2017Enacted

Resolutions

Carol Motycka, Speaker House of DelegatesDavid Mackarey, Vice Speaker

DirectorsDavid Pino (2017), Eric Alvarez (2018) and Matt Schneller (2019)

Jackie Donovan, Chair and Immediate Past Speaker

Suzy Wise, FPA President Elect and Ex-Officio

Michael Jackson, Secretary of the House

**Fiscal Impact Statement (should address the anticipated costs and benefits that will be derived should the resolution be passed)

$ - Minimal to low Impact (Example: Publishing position statements)

$$ - Low to Moderate Impact (Example: FPA preparing letters and op-ed papers to policy

makers)

$$$ - Moderate to Considerable (Example: FPA having to support comprehensive legislative

campaign)

$$$$ - Considerable to substantial (Example: FPA having to fund consultant assistance, support

comprehensive legislative campaign)

$$$$$ - Substantial Impact (Consist of FPA spending considerable resources on consultant assistance, funding comprehensive legislative campaigns, and invest in market outreach)

2017-1 - Prior Authorization Contact: Duyen Luu, alexjennyluu@gmail.com

2017-2 - OBRA 90 ModificationContact: Duyen Luu, alexjennyluu@gmail.com

2017-3 - Provision of complete and up-to-date Medication TherapyContact: Duyen Luu, alexjennyluu@gmail.com

2017-4 - Immunizing pharmacists continuing education opportunitiesContact: Barbara Beadle, bab83168@aol.com, Brevard County Pharmacy Association Teresa Tomerlin, teresapharmd@cfl.rr.com, Brevard County Pharmacy Association

2017-5 - Proper Identification of Central Fill PharmaciesContact: Ronald G. Haines Sr., Pasco Hernando Pharmacy Association- rxman@tampabay.rr.com 2017-6 - Pharmacist Administration of Naloxone containing products Contact: Norm Tomaka, flrx9@aol.com, Brevard County Pharmacy Association Barbara Beadle, bab83168@aol.com, Brevard County Pharmacy Association

2017-7 - Resolution to create ONE Governmental-Legal & Regulatory Council between all Florida Pharmacy AssociationsContact: Kathy Baldwin, kathleen.baldwin@bmcjax.com Scott Tomerlin, stomerlin@cfl.rr.com

2017-8 - Form ONE Political Action Committee between all Florida Pharmacy AssociationsContact: Kathy Baldwin, kathleen.baldwin@bmcjax.com Scott Tomerlin, Stomerlin@cfl.rr.com

2017-9 - Pharmacy Technician Representation on the Florida Board of PharmacyContact: William Garst wgarst1025@cox.net

2017-10 - Pharmacist Prescribing Authority for Prescription Drug Delivery Aids, Devices or AccessoriesContact: William Garst wgarst1025@cox.net

2017-11 - Online Continuing EducationContact: Terry V. Gubbins, Gubbins@prodigy.net

2017-12 - Transformation in the structure of leadership for the FPAContact: Tom Cuomo, tcrx0720@hotmail.com

2017-13 - Citizen’s CPR for CommunitiesContact: Michael Carulli, mcarulli@health.usf.edu Sarah Haley, sarahghaley@gmail.com

2017-14 - Rollover of Continuing EducationContact: Joshua Eisenman, rxjoshua@gmail.com

2017-15 - Review of Cannabis Therapy Contact: Matt Schneller, schnem18@gmail.com

2017-16 - Amending (Collaborative Practice Agreement (97-23))Contact: Matt Schneller, schnem18@gmail.com

2017-17 - Consumer Availability for Cost Effective Prescription DrugsContact: Barry Paraizo, ferrbp@bellsouth.net

2017-18 - Pharmacists Notification of Dispensed Medical Cannabis for Patients Under Direct CareContact: Kwame Fosu at 863-874-4834 or email polkcitysunshinepharmacy@gmail.com

2017-1

Prior Authorization

Contact: Duyen Luu, alexjennyluu@gmail.com

WHEREAS, pharmacists and pharmacy staff are tasked with resolving prior authorization with third party payers; and

WHEREAS, prior authorizations are defined as requirement to be completed by the prescribing physician.

THEREFORE BE IT RESOLVED, that the Florida Pharmacy Association or subdivision support requirements legislation that physicians should receive prior authorizations from insurance companies before issuing prescriptions to patients.

Problem: Prior authorization is required by health insurance plans before they will provide coverage for specific medications, however the current system requires that pharmacist contact the physician to initiate the process of prior authorization.

Intent: Improve efficiency of Pharmacy, create time for patient counseling, decrease confusion of patients waiting on prescriptions and expedite timely prescription drug therapy.

Proposed amendment offeredMotion to refer to the Professional Affairs CouncilMotion to refer to the Professional Affairs Council adoptedSTAFF NOTE: Legislation has been filed that requires health insurers to disclose prior authorization requirements. This legislation is in House bill 199 and Senate bill 98. These bills did not pass the House and Senate

FPA Fiscal Impact – $$

COMMENT: This is a proposed policy statement by the House of Delegates. The resolution appears to delegate authority for a subdivision of the FPA to provide comment on behalf of the FPA. Such delegation to a subdivision may require prior authorization from the FPA Board of Directors as articulated in Article V, Section 2 of the FPA Constitution. This resolution positions the Florida Pharmacy Association to support initiatives that seek to obligate prescribing practitioners to have access to their patients prescription drug benefit plan and screen for any prescription medications being considered that may have a prior authorization requirement. Such obligation may require the prescribing practitioner to interface with the patient’s health plan PBM contractor. During the 2017 legislative session Senate bill 530 was filed that would have created a number of obligations on HMOs or health insurers to authorize or deny a prior authorization request within 72 hours. This bill would have required PBMs to provide public access on its website to current prior authorization requirements, restrictions and forms and in written or electronic form upon request. There were a number of other requirements in place for PBM prior authorization programs in the proposed legislation. This bill ultimately passed the Florida Senate but died in the House.

2017-2

OBRA 90 Modification

Contact: Duyen Luu, alexjennyluu@gmail.com

WHEREAS, OBRA 90 mandates that pharmacist and pharmacy staff make an offer to counsel; and

WHEREAS, close ended questions such as “Do you have any questions for the pharmacist?” discourages patients’ active participation in their health and medication therapy.

THEREFORE BE IT RESOLVED, that the Florida Pharmacy Association or subdivision of the FPA encourages the use of open-ended; non-leading questions by pharmacists and pharmacy staff when making an offer to counsel.

Problem: OBRA 90 currently does not specify that an open ended question needs to be used which has led to poor communication techniques that do not elicit a proper response to allow for the pharmacist or pharmacy staff to gather sufficient information or insight about the patient’s needs (i.e. Adherence counseling, pill scheduling, or chewing extended release capsules)

Intent: Improve patient pharmacist relationship, empower patient to manage their disease state appropriately, improve patient education opportunities and medication adherence, and decrease medication errors.

