Florida Pharmacy Journal November 2020 by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association NOV. 2020

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 Executive Insight 14 News & Notes

VOL. 83 | NO. 11 NOVEMBER 2020 THE OFFICIAL PUBLICATION OF THE FLORIDA PHARMACY ASSOCIATION

Features

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The New Decade For The New Pharmacist

Pharmacists Visible Yet Invisible, Part III

Stay Healthy This Holiday Season

NOVEMBER 2020

FPA Calendar 2020

DECEMBER 3

Pharmacy Based Immunization Delivery Training Program Webinar

3-4

Florida Board of Pharmacy meetings

5-6

Regulatory and Law Conference Sarasota and available via webinar

Diabetes Care Training Program webinar

Board of Pharmacy Rules Committee

25-28 Christmas Holiday FPA Office Closed

JANUARY 1

New Years Day, FPA Office Closed

23-24 FPA Law and Regulatory Conference Sandestin 31

FPA election ballots due FEBRUARY

FPA awards nominations due MARCH

Legislative Session Begins

12-15 APhA Annual Meeting Los Angeles 20-21 FPA Councils, Committee and Board meetings TBD

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 two-hour CE requirement for pharmacists on the dispensing of controlled substances effective this biennial renewal period. Pharmacists and pharmacy technicians must also complete a one-hour Florida Board approved continuing education on human trafficking by Jan. 1, 2021. Pharmacists should have satisfied all continuing education requirements for this biennial period by Sept. 30, 2021, or prior to licensure renewal. Consultant pharmacists and technicians will need to renew their licenses and registrations by Dec. 31, 2020. For the 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

Mission Statements: 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 MICRO MERCHANTS........................................ 2 PARTNERSHIP FOR SAFE MEDICINES......... 7 PQC...................................................................... 12 PHARMACISTS MUTUAL.............................. 20

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.

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EMAIL YOUR SUGGESTIONS/IDEAS TO dave@fiorecommunications.com

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

Update on the FPA’s Birth Certificate

f you are a fan of history as I am, you probably have an insatiable curiosity of where things come from or how things got started. When it comes to the Florida Pharmacy Association, I teased the membership with snippets of things I have discovered while rooting through the FPA’s historical records and journals. The Florida Pharmacy Association was founded not here in Tallahassee, but in Jacksonville. You may also be surprised to know that the first president of the FPA was not a pharmacist but a physician. On June 8, 1887, a group of Florida pharmacists met in the Board of Trade room in Jacksonville at the intersection of Adams and Main streets. The intent was to initiate the organizational meeting of the Florida State Pharmaceutical Association. Dr. Henry (Hy) Robinson – who was a civic leader in Jacksonville who served as mayor and chairman of the Board of County Commissioners – was elected the first president. Sadly, there was a great fire in 1901 that destroyed the first meeting minutes. Information was gathered through reconstruction of newspaper accounts where the pharmacists at that time raised concerns. With 111 members and $81.30 in the treasury, this organization began its 133-year journey. One of the original descriptions of the benefits of the Florida State Pharmaceutical Association was “It elevates pharmacy as a profession, brightens the pathway of the pharmacist, encourages him to greater effort, and constantly benefits the entire public whose servant he must be.” Even back then, our mission was to support excellence in the delivery of health care to the citizens of our communities. I want

to give thanks to University of Florida professor and chairman of pharmaceutical chemistry Dr. L. G. Gramling, Ph.D, RPh. It was his book, “History of Pharmacy in Florida” where much of this information came from. Now what does all this have to do with the FPA’s “birth certificate?” In 1987, during the FPA’s annual conven-

