June/July 2017
GEORGIA TAMES THE MIDDLEMEN YOU’RE GONNA LOVE THIS NEW LAW
Inside: LIMITING DCH RECOUPMENT
M e ne et G w P p. CE hA 5 O ’s
“DIRECT SUPERVISION” DEFINED
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COVER STORY: TAMING THE MIDDLEMEN ...and other changes to Georgia’s rules and regs. We had major victories in the legislature this year, and we saw some much-needed changes to how the Board of Pharmacy enforces the law. Check out our 2017 legislative recap.
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10 legal injection The nitty-gritty of prescriptions from PAs and APRNs, and how to transfer a prescription for a control
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This ain’t Schoolhouse Rock On the last day of session, it was a race against time to try to pass one little bill.
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16 opioids: where are we now?
What’s happening in the Georgia pharmacy world What you need to know about EpiPens, meet our new CEO, the new skinny on salt, and more
Unless otherwise noted, the entire contents of this publication is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International license. Direct any questions to the editor at akantor@gpha.org.
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Georgia Pharmacy magazine is the official publication of the Georgia Pharmacy Association.
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Chief Executive Officer Bob Coleman President and Chair of the Board Lance Boles President-Elect Liza Chapman First Vice President Tim Short Immediate Past President Tommy Whitworth
See where we stand on the opioid epidemic — in America and in Georgia.
Director of Communications & Editor Andrew Kantor akantor@gpha.org Art Director Carole Erger-Fass ADVERTISING All advertising inquiries should be directed to Denis Mucha at dmucha@gpha.org or (404) 419-8120. Media kit and rates available upon request.
24 postscript ... but we shall all be changed The association changes, the healthcare landscape changes, and the business of pharmacy changes — and we change with it
SUBSCRIPTIONS Georgia Pharmacy is distributed as a regular membership service, paid for with membership dues. Non-members can subscribe for $50 per year domestic or $65 per year international. Single issues are $10 per issue domestic and $20 international. Practicing Georgia pharmacists who are not members of GPhA are not eligible for subscriptions.
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prescript
One bill’s story: This ain’t Schoolhouse Rock
ANDREW KANTOR
It was March 30, 2017, the 40th day in a 40-day legislative session, sine die — the last day, period. The hour was late, a major portion of I-85 was ablaze, the clock was ticking closer to midnight. And HB 206 had yet to be considered
on the senate floor. HB 206: It would allow health care providers to correct clerical errors on Medicaid claims without having to pay back the entire claim to DCH. If a clerical error led to an overpayment, it would restrict DCH to recouping only the amount of the overpayment. In short, HB 206 was important to us. It enjoyed broad support from providers and legislators alike. It had passed the house unanimously. Nothing could go wrong now. It did. In the final days of session, HB 206’s momentum slowed. Questions arose. Would the bill impede the state’s ability to investigate fraud? Would it subject the state to exposure for federal recoupments? Back to the table. Led by representatives Trey Kelley and Jesse Petrea, state agency reps met with provider stakeholders — including GPhA. The bill’s language was tweaked and tweaked and tweaked again until everyone was satisfied. But that process took time — time we just didn’t have. And now HB 206 faced a different uphill battle: the calendar. Things looked good at first, as the reworked bill cleared its next two hurdles; the senate HHS and Rules committees both gave it a thumbs up in their final meetings of the session. Now it just had to pass the full senate. On Day 40. There was, literally, no tomorrow. First, because of some political maneuvering that had nothing to do with the bill, it was almost not brought to vote. Hours passed. Lobbyists June/July 2017
lobbied. Deals were made. Finally, at 11:00 p.m., the sky cleared and HB 206 was brought to the senate floor. It passed unanimously. But the bill was now a “substitute,” which meant it had to go back to the house with less than an hour to go in the 2017 session. So it was off to the races ... until, of course, (potential) disaster struck. There was a problem getting the revised bill printed, and every member of the house must have a physical copy of the substitute bill on his or her desk. Exhausted lobbyists sprang into action, rushing between the senate and house rope lines and clerks’ offices in an effort to track down the bill, smashing windows and kicking in doors when necessary. Finally, printouts were made. Representatives Welch and Kelley literally ran down the halls to get copies on the desks of every representative. Watching this play out, one security guard dejectedly shook his head and said, “I don’t think it’s going to make it.” We weren’t giving up. While printouts were being hurriedly distributed, our pharmacy legislators were corralling representatives to ensure the bill would receive a vote in time. Midnight came and went. Was it too late? But then, at 12:03 a.m., we got word: the substitute bill had passed — unanimously. I can’t go so far as to say there were tears of joy, but there was jubilant celebration. Two sessions’ worth of work, and a frantic last few minutes, meant Georgia had passed a great bill — no, a great law — for providers. On May 1, Governor Deal signed HB 206. It takes effect July 1. “Limiting DCH recoupment” may not sound sexy, but it means pharmacies across Georgia will be saving millions of dollars. It was worth every stressful moment. Georgia Pharmacy A S S O C I AT I O N
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Andrew Kantor is GPhA’s communications director, and he promises there is not a drop of hyperbole in this account. Georgia Pharmacy
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news
SNAKE BITES ON THE RISE Snake bites in Georgia are up 50 percent from last year — and last year set a record. Why: Higher temperatures mean snakes are active for longer. Good news: You probably won’t die from a bite. (Get to a hospital, though. Don’t assume it’s not venomous.) Bad news: Anti-venom vials run from $15,000 to $20,000 a pop, and most people need four to six of them … but possibly up to 40. Pro tip: If bit, don’t wash the wound; the hospital needs to ID the venom.
“EXPIRED” EPIPENS ARE STILL GOOD (MOSTLY) A study found that EpiPens are still good even four years after their “expiration” date. At 29 months after expiration, the pens contained at least 90 percent of their stated amount of epinephrine. Pens 50 months — more than four years — past the printed expiration date had more than 84 percent of the medication. The study’s authors say that it’s still best to use an un-expired pen, but it’s worth keeping older ones around in case of emergency. 4
Georgia Pharmacy
SNOT WHAT YOU THINK Researchers from the Emory University School of Medicine got the idea to test the mucus of some frogs. (Science!) The result: “An Amphibian Host Defense Peptide Is Virucidal for Human H1 Hemagglutinin-Bearing Influenza Viruses.” Or, in human terms, “Frog mucus can kill some flu viruses.” Like bread mold gave us penicillin, this could lead to a
EpiPen recall info
new type of flu treatment. Meanwhile, scientists at George Mason University isolated a substance in dragon’s blood (Komodo dragons, that is) that has powerful antibiotic effects. Why look at dragons? Because they can sustain severe injuries without becoming infected. The Defense Department paid for the study.
