Florida Pharmacy Today April 2018 by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association APR. 2018

THE ROLE OF METHADONE, BUPRENORPHINE AND NALTREXONE IN TREATING OPIOID ADDICTION

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 11 FPA News & Notes 15 FPA Member Profile 26 Buyer’s Guide

VOL. 81 | NO. 2 APRIL 2018 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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Celebrate National Minority Health Month! Mission Possible: Addressing Health Disparities in Heart Disease and Stroke The Role of Methadone, Buprenorphine and Naltrexone in Treating Opioid Addiction

APRIL 2018

Mission Statements:

FPA Calendar 2018

MAY

of the Florida Pharmacy Today Journal JULY

6-8

NASPA National Leadership Retreat Kansas City, Mo.

Deadline for the submission of House of Delegates Resolutions

11 - 15 128th Annual Meeting and Convention of the FPA Bonita Springs

19-20 FPA CE Conference Jacksonville 28

21 - 28 FPA CE at Sea

Memorial Day - FPA office closed JUNE Deadline for the submission of items of new business for the House of Delegates

12-13 Florida Board of Pharmacy Meeting Howey-in-the-Hills

Independence Day FPA office closed

AUGUST 5-8

35th Annual Southeastern Gatherin’ Destin

7-8

Florida Board of Pharmacy Meeting Orlando SEPTEMBER

Labor Day - FPA office closed

8-9

Clinical Conference Miami

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, 2019 or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by December 31, 2018. For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office. For more information on CE programs or events, please contact the Florida Pharmacy Association at (850) 222-2400 or visit our website at www.pharmview.com

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 EPIC PHARMACY NETWORK......................... 2 PQC........................................................................ 9 KAHAN & ASSOCIATES................................. 10 PHARMACISTS MUTUAL.............................. 25

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 |

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

The President’s Viewpoint SUZY WISE, PHARMD/MBA CPH

The Opiate Crisis and the Pharmacist

ccording to the Centers for Disease Control (CDC), on average, 115 Americans die every day from an opiate overdose. Pharmacists play an important role alleviating the opiate crisis. Pharmacists are educators, and have the knowledge and ability to educate patients and caregivers on the appropriate use of opiate medications. Pharmacist counseling should include educating the patients on the risk and benefits of the opiate therapy, proper use, proper storage and disposal and understanding the potential for abuse. The CDC has provided guidance for practitioners on prescribing opiates for both acute and chronic pain. The guidelines suggest that the treatment of acute pain with opiates be limited to a maximum of seven days. They have also released guidelines around the use of opiates for the treatment of chronic pain. It is recommended that all of the benefits and risks be weighed before using opiates for pain management. With a focus on correcting the opiate crisis and the new CDC guidelines, many states are passing additional legislation on the prescribing and dispensing of opiates. New laws were passed in Florida and will go into effect on July 1, 2018 to help in reducing opiate use and potential for addiction. Many patients who struggle with opiate addiction often received their first opiate prescriptions after an acute injury. The new law in Florida aims to limit the opiate prescribing for acute injuries. How the new law affects pharmacists? There are a few significant changes that affect how pharmacists can dispense opiate medications. The first is

a new requirement to query the Prescription Drug Monitoring Program (PDMP). Florida’s PDMP is eForcse, which has recently moved to a new platform, florida.pmpaware.net. Since the inception of eForcse, pharmacists across the state have used the database to review controlled substance dispensing history for a patient prior to dispensing controlled substances. The new law will require pharmacists to perform a query, where in the

When a member or a local unit association has something they would like to see in FPA policy they can draft a resolution to be considered by the House of Delegates. past it was optional. If the pharmacist does not query the database, they must document the reason and are limited to dispensing a three-day supply of opiate medication. The prescribers are also required to query the database prior to issuing a schedule 2 opiate prescription. If the prescriber does not query the database, they are also required to document the reason and are limited to a three-day supply. Second, the law defines acute pain and limits prescriptions for acute pain to a three-day supply. In some situa-

Suzy Wise, Pharm.D./MBA CPh 2017-2018 FPA President

tions, a patient may need more than a three-day supply. For example, they may be seen in the Emergency Department and require an opiate prescription for more than three days while they wait to see a specialist. A prescription for a seven-day supply may be issued for acute pain by documenting on the prescription, “acute pain exception.” For chronic pain, prescriptions can be filled for more than the new threeand seven-day limits. These prescriptions must have “non-acute pain” documented on the prescription. With these new limits, it is essential for pharmacists to be aware of the limits based on the condition being treated and the requirements of the prescription to be filled for greater than a three-day supply. For detailed information on the new Florida law, visit the Legislative Advocacy Center on pharmview.com. n APRIL 2018

2017-18 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.