Resolution Adopted

Refer to Public Affairs Council

FPA Fiscal Impact – $ COMMENTS: This is a policy statement with direction to take action proposed by the House. The resolution appears to delegate authority for a subdivision of the FPA to take action on behalf of the FPA. Such delegation to a subdivision may require prior authorization from the FPA Board of Directors as articulated in Article V, Section 2 of the FPA Constitution.

2017-3

Provision of complete and up-to-date Medication Therapy

Contact: Duyen Luu, alexjennyluu@gmail.com

WHEREAS, a patient needs to be aware of their medication to encourage adherence, and

WHEREAS, some patients are prescribed multiple medications of which they are unsure of the indications and dosing requirements.

THEREFORE BE IT RESOLVED, that the Florida Pharmacy Association or subdivision of the FPA encourages pharmacists to provide their patients with an optional current list of medications on a Prescription Medication Drug card.

PROBLEM: patients become less adherent when they have multiple medications to take and are unsure of which prescriptions were removed or changed in their regimen.

INTENT: Improve Medication therapy management and quality of life of all patients. These services will assist patients with questions that they may have about the medications they are taking and ensure they are taking them as prescribed.

Resolution not adopted

FPA Fiscal Impact – $

COMMENT: This is a policy statement with direction to take action proposed by the House. The resolution appears to delegate authority for a subdivision of the FPA to take action on behalf of the FPA. Such delegation to a subdivision may require prior authorization from the FPA Board of Directors as articulated in Article V, Section 2 of the FPA Constitution. The provision of a medication drug card may require member pharmacists and pharmacies to obtain the necessary card printing technology and interface in real time with a pharmacy’s patient profile dispensing system. The printing of such cards will reflect medication information that is current within the dispensing pharmacy’s database however information may be missing on the card from prescriptions filled by other pharmacies that are not sharing a common database. Also any medications that the patient may be taking that have been provided as samples from the prescriber’s office may not be included on this card. Such information on a patient’s medication drug card can be useful with there is a need for the patient to provide medication history to other health care providers or first responders.

2017-4

Immunizing pharmacists continuing education opportunities

Contact: Barbara Beadle, bab83168@aol.com, Brevard County Pharmacy Association Teresa Tomerlin, teresapharmd@cfl.rr.com, Brevard County Pharmacy Association

WHEREAS, there is currently only one approved continuing education program approved by the Florida Board of Pharmacy for recertification of immunizing pharmacists, and

WHEREAS, more options should be available to Florida immunizing pharmacists to renew certification

THEREFORE BE IT RESOLVED, that the FPA seek legislation that would allow for Florida pharmacists to seek immunization continuing education credit for recertification from any ACPE approved program.

Problem: Only one board approved continuing education program currently approved by the Florida Board of Pharmacy. This program is offered by the Florida Medical Association.

Intent: To offer an alternative to the only continuing education program for immunization recertification in the state of Florida.

Resolution Adopted

Refer to Government Affairs CommitteeThere was no opportunity to make this change during the 2018 legislative session.

FPA Fiscal Impact – $$$

COMMENT: This is an action item for the Florida Pharmacy Association. During the 2012 legislative session the pharmacy practice act (465.189) was revised to allow pharmacists to administer not only influenza but also pneumococcal and shingles vaccines. This change in law also included a new continuing education obligation on pharmacists in F.S. 465.009 to complete a 3 hour vaccine safety course provided by a statewide association of physicians that is credentialed to offer AMA PRA Category I CME. This in effected limited the offering of this pharmacist continuing education program to only Florida’s medical associations. The action item in this resolution will require a change to F.S. 465.009.

2017-5

Proper Identification of Central Fill Pharmacies

Contact: Ronald G. Haines Sr., Pasco Hernando Pharmacy Association- rxman@tampabay.rr.com 727-858-8779

WHEREAS, central fill pharmacies are not identifying themselves properly as a central fill pharmacy and this is confusing to patients, physicians, nurse practitioners, dentists, physician assistants who are led to believe that they are talking to their own pharmacy.

WHEREAS, this action is causing delays for patients receiving potentially lifesaving medications.

WHEREAS, this action by the central fill pharmacy is causing problems for their own pharmacists at the store level.

WHEREAS, patients are being led to believe that their prescription will be ready for pickup upon their arrival at the pharmacy of their choice and that is not happening.

THEREFORE BE IT RESOLVED, that the FPA or a subdivision of FPA undertake whatever action is necessary with the appropriate governmental body (board, agency, department or legislature) to educate, investigate and enforce existing requirements that central centralized pharmacy call centers fill pharmacies properly identify themselves to patients and prescribers as a remote call centers. central fill pharmacy and to adopt changes to these existing requirements should additional public protection be necessary.

Problem: Patients not getting their medications in a timely fashion as promised and confusion for prescribers who think they are communicating with a local pharmacy.

Intent: To eliminate this deceptive practice in the hope that patient care will improve by eliminating delays in important therapy and to insure that prescribers know exactly who they are communicating with and their exact location.

FPA Fiscal Impact – $$$$

Amended by sponsorMotion to defer resolution to second sessionMotion to defer not adoptedUpon call of the voice vote Speaker unable to determine a concensusconsensusDivision of the House declaredResolution adopted on standing count

Refer to Governmental Affairs CommitteeIssue has been brought to the attention of the Board of Pharmacy at their August 2017 meeting in Ft. Lauderdale along with a request for rulemaking.

COMMENT: This is an action item proposed by the House. The resolution appears to delegate authority for a subdivision of the FPA to take action on behalf of the FPA. Such delegation to a subdivision may require prior authorization from the FPA Board of Directors as articulated in Article V, Section 2 of the FPA Constitution. The resolution’s suggestion that the FPA advocate for a mandate that central fill pharmacies cease and desist the practice of misleading patients and prescribers is rather broad and may need to be clarified. Current Florida laws under Florida Statues 456.072 (1), (a) state the following and could possibly be the genesis of a Board of Pharmacy rule:

“The following acts shall constitute grounds for which the disciplinary actions specified in subsection may be taken: Making misleading, deceptive, or fraudulent representations in or related to the practice of the licensee’s profession.”

Rule 64B16-28.450, which governs centralized prescription filing, requires that both the central fill and originating pharmacies be identified on the prescription container label. However, the rule does not otherwise require a central fill pharmacy to affirmatively notify patients that it is a central fill pharmacy.

