AUG. 2010

PRSRT STDUS POSTAGEPAIDTALLAHASSEE, FLPERMIT NO. 801

2010-2011 FPA President Humberto Martinez

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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a U G U S T 2 0 1 0 | 3

Vol. 73 | No. 8aUGUST 2010 The 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

7 executive insight

20 buyer’s Guide

FeaturesPharmacists’ immunization activities in Florida, 2008-09

FPa membership benefits

12

18

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

E-mAil yoUr sUGGEstions/idEAs to

dave@fiorecommunications.com

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 Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic is-sues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congru-ent with its expressed mission.

of the Florida Pharmacy Today boardof directors The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capac-ity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Associa-tion members to secure appropriate advertising to assist the Journal in its goal of self-support.

AdvertisersHeAlTHcAre consulTAnTs ....................... 3KAHAn ◆ sHIr, P.l. .......................................... 9mcKesson ......................................................... 2PPsc ................................................................... 11rx relIeF ........................................................... 9

2010

FPA Calendar AUGUst

28 – 29 FPA Council, Committee and Board MeetingsMarriott Orlando Airport

sEptEmbEr

1 Deadline for Nomination for FPA President Elect, Regional Director and Treasurer Offices

6 Labor Day FPA Office Closed

11 – 12 FPA Clinical Consultant ConferencePGA National Resort, Palm Beach Gardens

octobEr

2 - 3 FPA Midyear Clinical ConferenceRenaissance Orlando Airport

12-13 Board of Pharmacy MeetingResidence Inn - Tallahassee

23 – 27 NCPA Annual MeetingPhiladelphia, Pennsylvania

novEmbEr

6 - 7 FPA Committee and Council and Board Meetings (By conference call)

10 - 12 ASCP Senior Care Pharmacy MeetingOrlando, Florida

11 Veterans Day FPA Office Closed

12 Florida Pharmacy Council MeetingOrlando, Florida

25 – 26 Thanksgiving Day Holiday FPA Office Closed

dEcEmbEr 2010

4 – 5 FPA Law and Regulatory ConferenceHyatt Regency SarasotaSarasota, Florida

5 – 9 ASHP Midyear Clinical MeetingAnaheim, California

14-15 Board of Pharmacy MeetingGainesville, Florida

24 - 27 Christmas Holiday

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

a U G U S T 2 0 1 0 | 5

Editor's Note: The following is a transcript of the presidential address at the 120th FPA Annual Meeting and Convention in Marco Island, Florida.

Good morning.Thank you all for being here this

early in the morning to see your offi-cers being installed.

This year promises to be another ex-citing year in MTM services, pharma-cist’s immunizations, and member re-cruitment. It is amazing that we are wide awake this early in the morn-ing after the partying that we did last night. A good number of us stayed late after dinner and we closed the dance floor. The pharmacy students were great with their energy and we tried to keep up as best we could.

We will continue to work with our strategic plan and the four key focus areas:

■ Membership services, recruitment and retention

■ Public policy, politics and advocacy ■ Transitioning role of the profession ■ Financial viability of the association ■ And also to continue to keep our vi-

sion of the FPA: “To be the premier organization

representing pharmacy stakeholders in their endeavors to provide quality healthcare.”

I have the pleasure to have in front of you the chairs of the FPA’s standing councils and committees.

For Public Affairs Council, the chair is Suzanne Kelly. Her council will be in charge of both state health fairs and under her direction the council will or-ganize, recruit and coordinate our ef-forts in this area.

For Organizational Affairs Coun-cil, the chair is Kim Murray. Her coun-cil will be working on the FPA’s by-laws and constitution changes. Under her direction, these changes will go for approval to the Board of Directors and

the House of Delegates and then on to the ballot for final approval from the members. This council will continue to oversee the FPA awards selection pro-cess and coordinate the process for the local unit’s awards.

For Educational Affairs Council, the chair is Jennifer Pytlarz. She will coor-dinate and work to continue to main-tain and produce the quality continu-ing education programs that the FPA is already well- recognized for.

For Professional Affairs Council, the chair is Eric Alvarez. This council has

been charged to develop, refine, and implement changes to our practice act. They will focus on making the phar-macist more centralized in the delivery of primary health care as well as ad-dress the House of Delegates directives that have been referred and work close-ly with the Board of Directors and the Legislative Committee for the imple-mentation of new practice standards.

For Legislative Affairs Committee, the chair is David Andrews. He will oversee the prioritization of our legis-lative agenda with the feedback from our membership. This committee will coordinate our grass- roots efforts with the state Legislature and keep in con-stant communication with our lobbyist and our membership during the legis-lative session. During legislative days at the Capitol, we had great participa-tion from our members and students. One company in particular, Walgreens, was very active at the Capitol. They

Exciting Year Will Focus on Four Key Areas of FPA Strategic Plan

The President’s ViewpointHUmbErto mArtinEZ, FpA prEsidEnt

This year promises to be another

exciting year in MTM services,

pharmacist’s immunizations,

and member recruitment.

Humberto martinez, 2010-2011 FpA president

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

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.

