Florida Pharmacy Today June 2018 by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association JUNE 2018

HOW YOU CAN SUPPORT THE NATIONAL DPP LIFESTYLE CHANGE PROGRAM

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

VOL. 81 | NO. 6 JUNE 2018 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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Rx for the National Diabetes Prevention Program Community Pharmacists on the Front Lines of the Opioid Epidemic Calculating Total Daily Dose of Opioids for Safer Dosage Remembering FPA Past President John King

JUNE 2018

FPA Calendar 2018

JULY 4

Independence Day FPA office closed

11 - 15 128th Annual Meeting and Convention of the FPA Bonita Springs 21 - 28 FPA CE at Sea 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

of the Florida Pharmacy Today Journal OCTOBER

2 - 3

Florida Board of Pharmacy Meeting Ft. Lauderdale

6 - 7

Midyear Clinical Conference Kissimmee

6 - 7

Midyear Nuclear Conference Kissimmee

6 - 9

NCPA Annual Meeting Boston, Mass NOVEMBER

22-23 Thanksgiving - FPA office closed DECEMBER 1 - 2

Mission Statements:

Regulatory and Law Conference Sarasota

11 - 12 Florida Board of Pharmacy Meeting Orlando

For a complete calendar of events go to www.pharmview.com Events calendar subject to change CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours’ LIVE Continuing Education as part of the required 30 hours’ general education needed every license renewal period. 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 KAHAN & ASSOCIATES................................... 8 PQC........................................................................ 9 MEDSAFE .......................................................... 22 PHARMACISTS MUTUAL.............................. 27

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.

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FLORIDA PHARMACY TODAY

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

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

2017-2018 Year in Review: Connecting Healthcare and Advancing the Profession of Pharmacy

am honored to have served as the 2017-2018 president of the Florida Pharmacy Association and am very proud of all we have accomplished over the last year. Throughout the year, your FPA leadership team focused on Connecting Healthcare. Connecting pharmacists in all practice settings. Connecting pharmacists with other health care providers. Connecting pharmacists with legislators. Connecting the FPA with other health care organizations. Connecting the past, present and future of the association. The landscape of health care is constantly evolving and through leveraging our connections we can continue to strengthen the association and advance health care. As we look at the 2017-2018 Leadership year, there are so many great accomplishments of the association. By leveraging the strengths of our Councils and Committees we were able to achieve the following: ■■ Continuing our momentum toward provider status ■■ Engaging new practitioners ■■ Connecting past, current and future leadership to ensure continuity of our strategic plan ■■ Showcasing pharmacists with innovative practice models ■■ Exploring and implementing new ways of delivering content to members ■■ Strengthening and highlighting our relationships with other health care professionals ■■ Engaging more pharmacists around the state to strengthen our voice ■■ Evaluating the financial viability of new ideas and technologies ■■ Continuing the momentum to en-

sure a unified voice in legislation for pharmacy As we face many disruptive forces in health care and the profession of pharmacy, we have worked to remain nimble in implementing new technologies and meet the needs of our membership. During the last year we have evaluated new technologies to better serve the needs of our members and our legislative efforts. Several of these

This year’s PBM legislation was a hard fought victory and a huge stepping stone to additional legislation in the 2019 session. new platforms will be available later this summer. We have also worked to begin building the structure for new interest groups within the association to better represent our diverse membership. As we expected, it was a very interesting year legislatively, with many wins and many challenges. While we are not where we ultimately want to be in regard to legislation around PBMs, we have made great steps forward. This year’s PBM legislation was a hard fought victory and a huge stepping

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

stone to additional legislation in the 2019 session. As you have seen in the news, many states are making great advances in the regulation of PBMs and we will continue to partner with our national and other state associations in our efforts here in Florida. With all of the bills on collaborative practice and pharmacist services, we were able to educate legislators and the public on the value of the pharmacist. While those bills did not ultimately make it into law, we have made great strides this year and will continue to pursue these efforts in future sessions. During the legislative session we worked with pharmacists across the state to help educate legislators and other health care professionals on the differences between tele-health, telepharmacy and remote dispensing. The association, the leadership and the lobbying team worked tirelessly to ensure patient safety was the top priority JUNE 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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FLORIDA PHARMACY TODAY

when discussing tele-pharmacy. Ultimately, we successfully opposed the remote dispensing legislation this session. We will continue work with the other health professions to ensure patient safety is the priority in any future tele-pharmacy legislation. Throughout this past year, I have enjoyed all the time I was able to spend with the student pharmacists at Floridaâ&#x20AC;&#x2122;s great colleges of pharmacy. Being able to spread the messages of leadership and advocacy with these students gives me great hope for the future of our profession. This year we have built upon our successes and focused on strengthening connections to deliver on our mission and vision. I am truly humbled by this opportunity to serve the members of the Florida Pharmacy Association as president. I am excited for the great things we have accomplished together this year. I look forward to continuing to serve the Association in the 2018-2019 year as the chair of the Board of Directors. n

JOIN TODAY!