Scott Tomerlin....................................................................................................Board Chair Suzanne Wise...............................................................................................FPA President Ashley Huff.................................................................................................... FPA Treasurer Angela Garcia............................................................................................President-Elect David Mackarey........................................................................Speaker of the House Jeanette Connelly.......................................................Vice Speaker of the House Charzetta James.................................................................................. FSHP President Joyanna Wright................................................................................... Region 1 Director Neil Barnett............................................................................................Region 2 Director Dean Pedalino.......................................................................................Region 3 Director Linda Lazuka.........................................................................................Region 4 Director Melissa Ruble........................................................................................Region 5 Director Luther Laite IV.....................................................................................Region 6 Director Paul Delisser.......................................................................................... Region 7 Director Humberto Martinez..........................................................................Region 8 Director Mitchell Fingerhut.............................................................................Region 9 Director

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair....................................................Cristina Medina, cmmedina@cvs.com Treasurer...............................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

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JOIN TODAY!

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

#1 for Success A Member Benefit that Gives Back

he competitive nature of our species is to strive to find a way to be first. This is something driven into our daily lives through a society in which prestige and reward for hard work is recognized and acknowledged by our peers. It’s why we have the Olympics, March Madness, The Master’s golf tournament and the Stanley Cup. Yes, these are all athletic events, but the mission of the Florida Pharmacy Association is also a race to excellence. Over the years we have been extremely successful in a number of initiatives, programs and services. We have been blessed by very dedicated leadership, engaged volunteers and a hard-working staff. For the FPA to continue this tradition of success means that those of us reading this article do not need to be convinced that we are doing the right thing. What we have to do is to share the FPA story with our colleagues who are not aware of the things that your professional association has been doing over the years. This is the genesis behind the creation of our long-standing and popular #1 Club. The Florida Pharmacy Association’s prestigious #1 Club was established in 1985 and recognizes members who demonstrate extraordinary commitment to increasing membership in the FPA. It is actually a member benefit of extraordinary value to active FPA members and all that is required is to convince 10 of your pharmacist colleagues to become an active member.

So what is the #1 Club? Membership in the #1 Club may be attained by sponsoring 10 new active regular members to the FPA and participation in one retention program. The 10 recruited member records will need to be current and active just prior to the annual meeting of the FPA as determined by FPA staff.

Michael Jackson, B.Pharm

OK, that sounds interesting but what do I get for bringing 10 pharmacists into the FPA? For your efforts to recruit regular members to the FPA, you may be surprised to know that the benefits are significantly more than what you pay for your annual dues. It is a way of getting a rebate on your membership and then some. Here is what you get for your efforts. 1. One complimentary registration to the FPA Annual Meeting and Convention EACH YEAR that active membership in the #1 Club is maintained. ($345 value) 2. Engraved membership plaque to be awarded at the FPA Annual

Meeting and Convention when installed into the #1 Club. ($50 value) 3. Distinctive red jacket with #1 Club crest indicating membership in the #1 Club. ($150 value) So what this really means is that by being an active #1 Club member, FPA is providing you a benefit valued at $545. The opportunities to share your membership experience and recruitment efforts are significant. If you reach out to 20 pharmacists in your community, it is very likely that 19 of them are not current FPA members and could be included in your count toward #1 Club eligibility. This effort costs you nothing other than a conversation and dialog about your professional association. .

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

Director of Continuing Education Tian Merren-Owens, ext. 120

Educational Services Office Assistant Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110 Accounting Coordinator Ashley Gandy ext. 211

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. ©2018 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 8Web | Address: F L O R I D http://www.pharmview.com A PHARMACY TODAY

What resources are available that I can use to talk to member candidates? There is a lot of information available to assist you in your discussions with pharmacist candidates. Some of the tools we have include videos as well as a large list of projects that we have completed. Here are a couple of YouTube links of comments on the value of FPA membership: ■■ https://youtu.be/Zh7L_MfmO0g ■■ https://youtu.be/Nz5wtgl4A_A ■■ https://youtu.be/MSpBAcGqG0w Need more information? How about a sample of the projects that FPA is working on or have completed on behalf of members. Here is a short list: ■■ Requirement for legible prescriptions (revision in 2009) ■■ Continued support for the Medically Needy program ■■ Controlled substance monitoring program ■■ Adverse incident reporting efforts ■■ Medicaid auditing legislation ■■ Engagement on central fill issues ■■ Pharmacy Day at the Legislature ■■ Medication error CE programs ■■ Website FPA Law and Information Manual resource ■■ Educational programs on HIPAA compliance ■■ Canadian pharmacy issue engagement ■■ Guidelines for disposal of confidential patient records ■■ QRE pilot project ■■ Pedigree legislation engagement ■■ Stopped a mandatory Medicaid mail-order program ■■ Defended against efforts to restrict pharmacist dispensing ■■ Brought pharmacy technician training program to the membership ■■ Brought fraud, waste and abuse manual and training programs to the membership ■■ Fought against mandatory state employee mail-order program ■■ Advocated to the Board for changes to the 40-hour rule ■■ Representation on the Health Information Exchange Coordinating Committee