Karen Whalen ......................................................................... Chairman of the BoardHumberto Martinez .................................................................................FPA PresidentRobert Parrado ....................................................................................... President ElectDon Bergemann ....................................................................................................TreasurerWilliam Riffee ............................................Speaker of the House of DelegatesSuzanne Wise ...........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 7Joy Marcus, Director...........................................................................................Region 8Ayala Fishel, Director ..........................................................................................Region 9Alissa Fuller ............................................................................................... President FSHPMichael Jackson .......................................Executive Vice President and CEO

Florida pharmacy today Journal board

Chair................................................................. Betty Harris, beejpharm@gmail.comVice Chair ..........................................Jennifer Pytlarz, jlc_rxdoc@hotmail.comTreasurer ...................Stephen Grabowski, sgrabowski@seniormmc.comSecretary ..................................................................Stuart Ulrich, Stuarx@aol.comMember ............................................................ Don Bergemann, don@bceinfo.comMember ................................................Joseph Koptowsky, docjik1215@aol.comExecutive Editor ...............Michael Jackson, mjackson@pharmview.comManaging Editor ..................Dave Fiore, dave@fiorecommunications.com

2009/2010 FpA board of directors had all of their pharmacy supervisors from the state of Florida in Tallahassee and were actively participating in our health fair and legislative visits. I would like to thank Terry Gubbins for coordi-nating them with the FPA for successful health fair and legislative visits. And, I challenge the other pharmacy chains in the state to do the same with our efforts to keep our profession at the forefront of patient care.

In closing, I would just like to say that if my actions inspire others to Dream More, Learn More, Do More and Become More, then I will be satis-fied that I have done a good job as your president.

Thank you for having the confidence in electing me your president. I am here to serve.

Thank you again. ■

Your 2010-2011 FPA President,Humberto “ Bert” Martinez

JOIN TODAY!

Florida Pharmacy Association

a U G U S T 2 0 1 0 | 7

If you are confused by the new laws and rules related to pharma-cy technicians, you certainly are

not alone. New laws and subsequent rules published by the Florida Board of Pharmacy have created sweeping new standards and a regulatory identi-fication for Florida’s pharmacy techni-cians. We have published information on these changes in Stat News and also this journal as well as presented them at various Association continuing-edu-cation programs on several occasions. In some cases, our own members have struggled to grasp this new concept. Hopefully, in this article we can help you understand the new changes and what pharmacists and pharmacy tech-nician obligations are. Unfortunately, those who are not members of the Flor-ida Pharmacy Association will likely not receive this and will have to dis-cover what to do on their own.

To understand these changes, let us visit Senate Bill 1360 from the 2008 legislative session. That bill created the FPA-supported changes to Flor-ida Statutes 465 requiring pharma-cy technicians in this state to become registered. This issue goes even far-ther back to 1995 with the FPA House of Delegates meeting in Boca Raton. At this meeting, resolution 95-25 was placed into policy by the affiliated and invited pharmacy organizations in this state. It mandated that the Legislature should require pharmacy technicians to be certified. This issue was revisited in 2007 during the 117th Annual Meet-ing and Convention of the FPA in Mar-co Island where the members and del-egates advocated for the Association to seek legislative changes that call for the mandatory registration of pharmacy

technicians in Florida.Senate Bill 1360, as signed into law

by the governor of Florida, created the following new standards for anyone holding themselves out to be a phar-macy technician in this state:

■ Requires the Board of Pharmacy to adopt rules on registration

■ Requires registered technicians to be at least 17 years old

■ Requires 20 hours of continuing ed-ucation (4 hours live, 2 hours med errors and pharmacy law)

■ Registration must be available to the public as well as board inspec-tors

■ Pharmacy interns are exempt from registration as a technician

■ Technician students are exempt from registration as a technician

■ Pharmacists who have received dis-ciplinary action are not eligible to register as technician

Also included in this law was the following grandfather clause for indi-

viduals currently working as techni-cians:

By January 1, 2011, Registered Tech-nicians must have:

■ Completed a Board-approved train-ing program or

■ Have completed a certification pro-gram approved by the National Commission for Certifying Agen-cies (NCCA) or

■ Have worked a minimum of 1,500 hours under a licensed pharmacist

So what does all this mean and what are my obligations as a technician or supervising pharmacist? Let us try to answer this with some frequently asked questions.

registered pharmacy technician Frequently Asked Questions

Question: Why do I have to register as a pharmacy technician?

Executive Insightby micHAEl JAckson, rpH

Understanding Florida Technician Regulations

by micHAEl JAckson, FpA ExEcUtivE vicE prEsidEnt/cEo

michael Jackson, b.pharm

Hopefully, in this article we can help you understand the new changes and

what pharmacists and pharmacy technician

obligations are.

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

Executive Vice President/CEOMichael Jackson

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

Tian Merren-Owens, ext. 120Controller

Wanda Hall , ext. 211Membership CoordinatorRanada Simmons , ext. 110

Educational Services Office AssistantStacey Brooks , ext. 210

FloridA pHArmAcy todAy boArdChair..................................Betty Harris, Lighthouse Point Vice Chair ................................. Jennifer Pytlarz, BrandonTreasurer ..............................Stephen Grabowski, TampaSecretary ........................Stuart Ulrich, Boynton BeachMember ................Don Bergemann, don@bceinfo.comMember .................................... Joseph Koptowsky, MiamiExecutive Editor ........Michael Jackson, TallahasseeManaging Editor ........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2010, 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 STAFF Answer: Section 465.014, Florida Statutes (F.S.) was amended during the 2008 legislative session requiring all pharmacy technicians performing the duties as described in Rule 64B16-27.420, Florida Administrative Code (F.A.C.) to be registered to work in the state of Florida.

Question: What happens if my registration application was not approved on January 1, 2010, and I do not have a registration num-ber?

