Continuing Pharmacy Education - Conflict of Interest and Faculty Agreement

Information you need to know to disclose your financial relationships with companies related to healthcare products or services.

Why We Ask:

As an accredited provider, we require your assistance to comply with accreditation guidelines and help us create high-quality Accredited Continuing Pharmacy Education (ACPE) that is independent of industry influence. To participate in planning educational material, all individuals who have the ability to influence and/or control the content of the ACPE activity must disclose all financial relationships with all companies – whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients (deemed ineligible company) – over the past 24 months.

What to Disclose:
  • There is no minimum financial threshold; you must disclose all financial relationships, regardless of the amount, with companies described above. You only disclose your own financial relationships, not those of your spouse or life partner.
  • We ask you to disclose all financial relationships regardless of whether or not your view the relationships as relevant to the ACPE activity. Staff will determine if the information you provide is relevant to the topics of the ACPE activity in which you are a planner.
  • Since healthcare professionals serve as the trusted authorities when advising patients, they must protect the learning environment from industry influence to ensure they remain true to their ethical commitments.
  • If the staff determine that financial relationships create a conflict of interest, the staff will determine the appropriate method of mitigation. Mitigation may involve, but is not limited to, peer review of content by non-conflicted planners.
  • Many healthcare professionals have financial relationships with companies as defined above. By identifying and mitigating relevant financial relationships, we will work together to create a protected space to learn, teach, and engage in scientific discourse, free from the influence from organizations that may have an incentive to insert commercial bias into education.

Disclosure Form Required by The Standards for Integrity and Independence

Please disclose all financial relationships that you have had in the past 24 months with ineligible companies (defined above). For each financial relationship, enter the name of the ineligible company and the nature of the financial relationship(s). There is no minimum financial threshold. We ask that you disclose all financial relationships, regardless of the amount, with ineligible companies.

Asterisk (*) indicates a required field.

Contact Information
Types of Relevant Financial Relationships

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Please check all types of relationships that apply and provide the name of the commercial interest.

Off-Label Drug Use Disclosure

If any unapproved or off-label uses of products will be discussed, disclosure must be made to the participants regarding the unapproved or off-label use.

List products discussed as off-label usage

In order for any faculty/speaker to present or produce a Continuing Pharmacy Education (CPE) activity within St. Jude, you agree to the following:

1. Read the St. Jude Guidance Document for Developing CPE Activities and agree to comply with the policies and procedures outlined within it. If any questions regarding these policies or procedures arise, I will contact the Continuing Pharmacy Education Committee Chair for further clarification.

2. Agree to make changes or revisions to program content/activities in accordance with ACPE standards to ensure balance, independence, objectivity, scientific rigor, and full disclosure of agreed upon information.

3. In preparation for presenting the CPE activity, I will submit all program materials including, but not limited to: program learning objectives, slides or comprehensive outline, learning assessment questions, handouts and any other informational material, and other pertinent materials to the Continuing Pharmacy Education Committee Chair on the agree upon timelines.