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Represented at the Joint Commission on Pharmacy Practice table Has representation on the USP Convention Supports Florida Pharmacist Political Committee Supports independent pharmacy Issues Supports Florida Pharmacy Foundation Continues to publish monthly Journal to membership Publishes a monthly (at a minimum) newsletter Provided comments to the Center for Medicare and Medicaid services on AMP pricing Participating on the 10 Cities Challenge Project Provided Diabetes Certificate educational program Provided Immunization Certificate educational program Provided Women’s Health Certificate educational program Provided web-based Med Error CE program Made available a web-based pharmacy CQI program Representation on the Board of Pharmacy Tripartite Continuing Education Committee Attendance at most Board of Pharmacy meetings Attendance at meetings of the NCPA, APhA and ASCP Member of the National Alliance of State Pharmacy Associations Membership on various state advisory boards and panels Expanded pharmacist immunization services Defended against expansion of technician ratio expansion Defended against efforts to allow for remote dispensing pharmacies Advocated for 18 out of 27 members of the Florida Congressional House of Representatives to sponsor provider status Built strong coalitions of diverse pharmacy groups

“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 APRIL 2018

How do I maintain my #1 Club status with the Florida Pharmacy Association? Active membership in the #1 Club can be maintained by sponsoring three new regular members to the FPA each year following your installation and participation in one membership retention program per year or submission of a journal article on the advantages of membership. What are examples of member retention programs? The FPA will facilitate a number of projects to keep our members connected to our organization. These projects include, but are not limited to: 1. Call 20 members who have not renewed their membership dues; 2. Coordinate bringing a group of local pharmacists to Florida Pharmacy Association’s Legislative Days; 3. Serve on the Membership Council to develop new retention programs, discuss membership issues

Active membership in the #1 Club can be maintained by sponsoring three new regular members to the FPA each year following your installation or develop membership satisfaction surveys; 4. Call and welcome 20 new members who were not sponsored in the #1 Club Program; 5. Use the online “Refer a Friend’ tool to invite 10 pharmacists to become members; or 6. Visit a graduating class with FPA membership invitations.

A Pharmacist And A Lawyer Licensure Disciplinary Proceedings Insurance Company/PBM Audits and Appeals Purchase & Sales of Pharmacies Regulatory Compliance Consultants Business Operations Consultants KAHAN & ASSOCIATES, PLLC

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

STATEWIDE REPRESENTATION 561-392-9000 bkahan@kahanlaw.com 7000 West Palmetto Park Road, Suite 210 Boca Raton, FL 33433 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

Our #1 Club has withstood the test of time and is the envy of a number of state organizations. Our active #1 Club members have been very proactive in sharing the FPA story of success and are not shy about informing our colleagues about how important involvement is. You, too, can take advantage of this beneficial program, and if you succeed it will be our honor to present you with the coveted “red jacket” at a future annual meeting of the Florida Pharmacy Association.

JOIN TODAY!

FPA News & Notes Labeling Changes for Certain Cough and Cold Products (from AHCA) The U.S. Food and Drug Administration (FDA) is requiring labeling changes for codeine and hydrocodone containing prescription cough and cold medicines to limit their use to recipients 18 years of age and older due to their risks outweighing their benefits in recipients younger than 18 years of age. Additionally, the FDA is also requiring safety information about the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing be added to the boxed warning of these products. Florida Medicaid, in response to the FDA safety guideline recommendations, will adopt the minimum age limitation of 18 years of age on codeine and hydrocodone containing prescription cough and cold medicines, effective May 14, 2018. More information, and a list of these cough and cold medicines can be found on the FDA website.

Expert Panel Recommends FDA Approve New Medicine Made from Marijuana The Peripheral and Central Nervous System Drugs Advisory Committee met in April to discuss the use of cannabidiol for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in patients 2 years of age or older. The 13-member panel has recommended that the FPA consider approving the new drug application. It is anticipated that the Agency will give its decision sometime in June. July 1 Changes to PDMP Gov. Rick Scott signed House Bill 21 into law, creating a number of changes to the Prescription Drug Monitoring Program (PDMP) for prescribers and dispensers of controlled substances (see FPA 2018 Legislative Report). There is new information that will need to be included in your daily reports to PDMP as well as new requirements to query the PDMP for patients receiving controlled substances older than 16 years of age. Read more at floridahealth.gov/statistics-and-data/e-forcse.

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Celebrate National Minority Health Month! April is National Minority Health Month. The theme for 2018 is “Partnering for Health Equity.” Learn more and help raise awareness of the health disparities that affect minorities.

“Without health and long life, all else fails.” – Dr. Booker T. Washington

Recognizing that health is the key to progress and equity in all other things, Dr. Booker T. Washington proposed the observance of “National Negro Health Week” in April 1915. He called on local health departments, schools, churches, businesses, professional associations, and the most influential organizations in the African-American community to “pull together” and “unite… in one great National Health Movement.” That observance grew into what is today a month-long initiative to advance health equity across the country on behalf of all racial and ethnic minorities.

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Minority Health CDC’s Office of Minority Health and Health Equity’s mission is to advance health equity and women’s health issues across the nation through CDC’s science and programs, and increase CDC’s capacity to leverage its diverse workforce and engage stakeholders toward this end. What is Health Equity? Health equity is when everyone has the opportunity to be as healthy as possible. What Are Health Disparities? Health disparities are differences in health outcomes and their causes among groups of people. For example, African American children are more likely to die from asthma compared to non-Hispanic White children. Reducing health disparities creates better health for all Americans.