Michael Jackson, B.Pharm

tion (if my memory is correct), a commemorative bronze plaque was presented to the Florida Pharmacy Association at its convention in Jacksonville. This event commemorated the 100-year anniversary of the FPA. The whereabouts of the plaque after its presentation to the FPA became a mystery until Duval County Pharmacy Association member Howard Staats discovered its location. He began a personal crusade to have the plaque placed on display in an ap-

propriate location in Jacksonville. It was through Mr. Staats’ efforts that the next home for the plaque was at the intersection of Adams and Main streets on a tall, solidly built concrete pylon for all visitors to see. It was dedicated on Oct. 27, 2005, about 18 years after it was presented to the FPA. Fast forward to September 2018, and I am visiting with legislators in Duval County to discuss various pharmacy issues. While in downtown Jacksonville, I stroll over the intersection of Adams and Main streets to pay tribute to the birthplace of the FPA and was shocked to discover that the plaque and the monument it was resting on had been removed and nowhere to be found. This was shared with Dr. Carol Motycka, dean of the UF College of Pharmacy Jacksonville campus, who began working closely with the Duval County See Executive Insight, continued on page 6 NOVEMBER 2020

FPA STAFF

Executive Insight, from Page 5

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

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. . ©2020 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.

FPA's Michael Jackson, left, with Jacksonville City Commissioner and pharmacist Ron Salem, Dr. Carol Motycka, and Tim Rogers, chief librarian and director of the public library.

Pharmacy Association on relocating the plaque. We are pleased to share with the members that the plaque was located and an offer received by the leadership team of the Jacksonville Public Library to host the plaque in its commemorative archives room of their downtown facility. The FPA and the library share a common thread having history at the Board of Trade room. A special rededication event took place on Thursday, Oct. 29, attended by Dr. Motycka and the Duval County Pharmacy Association’s Eric Jakab. We are also pleased to report that during this event, a proclamation was presented by Jacksonville City Commissioner and Duval County pharmacist Ron Salem. This proclamation from Mayor Lenny Curry declared October 2020 as American Pharmacist Month. This is great news as the plaque is a long standing symbol of the FPA and its connections to Jacksonville and to the state of Florida. Our sincere thanks to Dr. Motycka and the Duval County Pharmacy Association for your hard work on this campaign. Also our thanks to Tim Rogers, chief librarian and director of the Jacksonville Public Library, for giving a home to the FPA’s birth certificate. The management team at the library will be working on a permanent location within its facility and, when it’s completed, please plan to visit it when your travels take you to that area of Florida.

THE NEW DECADE FOR THE NEW PHARMACIST

Jason Acevedo, Pharm.D. candidate

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Carol Motycka Pharm.D.

Eric F. Egelund, Pharm.D., Ph.D.

FLORIDA PHARMACY TODAY

Pharmacists have long served their community in many ways, including reviewing drug-drug interactions, conducting medication counseling and providing recommendations for self-care treatments. The services that pharmacists provide have expanded over time and student pharmacists are trained to fully care for patients as an integrated member of the clinical team. With more patients needing increased accessibility to quality care, the profession needs to take charge in developing further to meet these needs. While 2020 has been a challenging year for many reasons, opportunities have arisen for pharmacists for which we need to take advantage. COVID-19 has created a lot of unpredictability. But through the uncertainty, recent advances for the profession of pharmacy have occurred. One was the recent approval for pharmacists (and pharmacy interns) across the nation to vaccinate children 3 to 18 years of age. The United States Department of Health and Human Services authorized this new practice under the Public Readiness and Emergency Preparedness Act. This act helps ensure that the pediatric population has access to vaccines and assists in keeping immunization rates high during the pandemic. With social distancing and changes in primary care visits, concern exists that many children were missing out on important lifesaving immunizations. This new opportunity of vaccine administration has brought a mix of both excitement and concern. Although pharmacists have

already been administering immunizations to children in many other states, Florida pharmacists have not had the same opportunity, which has caused some apprehension. The immunization training provided to all pharmacists does include pediatric immunizations, and as comfort with working with children grows from experience, this will become less of a concern. A second concern is in relation to time constraints which are already an issue for pharmacists. Already being stretched thin on time and staffing, community pharmacists question the feasibility of adding yet another task to complete in their busy days. Furthermore, considering there is a COVID-19 vaccine on the horizon to potentially overlap with flu shots, the stress amongst the community pharmacist is on the rise (Strasburg, 2020). One possibility is setting apNOVEMBER 2020

pointments for vaccinations, which some companies have implemented. This would allow for one pharmacist to be dedicated to immunizing. Solutions need to be considered in order to provide the patient care needed during this challenging time. Another new development in the practice of pharmacy is one that the profession has been advocating for some time now. The governor approved the new Florida legislation that allows pharmacists to work in a collaborative practice agreement. This new legislation provides tremendous opportunities for pharmacists. For one, it allows for pharmacists to initiate, modify or discontinue drug therapy for several conditions which include: arthritis, asthma, COPD, Type 2 diabetes mellitus, HIV/AIDS, obesity and any other chronic conditions adopted in rule by the board. This practice is to be performed with a signed agreement from the physician, indicating with which patients the pharmacist may conduct such

