FEB. 2022
FTC STUDIES PBM ANTICOMPETITIVE PRACTICES AND ITS IMPACT ON HEALTHCARE PRACTICE AND PATIENT OUTCOMES
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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 Presidential Viewpoint 7 Executive Insight 9 Call for Resolutions 14 Call for Abstracts
VOL. 85 | NO. 2 FEBRUARY 2022 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION
Features
10
Tailored Pharmacy-Based Interventions
13
Covid-19 Vaccines and the VAERS
16
Pharmacists’ Role in Identifying and Addressing Healthcare Disparities
FPA Board of Directors
Daniel Buffington......................................... President and Interim Board Chair Carol Motycka...................................................................................President Elect Elias Chahine................................................................................... FSHP President Alexander Pytlarz.................................................................Speaker of the House Verender Brown........................................................................Technician Director William Mincy............................................................................................ Treasurer Kimberly Jones...................................................................................... Vice Speaker Joyanna Wright.............................................................................Region 1 Director Tejas Patel.......................................................................................Region 2 Director Matt Schneller..............................................................Region 3 Director (Interim) Cheryl Rouse.................................................................................Region 4 Director Bob Parrado...................................................................................Region 5 Director Katherine Petsos...........................................................................Region 6 Director Paul Delisser..................................................................................Region 7 Director Carmen Aceves Gordon..............................................................Region 8 Director Goar Alvarez.................................................................................Region 9 Director Michael Jackson......................................................................................EVP & CEO FEBRUARY 2022
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Mission Statements:
FPA Calendar 2022
MARCH 11
Last Day of Legislative Session
13
FPA Board of Directors Meeting
18 - 21 APhA Annual Meeting San Antonio, Texas APRIL 1
Point-of-Care Test and Treat Certificate Program Grand Hyatt Tampa
2-3
Geriatric Conference (Hybrid meeting) Grand Hyatt Tampa
13-14
FL BOP Meeting
15
Good Friday, FPA Office Closed
24-26
NASPA Leadership Retreat San Antonio, Texas
MAY 11
Last day to submit Resolutions for the House of Delegates
18
House of Delegates Board of Directors Zoom Meeting JUNE
8
Last day for delegate registration FPA House of Delegates
8
Last day to submit items of new business
15-16
Florida Board of Pharmacy Meetings (Subject to approval) JULY
6-10
132nd Annual Meeting and Convention Ft. Lauderdale
4
Independence Day, FPA Office Closed
31-3
39th Annual SE Gatherin' Destin
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 two-hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. The Reducing Medication Errors course is needed for pharmacists and technicians. Pharmacists should have satisfied all continuing education requirements for this biennial period by Sept. 30, 2023, or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by Dec. 31, 2022. For the 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.floridapharmacy.org CONTACTS FPA — Tian Merren-Owens (850) 222-2400 FSHP — Tamekia Bennett (850) 906-9333 UF — Emely McKitrick (352) 273-5169
FAMU — Dr. Selika Sampson (850) 599-3301
Note: The views of the authors do not necessarily represent the views or opinions of the Florida Pharmacy Association, Florida Pharmacy Today or any related entities.
Florida Pharmacy Today Journal The Florida Pharmacy Today Journal is a peer-reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.
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.
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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.
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FLORIDA PHARMACY TODAY
EMAIL YOUR SUGGESTIONS/IDEAS TO dave@fiorecommunications.com
Presidential Viewpoint BY MICHAEL JACKSON, RPH DANIEL E. BUFFINGTON, PHARMD, MBA, FAPHA
The United States Federal Trade Commission (FTC): Preparing to Study PBM Anticompetitive Practices and Its Impact on Healthcare Practice and Patient Outcomes
T
he connection between patients, pha r mac ist s, a nd hea lt h insurance companies is often clouded and negatively impacted by companies and software platforms referred to as Pharmacy Benefit Managers (PBM). These unregulated compa n ies apply cont rac t ua l mechanisms that regulate the cost and access to medications, and many even create unsupportable chargebacks or penalties as part of more global profiteering across healthcare entities. Ma ny of t hei r u n s c r upu lou s practices include withholding future payments, even after medications have been dispensed and payment claims have been adjudicated. This practice is built into their contracts, and it financially hurts healthcare providers and patients. These fees are modeled after a program implemented by the Centers for Medicare and Medicaid Services (CMS) called “Direct” and “Indirect” Remuneration (DIR) fees. However, even CMS has called out
commercial PBMs for misapplication and overutilization of these fees as unsupported late chargebacks. States across t he cou nt r y are studying the inappropriate business practices and negative fiscal impact of PBMs and increasing the level of regulatory oversight to apply controls focused on their predatory behaviors. Unregulated and allowed to continue, these PBM practices will continue to increase healthcare costs and create fewer points of access for patients and pharmacists. In many cases, PBMs strive to commandeer prescriptions away from local pharmacists and drive patients to utilize their corporately owned mail-order centers instead. Th is produces a break i n t he pha r mac i st-pat ient relat ion sh ip and increases the risk for adverse outcomes and failure to identify critical medication-related problems that can be identified at the point of care in a pharmacy practice setting. In 2003, the U.S. Congress urged the
Daniel E. Buffington, PharmD, MBA, FAPhA
Federal Trade Commission (FTC) to investigate and study the trends in PBM practices with the “Medicare Prescription Drug, Improvement, and Modernization Act.” Based on the proliferation of PBM profiteering and predatory
Lina M. Khan, Federal Trade Commission Chair, led the open commissioner meeting on February 17, 2022, which discussed a proposed study on Pharmacy Benefit Managers’ (PBMs) relationship with affiliated and independent pharmacies. FEBRUARY 2022
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Presidential Viewpoint, from Page 5