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

New Standards for Controlled Substance Prescribing and Dispensing

y now we are all familiar with House Bill 21 and the changes that will take place on July 1, 2018. What many of our members are struggling with is the pharmacy operational adjustments that may need to take place. It is anticipated that many prescribing practitioners may be unaware or unsure of what they must do when treating patients with acute or chronic pain. This is clearly based upon the many calls to the Florida Pharmacy Association office from physician prescribers. Let us step back in time a little and explore how and why we got here. The Florida Legislature was aware of and was provided a lot of information on the issues relating to opioid overuse and abuse in this state. Drug overdose death rates involving opioids has increased 200 percent since the year 2000 and has become the leading cause of death in the United States. In 2016, in Florida, heroin caused 952 deaths, fentanyl caused 1,390 deaths, oxycodone caused 723 deaths and hydrocodone caused 245 deaths. In March of 2016, the U.S. Center for Disease Control and Prevention released guidelines for the prescribing of opioids. In May of last year, Gov. Rick Scott signed an executive order directing the state’s surgeon general to declare a statewide public health emergency due to the opioid epidemic. In October of last year, President Trump declared a nationwide public health emergency and ordered a five-point strategy for combating the opioid crisis. With all this activity on this issue, it was just a matter of time before the House and Senate would consider

health policy changes that affect the provider community. This gave rise to the filing of House Bill 21. It was made very clear to us that this bill would progress through the legislative session with little to no changes to the language.

Many prescribing practitioners may be unaware or unsure of what they must do when treating patients with acute or chronic pain.

The FPA saw one issue in the bill that needed fixing and required multiple meetings with the House and Senate primary sponsors and also the Governor’s Office. The original language required a physician to write “Medically Necessary” on a prescription if there is an interest in prescribing more than a three-day supply. The use of this term would create considerable confusion as the dispensing pharmacist would not know the true intent of the prescriber. Would the notation on the prescription be for the additional days’ supply, or would the “Medically Necessary” term also be applicable to the dispens-

Michael Jackson, B.Pharm

ing of the branded drug as preferred to the generic? Pharmacists would be required to call and clarify with the prescribing practitioner prior to dispensing the drug. It took a lot of work and multiple meetings, but ultimately the FPA was successful on convincing the House and Senate to accept this change. Much of the bill, as filed at the beginning of the session, made it through to the governor’s desk without changes. So What Does H.B. 21 Do and How Do I Comply? The Journal, unfortunately, is not big enough to answer the multitude of questions or scenarios that a pharmacist will face when trying to figure out how the provisions in this legislation works and what our obligations are. It is clear that patients with acute JUNE 2018 |

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

pain are going to be affected the most. Chronic pain patients as defined in the law should not see any major changes. A full description on H.B. 21 is available on the FPA website in the 2018 Legislative Report. You will need to sign in with your username and password. There is also a list of frequently asked questions on the Board of Pharmacy website. We created a special link to that web page from the FPA resource on Pharmacy Laws and Rules on Pharmview. That special link is flagged with the word (NEW) in bold red letters. Don’t forget that you will have to query the PDMP database prior to dispensing a prescription drug for patients 16 years of age or older and the drug is a controlled substance. The only exception would be

for schedule V controlled substances that are not opioids, if the PDMP system is down or if there is a temporary electrical failure. What if I Still Don’t Understand these Changes? Where Can I Get More Information? We will talk about the provisions of H.B. 21 during our 2018 convention program on prescription drug validation. There were also a lot of questions answered at our recent law conference in Jacksonville in May. We will be available to help clear the air at our September, October and December educational conferences. Any new emerging guidance that the FPA receives will be shared by Stat News. n

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.

“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 JUNE 2018

â&#x201E;&#x17E;

Rx for the National Diabetes Prevention Program Action Guide for Community Pharmacists

FLORIDA PHARMACY TODAY

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ABOUT THE NATIONAL DIABETES PREVENTION PROGRAM The CDC-led National DPP is a partnership of public and private organizations working together to build the infrastructure for nationwide delivery of an evidence-based lifestyle change program to prevent or delay the onset of type 2 diabetes in adults with prediabetes. The National DPP lifestyle change program is based on the science of the Diabetes Prevention Program research study and several studies that followed. These studies showed that making modest behavior changes helped people with prediabetes lose 5% to 7% of their body weight and reduced their risk of developing type 2 diabetes by 58% (71% for people older than age 60). CDC’s Diabetes Prevention Recognition Program (DPRP) is the quality assurance arm of the National DPP. Through DPRP, CDC recognizes organizations that meet national standards and achieve the outcomes proven to prevent or delay the onset of type 2 diabetes.

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What Is Prediabetes? Prediabetes is a health condition marked by blood glucose levels that are higher than normal but not high enough to be diagnosed as type 2 diabetes. More than 84 million American adults—or 1 in 3—are estimated to have prediabetes, and 9 in 10 people with prediabetes don’t know they have it. Prediabetes can lead to heart disease and stroke, and without intervention, many people with prediabetes will go on to develop type 2 diabetes.

ABOUT THE NATIONAL DIABETES PREVENTION PROGRAM Prediabetes is defined by one of the following measures:

z CDC-led Hemoglobin A1C of 5.7% 6.4% or of public and private organizations working together to build The National DPP is atopartnership the infrastructure for nationwide delivery of an evidence-based lifestyle change program to prevent or z plasma glucose of 100intoadults 125 mg/dL or delayFasting the onset of type 2 diabetes with prediabetes. The National DPP lifestyle change program is based on the science of the Diabetes Prevention Program research study and several studies that followed. z Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dL.

These studies showed that making modest behavior changes helped people with prediabetes lose 5% to 7% of their body weight and reduced their risk of developing type 2 diabetes by 58% (71% for people older than age 60). CDC’s Diabetes Prevention Recognition Program (DPRP) is the quality assurance arm of the The National lifestyle change National DPP.DPP Through DPRP, CDC program: recognizes organizations that meet national standards and achieve the outcomes proven to prevent or delay onset ofonline, type 2or diabetes. z Is a 1-year group program offeredthe in person, through a combination of both approaches.

What Is the National DPP Lifestyle Change Program? It consists of:

What Is Prediabetes? ► An initial 6-month phase with at least 16 weekly sessions offered over a period of 16 to 24 weeks.

