June 2011 Florida Pharmacy Journal

JUNE 2011

Key Issues Facing Pharmacists and Technicians

A work-life survey from the Florida Society of Health-Systems Pharmacists in collaboration with the Florida Pharmacy Association.

The Official PublicationOf The Florida Pharmacy Association

2 | F l o r i d a P h a r m a c y T o d a y

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J U N E 2 0 1 1 | 3

Vol. 74 | No. 6JUNE 2011ThE oFFicial PUblicaTioN oF ThEFlorida Pharmacy associaTioNP H A R M A C Y T O D A Y

florida

Departments 4 calendar

4 advertisers

5 President’s Viewpoint

8 Executive insight

20 buyer’s Guide

FeaturessPEcial rEPorT:Key issues Facing Pharmacists and Technicians

National adverse drug Event Network launched

12

18


E-mail yoUr sUggEstioNs/idEas to

[email protected]

Mission Statements:of the Florida Pharmacy Today JournalThe Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Phar-macy 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.

of the 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 execu-tive editor of the Florida Pharmacy Today Journal in the establishment and interpreta-tion of the Journal’s policies and the manage-ment 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.

AdvertisersEPC...................................................................... 11HEaltHCarE.Consultants........................ 3KaHan.◆.sHIr,.P.l............................................ 2PPsC...................................................................... 2rx.rElIEf............................................................ 2

2011

FPA Calendar JUNE

22 - 26 FPA Annual Meeting and Convention Aventura, Florida

JUly

4 Independence Day FPA Office Closed

30 Legislative Committee MeetingOrlando, Florida

aUgUst

5-7 SE Officers ConferenceBiloxi Mississippi

7-8 28th Annual Southeastern Gatherin

16-17 Florida Board of Pharmacy Meeting Orlando

27-28 FPA Committee and Council Meetings

sEPtEmBEr

1 Deadline to receive nominations for FPA elected office

10-11 FPA Law ConferenceFt. Lauderdale

17-24 FPA CE at SEA

oCtoBEr

8-12 NCPA Annual MeetingNashville Tennessee

15-16 FPA Midyear Clinical Conference

18-19 Florida Board of Pharmacy MeetingTallahassee, Florida

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.Pharmacists.should.have.satisfied.all.continuing.education.requirements.for.this.biennial.

period.by.september.30,.2011.or.prior.to.licensure.renewal.*for.Pharmacy.technician.Certification.Board.application,.Exam.Information.and.study.

materials,.please.contact.ranada.simmons.in.the.fPa.office.for.More.Information.on.CE.Programs.or.Events:Contact.the.florida.Pharmacy.association.at.(850).222-2400.or.visit.our.Web.site.at.www.

pharmview.com

CoNtaCtsfPa.—.Michael.Jackson.(850).222-2400fsHP.—.Michael.McQuone.(850).906-9333u/f.—.Dan.robinson.(352).273-6240faMu.—.leola.Cleveland.(850).599-3301nsu.—.Carsten.Evans.(954).262-1300

disClaimEr articles.in.this.publication.are.designed.to.provide.accurate.and.authoritative.information.with.re-spect.to.the.subject.matter.covered..this.information.is.provided.with.the.understanding.that.neither.florida.Pharmacy.today.nor.the.florida.Pharmacy.association.are.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.

For a complete calendar of events go to www.pharmview.com

J U N E 2 0 1 1 | 5

It has been a great privilege and a humble honor to serve as presi-dent of the Florida Pharmacy Asso-

ciation during the 2010-2011 year. The theme for my presidency was “A Strong Foundation for Positive Outcomes.” We have accomplished great things for the FPA and our profession by being this strong foundation for pharmacy.

Our work for the 2010-2011 year be-gan in early June when the FPA held its leadership retreat. There, our strategic plan was reviewed and revised. Goals were set and assignments were made to continue with our strategic plan. Also, new charges were given to the councils and committees for their work throughout the year. We reviewed our mission statement as follows, “FPA is the professional society representing Florida pharmacists, united to improve public health and patient care, enhance professional development and advocate for the interest of the profession. The Association is organized to preserve and advance the practice of pharma-cy and to serve the professional needs of all pharmacists, pharmacy students, and pharmacy technicians.”

We also developed action plans to carry on this mission. Our vision state-ment was also reviewed as follows, “To be the premier organization represent-ing pharmacy stakeholders in their en-deavors to provide quality healthcare.” Ideas were shared and implemented to carry forth this vision throughout the year.

The Educational Affairs Coun-cil, chaired by Jennifer Pytlarz, was charged with developing a CE pro-gram in Tallahassee during the health fair/legislative days. This would help get more pharmacists to get out of work for some additional CE hours. There were over 200 people there dur-ing those days and it was the most suc-

cessful of all of our health fairs. The council was also charged with devel-oping and presenting educational pro-grams in the area of innovative quality pharmacy healthcare and coordinat-ing the planning of all CE programs for the FPA. I am happy to report that all was accomplished by this council. This

year, we had a greater number of FPA programs, throughout the state, than ever before.

The Public Affairs Council, chaired by Suzanne Kelley, was charged with coordinating the Tallahassee and Mi-ami health fairs. Both events were a success, and we received a lot of pos-itive comments from the attendees. Many attendees were not aware of the health screenings that can be done and are being done by pharmacists in many practice locations throughout the state. We had about 60 pharmacists and over 150 students in attendance. This year, we collaborated with FSHP and had representation from both associations at the legislative days in Tallahassee.

The council was also instrumen-tal in informing the community in Oc-tober that it was Pharmacist’s month. Several proclamations were made by public officials honoring pharmacists.

One charge was to show your com-munity the value of their pharmacist. This was accomplished by the various health fairs that were held throughout the state. The last charge was to coordi-nate a list of names for PERT- Pharma-cist Emergency Response Team. This was accomplished at the FPA conven-tion by the manning of tables by coun-cil members and getting people to sign up for the list.