Answer: You should not be work-ing as a registered pharmacy techni-cian. Once your application has been approved and a registration number is-sued, you will be able to work as a reg-istered pharmacy technician in Florida.

Question: May I register online?Answer: Beginning October 1, 2009,

pharmacy technician registration may be completed using an online process by visiting http://www.flhealthsource.com. You will need a valid email ad-dress, valid mailing and physical ad-dress, and payment by credit, debit card or other payer code.

Question: Where can I get an application form?

Hard copy applications are available on the http://www.doh.state.fl.us/mqa/pharmacy website and may be mailed to Florida Board of Pharmacy, P.O.B 6320, Tallahassee, FL 32314-6320 along with appropriate fees and supporting documents.

Question: What is the initial fee for regis-tration?

Answer: A person who wishes to register as a pharmacy technician must submit a completed application and a $105 fee to the Board of Pharmacy. The fee is composed of the following:

■ Application processing fee of $50 ■ Initial registration fee of $50 ■ Unlicensed activity fee of $5.00 ■ Cashier checks or money orders are

to be made payable to the “Depart-ment of Health.” The application will be reviewed within 30 days.

Question: How can my employer pay for my registration?

Answer: Instead of the employ-ee providing their own credit card for payment when completing the online registration application, they will have the option to enter the ‘Other Payer Code’ to complete the application pro-cess. The application will be uploaded for processing and will stay in pend-ing status until the employer makes the payment. Interested employers will need to register with the Florida Board of Pharmacy as an Other Payer and re-ceive an Other Payer Code.

Question: Who is responsible if my employ-er fails to pay my registration?

Answer: The applicant is responsible for submitting the required fees.

Question: How do I know if the Board has approved a training program?

Answer: Approved training pro-grams may be identified by check-ing the Board of Pharmacy website at http://www.doh.state.fl.us/mqa/phar-macy or by visiting www.CEBroker.com.

Question: Am I required to take a state exam or national certification exam to regis-ter as a pharmacy technician?

Answer: No, a state or national cer-tification exam is not required to be a registered pharmacy technician through December 31, 2010. However, any person wishing to provide proof of their national certification before De-cember 31, 2010, will meet the educa-tional requirements for registration.

Question: Can I work in a pharmacy as a technician if I plan to take the national certi-fication exam in the future?

Answer: Applying to take the Phar-macy Technician Certification Board (PTCB) or Institute for the Certifica-tion of Pharmacy Technicians (ICPT) is not considered enrollment in a Board approved training program. You may not work as a pharmacy technician un-less you are registered or enrolled in a Board approved training program. If you want to work while waiting for the certification by an agency accredited by the National Commission for Certify-

a U G U S T 2 0 1 0 | 9

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The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask us to send you free written information about our qualifications and experience.

ing Agencies, you must be enrolled in a Board approved training program.

Question: How do I submit my previous work experience as a technician to apply for the

1500 hours work experience credit?Answer: The experience must be re-

corded on the Pharmacy Technician Work Experience Form. This form is available in the Pharmacy Technician application packet or in the online ap-plication if you are applying by this method. At the end of your online ap-plication process, after you input your payment method, you can download the form and return to the Board of Pharmacy.

Question: Is work experience as a technician in other states acceptable

Answer: Yes, as long as it is docu-mented on the Pharmacy Technician Work Experience Form.

This form is available on the website at www.doh.state.fl.us/mqa/pharmacy.

Question: What laws and rules govern reg-istered pharmacy technicians?

Answer: Florida registered pharma-cy technicians are governed by Sec-tion 465.014, Florida Statutes, and Rule 64B16-26.103, 64B16-26.350, 64B16-26.351, 64B16-27.410, 64B16-27.420, F.A.C. The FPA has available as a member benefit the laws and rules governing the prac-tice of pharmacy. To access this infor-mation, sign into www.pharmview.com with your username and password.

Question: Does a person newly hired to be a pharmacy technician have a “grace period”

before they need to be registered with the Board of Pharmacy?

Answer: No. However if the person is enrolled in an approved pharma-cy technician training program, that person can work as a pharmacy tech-nician without registering with the Board. Once the person has completed the training program, they must regis-ter with the Board in order to contin-ue practicing as a pharmacy technician. Pursuant to Rule 64B16-26.351(2), F.A.C.

student technicians must complete a board approved training course.

Question: If I am a registered intern, will I need to register as a pharmacy technician?

Answer: No, a registered intern may work as a pharmacy technician and is exempt from being registered with the Florida Board of Pharmacy only during their internship.

Question: I am a foreign-trained pharma-cist. Will I need to register as a technician?

Answer: Yes.

Question: Will any technician certificate program be approved for technician regis-tration in Florida?

Answer: Approved pharmacy tech-nician training programs include those approved by American Soci-ety of Health-System Pharmacists, Southern Association of Colleges and Schools, Florida Department of Educa-tion or Florida Commission for Inde-pendent Education, programs provided by a branch of the federal armed servic-

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

es that provide a certificate of comple-tion as well as Board approved employ-er based training programs. Members need to note that this rule is still under revision as you read this. Please refer to Rule 64B16-26.351(2), F.A.C.

Question: Can I work if I am not a regis-tered pharmacy technician in Florida?

Answer: No, pharmacy technicians must be registered before starting to work in Florida.

Question: Will a pharmacy technician-training program taken in another state be accepted in Florida for registration?

Answer: Yes, if you have taken a pharmacy technician training program approved by the Florida Board pursu-ant to Rule 64B16-351, F.A.C. You will be required to submit an application, fees and supporting documentation.

