Governmental Affairs Committee Meeting

Friday, July 24, 2015

Sheraton Suites Orlando Airport
7550 Augusta National Drive
Orlando, Florida 32882

10:00am – 3:00pm

Minutes

  1. Call to Order – Chairman William Garst – The meeting was called to order by Chairman Garst at 10:00 am
  1. Invocation – FPA President Tim Rogers – The invocation was given by FPA President Tim Rogers
  1. Welcome and Introductions – Chairman William Garst – Chairman Garst welcomed committee members and allowed time for individual introductions.
  1. Roll Call – Michael Jackson – Prior to roll call EVP Michael Jackson gave a brief review of the purpose and makeup of the GAC. GAC members were also encouraged to review their online Pharmview.com profile and update where necessary.

Members Present: Lois Adams, William Garst, Michael Jackson, Mark Hobbs (representing the FPPC) (arrived at 2:17 pm), Preston McDonald, Jann Rigell, Tim Rogers, Joseph Scuro, Scott Tomerlin and representing Adams Street Advocates Robert Beck.

Staff Present: Michael Jackson

Members Unable to Attend: Jackie Donovan, Suzanne Kelley, Carol Motycka, DeAnn Mullins, Alexander Pytlarz

  1. Approval of the July 25, 2014 Meeting Minutes – A copy of the July 25, 2014 meeting minutes was provided to members of the Committee through the Pharmview.com calendar date for the meeting

M/S/C to approve the minutes as submitted

  1. Approval of July 24, 2015 Meeting Agenda – A copy of the meeting agenda was provided to members of the committee through the Pharmview.com meeting calendar date and also printed copies were available and distributed to Committee members.

M/S/C to accept the meeting agenda as presented.

  1. Review of Conflict of Interest, Antitrust and Ethics Policy – Tim Rogers – The FPA conflict of interest, antitrust and ethics policies were provided to members of the Committee through the Pharmview.com meeting calendar date. President Rogers asked Committee members to be familiar with the policies and complete the Ethics and Conflict of Interest forms and provide to the FPA office. Members were asked to disclose any conflicts related to the agenda items to be discussed at today’s meeting. No conflicts were disclosed.
  1. Old and Reoccurring Business
  1. Update on FPPC Fundraising and Candidate Support – Mark Hobbs– In the absence of FPPC Chair Mark Hobbs who will attend the meeting later in the agenda, EVP Michael Jackson reviewed the FPPC financials with the Committee including a contributions report and political campaigns supported. Also provided to the Committee members was a census of pharmacist stakeholders supporting the FPPC. While not required Committee members were asked to make a contribution. Adams Street Advocates will be providing a recommended spending plan for the FPPC Board to consider. No further action taken by the Committee.
  1. Resolutions assigned to Governmental Affairs Committee – Speaker Jackie Donovan – The items below represents the approved or referred House of Delegates resolutions assigned to the FPA GAC. There is a 3 year “sunset” policy in place where the status of resolutions where action items with policy changes is continued on the FPA’s advocacy plan. A report that includes the current status of each of the resolutions over the past 3 years was provided to the Committee.

i)Pharmacists to be Recognized as Health Care Providers (2013-4 – Late File) – Action on this issue may require some scope of practice revisions to the pharmacy practice act to take full advantage of federal provider status legislation if passed by Congress.

ii)FPA to Oppose Any Changes to Current Pharmacist-Pharmacy Technician Ratio (2013-6 – Late File) – While there are no proposed changes to Florida laws that we are aware of the Board has been looking at rule development on this issue. The FPA has been monitoring several rules which has not expanded the current ratio of 3:1 (for sterile compounding pharmacies), 4:1 (for other pharmacies) and 6:1 for pharmacies that do not dispense.