Prediabetes is a health condition marked by blood glucose levels that are higher than normal but not high ► A second 6-month phase with at least 1 session a month (minimum of 6 sessions). enough to be diagnosed as type 2 diabetes. More than 84 million American adults—or 1 in 3—are estimated tozhave prediabetes, and 9 in 10 people with prediabetes don’t know they have it. Prediabetes can lead to Is taught by a trained lifestyle coach. heart disease and stroke, and without intervention, many people with prediabetes will go on to develop type 2 diabetes. z Uses a CDC-approved curriculum. Prediabetes definedinteractions by one of the following z Includesisregular between the measures: lifestyle coach and participants. z

Hemoglobin A1C of 5.7% to 6.4% or Focuses on behavior change to improve healthy eating, increase physical activity, and manage stress.

Fasting glucose of 100 to 125 mg/dL or Providesplasma peer support.

z Plasma glucose 2 hours after a 75ongm glucose load ofDPP 140 website. to 199 mg/dL. More information on measured the program can be found CDC’s National

What Is the National DPP Lifestyle Change Program? The National DPP lifestyle change program:

RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM

JUNE 2018 |

Prediabetes is defined by one of the following measures: z

Hemoglobin A1C of 5.7% to 6.4% or

Fasting plasma glucose of 100 to 125 mg/dL or

Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dL.

What Is the National DPP Lifestyle Change Program? The National DPP lifestyle change program: z

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Is a 1-year group program offered in person, online, or through a combination of both approaches. It consists of: ►

An initial 6-month phase with at least 16 weekly sessions offered over a period of 16 to 24 weeks.

►

A second 6-month phase with at least 1 session a month (minimum of 6 sessions).

Is taught by a trained lifestyle coach.

Uses a CDC-approved curriculum.

Includes regular interactions between the lifestyle coach and participants.

Focuses on behavior change to improve healthy eating, increase physical activity, and manage stress.

Provides peer support.

More information on the program can be found on CDC’s National DPP website.

Why Should You Participate?

RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM

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Since its establishment in 2010, the National DPP has5 relied on a variety of public and private partners—such as community organizations, private insurers, employers, health care organizations, faith-based organizations, and government agencies—to expand the program nationwide. Pharmacists can be valuable partners in this effort for the following reasons: Pharmacists know preventive care. As a pharmacist, you deliver preventive health care services such as giving vaccinations, helping patients stop smoking and control their blood pressure, and delivering diabetes self-management education. The National DPP lifestyle change program aligns well with this service delivery model. Pharmacists have frequent patient encounters. You are likely to have daily encounters with patients who have prediabetes but are unaware of their condition or the risks involved. As a pharmacist, you may also play a key role in reaching populations that are underserved because of a lack of clinical or community resources.

The entire pharmacy workforce can benefit. Getting involved in the National DPP provides opportunities for you—as well as pharmacy technicians, residents, and students—to apply clinical knowledge, use motivational interviewing techniques, and help prevent type 2 diabetes in patients at risk. Pharmacies are an essential part of today’s health care system.

Questions or Comments?

For more information on the National DPP, visit the National DPP website.

For questions about the DPRP and becoming a CDC-recognized organization, visit the Requirements for CDC Recognition website or e-mail dprpask@cdc.gov.

FLORIDA PHARMACY TODAY

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HOW HOW YOU YOU CAN CAN SUPPORT SUPPORT THE THE NATIONAL NATIONAL DPP DPP Pharmacists—and the pharmacies they work in—can join the many other public and private organizations Pharmacists—and the pharmacies they work in—can join the many other public and private organizations that are working to support or deliver the National DPP lifestyle change program. By helping to expand the that are working to support or deliver the National DPP lifestyle change program. By helping to expand the reach of the National DPP, pharmacists can prevent new cases of type 2 diabetes among their patients at reach of the National DPP, pharmacists can prevent new cases of type 2 diabetes among their patients at high risk. All members of the pharmacy workforce can support these efforts by getting involved at one or high risk. All members of the pharmacy workforce can support these efforts by getting involved at one or more of the following levels: more of the following levels: Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk Tier 1. Promote Awareness of Prediabetes and the National DPP Among Patients at Risk Tier 2. Screen, Test, and Refer Patients Tier 2. Screen, Test, and Refer Patients Tier 3. Offer the National DPP Lifestyle Change Program Tier 3. Offer the National DPP Lifestyle Change Program

Tier Tier 1: 1: Promote Promote Awareness Awareness of of Prediabetes Prediabetes and and the the National National DPP Among Patients at Risk DPP Among Patients at Risk Promoting awareness of prediabetes and the National DPP is a simple, low-cost first step you can take to Promoting awareness of prediabetes and the National DPP is a simple, low-cost first step you can take to get involved in type 2 diabetes prevention efforts. By taking advantage of foot traffic and waiting periods get involved in type 2 diabetes prevention efforts. By taking advantage of foot traffic and waiting periods within the pharmacy, you have a unique opportunity to educate patients about prediabetes and the within the pharmacy, you have a unique opportunity to educate patients about prediabetes and the National DPP lifestyle change program. National DPP lifestyle change program. For example, you can: For example, you can: z Increase your patient population’s awareness of prediabetes. This often reversible condition z Increase your patient population’s awareness of prediabetes. This often reversible condition affects more than 84 million US adults, most of whom do not know they have it. Help your patients affects more than 84 million US adults, most of whom do not know they have it. Help your patients understand how they can prevent prediabetes from developing into type 2 diabetes. understand how they can prevent prediabetes from developing into type 2 diabetes. z Increase your knowledge of the National DPP. This 1-year program was developed to prevent z Increase your knowledge of the National DPP. This 1-year program was developed to prevent or delay the onset of type 2 diabetes in adults who have prediabetes or who are at high risk of or delay the onset of type 2 diabetes in adults who have prediabetes or who are at high risk of developing type 2 diabetes. developing type 2 diabetes. z Learn about the supporting evidence for the National DPP. z Learn about the supporting evidence for the National DPP.