THE GOVERNOR APPROVED THE NEW FLORIDA LEGISLATION THAT ALLOWS PHARMACISTS TO WORK IN A COLLABORATIVE PRACTICE AGREEMENT. THIS NEW LEGISLATION 10

FLORIDA PHARMACY TODAY

activities. Although this has been a part of pharmacists’ practices for many years, the legislation solidifies this form of patient care and opens the door for further opportunities for a wider range of pharmacists, as well opening up payment models for our effort. The other portion of this legislation allows for the testing and treatment of nonchronic health conditions. These conditions include influenza, streptococcus, lice, skin conditions and minor uncomplicated infections. Actions must be performed underneath an established written protocol. Additional criteria that need to be met and followed prior to beginning such practices may be found at: https://www.flsenate.gov/ Session/Bill/2020/389. With more than 90 percent of Americans living within two miles of a pharmacy, pharmacists are easily accessible. One study established that across the 50 states, patients visit their community pharmacy more often than their primary care office (Berenbrok, Gabriel, Coley, & Hernandez, 2020). For Florida residents, the average ratio of visits to the community pharmacy compared to PCP was 13 to 9 (Berenbrok et al., 2020). Even if one-quarter of pharmacies participated in CPAs, the portion of patients reached would be tremendous. An example model created to provide more accessible services for their patients can be seen with CVS’s HealthHUB. CVS developed HealthHUBs to increase patient access to chronic care management (Reuter, 2020). In contrast to Minute Clinics, which address more acute conditions, HealthHUBs allows the leveraging of pharmacists’ knowledge in collaboratively treating chronic conditions. The other major change brought this year was the surge in use of telehealth. In April, 43.5 percent of Medicare primary care visits were provided through telehealth (Bosworth, 2020) This was a dramatic increase from only 0.1 percent in February (Bosworth, 2020). For further perspective from mid-March to early July, 10.1 million patients received a telehealth service (Bosworth, 2020). While urban areas had larger increases in the utilization of telehealth compared to rural areas, the rural areas still had large increases in use as well. Of course, the use of telehealth was necessary to meet the demand of social distancing brought by the first COVID-19 spike, but this was only accomplished by swift action from the government with utilization of waiver authorities and emergency rulemaking to remove safety and security barriers. While the removal of these barriers was necessary at the time, primary care offices will most likely have to address safety and quality risks moving forward. This recent demand of telehealth plays a significant role in the health profession. Telehealth is a modality that provides improved access to primary health care services. This correlates to the recent legislation for CPA approval, as it was also a means to increase patient access to primary health care services. Simultaneously, Medicare plans are slowly converting

EVEN THOUGH 2020 HAS BEEN A YEAR OF SURPRISES AND UNCERTAINTY, THROUGH THAT UNKNOWN, OPPORTUNITY HAS ARISEN FOR PHARMACISTS TO EXPAND THEIR ROLES IN REGARDS TO PATIENT CARE SERVICES. from their fee-for-service programs for reimbursement to the new value-based programs. These value-based programs reward health care providers based on the quality of care their patients receive which is determined by patient outcomes. As shown in one study by Roberts et al., patients that participated in the value-based University of North Carolina’s Health Care Pharmacy Assistance Program were more adherent to their hypertension, hyperlipidemia, and/or diabetic medications. In the study “U.S. Pharmacists’ Effect as Team Members on Patient Care” by Chisholm-Burns et al., pharmacists improved therapeutic outcomes in regard to decreasing A1c, LDL and blood pressure emphasizing their contributions in regards to improving overall patient care in a value-based program. Moreover, pharmacists were shown to significantly reduce adverse drug events, improve patient adherence, patient knowledge, and general quality of life. All these positive effects on outcomes have a downstream effect of decreased emergency room visits and improved quality of life. Within the aforementioned changes is an opportunity for pharmacists to capitalize on improving patient care. By combining the accessibility of telehealth with the improved quality of care pharmacists can provide, health care can be dramatically improved for our patients. In a value-based model, pharmacists can help keep patients healthier, leading to increased insurance reimbursements, and encouraging a greater interprofessional team effort in regards to patient care. Even though 2020 has been a year of surprises and uncertainty, through that unknown, opportunity has arisen for pharmacists to expand their roles in regards to patient care services. However, opportunities, if not utilized in a timely manner, may never become fully actualized. The time is here and now to begin utilizing the knowledge and skills we have to better care for our community. New evidence will improve understanding of how a particular activity, service or approach to care can better meet patient and health care system needs. We just have to take that first step, and begin the journey.

