December 2019 Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association DEC. 2019

IN THE

2020

ELECTION

“I’M ALWAYS WATCHING OUT FOR MY PATIENTS, BUT WHO’S WATCHING OUT FOR ME?”

WE ARE. We are the Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization.

Our Pharmacy Quality Commitment (PQC) program: • • • •

Helps you implement and maintain a continuous quality improvement program Offers federal protection for your patient safety data and your quality improvement work Assists with quality assurance requirements found in network contracts, Medicare Part D, and state regulations Provides tools, training and support to keep your pharmacy running efficiently and your patients safe

Call toll free (866) 365-7472 or visit www.pqc.net PQC IS BROUGHT TO YOU BY YOUR STATE PHARMACY ASSOCIATION

florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint

7 Executive Insight

23 News & Notes

VOL. 82 | NO. 12 DECEMBER 2019 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

10 12 18

Changes are Coming!

New PTCB Requirements Take Effect in 2020

A Giant Leap: The Industry Adopts a New Verision of the E-Prescribing Standard

2020 FPA Election Ballot Information

DECEMBER 2019

|

3

Mission Statements:

FPA Calendar 2019

JANUARY

APRIL

14

Legislative Session Begins

10

20

Martin Luther King Jr. Day FPA Office Closed

18-19 Clinical Conference Grand Hyatt Tampa Bay

21-22 Pharmacy Days at the Capitol 25-26 FPA Law and Regulatory Conference Hilton - Sandestin Beach 31

Last Day for Election Ballots FEBRUARY

29

Award Nominations Due MARCH

13

Legislative Session Ends

20-23 APhA Annual Meeting Washington, D.C.

Good Friday, FPA Office Closed.

22-23 NCPA Fly-in Washington, D.C. MAY 16-17 Law Conference Jacksonville 13

House of Delegates Board of Directors conference call meeting

16 - 17 FPA CE Conference Jacksonville, Florida 17-19 NASPA Leadership Retreat San Antonio, Texas

FOR A COMPLETE CALENDAR OF EVENTS GO TO WWW.FLORIDAPHARMACY.ORG

Events calendar subject to change

CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours’ LIVE Continuing Education as part of the required 30 hours’ general education needed every license renewal period. There is a 2 hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. Pharmacists and pharmacy technicians must also complete a 1 hour Florida Board approved continuing education on human trafficking

by January 1, 2021.

Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2021 or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by December 31, 2020.

For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact the FPA office.

For more information on CE programs or events, please contact the Florida Pharmacy Association at (850) 222-2400 or visit our website at www.floridapharmacy.org CONTACTS FPA — Michael Jackson (850) 222-2400

FSHP — Tamekia Bennett (850) 906-9333 UF — Emely McKitrick (352) 273-5169

FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300

Note: The views of the authors do not necessarily represent the views or opinions of the Florida Pharmacy Association, Florida Pharmacy Today or any related entities.

DISCLAIMER

Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association is engaged in rendering legal or other professional services through this publication.

If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

4 |

FLORIDA PHARMACY TODAY

Florida Pharmacy Today Journal The Florida Pharmacy Today Journal is a peer-reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

Florida Pharmacy Today Board of Directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the Journal in its goal of self-support.

Advertisers ACPE........................................................................

FPA LAW.................................................................

KAHAN & ASSOCIATES................................. 16 PQC........................................................................ 2 PARTNERSHIP FOR SAFE MEDICINES......... 9 PHARMACISTS MUTUAL.............................. 20

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

The President’s Viewpoint DAVID "CHACHI" MACKERAY, RPH

A

Do We Truly Make New Members Feel Welcome?

s many of you have heard me say over and over again, membership is our No. 1 priority, our main concern and our constant focus. The Florida Pharmacy Association is created by our members and thus, the elected leaders need to remember that in every action taken.

As leaders, we like to think we remember the “golden rule,” but do we really? Do we really consider our members and how our decisions affect each of them on every action we take? Do we really represent our constituents as if we are “doing unto ourselves?”

How many of us even ask our members what they really want or how they feel about a certain subject? Is that really representation?

So, when I’m trying to recruit new members, which is always when I’m around anyone affiliated with the pharmacy profession, I usually hear some of the same old responses…. “What does FPA do for me?” “Will my voice really be heard or even make a difference?”

These are just a few of the comments I often hear, so I sometimes begin to ask myself what response would be most correct, professional and justifiable. I also honestly have to ask myself if these people were correct with their assumptions or if there was a major problem with our communication, perception and delivery.

As an FPA leader in multiple positions for the past seven years and the current president, I have personally recruited many co-workers, friends and even strangers and helped them become members of the FPA. I give the usual speech about the importance of becoming a member and why their involvement is so vital to help protect the

pharmacy profession and to help make the right decisions about the future of pharmacy.

I also encourage them to become an advocate for pharmacy and to make their voice heard in both Tallahassee

As leaders, we like to think we remember the “golden rule,” but do we really? Do we really consider our members and how our decisions affect each of them on every action we take? and Washington, D.C., through their FPA membership – another major reason to help them understand all the many things that the FPA does for its members. While many of the people I spoke with became members, some did not. Many are still members, some are not. But why or why not is something that I frequently ask myself.

David Mackeray, RPh

Another question I ponder often is…

“Are we being fair and honest with our members as well as realistic with our new leaders?” To elaborate a little more, I wonder if we are honest with our future leaders by letting them know what is truly expected of them, what their new responsibilities are and the committed volunteer time required.

These are serious questions that need to be answered and fully understood by anyone who is planning to become an FPA Leader. As one could imagine, a successful mentor is someone who recognizes these very important responsibilities of a good leader and then coaches, guides and teaches the newly elected leader to become the best they possibly can be. It’s the appropriate way to welcome new members into the pharmacy family…often called pharmily.

Now please don’t interpret this article as a complaint or anything negaSee President’s Viewpoint, continued on page 6 DECEMBER 2019

|

5

2018-19 FPA Board of Directors The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work diligently all year long on behalf of our members.

Angela Garcia.....................................................................................................Board Chair David Mackarey..........................................................................................FPA President Kimberly Jones.......................................................................................... FPA Treasurer Joseph Scuro............................................................................................ President Elect Gary Koesten..............................................................................Speaker of the House Eric Larson.......................................................................Vice Speaker of the House Bill Kernan................................................................................................... FSHP President Preston McDonald............................................................................. Region 1 Director Neil Barnett............................................................................................Region 2 Director Larry Alaimo..........................................................................................Region 3 Director Cheryl Rouse.........................................................................................Region 4 Director James Alcorn.......................................................................................Region 5 Director Barbara Beadle...................................................................................Region 6 Director Paul Delisser.......................................................................................... Region 7 Director Ramy Gabriel.........................................................................................Region 8 Director Mitchell Levinson...............................................................................Region 9 Director Julie Burger.......................................................................................Technician Director

Florida Pharmacy Today Journal Board Chair.............................................................. Carol Motycka, motycka@cop.ufl.edu Vice Chair....................................................Cristina Medina, cmmedina@cvs.com Treasurer.........................................................Eric Jakab, ericjakab@hotmail.com Secretary............................................. Julie Burger, julieburger133@gmail.com Member.................................................. Michael Finnick, michaelfinnick@ufl.edu Member.....................................................David Mackarey, dmackarey@aol.com Member.......................................................Matt Schneller, schnem18@gmail.com Member..........................................Teresa Tomerlin, teresapharmd@cfl.rr.com Member............................................Greta Pelegrin, gretapelegrin@yahoo.com Technician Member........................Julie Burger, julieburger133@gmail.com Executive Editor................Michael Jackson, mjackson@pharmview.com Managing Editor...................Dave Fiore, dave@fiorecommunications.com Journal Reviewer....................... Dr. Melissa Ruble, mruble@health.usf.edu Journal Reviewer....................................Dr. Angela Hill, ahill2@health.usf.edu

6 |

FLORIDA PHARMACY TODAY

President’s Viewpoint, from Page 5

tive about the FPA leadership, Membership Affairs Council or current methods being used, as I assure you that each of those individuals agree with me that our membership area needs some revamping, updating and improvements.

We need to honestly reevaluate our current system and raise the bar to match today’s technology and standards. We must also become more aware of the times and what the members want today, as well as in the near future, which is much different than what mine were years ago. Sustainability and success relates to the current times.

Lastly, when people become members of the FPA, we all must welcome them with open arms, because without them, we wouldn’t exist much longer. Remember that each member is volunteering and giving of their valuable time to help make the FPA a successful and powerful group.

