September 2016 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association SEP. 2016

FPA SUPPORTS BETTER PATIENT ACCESS TO ORAL CONTRACEPTIVES

OCTOBER IS AMERICAN PHARMACISTS MONTH (APhM)

Buying, Selling or Starting a Pharmacy? We can help you practice pharmacy your way. Our dedicated and experienced ownership consultants can help you achieve your goals. From planning and financing to site selection and product mix, we deliver answers you can trust. Set your pharmacy-ownership goals and point your future in the right direction with the help of RxOwnership. Visit RxOwnership.com or call 800.266.6781 today!

RxOwnership.com

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 28 News & Notes 30 Buyer’s Guide

VOL. 79 | NO. 9 SEPTEMBER 2016 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

10 12 20 23 26

More from the Florida Pharmacy Association’s 126th Annual Meeting and Convention October is American Pharmacists Month (APhM)

FPA Resolution Supports Florida Pharmacists Dispensing Oral Contraceptives Without a Prescription Small to Mid-Size Businesses Also Need a Strong Compliance Program in a Post-ACA Environment Two Views of Resolution 2016-9: Transferring Prescriptions with Patient Consent

SEPTEMBER 2016

Mission Statements:

FPA Calendar 2016

of the Florida Pharmacy Today Journal

OCTOBER 8-9

FPA Midyear Clinical Orlando

8-9

FPA Nuclear Conference Orlando

Pharmacy Small Business Town Hall Meeting Kissimmee

15 - 19 NCPA Annual Meeting New Orleans, Louisiana

DECEMBER 3-4

FPA Regulatory and Law Conference Sarasota

APhA Diabetes Certificate Program

13 - 14 Florida Board of Pharmacy Meeting 23 - 26 Christmas Holiday FPA Office Closed 30

18 - 19 Florida Board of Pharmacy Meeting NOVEMBER 1

FPA Board of Directors Conference Call

Veterans Day - FPA Office Closed

FPA Board of Directors Conference Call

New Year Holiday FPA Office Closed JANUARY

Forward Your Profession Through Leadership Orlando

28-29 Clinical Conference Destin

24-25 Thanksgiving - FPA Office Closed

For a complete calendar of events go to www.pharmview.com Events calendar subject to change CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours’ LIVE Continuing Education as part of the required 30 hours’ general education needed every license renewal period. There is a new 2 hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2017 or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by December 31, 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 THE HEALTH LAW FIRM............................... 24 KAHAN HEIMBERG, PLC............................... 22 PHARMACISTS MUTUAL.............................. 29 PHARMACY QUALITY COMMITMENT..... 19 RxOWNERSHIP................................................... 2

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

FLORIDA PHARMACY TODAY

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

The Presidentâ&#x20AC;&#x2122;s Viewpoint ANGELA S. GARCIA, PHARMD, MPH, CPH, GUEST COLUMNIST

Building a Legacy of Leadership Angela S. Garcia PharmD, MPH, CPh Assistant Professor, Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy Matthew Noble Doctor of Pharmacy Candidate, Class of 2019, University of South Florida College of Pharmacy Any time we are faced with change, regardless of whether it is perceived as positive or negative, we look to the strength of our leadership for guidance on how to respond, prepare ourselves and move forward as a cohesive unit. Our profession is so dynamic that we anticipate change on a regular basis. We identify where we want to grow and find out where we need to improve to be of greatest benefit to our patients and the health care system. Regardless of the organization, we are all struggling with how to recruit, grow and foster the development of

our membership to ensure continuity in our vision and strong meaningful contributions from our leadership over time. But how do we foster the growth of not only our membership in terms of numbers, but also of our active membership and the leadership it brings? How do we get pharmacists, interns and technicians involved who will sustain our long-term goals as a profession, allowing us to rise up to fight the good fight in legislation, and to build a legacy that each new generation will join? When we think of leadership, we think of specific positions and defined roles. The leaders often have a title and they have a task list that reflects their priorities. We can all identify people who we think of as natural leaders, whereas some leaders have grown into that role over time through experience, expertise or authority. Each of those leaders has a path or succession of events that led them to where they are and defined who they are to us. Everyone who has been identified

(Left to right) Matthew Noble; Angela Garcia, Pharm.D.; Jennifer Caldwell; Brandon Welch; Kevin Sneed, Pharm.D.; Benjamin Groves; Matthew Schneller, Pharm.D.; Bryan Figler.

Angela S. Garcia PharmD, MPH, CPh

or self-identifies as a leader will mention a person or group of people who mentored them along the way. Mentorship is necessary, but it takes much more than mentorship to facilitate the kind of leaders that create a true legacy of change within an organization, company or profession. That kind of leadership requires relationships. Relationships require an exchange between two people â&#x20AC;&#x201C; one serves as the teacher and the other the learner. However, this role is not static or unidirectional; as in any healthy relationship, both will teach one another and both will learn from each other. This commitment to one another defines a healthy relationship, and it requires work. Once this relationship is cultivated, it grows and becomes the foundation for amazing things to happen. Being in academia affords me the opportunity to see how actively engaged students and technicians are in outreach, advocacy and patient care. Their energy is infectious. It can literally change your entire attitude to SEPTEMBER 2016

2016-17 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work diligently all year long on behalf of our members.

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

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

hear their excitement, see their hustle and know you have to bring quite a bit to the table just in order to match it. We see them build their leadership skills over the course of their programs, serving as liaisons to the FPA Councils, serving on committees, taking on leadership positions with their respective student organizations and carrying these ideas forward. Their intentions are pure: They are working to make positive changes for their future. For our future, too. That was never more evident than this past summer in Fort Lauderdale at the Annual Convention during the House of Delegates, when we saw the student resolutions pass and students contributing to meaningful discussion and comments. We know that the students travel great distances to represent themselves and their profession during Legislative Days, and we see their excitement during the Annual Convention and conferences throughout the year. All year long they have community outreach opportunities in which they focus their energy and invest time in initiatives that will benefit patients and health care outcomes. While they are in school, they are unstoppable. It is important for us to recognize the change that occurs relative to time and priorities â&#x20AC;&#x153;lifeâ&#x20AC;? brings to us following graduation. There is a scramble for many students as they determine their path in the profession and what their future holds. Some will enter directly into the workforce. Others may work toward post-graduate education or training. Many will pursue Board or other certifications and specialty training. It is during this time period, following graduation, that we see a decline in the intern and technician levels of involvement as young leaders, even the ones who seemed to eat, breathe and sleep leadership. This drop in membership and activity is what we are hoping to target and improve with the introduction of the Advocacy and Leadership Committee, under the guidance, direction and support of President Tomerlin. We want to identify these strong student leaders now and work to identify mentors Viewpoint, continued on p. 8

6 |

FLORIDA PHARMACY TODAY

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

Let’s Talk About Pharmacy

s an industry, we have been very good at telling ourselves how important the work we do as health care providers is. We have published many articles on innovative pharmacy practices and what pharmacists are doing to save lives and improve health. We don’t need to prove the value of our services anymore. The data showing how pharmacists that

ers in your community. This includes the mayors of your towns, your county commissioners or, if you want to keep it local, you can get your homeowners’ association, churches or local civic groups to make a public statement. Don’t forget that your local media can pass on your message of support for American Pharmacist Month. All you need to do is to send an opinion letter

The FPA is pleased to announce that we have received a signed proclamation from Governor Rick Scott declaring October as American Pharmacist Month. are part of the team are strengthening health systems is overwhelmingly favorable. What we need to do now is stop talking to ourselves and start talking to others outside of pharmacy. Next month gives us the opportunity to get the message that we are so familiar with out into the general public. The FPA is pleased to announce that we have received a signed proclamation from Governor Rick Scott declaring October as American Pharmacist Month. This is acknowledgement from the highest political office in this state that pharmacists are to be recognized for their contribution to the health of Floridians. As pharmacists and stakeholders, you have the ability to do the exact same thing with political lead-

to your local media. Not sure how to do that? The FPA is always finding creative ways to help you become great advocates for your profession. Tucked away in the FPA’s “Legislative Advocacy Center” on Pharmview.com is a template “letter to the editor” that we have created on your behalf. Just include some additional comments that note the Governor’s declaration of October as American Pharmacist Month. This will give you a running start for getting a real opinion message on pharmacist services in your local newspaper. Remember that the best message is one that is personalized to what you do as a health care provider. Just make sure that you do not include the names of your patients or any other confidential health

Michael Jackson, B.Pharm

information. If you do get a letter published, or if you are able to get American Pharmacists Month recognized in your local communities, share that with us. We want to let the FPA membership know what you are doing.

