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June 27, 2014

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If you have questions or comments about the articles below, please contact bhoban@texaspharmacy.org
LAST CHANCE for Advance Registration:
Cut-off for the 2014 TPA Conference & Expo is June 30th


Top Stories
An Opportunity to Share Your Medicaid Managed Care Concerns
A special opportunity to participate in a Town Hall discussion for YOU to air your questions and concerns with Medicaid Managed Care and PBMs. It is open to all interested pharmacist. There is no charge and Conference registration is not required.READ MORE
Proposed Rules by the Texas State Board of Pharmacy
On June 13, the Texas State Board of Pharmacy proposed rules in seven areas of regulations which, if adopted, will impact pharmacies, pharmacists and pharmacy technicians. READ MORE
Sunset Commission Focuses on State Health Services
The Texas Sunset Advisory Commission, met on June 24 and 25 to review Commission staff reports on a number of state health agencies. More than 150 individuals testified during the two day hearing. READ MORE
National Community Pharmacy 2014 Cost of Dispensing Study Needs Input Before July 9
The Texas Sunset Advisory Commission, met on June 24 and 25 to review Commission staff reports on a number of state health agencies. More than 150 individuals testified during the two day hearing. READ MORE
Member Spotlight: Gay Dodson, Executive Director, Texas State Board of Pharmacy
If you grew up in the Dallas area in the 70’s or 80’s you may remember the Texas chain of drug stores called Skillern’s. And if you were a customer there, you might have been helped by Gay Dodson. READ MORE

Advocacy

As Promised, an Opportunity to Share Your Medicaid Managed Care Concerns...

Save the date!

9:00-11:30 a.m., Thursday, July 31, 2014. Held in conjunction with the TPA Annual Conference and Expo in San Marcos.

 

For what?

A special opportunity to participate in a Town Hall discussion for YOU to air your questions and concerns with Medicaid Managed Care and PBMs. It is open to all interested pharmacist. There is no charge and Conference registration is not required.

 

So who’s going to be there to listen and answer?
(Pictured from left: Todd Hunter, Chris Traylor, Andy Vasquez)

 

    

Ø Texas Representative Todd Hunter (R-Corpus Christi), chairman of the powerful House Calendars Committee and author of the 2013 PBM legislation;

Ø Chris Traylor, Deputy Commissioner, Texas Health and Human Services Commission, Austin;

Ø Andy Vasquez, Deputy Director, Medicaid and CHIP Vendor Drug Program, Texas Health and Human Services Commission, Austin:

Ø Representatives from Selected PBMs; and

Ø TPA Leadership

This important TPA Town Hall meeting is sponsored by YOUR professional Association and is based on a commitment the organization made to its members during the 2014 Leadership Symposium in Austin.  In addition to this critical Medicaid issue from 9:00-10:30am and immediately following these discussions, TPA will present its plans regarding our Pharmacists as Provider Initiative.  Along with TPA staff, Jon Roth, CEO, California Pharmacy Association will participate in this portion of the Town Hall from 10:30-11:30am.    Come learn more about California’s changes and what may happen in Texas next legislative session regarding the practice of pharmacy.  Your feedback will be vital!

More to come!

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Proposed Rules by the Texas State Board of Pharmacy
On June 13, the Texas State Board of Pharmacy proposed rules in seven areas of regulations which, if adopted, will impact pharmacies, pharmacists and pharmacy technicians. Below are excerpts of the rules along with page references from the Texas Register. Click here if you wish to access the actual, detailed set of the proposed rules as published in the Register. TPA will be submitting a comment letter on these proposed rules and will provide the Association’s membership with an analysis of the rules in the next two weeks prior to the July 31 comment deadline.

ØConcerning pharmacy license fees. The rule will decrease pharmacist license fees based on expected expenses. (page 39 TexReg 4596)

ØConcerning definitions; personnel; operational standards; and records for Class A (community) pharmacies. The rules update the reference to advance practice registered nurses; clarify that the requirements for dispensing a prescription are the same for a pharmacist and for an intern and eliminate references to sterile compounding that are no longer necessary. The rules also eliminate the requirement for the pharmacist to notify the prescriber of a substitution of dosage form.(page 39 TexReg 4597)

ØConcerning Class C (institutional) pharmacies located in a freestanding ambulatory surgical center. The rules clarify the labeling requirements for medications provided by ASC pharmacies; remove references to sterile compounding that are no longer necessary; and add tramadol to the record keeping requirements to be consistent with other sections.(page 39 TexReg 4602)