References:

1. U.S. Department of Health and Human Services. (2020, August 19). HHS Expands Access to Childhood Vaccines during COVID-19 Pandemic. Retrieved September 15, 2020, from https://www.hhs.gov/about/news/2020/08/19/ hhs-expands-access-childhood-vaccines-during-covid-19pandemic.html 2. Strasburg, J. (2020, September 10). AstraZeneca CEO Sees Oxford Vaccine Possible by End of Year, Despite Setback. https://www.wsj.com/articles/astrazeneca-ceo-seesoxford-vaccine-possible-by-end-of-year-despite-setback11599733063?mod=itp_wsj. 3. H.R. 389, Florida Cong. (2020) (enacted). 4. Berenbrok, L. A., Gabriel, N., Coley, K. C., & Hernandez, I. (2020). Evaluation of Frequency of Encounters With Primary Care Physicians vs Visits to Community Pharmacies Among Medicare Beneficiaries. JAMA Network Open, 3(7). doi:10.1001/ jamanetworkopen.2020.9132 5. Office of the Assistant Secretary for Planning and Evaluation, Bosworth, A., Ruhter, J., Wong Samson, L., Sheingold, S., Taplin, C., … Zuckerman, R., MEDICARE BENEFICIARY USE OF TELEHEALTH VISITS: EARLY DATA FROM THE START OF THE COVID-19 PANDEMIC (2020). 6. Reuter, E. (2020, August 31). Aetna rolls out new plan built around CVS pharmacies, retail clinics. Retrieved September 15, 2020, from https://medcitynews.com/2020/08/aetna-rollsout-new-plan-built-around-cvs-pharmacies-retail-clinics/?rf=1 7. CMS’ Value-Based Programs. (2020, January 06). Retrieved September 15, 2020, from https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/ValueBased-Programs/Value-Based-Programs 8. Roberts, A. W., Crisp, G. D., Esserman, D. A., Roth, M. T., Weinberger, M., & Farley, J. F. (2014, September). Patterns of Medication Adherence and Health Care Utilization Among Patients With Chronic Disease Who Were Enrolled in a Pharmacy Assistance Program. North Carolina Medical Journal, 75(5), 310–318. https://doi.org/10.18043/ncm.75.5.310 9. Chisholm-Burns, M. A., Lee, J. K., Spivey, C. A., Slack, M., Herrier, R. N., Hall-Lipsy, E., ... Wunz, T. (2010). US Pharmacistsʼ Effect as Team Members on Patient Care. Medical Care, 48(10), 923-933. doi:10.1097/mlr.0b013e3181e57962 10. Rakover J, Laderman M, Anderson A. Telemedicine: Center quality and safety. Healthcare Executive. 2020 Sept;35(5):48-49