M/S/C to continue to monitor for efforts to increase the pharmacist to technician ratio.

iii)Centers for Medicare and Medicaid Services (CMS) to Clarify Definition of “Qualified Provider” in Medication Therapy Management (MTM) Rules (2013-8 – Late File) – This issue is being triggered by MTM services being performed by non pharmacists. This resolution is not an action item rather it positions the FPA to support policy where a “Qualified Provider” is defined. The FPA should act when opportunities are presented on this issue.

iv)Encourage Governor to propose legislature to utilize population density and distribution in Board candidate selection (2014-1) – Past Chair Preston McDonald is in the process of drafting a letter for presentation by the FPA to the Governor. While this is a policy statement adopted by the House of Delegates the GAC was advised that efforts to tinker with the ability of the governor to make appointments could bring about some advocacy issues.

v)Lobbying for Pharmacist Involvement in Shaping Medical Marijuana Laws (2014-11)–The FPA has been attending rule hearings on this issue and has made the Department aware that the use of the word “dispensing” is a defined term of art in the pharmacy practice act. The issue with pharmacist involvement in medical marijuana is that the substance while authorized on a limited basis in Florida is still a federal class I drug and not authorized for medical purpose. While the Federal government has indicated that there will be no effort to enforce the use of Medical marijuana our members should exercise caution as it could create problems with licenses. FPA will continue to monitor this issue in Florida.

vi)Continuing of Maintenance Medication Therapy (2015-7) – This issue is seeking opportunities for pharmacist to provide a 30 day supply of maintenance drugs when the prescriber cannot be contacted instead of the currently allowed 72 hour supply. A 30 day supply is allowed when the Governor declares an emergency. This is a scope of practice issue that will require a change in F.S. 465.

  1. GAC Membership and Leadership Attendance at House and Senate Committee Meetings – William Garst–The legislative session for 2016 is scheduled to start January 12, 2016. Interim committee meetings will begin in September of this year. A schedule of volunteers are needed to be available in Tallahassee during the scheduled committee weeks in case there is need for testimony on issues that may be placed on committee agendas. Committee member Joe Scuro volunteered to be available on Tuesday and Wednesday of every other week. Committee member Lois Adams and Jann Rigell also volunteered to be placed on a schedule.

M/S/C for Chairman William Garst to develop a schedule of availability of volunteers.

  1. Attendance at Board of Pharmacy Meetings – William Garst – Committee members were also asked to be available to attend Board of Pharmacy meetings that may be held in their areas. Members were advised that if they wish to appear and testify before the Board of Pharmacy that they need to make clear that they are testifying on behalf of themselves and not as representatives of the FPA. Only the Board of Directors designated person can speak on behalf of the FPA.
  1. Health Fair and Legislative Day – Tim Rogers – EVP Michael Jackson reviewed with the Committee the purpose of the Health Fair and its evolution. The Health Fair event is primarily a volunteer event with minimal support by staff and elected FPA leaders to stay clear of any perceived gifting provisions under legislator ethics standards. It was noted that the Health Fair event has a lot of student volunteers but needed additional pharmacist volunteers to monitor student activity. The Committee will continue planning for the Legislative Day event however the Health Fair planning will be a function of the Public Affairs Council.

M/S/C to recommend the Health Fair event take place on Tuesday, January 19 with the Legislative Day event for Wednesday, January 20, 2016

  1. New Business
  1. 2015 Legislative Report - Michael Jackson – EVP Michael Jackson provided a copy of the 2014-2015 annual report that also included the legislative summary. Members also were presented a brief PowerPoint presentation on the issues.
  1. Key Board of Pharmacy Rule Revisions and other Activity – Michael Jackson

i)Patient access to pain medications – Committee members were made aware of the Board’s hearings on patients being refused their pain medications. Problems identified include pharmacies not being able to get product ordered. Suggestions that are being considered included a review of F.S. 499 that requires prescription drug wholesalers to review pharmacies that order 5,000 dosage units, a requirement for physicians to review the PDMP database prior to prescribing and consideration for the availability of diagnosis codes.

M/S/C to support changes to F. S. 499.0121 related to wholesaler supply

M/S/C to support prescriber inquiring PDMP prior to issuing prescriptions
The Committee preferred to continue to evaluate any requirements on diagnosis codes and recommended monitoring this issue.

ii)Revisions to Pharmacist to Technician Ratio 64B16-27.410 – Committee members were informed of changes to this rule that took effect on July 6th. The rule does not increase the ratio above the designation mentioned in item 8. b), 2) above.