SEPTEMBER 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...................Don Bergemann, Tarpon Springs Secretary.........................Stuart Ulrich, Boynton Beach Member..............................Rebecca Poston, Tallahassee Member.............................................. Patricia Nguebo, Ocala Member................................. Norman Tomaka, Melbourne Member..............................................Greta Pelegrin, Hialeah Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

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

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

FLORIDA PHARMACY TODAY

(Left to right) Matthew Noble, Rep. Kathy Castor and Stephanie McKinney.

locally (either in their schools or argitudinal professional mentorship. We eas they plan to return to after graduneed a transition from student leadation) that can help build the relationers to young professional leaders, and ships necessary to foster long-term without investing in relationships earcommitment to leadership roles at the ly, our chances of connecting with local unit associations, within the FPA them drop drastically. and regionally or nationally whenever We set out to identify where our possible to enhance the profession and leadership interested in this initiative practice. is from and thought about how to fosThe idea of creating a venue to build ter the relationships with our interns these strong relationships for our stuand technicians who embrace that dent leaders was presented to the FPA spirit of change that we need in leadleadership last spring with an overership. We targeted the students from whelming number of members in the American Pharmacists Association agreement and a commitment to serve – Academy of Student Pharmacists in these critical mentoring roles. Just as (APhA-ASP) who were attending the we need grassroots advocacy to make effective meaningful change, we needed that same local commitment to build relationships that will strengthen our leadership now and in the future. Students depend on their faculty and administration while they are in school; however, once they leave school, they leave a lot of relationships behind. We know we need to sup(Left to right) Jennifer Ryder, Han Le, Shannon Stittsworth, Matthew port those school-based Noble, Jeanette Alava, Billy Evans III, Aisha Shokoya, Jessica Castillo relationships with lon- Greenwood, Stephanie McKinney and Jeremy Sparks.

(Left to right) Jeanette Alava, Jessica Castillo Greenwood, Stephanie McKinney, Becca Brown (counsel to Rep. Ron DeSantis), Shannon Stittsworth and Matthew Noble.

Summer Leadership Institute in Washington D.C., as one group, our Leadership Council student representatives as another potential group and those who we have seen actively engaged in the conference and convention meetings as a third group. For the Summer Leadership Insti-

tute, students had workshops about leadership styles and approaches, as well as access to advocating to their senators and representatives. We are working to bring these students back to the local unit associations to share what they learned with the Board of Directors and membership as it relates

to issues in their communities and the practice of pharmacy. We will continue to reach out to our FPA leadership and other active members for their interest in serving as a mentor for these students. We aren’t looking for a specific set of criteria, but we want heart, soul and passion to be the foundation of our mentors—the essential criteria for building strong relationships. We will continue to utilize these groups of young leaders to share what they learned from their outreach and engagement and direct and indirect experiences in advocacy and work with them to establish plans for growth and involvement longitudinally at the local level of pharmacy. We will be pairing up local unit leadership and active local members with these students to start facilitating those critical relationships that lead to great leaders for our profession. As we identify other leaders locally and up and coming students and interns, we will help make those meaningful connections so there is a greater likelihood that, regardless of where they choose to go following graduation, the spirit of leadership is still supported, nurtured and encouraged. Often our leaders drop out right after graduation, and then a small number reappear a few years later. We aim to close this gap through the influence of relationship building, with mentorship being a large part of the relationship equation. No matter where they go to practice pharmacy, we want to make a difference in their lives by fostering strong relationships that will keep them connected to leadership. We know that hearing a story leaves a lasting memory, but sharing in that story leaves a lasting impact. Taking those experiences forward leaves us with vibrant transformation of ourselves and those who lives we touch. We are here to make lasting impressions on each other. This is the legacy of leadership, and it begins within each one of us. n

(Top left to bottom right) Jaclyn Cole, Pharm.D.; Melissa Ruble, Pharm.D.; Michael Carulli and Matthew Noble. SEPTEMBER 2016

More from the Florida Pharmacy Associationâ&#x20AC;&#x2122;s 126th Annual Meeting and Convention There were simply too many good images from this yearâ&#x20AC;&#x2122;s convention to get them all in one journal. Enjoy the following gallery and feel free to share your own photos on our Facebook page.

FLORIDA PHARMACY TODAY

SEPTEMBER 2016 |

October is American Pharmacists Month (APhM) wide and make it easier for everyone to participate, the APhA has posted dozens of ideas and resources for APhM activities and events you can utilize during American Pharmacists Month and all year long. We’ve filled the next few pages with ideas from the APhA for activities and events that spotlight pharmacists’ contributions toward improving medication use and advancing patient care in all practice settings. Use these ideas throughout October—and all year long—to inspire your celebrations. Get the Message to the People The whole purpose of American Pharmacists Month is to draw attention to your work and celebrate your profession. That means sending the right messages to the right people and generating buzz for your events. Below are dozens of tips to help you get the word out and give your audience the right impressions. Whenever you create any APhM materials, feel free to cut and paste from this information as much as you like. This will bring consistency to your messages message and save you time.

Every October, in conjunction with the American Pharmacists Association (APhA), Florida pharmacists join colleagues from across the country to celebrate American Pharmacists Month, otherwise known as APhM. The primary purpose of APhM is to promote pharmacists as medication experts, professionals directly involved in patient care and integral members of the national healthcare continuum. APhM is a well-orchestrated, monthlong effort designed to educate the public, policy makers and other health12

FLORIDA PHARMACY TODAY

care professionals about the essential role pharmacists play in the reduction of overall healthcare costs and the safe and effective management of medications. While the movement emanates from the APhA national headquarters, each pharmacist and pharmacy throughout Florida has a vital role in educating your patients, motivating your staff and inspiring your community to “Know Your Pharmacists, Know Your Medicine.” To help coordinate efforts nation-

Reach Your Community American Pharmacists Month is the time to take your message on the road. Don’t worry—you won’t have to go far. There are countless opportunities in your own community. Patients of all ages can benefit from discussions and information about how to use medications safely and effectively. Hit the malls: Ask management at a local mall about staging an exhibit or booth where pharmacists can answer shoppers’ questions about medications. Find the traffic: Create a medication education display for your local library, YMCA or other popular community site. Go back to school: Visit neighborhood schools for a “show-and-tell,” a science or math class or a career day to talk with students about medication safety, the dangers of prescription

abuse and exciting careers in pharmacy. Reach out to seniors: Conduct “medication check-up” reviews or seminars at senior day-use centers. Go with groups: Civic, neighborhood, religious, even book groups— ranging from the Lions to the Junior League to Scouting groups—are all good places to target for an educational talk on medication safety or the role of the pharmacist. Attract Media Coverage Attracting media attention requires a good story and good visual opportunities. Determine which media outlets you most want to reach and tailor your work to what they need in order to appeal to readers and viewers. STEP 1: TARGET YOUR MEDIA OUTLETS ■■

■■

Find the right size: Local and personal stories appeal more to small and local media. Issue-based stories can warrant regional or national coverage. Broaden your scope: There’s more to coverage than a news story or feature in a particular show or section. Try letters to the editor, opinion pieces, radio talk shows and TV station editorial segments. Don’t limit yourself to health: You might discover your story is more appropriately suited for the metro, business or lifestyle sections of a newspaper. Know your reporters: Check for particular writers, columnists or broadcast journalists who have covered pharmacy-related issues, and take your stories to them first. Check the media outlet’s website for contact information.

STEP 2: HAVE A GOOD STORY

What’s special about your American Pharmacists Month celebration? Are you trying to get as many seniors as possible to an event? Are you spotlighting a pharmacist with a strong relationship with patients? Are you looking at issues in the changing role or science in pharmacy? What are you most passionate about when it comes to pharmacy? What you care about is usually the seed

for a story others will care about, too. Media outlets want stories that are timely, interesting and full of local and personal appeal.