Promotional Promotional Materials Materials

CDC and its partners have developed many resources to promote awareness of prediabetes and the CDC and its partners have developed many resources to promote awareness of prediabetes and the National DPP. These resources and promotional materials can be used within your pharmacy or patient National DPP. These resources and promotional materials can be used within your pharmacy or patient care setting. This section provides links to these resources and suggestions on how to use them. care setting. This section provides links to these resources and suggestions on how to use them.

Print Print Materials Materials

Print materials can be used in the pharmacy setting in the following ways: Print materials can be used in the pharmacy setting in the following ways: z Display on bulletin boards or walls. z Display on bulletin boards or walls. z Give to patients who are picking up medications. z Give to patients who are picking up medications. z Display brochures and handouts on counters and tables in waiting rooms or other areas z Display brochures and handouts on counters and tables in waiting rooms or other areas with heavy foot traffic. with heavy foot traffic. z Use flyers as “bag stuffers” when distributing medications. z Use flyers as “bag stuffers” when distributing medications. JUNE 2018 RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM

Digital Digital Materials Materials Digital Materials Use digital platforms, such as televisions, computers, or tablets, within your pharmacy Use digital platforms, such as televisions, computers, or tablets, within your pharmacy Use digitalvideo platforms, such as televisions, computers, or tablets, within your pharmacy to content. to display display video content. to display video content.

Social Social Media Media Social Media Any of the promotional materials provided in this guide can be shared on

Any of the promotional materials provided in this guide can be shared on Any the promotional provided in this guide can be shared on social to the DPP. posting these materials socialofmedia media to promote promotematerials the National National DPP. Consider Consider posting these materials social media to promote National DPP. Consider postingin materials on dates, such Diabetes Alert Day® (4th March) or on special special dates, such as as the Diabetes Alert Day® (4th Tuesday Tuesday inthese March) or on special dates, such as Diabetes Alert Day® (4th Tuesday in March) or World Diabetes Day (November 14), or during Diabetes Awareness Month World Diabetes Day (November 14), or during Diabetes Awareness Month World Diabetes Day (November 14), or during Diabetes Awareness Month (November). (November). (November). Follow Follow CDC CDC Diabetes Diabetes on on Twitter Twitter (@CDCDiabetes) (@CDCDiabetes) and and Facebook Facebook (CDC (CDC Diabetes) Diabetes) for for diabetes-related diabetes-related Follow CDC Diabetes on Twitter (@CDCDiabetes) and Facebook (CDC Diabetes) for diabetes-related updates and information. Consider retweeting or sharing these posts with your followers. updates and information. Consider retweeting or sharing these posts with your followers. updates and information. Consider retweeting or sharing these posts with your followers.

Promotional Campaigns Promotional Promotional Campaigns Campaigns

Prevent Prevent Diabetes Diabetes STAT STAT Prevent Diabetes STAT Prevent Diabetes STAT (Screen/Test/Act Today) is an initiative created by CDC and the American Medical Prevent Diabetes STAT (Screen/Test/Act Today) is an initiative created by CDC and the American Medical Prevent Diabetes STAT (Screen/Test/Act Today) is an initiative created by CDC and American Medical Association (AMA). Health care use materials developed through this initiative to Association (AMA). Health care teams teams can can use the the materials developed through thisthe initiative to help help Association (AMA). Health care teams can use the materials developed through this initiative to help prevent type 2 diabetes by referring patients to in-person or online CDC-recognized lifestyle change prevent type 2 diabetes by referring patients to in-person or online CDC-recognized lifestyle change prevent type 2 diabetes referring patients to in-person or online CDC-recognized change programs. This initiative includes several informational handouts, which are at programs. This initiative by includes several informational handouts, which are available available lifestyle at the the Prevent Prevent programs. This initiative includes several informational handouts, which are available at the Prevent Diabetes Diabetes STAT STAT ToolKit ToolKit website. website. Diabetes STAT ToolKit website.

“Are “Are you you at at risk risk for for prediabetes?” prediabetes?” sheet “Are you at fact risk for prediabetes?” fact sheet fact sheet

“So you you have have prediabetes...now prediabetes...now what?” what?” “So fact sheet sheet “So you have prediabetes...now what?” fact fact sheet

Promoting Prediabetes Prediabetes Awareness Awareness Promoting poster Promoting Prediabetes Awareness poster poster

National National Prediabetes Prediabetes Awareness Awareness Campaign Campaign National Prediabetes Awareness Campaign This campaign is a partnership between AMA, CDC, and the Ad Council. It features a humorous approach

This campaign is a partnership between AMA, CDC, and the Ad Council. It features a humorous approach This campaign is aAudience partnership between AMA, CDC,to Ad Council. It features a humorous to topic. members are directed an interactive website where can a to a a serious serious topic. Audience members are directed toand an the interactive website where they they can take takeapproach a to a serious topic. Audience members are directed to an interactive website where they can take prediabetes risk test and learn more about type 2 diabetes prevention. The campaign includes prediabetes risk test and learn more about type 2 diabetes prevention. The campaign includes apublic public prediabetes risk test and learn about 2 diabetes prevention. campaign includes public service (PSAs) in the of posters that can print and or that service announcements announcements (PSAs) inmore the form form of type posters that pharmacies pharmacies canThe print and display display or videos videos that service announcements (PSAs) in the form of posters that pharmacies can print and display or videos that can be embedded in digital newsletters, e-mails, and other online communication shared with customers can be embedded in digital newsletters, e-mails, and other online communication shared with customers can be embedded in digital newsletters, e-mails, and other online communication shared with customers and patients. and patients. and patients.