Why is Health Equity Important? Health is central to human happiness and well-being and is affected by where people live, learn, work, and play. According to the World Health Organization, health also makes an important contribution to economic progress. In 2018 CDC’s Office of Minority Health and Health Equity celebrates 30 years of service. Since 1988, CDC has focused on reducing health disparities and ensuring a culturally competent public health workforce. The theme for the 30th anniversary commemoration is Mission: Possible. We believe “healthy lives for everyone” is possible and a goal that resonates in public health. Throughout 2018, CDC will highlight success stories from the national centers, institutes, and offices at CDC that capture how they have improved minority health and reduced health disparities.

MISSION POSSIBLE: Addressing Health Disparities in Heart Disease and Stroke Outcomes By Ursula Bauer, PhD, MPH and Betsy L. Thompson, MD, MSPH, DrPH

As the leading killer of Americans, heart disease and its associated behavioral causes are distributed throughout our country. Even so, some groups of people are more affected than others. Poverty and lack of education have long been associated with poorer health status and heart disease is no exception, occurring more frequently among people with lower incomes and less education. Racial and ethnic minorities, including African Americans and American Indians, whose histories in the United States are marked by severe trauma such as slavery, genocide, lack of human rights and loss of ancestral lands, and who today are often disadvantaged in terms of income and education, also experience higher rates of heart disease. Some geographic areas, such as the Southeast, Appalachia and the Mississippi Delta, places often characterized by poverty, lack of opportunity and low education, as well as lack of access to health care and community supports for healthy behaviors, also have higher rates of heart disease. Public health as a discipline was established specifically to address histor-

ical, structural and other disadvantages that result in poor health status for some. Early public health successes establishing water and sanitation systems, housing and building codes, and pasteurization of milk and food safety regulations, as well as government programs such as public education, social security, Medicaid and a minimum wage, have all lifted up those most in need and contributed to improvements

in health status for all. Heart disease has been the leading killer of Americans since 1921, following advances in cigarette manufacturing and marketing, dramatically expanding access to the leading â&#x20AC;&#x153;actualâ&#x20AC;? cause of death for Americans. While cigarette use emerged more widely in the 1910s and 1920s as a status symbol among the well-to-do, wide availability and two world wars rapidly expanded access. After conclusive evidence of the causal relationship between cigarette use and disease, many Americans quit smoking, with the risk factor more likely to affect those with less education and lower incomes. Today, tobacco use, poor diet and lack of physical activity continue to drive heart disease rates, while public health interventions to prevent and reduce tobacco use, improve nutrition, increase opportunities for physical activity and better control hypertension have been more successful in some populations compared to others, exacerbating disparities. In 2013 the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) at CDC convened an internal Advancing Health

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Equity Call to Action meeting to initiate action to address the persistent challenges, as well as implement the recommendations that were made by the CDC Health Disparities Subcommittee in collaboration with the CDC Office of Minority Health and Health Equity. New and tailored activities were initiated both internally and externally with funded and unfunded partners in response to that meeting. For example, the Health Disparities Subcommittee recommends the usage of a dual strategy that includes national and locally determined interventions available to everyone as well as targeted interventions available to populations with specific needs. This dual approach was implemented in the CDCâ&#x20AC;&#x2122;s State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke cooperative agreement in 2014. In addition, training on Geographic Information System (GIS) mapping that CDC provides to state public health departments is an effective tool to locate populations with the highest burden of heart disease, and related conditions and risk factors. Today, the public health enterprise continues to double down on support for populations most in need. Within NCCDPHP, the Division for Heart Disease and Stroke Prevention is doing its part to address the health disparities in heart disease and stroke outcomes. In addition to primary prevention strategies, partnerships with health care 14

FLORIDA PHARMACY TODAY

payers and delivery, including with Medicaid and Federally Qualified Health Centers, help address gaps in access and treatment, particularly control of high bloo d pressure and high cholesterol. Better management and control of these risk factors can substantially reduce the risk of heart disease, heart attack and stroke. As heart disease mortality rates continue to decline, public health is ever mindful of the potential for gaps in health status to widen, for some to be left out of the overall progress, and the need to ensure that progress for the whole population includes every group within the population. Factors outside of traditional public health, such as the social environment, education, and economic opportunity, play an important role in the health outcomes. It is important that we identify and collaborate with a wide array of partners to address these upstream factors that shape health. When we work together with other sectors that influence health outcomes, we can build greater momentum to move the needle on the issues that have the largest impact on heart health. Source: Centers for Disease Control and Prevention

FPA Member Profile David Laven

THE STATS Hometown: Longwood, Florida | Employer: State of Florida What do you value about your FPA membership?

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

There are benefits to the comradery and networking with colleagues and pharmacists from other areas of professional interest, coming together through the FPA’s many platforms for involvement to expand scope and solve issues facing pharmacy. The membership can benefit greatly from learning firsthand the outcomes and latest advocacy efforts of the FPA’s work on behalf pharmacy under the work of the FPA staff and volunteer leaders.

