Unapproved minutes of the 3/11/2011 NYS Pharmacy Conference meeting
New York State Pharmacy Conference
March 11th. 2011: 10:30 AM – 2:30 PM
****PSSNY Board Room ****
210 Washington Avenue Extension
Albany, NY 12205
Minutes (Unapproved)
Attendees: Thomas Behanna, Joe Bova, Joe Brocavich, Craig Burridge, John Cocchiara, Selig Corman, Patty Donato, Delia Easton, Karen Falk, Deb Feinberg, Stuart Feldman, Karl Fiebelkorn, Anne Fellows, Vince Galletta, Gina Garrison, Luke Gilmore, Debra Hotaling, Christopher Jadoch, Elizabeth Lasky, Kim Leonard, Gerald Levy, Tom Lombardi, James Lytle, Nasir Mahmood, Harold Manley, John Marraffa, Larry Mokhiber, Anita Murray, Anne Myrka, LouAnn Obernesser, Rich O’Brocta, Diane Reed, Roxanne Richardson, Marcy Savage, Sarah Scarpace, Priya Sharma, Gary Stoehr, Janet Zachary-Elkind, Michael Zandri
1. Welcome and Introductions: Joe Brocavich, Chair.
2. Approval of Minutes/Sign In/Verification of Contact Information
-Motion – Garrison, Mahmood – approved unanimously
3. Reports by Colleges of Pharmacy
a. Albany College of Pharmacy and Health Sciences (Sarah Scarpace) – ACPE visit for 6-year accreditation on 3/1-3/3/2011; visit went very well. Final determination expected after June ACPE meeting.
b. D’Youville College of Pharmacy (Gary Stoehr) – awaiting ACPE site visit for end of march to get candidate status to allow admitted students to sit for board exam; 20 faculty and staff on board with more on the way; 2 will start in July; participate in a drug disposal day in April; Chris Jadoch will replace Gary at this meeting going forward
c. Long Island University- (Joe Bova) – 125 year anniversary with ceremonies starting in April; NCAA tournament win last week was first time since 1997
d. St. John Fisher-Wegmans (Rich O’Brocta) – hiring 6 new faculty; 4 pharmacy practice and 2 pharm science; proposal for a joint PharmD/MBA program
e. St. John’s University (Joe Brocavich) – received full approval from ACPE thru 2015-2016 in January; maintain 0-6 configuration; building new pharmacy research building to support PhD program in industrial pharmacy; 3 new faculty hired and 4 new positions for 2011; couple changes in administrative structure; new dean for budgeting; new dean for experiential education - both are full-time faculty with administrative responsibilities; 52nd annual pharmacy conference held recently with focus on healthcare reform and impact on pharmacy now and in the future; 3000 applications for fall 2011 class
f. Touro College (Stuart Feldman): graduating first class in June 2012
g. University at Buffalo (Karl D. Fiebelkorn) –125th year anniversary; more faculty; more programs with Medicaid in Buffalo and NYC; “mini-campus” in NYC office with 5 faculty there; MTM program in Bronx; last drug disposal/DEA medication take-back on 9/25/2010 DEA informed UB that Western NY was #1 in nation with 64,000 doses of controlled substances plus 2 tons of other drugs; partnering with D’Youville for next year; self-study right now for ACPE; new building is ahead of schedule and might move in next spring/summer; search committee for new assoc dean for academic affairs and outcomes; just trained p3 class in immunizationss; outreach programs with Erie County Dept of Health for MTM, senior services, and drug abuse program for middle school kids
4. 2011 Certified Immunizer Pharmacist Survey: Priya Sharma, Delia Easton
a. Report attached
b. Limitations to data: only 4 pharmacy chains reported (Rite Aid, Walgreens, Wegmans, Price Chopper); logistical issues with NYSIS; numbers reported during H1N1 vaccine shortage; pharmacists who participated in health clinics or pods did not report because assumed agencies were reporting when in reality agencies only reported that a dose was administered, not who administered it
c. 28/57 counties have responded back about why they are not signing the standing orders; 13 have cited fear of liability. Discussion that this should not be a concern because they sign the orders for nurses, including LPNs and most pharmacists have their own liability insurance; also, no complaints have been received by BOP
d. Recommendations: RPhs need to keep track of doses they administer; RPhs need to get a Health Commerce account and report; BOP may include information about Health Commerce in the information packet they send when the RPh registers as immunizer; consider adding NDC numbers for flu and pneumonia shots into the controlled substance fields so that can capture data from BNE since system already exists; RPh can consider sending copy of their liability insurance to county health commissioner to ask for standing order