FLORIDA PHARMACY TODA Y RX RX FOR FOR THE THE NATIONAL NATIONAL DIABETES DIABETES PREVENTION PREVENTION PROGRAM PROGRAM RX FOR THE NATIONAL DIABETES 8 PREVENTION PROGRAM

Pharmacies can also place PSAs in local media, but the Ad Council requires that all costs for media placement be donated. More information about the campaign and its materials can be accessed online on the Type 2 Diabetes Prevention website of the Ad Council’s Digital PSA Library.

Prediabetes video PSA

Prediabetes print PSA Your Health with Joan Lunden and CDC

Your Health with Joan Lunden and CDC CDC partnered with television network CBS on a campaign that features award-winning journalist Joan Lunden discussing prediabetes and diabetes in mini-interviews with leading CDC and medical experts. The interviews are presented in 2- to 3-minute segments on CBS television stations. The campaign also features 30-second spots that pharmacies can buy and customize with their own logo and call to action, including directing viewers to visit their website or call a phone number. Video segments can be placed on a pharmacy’s website, on mobile devices using geofencing technology, or on televisions in doctors’ offices. To watch the segments, click on CDC’s Your Health with Joan Lunden and CDC website. If your organization is interested in buying segments, e-mail John Patton at the National Association of Chronic Disease Directors at Jpatton@chronicdisease.org.

Tier 2: Screen, Test, and Refer Patients To meet the eligibility requirements for the National DPP lifestyle change program, participants must have prediabetes or be at high risk of developing type 2 diabetes. Pharmacists can help determine eligibility by screening patients using a CDC-approved risk assessment test, administering a blood glucose test, or referring patients to their primary care provider for a blood glucose test. They can then refer eligible patients to a CDC-recognized lifestyle change program.

JUNE 2018 RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM

Screen Screening for prediabetes is the first step that pharmacists can take to determine if the National DPP lifestyle change program is appropriate for their patients. All Screen pharmacists can add these screening tests to theirScreening workflowfor toprediabetes start conversations is the first step with patients about riskcan factors and that pharmacists take to determine if the National DPP lifestyle change program recommended next steps.

Tips for Screening Patients z

Consider giving the test verbally instead of giving patients a paper Tips for Screening Patients copy to fill out. This approach may help zestablish Use waiting time to administer a connection with patients the paper risk assessment. and make it easier to personalize your zrecommendations. Consider giving theThe testassessment verbally test typically takespatients about 2a minutes instead of giving paper to fill out. This approach may help tocopy complete.

Itâ&#x20AC;&#x2122;s better for participants to enroll and make it easier to personalize your in recommendations. the National DPP The on the basis of assessment blood glucose takes test results. should test typically about 2You minutes encourage a blood glucose test for to complete. any patient who scores high on the z Itâ&#x20AC;&#x2122;s better for participants to enroll risk assessment.

is appropriate for their patients. All

CDC-approved riskcan assessments include tests pharmacists add these screening the CDC Prediabetes Screening Test, to their workflow to start conversations patients about factors andhand, which with can be printed andrisk filled out by recommended next steps. and the CDC Prediabetes Risk Test and American Diabetes Association Type 2 CDC-approved risk assessments include Diabetes RiskPrediabetes Test, both ofScreening which canTest, be the CDC completed on paper. whichonline can beorprinted and filled out by hand, and the CDC Prediabetes Risk Test and American Diabetes Association Type 2 Diabetes Risk Test, both of which can be completed on paper. A blood glucose online test is or another way

Test

to determine if a patient is at risk of developing Testtype 2 diabetes. If you cannot offer a blood glucose test, refer patients blood glucose testpaper is another way risk with a A high score on the or online to determine if a patient is at risk of assessment to a clinical partner or primary developing type 2 diabetes. If you cannot care provider for confirmatory blood offer a blood glucose test, refer patients glucose testing. provides information with a highTable score1on the paper or online risk about assessment the tests used identify prediabetes to ato clinical partner or primary and the follow-up actions recommended care provider for confirmatory blood depending on testing. the results. glucose Table 1 provides information about the tests used to identify prediabetes and the follow-up actions recommended depending on the results.

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Use waiting time to administer the paper risk assessment.

establish a connection with patients

in the National DPP on the basis of glucose testaresults. You should Allblood adults can take prediabetes risk encourage test. a blood glucose testtake for assessment Patients who any patient or who scores on the medications who havehigh health risk assessment. conditions that may put them at

zhigher risk of shouldrisk be All adults canprediabetes take a prediabetes

assessment Patients who take given special test. consideration.

medications or who have health

Administer a blood glucose test to all conditions that may put them at patients who high onshould the risk higher risk ofscore prediabetes be assessment, or refer them to a health given special consideration. care provider for blood glucose testing.

Administer a blood glucose test to all patients who score high on the risk assessment, or refer them to a health care provider for blood glucose testing.