The evolution of professional growth and involvement in many traditional and nontraditional areas of health care in general will continue if regulatory positions and corporate philosophies do not become overwhelming.

What are some thoughts that you have on pharmacy as a profession right now? The new generation of pharmacists entering the profession are armed with many skills, including embracing technological innovation, and can excel at high levels of their traditional or nontraditional work environment, allowing them to exert their talents. There is a chasm between senior pharmacy management and administration and the direct patient-care services provided by front line pharmacists, particularly in the community pharmacy setting. Better collaboration by these two groups can be of great benefit to patients from a better understanding of what the needs are in the hands-on delivery of high quality patient-care services.

What do you wish everybody knew about pharmacy? Literally every pharmacist has experienced the opportunities and challenges of working in a community pharmacy retail setting but there are many other areas in nontraditional settings, including institutional-based areas, that can be pursued. These alternatives will be equally, if not more, rewarding and satisfying to meet one’s many professional goals. What got you interested in pharmacy in the first place? Pharmacy was initially not my first choice as I sought two previous degrees to pursue a pre-med track and then psychology. Back in the day, the challenges of embarking on a career were different than they are today. I heard about emerging non-traditional areas in pharmacy that were an alternative to the retail community, which was focused, yet closely aligned with medicine. So, I pursued nuclear pharmacy practice. This route afforded clinical

and research opportunities, as well as publishing, public speaking and specialty practice association volunteerism. What is the most humorous thing that has ever happened to you? Before I started pharmacy school and was pursuing my second degree in psychology, I needed a job to pay basic bills. I applied for a job as a delivery technician for a company in Michigan that was making deliveries to hospitals and clinics during early morning hours. I did not get the job offer because I was deemed overqualified because of my completed college work. When I graduated pharmacy school, entities came on campus to facilitate career interviews. This was a time when there were plenty of opportunities for pharmacist candidates that included encouraging relocation to a number of cities in Florida, as well as other states that had a critical need for pharmacists. The offer was made and I opted to start my pharmacy career in Miami. I found it amusing that the company that I was hired as a pharmacist and who provided a moving allowance and a much larger salary was the same company that did not see me as a viable candidate for a job as a delivery driver at $9.00 an hour.

APRIL 2018

The Role of Methadone, Buprenorphine and Naltrexone in Treating Opioid Addiction Geraldo Neziraj, Pharm.D. Carol Motycka, Pharm.D., UF Jacksonville Campus Asst. Dean The history of opioid addiction dates back prior to 1800, but documentation of opiates being given to soldiers during the Civil War to help with pain dates to 1861 in the United States1. It is estimated that there were 200,000 soldiers addicted Geraldo Neziraj Carol Motycka to opiates by 1900. Fast forward 100 years, and in the late 1900s there was a push to pay closer attention to pain, and therefore pain was announced as the fifth vital sign needing to be evaluated by practitioners. Pharmaceutical companies sponsored acute pain specialists such as Dr. Portnoy to give innumerable lectures on the use of opioids2. A New England Journal of Medicine letter in 1980 portrayed opiates as being safe, however, the study referenced was very limited in determining the long term effects of opioids. Primary care physicians began prescribing very large amounts of opioids to treat pain without pushback from regulatory action as long as the patient was under a treatment plan. Furthermore, in 2004, The Joint Commission became involved and made the under-treatment of pain punishable for the first time. These events likely contributed to the rise in opioid use in America. Data from 2000 to 2016 reports 600,000 deaths from drug overdose due primarily to opioids. On average, 115 Americans die daily from an opioid overdose3. Efforts taken to stop the opioid epidemic are mainly focused on supply or accessibility of these drugs. In 2016, the CDC released guidelines for opioid prescribing for chronic, non-malignant pain. Furthermore, utilization of prescription drug monitoring programs started being used by pharmacists and other healthcare professionals in efforts to minimize “pharmacy or doctor shopping.”

Along with those efforts, manufacturers began formulating abuse deterrent opioid medications, and insurance companies started requiring prior authorizations for certain quantities of opioids prescribed. However, these changes do not target the demand of opioids, only the supply. This springs forth the theory of the “Seesaw Effect.” It is thought that by decreasing the supply of opioids, patients still remain addicted and turn to an alternative such as heroin4. Heroin is the drug of choice due to higher accessibility and similar pharmacology to most prescription opioids. The heroin used today is not the same as in the past. To make it more addictive in nature, it is often laced with fentanyl or fentanyl derivatives making it much more dangerous. The unsuspecting user may not be aware of this tampering and is at an increased risk for overdose and death5. As the mechanism of diabetes involves organs such as the pancreas, the brain is the main target in opioid addiction. The mechanism of addiction is thought to be comprised of three different stages: preoccupation, intoxication and withdrawal7-8. It can be conceptualized as each of these stages feeding into one another and intensifying over time leading to the pathological state known as addiction. The areas of the brain involved deal with the reward system such as the nucleus accumbens. Repeated use of opioids tricks the brain to repeat an action that provided the reward. As with other disease states, opioid addiction can be diagnosed using guidelines such as the diagnostic and statistical manual 5th addition. In the past, treatment of opioid addiction consisted mainly of cognitive behavioral therapy (CBT). However, many patients receiving CBT returned to opioids after a short time of abstinence. Studies have shown that medication-assisted treatment increases retention rates in opioid treatment programs and relapse8,9. Commonly used medications for opioid addiction treatment are methadone, buprenorphine and naltrexone. Currently, the two major medications that dominate the field are methadone and buprenorphine. A decision on which medication to use for opioid addiction will depend on compliance, accessibility, retention rates in opioid treatment programs, abuse potential, withdrawal and patient specific factors. Clinical trials comparing methadone to buprenorphine show that methadone users have a higher percentage of retention rates in opioid treatment programs10-12. However, buprenorphine users were more likely to reach detoxification (negative urine drug tests for other opioids)