So, yeah, EpiPens and EpiPen Jrs. have been recalled. In a few cases they’ve failed to activate; there’s nothing wrong with the medication itself. (Also see the story to the left.) Look for an expiration date between April and October 2017. Then look for either 0.3 mg or 0.15 mg strength. atients should keep theirs P until they get a replacement. Contact Mylan for information: call (800) 796-9526 or write to customer.service@mylan.com
June/July 2017
EVERYTHING WE KNOW ABOUT SALT MAY BE WRONG
GPHA REPRESENTS AT NCPA PHARMACY FLY-IN’ The National Community Pharmacists Association’s “Congressional Pharmacy Fly-In” in April resulted in more than 600 ‘interactions’ with congressfolk. The goal of GPhA’s delegation to the event was to talk about the need to ensure patient choice while maintaining access to healthcare. NCPA is already planning the next one for April 2018.
GPhA’s delegation to D.C. met with (from the top) congressmen John Lewis, Doug Collins, Rick Allen, and Austin Scott.
GPHA WELCOMES NEW CE0 On May 16, GPhA welcomed Robert “Bob” Coleman as our new chief executive officer after a search lasting more than three months. An Atlanta native and UGA grad, Coleman has earned both a bachelor’s in business administration and an MBA. For the past 23 years he’s held various leadership roles for PADI, the Professional Association of Diving Instructors — the world’s largest June/July 2017
SCUBA training organization. Before his PADI work, Coleman spent his career in the cable-TV industry in Texas and California, where he was heavily involved in government relations with local and state leaders. His focus at GPhA will be, well, everything ... but primarily growing the membership. “Why isn’t every pharmacist in Georgia a member?” he asked.
It doesn’t make you thirstier. In fact, you burn more calories when you eat more salt. This comes from a detailed study of Russian cosmonauts. The test crew actually drank less when they were given a saltier diet; they burned more calories as well, and their bodies broke down fat and muscle tissue. But everyone knows eating salty foods makes you thirsty. Yes… sort of. In fact, you get thirsty not because you need water, but because the salt stimulates an urge to drink. “This kind of ‘thirst’,” wrote the authors, “may have nothing to do with the body’s actual need for water.”
REMEMBER TO RENEW Remember, pharmacy licenses and technician licenses must be renewed every two years — that is, every odd year. The deadline for the upcoming renewal period is June 30, 2017.
read more @ gphabuzz.com
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Representing pharmacists and pharmacies before the Georgia Pharmacy Board, GDNA and DEA. AREAS OF PRACTICE Professional Licensing Medicare and Medicaid Fraud and Reimbursement Criminal Defense Administrative Law Healthcare Law Legal Advice for Licensed Professionals
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CHAPMAN NAMED APHA FELLOW Congratulations to GPhA president-elect and Kroger pharmacist Liza Chapman of Dawsonville, who was been named a Fellow of the American Pharmacists Association’s Academy of Pharmacy Practice and Management. The honor is given to pharmacists with a minimum of 10 years professional experience who have “demonstrated exemplary professional achievements and service to the profession through activities with APhA and other national, state or local professional organizations.” Chapman accepted the honor at the APhA Annual Convention in San Francisco.
When is grassroots artificial turf? A non-profit organization, the “Partnership for Safe Drugs,” is fighting against allowing people (and pharmacies) to import less-expensive drugs from Canada. Why? Are Canadian drugs somehow less safe than American ones? Or is the real reason that the group isn’t all that grassroots at all? Turns out it has ties to the Pharmaceutical Research and Manufacturers of America — PhRMA, the U.S. pharmaceutical industry lobbying group. June/July 2017
GREAT VIDEO EXPLAINING PBMS
DIABETES MIGHT BE WORSE THAN WE THOUGHT When figuring out what kills us, researchers look at death certificates. Those often list the immediate cause, not the underlying one — which is often diabetes. Mortality rates attributed to diabetes are imprecise largely because death results from both immediate
and underlying causes, and not every one of them gets recorded. If that’s correct, diabetes could be the third leading cause of death in the U.S., according to a new study in PLOS One— and could be responsible for 12 percent of Americans’ deaths.
ZIKA IS COMING As mosquito season looms, Georgia is — well, not quite in the crosshairs of Zika, but close enough. That’s according to new research out of Saint Louis University that found 507 “high risk” areas in the state based on mosquito population (for transmitting the virus) and presence of STDs (which indicates higher-risk sexual activity). The CDC reports that about one in 10 women who were infected with Zika and carried to term had a baby with birth defects. Remember this when mosquito season rolls around — it’s not a chance you or your patients want to take. June/July 2017
The good folks at NCPA have created a short animated video (not even three minutes) that explains all about PBMs — great for sharing with laypeople. “The PBM Story” offers an overview of how PBMs got their start, how they morphed into money-making machines, how exactly they make that money, and the documented effect they’ve had — and continue to have — in increasing prescription drug costs. You can check it out at GPhA.org/ncpavideo — be sure to share it with the people who don’t realize the problem. (Psst: The voiceover is fantastic.)
ANTHEM, EXPRESS SCRIPTS BREAK IT OFF After a lawsuit alleging that Express Scripts inflated prices and refused to negotiate in good faith, Anthem has had enough. The company said it will not renew its contract with Express Scripts when it expires at the end of 2019. Despite the lawsuit — in which Anthem said it had lost $15 billion because of Express Scripts — the PBM’s CEO said he was “perplexed” at the decision. He also cited the company’s “98 percent retention rate.” That referred to the number of clients, not their size; Anthem represented at least 17 percent of Express Scripts’ revenue in 2016. Georgia Pharmacy
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Georgia’s compounding pharmacies are experiencing closer scrutiny by state pharmacy regulators and the Food and Drug Administration.
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news Georgia kids’ health isn’t so great
The latest data on kids’ health has been crunched by the folks at WalletHub. The good news: There are worse states than Georgia for children’s health. The bad news: There are only six of them. Besides ranking 7th worst for overall kids’ health (out of 51, including D.C.), Georgia ranks... • 48th for obesity in kids 10-17 • 47th for infant death rate • 43rd for percent of uninsured children The better news is that we’re in the middle of the pack (22nd) for kids with good teeth and 25th for pediatricians and family physicians.