STEP 2:

STEP 3: CULTIVATE MEDIA RELATIONSHIPS

STEP 3:

Even in a short-term contact, a successful relationship with media outlets will go a long way toward accurate and compelling coverage. Here are some professional-caliber instructions to keep your work top quality: ■■ Send a pitch letter or email to your media list about 20 days in advance of an event. ■■ Prepare and send a media advisory the day before or the morning of an event. A follow-up phone call can help increase interest and attendance. ■■ Prepare a press release featuring greater detail; releases help reporters write full stories. ■■ Assemble media kits to distribute at the event. Include the press release and information about your practice and the services it provides. ■■ Immediately after the event, distribute the release to members of the media unable to attend. ■■ Monitor the media for stories about your event. Send a thank-you to reporters who covered it. ■■ Keep copies of the press clippings to include in future media kits. See if you can get permission to post a video clip to social media. Get Official Recognition You can get official recognition for American Pharmacists Month in your municipality, city, county or state, which can lead to a ceremony with a wealth of promotional opportunities. It’s fairly simple to do, but the process can take up to a few months. Here’s the step-by-step guide to getting an official proclamation:

■■

Find out if officials can issue proclamations without action from the city council or state legislature. If legislative approval is not required to issue a proclamation:

Prepare your proclamation language. Under the APhM Month Resources and Promotional Materials section on the APhA website is a sample template to get you started. Localize relevant facts about pharmacy and explain why American Pharmacists Month should be recognized by your city or state.

STEP 4: ■■

■■

Try to elicit support from other pharmacy leaders in your area. Ask local pharmacy associations, health organizations, and academic and business leaders and groups to write a letter of support to the governor. Provide addresses and sample letters. Broad correspondence and support from state leaders reflects wide interest and gives your proclamation a better chance. If legislative action is required to issue a proclamation:

STEP 5: ■■

Contact your local senator’s or representative’s office to get instructions for the proclamation process.

STEP 6: ■■

Because resolutions typically must be sponsored by a member of the appropriate governmental body, find an official who supports pharmacy. An alternative is to focus on a government official who has not yet worked with you, whom you could educate. Is there a pharmacist among the legislators?

STEP 7: ■■

STEP 1: ■■

Call the mayor/governor’s office to find out how proclamations are issued.

Ready your proclamation—use the sample template provided under APhM Month Resources and Promotional Materials on the APhA website.

STEP 8: ■■

Work with your proclamation sponsor to find out how you can help SEPTEMBER 2016

get the proclamation approved. You will probably need to lobby potential supporters and identify cosponsors. Start by writing your legislators about the proclamation and soliciting their support. Remember, a follow-up phone call might be necessary. The final steps come after the proclamation is issued. Be sure to invite those instrumental in getting it approved to any ceremonies planned. After APhM, send letters of thanks and appreciation. Use Social Media It’s the easiest, fastest and probably your favorite way to promote American Pharmacists Month events. But with social media, your message could get lost in a flood of information. Here are some tips for standing out and getting leverage. And remember—stick with APhA messages for best results. ■■ Just the facts: For the whole month, post a daily pharmacy fact, tip, link or article to your Facebook wall or Twitter stream. ■■ Tag it: Use the Twitter hashtag #APhM2016 when tweeting about the profession, the month or your event. The more people who use a hashtag, the better chance it has of becoming a “trending” topic. This also increases the chances that other non-pharmacy users will run across the information. ■■ Let Facebook help: If you’re hosting a special event in honor of APhM, spread the word through Facebook. It makes it easy to send invites and for attendees to share the event with friends. It’s also a neat way for attendees to see the guest list of who’s going (which helps get them to the page). ■■ Get visual: Get out your smart phone and start shooting and posting photos of events. Three things to remember: Ask permission, use cap-

■■

tions and check before tagging. Document with video: Create a serious record of your events that others can learn from, or try a short, fun video with music or voice-overs. Once you’ve asked permission, post away. Pin it up: Pinterest and similar visual-based social media sites can be a good place to share tips and information. Consider: ●● Recipes for people with diabetes, allergies or other chronic conditions ●● A poster showing flavors available for children’s medication ●● Ideas on storing or remembering medications ●● A calendar for medications or a tip-a-day ●● Photos of pharmacists providing patient care services ●● GIF videos or images of food and drugs that may interact ●● Don’t forget to fill in the description box with extra information Get personal with a blog: If you don’t have a blog already, APhM is a great time to start one. Or use a group blog where contributors rotate. Use this month to write about your work or what the profession means to you, or to share tips with students or professionals on continuing education or career advancement. A blog is an easy, relatable way to talk about the profession. Posts can be short and informal— the key is keeping the content fresh and consistent. Record a podcast: This is a great way to address an issue in pharmacy that’s important to you. A podcast is typically a short recorded audio session, and it’s easy to do through the microphone on your computer. Try talking about pharmacy, interviewing a patient or colleague, or describ-

REMEMBER, YOU DON’T NEED A BIG BUDGET TO MAKE A BIG SPLASH. THE FLORIDA PHARMACY ASSOCIATION OR STUDENTS FROM A NEARBY SCHOOL OF PHARMACY MAY BE WILLING TO WORK WITH YOU TO HOST EDUCATIONAL EVENTS FOR YOUR PATIENTS. 14

FLORIDA PHARMACY TODAY

■■

ing how pharmacists can help someone with a certain condition, such as diabetes. Tell your friends: After people sign up for your event, take them to a “Tell Your Friends You’re Attending” page. With the click of a button, a customized tweet is created and posted for them. This makes it simple for attendees to share that they’re going—and gives a link for readers in their network to click. Add a Twitter widget: If people are already talking about the event, why not use that as proof to market to other potential attendees? The widget is a box that allows users to scroll through just the tweets relevant to your event (with your hashtag – #APhM2016). Build the excitement: Are you able to give away some free tickets to your upcoming event, or offer freebies or prizes? Social media is particularly conducive to building excitement around things like giveaways. It encourages people to share/retweet/ repost—and it will enhance the awareness of your event. Capture the experts: Will your upcoming events feature interesting or popular speakers? Get your social media audience acquainted with them—and excited to hear more. Promote their appearance before the event, and be sure to get permission to post content, a report or a video of their presentation or a Q&A. Invite leaders: Most senators and representatives now use social media tools. Contact your local legislators via social media and invite them publicly to attend your events. Provide online answers: Spend some time during APhM visiting a Q&A website such as WikiAnswers or YahooAnswers, and offer professional advice reminding people to contact their pharmacists with questions about issues such as potential drug interaction-related symptoms.

Save the Date

127th Annual Meeting and Convention

July 13 â&#x20AC;&#x201C; July 16, 2017 JW Marriot Orlando Grande Lakes 4040 Central Florida Parkway Orlando, Florida

SEPTEMBER 2016

Ways to Celebrate APhM in Your Practice Inform, Engage, Inspire There are more ways to celebrate American Pharmacists Month than there are days in October. You just need to figure out what works best for your pharmacy. Remember, you don’t need a big budget to make a big splash. The Florida Pharmacy Association or students from a nearby school of pharmacy may be willing to work with you to host educational events for your patients. Below is a list of great ideas to help inspire you; some work anywhere, while others are best suited for specific settings. Always be sure to pick quality over quantity so that your events are memorable for everyone involved: Ideas for Pharmacists in All Settings ■■ Make time for face time: Schedule special events where patients can meet and talk to their pharmacist. Use the time to promote vaccinations, flu shots or host screenings for cholesterol, diabetes or osteoporosis. ■■ Check on medication: Invite patients to bring all the prescription and nonprescription medications they take, so pharmacists can answer any questions and conduct a medication checkup for potential interactions, unneeded or duplicate medications, adverse reactions and passed or upcoming expiration dates. ■■ Serve healthy lessons for lunch: Ask local businesses if you can come in during employee lunch hours and make presentations about safe medication usage and answer medication-related questions. ■■ Clarify Medicare for seniors: Set aside time each day/ week to answer questions about Medicare drug coverage for local seniors. Use the questions and your knowledge for a local newspaper column or call-in radio show. You can also offer personalized counseling by contacting the Florida Department of Elder Affairs. ■■ Host local leaders: Provide your legislators with an invaluable view of 16

FLORIDA PHARMACY TODAY

■■

the contemporary roles of pharmacists. Make sure they talk to a patient who has benefitted from interaction with his or her pharmacist and get to watch a pharmacist in your facility conduct patient care services, like MTM, immunizations, patient education and wellness screenings. Create a social media challenge: Establish a goal of organizing and understanding medications by the end of the month. Activities can include: ●● A daily tip delivered through social media ●● A drug disposal day a week, with reminders ●● Reminders to do a drug checkup (check expiration, interactions, etc.) ●● Lead discussions on how patients keep track of medication use or what gets in the way of consistent adherence ●● Links to articles and research ●● A blog for the month with articles, links and interviews about organization, using technology and smart phones, etc.

