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"To Preserve, Protect and Promote

the Interests of Pharmacy Owners."

February 2019
In This Issue
Save the Dates

PDS Conference
Orlando, FL
February 21-23, 2019

AAP Annual Conference
San Antonio, TX
April 11-13, 2019
Welcome New
PFOA Members
Mountain Key Pharmacy
Florissant, CO
Meiji Pharmacy
Gardena, CA
Market Street Pharmacy
Wilmington, NC
Border Village Pharmacy
San Ysidro, CA
My Best Pharmacy
Boynton Beach, FL
Accardi Clinical Pharmacy
Orange City, FL
Saegertown Pharmacy
Saegertown, PA
Ivylea Pharmacy
Kenmore, NY
 February is American Heart Month
Each February the National Heart, Lung, and Blood Institute (NHLBI) raises awareness about heart health through American Heart Month. This year, as part of the campaign to urge Americans to lower their risk for developing heart diseases NHLBI is launching #OurHearts , a national initiative to encourage and motivate everyone to adopt heart healthy behaviors, together. 
With a different theme for every week of the month, NHLBI is making it easier than ever to promote American Heart Month at your pharmacy. Their toolkit includes information on heart diseases, the important of social support for reaching heart health goals, and educational materials and social media resources (including sample posts in English and Spanish) you can use to build awareness in your community and connect with your patients in store and online.
From National Heart, Lung, and Blood Institute Published in Elevate Provider Network Newsletter
 Collins Reintroduces PBM Legislation

Longtime community pharmacy champion Rep. Doug Collins (R-Ga.) has reintroduced two bipartisan bills that address NCPA priority issues. The
Prescription Drug Price Transparency Act (H.R. 1035) would require PBMs to update their maximum allowable cost lists at least every seven days and disclose their sources on information in determining MAC prices. The
Phair Pricing Act (H.R. 1034) would require all pharmacy price concessions in Medicare Part D - excluding positive contingent amounts - to be applied at point of sale. The bill also requires all Part D sponsors to utilize CMS-established quality measures that are standardized and pharmacy-specific. The bills were not yet posted at press time.
Published By NCPA
 Is Your Pharmacy 
Set to Thrive?
Pharmacy owners, ask yourself these questions:
1. Are you relying too much on dispensing to carry your pharmacy business?
2. Is your front-end design current, or do you need a refresh?
3. Are you marketing well (including services like in-person delivery or adherence packaging)?
4. Are you focused on scripts-per-day or on patient health outcomes?
5. Do you know your numbers or is every month-end a surprise?
6. Does your team know - and share - your values?
7. Do you know where to turn when you need ideas and support?
If any of your answers make you pause, take a look at '7 Strategies for Invigorating Your Pharmacy Business,' from our America's Pharmacist® archives. You'll find plenty of helpful tips to help your business not merely survive but thrive. (And while you're there, take a look at the wealth of useful info in past issues of NCPA's flagship publication.) Your NCPA login is required.
Published by NCPA 
 How a GER Works
During the year, generic claims are still paid at MAC price (or sometimes through other calculations). At the end of the year, the actual results paid to all network pharmacies for all generic claims are aggregated and compared to the aggregate Average Wholesale Price (AWP) as published by Medi-Span. The resulting ratio is then compared to the contracted GER. If the network has been paid more than the contracted GER, the network members will owe money back to the PBM. If the amount is less, than network members will be due additional reimbursement. The calculations will be similar for the BER (brand products) and DFER (dispense fees) contracted rates. This means that pharmacies can expect year-end adjustments in the form of a recoupment or additional reimbursement as part of an annual true-up process.
By Peter J. Kounelis, R.Ph., MBA, Vice President, Elevate Provider Network  
PFOA logo
Board of Directors
Todd Pendergraft

Vice President:
 Doug Coyle
    Larry McIntosh

Phil Rigsby

  Board Members: 

Gabriel Guijarro

 Eric Pusey

  Ron Robichaux

Ty Stout
John Zuzack

Non-Voting Board Members:

Dirk Andrepont

Gaye Moseman

Board of Directors
Dirk Andrepont
John Zuzack
David Cole

Phil Rigsby
Board of Directors

Eric Pusey
Vice President:
Devin Trone
Bobbie Barbrey

PFOA Staff
Contact Information 
David Mayper
Executive Director
Nancy Coibion
Administrative Assistant
Mailing Address
  10944-B Gravois Industrial Court 
  St. Louis, MO 63128
Wesley Behar
West Region Sales

Karen Godbold
Executive Administrator

Shelly Gritz
Administrative Assistant
954-340-5944 x138

Ronda Hubbard  
Generics Specialist/Sales
Fax: 270-632-4206

Patrick Kittoe
Southeast Sales
Al Schuster
Northeast Sales
Bob Sutton
Vendor Programs/Mid-West Sales
Nancy Tataronis
Vendor Relations/Marketing
  Jamie Wilbanks
Inside Sales/Service
Toll Free: 888-406-7467

Get Linked In!  

Pharmacy Franchisees and Owners Assn
(FPN) Federation of Pharmacy Networks
       (NCPDP) National Council for Prescription Drug Programs  
        (NCPA)  National Community Pharmacists Association 

(NABP) National Association of
Boards of Pharmacy

(NASPA) National Alliance of State Pharmacy Associations

  Pharmacist E-Link   

Dave Mayper
We had a successful face to face PFOA staff meeting at the end of January where we covered a wide range of topics in terms of education, procedural improvements and discussion on direction of the organization.  Our newest employees, Patrick Kittoe and Shelly Gritz, have been performing well.
Al Schuster and Wes Behar have been handling the sales management duties, working well with the staff and together. 
We will be attending the PDS annual meeting and hosting a PFOA member dinner. This dinner invitation is open to any PFOA members attending the PDS conference as well as any member located within driving distance to the Orlando restaurant.  I am happy to announce that Anda has agreed to sponsor the dinner. March brings our board meeting in South Florida as well as our participation in the Federation of Pharmacy Networks meeting in San Diego.  We get a number of our program offerings with this group.  We use the meeting for networking, staying on top of industry topics and vendor relationships. 
We have been working with API, arranging for them to send rebates directly to our members beginning with the January API rebate due mid-March.  This will speed the process of getting the money into members' hands quicker as well as reduce costs of doing such.  API pays out a portion of rebate off their invoice. Our changes in the American Pharmacies program allowing dual membership in both groups also has a mid-month pre-bate on its ABC rebates.  IPC has a similar program with its McKesson program.
The beginning of the each year never fails to bring challenge and opportunity to independent pharmacy.  This year appears to be no different in terms of reimbursement and program changes from our PBMs.  It has been a challenge to members' access to patients, cash flow and the way they do business.  It will be PFOA's responsibility to adjust and help members.  Aligning with organizations that improve cash flow methodology is a start but we need to dig in and help the membership more.  We should all look forward to the challenge.  I participated in a recent CE from McKesson focusing on developing collaborative agreements which shows promise.  The PDS group should bring additional areas for consideration.  Data mining offers promise.  There are many more products and ideas that our members will be able to adopt and adapt to. 
As always, I thank you for the opportunity to serve as your executive director.    

Yours Truly,
David Mayper
APhA Revises Guidelines on Pharmacy-Based Immunizations

