Legislative Committee Agenda DRAFT

Legislative Committee Agenda DRAFT

Florida Pharmacy Association
Governmental Affairs Committee Meeting

Friday, August 9, 2013

Renaissance Orlando Airport
5455 Forbes Place
Orlando, Florida 32812

10:00am – 3:00pm

Minutes

  1. Call to Order – Chairman Shannon Wedekind - The meeting was called to order at 10:12am.
  1. Invocation – Terry Gubbins – The invocation for the group was facilitated by President Terry Gubbins
  1. Welcome and Introductions – Chairman Shannon Wedekind – Chairman Wedekind welcomed committee members to the meeting and asked members to make a brief introduction.
  1. Roll Call – Michael Jackson

Members Present: Terry Gubbins, Shannon Wedekind, Jonathan Hickman (by conference call), Suzanne Kelley, Humberto Martinez, Goar Alvarez (by conference call), Bob Parrado, Rizwan Khaliq, Richard Kessler and Mike Burns for Lori Weems

Members Unable to Attend: Alexander Pytlarz, Jan Rigell, Gary Koesten, Mark Hobbs, Amanda Waltemath, Doug Pauly

Staff Present: Michael Jackson

  1. Approval of the August 9, 2013 Meeting Agenda – A copy of the meeting agenda was provided to members in the group calendar and also by email. There were no recommended changes to the meeting agenda.

M/S/C to approved the August 9, 2013 meeting agenda as submitted

  1. Approval of meeting minutes from July 27, 2012 Meeting Minutes – A copy of the July 27, 2012 meeting minutes was provided to members in the group calendar and also by email. There were no recommended corrections to the July 2t, 2013 meeting minutes.

M/S/C to approve the July 27, 2012 meeting minutes as submitted

  1. Review of Conflict of Interest Policy – Terry Gubbins – A copy of the FPA’s conflict of interest policy and questionnaire was provided to members of the Governmental Affairs Committee attending the meeting. Copies were also made available in the group calendar for committee members and also provided by email to review. The policy was explained by President Gubbins. Members were asked if any of the agenda items to be discussed would pose a conflict of interest and all were given an opportunity to respond. Committee members Terry Gubbins, Shannon Wedekind and Jonathan Hickman all noted for the record that they have an affiliation with an employer who has an interest in the pharmacy technician ratio issue on the agenda. All have indicated that this issue would have no impact on their ability to represent the members of the FPA on this issue.
  1. Review of FPA Antitrust Policy – Terry Gubbins – A copy of the FPA’s antitrust policy was provided to members of the Governmental Affairs Committee attending the meeting. Copies were also made available in the group calendar for committee members and also provided by email to review. The policy was explained by President Gubbins.
  1. Old Business
  1. Update on PACCE – Mark Hobbs– On behalf of PACCE chair Mark Hobbs Michael Jackson updated the Committee on the transition plan of the PACCE to a PAC format. This change is necessary due to revisions of Florida laws that will decertify all committees of continuous existence. These changes will all be in place by September 30, 2013. PAC’s currently are limited to making $500 contributions to candidates for the Florida legislature and $3,000 for cabinet races. According to Mike Burns substituting for Lori Weems there are no limits on what members can contribute to the soon to be developed FPA PAC. The limits currently would be what the PAC can give to a candidate. EVP Michael Jackson is working with consultants and the PACCE board on the PACCE transfer. Plans are to begin marketing a new branding campaign when the transition is completed.

Members were also provided a copy of contribution reports from the Division of Elections web site for the FPA PACCE, Florida Nurses Association, Florida Medical Association and also the Florida Association of Health Plans.

  1. Resolutions assigned to Governmental Affairs Committee – Speaker Elect Robert Parrado for Speaker Koesten– Some of the resolutions adopted by the FPA House of Delegates have been referred to the Governmental Affairs Committee. EVP Michael Jackson briefed the committee on each of the resolutions and the action to date. These resolutions help to shape the FPA advocacy plan for 2013-2014.

i)Minor Infractions’ statute of limitations and expunging of infractions (2010.2 – Sunset Issue) – This resolution was designed to encourage the FPA to seek legislative changes to help remove minor disciplinary issues that may be published in the pharmacist or technician’s permanent licensure record. The FPA has advocated before the Board of Pharmacy to increase the number of disciplinary issues that can be handled through citation. Citations are not published as discipline. There has been no opportunity so far to advance this issue within the Florida legislature. Since this was a 2010 resolution with results published in the Speaker’s report at the 2013 convention, the House has not given further direction to the GAC as the resolution has been sunset. This was provided to members of the GAC for their information.

