12039 june gpha journal cj fnl lo by Georgia Pharmacy Association

June 2013 VOLUME 35, Issue 6

Pamala Marquess, Pharm. D Georgia Pharmacy Association President 2013-2014

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June 2013 Editor: Jim Bracewell jbracewell@gpha.org Managing Editor: Kim McNeely kmcneely@gpha.org The Georgia Pharmacy Journal® (GPJ) is the official publication of the Georgia Pharmacy Association, Inc. (GPhA). Copyright © 2012, Georgia Pharmacy Association, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording or information storage retrieval systems, without prior written permission from the publisher and managing editor. All views expressed in bylined articles are the opinions of the author and do not necessarily express the views or policies of the editors, officers or members of the Georgia Pharmacy Association. ARTICLES AND ARTWORK Those interested in writing for this publication are encouraged to request the official “GPJ Guidelines for Writers.” Artists or photographers wishing to submit artwork for use on the cover should call, write or email jbracewell@gpha.org. SUBSCRIPTIONS AND CHANGE OF ADDRESS The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is distributed as a regular membership service, paid for through allocation of membership dues. Subscription rate for non-members is $50.00 per year domestic and $10.00 per single copy; international rates $65.00 per year and $20.00 single copy. Subscriptions are not available for non-GPhA member pharmacists licensed and practicing in Georgia. The Georgia Pharmacy Journal® (GPJ) (ISSN 1075-6965) is published monthly by the GPhA, 50 Lenox Pointe, NE, Atlanta, GA 30324. Periodicals postage paid at Atlanta, GA and additional offices. POSTMASTER: Send address changes to The Georgia Pharmacy Journal®, 50 Lenox Pointe, NE, Atlanta, GA 30324.

CONTENTS

2 3 4 5 7-11 15-17 18-19 21-27

Message From Robert Hatton................................................

Election Schedule......................................................................

Message From Jim Bracewell.................................................

Welcome New GPhA Members..............................................

2013-2014 President Pam Marquess .................

Prescription Labeling Techniques.................

PharmPAC Supporters................................

Continuing Education...................................

ADVERTISING Advertising copy deadline and rates are available upon request. All advertising and production orders should be sent to the GPhA headquarters at jbracewell@gpha.org. GPhA HEADQUARTERS 50 Lenox Pointe, NE Atlanta, Georgia 30324 t 404-231-5074 f 404-237-8435

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MESSAGE from Robert Hatton Wow! I was told this would be the fastest year of my life and that has certainly proved to be the case.

Robert Hatton

When I took over the presidency of GPhA a year ago, I remember thinking how unprepared I felt. I wondered how I would follow the leaders who had come before me and handle the challenges that would certainly occur. We did have some challenges during the year, but what I failed to realize a year ago is that all of these would be met by a team. My individual effort would be important but the team should get the credit. The year started in late July when the Executive Committee (EC) met for its annual retreat. During the retreat the EC looks ahead at the whole year and tries to outline the year from meeting dates to legislative agendas. We even start to look at next year’s convention which has just occurred two weeks before. The next event two weeks later was the Southeastern officers convention in Savannah. It was our turn to host the weekend and I admit that Georgia has now set the bar very high for this meeting. Thanks to the extraordinary effort of the GPhA staff and Jim Bracewell, this was a weekend that all the visiting officers will not soon forget. We were able to share professional and legislative ideas with many other states and bring some of those ideas back to our members. Next up was the Board of Directors meeting at the end of August. This was the first meeting for the new board and was held at Jekyll Island Club. Much of the direction for the remainder of the year is shared at this meeting and I thank the Board members for making the meeting a success. Their ideas and input set the course for a great year for GPhA. In mid-October, the EC set course for San Diego for the annual NCPA convention. This was definitely one of the highlights of the year. We were honored to be there supporting two past presidents of GPhA who are on the NCPA executive committee, Hugh Chancy and John Sherrer. NCPA is the community pharmacist’s voice at the national level. After this year, I have a new and profound respect for what NCPA does for pharmacy. Without NCPA, pharmacy would be struggling to find a unified voice for our concerns and I would like to take this opportunity to personally thank them. After fall region meetings and the holidays, the Board of Directors had its second yearly meeting in mid-January. This meeting was held in Atlanta for 2013. This annual meeting serves to make sure the association is following the recommendations set forth by the various committees. This year’s meeting was very productive. Many of the legislative accomplishments of GPhA were a direct result of discussions that came out of this meeting. I can’t begin to express my gratitude, particularly for those committee chairs that made this year a success. The next noteworthy event was VIP Day held February 14th. Wow! For those of you that missed it, this was a landmark day in the history of Georgia pharmacy. 550 students and pharmacists gathered at the capitol making this the largest state sponsored pharmacy legislative event in the nation. Georgia pharmacists were on hand to make sure that our legislators understand that the pharmacists of Georgia are engaged and concerned about their profession. If

Continued on page 3 2

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you don’t attend any other event, make sure that in 2014, VIP Day is on your calendar. It makes a difference when our collective voices are heard. In addition to the above events, your Executive Committee has been involved in countless phone calls with members, meetings with our legislators, Region meetings, political fund raisers and weekend events such as the New Practitioners Leadership Conference. As I close out what has been the busiest year of my professional life, I would like to encourage you to get involved in leadership. Yes, it is a lot of work, but the rewards are well worth it. I have met some of the finest people in our profession and have forged lifetime friendships. I look forward to my remaining year on the Executive Committee as Chairman and I do so knowing that GPhA is one of the most capable associations in the country. We are a great organization and will only get stronger with your help. Thanks for all you do to make GPhA the best pharmacy association in the United States and I look forward to continuing to serve you. Sincerely, Robert M. Hatton, Pharm. D.