We must also remember that each individual member will dedicate and give what he/she is able to give and sacrifice at whatever level they are able to dedicate. We shouldn’t judge or put expectations on these new leaders, especially those who are still learning their way around the FPA. Yes, I know there are certain levels of responsibilities and duties that come with different positions to keep the association moving and advancing successfully, but we should be more welcoming and help them along the way. We should ask them if any of our past experience is needed, or better yet….thank them for being involved and doing such a great job. Finally, be sure to tell them what a pleasure it is to have them as a part of the pharmily. n

Executive Insight

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

Supporting Our Disaster Campaign

W

ith the hurricane season behind us we now pause to evaluate how fortunate many of us have been. This year we saw 18 named storms and 20 tropical cyclones in our region. Last year, Hurricane Michael struck the Florida panhandle, which is still in full recovery mode. This year, Hurricane Dorian devastated the US Virgin Islands and part of the Bahamas. Several of our members have been involved in the relief efforts of these storms. Our state is in the crosshairs of storm activity and is extremely vulnerable to potential disaster. It is not a question of “if” but “when” we will see another disaster, whether natural or man-made.

Those of us who were around to remember Hurricane Andrew in 1992 and Hurricane Katrina in 2005, experienced the devastation either first-hand or worked with and or assisted others who were impacted. The best time to prepare for any disaster is when there isn’t one. We need to build resources to help our members who

Michael Jackson, B.Pharm

may be affected should an unfortunate event occur.

After Hurricane Michael, the FPA received appeals for help and we had little access to any reserves to assist. We are working with the Florida Pharmacy Foundation on the creation of a disaster fund. I would like to take this moment to thank Foundation President Todd Schmidt for his assistance and support of the creation of this campaign. You can make a tax-deductible contribution to the Florida Pharmacy Foundation at this website (https://www.flpharmfound.org/fundraising/).

Your contribution to this campaign will be used exclusively to address disaster-related issues. Please join me in supporting this effort. When the time comes and the need arises, we would be able to assist our colleagues. Please join with me in being a supporter of the Florida Pharmacy Foundation Hurricane Disaster Relief Fund. n

DECEMBER 2019 |

7

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

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

Continuing Education Coordinator Stacey Brooks, ext. 210 Coordinator of Membership Christopher Heil, ext. 110 Accounting Coordinator Ashley Gandy ext. 211

FLORIDA PHARMACY TODAY BOARD Chair............................... Carol Motycka, St. Augustine Vice Chair.........................Cristina Medina, Hollywood Treasurer.................................... Eric Jakab, Gainesville Secretary............................. Julie Burger, Pensacola Member.........................Michael Finnick, Jacksonville Member.............David Mackarey, Boynton Beach Member....................................... Matt Schneller, Tampa Member............................Teresa Tomerlin, Rockledge Member...................................... Greta Pelegrin, Hialeah Technician Member..........Julie Burger, Pensacola Executive Editor.......Michael Jackson, Tallahassee Managing Editor...................Dave Fiore, Tallahassee Journal Reviewer........................... Dr. Melissa Ruble Journal Reviewer....................................Dr. Angela Hill This is a peer-reviewed publication. ©2019 FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today.

The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association.

The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board.

FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax.

FLORIDA PHARMACY ASSOCIATION

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web address: www.floridapharmacy.org

IN MEMORIAM

Jim Powers, who served as executive vice president of the Florida Pharmacy Association for 21 years, died Dec. 10. He was 91.

“James B. Powers was one of those uniquely qualified to carry the leadership flag for our profession,” said Michael Jackson, executive vice president and CEO of the Florida Pharmacy Association. He said Powers is his mentor, and “it is not unusual to navigate the FPA office and not see or experience something that Jim had a hand in.”

Powers was a Minnesota native who was raised in Florida. He served in the Marine Corps and was a graduate of the University of Florida College of Pharmacy, where he was member of Kappa Psi Pharmaceutical Fraternity, Rho Chi Pharmaceutical Honor Society and Gamma Sigma Epsilon Chemical Fraternity.

Powers was an independent retail pharmacist who also served with the Bureau of Narcotics with the Florida State Board of Health and with the Florida Medicaid and other programs.

He was first elected to the association’s executive vice president role in 1969 and served for 21 years. During his tenure, the association established the Florida Pharmacy Foundation, the Recovering Pharmacists Network of Florida, the Pharmacy Provider Services Corp., and a Pharmacy Political Action Committee. Powers also helped create the Florida Independent Pharmacy Network.

“It was 22 golden years for pharmacy because much of the legislation and rules for the board of pharmacy were achieved in that period,” Powers said in a 2017 interview with GatorRx, the magazine of the University of Florida College of Pharmacy.

Many people who worked under Powers at the FPA went on to other leadership roles in health care, Jackson said. These include Mitchell Rothholtz, who became executive director of the Alabama Pharmacy Association and is now chief of staff at the APhA; Lucy Gee, who became division director for medical quality assurance at the state Department of Health; William Mincy, vice president for development at Pharmacy Provider Services Corp.

“Sometimes you just have to admire how successful a leader is at mentoring others, and Jim was an expert,” Jackson said.

Mincy calls Powers the lion of pharmacy.

“He was a passionate advocate for the profession of pharmacy and a vocal protector of Florida independent pharmacists and their patients,” Mincy said. “Through Jim’s forward thinking and incredible energy, the FPA became a nationally recognized leader among state pharmacy associations.”

Powers served on the Governor’s Commission on Drug and Alcohol Concerns and on the Florida Board of Pharmacy, and was honored by Florida Gov. Bob Graham for his work with a certificate of appreciation. He was also the recipient of the University of Florida College of Pharmacy Distinguished Alumnus Award, the American Pharmaceutical Association Hugo H. Schaefer Medal, the FPA James H. Beal Pharmacist of the Year Award, the FSHP Pharmacist of the Year Award, the Bowl of Hygeia Award, and a Florida A&M University College of Pharmacy and Pharmaceutical Services Award.

Powers is predeceased by his parents, William H. Powers and Mary Lulu Brandon Powers, and by siblings Dave, Jalene, Shirley and Bill. He is survived by his wife of 70 years, Patsey Jane Olsen Powers; his sons, Kelly and Robby (Sheri); his sister, Mary Lou Matthews; two grandchildren, Sarah Roy (Jamie) and Kayla; and two great grandchildren, Stella Rose Roy and Kylie Grace Roy. “Everyone experiences an unforgettable character in our lifetime,” Jackson said.

“Though that sun has set on the life of the great James B. Powers, his legacy is forever strong within pharmacy and the Florida Pharmacy Association. I am extremely thankful to have experienced our friendship.”

To help honor Powers’ legacy, donate to the James B. and Patsey Powers Scholarship from the Florida Pharmacy Foundation. Visit www.flpharmfound.org/donate.

CHANGES ARE COMING! New PTCB Requirements Take Effect in 2020 We have some important information about the Pharmacy Technician Certification Board’s upcoming changes to Certified Pharmacy Technician eligibility requirements and the Pharmacy Technician Certification Exam content blueprint.

CPhT Certification Applicants Must Meet New Requirements Starting in 2020, PTCB is changing requirements for the CPhT Program and updating the PTCE. PTCB will require individuals to complete a recognized education/training program or have equivalent work experience to be eligible to apply for the CPhT credential.

Pharmacy Technician Educators Must Become Recognized Education/training programs for pharmacy technicians must become PTCB-recognized to ensure students are eligible to take the PTCE after they complete the program.

■■ If a program is not PTCB-recognized, its students are not eligible to test as of Jan. 1.

■■ The process to become PTCB-recognized is easy and there’s no cost.

To be recognized, a program must attest that its curriculum includes PTCB-required knowledge. This knowledge is identified in PTCB’s new PTCE 2020 exam blueprint.

Accreditation is not required to become a PTCB-Recognized Education/Training Program. However, PTCB automatically recognizes programs accredited by the American Society of Health-System Pharmacists/Accreditation Council for Pharmacy Education or the Accrediting Bureau of Health Education Schools. These accredited programs do not need to submit an attestation.

STARTING IN 2020, PTCB IS CHANGING REQUIREMENTS FOR THE CPHT PROGRAM AND UPDATING THE PTCE.

10

|

FLORIDA PHARMACY TODAY

PTCB Certification Eligibility Requirements To Change in 2020 Education/Training Programs Can Apply Now for PTCB Recognition WASHINGTON, DC -- Starting in 2020, PTCB, the nation’s leading certifying organization for pharmacy technicians, will change its eligibility requirements for the Certified Pharmacy Technician (CPhT) Program and update its Pharmacy Technician Certification Exam (PTCE). PTCB will offer two eligibility pathways for technicians submitting certification applications beginning January 1, 2020. One will be completion of a PTCB-recognized education/training program, and the other will be equivalent work experience.

Announced in January 2018, these changes are based on data PTCB collected via Job Task Analysis survey responses from more than 40,000 pharmacy technicians and comments from the pharmacy community, including technician employers and educators, state and national pharmacy associations, and state boards of pharmacy.