5. CDTM (collaborative drug therapy management): Deb Feinberg/ Jim Lytle – current version of the bill is more limited than previously and will apply only to teaching hospitals and those facilities with which they affiliate (list of teaching hospitals is attached). Bill would apply to any RPh with at least 2 years of experience (therefore excludes PGY1 and PGY2 residents from participating). Bill has been reported from Assembly Higher Ed committee this week and now on floor of the Codes Committee; also has passed the Senate. Hope is to revisit and expand before the 3-year sunset expires. Most important provision is that there is nothing in the bill that limits the practice of pharmacy that existed before the bill existed such as MTM. Much discussion about the word “disease state” and whether this is singular or plural. Mr. Lytle assures “state” would be interpreted as plural. Public Health law allows hospitals to obtain a general consent from patients for care so separate individual consent of patient is not needed. CDTM CE is not defined and will be administratively laborious to enforce – onus will be on the hospitals to ensure that the RPhs who participate meet competencies. Will be difficult to show incremental benefits in teaching hospitals where many RPhs already engage in clinical care but reality is legislature more likely to look for harm. To be clear, BOP is supportive of CDTM
6. DOH Medicaid: Janet Zachary-Elkind –
a. Medicaid Redesign Team Proposal 11: Bundle Pharmacy into MMC (Medicaid Managed Care) – see pgs 11-12/237 of the pdf on http://www.health.state.ny.us/health_care/medicaid/redesign/docs/descriptions_of_recommendations.pdf
i. Effective 10/1/2011
ii. Concerns: cost-savings may end up being shifted to premiums or other costs of the plan; perceived conflict of interest between Mercer actuaries and a large PBM; theoretically patient could be told to change pharmacies; must have access standards but not clear that if a pharmacy meets the criteraia will automatically be allowed to stay in the network; mail order could be used and concern than these mail order companies are not in NYS therefore tax dollars being sent out of state; mailorder guidance is yet to be determined; uinkown what role OMIG will have
b. Medicaid Redesign Team Proposal 15 and attachments 15a – 15L: Consolidate all pharmacy fee-for-service proposals into a comprehensive reform package – see pgs 18-46/237 of the pdf on http://www.health.state.ny.us/health_care/medicaid/redesign/docs/descriptions_of_recommendations.pdf
i. Concerns: 90 days supply contributes to envivornmenal and economic waste; concern for potential with fraud when non-“Medicaid Only” diabetic supplies are dispensed; reimbursement only pays for product and cost to deliver it, not for education/counseling; cuts are so drastic that independents and other pharmacies going out of business
7. DOH Bureau of Narcotic Enforcement: Debra Hotaling/ Tom Behanna (confirmed) – website for DOH where the information about 80.67 and 80.69 (what RPh can/cannot add to an official prescription) is: http://www.nyhealth.gov/professionals/narcotic/. Chart is from 1999 and will be updated soon. Changes coming with needle and syringe regulations to change language and supporting documentation; in 8.1.31 will accomplish electronic rxs, transfer of refills, allow employees of prescriber to orally communicate; remove requirements for follow up for any oral order; allow electronic records of refills so no longer need to pull paper rx; allow oral transcription directly to electronic rather than paper; RPh with contract with longterm care facilities can commit to patient specific form; timeline unknown but is high on priority list even though discussed since august. Notifying practitioners of online patient lookup account if have health commerce account so they can view controlled substance record of patients; will allow pharmacists to have access to that system too; Right now this only applies to syringes not controls but that is coming eventually; Discussion on handling patients with own meds in hospitals deferred. Pediatrics who need rx’s from other countries with controlled substances so even though controlled rx, hospital pharmacy cannot redispense but neither BOP nor BNE will prosecute because can’t borrow it; BNE has discussed with DEA who is also ok; in regs, class 3 facility can only bring in controlled substances through distributor but compassionate use cases are allowed; BOP does not prohibit an inst from using patient’s own meds; DEA regs re central fills: prescription has to exist where dispensing it from because otherwise it is considered mail order for controlled substances
--Break for Lunch---
8. 2011 NYS Pharmacy Advocacy Day collaboration: Sarah Scarpace (please see Facebook page: http://tinyurl.com/NYLegDay); interest from ACPHS students to coordinate visits amongst the Schools so that students from different schools could be in the same visit. Facebook page established to help facilitate communication amongst the students. Email Craig Burridge to coordinate the buses.