In line with the increased role of pharmacists in providing immunizations, The American Pharmacists Association announced that it has revised its Guidelines for Pharmacy-based Immunization Advocacy and Administration. The new guidelines encompass prevention, partnership, quality, documentation, and empowerment.
Originally approved in 1997, the APhA board of trustees had reviewed, updated, and approved these guidelines in 2012, and on Jan. 26, after receiving input from the APhA Academy of Pharmacy Practice and Management's Immunizing Pharmacists Special Interest Group and following a public comment period.
The revised guidelines encourage pharmacists to protect their patients' health by being vaccine advocates; to collaborate, coordinate and communicate with immunization stakeholders to protect the community from vaccine-preventable diseases and to ensure quality by achieving and maintaining competence to administer immunizations.
The guidelines state that pharmacists should document immunizations fully, report clinically significant events using the Vaccine Adverse Event Reporting System, educate patients about immunizations and respect patients' rights as well as their beliefs.
By Sandra Levy Published in Drug Store News (edited)
House Bill Looks to Curb DXM Abuse
Two members of Congress introduced legislation aimed at reducing cough medicine abuse among teens. Reps. Doris Matsui, D-Calif., and Bill Johnson, R-Ohio, are co-sponsoring the DXM Abuse Prevention Act of 2019. It would set a national requirement that a consumer be 18 years old to buy OTC medicines with cough suppressant dextromethorphan.
"This bill is a commonsense step to ensuring that children are unable to easily access DXM - helping to keep them safe while ensuring that cough medicine is still available over the counter," Matsui said. "Congress should not wait any longer to take up this bipartisan bill that will prevent more children from abusing this drug."
The bill comes as teen misuse of DXM is on the decline - the 2018 National Institute on Drug Abuse's "Monitoring the Future" study found that roughly 1-in-30 teens reported abusing it to get high. In 2006, the self-reported number was twice that. Scott Melville, president and CEO of the Consumer Healthcare Products Association, said state-level age restriction laws in 17 states have played a role in reducing the number of teens abusing DXM.
CHPA said that in addition to supporting legislation on age restriction, the organization works to prevent DXM abuse through its "Stop Medicine Abuse" campaign, which is undertaken in partnership with the Community Anti-Drug Coalitions of America. The organization also works with the Partnership for Drug-Free Kids on its "What is DXM" campaign.

By David Salazar Published in Drug Store News (edited)
Being the 'Go-To' Pharmacy for Diabetes Care
Pharmacists have never been in a better position to take on the role of chronic disease managers than in the current landscape with the management of people with diabetes. Too many people with diabetes and not enough healthcare professionals to go around has resulted in less than half of diabetes patients achieving good glycemic control and the desired A1C goal of 7%.
Where there is a need there is opportunity. Community pharmacists are in an ideal position to fill the need that patients have in self-managing their disease by becoming the "go-to" pharmacy for diabetes care in their community - the one that can answer all questions about diabetes care or make every attempt to find an answer. The "go-to" pharmacy also carries a higher level of diabetes supplies and has a staff that supports the pharmacist in caring for the diabetes patient.
What changes are needed for this to occur?
One important change is to utilize staff members to the top of their license and abilities, which means delegating repetitive jobs. It also means getting the entire staff to buy into the idea that the pharmacy is going to become the "go-to" pharmacy for all things diabetes.
It also could mean appointing a "chief diabetes technician" to handle such tasks as demonstrating and troubleshooting blood glucose meters, leaving the pharmacist time to discuss the results of a blood glucose value with the patient, or addressing other diabetes-management questions.
Another change is to gain the confidence and skills to effectively counsel patients through motivational interviewing, using such core concepts as open-ended questions, empathy and reflective listening. This approach allows the pharmacist to convey the appropriate information to the patient while resolving ambivalence, resulting in better outcomes from behavior change. Pharmacists also need to move from being retail pharmacists to clinical community pharmacists, from dispensing products to dispensing care.
The rewards for becoming the diabetes expert and "go-to" diabetes center in your community? Inheriting what we in our pharmacy term the "$10,000 patient." If someone with diabetes walks out of our pharmacy because we didn't win them over with our service and knowledge, we didn't lose the profit on a couple of prescriptions. We lost $10,000 - the amount we estimate a diabetes patient and his or her family would spend with us on prescriptions, OTC items, vaccinations, education, diabetes shoes and supplies over the next three to four years.
Few, if any, chronic disease patients will spend as much money in your pharmacy as a person with diabetes. An engaged and informed staff can help recognize these customers, and help increase their loyalty through special services offered, engaging them at every opportunity and being knowledgeable about the special products that people with diabetes require.
The successful "go-to" diabetes pharmacy will become as creative in working with its diabetes patients as the airlines are in dealing with their best customers. The end result is a pharmacy that is recognized throughout the professional, as well as the lay community, as a resource for all areas of diabetes care.
The need for diabetes care is great. The opportunity to become the profession that fills the gap of needed care is sitting in front of us. I hope you set as your goal for the coming year to join me in becoming the "go-to" center for diabetes care in your community. I think you'll find the efforts and overall rewards, both financially and professionally, well worth it.
By Jerry Meese Published in Drug Store News
Pass-Through Deduction Final Rule:
Pharmacy Owners Fact Sheet