The Organizational Affairs Coun-cil, chaired by Kimberly Murray, was charged with several FPA constitution and by-laws changes to clear up some directions the association had on pol-icy issues. After these changes, the FPA Board of Directors will be approv-ing all policy issues for the association and be the only entity able to speak for the FPA. Also, the membership on our councils and committees was cleared up in the by-law changes. They also finished the revised membership ap-plications specific to each category. We now have specific FPA membership applications for pharmacists, students

FPA: A Year in Review

There were over 200 people there during

those days [Health Fair/Legislative Days] and it was the most successful of all of our health fairs.

The President’s ViewpointHUmBErto martiNEZ, FPa PrEsidENt

Humberto Martinez, 2010-2011 FPA President


The Florida Pharmacy Association gratefully acknowledges the hard work and dedication of the following members of the FPA leadership who work deligently all year long on behalf of our members.

Humberto Martinez ............................................................ Chairman of the BoardRobert Parrado .........................................................................................FPA PresidentGoar Alvarez .............................................................................................. President ElectBetty Harris ............................................................................................................TreasurerSuzanne Wise ...........................................Speaker of the House of DelegatesEric Alvarez ....................................Vice Speaker of the House of DelegatesPreston McDonald, Director ...........................................................................Region 1Marcus Dodd-o, Director .................................................................................Region 2Al Tower, Director .................................................................................................Region 3 Raul N. Correa, Director ...................................................................................Region 4 John Noriega, Director ......................................................................................Region 5 Chris Lent, Director ..............................................................................................Region 6Kim Murray, Director ........................................................................................... Region 7Raul Gallo, Director ................................................................................................Region 8Paul Elias .......................................................................................................................Region 9Alissa Fuller ............................................................................................... President FSHPMichael Jackson .......................................Executive Vice President and CEO

Florida Pharmacy today Journal Board

Chair......................................................Jennifer Pytlarz, [email protected] Chair ........................................................ Don Bergemann, [email protected] ...................Stephen Grabowski, [email protected] ..................................................................Stuart Ulrich, [email protected] ............................................................ Don Bergemann, [email protected] ................................................Joseph Koptowsky, [email protected] .......................Rebecca Poston, [email protected] Editor ...............Michael Jackson, [email protected] Editor ..................Dave Fiore, [email protected]

2011/2012 FPa Board of directors and pharmacy technicians. And I am glad that all their strategic plan incen-tives were accomplished. These by-laws changes will be voted on at the FPA an-nual convention in the House of Dele-gates and hopefully be approved. This council accomplished a lot of hard work for the association.

The Professional Affairs Coun-cil was charged with the expansion of pharmacy standards of practice and MTM services. Also, I proposed them a question of “How to make the phar-macist indispensable to the employer.” And they worked with this and have come up with some very good ideas. A new resolution will be presented by them at the HOD to address this ques-tion. Several resolutions from last year’s HOD were given to them for implemen-tation.

Council Chair Eric Alvarez has worked relentlessly to get his council to accomplish these many things. He has traveled to Tallahassee to speak before the Board of Pharmacy to implement one of the resolutions assigned to his council and he has represented the FPA at many events throughout the state. Eric was hospitalized for a short time and he still got his council to finish all of their charges. I would like to congrat-ulate him for a job well done.

The Ad Hoc Membership Commit-tee was co-chaired by Tom Coumo and Al Tower. They were charged with com-ing up with some ideas on how to in-crease membership and to come up with a golden handcuff that would re-tain our members after they join. They talked to several members throughout the state and a compilation of all those conversations was presented in the an-nual report from their committee.

FPA leadership traveled to all the pharmacy schools in the state and of-fered free membership in the FPA for six months after graduation. Hopeful-ly, we will be able to retain them after they start practicing pharmacy. Mem-bers are the backbone of this associa-tion and we need increased numbers to be a strong foundation to be able to ac-complish positive outcomes for the FPA. There are over 25,000 registered phar-macists in this state and about 2000 find it beneficial to be a member of their pro-

J U N E 2 0 1 1 | 7

fessional association. That is less than 7 percent of the Florida pharmacists, and it amazes me that we can accomplish what we are charged to do for our pro-fession.

I would like to thank the core team of members that have helped us move forward and accomplish the many things that our members ask of us. And I would like to challenge any pharma-cy stakeholder to join the FPA and help us to be the premier organization repre-senting them in their endeavors to pro-vide quality healthcare.

The Governmental Affairs Coun-cil (formally Legislative Affairs) was chaired by David Andrews. The coun-cil met in July of last year and set our legislative agenda with input from our members. We had eight issues to advo-cate for in this legislative session.

■ Advocate for a process for intern im-munization administration under the supervision of a pharmacist and expansion of immunization author-ity.

■ Advocate for PBM transparency. ■ Monitor Medicaid reform and advo-

cate for open networks and manda-tory MTM services.

■ Advocate for moving 499 back to the Department of Health.

■ Advocate expansion for Medicaid audit standards to other third party programs.

■ Monitoring and defense from Med-icaid reimbursement cuts.

■ Look for opportunities to expunge disciplinary records for minor viola-tions through referring to FPA lob-byist to assess the viability of suc-cessful advocating this program.

■ Monitoring for opportunities to re-vise the self-care consultant act which would allow the prescribing of vitamins, minerals, etc. by phar-macists if the federal laws change. Work with the naturopathic associ-ation.

Many thanks go to out lobbying team of Prieguez and Weems and our own EVP, Michael Jackson, for their tireless efforts to get our issues heard and passed by the Legislature. They fought extensively against the hard-ships on our profession in HB7095.

This bill has generated a lot of concern among pharmacists throughout the state and I hope that we have sent the message that there is strength in num-bers and we need members to represent you.