contracting models, there have been further regulatory efforts, through the Prescription Pricing for the People Act of 2021,” which requires the FTC to study PBMs and evaluate their impact on pharmacy practice and patient care outcomes. In addition, healthcare stakeholders and patient advocates have generated multiple public protests that are helping to drive a sense of urgency for the auditing of dangerous PBM practices. On February 17, 2022, the FTC held an open commission meeting to review the design and objectives of a proposed PBM study. Unfortunately, the proposed study summary was submitted late on the day prior to the meeting, which did not allow sufficient time to assess the study outline and gauge healthcare stakeholder concerns. The commission is designed to be comprised of five members but currently operates with four members while awaiting the appointment of the fifth commissioner by the U.S. president. During this meeting, there was compelling testimony from many national healthcare organizations, including American Pharmacists Association (APhA), Communit y Oncology Alliance (COA), and the American Pharmacy Cooperative (APC). Scott Knoer, EVP/CEO of APhA testified, “While we support a new study, we already have mountains of data from Medicaid and commercial plans on PBMs’ uncompetitive and deceptive trade practices that target patients with chronic conditions and force them to use PBM-owned specialty, mail order, and network pharmacies. The FTC should take action now, follow-the data, and break them up!” The commission vote was 2-2, expressing the need to ensure that the study is designed properly to a id i n ma k i ng f ut ure dec ision s regarding ways to enhance future PBM regulations. A stalemate at this point should not be interpreted as a setback toward future PBM regulations. Instead, it should be viewed as an opportunity to ensure that the upcoming audit is designed 6 |
FLORIDA PHARMACY TODAY
to reveal the diverse ways that PBMs can manipulate and disproportionally divert prescription funding toward their excessive personal gain as opposed to improving healthcare quality and outcomes. The FTC Chair stated, “I have to say I’m really disappointed by this outcome. I think we’ve now for months been building a record with testimony from both patients and pharmacies alike, underscoring the real urgency and lifeand-death stakes in some instances, of this work. I see this as an area where we have a real moral imperative as an agency to act given the authority that Congress has given us. I think this inquiry is long overdue and just one of the many actions that I hope this agency will undertake in this sector.” The commissioners who voted “no” on the proposed study also articulated significant support for pursuing a study into PBM practices but were concerned about the short amount of time to prepare for the meeting and want to ensure the proper scope and design of any proposed audit or study. During the closing statements, Commissioner Christine Wilson outlined additional questions that should be answered. “I cer ta i n ly have quest ion s I wou ld l i k e a n swer ed. How do patient experiences including price, qualit y, convenience, and access vary depending on whether their pr e s c r ipt ion s a r e d i sp e n s ed at independent pharmacies or PBM affiliated pharmacies? What factors d r ive for mu l a r y de sig n? Wh at mechanisms do manufacturers use to disincentivize PBMs from placing their rivals on formularies?” Independent pharmacies are much smaller entities compared to their larger chain pharmacy counterparts. In addition, some PBMs now own larger pharmacies and the fairness of their fee schedules comes into question when discussing how smaller pharmacies are reimbursed in comparison to PBMowned pharmacies. Many independent pharmacy owners are stating that it is becoming increasingly difficult to maintain a competitive business model.
Independent pharmacies are also being selectively disadvantaged by the use of direct and indirect remuneration fees (DIR) or penalties. PBMs have been found setting disparate pricing models for their competitors, typically smaller pharmacies, favoring their own economic advantage. In addition, PBMs often restrict patient access to critical medications and supplies, by limiting their choices of pharmacists and pharmacies. These anti-competitive and monopolistic practices are leading to decreased access to care for patients and economic disadvantages for many pharmacies and pharmacists. While it seems like a setback for the timely need for a government study into PBM practices, it’s important to note that even the two commission members who voted no at this meeting expressed their support to see a future study designed and completed properly to fully understand the impact of these companies on the patient care outcomes and their potential negative impact on the future viability of pharmacy practice in the United States. It is imperative for healthcare entities and practitioners to track and support the FTC’s ongoing commitment to implementing a comprehensive study of PBM practices that can reform and remedy the hemorrhaging of essential healthcare funding. It’s time to educate the public and the media about the importance and clinical value of pharmacist-patient relationships and to ensure a fair and equitable healthcare marketplace for providers and patients alike. n
Executive Insight BYRETIRED MICHAEL JACKSON, RPH PHARMACY ASSOCIATION MICHAEL JACKSON, BPHARM, EVP & CEO, FLORIDA
F
History is Being Made in Pharmacy
lorida Pharmacy Today is a monthly publication of articles of interest to the profession of pharmacy in Florida. Since the 1930s it has been a media production of current events that our member stakeholders would take an interest in. It is also a valuable historical reference and chronological collection of the significant changes that we see in pharmacy. For this issue, we are proud to share with our members that something wonderful is happening. Florida has a long history of producing state and national leaders in government, academia, the nonprofit community as well as our profession. FPA members have run and are continuing to run for political office. We also have had members who have served on Boards and in leadership of many of our national pharmacy organizations. The American Pharmacists Association is the largest association of pharmacists in the United States and is the only organization advancing the entire pharmacy profession. Headquartered in The Mall in Washington, D.C., it is the organization involved in pharmacy advocacy, continuing professional development and promotion of patient care services on a national level. APhA’s mission as published on its website is to inspire, innovate, and create opportunities for members and pharmacists worldwide to optimize medication use and health for all. Since its founding in 1852, there have been two Florida pharmacists who have served as president. One is R. Q. Richards (FPA President 1937-1938) and who the FPA’s award for outstanding achievement in public relations is named after. R. Q. Richards was also the secretary manager for the FPA from 1940 until 1968.
