July 2022 Florida Pharmacy Journal by Florida Pharmacy Today

JULY 2022 CAROLFPA2022-23PRESIDENTMOTYCKA

24/7 coverage lets you focus on patients, not potential mistakes. PROFESSIONAL LIABILITY COVERAGE COMPARISON PHARMACIST MUTUAL INSURANCE COMPANY COMPETITOR ProfessionalPharmacists Liability $1MM per occurrence / $3MM aggregate $2MM per occurrence / $4MM aggregate $1MM per occurrence / $3MM aggregate Sterile Compounding Available ? Pharmacists License Defense Coverage $250,000 per occurrence / $250,000 aggregate $25,000 Board of Pharmacy Imposed Fees $2,500 sublimit ? HIPAA Claim Defense Coverage $50,000 $25,000 Assault Coverage $25,000 $25,000 Sexual and Physical Abuse Coverage $50,000 $25,000 sublimit Loss of Income $1,500 per day / $50,000 per occurrence 1,000 per day / aggregate$25,000 Legal fees – Respond to Subpoena $50,000 limit $10,000 aggregate WHAT IF you have a second job, volunteer, or give advice to a friend neighbor?or WHAT IF you were named in a lawsuit and needed a lawyer? WHAT IF your employer does not have protectcoveragethetoyou? Policy terms and conditions control. Coverage may not be available in all states. Life and disability insurance are written through PMC Advantage Insurance Services, Inc., a wholly-owned subsidiary of Pharmacists Mutual Insurance Company. Professional | Commercial | Personal | Life & Disability phmic.com

Department of Health and Human Services Guidance to Nation's Retail Pharmacies 9

JULY 2022 | 3 VOL. 85 | NO. 7 JULY 2022 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATIONPHARMACY TODAY florida Departments 4 Calendar 4 Advertisers 5 The ViewpointPresident's 7 Executive Insight 8 Officer and NominationsDirector Features

FPA

U.S.

Board of Directors Announce New FPA CEO FPA 2022 Convention Highlights Hurricane Reminders from the CDC What's with Expiration Dates?14131617

1 Deadline for Officer and Director Nominations

Florida Pharmacy Today Journal

CE CREDITS (CE cycle)

21 FPA Board of Director Meeting Orlando, Florida

25 Board of Pharmacy Meeting Aloft Jacksonville Tapestry Park

SEPTEMBER

10-11 FPA Clinical Conference via Zoom

NOVEMBER

11 Veterans Day FPA Office Closed

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 Jour nal 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 ap propriate advertising to assist the Journal in its goal of self-support. Calendar

FPA — Tian Merren-Owens (850) 222-2400

NSU — Carsten Evans (954) 262-1300

26-27 Christmas HolidayFPA Office Closed

4 | FLORIDA PHARMACY TODAY EMAIL SUGGESTIONS/IDEASYOUR dave@fiorecommunications.comTO

DISCLAIMER

5 Labor Day

FSHP — Tamekia Bennett (850) 906-9333

The Florida Board of Pharmacy requires 10 hours’ LIVE continuing education as part of the required 30 hours’ general education needed every license renewal period. There is a two-hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. The Reducing Medication Errors course is needed for pharmacists and technicians.

Florida Pharmacy Today Board of Directors

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

Pharmacists should have satisfied all continuing education requirements for this biennial period by Sept. 30, 2023, or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by Dec. 31, 2022.

AUGUST

FAMU — Dr. Selika Sampson (850) 599-3301

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

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.

FPA Office Closed

7 FPA Point of Care Test & Treat training program Kissimmee, Florida

20 FPA Budget and Finance and Council Meetings Orlando, Florida

24-25 Thanksgiving FPA Office Closed

Statements:Mission

3-4 FPA Regulatory and Law Zoom Conference

Advertisers PHARMACISTS MUTUAL 2 APMS 6 EPIC..................................................................... 18 MY RX PRO 19 PQC 20 2022 FPA

UF — Emely McKitrick (352) 273-5169

OCTOBER

8-9 FPA Midyear Clinical Kissimmee, Florida

For the Pharmacy Technician Certification Board application, exam information and study materials, please contact the FPA office.

DECEMBER

CONTACTS

Articles in this publication are designed to provide accurate and authoritative infor mation 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.

1-4 NCPA Annual Meeting Kansas City

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

JULY 2022 | 5

The President’s Viewpoint

want to say thank you all for putting your trust in me to serve the members and the profession for the next year. Most importantly, I want to thank my family for support ing me through this journey. To my dad, thank you for being a role mod el as a community pharmacist for over 50 years, caring for your patients and our profession and setting an example of what a great pharmacist should be. To my children, Braden, Bryce, and Bri anna, thank you for being understand ing if I have to miss one of your events and know that if I could clone myself to be there, I would spend every dol lar I have to do that. And to my eversupportive husband, Brent, thank you for being the rock of the family, always helping if I can’t be there and making me feel like a part of events through video and Facetime. It means more than you can ever imagine.

Ifirst

CAROL MOTYCKA, PHARM.D., CHSE

Long-distance running is reminiscent of pharmacy’s continued efforts towards putting our patients first and ensuring pharmacists are able to provide the pharmaceuticalincrediblecareweallknowwearefullycapableof.