PRIMARY CARE PHYSICIANS BEGAN PRESCRIBING VERY LARGE AMOUNTS OF OPIOIDS TO TREAT PAIN WITHOUT PUSHBACK FROM REGULATORY ACTION AS LONG AS THE PATIENT WAS UNDER A TREATMENT PLAN. 16

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while being treated. Toxicity among these agents will mainly reflect the dose used. Methadone has been associated with increased risk of death during the induction phase when doses higher than 40 mg are used13. Also, when considering accessibility, it is important to think about patient location, transportation and cost. Methadone doses are given in a clinic whereas buprenorphine can be obtained from a community pharmacy and self-administered. The cost between these two agents will vary depending on pharmacy, insurance and dosage. The yearly cost of methadone and buprenorphine may be up to $5,250 and $7,680 respectively11. Oftentimes, cost is the deciding factor for drug of choice between methadone and buprenorphine. The induction phase will begin once a decision on drug of choice is reached by the patient and physician. This is the most critical phase because most medication-assisted treatment dropouts occur during this initial treatment time10,14. If methadone was chosen, physicians must assess opioid tolerance before administering a dose. There is no formula for estimating tolerance, and patient interviewing is highly relied upon by the physician. The first day dose for methadone is usually between 10-

THE MECHANISM OF ADDICTION IS THOUGHT TO BE COMPRISED OF THREE DIFFERENT STAGES: PREOCCUPATION, INTOXICATION AND WITHDRAWAL7-8. 30 mg and up to a maximum of 40 mg daily. However, the maximum can be exceeded with proper documentation. Doses will be given under supervision of the provider, and the patient will be monitored for withdrawal using tools such as the Clinical Opiate Withdrawal Scale (COWS). The same dose will be given for the next three days even if the patient experiences withdrawal due to the accumulation factor for methadone. However, if withdrawal continues past day three, then the dose may be increased by increments of 5-10 mg every three days up to a maximum of 20 mg per week. Usual stabilization doses for methadone are 100 â&#x20AC;&#x201C; 140 mg per day, therefore, the induction phase may take a few weeks. Patients have to present to the methadone clinic to receive APRIL 2018

their dose. Take-home doses are only allowed if there is a holiday and the clinic is closed13-15. It is important to note that methadone may also be used for the treatment of pain, however the dosing is different. The analgesic effect of methadone is only about four to eight hours, which warrants multiple daily dosing. This may be used as a clue regarding indication for treatment if a patient presents to a community pharmacy to fill methadone. Keep in mind, however, that in rare cases there may be instances where split dosing is used during the induction phase16. If a prescription presents with twice daily dosing, it would be best practice if the prescriber is contacted to confirm the indication. If the intention is for opioid addiction treatment, the prescription cannot be filled according to federal law 42 CFR 8.12. On the other hand, if buprenorphine is chosen as the drug of choice, the induction phase may still require an estimate of tolerance but it is not as crucial for initial dosing. Guidelines recommend that induction should be conducted in an officebased setting under the supervision of a clinician, but a study conducted in New York shows that home induction may be safe and effective17,18. Regardless of where the induction will take place, the first dose of buprenorphine should be taken when withdrawal symptoms occur 12-24 hours from last dose of abused short acting opioid and 36-72 hours from long-acting opioid18. The initial dose consists of buprenorphine/naloxone 4/1 mg followed by observation for withdrawal for two hours. If no withdrawal occurs, then the maintenance dose is determined. The maintenance dose for buprenorphine is usually around 12-16 mg/day12. If withdrawal occurs after the first dose, another 4/1 mg dose may be given. If withdrawal occurs after the second dose, manage patientâ&#x20AC;&#x2122;s symptoms with non-opioids as the max dose for day one is 8/2 mg. The next day (day two), the dose will be the previous day (day one) dose plus 4/1 mg for a total of 12/3 mg of buprenorphine/nal-