ØConcerning pharmacies compounding sterile preparations. The proposed rules clarify the training requirements for pharmacy technicians in American Society of Health-System Pharmacists accredited programs. (page 39 TexReg 4604)

ØConcerning Class F pharmacies, which are pharmacies located in a freestanding emergency medical care center. The rules clarify the labeling requirements for medications provided by Class F pharmacies; remove references to sterile compounding that are no longer necessary; and add tramadol to the record keeping requirements to be consistent with other sections.(page 39 TexReg 4605)

ØConcerning pharmacist license or renewal fees. The rules will decrease pharmacist license fees based on expected expenses.(page 39 TexReg 4607)

ØConcerning fees. The rules will decrease pharmacy technician and pharmacy technician trainee fees based on expected expenses.(page 39 TexReg 4608)

Comments on these proposed rules should be submitted to Allison Benz, R.Ph., M.S., Director of Professional Services, Texas State Board of Pharmacy, 333 Guadalupe Street, Suite 3-600, Austin, Texas 78701, fax (512) 305-8008. Comments must be received by 5:00 p.m., July 31, 2014.

Click Here to View Proposed Rules
Comments on these proposed rules should be submitted to Allison Benz, R.Ph., M.S., Director of Professional Services, Texas State Board of Pharmacy, 333 Guadalupe Street, Suite 3-600, Austin, Texas 78701, fax (512) 305-8008. Comments must be received by 5:00 p.m., July 31, 2014.

Spotlight on Gay Dodson, TSBP's Executive Director

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National Community Pharmacy 2014 Cost of Dispensing Study Needs Input Before July 9

The Coalition for Community Pharmacy Action (CCPA) is sponsoring a national community pharmacy cost of dispensing study. CCPA is an alliance between the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) and has contracted with the MPI Group, an independent survey organization, to conduct this survey. The last study was conducted in 2006.Medicaid’s movement toward an acquisition cost system of reimbursement, and CMS’ public posting of a final National Average Drug Acquisition Cost (NADAC) file, make the timing of this survey critical and we need your help in responding to the survey.

If you are an owner or manager of a community pharmacy, please complete the questionnaire by July 9 at www.2014CostofDispensing.com. If you answer for multiple pharmacies, a spreadsheet questionnaire is available by sending an email request to CODsupport@mpi-group.net. You can also download a Word version of the survey and mail it to Cost of Dispensing Study, P.O. Box 4330, Dublin, OH 43016 or fax it to 614-389-3816. Please do not send your responses to NCPA.


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CMS Includes MAC Transparency in Final Medicare Rule
After abandoning efforts to expand pharmacy participation in preferred networks, CMS had a bit of good news for independent community pharmacy in its final Medicare rule. CMS finalized language that requires Part D plan sponsors to both disclose to pharmacies the maximum allowable cost (MAC) reimbursement limits for many generic drugs and to update MAC-based reimbursement every seven days to better reflect market costs. This is an important step in the right direction to help ensure pharmacies are fairly reimbursed for the generic medications they dispense and to allow them to continue to serve the patients who rely on them.

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Sunset Commission Focuses on State Health Services
The Texas Sunset Advisory Commission, met on June 24 and 25 to review Commission staff reports on a number of state health agencies. More than 150 individuals testified during the two day hearing.

Currently chaired by Senator Jane Nelson (R-Flower Mound), the Sunset Commission is reviewing the Health and Human Services Commission (HHSC), the Department of State Health Services (DSHS), the Department of Family and Protective Services (DFPS), the Department of Assistive and Rehabilative Services (DARS), the Department of Aging and Disability Services (DADS) and the University Interscholastic League (UIL). Click here to view the agencies’ reports.

During discussions about the Texas Department of State Health Services, the director of the Sunset Commission, Ken Levine, and DSHS Project Manager, Jennifer Jones, shared their findings which indicated that the Agency lacks adequate leadership and staffing, stating that few agencies had the breadth and scope of DSHS. It is a "jack of all trades, and master of none." Additionally, they have not followed the recommendations of the committee and the legislature.

Kyle Janek M.D., THHSC Executive Commissioner, and David Lakey, M.D., DSHS Commissioner, testified that DSHS is a "very large, and complex agency." Dr. Lakey noted that he had no doubt that the Agency could improve and is ready to work with the Sunset Commission to help the agency enhance the health and wellbeing of Texans.