“PTCB relies on data and pharmacy stakeholder conversations in all we do with the goal of advancing medication safety,” said William Schimmel, PTCB Executive Director and CEO. “The new eligibility requirements are based on input from pharmacy professionals that certain knowledge, skills, and abilities are acquired most effectively through education/ training or work experience. Pharmacy employers can be confident that PTCB-certified pharmacy technicians have demonstrated they have the knowledge to advance patient care in today’s pharmacy,” Schimmel said.

EDUCATION/TRAINING PROGRAM RECOGNITION

In preparation for 2020, PTCB has launched an application process for education/training programs to become PTCBrecognized by attesting that their curriculum meets specified knowledge requirements. The process requires directors of education/training programs not accredited by the American Society of Health-System Pharmacists/Accreditation Council for Pharmacy Education (ASHP/ACPE) and/or by the Accrediting Bureau of Health Education Schools (ABHES) to submit attestation.

Programs that are ASHP/ACPE and ABHES-accredited are recognized as fulfilling PTCB’s curriculum requirements and are not required to attest. More than 600 programs have become recognized to date. “Our recognition process for education/training programs lays the foundation for implement-

ing significant changes in CPhT eligibility requirements along with updates to the PTCE,” said Schimmel.

NEW ELIGIBILITY REQUIREMENTS

Students who complete a PTCB-recognized education/ training program will be eligible to apply for, and earn, their CPhT credential starting in 2020. As an alternative, PTCB will offer a second eligibility pathway based on work experience for technicians who have completed 500 work hours and attest to fulfilling specified knowledge requirements. “While PTCB values education as a key component to earning certification, we also recognize the merit of work experience,” Schimmel said. “This pathway means technicians who’ve worked extensively in the field, but haven’t been in a position to complete PTCB-recognized education can still pursue our national certification.”

“Aspiring CPhTs must show they have the necessary knowledge and skills to do their jobs safely and effectively,” said PTCB Certification Council President Kilee Yarosh, RPh, Market Director of Pharmacy Steward Healthcare, Warren OH. “PTCB’s eligibility requirements in 2020 go beyond high school and ensure those seeking to earn their certification are qualified and can successfully demonstrate competence.”

EXAM (PTCE) UPDATES

As of Jan. 1, PTCE content must be organized into four knowledge areas rather than the current nine, and will focus only on essential knowledge that applies across practice settings. Consistent with industry best practices and accreditation standards, PTCB periodically conducts a Job Task Analysis study approximately every five years as the foundation

for its national certification program. “The data from PTCB’s study in 2016 informed the updates to be made in 2020, and reflect technician responsibilities in current pharmacy practice,” said Levi Boren, PhD, PTCB Senior Director of Certification Programs. PTCB also received more than 500 individual comments during a 90-day comment period on implementation of the education/training eligibility pathway. “PTCB listens to the pharmacy community. Our comment period allowed us to collect valuable feedback,” Boren added.

“PTCB’s research-based changes are critical for keeping PTCB’s CPhT Program up to date on pharmacy practice and the vital role of pharmacy technicians,” added Barbara Limburg, PharmD, PTCE Exam Development Committee Chair and former sterile compounding professor of pharmacy technicians at South Suburban College and Associate Professor at Chicago State University College of Pharmacy.

More information is available on PTCB’s website, including the listing of PTCB-recognized education/training programs, program recognition attestation form, and updated PTCE content outline.

“PTCB’S RESEARCH-BASED CHANGES ARE CRITICAL FOR KEEPING PTCB’S CPHT PROGRAM UP TO DATE ON PHARMACY PRACTICE AND THE VITAL ROLE OF PHARMACY TECHNICIANS,” ADDED BARBARA LIMBURG, PHARMD, PTCE EXAM DEVELOPMENT COMMITTEE CHAIR AND FORMER STERILE COMPOUNDING PROFESSOR OF PHARMACY TECHNICIANS AT SOUTH SUBURBAN COLLEGE AND ASSOCIATE PROFESSOR AT CHICAGO STATE UNIVERSITY COLLEGE OF PHARMACY.

DECEMBER 2019 |

11

A giant leap: The industry adopts a new version of the national e-prescribing standard

CONTINUING EDUCATION

by Lisa Schwartz, PharmD, RPh; and Ken Whittemore, Jr., RPh, MBA

Nov. 1, 2019 (expires Nov. 1, 2022) Activity Type: Knowledge-based To earn continuing education credit: ACPE UAN: 0207-0000-19-398-H04-P; ACPE UAN: 0207-0000-19-398-H04-T

Upon successful completion of this article, the pharmacist should be able to: 1. Discuss how the adoption of a new, updated version and the effective date of the national NCPDP SCRIPT e-prescribing standard is determined.

2. Discuss policy and operational aspects that led to rapid growth in e-prescribing volume between 2008-2018.

3. List the new messages in NCPDP SCRIPT 2017071 and several of the data elements or codes that will improve data exchange between prescribers and pharmacists.

4. Explain the role of independent pharmacies in adopting the full range of messages available Upon successful completion of this article, the pharmacy technician should be able to: 1. Discuss how the adoption of a new, updated version and the effective date of the national NCPDP SCRIPT e-prescribing standard is determined.

2. Discuss policy and operational aspects that led to rapid growth in e-prescribing volume between 2008-2018.

3. List the new messages in NCPDP SCRIPT 2017071 and several of the data elements or codes that will improve data exchange between prescribers and pharmacists.

4. Explain the role of independent pharmacies in adopting the full range of messages available

NCPAÂŽ is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NCPA has assigned 1.5 contact hours (0.15 CEU) of continuing education credit to this article. Eligibility to receive continuing education credit for this article expires three years from the month published.

www.ncpanet.org/ap

12

|

FLORIDA PHARMACY TODAY

FREE ONLINE CE. To take advantage of free continuing pharmacy education (CPE) for this program, pharmacists and pharmacy technicians must achieve a passing score of 70% on the online continuing education quiz for the program. If a passing score is not achieved, one free reexamination is permitted. To take this test, go to www.ncpalearn.org. This activity is listed under Online Activities. If you have not registered with this site, you must do so before being able to access the CE Center. You will receive immediate online test results and credits will be posted to CPE Monitor within six weeks. To obtain your CPE Monitor e-Profile ID, please go to www.cpemonitor.com to register.

43

STANDARDS … WHO NEEDS THEM? As it turns out, in this modern world, everyone does.

They are found everywhere, though most people are probably unaware of their existence. For example, how is it that you can buy light bulbs from dozens of different manufacturers and they all easily fit in your fixtures at home? Because there is a national standard that specifies the width, the length, and what the thread pitch on a light bulb should be. What about tires? How is it that a variety of tires can fit on countless different vehicles?

Standards. Compact discs and DVDs can be played on many different types of hardware. Why? Standards. You can send emails, texts, photos, and videos back and forth with ease between cellphones, tablets, laptops, and personal computers all because of information technology standards. And, since 1997, there has been a national standard available to transmit prescriptions electronically from prescribers to pharmacies in the U.S. So what does the national e-prescribing standard look like? Well, it’s pretty complicated — probably far more complicated than most pharmacists or pharmacy technicians would imagine. After all, the information required to be included in prescriptions by most state boards of pharmacy and the federal Drug Enforcement Administration consists of the following: • The patient’s name and address.

• Drug name, strength, and form.

• Directions for use, such as the sig.

• Number of refills, if any.

• The prescriber’s name, address, and license number(s).

Yes, on occasion, regulatory authorities require a bit more than those bullet points on prescriptions, but not to the extent that it would require several hundred data fields to transmit the information. Yet that is easily the number of fields that make up just the new prescription portion of the national e-prescribing standard known as SCRIPT. SCRIPT — which is capitalized but isn’t an acronym — is the backbone of nationwide e-prescribing. It is a standardized set of data elements and codes developed and maintained by the members of the National Council for Prescription Drug Programs, or NCPDP. Another way to say it is that there is a group of people from all sides of the e-prescribing world that developed a big set of form fields and preselected codes used to quickly and accurately fill in an electronic form. The currently adopted version of this standard is known as NCPDP SCRIPT Version 10.6, but on Jan. 1, 2020, the industry will be adopting the first update in almost seven years by moving to NCPDP SCRIPT Version 2017071.

44

WHY SO LONG BETWEEN UPDATES? The members of NCPDP, which includes representatives from the pharmacy profession, are constantly working to make sure that SCRIPT is a complete and responsive standard for e-prescribing and related messages that meets the varied professional and business needs of all users (please see Table 1). You can just imagine the number of changes packed into an update when the past seven years have seen rapid adoption of e-prescribing due to prescriber use incentives, new data requirements to improve patient care, and a preference for codes instead of free text to streamline and improve automation.

This said, somewhat incongruously, it is not really up to NCPDP or its members to decide when the industry will move to a new version of SCRIPT. Instead, it is actually the Centers for Medicare & Medicaid Services that makes this decision.