Our lobbyist team coordinated the visits of over 30 legislators during our Tallahassee health fair and legislative day. They also coordinated the visit of a “Pharmacist a Week” during the leg-islative session. Not too many pharma-cists could take the time off to be in Tal-lahassee for a week at a time. But, I am hopeful that we will find more pharma-cists next year to respond to be there to help our profession.

I very much like this quote from Pla-to: “Apathy can lead you to be lead by evil men.” We cannot be apathetic and let our legislature make laws that will affect our profession adversely. We have to be involved and engaged with our association that will help prevent some of these things from happening. I will not go into the details of what was passed and not passed, for Michael will be giving a more extensive legislative update. Over all, we were successful in stopping and minimizing some adverse legislation to our profession.

This year, FPA leadership and espe-cially our EVP, Michael Jackson, have traveled to many meetings being held throughout the state on the issues com-ing out of the legislative session. Many people found out about the issues af-ter they passed both houses and were waiting for the governor’s signature to become law. They received the mes-sage that if they were a member of the FPA, then they would have been in-formed about these issues before they were passed. We also advocated for do-nations to our Political Action Commit-tee of Continuous Existence (PACCE). Many new members joined and we col-lected more than double our total do-nations to the PACCE from the previ-ous year. The continued support of our members is essential to the success of our association and the future of phar-macy in Florida.

As your president, I have traveled throughout the state and represented the FPA at many national events. I will go anywhere I can to be there and advo-

cate for our profession. I was at a meet-ing in Austin, Texas, and the speaker said that out of most association mem-berships, only 10 percent are doers, 5 percent are donors, 5 percent are door openers, and 80 percent are dues pay-ers. In my first speech as your presi-dent, I said that I would like my actions to inspire others to Dream More, Learn More, Do More and Become More. I will be satisfied that I have done a good job as your president if I have increased the number of doers in this association by my actions.

In closing, I would like to thank the members of the President’s Commit-tee and the Board of Directors for all of their hard work and dedication this year. I would especially like to thank our hard working, committed and de-voted executive vice president and CEO, Michael Jackson. We all appreciate his dedication to our association. Also, I would like to thank the staff of the FPA. Without them in the back office, our as-sociation would not run smoothly. I wish incoming president, Bob Parrado, and incoming president-elect, Goar Al-varez, the best of luck during their year. I am confident that our association will be in good hands and continue to grow and move forward under their leader-ship. I will still be serving as the chair of the Board of Directors and will con-tinue to serve our association in what-ever capacity is needed. Thank you for your confidence in me for the last year, and I shall continue to serve this associ-ation and profession that I love. ■

Your 2010-2011 FPA PresidentHumberto “Bert” Martinez


Unfortunately, there continue to be no

pharmacists serving in the Florida House

of Representatives, the Florida Senate or any cabinet level positions.

This means that much of the policymaking affecting

professional pharmacy is being driven by pro-

and anti-pharmacy advocacy organizations,

other professional medical organizations and legislative staff.

During the course of the 2011 leg-islative session, we again expe-rienced the ongoing impacts of

term limits caused by legislators hav-ing less and less legislative experience. The 2011 Legislature passed fewer than 300 bills – the lowest number of total bills passed in recent memory. Yet the magnitude of the issues taken on by the Legislature was great and will have huge impacts on our state’s financial resources and health care system for years to come.

The Florida Pharmacy Association actively advocated, monitored and of-fered input on numerous legislative proposals that will be impactful on our profession and business models. Unfor-tunately, there continue to be no phar-macists serving in the Florida House of Representatives, the Florida Sen-ate or any cabinet level positions. This means that much of the policymaking affecting professional pharmacy is be-ing driven by pro- and anti-pharmacy advocacy organizations, other profes-sional medical organizations and legis-lative staff.

To a great extent – and largely be-cause of the challenges we faced dur-ing this year’s legislative session – the responses to our calls for support of the Florida Pharmacy Political Action Com-mittee of Continuous Existence and the Florida Pharmacy Association legal de-fense fund has been phenomenal. Many of you have poured thousands of dol-lars into our political and legal accounts. Decisions and laws are being made that directly determine how you will prac-tice your profession of pharmacy, run your pharmacy business, and care for your patients, as well as how health

care costs affect our state budget. Your contributions have a direct impact on electing candidates who can and will represent you effectively and will make decisions allowing for the continuation and growth of the future of your cho-

sen profession. The Florida Pharmacy Political Ac-

tion Committee of Continuous Exis-tence (FP-PACCE) is a means for us to “pool” our political contribution re-

sources to allow for a greater reach to political candidates who have or will have an understanding of what’s best for the practice of pharmacy and each aspect of patient care. When the Leg-islature is in session we are prohibit-ed from making political contributions. When the session is over, this gives us all an opportunity to support those campaigns that are friendly to phar-macy issues. So far in calendar year 2011, the PACCE has raised over $18,000. Much of that has come in within the last two months in response to some very onerous decisions under consid-eration here in Tallahassee. The PACCE Board extends many thanks to those of you who are supporting our fundrais-ing campaign. It is not hard to do. Just think of it as making an investment in your profession. A bottle of water may cost around $1.00. If you buy two each week, that will add up to about $100 per year. Just imagine if each of Florida’s

2011 Legislative Report and Advocacy Program

Executive InsightBy miCHaEl JaCksoN, rPHmiCHaEl JaCksoN, BPHarm, EVP & CEo, Florida PHarmaCy assoCiatioN

Michael Jackson, B.Pharm

J U N E 2 0 1 1 | 9

Executive Vice President/CEOMichael Jackson

(850) 222-2400, ext. 200Director of Continuing Education

Tian Merren-Owens, ext. 120Controller

Wanda Hall , ext. 211Membership Coordinator

Ranada Howard, ext. 110 Educational Services Office Assistant

Stacey Brooks , ext. 210

Florida PHarmaCy today BoardChair............................................. Jennifer Pytlarz, BrandonVice Chair ..................Don Bergemann, Tarpon SpringsTreasurer ..............................Stephen Grabowski, TampaSecretary ........................Stuart Ulrich, Boynton BeachMember .................................... Joseph Koptowsky, MiamiMember ............................................................Rebecca PostonExecutive Editor ........Michael Jackson, TallahasseeManaging Editor ........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2011, FLORIDA PHARMACY JOURNAL, INC.