The second Floridian to serve as APhA president is Ed Hamilton of Lake Alfred, Florida. Ed served as president of the FPA in 1990 – 1991. During the APhA annual meeting in San Antonio in March, transition of APhA leadership will pass on to a third Floridian. Grant,
Theresa Tolle will be seated as president for 2022-2023. It is befitting that this takes place in March during the nationally celebrated National Women’s History Month. Florida, pharmacist Theresa Tolle will be seated as president for 2022-2023. It is befitting that this takes place in March during the nationally celebrated National Women’s History Month. So, who is Theresa Tolle? If you are from Florida, or if you are involved in national pharmacy organizations, you would not have to ask that question. Just in case there are a few of you reading this magazine who do not know Theresa, I have the honor of making this introduction. Theresa Wells Tolle has her roots in Northwest Florida having graduated f rom Ch ipola Ju n ior College i n Marianna. She is a 1988 graduate of the University of Florida College of Pharmacy in Gainesville. She is
Michael Jackson, B.Pharm, CPh EVP & CEO
the owner of Bay Street Pharmacy. Her many recognitions and awards received include but are not limited to the Al Tower Philanthropy Award from the Florida Pharmacy Foundation, Ken Wurster Community Leadership Award, Cardinal Health, Sebastian’s Woman of the Year, Jean Lamberti Leadership/Mentorship Award, IPA Roman Maximo Corrons Inspiration and Motivation Award, Bowl of Hygeia Award and numerous President’s Awards of Excellence. She is also a fellow of the American Pharmacists Association. Theresa has also received t he James H. Beal (now the Beal and Powers) Pharmacist of the Year award, Distinguished Pharmacy Service Alumnus from the University of Florida, Good Government Pharmacist of t he Year from APhA, Sidney Simkowitz Pharmacist Involvement Award and t he Brevard Count y Pharmacy Association Pharmacist of
Executive Insight, continued on page 8 FEBRUARY 2022 |
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Executive Insight, from Page 7
FPA STAFF Director of Continuing Education Tian Merren-Owens, ext. 120
Continuing Education Coordinator Stacey Brooks, ext. 210 Coordinator of Membership Ranada Howard, ext. 110
FLORIDA PHARMACY TODAY BOARD Chair....................David Mackarey, Boynton Beach Vice Chair................................... Matt Schneller, Tampa Treasurer.................................... Eric Jakab, Gainesville Secretary............................. Julie Burger, Pensacola Member.........................Michael Finnick, Jacksonville Member....................... Carol Motycka, Jacksonville Member............................Teresa Tomerlin, Rockledge Member...................................... Greta Pelegrin, Hialeah Technician Member..........Julie Burger, Pensacola Executive Editor.......Michael Jackson, Tallahassee Managing Editor...................Dave Fiore, Tallahassee Journal Reviewer........................... Dr. Melissa Ruble Journal Reviewer....................................Dr. Angela Hill This is a peer-reviewed publication. . ©2022 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 ASSOCIATION
610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web address: www.floridapharmacy.org.
the Year. Currently, she is serving as the treasurer of the Florida Pharmacist Political Committee and has been active on many councils and committees of the FPA, APhA and NCPA. Add to her resume the role as luminary for the Community Pha r mac y En ha nced Ser v ices Network (CPESN) and you will have a brief description of who this very active health care professional is. I can only add that her husband and partner in life, Joe Tolle, has been a great friend to pharmacy and to our state and national organizations by supporting this very fascinating health care professional as she guides us through the many issues facing pharmacy. It has been truly a special honor working with Theresa over the years and also working with two of the three Floridians who were given the honor of being seated at the senior table of leadership for the pro-
fession of pharmacy in the U.S. I call on all of our readers of this month’s Journal to extend our hand in support of the 2022-2023 management team at APhA. Let’s show the nation that Florida is behind our home-grown leaders. When the call for action comes in (and it will), answer with enthusiasm a nd suppor t. Sha re w it h ou r colleagues who may not be engaged and press them to become active members of both the FPA and APhA. We have one of our own at the decision table, and giving Theresa Tolle our full support can make a huge difference. If you could not make it to San Antonio for the APhA meeting, mark your calendar for March 24 – 27, 2023, and plan to attend APhA2023 in Phoenix, Arizona. n
JOIN TODAY!