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oxone. If withdrawal occurs, an additional 4/1 mg may be given for a max of 16/4 mg. If withdrawal symptoms continue past day two, then give up to 32/8 mg of buprenorphine/naloxone on day three. For patients abusing long-acting opioids, the only difference is that buprenorphine is used without the addition of naloxone. The important thing to remember when filling a buprenorphine prescription is to make sure the provider is qualified for a waiver. This can be confirmed through samhsa.gov. Methadone and buprenorphine for medication-assisted treatment are used to diminish opioid craving. Naltrexone is another commonly used agent that uses a different approach to this issue. Naltrexone is a mu receptor antagonist and it is hypothesized so that it works by treating opioid addiction by eliminating a conditioned response to the drug19,20. Oral naltrexone has been used for alcohol and opioid dependence, but due to low compliance, poor retention rates in opioid assisted treatment programs and high risk for opioid overdose, an injectable formulation was manufactured (VivitrolÂŽ). Injectable naltrexone is dosed once every four weeks. Despite the change in formulation, limitations for use continue to exist due to a tedious detoxification phase prior to use. There is no set guideline on how to properly detoxify an opioid-addicted patient prior to starting naltrexone, but rather a set of pharmacologic approaches and treatment settings that can be customized to individual patient needs21. Once patients pass through the detoxification phase, retention rates improve tremendously and studies have shown non-inferiority to buprenorphine/naloxone14,22. An advantage of using naltrexone over methadone or buprenorphine is that it is not a controlled substance and there are less restrictions to physicians when prescribing11. In summary, the opioid epidemic in America has taken the lives of many people. Action has been taken to decrease the unnecessary supply of prescription opioids, but addicted individuals continue to search for other illicit substances to alle-

viate the cravings, such as heroin. Opioid addiction is a disease that may require a combination of medication and behavioral therapy. Commonly used medications are methadone, buprenorphine and naltrexone. These agents are used to prevent opioid abuse and subsequently overdose, which may occur. Patient-centered care should be utilized to make a decision on which agent to use for the purposes of medication-assisted treatment for opioid disorder. References

1. Courtwright DT. Opioid Addiction as a Consequence of the Civil War. Civil War History 1978;4:101-11. 2. Zhang S. The One-Paragraph Letter from 1980 That Fueled the Opioid Crisis. Health 2017. Accessed Feb 18, 2018.https:// www.theatlantic.com/health/archive/2017/06/nejm-letteropioids/528840/. 3. Center for Disease Control and Prevention. Understanding the Epidemic. 2016. Accessed Feb 18, 2018. https://www.cdc.gov/ drugoverdose/epidemic/index.html. 4. Compton WM, Jones CM, Baldwin TG. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. NEJM 2016; 374:154-63. 5. Lewis N, Ockerman E, Achenbach J, Lowery W. Fentanyl linked to thousands of urban overdose deaths. 2017. Accessed Feb 18, 2018. https://www.washingtonpost. com/graphics/2017/national/fentanyl-overdoses/?utm_ term=.0484e64e2c43. 6. Koob GF, Volkow ND. Neurocircuitry of Addiction. Neuropsychopharmacology. 2010;35(1):217-38. doi:10 7. Herman MA, Roberto M. The addicted brain: understanding the neurophysiological mechanisms of addictive disorders. Frontiers in Integrative Neuroscience. 2015;9:18. 8. Kakko J, Svanborg KD, Kreek MJ, Heilig M. 1 year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomized, placebo-controlled trial. The Lancet 2003;361:6628. 9. Winstock AR, Lintzeris N, Lea T. International Journal of Drug Policy 2011;22:77-81. 10. Hser Y-I, Saxon AJ, Huang D, et al. Treatment Retention among Patients Randomized to Buprenorphine/Naloxone Compared to Methadone in A Multi-site Trial. Addiction. 2014;109(1):7987. 11. Peddicord A, Bush C, Cruze C. A Comparison of Suboxone and Methadone in the Treatment of Opiate Addiction. J Addict Res Ther 2015; 6:4. 12. Pinto H, Maskrey V, Swift L, Rumball D et al. The SUMMIT Trial: a field comparison of buprenorphine versus methadone maintenance treatment. J Subst Abuse Treat 2010;4:340-52. 13. Baxter L, Campbell A, DeShields M, Levounis P et al. Safe Methadone Induction and Stabilization. Report of an Expert Panel. J Addict Med 2013; 7: 377-86. 14. Lee JD, Nunes EV, Novo P, Bachrach K et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicenter, open-label, randomized controlled trial. The Lancet 2017;391:309-18. 15. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 6, Methadone maintenance treatment. 16. Leavitt SB. Methadone Dosing and Safety in the Treatment of

Opioid Addiction. Forum 2003:1-8. 17. Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary care. J Gen Intern Med 2009;2:226-32. 18. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction 2004 19. Kjome KL, Moeller FG. Long-Acting Injectable Naltrexone for the Management of Patients with Opioid Dependence. Substance Abuse: Research and Treatment. 2011;5:1-9 20. Vivitrol (naltrexone for extended-release injectable suspension). Waltham, MA: Alkermes Inc; 2010. 21. Sigmon SC, Bisaga A, Nunes E, Oâ&#x20AC;&#x2122;Connor PG et al. Opioid Detoxification and Naltrexone Induction Strategies: Recommendations for Clinical Practice. Am J Drug Alcohol Abuse 2012;3:187-99. 22. Tanum L, Klemmetsbu S, Latif Z, Benth J et al. Effectiveness of Inejctable Extended-Release Naltrexone vs Daily Buprenorphine-Naloxone for Opioid Dependence. JAMA 2017;74(12):1197-1205.