Why is CMS in charge when it comes to deciding which version of SCRIPT the industry will use? You have to go all the way back to 2003, when the Medicare Modernization Act — also known as Medicare Part D — was enacted. Among the 400 plus pages of the MMA, one section on one page gave the Department of Health and Human Services secretary the responsibility for determining which e-prescribing standards should be used for Medicare Part D. Given the size of that program, this effectively means that HHS, through CMS, determines which e-prescribing standard is used nationwide. Most recently, in April 2018, in response to the industry’s petitions, CMS published a final rule that gave the industry until Jan. 1, 2020, to move to SCRIPT 2017071, which is what the entire industry is now focused upon. (Interestingly, SCRIPT is not the named standard in the Part D program for electronic prior authorization, or ePA, which helps explain why ePA solutions have had a harder time in terms of adoption and utilization.)

Table 1: Examples of related messages

Prescriber-initiated: • Cancel Rx • Census • Drug administration • Recertification • Resupply • Rx change response • Rx renewal response

Pharmacy-initiated: • NewRx request • RxChange request • Cancel Rx response • Rx fill • Rx renewal request • RxTransfer

America’s PHARMACIST | November 2019

DECEMBER 2019

|

13

A BRIEF HISTORY OF E-PRESCRIBING To promote a baseline level of understanding of e-prescribing before getting into the substantial upgrades included in SCRIPT 2017071, let’s review the 20-plus years the standard has been available. After a relatively slow first decade, in 2009, Congress enacted MIPPA — the Medicare Improvements for Patients and Providers Act — which offered modest financial enticements for providers to adopt and utilize e-prescribing. Not long thereafter, adoption took a giant leap forward after the enactment of the Health Information Technology for Economic and Clinical Health Act, which offered huge incentives for prescribers to adopt electronic health records. All such EHRs were required to include an e-prescribing functionality. HITECH’s goal was to encourage electronic health information exchange, but the rush to comply with the program’s numerous certification requirements translated into some EHR systems being poorly designed and implemented, the results of which were often felt downstream in community pharmacies.

Over the past several years, critical performance improvement efforts have been directed at correcting such deficiencies and perfecting the e-prescribing process.

Today, 98 percent of pharmacies and 76 percent of prescribers have adopted e-prescribing in general, and 96 percent of pharmacies and 40 percent of prescribers are now enabled for e-prescribing for controlled substance drugs.

E-prescribing for controlled substances, or EPCS, was not

permitted until 2010, when the DEA published rules permitting it, and after that about half of the states had to revise their statutes and/or regulations to align with those of the DEA to allow EPCS. This delay in regulatory authorization has meant that at this time slightly fewer pharmacies are able to accept EPCSs, and prescribers in states without active EPCS mandate laws lag significantly behind in the adoption of EPCS (see Table 2). In response, both states and the federal government are adopting rules that require prescribers to adopt e-prescribing. Specifically, 28 states have now enacted legislation that will require e-prescribing across the board, e-prescribing for all controlled substances, or e-prescribing for just a subset of controlled substances, such as opioids. On the federal side, the SUPPORT for Patients and Communities Act of 2018 includes a mandate that prescriptions for controlled substances billed to Medicare must be prescribed electronically by Jan. 1, 2021.

WINTER IS COMING … BUT FOR PHARMACIES RECEIVING E-PRESCRIPTIONS, IT’S A GOOD THING Let’s now return to the primary subject at hand — the aforementioned January 2020 industry move to the new version of the national e-prescribing standard known as SCRIPT 2017071. Broadly, the enhancements brought to bear by this version fall into two categories: • The incorporation of new data segments, elements, and codes to existing messages such as new prescriptions (NewRx).

Table 2: Electronic Prescribing requirements NOW EXIST IN 28 STATES (07/17/2019)

All prescription electronic requirement in effect All prescription electronic requirement in future All EPCS requirement in effect

L

All EPCS requirement in future EPCS subset requirement (e.g., opioids) in effect EPCS subset requirement (e.g., opioids) in future EHR EPCS adoption requirement eRx/EPCS legislation in progress (L)

Copyright © 2019 by Surescripts, LLC. All rights reserved.

www.ncpanet.org/ap

14

|

FLORIDA PHARMACY TODAY

Note: CO and MO requirements exclude Schedule V.

45

•

The addition of new messages that allow the exchange of information not originally contemplated

by SCRIPT, such as the ability to transfer electronic prescription information between pharmacies (RxTransfer).

All told, SCRIPT 2017071 makes hundreds of improvements to the e-prescribing process, but most of them are not likely of day-to-day interest to pharmacy personnel.

Thus, for the purposes of this discussion, the focus will be on changes that most directly and significantly affect pharmacy practice, some of which pharmacists and pharmacy technicians have been wishing would happen for some time.

It might be going out on a limb a bit, but experience suggests that the first SCRIPT upgrade that should be mentioned is that the new standard is designed to accommodate the electronic prescribing of compounded prescriptions. None of the earlier versions of SCRIPT were designed to convey information about compounded prescriptions, but as many pharmacists and pharmacy technicians have experienced, prescribers have often tried to shoehorn such information into electronic prescriptions anyway, leading to much confusion among those receiving such prescriptions. This should no longer happen after January 2020, because the new version of SCRIPT is able to incorporate the drug name and quantity for up to 25 different ingredients in one electronic prescription. And if all else fails, for the applications that support it, the compounding pharmacy can request a new prescription.

Another component of electronic prescriptions that has been problematic for pharmacy personnel over the years is the sig, or patient instructions, field. All previous versions of SCRIPT have limited the length of this field to 140 characters, which in many cases was insufficient for prescribers to express their instructions to patients as they wished. This, too, often led to confusion and delays in pharmacies, requiring pharmacy personnel to reach out to prescribers to clarify what they meant. To address this e-prescribing challenge, NCPDP members approved a sig field expansion to 1,000 characters in SCRIPT 2017071. Hopefully there will be very few instances in which a prescriber will actually use all 1,000 characters available to write a sig, because that would cause a different type of problem at the pharmacy end (think about trying to fit all of that on a prescription label!), but the added capacity should definitely resolve more issues than it causes. It also is anticipated that pharmacy software vendors will devise methods of handling sigs that are toward the higher end of this new limit.

46

As was mentioned previously, there are many additional improvements contained in the new e-prescribing standard, so let’s touch on several more examples from among the hundreds of changes made in SCRIPT 2017071 in the form of a “lighting round:” • Allergies: A patient’s allergies can be sent using SNOMED codes.

• Brand medically necessary: This data element is being updated to meet CMS guidelines.

• Codified notes: A brief list of standardized notes, such as “Needs Appointment,” is being added.

• Do not fill: Prescribers may indicate that the prescription should not be filled because it is a cover prescription or should be kept on file until the patient requests it.

• International address: A country code will be available to support international addresses.

• Prescriber identifiers: Additional fields are being added to accommodate multiple prescriber identifiers, such as DATA 2000/NADEAN (the ‘X’ DEA number).

• Primary language: The patient’s preferred language can be indicated if other than English, which is useful in general and is a requirement in some states.

• Prohibit refill requests & follow-up prescriber information: Prescribers may indicate that they do not want to receive renewal requests (such as in the case of emergency rooms or urgent care) and/or they can designate an alternate prescriber for follow up.

• Substance use: If applicable, the patient’s substance abuse history can be shared with pharmacy personnel.

• Urgent Rx: Allows a prescriber to request expedited dispensing of a particular prescription.

• Weight: Not new, but frequently requested, a patient’s weight can be sent in kilograms in the “Observation” field.

All of these examples are considered to be of special interest to pharmacy personnel, but please be advised that this list represents only a small portion of what is in store in the new version of the e-prescribing standard.

Now let’s look at just a couple of the entirely new messages being introduced in SCRIPT 2017071. As was mentioned earlier, these messages deal with unmet needs that earlier versions of the e-prescribing standard did not anticipate: • RxTransfer: This message is exactly what you would think from its name — it’s an electronic way to perform the age-old procedure of transferring a patient’s prescription from one pharmacy to another.

America’s PHARMACIST | November 2019

DECEMBER 2019

|

15

Frankly, it is a little surprising that NCPDP didn’t tackle this need earlier, but the oversight will be corrected soon.

From a workflow standpoint, RxTransfer is modeled on the current process in that the pharmacy where the patient would like to have his or her prescription filled initiates a message to “pull” the prescription from the pharmacy that originally dispensed it. It is important to understand this point, because there are some in the industry who have the mistaken impression that RxTransfer can also be used as a “push” message, meaning the pharmacy that originally dispensed a prescription can simply forward

it to another pharmacy at the patient’s request. This is not possible with the version of RxTransfer that currently is being adopted. Once the pharmacy that originally dispensed the prescription receives the transfer request, it will send a response with the prescription information or a response denying the request (such as the prescription was already transferred, no refills remain, or the prescription was not found).

