Legislative UpdateKelly Vyzral, Director of Government Affairs;
Ryan Schneider, ONU Pharm.D. Candidate and OPA Extern
A new legislative year is upon us and, as expected, it has been very busy. We have already seen the introduction of four bills dealing directly with pharmacy, and of course the budget bill.
House Bill 66: the Biennial Budget, is currently being debated in the House of Representatives. Several provisions in the Medicaid portion of the budget are of major concern to the Ohio Pharmacists Association. Currently, HB 66 and rules that will be proposed by the Ohio Department of Job and Family Services (ODJFS) propose to:
Reduce reimbursement for product cost from WAC + 9% to WAC + 7%
Institute Co-pays on all Medicaid prescriptions
$3 on all non-formulary drugs
$2 on brand name drugs
$1 on all generics
Eliminate the requirement of ODJFS to conduct a Medicaid Dispensing Fee survey every two years which has helped ODJFS establish the Medicaid dispensing fee
Consolidate the 26 boards, including the Ohio Board of Pharmacy, and commissions into the Departments of Health, Commerce, and Public Safety not later than July 1, 2006
We have testified before the Human Services Sub-committee and the full Finance Committee in opposition to these proposed changes. We outlined our concerns with provisions detrimental to pharmacy in HB 66, and suggested some quick fixes that would help pharmacists immediately, such as having ODJFS switch to nightly or weekly price updates as is done with almost all other third party payers, or linking price changes from the manufacturer to the price updates done by ODJFS. More importantly, we highlighted opportunities where pharmacists could help provide significant savings in the Ohio Medicaid budget. We asked that the following savings? approaches be given serious consideration.
Language be added to the budget that would allow pharmacists to refuse service to patients who refuse to pay the co-pay after the first time, if this is the normal course of business with cash paying customers and third party payers. This would allow pharmacists to make decisions on a case-by-case basis in the course of their daily business.
Removing the $1 co-pay on generic drugs which would give incentives to Medicaid patients to use the less expensive generic drugs. Another alternative would be to require the use of generic drugs for Medicaid patients when it is medically effective and safe to do so.
Restore language to the budget authorizing the pharmacy cost survey by ODJFS, and suggest that the results of the survey be taken more seriously when ODJFS sets the Medicaid dispensing fee.
We also suggested:
The use of Step Therapy (using the most cost-effective drug first) in Medicaid prescribing;
Monthly Brand Limits (allowing only three or four brand name drugs to be used each month);
Medication Therapy Management which would reimburse pharmacists for consulting services such as eliminating duplicative and unnecessary drug therapies, modifying inefficient drug regimens and implementing safe and cost-effective drug therapies.
Access to Over-the-Counter Drugs Directly from the Pharmacist. We suggested that Medicaid develop a program to allow access to OTC medications to treat cough, cold, and flu through the advice of the pharmacist. The pharmacist would be reimbursed for time spent assessing and recommending products. This could decrease physician and hospital visits.
Therapeutic Interchange which would encourage pharmacists and doctors to work together to choose the best drug for individual patients. (See page 12.)
Please contact your state representative and senator to let them know how the implementation of copays that you cannot collect, and a cut in reimbursement, will impact your pharmacy.
Update on Current Legislation
SB 18: Compounding Legislation. Sen. Wachtmann (R-Napoleon). This legislation would allow for non-patient specific compounding. During last session, this bill was on a fast track after compromise language was agreed upon between the sponsor and the Board of Pharmacy. When SB 196 went to the House floor for a vote, Rep. Faber amended the bill to include his Conscience Clause language to the bill. When the bill went back to the Senate for concurrence, the Senate refused to concur because of the Conscience Clause language and the bill died. Sen. Wachtmann reintroduced the bill this Session as SB 18. The bill had one hearing in the Senate Health Committee, and was unanimously voted out, and is now in the House Health Committee waiting further hearings. OPA is supporting this legislation.
HB 89: Price Posting. Rep. Blessing (R-Cincinnati). This legislation would require the Board of Pharmacy to compile a list of the top 100 prescription drugs according to price, and update it every three months. Each pharmacy would then be required to post this list along with pricing information, and update the prices at least every two weeks. OPA is opposing this bill, since it will increase work and costs for pharmacies, and not produce a significant benefit for patients.
Violations of this proposed legislation would result in misdemeanor charges. This same bill has been introduced by Rep. Blessing yearly for at least the past 10 years, and each time OPA has been able to stop the bill from being passed. This year, however, the bill has taken new life, and many members of the House of Representatives Health Committee think price posting of prescription drugs is a good idea. Some Representatives even compared the pricing of prescription drugs to pricing of other consumer goods such as gas or milk. They also said that this legislation would make it easier for consumers to shop around to different pharmacies in order to cut prescription drug costs.
On Wednesday March 16, 2005, two OPA members testified before the House Health Committee in opposition to this bill. During this testimony, Tony Buchta, R.Ph., MBA of the Central Ohio Compounding Pharmacy in Columbus discussed how this proposed legislation would adversely affect pharmacies with regard to the cost and time involved in preparing and maintaining this list. He also stated that consumers would likely be confused by the list because there are many variables that determine the pricing of prescription drugs. Ryan Schneider, Pharm.D. Candidate from Ohio Northern University and current OPA extern, also testified at this hearing. He explained that this list would promote ?pharmacy-shopping,? which would be detrimental to patient care. Ryan further elaborated on the risks that patients would be taking if they received their drug regimens from multiple pharmacies. At the time of writing this article, this bill is still in the hands of the House Health Committee, where it could face more hearings, or could be voted out to the entire House of Representatives. OPA will continue to actively oppose this piece of legislation. Please contact your state representative expressing your opposition to this legislation.