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Have You Heard the GPhA Choir Sing? Have you heard the GPhA choir sing? My wife knows how I love to sing or perhaps “make a joyful noise” is how she describes my singing at church.

Jim Bracewell

Executive Vice President

When at church, do you ever take time to notice all the different individuals that make up your church choir? On any given Sunday morning I have noticed men and women, young and old from a variety of backgrounds, from a variety of skills and levels of talent all coming together with a common goal to sing their part in a unified voice to make a beautiful vocal presentation. The GPhA Choir (GPhA members) is made up of new practitioners and senior practitioners with many years of practice experience. They come from every practice setting, retail, LTC, institutions, academia, industry and research. They are all united in a common voice to advance and protect the profession they have chosen. Isn’t it time you took a more active role in the GPhA choir? The next meeting of this year’s choir is this month at our Annual Meeting and Convention at Amelia Island, FL. If you are missing this meeting, you have nothing to worry about. Your Association is planning a full agenda for this next year. Come, join in and let your strong voice help the profession you have chosen for your life and career and do all you can to help it be everything it can in healthcare. There is the local church choir and there is the Mormon Tabernacle Choir. Is the music different? Are the voices different? Not really, but the commitment and the size of the choir are the result of pride, tradition and volunteer service. Would you invite a pharmacist friend to join our choir of membership? Can you imagine the voice we could have in healthcare changes and how they could affect pharmacy if we had a big GPhA choir make a strong voice for the future of your profession? Most people don’t join a choir until someone invites them. When is the last time you invited a fellow pharmacist to join GPhA and contribute their voice to harmonize with the choir? You have a new membership option - $14.58 per month paid by credit card that will officially makeyou a full sustaining member of GPhA. Listen…. I think GPhA is singing your song.

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WELCOME New GPhA Members Tamara Coburn - Atlanta, GA Active Pharmacist Maggie Bryan - St Simons Island, GA Active Pharmacist

About GPhA

The Georgia Pharmacy Association is the collective voice of the pharmacy profession, aggressively advocating for the profession in the shaping of public policy, encouraging ethical health care practices, advancing educational leadership while ensuring the professionâ&#x20AC;&#x2122;s future is economically prosperous. The members of GPhA would like to welcome all our new members and encourage them to take advantage of all the benefits membership offers.

Cecilia Harvey - Warner Robins, GA Active Pharmacist Brooke Winslette - Rome, GA Active Pharmacist Tonya Conner- Bishop, GA Active Pharmacist Jim Reed- Atlanta, GA Active Pharmacist

THANK YOU FOR YOUR MEMBERSHIP!

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Senator Buddy Carter Runs for Congress

Andy Freeman Director of Government Affairs

When the Founding Fathers set up Congress, they wanted the House of Representatives to be the “People’s House” and have members from various walks of life. Today there are former professional athletes, a comedian, two almond orchard owners and a variety of other occupations making up the membership. When it comes to healthcare occupations there are 17 doctors, an optometrist, five nurses, three psychologists, two dentists, two veterinarians, one ophthalmologist and one psychiatrist but no pharmacists in the US House. When Congressman Jack Kingston announced his intention to run for the US Senate next year for the seat being vacated by the retiring Saxby Chambliss, Buddy Carter declared his candidacy for the First Congressional District in Georgia by crisscrossing the entire District to hold several events. Each stop was well attended by pharmacists excited about the prospect of having someone in Congress that understands how Government reimbursement rates effect their pharmacy and what PBMs are allowed to do when they are unregulated.

Senator Buddy Carter, RPh,

Buddy is a member of GPhA and the Academy of Independent Pharmacies. He is a previous Mayor and State Representative and currently serves as a State Senator when he isn’t serving his patients at one of his three pharmacies.

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Pam Marquess Begins Presidency at Annual Convention

The Marquess family - Will, Pam, Jonathan and Madison

â&#x20AC;&#x153;My roots run deep in faith, a good work ethic and perseverance.â&#x20AC;?

- Pam Marquess GPhA President 2013-2014

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Pam Marquess Looks Forward to Coming Year Leading GPhA Pam Marquess was only seven years old when she realized she wanted to be a pharmacist after seeing the interesting textbooks a family friend in pharmacy school showed to her. Fascinated that someone could know all of that information and know all of those different medications, Pam knew what she wanted to be when she grew up. This year, Pam will serve the Georgia Pharmacy Association as president for 2013-2014 year and hopes to share her knowledge and passion for healthcare with pharmacists all over the state. Growing up with two older brothers helped Pam learn how to compete at an early age, as they would often have contests with them for who could eat the fastest, run the fastest and anything else they could come up with. Along with her brothers, she learned life skills and in some cases, survival skills that she says she still uses today. Pam says that when she was growing up she “practiced” the caretaking skills she would need on her future patients on many of the family pets. These days, Pam and her husband Jonathan (GPhA president 2004-2005) own eight stores, The Institute for Wellness and Education and Pam works as a National Pharmacist spokesperson for Oral Health. Her days start early with driving carpool for their two children, Will and Madison and then arriving at her store before her staff to get ready for the day. Visiting Pam her store is like walking into a family environment where she is surrounded by the staff who share hers and her husband’s passion for patient care. What is it like to be in a household with two pharmacists? “We both are so passionate about the profession, that it is nice to go home at the end of the day to talk about pharmacy with someone I respect,” she said, “I bounce ideas off him and ask him about certain

