The Meeting Minutes from 2008 can be downloaded here as a printable PDF.

Minutes
The Pharmacy Alliance
First Annual Meeting
19-20 April 2008
San Luis Resort Complex
Galveston, Texas, USA

This first annual meeting of The Pharmacy Alliance was called to order at 8:00 A.M. in the Paradise North Ballroom, Holiday Inn On The Beach, Galveston, Texas, on Saturday, April 19, 2008. The members and guests present were: Kendra Brookshire; Myron Bryant, Acting Treasurer; Michelle Friday ;Kay Geers; Cindy Mende; Heather Morinelli; Karen Orchard , Jim Plagakis, Founding Director; Victoria Plagakis; David Pehrson; Bill Pennington; Elke Pennington; Kathy Rothrock ; Diane Sandifer; Ken Sandifer; Brenda Schroer; Jerry Schroer; and Paul Trusten, Acting Secretary.

Founding Director Jim Plagakis thanked the hotel for its offer of bargain rates for the meeting rooms. He reviewed some of the basic principles of the organization. Founding Secretary Paul Trusten delivered some opening remarks about the purpose of the organization and comparison to an “Army of Gladiators.”

Director Plagakis asked for comments. David Pehrson recollected for the group his TPA-related experience in making a job decision.

Treasurer Myron Bryant discussed his concept of “core issues” for TPA, involving the attainment of a specific success to demonstrate the new organization’s strength. He suggested that the issue be communication with pharmacy students. He pointed out that the TPA message will be disseminated to the employers more effectively by students armed with TPA documents, that they will be the ones that will be sitting down with recruiters. He noted that if TPA’s message and guidance is in their hands, and they use the Bowl points, TPA sign-on contract, etc., then, those that are recruiting will be forced to address the TPA agenda. He suggested that TPA could make the various employers compete to comply with our tenets of Dignity, Self-respect, and Integrity (DSI). He said that, given that the students generally have no preconceived notions about their impending situation, TPA can guide their career planning and help them avoid abusive working environments. Students can then spread the word about the effectiveness of DSI and TPA.

As an additional core issue, Dave Pehrson suggested, “‘No’ is not a four-letter word”; that is, pharmacy personnel have the right to say no to unacceptable working conditions.

Director Plagakis then called for a discussion of The Bowl, the points of professional practice that had been composed online by participating members. After being reviewed individually, the following 14 Bowl points were adopted by the membership present:

1) Pharmacy professionals will request direct compensation, in addition to their wage, for providing

specialized professional services.

2) Pharmacy professionals will insist upon a 30-minute uninterrupted meal break for every 8 hour shift

And an additional 15 minute uninterrupted rest period for a 12 hour shift.

3)Pharmacy professionals will feel empowered to use the word “no” when faced with undignified, unprofessional, dangerous, dishonest, insulting or offensive situations.

[TPA will take the lead on advocating legislation that will benefit pharmacy professionals and will Discourage legislations that will be detrimental to pharmacy professionals. Tabled.]

4)Pharmacy professionals will counsel patients when appropriate and will advocate for a professional environment and for patient safety.

5)Pharmacy professionals will insist on being managed by pharmacists and not by non-pharmacist managers.

6) Pharmacy professionals will not tolerate abuse under any circumstances, directed toward themselves or their staff.

7)Pharmacy professionals should not sign a “sign-on bonus” agreement until the company

Representative signs a TPA “Sign-On DSI agreement.”

8)Pharmacy professionals will not engage in promoting undignified prescription pricing policies that do not provide for reasonable profit and are an insult to our standing as professionals.

9)Pharmacy professionals will treat each other with dignity and respect.

10)Pharmacy professionals will not accept compensation as a substitute for DSI.

11)Pharmacy professionals will advocate working in pharmacies where the physical layout of the department safeguards privacy and safety.

12)Pharmacy drive-thru areas should only be responsible for dispensing pharmacy-related products if sufficiently staffed.

13)A pharmacist will determine who is assigned to work in the pharmacy.

14) TPA will advocate for certification and licensure requirements for pharmacy technicians in all 50 states.

The members present then separated into four focus groups as follows, to report back at the next day’s session:

1)Liaison to State Boards of Pharmacy (Michelle Friday, Chairwoman; Karen Orchard, David Pehrson, Myron Bryant) 2) Independent Pharmacy (Kay Geers., Chairwoman; Kathy Rothrock; Ken Sandifer)

3) Liaison to Other Pharmacy Organizations (Paul Trusten, Chairman; KendraBrookshire,; Jerry Schroer, R.Ph.)