ARTICLE ACCEPTANCE: The Florida Phar-macy 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 sub-scription - United States and foreign, Indi-vidual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax.

Florida Pharmacy association

610 N. Adams St. • Tallahassee, FL 32301850/222-2400 • FAX 850/561-6758

Web Address: http://www.pharmview.com

FPA STAFF25,000 licensed pharmacists matched what he or she pays for bottled water with an equal amount of a PACCE con-tribution. We would have a political war chest of over $2.5 million of which could bring a tremendous amount of pharmacy political muscle to our ef-forts in Tallahassee.

Where do your PACCE funds go? According to PACCE Treasurer There-sa Tolle, nearly all of it (approximately 90%) is used to support political cam-paigns. Of the political candidates that we supported with contributions, over 80% were successful in their cam-paigns. Funds that are not used to di-rectly support political campaigns are used to help raise additional money such as direct mailing expenses, PAC-CE brochure printing, post office box fees and the PACCE golf tournament and reception fundraising events.

A healthy PACCE fundraising pro-gram makes it much easier to bring to the forefront of elected policymakers the challenges that you face in provid-ing patient care services on a daily ba-sis. Some of these challenges include abuses by pharmacy benefit manag-ers and their auditors, outdated prac-tice act standards that restrict you from providing the care that you have been trained for and the pressure to increase volume driven by declining pharmacy reimbursements. Below are the issues that we are monitored on your behalf this session.

This year’s legislative session saw very few bills get passed for presenta-tion to the governor. As this report is being prepared, the governor had not signed any pharmacy-related bills. A final report was made available at the 2011 annual meeting and convention in Aventura, Florida.

HB 7095 Approved by Legislature (Pharmacy Permit Requirements and Controlled Substances) – This legis-lation, as filed, sought to control pain clinics and physician dispensing. The original bill was only 31 pages and then took on a strike all 91 page amend-ment restricting pharmacies from dis-pensing controlled drugs under many circumstances. The FPA launched a massive advocacy campaign to cre-ate awareness on how this version of

the legislation would harm pharma-cy businesses. There were some minor modifications to the pharmacy provi-sions that were applied in a House Ap-propriations Committee. While the bill passed unanimously, several members of the committee expressed concern with the pharmacy provisions. A num-ber of independent pharmacy own-ers testified on the issues found in the original version of the bill. This legisla-tion ultimately bounced back and forth between the Florida Senate and the House.

Major troublesome issues in the bill that the FPA began fighting against in-cluded the following:

■ Restrict wholesalers from shipping 5,000 dosage units each of hydroco-done, morphine, oxycodone, metha-done or any benzodiazepine or de-rivative of benzodiazepine to any retail pharmacy in any given month.

■ Require community pharmacies to apply for a new permit under the bills revised permitting standards by March 1, 2012, in order to be eli-gible to dispense Schedule II or III controlled substances at all. (One version of this bill would have re-quired pharmacies to get this per-mit by January 1, 2012. This is some-thing that the FPA believed the Department of Health could not achieve.)

■ Created an unlawful act for phar-macists to fail to report fraudu-lent prescriptions to the sheriff’s of-fice within 24 hours of believing a fraudulent activity had taken place.

■ One version of this bill would have restricted entirely the dispensing of controlled substances by pharma-cies that:

• Were not publically traded;• Were not operational for at least

10 years; or• Did not have over $100 million in

assets.

We worked tirelessly on this legisla-tion to remove these burdens on small pharmacy businesses and to assure that patients with legitimate needs for controlled substances had access to the drugs they needed. Published in the enrolled version of the bill (approved


by the House and Senate and signed by the governor) are the following changes or additions to Florida law:

■ Creates additional penalties for in-appropriate prescribing of con-trolled substances and non-compli-ance with F. S. 456.44.

■ Requires physical examination prior to prescribing controlled substances in pain clinics.

■ Requires written controlled sub-stance prescriptions to be on coun-terfeit-proof prescription blanks.

■ Prohibits physician dispensing of Schedule II and Schedule III con-trolled substances and creates pen-alties if a physician dispenses such controlled substance in violation of dispensing practitioner laws.

■ Provides following exceptions to ban on physicians from dispens-ing Schedule II & Schedule III con-trolled substances:

■ A labeled sample; ■ Within the Department of Correc-

tions; ■ After an approved surgical proce-

dure (not to exceed 14 day supply); ■ Pursuant to a clinical trial; ■ Through licensed opiate treatment

facilities; or ■ Through licensed hospices. ■ Grants authority for the Department

of Health to deny or to revoke a li-cense for prescription processing er-rors.

■ Create new grounds for denying a pharmacy permit (including being on the OIG list).

■ Requires all community pharma-cies to have a new permit issued by 7/1/2012 in order to dispense Sched-ule II and Schedule III controlled substances and establishing new standards so as to significantly re-strict the issuing of this permit only to those persons who are qualified to receive one.

■ Further defines precisely who a pharmacy permit may be issued to.

■ Establishes new policies, procedures and penalties to minimize dispens-ing based upon fraud.

■ Provides that the department “may” deny a permit for violations of sec-tions 465, 499, 893, etc., by the phar-macy owners. This may also include

denying the pharmacy permit ap-plication if the prescription depart-ment manager or consultant of re-cord has a “disqualifying offense” as specified by the statute.

■ Requires comprehensive reports to be filed when wholesaling drugs listed under F. S. 893.02.

■ Makes it unlawful for a pharmacist to fail to report to the sheriff with-in 24 hours (or after the close of the next business day whichever is later) after learning of a person attempt-ing to obtain a controlled substance from a pharmacy fraudulently.