Table 1. Blood Glucose Tests Used to Identify Prediabetes and Recommended Follow-Up Table 1. Blood Glucose Tests Used to Identify Prediabetes and Recommended Follow-Up Test

A1C

Test Fasting plasma Fasting glucose plasma

Normal

<5.7%

<100 mg/dL

Normal

<5.7%

<100 mg/dL

<140 mg/dL

Prediabetes

5.7%–6.4%

100–125 mg/dL*

140–199 mg/dL

Prediabetes

5.7%–6.4%

100–125 mg/dL*

140–199 mg/dL

Results Results

A1C

glucose

Plasma glucose measured 2 hours Plasma glucose after a 75 gm measured 2 hours glucose load after a 75 gm glucose load <140 mg/dL

Follow-Up Action Follow-Up Action Encourage patient to maintain a healthy lifestyle. Encourage patient to maintain a healthy lifestyle. Refer patient to a primary care provider and a CDC-recognized Refer patient to a primary care lifestyle change program. provider and a CDC-recognized lifestyle change Refer patient to program. a primary care

provider for confirmatory diagnosis, Refer patient to a primary care diabetes self-management education provider for confirmatory diagnosis, and support, and treatment if diabetes self-management education Diabetes ≥6.5% ≥126 mg/dL ≥200 mg/dL appropriate. and support, and treatment if * The fasting plasma glucose requirement for Medicare Diabetes Prevention Program suppliers is 110–125 mg/dL. appropriate. Diabetes

≥6.5%

≥126 mg/dL

≥200 mg/dL

* The fasting plasma glucose requirement for Medicare Diabetes Prevention Program suppliers is 110–125 mg/dL.

Refer When you screen patients with a risk assessment test and Refer

administer blood glucose youassessment will identifytest patients When you screen patientstesting, with a risk and with prediabetes. Use this opportunity to apply elements administer blood glucose testing, you will identify patientsof motivational interviewing, goal-setting,to problem-solving, with prediabetes. Use this opportunity apply elements and of cultural sensitivity to guide patients toward enrollment inand a CDCmotivational interviewing, goal-setting, problem-solving, recognized lifestyle change program. In some cases, you may cultural sensitivity to guide patients toward enrollment in a CDCuncover newlifestyle cases of diabetes. WhenIn this occurs, refer recognized change program. some cases, youpatients may to a primarynew care physician for a confirmatory diagnosis diabetes uncover cases of diabetes. When this occurs, referand patients to management services. a primary care physician for a confirmatory diagnosis and diabetes management When patientsservices. are found to be at high risk of developing type 2 diabetes because of a risk assessment score or an elevated When patients are found to be at high risk of developing type blood glucose level in the prediabetes range, refer to both 2 diabetes because of a risk assessment score or anthem elevated of the glucose following: blood level in the prediabetes range, refer them to both

of the following: z Primary care physician Tell the patient’s primary care physician about screening or z Primary care physician blood test resultscare so the diagnosis canscreening be confirmed, Tell theglucose patient’s primary physician about or documented, and managed. Refer patients to a nearby blood glucose test results so the diagnosis can be confirmed, primary care physician if theyRefer do not already one. documented, and managed. patients tohave a nearby z z

Program Costs Program Costs If you refer a patient to a program, they may ask If you refer a patient to about a the cost. There is noask fixed cost program, they may about for the National DPP lifestyle the cost. There is no fixed cost change program.DPP Costs depend for the National lifestyle on the organization offering the change program. Costs depend program. Some programs arethe on the organization offering free, while others charge a fee. program. Some programs are Some employers and insurance free, while others charge a fee. carriers offer the and program as Some employers insurance a covered health wellness carriers offer the or program as benefit. You can recommend a covered health or wellness that yourYou patients contact their benefit. can recommend employer or insurance provider that your patients contact their to find outorif insurance they coverprovider this employer type ofout program. to find if they cover this type of program.

primary care physician if they do not already have one. CDC-recognized lifestyle change program Establish relationships withchange one orprogram more CDC-recognized lifestyle change programs nearby or online. CDC-recognized lifestyle Take timerelationships to understand their processes policies so you can refer eligible patients to a program. Establish with one or more and CDC-recognized lifestyle change programs nearby or online. To find a CDC-recognized lifestyle change program near you, go to the National DPP’s Find a Class Take time to understand their processes and policies so you can refer eligible patients to a program. Location Near You website to find programs delivered in your area. Go to the National DPP’s To find a CDC-recognized lifestyle change program near you, go to the National DPP’s Find a Class Find an Online Program website find a listdelivered of online in programs. Location Near You website to findtoprograms your area. Go to the National DPP’s Find an Online Program website to find a list of online programs.

RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM 11 RX FOR THE NATIONAL DIABETES PREVENTION PROGRAM

JUNE 2018

Who Is Eligible to Enroll in the National DPP Lifestyle Change Program? CDC-recognized organizations can accept referrals based on the results of a risk assessment alone. However, eligibility may vary according to the individual program or the policies of the payers, as well as by whether the organization is a Medicare Diabetes Prevention Program (MDPP) supplier. The Centers for Medicare & Medicaid Services (CMS) requires blood glucose testing for the MDPP. Participant eligibility and enrollment requirements for MDPP suppliers are highlighted throughout this section. For more information about MDPP, visit the Medicare Diabetes Prevention Program (MDPP) Expanded Model website. See below for a summary of the criteria for enrollment in a National DPP. Note that CMS requires a blood glucose test confirming a diagnosis of prediabetes to cover payment for the program through the MDPP.

Criteria for Enrollment in a National Diabetes Prevention Program Lifestyle Change Program ALL PARTICIPANTS MUST:

Be at least 18 years old and not pregnant at the time of enrollment.

AND

A MINIMUM OF 35% OF PARTICIPANTS MUST:

Be overweight, with a body mass index ≥25 kg/m2 (≥23 kg/m2 if Asian).

Have a blood glucose test result in the prediabetes range within the past year or a claim code indicating that they have prediabetes according to one of the following measures: ►

Hemoglobin A1C of 5.7% to 6.4% or

►

Fasting plasma glucose of 100 to 125 mg/dL (Note: CMS eligibility requirement for MDPP suppliers is 110 to 125 mg/dL.) or

►

Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dL.