CALL FOR RESOLUTIONS TO THE 2022 HOUSE OF DELEGATES The House of Delegates is now accepting resolutions for 2022. The last day to submit resolutions is May 11, 2022. 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
FEBRUARY 2022
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Tailored Pharmacy-Based Interventions Source: Centers for Disease Control and Prevention
In The Community Guide, the Community Preventive Services Task Force (CPSTF) recommends tailored pharmacy-based interventions to support adherence to medications prescribed to prevent cardiovascular disease (CVD). The CPSTF found these interventions to be cost-effective for preventing CVD. The Surgeon General’s 2020 Call to Action to Control Hypertension also encourages the use of supportive strategies for medication adherence, including pharmacists as integral members of hypertension care teams. Public health practitioners and state and local health departments can support use of the CPSTF recommendation by promoting and helping pharmacies implement tailored pharmacy-based interventions. Tailored pharmacy-based interventions aim to help patients who are at risk for CVD take their medications as prescribed. Interventions include the following: ■ Assessment—Interviews or assessment tools are used to identify adherence barriers. ■ Tailored guidance and services—A pharmacist use the results obtained from the patient’s assessment to develop and deliver tailored guidance and services that aim to remove or reduce identified barriers. Important Definitions Medication nonadherence is when a patient does not take a prescribed medicine or follow the provider’s instructions for taking the medicine. Barriers that prevent patients from taking their medications can appear at the patient, provider, or health system level. Nonadherence is associated with uncontrolled blood pressure and higher rates of hospital admissions. The Pharmacists’ Patient Care Process was established by the Joint Commission of Pharmacy Practitioners to help pharmacists deliver patient care and services in a consistent way. ■ Tailored guidance includes focused medication counseling or motivational interviewing sessions. ■ Tailored services include one or more of the following: patient tools, such as pillboxes, medication cards, and calendars; medication refill synchronization; and enhanced follow-up. Interventions may be set in community or health system pharmacies. They may include additional components, such as patient education materials or communication between the pharmacist and the patient’s primary care provider. Interventions may be used alone, or as part of a broader intervention to reduce patients’ cardiovascular disease risk. Tailored pharmacy-based interventions address barriers to medication adherence by examining the factors that affect a person’s ability to take their medications. These barriers may 10
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be complex and include factors related to socioeconomics, health care system structures and processes, severity of cooccurring medical conditions, complexity of medication and nonmedication therapies, and patient concerns. Factors that affect a patient’s medication adherence may include: ■ Medication cost. ■ Busy schedules that make it hard to remember to take medications consistently. ■ Ease of scheduling appointments. ■ Time needed to schedule and attend appointments. ■ Ease and comfort level of communicating with the pharmacist or other providers. ■ Understanding when and how often to take medications. ■ Ability to sync medications and receive automated 30-day or 90-day refills. ■ Health condition severity and beliefs about their condition. ■ Expectations around possible effects of the medication. These factors may be intensified by a lack of health care and pharmacy access in the community; lack of trust and effective communication with providers; and limited patient involvement in shared decision-making. Studies have shown that patients who were adherent to their antihypertensive medications were 30% to 45% more likely to achieve blood pressure control compared to those who were not. Nonadherence to medications to prevent CVD has been associated with a significant increase in the risk of premature death from any cause, CVD death, hospitalization for heart attack or heart failure, and coronary revascularization procedures. Strategies that Support the Pharmacists’ Patient Care Process and Tailored PharmacyBased Interventions The Joint Commission of Pharmacy Practitioners developed the Pharmacists’ Patient Care Process to address medication nonadherence for chronic diseases. Steps in the process (collect, assess, plan, implement, follow-up, and monitor) closely align with how a pharmacist selects tailored actions to remove or reduce patient adherence barriers. Use the tools and resources below to help identify patient populations, assess facilitators and barriers, and implement the interventions. Tailored, pharmacy-based interventions may be implemented as one component of the broader. Strategies that support the Pharmacists’ Patient Care Process include medication therapy management, the appointment-based model, collaborative practice agreements, and text messaging.
■
■
■
■
Medication therapy management (MTM) includes a broad range of health care services provided by pharmacists—the medication experts on a patient’s health care team. It allows pharmacists to actively manage patients’ medications and identify, prevent, and resolve medication-related problems. This support helps patients get the most benefit from their medications. MTM services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs, and many other clinical services. The appointment-based model (ABM) is a patientfocused care model that can help patients take their medications, make a pharmacy’s workflow more efficient, and prevent problems before patients arrive at the pharmacy. Patients enrolled in the ABM have a designated appointment day to pick up all medications. Pharmacy staff call patients before their appointment to identify any changes to their medications and confirm that each prescription should be refilled. The ABM shifts the pharmacy staff’s focus from passively filling prescriptions at the request of the patient on an unaligned schedule to proactively synchronizing a pick-up date for chronic medicines. Staff also review the patient’s medications each month to ensure that they are getting the correct medications and to identify any potential problems. A pharmacist collaborative practice agreement (CPA) is a formal agreement between prescriber(s) and pharmacist(s). A CPA allows licensed health care providers to make diagnoses, supervise patient care, and refer patients to pharmacists. Pharmacists are then allowed to perform specific patient care functions, such as renewing prescriptions, modifying medication therapy according to the protocol, and ordering lab tests. Text messaging is available on mobile devices and is used widely by people in all age and socioeconomic groups. It can be used to communicate health information to patients to improve medication adherence.
Considering the Costs and Benefits of Implementation The CPSTF found these tailored pharmacy-based interventions to be cost-effective in preventing CVD among patients with CVD risk factors. They also found evidence that among patients with existing CVD, the cost savings from averted health care exceeded the costs of implementation. CVD is a major driver of health care costs in the United States—with over $363.4 billion going toward health care services, medications, and lost productivity due to premature death each year. The implications of medication nonadherence are widespread and have financial impacts on health systems, providers, payers, and most importantly, patients. In the United States, the costs of nonadherence to prescribed medications are high and place significant financial strains on the health care system as a whole.