He said that the scope of services provide by his agency impacts the lives of all Texans in one way or another. It is an "umbrella organization” and responds to everything from nuclear disasters to public immunization and sanitation. Dr. Lakey closed by saying that he is ready to implement the Sunset staff’s suggestions.

Sen. Nelson stated that "there was so much to be done." She was especially concerned that there still wasn’t a dependable process to prepare the agency to meet the demand for mental health issues.

Dr. Lakey responded to this by saying that, while there is a clear need for more mental health treatment, the agency already has significant financial burdens in addressing the day to day demands in Texas. He agreed that more funds should be directed toward mental health, but the agency would need greater legislative allocation of funds. Dr. Janek added to this, saying that it is "hard to open up this subject without opening up direct delivery of services to individuals."

When the topic of telemedicine surfaced, Dr. Janek commented stated that there are a number of obstacles, including DEA regulation. Rep. Richard Raymond (D) balked at the claim that DSHS does not have adequate leadership. He respects Dr. Lakey and feels that he was unfairly judged by local healthcare groups and municipalities.

As a general comment regarding state health services, Dr. Janek said that it would be interesting to study the possible benefits of completely privately run state health services.

The Texas Sunset Advisory Commission is a 12-member legislative body tasked with identifying and eliminating waste, duplication, and inefficiency for more than 130 Texas state agencies. The Commission has five Senators, five Representatives, and two members of the public, appointed by the Lieutenant Governor and the Speaker of the House. The position of chair rotates between the House and the Senate every two years. Current membership includes:

Senate Members

Jane Nelson, Chair
Flower Mound
2013 to 2017

Brian Birdwell
Granbury
2011 to 2015

Juan "Chuy” Hinojosa
McAllen
2013 to 2017

Dan Patrick
Houston
2011 to 2015

Charles Schwertner
Georgetown
2013 to 2017

Dawn Buckingham, M.D. - Public Member
Austin
2013 to 2015

House Members

Four Price, Vice Chair
Amarillo
2011 to 2015

Cindy Burkett
Sunnyvale
2013 to 2017

Harold V. Dutton, Jr.
Houston
2011 to 2015

Larry Gonzales
Round Rock
2013 to 2017

Richard Peña Raymond
Laredo
2013 to 2017

Tom Luce - Public Member
Dallas
2013 to 2015

The Commission’s role is to question the need for each agency, look for potential duplication of other public services or programs, and consider new and innovative changes to improve each agency's operations and activities. The Commission seeks public input on every agency under Sunset review and recommends actions on each agency to the full Legislature. In most cases, agencies under Sunset review are automatically abolished unless legislation is enacted to continue them.

The Sunset review is a three step process.

1. Sunset Commission staff evaluates a state agency and issues a report recommending solutions to problems found. These reports are listed by agency on the Sunset Commission’s website at www.sunset.texas.gov

2. The Sunset Commission meets to hear public testimony on the agency and the recommendations of the Sunset staff.

3. Based on public input and the Sunset staff report, the Sunset Commission adopts recommendations for the full Legislature to consider when it convenes in January 2015.

After the Sunset staff report has been issued, the Sunset Commission conducts a public hearing to receive feedback on the staff’s work.

The Sunset process has streamlined and changed state government. Since its inception in 1977, the Commission’s activities has resulted in 79 agencies being abolished, including 37 agencies that were completely abolished and 42 that were abolished with certain functions transferred to existing or newly created agencies. The Legislature typically enacts a large majority of the Sunset Commission’s recommendations. The Texas State Board of Pharmacy is scheduled for Sunset Review in 2017.

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Member Spotlight: Gay Dodson, Executive Director, Texas State Board of Pharmacy

If you grew up in the Dallas area in the 70’s or 80’s you may remember the Texas chain of drug stores called Skillern’s. And if you were a customer there, you might have been helped by Gay Dodson. Although the Skillern’s Pharmacy chain is long gone, Dodson has moved on to one of the most prominent positions in Texas pharmacy.

"I worked as a pharmacist at the Skillern’s in Lancaster,” says Dodson. "We built it up to be a really busy store.”
Eventually, Dodson grew interested in management, and started looking around. Around that time there was an ad in the Texas State Board of Pharmacy (TSBP) newsletter for a compliance officer in the Houston area, and she decided to investigate.

"I didn’t really want to go to Houston,” says Dodson, "but I thought I’d look into it.”

This was when compliance officers were initially put into the field by TSBP, and it turned out to be a good move. Beginning in 1982, Dodson served two years as a compliance officer in Austin, three years as the senior compliance officer, 10 years as Director of Compliance and began as Executive Director in 1997.