Will and Pam Marquess scenarios. I love being married to a pharmacist; otherwise I would have to stop working when I get home.” Pharmacy is truly a family business in the Marquess home. Will, age 14 and Madison, 11 work in their parent’s stores, learning the business by stocking shelves, loading drink machines and helping out wherever they can. Of course, the family has discussed whether the children will follow in the family business, and it looks like Will may do so while Madison is considering becoming a veterinarian. Either way, Pam and Jonathan will be happy, “We like the fact that both of our children want to focus on caring for others.” This year, Pam hopes to convey to pharmacists across the state that they can be included in the process of the Association. When pharmacists are a part of GPhA, no matter what kind of practice setting they are in, Pam hopes they will feel part of what the association does for the profession. She said she will measure the success of her presidency based on how many new people she sees getting involved in the Association, attending events and becoming a part of GPhA. She feels that getting pharmacists involved in GPhA and helping them attain their professional goals is what will be important to her and the board members working alongside her. Pam says that if she had not chosen to be a pharmacist, she thinks her career path would still include her working with people. Some of her best days, she says, have been days outside of the pharmacy setting where she has worked directly with people, including when she and other pharmacists assisted patients who had been misplaced due to floods in Georgia. “That experience showed how truly caring pharmacists really are and how much they care for the patients they serve,” she said. She hopes one day to do mission work both inside and outside of the United States and of course, make the most of her presidency in GPhA and be a leader to the Association and the members. One of Pam’s favorite quotes that will surely help her with the upcoming year is from Colin Powell is “A dream doesn’t become reality through magic; it takes sweat, determination and hard work.”

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Pam and Madison Marquess

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2013-2014 GPhA President Pam Marquess Outlines Upcoming Year Ladies and Gentlemen, Thank you for the opportunity to lead this association. I appreciate your trust in me to lead GPhA over the next year. It is no secret that we have challenges in our profession. We see challenges every day but I believe we have many opportunities beyond the challenges. Today’s pharmacists provide more value to patients-and to the health care system-than ever before. Over the past decade, our profession has grown in diversity, capacities, and responsibilities. In the next five years, the profession of pharmacy will change to be almost unrecognizable as we know it today. Pharmacists have risen to meet the challenges in the past and will do so again. Pharmacists have pursued new skills and education, stayed active in policy issues, and has created innovative practice models to meet these challenges. The challenge that I lay before you to-

night is will YOU seize the opportunity to “Cross the Line” for our profession? Will you make changes in your personal practice setting? What will be the ONE thing you do to “Cross the Line” that demonstrates that we are health care providers? At the center of your table is a black line. It represents the many challenges that the profession of pharmacy encounters and that each of you face individually. Will you cross the line? I encourage you to identify one challenge in your professional life. How will you face that challenge? Cross the line! Pharmacists are now recognized as providers of immunizations and personalized medicine and have established practices in settings ranging from health systems pharmacy and ambulatory care centers to nursing homes and clinical community pharmacies. With all these changes, we still find ourselves in a system that does not recognize pharmacists as health care providers. We must seek

2013-2014 GPhA President Pam Marquess to be recognized as a healthcare provider. This effort will be our number one priority for the future and will require pharmacists from all practice settings to unite with one voice. Reforms to the U.S. health care system are changing the way health care professionals practice and are providing new and different opportunities for pharmacists to provide valuable services through teambased care. The Affordable Care Act (ACA) is looming in the future. The ACA will require increased access to care which will expand health care coverage. Secondly, it seeks to improve the quality of care through pay-for-performance and other quality incentives. Lastly, it will reduce the costs of care by cutting services, fees, product reimbursement and bundle payments.

The 2012-2013 GPhA Executive Committee and RADM Scott Giberson posed at the Capitol on VIP Day. From left, Jack Dunn, Pam Marquess, Robert Hatton, Jim Bracewell, Giberson, Bobby Moody and Tommy Whitworth.

Many of us have already experienced the cutting fees this year with Medi-

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Presidential Speech at Annual Convention, continued care Part B and Diabetes Test Strips and other DME. By 2015, physicians will be paid on quality NOT quantity. New service delivery and payment models to address the three-part aim are emerging in both the public and private sectors. These models focus on better coordination of patient care and offering incentives to health care providers-primarily physicians-to provide higher quality care. Various data models have been developed to evaluate these incentive-based initiatives. Medical homes and accountable care organizations (ACO’s) are two prominent models emerging in the marketplace. Accountable Care Organizations (ACO’s) will have a set of providers accountable for the quality and cost of defined patient populations. They will share the risk and year-end savings if quality and cost thresholds are met. Medical Home Models are team-based approach to comprehensive primary care coordinated by a personal physician. Administrative fees are paid to the physician to coordinate care and incentives are given to meet quality measures for care. These new models provide opportunities for pharmacists to demonstrate value. Medication-related problems cost the U.S. health care system approximately $300 billion a year and are a frequent contributor to costly events such as readmission to hospitals. There is an increased recognition that appropriate management of medications by pharmacists-especially high-risk medications, complex medication therapies, and during care transition-is an important component in improving health care outcomes. Pharmacists are being integrated into emerging medical homes, ACOs, and other integrated care models to deliver medication therapy management services, chronic disease management, and other services. Some other emerging trends that present opportunities for pharmacists to serve in new roles include medication management, adherence, transitions in care, medication reconciliation, cost management, and chronic disease management to