As some of you may know, I have a family of long-distance runners and there is so much to be learned from long-distance running. For those of you who aren’t as familiar with the sport, it is just as much a mental chal lenge as it is a physical one. Some where during the run, your body be gins to tell you that you should stop the pain and exhaustion and just slow down, or better yet, stop altogether. Runners have to fight through those mental and physical cues because they know that at the end of the run is that finish line and the glory of the ac complishment they just achieved. Af ter they have completed the race, they are exhausted and exhilarated. There is a short time to celebrate before they quickly begin their training again as they gear up for that next race. And so the story goes again and again.

My family is inspired by David Goggins, who once stated: “Don’t stop when you are tired, stop when you are done,” and that is exactly what phar macists did day after day, week af ter week. And after pharmacists have proven themselves again and again that they are fully capable of provid ing excellent care to patients through review of drug-drug interactions, dose

pandemic has changed all of us in many ways forever, much as it has also changed our profession. Pharmacists worked through the exhaustion and sometimes pain to provide care for mil lions of patients. Patients often sought advice for care from us because they had difficulty getting into their physi cian’s office, but the pharmacist was al ways there, always available. From ,

Long-distance running is reminis

See President’s Viewpoint, continued on page 18

OTC medication counseling for a sick child to advice for a loved one suffering with Alzheimer’s, pharmacists have been there, never shutting their doors when the uncertainty of COVID made going out of the house unbearable to face for some. Pharmacists were grant ed the ability to provide immuniza tions to millions and they took up the challenge without any hesitation. Al though you were exhausted and wea ry, and sometimes even in pain, wheth er it be from the loss of a loved one or the ache in your back as you put in one more 12-hour day, you all, the pharma cists, were there to push through.

Carol Motycka, Pharm.D., CHSE

Lace Up and Don't Stop

cent of pharmacy’s continued efforts to wards putting our patients first and en suring pharmacists are able to provide the incredible pharmaceutical care we all know we are fully capable of. The

Learn more at www.medicationsafety.org or call us at (866) 365-7472. The Alliance of Medication Safety (APMS) is a federally listed Patient Safety Organization (PSO). Protect pharmacy.Protectpatients.youryour ERRORS CAN INJURE PATIENTS AND PUT YOUR PHARMACY IN FINANCIAL JEOPARDY. The PQC+ QA program can improve efficiency and increase patient safety as well as help you meet accreditation, credentialing, PBM and state Quality Assurance requirements. • Training, Quality Assurance CE, and resources • Patient Safety Organization protection for your QA work • Practical tools to collect and analyze patient safety data

MICHAEL JACKSON, BPHARM, RETIRED EVP & CEO, FLORIDA PHARMACY ASSOCIATION

The FPA staff will be building an ex cellent convention program designed to arm you with the latest innovations in professional services that can be found in pharmacy. You will also have the ability to meet the FPA leadership that is working hard on your behalf. You will also get to meet your new CEO, Dr. Helen Sairany, who will be carrying the FPA flag to new heights. Hopeful ly, I will be seeing all of our members in Marco Island, July 6-9, 2023. Let’s spread the word. n

Michael Jackson, B.Pharm, CPh FPA CEO (Ret)

joyed the facility and its beaches. If you have not been there in a while, you will be pleasantly surprised to see that there are changes that will take you to a level 10+ on your “wow” meter.

JULY 2022 | 7

Highlights of the FPA Convention.

We Missed You at the FPA Convention Executive Insight

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758

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SIGNATURE:DATENAME:NOMINATEDTechnicianBY:SUBMITTED:

Chair David Mackarey, Boynton Beach Vice Chair Matt Schneller, Tampa

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FOR THE FOLLOWING OFFICE:

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FLORIDA PHARMACY ASSOCIATION

8 | FLORIDA PHARMACY TODAY

JULY 2019 | 15

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This is a peer-reviewed publication.

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.

The FPA bylaws specify that any subdivision or any member in good standing may nominate one person for the office of President-Elect and one per son for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The Treasurer shall serve a two-year term and may suc ceed to one consecutive term of office in that capaci ty. Nominees must be Florida registered pharmacists in good standing with the Florida Pharmacy Associ ation and the Florida Board of Pharmacy. Nominees for President-Elect should have a good understand ing of how the Association functions and should be current on the issues impacting pharmacy. Nominees for Treasurer should have good analytical skills and experience and ability in financial management and budget

I AM PLEASED TO SUBMIT THE FOLLOWING

DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2019

FPA Officer and Director Nominations

FOR THE FOLLOWING OFFICE: deadline: September 1, 2019) President-Elect Board Director Region 2 Region 4 Region 6 Region 8

Therepreparation.arenineregional Board Directors who shall serve two-year terms. A nominee must be a Florida registered pharmacist in good standing with the Flor ida Pharmacy Association and the Florida Board of Pharmacy. Additionally, each Board Director must be a member of at least one the FPA Unit Associa tions within their region. Board Directors’ terms are staggered such that even-numbered regions shall be elected in even-numbered years and odd-numbered regions shall be elected in odd-numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annu al meeting of the second ensuing year.