4)Pharmacy Technicians (Bill Pennington, Chairman; Heather Morinelli;, Victoria Plagakis, Elke Pennington, Cindy Mende)

The meeting recessed at noon for lunch in the Jetty Restaurant inside the Holiday Inn, and reconvened at 6:00 P.M. in the Tarpon Room at the San Luis Resort Hotel next door to the Holiday Inn.

Bill Pennington handed out news items on pending Congressional legislation, namely a bill to mandate national certification of pharmacy technicians; and a bill to eliminate the anti-trust barriers to independent-pharmacy from collective negotiations with pharmacy benefit managers on reimbursement rates and contract details.

Cindy Mende reported on the progress of the development of the TPA Web site. The group discussed alternative message board servers for the message board portion of the site. Vbulletin and Online Institute are possibilities. Ms. Mende reported that the startup cost for which we contracted would be about $1200.

Paul Trusten reviewed the history of TPA and read a Drug Topics article by John Lemberger, R.Ph. That illustrated all the problems in contemporary community pharmacy practice.

Myron Bryant, Acting Treasurer, reported that TPA has taken in approximately $3400 in revenue. Expenses have been about $250. There is one outstanding check, issued today (April 19) to pay the expenses at the hotel. As of April 19, TPA’s balance was $3120, not including the Web site design.

Director Plagakis opened up the topic of publicity. He announced that Judi Chi, Drug Topics editor, will be running an article in that magazine on TPA.

Kay Geers suggested that a standard lecture or presentation be prepared to deliver to pharmacy schools about the organization, and also to prepare as letters to the editor to explain to the public the state of working conditions in pharmacy.

Paul Trusten mentioned the possibility of corporate or company memberships for TPA, drawing on his experience in a non-profit organization that has corporate as well as individual members. This suggestion met with considerable enthusiasm from the group. Elke Pennington suggested that pharmacy liability insurance companies might be interested in sponsoring TPA because improved working conditions in pharmacy would tend to decrease the likelihood of liability events.

The meeting recessed at 9:00 P.M, and reconvened back at the Paradise North Ballroom, Holiday Inn,

At 9:00 A.M., April 20, 2008.

Each participant was given an opportunity to introduce himself or herself and to summarize their reasons for involvement in TPA.

Director Plagakis called for nominations for the election of TPA officers. He nominated the following slate: Myron Bryant for President, Cindy Mende for Vice President, Paul Trusten for Secretary, and Karen Orchard for Treasurer. Dave Pehrson seconded the nominations on the floor. The membership voted to elect the nominated slate of officers.

Director Plagakis then called for the reports of the focus groups, which were as follows:.

I. Focus Group on Liaisons with State Boards of Pharmacy

Michelle Friday announced that the focus group on Boards of Pharmacy would contact all state boards of pharmacy and do the following:

1. seek each board’s position on adverse pharmacist working condition issues (excessive prescription volume, insufficient staffing, inadequate toilet facilities, etc.)2. seek each board’s position on the scenario of a pharmacist closing for business because the pharmacist believed that the safety of the public was being compromised, vs. employer discipline (favorable , unfavorable, or neutral toward pharmacist taking the action)3) publish the results/responses (or lack of) from each state board

Upon Jerry Schroer’s suggestion, the group discussed the possibility of collecting data on dispensing incidents that result from TPA issues. Michelle suggested customer form letters to send to the state boards.

II. Focus Group on Independent Pharmacy

Kay Geers submitted the following report on independent pharmacy issues:

“The independent pharmacists of The Pharmacy Alliance feel that independent pharmacies require an organization that speaks directly to their financial viability. To achieve a level playing field, The Pharmacy Alliance must strive to address several issues.

Independent pharmacies serve the majority of small town America. Due to the fact that these smaller towns tend to have a higher percentage of Medicaid and senior patients, many with the inability to travel even short distances, the independent pharmacy is critical to the access of these patients to appropriate healthcare. In many instances, pharmacies are the only healthcare available in these areas.

Independent pharmacies have been under assault by insurance companies and pharmacy benefit managers (PBMs) for years. This attack has accelerated since Medicare Part D plans were implemented in 2006. Since then, over 1000 pharmacies have closed their doors. Those sold to larger companies are not included in this estimate. Out of the 160 independents In Wyoming, six (almost 4% of the state’s total) closed in late 2006 alone.

