 353 84 59 437 272 211 101 190 241 0 146 547 296 155 63 297 65 216 188 c 212 79 824 315 84 588 197 185 933 89 67 182 272 626 50 0 319 171 162 136 48 11869

2016a 246 203 169 949 192 174 59 921 480 84 59 658 339 211 101 190 241 156 273 567 309 155 109 297 65 216 138 50 293 79 959 378 84 638 197 185 936 89 67 320 542 656 159 66 319 196 238 217 48 14277

15-Year Growth, %b 32 256 138 63 205 222 -5 189 168 NA 23 101 53 37 16 147 35 NA 200 33 24 118 95 41 23 39 NA NA 202 7 153 100 42 71 135 85 100 11 49 300 502 93 238 NA 164 33 386 117 9 105

a Projections for 2016 are based on the 2011 values for existing schools and 95% of class size for schools starting after 2011. Data taken from www.aacp.org and www.pharmcas.org. b Percent growth from 2001 to 2016. c LECOM, Roseman, Albany, Mass-Worchester, and South (GA) each have a satellite program in another state (FL, UT, VT, NH and SC, respectively). AACP reports all graduates within a program’s home state. For this table, projected 2016 graduates of satellite programs have been shifted to the state of graduation. d Alaska and Delaware do not have a pharmacy school. New Hampshire and Vermont only have a satellite PharmD program from a school in another state. e These totals do not include graduates in Puerto Rico or Lebanon as reported by AACP.

more during the 15-year period from 2001 to 2016.8 (See Table 1). The growth has yet to abate. Although 27 new pharmacy colleges and schools had not graduated a class as of 2011, their class sizes totaled 2,250 students. By 2016, when the graduates of these colleges and schools are included in the count and when the recent expansion of existing programs has taken effect, the number of PharmD graduates will range between 14,000 and 15,000 per year, more than double the number in 2001. Trends in the Pharmacy Workforce The Pharmacy Workforce Center (PWC), formerly known as the Pharmacy Manpower Project, Inc, tracks the pharmacist workforce for multiple pharmacy organizations.7 The primary data element compiled by the PWC is the aggregate demand index (ADI) which is derived from feedback obtained from a nationwide panel of participants who are engaged in hiring pharmacists. Panel members report their impressions of the pharmacist job market to PWC on a monthly basis using a 5-point scale, where 5 = high demand—difficult to fill open positions; 4 = moderate demand—some difficulty filling open positions; 3 = demand in balance with supply; 2 = demand is less than the pharmacist supply available; and 1 = demand is much less than the pharmacist supply available.9 A national 10-year trend map of ADI shows that it remained fairly steady at a level of about 4 (moderate demand) from 2002 through early 2008, indicative of a modest but stable pharmacist shortage (Figure 1).10 However, the ADI then began a downward trend that brought it closer to the “equilibrium point” of 3 in 2010, where it has hovered since. The drop in ADI of a full point in just a couple of years, in contrast to predictions of a persistent pharmacist shortage for many years to come, is cause for concern. The November 2012 regional ADI results shed a bit more light on the job market and might serve as a harbinger of what lies ahead. The Northeast, with several states already having demonstrated major academic growth, has seen the ADI drop to 2.85.11 Several states in the South are about to drop below 3.0 in the not-too-distant future (Florida already has), and other regions will follow suit shortly thereafter. Furthermore, the November 2012 national ADI for community pharmacies was only 2.83, suggesting that the most prevalent pharmacy practice setting is already showing a net surplus of pharmacists nationwide.12 Figure 1.

Plot of monthly national averages of the Aggregate Demand Index for the 10-year period of December 2002 through November 2012.10 Note the downward trend of data points that started in June of 2008.

NOVEMBER 2013 |

Institutional pharmacy shows similar trends. Pharmacy Forecast 2013– 2017, a strategic planning report for institutional pharmacy, reports that the vacancy rate for pharmacists in hospital practice dropped from 7.2% in 2002 to 2.4% in 2011.13 The report notes that although the market for staff pharmacists has leveled off, it remains difficult to fill some managerial and clinical specialist positions. This phenomenon might have been exacerbated by the rapid expansion of academia, which has created a bountiful supply of new leadership and clinical positions to be filled since 2001. Along with an increasing rate of production of pharmacy graduates, a lower-than-expected creation of new pharmacist jobs also serves as a critical component of the pharmacy manpower equation. The projected need for pharmacy services in 2020 assumed a reduction of 36,400 pharmacist FTEs needed for dispensing and a pronounced increase of 135,000 FTEs for primary care services.4 This role transformation is simply not happening, at least not at the rate or extent predicted. According to results from the 2009 National Pharmacist Workforce Survey, 70% of pharmacist time in the community setting is devoted to dispensing, with just 10% spent on patient care activities.14 In hospitals and other patient care settings, 43% of pharmacist time was allocated to dispensing activities, compared to 27% allocated for direct patient care. The reasons for which medication therapy management services and primary care activities in ambulatory clinics have not dramatically impacted the pharmacist job market are beyond the scope of this commentary. However, there is no disputing that direct patient care jobs for pharmacists outside of acute care facilities have been slow to develop. Furthermore, not much has changed in community pharmacy practice to enhance the level of direct patient care services provided with every prescription. Community pharmacy jobs are still more closely linked to prescription volume than to the demand for patient care services.15