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JULY 2019 | 15

FOR THE FOLLOWING OFFICE: (Nomination deadline: September 1, 2019) President-Elect Board Director Region 2 Region 4 Region 6 Region 8

FPA STAFF FPA OFFICER AND NOMINATIONSDIRECTOR

I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION:

Nominations may be submitted online through www.floridapharmacy.org

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 as sumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today

ADDRESS:NAME:NOMINATION:

Secretary Julie Burger, Pensacola

• FAX 850/561-6758

Tian Merren-Owens, ext. 120

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Technician Member Julie Burger, Pensacola

(Nomination deadline: Sept. 1, 2022)

FPA Candidate Nomination Form

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DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2019

Although we have just finished the election for a President-Elect and Directors for the odd-num bered regions who were installed at the 2019 annual meeting, it is time to start thinking about nom inees for the 2020 election, since the nomination deadline is September 1 of this year (9/1/19). As the form below indicates, this year we will need candidates for President-Elect, Technician and Direc tors for the even-numbered regions. Please note that you may nominate yourself.

FPA Candidate Nomination Form

Director of Continuing Education

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Although we have just finished the election for a President-Elect and Directors for the odd-numbered regions who were installed at the 2019 annual meeting, it is time to start thinking about nom inees for the 2020 election, since the nomination deadline is September 1 of this year (9/1/19). As the form below indicates, this year we will need candidates for President-Elect, Technician and Direc tors for the even-numbered regions. Please note that you may nominate yourself.

Journal Reviewer Dr. Angela Hill

CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2020 Elections

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Web address: www.floridapharmacy.org

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MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758

ADDRESS:NAME:NOMINATION:

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MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758

FPA Officer and Director Nominations

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FPA Candidate Nomination Form

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Coordinator of Membership Ranada Howard, ext. 110

FOR THE FOLLOWING OFFICE: (Nomination deadline: September 1, 2019) President-Elect Board Director Region 2 Region 4 Region 6 Region 8

Managing Editor Dave Fiore, Tallahassee

I AM PLEASED TO SUBMIT THE FOLLOWING

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Member Michael Finnick, Jacksonville

Member Teresa Tomerlin, Rockledge

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Treasurer Eric Jakab, Gainesville

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SIGNATURE:DATENAME:NOMINATEDTechnicianBY:SUBMITTED:

ADDRESS:NAME:NOMINATION:

Although we have just finished the election for a President-Elect and Directors for the odd-num bered regions who were installed at the 2019 annual meeting, it is time to start thinking about nom inees for the 2020 election, since the nomination deadline is September 1 of this year (9/1/19). As the form below indicates, this year we will need candidates for President-Elect, Technician and Directors for the even-numbered regions. Please note that you may nominate yourself. President-Elect Region 1 Region 3 Region 5 Region 7 Region 9 Treasurer

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MAIL NOMINATIONS TO: Election nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758

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Member Greta Pelegrin, Hialeah

DEADLINE FOR NOMINATIONS IS SEPT. 1, 2022

SIGNATURE:DATENAME:NOMINATEDTechnicianBY:SUBMITTED:

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I AM PLEASED TO SUBMIT THE FOLLOWING

Continuing Education Coordinator Stacey Brooks, ext. 210

Executive Editor Michael Jackson, Tallahassee

JULY 2019 | 15

Member Carol Motycka, Jacksonville

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400

FLORIDA PHARMACY TODAY BOARD

(Nomination

Journal Reviewer Dr. Melissa Ruble

CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2020 Elections

DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2019

Pharmacies and the pharmacists they employ—play a critical role in the American health care system. This has never been more apparent than the efforts taken to administer vaccines during the COVID-19 pandemic, for which your continued partnership has been crucial. 1 As our nation faces another significant health care crisis, this guidance is to remind the roughly 60,000 retail pharmacies in the United States 2 of the unique role pharmacies play in ensuring access to comprehensive reproductive health care services. This guidance covers the nondiscrimination obligations of pharmacies under federal civil rights laws.

DEPARTMENT OF HEALTH

JULY 2022 | 9 1

Under Section 1557 of the Affordable Care Act (Section 1557), 42 U.S.C. § 18116, and its implementing regulation, 45 C.F.R. part 92, recipients of federal financial assistance are prohibited from excluding an individual from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex and disability, among other bases, in their health programs and activities. 3 Under Section 504 of the Rehabilitation Act of 1973 (Section 504), 29 U.S.C. 794, recipients of federal financial assistance are prohibited from discriminating in all programs and activities, on the basis of disability Pharmacies, therefore, may not discriminate against pharmacy customers on the bases prohibited by Section 1557and Section 504—including with regard to supplying medications; making determinations regarding the suitability of a prescribed medication for a patient; or advising patients about medications and how to take them.

U.S. AND HUMAN SERVICES

Off ice for Civ il Rights

Guidance to Nation’s Retail Pharmacies: Obligations under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive Health Care Services

The United States has the highest maternal mortality rate among developed nations; though most maternal deaths in the United States are preventable, they have been rising over the last two decades. 4 Maternal deaths are especially high among Black women and Native American

1 See, e.g., The Federal Retail Pharmacy Program for COVID 19 Vaccination, U.S. Dep’t of Health & Human Servs., Ctrs. for Disease Control & Prevention (last updated June 24, 2022), https://www.cdc.gov/vaccines/covid 19/retail pharmacy program/index.html

2 IQVIA, U.S. National Pharmacy Market Summary 2021: Market Insights Report https://www.onekeydata.com/downloads/reports/2021_US_Pharmacy_Market_Report.pdf(2021),3CoveredentitiesshouldalsonotethatTitleIXoftheEducationAmendmentsof1972(Title IX), 20 U.S.C. § 1681 et seq., prohibits discrimination on the basis of sex in education programs and activities of recipients of federal financial assistance. Pharmacies that are affiliated with a covered education program or activity are also subject to Title IX nondiscrimination requirements. See also 45 C.F.R. part 86 (HHS Title IX implementing regulations).