BUT… WE’RE NEAR THE TOP FOR VACCINATIONS While Georgia might not have overall great healthcare for kids, there’s one way we’re way ahead: vaccinations. The state has among the highest rates of early childhood vaccinations according to DPH figures: 75.6 percent of children 19-35 months have had their seven shots, compared to only 72.2 percent nationwide. With measles and mumps making comebacks, that kind of coverage is critical. 8
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New GPhA Members GPhA welcomes our newest members (as of May 15, 2017). Pharmacists Danny Basri; Atlanta, Ga. Paul Bright; Blairesville, Ga. Ashlyn Carter; Peachtree Corners, Ga. Phillip Carver; Alma, Ga. Jeffrey Crisp; Sharpsburg, Ga. Erin Dalton; Pooler, Ga. Pachia Dixon; Garden City, Ga. Jerrica Dodd; Marietta, Ga. Kenneth Flakes; Hephzibah, Ga. Charlotte Hall; Macon, Ga. John Andrew Herndon; Douglas, Ga. Justin Hildreth; Cumming, Ga. Tracy Hilley; Athens, Ga. Uche Ibiam-Gresham; Macon, Ga. Jannifer Johnson; Decatur, Ga.
David Jones; Evans, Ga. E die Swaggard-Green; Douglasville, Ga. Tomeka Kim; Suwanee, Ga. SaraPharmacy Traylor; Carrollton, Ga. Georgia Adrienne Marzano; Buford, Ga. Dee Vallee; Johns Creek, Ga. Myrna McIntosh; Snellville, Ga. David Watson; Warner Robins, Ga. DeeDee Miller; Lawrenceville, Ga. Izabela Welch; Acworth, Ga. Tiffany Mond; Mableton, Ga. John Whitehead; Columbus, Ga. Darla Moughon; Macon, Ga. Jenna Wilson; Millen, Ga. Tara Nalley; Canton, Ga. Kaitlyn Patterson; Valdosta, Ga. Pharmacy Technicians William Perry; Forsyth, Ga. Kirynn Larson; Blue Ridge, Ga. BLACK & WHITE OPEN Sarah Price; Milton, Fla. Joanna Roller; Macon, Ga. N eena Samuel; Farmington Hills, Mich. Stacey Schuessler; Conyers, Ga. Rebecca Store; Athens, Ga. Meagan Strickland; Atlanta, Ga. A S S O C I AT I O N
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calendar For details, registration, and more info visit GPhA.org/calendar.
July 22 GPhA’s Practical Skills Refresher Course (Suwanee)
June 3 GPhA’s Practical Skills Refresher Course
August 3 Future Trends for Pharmacy Technicians (CPEasy)
June 15-18 2017 Georgia Pharmacy Convention Amelia Island, Florida
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August 8 & 15 The Dreaded OSHA Update (CPEasy) August 10 Pharmacy Abbreviations and Calculations for Technicians
August 13 APhA’s Pharmacy-Based Immunization Delivery: A Certificate Program for Pharmacists August 17 Laws and Regulations in Georgia: What Pharmacy Technicians Must Know (Webinar)
July 6 Prescribing Guidelines, Quality Measures and Care Practices to Improve Opioid Safety (CPEasy) July 13 Understanding Naloxone: Products, Protocols, and Georgia Law (CPEasy) July 20 The Pharmacist’s Obligation with Controlled Substances (CPEasy) June/July 2017
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legal injection
Prescription nitty-gritty Greg Reybold, GPhA‘s vice president of public policy and association counsel, offers his perspective on issues specific to pharmacy. As a reminder, nothing in this column constitutes legal advice. If you have a legal issue or question, consult your own attorney. Do prescriptions from physician assistants and advanced practice registered nurses have to have the name of the supervising physician? Yes. With regard to physician assistants, both the GREG REYBOLD Georgia code and Georgia Board of Pharmacy rules explicitly require that prescriptions — written or transmitted electronically or by fax — include the name, address, and telephone number of the supervising physician as well as the physician assistant. As to APRNs, while less clear, the requirements are ultimately the same. In those cases, the Georgia code requires that written prescriptions contain the name of the APRN and the delegating physician who are parties to the nurse protocol agreement. It does not specify this same requirement for prescription drug orders transmitted electronically or via fax, which often creates confusion. However, Georgia Board of Pharmacy rules explicitly provide that APRN-written prescriptions — as well as those transmitted electronically or via fax — must contain the name, address, and telephone number of the supervising physician and the name of the prescribing APRN. It is no secret pharmacies receive prescriptions from physician assistants and advanced practice registered nurses without the name of the supervising physicians from time to time. Be warned: Filling these prescriptions subjects the pharmacy
to exposure from a regulatory perspective as well as possible recoupments resulting from audits. Are there requirements of pharmacists in connection with the transfer of a controlled substance prescription to another pharmacy? If so, what are they? There are several requirements in connection with the transfer of a controlled substance prescription drug order. For starters, Board of Pharmacy rules provide that the transfer of original prescription information for a scheduled drug (for the purpose of refill dispensing) is permissible between pharmacies on a one-time basis only. More generally, the transfer of a controlled substance prescription must be communicated directly between licensed pharmacists, or by interns/ externs under the direct supervision of licensed pharmacists on both sides of the transfer. The pharmacist (or intern or extern) transferring a controlled substance prescription must do the following: • Write the word “VOID” on the face of the invalidated prescription drug order; • Record on the reverse side of the invalidated prescription drug order the name, address, telephone number, and DEA number of the pharmacy to which it was transferred, and the name of the pharmacist or intern or extern receiving the prescription drug order; • Record the date of the transfer and the name of the pharmacist or intern or extern transferring the information; and •R eflect in the computer record the fact that the prescription drug order has been transferred, the name of the pharmacy to which it was transferred, and the date of the transfer (exceptions exist for pharmacies utilizing common databases).
DO YOU HAVE AN ISSUE YOU’D LIKE TO SEE ADDRESSED IN THIS COLUMN? LET US KNOW — SUBMIT IT TO GREG AT GREYBOLD@GPHA.ORG.