FLORIDA PHARMACY TODAY

The Math of Supply and Demand When considering the dynamics of increasing the supply of pharmacy graduates into the job market, one must account for a 4-year lag period from the time at which a PharmD program starts or expands. Thereafter, following graduation of the first new or expanded class, it takes another 2 to 3 years for the job market to equilibrate, as it adjusts to a higher annual input of graduates. From that perspective, the net impact of academic growth is best measured when equilibrium is achieved—about 6 to 7 years after the initial increase in the number of students entering a PharmD program. Even if 2012 proves to be the last year of major academic expansion, the full impact will not be felt until 2018, at which time the job market will have to assimilate new pharmacists at a rate of about 15,000 per year. Contrast that rate with the 30-year period from 1974 to 2003, during which the annual number of pharmacy graduates ranged between 6,000 and 8,000.16 The number surpassed 8,000 for the first time in 2004. By 2008, it had risen to 10,000. It exceeded 12,000 in 2012 and is poised to exceed 14,000 by 2016.7 No one can question that producing the 2003 rate of 6,000 to 8,000 graduates a year was not sufficient. In retrospect, however, it would have been prudent for the academy to engage in a plan of moderate growth up to about 10,000 graduates per year and then reassess the need to expand further. Realistically, a graduation rate in the range of 10,000 to 12,000 a year is probably warranted. The math is not complicated, which suggests that it may have been overlooked due to the lure of economic gain, a possibility that is beyond the scope of this paper. The health needs of aging baby boomers and the Affordable Care Act could serve as mitigating factors to increase the demand side of the pharmacy manpower equation, though it is likely to be a matter of “too little too late.” Even if the job market is able to accommodate up to 12,000 graduates a year for the next several years, that still translates into at least 3,000 graduates each year who will not find suitable employment—20% of the cohort

of new graduates! Despite the overall unemployment rate for the profession remaining relatively low, the joblessness rate among new graduates could be staggeringly high. In the 2012 Pharmacy Graduating Student Survey conducted by the American Association of Colleges of Pharmacy (AACP), 88.7% of graduates indicated that they had taken out student loans, with an average loan amount of $123,000.17 While the potential of a 20% (or higher) joblessness rate among new pharmacy graduates is alarming enough, the looming economic hardships and personal tragedies are incalculable. Implications for the Academy Unfortunately, it is too late to call for the academy to pursue a more prudent plan of growth. To paraphrase an old cliché, “The horse is out of the barn.” The pendulum has swung so far to the supply side that the market is about to take over, forcing the engine of academic growth to finally grind to a halt. But there will be a high price to pay in the form of a pharmacist surplus for years to come until the market establishes a new manpower equilibrium. Ironically, academic expansion is not only contributing to new graduate joblessness, but it has also functioned to mask the problem. By creating a plethora of pharmacy practice faculty positions, the academy has provided employment for hundreds of pharmacists with advanced training who might have otherwise brought more attention to a weakening job market outside of academia. Consequently, when academic growth subsides and vacant faculty positions are no longer plentiful, pharmacists coming out of residency training will find it increasingly difficult to secure jobs commensurate with their abilities—particularly if they have specialized in ambulatory care. New PharmD and/or residency graduates will not be the only victims of academic overgrowth. The academy itself will suffer repercussions. Awareness of new graduate joblessness will eventually lead to a decrease in applications to pharmacy colleges and schools, making it more difficult to meet enrollment targets. Risks of diminished en-

rollment will jeopardize anticipated tuition revenue that has been counted on to fund faculty positions and/or new facilities. Economic pressures may inevitably force downsizing of programs, if not outright closing of some colleges and schools. If that occurs, some faculty positions likely will be lost. Challenges Going Forward Regardless of the job market, those new graduates who are “fittest” will be able to find employment. But the profession of pharmacy should not fall victim to viewing graduates as commodities who must fend for themselves in Darwinian fashion. Some might opine that the profession would benefit from filtering out its less capable pharmacists, but faculty members and administrators must not become insensitive to the plight of each graduate amid a backdrop of broader institutional concerns. The academy must honor its fiduciary responsibility as teachers, first and foremost, to serve the best interests of every student. The academy exists for students and because of students— the reality of which is going to become gravely evident as 2020 approaches. Pharmacy colleges and schools would be wise to revisit their respective strategic plans and prepare for a new era in which the challenges of recruiting and admitting student applicants will be vastly different from just a few years ago. In the meantime, it is incumbent upon the academy to responsibly focus on that which is within its control. Growth of the academy needs to cease forthwith. Institutions considering establishment of a new PharmD program should be discouraged from doing so by all sectors of the profession. Existing programs contemplating expansion should seriously consider putting their plans on hold. All of the profession’s organizations need to focus more heavily on establishing new pharmacist roles and activities that will create sustainable jobs as rapidly as possible. The patient care vision of pharmacists widely employed as ambulatory clinic practitioners may need to give way to a more practical vision of a new breed

of community pharmacy practitioner, such that new jobs are the result of expanded patient care roles rather than increased prescription volume or the construction of new stores.15 To better influence job creation, academia would be well served to pay greater attention to where the majority of pharmacists practice: community retail pharmacies. If the academy is to remain on a path of growth, let the emphasis shift from PharmD expansion to the formation of partnerships that establish new community pharmacy residencies. That is where the innovative clinical leaders of tomorrow are most needed. No one could have anticipated the magnitude of academic growth that has taken place since 2000. Likewise, no one knows what the future holds for those who are about to embark on a career in pharmacy. Those in academia should look to the future with hope and optimism, born of the knowledge that the academy has done everything possible to prepare the next generation of pharmacists for whatever lies ahead. References 1 Hussar DA. How many colleges of pharmacy is enough? J Am Pharm Assoc. 2005:45(4):428–431. 2 Brown DL. From shortage to surplus: the hazards of uncontrolled academic growth. Am J Pharm Educ. 2010;74(10):Article 185. 3 American Pharmacists Association Academy of Student Pharmacists. Active Resolutions. APhA-ASP Adopted Resolutions 1973– 2012. http://www.pharmacist.com/ sites/default/files/files/APhA-ASP%20 Adopted%20Resolutions%20-%20Updated% 20September%202012.pdf. Accessed January 5, 2013. 4 Knapp DA. Professionally determined need for pharmacy services in 2020. Am J Pharm Educ. 2002;66(Winter):421–429. 5 Accredited Programs. Accreditation Council for Pharmacy Education. https:// www.acpe-accredit.org/shared_info/ programsSecure.asp. Accessed January 6, 2013. 6 American Association of Colleges of Pharmacy. Table 26. Number of Degrees Conferred by 2000–01 by School, Degree and Gender. http://www.aacp.org/ resources/research/institutionalresearch/ Documents/01DegConf.pdf. Accessed May 20, 2013. 7 American Association of Colleges of Pharmacy. Table 22. Number of Degrees Conferred 2010–11 by School, Degree and Gender. http://www.aacp.org/ resources/research/institutionalresearch/ Documents/11_Degrees%20Conferred.pdf. Accessed May 20, 2013. 8 Pharmacy College Application Service.

