September Legislative Update
Ohio's Pharmacists Must Act!
Alyson Welsh, Director of Government Affairs
Pharmacist Negotiation Bill
House Bill 325, sponsored by State Representative Jim Trakas, would permit two or more pharmacies or health care providers to jointly negotiate with health insurance companies. Ohio's pharmacists will be able to collectively negotiate if this legislation passes. HB 325 states that providers may jointly negotiate on the definition of medically necessary, utilization review criteria; clinical practice guidelines; preventive care and other medical management policies; patient referral standards and procedures; drug formularies and standards for prescribing off-formulary drugs; quality assurance programs; liability; methods of payment; credentialing standards; and mechanisms for resolving disputes. Additionally, providers can jointly negotiate on the amount of payment, the conversion factor for a resource-based relative value scale, and the amount of any discount on the price of a service, the procedure code, and the amount of a bonus. Providers must file a petition with the Attorney General before engaging in any joint negotiations. HB 325 has not received any hearings yet in the Ohio General Assembly. OPA is supporting this measure and working with the sponsor of the bill and the Ohio Health Care Coalition.
Pharmacy Freedom of Access Legislation
House Bill 53, sponsored by State Representative Bryan Williams, was on hold while the legislature sent it out to a private actuarial group, Milliman USA, to assess the cost impact of this legislation. Milliman USA published its study on HB 53 on July 24, 2001. The executive summary states that they estimate the premium increase to be between 0.1 to 0.3 percent. The study also noted that HB 53 would be expected to have minimal impact on the number of insureds in Ohio. It went on to state that the 0.1 to 0.3 percent increases likely under HB 53 are small relative to the yearly increases in health plan premiums which are generally 5 to 15 percent. Based on these findings, we are very hopeful that HB 53 will receive additional hearings when the Ohio Legislature reconvenes in the fall. OPA will be working to relay the findings of this study to the members of the Ohio General Assembly.
Medicare Rx Discount Card Initiative: Ohio's Pharmacists Must Act!
In the month since President Bush announced his plan to create a discount prescription drug card program, community pharmacy has been voicing its strong opposition to this program to the White House and to members of Congress. Nonetheless, there is still much confusion about the "specific details" of the program. In mid-August, The Pharmacy Care Management Association (PCMA), the organization that represents the pharmacy benefits manager, issued the first document regarding the administration's discount card program. PCMA carefully crafted its announcement that contained information about how much money seniors will save from their discount card program. Needless to say, the administration needs to keep receiving phone calls, letters and e-mails explaining the problems associated with the plan that was devised in secret with the PCMA. The important question still remains as to HOW the rebates will be trickled down to the seniors, as the administration has stated.
The plan, intended to make drugs more affordable for seniors, will rely on PBMs to secure discounts at the point-of-sale from pharmacy providers. Bush plans to have this proposal available to all seniors by early next year and is stating that he believes these cards will provide 10 to 25 percent discounts in retail settings and 30 to 40 percent discounts on generics through mail order services. Other provisions stated by the administration include a nominal fee of no more than $25, allow beneficiaries to enroll in only one plan at a time with the flexibility to switch plans on a semi-annual basis. NACDS/NCPA filed a preliminary injunction against the President's prescription drug discount card plan. August 31, 2001 was the deadline for discount card providers (PBMs) to submit applications to be endorsed as providers. The administration has stated that they plan to announce the endorsements for this program on September 21, 2001.
Ohio's plan, House Bill 4, was on hold temporarily during the summer months. The Ohio Legislature reconvenes this month and hearings may continue on the state proposal for discount drug cards for Ohio's seniors. Please contact your state and federal representatives regarding President Bush's Discount Drug Card proposal!
Drug Reimportation Issues
The U.S. House of Representatives passed a bill that will allow individuals to purchase their prescriptiondrugs in certain other countries. OPA has strongly objected to this provision. While technically this practice is currently not allowed, some Americans are doing it anyway. The bill's future in the Senate or with the President is unclear. However, the bigger aspect of reimportation, allowing pharmacies to purchase prescription drugs from other countries, was virtually put to rest indefinitely as the U. S. House defeated an amendment to allow commercial reimportation.
Patient Access Legislation
Two bills have been introduced in the Ohio General Assembly, Senate Bill 55 (Senator Lou Blessing) and House Bill 265 (Representative Merle Kearns). These bills allow patients to choose an out-of-network provider for their health care services. Those patients who utilize this service will be required to pay a "consumer portability surcharge" for going out-of-network that would be paid to the provider. Under the current bills, patients will pay a 4 percent surcharge to see an out-of-network pharmacist. In many cases patients are losing relationships with their pharmacist or other health care provider when their employer changes insurance companies and they can't afford to continue that relationship. In some rural areas of Ohio, patients aren't given the choice of a pharmacist in their community, but rather one who is 50 miles away. These bills will alleviate these situations by allowing the patient the option of choosing a pharmacist who may not be on their insurance plan's provider network. Both SB 55 and HB 265 have each received one hearing in their respective insurance committees. OPA is a member of the Patient Access Coalition, along with many other provider groups, that is strongly supporting this legislation.
Insurance Fraud Bill
Senator Lynn Wachtmann, Chair of the Senate Health Committee, recently introduced Senate Bill 137. This bill would require anyone convicted of insurance fraud in connection with policies, contracts and agreements of health care, to make restitution to the health-insuring corporation. The bill also requires the amount of the restitution to include reimbursement for reasonable attorneys' fees and investigative costs. Sen. Wachtmann's office stated that this issue was brought to their attention by the insurance industry that stated that when providers are convicted of insurance fraud, they are currently not required to pay the money back to the health insurance company. Current law allows a judge to decide the amount, and the insurance companies are not happy with that situation. SB 137 has not received any hearings yet. OPA has strong concerns about this bill, since insurance companies could put large financial burdens on pharmacies.
The Health Care Workforce Shortage Task Force Created
Within House Bill 94, the state budget bill, the Health Care Workforce Shortage Task Force was created. The pharmacist shortage is one of the targets of this provision. The Task Force has been given the duty of studying the shortage of health care professionals and health care workers in the health care workforce, and to propose a state plan to address the problem. The Task Force will consist of four legislative members, as well as members from several health care organizations, including OPA. Members will be appointed by the Director of Health, and will serve without compensation. The Task Force is required to submit its findings and recommendations to the leaders in the Ohio Senate and Ohio House of Representatives later than July 1, 2002. Several issues must be addressed according to law, including: the review of licensing standards; strategies to increase recruitment, retention, and development of qualified health care professionals in health care settings; recommen-dations for improving scopes of practice to remove unnecessary barriers to high quality health care; possible demonstration projects to present technology's potential to increase efficiency; and education strategies to meet health care workforce needs. After submission of their report, the Task Force will cease.
Ohio General Assembly Reconvenes This Month!
The Ohio General Assembly is returning from summer break this month to a full agenda. Hopefully, you had an opportunity to talk with your state senator or state representative at your local county fair or another summer event! Ohio legislators are now finished with the state budget and will be focusing on many other pieces of legislation, many of which affect pharmacy! Keep pharmacy's voice strong by maintaining or obtaining a relationship with your elected officials!
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