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TRANSFERRING A PRESCRIPTION FOR A SCHEDULED DRUG IS PERMISSIBLE ON A ONE-TIME BASIS ONLY The pharmacist (or intern or extern) receiving the transferred prescription, must do the following:
• Record the name, address, DEA registration number, telephone number and original prescription drug order serial number from the pharmacy that transferred the prescription information and • Record the name of the transferring pharmacist, intern, or extern.
•W rite the word “TRANSFER” on the face of the transferred prescription drug order; •R ecord the date of issuance of the original prescription drug order; •R ecord the original number of refills authorized on the original prescription drug order •R ecord the date of original dispensing; •R ecord the number of valid refills remaining, dates of previous refills, and pharmacy location(s) where any previous refills were dispensed;
Additionally, both the original and transferred prescription drug order must be maintained for a period of two years from the date of last refill. Pharmacies utilizing automated data processing systems must satisfy all information requirements of a manual mode for prescription transferal. Georgia Pharmacy A S S O C I AT I O N
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Use of this article, or the information it contains, does not constitute any legal advice, does NOT establish any attorney-client relationship, and does NOT create any legal duty on the part of the author or the Georgia Pharmacy Association. When making a decision that may have legal consequences, readers should consult with qualified legal counsel.
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cover story
GEORGIA LEGISLATORS
TAME THE MIDDLEMEN
... and other changes to the rules and regs BY ANDREW KANTOR
OK, folks, let’s get down to business. GPhA had a terrific year in the legislature, with the passage of two bills that will have a significant effect on pharmacies and pharmacists across the state, and one major change in pharmacy regulation that we think was long overdue. They’re part of several new pharmacy-related laws, regulations, and policies you need to know about. So, without further ado, here’s what’s changing when these new laws take effect.
LIM IT S O N P B M S (AND OTH ERS ) : T H E PHARM ACY PAT I ENT FA I R PRACTI CES ACT This is — in case you missed the e-mails, blog and Facebook posts, tweets, phone calls, and magazine articles — our major piece of legislation, and our major victory, for 2017. It’s huge news, and that’s not just blowing our own horn. The new law, signed by Governor Deal on May 8 is a sweeping regulation that fundamentally changes the relationship between 12 Georgia Pharmacy
pharmacies and PBMs. It puts significant limits on the most egregious PBM practices — the kind that hurt both patients and pharmacies — and it comes with teeth to enforce them. It’s already being used as a model for other states looking to curb those same practices. Even better, it doesn’t require you to do anything — the impetus is (almost) entirely on PBMs. Simply put, the Pharmacy Patient Fair Practices Act is one of the most aggressive PBM-limiting legislative initiatives in the country. Here, in a nutshell, are the limits it puts on PBM practices:
You can tell your patients about less-costly alternatives. PBMs can no longer restrict pharmacies from providing patients with that information (e.g., less-costly generic versions), nor can they prohibit you from selling patients those less-costly drugs.
You can deliver medications. PBMs can no longer restrict pharmacies from offering direct-delivery services to their patients as an ancillary service. June/July 2017
Governor Deal signs the Pharmacy Patient Fair Practices Act
Your patients’ co-pays can no longer be higher than the cost of the drug. PBMs can no longer “claw back” copays that are higher than the actual cost of the drugs to the patient.
You will not have to pay certain transaction fees. PBMs can no longer charge pharmacies fees related to the adjudication of a claim.
If a PBM wants to recoup money, it needs to do an audit. PBMs can no longer recoup money from a pharmacy outside the audit process, unless otherwise authorized or required by law.
You have rights, and you can exercise them. PBMs can no longer penalize or retaliate against a pharmacy for seeking to enforce their rights.
Gone are patients’ mandatory mail-order requirements... ...at least under group, blanket, and individual accident and sickness policies. (There are several large swaths of the mail-order market that this bill will not directly impact due to federal law and other considerations.) June/July 2017
And the teeth: The law gives the commissioner of insurance the authority to enforce these rules and regulations. Why is that important? The commish doesn’t have to submit to arbitration.
RE S T RICT ING DCH RE COU PME NT S The problem: If there was a clerical error in a Medicaid claim submitted to the Department of Community Health — even something as small as a transposed NPI number — DCH could require the pharmacy to repay the claim. The entire claim. We love pharmacists, but we realize they’re human and sometimes make mistakes. (Not you of course. We’re talking about other pharmacists.) They should be allowed to correct a minor error without being penalized. Hence this law. Pharmacists and other providers now have the right to correct any clerical errors in Medicaid claims, and not have to pay back the entire claim. In other words, DCH is prohibited from any recoupment for a corrected clerical error if there was no overpayment. If there was an overpayment because of a clerical error, DCH can recoup the amount of the Georgia Pharmacy 13
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overpayment, period. If you’re thinking, “This sounds like both common sense and a big deal,” we’re with you. It was a critical piece of legislation, and it’s going to save pharmacists millions of dollars in what we consider inappropriate recoupments.
“ DI REC T S U P ERV I SI ON” D E F I N ED Georgia was tough when it came to pharmacists supervising technicians; there had to be a “line of sight” between them at all times. That meant no counseling patients off to the side, and no helping customers in the pharmacy aisle — not to mention the trouble with bathroom breaks. That’s changed. The Georgia Board of Pharmacy now allows pharmacists to spend up to five minutes providing patient care and consultation — think consultation rooms, vaccination rooms, and areas where OTC drugs are sold — as long as they’re still available to “provide assistance and direction to pharmacy personnel.” Pharmacists will still be responsible for everyone under their supervision, of course. But gone is that line-of-sight requirement in favor of a more reasonable rule.
OT H ER B I LLS OF NOTE GPhA did not have an official position on any of these bills, but we were sure to have pharmacists’ input considered.
VETOED Governor Deal vetoed a bill that would have allowed physicians assistants to prescribe certain hydrocodone products. “Like many other states, Georgia is currently in the grips of an opioid abuse epidemic,” he said, “and this change is incongruent with the state’s efforts to quell that problem.”
PDMP Reforms Starting this year, Georgia’s prescription drug monitoring program will be administered by the Department of Public Health. Of note for pharmacists, you’ll be required to submit prescription information (for scheduled meds) to the PDMP at least every 24 hours. Importantly, you’ll be allowed to delegate retrieval and review of PDMP information to technicians (to identify misuse, abuse, or underutilization) — but no more than two techs per pharmacist shift or rotation. Finally, the PDMP advisory committee will now include at least one pharmacist member of the Board of Pharmacy.