Ideas for Community Pharmacies ■■ Conduct OTC aisle tours: Gear them to specific groups, like parents, older adults and athletes. Help each group understand how to pick the right products for the conditions most likely to affect them. Emphasize the

■■

importance of reading labels, knowing the active ingredients and asking the pharmacist questions. Join the race: People interested in fitness and health activities are a built-in audience for the pharmacy message. Marathons, 5Ks and walkathons are excellent settings to spread the word. Choose ones that align with your message and be on hand with giveaways, like water bottles, T-shirts, bandanas and headbands. Or if you’re feeling adventurous, you could organize your own race. Get cooking: Check local cooking classes that give instruction in cooking and nutrition for health issues such as diabetes, heart-healthy or allergies, and ask the instructor for five minutes to make a presentation about the importance of talking to your pharmacist and knowing about food/medication interactions. Get down to business: Reach out to stores, restaurants and services in your block, mall or shopping center. Note: Chain stores may have restrictions about promotional activities, so start with independent, local businesses first: Approach restaurants about having a pharmacy awareness day where they promote healthy choices or give out material with the check. Work with local retail stores or dance and exercise studios to generate a month-long information or

■■

coupon promotion and exchange. Create a “sidewalk sale” day where local businesses promote themselves outside their stores and you promote pharmacist-provided patient care services or offer mini-health screenings.

Ideas for Hospital and Managed Care Pharmacies ■■ Join the class: Find out when diabetes, nutrition and prenatal classes are being held at your hospital or managed care setting throughout October. Check with the class organizers to see if they can give you time for a five-minute presentation on the importance of knowing their medications and talking to pharmacists. ■■ Give parting gifts: Patients and class attendees are often given “care packages” when they leave the hospital. See if you can add an information card or fun giveaway for APhM promoting the importance of talking to pharmacists, especially for diabetes patients, heart patients, new parents and chemotherapy/cancer patients. ■■ Make the rounds: Visit patients in their rooms. Introduce yourself and answer any questions they may have about pharmacy services, their current drug therapy or how to transition back to a normal medication routine when they leave the hospital. Give them patient education brochures and small APhM themed giveaways like magnets, pens and tote bags. ■■ Set the stage: Create a lobby display to promote the pharmacy department. Include information about pharmacy services and photos of your staff. If your facility is large, consider changing the display weekly to focus on a different pharmacy activity or function. Make the display colorful and fun, with eyecatching elements like red and white streamers or APhM balloons and banners. ■■ Open your doors: Invite all hospital and managed care setting employees to visit the pharmacy. Conduct brief tours that showcase daily pharmacy operations and describe how

■■

medications move from the initial physician order to the patient. Decorate ambulatory care pharmacies: Hanging APhM decorations like banners, posters and balloons is a great way to publicize your events and draw attention to your pharmacy. Offer curbside service: Encourage patients and caregivers to talk with pharmacists about medication therapy issues. Hold the sessions in a conference room or other relatively private area, and allot from 5 to 10 minutes per person.

Ideas for Long-Term Care Settings ■■ Head to class: Visit the chair dance, stretch or dance class with the message that patients can talk to their pharmacist about how their fitness and movement activities affect their medications, and vice-versa. ■■ Start a project: Engage in a monthlong project with facility residents, meeting once or twice a week with a clear goal and outcome. Here are some ideas: ●● Create a cookbook with healthy recipes contributed by residents. ●● Create a short joke book with funny stories and jokes around the theme of “My Meds.” ●● Stage a talent show around the theme of “My Meds.” ■■ Share information: Hold a visitor information day once a week during APhM, complete with an information table and giveaways, where visitors and relatives can get information about how your pharmacy works, meet the pharmacists and become aware of the importance of the pharmacists in their relatives’ health and well-being. ■■ Open your doors: Invite all longterm care center employees to visit the pharmacy. Conduct brief tours that showcase daily pharmacy operations, and describe how medications move from the initial physician order to the patient. ■■ Throw a party: Invite residents and their guests to a special APhM party. Maybe host an afternoon tea or another themed event. Decorate the

■■

designated areas with streamers and APhM balloons, banners and posters. Provide patient education brochures and small themed giveaways, like magnets and pens. Make the rounds: Visit patients in their rooms. Introduce yourself and answer any questions they may have about pharmacy services or drug therapy. Give them patient education brochures and small APhMthemed giveaways. Serve a side of advice: Develop lunch tray tent cards that explain the goals of the pharmacy and the services you offer residents. Encourage them to ask to speak with the pharmacist if they have any questions about their medication.

Roles for Student Pharmacists and APhA-ASP Chapters Give your Campus a Crash Course on the Importance of Pharmacy Students, American Pharmacists Month is your time to educate. Cultivate your future in pharmacy by showing your campus and community the importance of talking to pharmacists and knowing their medications. You’ll raise awareness and help people at the same time. If you’re a student who works in a pharmacy, lots of the activities throughout this article could inspire you. You can also spread the word by: ■■ Sharing the daily #APhM2016 facts on the APhAASP Facebook and Twitter pages on chapter and personal pages ■■ Writing an article or op-ed for a school-connected professional journal or your school paper presenting a point of view or issue of importance to pharmacy students ■■ Tweeting about community events and sharing relevant articles about pharmacy ■■ Incorporating American Pharmacists Month into your social media posts

SEPTEMBER 2016

Ideas for APhA-ASP Chapter Activities ■■ Hold a chapter fundraiser: Sell American Pharmacists Month Tshirts and/or other promotional items to student pharmacists and faculty. ”Know Your Pharmacist, Know Your Medicine” merchandise is available through the APhM store. ■■ Coordinating care: Get more attention and more mileage out of your work by collaborating and combining forces. Schedule Operation Immunization, Operation Diabetes and Operation Heart in October, and promote American Pharmacists Month during these events. Attract notice by decorating the event area with themed balloons, posters or banners. You can order materials through www.pharmacist.com/ shop. ■■ Host a lunch: Celebrate American Pharmacists Month on campus by holding a celebratory lunch for all student pharmacists. Offer them a unique experience by inviting an honored local practitioner to discuss the importance of leadership and professionalism in pharmacy. ■■ Mobilize for better health: Partner with faculty members to conduct free health screenings, medication checkups and other community education events for area businesses and civic organizations. Check out collaboration opportunities with community service groups that do outreach to senior or low-income communities. ■■ Inspire future pharmacists: Visit a local high school to talk with students about careers in pharmacy. ■■ Host a healthy happy hour: Serve non-alcoholic smoothies or juices, along with pharmacy information. ■■ Serve info to go: Ask your local coffee shop or on-campus café if your group can host a pharmacy hour or pharmacy day, with giveaways, coupons or other promotional material about the profession and health. ■■ Be good sports: Establish a relationship with one or more of the school’s athletic teams. At games or competitions, sponsor shows, giveaways, put messages on the scoreboard or 18

FLORIDA PHARMACY TODAY

■■

put a message in a program. Hold an APhM Day at a football game, soccer game or tennis match, for instance. Pharmacy students can also give presentations to the team or provide information to coaches— building awareness of the importance of student athletes talking to pharmacists and knowing their medications. Try something unique: Student pharmacists are unique in their ability to creatively describe how pharmacists benefit and enhance the patient experience. You are also uniquely positioned to produce content on the many new applications and mediums that exist. Showcase your talents: Produce a YouTube video about being a pharmacist; put together a pharmacy flash mob in your student union building; have the College of Pharmacy host a medicine and wellnessthemed talent show; or put together an APhM photo or video journal about your monthly adventures as a pharmacist and display it in the college’s main building. Cross disciplines: Reach out to other departments at your school to engage different populations. For instance, work with visual and performing arts and literary groups. Consider sponsoring or collaborating with a performance or contest for creative work. (Artists, writers and performers are always looking for opportunities to create, and health and medicine is a powerful human theme for them to explore.) Buy or barter an ad in a theater program or student publication. Get some culture: Work with foreign language clubs or foreign exchange students for opportunities to learn about the cultural differences in pharmacies, the need for language skills and the importance of diversity training.