Colleges and schools by institutional name. http://www.pharmcas.org/ collegesschools/directoryalpha.htm. Accessed January 5, 2013. 9 American Association of Colleges of Pharmacy. Pharmacy workforce center. http://www.aacp.org/resources/research/ pharmacymanpower/Pages/default.aspx. Accessed February 10, 2013. 10 ADI data for national (Dec 2002 to Nov 2012). Pharmacy Workforce Center. American Association of Colleges of Pharmacy. http://www. pharmacymanpower.com/trends.jsp. Accessed February 10, 2013. 11 Regional and Divisional Demand Index – Nov 2012. Pharmacy Workforce Center. American Association of Colleges of Pharmacy. http://www. pharmacymanpower.com/region.jsp. Accessed February 10, 2013. 12 National Pharmacist Demand by Practice Setting – Nov 2012. Pharmacy Workforce Center. American Association of Colleges of Pharmacy. http://www. pharmacymanpower.com/setting.jsp. Accessed February 10, 2013. 13 Pharmacy Workforce. Pharmacy Forecast 2013 – 2017. American Association of Health-System Pharmacists Research and Education Foundation. http:// www.nxtbook.com/ygsreprints/ ASHPFoundation/d28547_ashpf_ forecastbook2013/#/14. Accessed May 20, 2013. 14 Midwest Pharmacy Workforce Research Consortium. Work activities for pharmacists working full-time. Final Report of the 2009 National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. http://www.aacp.org/resources/research/ pharmacymanpower/Documents/2009%20 National%20Pharmacist%20Workforce%20 Survey%20- %20FINAL%20REPORT.pdf. Accessed January 5, 2013. 15 Brown D. The paradox of pharmacy: a profession’s house divided. J Am Pharm Assoc. 2012:e139-e143. doi:10.1331/ JAPhA.2012.11275. 16 Midwest Pharmacy Workforce Research Consortium. Figure 1.2: number of U.S. pharmacy school graduates: 1960–2008. Final Report of the 2009 National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. http:// www.aacp.org/resources/research/ pharmacymanpower/Documents/2009%20 National%20Pharmacist%20Workforce% 20Survey%20-%20FINAL%20REPORT.pdf. Accessed January 5, 2013. 17 American Association of Colleges of Pharmacy. Pharmacy Graduating Student Survey Summary Report 2012. http:// www.aacp.org/resources/research/ institutionalresearch/Documents/2012_ GSS_final%20summary%20report_all%20 schools_105_ with%20charts.pdf. Accessed January 5, 2013.

Reprinted with permission: American Journal of

NOVEMBER 2013

Pharmacy in Crisis? Two Views of an Evolving Job Market THE RESPONSE: Katherine Knapp, PharmD, Touro University California College of Pharmacy and Jon C. Schommer, PhD, University of Minnesota College of Pharmacy

Finding a Path Through Times of Change The statement, “A Looming Joblessness Crisis for New Pharmacy Graduates and Its Implications for the Academy,” addresses a topic of wide discussion and increasing concern.1 Brown, who is recognized for work in this area, describes the unprecedented growth in pharmacy graduates observed since 2000 and concludes that “looming joblessness” is an inescapable outcome.2 The data, analysis, and reasoning presented are reminiscent of equally compelling data and analyses presented in 2000 that led to the conclusion that there was an acute shortage of pharmacists in the United States that would persist for 5 to 10 years.3 But things did not turn out that way. The pharmacist “shortage” slowly lessened from 2000 to 2005; and since 2006, a steady downturn in available pharmacist jobs as measured by the Aggregate Demand Index as well as many anecdotal sources, has been observed.4 A similar phenomenon was observed in nursing where the shortage of the early 2000s disappeared more or less concurrent with the Great Recession of 2008.5 The widely accepted physician “surplus,” on the other hand, gave way to a primary care physician shortage over the same period.6 From these dramatic and rather rapid workforce swings in 3 major health professions, pharmacy educators are forced to acknowledge that projections, even when based on the most solid evidence available, are not inescapable outcomes. How then should research, 14

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projections, and data trends be used? This response addresses that question and examines some of the assumptions underlying the reasoning presented in Brown’s statement and offers alternative scenarios. The authors must challenge Brown’s assertion that the pharmacy academy was somehow negligent in allowing unprecedented growth to occur. The Accreditation Council for Pharmacy Education (ACPE) has been similarly targeted. This position disregards the reality that market conditions govern the educational enterprise in the United States. Attempts to block new colleges or schools or college or school expansion could be subject to restraint of trade or antitrust lawsuits based on the Sherman Anti-Trust Act of 1890.7 While pharmacy education expansion is a key issue for the pharmacy academy, the “elephant in the room” over the last 6 to 7 years has been the weak US economy. Interpreting any phenomenon involving workforce issues requires attention to the core driver of jobs in all sectors: the economy. A 2013 study confirmed an earlier analysis showing that unemployment rates, a surrogate for the state of the economy, were the strongest driver of the unmet demand for pharmacists from 2001 to 2010.8 The study also identified graduate numbers, prescription growth rates, and Medicare Part D as less strong but significant drivers of unmet demand. While pharmacy stakeholders can anticipate that the improving economy