MEDICATION NONADHERENCE IS ASSOCIATED WITH WORSE HEALTH OUTCOMES AND HIGHER HEALTH CARE COSTS AMONG PEOPLE WITH CVD OR CVD RISK FACTORS. Medication nonadherence is associated with worse health outcomes and higher health care costs among people with CVD or CVD risk factors. In one study, higher adherence to prescribed medications for congestive heart failure, high blood pressure, and high LDL cholesterol levels reduced annual health care spending per person by an estimated $7,800, $3,900, and $1,250, respectively, compared to patients with poorer adherence. Tailored pharmacy-based interventions to improve medication adherence among patients with CVD risk factors help address growing health care costs. These interventions lead to cost savings from reductions in outpatient primary care and specialist visits, hospitalizations, and emergency department use. The full economic impact of implementing these interventions for key partners and participants involved in the delivery, payment, and receipt of these interventions have been largely unexplored by researchers. As state and local health departments consider introducing or expanding these interventions in their communities, an important first step is to recognize and convene partners involved in implementing the interventions to ensure greater efficiencies, better health, and cost savings. By considering each key player’s role in terms of potential costs and benefits, state and local health departments and their partners may better understand how each may facilitate their implementation and be affected by them.
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CDC and Partner Tools and Resources Identify ■ Identify patient populations that need help. For example, practitioners and health departments canMap populations with high medication nonadherence rates. ■ Measure medication adherence in a population with high blood pressure. The proportion of days covered (PDC) is the leading method used to calculate medication adherence at the population level. A population is considered adherent if 80% of people have access to their medications for at least 80% of days in a defined study period (e.g., 80% of 365 days). These tools and resources can help public health practitioners and state and local health departments identify patient populations that need help. Assess Assess facilitators and the barriers to implementing tailored pharmacy-based interventions. For example, practitioners and health departments can ■ Identify pharmacies that offer tailored pharmacy-based interventions or supporting strategies or pharmacies that are interested in implementing these services.
■
Determine what factors help patients access and enroll in pharmacies that provide MTM, ABM, or medication synchronization—and what factors prevent access.
These tools and resources can help public health practitioners and state and local health departments assess facilitators and the barriers to implementation. Act Act to implement tailored pharmacy-based interventions with strategies that complement the CPSTF recommendation. For example, practitioners and health departments can ■ Share information with pharmacy partners and support ABM and medication synchronization. ■ Promote team-based care through MTM and other tailored pharmacy-based interventions. These tools and resources, in addition to those available through The Community Guide, can help public health practitioners and state and local health departments implement tailored pharmacy-based interventions.
Interested in How the Florida Pharmacy Association Works? Members can access the FPA Articles of Incorporation, Constitution and Bylaws anytime on the association website. Visit https://www.floridapharmacy.org/page/Organiz-governdocs or simply go to www.floridapharamcy.org and from the menu go to "About FPA" "Leadership and Governance" - then select "Constitution, Bylaws, Policies & Procedures.”
We encourage members to get familiar with FPA governance – especially if it prompts you to get more involved!
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Covid-19 Vaccines and the VAERS By William Garst
In early June of this year, I wrote about vaccines and the VAERS (Vaccine Adverse Event Reporting System). At that time, the Covid-19 pandemic was making a big impact, but the vaccines were only in development. Now that the first Covid-19 vaccines have been released I thought it would be a good idea to revisit the topic. William Garst, The purpose of vaccines is to stimulate Pharm.D. the production of antibodies. Vaccines are Consultant defined as biological preparations that Pharmacist provide active acquired immunity to a particular infectious disease. Vaccines have been responsible for the worldwide eradication of smallpox and the restriction of diseases such as polio, measles, and tetanus from much of the world. Currently the World Health Organization (WHO) reports that there are twenty-five vaccines for different preventable infections. Vaccine types include: inactivated, attenuated, toxoid, subunit, conjugate, heterotypic, and mRNA (messenger ribonucleic acid). There are also several experimental vaccine types currently being researched. The Covid-19 vaccines are the first mRNA vaccines to be licensed for mass vaccination programs. The vaccines were licensed because they were shown to be highly effective (greater than 90%) and to cause few adverse effects in their clinical trials. However, there is interest in observing the administration of these vaccines to millions of people because even though most adverse reactions can be detected in thousands of patients in clinical trials, sometimes there are adverse reactions that are so rare they cannot be detected until many people have been exposed to the product. The Covid-19 vaccines are of this new type, mRNA, and it is important that reports of reactions be collected. This is where the VAERS is so significant. The VAERS was established in 1990 and managed jointly by the CDC and the FDA. It is meant to be an “early warning system” for providers and researchers to identify possible unforeseen reactions or side effects of vaccinations. The VAERS is similar to the MedWatch Program that collects reports of drugs and medical devices and other products such as supplements, cosmetics, medical foods, and infant formulas. However, the VAERS only collects reports regarding vaccines. Similar to the MedWatch Program, individual patients can report directly to the VAERS through their website https:// vaers.hhs.gov/. It only takes a few minutes to complete the form online, and there is a printable PDF form that can be filled out or one can email them at info@VAERS.org or call 1-800-822-7967. Here is a direct quote from the CDC.gov website: “CDC and FDA encourage the public to report possible side effects (called adverse events) to the Vaccine Adverse Event
VACCINES HAVE BEEN RESPONSIBLE FOR THE WORLDWIDE ERADICATION OF SMALLPOX AND THE RESTRICTION OF DISEASES SUCH AS POLIO, MEASLES, AND TETANUS FROM MUCH OF THE WORLD. CURRENTLY THE WORLD HEALTH ORGANIZATION (WHO) REPORTS THAT THERE ARE TWENTY-FIVE VACCINES FOR DIFFERENT PREVENTABLE INFECTIONS. Reporting System (VAERS). This national system collects these data to look for adverse events that are unexpected, appear to happen more often than expected, or have unusual patterns of occurrence. Learn about the difference between a vaccine side effect and an adverse event. Reports to VAERS help CDC monitor the safety of vaccines. Safety is a top priority.” Common side effects of the immunizations appear to be mild and should subside after a few days. Reporting to VAERS will be an important process and I encourage all who receive the vaccine to report any untoward reaction even if it is mild. It is beneficial to us all to collect as much data as possible. Stay informed and stay healthy. William Garst is a consultant pharmacist who resides in Alachua, Florida. He received his bachelor’s degree in pharmacy from Auburn University in 1975. He earned a master’s degree in pharmacy from the University of Florida in 2001. In 2007, he received his doctor of pharmacy from the University of Colorado. Dr. Garst is a member of many national professional associations as well as the local Alachua County Association of Pharmacists. He serves on the Alachua County Health Care Advisory Board. He works part-time at the UF Health Psychiatric Hospital and retired from the VA in 2016. Dr. Garst enjoys golf, reading (especially history) and family. He writes a blog called The Pharmacy Newsletter (https://thepharmacy newsletter.com). He can be contacted at communitypharmacynewsletter@gmail.com.