APhM Roles for Pharmacy Technicians Add Your Special Touch Team up with your fellow technicians and the pharmacists at your practice to help make your patients more aware of the important role you play in their healthcare. Here are a few simple ideas to try: ■■ Get decked out: Decorate your pharmacy with banners, posters and balloons that let everyone know it’s American Pharmacists Month. You can order materials through www. pharmacist.com/shop. ■■ Coordinate special health events: Work with the pharmacy team to set up an event where they can conduct blood pressure screenings or other pharmacy-based patient care services. ■■ Host a party: Invite community members to come in for cake and other treats. Give them goodie bags stuffed with educational brochures and other freebies, like magnets, pill cases, tote bags and pens. Volunteer as a greeter and demonstrate the prescription-filling process. ■■ Change your bags: Encourage your pharmacists to put APhM stickers on pharmacy and prescription bags or other purchases. ■■ Customize your phone greeting: Change your automated voicemail greeting or answer your phones with something like, “Hello, this is Main Street Pharmacy, where we’re celebrating American Pharmacists Month.” ■■ Get social: Incorporate APhM messages and events into your Facebook posts, tweets, blog posts and other social media activity. Find more social media tips in the “Use Social Media” section. Your Special Day Remind your team members that the fourth Tuesday of October is National Pharmacy Technician Day. This is a day dedicated to recognizing the invaluable contributions technicians like you make in all practice settings throughout the year. Go ahead and celebrate!

“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

SEPTEMBER 2016

FPA Supports Better Patient Access to Oral Contraceptives April Glasper, 4th Year Pharm.D Candidate Florida Agricultural & Mechanical University College of Pharmacy

At the 2016 Florida Pharmacy Association Annual Meeting & Convention, a resolution was adopted by the FPA that supports Florida-licensed pharmacists to initiate hormonebased oral contraceptive medications without a prescription. Currently, only four states allow this practice: California, Oregon, Washington and New Jersey. However, in those states, April Glasper pharmacists must complete a training program designed by their boards of pharmacy prior to carrying out this new law. For years, many have questioned why oral contraceptives require a prescription. In many parts of the world, patients can walk into drugstores and buy birth control either over the counter or without physician intervention.1 A study conducted by Contraception Journal found that oral contraceptives were available without a prescription or screening in 62 percent of the 147 countries examined, while only 33 percent of these countries required a prescription. Those countries include Canada and the U.S. 1 20

FLORIDA PHARMACY TODAY

Many physicians and lawmakers state the prescription is necessary due to safety concerns. Oral contraceptives have been known to cause common, less serious side effects such as nausea, weight gain, sore and swollen breasts, spotting, lighter periods and mood changes. Less common but serious side effects are expressed by the acronym ACHES: abdominal pain, chest pain, headaches, eye problems (such as blurred vision) and swelling in the legs or thighs. Birth control that contains drospirenone has been investigated by the FDA because drospirenone-containing birth control doubles the chances of fatal blood clots.2,3 According to the Center for Research: Blood clots are dangerous because they can detach from the vein and travel through the blood stream, blocking blood flow to the lungs or brain. They can cause disability or death, even in young, healthy women. Several families testified at a health care meeting about the death of their healthy, young daughters as a result of taking drospirenone and similar pills made with drospirenone.3 The FDA has also reported that there have been more than 50 deaths associated with drospirenone and other similar oral

contraceptives, that women as young as 17 have died while taking drospirenone and that there have been thousands of complaints of serious and dangerous side effects associated with drospirenone. Those not in favor of removing physician-prescribed oral contraceptives say that removing the physician is removing a “gatekeeper,” but groups such as the American Congress of Obstetricians and Gynecologist and the Oral Contraceptives Over the Counter (OCs OTC) Working Group argue in favor of pharmacy-dispensed birth control without a prescription, stating that these laws are not truly removing a barrier to obtaining contraception. “This replaces one gatekeeper, the physician, with another gatekeeper, the pharmacist,” said Daniel Grossman, an obstetrics and gynecology professor at the University of California at San Francisco and a member of the OCs OTC Working Group.4 People in favor of removing the physician prescriber requirement also argue that while ACHES side effects are serious, they don’t occur often (10 per 10,000 women on oral contraceptives will get a blood clot—a risk about half as high as that associated with pregnancy) and the common side effects can be found in any drug product. Other arguments in favor of removing physician–patient contact include the fact that oral contraceptive drugs have rarely changed in the last 50 years and have been intensely studied, thus raising questions as to why prescriptions are required. Patients have also expressed that doctor-prescribed oral contraceptives are not necessarily beneficial for them because some doctors push for newer and pricier drugs, such as brand-name medications.1 In 2015, Oregon became the first state to allow pharmacists to initiate a prescription for birth control in order to reduce accidental pregnancies, increase access to oral contraceptives and implement team-based health care. According to National Area Health Education Center (AHEC) Organization team-based health care is “the provision of health services to individuals, families and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient— to accomplish shared goals within and across settings to achieve coordinated, high-quality care.”5 Team-based health care is another primary reason for the move to phar-

RECENTLY, FPA ADOPTED A RESOLUTION TO ADVOCATE FOR SUPPORT OF SIMILAR LEGISLATION ALLOWING PHARMACISTS TO DISPENSE ORAL CONTRACEPTIVES WITHOUT A PRESCRIPTION IN FLORIDA. UNLIKE CALIFORNIA AND OREGON, NO ADDITIONAL TRAINING WOULD BE REQUIRED OF THE PHARMACIST.

macists dispensing without a prescription. California pharmacists started prescribing oral contraceptives in March 2016, but unlike Oregon’s laws, they’re allowed to prescribe vaginal rings and birth control shots in addition to patches and pills, and work with patients younger than 18 years of age without physician contact.4 Recently, FPA adopted a resolution to advocate for support of similar legislation allowing pharmacists to dispense oral contraceptives without a prescription in Florida. Unlike California and Oregon, no additional training would be required of the pharmacist. The resolution also states that the pharmacist can turn down a request if the information provided in a therapy patient assessment suggests hormone-based contraceptives could pose a health risk. The proposal presented at the FPA Annual Meeting stated the change was necessary due to the fact that oral contraceptives have become more advanced and modern, but the way women access them has not. The proposal also states the intent is to “make family planning easier and less expensive for people who lack insurance, have trouble getting a medical appointment or can’t take time off of work to see the doctor.” In order to currently receive oral contraception, a woman must visit her doctor. Paige Clark, a pharmacist with Oregon State University (OSU) College of Pharmacy, states those visits can include a pelvic exam or pap smear which has “no medical bearing on whether a woman can get a prescription for birth control. Uncoupling the exams from prescriptions improves access to the contraceptives.”4 Access to a pharmacy is easier because, according to Pharmacy Choice and Access Now, 93 percent of Americans live within five miles of community retail pharmacy,6 which is within walking distance for many patients. The downside of this proposal is the political and advocacy resources necessary to convince the Florida House and the Senate to approve these changes to the Pharmacy Practice Act and for the governor to sign the bill if it gets to his desk. Such a proposal would require a tremendous amount of spending by the FPA. Based on the proposal, the fiscal impact would be considerable. Examples include FPA having to fund consultant assistance and support a comprehensive legislative campaign. The exact cost is unknown at this time. In states where similar proposals have been adopted and are now being practiced, the cost of birth control is covered by patients’ insurance, just as if they were to go to their physician. Under the Affordable Care Act, all prescription birth control is covered by insurance. The only possible additional cost, according to the New York Times, is an annual fee or one-time fee of $25 for assessment services provided by the pharmacist.7 However, insurance companies are not offering compensation to pharmacists for their services as they do with physicians, physician assistants, nurses, nurse practitioners and nurse midwives. Pharmacists can charge an out-ofpocket fee to patients and then submit the receipt to the patient’s insurance company for compensation.8 Another downside to the proposal is liability. In the state of Oregon, a pharmacist can be sued for malpractice if they “act without the level of care that is expected in his or her poSEPTEMBER 2016