Question: Am I required to report a change of address when I move? If so, how do I do this?

Answer: Yes, you may update your address online at www.flhealthsource.com.

Question: Am I required to report change of employment location each time?

Answer: Yes, you are required to no-tify the Department within 10 days of a practice location change.

Question: What happens to my registration if I cease employment as a registered phar-macy technician?

Answer: The registration remains ac-tive until the registration expires or re-newed for the next biennial.

Question: What is required to maintain pharmacy technician registration?

Answer: A pharmacy technician must submit a $55 biennial renewal fee and complete 20 hours of pharma-cy continuing education appropriate for pharmacy technicians as required in

Rule 64B16-26.103, Florida Adminis-trative Code (F.A.C.).

Question: How will the Department notify me when my registration is about to expire?

Answer: Renewal cards will be sent to the last mailing address of record 90

days prior to the expiration.

Question: What are the requirements for continuing education?

Answer: Registered Pharmacy Tech-nicians are required to obtain a mini-mum of 20 contact hours of continuing education (CE) per biennial renewal pe-riod of which 4 hours must be via live presentation and 2 hours must be relat-ed to the prevention of medication er-rors and the law.

Question: Do I have to obtain credits from any particular providers?

Answer: Yes. In order to meet the CE requirements, courses must be ei-ther ACPE approved or approved by the Florida Board of Pharmacy. Any credits taken that do not meet these re-quirements cannot be used to satisfy CE hours.

Question: What crimes or licensure disci-pline must be reported on the application?

Answer: All convictions, guilty pleas, and nolo contendre pleas must be reported, except for minor traffic vi-olations not related to the use of drugs or alcohol. This includes misdemean-ors, felonies, “driving while intoxicat-ed (DWI)” and “driving under the influ-ence (DUI).”

Crimes must be reported even if they are a suspended imposition of sentence. All prior disciplinary action against any other professional licenses must be re-ported, whether it occurred in Florida or another state or territory.

Question: Can a person obtain registration as a pharmacy technician if they have a mis-demeanor or felony crime on their record?

Answer: Each application is evalu-ated on a case-by-case basis. The board considers the nature, severity, and date of offenses, as well as rehabilitation and other factors. The board cannot make a determination for approval or denial of licensure without evaluating the entire application and supporting documenta-tion.

Question: Do I have to report charges if I completed a period of probation and the charges were dismissed or closed?

Answer: Yes. Offenses must be re-

ported to the board even if you received a suspended imposition of sentence and the record is now considered closed.

Question: What type of documentation do I need to submit in support of my application if I have a prior criminal record or licensure discipline?

Answer: (1) Certified official court document(s) relative to your crimi-nal record, showing the date(s) and circumstance(s) surrounding your arrest(s)/conviction(s), section(s) of the law violated, and disposition of the case. This would normally consist of the Complaint or Indictment, the Judgment, Docket Sheet or other documents show-ing the disposition of your case. This may also be referred to as the Order of Probation. The clerk of court must certi-fy these documents.

(2) Certified copy of document(s) relative to any disciplinary action tak-en against any license. The documents must come from the agency that took the disciplinary action and must be certified by that agency. (3) A detailed description of the circumstances sur-rounding your criminal record or dis-ciplinary action and a thorough de-scription of the rehabilitative changes in your lifestyle since the time of the offense or disciplinary action, which would enable you to avoid future occur-rences. It would be helpful to include factors in your life, which you feel may have contributed to your crime or disci-plinary action, what you have learned about yourself since that time, and the changes you have made that support your rehabilitation.

Members need to be aware that this is an obligation for pharmacy techni-cians to fulfill. This is a new concept for these individuals who will most like-ly need your guidance and support. There is a perception that completing a technician “certification” program such as passing the Pharmacy Technician Certification Board (PTCB) examina-tion will satisfy Florida requirements. Remember that this is currently one of three options available to “grandfather” current pharmacy technicians into full registration status. These options are available only until the end of this year.

a U G U S T 2 0 1 0 | 11

Beginning January 1, 2011, the only way to become registered in Florida as a technician is to successfully complete one of the Board approved technician training programs as defined by rule.

It is recommended that you verify the registration status of your pharma-cy technicians. You can do so by vis-iting a link at the bottom of the www.pharmview.com homepage and doing a licensure search. Technicians who are fully registered should have an expira-tion date of December 31, 2012. Techni-cians who are conditionally registered will have an expiration date of Decem-ber 31, 2010, and will need to submit to the Board evidence of either having passed the PTCB exam, worked 1,500 hours under a licensed pharmacist or have completed a Board approved training program. To keep their regis-tration status they will need to do the required CE each biennium and “re-new” their registration just like each of us have to renew our pharmacist li-cense.

Finally, encourage your pharmacy technicians to become members of the Florida Pharmacy Association. They can join online for $30 or they can call our office at (850) 222-2400 and our staff will be very happy to assist them. With their new registration status they will need to be informed on pharmacy is-sues just as you are.

See you in Aventura in 2011. ■

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change in Journal printing scheduleDue to the importance and timeliness of the immunization study re-

leased this month, the Journal board decided to print this issue in addition to posting it online as scheduled. Next month's issue, which will feature the award-winners and festivities from the FPA Annual Convention in Marco Island, will be printed and posted as scheduled. This schedule change will result in the October, November and December issues of the Florida Phar-macy Journal to be posted online and not printed.