4 Roosa Tikkanen et al., Issue Brief: Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries, Commonwealth Fund (Nov. 18, 2020),

8 Prescription Drugs, Georgetown Univ., Health Pol’y Inst., https://hpi.georgetown.edu/rxdrugs (last visited June 29, 2022)

10 Kimberly Daniels & Joyce C. Abma, U.S. Dep’t of Health & Human Servs., Ctrs. for Disease Control & Prevention, Nat’l Ctr. for Health Stats , Data Brief: Current Contraceptive Status Among Women Aged 15 49: United States, 2015 2017 (2018), https://www.cdc.gov/nchs/data/databriefs/db327 h.pdf

Pharmacies are often the most accessible health care provider for millions of Americans, with most Americans living within five miles of a pharmacy. 7 It is estimated that more than 131 million people (66 percent of adults) in the United States use prescription medication, 8 and therefore come into contact with pharmacies. Of the 7.6 billion retail prescription drugs filled by pharmacies in 2019, 44 percent were paid for either by Medicare or Medicaid health coverage. 9 As recipients of federal financial assistance, including Medicare and Medicaid payments, pharmacies are prohibited from discriminating on the basis of race, color, national origin, sex, age, and disability in their programs and activities under a range of federal civil rights laws.

5 Emily Petersen et al., Racial/Ethnic Disparities in Pregnancy Related Deaths — United States, 2007 2016, 68 Morbidity & Mortality Wkly Rep. 762 (2019), https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6835a3 H.pdf

9 Number of Retail Prescription Drugs Filled at Pharmacies by Payer, Kaiser Fam Found , https://www.kff.org/health costs/state indicator/total retail rx drugs/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (last visited June 29, 2022).

Among its civil rights enforcement responsibilities, the Department of Health and Human Services’ (HHS or Department) Office for Civil Rights (OCR) is responsible for protecting the rights of women and pregnant people in their ability to access care that is free from discrimination. This includes their ability to access reproductive health care, including prescription medication from their pharmacy, free from discrimination. A recent study by the Centers for Disease Control and Prevention showed that nearly 25 percent of women aged 15–49 in the United States who use contraception use some form of prescribed method (e.g., oral contraception pill, contraceptive ring). 10

Furthermore, discrimination against pregnant people on the basis of their pregnancy or related conditions (examples below) is a form of sex discrimination. Such discrimination can have significant health consequences from denial of medication or treatment which can have negative health impacts on a patient. Under federal civil rights law, pregnancy discrimination

6 FAQs: Early Pregnancy Loss, Am. Coll. of Obstetricians & Gynecologists (last updated Jan. 2022), https://www.acog.org/womens health/faqs/early pregnancy loss

10 | FLORIDA PHARMACY TODAY 2

women—regardless of their income or education levels. 5 The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, No. 19-1392, 2022 WL 2276808 (U.S. June 24, 2022), will exacerbate these inequities and disparities for women across the country. Further, the early loss of pregnancy (before 13 completed weeks) is extremely common, experienced by about 10 percent of those who know they are pregnant. 6 The Department is committed to improving maternal health—including for individuals who experience miscarriages—and vigorous enforcement of our civil rights laws is one way in which we plan to do so.

https://www.commonwealthfund.org/publications/issue briefs/2020/nov/maternal mortality maternity care us compared-10-countries

7 Federal Retail Pharmacy Program, U.S. Dep’t of Health & Human Servs., Ctrs. for Disease Control & Prevention (last updated June 24, 2022), https://www.cdc.gov/vaccines/covid 19/retail pharmacy program/index.html

• An individual experiences severe and chronic stomach ulcers, such that their condition meets the definition of a disability under civil rights laws. Their gastroenterologist prescribes misoprostol to decrease risk of serious complications associated with ulcers. If the pharmacy refuses to fill the individual’s prescription or does not stock misoprostol because of its alternate uses, it may be discriminating on the basis of disability.

• An individual experiences an early pregnancy loss (first-trimester miscarriage) and their health care provider prescribes pretreatment with mifepristone followed by treatment with misoprostol to assist with the passing of the miscarriage. 12 If a pharmacy refuses to fill the individual’s prescription—including medications needed to manage a miscarriage or complications from pregnancy loss, because these medications can also be used to terminate a pregnancy—the pharmacy may be discriminating on the basis of sex.

11 Covered entities should also note that, while pregnancy itself is not a disability, medical issues resulting from pregnancy can qualify as a disability under Section 504 of the Rehabilitation Act of 1973 (Section 504), 29 U.S.C § 794, which prohibits discrimination on the basis of disability in programs and activities of recipients of federal financial assistance Webster v. U.S. Dep’t of Energy, 267 F. Supp. 3d 246, 267 (D.D.C. 2017)

12 Am. Coll. of Obstetricians and Gynecologists, Practice Bulletin: Pregnancy Loss (2018), https://www.acog.org/clinical/clinical guidance/practice bulletin/articles/2018/11/early pregnancy loss.