■ Clarifies that law enforcement and the Department of Health shall have access to controlled substance dis-pensing records upon request and that a subpoena or search warrant is not required to obtain access to, or copies of, records related to con-trolled substances.

■ Adds consultant pharmacist of re-cord to the list of those who must be fingerprinted as part of the phar-macist and pharmacy background check procedures.

■ Requires the permittee to notify the Department of a change in prescrip-tion department manager within 10 days of any such change.

■ Defines certain duties of the pre-scription department manager.

■ Requires prescription department managers to notify the Board of Pharmacy of significant theft or loss of controlled substances by the busi-ness day following any such theft or loss.

■ Increases recordkeeping require-ments for controlled substance pre-scription and dispensing records from two years to four years.

■ Prohibits the transferring of phar-macy permits.

■ Require pharmacy controlled sub-stance records to be immediately re-trievable.

■ Requires wholesalers to undergo and conduct background screening and credentialing of customers and clients.

■ Requires wholesalers to review and analyze controlled substance orders greater than 5,000 unit doses per month.

■ Requires wholesaling data to be col-lected and reported to the governor, Senate president and House speaker by November 1, 2011.

■ Enhances possession and trafficking offenses relating to controlled sub-stances.

■ Retains the prescription drug mon-itoring program that was objected to by the governor and the Florida House of Representatives leadership early in the session and enhances the reporting and functionality re-quirements.

■ Reduces the deadline for a pharma-cy’s reporting to the prescription drug monitoring program of con-trolled substances drugs dispensed by a pharmacy from 15 days to 7 days

■ Creates buy-back and returns pro-gram for Schedule II and Schedule III drugs in physician offices so that physicians who are no longer per-mitted to dispense such drugs will be able to return unused inventory.

■ Provide a $3 million in budgetary funding to facilitate the buy-back program

■ Grants authority for law enforce-ment to “quarantine” and “seize” Schedule II & III controlled sub-stance inventory in physician offices that is not returned.

The FPA has also been working with the Florida Attorney General’s office that made passage of this legislation its top priority during this session. It is possible that some permit holders who have disqualifying offenses may have difficulty renewing by the July 1, 2012, deadline. We believe that the Depart-ment of Health will be required write rules for its permit application for com-munity pharmacies. We do not know if those rules will be in place prior to the deadline. The Board of Pharmacy at its Fort Lauderdale meeting did say on the record that they are not recommending pharmacies have to pay a permit appli-cation. The FPA will continue to moni-tor the Department of Health’s effort to issue these new permits. If it is appar-ent that the July 1, 2012, deadline is not possible then we will have another op-portunity during the legislative session

J U N E 2 0 1 1 | 11

for 2012 to advocate for an extension. HB585, SB1268 Not Adopted by the

Legislature (Pharmacist Immuniza-tion Services) – This legislation would have authorized pharmacy interns to administer the same vaccines autho-rized to be administered by pharma-cists, under certain circumstances. The legislation would have expanded the immunization authority of pharma-cists to permit – in addition to the in-fluenza vaccination pharmacists are currently permitted to administer to adults – pneumonia and shingle vac-cines for the elderly. The bill also would have granted authority for pharmacists and pharmacy interns to administer an epinephrine auto injection under cer-tain circumstances. This bill passed one committee in the Senate but was defeat-ed by a one vote margin in the House Health and Human Services Quality Subcommittee meeting on Wednesday, April 6. Testifying before the committee was Tallahassee immunizing pharma-cist Jonathan Hickman. Jon provided the committee with extensive and com-prehensive testimony on the benefits of

these services provided by pharmacists and how his practice has helped pa-tients. You can see the video of his testi-mony by going to the House Health and Human Services Quality Subcommit-tee web page. You can Google that web page by searching “Online Sunshine”. When you find the video link, advance the slide bar to 27.00 where you will see the HB585 being introduced and debat-ed.

SB2000 and SB2144 Approved by the Legislature (Florida Budget) – The 2011-12 budget did not include the re-quirement that AHCA implement a mail order program for chronically dis-eased Medicaid patients as passed dur-ing the 2010 legislative session. The language adopted in the AHCA con-forming bill gives the Agency for Health Care Administration the discre-tion to implement a voluntary mail or-der program for home delivery of main-tenance pharmaceuticals. There was a proposed dispensing fee reduction of $.50 per prescription on the Senate side, however the House did not agree. Keep in mind though that Medicaid pa-

tients are transitioning to managed care which means that reimbursement could be driven by whatever contractual agreements that the plans are offering. The current dispensing fee for Medic-aid will remain at $3.73. There was an ingredient cost reduction in the budget that is estimated to save the state (and cost pharmacy providers) a little over $22 million. That reduction revised the current ingredient cost reduction “low-est-of” formula to provide that any Medicaid drugs dispensed at whole-sale acquisition cost (WAC) will be re-imbursed at WAC plus 1.5% instead of WAC plus 4.5%.

HB39, HB1039 – Approved by the Florida Legislature (Regulation of Controlled Substances) – House bill 39 defined what a “homologue” is. Also both bills added the following to the list of schedule I controlled substances:

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The authors would like to acknowledge the contributions of the 2009-2010 FSHP Administrative Affairs Council. Additional members included: Richard Kessler, David Osterberger, Earnestine Pringley, Kimberly Thorp, Renee Zawistowski and Gail Brown.

SPECIAL REPORT:

Key Issues Facing Pharmacists and Technicians

A work - life survey from the Florida Society of Health-Systems Pharmacists in collaboration with

the Florida Pharmacy Association.