sition (such as writing a prescription for birth control without first thoroughly reviewing the patient’s required medical form or filling out the questionnaire).”9 It is important that we also take into account the pharmacist’s “Right of Conscience.” According to Florida Statute 381.0051, a physician or other person may refuse to furnish any contraceptive or family planning service, supplies or information for medical or religious reasons, and the physician or other person shall not be held liable for such a refusal.10 Conscience refers to recognizing the distinction between right and wrong in regard to one’s own conduct. Conscientious objections may occur in issues surrounding medications prescribed for assisted death, execution by lethal injections, termination of pregnancy and prevention of pregnancy. Pharmacists have the right to refuse the dispensing of oral contraceptives but they do not have the right to abandon a patient due to their own personal beliefs. There must be an appropriate balance between moral obligations and professional responsibility. If a situation like this arises, the pharmacist is encouraged to direct the patient to an alternative source that can provide the service the patient requested. Objections to the provision of certain pharmacy services should be disclosed to employers during job interviews and any concerns disclosed to management at the earliest opportunity. In conclusion, the resolution adopted by the FPA is a great idea and would be very beneficial. Women would have easier access to their oral contraceptives without having to go through the hassle of meeting with their primary physician

A Pharmacist And A Lawyer Board of Pharmacy Licensure Disciplinary Proceedings Compounding Violations, DEA Investigations Mergers and Acquisitions Pharmacy Risk Assessment/Management Evaluations KAHAN ◆ HEIMBERG, PLC

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

STATEWIDE REPRESENTATION 561-392-9000 bkahan@kahanlaw.com 2300 N.W. Corporate Blvd., Suite 123 Boca Raton, FL 33431 The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

FLORIDA PHARMACY TODAY

or experiencing other inconveniences as mentioned. While there are some concerns about lack of physician intervention, pharmacists will be there to act as a “safety net.” Patients are still recommended and encouraged to get an annual checkup despite not having to visit their physician or gynecologist as often.11 Another benefit of this adopted resolution is that it will give pharmacists more responsibilities and free up physicians and other health care providers, thus allowing them more time to spend with other patients and improve their health care. References

1 Nolan-Brown, E. (2014). Over-the-Counter Birth Control Pills? Not In America. Retrieved July 27, 2016, from http://reason. com/archives/2014/03/26/over-the-counter-birth-controlpills-us 2 Birth Control Pill: Side Effects, Effectiveness, How the Pill Works, and Types. (n.d.). Retrieved July 27, 2016, from http://www.webmd.com/sex/birth-control/birth-controlpills?page=4#2 3 Casciotti, D., PhD, Zuckerman, D., PhD, & Stebbins, J. (2015). Are some birth control pills too risky? . Retrieved July 27, 2016, from http://center4research.org/child-teen-health/generalhealth-and-mental-health/are-bayers-birth-control-pills-toorisky/ 4 Breitenbach, S. (n.d.). States Start to Let Pharmacists Prescribe Birth Control Pills. Retrieved July 27, 2016, from http:// www.pewtrusts.org/en/research-and-analysis/blogs/ stateline/2016/02/18/states-start-to-let-pharmacistsprescribe-birth-control-pills 5 Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C., . . . Von Kohorn, I. (2012). Core Principles & Values of Effective Team-Based Health Care. Retrieved July 26, 2016, from https://www.nationalahec.org/pdfs/vsrt-team-basedcare-principles-values.pdf 6 The Value of Community Pharmacies - Pharmacy Choice and Access Now. (n.d.). Retrieved July 27, 2016, from http:// www.rxchoiceandaccess.com/about-us/value-of-communitypharmacies/#_edn3 7 Belluck, P. (2016). Birth Control Without Seeing a Doctor: Oregon Now, More States Later. Retrieved August 11, 2016, from http://www.nytimes.com/interactive/2016/01/04/ health/birth-control-oregon-contraception.html?_r=0 8 Rafoe, S., PharmdD, BCPS. (2016, April 11). California Pharmacists Can Prescribe Birth Control. Retrieved July 27, 2016, from http://www.pharmacytimes.com/contributor/ sally-rafie-pharmd/2016/04/california-pharmacists-canprescribe-birth-control 9 Oregon Becomes the First State in the Nation to Offer Birth Control Without a Doctor’s Prescription -. (2016). Retrieved August 01, 2016, from http://cprlaw.com/oregon-becomesfirst-state-nation-offer-birth-control-without-doctorsprescription/ 10 Statutes & Constitution :View Statutes : Online Sunshine. (2016). Retrieved August 12, 2016, from http://www. leg.state.fl.us/Statutes/index.cfm?App_mode=Display_ Statute&URL=0300-0399/0381/Sections/0381.0051.html 11 Begay, J. (2016, January 6). In Oregon, Birth Control is Now Available Without a Doctor’s Prescription | Women At The Center. Retrieved July 27, 2016, from http:// womenatthecenter.org/blog/in-oregon-birth-control-is-nowavailable-without-a-doctors-prescription/

Small to Mid-Size Businesses Also Need a Strong Compliance Program in a Post-ACA Environment by Marlon A. Onias, Esq.

Numerous small to mid-size businesses that provide medical services or supplies to the federal government have been lulled into a false belief that having a compliance plan in place is too costly. Some make the mistake of relying on their contracted sponsors or pharmacy benefit manager to provide the essential training needed for their organization to combat fraud, waste and abuse (FWA). Many businesses have mistakenly believed that having a strong compliance plan in place is only a requirement for the larger organizations that have the means, and employees, to support such efforts; however, this is no longer the case. Since the passage and reaffirmation

of the Patient Protection and Affordable Care Act (PPACA), the nationâ&#x20AC;&#x2122;s healthcare landscape has undergone broad, sweeping changes. The Department of Health and Human Services (HHS) and its undersigned, the Centers for Medicare and Medicaid (CMS), have been dubiously delegated responsibility for assuring all entities engaging the government with services or supplies for Medicare/Medicaid or the Childrenâ&#x20AC;&#x2122;s Health Insurance Plan (CHIP) have an effective compliance plan in place. Section 6401 of the PPACA holds that any entity providing the federal government with services or supplies must have an effective compliance plan in place. This includes pharmacy bene-

fits managers, pharmacies and durable medical equipment companies, to name a few. Prior to the passage of the PPACA, many small to medium-size health service providers and suppliers operated without a compliance plan in place. Now, with the advent of the PPACA, there is a shift in value and increased risk for suppliers and providers to begin to self-police and aid the federal government in combating fraud, waste and abuse. Per CMS, fraud, waste and abuse encompass three separate areas of concern in which compliance is geared toward regulating. In the case of fraud, CMS or its contractors, such as Zone Program Integrity Contractors (ZPIC), look for a SEPTEMBER 2016

knowing and willing misrepresentation of a claim for payment in which services where not rendered or charges have been inflated. Any allegations of waste are due to the overutilization of services that may not be necessary. As for abuse, many may confuse it with fraud, and rightfully so; however, per CMS, the two are not the same, but bear a close nexus. Abuse is not necessary fraud, but can serve as a starting point of where fraud may be present.

pharmacies and other related entities. No matter where you fall within the continuum, an effective compliance plan is now the norm. The changed implemented by the PPACA can primarily be attributed to the excessive and rising cost of healthcare. CMS recent data reveals that if Medicare/Medicaid spending is not curtailed now, by 2019 healthcare will become 19 to 20 percent of the federal government’s budget.