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

Pharmacists’ Immunization Activities in Florida, 2008-09Earlene Lipowski, RPh, PhDBingcao Wu, BSKaren Whalen, PharmD, BCPS, CDE

a U G U S T 2 0 1 0 | 13

AbstrAct

objective: To describe immunization practices

of Florida pharmacists during the 2008-09 flu season.

Participants: all certified pharmacist immunizers registered by the Florida Board of Pharmacy as of May 30, 2009 (N=1,467)

method: Survey.

main outcome measures: Self-reported training and vaccina-

tion activities of Florida pharmacists for the 2008-09 flu season, the type and characteristics of their practice settings, and the opportunities and challenges of providing immunizations in pharmacy settings.

results: Most certified pharmacist immuniz-

ers (86%) received immunization train-ing through their employer and the vast majority of those certified (89%) administered influenza vaccine dur-ing the 2008-09 flu season. Nearly all of the survey respondents worked in a community-chain pharmacy (74%) or a pharmacy located within a grocery store (21%). The pharmacists reported that customers frequently asked about

the availability of other vaccines, such as pneumococcal pneumonia vaccine, which pharmacists are not allowed to administer under current Florida law. Restricting vaccine administration to adults also limited immunizations re-quested by the public.

Pharmacists cited the availability of time, lack of staff support, and inade-quate third party reimbursement as the top 3 barriers to providing immuniza-tion services. However, 71% of pharma-cists in all practice settings predicted that they would administer more influ-enza vaccination next season. Pharma-cist managers and owners were even more likely to anticipate an increase in demand for pharmacist immunizations in the upcoming year.

conclusion: Florida law permitted certified phar-

macists to administer influenza vac-cine for the first time in 2008-09. Phar-macists working in chain and grocery settings availed themselves of employer sponsored training and became active immunizers. The pharmacists report-ed that customers frequently asked for other vaccinations which are beyond the scope of current law. Pharmacists cited lack of time, insufficient staff sup-port and inadequate reimbursement as the primary impediments to pharmacy-based immunizations but generally an-

ticipated increasing demand for these services.

tHE rEsEArcH

In 2008 the Centers for Disease Con-trol and Prevention (CDC) called for greater public awareness of immuniza-tion guidelines. One of the CDC’s aims was to increase the number of adults being immunized, and to reduce ra-cial and ethnic disparities in the dis-tribution of recommended vaccines for adults.1,2 Roughly two-thirds (63.6%) of Floridians aged 65 and older had a flu shot in the 2007-08 season according to the Behavioral Risk Factor Surveillance System (BRFSS).3 This level placed Flor-ida among states with the lowest level of compliance with CDC recommenda-tions. Vaccination rates are even lower among near elderly, minority, and low-income populations.

The goal set by Healthy People 2010 is to reach immunization rates of 90 percent or more among persons aged 65 and over.4 Immunization rates in the range of 90% create herd immu-nity. That is, if a sufficient proportion of individuals are immune, protection improves for the entire population. A high level of immunity lowers the prob-ability that a susceptible person will come into contact with an infected in-dividual. These goals stand to prevent seasonal illness, reduce absence from work and school as well as decrease hospitalization and mortality among those most likely to become seriously ill from influenza.

Benefits of having pharmacists pro-vide vaccinations have been document-ed. Using the community pharmacy for the delivery of seasonal influenza vac-cines is cost-effective.5 The practice has provided better access and increased vaccination rates in high risk popula-tions,6-8 with particular success among hard-to-reach populations.5,9,10 Patients express satisfaction with these services.

bioGrApHiEsEarlene Lipowski, PhD, Professor, Pharmaceutical Outcomes & Policy,

University of Florida.Bingcao Wu, BS, Graduate Student, Pharmaceutical Outcomes & Policy,

University of Florida.Karen Whalen, PharmD, BCPS, CDE, Clinical Associate Professor, Distance,

Continuing & Executive Education, University of Florida; and President, Florida Pharmacy Association

DECLARATION OF FUNDING INTERESTS: This study was self-funded. The authors have no conflicts of interest to declare.

Pharmacists’ Immunization Activities in Florida, 2008-09Earlene Lipowski, RPh, PhDBingcao Wu, BSKaren Whalen, PharmD, BCPS, CDE

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

In addition, expanding the pool of cer-tified immunizers contributes to emer-gency preparedness in the event of a natural or man-made disaster. Increas-ing both the number of providers and locations for immunizations is critical to mounting an adequate response in the event of a pandemic.

Legislation permitting certified pharmacists to administer influenza vaccinations to adults passed in Florida in 2007. The Florida Board of Pharmacy subsequently promulgated regulations and the first opportunity for pharma-cists to contribute in closing the gap be-tween actual and recommended vacci-nation rates was during the 2008-09 flu season.

The objective of this study was to describe the immunization activities of certified pharmacist immunizers in Florida during the 2008-09 flu season, taking note of any challenges pharma-cists experienced in providing immuni-zation services. Having a pharmacist’s perspective represents an opportuni-ty for additional improvements in ef-ficiency and quality of immunization programs and contributes to emergen-cy preparedness.

mEtHodsA list of pharmacist immunizers cer-

tified by the Florida Board of Pharma-cy was obtained from the Florida De-partment of Health. Pharmacists with a Florida mailing address were asked to participate in a survey. The invita-tion letter included an explanation of the project, the contact information for the principal investigator and a link to a web-based survey. A prepaid response card was enclosed giving potential re-spondents the opportunity to receive a mail survey or electronic invitation at an Internet address of their choos-ing. The Institutional Review Board at the University of Florida approved the study protocol.