Jennifer Williams, Pharm.D. University of Florida College of Pharmacy

St. Petersburg, FL

Sandy Estrada, Pharm.D., BCPS Lee Memorial Health System

Fort Myers, FL

Connie Hogrefe, Pharm.D. Lee Memorial Health System

Fort Myers, FL

AUTHORS:

J U N E 2 0 1 1 | 13

K e y I S S u e S F A c I n g P H A r m A c I S T S A n d T e c H n I c I A n S

introduction The Administrative Affairs Council of the Florida Society

of Health-Systems Pharmacists (FSHP) was charged in 2009 to develop a survey to obtain salary data and measure the general work-life satisfaction of pharmacists and technicians in the State of Florida. This survey was conducted in collab-oration with the Florida Pharmacists Association (FPA). The goal of this survey is to provide pharmacy leadership in the state of Florida with information on the important issues fac-ing pharmacists and technicians. In addition to surveying the membership in 2010, the continuing goal is to re-survey annu-ally to trend the data collected.

methods The FSHP Administrative Affairs Council developed the

questions for the survey based on past surveys and council discussions. The survey was approved by the FSHP and FPA Board of directors in 2010. A Survey Monkey ™ survey was created and sent to the membership of FSHP and FPA in De-cember 2010. All responses were anonymous and aggregate data is reported.

results

technician survey 118 survey responders indicated they were technicians

(18% of total survey response). Table 1 shows all survey ques-tions and the response rate for each question. The majority of technician respondents work in hospital or health systems (60.2%) or community chain pharmacies (13.6%). Technicians that chose “other” specified settings such as ambulatory, on-cology/cancer center settings, contract manager, call centers and specialty pharmacies. Due to the relatively low techni-cian response the data was not analyzed by geographic re-gion.

Amongst technicians, 33% indicated staff technician as

their current position and 24.3% indicated “other”. (Chart 1) The responses indicated as “other” included a wide variety of specialized technician positions such as Pyxis™ technician, chemo technicians and technician interns. Chart 2 shows the current position/title of technician respondents with the ma-jority indicating staff technician. About half, (50.5%) indicat-ed that they did complete a pharmacy technician program (diploma/certificate). 12.6% responded that they completed a pharmacy technician associate’s degree program. Overall, 87.4% of technicians did not complete a pharmacy technician associate’s degree program although they may have had some higher education in a different field. 82.5% of technician re-spondents are currently certified by the Pharmacy Technician Certification Board (PTCB). Almost one-third (32%) of phar-macy technicians indicated the intention to attend pharmacy school in the future. 73.6% indicated their employer offers tu-ition reimbursement and/or assistance. 36.8% indicated their employer reimburses for attendance at conferences or educa-tional meetings. Thirty-six technicians responded to the ques-tion “Does reimbursement include travel and/or salary com-pensation?” with 58.3% responding affirmatively.

Technicians were asked how many years of experience they had. 17.9% indicated 0-3 years, 29.5% indicated 4-10 years, 17.9% was 11-15 years, 9.5% was 16-20 years and 25.3 was greater than 20 years. When asked how many years they had been in their current position, 46.3% indicated 0-3 years, 41.1 indicated 4-10 years and the remaining indicated greater than 11 years.

Less than half (42.9%) responded that they work 40 hours per week. 29.6% indicated they worked greater than 40 hours per week. 14.3% indicated that they worked less than 24 hours per week with the remainder indicating between 24 and 39 hours per week. 83.7% of respondents indicated they were paid hourly (Chart 3), 13.3% were paid by salary and 3.1% were per diem. Of the 13.3% indicating they were paid by sal-ary 12/13 responded they made greater than $31,200. Nine-ty five technicians responded that they receive compensation



Table 1. Survey Questions and Number of Responses to Each Question

Question Number of Pharmacist Responders

Number of Technician Responders

Are you a pharmacist or technician? 536 118 Primary Pharmacy Practice Setting 500 103 Zip Code of Primary Practice Site 500 103 Position/Title 500 103Degree/Certification (check all that apply) 500 Work Hours per Week 500 98Compensation: Salary vs. Hourly 500 98 Did you complete a Pharmacy Technician Program Diploma/Certificate

103

Did you complete a Pharmacy Technician Associates Degree Program?

103

Do you have plans to attend pharmacy school? 103Are you certified? 103What type of certification? 90Average Salary Base 327 13 Base pay per hour 167 84Additional payment/earnings not included in base pay 487 95Years of Experience 487 95Years in Current Position 487 95Does your employer reimburse for your attendance to conference/educational meetings?

487 95

Does reimbursement include travel and/or salary compensation? 278 36Does your employer offer tuition reimbursement and/or assistance?

470 87

Work Environment/Professional Activity (total% time spent= 100%) 470 87How satisfied are you with your current job at your primary place of employment? (with 1 being least satisfied and 5 being very satisfied)

470 87

Work Load Assessment 470 87Have current third party program policies affected pharmacist patient care services?

470

Gender 550 Ethnic/Racial Background 542 State of Initial Pharmacy License 500 *Shadowed boxes indicate the group was not asked the question.

J U N E 2 0 1 1 | 15


not included in their base pay. More than one type of com-pensation could be selected with 49 responses for overtime, 24 retirement benefits, 19 bonuses, 10 profit sharing, 10 indi-cated none and 14 indicated “other” including shift or week-end differential.

Eighty-seven technicians responded to the question re-garding work environment/professional activity. Ten re-sponses were excluded due to incomplete response to the questions, leaving 77 evaluable responses. Of the 77 respons-es the average amount of time technician responders spend in the following professional activities is as follows:- Dispens-ing/Distributions/Operation- 52.4%, Patient Medication Re-lated Needs- 23.2%, Business Management- 10.7%, Other (re-search/instruction/preceptorship)- 13.6.

Four questions were asked regarding job satisfaction at the primary place of employment with a response of 1 represent-ing least satisfied and 5 representing very satisfied (Chart 4).

The following percentage of technician responders reported 4 or 5 for the following questions: Satisfaction with the job as a whole- 66.6%, Progress towards personal/professional goals- 59.3%, Opportunities for advancement- 41.9% and Job fit to personal skill set- 62.8%. Technicians were asked if their workload had changed from previous year with the majority (75.9%) responding that the workload had increased or great-ly increased.