13 An ectopic pregnancy is a pregnancy that occurs when fertilized egg grows outside of the uterus. FAQs: Ectopic Pregnancy, Am. Coll. of Obstetricians and Gynecologists (last updated Feb. 2018), https://www.acog.org/womens health/faqs/ectopic pregnancy

• An individual who has been undergoing fertility treatments receives a positive pregnancy test. After the individual expresses concern with symptoms associated with an ectopic pregnancy, 13 their medical provider performs an ultrasound to determine where the pregnancy is developing. The ultrasound indicates the fertilized egg is growing in a fallopian tube. The medical provider orders methotrexate to halt the pregnancy. If a pharmacy refuses

JULY 2022 | 11 3

• An individual presents to a hospital emergency department with chills, fever, and vaginal bleeding. The treating physician diagnoses a miscarriage complicated by a uterine infection (known medically as a septic abortion) and orders an antibiotic. If the hospital pharmacy refuses to provide the antibiotic required for treatment because of concern that subsequent care may include uterine evacuation (via medical or surgical abortion), the pharmacy may be discriminating on the basis of sex.

• An individual with a bleeding disorder is scheduled for a surgical abortion and their health care provider prescribes hemoglobin or hematocrit to reduce the risk of hemorrhage after the procedure. If a pharmacy refuses to fill the individual’s prescription because it becomes aware that the medication is being taken as a life-saving preventive measure related to a scheduled surgical abortion, the pharmacy may be discriminating on the basis of sex.

includes discrimination based on current pregnancy, past pregnancy, potential or intended pregnancy, and medical conditions related to pregnancy or childbirth. 11

Examples:

to fill the prescription because it will halt the growing of cells and end the pregnancy, it may be discriminating on the basis of sex.

In addition to the aforementioned civil rights laws, OCR also enforces the Church Amendments, codified at 42 U.S.C. § 300a-7, which protect health care personnel from discrimination related to their employment because they refused to perform or assist in the performance of abortion or sterilization because of their religious beliefs or moral convictions. It also protects health care personnel from discrimination related to their employment because they performed or assisted in the performance of abortion or sterilization. This guidance does not address how the Church Amendments would apply in a given case. OCR will evaluate and apply the Church Amendments on a case-by-case basis. To learn more about OCR’s enforcement of this statutory protection, see HHS’s Guidance on Nondiscrimination Protections under the Church Amendments.

DISCLAIMER: The contents of this document do not have the force and effect of law and are not meant to bind the public in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or the Departments’ policies.

• An individual with rheumatoid arthritis, such that their condition meets the definition of a disability under civil rights laws, is prescribed methotrexate by their physician’s assistant as a standard immunosuppressive treatment. If the pharmacy refuses to fill the individual’s prescription or does not stock methotrexate because of its alternate uses, it may be discriminating on the basis of disability.

12 | FLORIDA PHARMACY TODAY 4

To obtain this information in an alternate format, contact the HHS Office for Civil Rights at (800) 368-1019, TDD toll-free: (800) 537-7697, or by emailing OCRMail@hhs.gov. Language assistance services for OCR matters are available and provided free of charge.

• An individual’s health care provider sends the individual’s prescription for hormonal contraception (e.g., oral contraceptive pill, emergency contraception, a patch placed on the skin, a contraceptive ring, or any other FDA-approved contraceptive product) to a pharmacy. If the pharmacy otherwise provides contraceptives (e.g., external and internal condoms) but refuses to fill a certain type of contraceptive because it may prevent a pregnancy, the pharmacy may be discriminating on the basis of sex.

For additional information, contact the Office for Civil Rights at (800) 368-1019 or OCRMail@hhs.gov. If you believe that your or another person’s civil rights, conscience rights, or health information privacy rights have been violated, visit the OCR complaint portal to file a complaint online at: https://www.hhs.gov/ocr/complaints/index.html.

• An individual presents a prescription for an emergency contraceptive at their local pharmacy after a sexual assault to prevent pregnancy. If the pharmacy otherwise provides contraceptives (e.g., external and internal condoms) but refuses to fill the emergency contraceptive prescription because it can prevent ovulation or block fertilization, the pharmacy may be discriminating of the basis of sex.

SCOTT

JULY 2022 | 13

The Florida Pharmacy Associa tion is pleased to announce that Rock ledge, Florida Pharmacist Robert Scott Tomerlin has been named Pharmacist of the Year. This award is named after James Hartley Beal, who was a pharma cist from Ohio and was the first recipi ent of the prestigious Remington Medal for Distinguished Service to American Pharmacy. James Beal was president of the American Pharmacist Association and eventually made Okaloosa County, Florida his home.

The Florida Pharmacy Association is pleased to announce that Marilyn Ryan has been named Pharmacy Techni cian of the Year. Ms. Ryan is a certified pharmacy technician from PTCB and is currently working at UF Health Vista Psychiatric Hospital. She has authored several books that are available on Am azon and is a member of the Alachua County Association of Pharmacists.

DR.

FPA 2022 Convention Highlights

She is the daughter of a community pharmacist who continues to work pro viding health care services to patients.