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CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS FLORIDA PHARMACY ASSOCIATION 132nd ANNUAL MEETING AND CONVENTION
July 6-10, 2022 Marriott Harbor Beach Resort ♦ Ft. Lauderdale, Florida Poster Session: Friday, July 8, 2022 ♦ 11:00AM-1:00PM COST ONE DAY REGISTRATION The FPA Poster Presentations are open to PHARMACISTS, RESIDENTS, STUDENTS, AND TECHNICIANS. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Friday, May 6, 2022. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to:
PLEASE TYPE
Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association 610 N. Adams Street Tallahassee, FL 32301 tmerren@pharmview.com
Contact Information: Presenter's Name: _______________________________________________________________________________ □ Pharmacist
□ Resident
□Student
□ Technician
Address: ________________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ College of Pharmacy: _____________________________________________________________________________ Abstract Title: ____________________________________________________________________________________ Poster Type:
□ Basic Science Research □ Best Practice □ Clinical Research □ Literature Review □ Translational Research (Basic Science and Clinical Research)
Primary Author: __________________________________________________________________________________ (Presenter will be notified by mail of acceptance). Co-Author(s): ____________________________________________________________________________________ Awards:
Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)
ABSTRACT FORMAT The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions. Abstracts will not be accepted if they are not in this format. Do not include figures or graphs.
Please direct all questions and concerns to: Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com DEADLINE DATE: FRIDAY, MAY 6, 2022
Protect your patients. Protect your pharmacy. ERRORS CA N IN JURE PATIENTS A N D PUT YOUR PHARMACY IN F I NANCIAL JEO PARDY.
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Learn more at www.medicationsafety.org or call us at (866) 365-7472. The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO). F E B R U A R Y 2 0 2 2 | 15
Pharmacists’ Role in Identifying and Addressing Healthcare Disparities By Yasmin George 4th Year Doctor of Pharmacy Candidate FAMU College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health Ph a r mac i st s a r e a nec e s sit y when it comes to identifying and addressing health care disparities in their communities, especially those in the retail and hospital sectors. It is noted that approximately 80 percent of Black and Latino populations reside in major cities, however, pharmacies are closing at exponential rates in these communities.1 A study conducted by HealthAffairs recalled that "26.7 Yasmin George percent of white and 28.2 percent of diverse neighborhoods were pharmacy deserts, compared with 38.5 percent and 39.5 percent of Black and Hispanic/ Latino neighborhoods, respectively." 2 This divide is one of the primary causes of health disparities regularly observed in minority neighborhoods today. As pharmacists, it is important to acknowledge that the services that we provide makes us the most accessible health care profession and allows us to play an instrumental role in improving access to quality health care for all. Due to the lack of access to quality care in certain communities, pharmacists must create innovative ways to reach their communities. The National Association of Chain Drug Stores (NACDS) noted that 92 percent of Americans reside within 5 miles of a community pharmacy.3 While this statistic sounds exceptional to most, for many patients, 5 miles is not a realistic journey for them to trek to receive access to quality health care. Many patients in rural and urban areas may not have the transportation or time to visit these pharmacies, and if they do, due to strategy, these pharmacies are often provided with a limited formulary causing patients to be advised to seek help elsewhere. This is where the role of the health disparities-aware pharmacist is essential. Throughout recent years, pharmacists have implemented free medication delivery services, enrolled as 340B hospitals, began collaborating with other healthcare professionals, and implemented "wellness on wheels" programs. Many owners of independent pharmacies serving underserved, primarily minority populations, have home delivery programs in place that operate simply through text message. This service allows patients without adequate transportation the opportunity to receive their medications on time, leading to positively enhanced health outcomes. 340B hospitals “enable covered entities to stretch scarce federal resources as far as possible, reaching more eligible 16
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patients and providing more comprehensive services.” 4 Hospitals enrolled in 340B programs receive outpatient medications at a discounted cost from manufacturers involved in Medicaid programs. The capital saved by these hospitals grants them the freedom to provide health services to underserved populations. For example, a 340B hospital in Illinois uses its financial savings to aid its community by developing programs assisting with housing and transportation, educating students from kindergarten through college about careers in health care, and partnering with local non-profit organizations to increase affordable, healthy food access in known food deserts.5 Pharmacists began enrolling in collaborative practice agreements with physicians as a way to improve patient health and reduce treatment and medication costs.