Additionally, unlike other e-prescribing messages, this communication takes place solely between pharmacies, which means that both the receiving and sending pharmacies must be enabled to handle

An underutilized e-prescribing message becomes more muscular

There are multiple reasons why a pharmacist might want to suggest that a prescriber make a change in a patient’s prescription, and traditionally such recommendations have been made in verbal or paper form. For many years, however, there has been an electronic message available for transmission via the e-prescribing infrastructure that can convey change recommendations from pharmacists to prescribers. This message is called RxChange, and thus far the pharmacy community has not taken advantage of its functionality to the degree that you might expect. SCRIPT 2017071 significantly expands the number of circumstances in which this message can be used, though, so it is hoped that dramatic increases in the use of this message will be noted in the future.

Presently, there are three uses cases available for RxChange: • Generic substitution: This is suitable when a new generic becomes available during ongoing treatment, the prescriber has indicated dispense as written but the patient still wants a generic, a brand is not covered, a high copay or coinsurance makes the brand unaffordable, the patient desires a biosimilar that requires prescriber authorization, or the pharmacy does not carry a specific product.

• Prior authorization: It’s used when a pharmacy receives a prescription claim reject indicating that a prior authorization number is needed from the prescriber before the prescription will be covered by a patient’s insurance.

• Therapeutic interchange: It’s appropriate whenever a pharmacist determines a change in therapy would benefit the patient.

These are beneficial to be sure, but the industry has added several more valuable use cases in the new version of SCRIPT: • Drug use evaluation: This is applicable when a pharmacist determines there are alternative drugs that could be dispensed with fewer adverse effects.

• Script clarification: This is employed when a pharmacist or pharmacy technician needs clarification to the medication information contained in a prescription to be able to dispense it.

• Out of stock: The pharmacy does not have any of the medication in stock and does not anticipate it will obtain it soon enough for the patient.

• Prescriber authorization: This is useful when the pharmacist wishes to confirm the prescriber’s authority to prescribe (a limited use case).

Judging by feedback that has been received from pharmacy personnel over the years, script clarification might end up being the most helpful of all of the new RxChange use cases. Pharmacy owners and managers interested in using RxChange for this new purpose should reach out to their pharmacy software vendor to ensure that this new feature is going to be made available to them with their SCRIPT 2017071 update.

16

|

FLORIDA PHARMACY TODAY www.ncpanet.org/ap

47

•

RxTransfer messages. For this to happen, pharmacy software vendors must incorporate RxTransfer message capabilities into their applications. Pharmacy owners and managers who have an interest in using RxTransfer messages should therefore have a conversation with their pharmacy software vendors sharing their interest. Finally, pharmacists must consider whether such electronic prescription transfers are allowed by their state’s laws and regulations.

NewRxRequest: This, too, is a message designed to attend to a previously unmet need, although this type of communication is not as commonplace as transferring prescriptions. It allows a pharmacist to request a new prescription from a prescriber with either minimal information or expired prescription information. For example, a patient might come to the pharmacy saying that his or her physician was going to send a prescription for an antibiotic to the pharmacy, but no such prescription is in the pharmacy’s records. In this case, a NewRxRequest can be sent to the prescriber indicating simply that the patient has requested an antibiotic, and then the prescriber can respond as they see fit. Another possible use for this transaction is related to prescriptions for which patients have an ongoing — yet very intermittent — need, such as allergy medications or asthma inhalers. If a patient’s prescription is too old, or the information about the prescription is incomplete, a NewRxRequest will probably be the best choice to attempt to attend to the patient’s medication need.

and e-prescribing intermediaries have been preparing intently for more than a year for CMS’s Jan. 1, 2020 deadline, and most industry participants should be ready for the cutover on that date. It is hoped that by sharing information in this article on the most noteworthy new features to be delivered by SCRIPT 2017071, practicing pharmacists and pharmacy technicians will come to understand the importance of this critical transition and will be encouraged to do what they can to participate in the process and fully utilize the new and/or enhanced technological tools that they will be given. ■ Lisa Schwartz is NCPA senior director, professional affairs.

Ken Whittemore is Surescripts vice president of professional and regulatory affairs. Questions of a technical nature should be sent to Whittemore at ken.whittemore@surescripts.com.

Other questions may be sent to lschwartz@ncpanet.org.

This article was originally published in the November 2019 issue of America’s Pharmacist. It is accredited for 1.5 hours of continuing pharmacy education for pharmacists and pharmacy technicians through the National Community Pharmacists Association. For full information or to claim CPE for this article, please visit www.ncpalearn.org and click on “A Giant Leap: The Industry Adopts a New Version of the National E-Prescribing Standard” under online activities.

Again, similar to the data elements mentioned earlier, these are just two out of the 10 new messages made available by SCRIPT 2017071, but they are likely the ones that will be of the greatest interest to pharmacy personnel.

TAKING ADVANTAGE OF ALL THAT SCRIPT 2017071 HAS TO OFFER The adoption and utilization of e-prescribing over the past two decades has delivered on much of the technology’s promise of increased accuracy and safety, greater pharmacy and prescriber efficiencies, more robust communication between medical professionals, and reduced costs. This said, as is the case with virtually every modern technology, regular updates are critical to maintaining relevance, delivering enhanced capabilities, and yes, remediating deficiencies and imperfections.

Because the industry is constrained by federal requirements in terms of how often it can move to new versions of the SCRIPT standard, it is that much more important that maximum utility and value are wrung out of every upgrade. EHR vendors, pharmacy software vendors, 48

DECEM B E R 2 02019 19 | America’s PHARMACIST | November

17

2020 FPA CANDIDATES

2020 Election Ballot Information The election for FPA president elect, and regional and technician directors will be done by computer. An email containing instructions on how to cast your vote will be sent to you shortly. Please make sure that we have your correct email address in your member profile. You will sign in with your username and password to vote. If you live in regions 1, 3, 5, 7 or 9, you will not be voting for a regional director. Those regions will have their election next year. You will, however, have an opportunity to select the next president-elect and technician board member. If you live in regions 2, 4, 6 or 8, make your selection for your regional director and technician. Remember, the system will allow you to vote only one time. The results will be tallied by the canvassing committee appointed by the president of the Florida Pharmacy Association in accordance with FPA bylaws. The last day to vote will be Jan. 31. If you do not receive your email invitation, please contact us at cheil@pharmview.com.

CANDIDATES FOR FPA PRESIDENT ELECT Daniel Buffington FPA Member Since 1992 Dr. Daniel Buffington is the president and practice director at Clinical Pharmacology Services, located in Tampa. He is also on faculty at the University of South Florida College of Medicine and Pharmacy and serves as an experiential preceptor for numerous colleges across the

United States.

He studied biology/biochemistry at the University of South Florida, received the doctor of pharmacy and master’s of business administration from Mercer University.

His postgraduate training included a pharmacy practice residency and clinical pharmacology fellowship from Emory University.

Dr. Buffington is a clinical pharmacology specialist and provides medication therapy management services, serves as a principal investigator for Phase II and III clinical trials and manages a national drug information service the provides clinical support for medical practices, health systems, and health plans. The practice also includes a forensic pharmacology division that supports medical examiners, law enforcement, state and federal agencies, and provides expert testimony in courts.

His practice focuses on patients taking chronic or high risk medications and provides medication therapy management services to improve health outcomes and patient safety.

He served for six years on the Board of Trustees of the American Pharmacists Association and represents pharmacists on the American Medical Association’s Current Procedural Terminology Editorial Panel. He served for five years as a medication safety expert with the U.S. Centers for Medicare and Medicaid Services on the health care reform team in the CMS Innovation Center and the Center for Clinical Standards and Quality, focused on improv18

|

FLORIDA PHARMACY TODAY

ing health outcomes, patient safety and alternate payment models.

His interests include developing advanced clinical practice models and practice resources for improving medication utilization, patient safety, health care service reimbursement and health informatics.

POSITION STATEMENT

This is a critical time for our profession, and we need to strive for innovative practice models and legislative advances that ensure patients have access to the leading pharmacology specialists in the entire health care system. Our services promote improved health outcomes, patient safety and affordable access to essential medications. It is imperative to have pharmacists integrated at all levels, from patient care settings through health care administration and policy development, to ensure optimal health care. I am committed to developing improved collaboration and I would be honored to serve FPA in this role and will dedicate my personal time, experience and resources toward the further advancement of our profession.

Kevin Duane FPA Member Since 2013 My name is Kevin Duane, and I am writing this letter to share my interest in running for the position of presidentelect.

I graduated with my doctor of pharmacy degree from the University of Florida’s College of Pharmacy in 2013 and have been an active member of FPA since graduation. I am currently practicing as a pharmacist and I am in good standing with the Florida Board of Pharmacy. I have reviewed the FPA’s governance documents and I am confident that I meet all the necessary requirements to serve the Association for the three-year term.