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name a few. Evidence shows that when pharmacists contribute to health care teams, health outcomes improve. The integration of technology into healthcare will reduce cost; improve quality and efficacy of care. This will be one of the areas of greatest change for pharmacy. Technology changes so rapidly whereas healthcare traditionally changes very slowly. The rising demand for greater patient care services in the transforming U.S. health care system presents pharmacists with more opportunities along with an increased call for competencies beyond the traditional pharmacy

Your present circumstances don’t determine where you can go; they merely determine where you start.” - Nido Qubein practice. 270 million people walk into a pharmacy each week. 99% of Medicare spending is on chronic care. This is the crossroads of pharmacy. We can make a difference! We must Cross the Line! GPhA will host several events during the next year to facilitate your involvement in these new opportunities. 1. GPhA will host an ACO Initiative to bring together stakeholders across our state to lead the ACO arena. This will assist you in identifying your opportunities in this arena. 2. GPhA will collaborate with GSHP, GA-ASCP, and other state and national pharmacy organizations to unite with one voice for pharmacist recognition as health care providers. GPhA will host a

Pharmacy Provider Strategies Summit focusing on provider status. 3. GPhA will partner with pharmacists and payors across the state to demonstrate pharmacists led patient care models. Published literature and practice-based experience have shown that when pharmacists get involved, overall health care costs go down while quality and patient safety improve. These pharmacist led patient care endeavors will prove our value to the healthcare system. 4. GPhA will provide lifelong learning opportunities for pharmacists to optimize patient care, move into emerging markets and provide quality pharmacy services with a sustainable business model. New graduates are entering the profession practice ready. The goal is to present the right material to help pharmacists understand, learn, and ultimately incorporate vital information into their practice. 5. GPhA will provide leadership and management opportunities for pharmacists thru two new initiatives. GPhA will host a leadership and management weekend for all pharmacists in the winter of 2014 and a women’s leadership summit in November 2013. These initiatives will focus on personal growth and professional leadership. Which one of these events will you become involved with? As I mentioned earlier, pharmacists provide more value to patients and the healthcare system than ever before. I have a short video I wish to share with each of you to encourage you to Cross the Line. Please direct your attention to the screen. In closing, I will share a quote from one of my favorite entrepreneurs, Nido Qubein, “Your present circumstances don’t determine where you can go; they merely determine where you start.” Are you ready to Cross the Line? Your Executive Committee and Board of Directors are committed. Join us! Thank you!

GPhA Goes to Washington!

GPhA Staff and Leadership visited the offices of Senator Johnny Isaakson last month in Washington, D.C. Back row 1st Vice President Bobby Moody, Chairman Jack Dunn, President Robert Hatton, 2nd Vice President Tommy Whitworth and AIP Chairman Drew Miller. Front row Ira Katz, President-Elect Pam Marquess, Senator Isaakson and GPhA Executive Vice President Jim Bracewell.

The visit to Washington D.C. included a trip to visit to the offices of Representative Tom Price (left) and Representative John Lewis.

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Attorney Offers Advice To Independent Pharmacy Owners Most independent pharmacy owners in America today know the benefits of running their businesses under the protection of a corporation or LLC. Better liability protection, better tax benefits and better growth opportunities are given to these pharmacy owners who run their business this way. However, many of these same owners are not running their companies properly. If you operate your pharmacy as a corporation or LLC you need to meet certain documentation and compliance requirements. These are the rules and regulations that your company must follow to maintain your personal liability protection. Annual meetings, major decisions, and ownership certificates need to be properly issued and recorded or benefits and protections can be lost. This compliance is required because corporations and LLC’s are considered separate people. However, unlike a natural person your company cannot talk. Therefore, compliance is the legal equivalent of giving your company a voice. This “separate” voice concept is the foundation of its liability protection and tax benefits for you. This legal fiction of separation creates the “other” responsible party if your business is ever sued. You can sue the business, but the owner is not liable. But the problem is that most business owners are unfamiliar with these rules and fail to meet these minimum expectations. So when the company gets sued or audited, and these documents are not done, you can lose your liability protection and tax benefits. So what is expected of you? You are supposed to “know” how to conduct and record annual meetings, and how to write resolutions for every major company decision. Seems unfair doesn’t it? You are held to this higher standard, but no one gave you the rules or instruction. In fact more than 90% of all corporate or LLC business owners in America are not meeting this standard! If you are not sure if you are meeting this standard of conduct, please call me. If you are a member of the Georgia Pharmacy Association, you can now have FREE recordkeeping for your pharmacy as part of your membership package. Just mention the GHPA when you call and we can discuss how to get you enrolled in this FREE service.

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Scott Burnett, Esq. is a former trial attorney who used to sue closely held Corporations and LLC’s. He now teaches business owners how to avoid frivolous litigation and over taxation. You can call Scott at Burnett & Associates, Inc. at 877-836-9691 or visit his website at www.burnettandassociates.com

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Labeling Techniques Provide Preventative Tips For Pharmacists Medication misuse has resulted in more than 1 million adverse drug events per year in the United States. Patients’ best source (and often only source) of information regarding the medications they have been prescribed is on the prescription container label. Although other written information and oral counseling sometimes may be available, the prescription container label must fulfill the professional obligations of the prescriber and pharmacist. These obligations include giving the patient the most essential information needed to understand how to safely and appropriately use the medication and adhere to the prescribed medication regimen. Inadequate understanding of prescription directions for use and auxiliary information on dispensed containers is widespread. Studies have found that 46% of patients misunderstood one or more dosage instructions, and 56% misunderstood one or more auxiliary warnings. The problem of misunderstanding is particularly troublesome in patients with low or marginal literacy and in patients receiving multiple medications that are scheduled for administration using unnecessarily complex, nonstandardized time periods. In one study, patients with low literacy were 34 times more likely to misinterpret prescription medication warning labels. However, even patients with adequate literacy often misunderstand common prescription directions and warnings. In addition, there is great variability in the actual auxiliary warning and supplemental instructional information applied by individual practitioners to the same prescription. The specific evidence to support a given auxiliary statement often is unclear, and patients often ignore such information. The essential need for, and benefit of, auxiliary label information (both text and icons) in improving patient understanding about safe and appropriate use of their