Dr. Carol Motycka Dr. Carol Motycka graduated from the University of Florida with her Pharm.D. and completed a residency in Ambulatory Care at Florida Hospital in Orlando. After practicing at Florida Hospital for several years, Motycka joined the University of Florida to help build the College of Pharmacy program in Jacksonville. She is board certified in Ambulatory Care has completed fellowships in both leadership and education. Motycka has been published in multiple academic and clinical journals and has provided over 100 presentations in the field. She has received awards on the state and national level for her teaching, research, and leadership. Motycka is a strong advocate of the profession of pharmacy and serves the profession through public relations events in her community and professional organizations where she has served in multiple capacities including Speaker of the House for the Florida Pharmacy Association and President of Duval County Pharmacy Association. As assistant dean of the University of Florida College of Pharmacy Jacksonville Campus, Motycka spends her time teaching, completing research, advising and administrating. Dr. Geraldo Neziraj Dr. Geraldo Neziraj is from Jacksonville, Fla., and received his Doctor of Pharmacy degree from the University Of Florida College Of Pharmacy in 2017. He has worked in a community pharmacy for five years. His practice interests include internal medicine and ambulatory care. His research this year is evaluating the clinical impact of antimicrobial stewardship education/intervention on days of antimicrobial therapy for treatment of community-acquired pneumonia. Upon completion of his PGY1 residency, Geraldo plans to become board certified in pharmacotherapy and pursue a clinical position in internal medicine or ambulatory specialty pharmacy. For his PGY-1 grand rounds, Geraldo presented on acute pain management for patients on medication assisted treatment. The interest for this topic was spurred by his pain management rotations at UF Health Jacksonville. Geraldo continues to be vigilant about opioid use in the inpatient setting and closely monitors opioid orders for appropriate use. APRIL 2018

CALL FOR RESOLUTIONS TO THE 2018 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in May 2018 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is May 11, 2018! PLEASE NOTE THIS DEADLINE. The last day to submit items of new business is June 8, 2018.

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

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APRIL 2018

FLORIDA PHARMACY TODAY

APRIL 2018

FPA 128th Annual Meeting and Convention July 11-15, 2018 Bonita Springs, FL

55Daily Education Registration

Participant Information Participant Information

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

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

June 22

Onsite

Amount

FPA Member

$165

$185

$_______

Non Member

$215

$235

$_______

Member Technician

$65

$85

$_______

Non Member Technician

$90

$110

$_______

Handbooks

$40

N/A

$_______

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

Full Package Registration

Full package registration includes Educational Programs Thursday-Sunday, Exhibit Hall Friday and Saturday, and Awards Event on Saturday. Handbooks are not included in full package registration. Handouts will be available on our website, www.pharmview.com, the week of the convention. Before June 22

Onsite

Amount_

FPA Member

$345

$430

$_______

Non Member

$525

$610

$_______

Pharmacist BEST Value

$540

$625

$_______

Member Technician

$155

$185

$_______

Non Member Technician

$175

$210

$_______

Technician BEST Value

$185

$220

$_______

Student

$150

$170

$_______

Guest (no CE)

$160

$_______

Guest Name_ Handbooks

_______ $40

__ N/A

$_______

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



House of Delegates (Thursday)



Exhibit Hall (Friday and/or Saturday)



Awards Event (Saturday)



I will not attend any of these functions.

Before June 22

Additional Tickets

Quantity

Price

Amount

Exhibit Hall

@ $30

$______

Awards Event

@ $80

$______

Special Events Registration

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

Price

Amount

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

$_____

Christian Fellowship

$_____

_________

@ N/C

(Complimentary event, indicate if attending)

_________

Quantity Price 

@ $50

$_____

FPA Polo Shirt (Deadline is June 8, 2018) Yes

______ @ $35

Payment

M/F ______

Size ______

Amount $_______

Total Enclosed: $______

Check (To: FPA) AMEX Discover MasterCard Visa Account # ____________________________________________

$35

Onsite

Amount

$50

______

Billing Address ________________________________________ Signature ____________________________________________

Four Ways to Register

Sunday

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

Mail: FPA, 610 North Adams Street, Tallahassee, FL 32301 Phone: 850-222-2400 Fax: 850-561-6758 Web: www.pharmview.com 24

Saturday

Security Code _________________ Expiration Date __________

House of Delegates

House of Delegates (Non-convention registrants)

Friday

Student Awards Event

(BEST Value includes Registration & Membership)

Before

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Schedule Subject to Change

Pharmacy

Tomorrow. Imagine That.

phmic.com

All products may not be available in all states and territories.

APRIL 2018

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 & Associates, PLLC 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. 26

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