MARILYN

Dr. Motycka is the current campus dean at the University of Florida Col lege of Pharmacy in Jacksonville. She serves her community as the co-chair for the Poly-Drug Task Force with Drug Free Duval where she provides training to students and the community to help curb the opioid epidemic.

Ms. Ryan is a volunteer Eucharistic Minister for her church and is an events committee chairman at UF Health Shands Psychiatric Hospital where she coordinates activities related to hospi tal week, staff birthdays, staff work an niversaries and miscellaneous other oc casions.

She completed a residency in Ambu latory Care at Florida Hospital Orlan do and ran their anticoagulation clinic, asthma clinic and outpatient pharmacy. She transitioned into teaching at Nova Southeastern, University of Central Florida Nursing School and the techni cian program at Seminole State College.

OFTECHNICIANPHARMACYNAMEDRYANTHEYEAR

BEALRECEIVESTOMERLINTHEANDPOWERSPHARMACISTOFTHEYEARAWARD

The award is also named after for mer FPA Executive Vice President James B. Powers in honor of his many years of service to the profession of pharmacy in Florida.Dr.Tomerlin received his PharmD from Mercer University and also at tended University of Louisville’s prepharmacy program. He was an Eagle Scout and was president of the Brevard County Pharmacy Association and the Florida Pharmacy Association where he served as chairman of the board of di rectors.Hewas Honor Council President at Mercer University, inducted into the Golden Key Honor Society and received the Louisville Rotary Club “Unsung Hero” Award in 2000.

The Florida Pharmacy Association has announced that its president for 2022-2023 will be Dr. Carol Motycka of St. Augustine. She began her work as a pharmacy technician with Eckerd Drugs and graduated from the Univer sity of Florida College of Pharmacy.

MOTYCKACAROLTOSERVEASFPAPRESIDENT,2022-2023

her work on addressing suicide preven tion, mental health, and combating opi oid abuse and misuse.

Dr. Sairany earned her Doctor of Pharmacy from Northeastern Univer sity in Boston, MA, and completed her Master of Business Administration at the University of Maryland. She brings expertise in both national and state as sociation management. In her role as CEO of SCPhA, she worked closely with the Association’s board of direc tors to meet the immediate needs of the membership. Under her leadership as the CEO of SCPhA, she has increased membership revenue, rebranded the as sociation’s communication and digital engagement strategy to include a transi tion to a new website and membership management system, started an execu tive fellowship in association manage ment and leadership and brought in do nations to improve the infrastructure of the SCPhA headquarters. She also ex panded SCPhA’s live and on-demand educational offerings.

Borders in Iraq and Western Syria.

In her position at APhA, she strate gized and managed educational con tent associated with certificate training, advanced practice training, and nation al meetings. She was also responsible for member benefit programs for phar macists, pharmacy technicians, resi dents, and pharmacy students. Her big gest contributions to APhA have been

FPA Board of Directors Announce New FPA CEO

Retiring FPA CEO Michael Jackson thanked for 25 years of service to the membership

The FPA board of directors and membership express their apprecia tion for retiring EVP and CEO, Michael Jackson, for 25 years of dedication, pas sionate service, and strong association management that has continuously pro moted the advancement of the profes sion of pharmacy.

14 | FLORIDA PHARMACY TODAY

Dr. Sairany has extensive knowl edge, skills, and experience in execu tive leadership, administrative man agement, regulatory, practice, and accreditation systems gained through her many years of work as a pharma cist, state executive and CEO for the South Carolina Pharmacy Association (SCPhA), Director of Content Develop ment and Partnership at the American Pharmacists Association (APhA), Direc tor of Quality Assurance at the Univer sity of Duhok College of Pharmacy, and as a field provider for Doctors Without

“The pharmacy profession is at a pivotal moment,” said Dr. Dan Buff ington, PharmD, FPA President. “We are faced with diverse challenges, but also countless opportunities. We are ex cited to have Dr. Sairany join the Flori da Pharmacy Association’s (FPA) lead ership team during this critical time in our profession. We are confident under her leadership that we can continue to increase membership, member engage ment, expand educational offerings, and promote practice advancement to reach new heights.”

In 2019, she was recognized by the Washington Business Journal as a “40 Under 40” leader. She has successful ly developed funding initiatives, im plemented marketing plans, and creat ed and proposed strategies that led to increased APhA membership through innovative programs like PharmTalk, PharmTank, trainings on statewide pro tocols, and the APhA Institute on Sub stance Use Disorders (SUD) and Patient Wellbeing.“Iamgrateful to the FPA Board of Directors and member of Search Com mittee for entrusting me with the op portunity to serve as their executive vice president and CEO,” Dr. Sairany said. “I look forward to meeting and working directly with Florida pharma cists, pharmacy students, and pharma cy technicians. I look forward to imple menting innovative programs to help advance the profession, improve the awareness of the valued impact that pharmacists make on patient’s health outcomes, and helping to make FPA the leading state pharmacy association,”

The Florida Pharmacy Association (FPA) Board of Directors and members of the search committee are thrilled to announce that Helen Sairany, BA, Phar mD, MBA, RPh, BCACP will serve as the Association’s next executive vice president and CEO.