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medications vs. explicit simplified language alone require further study. Lack of universal standards for labeling on dispensed prescription containers is a root cause for patient misunderstanding, nonadherence, and medication errors. On May 18, 2007, the USP Safe Medication Use Expert Committee established an Advisory Panel to: 1) determine optimal prescription label content and format to promote safe medication use by critically reviewing factors that promote or distract from patient understanding of prescription medication instructions and 2) create universal prescription label standards for format/appearance and content/ language.

Inadequate understanding of prescription directions for use and auxiliary information on dispensed containers is widespread.

In November 2009, the Health Literacy and Prescription Container Labeling Advisory Panel presented its recommendations to the Safe Medication Use Expert Committee, which then requested that USP develop patient-centered label standards for the format, appearance, content, and language of prescription medication instructions to promote patient understanding. These recommendations form the basis of this general chapter. Note—These standards do not apply when a prescription drug will be administered to a patient by licensed personnel who are acting within their scope of practice.

Information shall be organized in a way that best reflects how most patients seek out and understand medication instructions. Prescription container labeling should feature only the most important patient information needed for safe and effective understanding and use. Emphasize instructions and other information important to patients: Prominently display information that is critical for patients’ safe and effective use of the medicine. At the top of the label specify the patient’s name, drug name (spell out full generic and brand name) and strength, and explicit clear directions for use in simple language. The prescription directions should follow a standard format so the patient can expect that each element will be in a regimented order each time a prescription is received. Other less critical but important content (e.g., pharmacy name and phone number, prescriber name, fill date, refill information, expiration date, prescription number, drug quantity, physical description, and evidencebased auxiliary information) should not supersede critical patient information. Such less critical information should be placed away from dosing instructions (e.g., at the bottom of the label or in another less prominent location) because it distracts patients, which can impair their recognition and understanding. Simplify language: Language on the label should be clear, simplified, concise, and familiar, and should be used in a standardized manner. Only common terms and sentences should be used. Do not use unfamiliar words (including Latin terms) or medical jargon. Use of readability formulas and software is not recommended to simplify short excerpts of text like those on prescription labels. Instead, use simplified, standardized sentences that

Continued on page 16 15

Prescription Labeling Tips, Continued

Whenever possible, the directions for use on a prescription container label should be provided in the patient’s preferred language. have been developed to ensure ease of understanding the instructions correctly (by seeking feedback from samples of diverse consumers). Instructions for use (i.e., the SIG or signature) should clearly separate the dose itself from the timing of each dose in order to explicitly convey the number of dosage units to be taken and when (e.g., specific time periods each day such as morning, noon, evening, and bedtime). Instructions shall include specifics on time periods. Do not use alphabetic characters for numbers. For example, write “Take 2 tablets in the morning and 2 tablets in the evening” rather than “Take two tablets twice daily”). Whenever available, use standardized directions (e.g., write “Take 1 tablet in the morning and 1 tablet in the evening” if the prescription reads b.i.d.). Vague instructions based on dosing intervals such as twice daily or 3 times daily, or hourly intervals such as every 12 hours, generally should be avoided because such instructions are implicit rather than explicit, they may involve numeracy skills, and patient interpretation may vary from prescriber intent. Although instructions that use specific hourly times (e.g., 8 a.m. and 10 p.m.) may seem to be more easily understood than implicit vague instructions, recommending dosing by precise hours of the day is less readily understood and

may present greater adherence issues due to individual lifestyle patterns, e.g., shift work, than more general time frames such as in the morning, in the evening, after breakfast, with lunch, or at bedtime. Consistent use of the same terms should help avoid patient confusion. Ambiguous directions such as “take as directed” should be avoided unless clear and unambiguous supplemental instructions and counseling are provided (e.g., directions for use that will not fit on the prescription container label). A clear statement referring the patient to such supplemental materials should be included on the container label. If the purpose of the medication is included on the prescription, it should be included on the prescription container label unless the patient prefers that it not appear. Always ask patients their preference when prescriptions are submitted for filling. Confidentiality and FDA approval for intended use (e.g., labeled vs. off-label use) may limit inclusion of the purpose on labels. Current evidence supports inclusion of purpose-for-use language in clear, simple terms (e.g., “for high blood pressure” rather than “for hypertension”). Auxiliary information on the prescription container label should be evidence-based in simple explicit language that is minimized to avoid

distracting patients with nonessential information. Most patients, particularly those with low literacy, pay little attention to auxiliary information. The information should be presented in a standardized manner and should be critical for patient understanding and safe medication use (e.g., warnings and critical administration alerts). Icons are frequently misunderstood by patients. In addition, icons that provide abstract imagery for messages that are difficult to visually depict may be ineffective at improving understanding compared with simplified text alone. Use only icons for which there is adequate evidence, through consumer testing, that they improve patient understanding about correct use. Evidence-based auxiliary information, both text and icons, should be standardized so that it is applied consistently and does not depend on individual practitioner choice. Address limited English proficiency: Whenever possible, the directions for use on a prescription container label should be provided in the patient’s preferred language. Otherwise there is a risk of misinterpretation of instructions by patients with limited English proficiency, which could lead to medication errors and adverse health outcomes. Additionally,