OR z

Have been previously diagnosed with gestational diabetes (may be self-reported). (Note: A previous history of gestational diabetes is not an eligibility qualification for MDPP suppliers.)

A MAXIMUM OF 65% OF PARTICIPANTS MAY:

Enroll on the basis of a high risk score using one of two risk assessment tests, either the CDC Prediabetes Screening Test or the American Diabetes Association Type 2 Diabetes Risk Test.

TO BE ENROLLED AS AN MDPP BENEFICIARY, ALL PARTICIPANTS MUST:

Have a blood glucose test result in the prediabetes range within the past year indicating that they have prediabetes according to one of the following measures: ►

Hemoglobin A1C of 5.7 to 6.4% or

►

Fasting plasma glucose of 110 to 125 mg/dL or

►

Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dL.

Note: This information cannot be self-reported. Abbreviations: CMS = Centers for Medicare & Medicaid Services; MDPP = Medicare Diabetes Prevention Program.

F L O R I D A P H A R M A C Y T O D ARX Y FOR THE NATIONAL DIABETES PREVENTION PROGRAM 12

Community Pharmacists on the Front Lines of the Opioid Epidemic B. Douglas Hoey

There was a day when the occasional conversation about opioids at pharmacist cocktail parties eventually led to mu, kappa, and delta receptors, 222 forms, constipation stories, and the occasional B. Douglas Hoey story about thwarting a forged or altered prescription (Dear Drug Seeker, did you really think I wouldn’t catch your forged out-of-state prescription for Tylenol No. 4 from Dr. Longnecker?) Not exactly scintillating conversation but, frankly, a breath of fresh air compared to what’s in the current headlines about opioids. The number of opioid prescriptions declined 10.2 percent last year. That’s the good news. The bad news is that more than 42,000 people died from opioid-related overdoses in 2016, according to the Centers for Disease Control and Prevention. Medicinal opioid prescriptions have gone down, but use of, and deaths from, fentanyllaced heroin have increased. Congress has taken action, and in this election year, political candidates want to make sure that they can campaign that they are doing something. This has resulted in the introduction of an eye-popping 50 pieces of legislation. With so much legislation trying to solve a complex problem, there are bound to be some unintended consequences. NCPA has tracked all of these bills to make sure they are helpful to community pharmacists and the patients they serve or, at a minimum, are neutral or do no harm. So far, so good. Two bills endorsed by NCPA, H.R. 3528, the Every Prescription Conveyed Securely Act, which maintained provisions sought by NCPA to exempt long-term care patients and to ensure that patients’

choice of pharmacy is respected, and H.R. 4275, the Empowering Pharmacists in the Fight Against Opioid Abuse Act, are among those making their way through the legislative process. Legislation can only do so much, of course. One of the things making the biggest difference in communities is the work community pharmacists are doing to educate patients about the appropriate use of opioids to treat pain while safeguarding against addiction. Proper disposal of prescription opioids also makes a difference. NCPA members can buy discounted, DEA-compliant disposal systems and mail back envelopes through the NCPA Foundation’s Dispose My Meds program. Contact the NCPA Foundation to request information, list your pharmacy on the locator tool, or, while supplies last, request a package of mail-back envelopes to send home with patients, made possible by a donation from Cardinal Health. An example of pharmacists helping their communities came across my desk this week. Georgia pharmacy owner and NCPA member Ira Katz used naloxone to save a life – again. Katz is a fixture in the Little Five Points area of Atlanta, having owned Little Five Points Pharmacy for nearly 40 years. Some of you may have heard Ira speaking about one of his successful business niches, natural supplements, at NCPA’s Annual Convention. Recently he became the subject of a social media spotlight and a bit of a local hero for his part in saving a 21-year-old man’s life. When a customer noticed the man, motionless behind of the wheel of his Mercedes SUV about 8:30 a.m. just outside Katz’s pharmacy, she first thought he was sleeping. Quickly, she realized he was passed out, and she burst into the store, calling for help. Katz ran out, opened the car door and felt for a pulse. It was faint, he said, and the man was not breathing. Katz recognized the

problem and instructed his technician to bring naloxone and yelled for someone to call 911. He administered the naloxone and did CPR for more than five minutes. Finally, the man breathed on his own and eventually was able to walk to the ambulance. It was a close call. It was the second time in eight days that he’d administered Narcan. The world has changed in the 40 years he’s been a pharmacist, Katz says, and sadly, this scene happens every day in every community. “The point I want to get across is that every pharmacy needs to have Narcan or naloxone available. The drugs are out there. We’re not seeing as many prescription opioids and now they’re getting junk on the street, and they don’t know what’s in it.” Katz doesn’t think he’s a hero. He’s just taking care of people, as he has done for 40 years. “They need help,” he says. “They need counseling. It’s not out there.” Luckily for this 21-year-old man, his community’s pharmacist, Ira Katz, was there making a difference in changing the conversation about the opioid epidemic. B. Douglas Hoey Brian Douglas (Doug) Hoey is the CEO of the National Community Pharmacists Association. He has spent 25+ years working in and representing community pharmacies. Hoey is a licensed pharmacist in Oklahoma, Virginia, and Texas and practiced for five years in community pharmacies, including his own family’s pharmacy. He earned his pharmacy degree from the University of Oklahoma College of Pharmacy and his MBA from the Oklahoma City University Graduate School of Business.

JUNE 2018

CALCULATING TOTAL DAILY DOSE OF OPIOIDS FOR SAFER DOSAGE Higher Dosage, Higher Risk. Higher dosages of opioids are associated with higher risk of overdose and death—even relatively low dosages (20-50 morphine milligram equivalents (MME) per day) increase risk. Higher dosages haven’t been shown to reduce pain over the long term. One randomized trial found no difference in pain or function between a more liberal opioid dose escalation strategy (with average final dosage 52 MME) and maintenance of current dosage (average final dosage 40 MME).