ii)Freedom of Choice and Standardized Reimbursement (2010.3 – Sunset Issue) – The intent of this resolution was to find legislative ways to allow patients to select their pharmacy provider and work towards open networks. This issue also included a request for the GAC to find a legislative solution to the unlevel playing field related to reimbursement for different pharmacy provider types. There has been no opportunity so far to advance this issue within the Florida legislature. Since this was a 2010 resolution with results published in the Speaker’s report at the 2013 convention the House has not given further direction to the GAC as the resolution has been sunset. This was provided to members of the GAC for their information. Members of the GAC expressed interest in continuing to pursue this issue as it is still a problem that needs to be resolved.

iii)Advocating for Intern Immunizing (2010.7 – Sunset Issue) – Current Florida laws only allow licensed pharmacists who have completed the Board approved training program to immunize patients. Registered pharmacy interns training under that supervision of licensed pharmacists currently are not able to do this. There has been resistance from the Medical community on allowing registered interns to immunize patients citing safety concerns. There has been no opportunity so far to advance this issue within the Florida legislature. Since this was a 2010 resolution with results published in the Speaker’s report at the 2013 convention the House has not given further direction to the GAC as the resolution has been sunset. This was provided to members of the GAC for their information. Members of the GAC expressed interest in continuing to pursue this issue as it is still a problem that needs to be resolved.

iv)Inspection of Pain Management Clinics by Florida Consultant Pharmacists (2011.2) – This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. It is related to providing pharmacist oversight over efforts by physicians who wish to dispense. Recent changes in Florida laws have restricted physician dispensing of controlled substances significantly.

v)Removing “On the Face Of Prescription” language in F.S. 893.04 (2011.3) – This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. Some pharmacies who have been going through some audits have found recoupment demands simply because the prescription records did not have all of the required information on the face of the prescription hard copy even though such information was available in the pharmacy’s electronic records. Auditors have been citing 893.04 and in some cases similar language found in F.S. 456 saying that all information must be on the face of the prescription. The association has been asked to revise the statutes necessary to minimize the recoupment due to simple recordkeeping issues.

vi)Encouraging the use of NPI number (2011.6) – This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. It is felt that if all pharmacists had NPI numbers then it would help to remove perceived barriers to payment for pharmacist services. The Association facilitated an NPI registration campaign during the annual meeting and convention.

vii)Limitation and Reversal of Physician Scope of Practice Expansion into Dispensing (2012-4 – Late File) – This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. Physician dispensing has increased particularly as noted in the workers compensation program. A bill was filed and signed by the Governor during the 2013 legislative session that placed a cap on physician reimbursement for dispensing to workers compensation patient. While the reimbursement is significantly higher than what is available through community pharmacies a ceiling has been created where there was none before.

viii)Pharmacists to be Recognized as Health Care Providers (2013-4 – Late File) - This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. Debate within our industry has suggested that pharmacists need to be recognized as health care providers. There is omitted language referencing pharmacists as health care providers in Medicare Part B. APhA has a comprehensive campaign to try to change that. Some states such as California are working to modify their practice acts to insure that pharmacists are listed as health care providers.

ix)FPA to Oppose Any Changes to Current Pharmacist-Pharmacy Technician Ratio (2013-6 – Late File) - This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. During the 2013 legislative session language was introduced to increase the number of technicians that a pharmacist can supervise. Currently a pharmacist can supervise 1 technician and can request up to 3 technicians. A pharmacist can also supervise several interns and an indeterminate number of pharmacy technician students in training. The FPA is working with FSHP has opposed this proposed change.

x)Centers for Medicare and Medicaid Services (CMS) to Clarify Definition of “Qualified Provider” in Medication Therapy Management (MTM) Rules (2013-8 – Late File) – This resolution was introduced in the FPA House of Delegates for the Association to take action on through the GAC. In rules from CMS there is a list of providers who may be designated as “Qualified Providers”. Pharmacists are left off of that list.

  1. Attendance at House and Senate Committee Meetings – Shannon Wedekind, Goar Alvarez – The 2014 Florida legislature will begin its session on March 4th and meet until May 2nd, 2014 unless extended. Committee members discussed having a representative in Tallahassee at least each week of the committee meeting which generally is during the first 6 weeks or so of the session. President Gubbins and GAC Chair Shannon Wedekind has committed to be available for ½ of the session though it is currently too early to confirm on the calendar which days. Speaker elect Bob Parrado has volunteered all days if needed. President elect Suzanne Kelley has committed to do whatever she can to be available. It is possible that members of the FPA Board of Directors may be available to assist. Members were reminded that the FPA has not budgeted for volunteers to travel to Tallahassee for committee hearings.
  1. Attendance at Board of Pharmacy Meetings – Shannon Wedekind, Terry Gubbins – Board of pharmacy meetings for 2014 has not been confirmed just yet. President Terry Gubbins, Shannon Wedekind and Bob Parrado have committed to attending the 2013 August and December meetings of the Board. Suzanne will see if she can attend the Board meeting scheduled for Panama City.
  1. Health Fair and Legislative Day – Terry Gubbins – There was a consensus of the group that the scheduled April 22nd day of the health fair and legislative day event would not work well for student participation. Members were advised that space could be a problem.