TODAY!JOIN

Hometown: Columbia, SC

Aiya Almogaber, PharmD

Almogaber Joins Journal Board

Title: Clinical Pharmacology and Toxicology Fellow

Aiya is a Clinical Pharmacology and Toxicology Fellow at Clinical Pharmacology Services, Inc. in Tampa, Florida. Prior to her fellow ship, Aiya advanced pharmacy practice, advocacy, and government affairs as an executive resident at the American Pharmacists Asso ciation. Aiya brings a wealth of insight from her time traveling and learning about pharmacy practice across the U.S. Her diverse experi ences have served as catalysts for her knack for connection, influence, and progress for the pharmacy profession across practice settings and the continuum of care. With a strong pulse on current issues and hot topics, Aiya will discuss all things pharmacy, careers, health, well ness, and lifestyle.

JULY 2022 | 15

16 | FLORIDA PHARMACY TODAY

n Pay attention to the COVID-19 Community Level in your area and follow recommendations to stay safe. Take steps to protect yours and others’ health while preparing for the hurricane.

n Have several ways to receive weather alerts, such as Na tional Weather Service cell phone alerts, NOAA Weather Radio, or (@NWS) Twitter alerts.

In addition to following guidance for staying safe and healthy after a hurricane, note that:

Hurricane Reminders from the CDC

n Follow everyday preventive actions, including cover ing coughs and sneezes, washing your hands often, and avoiding touching your eyes, nose, and mouth with un washed hands.

n If you have to travel away from your community to evacu ate, follow safety precautions for travelers to protect your self and others from COVID-19.

n Does either household have someone at high risk of get ting very sick from COVID-19, including older adults or people of any age who have certain medical conditions? Make sure everyone knows what they can do to keep them safe from COVID-19. Consider taking rapid COV ID-19 tests if possible before sharing living spaces. This is especially important before gathering with individuals with certain medical conditions, older adults, those who are immunocompromised, or people who are not up to date on their COVID-19 vaccines, including children who cannot get vaccinated yet.

n If you are injured or ill, contact your medical provider for treatment recommendations. Keep wounds clean to pre vent infection. Remember, accessing medical care may be more difficult than usual during medium or high COV ID-19 Community Levels.

n The COVID-19 Community Level may change after a hur ricane as people move around. Pay attention to your local health department so that you can take the right actions to stay safe and healthy.

n Follow guidance from your local public health or emer gency management officials on when and where to shel ter.

n Stay up to date on your COVID-19 vaccines. COVID-19 vaccines help protect you from getting sick or severely ill with COVID-19. Staying up to date on vaccines makes it less likely that you will be sick with COVID-19 while sheltering or evacuating from a hurricane, and less likely to need medical services while hospitals are under strain from the natural disaster.

n Pay attention to local guidance about updated plans for evacuations and shelters, including shelters for your pets

Preparing for a Hurricane

Prepare to Evacuate

n Take steps to prevent carbon monoxide poisoning if you use a generator.

If you plan to stay with friends or family outside your household when you evacuate from a storm, talk to them about how to protect yourselves and those you are staying with from COVID-19:

Staying Safe After a Hurricane

n Make a plan and prepare a disaster kit for your pets. Find out if your disaster shelter will accept pets. Typically, when shelters accommodate pets, the pets are housed in a separate area from people.

You can’t stop a tropical storm or hurricane, but you can take steps now to protect yourself and your family. Planning for hurricane season and other potential disasters can be stressful, and with COVID-19 to consider as well, it may be especially so.

n Know what to do if someone in your family or in the household you are staying with becomes sick with COV ID-19.

n Take steps to keep your pets safe.

n If you may need to evacuate, prepare a “go kit” with per sonal items you cannot do without during an emergency. Include items that can help protect you and others from COVID-19, such as hand sanitizer with at least 60% alco hol, bar or liquid soap, disinfectant wipes (if available) and multiple, clean masks for everyone age 2 or older.

n When you check on neighbors and friends, be sure to follow CDC recommendations to protect yourself and others.

n If you need to go to a disaster shelter, follow CDC recom mendations for staying safe and healthy in a public disas ter shelter during the COVID-19 pandemic.

Staying with Friends or Family

n Ventilate the home to the extent you can. If you have pow er, you can use fans and portable HEPA air cleaners, and run your HVAC fan continuously. After the storm passes, if it is safe to do so, you can open windows and doors.

n Dealing with disasters can cause stress and strong emo tions, particularly during the COVID-19 pandemic. It is natural to feel anxiety, grief, and worry. Coping with these feelings and getting help when you need it will help you, your family, and your community recover.

n Find out if your local public shelter is open, in case you need to evacuate your home and go there.

n Eye drops because of the risk of con Mytamination.adviceand the advice of the FDA is not to use an expired product. Even though a product may be perfectly safe, there is always the risk that it is subpo tent and/or contaminated.

called the Shelf Life Extension Program (SLEP). The government knows where these stockpiles are kept, along with the lot numbers and expiration dates of all these products. When a product is near ing its expiration date, the government will inform the manufacturer to test the specific lot the manufacturer keeps to determine if these lots are still usable. If they are still good, then the govern ment will send out stickers to be placed on the stockpiled drugs indicating their new expiration dates. This program has saved the federal government, and us, millions of dollars by not having to buy new drugs to replace these stockpiled drugs. Unfortunately, we as consumers do not have the luxury to ask manufac turers to extend expiration dates.