Pharmacist survey 536 survey responders indicated they were pharmacists

(82% of total survey response). Refer to Table 1 for all survey questions and the response rate for each question. 59.5% of respondents were female and 40.5% were male. 71.6% were Caucasian, 9.4% were black, 7.2% were Asian, 6.8% were His-panic and 5% were other. 326 of pharmacist responders were initially licensed in Florida.

The majority of pharmacist responders work in hospital



or health systems (60.2%) or community (chain and indepen-dent) pharmacies (11%) (Chart 5). Pharmacists that chose “oth-er” specified settings such as hospice and other specialties. Zip codes of primary practice site were collected and will be used for further data analysis in the future.

Clinical pharmacists represented 29.8% of the respondents followed by 23.8% as staff pharmacists. (Chart 6) Residents or other pharmacy specialties including industry comprised the “other” category. The majority (67%) of respondents had a Pharm.D. degree with 46.2% holding a bachelors degree in pharmacy. Thirteen percent of pharmacist respondents indi-cated board certification.

42.6% of pharmacists responded that they work 40 hours per week and 47.8% indicated they worked greater than 40 hours per week. Three percent indicated that they worked less than 24 hours per week with the remainder indicating between 24 and 39 hours per week. 32.6% of responders indi-

cated they were paid hourly, 66.4% were paid by salary and 1% was per diem. 44.3% of the pharmacists paid hourly were paid $50-$55. Chart 7 shows the breakdown of pharmacist av-erage salary base and Chart 8 shows the pharmacists aver-age hourly base. 487 pharmacists responded that they receive compensation not included in their base pay. More than one type of compensation could be selected with 144 responses for overtime, 191 retirement benefits, 167 bonuses, 45 profit sharing, 126 indicated none and 41 indicated “other” includ-ing shift or weekend differential.

Pharmacists were asked how many years of experience they had. 16.8% indicated 0-3 years, 22.8% indicated 4-10 years, 10.7% indicated 11-15 years, 7.4% indicted 16-20 years and 42.3 indicated greater than 20 years. When asked how many years they had been in their current position, 39.4% in-dicated 0-3 years, 36.1 indicated 4-10 years , 11.3% indicated 11-15 years, and 4.5% indicated 16-20 years and 8.6% indicated greater than 20 years.

Over half (57.3%) indicated their employer reimburses for attendance at conferences or educational meetings. 278 phar-macists responded to the question “Does reimbursement in-clude travel and/or salary compensation?” with 84.9% re-sponding affirmatively. 68.1% indicated their employer offers tuition reimbursement and/or assistance.

470 pharmacists responded to the question regarding work environment/professional activity. Nineteen responses were excluded due to incomplete response to the questions, leav-ing 451 evaluable responses. Of the 451 responses the average amount of time pharmacist respondents spend in the follow-ing professional activities is as follows - Dispensing/Distri-butions/Operation: 33.8%, Patient Medication Related Needs: 30.7%, Business Management: 21.2%, Other (research/instruc-tion/preceptorship): 14.3.

Four questions were asked regarding job satisfaction at the primary place of employment with a response of 1 represent-ing least satisfied and 5 representing very satisfied (Chart 9). The following percentage of pharmacist responders reported 4 or 5 for the following questions: Satisfaction with the job as a whole: 69.7%, Progress towards personal/professional goals: 63.3%, Opportunities for advancement: 45% and Job fit to per-sonal skill set: 68.9%.

Pharmacists were asked if their workload had changed from the previous year with 72.4% indicating workload had increased or greatly increased. Pharmacists were asked if cur-rent 3rd party program policies affected pharmacist patient care services with 17.9% responding yes, 32.8% no and 49.4% responding not applicable.

discussion One of the most striking results from the technician survey

was that less than half feel they have the opportunity for ad-vancement in their current position and approximately one-third have the longterm goal of attending pharmacy school. Overall pharmacists are satisfied with their job as a whole.

J U N E 2 0 1 1 | 17


Not surprisingly, both pharmacists and technicians feel their workload has increased significantly in the last year.

The majority of pharmacists responding to the survey work in hospital or health-systems settings. Future surveys should focus on increasing the response rates amongst com-munity/chain pharmacist in order to ensure a better represen-tation of pharmacy practice in Florida. Consideration might also be given to separating pharmacy residents/fellows from the pharmacist category due to the large focus of the sur-vey on compensation and job satisfaction. Compensation for pharmacy residents/fellows cannot be compared to that of pharmacists as a whole.

ConclusionsThe results of this survey provide a good baseline against

which future survey results can be compared.


PDR Network and its partners today announced the launch of a new online network to collect and distribute ad-verse drug events in the United States. The new service, called RxEvent, is now available to all U.S. prescribers via in-tegration into electronic health record (“EHR”) platforms and other online services, including directly at www.Rx-Event.org.

Roughly half a million adverse drug events are reported annually to the U.S. Food and Drug Administration (“FDA”) and the number is growing rapidly ac-cording to data from the FDA. More than 90 percent of these reports come from pharmaceutical manufacturers who receive them initially from physi-cians and other providers, typically via telephone. Manufacturers then triage and attempt to investigate these reports, notifying the FDA when appropriate. Published studies indicate that as few as one in ten adverse drug events are actually reported by healthcare profes-sionals largely due to the time-consum-ing and inefficient processes involved in reporting adverse drug events.

“RxEvent was designed to improve the convenience of adverse event re-porting for physicians, the cost-efficien-cy for manufacturers, and the quality of information ultimately reported to the FDA,” explained Edward Fotsch, MD, CEO of PDR Network, the com-pany providing the RxEvent service along with major EHR vendors and other partners. “RxEvent is part of the new suite of eCare Services that we are rolling out with content integrated into EHRs to increase drug and device effi-cacy and efficiency.”