NCPA has continued to advocate for the pass-through provisions of the TCJA apply to community pharmacy owners to provide the needed tax relief.. Under new IRS regulations, the IRS clarified that a pharmacy owner can qualify for the pass-through deduction if the pharmacy only sells pharmaceutical product or medical devices or gross receipts are less than $25 million and 10% or less of those gross receipts are attributable to the performance of medical services.1 
What just happened?  The Tax Cuts and Jobs Act ("TCJA")2 became law on December 22, 2017.  Section 199A of the TCJA provides individuals with a deduction of up to 20 percent of their qualified business income (also known as the "passthrough" deduction).3 A small business may qualify for the pass-through deduction so long as they are not considered a "specified service trade or business" ( "SSTB") or unless an exception applies. In January of 2019, the IRS published a final rule that outlines the when and how certain small businesses qualify for the pass-through deduction. 
What does the final rule do? The final rule classifies pharmacies as SSTBs, a class of businesses that are not eligible for the pass-through deduction.4 However, the final rule outlines two applicable instances that would allow a pharmacy to be eligible for the pass-through deduction. First, the IRS correctly states that a pharmacist is not an SSTB if a pharmacy merely sells pharmaceutical product or medical devices.5 A pharmacy who conducts any level of medical services such as immunizations,6 however, will be considered an SSTB that is not eligible for the passthrough deduction unless another exception applies. The final rule outlines a second exception that allows a pharmacy who is considered an SSTB to take the pass-through deduction so long as the pharmacy's gross receipts are less than $25 million and 10% or less of those gross receipts are attributable to the performance of medical services.7
What should pharmacy owners do next? Pharmacy owners should talk to their accountant or tax counsel on the applicability of this pass-through deduction to your business based on the types of services and product dispensing conducted at your pharmacy
FDA Creates Model Drug Facts Label 
to Support Development of 
Over-the-Counter Naloxone
To encourage pharmaceutical companies to enter the over-the-counter (OTC) market and increase access to naloxone, Food and Drug Administration (FDA) has developed two model drug facts labels: one for use with a nasal spray and one for use with an auto-injector. The labels include easy-to-understand pictograms on how to use the drug. The agency also conducted comprehension testing to ensure the instructions were simple to follow, according to a statement posted to the FDA website from Commissioner Scott Gottlieb, MD.
This is the first time FDA has proactively developed and tested a drug facts label for a drug to support development of an OTC product. "We proactively designed, tested, and validated the key labeling requirements necessary to approve an OTC version of naloxone and make it available to patients," Gottlieb said in the statement. "In short, we've crafted model labeling that sponsors can use to obtain approval for OTC naloxone and increase its access."
A full summary of the development, testing, and review of these labels is available on the FDA website.
From NABP e-News
Help Raise Patients' Awareness About Potential Harmful Interactions of Mixing Medications with Alcohol
Drinking alcohol while taking some prescription medications is a health risk for many baby boomers (ages 51-69) and older adults, indicates the National Council on Patient Information and Education's NeedyMeds blog. While celebrating the new year, patients should be aware about the potential harmful interactions and side effects of mixing prescription and over-the-counter medications with alcohol. The NeedyMeds blog encourages pharmacists to initiate dialogue with patients to help raise awareness. Specifically, the blog post offers several tips for starting a discussion with patients, including the following:
Review the National Institute on Alcohol Abuse and Alcoholism's recommended drinking guidelines with patients.
Remind older adult patients about the potential for increased sensitivity to medication and decreased tolerance for alcohol.
Explain that medication can linger in the body for hours and that alcohol can still interact with prescriptions long after taking them.
Discuss the importance of reading and understanding medication label instructions and warnings.