2017-6

Pharmacist Administration of Naloxone containing products Contact: Norm Tomaka, flrx9@aol.com, Brevard County Pharmacy Association Barbara Beadle, bab83168@aol.com, Brevard County Pharmacy Association WHEREAS: In May, 2017, the CDC declared a national opioid epidemic, followed by Governor Rick Scott and Surgeon General Celeste Philip declaring a public health emergency in the State of Florida, AND WHEREAS: In 2015, Heroin, Fentanyl and Oxycodone were directly responsible for the deaths of 3,896 Floridians, according to FDLE; with 33,000 persons Nationwide dying that year of opioid overdoses, AND WHEREAS: Currently, Pharmacists in the State of Florida are allowed to dispense Naloxone containing products, via a standing order protocol under FS 381.887 to a patient or caregiver pursuant to a prescription or non-patient specific standing order, AND WHEREAS: Other health care providers, including emergency responders, are recognized as having the authority to administer Naloxone containing products to persons exhibiting signs of opioid overdose THEREFORE, BE IT RESOLVED That the FPA advocate for legislative change to FS 381.887 to allow pharmacists the authority to administer Naloxone containing products, consistent with the authority granted to other health care providers. PROBLEM: Pharmacists, while granted authority to dispense Naloxone containing products, are not recognized as having the authority to administer this life saving care to patients who show signs of opioid overdose. This gap in care could be detrimental to a patient’s survival of an opioid overdose, as every second of response is critical. INTENT: To enable Pharmacists to provide adequate treatment and care to those patients that present with signs of opioid overdose.

Resolution adopted

Refer to Governmental Affairs CommitteeThere was no opportunity to get this through the 2018 legislative session. FPA FISCAL IMPACT- $$$

COMMENT: This resolution is an action item recommended by the FPA House of Delegates. In the past few years the Florida legislature included in a statute that is not the practice of pharmacy the authority for pharmacists to dispense narcotic antagonists to not only a patient but also the patient’s caregiver. Additional language was added that granted authority for first responders to possess narcotic antagonists and also pharmacists could dispense via standing orders. These changes were in response to the growing opioid epidemic in Florida and that have access to time sensitive narcotic antagonists would save lives. During the month of May the Governor of Florida as well as the state’s surgeon

general issued emergency orders that granted 60 day authority for pharmacists to release certain narcotic antagonists to first responders. Those emergency orders have an expiration date. While the availability of narcotic antagonists are in F. S. 381.887 it is suggested that the ability for pharmacists to administer narcotic antagonists is best included in Florida Statutes 465.

2017-7

Resolution to create ONE Governmental-Legal & Regulatory Council between all Florida Pharmacy Associations

Contact: Kathy Baldwin, kathleen.baldwin@bmcjax.com Scott Tomerlin, stomerlin@cfl.rr.com

WHEREAS, pharmacists involved in advocating for our profession before the Florida legislature are often asked what pharmacy group we are representing; and

WHEREAS, it would serve the Profession of Pharmacy best if the profession could be perceived as having “ONE VOICE” by those legislators with whom we communicate; and

WHEREAS, joining resources between the Florida Pharmacy Association, the Florida Society of Health Systems Pharmacists and the Florida Independent Pharmacists Network to make better and more efficient use of these resources; and

WHEREAS, the joining of these resources would help with discussion and agreement on top priority issues, topics and legislative initiatives of importance to the Profession of Pharmacy in Florida as a whole.

THEREFORE, BE IT RESOLVED, that the Florida Pharmacy Association , direct the association to implement the merging of the FSHP Legal & Regulatory Affairs Council with the FPA Governmental Affairs Council and the FIPN Governmental Affairs Council, if said implementation is agreed to by the other sister organizations; and

BE IT FURTHER RESOLVED, that a committee of the whole be formed with representative members of each of the sister organizations which would develop priority issues to be brought to the legislature that represent the interests of the Profession as a whole; and

BE IT FURTHER RESOLVED, that since this is an item of some urgency, that said implementation plan be completed by a time certain (i.e. – six months from date of adoption)

THEREFORE, BE IT RESOLVED, that the Florida Pharmacy Association, join the Florida Pharmacy Coalition to collaborate on all pharmacy legislative issues.

Introduced and amended by the sponsorsAdopted as amended

Refer to Organizational Affairs Council

FPA FISCAL IMPACT- $$

COMMENT: This resolution is an action item recommended by the FPA House of Delegates. During previous meetings of the House of Delegates, there have been proposed policy statements and action items to blend FPA and FSHP activities. Resolution 94-27 attempted facilitate a reciprocal arrangement

with the creation and management of an electronic bulletin board. Resolution 13-7 was adopted to create a task force to study the possibility of forming a new statewide pharmacy organization. Resolution 14-3 directed to FPA to explore an opportunity for dual membership with FSHP. Resolution 03-11 was introduced to have the leadership of FPA and FSHP facilitate joint meetings. Resolution 95-9 which appears to be similar to this proposed resolution from the FPA House was introduced to initiate discussions with FSHP for the purpose of combining legislative and lobbying activities to facilitate a unified voice for pharmacy. Resolution 93-31 recommended that the FPA and FSHP engage in dialog with the Governor on diversity of practice site skills in Board of Pharmacy appointments. Resolution 7-10 encouraged the engagement of FPA with FSHP on the issue of medication reconciliation. These resolutions as well as a few others can be found within the FPA’s currently policy manual. There are some synergies that can be achieved through the blending of advocacy efforts. Issues brought before the House, Senate and or state agencies could have a common theme and message which could eliminate confusion. Organizational meetings, planning sessions and policy briefings can be done jointly to maximize volunteer, staff and political contractor time. Such collaboration could reduce potential duplication of effort and conserve some costs.

Both organizations will need to have clear consensus on the priorities for a legislative action plan. Organizations generally establish their policy goals based upon member input, resources, political committee giving and any strategic plan adopted by the organizations governing Board. The legal and regulatory initiatives of two distinct organizations will need to be aligned in such a way as issues that can be agreed to be clear. Issues that organizations cannot agree to could create speed bumps in collaborative policy advocacy and could greatly impede measurable progress. Not only is it necessary to resolve any policy differences there will be a need for the organizations to be clear on which initiatives are mission critical and are high priority. Any discrepancies will need to be resolved prior to the start of an advocacy campaign.

The FPA and FSHP each have their own contract lobbyists and legal support team. These contractors are agents of their respective organization’s Board of Directors and have a singular responsibility to fulfill their obligations to the organizations that hired them. On occasion there may be conflicting guidance that a contractor may provide to their organization’s leadership. The collaborating Board members will need to manage these conflicts and resolve them in a timely fashion so as not to slow down the advocacy efforts. This will become challenging as a legislative session gets into the final week when issues become fast moving. It is recommended that both organizations’ Board of Directors consider the delegation of authority to an individual from both organizations to manage emerging issues and coordinate contractor efforts. Such individuals will need to be given decision making authority by their Boards in order to be nimble on the issues.