NOVEMBER 2020 |

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PHARMACISTS: Visible, Yet Invisible, Part III The question may be asked: What other places can one find pharmacists? As we have discussed in previous columns, there are many places where pharmacists make posWilliam Garst itive impacts on health care outcomes other than in the traditional community pharmacy. Opioid treatment programs, also known as methadone clinics, specialize in treating people with opioid addictions, particularly heroin. The consultant pharmacist is responsible for overseeing the inventory of methadone – a controlled substance – and ensuring the inventory is accurate and monitored for any diversion. The pharmacist visits a minimum of twice a month, and, during the visits, the methadone inventory is counted and compared to the inventory count at the clinic. If there is a discrepancy, the error is resolved before the pharmacist leaves the facility. Methadone is given to patients in prescribed doses and is helpful in having people escape the addiction of heroin or other opioids. The pharmacist monitors the doses that are prescribed for a random group of patients to make sure the dosing is being done correctly. Another facility that uses a consultant pharmacist is a crisis stabilization unit, or CSU. When people go through an extreme emotional crisis, they are sometimes brought to a CSU. In this kind of facility, there is a secure medication room where a variety of commonly used medications are kept to treat the emotional and medical needs of the patient. The consultant pharmacist is responsible for the medication system at the facility and visits monthly to monitor the medication stock for any outdated products. Because a CSU is where emotionally disturbed patients are treated, it stocks some controlled drugs that are used to bring calming or seda-

tion. The pharmacist makes sure all the counts are accurate and every dose taken out of stock is administered to the patient by monitoring the recording of the dose in the medication administration record. During each visit, the pharmacist conducts a random audit of charts to ensure orders are being entered correctly, medication doses are reasonable, and any conflicting allergies have been noted and accounted for. Medication therapy management is a term used to describe a broad range of services provided by pharmacists. These services can be provided in a pharmacy, but many times the services are provided over the telephone. This program was introduced when Medicare Part D

cess or Helping Hands clinics. These clinics help with funding the medications and the pharmacy is staffed by pharmacists and technicians who volunteer their time. Alachua County has graciously given Grace Pharmacy a grant to have a part-time pharmacy coordinator. If you want more information, visit https://www.gracehealthcs. com/. As mentioned above, there is no charge for the prescription or the overthe-counter medications and the pharmacy does not have a cash register. Donations are welcome and can be given through the website. Pharmacists are active in many areas of the healthcare system, from the most visible – community pharma-

OPIOID TREATMENT PROGRAMS, ALSO KNOWN AS METHADONE CLINICS, SPECIALIZE IN TREATING PEOPLE WITH OPIOID ADDICTIONS, PARTICULARLY HEROIN. (the prescription part of Medicare) was enacted in 2006. These services include medication therapy review, personal medication records, medication-related action plans, intervention or referrals, and documentation and follow-up. These services were included in Medicare Part D because it was recognized that pharmacists are an important part in preventing medication-related adverse events, which had reached an estimated 1.5 million preventable adverse events each year costing $177 billion. In 2017, Harvey Rohlwing, M.D., and Tim Rogers, RPh., were returning from a medical mission trip to Haiti. As they were talking on their way home, they wondered if they could find a way to provide medications to Alachua County’s poor and homeless population as was being done in Haiti. This was the seed of what is called Grace Pharmacy located at Grace Marketplace in Gainesville. All the patients it serves must be seen by the UF Mobile Clinic, Equal Ac-

cies – to a variety of institutional settings where they have limited visibility. Wherever they are, they are serving you and watching out for your interests and health. William Garst is a consultant pharmacist who resides in Alachua, Florida. He received his bachelor’s degree in pharmacy 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 associations as well as the local Alachua County Association of Pharmacists. He serves on the Alachua County Health Care Advisory Board. He works parttime 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 Newsletter (https://thepharmacy newsletter.com). He can be contacted at communitypharmacynewsletter@gmail.com . NOVEMBER 2020