Expedited Partner Therapy If someone has a sexually transmitted disease, there’s a good chance his or her current partner(s) also have it. So it makes sense to treat both the patient and the partner, right? (Otherwise you’ll just be treating them both again soon enough.) This law allows physicians to provide people diagnosed with chlamydia or gonorrhea antibiotic prescriptions to give to their partners, without first examining those partners. For pharmacists, this means you can fill a prescription for someone who isn’t your patient; i.e., someone might bring in prescriptions for himself and his partner.
Naloxone
POWER OF THE PAC Without the power of PharmPAC behind us, achieving these victories would have been much more difficult. By helping elect pharmacy-friendly legislators, your PharmPAC investment made our lobbying that much easier. Thank you, PharmPAC investors!
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Last December, Governor Deal signed an emergency order that allowed pharmacies to dispense naloxone without a prescription. Instead, the Department of Health’s standing order — signed by Commissioner Brenda Fitzgerald — acted in lieu of individual prescriptions. The law passed simply codifies that order. Note that you must keep a copy of the standing order on file, and that naloxone remains classified as a dangerous drug rather than exempt Scheduled V. If you do dispense naloxone, you do not have to enJune/July 2017
ter that information into the state’s prescription drug monitoring program database.
Med Sync This is a patient- and pharmacy-friendly bill similar to legislation enacted in many other states. Simply put, it prohibits insurers and other plan sponsors from making it more difficult or more expensive to synchronize medication refills. • They cannot deny coverage for filling partial prescriptions in order to synchronize them. • They cannot prorate your dispensing fees for partial fills in connection with med sync.
Low-THC cannabis oil The list of conditions in which a patient is eligible for a license to possess medicinal cannabis oil has been expanded to include: • severe Tourette’s syndrome; • autism (for patients at least 18 years old, or severe autism for younger patients); • epidermolysis bullosa; • severe or end-state AIDS, Alzheimer’s, or peripheral neuropathy. Note that buying or selling cannabis oil remains illegal in Georgia, and transporting it across state lines violates federal law.
DME Licensure Requires DME suppliers to obtain a license from the Board of Pharmacy. (This contains several exemptions, including one for pharmacists and pharmacies — unless they have a separate company, corporation, or division.)
Annual drug update • Adds fentanyl analog structural class to Schedule I • Adds thiafentanil to Schedule II To say that GPhA had a good year in the legislature would be an understatement. Our legislative team went in hoping to make some changes to the laws, and to lay the groundwork for the future. Instead, they — and you — walked away with a list of tremendous victories. Recoupment limits and defining “direct supervision” were major successes alone. But when you add the extensive PBM reform that’s been enacted, it’s no stretch to say that 2017 was one of our best ever. With healthcare and healthcare costs in the national spotlight, perhaps the timing was just right. Maybe the right legislators were serving, and received enough phone calls from constituents. Or maybe this was just our year. Georgia Pharmacy A S S O C I AT I O N
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Who cares if your pharmacy technicians are certified? Your patients. Listen to your patients. Choose PTCB Certification. A 2016 survey* of the public found:
94% 85% 76%
say trust in their pharmacy would increase with standardized certification for technicians. believe it’s very important for pharmacy technicians to be certified. say they would change pharmacies if technicians were not certified.
SETTING THE STANDARD. ADVANCING PATIENT CARE. PHARMACY TECHNICIAN CERTIFICATION BOARD
June/July 2017
What makes PTCB Certification stand out? Excellence. • • • •
Portable and accepted in all 50 states, DC, Guam, and Puerto Rico Pharmacy profession-endorsed Only non-profit certification program More that 585,000 certifications granted
Learn more at www.ptcb.org. *KRC Research, 2016 ptcb.org/resources/research
Georgia Pharmacy 15
opioids: where
now? ARE WE
BY ANDREW KANTOR
B
y the time you read this article, there will be some new statistics about the opioid epidemic in the U.S. and in Georgia. This many deaths, these families broken, this increase in crime, this cost to taxpayers and communities. And yes, “epidemic” is the right word — check Webster’s. We all know how we got here — pain meds are nothing new, but in the 1990s their marketing pushed them onto physicians and into patients in a big way. But then those patients began to realize they couldn’t live without the drugs. People who had a legitimate, short-term need found themselves addicted. They were visiting pain clinics, “doc shopping” for new scripts, and hopping state lines to get a fix.
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One part of the solution was to make the drugs harder to get, a process that is ongoing: Close those pain clinics, educate physicians, limit dosages and refills, and so on. That led to at least two unfortunate side effects. First, pharmacy robberies and burglaries. As drugs get harder to obtain and more valuable, the risk-reward calculation of stealing them begins to tilt. If you think pharmacy theft has been increasing lately, you’re not imagining it. The other effect is that illegal narcotics — heroin, in particular — have become easier to get (and often less expensive) than hydrocodone and other prescription opioids. Not only has that led to increases in street crime among the gangs that sell it, the wildly varying dosages — and combinations with more potent drugs like fentanyl and carfentanil — have led to overdoses and angst-ridden news stories. At least one study found that, simply put, as opioid prescriptions went down, heroin and fentanyl overdoses went up. Roughly 75 percent of new heroin users report first using prescription opioids, the government says. And almost lost in the shuffle of laws and regulations are the people who legitimately need long-term painkillers and who are now having a much tougher time getting them. It’s a mess.
Effects Public health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,000 people in 2015 according to CDC figures. That puts overdose deaths nearly equal to those from automobile crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides. Those are the direct deaths. But the problem goes deeper.
June/July 2017 2017 June/July
The spread of HIV and hepatitis from dirty needles has risen dramatically — hepatitis C cases rose nearly 300 percent from 2010 to 2015 directly as a result of dirty needles from heroin and other injected drugs. It’s reached the point where coroner’s offices in several states have run out of room to store the bodies of overdose victims. Then there are the costs: for first responders, for medical care, for hospitalizations. Families from across the social spectrum — white collar, blue collar, rich, poor, and middle-class — are struggling with the impact of opioid abuse. The cost to society may be vague, but it’s real. That’s the problem in a nutshell. What’s to be done?