2017-8

Form ONE Political Action Committee between all Florida Pharmacy Associations

Contact: Kathy Baldwin, kathleen.baldwin@bmcjax.com Scott Tomerlin, Stomerlin@cfl.rr.com

WHEREAS, pharmacists involved in advocating for our profession before the Florida legislature are often asked what pharmacy group we are representing; and

WHEREAS, it would serve the Profession of Pharmacy best if the profession could be perceived as having “ONE VOICE” by those legislators with whom we communicate; and

WHEREAS, joining resources between the Florida Pharmacy Association, the Florida Society of Health Systems Pharmacists and the Florida Independent Pharmacists Network to make better and more efficient use of these resources; and

WHEREAS, the joining of these resources would help with collectively raising funds for legislative initiatives as well as other events and opportunities,

THEREFORE BE IT RESOLVED, that the Florida Pharmacy Association direct the association to implement the formation of ONE Political Action Committee comprised of the Florida Pharmacy Association, Florida Society of Health Systems Pharmacists and the Florida Independent Pharmacists Network, if said implementation is agreed to by the other sister organizations; and

BE IT FURTHER RESOLVED, that said committee, formed by representative members of each of the sister organizations, develop priority issues to be brought to the legislature that represents the interests of the Profession as a whole and help identify “friends of pharmacy” in the legislature or prospective “friends of pharmacy” that the profession as a whole can help support; and

BE IT FURTHER RESOLVED, that since this is an item of some urgency, that said implementation plan be completed by a time certain (i.e. – six months from date of adoption)

Withdrawn by sponsor

FPA FISCAL IMPACT- N/A

COMMENT: This resolution is an action item to be considered by the House of Delegates. There is a recommendation to consider a revision of the third resolve to allow that action item to stand independently on its own. Political committees are fairly expensive to run and require a fair amount of administrative work. There are advantages to pooling political committee management efforts into one because there is an economy of scale on the administrative costs. In addition when checks are delivered it should be coordinated with members who live in the districts of the legislators. Sometimes members of one organization may live in the areas that need to get a contribution where other organizations may not have a member. Florida rules allow for an unlimited amount of money that can be contributed into a political committee however we are limited to $1,000 contribution to a legislator. This is generally not an issue with the Florida Pharmacist Political Committee because there is generally a greater need for money to support political campaigns than there are political campaigns to support. There is no $1,000

limit to support a legislator's political committee an on occasion the Florida Pharmacist political committee is asked to do that. These political committee donations may be at the request of a political party or leadership of the House or Senate. Some requests have been from $5,000 to $10,000. Organizations that combine their political giving would need to consider the creation of a weighting mechanism of donations by our various stakeholder groups. For example if the PACs were to be combined as one and all pharmacists are asked to give, there needs to be clear transparency and disclosure to the members of every organization. Administratively this can be done by classifying contributions either by issue or by member organization. If for example we have certain pharmacy classes of trade provide 70% of the contributions to the PAC, that group is going to want to see 70% of their issues listed as a legislative priority. These issues will need to be worked out by each organization’s respective governing boards. If you have a combined political committee account then there will need to be a process for considering check requests from the contracted lobbyists who may recommend contributions to flow to certain candidates that they have relationships with. Any requests may have to be sorted out by the political committee's Board of Directors who would review and approve all political committee giving. Then we would have to revisit the political committee bylaws that define who gets to be on the FPPC Board of Directors (or whatever this political committee will need to be renamed as. If we have multiple organizations supporting one PAC then they are going to want seats on the FPPC Board.

2017-9

Pharmacy Technician Representation on the Florida Board of Pharmacy

Contact: William Garst wgarst1025@cox.net

WHEREAS Pharmacy Technicians in the State of Florida are required to be registered by The Florida Board of Pharmacy,

WHEREAS, Florida Registered Pharmacy Technicians are regulated by the Florida Board of Pharmacy,

WHEREAS, Florida Registered Pharmacy Technicians are part of The Patient Care Team,

WHEREAS, Florida Registered Pharmacy Technicians have become increasingly more participatory in providing Pharmaceutical Care,

WHEREAS Florida Registered Pharmacists have become more reliant upon Florida Registered Pharmacy Technicians to enhance, promote, improve, and maintain the stature and dignity of the Profession of Pharmacy and Patient Care,

THEREFORE, BE IT RESOLVED that the FPA or a subdivision thereof support the inclusion of a Florida Registered Technician on the Florida Board of Pharmacy.

PROBLEM: Florida Pharmacy Technicians are regulated and disciplined through the Board of Pharmacy, therefore they should have representation on the Board.

INTENT: To provide representation of Florida Pharmacy Technicians on the Board of Pharmacy.

Resolution not adopted

FPA FISCAL IMPACT- $$$

COMMENT: This is a policy statement proposed by the House. The resolution appears to delegate authority for a subdivision of the FPA to provide comment on behalf of the FPA. Such delegation to a subdivision may require prior authorization from the FPA Board of Directors as articulated in Article V, Section 2 of the FPA Constitution. The resolution if adopted in its present form would require legislative advocacy to modify Florida statutes 465.004 (2). This may also require a change to paragraph (2) of the same statute if there is interest in increasing or decreasing the number of members who serve on the Board. The Florida Pharmacy Association endorses the concepts of technician engagement through its support of the Pharmacy Technician Certification Board (PTCB).

2017-10

Pharmacist Prescribing Authority for Prescription Drug Delivery Aids, Devices or Accessories

Contact: William Garst wgarst1025@cox.net

WHEREAS, many pharmaceuticals and pharmaceutical administration/delivery aids, devices, or accessories are required to maximize effective, efficient, or safe administration and

WHEREAS, often the required pharmaceutical aids, devices or accessories are omitted from orders for such pharmaceuticals prescriptions for the effective, efficient, or safe administration and

WHEREAS, the goal of all health systems and patient care programs is to provide timely, safe, quality services, pharmaceuticals and pharmaceutical administration or delivery aids, devices or accessories and

WHEREAS, patients will have less time awaiting pharmaceuticals and pharmaceutical administration or delivery aids, devices or accessories and also allow pharmacists to deliver timely and appropriate care for our patients and

WHEREAS, the need and use of such pharmaceuticals and pharmaceutical aids, devices, or accessories are essential for the proper delivery and administration of certain prescription medications

THEREFORE, BE IT RESOLVED the FPA support amending F.S. Chapter 465, Rule 64, and/or related legislative areas to give pharmacists prescribing authority for drug delivery aids, devices or accessories.

PROBLEM: Many times aids, devices and accessories for pharmaceuticals are not ordered concurrently with certain prescribed medications. Pharmacists must obtain a prescribers order for legal and reimbursable orders for prescription drug aids, devices and accessories. For example a prescriber may order insulin for a patient that has to be administered by injection however there is no accompanying prescription for the syringes and needles that must be used with the ordered insulin. The pharmacist must either collect the cost of the syringes and needles from the patient or contact the prescriber and wait for authorization. This can cause a delay in treatment when the issue could be resolved with pharmacist prescribing authority for these kinds of medical aids. Having this authority can also resolve local issues where some city or county jurisdictions may require insulin needles and syringes to be prescribed. Other examples may include the need for an inhaler spacer or home glucose testing kits that may be covered by the patient’s health benefit plan. Many drugs that are prescribed in many cases cannot be administered without these aids.