NO MATTER WHERE YOU FALL WITHIN THE CONTINUUM, AN EFFECTIVE COMPLIANCE PLAN IS NOW THE NORM. Abuse is viewed as an unnecessary cost to Medicare, via submission of improper overpayments or payment for services that do not come in line with a professionally recognized standard of care, in which there is no legal entitlement to payment Federal compliance is a system in which rules and means are in place to address violation of those rules and means. It is to establish, communicate, combat and punish violators. In a post PPACA environment, a compliance plan is now no longer an option, but mandatory. This includes program sponsors, such as Humana and WellCare, first-tier providers, pharmacy benefit managers, downstream entities such as

Representing Health Care Professionals

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

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

FLORIDA PHARMACY TODAY

According to The Henry J. Kaiser Foundation and CMS, healthcare spending has ballooned from $356 per capita in 1970 to $8,402 in 2010. One of the primary functions of the PPACA now becomes a cost containment unit with a corresponding focus on detecting FWA. HHS and the Office of Inspector General (OIG) have established core elements needed for an effective compliance plan. In January of 2013, CMS updated Chapter 9 of Medicare Prescription Drug Benefits Manual “Compliance Program Guidelines,” outlining these necessary elements. This article is meant to give a foundational perspective on

JOIN TODAY! Florida Pharmacy Association

how to build a strong compliance plan tilted towards downstream entities within today’s current healthcare environment. Having an effective compliance plan in place may save you thousands of dollars down the road in legal fees, audit repayments and government fines. The first step in developing a strong compliance plan is:

The selected compliance officer should have a system in place in which, on a monthly basis, he reviews purchase orders, filled prescription receipts and other pertinent documents that may reveal noncompliance or FWA concerns. The compliance officer is also responsible for assuring diversion is not occurring within his/her pharmacy.

1. Elect a compliance officer Many other sources place this as number two; however, they do not take into account that smaller entities operate on budgets that are a fraction of what hospitals and major chain drug retailers operate on. Therefore, the compliance officer more likely will be the owner/pharmacist or pharmacy drug manager (PDM). In such situations, it is imperative that an open means of communication and accountability be established, with the formation of a compliance committee used as a safe guard to assure the compliance officer is adhering to all rules and regulations.

5. Assure employees are given open means of communication. Effective lines of communication must be established and implemented between the compliance officer and compliance committee and employees. Employees must have a reasonable means in which they may communicate any suspected violations. In the event of noncompliance or FWA allegations, employees should not be shunned, but management is to maintain an open door policy with regards to reporting suspected violations. Any retaliation against whistle blowers violates the False Claim Act and Florida’s Private Whistle Blower Act and is actionable in a court of law.

2. Develop a strong set of policies, procedures and standards of conduct. No organization can exist without properly delineated rules and regulations used as a guiding point to direct, correct and affect employee behavior. CMS has made great efforts to assure Congress that all those providing services or supplies to the federal government have in place effective compliance plans that are updated annually. Policy and procedures (P&P) are the vocal cord of any organization’s regulations. Owners must assure that P&P and standards of conduct clearly state what is accepted and not accepted behavior. They state the organization’s unyielding efforts to abide by government rules and provide in detail who is responsible for addressing noncompliance and FWA concerns and how they are handled. This policy is to be one of non-intimidation or retaliation for any employee revealing noncompliance or FWA concerns. 3. Provide quarterly training, and training 90 days from the date of initial hiring. In many smaller pharmacies, due to the size of the staff, it can be difficult to find the time to provide necessary training; although difficult, training is absolutely necessary and required. CMS has provided an online video that is available through their learning network at http://www.cms.gov/MLNProducts and can be viewed to help meet internal FWA training required by Medicare Part D participants. Assure that PDMs or owners carve out compensated time at work to allow staff to view this video, whether before, during or after work hours. Once each employee has completed training, assure that a signed attestation of participation is placed within employee folder.

6. Quickly resolve issues firmly. Upon receipt of complaints of noncompliance or FWA concerns, the compliance officer is to conduct a reasonable inquiry immediately, or no later than two weeks from the date of report. If, upon investigation, alleged offenses prove true, the entity may have to self-report, inform the National Benefit Institute or Medicare Drug Integrity Contractor (MEDIC) or contact legal counsel to advise on how to further proceed. If your organization has observed or is in receipt of information regarding noncompliance or FWA on the part of your sponsor or another entity, you may contact CMS or your attorney on how to further proceed. 7. Update P&P annually. Keeping abreast of changing laws, rules and regulation are essential to maintaining an effective compliance plan. Every year CMS proposes new rules and regulations that may impact the way you interact with the federal government. Staying in tune to proposed legislation and changes to legislation will keep you on the right side on the compliance track. If you need any assistance in developing an effective compliance plan, or have other legal questions pertaining to health law, please contact our office at 407-715-3295. Marlon Onias is the Chief Managing Member of Onias Law, P.L., an Orlando-based law firm focusing on health law concerns.

4. Develop an internal audit system. Preventing noncompliance and FWA starts with a strong internal auditing system that monitors and identifies compliance risk. Monitoring and auditing are to be tested against Medicare regulations, and other contractual matters. SEPTEMBER 2016

Two Views of Resolution 2016-9 Transferring Prescriptions with Patient Consent IN OPPOSITION By Raul N. Correa, B.Pharm President, CFPhA; FPA Professional Affairs Council member This resolution was presented by David “Chachi” Mackarey of the Palm Beach County Pharmacy Association at the 2016 FPA Convention and referred to the Professional Affairs council. The resolution requests FPA support of a requirement for a patient’s informed consent and approval, either verbal or written, directly or indirectly by a caregiver or guardian, agreeing to the prescription transfer request before the transfer can legally be completed. With due respect to my friend Chachi and my fellow colleagues at Palm Beach County Pharmacy Association, I stand in opposition to this resolution. I understand the frustration over the unsavory practice of the “switching” of patient prescriptions to a pharmacy benefit manager (PBM) preferred pharmacy. I do not believe that this resolution solves more issues than it has the potential to create. This stance is my personal opinion and should not be interpreted as the position of the Professional Affairs council, of which I am a member, at this present time. The transfer of a prescription at the request of a patient or caregiver is already time consuming and fraught with delays as it is presently legislated. However, section 465.026(1)(a) of the Florida Statutes, as it currently exists, does fulfill the need for the patient to be informed that the transfer is being performed by listing advisement of the patient of the need to cancel the prescription at the other pharmacy as one of several mandatory steps in the law that must be taken prior to the dispensing of any transferred prescription: “(1) Prior to dispensing any transferred prescription, the dispensing pharmacist MUST, either verbally or by any electronic means, do all of the following: Advise the patient that the prescription on file at the other pharmacy must be cancelled before it may be filled or refilled.” Creating additional legislation requiring the patient’s informed consent and approval in either verbal or written form creates an unnecessary burden on the pharmacist performing 26

FLORIDA PHARMACY TODAY

the transfer. This additional requirement will not have its intended effect on the individuals involved in “switching” the patient’s prescriptions from their original pharmacy to the pharmacy initiating the transfer without the patient’s consent. Those individuals choosing to carry out this “switching” practice without following section 465.026 (1)(a) are subject to its consequences, which can be addressed if enforced. Pharmacists can encourage affected patients to issue complaints to the Florida Board of Pharmacy for their specific circumstances concerning these practices to assert the need for enforcement. Pursuing legislation will have the unintended consequence of the PBM obtaining consent from the patient for the transfer of their prescriptions from the patient’s original pharmacy to the PBM-preferred pharmacy at enrollment, if this practice is not being performed already. It will impact all pharmacists performing the transfer, as they now must produce this informed consent by the patient at the request of a Board inspector. I have experienced delays in the transfer process by pharmacists claiming to be tasked at the time the transfer is initiated, or even going to the lengths of calling the patient to determine if consent was obtained despite my citation of section 465.026 and the pharmacist’s obligation to include advising the patient of the need to cancel the prescription at the other pharmacy as a necessary step that must be taken prior to dispensing any transferred prescription. There are many issues that beset the pharmacy profession, including attainment of pharmacist provider status via legislative support of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/S. 314) and enforcing legislation already passed (i.e. Fla. Stat. §465.1862 Pharmacy Benefits Manager Contracts, which mandates timely pricing updates by PBM’s to their participating pharmacies among other requirements). These important issues require funding to pass legislation (e.g. the MAC Transparency Act [H.R. 224]) and motivate responsible parties to enforce legislation that already exists. The resources that exist to allow the FPA and its leadership to support these issues should not be diluted by Resolution 2016-9. My hope is that those who read this opinion statement give due consideration to the impact Resolution 2016-9 has the po-