Much of the shipping of products long distance started in the late 1800s with the industrial revolution, but it was not until the early part of the 1900s that expiration dates were needed. An interesting urban myth is that the ex piration dates on milk products were started by Al Capone - yes, the notori ous gangster from Chicago. The story goes that a relative of Mr. Capone be came ill by ingesting some spoiled milk and he made sure expiration dates be came mandatory, at least in the Chicago area. When Prohibition ended in 1933, Capone was looking for another busi ness to enter and he made sure that sellby dates were added to milk products and was prepared for that process. It is rumored Mr. Capone had a corner on the bottle printing equipment, so, either way, he would make money.

n Tetracycline-like drugs because if they degrade, the metabolite will be come a substance that can damage the kidneys.

n Vaccines and other injectables be cause they are subject to quick deg radation.

William Garst is a consultant pharma cist who resides in Alachua, Florida. He received his bachelor’s degree in pharma cy from Auburn University in 1975. He earned a master’s degree in pharmacy from the University of Florida in 2001. In 2007, he received his doctor of pharmacy from the University of Colorado. Dr. Garst is a member of many national professional asso ciations as well as the local Alachua Coun ty Association of Pharmacists. He serves on the Alachua County Health Care Advi sory Board. He works part-time at the UF Health Psychiatric Hospital and retired from the VA in 2016. Dr. Garst enjoys golf, reading (especially history) and family. He writes a blog called The Pharmacy News letter (https://thepharmacy newsletter.com). He can be contacted at cynewsletter@gmail.comcommunitypharma.

items bought by the consumer came from local or reasonably local sourc es. It was with innovations in the fac tors mentioned above, transportation, etc., that perishable items such as food and drugs could be shipped long dis tances with the result that consumers did not know who made the products, how they were made, or what was even in the products. When perishables were purchased locally, the knowledge of who made the products, how they were made, and the ingredients were readily seen and known.

Expiration dates, also called beyond-use dates or do not sell af ter dates have been used for several de cades, but it hasn’t al ways been this way. Before tions,financialandfacturingrefrigeration,transportation,manuprocesses,evenconvenienttransacmostperishable

n Liquid antibiotics because of degra dation.

JULY 2022 | 17

Today, expiration dates or sell by dates are ubiquitous and we take them for granted because they are required by federal law to be on all perishable,

Another interesting story about ex piration dates is that the Federal Gov ernment spends millions of dollars on drugs stockpiled in the event of emer gencies such as a bioterrorism attack or natural disaster. The program is

To answer the original question, what’s with expiration dates? Their purpose is to protect the consumer and give the assurance that the product will have the stated potency for the time in dicated on the package if stored un der the recommended conditions, and because most things we purchase are made or processed far from our com munities, we need the information these expiration dates give us.

consumable products. Manufactur ers are responsible for putting these dates on products, as well as lot num bers on all their packaging. The com panies test their products by exposing them to heat and moisture, then, using predetermined formulas, they calculate an estimated time they can guarantee the product will have the stated poten cy. There is always an element of error in these calculations so companies will err on the side of caution and place ex piration dates that are before the prod uct will really expire. This happens to be good for business, because then the company may sell more products. For the company it is a win-win situation.

What's with Expiration Dates?

William PharmacistConsultantPharm.D.Garst,

n Insulin because it is susceptible to degradation.

There are many articles written that say medicines can be used past their ex piration dates and this may be correct. However, there are a few products that should never be used past their expira tion date:

Stay informed and stay healthy.

n Oral nitroglycerin because it loses its potency quickly after the bottle has been opened.

William Garst, Pharm.D., Consultant Pharmacist

Interested in How the Florida Pharmacy Association Works? We encourage members to get familiar with FPA governance – especially if it prompts you to get more involved! President's Viewpoint, continued from Page 5

I thank you again for giving me the opportunity to serve you during these exciting times as we push through what has felt like a marathon, knowing the finish line is just around the corner. We will stay strong and focused and I will work hard to lead you to our goals. I end with a quote from the great Martin Luther King, Jr: “If you can’t fly then run. If you can’t run, then walk. If you can’t walk then crawl. But whatev er you do, you have to keep moving forward.” Thank you. n

Members can access the FPA Articles of Incorporation, Constitution and Bylaws anytime on the association website. Visit https://www.floridapharmacy.org/page/Organiz-govern-docs or simply go to www.floridapharamcy.org and from the menu go to "About FPA" - "Leader ship and Governance" - then select "Constitution, Bylaws, Policies & Procedures.”

adjustments, or navigating a patient’s medical history, they were faced with opposition to provide “test-to-treat” for CO VID patients and beyond. This is not the time to take those mental and physical cues and slow down or stop, but rather the time to fight through to the finish line which is recognition for being the health care providers we are every single day. Of course, when we cross that finish line, we will have some time to celebrate our accomplishments, but we know that we will again pick ourselves up and begin our journey towards that next race, because our patients need us to be strong and to be their greatest advocates as pharmaceutical care providers. We are pharmacists, and pharmacists are strong and resilient and are always there for the betterment of our patients. As one of the greatest runners in history, Steve Prefontaine, once said, “To give anything less than your best is to sacrifice the gift,” and we have been given the gift as pharmacists and must con tinue to use it.

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July 2022 Florida Pharmacy Journal

Articles inside

Executive Insight

The President's