The survey posed 17 questions about their training and the immunizations they personally administered during the 2008-09 flu season. Respondents who actively immunized during the 2008-09 flu season answered four ad-ditional questions about their experi-ence and difficulties, if any, in provid-

ing immunization services. Responses were anonymous but pharmacists were asked six questions about their practice and demographic in-formation.

Survey responses were collected in collaboration with the Florida Pharmacy Association (FPA) from Octo-ber 22, 2009 to January 6, 2010 using Survey MonkeyTM soft-ware. One reminder post-card was sent to respondents prior to ending the data col-lection period. Respons-es were summarized using descriptive statistics. We used ArcMapTM 9.3 soft-ware to map the geographic distribu-tion of certified immunizers and sur-vey respondents.

rEsUltsAs of May 30, 2009 there were 1,564

pharmacists registered as certified im-munizers with the Florida Department of Health. After excluding pharmacists with an out-of-state address, 1,467 phar-macists were invited to participate in the web-based survey. Seventy-three invitation letters were returned as un-deliverable. Thirty-four pharmacists re-quested and were sent a survey by post; 28 of these were returned. Altogether there were 156 responses available, a re-sponse rate of 11.2 percent.

The geographic distribution of the survey respondents is illustrated on the map in Figure 1 through color-cod-ing of the respondents’ counties of res-idence. The geographic distribution of Florida’s certified pharmacist immuniz-ers is marked on the map as well. The illustration shows survey respondents distributed among the population of certified immunizers, with the greatest number located between Jacksonville and Miami on the Atlantic coast, from Pensacola to Tampa Bay along the Gulf of Mexico and in the most densely pop-ulated areas of central Florida.

Almost all of the pharmacists who responded (95%) worked in commu-nity settings, primarily traditional chain (74%) and grocery pharmacies (21%). Survey responses came from staff pharmacists (55%), managers (39%)

and pharmacy owners (1.4%). The ma-jority (74%) received their first profes-sional degree more than 10 years ago, while the remaining 26% graduated af-ter 2000. Just over 40 percent of the re-spondents reported having a PharmD degree. Training required for the im-munization certificate was largely pro-vided by employers (86%), but only 11.5% reported that the training was re-quired as a condition of their employ-ment.

Ninety-nine percent of the survey re-spondents gave influenza vaccinations during the 2008-09 flu season. The typ-ical respondent administered up to 500 doses although others reported giv-ing more than 1000 vaccinations. Only 1.5% reported giving intranasal influen-za vaccinations and those were for rela-tively few patients, typically 10-20 per-sons.

Figure 2 shows that pharmacies used a variety of delivery models for their vaccination services. In nearly 87% of cases the vaccine was available on de-mand to customers who walked in and requested the injection. Almost half of the respondents reported that they of-fered appointments during routine business hours whereas about 40% re-stricted appointments to specific dates or times. Specific dates and times for mass clinic also were common events reported by two-thirds of the pharma-cists. Roughly 20 percent provided ser-vices at an off-site location including work sites, churches, health fairs, nurs-ing homes and assisted living facilities, fire and police stations, civic clubs, com-munity and neighborhood centers and schools.

a U G U S T 2 0 1 0 | 15

Pharmacists used a wide variety of methods to promote vaccination ser-vices but the most common strategies were in-house including signage in the pharmacy (95%), personal recom-mendations from pharmacists, techni-cians and clerks (81%), written remind-ers inserted in bags with merchandise (60%) and web-based advertisements (46%). Typical promotions were used to a lesser extent including advertise-ments in local newspapers (57%), on ra-dio and television (52%) and through direct mail (21%). More than a quarter of the pharmacists reported contacting

local organizations and senior citizen groups. Additional promotions that were mentioned included outdoor sig-nage, posting on local announcement boards, working in collaboration with physicians and placing announcements in medical offices and clinics. Word-of-mouth by individuals and groups also had noticeable impact. Less than 10% of respondents reported an affiliation with an immunization coalition.

Ninety-five percent of the pharma-cist immunizers received inquiries about the availability of vaccines in ad-dition to seasonal influenza, with over 40% reporting that they received those requests often. According to the phar-macists, customers most frequently re-quested pneumococcal pneumonia (69%), herpes zoster (55%), tetanus (14%), human papillomavirus (HPV) (14%), and hepatitis B (10%). Pharmacists are

only allowed to administer influenza vaccine under current Florida law.

All respondents were asked to iden-tify barriers that they perceived to pro-viding immunizations during 2008-09 flu season. Eighty-three percent of re-spondents cited the age restriction (to those 18 years and older) as the great-est regulatory limitation on the num-ber of immunizations that they pro-vided. The top practice impediments to immunization services identified by respondents included: insufficient time (67%); lack of staff support (49%); inade-quate third party reimbursement (31%);

and inconsistent availability of vaccine (21%). About two-thirds of respondents reported that there was no designat-ed vaccination area at their pharma-cy. However only 23% of respondents named lack of area/space at their prac-tice site as an impediment.

