Proposed Policy Topics for statement development by the APhA Policy Committee

1. Proposed Policy Topics for statement development by the APhA Policy Committee Moderator: Bradley P. Tice, PharmD, MBA, FAPhA Speaker, APhA House of Delegates

2. For Your Information • Please submit your thoughts on the policy topics throughout the webinar or send them to HOD@aphanet.org • If you are using a phone line to listen, please dial 415-655-0062; Access Code: 856-377-400. Be sure to include your Audio PIN • To request to speak, click on the raise hand tab and you will be placed in the queue. The comments we take or mention on the webinar may be limited due to time. However, all comments will be provided to the Policy Committee for use in their deliberations. • The moderator will clarify issues but will not engage in debate. • Remember, be courteous to your colleagues in your communications.

3. Goals • To provide an opportunity for member input on policy topics prior to the proposed statement development by the Policy Committee • To promote the early engagement of Delegates on the development and submission of quality new business items on topics not assigned to the Policy Committee • To generate Delegate interest in Policy and House-related committees as part of the policy development process

4. Objectives • Review the purpose of the House of Delegates • Review the policy development process • Review 2013 proposed policy topics and gain perspectives on the issues • Generate interest and solicit names for House Committees • Webinar scheduled for 90 minutes. • 10 minutes for intro, 20 minutes per topic, 20 minutes for final comments

5. Purpose of the House of Delegates & Association Policy • House of Delegates • “serves as a legislative body in the development of ASSOCIATION policy. It shall act on such policy recommendations as shall come before it and shall adopt rules or procedures for the conduct of its business.” (from APhA Bylaws) • Association Policy • Advocacy Activities • External Communications • Advisory Committees • Association Activities

6. APhA House of Delegates Committees • House of Delegates Policy Committees • Policy Committee • Policy Review Committee • Policy Reference Committee • New Business Review Committee • House Rules Review Committee • House of Delegates Election Committees (every other year) • Committee on Nominations • Committee of Canvassers

7. APhA House of Delegates by the Numbers • 50 states plus DC, Guam, and Puerto Rico • 12 National Pharmacy Organizations • AAPS, AACP, ACA, ACCP, AIHP, AMCP, ASHP, ASCP, ASPL, NCPA, National Pharmaceutical Association, National Pharmacists Association • 5 Federal Pharmacy Groups • Air Force, Army, Navy, PHS, VA • APhA • Academies: APPM, APRS, ASP • Board of Trustees • Former Presidents • Former Speakers

8. Officers of the APhA House of Delegates Thomas E. Menighan, BS Pharm, MBA, ScD (Hon), FAPhA Secretary, APhA House of Delegates APhA Executive Vice President & CEO APhA Board of Trustees William H. Riffee, PhD Speaker - Elect, APhA House of Delegates Bradley P. Tice, PharmD, MBA, FAPhA Speaker, APhA House of Delegates APhA Board of Trustees

9. Joint Policy Standing Committee Assignments • Topic Generation • Ideas obtained from Delegates, Members, State Pharmacy Associations, Committees, Trustees, Staff, and Surveys • 43 topic submissions received • Recommendations by APhA-APPM/APRS/ASP Joint Policy Standing Committee • Background on issues and potential direction assembled • Topic Prioritization • Committee discussed the top 15 topics • Further discussed top 15, topics combined, and then ranked top 3 • Refined direction of top 3 by answering key questions

10. Guidance to Joint Policy Standing Committee on each Topic • What is the problem? • Why is it a problem? • What are the issues that need to be addressed?

11. Top 3 Policy Topic Ideas 1. Expanding Access to Pharmaceuticals 2. Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care)  3. Medication Take Back/Disposal Programs

12. APhAPolTransforming Ideas into Action APhA House of Delegates APhA Members APhA- APPM/APRS/ASP Joint Policy Standing Committee APhA Board of Trustees Webinar 1 2 3 APhA Staff State Associations IDEA APhA House of Delegates Policy Committee Surveys, Other IDEA GAC IDEA APhA- APPM/APRS/ASP Joint Policy Standing Committee PROPOSED Policy Statement YOU! APhA Board of Trustees APhA House of Delegates 6 5 4 Webinar ACTION ADOPTED Policy Statements Implementation IDEAS For Policy Statements