INTENT: The purpose and intent of this policy statement is to support the ability for pharmacists to order and dispense pharmaceutical aids, devices and accessories for proper administration and use of certain prescribed medications. Achieving this authority will improve patient care and reduce any delays to therapy.

Resolution adopted

Refer to Governmental Affairs Committee

Staff Note: Legislation has been introduced that grants the ability for consultant pharmacist to initiate, modify or discontinue drug therapy. It is possible that this authority if adopted by the legislature and signed into law by Governor Scott could result in the ability for pharmacist to provide drug delivery aids, devices or accessories. The bills related to this issue passed the House and was placed on the Health Policy Committee in the Senate but was withdrawn due to committee member concerns.

FPA FISCAL IMPACT- $$$

COMMENT: This is a policy statement proposed by the House. The resolution positions the FPA to support revisions of the pharmacy practice act, its administrative rules or any other laws that would allow for pharmacist prescribing authority and a mechanism of payment for the provision of pharmaceutical aids, devices and accessories for proper pharmaceutical administration. The resolution suggests that third party payers will reimburse for these products if prescribed. Third party payers are not regulated by Florida statutes 465 or the Board of Pharmacy rules however they do review pharmacy laws and rules to determine whether payment is appropriate and within the pharmacist scope of practice. For example the provision of orthotics and pedorthics is included in the practice of pharmacy under 465.1901.

2017-11

Online Continuing Education

Contact: Terry V. Gubbins, Gubbins@prodigy.net

WHEREAS, most pharmacists complete their continuing education online, and

WHEREAS, pharmacists are so computer savvy and connected to the internet, and

WHEREAS, all but three states with schools in the Southeastern Conference offer online continuing education on their pharmacy association websites,

THEREFORE, BE IT RESOLVED, the FPA provide online continuing education using webinar or similar technology by July 1, 2019

PROBLEM: Lack of availability of online continuing education on the Florida Pharmacy Association website

INTENT: To offer our membership the benefit of completing their pharmacy continuing education online through webinars.

Motion to refer to the Continuing Education CouncilMotion to refer adopted on voice vote

Staff Note: The FPA has facilitated an online webinar of our September consultant CE conference that was cancelled due to a hurricane.

FPA FISCAL IMPACT-$$

COMMENT: This is an action item proposed by the House. Continuing education currently provided by the Florida Pharmacy Association includes an average of nine live conferences throughout the state of Florida. Also included in the inventory of FPA educational offerings are both general and consultant web based CE that can be done in the comfort of a member or nonmember’s home. There are also home study programs available through the FPA to meet the requirements for medication errors and also the new requirement for prescription drug validation. The majority of these programs can be ordered and completed online with the satisfactory passing of each course’s examination. According to the Accreditation Council of Pharmacy Education 70% of the continuing education offered by providers is live CE while 30% is home study. Conversely 70% of pharmacy stakeholders complete their continuing education via the home study route with 30% fulfilling their CE through live conferences. The Association currently has webinar software with the ability to service up to 100 participants and faculty.

2017-12

Transformation in the structure of leadership for the FPA

Contact: Tom Cuomo, tcrx0720@hotmail.com

WHEREAS, it is called for that the Florida Pharmacy Association elect a president and a vice- president together for a term of two (2) years to lead our professional organization into the future. A president for one year followed by a president-elect for one year does not give this organization the strength, knowledge or continuity to handle the challenges that are facing us repetitively and most importantly it would also establish connecting relationships with legislators for consecutive legislative sessions. A president would be able to delegate duties to the vice-president as it becomes important and necessary by working together. Pharmacists who volunteer time to lead our organization also have a personal life and need others to help accomplish and bring success to the principles and values of the FPA.

WHEREAS, in addition a two-year term would allow resolutions approved by the House of Delegates to be completed timely. This would be accomplished by establishing the vice president of the FPA as the chairperson of the board of directors for their term to accomplish these tasks.

WHEREAS, a president or vice president would be allowed if desired to run again for one more term for a total of four (4) years under their current office. If a president cannot complete an elected term, then the current FPA vice-president would assume the role of president of the FPA for the remainder of the term.

THEREFORE, BE IT RESOLVED that this resolution of electing a president & vice-president together as new leadership of the FPA be voted on by the House of Delegates to take effect with the 2018 FPA elections. We so move.

PROBLEM: Leadership Permanence

INTENT: Allow Leadership continual time to meet with legislators to have them understand the profession of pharmacy’s challenges without changing the appearance of leadership every year of the FPA.Motion to refer to Organizational Affairs CouncilMotion to refer not adoptedResolution not adopted

FPA FISCAL IMPACT-$

COMMENT: This is an action item proposed by the House. The current election and leadership procedure in place for the offices of president elect and president defined by the FPA governing documents begins with the election of president elect. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. This means that upon the election of office, the successful candidate will serve as FPA president elect for one full year beginning from the installation breakfast on Sunday of the FPA convention. That position includes a seat on the FPA Board of Directors, Budget and Finance Committee, Governmental Affairs Committee, Presidents Committee, House of Delegates Board of

Directors and also the Advisory Council on Pharmacy Practice. Upon successful completion of a year in the role as president elect this officer will then ascend to the role as FPA president who will then continue on in the above mention committees with the exception of the House of Delegates Board of Directors. Upon completion of the year serving as the FPA president this same officer will serve as chair of the FPA Board of Directors and also on each of the above mentioned committees with the exception again of the House of Delegates Board of Directors. After completing a year serving as chair of the board of directors the immediate past chair of the Board will then chair a nominating committee for president elect and or treasurer elect. This represents a three year commitment in FPA senior leadership with additional time on the nominating committee. The individual who completes their tour as president elect, president and board chair can consider running again for office however if they choose to do so they cannot serve on the nominating committee.

In reviewing the “Therefore be it resolved” statement, what is missing is the length of service for the president and vice president ticket that is included in the “Whereas” statement. Assuming that an elected president and vice president serves a two year term then the House should be aware of the following:

1. It shall be understood that an individual serving in the role as vice president will not transition into the role of president at the end of their 2 year term and will be required to file a request to the nominating committee for consideration as a candidate for FPA president. This is assuming that the vice president chooses to not run again for a second term as vice president.

2. Presidential elections will be held every other year which means that individuals who may be considering a role as vice president or president of the FPA will need to wait 2 years before the next election cycle.

3. The resolutions contemplates a succession procedure for a vacancy of the FPA president however there may need to be considered an additional succession plan in the event the vice president is unable to serve or there is a vacancy of the vice president from the assumption of the office of FPA president due to an unplanned vacancy of that office.