Three-quarters of the pharmacists worked at locations where there was more than one certified immunizer. Generally two pharmacists were avail-able to cover walk-in requests for vac-cine. Seventy percent of the pharma-cists reported that their immunization site was more than 5 miles from the nearest public health facility; 55% were 5 miles or more from the nearest retail clinic. On the other hand 97% of the pharmacies were located within 5 miles of the nearest physician office and 89% were within 5 miles of an urgent care center that could serve as alternative

vaccination site.Pharmacists estimated that approx-

imately 58% of reimbursement for im-munization services was from Medi-care, which they identified as the primary payer for influenza immuni-zations. Another 25% of the revenue for immunization services was estimat-ed to be from out-of-pocket payments by patients, with 12% and 5% from pri-vate third party coverage and Medic-aid respectively. The revenue sources for immunizations differed from the reimbursement sources reported for prescriptions dispensed at the same pharmacies. For prescriptions, the pharmacists estimated the reimburse-ment mix to be 40% private third par-ties, 32% Medicare, 16% Medicaid, and 13% out-of-pocket.

Despite any perceived obstacles or impediments to the practice, a large majority (71%) of the respondents ex-pect to offer a greater number of immu-nizations in 2009-10. Pharmacy owners, managers were more likely to predict increased activities in the future. These expectations did not differ by pharma-cy type or professional degree.

The overall response rate of 11.2% is a limitation of this study but we believe that the results are a reasonable rep-resentation of the uptake and overall characteristics of pharmacy-based im-munization practice in Florida in 2008-09. Of those who responded to the sur-vey, 99% provided immunizations in 2008-09 and their geographic distribu-tion is representative of the overall dis-tribution of Florida certified pharmacist immunizers. We offer the results of this initial survey as a baseline description of services under this extension of phar-macy practice.

discUssionStarting with the 2008-09 flu season,

certified pharmacists in Florida were allowed to administer influenza vacci-nation to adults under protocol with a supervising Florida-licensed physician or by written agreement with a coun-ty health department. This descriptive study is our attempt to examine the practice and the characteristics of phar-macists who initiated immunization services in Florida.

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

This study shows evidence of phar-macist and consumer uptake in immu-nization services at community phar-macies. Pharmacists relied on low-cost and local methods to inform the pub-lic by making use of a community net-work as well as in-house messaging in 2008-09. They reported a number of promotions in addition to those that were check-off options on the survey form. Offering a gift certificate option – or “flu-gram” – deserves mention as one of the more clever suggestions for pro-moting awareness and access.

A number of pharmacists offered immunization services at locations oth-er than the pharmacy. In addition to the organizations and firms named by the respondents, potential locations for collaborations include community col-leges, other health-related firms like physical therapy and fitness centers, or even day care providers and parents. There may be opportunities for individ-ual pharmacists to coordinate and col-laborate with other pharmacies in their area to maximize efficiency while in-creasing convenience for customers.

However, fewer than ten percent of our respondents reported affiliation with an immunization coalition. An immunization coalition is a group of health professionals and consumers, often locally organized, who work to-

gether to increase immunization rates. Coalitions attract members with a va-riety of talent and resources including health departments, hospitals, insurers, health maintenance organizations, pri-vate practices, nonprofit organizations, vaccine company representatives and individuals. The web site of Florida De-partment of Health lists coalitions and community partners that are active in

the state (http://www.immunizeflori-da.org/community/partners.htm) . The same site provides links to professional associations, service organizations and state and federal agencies with resourc-es for actively promoting vaccination.

We find little or no information in the professional literature about per-sons who choose to get their flu shot at a community pharmacy. For exam-ple, we do not know whether the avail-ability of this service attracts new cus-tomers to the pharmacy and the extent to which it improves customer satis-faction and loyalty among existing pa-trons. Valuable information may be generated by those pharmacies that re-cord each immunization in the pre-scription record system. By generating management reports about the popula-tion, pharmacists might determine the percentage of new patients who become steady customers, and whether those who take advantage of the service come from the group of persons who stand to benefit based upon their concurrent use of prescription medications for treating chronic illnesses.

Although 65% reported that there was no designated vaccination area in their primary practice site, only 23% designated the lack of space or desig-nated area at the practice site as a bar-rier to pharmacy-based immunization

services. A few respondents shared their reservations about consumer pri-vacy and concerns about safety due to not having a designated clean room for vaccination. These concerns should be addressed if immunization services ex-pand as anticipated.

Medicare currently is the primary payer for the pharmacist-based immu-nization services in Florida, while Med-

icaid only contributes a very small por-tion. Influenza vaccine is not covered under Florida Medicaid except for ben-eficiaries who reside in a long term care facility. Additional subpopulations des-ignated by CDC as candidates for an-nual immunizations include pregnant women and non-institutionalized el-derly.

Health insurance firms that cover the private sector are reportedly reviewing their administrative options and con-tractual obligations regarding coverage for vaccines. The trend is to shift vac-cines from the medical benefit compo-nent of the policy to the prescription drug rider, and to add registered nurs-es, retail clinics and pharmacists as pro-viders eligible for reimbursement for vaccine administration.11 As of Decem-ber 2009 Tri-Care covers three vaccines in the retail pharmacy setting: H1N1, seasonal influenza and pneumococcal vaccine where permitted by state law.12

Cost may not be a deciding factor in an adult’s decision to obtain the influ-enza vaccine and customers may elect to obtain seasonal flu vaccine as an out-of-pocket expense. According to a 2008 study, 50 percent of adults surveyed skipped getting vaccinated because they did not think they needed it. Only 12% chose not to get the shot because they said it cost too much.13 However, if immunizations increase in price and expand to other, more expensive prep-arations, insurance coverage will in-crease in importance.