DUE TO THE LACK OF ACCESS TO QUALITY CARE IN CERTAIN COMMUNITIES, PHARMACISTS MUST CREATE INNOVATIVE WAYS TO REACH THEIR COMMUNITIES. In many underserved and minority communities, pharmacists also work with nurses, physicians, and social workers as integral members of an interprofessional team. When pharmacists are dispersed throughout interprofessional healthcare teams this limits the cost and number of trips patients must take to visit their healthcare providers, by having each team member in one consolidated location.6 When healthcare professionals are interconnected, the number of medication errors decreases along with mortality rates. In a study conducted by a health clinic in Minnesota, it was proven that the addition of a pharmacist to an interprofessional health care team improved drug therapy outcomes by 24 percent.7 Many pharmacies around the country have implemented "wellness on wheels/WOW'' programs, or the use of automobiles driving throughout communities offering free blood glucose, blood pressure, cholesterol, and HIV testing. In April of 2009, Walgreens partnered with the American Association of Retired Persons (AARP) to conduct free health tests throughout the United States and its territory of Puerto Rico under a program named, "AARP/Walgreens Way to
Well Tour." This pharmacy-led tour conducted blood pressure, body mass index (BMI), cholesterol, glucose, waist circumference, and bone density testing throughout underserved neighborhoods while providing educational materials to all patients.8 Throughout this tour, the WOW bus changed lives in over 3,000 communities who previously lacked access to adequate health care services; like Dr. Richard Logan, owner of Logan & Seiler, Inc L&S Pharmacy in Charleston, Missouri said, “the best health care system in the world is of no use to a patient who cannot access it.” 9 The lack of proximity to pharmacies for most minorities is directly correlated to the decreased vaccination rates commonly seen in these populations and recently brought to light in wake of the ongoing COVID-19 pandemic. Due to this, President Biden implemented a "Shots at the Shop" initiative where health care professionals and students visit Blackowned hair salons and barbershops throughout their neighborhoods to offer vaccinations in a safe space for community members.10 With this initiative, more community members received their COVID-19 vaccinations in comparison to driving or taking public transportation to a pharmacy surrounded by unfamiliar faces. Knowing healthcare professionals are planning to be at comfortable, trusted locations administering vaccines puts many community members at ease. Pharmacists also improve health disparities by enhancing the health literacy rates of their patients. A study conducted by the United States Department of Health and Human Services (HHS) concluded that only 12% of Americans displayed proficient health literacy levels.11 Due to the majority of Americans displaying an average or below-average literacy level, the risks of medication errors increases and eventually leads to poor health outcomes. Pharmacists can aid in closing the literacy gap by first, acknowledging that it exists, reducing their use of medical jargon, using the "teach-back" method, and distributing easy-to-navigate pill cards to patients having a difficult time comprehending essential aspects of their medications. Pharmacists play a role in acknowledging health disparities by closing the language barrier gap. In 2018, 67.3 million United States residents reported not speaking English at home, with 30 percent of people located right here in Florida.12 As a way to close the language barrier gap and increase patient understanding of prescribed medications, pharmacies have implemented multilingual medication labels and medication leaflets. With the inclusion of multilingual labels, the percentage of potentially harmful and fatal medication errors decreases amongst minority populations. As a prospective member of the pharmacy profession, I find it essential to acknowledge the disparities touching our communities. As a healthcare professional, I seek to be well-rounded by devising various ways to communicate to non-English speaking patients and initiating programs and services that will positively impact my community. As a pharmacist, it is paramount to begin addressing these health care disparities and identifying our role in improving access to quality health care for all. References:
1. Guadamuz JS, Qato DM, Wilder JR, et al. University of Southern California Schaeffer. Fewer Pharmacies in Black and Hispanic/Latino Neighborhoods Compared with White or Diverse Neighborhoods, 2007-2015. https://healthpolicy. usc.edu/research/fewer-pharmacies-in-black-and-hispaniclatino-neighborhoods-compared-with-white-or-diverseneighborhoods-2007-15/ Published May 3, 2021. Accessed January 20, 2022. 2. Boerger E. State of Reform. Pharmacy Deserts More Common in Black and Hispanic/Latino Neighborhoods. https:// stateofreform.com/featured/2021/05/pharmacy-desertsmore-common-in-black-and-hispanic-latino-neighborhoods/ Published May 27, 2021. Accessed January 20, 2022. 3. Gebhart F. The Growing Problem of Pharmacy Deserts. Drug Top 2019; 163(9) https://www.drugtopics.com/view/growingproblem-pharmacy-deserts 4. Health Resources and Services Administration. 340B Drug Pricing Program. https://www.hrsa.gov/opa/index.html Published April 21, 2017. Accessed January 20, 2022. 5. 340B Informed. 340B Hospitals in Pursuit of Health Equity Best Practices from the Field. https://www.340bhealth.org/ files/Health_Equity_Report_2021_FINAL.pdf Published February 8, 2021. Accessed January 20, 2022. 6. Vanderbilt AA, Dail MD, Jaberi P. Reducing Health Disparities in Underserved Communities via Interprofessional Collaboration Across Health Care Professions. J Multidiscip Healthc. 2015; 8(205-208). DOI: 10.2147/JMDH.S74129 7. Moghadam SS, Leal S. American Medical Association Journal of Ethics. How Should Physicians and Pharmacists Collaborate to Motivate Health Equity in Underserved Communities? https://journalofethics.ama-assn.org/article/how-shouldphysicians-and-pharmacists-collaborate-motivate-healthequity-underserved-communities/2021-02 Published February 01, 2021. Accessed January 20, 2022. 8. Walgreens. AARP/Walgreens Way to Well Tour. https:// www.walgreens.com/topic/sr/sr_community_wellness.jsp Accessed January 20, 2022. 9. Schiezer J. Social Determinants of Health: Tackle Disparities from the Pharmacy. Drug Top 2020; 164(7) https://www. drugtopics.com/view/tackle-disparities-from-the-pharmacy 10. The White House. Fact Sheet: President Biden to Announce National Month of Action to Mobilize an Allof-America Sprint to Get More People Vaccinated by July 4th. https://www.whitehouse.gov/briefing-room/ statements-releases/2021/06/02/fact-sheet-president-bidento-announce-national-month-of-action-to-mobilize-an-all-ofamerica-sprint-to-get-more-people-vaccinated-by-july-4th/ 11. Agency for Healthcare Research and Quality. AHRQ Pharmacy Health Literacy Center. https://www.ahrq.gov/healthliteracy/improve/pharmacy/index.html Published July 2013. Accessed January 20, 2022. 12. Zeigler K, Camarota SA. Center for Immigration Studies. 67.3 Million in the United States Spoke a Foreign Language at Home in 2018. https://cis.org/Report/673-Million-UnitedStates-Spoke-Foreign-Language-Home-2018 Published October 29, 2019. Accessed January 20, 2022.