Continued on page 17 The Georgia Pharmacy Journal

Prescription Labeling Tips, Continued whenever possible, directions for use should appear in English, to facilitate counseling. The drug name shall be in English so that emergency personnel and other intermediaries can have quick access to the information. Translations of prescription medication labels should be produced using a highquality translation process. An example of a high-quality translation process is: • Translation by a trained translator who is a native speaker of the target language • Review of the translation by a second trained translator and reconciliation of any differences • Review of the translation by a pharmacist who is a native speaker of the target language and reconciliation of any differences • Testing of comprehension with target audience If a high-quality translation process cannot be provided, labels should be printed in English and trained interpreter services used whenever possible to ensure patient comprehension. The use of computer-generated translations should be limited to programs with demonstrated quality because dosage instructions can be inconsistent and potentially hazardous. Standardized translated instructions and technology advances are needed to ensure the accuracy and safety of prescription container labeling for patients with low English proficiency. Improve readability: Labels should be designed and formatted so they are easy to read. Currently there is not any strong evidence that supports the superiority in legibility of serif vs. sans serif typefaces, so simple uncondensed fonts of either type can be used. Optimize typography by using the following techniques: • High-contrast print (e.g., black print on white background). • Simple, uncondensed familiar fonts with sufficient space within letters and between letters (e.g., Times Roman or Arial).

The Georgia Pharmacy Journal

• Sentence case (i.e., punctuated like a sentence in English: initial capital followed by lower-case words except proper nouns). • Large font size (e.g., minimum 12-point Times Roman or 11-point Arial) for critical information. Note that point size is not the actual size of the letter, so 2 fonts with the same nominal point size can have different actual letter sizes. X-height, the height of the lower-case x in typeface, has been used as a more accurate indicator of apparent size than point size. For example, for a given point size, the x-height and apparent size of Arial are actually bigger than those for Times Roman. Do not use type smaller than 10-point Times Roman or equivalent size of another font. Older adults, in particular, have difficulty reading small print. • Adequate white space between lines of text (25%–30% of the point size). • White space to distinguish sections on the label such as directions for use vs. pharmacy information. • Horizontal text only. Other measures that can also improve readability: • If possible, minimize the need to turn the container in order to read lines of text. • Never truncate or abbreviate critical information. • Highlighting, bolding, and other typographical cues should preserve readability (e.g., high-contrast print and light color for highlighting) and should emphasize patient-centric information or information that facilitates adherence (e.g., refill ordering). • Limit the number of colors used for highlighting (e.g., no more than one or two). • Use of separate lines to distinguish when each dose should be taken. Address visual impairment: • Provide alternative access for visually impaired patients (e.g., tactile, auditory, or enhanced visual systems that may employ advanced mechanics of assistive technology).

Membership Milestones GRADUATION

Sarah Hatton Sarah Hatton is a Lowndes High School honor graduate. She was drum major for the Georgia Bridgemen, Vice President of Interact Club and Beta Club, and a member of the Jazz Band, Student Council, and Academic Quiz Bowl. Sarah will attend the University of Georgia and major in biology. She is the daughter of Robert and Kim Hatton.

HOLE IN ONE!

Jack Dunn Congratulations to Jack Dunn on a hole in one during a game last month! Number three since he started playing.

Thanks To All Our Supporters Diamond Level

$4,800 minimum pledge Cynthia K. Moon Scott Meeks, R.Ph.

Titanium Level

$2,400 minimum pledge T.M. Bridges, R.Ph. Ben Cravey, R.Ph. Michael E. Farmer, R.Ph. David B. Graves, R.Ph. Raymond G Hickman, R.Ph. Ted M. Hunt, R.Ph. Robert A. Ledbetter, R.Ph. Marvin O. McCord, R.Ph. Loren B. Pierce, R.Ph. Fred F. Sharpe, R.Ph. Jeff Sikes, R.Ph. Dean Stone, R.Ph., CDM

Platinum Level

$1,200 minimum pledge Ralph W. Balchin, R.Ph. Jim R. Bracewell Larry L. Braden, R. Ph. Bruce L. Broadrick, Sr., R.Ph. William G. Cagle, R.Ph. Hugh M. Chancy, R.Ph. Keith E. Chapman, R.Ph. Dale M. Coker, R.Ph., FIACP Billy Conley R.Ph. Al Dixon Jr R.Ph. Ashley Dukes, R.Ph. Jack Dunn, Jr. R.Ph. Neal Florence, R.Ph. Andy Freeman Robert M. Hatton, Pharm.D. Ted Hunt, R.Ph. Alan M. Jones, R.Ph. Ira Katz, R.Ph. Hal M. Kemp, Pharm.D. 18

Brandall S. Lovvorn, Pharm.D. Eddie M. Madden, R.Ph. Jonathan Marquess, Pharm.D., Pam Marquess, Pharm.D. Kenneth A. McCarthy, R.Ph. Ivey Brogdon McCurdy Pharm. D Drew Miller, R.Ph., CDM Laird Miller, R.Ph. Jay Mosley, R.Ph. Mark Parris, Pharm.D. Allen Partridge, R.Ph. Houston Lee Rogers, Pharm.D., Tim Short, R.Ph. Benjamin Stanley, Pharm.D. Danny Toth, R.Ph. Christopher Thurmond, Pharm.D. Alex Tucker Pharm D Tommy Whitworth, R.Ph.,CDM