IN SUPPORT By David “Chachi” Mackarey, B.Pharm., RPh. Chairman, Palm Beach County Pharmacy Assoc.; Speaker-Elect, FPA Board of Directors

Some of you are probably wondering why our profession would even want another law to obey, as if we don’t have enough already. Well, times change, people change and professionalism changes also. I am the author of Resolution 2016-9 titled “Transferring Prescriptions with Patient Consent,” which I presented at the 2016 FPA Convention this past June on behalf of the Palm Beach County Pharmacy Association. The resolution requests a patient’s informed consent and approval, either verbal or written, directly or indirectly by a caregiver or guardian, agreeing to the prescription transfer request before it can legally occur. I personally support this resolution, as well as those pharmacists who spoke with me about their concerns about prescription transfers occurring without patients’ consent or complete understanding of its process. The problem has been increasing over the years. Maybe not all areas of pharmacy practice are affected by this, but many specialty and independent pharmacies are frequently dealing with such problems, as extremely costly biologic drugs and highly competitive business markets make every script a valuable commodity. I’ll give you a few examples (of many more) that I personally experienced working at a specialty pharmacy. I called another specialty pharmacy to transfer a script that a patient had requested. The other pharmacist took my name and number and said he would call me back with the info only after he had confirmation from the patient, even after I told him I had just spoken with the patient. He replied that it was company policy, as many patients don’t completely know what’s about to occur to their script. Another example is when my technician heard me on the phone transferring a script to another pharmacy and questioned if I had spoken to the patient myself, as the patient was a personal friend of her family’s and a long-time patient of our pharmacy. After calling the patient, it turned out that the

other pharmacy had called her saying that they were her new pharmacy provider in her network on her insurance plan. That may very well have been true, but she didn’t want or request to have her scripts filled there, when she was totally happy with our pharmacy for years and we were still a participating pharmacy with her insurance. She had no idea what was about to occur with her medications. These are just some ways that dishonest tactics, incomplete statements or half-truths are used to gain control of personal prescription provider status. These patients are already so confused with the constantly changing health care system, insurance plans and terminology used that they have no idea what they are agreeing to. This type of practice can devalue the pharmacy profession, making it less trustworthy, and also possibly disrupt the patient’s continuity of care, putting the health and wellness of the consumer at unnecessary risk. Some may argue that this resolution creates an extra step and unnecessary burden. My personal response to that is, under current law, the two pharmacies must speak with one another already; this “extra step” just confirms the patient’s request, preventing the two pharmacies from having to speak again to transfer it back to the original pharmacy because the patient never wanted it transferred out in the first place. Also, if it’s a prescription for a controlled drug, by law, it now cannot be transferred back, as controlled prescriptions can only be transferred once. Another positive point with this resolution is that the patient themselves can initiate and make the call to give consent and also give the pharmacist a “heads up” to expect a call to transfer out the prescription, which also gives that pharmacist the time to get it ready for transfer, as opposed to getting a call at the worst possible or busiest time, keeping the other pharmacist on hold for 10 to 15 minutes before you can get to them.

SEPTEMBER 2016

FPA News & Notes The Surgeon General is Calling on Us to Lead The U.S. Surgeon General took historic action by sending a personal letter to more than 2.3 million health care practitioners and public health leaders. He is seeking our help to address the prescription opioid crisis. To view a copy of the letter, please visit this link. Please take a moment to read it. Then go to www.TurnTheTideRx.org/ join to join with clinicians and public health leaders from across the country in a simple but powerful movement to end this epidemic. Rule Allowing Designee Access to PDMP Pending Rule revisions to 64K-1.003 allowing a “designee” of a prescriber or dispenser to access the Prescription Drug Monitoring Program database are about to become effective. Recent changes in Florida laws now create authority for pharmacy technicians to query the PDMP. It was necessary to make changes in the current rules. Access to the PDMP by a pharmacy technician would require a registration and the acceptance of the responsibility of the pharmacist. FPA Schedules Town Hall Meeting for Independent Pharmacy Owners The Florida Pharmacy Association is very aware of the many issues facing small pharmacy businesses today. We are working on many of these issues, forming partnerships and coalitions to address some of the challenges to providing patient care, growing jobs and improving business value. This meeting is designed to brief pharmacy business owners on the emerging issues, what the challenges are and what possible solutions may help pharmacy businesses succeed in today’s managed care market. Information on the meeting will be sent to our members who have indicated in their profiles that their “Your Profession” type is set to “independent.” Legislation Introduced to Ban DIR Fees New legislation has been introduced in Congress that would increase transparency and accuracy in Medicare Part D prescription drug spending and reporting. The legislation would also effectively ban so-called “DIR fees” applied retroactively, which threaten the viability of many independent community pharmacies. This NCPA endorsed legislation (H.R. 5951) would address what has become a top concern for independent community pharmacy owners, which includes huge clawbacks assessed by Medicare drug plans, or their intermediaries, pharma-

FLORIDA PHARMACY TODAY

cy benefit manager (PBM) corporations, long after prescriptions are filled. The Florida Pharmacy Association is working with the National Community Pharmacists Association on the issue of Direct and Indirect Renumeration (DIR) fees that are charged to pharmacies for Medicare Part D prescription claims. You are asked to send a message to your Florida Congressional delegation now and ask that they support these two bills. All 27 Florida Congressional members and both Senators Nelson and Rubio should proactively sign on in support today. The Florida Pharmacy Association, with the help of NCPA, has already drafted a message that you can send through our web site. Enter Here to Get Started. Florida Technician and FPA Member Receives National Honor Sponsored by Parata and Pharmacy Times, the Next Generation Pharmacist national awards program honors pharmacists, technicians, students and industry advocates who are defining the future of pharmacy. Since 2010, more than 200 pharmacy leaders have been named finalists or winners. Last year’s technician winner was Verender Gail Brown, also a Florida PTCB certified technician and FPA member. We are pleased to announce that this year’s winner is FPA’s Zipporah-Darvi Redding, Lead Adherence Pharmacy Technician, University of Florida College of Pharmacy Department of Pharmacotherapy & Translational Research, MTM Communication and Care Center- Lake Nona. Congratulations Zipporah.

Endorsed* by:

Introducing Our Newest Florida Sales Team Member

Sarrah Sheppard

Pharmacists Mutual Insurance Company, THE national pharmacy leader in providing insurance and risk management solutions, is pleased to introduce our newest Florida sales team member – Sarrah Sheppard. Sarrah joins Chuck Neyland in serving Florida pharmacists insurance needs.

Sarrah Sheppard Serves Central Florida

813.486.7427

sarrah.sheppard@phmic.com

Why insure with Pharmacists Mutual Companies: • Competitive rates • Dedicated to pharmacists and the pharmacy profession since 1909! • Endorsed by over 40 state and national pharmacy associations* • Dividends paid annually for 105 years** • A (Excellent) rating by AM Best for over 75 years

Contact Sarrah or Chuck for a no obligation proposal for your insurance needs.

Chuck Neyland Serves the Florida Panhandle

251.656.7219

chuck.neyland@phmic.com *Compensated endorsement. ** Dividends cannot be guaranteed; however, they have been returned uninterrupted since 1909.

Find us on Social Media:

www.phmic.com 800.247.5930 Commercial Auto Professional Liability | Business Protection Umbrella Liability | Workers Compensation Not licensed to sell all products in all states.

SEPTEMBER 2016

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. 30

FLORIDA PHARMACY TODAY

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