Pharmacists clearly expect to expand immunization services in the future with 71% of our survey respondents predicting that they will administer more influenza vaccinations in 2009-10 flu season than they administered in the initial year. Beginning in 2010-11 the CDC recommends that every-one 6 months of age or older should be vaccinated against seasonal influenza. The recommendation alone should in-crease the demand for vaccinations at pharmacies as only individuals in high risk categories were advised to receive the seasonal influenza vaccine in 2008-09 when this survey was conducted. CDC is also promoting immunization beyond a few months in autumn. This practice makes particularly good sense

Medicare currently is the primary payer for the pharmacist-based immunization services in Florida, while Medicaid only contributes a very small portion.

a U G U S T 2 0 1 0 | 17

for curbing possible outbreaks of influ-enza in Florida which could coincide with the mid-winter arrival of snow-birds and tourists.

While expanding CDC recommen-dations and health reform may increase the numbers eligible for coverage of preventive services, the changes may place new emphasis on the medical home and coordination of care. It will be important for pharmacists to find ways to communicate vaccination sta-tus with members of the primary care team. Information technology, also an important feature of reform efforts, may be a reasonable means for recording and disseminating vaccination status.

We are planning to conduct follow-up studies to create a longitudinal re-cord of changes in the practice patterns and characteristics of pharmacist-based immunization services in Florida. Re-cent evidence from researchers at the RAND Corporation questions previ-ous findings which claim that alternate immunization sites serve an important sector of the population. According to a nation-wide survey conducted in spring of 2008, alternative vaccination locations including retail clinics and work sites serve younger, working in-dividuals in metropolitan areas, rather than minority, rural and lower income patients. The researchers speculate that while convenience may increase the number of persons being immunized, it may not be those who are most vulner-able to the morbidity associated with the influenza virus.14

Studies that evaluate the cost-effec-tiveness of pharmacist immunization practice and measure consumer satis-faction are of interest. Results that as-sess a change in vaccination rates in Florida and better health outcomes in-form any legislation that would expand pharmacist-based immunization servic-es. For any future research, it is neces-sary that we find ways of increasing the response rate so that these efforts gen-erate convincing evidence about the populations of interest.

conclUsionsThis web-based survey study marks

the baseline for pharmacist immuni-zation services by characterizing these

practices in Florida 2008-09. It docu-ments customer interest in receiving additional vaccines at pharmacies. Al-though pharmacists named regulato-ry and practice-related impediments to immunization services, the study con-firms that pharmacists fully expect im-munization services to expand in the future.

rEFErEncEs

1. Lu P, Bridges CB, Euler GL, Singleton JA. Influenza vaccination of recommended adult populations, U.S., 1989-2005. Vaccine 2008;26:1786-1793.

2. CDC. Influenza vaccination coverage among children and adults - United States, 2008-09 influenza season. MMWR Weekly. 2009; 58:1091-1095.

3. CDC. Behavioral Risk Factor Surveillance System Survey 2008. Accessed April 10, 2010 at http://www.cdc.gov/BRFS S/.

4. Healthy People 2010. Leading health indicators. Accessed on April 10, 2010 at http://www.healthypeople.gov/Document/html/uih/uih_4.htm#immuniz

5. Prosser LA, O’Brien MA, Molinari NM, Hohman KH, Nichol KL, Messonnier ML, Lieu TA. Non-traditional settings for influenza vaccination of adults. Costs and cost effectiveness. Pharmacoeconomics 2008; 26:163-178.

6. Steyer TE, Ragucci KR, Pearson WS, Mainous AG. The role of pharmacists in the delivery of influenza vaccinations. Vaccine 2004;22:1001-1006.

7. Kamal KM, Madhavan SS, Maine LL. Pharmacy and immunization services: pharmacists’ participation and impact. J Am Pharm Assoc 2003;43:470-482.

8. Vlahov D, Coady MH, Ompad DC, Galea S. Strategies for improving influenza immunization rates among hard-to-reach populations. J Urban Health 2007;84:615-631.

9. Kummer GL, Foushee LL. Description of the characteristics of pharmacist-based immunization services in North Carolina: results of a pharmacist survey. J Am Pharm Assoc 2008;48:744-751.

10. Klepser ME. Seasonal and pandemic influenza: preparing pharmacists for the frontline. J Am Pharm Assoc 2008;48:312-314.

11. Sipkoff M. Should pharmacists be allowed to vaccinate their patients? Manag Care 2008;17:13-14.

12. Office of the Secretary, Department of Defense. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)/ TRICARE: Inclusion of retail network pharmacies as authorized TRICARE Providers for the administration of TRICARE covered vaccines. Fed Register. 2009; 74(236): 65436-38. Interim final rule.

13. American Institute for Research. Flu shots save lives, so why do so many fail to protect themselves. AIR News 2008; 27:1,8.

14. Lee BY, Mehotra A, Burns RM, Harris KM. Alternative vaccination locations: who uses them and can they increase flu vaccination rates? Vaccine 2009;27:4252-4256.

The 2010 survey of immuniza-tion practices by Florida pharmacists was mailed early in August to rough-ly 2000 certified immunizers. If you received a survey and returned your response, thank you very much! If you received a survey and did not send your response, please take a few minutes and do so today. If you re-ceived and survey and it was mis-placed, contact Earlene Lipowski at 352-273-6268 or at lipowski@cop.ufl.edu and you’ll promptly receive a re-placement.

Florida pharmacists exerted a great deal of effort to achieve immu-nization status. With your help we plan to continue monitoring – and re-porting - the contribution of pharma-cists to public health goals and emer-gency preparedness in the state of Florida.

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

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