will improve pharmacist job prospects, these other factors—including growth in the number of pharmacy graduates —may play a stronger role in the future. The authors suggest, therefore, that passively waiting for the economy to bring back a strong demand for pharmacist services is probably not the wisest course. National Consumers League, corporations producing medications and medical supplies, and others. Faced with the overwhelming national consensus to combat the shortage, colleges and schools of pharmacy—both public and private—took action to expand class size, open new campuses, and open new colleges and schools. Thus began 101 years of unprecedented expansion. As reasoned in Brown’s statement, expansion per se is not harmful. Up to a certain (undefined) point, expansion can relieve the stress on previously overworked pharmacists; it serves to encourage additional training (residencies), motivates experimentation with new roles, and provides adequate personnel to staff new services. With such compelling consensus for expansion, however, the pendulum representing the shifting balance between demand and supply likely overshot the ideal balance point. What should be done then? As noted earlier, doing nothing is probably not the best response to the conditions outlined in Brown’s statement. Rather, the pharmacy academy needs to join with other stakeholders to create the

best future for graduates, practitioners, and patients in a changing healthcare system. As noted by Dr. Dennis Helling upon receiving the 2013 Remington Honor Medal, “If you don’t like change, you will like irrelevance even less.”9 The pharmacy profession currently has and will continue to build capacity for contributing to the US health care system.10 However, as shifts in professional roles occur, it is important to not only monitor what might occur in the future but also to consider the rate of adoption for new innovations and new roles. The rate of adoption (including the rate of discontinuance) can help identify tipping points at which a new innovation is adopted (or discontinued) at a comparatively quick rate so that the timing of corresponding actions can be made in the health care system and in the pharmacy profession.11 Examples of past tipping points in pharmacy include counseling patients regarding the Omnibus Budget Reconciliation Act (OBRA) of 1990, drive-through service for added convenience, online adjudication of claims, pharmacist-administered immunizations, e-prescribing, and pharmacists embedded in clinics – currently, electronic health records may be reaching the tipping point. In each case, once the tipping point was reached, the majority of the profession “followed.” Once a tipping point is reached, a great deal of production capacity is required related to new service provision as well as strategic decisions regarding workforce, educational training, professional training and redeployment, updates to practice acts and regulations, new documentation and billing systems, enhanced information exchange, collaborative practice models, infrastructure, technology, policy, and new business models. Resources are scarce, so an understanding of the most appropriate timing for making such changes can lead to cost-effective use of limited resources for improving patient care. Also, by continually monitoring aspects of the diffusion of innovations in pharmacy and health care, better decisions can be made as stakeholders look to predict, shape, and experience pharmacy’s future.12

The following ideas are offered for consideration as pharmacist capacity is further developed and integrated into the US healthcare system: (1) Continual improvements to doctor of pharmacy (PharmD) training will be needed, especially the development of team-based, interprofessional training that will help health care providers learn about and experience team-based patient care. Also, expansion of pharmacy residencies (with suitable funding for such training) could help meet the advanced training requirements for pharmacists. The establishment of “industry norms” that require pharmacy residency training as a condition for certain types of pharmacist employment would help position such residencies for legitimate consideration of graduate medical education funding. Such norms also could provide assurances to other healthcare professionals regarding pharmacists’ competence for providing patient care. (2) The rate of discontinuance of some community pharmacy business models and the adoption of new business models that could help pharmacists fulfill their potential in the health care system should be monitored. Community pharmacy practice business models are still focused primarily on medication distribution. There are new models emerging in community pharmacies that use advanced logistics (eg, “centralized fill”), technology (eg, bar code scanning, e-prescribing, robotics), technicians, specialty pharmacy services, corporate (in-house) pharmacies, and new patient care service models. Where and how pharmacists might contribute to these models to ensure patient access to medications and associated services are questions that will need to be addressed. In addition, supply and demand balance or imbalance for pharmacists should be monitored as these changes to business models occur. (3) Pharmacy practice acts and other health profession practice acts (that define scope of practice) should be updated on an ongoing basis to reflect and accommodate new roles for health professionals and for team-based care. In pharmacy, the National Association of

Boards of Pharmacy (www.napb.net ) could take the lead in updating the Pharmacy Model Practice Act, which could be used by state boards of pharmacy as they develop their states’ practice acts. New thinking about what embodies pharmacy practice in the health care system is continually needed. Agreement on such things as provider status and scope of practice is needed, including consensus from other health care fields and systems. (4) Significant efforts should be made regarding the alignment of payment policies for not only supporting new pharmacist roles and services, but also to provide adequate payment for the providers of these services and evidence of cost-effectiveness for the payers of these services. (5) The potential for flexibility in medical/health care home designs to create innovative and responsive practice structures that integrate pharmacist expertise in medication therapy coordination and management under varying geographic regions, practice setting types, and patient population types should be explored. Balancing such flexibility with the need for standards of care is a challenge that needs to be addressed in the reforming healthcare system. (6) Access to necessary patient health and treatment records to support and inform patient care service and decision-making functions should be secured for all members of collaborative healthcare teams, including pharmacists. Such access should include both the authority and responsibility to input information into these records to facilitate team-based collaborative care. Consensus also must be reached about what patient information is proprietary, related to business functions, and related to patient health and treatment as access to this information will have an immense impact on the ability of pharmacists to fully contribute to the developing health care system. (7) Discussion should take place regarding bundling pharmacists’ services into “episodes of care.” By packaging related services together in a way that supports high quality, lower-cost care, providers, payers, and patients could NOVEMBER 2013

begin to view episodes of care as a unified patient care experience rather than a series of disparate services. For example, products and services associated with the treatment of diabetes could be bundled in a way to influence overall pay-for-performance outcome measures. Pharmacist capacity for medication coordination throughout the whole episode of care could be valuable for improving quality and avoiding waste in medication therapy. As mentioned previously, payment redesign in addition to care redesign will need to be addressed to bring pharmacists’ full capacity to fruition. (8) Efforts should be undertaken to educate US health consumers’ regarding pharmacists and the roles they play in health care so that consumers have an accurate view of phamacists’ true capacity for patient care. Achieving consensus across the pharmacy profession and collaborative healthcare teams regarding processes of pharmacist provided patient care and the language that is used to describe pharmacistbased care would have more impact on changing patients’ perceptions than public service campaigns or advertising. Responsible actions, as outlined above, will still not necessarily result in a predictable future. To this end and given the failure of past projections to predict market realities, we present 6 scenarios under which “looming joblessness” might not occur. These scenarios are presented in no particular order and more research is needed to understand the comparative impact of specific variables. The expansion period in pharmacy education will end. Discomfort with the continued expansion has been growing. Recent experiences with economic “bubbles” in real estate and the stock market have sensitized would-be investors (in this case, university administrators) that market directions can change rapidly and unexpectedly, leaving late entrants at great risk. The improving US economy will increase demand for all healthcare services, including those related to medications. Pharmacists will be granted provider status, enabling a broader participa16