4. The officers of the Florida Pharmacy Association affected by this proposed resolution are defined in the FPA Constitution. To facilitate this change means that the Constitution will need to be amended first followed by appropriate changes in the FPA bylaws. Amendments to the FPA Constitution is defined in Article XII and reads as follows:

This Constitution may be altered or amended provided that such proposal to alter or amend same shall be submitted to the Chair of the Organizational Affairs Council in writing. The proposed alteration or amendment to the Constitution shall be read at the annual meeting of the Association. Upon majority approval of the membership voting, the proposed amendment shall then be referred to the Board of Directors who shall cause the Executive Vice President to publish such proposed amendment in the Florida Pharmacy Today, which is placed in circulation at least thirty (30) days prior to the ballot being mailed to the membership. Upon the vote of three-fourths (3/4) of the voting members returning the ballot by the specified deadline, in favor of adoption of the amendment, it shall become a part of this Constitution.

Amendments to the FPA bylaws can be found in Article X and reads as follows:

Amendments to these Bylaws shall be approved by the Board of Directors and proposed by them to the House of Delegates and approved by a two-thirds vote of those voting members present at a regular meeting or special meeting called for that purpose; provided, however, that

thirty (30) days notice of that meeting shall be given by the House of Delegates in a manner approved by the Board of Directors.

This resolution, if it passes, may need to be considered as a proposal to amend the FPA Constitution and or Bylaws and should be referred to the Chair of the Organizational Affairs Council.

2017-13

Citizen’s CPR for Communities

Contact: Michael Carulli, mcarulli@health.usf.edu Sarah Haley, sarahghaley@gmail.com

WEREAS, it has been shown that providing CPR during the first few minutes of cardiac arrest can double or triple a person’s chance for survival, AND 70% of instances of cardiac arrests outside of a hospital setting occur in the home. WEREAS, pharmacists and student pharmacists possess a skill set capable of delivering education and demonstrating life saving techniques within the community,

THEREFORE BE IT RESOLVED that the FPA support the implementation of Citizen’s CPR training within communities in order to promote awareness, readiness, and preparedness in potentially life-threatening situations.

BE IT FURTHER RESOLVED that the FPA support and/or seek out opportunities for pharmacists and student pharmacists to provide this training.

Resolution not adopted

Background Statement:

This can be accomplished by:1. Pharmacy students from all Florida colleges of pharmacy attending meetings of local school

boards encouraging High School students to take a Citizen’s CPR training course. This can be accomplished through their Physical Education curriculum..

2. Partnering Pharmacy with Public Health to further these initiatives, identify the population health impact, and research the improvements made in our communities.

3. Promoting Student Pharmacists to receive Citizen’s CPR lead training in order to go out to their communities and teach the course. This can include, but is not limited to, training at local High Schools, health fairs, gyms, local businesses, etc.

Citizen’s Cardiopulmonary resuscitation (CPR) is a training course developed by the American Red Cross to teach hands-only CPR in 30 minutes. Hands-only CPR is giving chest compressions without mouth-to-mouth breaths, and it was created to help teach communities the basics of this life-saving technique. If we do our part to educate our communities by teaching them this course, there will be a much greater chance of someone’s life being saved in an emergency. Hands-only CPR and continuous compressions have been proven to be effective in sustaining someone’s life after cardiac arrest or other emergency. Also by removing the mouth-to-mouth part of CPR, bystanders are more likely to jump into action and help the individual because mouth-to-mouth deters bystanders from helping.

We would like to encourage Citizen’s CPR as a requirement at all High Schools because we feel that they are accessible in their classrooms, and training them would be a great start to educating the community. We also feel that this course could be a stepping stone to helping high schoolers learn more about health, and we can use that opportunity to share with them what other levels of training they can do as

well as encourage entry into the health care field. The incorporation of student pharmacists in this policy is key because having our qualified body of licensed interns teaching the public is a great way to get the word out, spread awareness, and educate important, life-saving skills.

Collaborating with Public Health to gather population data and conduct research would be a wonderful way to prove the effectiveness of this volunteer initiative in action. Certain things to look into would be number of cardiac arrests in a specific community or area and number of potential lives saved due to action from a bystander with hands-only CPR.

A con or drawback that we foresee with this policy is the difficulty of implementing Citizen’s CPR as a requirement for all high schools through legislation, but the good thing about this program is that it does not cost anything to attend, and there is no official licensure upon completing the course. This is mainly used as an informative and educational course so that people can be more prepared during emergencies. For that reason, it may be easier to push for approval at school boards due to the simple logistics of the course itself. We need to identify community champions for the local high schools to support our chapter efforts longitudinally.

References:1. González-Salvado V, Fernández-Méndez F, Barcala-Furelos R, Peña-Gil C, González-Juanatey JR,

Rodríguez-Núñez A. Very brief training for laypeople in hands-only cardiopulmonary resuscitation. Effect of real-time feedback. Am J Emerg Med. 2016 Jun;34(6):993-8.

2. Hands Only CPR [Internet]. Washington: American Red Cross; 2016 [cited 2016 Sep 16]; [about 1 screen]. Available from: http://www.redcross.org/get-help/prepare-for-emergencies/be-red-cross-ready/hands-only-cpr

3. Hands-Only CPR [Internet]. Dallas: American Heart Association; 2016 [cited 2016 Sep 16]; [about 1 screen]. Available from: http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands-Only-CPR.jsp

4. Stolte D. New Studies Confirm Chest Compressions Alone are Life-saving for Cardiac Arrest. UANews [Internet]. 2007 Dec 21 [cited 2016 Sep 17]; [about 2 p.]. Available from: https://uanews.arizona.edu/story/new-studies-confirm-chest-compressions-alone-are-life-saving-for-cardiac-arrest

5. Citizen CPR Train-A-Thon for Red Cross Clubs. Available from: http://redcrossyouth.org/wp-content/uploads/2014/08/citizencpryouthguide.pdf

FPA FISCAL IMPACT- $

COMMENT: This resolution is a policy statement with an action item offered by the House of Delegates. The resolution if adopted in its current form positions the FPA as supporting greater accessibility to CPR training. The resolution also directs the FPA to engage in changes to the statutes that may require revisions to high school curriculum and/or Florida educational standards.

2017-14

Rollover of Continuing Education

Contact: Joshua Eisenman, rxjoshua@gmail.com

WHEREAS, continuing education credits are required for the renewal of a pharmacist license and

WHEREAS, credits in excess of the renewal requirements are lost and

WHEREAS, Florida statutes 465.009 state that prior to renewing a license that continuing education must be done during the 2 years prior to application for renewal of the license and

WHEREAS, There does not appear to be an exception in the statues that allow for excess earned continuing education credit to be forwarded to other licensure renewal years

WHEREAS, participation in continuing education sessions is reduced due to lack of need,

THEREFORE BE IT RESOLVED, The FPA advocate for changes to Florida Statutes 465.009 to allow Board of Pharmacy rulemaking discretion for the use of excess earned continuing education credits during a biennial renewal period to be allowed for use within the next sequential licensure renewal period and,

THEREFORE BE IT ALSO RESOLVED , Upon passage of a change to Florida statutes 465.009 allowing for use of excess continuing education the FPA petition the Florida Board of Pharmacy for rulemaking allowing the rollover of continuing excess education credits for the renewal of a Pharmacist license.