FPA News & Notes State, Feds Prepare for COVID-19 Vaccine The Florida Department of Health recently released a COVID-19 vaccination plan. The state’s plan is based on a template provided by the Centers for Disease Control and Prevention. It draws from experience in the H1N1 pandemic, seasonal flu and the hepatitis A vaccination program. Florida is using seasonal flu vaccinations to test plans for administering the COVID-19 vaccine, with each county holding an exercise by Dec. 1. The exercises will focus on increasing daily vaccinations, implementing social distancing and other mitigation measures, including expanded use of personal protective equipment. The CDC has not yet prioritized vaccine recipients, but it is expected that vaccines will be given first to health care personnel, essential workers, people with medical conditions that place them at high risk for COVID-19 complications and older adults. The Florida Pharmacy Association is reviewing the plan. The American Medical Association also recently released an update to the Current Procedural Terminology code set to include vaccine-specific codes for a COVID-19 vaccine. The CPT editorial panel approved a unique code for each of two coronavirus vaccine as well as administration codes unique to each vaccine. The new codes clinically distinguish each vaccine for better tracking, reporting and analysis to support data-driven planning and allocation. The codes are available now so that health care systems can be updated. Loxha Recalls Oral Rinse for Contamination Pharmaceutical company Lohxa is voluntarily recalling chlorhexidine gluconate oral rinse USP, 0.12 percent alcohol free. The affected products have the expiration date from Jan. 31, 2021, to March 31, 2021. The product was sourced and repackaged from Sunstar Americas and may be contaminated with the bacteria Burkholderia lata. Using the rinse may result in oral and systemic infections requiring antibacterial therapy. It may also result in life-threatening infections such as pneumonia and bacteremia. Chlorhexidine gluconate oral rinse USP, 0.12 percent alcohol free was distributed nationally to hospital pharmacies. The affected lots are T09101A, T08292A, T10011A,

FLORIDA PHARMACY TODAY

M10193A and T10223A. The rinse is used for the treatment of gingivitis. The Florida Department of Health is investigating a cluster of Burkholderia lata reported by a health care system that had 15 clinical infections among patients. The department warns that not all laboratories are able to perform the tests needed to properly identify Burkholderia lata. Without a matrix-assisted laser desporption/ionization time-of-flight mass spectrometer, most labs will identify it as Burkholderia cepacia or Burkholderia cepacia complex. Any health care facilities should do a laboratory lookback and notify county health officials of: ■ An increase above baseline in cases of Burkholderia cepacian or BCC in non-cystic fibrosis patients from any specimen source since Jan. 1. ■ Cases of Burkholderia lata from any specimen source since Jan. 1. States to Consider Memo on Compounding The Food and Drug Administration revised and asked state Boards of Pharmacy to endorse a memorandum of understanding on pharmacy compounding. The memo aims to create a consensus understanding that states will investigate and report to the FDA on inordinate amounts of compounded products being distributed interstate. States can sign the memo and report on interstate shipping or not sign the memo and limit pharmacies to shipping no more than 5 percent of all prescription orders dispensed out of state. Florida examined a previous memo on the subject last year and was advised by the Department of Health’s general counsel that state laws would make the department unable to comply with the terms and conditions. The state has up to a year to review and sign the revised memo.

FDA: COVID-19 Antigen Tests Can Have False Positives Clinical laboratory staff and other health care providers should be aware that false positive results can occur with COVID-19 antigen tests, the FDA says. Antigen tests are used to detect COVID-19 in authorized specimen types collected from people suspected of having the new coronavirus by their provider within a certain number of days from symptom onset. Providers using the antigen tests for rapid detection should be aware of the manufacturer’s instructions for use, typically found in the package insert, when performing the test and reading results, the FDA says. Furthermore, providers should make sure the tests are stored properly prior to use. Reading the test correctly is also important. Reading it before or after the manufacturer’s specified time can result in either false positives or false negatives. Processing many tests in a batch may make it more challenging to ensure the correct incubation time. Any positive results should be considered in combination with clinical observations, patient history and epidemiological information.

FPPC Candidates Win Races The Florida Pharmacist Political Committee is pleased to report that nearly all of the campaigns supported by your donations won their races. There were 120 House seats up for grabs and 20 Senate seats. The FPA and FPPC supported 8 Senate candidates and 11 House candidates. The winners include: ■ Allison Tant, House District 9 ■ Rep. Randy Fine, House District 53 ■ Michele Rayner, House District 70 ■ Kelly Skidmore, House District 81 ■ Rep. Bobby B. DuBose, House District 94 ■ Rep. Daniel Perez, House District 116 ■ Jim Mooney, House District 120 ■ Rep. Shevrin Jones, Senate District 35 ■ Loranne Ausley, Senate District 3 ■ Jennifer Bradley, Senate District 5 ■ Jason Brodeur, Senate District 9 ■ Sen. Debbie Mayfield, Senate District 17 ■ Danny Burgess, Senate District 20 ■ Ray Rodrigues, Senate District 27 ■ Ana Maria Rodriguez, Senate District 39 ■ Rep. Jayer Williamson, House District 3 ■ Rep. Cord Byrd, House District 11 ■ Rep. Jason Fischer, House District 16 ■ Keith Truenow, House District 31 ■ Rep. Amber Mariano, House District 36 ■ Rep. Josie Tomkow, House District 39 ■ Rep. Colleen Burton, House District 40 ■ Rep. Tyler I. Sirois, House District 51 ■ Rep. Mike Beltran, House District 57 ■ Rep. Jackie Toledo, House District 60 ■ Rep. Nicholas X. Duran, House District 112