9. IPRO: Anne Myrka on behalf of Darren Triller- CMS provided a statement of work; charged to reduce ADE’s in NYS and work as a quality improvement organization; focus is on managed care Medicare dual eligibles over 65; CE program at LaGuardia Marriot LIU School of Pharmacy – medical home and electronic health records on May 22nd; members of this Conference can contact Joe Bova for complementary registration
10. ESRD Prospective Payment and Medications: Harold Manley (DaVita/Village Health) – report attached. Starting 1/1/2011 all meds for dialysis will have to be provided by dialysis provider ie dispensed to the patient and moved from part d to part b payment. Concern that there will be a potential for medication errors because community pharmacists may not be aware that meds are being filled at a dialysis center. Another issue is moving these meds to Part B will impact the drug spend requirement for MTM services to be reimbursed. An opportunity exists for pharmacists: medical director on all the quality patient care plans has to assure that there are no drug interactions and that all meds have a continued use; huge issue is that the nephrologist is now responsible even for drugs which he did not write, so now actually a lot of opportunity in the dialysis centers to provide these services to patients
11. EPIC Update: Diane Reed – proposed 2011/2012 budget act for EPIC – will modify program to focus coverage to donut hole; effective Jan 2012 EPIC will only cover donut hole including the epic-excluded drugs; on July 1 EPIC patients are responsible for their part D copays; March 1 EPIC will require bin and id qualifier with other coverage code of 8 so if bill part d first want to know bin number want to be sure that part D first; Diane will follow-up regarding how people with subsidized plan rather than part D should be billed
12. CMS/ Medicaid: Medicare Part D program: John Cocchiara – memo that was attached to IPRO’s write-up is the second memo; first was January 13th ; this one gives operational guidance; requires no involvement on part of pharmacist so pharmacy does not have to bill a secondary payer; complaint form on www.medicare.gov site has 14-30 days to turn around; complaints will be handled by each individual sponsor; new Center of Innovation has been funded with $1-2 billion to provide new initiatives instead of asking Secretary for demonstration authority; Office of Consumer Info and Insurance Info has been absorbed into CMS as CCIO as a new center; acceptable training for pharmacist on fraud – up to each individual sponsor to provide fraud waste and abuse training to their providers; soon CMS will have their own education which would meet the FWA criteria in chapter 9 of the manual; no date for release so before that use the one from sponsors
13. DOH Division of Quality and Patient Safety: Jennifer Treacy, Deputy Director – no report
14. Counseling: Joe Bova – nothing new to report
15. NYS Board of Pharmacy: Larry Mokhiber – BOP Executive meeting is 3/22; public session is 3/23 at St John’s; 3/23 is the open meeting; NABP annual meeting May 21 - 24; NABP task force on DEA laws, rules and regs to make them contemporary; staffing still a problem; Frank Munoz is retiring; NY was a net exporter of pharmacists last year but this year 367 applied for reciprocity out and 462 applied into NY; assembly technician bill needs some technical amendments; citizenship bill in Assembly for all 13 professions; fed lawsuit which challenges constitutionality still in federal circuit court; bill to allow electronic prescribing and get rid of DAW box passed senate; Board of Regents would prefer a more expansive CDTM bill; proposal to have NPI on all prescriptions for diagnosis and diagnostic code and allow commingling of drugs may be published by May with July implementation; continue to get questions on bonus or inducement for professional service: gifts unrelated to pharmaceuticals are banned in all 48 professions; tightening up regs on electronic tracking and moral character; students can fill syringes for vaccine but not administer the shot; 1000 hours have to be in practice not research etc
16. Reports by Associations
a. NYSASCP: Vince Galletta – sent 2 letters today for short cycle dispensing and Medicaid and the other of nurse as agent which in nursing homes only in this period of time before electronic prescribing that an MD who is not on the premises could designate a specific nurse (must be an RN) for purpose of receiving from pharmacy a controlled substance from pharmacy for a patient who needs it because immediate need and assessed by nurse and med is not in the e-kit. Discussed with BNE, nursing assoc, and the nursing homes. Midstate meeting is June 2nd in Syracuse at Justin’s Grill
b. Chain Pharmacy Association of NY: Anne Fellows on behalf of Marcy Savage - lobby day on Tuesday – reimbursement and immunization sunset major points
c. NYSACCP: Jeff Huntress- no report
d. NYSCHP Debra Feinberg – major issue is CDTM
e. PSSNY Craig Burridge- Lobby Day April 12th; a lot of turmoil with reimbursement with no voice at the table; cuts are not limited to Medicaid – affects all state plans; fear this will have a significant impact on ability of pharmacies to operate and are impacting employment/job opportunities for graduates and practicing pharmacists alike. Please also give Craig updated list of who will represent your organization (see attached agenda from 2010 and provide update for 2011)