The Insurance Companies and PBMs should be required to add another layer to their contract practices. This layer would provide MACs that actually cover the costs of the medication and would require MACs to remain constant from the date of initial contracting for at least a year. Due to higher overhead costs and not having the ability to fill medications as loss leaders or to compete with larger merchandisers for front end movement, independents would require a dispensing fee as close to $10.00 as can be negotiated. We would require that they update their price files daily to reflect real time costs. We would expect extra payment for fulfilling Prior Authorizations, Preferred Drug List and clinical edits as they require extra time away from dispensing and counseling. In this electronic age, they have the ability to contact the doctors for these issues themselves. In addition, there should be a higher fee to fill a prescription that is used to hold a patient over until their mail-order prescription arrives in the mail.

Insurance plans have always provided low-ball contracts that are “take it or leave it”. In conversations with CMS, we have discovered that they believe that “take it or leave it” is negotiating. According to Webster’s Dictionary, “to negotiate” is “to arrange for or bring about through conference, discussion and compromise”. “Take it or leave it” does not include conference or discussion or compromise. We strongly support HB 971 and wish all to contact their representatives to ask for their support also. We plan to work with CMS and other insurance providers to change the wording of contracts and actually allow negotiation, along with several other issues.

Regarding audit procedures, PBMs have the right, under current CMS guidelines, to take samples of prescriptions and audit for correct submission. They can then extrapolate that data to 10 years of prescriptions. This would potentially cause a pharmacy to close due to possible recoupment that could be exorbitant. It is our belief that if pharmacies are required to submit a clean claim within 18 months, the PBM should be required to have an additional year to audit such claims, therefore negating the need to sample and extrapolate.

Independent pharmacies have to arrange their own Internet access in order to submit claims electronically to PBMs. We are saving these companies thousands of dollars in time and the labor involved in processing paper claims. We should not be required to pay transmission fees to send clean claims to them. Also, we should not pay for e-prescribing transmissions. E-prescribing has already shown itself to require added time, in some instances, to verify the accuracy of these prescriptions due to user input errors (prescribers not choosing the correct drug, not using appropriate directions, and using “as indeterminate patient directions, such as “as directed.”

We are opposed to the added responsibilities placed upon us by unreasonable laws that require us to maintain pseudoephedrine logs, monitor the use of tamper resistant prescription forms, and police drug diversion without adequate information. These procedures take time away from pharmacists’ being available to verify prescriptions for accuracy and counseling patients.

The independent pharmacies of this country have been serving the public since before the advent of insurance plans, large chain stores, and Medicare D. In some instances, it has been said that pharmacists have saved the day in emergency situations, most notably, Hurricane Katrina. We are the last professionals that patients have contact with before their ambulatory treatment starts.

The implementation of these issues will be dependent on the combined efforts of all independent pharmacists-staff pharmacists, be they owners or employees. Several of these issues affect chain pharmacists as well.”

III. Focus Group on Liaisons with Other Pharmacy Organizations Paul Trusten reported for the focus group on liaisons with other pharmacy organizations. The group will introduce TPA to the major national pharmacy organizations (APhA, ASHP, NCPA, et al.), but wishes to seek cooperation, not confrontation, with them. The group prefers to concentrate on establishing liaisons with student organizations, as follows:

1) Letters, followed by telephone calls, to student leaders (student body presidents or class presidents) and state pharmacy association leaders.

2) Written follow-up should contain a point-by-point explanation of the 14 bowl items for the students

3)First-year free membership offer to the student leaders we contact

4) Inclusion of a “webinar” portal on the TPA Web site, with webinars to be held at regularly scheduled intervals (perhaps once a month), staffed by TPA members on a rotating basis, for students to discuss and

learn about TPA

IV. Focus Group on Pharmacy Technicians

Bill Pennington submitted the following report for the focus group on pharmacy technicians:

“With the increase in demand for pharmaceutical products, pharmacy technicians have been given increasingly complicated duties. At present, no federal and few state requirements exist for the formal training of pharmacy technicians. This is an Rx for disaster. This focus group supports nationwide minimal requirements concerning both the education and certification/licensure of pharmacy technicians. This action is vital to ensure the safe practice of pharmacy. The reform can best be achieved not only by supporting applicable legislation, but also by encouraging our pharmacist colleagues to request that their pharmacies be staffed only with adequately trained and certified pharmacy technicians. Such a policy will result in increased business for the pharmacy, an improved public perception of the pharmacy practice, and the attainment of TPA’s goal of dignity, self respect and integrity for all pharmacy professionals.”

Near the conclusion of the meeting, the membership decided to reconvene for TPA’s 2^nd annual meeting in Galveston on Saturday and Sunday, April 25 and 26, 2009. The specific site of the meeting will be announced at a later date.

The meeting was adjourned at 12:00 noon, April 20, 2008.

Respectfully submitted,

Paul Trusten, R.Ph.

Secretary