If questions arise about medications and alcohol use, NeedyMeds encourages patients to consider their local pharmacist or physician as a valuable source of information.
From nabp e news
FDA Commissioner Announces New Efforts to Increase Oversight and Strengthen Regulation of Dietary Supplements
Noting that three in four Americans now take at least one dietary supplement on a regular basis, and that the dietary supplement industry has expanded to include as many as 80,000 different products for consumers, FDA Commissioner Scott Gottlieb, MD, has announced new plans to increase the agency's oversight of dietary supplements. These initiatives include communicating to the public as soon as possible when there is a concern about a dietary supplement on the market, ensuring that the regulatory framework is flexible enough to adequately evaluate product safety, and continuing to work closely with industry partners. FDA is also developing new enforcement strategies to respond to entities that violate standards established under the Dietary Supplement Health and Education Act of 1994. 
On February 11, 2019, FDA sent 12 warning letters and five online advisory letters to foreign and domestic companies that are illegally selling more than 58 products. The products are being illegally marketed as unapproved new drugs, which make unproven claims about preventing, treating, or curing Alzheimer's disease, as well as a number of other serious diseases and health conditions, such as diabetes and cancer. In his statement, Gottlieb noted that most stakeholders in the industry act responsibly, but expressed concern over the ability of bad actors to exploit the system by providing potentially dangerous products and making unproven or misleading claims about the health benefits supplements may offer.
FDA is planning a public meeting on this topic in the spring, and will release additional information about these efforts in the coming months.  
From NABP e-News
New Advances in Pharmacy Practice, 
New Regulatory Challenges
Pharmacogenomics, once a hypothetical, someday in-the-future ideal, promising optimal medication usage and improved treatment outcomes, is increasingly becoming a reality - with the notable involvement of pharmacists. Often abbreviated PGx, this marriage of pharmacology and genomics gives pharmacists and other health care practitioners patient-specific information about how a person's genes will affect the way he or she responds to a particular medication. 
FDA currently includes PGx information on the labeling of more than 200 therapeutic products, encompassing medications used in diverse medical areas, from oncology (the most common) and psychiatry to infectious disease and cardiology, to name a few. While PGx by itself does not explain all variability in patients' response to medications, it nonetheless provides important data that can inform clinical decision making and has the potential to improve medication-related outcomes in a number of ways, including better selection of appropriate therapies, reduction in adverse drug events, improved medication adherence, and decreased treatment costs. As pharmacology experts and trusted, easily accessible health care professionals, pharmacists in numerous practice settings are well placed to assist patients and other health care providers in accessing and navigating the continually evolving PGx field. Nonetheless, barriers still exist that impede the easy spread of pharmacist-provided PGx care services, even as a recent regulatory change allowing the sale of direct-to-consumer PGx tests has raised new questions about how consumers will choose to use the resulting data, and where and how they might turn for professional assistance.
Read the full article in the February 2019 issue of Innovations (pdf; pages 6-7, and 12), available on the NABP website. 
NCPA: Nearly 3500 Pharmacists Voice Support for DIR Proposal 
The National Community Pharmacists Association's year-long effort to build support for a proposal to move pharmacy price concessions to point of sale has culminated in a milestone.
Nearly 3,500 pharmacists and 170 patients have formally voiced their support for parts of a proposed Centers for Medicare and Medicaid Services' drug pricing rule that would eliminate the retroactive nature of pharmacy direct and indirect remuneration, or DIR, fees.
The proposed changes also received support from more than 150 pharmacy stakeholder organizations representing diverse interests, which unified their voices and submitted a joint letter of support to CMS. Additionally, more than two dozen patient advocacy organizations supported the proposed rule on the premise that, if finalized, the pharmacy DIR fixes will save the average patient nearly $200 per year or more, in some cases on their out-of-pocket prescription drug costs.
Several letters supporting the proposed DIR fixes also are being sent by members of Congress.

By Sandra Levy Published in Drug Store News (edited)