Gold Level

$600 minimum pledge James Bartling, Pharm.D., William F. Brewster, R.Ph. Liza G. Chapman, Pharm.D. Craig W. Cocke, R.Ph. Mahlon Davidson, R.Ph., CDM Benjamin Keith Dupree, Sr., R.Ph Stewart Flanagin R.Ph. Kevin M. Florence, Pharm.D. Kerry A. Griffin, R.Ph. Michael Iteogu R.Ph. James Jordan, Pharm.D. Ed Kalvelage R.Ph. John D. Kalvelage R.Ph. Steve D. Kalvelage R.Ph. Jeff L. Lurey, R.Ph. John W. McKinnon, Jr., R.Ph. Robert B. Moody, R.Ph. Sherri S. Moody, Pharm.D. William A. Moye, R.Ph. Anthony Boyd Ray, R.Ph. Jeffrey Grady Richardson, R.Ph.

Andy Rogers, R.Ph. Daniel C. Royal, Jr., R.Ph. John Thomas Sherrer, R.Ph. Sharon Mills Sherrer, Pharm.D. Michael T. Tarrant James Thomas R.Ph. Mark H. White, R.Ph. William Wolfe R.Ph.

Silver Level

$300 minimum pledge Renee D. Adamson, Pharm.D. Larry L Batten, R. Ph. Patrick M. Cook, Pharm.D. Ed Stevens Dozier, R.Ph. Terry Dunn, R.Ph. Charles Alan Earnest, R.Ph. Stewart Flanagin Jr R.Ph Marshall L. Frost, Pharm.D. Johnathan Hamrick, Pharm.D. James A. Harris, Jr., R.Ph. Michael O. Iteogu, Pharm.D. Joshua D. Kinsey, Pharm.D. Willie O. Latch, R.Ph. Hilary Mbadugha Kalen Manasco, Pharm.D. William J. McLeer, R.Ph. Sheri D. Mills, C.Ph.T. Albert Nichols Richard Noell, R.Ph. Bill Prather, R.Ph. Kristy Pucylowski, Pharm.D. Edward Reynolds, R.Ph. Sukhmani Sarao, Pharm.D. Alex S. Tucker, Pharm.D. Walter Alan White, R.Ph. Charles W. Wilson, Jr., R.Ph. Steve Wilson, Pharm.D. William T. Wolfe, R.Ph. Sharon Zerillo, R.Ph.

The Georgia Pharmacy Journal

Highlight denotes new and increased contributors.

Bronze Level

$150 minimum pledge Sylvia Ann Davis Adams,R.Ph. Julie Wickman Bierster, Pharm.D. Nicholas O. Bland, Pharm.D. Lance P. Boles, R.Ph. William Crowley, R.Ph. Rabun E. Deckle, Pharm.D. Ashley Faulk, Pharm.D. James W. Fetterman, Jr., Pharm.D. Charles C. Gass, R.Ph. Kimberly Grubbs R.Ph. Larry Harkleroad R.Ph. Winton C. Harris, Jr., R.Ph. Thomas Jeter R.Ph., CGP Brenton Lake, R.Ph. Tracie D. Lunde, Pharm.D. Michael Lewis, Pharm.D. Ashley Sherwood London Max A. Mason, R.Ph. Susan W. McLeer, R.Ph. Judson Mullican R.Ph. Natalie Nielsen R.Ph. Amanda Rose Paisley, Pharm.D. Rose Pinkstaff, R.Ph. Alex Pinkston IV R.Ph Don K. Richie, R.Ph. Laurence Neil Ryan, Pharm.D. Benjamin Lake Stanley, Pharm.D. Dana E. Strickland, R.Ph. Shad Jason Sutherland Archie Thompson, Jr., R.Ph. G.H. Thurmond, R.Ph. William Turner Charles Wilson R.Ph. Christy Zwygart, Pharm.D.

Members

No minimum pledge G.M. Atkinson, R.Ph. Robert C. Ault, R.Ph. Mary S. Bates, R.Ph. The Georgia Pharmacy Journal

Fred W. Barber, R.Ph. Lucinda F. Burroughs, R.Ph. David Carver R.Ph. Henry Cobb, III, R.Ph., Jean N. Courson, R.Ph. Guy Anderson Cox, R.Ph. Carleton C. Crabill, R.Ph. Marshall Curtis Wendy A. Dorminey, Pharm.D., Charles A. Fulmer, R.Ph. Thomas Bagby Garner Jr., R.Ph. Charles Gass R.Ph. Kimberly Dawn Grubbs, R.Ph. Christopher Gurley, Pharm.D. Fred C. Gurley, R.Ph. Keith Herist, Pharm.D., William “Woody” Hunt, Jr., RPh Carey B. Jones, R.Ph. Susan M Kane, R.Ph. William Lee R.Ph. Ralph K. Marett, R.Ph.,M.S. Kenneth McCarthy Roy McClendon R.Ph. Darby R. Norman, R.Ph. Christopher Brown Painter, R.Ph. Whitney B. Pickett, R.Ph. Lewis Powell R.Ph. Robert J. Probst, Jr. Pharm.D. Ola Reffell R.Ph. Carlos Rodriguez-Feo R.Ph. Hugh Rogers Terry Donald Shaw, Pharm.D. Negin Sovaidi - Moon Charles Iverson Storey III, R.Ph. James E. Stowe, Jr., R.Ph. James R. Strickland, R.Ph. William Thompson Carey Austin Vaughan, Pharm.D. Erica Lynn Veasley, R.Ph. Allen M. Wallace R.Ph. William D. Whitaker, R.Ph. Jonathon Williams, Pharm.D.