PROBLEM: Excess continuing education credits are lost after the bi-annual renewal. This limits participation in continuing education courses as credits will be lost after bi-annual requirement is met.

INTENT: To allow pharmacist to apply excess continuing education credits to future license renewals

Resolution not adopted

FPA Fiscal Impact - $$

COMMENT: This is an action item proposed by the House of Delegates. The biennial renewal period for pharmacists and pharmacy technicians may vary depending upon the type of license. For example all pharmacist consultant licenses expire at the end of every even numbered year while the general or PS licenses of pharmacists will expire after September 30th of each odd numbered year. The registration of technicians will expire the same time that consultant pharmacist licenses expire. Nuclear pharmacist licenses will expire at the end of February of each even year. The House may need to be aware that it is our understanding that excess earned consultant continuing education credits issued during a biennial renewal period for consultant pharmacists are rolled over to the general or PS license. While the changes to Florida laws may help Florida licensed pharmacists, those pharmacy stakeholders licensed or registered in other states will still have to comply with the other state’s pharmacy laws on continuing education.

2017-15

Review of Cannabis Therapy

Contact: Matt Schneller, schnem18@gmail.com

WHEREAS, medicinal cannabis will be prescribed in the state of Florida and

WHEREAS, pharmacist licensed in the state of Florida have a duty to review complete medication records prior to dispensing a medication and,

WHEREAS, the dispensing of cannabis/marijuana in Florida doesn’t currently involve the professional services of a pharmacist,

THEREFORE BE IT RESOLVED, the FPA supports the dispensing process of cannabis to include pharmacist services.

PROBLEM: Historical policy does not give direction for the involvement of pharmacies tin the dispensing process. Existing historical policy includes: DISPENSING OF MEDICAL MARIJUANA (14-11). The FPA take an active stance in lobbying for pharmacists involvement in shaping medical marijuana laws.

INTENT: Ensure patient safety on medication regimens that include medicinal cannabis by ensure a pharmacist is able to review a patient medication profile prior to each dispensing.

Resolution not adopted Division of the House CalledResolution adopted on standing vote

Refer to Governmental Affairs CommitteeThere were several bills filed during the 2018 session related to cannabis however very few address pharmacist involvement. There continues to be a conflict between state and federal laws on this issue. The FPA has heard from a pharmacist liability insurer that because of this conflict there may not be any practice liability insurance coverage.

FPA Fiscal Impact - $$

COMMENT: This is a policy statement proposed by the House of Delegates. During the 2014 House of Delegates session two resolutions were adopted by the House that addresses the dispensing of Medical Marijuana. Resolution 2014-11 created an action item that the FPA take an active stance in lobbying for pharmacist involvement in the shaping of medical marijuana laws. That resolution did not clarify whether the FPA should advocate for pharmacist involvement in medical marijuana availability or dispensing rather it placed the FPA at the discussion table on this issue of law development. The FPA has been present at a number of hearings on the issue as well as having attended several meetings at the Florida Capitol where legislation was introduced. Also during 2014 a constitutional amendment was proposed during the general election that was entitled the Compassionate Medical Cannabis Act of 2014. Resolution 2014-12 was introduced during the FPA House of Delegates that positioned the FPA in

opposition of that constitutional amendment. The amendment ultimately did not pass but received support from more than 50% of Florida voters. A subsequent constitutional amendment was filed during the 2016 Florida election that modified slightly the provisions of the 2014 constitutional ballot initiative. That proposed constitutional change was found favorable by more than 70% of Florida voting citizens. Several bills were filed and debated during the 2017 legislative session but none ultimately passed. The Department of Health has until July 3, 2017 to complete rulemaking required by the passage of the 2016 amendment 2 on medical marijuana.

For the moment cannabis is considered a schedule I controlled substance by the Federal government which means that it has no accepted medical use. A number of states have changed their laws to allow for the use of medical marijuana. Under the Obama administration the Department of Justice took the position that while this substance cannot be legally used, there will be no enforcement measures taken in states enacting laws on the use of Medical marijuana. Connecticut, New York and Minnesota appear to allow pharmacists to dispense cannabis. It is unclear whether such dispensing can take place in a pharmacy possessing a DEA license. Several articles on this issue have been published in Florida Pharmacy Today. (See October and November 2014 issues of Florida Pharmacy Today).

2017-16

Amending (Collaborative Practice Agreement (97-23))

Contact: Matt Schneller, schnem18@gmail.com

WHEREAS, patients access to primary, ambulatory, and outpatient healthcare services is limited and

WHEREAS, existing policy COLLABORATIVE PRACTICE AGREEMENTS (97-23) needs updating to reflect current practices,

THEREFORE BE RESOLVED: the FPA amend existing resolution COLLABORATIVE PRACTICE AGREEMENTS (97-23) to read:

The FPA seek legislation to authorize pharmacists to initiate, modify or discontinue medication therapy, order and interpret laboratory test results, and administer medications pursuant to a protocol or collaborative agreement with a physician or group, and the FPA shall cooperate with the FSHP to draft language for introduction by the Legislature.

SUBSTITUTE LANGUAGE: The FPA collaborate with the Florida Pharmacy coalition to seek legislation that authorizes consultant or board certified pharmacists to initiate, modify or discontinue medication therapy, order and interpret laboratory tests and administer medications.

Substitute resolution adopted

Refer to Governmental Affairs CommitteeStaff Note: Legislation has been filed in both the House and Senate. The bill numbers are SB914 and HB689. These bills were not found favorable by the 2018 legislature.

PROBLEM: Existing policy COLLABORATIVE PRACTICE AGREEMENTS (97-23) needs updating to reflect current practices.

Existing language:The FPA supports the concept of pharmacists receiving authority to initiate and modify medication therapy pursuant to a protocol or collaborative agreement with a physician or group, and the FPA shall cooperate with the FSHP to draft language for introduction by the Legislature.

INTENT: Update existing policy to reflect current practices. Seek legislation to improve patient’s access to pharmacist provided patient care services.

FPA Fiscal Impact -$$$$

COMMENT: This resolution is an action item proposed by the House of Delegates. During the 2017 legislative session Senate bill 1180 was filed to revise the consultant part of the pharmacy practice act. The legislation if signed into law would have allowed Florida licensed consultant pharmacists to initiate, modify or discontinue prescription drug therapy in collaboration with the patient’s treating health care

provider or medical director. There was no House companion bill filed and the legislation was not heard in either the House or Senate. This bill also included language that would have allowed pharmacists to initiate treatment for patients with influenza.