FLORIDA PHARMACY TODAY

tion in healthcare. The large cohort of pharmacists trained during the 1970s, the so-called “health-provider education capitationyears” will retire in greater numbers as retirement accounts return to prerecession levels. The percent of pharmacists working part-time will continue to increase, requiring more pharmacists in order to keep up with demand. Colleges and schools of pharmacy will decrease enrollments if applicant pools drop in number and/or quality and/or jobs are not available for graduates. Making projections and monitoring data trends are necessary but not sufficient to guarantee the best future for pharmacy graduates, practitioners, and patients in a changing healthcare system. Rather, pharmacy administrators, educators, and other stakeholders need to use the projections and data trends as tools to identify and embrace those actions that will lead the profession forward in uncertain times. REFERENCES 1. Brown DL. A looming joblessness crisis for new pharmacy graduates: Implications for the Academy. Am J Pharm Educ. 2013; 77(5):Article 90. 2. Brown DL. From shortage to surplus: the hazards of uncontrolled academic growth. Am J Pharm Educ. 2010;74(10): Article 185. 3. Health Resources & Services Administration. The pharmacist workforce: a study of the supply and demand for pharmacists. Rockville, MD: Health Resources & Services Administration. December 2000. 4. Knapp KK, Shah BM, Barnett MJ. The Pharmacist Aggregate Demand Index to explain changing pharmacist demand over a ten-year period. Am J Pharm Educ. 2010;74(10):Article 189. 5. Staiger DO, Auerbach DI, Buerhaus PI, Registered nurse labor supply and the Recession—Are we in a bubble? N Engl J Med. 2012;16:1463-1465. 6. Jolly P, Erikson C, Garrison G. U.S. Graduate Medical Education and Physician Specialty Choice. Acad Med. 2013: Feb 19. [Epubahead of print]. 7. Act of July 2, 1890(Sherman Anti-Trust Act), July 2, 1890; Enrolled Acts and Resolutions of Congress, 1789–1992; General Records of the United States Government; Record Group 11; National Archives. 8. Taylor TN, Knapp KK, Shah BM, Barnett MJ, Miller L.Unemployment, pharmacy graduates, prescription growth rates and Medicare Part D affect the unmet demand for pharmacists: A statelevel analysis using Aggregate Demand Index data. J Am Pharm Assoc. In press. 9. Helling DR. 2013 Remington Honor Medal

Address. http://www.pharmacist.com/ dennis-k-helling-receives-remington-honormedalhighest-honor-pharmacy. Accessed April 8 2013. 10. Schommer JC, Planas LG, Johnson KA, Doucette WR, Gaither CA, Kreling DH, Mott DA. Pharmacist capacity for contributions to the reforming US healthcare system. Innov Pharmacy. 2010; l(1): Article 7. 11. Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: Free Press; 2003. 12. Schommer JC, Clince RR, Uden DL, Larson TA, Hadsall RS, and Schondelmeyer SW. Pharmacy looks to the future. In: Smith MI. Fincham, JE, Wertheimer A, eds. Pharmacy and the U.S. Health Care System. 3rd ed; 2005:417-443.

NOVEMBER 2013

2014 FPA CANDIDATES

FPA 2014 Election Information Election will be online at www.pharmview.com

CANDIDATE FOR PRESIDENT-ELECT Tim Rogers FPA Member Since February 1980 Tim grew up in Dunedin, Florida, and moved to Gainesville/Newberry, Florida, to attend The University of Florida. He has been married to his wife, Belinda, for 43 years and has five children, ages 28 to 39. He has been active in The Alachua County Association of Pharmacists since his graduation from the University of Florida College of Pharmacy in 1975. He has served The Alachua County Association of Pharmacists as FPA delegate since 1979, Treasurer from 1991-1997, President from 1980-81 and 1997-98, and Continuing Education Director for the last 30 years. Tim has been a member of The Florida Pharmacy Association for the last 32 years, serving as a delegate from Alachua County for most of those years. He is a recipient of the Bowl of Hygeia (2005) and the Sidney Simkowitz Award (2013) from the FPA. He served as the Regional Representative on the FPA Board of Directors from 1998-2001 and is currently serving as the Region 1 Representative starting in June of 2013. Tim has been active in many community organizations including participation in 15 medical mission trips to Central and South America through his church and UF. POSITION STATEMENT

I would like to take a more active role in FPA to help strengthen the profession and represent the needs of Florida pharmacists. I would like to continue our efforts of strengthening the ties between the different areas of our profession (Community, Health System, Nuclear, Consulting, Academia, Technicians, and Students) so that we can be represented by one voice. My experience in pharmacy includes: independent and chain pharmacy, home infusion, compounding, consulting and teaching. I will use my background in these areas of our profession to represent all pharmacists and further our professional goals and improve patient care.