In Washington It’s hard to get a read on whether or how the federal government is looking to deal with the problem. Both President Obama and presidential candidate Donald Trump spoke of fighting opioid abuse, especially in rural areas. But now the signals are mixed; President Trump proposed cutting the office of National Drug Control Policy (the “drug czar”) by 90 percent. It’s not just the executive branch. In 2016, Congress passed the Comprehensive Addiction and Recovery Act, which was supposed to establish a wide range of state and national programs to reduce drug abuse… but then it never actually funded the program. There has been talk about limiting the flow of illegal narcotics from Mexico (notably heroin), but very little about stopping what’s coming from China (notably fentanyl). In short, the federal government seems to want to fix the problem, but can’t seem to settle on a way to actually do much about it. At the heart of the issue is — as always — money, but there’s also the larger question: Should we treat the opioid epidemic as a healthcare issue or a law enforcement issue?
17 Georgia Pharmacy Pharmacy 17 Georgia
Coverage You Need. Service You Deserve. A Price You Can Afford.
opioids In other states Meanwhile, states have been busy tackling the issue with a spate of legislation. An emerging theme — overprescribing. New Jersey and Pennsylvania, for example, have limits on the first prescription for opioids; Florida just passed a law limiting that first prescription to a five-day supply, and Delaware and Indiana (and other states) are considering a similar laws. California and New York are proposing removing opioids from the states preferred formulary for Medicaid, and New York now limits opioid prescriptions to only seven days (except for chronic pain), and requires mandatory prescriber education on pain management. In Ohio, Governor John Kasich signed a law that limits opiate pills from a single prescription to a 90-day supply and that invalidates unused opiate prescriptions after 30 days. And so on. Earlier this year, the National Governors Association released its “Priorities for Addressing the Nation’s Opioid Crisis,” which made a list of requests from the feds, including • providing emergency funding for states, including for prescription drug monitoring programs; • improving provider education, especially through accreditation organizations; • better pain-treatment guidelines from the CDC; • More “abuse-deterrent” versions of drugs; • PDMP registration as a condition of a DEA license; • requiring the VA to use PDMPs, and setting up a national approach to sharing PDMP data; and • allowing nurses and physicians assistants to prescribe anti-withdrawal drugs The NGA also asked for more funding for the Children’s Health Insurance Program, continued Medicaid financing, and developing awareness, education, and monitoring programs to reduce drug abuse. Tackling some of the effects of the problem, many states have expanded access to naloxone, which can save the life of someone overdosing on opioids. A tactic gaining ground, and enacted in Georgia, is allowing pharmacies to dispense it via a standing order — i.e., without a typical prescription. June/July 2017
dispensing NALOXONE HERE’S HOW IT WORKS. • Pharmacists and interns and externs under pharmacist supervision are authorized to dispense naloxone either (1) through a prescription from a licensed practitioner; or (2) through the standing order of the state health officer. • You must keep a record of each prescription of naloxone you issue through that standing order, including the name of each purchaser, his or her date of birth, address, city, state, and ZIP Code. (Electronically is fine.) • You must keep that record for at least two years. • You are not required to submit information regarding each naloxone prescription dispensed to Georgia’s PDMP. • You are not required to maintain naloxone in your biennial inventories. • You must keep a copy of the standing order on file.
And one argument for expanded access to marijuana — either recreational or medical — is that it appears to lower the need for opioid painkillers. Not making these efforts any easier are the efforts of the drug companies; an Associated Press investigation found that, in the decade from 2006 through 2015, the pharmaceutical industry spent 200 times as much advocating for less-restrictive opioid policies than groups did fighting against the drugs.
Here in Georgia GPhA supported Georgia’s PDMP since its inception and has consistently supported improvements to the program; we obviously want to do the best we can to protect patients from prescription opioid diversion and misuse. We know that pharmacists play a critical role in detecting drug-diversionary behaviors and providing access to lifesaving treatments. This was the assumption that GPhA carried to the Georgia Dome during the 2017 legislative session — in testimony before The Senate Health and Human Services Committee and the House Judiciary Non-Civil Committee. This legislative session saw a great deal of attention paid to the issue of opioid abuse — several bills were introduced to address the epidemic. As a result, Georgia pharmacists can expect substantial, pharmacy-focused changes in two areas: naloxone dispensing and Georgia’s PDMP. Here’s what pharmacists need to know about each. Georgia Pharmacy 19
opioids
frightening NUMBERS On an average day in the U.S.: More than
Naloxone Before December 2016, pharmacists could only dispense naloxone with a prescription. That would mean friends or family of an opioid user would have to both know about the problem, and go to a physician for a prescription just in case. The practical result was that the drug was limited for the most part to first responders, which was widely regarded as a barrier to its effectiveness. Georgia’s Opioid Abuse Senate Study Committee agreed, and, after considering a number of approaches, (e.g., collaborate practice agreements, or pharmacist-as-prescriber), eventually opted for a standing order. Working with the Department of Public Health and the Board of Pharmacy, Governor Deal issued an emergency order in December 2016 allowing pharmacists to dispense naloxone pursuant to a standing order. In April it became law.
Georgia’s PDMP Efforts to curtail over-prescribing through Ohiostyle legislation didn’t gain much traction in the legislature, but the intent arguably did, thanks to some judicious tweaks to the state’s PDMP policy. First, some backstory: Georgia established its PDMP in 2011 with three goals in mind: to help reduce controlled substance abuse; to promote the proper use of pain medication; and to reduce duplicative and unnecessary opioid prescriptions. The law required Georgia-licensed dispensers to submit information about controlled substances to the state’s PDMP (called PMP Aware) on a weekly basis, but only physicians owning or practicing in pain management clinics were required to register with or use the PDMP. Although a good first step, the 2011 law didn’t go far enough. In 2016, GPhA worked with GDNA and the Medical Association of Georgia to bring changes to the PDMP to increase its effectiveness — like giving providers the ability to communicate concerns to other providers, and to delegate checking the system to certain members of their staff. While these were important improvements, there was more work to do, and the legislature enacted several changes this year that will impact prescribers and dispensers alike. For example, prescribers with DEA numbers must enroll to become users of PDMP no later
650,000 opioid prescriptions are dispensed
78
people die from an opioid-related overdose
3,900
people START using prescription opioids for nonmedical reasons
580
people START using heroin
In 2015, for the first time, more Americans died from heroin overdoses than from gun homicides. Source: CDC
than January 1, 2018. Effective July 1, 2018, they will be required to check the PDMP when prescribing schedule IIs and benzodiazepines the first time they issue C-II prescriptions to patients, and thereafter at least once every 90 days (with some exceptions). On the dispensing end, pharmacists will need to pay close attention to a couple of big changes. 1. Pharmacists will need to update their PDMP data every 24 hours, not every week. (Because the PDMP is largely software-driven, that shouldn’t mean a dramatic change in workflow.) 2. Pharmacists will still be allowed to delegate retrieval and review responsibilities to technicians, but no more than two techs per pharmacist shift or rotation can serve in this capacity. Thus, with a minor change in workflow, Georgia’s PDMP has become significantly more effective. As Greg Reybold, GPhA’s vice president of public policy put it, “The more it’s used the more effective it is at curtailing opioid diversion.” Reybold anticipates more proposed changes to Georgia’s PDMP in future legislative sessions, including a feature some view as the Holy Grail of PDMP functions — interoperability with other states. Big problems rarely have simple solutions, certainly not one like the opioid epidemic that’s so widespread, intractable, and that’s been years in the making. There’s no magic button and no simple change that will reverse the course. But there are steps to take — some small, some larger, some easy, some harder — to begin that 1,000mile journey. We’ve already taken the first steps. Georgia Pharmacy A S S O C I AT I O N
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INVESTING IN PHARMPAC IS INVESTING IN YOUR PRACTICE. 2017 PHARMPAC INVESTORS The following pharmacists, pharmacy technicians, students, and others have joined GPhA’s PharmPAC for the 2017 calendar year. The contribution levels are based on investment through April 30, 2017.