13. TOPIC 1: Expanding Access to Pharmaceuticals

14. Expanding Access to Pharmaceuticals • Setting the stage • Current drug classification system • Rx and OTC (some state variances) • Role / Involvement of pharmacists is variable • Access by patients to some pharmaceuticals restricted • Practice acts • Insurance • Access to care provider

15. Expanding Access to Pharmaceuticals • Summary of Key Concepts • Financial constraints / shortage of primary care physicians • Growing interest in increasing access • Pharmacists have knowledge / skills • When pharmacists are more involved in patient care, health outcomes improve and costs go down. • FDA is considering a new paradigm of medication use • Reluctance among the physician community and some consumer groups that the new paradigm will sever the patient-physician relationship. • Concern with use of vending machines, that are resulting in patients purchasing prescription and behind-the-counter medications without access to a pharmacist.

16. Expanding Access to Pharmaceuticals Potential Scope • Supporting the creation of an “OTC+” or “Conditions of Safe Use” category of drugs which require pharmacist intervention • Behind the counter and vending machine distribution of medications (EC) • Stress importance of patients having access to beneficial medications and access to pharmacists’ services

17. Expanding Access to Pharmaceuticals What are the issues that a proposed policy statement should address and what are your suggested directions that the Policy Committee should consider in crafting proposed policy language? • Overall importance of patient access to pharmacists • OTC+ • Support opportunities for pharmacists to assume patient care roles, including OTC+ • Support updating state and federal laws/regulations to require access to pharmacists • Need some pilots • Which prescription medications (or categories), if any, are appropriate for the OTC+ concept? • What drug categories should be included; that we support the process, include monitoring and follow-up; could incorporate adherence for chronic disease medications. • Opportunity to increase access and decrease cost • Way to loop people back into the healthcare system (coordination and collaboration) • Coordination with payers for payment and quality measures • Way to improve quality ratings • Address concerns raised by other health professions

18. Expanding Access to Pharmaceuticals What are the issues that a proposed policy statement should address and what are your suggested directions that the Policy Committee should consider in crafting proposed policy language? • How should vending machine distribution be controlled to ensure patient safety? • Are there features that should be included (access to pharmacist?) • Are there medications that should not be distributed via this mechanism?

19. Expanding Access to Pharmaceuticals What are your thoughts?

20. TOPIC 2: Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care) 

21. Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care)  Potential Scope of Proposed Policy • What is preventing pharmacists from performing medication therapy management (MTM) or other patient care services? • Are there system issues impacting this? • What is preventing payers from incentivizing or encouraging pharmacists to perform MTM or other patient care services? • Are there practice issues creating barriers?

22. Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care)  What Is The Problem? What are the issues that a proposed policy statement should address and what are your suggested directions that the Policy Committee should consider in crafting proposed policy language? • Health benefit data (medical and pharmacy) should be connected • look at pharmacoeconomic and overall healthcare costs. • Decisions need to be pursuant to evidence-based data • CMS standards for MTM programs and contracting directly with providers

23. Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care)  What Is The Problem? What are the issues that a proposed policy statement should address and what are your suggested directions that the Policy Committee should consider in crafting proposed policy language? • Others • Prior authorization programs and formulary management policies can create barriers to patient care •  Payment to pharmacists by insurance and PBMs for medication management/patient care services • PBM transparency • Pharmacy overregulation • Accountability of PBMs regarding the MTM benefit administration and the scope of benefits • Provider status recognition and network inclusion

24. Ensuring Access to Pharmacists’ Services (Role of payers and providers in Patient Care)  What are your thoughts?

25. TOPIC 3:Medication Take Back / Disposal Programs

26. Medication Take Back / Disposal Programs Potential Scope • Pharmaceuticals and Personal Care Products in the Environments • Look at 2012 APhA-ASP policy • Develop and implement standardized guidelines for the proper disposal of unused or expired medications that help prevent drug abuse and reduce harm to the environment. (Source: APhA-ASP 2012.3 – Proper Medication Disposal and Drug Take-Back Programs) • Allow pharmacies to take back unused or expired medications, including controlled substances, through a process that minimizes diversion, liability, and financial burden to all stakeholders. (Source: APhA-ASP 2012.3 – Proper Medication Disposal and Drug Take-Back Programs) • Encourage pharmacists and student pharmacists to serve as a source of information for the public on the proper disposal of unused or expired medications. (Source: APhA-ASP 2012.3 – Proper Medication Disposal and Drug Take-Back Programs)