The All-new FPA Website is Now Online Pharmview 3.0 offers more features, greater access and increased opportunities for member interaction. ■■ ■■ ■■ ■■

Keep your dues current with the most accurate information in your membership accounts Register for conferences and educational programs Register online and you can print a receipt instantly without having to wait for one to be mailed to you Your continuing education credits earned through FPA programs will be published as transcripts and certificates in your member record

Take advantage of all the possibilities and visit your new website today at www.pharmview.com. 18

FLORIDA PHARMACY TODAY

2014 FPA CANDIDATES

CANDIDATE FOR REGION 2

CANDIDATE FOR REGION 4

Michael Hebb, BPharm FPA Member Since: 2009

Linda Lazuka FPA Member Since: 2012

Local Association Activities: Duval County Pharmacy Association Member from 1977 to present, Member of the Duval County Board of Directors from November 2004 through December 2005. Vice president of the Duval County Pharmacy Association from December 2005 through December 2008. Served as President from December 2008 through December 2010. Chairman of Board December from 2010 through December 2012. Current Chair of the Duval County Pharmacy Association Board of Directors. Pharmacy Related Activities: Florida Pharmacy Association elected member 1977, American Pharmacy Association elected member 1978, Florida Pharmacist License PS15984 1977, Florida Nuclear Pharmacist License NP56 1984, Florida Consultant License 1977, Certified to Administer Immunization 2009, Pierce Rx Shop, O’Steens, Revco, Wal-Mart, Nuclear Pharmacy, Albertsons, Drug Emporium, Humana Hospital, Atkinson Home Health Care, Advanced Rx & Compounding Pharmacy 1977 - 1992 , Floater, Staff, Rx Dept Manager Winn-Dixie 1992 - 2004, Floater, then Staff Pharmacist Walgreens Pharmacy since 2004 and still employed, Oh! ---University of Florida Gator for life!

I am a native Tennessean raised in Greenbriar, Tennessee; a rural area 30 miles north of Nashville. I have lived in various states, and several foreign countries including New Zealand, Germany, and Mexico. I am married to Vincent Lazuka and we live in Oviedo with our four rascally, rescued cats. We are both active members of Oviedo First Baptist Church and serve in several ministries. As a graduate of Mercer University, where I received my Doctor of Pharmacy degree, I had the opportunity to serve as the ambassador to New Zealand to study and observe a form of socialized medicine; a path this country does not want to travel. Also, I interned at the C.R.I.T Indian Reservation in Parker Arizona under the auspice of Indian Health Services (IHS). I am the recipient of the Roche Pharmacy Communication Award, was the 3rd runner up in the National Patient Counseling Competition (1990), and served as President of Phi Lamda Sigma 1990-1991. Currently, I am the owner, along with my husband, of Hometown Old Country Pharmacy, in Winter Park. This is a closed door pharmacy, not open to the public that serves group homes, ALF’s; ICF’s -DD. We currently have a staff of seven, all of whom are members of the Central Florida Pharmacy Association and three of which are members of FPA. I have served as the Secretary and C.E. Coordinator of the CFPA since 2010. I hold a Florida pharmacy license and consultant license. I have served on the Pre-Med Advisory Board for UNF, and currently partner with Fortis and Concord Colleges to guide pharmacy technicians into the field of pharmacy by providing an intern location for their internship hours. I have enjoyed two stints of employment with Walgreen Corporation as a staff pharmacist and pharmacy manager in Tampa, Jacksonville, and Daytona.

POSITION STATEMENT:

My intent as Board of Directors Region 2 will be to help with notification of possible changes and monitoring of the explosive growth and changes in the Pharmacist position as I see it with my past experiences, from Pharmacy delivery boy after Bishop Kenny High School to most recently representing FPA at the Board of Pharmacy meeting on the compounding issue.

POSITION STATEMENT:

I would greatly appreciate the opportunity to serve the Florida Pharmacy Association in the capacity as Director of Region 4, as I consider it a privilege to be a pharmacist and to serve our profession.

NOVEMBER 2013

2014 FPA CANDIDATES

CANDIDATE FOR REGION 6

CANDIDATES FOR REGION 8

Luther V. Laite IV FPA Member Since: 2003

Humberto “Bert” Martinez FPA Member since 1991

Luther V Laite IV is a registered Florida pharmacist. He obtained his doctor of pharmacy degree from Palm Beach Atlantic University in 2007. Luther began his career in pharmacy at Walgreens where he held the position of pharmacy manager for five years. After 11 years with Walgreens, Luther decided to expand his pharmacy expertise by obtaining a position in hospital pharmacy. He is currently employed by Health First at Holmes Regional Medical Center in Melbourne. Additionally, he obtained his consultant license in 2010 and serves as consultant pharmacist for surgery centers on the east coast of Florida. With regards to his other professional affiliations, Luther served as the 2012 presidentelect of the Brevard County Pharmacy Association (BCPA) and is currently serving as president. He is actively involved with his local peers and other health care professionals in the county.

Humberto “Bert” Martinez is an alumnus of Florida A&M University School of Pharmacy and has been a pharmacist for over 35 years. He is currently a practicing pharmacist for the Navarro Discount Pharmacy Chain in Miami, Florida. In the past, he has been an owner of his own independent pharmacy for over 15 years and has experience in working with a national chain pharmacy for another 12 years. He has received certifications in Pharmacy-Based Immunization Delivery, Mass Antibiotic Dispensing, Disaster Behavioral Health Training (R-FAST) (BFAST+SN), and Mass Radiological event training. Also, he has received certifications as a First Responder in Disaster Response and training as a Community Emergency Response Team (CERT) member in Miami. He is trained as a Technical Specialist in Pharmacy for the Florida Department of Health (ESF8) and is a Medical Reserve Corps (MRC) volunteer for the Miami-Dade County Department of Health. Local Association Activities: In the past, he has served as the FPA President for 2010-2011 and has been the Chair for the FPA Governmental Affairs Committee, Public Affairs Council, Professional Affairs Council, and the Organizational Affairs Council. He has been the Region 7 representative on the FPA Executive Committee. Also, he has been the Vice-Speaker and Speaker of the FPA House of Delegates and served has a member of several FPA councils and committees. Currently, he is a member of the FPA Organizational Affairs Council and on the coordinating committee for the Tallahassee Health Fair. He is also the Chair of the Ad Hoc Committee for the Miami-Dade Health Fair and the FPA liaison to the Florida Department of Health in Emergency Preparedness. On the local level, he is currently the Chairman of Interamerican Pharmacists Association (IPA) and a member of the Dade County Pharmacy Association (DCPA) Executive Committee. He is a two time past President for both Associations and serves as the C.E. Program Director for IPA for the past 20 years. In the past, he has chaired several committees in both associations and has been an active member on several of them.