M/S/C to continue to oppose any increase in the pharmacist to technician ratio beyond the current rule.

iii)Revisions to Technician Delegable Tasks 64B16-27.420 – Some minor revisions to this rule also took effect which clarified which tasks can be delegated to a technician and which cannot. The changes took effect on July 6, 2015. No further action taken by the committee.

iv)Yellow fever vaccination training and qualifications – Committee members were provided information on this issue on the Department of Health web site. Pharmacists who are seeking to administer yellow fever vaccines may be required to complete a DOH questionnaire.

M/S/C for the FPA to create a yellow fever resource and support the FPA to provide any necessary training.

v)Intern qualification to administer vaccines – It was recommended that interns who become qualified to administer vaccines have a limit on how long they can hold that designation. Committee members were reminded that the intern registration does not expire even after graduation from pharmacy school.

  1. Provider Status Initiatives – Committee as a whole–Committee members were reminded that proposed policy changes being considered for pharmacist provider status may create the need to make minor changes in the pharmacy practice act to take advantage of the opportunities. EVP Michael Jackson provided the committee with draft language that was discussed between joint meetings of the FPA and FSHP leadership. The language involves some scope of practice changes that defines consultant pharmacists and PharmDs as being able to provide health and wellness services as well as expanding the ability to order laboratory studies beyond the limited environments in current laws.

M/S/C to have GAC member Joseph Scuro examine the language and make recommended changes and provide to the FPA office. FPA staff will then work with our general counsel and lobbyists on the final language.

  1. 3 Hour Vaccine Safety Training Program - F.S. 465.009 (6) – Committee members expressed concern over the current vaccine safety program that has not been revised over the years since implementation. This program by law is only allowed to be provided by a state wide association of physicians offering AMA PRA Category I CME. FPA cannot offer this CE training program.

M/S/C to recommend that this language in F.S. 465.009 be revised to allow ACPE providers to offer this program and that it should only have to be taken every other biennial renewal period.

  1. 2015 Legislative Advocacy Program, Priorities and Strategic Plan – Committee as a Whole – Committee members evaluated the issues discussed during this meeting and recommend the following to the FPA Board of Directors for their approval.

M/S/C to approve the suggested action items below

i)Advocate for standalone legislation and rulemaking

  1. FPA should advocate for changes to F.S. 499.0121 that would help to provide relief to pharmacies that are struggling with getting adequate supplies of pain medications to treat their patients.
  1. Intern registry should have a designated expiration date
  1. The 3 hour vaccine safety requirements in F.S. 465.009 should allow ACPE providers to deliver this program.
  1. Continue with efforts to support the national provider status initiatives
  1. Advocate for changes in Florida laws to allow pharmacists to dispense a 30 day supply of maintenance medications as current allowed for a 3 day supply when the prescriber cannot be contacted.

ii)Advocate for if opportunity presented

  1. Consider recommended changes to the pharmacy practice act as identified in the draft revisions to F.S. 465.0125 to help pharmacists with patient health and wellness issues and advocate for if an opportunity is presented.

iii)Monitor

  1. Continue to monitor for the development of Florida’s medical marijuana initiatives
  1. Development of Position Papers and Talking Points for Items on the FPA Legislative Program, Priority and Strategic Plan – Tim Rogers– President Tim Rogers has been designated the task of working with Adams Street Advocates on the development of talking points on the various issues that we will be working on for the 2015-2016 year.
  1. Other Business
  1. MAC Pricing Issue – EVP Michael Jackson FPPC chair Mark Hobbs informed the committee that there continues to be issues with MAC pricing even with the current laws in place. FPA staff is working with our General Counsel on a letter to the Florida Board of Pharmacy since the law defines PBMs in the pharmacy practice act and also includes the requirement for the MAC list to be updated every 7 days. There is also continued interest in PBM transparency and accountability.
  1. Adjourn – M/S/C to adjourn the meeting at 3:16 pm

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William Garst, ChairMichael Jackson, Staff