Diamond Investors ($4,800 or $400/month)
RALPH BALCHIN Fayetteville
CHARLES BARNES Valdosta
MAC McCORD Atlanta
SCOTT MEEKS Douglas
FRED SHARPE Albany
Titanium Investors ($2,400 or $200/month)
TOMMY LINDSEY Omega
DAVID GRAVES Macon
LON LEWIS St. Simons Island
BRANDALL LOVVORN Bremen
DEAN STONE Metter
David Graves, Macon, PharmPAC chairman June/July 2017
Georgia Pharmacy 21
2017 PHARMPAC INVESTORS Platinum Investors ($1,200 or $100/month) BRUCE BROADRICK THOMAS BRYAN, JR. WILLIAM CAGLE HUGH CHANCY KEITH CHAPMAN WES CHAPMAN DALE COKER BILLY CONLEY BEN CRAVEY BLAKE DANIEL AL DIXON JACK DUNN ROBERT HATTON CASSIE HAYES MARSHA KAPILOFF IRA KATZ
Silver Investors
($300 or $25/month)
Michael Adeleye Michael Azzolin James Carpenter Chandler Conner Gregory Drake Marshall Frost Amy Galloway Becky Hamilton Joe Holt Susan Kane Willie Latch Tracie Lunde Hillary Jack Mbadugha Bill McLeer Donald Piela, Jr.
(CONTINUED)
Gold Investors ($600 or $50/month)
JEFF LUREY DREW MILLER LAIRD MILLER WALLACE PARTRIDGE HOUSTON ROGERS DANIEL ROYAL JOHN SANDLIN TIM SHORT TERESA SMITH CARL STANLEY DENNIS STRICKLAND CHRIS THURMOND DANNY TOTH ALEX TUCKER TOMMY WHITWORTH
JAMES BARTLING LANCE BOLES WILLIAM BREWSTER LIZA CHAPMAN BARON CURTIS MARSHALL CURTIS MAHLON DAVIDSON SHARON DEASON ED DOZIER KEVIN FLORENCE KERRY GRIFFIN MICHAEL ITEOGU STEPHANIE KIRKLAND GEORGE LAUNIUS MACK LOWREY EUGENE MCDONALD
Jonathan Sinyard Renee Smith Austin Tull
Terry Shaw Amanda Stankiewicz
Bronze Investors
(up to $150)
Phil Barfield Claude Bates Bryce Carter Jean Cox Mathew Crist Michael Crooks Larry Harkleroad Hannah Head Phillip James Brenton Lake Micheal Lewis
Nelson Anglin Marla Banks Joe Brogdon Tricia Francetich Josh Greeson Jonathan Hamrick Lori Harvey John Herndon Iris Ivey Jennifer Leavy Charles Lott Mike Martin
Member Investors
($150 or $12.50/month)
BOBBY MOODY SUJAL PATEL GREG REYBOLD DARYL REYNOLDS ANDY ROGERS JEFF SIKES JAMES THOMAS WILLIAM TURNER CHUCK WILSON H.D. WILSON III INTEGRATED FINANCIAL GROUP MERCER UNIVERSITY STUDENTS
Kathy McLeod Darby Norman Mi-Deok Park Donnie Payne William Perry Alex Pinkston Thomas Rawls Jennifer Richardson Brian Rickard Stacey Schuessler Amanda Smith Sara Traylor John Whitehead Kelestan Packaging Prescription Packaging Investment
HELP US REACH OUR GOAL FOR 2017! PharmPAC funds help elect legislators who are friendly to pharmacy. As of April 30, 2017, we still had a long way to $130,000, our goal for the year.
$42,391
Goal: $130,000 $130,000
$0
Thank you to all our PharmPAC investors for their contributions to the future of pharmacy in Georgia. Visit GPhA.org/PharmPAC to find out more.