M/S/C to change the planned April 22nd date of the health fair to March 18th. March 11th could be considered an alternate date.

M/S/C to facilitate the health fair and legislative day visits on the same day (Tuesday). The education and training should take place on Monday afternoon.

NOTE: Suzanne Kelley will connect with Preston McDonald who will be coordinating the legislative day activities.

  1. New Business
  1. 2013 Legislative Report - Michael Jackson – Michael Jackson reviewed with Committee members the advocacy program during the 2013 legislative session. A copy of the 2013 legislative report was published on the Governmental Affairs Committee group calendar and also provided by email. There is also a link to a copy published in the membership portal of
  1. State Employee Prescription Benefit Plan Mail Order Requirements–For the past several years the Florida legislature has required its employees who are in the PPO program to get their maintenance prescriptions filled through the mail after the 3rd fill. This has excluded local community pharmacies from servicing state employees. This language can be removed but may require equal savings to replace this initiative.
  1. Key Board of Pharmacy Rule Revisions and other Activity – Michael Jackson – On Monday, August 12, 2013 the Board rules committee will be meeting to discuss several rule changes. The GAC was also made aware that the Board will be examining sterile compounding rule 64B16-27.797. There may be an interest in adopting all of USP 797 as the rule for Florida for sterile compounding. The committee was asked to make a recommendation to the FPA Board of Directors on where we need to be on this issue.

M/S/C that that FPA recommend support for adoption of some components of USP 797 as a rule as suggested by our compounding pharmacist members.

NOTE: It was acknowledged that GAC member Alexander Pytlarz is familiar with compounding issues and can help to guide the FPA.

  1. 2014 Legislative Advocacy Program, Priorities and Strategic Plan – Committee as a Whole – In this section of the agenda that various issues discussed during this meeting were tabulated into recommended action plan for the association to consider during the 2013-2014 legislative advocacy strategic plan. Those recommendations are prioritized as follows:

i)Advocate for standalone legislation

  1. Pharmacist to be recognized as health care providers. (Terry Gubbins on point)
  2. Remove “On the Face of Prescription” language found in 893.04 and also in F.S. 456 (Bob Parrado on point)
  3. Support efforts to advocate for funding of the prescription drug monitoring program. This includes collaborating with other groups. (Bob Parrado on point)
  4. Remove mandatory mail order prescription requirements for state employees. Collaborate with the Florida Retail Federation. (Gary Koesten on point)

ii)Advocate for if opportunity presented

  1. FPA to oppose any changes to current pharmacist to pharmacy technician ratio. Recommended for the FPA Board of Directors to invite interested principles on this issue for dialog during a Board of Directors meeting.
  2. FPA to support efforts to change to the pharmacy practice act that will allow registered pharmacy interns under the supervision of a licensed pharmacist to administer immunizations as part of their training program. FPA to recommend to all Florida pharmacy schools that the immunization training program be included in the basic curriculum. This can help advocacy efforts.
  3. FPA to support efforts for the removal of minor infractions and expunging of disciplinary records for minor violations. It is recommended that minor violations should be removed after 2 biennial renewal periods.
  4. FPA tosupport any efforts to expand pharmacist immunization services with a goal towards allowing all immunizations that follow CDC guidelines.This can help advocacy efforts so that FPA can support efforts to change the pharmacy practice act that will allow registered pharmacy interns under the supervision of a licensed pharmacist to administer immunizations as part of their training program.
  5. FPA to support efforts that revise auditing standards for all plans to be consistent with current Medicaid auditing standards

iii)Monitor

  1. FPA to monitor efforts that limit or expand physician scope of practice expansion into dispensing.
  2. FPA to monitor for any changes to pain clinic legislation.

M/S/C to adopt the above legislative strategic plan and recommend to the FPA Board of Directors for approval at the next meeting.

  1. Development of Position Papers and Talking Points for Items on the FPA Legislative Program, Priority and Strategic Plan – Terry Gubbins– The Governmental Affairs Committee recommends that position papers and or talking points on the above issues be drafted in advance and available for distribution to FPA advocates. Dialog should begin as soon as possible so that members of the House and Senate are aware of these issues. The goal is to have drafts ready by August 31st for review by the GAC.
  1. Other Business – There was no other business introduced at this meeting
  1. Adjourn – M/S/C to adjourn the meeting at 4:04pm.

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Shannon Wedekind, ChairMichael Jackson, Staff

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