“Our network of physicians is grow-ing rapidly and with it grows our abil-ity to contribute to drug safety,” stated Todd Rothenhaus, Chief Medical Infor-mation Officer, athenahealth, Inc. “Rx-Event integrated into athenaClinicals® supports our mission of physician con-venience and patient safety.”

EHR use among physicians in the U.S. has grown dramatically and is ap-proaching 50 percent, in part due to fed-eral and industry subsidies to help cov-er the cost of these systems. Studies show that adverse drug event report-ing integrated into EHRs increases the convenience, content and volume of ad-verse event reports.[1]

“Through our PrimeRESEARCH™ clinical trials network integrated with-in Greenway’s PrimeSUITE® EHR, we know that providers are vigilant to ad-verse events and are seeking a stream-lined reporting process,” said Green-way® President and CEO Tee Green. “We are pleased to be working with PDR Network to further improve the efficiencies that enable our provider customers on the front lines to improve drug quality and patient safety through an EHR reporting system that will also advance our ability to enable innovative clinical trials procedures.”

“Adverse drug event reporting is the tip of the spear in ensuring ongo-ing monitoring of prescription drugs. Drug safety requires a robust mecha-nism to identify, route, investigate and report adverse drug events,” noted Ja-net Woodcock, MD, Director, Center for Drug Evaluation and Research, FDA. “Integration of adverse event reporting into EHR systems places this service at the prescriber’s fingertips, adding to convenience and ultimately improved drug safety. We applaud PDR Network and their partners for their efforts.”

Jim Naughton, MD, an internist and EHR user who practices in the San Francisco Bay Area has had early ac-cess to the RxEvent service. He com-mented, “We see adverse drug events in our practice and I have reported them at times in the past. But the process has been cumbersome and certainly in-hibits reporting at times. RxEvent im-proves both EHRs and adverse event reporting by making reporting much more physician-friendly.”

RxEvent will also be used by phar-macists who report tens of thousands of adverse events annually.

“Pharmacists are actively involved in promoting and monitoring safe medica-tion use by their patients. By support-ing RxEvent, we hope to facilitate en-hanced reporting by pharmacists, who see tens of thousands of adverse drug events annually,” said Thomas Me-nighan, executive vice president and CEO of the American Pharmacists As-sociation (APhA). “Pharmacists repre-sent a key contributor to drug safety and we are working closely with PDR, as well as pharmacists in all practice settings across the country, to ensure that RxEvent is immediately available to all U.S. pharmacists.”

“The RxEvent service integrated into EHRs provides quick and convenient access for physicians and has been de-signed to include pre-population of information as well as an improved mechanism for pharmaceutical manu-facturers or the FDA to contact the re-porting provider when additional infor-mation is required.

National Adverse Drug Event Network LaunchedElectronic Health record systems Used to improve drug Event reporting and Patient safety

“RxEvent was designed to improve the convenience of adverse event reporting for physicians, the cost-efficiency for manufacturers, and the quality of information ultimately reported to the FDA.”

J U N E 2 0 1 1 | 19

Employer Based Technician Training Program for all Florida Pharmacies

The Florida Pharmacy Association partnering with PassAssured of Orange Texas is

pleased to present a web based employer based technician training program for

Florida pharmacies. Florida Statutes 465.014 requires pharmacy technicians to

register with the Florida Department of Health. To be eligible for registration techni-

cians must complete a Board approved training program as defined under rule

64B16-26.351.

All employer based technician training programs must be approved by the Florida

Board of Pharmacy. The FPA is offering assistance to pharmacies in their efforts to

get their training programs approved. Simply follow the steps published on the FPA

web site in the shopping cart where the program’s information is published. There

is no cost to apply to the Board.

Send us your contact information and we will be glad to help you.

Name _______________________________ Address _________________________________

City _________________________ State _______________ Zip Code ____________________

E-mail address ________________________________________________________________

Phone ______________________________ Fax _____________________________________

Name of Pharmacy _____________________________________________________________

This program is designed to supplement your on-site training

program for pharmacy technicians.

610 North Adams Street Tallahassee, Florida

Phone: (850) 222-2400 Fax: (850) 561-6758

E-mail: [email protected]

The FPA has made it easy

for you to file for approval

for your employer based

training program with the

Board for approval. Once

approved you can enroll

your technicians in the

comprehensive training

modules. The cost per

technician is $290.

Technicians who join the

FPA as members only pay

250. It should take about

160 hours for your

technician to complete

the program.


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Rx Relief(800) RXRELIEF

bUyEr’s GUidEADVERTISERS: This is a special section designed to give your company more exposure and to act as an easy reference for the pharmacist.

P H A R M A C Y T O D A Yflorida

advertising in Florida Pharmacy todaydisplay advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional referral ads: FPA Members: $50 per 50 words; Non-members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt.

AHCA MEDICAID PHARMACY SERVICES2727 Mahan DriveTallahassee, FL 32308(850) 487-4441www.fdhc.state.fl.us/medicaid/pharmacy

AMERICAN PHARMACISTSASSOCIATION (APhA)Washington, D.C. (800) 237-2742www.pharmacist.com

AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTSBethesda, MD (301) 657-3000www.ashp.com/main.htm

DRug INFORMATION CENTERPalm Beach Atlantic University(561) [email protected]

FLORIDA BOARD OF PHARMACY4052 Bald Cypress WayBin #C04Tallahassee, FL 32399-3254(850) 245-4292www.doh.state.fl.us/mqa

FLORIDA POISON INFORMATION CENTER NETWORK(800) 222-1222www.fpicn.org

NATIONAL COMMuNITY PHARMACISTS ASSOCIATION 100 Daingerfield Road Alexandria, VA 22314703.683.8200703.683.3619 [email protected]

RECOVERINg PHARMACISTS NETWORK OF FLORIDA(407) 257-6606 “Pharmacists Helping Pharmacists”

FrEQUENtly CallEd NUmBErs

Documents

June 2011 Florida Pharmacy Journal