"It’s something I really enjoy doing,” says Dodson of her position at TSBP. "No two days are alike. Every time I think I’ve heard it all, I hear something new! It’s constantly a challenge to see what people are proposing. When we are looking at changing the rules to accommodate changes in practice, we always have to look at how the rule will protect the public first, since that’s the mission of the Board.

Dodson has seen considerable change during her career, especially in the area of technology.

"Change seems to be the norm,” she says. "Technology has changed the way pharmacy is practiced. Also, there has been a continuing emphasis on pharmaceutical care—taking care of a patient beyond just dispensing drugs. We are continuing to find ways to help pharmacists do a better job in that area. I’ve always said that the most important factor in good patient counseling is whether or not pharmacists want to counsel.

Pharmacists as Healthcare Providers
With California leading the way, it seems like only a matter of time before other states pass legislation recognizing pharmacists as healthcare providers.

"I think it’s crucial to the profession moving forward for pharmacists to be recognized as providers federally by Medicare/Medicaid. That’s when compensation will follow, and that’s when you’ll see it really take off.”
Looking at the job market in Texas, Dodson points out that things have tightened up a bit for pharmacists, but opportunities exist.

"Right now, it appears there are still jobs,” she says. "We’ve had a great influx of pharmacists coming into the state—largely due to the number of colleges of pharmacy in Texas and nationwide. We’ve had many more people graduating—the number of pharmacists we’ve licensed has increased by 26% since 2006. Folks entering the profession may not get their first choice as to where they want to work, but they should be able to find a job.”
Concerning pharmacy technicians, Dodson observes that there’s still a strong demand.

"There are currently 56,500 pharmacy technicians in Texas, and that’s been growing every year,” she says. "Of course, the number of pharmacies is also growing. At the end of FY13, we’d licensed 7,350 active pharmacies, that’s a 19% increase since 2006. We currently have about 29,500 pharmacists with an active license.”

Don’t miss Dodson’s Texas State Board of Pharmacy Update at the 2014 TPA Conference & Expo (1:30-3:00 p.m. Friday, August 1). Attendees can expect to hear about any changes in the laws and rules over the last year.
"We’ll have a number of TSBP board members at the conference, and attendees will be able to ask us questions,” says Dodson.

Follow TPA on Twitter
TPA has re-launched its Twitter feed. The previous one is inactive, so you’ll need to follow us on our new one. Spread the word!

Plan Now to Participate in the PharmPAC Golf Tournament!

In conjunction with the Texas Pharmacy Association’s Annual Conference & Expo to be held in San Marcos, PharmPAC will hostits popular annual golf tournament. The event will be held starting at 1:00 p.m., Wednesday, July 30, 2014 at the Bandit Golf Course in New Braunfels, Texas,www.banditgolfclub.net, a short 25 minute drive from the Conference Hotel.

Sponsors are needed for this annual event! Please Visit here to sign up!

More than 80 golfers participated in the 2013 Daryl Spence Golf Classic. With sponsorships, the event raised more than $20,000 for PharmPAC. Help make the 2014 event even more successful!

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Table of Contents


Advocacy
An Opportunity to Share Your Medicaid Managed Care Concerns

Proposed Rules by the Texas State Board of Pharmacy

Sunset Commission Focuses on State Health Services

CMS Includes MAC Transparency in Final Medicare Rule

National Community Pharmacy 2014 Cost of Dispensing Study Needs Input Before July 9


Association News
Member Spotlight: Gay Dodson, Executive Director, TSBP

PharmPAC Golf Tournament

TPA Educational Opportunities

REGISTER NOW FOR 2014 TPA Conference & Expo- July 31- August 2

TPA offers other education programs on a wide range of topics. For information on all of TPA’s upcoming educational events, visit the TPA Education Calendar.


Trending News
Pharmacist Provider Status

Pharmacists Help Reduce Readmissions Among High-risk Patients


 


Texas Pharmacy Today

Editor:
Brom Hoban, Manager Communications & Marketing, TPA • 512.615-9140

Texas Pharmacy Association:
Joe DaSilva Chief Executive Officer, TPA • 512.615.9170

Disclaimer: Texas Pharmacy Today is a weekly e-newsletter for members of the Texas Pharmacy Association, 6207 Bee Cave Rd. Suite 120, Austin, TX 78746. According to Texas Government Code 305.027, this material may be considered "legislative advertising." Authorization for its publication is made by Joe A. DaSilva, CEO, Texas Pharmacy Association.


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