WHY IS IT IMPORTANT TO CALCULATE THE TOTAL DAILY DOSAGE OF OPIOIDS?

Dosages at or above 50 MME/day increase risks for overdose by at least

Patients prescribed higher opioid dosages are at higher risk of overdose death. In a national sample of Veterans Health Administration (VHA) patients with chronic pain receiving opioids from 2004–2009, patients who died of opioid overdose were prescribed an average of 98 MME/day, while other patients were prescribed an average of 48 MME/day. Calculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, or other measures to reduce risk of overdose.

the risk at

<20 MME/day.

HOW MUCH IS 50 OR 90 MME/DAY FOR COMMONLY PRESCRIBED OPIOIDS? 50 MME/day:

90 MME/day:

•

50 mg of hydrocodone (10 tablets of hydrocodone/ acetaminophen 5/300)

•

90 mg of hydrocodone (9 tablets of hydrocodone/ acetaminophen 10/325)

•

33 mg of oxycodone (~2 tablets of oxycodone sustained-release 15 mg)

•

60 mg of oxycodone (~2 tablets of oxycodone sustained-release 30 mg)

•

12 mg of methadone ( <3 tablets of methadone 5 mg)

•

~20 mg of methadone (4 tablets of methadone 5 mg)

L E A R N M O R E | www.cdc.gov/drugoverdose/prescribing/guideline.html

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HOW SHOULD THE TOTAL DAILY DOSE OF OPIOIDS BE CALCULATED?

1 2

DETERMINE the total daily amount of each opioid the patient takes.

CONVERT each to MMEs—multiply the dose for each opioid by the conversion factor. (see table)

ADD them together.

Calculating morphine milligram equivalents (MME) OPIOID (doses in mg/day except where noted)

CONVERSION FACTOR

Codeine

0.15

Fentanyl transdermal (in mcg/hr)

2.4

Hydrocodone

Hydromorphone

Methadone 1-20 mg/day

21-40 mg/day

41-60 mg/day

≥ 61-80 mg/day

Morphine Oxycodone Oxymorphone

1 1.5 3

These dose conversions are estimated and cannot account for all individual differences in genetics and pharmacokinetics.

CAUTION:

USE EXTRA CAUTION:

•

• Methadone: the conversion factor increases at higher doses

Do not use the calculated dose in MMEs to determine dosage for converting one opioid to another—the new opioid should be lower to avoid unintentional overdose caused by incomplete cross-tolerance and individual differences in opioid pharmacokinetics. Consult the medication label.

• Fentanyl: dosed in mcg/hr instead of mg/day, and absorption is affected by heat and other factors

HOW SHOULD PROVIDERS USE THE TOTAL DAILY OPIOID DOSE IN CLINICAL PRACTICE? •

Use caution when prescribing opioids at any dosage and prescribe the lowest effective dose.

•

Use extra precautions when increasing to ≥50 MME per day* such as: - Monitor and assess pain and function more frequently. - Discuss reducing dose or tapering and discontinuing opioids if benefits do not outweigh harms. - Consider offering naloxone.

•

Avoid or carefully justify increasing dosage to ≥90 MME/day.* * These dosage thresholds are based on overdose risk when opioids are prescribed for pain and should not guide dosing of medication-assisted treatment for opioid use disorder.

L E A R N M O R E | www.cdc.gov/drugoverdose/prescribing/guideline.html

JUNE 2018

Remembering FPA Past President John King It is with much sadness that we report the passing of John King, FPA past president from 1982-1983. Born Nov. 4, 1924, in Indianapolis, he was the son of the late Foy E. and Gertrude (Evans) King. Mr. King was a veteran of the U.S. Army and served in both WWII and in the Korean War. He was the owner and operator of K.T. Pharmacy in Bartow, where he also served as its pharmacist since it opened on Jan. 9, 1956, until he retired in 2013. “Service is my pledge to you; and be it assured that I shall devote my energies not to grandiose programs or promises but rather to a strengthening of the association and its many programs,” said Mr. King during his

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presidential address at the 1982 FPA Annual Convention at Innisbrook Resort in Tarpon Springs. John also remarked, “We, you and I, shall move

through this year (1982-1983) with an attitude of optimism, acknowledging problems as opportunities for success or growth and we shall never be discouraged.” “John King was the reason for my interest and involvement in the FPA,” said Ed Hamilton, FPA and APhA past president. “John reached out to me and got me involved early in my career and stressed the importance of staying connected.” His memorial service was held on Friday, June 22, at Holy Trinity Episcopal Church in Bartow. Memorials may be made to the church at P.O. Box 197, Bartow, FL 33831.

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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_________________________

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. 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

$_______

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:

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.

Saturday

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

$______

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)

_________

$_____

FPA Polo Shirt (Deadline is June 8, 2018) Quantity Price 

@ $50

Yes

______ @ $35

Payment

M/F ______

Size ______

Amount $_______

Total Enclosed: $______

Check (To: FPA) AMEX Discover MasterCard Visa Account # ____________________________________________ Security Code _________________ Expiration Date __________

House of Delegates

Before June 22

House of Delegates (Non-convention registrants)

Friday

Student Awards Event

(BEST Value includes Registration & Membership)

June 22

Thursday

Before June 22

Before

$35

Onsite

Amount

$50

______

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.pharmview.com

Schedule Subject to Change

Life

Tomorrow. Imagine That.

phmic.com

Life insurance products are sold through PMC Advantage Insurance Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company. All products may not be available in all states and territories.

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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. 28

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