Besides giving to PharmPAC, how can I support a candidate for office? Donations to Candidates The easiest way to support a candidate with whom you agree on the issues is by donating to that individual’s campaign. But donations to candidates are strictly limited both in the amount and the source. Donations to candidates for federal office (like the Presidency, US Senate, and Congress) can only be made from personal funds and cannot exceed $2,600 per election. In contrast, donations to candidates for state office (like the Governor and state legislators) can be made from corporate or personal funds up to $6,300 per election for a statewide candidate and up to $2,500 for a state legislative candidate. Donations to Organizations Supporting Candidates Many organizations that support candidates do not face the same limitations as the candidates themselves. You can also donate to a Political Action Committee, such as PharmPAC, which is able to take a number of donations and give a larger (but still limited) amount to a candidate for office. Another option is donations to a “SuperPAC” that supports a federal candidate or candidates. These donations can be made with corporate or individual funds and are not subject to any limits on the total amount of donations. Similar organizations exist to support state candidates for office.

Region Meetings Offer Networking Opportunities

Each spring and fall, GPhA Region Presidents host a program for pharamcists in their region that includes a speaker and continuing education opportunities. More than 350 members and non members of GPhA attended the region meetings held all over the state of Georgia. Donâ&#x20AC;&#x2122;t miss a chance this fall to meet with your colleagues, enjoy a great meal and earn CEs. Visit gpha.org and find out more about how you can become involved in your region.

The Georgia Pharmacy Journal

Georgia Pharmacy Association

2012-2013 BOARD OF DIRECTORS Name

Position

L. Jack Dunn Robert M. Hatton Pamala S. Marquess Robert B. Moody Thomas H. Whitworth Hugh M. Chancy Liza G. Chapman Keith N. Herist Joshua D. Kinsey Tracie D. Lunde Eddie M. Madden Jonathan G. Marquess Christine Somers Ed S. Dozier Renee D. Adamson Nicholas O. Bland Julie W. Bierster Sherri S. Moody Amanda McCall Michael Lewis Kristy L. Pucylowski Lance P. Boles Ashley London Ken Von Eiland Thomas R. Jeter Sharon B. Zerillo Archie R. Thompson Drew Miller Linda Gail Lowney Robert Bentley John T. Sherrer Michael E. Farmer Al McConnell Megan Freeman Systems Pharmacists Amy C. Grimsley Rusty Fetterman Sukhmani K. Sarao Negin Sovaidi Moon Amanda Brown Leah Stowers Jim Bracewell

Chairman of the Board President President-Elect First Vice President Second Vice President State At Large State At Large State At Large State At Large State At Large State At Large State At Large 1st Region President 2nd Region President 3rd Region President 4th Region President 5th Region President 6th Region President 7th Region President 8th Region President 9th Region President 10th Region President 11th Region President 12th Region President ACP Chairman AEP Chairman AHP Chairman AIP Chairman APT Chairman ASA Chairman Foundation Chairman Insurance Trust Chairman Georgia Board of Pharmacy Chairman Georgia Society of Health

Mercer Faculty Representative South Faculty Representative UGA Faculty Representative ASP, Mercer University ASP, South University ASP, UGA Executive Vice President

Melvin M. Goldstein, P.C. A T T O R N E___ Y AT L AW 248 Roswell Street Marietta, Georgia 30060 Telephone 770/427-7004 Fax 770/426-9584 www.melvinmgoldstein.com

n Private practitioner with an emphasis on representing healthcare professionals in administrative cases as well as other legal matters n Former Assistant Attorney General for the State of Georgia and Counsel for professional licensing boards including the Georgia Board of Pharmacy and the Georgia Drugs and Narcotics Agency n Former Administrative Law Judge for the Office of State Administrative Hearings

The Georgia Pharmacy Journal

Keeping Independents Independent Dear Jeff, Jennie and I want to thank you for your recent intervention to help us retire and to keep our pharmacy independent. When we made our decision to sell Warwick Drugs, you were our first contact. You

Is it time to sell your pharmacy?

acted quickly and professionally to find a buyer in 5 days! We joined AIP at its inception. We

Do you want to own your own pharmacy or buy another pharmacy?

have participated in its programs, utilized the extensive information network and treasured our relationships with exceptional people, like you. We wish the best for all of you and the role you all play in our healthcare future. If we can ever be of assistance, please call on us. Thanks again; our best regards to all. Sincerely yours, Cliff Hilliard, RPH, PHD

Call Jeff Lurey, R.Ph. AIP Director 404-419-8103 jlurey@gpha.org

The Georgia Pharmacy Journal

Georgia Pharmacy Association

50 Lenox Point NE Atlanta, GA 30324

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Chartered Retirement Plans SpecialistSM and CRPS® are registered service marks of the College for Financial Planning®. Neither UBS Financial Services Inc. nor any of its employees provides legal or tax advice. You should consult with your personal legal or tax advisor regarding your personal circumstances. As a firm providing wealth management services to clients, we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. For more information on the distinctions between our brokerage and investment advisory services, please speak with your Financial Advisor, the Wile Consulting Group, or visit our website at ubs.com/workingwithus. Financial Planning services are provided in our capacity as a registered investment adviser. As a firm providing wealth management services to clients in the U.S., we offer both investment advisory and brokerage services. These services are separate and distinct, differ in material ways and are governed by different laws and separate contracts. ©UBS 2013. All rights reserved. UBS Financial Services Inc. is a subsidiary of UBS AG. Member SIPC. 7.00_8.5x8_AX0313_WilE 0313150 exp3/22/15