POSITION STATEMENT:

Pharmacy is in a tough position as a profession. We are struggling every day to find our place in the medical field. You may personally feel that as an individual pharmacist you help people and are an important person on the healthcare team. And, I would agree with you. Unfortunately, not everyone in our society and in the healthcare profession feels this way. Although they may comprehend that we are capable, important, and influential, their own personal gain and money-saving desires keep them from publicly acknowledging these feelings. Only through a large organization such as the Florida Pharmacy Association, is it possible for us to effectively raise public and peer awareness as to the importance of our profession. This organization is the voice of pharmacy for Florida. We are the organization that pharmacists rely on to protect the vitality and success of our profession. It is my hope that as the region 6 director of this organization, I can help influence the growth needed to have more impact in this state.

POSITION STATEMENT:

I believe very much in community involvement and letting our community know what pharmacists can do as healthcare providers. I am dedicated to do all that I can to help pharmacists to be recognized as healthcare providers. My record speaks for itself and I am here to serve, to the best of my abilities, as your Director for Region 8. 20

FLORIDA PHARMACY TODAY

2014 FPA CANDIDATES

CANDIDATES FOR REGION 8 David Pino FPA member since 2012 Local Association Activities: David has been involved in the political aspects of pharmacy since starting his second year of the Pharm D. program at Nova Southeastern University. He ran for NSUâ&#x20AC;&#x2122;s American Pharmacists Association student organization (APhA-ASP) and was elected Communication and Technology Coordinator for three years until graduating in 2010. During those years of service, he represented NSU at the APhA Convention held in Washington D.C. and helped organize community outreach events to further educate the public on how pharmacists can make a difference in health care. Upon graduating in 2010, David began working at Walgreens where he was able to become pharmacy manager of a Diabetes Center of Excellence for his community. Currently, David is a member of Interamerican Pharmacists Association (IPA) where he has helped coordinate multiple CE seminars to enhance pharmacist knowledge and serve the pharmacist community. He also attended the FPA 2013 convention as a delegate for IPA to voice his opinion on house matters such as the proposed technician ratio change and the required immunization course for pharmacists. POSITION STATEMENT:

I believe that the profession of pharmacy must be protected and guided down the right path. When I first began the Pharm.D program, I would never have imagined that a profession could become an extension of oneself. It

does though, and I feel sadness when something shameful comes from the profession, and I am proud when the profession rises above the odds to prove its worth. I knew I wanted to be involved, to motivate others to act, to make sure the profession remained strong and could continue to improve. With your help, I hope to continue to honor this profession and move it forward. Towards a place where pharmacists are not believed to simply count medication and watch over technicians but to be known for providing excellent care for our patients. Towards a place where pharmacists are called upon more often to advise other health-care professionals in medication use, side effects, and choices due to our recognized expertise. A place where pharmacists play an even more important and crucial role in patient care and quality of life. A place that has been long overdue for such a prestigious and educated profession. I know these changes will take time, but the longest journey begins with a single step. My personal goals within this position include the following: to continue defending the practice of pharmacy through legislation against PBM practices that have damaged the profession and to help unify the divided subclasses (Consultants, Clinical, Community, Etc.) of pharmacists as a single entity with a stronger voice. My experience when compared to others within the organization is limited but I have been blessed to have worked with wonderful mentors that always reinforced the need to not only be involved but involve others in the future of pharmacy. I would like to thank you for this opportunity to serve you and the profession to the best of my abilities.

NOVEMBER 2013

THE WALKWAY OF RECOGNITION

FPA OFFICE

YOUR NAME HERE

Have you been searching for just the right gift or thought of placing your name in perpetuity? If so, then consider purchasing an engraved brick for you or someone else. The main sidewalk at the Florida Pharmacy Association needs replacing. The Florida Pharmacy Foundation has undertaken the project to repair and beautify the sidewalk with engraved personal bricks purchased by pharmacists or friends of pharmacy. Engraved 4x8 bricks can be purchased for $250.00 each with the donor’s name engraved (3 lines available) or you could also purchase an engraved brick for someone you feel should be honored or remembered. The monies earned from this project will be used to fulfill the goals and future of the Foundation. There are a limited number of bricks available – so, it is first come first served.

ORDER FORM

The Walkway of Recognition

❑ YES, I want to order _______ concrete brick/s at $250.00 each. (Please copy form for additional inscriptions). PL E A S E P R INT I NSC RIP TION

The concrete bricks are 4x8 and can be engraved with up to 14 characters per line, three lines available, spaces and punctuation count as one character. Please find enclosed my check for $_________ for _________ bricks. PLEASE PRINT: Please charge my

❑ Master Card

CARD #

Contributions to the Florida Pharmacy Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details. Fed Emp. I.D. #59-2190074

❑ Visa EXP. DATE

AUTHORIZED SIGNATURE NAME ADDRESS CITY

STATE

PHONE (W)

(H)

Send to Florida Pharmacy Foundation, 610 N. Adams St., Tallahassee, FL 32301, or fax to (850) 561-6758.

ZIP

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE.

FPA Member Profile Mehrdad Hariri

THE STATS Hometown: Maitland, Florida Employer: Medicine Shoppe Pharmacy

What do you value most about your FPA Membership?

What got you interested in pharmacy in the first place?

What I value most about FPA is that it advocates for the pharmacy profession, promotes professionalism and fosters leadership.

While working for an independent pharmacy over a summer break in college, I immediately fell in love with my profession. I had a great mentor!

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

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

Pharmacy has been an ever-changing profession. Pharmacists should be in control of the profession, not companies. It is important for each pharmacist, regardless of practice setting, to make their profession a priority and get involved in issues that matters to us most. Pharmacists need to have a voice as our profession moves forward.

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

I have always practiced with honesty and integrity. To err is human, but we need to learn from our mistakes, whether trusting an associate or a patient. I have learned the value of looking at the past to improve the future in my practice. To be trusted is the greatest compliment a healthcare provider can receive.

What excites me most is that the pharmacy profession represents a wide spectrum of opportunities. After close to 30 years as a pharmacist, I still see opportunities for pharmacists to improve and use their skills to improve our profession.