I currently own and operate two independent community pharmacies in the North Florida area, leading a team of

2020 FPA CANDIDATES

six pharmacists, 13 technicians and support staff, and one pharmacy intern. I manage a collective budget that exceeds $10,000,000 per year. Additionally, I helped start the University of Florida’s first community pharmacy residency program and am currently one of only two sites in the state precepting this residency’s students. Prior to these current experiences, I was named an emerging leader at CVS Health corporation, where in a short seven years working, was promoted three times, and slated to receive a district leader position. I would have been one of the youngest pharmacists in our region to achieve that. I was very proud of my accomplishments and work ethic. I was named one of the University of Florida’s most outstanding young alumni in 2018. I currently serve as a luminary pharmacy with CPESN Florida, a leadership position that is transforming the way that we practice community pharmacy.

These leadership roles and experiences I believe uniquely position me to succeed as president-elect of the association.

I deeply care about and am very passionate for our profession. I have taken a special interest in Legislative Days at the Capitol and have worked as a volunteer facilitator on multiple occasions. Additionally, I have met with legislators and other parties sympathetic to our profession’s issues and have been a staunch advocate for positive change.

I have also helped organize grassroots efforts to do the same. I am confident I can be a unifying servant leader that helps propel our association and our profession forward in a positive and sustainable way.

Thank you for your consideration, and I look forward to working with you all soon after my election.

BIOGRAPHICAL DESCRIPTION:

I have been an active FPA member since my graduation from the University of Florida’s College of Pharmacy in 2013. I knew I had found my passion for pharmacy leadership after attending my first Legislative Days session as a second-year student. My knack for leadership continued as I was named an emerging pharmacist leader at my chain pharmacy position just over 1 year past my initial licensure, one of the youngest licensed pharmacists in the company to achieve that honor. I bought my first pharmacy at 29 and now own and manage several independent community pharmacies in the North Florida area. I have been involved in leadership development and continue to apply principles to my businesses to elevate my team.

My passion for advocacy at the state and federal level has been a priority, and I continue to mentor others through outreach and grassroots advocacy. When I’m not working in my business,s you might find me meeting with a legislator or working with my peers to develop legislation to protect, preserve and advance our profession. I provide rotation experiences for students and residents, and continue to innovate services for community services and patient

care outcomes. I am a CPESN luminary and as such, help lead the state’s pharmacies into new and innovative practice models “beyond the fill.”

Away from work, I am an avid outdoorsman and love to fish. I also am a huge sports fan, so on most weekends you’ll catch me rooting on the Florida Gators and the Jacksonville Jaguars. My lovely wife Alyssa and I were high school sweethearts and I wouldn’t be where I am today without her steadfast love and support. Even though we both live busy lives, we are always able to drop everything and enjoy the most wonderful thing to ever happen to us — our three-year-old daughter Maggie. I am committed to my service and this profession and will serve to my fullest capacity in leadership for the FPA. POSITION STATEMENT:

The profession of pharmacy is at an inflection point and FPA needs a leader on the forefront of this change to guide its membership through to a path of success and sustainability.

Independent pharmacists are being driven out of business by PBMs with little to no help in regulation. Chain pharmacists are being fired based on how fast they answer the telephone, number of vaccines administered or how many care cards they scan — nothing to do with clinical skill. Technicians get their licenses suspended for delinquent student loans without any representation on the board acting against them. Interns are graduating with increasingly large student loans and fewer jobs available.

Pharmacy professionals in this state need an association with a fresh voice that can advocate for their interests, and I can be that voice.

Our members seek our support and outreach. The new generation of pharmacy professionals consumes information in completely different ways, and the association must adapt to this changing landscape. Membership in an organization is directly correlated with engagement by the association to its membership and perception of value. More than ever, the association must use social media and other platforms of communication to cultivate new membership and preserve membership for years to come. The incorporation of innovative ideas while preserving the historical integrity of the association is the path to our future.

I ask for your vote for me as president-elect so that together we can work to fill this “prescription for change.”

Thank you.

DECEMBER 2019

|

19

2020 FPA CANDIDATES

CANDIDATE FOR FPA REGION 2

CANDIDATE FOR FPA REGION 4

(Nassau, Duval, Marion, Volusia, Flagler, Putnam, St. Johns, Clay Counties)

(Seminole, Orange, Osceola, Lake, Sumter Counties)

Tejas Patel FPA Member Since 2018 POSITION STATEMENT

I am honored to be nominated and considered for FPA Region 2 Representative.

My intent as Region 2 representative will be to help with notification of possible changes and monitoring of the explosive growth and changes in the pharmacist profession.

From July 2012, working as an independent pharmacy owner, I have seen many ups and downs within community pharmacy. Network restrictions, low reimbursements, targeted audits and DIR or other fees from pharmacy benefit managers cause constant uncertainty. To improve the current conditions, we must work together.

■■ I am a foreign pharmacy graduate from India (May 2001).

■■ I completed FPGEC (Foreign Pharmacy Graduate Examination Committee certification) in December 2005.

■■ I worked as a pharmacist intern at Walgreens Pharmacy from September 2003 till December 2005. As a pharmacy manager from December 2006 until June 2012.

■■ Florida Pharmacist License PS41608.

■■ Florida Consultant License PU8348.

■■ Certified to administer immunization.

■■ Medication Therapy Management trained.

■■ Managed Center of Excellence for HIV and Diabetes (fFor Walgreens).

■■ From July 2012 as an independent pharmacy owner at Ricker Pharmacy.

■■ I am a member of Duval County Pharmacists Association and a member of FPA.

20

|

FLORIDA PHARMACY TODAY

Cheryl Rouse FPA Member Since 2016 Cheryl began her pharmacy career as a clinical pharmacist at AMI Brookwood Hospital.

Her professional experiences include hospital pharmacy administration, home health, psychiatric and retail pharmacy. Cheryl and her husband opened the doors of C&C Community Pharmacy in 1992 and has been serving the community in which she was raised for 25 years. She has served as FPA Region 4 director since 2018.

POSITION STATEMENT:

I am excited for the opportunity to serve my colleagues and profession. With a passion to preserve the neighborhood drugstore, this is still the first and most convenient access to care for many of our patients. It also is their last line of defense. A pharmacist’s access is vital to a community.

CANDIDATES FOR FPA REGION 6 (Brevard, Manatee, Hardee, Okeechobee, Highlands, Desoto, Sarasota, Charlotte, Glades, Martin, St. Lucie, Indian River Counties) Kathy Petsos FPA Member Since 1985 Kat her i ne Pet sos, BSPha r m,C. Ph.,FAPhA, is a 1979 graduate of the University of Florida College of Pharmacy.

She works for Walgreens in Cocoa Beach and resides in Cape Canaveral. Kathy is a past president of the Florida Pharmacy Association and Brevard County Pharmacy Association. She is a member of the Florida Pharmacy Association, Brevard County Pharmacy Association, American Pharmacists Association and American Association of Diabetes Educators. Awards she has received from the FPA are the Bowl of Hygeia Award, R.Q. Richards Award, James H. Beale Award and Jean Lamberti Mentorship Award. Kathy has served as chairwoman of the Professional Affairs Council, Public Affairs Council and Membership Council, as well as a member of the Organizational Affairs Council for the FPA. At the national level, she has served as a delegate for the FPA at the APhA House of Delegates for many years and on various House of Delegates

2020 FPA CANDIDATES

committees as well as being chairwoman of the Policy Review Committee. Currently she is a member of the FPA Membership Council and the Brevard County Pharmacy Assn Executive Committee.

POSITION STATEMENT

First let me say how proud I would be to represent all pharmacists in our region whether you are independent, chain, long-term care, nuclear, hospital, etc. I want to know your issues and work on solutions to these problems. Second, my priorities are to focus on the quality of care for our patients and the advancement of our profession.

There are many issues that need to be addressed that impact the quality of care of our patients. One is the Test and Treat Bill that is being sponsored by our Brevard County Rep. Tyler Sirois. We would be able to positively impact our patient’s wellbeing by being able to quickly test for influenza and prescribing the medicine they need to recover in a timely manner. We also need to address improving the transition of care process as patients move between care levels such as from hospital to home or rehabilitation center to home to name a few.

There are a few issues that affect the ability to provide these patient services due to their impact on the profitability of both independent and chain pharmacies. They are regulating pharmacy benefit managers and increasing the transparency of their business practices and the elimination of DIR fees. These same issues negatively affect the amount of support help the community pharmacist receives from their employer. The Brevard County Pharmacy Association introduced a resolution at the FPA House of Delegates asking that a pharmacist never be left alone not only for patient safety and delivery of services, but also for personal safety.

The issue at the forefront of advancing our profession is obtaining provider status for pharmacists. This would allow us to expand our opportunities and bill for professional services. We should not have to rely on collaboration with physicians in order to be reimbursed for our services.

In order to make any of this a reality, we need to collaborate with other pharmacy stakeholders and make sure we are speaking with a unified voice. We also need pharmacists to become advocates for their profession and their patients.