27. Medication Take Back / Disposal Programsexisting policy • 2009 Medication Disposal 1. APhA encourages appropriate public and private partnerships to accept responsibility for the costs of implementing safe medication disposal programs for consumers. Further, APhA urges DEA to permit the safe disposal of controlled substances by consumers. 2. APhA encourages provision of patient appropriate quantities of medication supplies to minimize unused medications and unnecessary medication disposal. (JAPhA NS49(4):493 July/August 2009)

28. Medication Take Back / Disposal Programs What are the issues that a proposed policy statement should address and what are your suggested directions that the Policy Committee should consider in crafting proposed policy language? • Uniform disposal guidelines that align requirements for state and federal laws and regulations for pharmacists and patients • Disposal of medications and hazardous pharmaceuticals and materials • Safety in the household; lack of effective and available medication take back systems and programs in the community and through local pharmacies. • Disposal guidelines and support for it. Should include public awareness of the issue. Take back guidelines (unit of use vs non-unit of use), liability issues, who should pay for the programs • Address liability in relation to diversion by having policies and procedures, protection of public and the patient aspect of this • Address pharmacist education on take back programs and environment • Policies that are driving excess meds in environment (like 90 days supply, auto refills, etc) • Re-use of meds returned • Cost issues • Ease take back program requirements through unit of use packaging

29. Medication Take Back / Disposal Programsexisting policy • 2012 Controlled Substances Regulation and Patient Care • APhA encourages the U.S. Department of Justice to collaborate with professional organizations to identify and reduce (a) the burdens on health care providers, (b) the cost of health care delivery, and (c) the barriers to patient care in the establishment and enforcement of controlled substance laws.

30. Medication Take Back / Disposal Programsexisting policy • 2006/2003 Unit-of-Use Packaging • APhA encourages the continued development, distribution and use of unit-of-use packaging as the industry standard to enhance patient safety, patient compliance, and efficiencies in drug distribution.

31. Medication Take Back / Disposal Programs What are your thoughts?

32. 2012-13 APhA Policy Review CommitteeAssignment • Continue its review of the current APhA Policy Manual by reviewing those statements last reviewed in 2008 (17 statements) . • The 2012-13 APhA Policy Review committee will review any current APhA policy that may be affected by statements/topics proposed by the 2012-13 APhA Policy Committee • Topics Include: • Automation and Technology in Pharmacy Practice • Automation and Technical Assistance • Experiential Education • Residency Programs • Expansion and Recognition of Internship, Externship, and Clerkships • Residencies in Community Pharmacy • Pharmacy Schools' Curriculum and Contemporary Pharmacy Needs • State Boards of Pharmacy/Inspections • National Framework for Practice Regulation • Sale of Home-use Diagnostic and Monitoring Products • Prior Authorization • Regulatory Compliance/Regulatory Burden • Pharmacists' Role in the Development and Implementation of Disease-Based Clinical Guidelines • Pharmacists and Ambulatory Patients • Promotion of Pharmaceutical Care

33. Questions / Comments • Opportunity to share additional thoughts or questions • Remember, all comments will be provided to the Policy Committee for use in their deliberations. • You may also send your comments to HOD@aphanet.org

34. Policy Development Next Steps • Policy Committee Meeting • Sept 7-9, 2012 • Webinar on proposed policy statements • January 2013 / February 2013 • 2013 APhA House of Delegates • Policy Reference Committee Open Hearing

35. Do you have a policy topic for the House? • New Business opportunity • Forms available on website: www.pharmacist.com/hod • For more information, Email: hod@aphanet.org

36. Thanks for your Attention! • Questions

37. Thanks for your Attention! • This concludes our webinar. • Thank you for your participation and comments. • Questions / Comments • Bradley P. Tice, PharmD, MBA, FAPhA Speaker, APhA House of Delegates Email: HOD@aphanet.org