What do you wish everybody knew about pharmacy?

Pharmacists are among the most respected and trusted profession.

NOVEMBER 2013

C A L L

F O R

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

FLORIDA PHARMACY TODAY

N O M I N A T I O N S commitment to community service.

■■ Candidate is not a past recipient of

this award.

R.Q. Richards Award This award is based on outstanding achievement in the field of pharmaceutical public relations in Florida. Criteria: ■■  recipient must be a Florida registered pharmacist and a member of the FPA. ■■   has displayed outstanding achievement in the field of pharmaceutical public relations in Florida. Frank Toback/AZO Consultant Pharmacist Award Criteria: ■■ Candidate must be an FPA member, registered with the Florida Board of Pharmacy as a consultant pharmacist in good standing. ■■ Candidate should be selected based on their outstanding achievements in the field of consultant pharmacy. DCPA Sidney Simkowitz Pharmacy Involvement Award Presented annually to a Florida pharmacist who has been active at the local and state pharmacy association level in advancement of the profession of pharmacy in Florida. Criteria: ■■ A minimum of five years of active involvement in and contributions to the local association and FPA. ■■ Candidate must have held office at local-level pharmacy association. ■■ Member in good standing for a period of at least five years in the FPA and must have served as a member or chairman of a committee of the association. ■■ Candidate must have been actively involved in a project that has or could potentially be of benefit to members of the profession. Pharmacists Mutual Companies Distinguished Young Pharmacist Award Awarded to a young pharmacist for their involvement and dedication to the

F P A

practice of pharmacy. Criteria: ■■ Licensed to practice for nine (9) years or less. ■■ Licensed to practice in the state in which selected. ■■ Participation in national pharmacy association, professional programs, and/or community service. IPA Roman Maximo Corrons Inspiration & Motivation Award Interamerican Pharmacists Association created this award to honor the memory of Roman M. Corrons who inspired and motivated countless pharmacists to participate actively and aspire to take on leadership roles in their profession. Roman was always there with guidance and support that motivated pharmacists and encouraged visionary leadership, approachable active membership and succession planning. This award recognizes the motivators among us who inspire others to continue to advance the profession. Criteria: ■■ The recipient must be a Florida Licensed Pharmacist and a member of the FPA. ■■ Candidate should motivate others to excel within the profession by encouraging them to be leaders. ■■ Candidate is not necessarily an association officer, but guides, supports and/or inspires others. A brief description on the candidate’s motivational/inspirational skills must accompany the nomination. The Jean Lamberti Mentorship Award The Jean Lamberti Mentorship Award was established in 1998 to honor those pharmacists who have taken time to share their knowledge and experience with pharmacist candidates. The award is named in honor of long time FPA member Jean Lamberti for her effort in working with pharmacy students. Criteria: ■■ The recipient must be an FPA member. ■■ The recipient must serve as a role model for the profession of pharmacy.

A W A R D S

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Upsher Smith Excellence in Innovation Award Awarded to honor practicing pharmacists who have demonstrated innovation in pharmacy practice that has resulted in improved patient care. Criteria: ■■ The recipient has demonstrated innovative pharmacy practice resulting in improved patient care. ■■ The recipient should be a practicing pharmacist within the geographic area represented by the presenting association. Cardinal Generation Rx Award The Cardinal Health Generation Rx Champions Award recognizes a pharmacist who has demonstrated excellence in community-based prescription drug abuse prevention. The award is intended to recognize outstanding efforts with-

in the pharmacy community to raise awareness of this serious public health problem. It is also intended to encourage educational prevention efforts aimed at patients, youth and other members of the community. The nominee must be a pharmacist who is a member of the state association. Self-nominations are allowed. Applications will be evaluated based upon the following criteria: ■■ Commitment to community-based educational prevention efforts aimed at prescription drug abuse ■■ Involvement of other community groups in the planning and implementation of prevention programs ■■ Innovation and creativity in the creation and implementation of prevention activities

■■ Scope/magnitude of prescription

drug abuse efforts

■■ Demonstrated impact of prescription

drug abuse prevention efforts

DEADLINE FOR NOMINATIONS: FEBRUARY 28, 2014 FPA AWARDS NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NOMINATED BY:

Name:

Address:

Date Submitted: Signature:

FOR THE FOLLOWING AWARD: (Nomination Deadline February 28, 2014)  APhA Foundation and NASPA Bowl of Hygeia  James H. Beal Award

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

 R.Q. Richards Award  Frank Toback/AZO Consultant Pharmacist Award  DCPA Sydney Simkowitz Award  Pharmacists Mutual Co. Distinguished Young Pharmacist Award  Academy of Pharmacy Practice Practitioner Merit Award  The Jean Lamberti Mentorship Award  IPA Roman Maximo Corrons Inspiration & Motivation Award  Upsher Smith Excellence in Innovation Award  Technician of the Year Award  Cardinal Generation Rx Award MAIL NOMINATONS TO: Annual Awards, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS FEBRUARY 28, 2014

NOVEMBER 2013

CALL FOR RESOLUTIONS TO THE 2014 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in March 2013 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is March 15, 2014! 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

BUYER’S GUIDE florida PHARMACY TODAY

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

PHARMACY RESOURCES Abbott Diabetes Care Hernan Castellon (305) 220-0414 PPSC Retail Pharmacy Purchasing Program (888) 778-9909

LEGAL ASSISTANCE Kahan ◆ Heimberg, PLC Brian A. Kahan, R.Ph., Attorney at Law 561-392-9000 Fried Law Office, P.A. Dennis A. Fried, M.D., J.D. (407) 476-1427 The Health Law Firm George F. Indest III, J.D., M.P.A., LL.M. (407) 331-6620

PHARMACEUTICAL WHOLESALER

PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Bob Miller, BPharm, CPH (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPh President (855) 374-1029 Office

TEMPORARY PHARMACISTS – STAFFING HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652 Empire Pharmacy Consultants Michael Chen PharmD., CPh President (855) 374-1029 Rx Relief (800) RXRELIEF

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

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

NOVEMBER 2013

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