I am dedicated to making all of this come to fruition. I would be honored to receive your vote.

James Wright FPA Member Since 2012 James A. Wright III is a seventh-generation Floridian from Rockledge, Florida. He graduated from the University of Florida College of Pharmacy in 2008 with a doctor of pharmacy degree. In 2012, James reopened Five Points Pharmacy and Wellness, a retail pharmacy serving the community of Cocoa since the 1960s. Prior to being a small business pharmacy owner, he was a staff clinical pharmacist at Orlando Regional Medicaid Center.

He has been a member of the Florida Pharmacy Association since February 2012 and served on the Government Affairs Council in 2016, 2017 and 2018. James was a delegate for the Brevard County Pharmacy Association at the FPA House of Delegates in 2018 and 2019. Other memberships include National Community Pharmacy Association, Pharmacists United for Truth and Transparency, Small Business Pharmacies Aligned for Reform and the Cocoa Beach Regional Chamber of Commerce.

James lives in central Florida along with his wife Rachel and their two daughters, Harper and Caroline.

POSITION STATION:

As the pharmacy profession changes, our association needs to evolve as well. Our profession has so many talented, creative and honorable members. We should listen and learn from those with wisdom and experience, but not be afraid to embrace the change of the future.

My career as a pharmacist has taken place over a period of uneasiness requiring everyone to do more with less. I held a staff pharmacist position at a hospital during the last economic recession and saw pharmacy layoffs and hours cut as the organization trimmed the budget.

Later, as an independent pharmacy owner, I felt the pain of an industry under fire. Network restrictions, low reimbursements, targeted audits, and DIR or other fees from pharmacy benefit managers cause constant uncertainty.

The working conditions for pharmacists and technicians employed by large chain pharmacies continue to deteriorate.

We are wedged between giant industries: PBMs, wholesalers, insurance companies, chain pharmacies and PhRMA. To improve the current conditions, we must work together to create a louder voice. This includes political advocacy or other forms of union and protest.

As a regional director, I would work to facilitate communication and transparency from FPA leadership to regional members and continue advocating for our profession.

DECEMBER 2019

|

21

2020 FPA CANDIDATES

CANDIDATE FOR FPA REGION 8 (Collier, Monroe, and Dade Counties) No candidate information received by the Sept. 1 deadline. The Region 8 director will be write-in only.

CANDIDATE FOR TECHNICIAN MEMBER Verender Gail Brown FPA Member Since 2006 BIOGRAPHICAL DESCRIPTION:

In over 40 years as a pharmacy technician, Ms. Brown has carved out a career being more than “just a tech.” Accuracy, geriatric care and MTM have been her personal passion for decades, along with technician development in Florida. To that end, she has been: developer and implementer of a successful internal district pharmacy auditing campaign; corporate longterm care policy and procedure developer, writer and collaborator; policy and procedure writer and implementer for two independent pharmacies; and pharmacy software trainer for North Florida and the Panhandle. As co-chair one year, and then chair of the FSHP Technician Council (three years total, 2008-2012), Ms. Brown was instrumental in helping develop the criteria for the Florida Registered Technician registration process.

Notably, Gail was appointed to the APhA Books and Electronic Products Editorial Advisory Board (three-year term), and as the inaugural technician appointed to the FPA Advisory Council on Pharmacy Practice. She has served on other state and national committees and councils for FPA, FSHP, AAPT (American Association of Pharmacy Technicians, Executive Regional Officer), Florida Department of Education – Pharmacy Technician Curriculum Revision Committee, and the Journal of Pharmacy Technology. She is a published reviewer of several pharmacy and health care reference and textbooks.

Of the new Pharmacy Technician Certification Board’s new advanced certification credentials being developed and implemented (CPhT-Adv), Gail was doing in the 1980s and 1990s. Developing the billing and reimbursement procedures for her Albertsons district pharmacies, ensuring claims were properly resubmitted for payment, then educating pharmacists and staff on how to maintain the $10,000-=plus in sales recouped for several stores in the Palm Harbor, St. Pete/Clearwater and Tampa areas. Headquarted in West Orlando, she worked with a physicianowned group of 27 clinics from Jacksonville to St. Pete/ 22

|

FLORIDA PHARMACY TODAY

Tampa, as the MTM coordinator/educator to help develop and implement an MTM program to meet the adherence and cost saving needs of 4500-plus patients. The organization was one of the nation’s eight ACOs at that time.

An educator for over 12 years covering two institutions, she has served as pharmacy technician instructor and as program manager/extern coordinator. Gail is the 20182019 Inaugural Teacher of the Year for Osceola Technical College (formerly known as Technical Education Center Osceola). In 2015, she was named Next-Generation Pharmacist® Technician of the Year by Pharmacy Times and Parata Systems. She will always be honored to be chosen Florida Pharmacy Association’s Inaugural Technician of the Year award recipient (2008), followed by the Florida Society of Health-Systems Pharmacists Technician of the Year award (2012), affording her the honor of being the first technician in Florida to receive Technician of the Year awards from both state organizations.

With this history and her passion for pharmacy, it is believed Ms. Verender Gail Brown, BS, CPhT, RPhT, will be an asset as technician member to the Florida Pharmacy Association’s Board of Directors.

FPA NEWS & NOTES PBM Legislation Filed A number of bills have been filed addressing pharmacy benefit managers. HB961 by Representative Jackie Toledo includes a large number of FPA supported initiatives designed to bring more transparency and fairness in the PBM marketplace. Co-sponsors of the bill include Representatives Beltran, Brown, Eskamani, Geller, Mercado, Sabatini, Santiago and Sirois. A few of the many items in this legislation, if in its present form is signed into law by Governor DeSantis would: ■■ Impose a fiduciary duty on PBMs to the covered individuals and the payors and prohibits a contract between a PBM and payor from limiting the fiduciary duty ■■ Authorize a licensed pharmacy or pharmacist to contract with a PBM without a probation period, exclusion period, or minimum inventory requirements.

■■ Require a PBM to respond to a MAC appeal with 7 days or the appeal is deemed approved ■■ Establish a list of prohibited practices including spread pricing, charging fees for adjudicating claims, paying a pharmacy less than the actual cost incurred by the pharmacy for providing the drug, retroactively denying a claim, and referring covered individuals to an affiliate.

■■ Require a PBM to disclose to the payor any practice that presents a conflict of interest with covered individuals or the payor and to report to the payor any income resulting from pricing discounts, rebates, clawbacks, etc.

■■ Subject a PBM to a civil fine of $10,000 fine or revocation of its registration for certain violations. A pattern of violations subjects a PBM to Florida Deceptive and Unfair Trade Practices Act (FDUTPA) FPA Members are encouraged to contact members of the Florida House and ask that they sign on as a cosponsor and support HB961. Senator Tim Wright has also filed a bill related to PBMs. SB1338 is different from HB961.

FPA supported HB1338 takes a slightly different approach to regulating PBMs. Some of the items in this bill would: ■■ Create an appeals process for pharmacies after receipt of a final audit report ■■ Hold health insurer or HMO responsible for PBM violations of Florida laws ■■ Require PBMs to report to the state data such as but not limited to comparisons of retail and mail-order prescription services, generic dispensing rates of mail order and retail pharmacies and a report of aggregate data on amount and types of rebates, discounts, price

■■ ■■ ■■

concessions etc.

Require single sourced generic drugs to be reimbursed as a branded drug Creates a standard that MAC drugs need to be based upon Require rebates or other financial incentives to be passed through to the insurer

New NCPDP Script Standards Take Effect January 1 The pharmacy industry adopted a new standard for electronic prescribing on Jan. 1. This is the first major revision executed in over seven years. On the first of the year, we moved to NCPDP SCRIPT version 2017071. A lot of what is going into this change is being driven by the Center for Medicare and Medicaid Services (CMS) and also badly needed revisions such as the ability to transmit more comprehensive information for compounded medications. Also by January 1, 2021, all controlled substances billed to Medicare must be electronically prescribed.

Look for an article on this issue to be published in Florida Pharmacy Today very soon. Members may want to make sure that your pharmacy systems are enabled and compatible with the new SCRIPT standards by verifying with your software vendor.

FPA Participates in e-Prescribing Panel Webinar EVP Michael Jackson served on a virtual panel with representatives from Surescripts, medicine and the Board of Pharmacy. The panel was facilitated by the Agency for Health Care Administration to share information on electronic prescribing in Florida and review changes in Florida laws that created a requirement for Florida physicians to prescribe electronically. You may have to register to view the webinar. To view this webinar please click here.