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contact OPEN
Keep in touch
REACH US AT 404.231.5074 OR GPhA.ORG
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GPhA LEADERSHIP President & Chair of the Board LANCE BOLES, Hartwell lanceboles@hotmail.com President-Elect LIZA CHAPMAN, Dawsonville liza.chapman@kroger.com First Vice President TIM SHORT, Cumming garph9@aol.com Immediate Past President TOMMY WHITWORTH, LaGrange twhitworth@corleydrug.com Directors MICHAEL AZZOLIN, Bishop azzolinm@pharmdondemand.com SHARON DEASON, Newnan sdeason99@hotmail.com AMY MILLER, Gainesville amylulapharmacy@gmail.com FRED SHARPE, Albany fsharpe@u-save-it.com JONATHAN SINYARD, Cordele sinyardj@gmail.com RENEE SMITH, Columbus rdapharmd1995@gmail.com CHRIS THURMOND, Athens vildrug@bellsouth.net Chief Executive Officer BOB COLEMAN bcoleman@gpha.org
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For membership questions Mary Ritchie Director of Membership Operations (404) 419-8115 mritchie@gpha.org For questions about our magazine, blog, websites, or social media Andrew Kantor Director of Communications akantor@gpha.org For questions about our educational offerings Phillip Ratliff Education Consultant pratliff@gpha.org For questions about any of our insurance products Denis Mucha Manager — Member Services (404) 419-8120 dmucha@gpha.org For questions about governmental affairs Greg Reybold Vice President of Public Policy greybold@gpha.org For questions about the Board of Directors or GPhA governance policies Ruth Ann McGehee Executive Assistant and Governance Manager (404) 419-8173 rmcgehee@gpha.org
For operational or accounting questions: Dianne Jones Vice President of Finance & Administration (404) 419-8129 djones@gpha.org Patricia Aguilar Accounting Coordinator (404) 419-8124 paguilar@gpha.org
For assistance with independent-pharmacy issues Jeff Lurey, R.Ph. VP of Independent Pharmacy (404) 419-8103 jlurey@gpha.org For questions about your AIP membership Verouschka “V” Betancourt-Whigham Manager of AIP Member Services (404) 419-8102 vbwhigham@gpha.org AIP Member Service Representatives Rhonda Bonner (229) 854-2797 rbonner@gpha.org Charles Boone (478) 955-7789 cboone@gpha.org
GPhA’S MEMBER SERVICE PARTNERS InfiniTrak infinitrak.us Track and trace compliance software (844) 464-4641 Pharmacy Quality Commitment pqc.net Quality assurance compliance resources (866) 365-7472 Pharmacy Technician Certification Board ptcb.org (800) 363-8012 SoFi sofi.com/gpha Student-loan refinancing (855) 456-7634
Got a concern about a GPhA program or service? Want to compliment or complain? Drop a note to info@gpha.org.
Melissa Metheny (678) 485-6126 mmetheny@gpha.org Gene Smith (423) 667-7949 gsmith@gpha.org
Georgia Pharmacy A S S O C I AT I O N
June/July 2017
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postscript
“We shall not all sleep, but we shall all be changed” Change is constant and it is inevitable. Our preparation and how we adapt to change influences its impact upon many aspects of our daily life. While we cannot halt or slow change, we can control our preparation and reaction, which often deLANCE BOLES termines our success. Both our profession and our association have seen its share of change over the past several years; Over the past several years, our association has seen its own share of change. Your GPhA leadership and staff embraced a significant new direction in our governance structure and strategic planning initiatives. GPhA’s investment in both short-term and long range planning, with measurable progress markers, has provided us clear direction to remain moving forward on its mission. Building a strong staff team and leadership contingency planning enabled GPhA to make a smooth transition during an interim period these past few months. The execution of the work performed by the GPhA team has allowed our association to flourish rather than stagnate and lose momentum. It is a great lesson that is applicable to many facets of our lives, and it’s one that reminds us that the right plan, well delivered, can bring success in spite of the challenge. Pharmacy finds itself immersed in a changing healthcare system; this is neither surprising nor new to our profession. Currently, the transition in the manner by which pharmacies and pharmacists are reimbursed for the services that we provide is at the forefront of our minds. Passing by quickly are the days where simply filling prescriptions represents a sustainable business model. As healthcare payments become based on the value and quality of services delivered, pharmacy finds itself again in the crossroads. Preparation for this shift in reimbursement methodology will determine whether a pharmacist or a business is positioned to thrive as our profession’s scope of 24 Georgia Pharmacy
PASSING BY QUICKLY ARE THE DAYS WHERE SIMPLY FILLING PRESCRIPTIONS REPRESENTS A SUSTAINABLE BUSINESS MODEL. practice evolves. Pharmacist recognition as healthcare providers by CMS and other payors is critical to our ability to fully offer expanded clinical services to our patients; it is imperative that pharmacists are able to align their daily practice to utilize the high level of clinical expertise that we possess. Our future depends on our preparedness to advance our clinical practice; we must continue to demonstrate the quality results and value that pharmacist-delivered services bring to both the patient and the healthcare system. While our profession and GPhA will never be immune to the challenges of changing dynamics, thoughtful preparation and timely action remains necessary to thrive in a new environment; it is also the key to long-term success of an individual, a business, or an organization. As GPhA welcomes a new CEO and a new president in the coming days, I am confident that we have the leadership in place to continue on our path to excellence. It has been a great honor to serve you as your 2016-2017 GPhA President — I am proud of our work this year, humbled by the volunteers that have contributed to our successes, and thankful for the opportunity to lead an association that has been so important to my professional and personal development. Georgia Pharmacy A S S O C I AT I O N
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Lance Boles is GPhA’s 2016-2017 president and owner of independent pharmacies in Hartwell, Ga., and Iva, S.C. June/July 2017
IT’S NOT TOO LATE Register on-site for the 2017 Georgia Pharmacy Convention!
OMNI AMELIA ISLAND PLANTATION RESORT, JUNE 15-18, 2017
More than 30 hours of CPE. Every course approved for pharmacists and techs. Amazing networking opportunities. An incredible resort. CHECK OUT OUR KEYNOTERS: THURSDAY JUNE 15 Millennials, GenXers, Boomers, and Beyond: How Not to Become Roadkill When Crossing the Generational Divide TERRY WATSON With his inimitable style and humor, Terry Watson will help separate myth from fact about generational differences in the workplace. His message: Approaching these differences with understanding and a sense of humor will help you reach your optimal levels as a manager, co-worker, and healthcare provider.
FRIDAY JUNE 16 Impacting Health Care Quality and Value with a High Performing Pharmacy Team TRIPP LOGAN, PHARM.D There’s a wealth of opportunity waiting for reimagining and re-orienting your pharmacy team toward new roles and better outcomes. Learn why pharmacy is changing and how pharmacists and pharmacy technicians can optimize their teams to succeed in the new pharmacy environment.
SATURDAY JUNE 17 Research Showcase: Innovations in Diabetes Treatment and More, from Georgia’s Schools of Pharmacy ASHISH ADVANI, PHARM.D Research conducted in Georgia’s four pharmacy schools is changing the way pharmacists everywhere will practice the profession. Do you know what’s going on in your own pharmacy-®research backyard? Join 2015 Generation Rx award winner Ashish Advani and guests from Mercer, PCOM, South University, and UGA for a look at some of the latest.
Visit GPhAconvention.com for the details, then come to Amelia Island for the biggest Georgia pharmacy event of the year.
Georgia Pharmacy A S S O C I AT I O N
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> David Graves - Graves Pharmacy
LET CPA® ADVOCATE FOR YOU. call 888.434.0308 visit compliantrx.com email sales@compliantrx.com