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132nd 132nd Annual Meeting and Convention an
General Education Track You You Don't Don't Consultant Education Track Want Want to Miss Student & Technician to Track Mis Social Distanced Special Events This! This! Networking Opportunities
Exhibits • Poster Presentations Exh • Receptions i b i t•s Awards •
Po
Room Rates: Room $195 plus tax based on Rates: single/double occupancy.$195 The room reservation room deadline is Friday, reservation June 17, 2022 or when room d block is full. block is full. Thereafter, reservations may be taken on a space Ther available or available rate available basis. There is an optional or resort rate fee. Selfav parking is parking discounted to $12 per day. Please is be sure discoun to ask for the Florida Pharmacy Florida Association group rate. Pharmacy All reservations must be accompanied accompanied by a first night room deposit guaranteed with a major by a credit card. credit The check-in time is 4:00 card. p.m. and the checkout The time is ch 11:00 a.m. 11:00 a.m.
132nd and July 6 -10, 2022
Room reservations Marriot Marriot Harbor Beach ResortHarbor Beach Reso M can be made by calling && Spa, Ft. Spa, Lauderdale, FL, Ft. Lauderdale, FL 33316 33316 (800) 222-6543 18
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Venue
FLORIDA PHARMACY TODAY
1
FPA 132nd Annual Meeting and Convention July 6-10, 2022v Ft. Lauderdale, 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 5.
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_________________________
2
Full Package Registration
Full package registration includes Educational Programs Thursday-Sunday, House of Delegates on Thursday, Exhibit Hall Friday and Saturday, Receptions, and Awards Event on Saturday. Handbooks are not included in full package registration. Handouts will be available the week of the convention on our website, www.floridapharmacy.org. Onsite
Amount_
2FPA 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
$_______
$150
$170
$_______
$40
$40
$_______
3Student
Handbooks
(BEST Value includes Registration & Membership)
3
Onsite
Amount
FPA Member
$165
$185
$_______
Non-Member
$215
$235
$_______
Member Technician
$65
$85
$_______
Non-Member Technician
$90
$110
$_______
Handbooks
$40
$40
$_______
Please select the day(s) you will attend: ¨Thursday
Before June 17
3
Before
June 17
6
¨Friday
¨Sunday
Additional Tickets
The following events are included in the Full Registration Package, if requested. However, you must purchase additional tickets for guests who are NOT registered. Quantity
Price
Amount
Exhibit Hall
$30
$______
Awards Event
$80
$______
7
Special Events Registration
The Poster Event is available to all pharmacy professionals and included in full and daily registrations. The Student Awards Event is not included in any registration packages. Quantity
Price
Amount
Poster Presenter One Day Registration $______ (Registration fee is based upon membership and professional status for non-convention registrants.) Student Awards Event
Please indicate below which functions you will attend. If no boxes are selected, we will assume you will not attend any of the events listed below. Please see box 6 for additional tickets.
¨Saturday
8
_______
$50
$______
FPA Polo Shirt (Deadline is June 3) Quantity Price ¨
Yes
______
$35
M/F ______
Size ______
Amount $_______
¨
House of Delegates (Thursday)
¨
FPPC Reception (Thursday)
¨
Exhibit Hall (Friday and/or Saturday)
¨
Awards Event (Saturday)
¨
Christian Fellowship (Sunday)
¨Check (To: FPA) ¨AMEX ¨Discover ¨MasterCard ¨Visa
¨
I will not attend any of these functions.
Account # ____________________________________________
4
House of Delegates
House of Delegates (Non-convention registrants)
9
Payment
Total Enclosed: $______
Security Code _________________ Expiration Date __________ Before June 8 $165
Amount ______
Billing Address ________________________________________ Signature ____________________________________________
Four Ways to Register
Mail: FPA, 610 North Adams Street, Tallahassee, FL 32301 Phone: 850-222-2400 Fax: 850-561-6758 Web: www.floridapharmacy.org
Schedule and Fees Subject to Change
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“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