DECEMBER 2019

|

23

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

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

STATEWIDE REPRESENTATION 561-392-9000 bkahan@kahanlaw.com 2300 N.W. Corporate Blvd., Suite 123 Boca Raton, FL 33431 The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

We Deliver Solutions for a Healthier Bottom Line • Group volume purchasing power • Aggressive wholesaler pricing programs • Profits distributed to members at year-end • EPIC Pharmacy Network, Inc. (EPN) membership fee included at no cost – access to third-party contracts • Clinical services tools, including expert assistance from our in-house pharmacist and access to custom PrescribeWellness offerings and EQuIPPTM • – free third-party claims reconciliation program and automated reimbursements below cost system • – Web-based solution for pharmacy regulatory and compliance management

PUT THE POWER OF A NETWORK BEHIND YOU

800-965-EPIC | EPICRX.COM

Florida Pharmacy Association Offers Online Correspondence Courses Too busy with life’s hectic schedule to fit in one of Florida Pharmacy Association’s (FPA) live continuing education conferences? We have a solution for you! FPA offers online correspondence continuing education courses. You can learn from wherever you are. Earn your pharmacy continuing education hours at your convenience. Online education just got a whole lot better with the FPA. The courses below are being offered for general and consultant recertification continuing education credits.

Management of Asthma Management of Diabetes Management of Geriatric Disorders Management of Hepatitis Management of Hyperlipidemia Management of Hypertension Management of IBS and IBD Management of Sexually Transmitted Diseases

3 Contact Hours 3 Contact Hours 6 Contact Hours 3 Contact Hours 3 Contact Hours 3 Contact Hours 3 Contact Hours 3 Contact Hours

In addition, we offer the following Florida Board approved courses: 2 hour Medication Errors, 2 hour Validation of Controlled Substances, 1 hour HIV/AIDS, 1 hour Human Trafficking for Pharmacy, 8 hour Pharmacy Errors, and 12 hour Pharmacy Laws and Rules. Please contact the FPA office (850) 222-2400 or visit our website www.floridapharmacy.org for details and pricing.

The Florida Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education.

24

|

FLORIDA PHARMACY TODAY

CALL FOR RESOLUTIONS TO THE 2020 HOUSE OF DELEGATES The House of Delegates Board of Directors will meet in May 2020 to review and approve resolutions for the Annual Meeting. The deadline for submitting resolutions is May 10, 2020!

PLEASE NOTE THIS DEADLINE. The last day to submit items of new business is June 7, 2020.

The following information will be needed when submitting resolutions: 1. Name of organization: The name of the organization submitting the resolutions(s); 2. Name and telephone number of individuals: A contact in the event clarification or further information is needed; 3. Problem: A statement of the problem addressed by the resolution; 4. Intent: A statement of what passage of the resolution will accomplish; 5. Resolution Format: Please type and use double spacing.

TITLE OF RESOLUTION NAME OF ORGANIZATION WHEREAS , AND

WHEREAS :

THEREFORE BE IT RESOLVED (THAT THE FPA OR SUBDIVISION OF FPA)

CONTACT NAME AND PHONE #: PROBLEM: INTENT:

Return this form to: Membership Coordinator, Florida Pharmacy Association, 610 North Adams Street, Tallahassee, Florida 32301 or fax (850) 561-6758

DECEMBER 2019

|

25

C A L L

F O R

APhA Foundation and NASPA Bowl of Hygeia Awarded to a pharmacist for outstanding community service above and beyond professional duties. The use of the following selection criteria is required: ■■ The recipient must be a Florida licensed pharmacist and a member of FPA. ■■           ■■ T recipient has not previously received the award.

■■               two  on its award committee or an officer of the association other than in an ex officio capacity.

■■   has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession.

James H. Beal Award Awarded to the “Pharmacist of the Year.”

Criteria: ■■   must be a Florida registered pharmacist and a member of the FPA. ■■   has rendered outstanding service to pharmacy within the past five years.

Technician of the Year Award Awarded annually to a Florida pharmacy technician who is recognized for his/her outstanding performance and achievement during his/her career.

Criteria: ■■ Candidate must be a member of the Florida Pharmacy Association for at least two years.

■■ Candidate must have demonstrated contributions and dedication to the advancement of pharmacy technician practice.

■■ Candidate must have demonstrated

26

|

FLORIDA PHARMACY TODAY

N O M I N A T I O N S contributions to the Florida Pharmacy Association and/or other pharmacy organizations.

■■ Candidate must have demonstrated commitment to community service.

■■ Candidate is not a past recipient of this award.

R.Q. Richards Award This award is based on outstanding achievement in the field of pharmaceutical public relations in Florida.

Criteria: ■■  recipient must be a Florida registered pharmacist and a member of the FPA. ■■   has displayed outstanding achievement in the field of pharmaceutical public relations in Florida.

Frank Toback/AZO Consultant Pharmacist Award Criteria: ■■ Candidate must be an FPA member, registered with the Florida Board of Pharmacy as a consultant pharmacist in good standing.

■■ Candidate should be selected based on their outstanding achievements in the field of consultant pharmacy.

DCPA Sidney Simkowitz Pharmacy Involvement Award Presented annually to a Florida pharmacist who has been active at the local and state pharmacy association level in advancement of the profession of pharmacy in Florida.

Criteria: ■■ A minimum of five years of active involvement in and contributions to the local association and FPA. ■■ Candidate must have held office at local level pharmacy association.

■■ Member in good standing for a period of at least five years in the FPA and must have served as a member or chairman of a committee of the association.

F P A

■■ Candidate must have been active-

ly involved in a project that has or could potentially be of benefit to members of the profession.

Pharmacists Mutual Companies Distinguished Young Pharmacist Award Awarded to a young pharmacist for their involvement and dedication to the practice of pharmacy.

Criteria: ■■ Licensed to practice for nine years or fewer.

■■ Licensed to practice in the state in which selected.

■■ Participation in national pharmacy association, professional programs, and/or community service.

IPA Roman Maximo Corrons Inspiration & Motivation Award Interamerican Pharmacists Association created this award to honor the memory of Roman M. Corrons who inspired and motivated countless pharmacists to participate actively and aspire to take on leadership roles in their profession. Roman was always there with guidance and support that motivated pharmacists and encouraged visionary leadership, approachable active membership and succession planning.

This award recognizes the motivators among us who inspire others to continue to advance the profession.

Criteria: ■■ The recipient must be a Florida Licensed Pharmacist and a member of the FPA. ■■ Candidate should motivate others to excel within the profession by encouraging them to be leaders.

■■ Candidate is not necessarily an association officer, but guides, supports and/or inspires others.

A brief description on the candidate’s motivational/inspirational skills must accompany the nomination.

A W A R D S

2 0 1 9 - 2 0 2 0

The Jean Lamberti Mentorship Award The Jean Lamberti Mentorship Award was established in 1998 to honor those pharmacists who have taken time to share their knowledge and experience with pharmacist candidates. The award is named in honor of long time FPA member Jean Lamberti for her effort in working with pharmacy students.

Criteria: ■■ The recipient must be an FPA member.

■■ The recipient must serve as a role model for the profession of pharmacy.

Upsher Smith Excellence in Innovation Award Awarded to honor practicing pharmacists who have demonstrated innovation in pharmacy practice that has resulted in improved patient care.

Criteria: ■■ The recipient has demonstrated innovative pharmacy practice resulting in improved patient care.

■■ The recipient should be a practicing pharmacist within the geographic area represented by the presenting Association.

Qualified Nominee: A pharmacist practicing within the geographic area represented by the presenting Association.

DEADLINE FOR NOMINATIONS: FEBRUARY 28, 2020 FPA AWARDS NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

NOMINATED BY:

Name:

Name:

Address:

Date Submitted: Signature:

FOR THE FOLLOWING AWARD:  APhA Foundation and NASPA Bowl of Hygeia  James H. Beal Award  R.Q. Richards Award

Please describe briefly below the nominee's accomplishments, indicating why you feel he or she should receive this award.

(Attach additional sheets if necessary.)

 Frank Toback/AZO Consultant Pharmacist Award  DCPA Sydney Simkowitz Award  Pharmacists Mutual Co. Distinguished Young Pharmacist Award  IPA Roman Maximo Corrons Inspiration & Motivation Award  The Jean Lamberti Mentorship Award  Upsher Smith Excellence in Innovation Award

MAIL NOMINATONS TO: Annual Awards, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS FEBRUARY 28, 2020

DECEMBER 2019

|

27

Quick, Easy, and Secure REGISTER FOR OUR ONLINE SERVICES TODAY!

MEMBER PORTAL

RISK MANAGEMENT CENTER

PAPERLESS BILLING

! *Only Available for Commercial Accounts

*Not available in the state of Ohio

TO ACCESS YOUR ACCOUNT ONLINE VISIT: https://www.phmic.com/memberportal You will need your customer number and email address.

Pharmacists Mutual Insurance Company 808 Highway 18 W | PO Box 370 | Algona, Iowa 50511 P. 800.247.5930, ext. 4050 | F. 515.295.9306 | E. member.services@phmic.com

phmic.com