SB 53: Methamphetamine Precursors. Sen. John Carey (R-Wellston), chairman of the Senate Finance & Financial Institutions Committee, introduced this legislation. The bill would require that all products containing pseudoephedrine as the only active ingredient be placed behind the counter. Purchases would be limited to two (2) packages or 6 grams, and customers would have to show a photo ID to prove they are over 18-years-old. There would be no registry requirement. There are currently no penalties in the bill, but may be added on the purchaser. Rep. Tim DeGeeter (D-Parma) has introduced HB 99, a much more restrictive and punitive bill also dealing with this subject. OPA has expressed concern about the increased time that a pharmacist would have to take to police this drug. Of course, OPA is opposed to meth labs, but would like a solution that does not inconvenience our patients or OPA members. If you have a suggestion that could be reasonable, let us know. We continue to explore options to reduce pseudoephedrine misuse, while allowing reasonable access.
SB 14: Drug Importation Program. Sen. Hagan (D-Youngstown). This bill would create the Drug Importation Program under which public employee benefit plans are permitted to purchase drugs from approved drug distributors located outside the United States, and requires the State Board of Pharmacy to adopt rules governing the Program, including rules for the approval of non-domestic distributors. OPA is adamantly opposed to this legislation.
Therapeutic Interchange. We have had a great deal of interest in the idea of pharmacists performing therapeutic interchange in community pharmacy. This practice is used extensively by hospital pharmacists in collaboration with the medical staff, and has proven cost-effective. We have met with the Rep. John White (R-Kettering), Chairman of the House Health Committee, medical association representatives, and ODJFS. We feel this could be a huge benefit, and big step forward for the profession of pharmacy in Ohio. Although we realize that not all pharmacists would be interested in participating, it would help get the most cost-effective medications to be utilized.
Pharmacist Immunization. Rep. Martin (R-Avon Lake) is interested in introducing legislation that would make certain changes to the Pharmacy Practice Act including:
adding the administration of epinephrine and diphenhydramine for emergency situations pursuant to physician-approved protocols;
adding meningitis and diphtheria (i.e., tetanus/diphtheria) to the current list of approved vaccines;
removing the 30-day notification to the patient?s family physician or Department of Health;
allowing pharmacy interns, who have completed the prescribed training and are working under the supervision of a pharmacist who has completed the training, to administer these vaccines; and
removing the word ?adult? when referring to who can receive a vaccination from a pharmacist, and add ?persons 14 years and older.? OPA strongly supports this legislation.
Freedom of Access. Rep. Tom Patton (R-Strongsville) has agreed to sponsor this legislation again this year. Under this legislation, insurance companies would be prohibited from excluding covered drugs dispensed by a nonparticipating pharmacy, as long as the pharmacy is willing to meet the terms of the insurance contract. It would also require equal co-pays, equal days supply, and open access to any pharmacy. We have spoken with Rep. Patton and indicated that this will be one of our top priorities for this General Assembly. I would look for this legislation to be introduced as soon as the budget process is finished.
Donated Drugs. This legislation would allow colleges of pharmacy to use outdated or unusable drugs for the instruction of pharmacy students. The cost of buying new drugs to use for instruction is becoming prohibitive. The Board of Pharmacy supports this practice, but has requested that it be written into law. We have contacted Rep. Sean Webster (R-Hamilton), who drafted legislation for us on this subject last session, and he indicated his interest in introducing the bill this session.
HB 6: Bioterrorism. The goal of this piece of legislation was to set guidelines for the Ohio Department of Health and other governmental entities in regards to the detection and containment of a terrorist attack involving biological agents. HB 6 was introduced in the House of Representatives in January 2003. After multiple revisions, it was signed by the Governor and took effect February 2004. The Ohio Department of Health was charged with the responsibility of writing the rules and monitoring this piece of legislation. The rules for HB 6 went into effect February 2, 2005. The following summarizes these rules as they pertain to pharmacists.
Pharmacists and pharmacies are required to report to the local health commissioner any significant changes or unexpected increases in:
1. the number of prescriptions issued for
2. the number of prescriptions issued for
medications to treat fever, respiratory or gastrointestinal complaints;
3. a spike in sales of or requests for over-the-counter medication to treat fever, respiratory, or gastrointestinal complaints.
Currently, there is no specific list of medications or antibiotics that must be reported. However, the rules leave it to the discretion of the Director of the Department of Health in conjunction with the Board of Pharmacy to create such a list at a future date.
Each pharmacy will name a person or persons working in the pharmacy to be the contact person for this rule, and provide such information to the local health commissioner. Information may be reported via telephone or electronically.
The rules indicate that failure to report such changes or increases of the medication categories listed above can result in the levying of administrative fines. In the original language of the rules, the imposition of fines was mandatory; however, OPA strongly opposed this. We were successful in that the rules as adopted indicate that the imposition of fines is at the discretion of the Director of the Department of Health. In our discussions with the Director of the Department of Health, he has indicated that he does not foresee the need to levy the fines unless absolutely necessary.
If you have any questions or comments about the bills or issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs at 614.586.1497 or firstname.lastname@example.org.
What is the Ohio Pharmacy PAC?
The Pharmacy Political Action Committee is a voluntary, nonprofit, nonpartisan organization of pharmacists who are interested in promoting good government and public health. Pharmacy PAC money contributed by pharmacists goes to help candidates who support pharmacy in Ohio. That's right, your money is used to support political clout for Pharmacy right here in Ohio!
To make a secure online donation to the Ohio Pharmacy PAC, $$Link,AWS_SSL:DisplayInputForm&FormID=37, CLICK HERE!$$