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Oct. Leg. Update: Prompt Pay Prov., OH Rx Pad Program, Cancer Protection, PBM Regulation & more

Kelly Vyzral, Director of Government Affairs

Although the legislature is back in Session officially, they will not be spending much time in Columbus.  The election is fast approaching and the candidates will be spending most of their time in their districts campaigning.  This is the perfect time to invite them into your pharmacy to see what you do and how important you are to the health care system. 

Prompt Pay Provisions Taking Effect for Pharmacy
A provision in HB 1, the budget bill, requires third party payers to pay claims for health care services to a provider electronically when the third party payor receives the claim electronically.  This provision will become effective on October 16, 2010.  You should be receiving communication from the third party payors you contract with requesting information that will allow them to pay you by electronic funds transfer (EFT).

HB 267:  Official Ohio Prescription Pad Program
This bill, sponsored by Rep. Clayton Luckie (D-Dayton), would require prescribers to use an official Ohio prescription form, purchased from the Board of Pharmacy, when writing prescriptions.  Prescribers would pay $250 each year.  This would cover computer maintenance and prescription pads.  The legislation would require pharmacies to enter a serialized prescription number every time a prescription is filled, and would require additional computer software to scan prescriptions and send the information to a database.  OPA opposes the computerization, or any part of the bill that would require the pharmacist to input a serialized number in order to fill the prescription.

HB 453:  Insurers to Provide Written Notice of Changes
HB 453 requires insurers to provide prior written notice to network health care providers and covered persons before changing the drug benefit formulary. It has had sponsor testimony and proponent testimony. It is important to note that the sponsor of the bill, Rep. Boyd, is also the chairperson of the House Health Committee where the bill is being heard. We have requested that the language regarding interchanging prescription drugs be removed from the bill. OPA would be interested to hear if you think this type of regulation would make your job as a pharmacist easier. The bill is meeting with the usual objections from PBMs and health plans, but has strong support from drug manufacturers and patients of transplants, chemotherapy, and other very high cost drugs.

HB 237:  Cancer Protection Bill
Sponsored by Rep. Newcomb, HB 237 ensures equal health insurance coverage for oral and IV chemotherapy drugs and the procedures insured persons are required or permitted to use in acquiring certain non-self-injectable and compounded medications.  Many existing insurance plans disadvantage oral chemotherapy drugs that fall into the plan’s prescription drug program.  The bill would prohibit insurance companies from requiring a patient to directly receive or obtain their dangerous, non self-administrable drugs from a retail pharmacy or through the mail.  This bill has had sponsor testimony as well as proponent and opponent testimony.  It has a companion bill in the Senate, SB 133, which was introduced by Sen. Gillmor.

SB 133:  Cancer Protection Bill
SB 133, sponsored by Sen. Gillmor, is a companion bill to HB 237 (above). This bill has had sponsor testimony as well as proponent and opponent testimony. 

SB 154:  To Regulate PBM Relationships
Sponsored by Sen. Patton, this bill would require a PBM, that has a relationship with a retail pharmacy, to guarantee a firewall between the PBM and the pharmacy that would prohibit inappropriate information sharing.  It would also require the PBM to have a non discriminatory policy in regards to other pharmacies.  SB 154 had sponsor testimony in the Senate Health Committee. We are looking forward to further hearings and the opportunity to bring forward pharmacists to testify to the damaging effects of this PBM policy.

SB 277:  Medicaid Reimbursement Rate
The Medicaid reimbursement rate for estimated acquisition cost pharmaceuticals, the Medicaid dispensing fee, and the number of brand name drugs available at one time under the Medicaid program without prior authorization are all included in this bill. Sponsored by Sen. Jones, this legislation would require:

•the Ohio Department of Job and Family Services (ODJFS) to conduct an annual cost of dispensing survey, conducted by an educational institution, to determine the actual cost to pharmacies to dispense Medicaid prescriptions;
•require ODJFS to amend the Medicaid rules within 90 days of the completion of the survey to set the dispensing fee at a rate equal to the actual cost to dispense Medicaid prescriptions as determined by the survey;
•restore the dispensing fee to $3.70 until the survey is completed;
•require ODJFS to initiate a four brand name prescription limit for Medicaid recipients.
•allow for an override of the four brand name limit using proper prior authorization procedures;
•require ODJFS to update the product price component of the Medicaid reimbursement formula within 24 hours of changes to a manufacturer’s price for a drug, so reimbursement is based on the actual current cost to purchase the drug.

SB 277 was assigned to the Senate Health Committee but had not had a hearing.

If you have any questions or comments about the issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs, at 614.586.1497 or kvyzral@ohiopharmacists.org.


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