NOVEMBER 2020

Stay Healthy This Holiday Season Source: The Office of Federal Occupational Health

FLORIDA PHARMACY TODAY

The holidays are joyous times of the year, but it can get stressful. Follow these tips from the Office of Federal Occupational Health to keep 2020 merry and bright. Plan Ahead It’s tempting to procrastinate, but with the rapid-fire jolliness of the holidays, you’d do well to start your holiday prep before crunch time. This can keep your holiday more calm and balanced. Set aside days to clean, bake, shop and do your other activities well ahead of time. And ask for help if you need it. Strike a Balance Try to stay fit as best you can. Regular exercise can help you stay fit and fight stress, as well as avoid the dreaded holiday weight gain. Instead of chowing down on fatand sugar-laden foods at holiday parties, bring your own healthy alternatives, like fruits and veggies. And move more. If you have a regular fitness routine, keep to it. If you don’t, try taking a walk after meals. Get everyone involved – set up a game of flag football in the yard. Sub It Out Instead of overindulging in too much rich holiday food, try substituting these items for traditional holiday foods. ■ Cream cheese: Pureed cottage cheese, low-fat cream cheese. ■ Butter: Avocado (for baked goods), applesauce or other pureed fruits, vegetable oil. ■ Frosting: Fruit preserves and sweet chutneys. ■ Chocolate: Cocoa powder, dried fruits, nuts. ■ Heavy cream: Blended potatoes or cashews, heavy cream mixed with half-and-half, light cream and whole milk, silken tofu, non-dairy milks. ■ Sour cream: Plain Greek yogurt. ■ White flour: Almond flour, brown rice flour, chickpea flour, oat flour, whole wheat flour. ■ Sugar: Applesauce or other pureed fruits, dates, fruit juice, stevia or other sweeteners. Set Aside Time to Relax Even amidst all the busy-ness, remember to take some time for yourself. Even just 15 minutes can refresh you. Try slowing your breathing, calming your mind or even taking some yoga classes.

Everything in Moderation The holidays can be a time of excess. Too much to do, too much food, too much shopping. But remember to do everything in moderation. Avoid overeating by eating a light snack before heading out to a party where there will be heavy foods. Limit your portion sizes, especially of sugary treats at work or at parties. If you drink, watch how much alcohol you consume at parties. Don’t binge, or drink more than four drinks in a two-hour period. Learn to Say No The fastest way to get overwhelmed during the holiday season is to say yes to everything you’re invited to. Know that it’s OK if you can’t be at every holiday activity. Start with small commitments to the things that are most meaningful to you. Rest Make sure you get enough sleep. On holiday vacation days, forgo the alarm clock and wake up naturally. If you stay out too late with friends or family, try to leave as early as you can. If you feel like you’re missing out, try to make plans to meet again soon. Don’t be afraid to take a 20- or 30-minute power nap if you need it. Sleep rejuvenates the body and mind, helping your mood and your immune system. Stay Safe If you’re cooking, make sure you prepare your food with care. Remember that consuming raw meat or seafood, poultry or eggs may increase your risk of foodborne illness. Avoid cross contamination and properly cook and store food. Wash your hands frequently to avoid spreading germs, wear a mask when in public and social distance. Keep up with your regular health screenings and vaccinations.

NOVEMBER 2020

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FLORIDA PHARMACY TODAY

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December 1, 2020

https://www.flpharmfound.org/ NOVEMBER 2020

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