Pharmacist leaders have been working with our medical association colleagues to help them understand the need and the benefit of these services. While there has been significant progress there is still more work that needs to be done.

2017-17

Consumer Availability for Cost Effective Prescription Drugs

Contact: Barry Paraizo, ferrbp@bellsouth.net

WHEREAS, many American citizens “can’t afford expensive drugs” and must choose between medication and food and

WHEREAS, prescription drug pricing for medications that have been off patent for years continue to be cost prohibitive for consumers and

WHEREAS, the huge price increases for drugs like epinephrine autoinjection for emergency allergy treatment and pyrimethamine, a 62 year old drug used to treat protozoal infections have been in the news recently with a call for some kind of reform and

WHEREAS, the mergers of various manufacturers and suppliers of consumer prescription medications may be contributing to this increase in prices

THEREFORE BE IT RESOLVED, that the FPA support H. R. 749 being considered by Congress to allow the FDA to prioritize the review of generic drug applications.

PROBLEM: The cost of prescription medications has increased in price significantly over the past few years in part due to governmental regulations. In some cases these regulations may allow for the charging of monopolistic pricing. The result is according to an August 24, 2016 report on CBSNews.com, each person in the United States will spend $858 on prescription drugs compared with an average of $400 per person in 19 other industrialized nations. Consumers are not very knowledgeable of the drug approval process and instead question pharmacists for the cause of prescription drug prices. This is an answer to questions that are impossible to respond to.

INTENT: An Abbreviated New Drug Application (ANDA) contains data which when submitted to FDA's Center for Drug Evaluation and Research, Office of Generic Drugs, provides for the review and ultimate approval of a generic drug product. Once approved, an applicant may manufacture and market the generic drug product to provide a safe, effective, low cost alternative to the American public. The current process for review of these applications could be impeding the availability of lower cost generic alternatives to prescription medications whose patent has expired. Generic alternatives could possibly relieve the upward spiral of the cost of prescription medications for consumers. HR 749 if signed into law by President Trump would amend the Federal Food, Drug, and Cosmetic Act by revising provisions regarding review and approval of generic drug applications or supplements to generic drug applications for drugs: (1) for which there is a shortage, or (2) that have not been recently introduced to the market

by more than one manufacturer and for which tentative approval has not been granted to more than two applications. The legislation requires the Food and Drug Administration (FDA) to prioritize the review of such submissions and act on them within 180 days. The FDA may expedite the inspection of a facility proposed to manufacture such a drug.

Resolution not introduced into business

FPA Fiscal Impact - $$

COMMENT: This is a policy statement proposed by the FPA House of Delegates. H.R. 749 which has been filed currently has no Senate companion. Monopolization is currently prohibited at both the federal and state levels. The Sherman Act is a federal law that prohibits unreasonable restraints on trade and monopolies. Chapter 542, Florida Statutes, the Florida Antitrust Act, similarly prohibits restraints on trade through monopolies. This issue may arise from bureaucratic procedures that may be affecting prescription drug pricing.

2017-18

Pharmacists Notification of Dispensed Medical Cannabis for Patients Under Direct Care

Submitting Organization: Coalition of Concerned Pharmacists and Citizens, Inc. Contact: Kwame Fosu at 863-874-4834 or email polkcitysunshinepharmacy@gmail.com

WHEREAS, Pharmacists and pharmacy staff are strictly guided by federal, and state laws to provide unparalleled consultation concerning the effects and interactions of different drugs.

WHEREAS, Florida’s recent passage of Amendment 2 lacks any provision concerning pharmacists’ notification of patients under their direct care to be notified of the dispensing of medicinal cannabis.

BE IT RESOLVED, that Florida Pharmacy Association along with any affiliated organizations support requirements for dispensing organizations regulated under the Florida Office of Compassionate Office of Medical Marijuana Use Use to report to the Florida prescription drug monitoring program the same manner as pharmacies are required to report when patients under a pharmacist’s direct care will be dispensed medicinal cannabis.

Motion to Refer to Professional Affairs CommitteeMotion to refer adopted

PROBLEM: Medical Cannabis utilization co-administered alongside other drugs may pose potent interactions: Such as the inhibition of the CYP3A (Liver) enzymes, especially CYP3A4 and CYP3A5 i. For those with cardiovascular disease medical cannabis alongside other drugs taken may cause an increased risk of heart attack.

Cannabis taken with blood thinners may also inhibit platelet aggregation, by increasing the risk of bleeding when used concomitantly with anticoagulant/antiplatelet drugs. Some of these drugs include aspirin; clopidogrel (Plavix); nonsteroidal anti-inflammatory drugs (NSAIDs) dalteparin (Fragmin); enoxaparin (Lovenox); heparin; warfarin (Coumadin); and others. Concomitant use with cannabis may decrease warfarin metabolism or decrease the amount of warfarin bound to plasma proteins and increase warfarin effectsii.

Diabetics using cannabis are to be closely monitored by physician, and pharmacist. Drug interactions may result in low blood pressure over the extended use of medical cannabis iii

INTENT: Prevent detrimental harm to patients who may fall into any of the above listed categories. Provide better communications with medical cannabis dispensaries who serve the same patients.

FPA Fiscal Impact -$$$

COMMENT: This resolution is a policy statement proposed by the House of Delegates. Members of the House of Delegates need to be aware that there are no requirements for cannabis dispensing organizations to report to the state’s prescription drug monitoring program (PDMP) because the substance being provided is not a schedule II, III or IV substance. As such this means that pharmacists who query the PDMP database will find no reference to providers who have dispensed cannabis or its

analogs to patients. Dispensing organizations are regulated under F. S. 381.986 – Compassionate use of low-THC and medical cannabis. It is likely that language will need to be added to that statute as well as possible rulemaking that requires dispensing organizations and or referring prescribing practitioners to get from eligible patients the name and contact information for their providing pharmacy. Such changes in Florida laws should compel the dispensing organization and or referring physician provider to give notice to that treating pharmacy that their patient is being treated with medical cannabis. Alternatively, section 381.986 could be amended to authorize pharmacists to access the compassionate use registry which is a database containing the names of patients who are qualified to use medical cannabis. Once a pharmacy receives this information there could be a duty and responsibility to act on this information.

i National Institute of Health Life Sci. 2011 Apr 11;88(15-16):730-6. doi: 10.1016/j.lfs.2011.02.017. Epub 2011 Feb 26.ii National Institute of Health Ann Pharmacother. 2009 Jul;43(7):1347-53. doi: 10.1345/aph.1M064. Epub 2009 Jun 16.iii Mayo Clinic http://www.mayoclinic.org/drugs-supplements/marijuana/interactions/hrb-20059701