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"Prescription Drug Fair Pricing Act”, State Medicaid Dept. Looking at Further Cuts

Get Involved Politically !

Legislative Update
October 2002

Alyson Welsh, Director of Government Affairs

Rx Coalition Pursuing Enactment of
“The Prescription Drug Fair Pricing Act”

The Coalition for Affordable Prescription Drugs has started a petition drive to require state legislators to enact the Prescription Drug Fair Pricing Act, House Bill 290/Senate Bill 127. These bills have been pending in the Ohio House of Representatives and the Ohio Senate, and have not received any hearings and/or debate on their content. Democratic state legislators have been publicly criticizing Republican leaders in both the Ohio Senate and Ohio House for not allowing these bills to receive any time before their respective health committees. Because these bills have received little attention, the Coalition for Affordable Prescription Drugs has decided to let the voters get involved by obtaining petition signatures. Under this process, the Coalition must collect nearly 101,000 valid signatures. If this is accomplished, the 125th Ohio General Assembly will have four months to enact the legislation. The 125th Ohio General Assembly will begin January 1, 2003. If the Ohio Legislature proposes any changes to the issue, the Coalition must agree to the changes or they can’t be made. If legislation is not passed within four months, the Coalition will have 90 days to collect another 100,000 to 150,000 signatures in order to put this issue on the November 2003 ballot. HB 290/SB 127 would authorize the state to negotiate savings directly with pharmaceutical companies to receive significant savings. These proposals are similar to the law passed last year in Maine that is currently suspended pending a U.S. Supreme Court review.

Golden Buckeye Prescription Drug Card to be Available in January 2003
Since the passage of House Bill 4 by the Ohio General Assembly several months ago, the Taft Administration has been moving the process along quickly to make this discount drug card available to Ohio seniors. HB 4 allows the Ohio Department of Aging to contract with a Pharmacy Benefits Manager (PBM) to offer a prescription discount card to Golden Buckeye card holders. Seven companies responded to a request for proposals for a PBM to run the Golden Buckeye Prescription Drug Program. Those companies that submitted proposals are: Advance PCS, Argus, Express Scripts, MEDCO Health Solution Inc., Member Health, Inc., PBM Plus, Inc., and Script Solutions. A team of analysts from the Ohio Department of Administrative Services (DAS) will analyze and review all the proposals. They will select a finalist to manage the program and then go before the State Controlling Board for final approval. The state hopes to be able to have cards issued to Ohio’s senior citizens starting in January 2003. OPA will continue to follow the process and inform you when the cards will be available to seniors in your communities.

Ohio Department of Jobs & Family Services Pursuing Cost Savings Program for Long Term Care Pharmacies
The state is embarking upon an experiment in long term care pharmacy to see what cost savings are possible without compromising patient care. The Ohio Department of Jobs and Family Services (ODJFS) will be participating in the “best practices management incentive payment program” beginning July 1, 2002 and ending June 30, 2004. This two-year pilot program will then be evaluated in 2005 to determine the impact on pharmacy Medicaid costs and quality of patient care. The program will test the assumption that incentive based drug utilization management can reduce pharmacy expenditures for Medicaid consumers living in nursing home facilities. Long term care pharmacies will be able to choose if they want to participate in the program. If a pharmacy does choose to participate, and shows the state that they have saved money without compromising patient care, they will split the savings accrued with the state. This program, also referred to as the “catalyst program” is the first step in the state’s plan to minimize costs for the Medicaid budget. OPA will continue to monitor the progress of this program and will work with the Medicaid Department on the possibility of expanding the program in the upcoming year.

Ohio General Assembly Awaiting New Members
The 125th Ohio General Assembly will begin January 1, 2003 with many new members. As term limits continue to play a vital role in the status and longevity of state legislators, many legislators will be finishing out their terms this year, and many new legislators will be making their way to Columbus. The new legislature will have a full load of issues to analyze, most importantly a dwindling state budget. It is extremely important for pharmacists to maintain and/or initiate relationships with new and current state legislators in your areas. As these state legislators continue to grapple with Medicaid cuts, it is important that they realize the recent cuts that retail pharmacy has experienced and it’s important that they hear that from their district pharmacists! Please take a moment to call the OPA office to familiarize yourself with your state legislators and how you can take an active role as a constituent and pharmacist!

State Medicaid Department Looking at Further Cuts!
The Ohio Department of Jobs and Family Services (ODJFS) has already begun their research on ways to reduce their upcoming budget for 2004-05. ODJFS houses the state’s Medicaid program, now being referred to as Ohio Health Plans. The Ohio Legislature is also working with ODJFS to study and analyze recent cuts and other routes to explore as they look for ways to trim the program’s budget. The Ohio House Select Committee on Medicaid Reform was created to allow state legislators an outlet to hear about past budget cuts and possibilities for future cuts. This legislative committee is hearing from most interested parties that will be or already have been affected by the state’s dismal fiscal situation.

Ohio Health Plans is under extreme pressure to reduce costs, including those associated with pharmacy claims. As you know, retail pharmacy suffered a 2 percent reimbursement cut last year that will save the Medicaid Department an estimated $16 million. OPA has provided the department with other cost savings options, such as disease management. The department also won approval for a “prior authorization” program in last year’s budget bill. The Pharmaceutical Research and Manufacturers of America (PhRMA) has filed a lawsuit against this program, similar to their lawsuits in other states that have passed a prior authorization program for their Medicaid programs. As mentioned above, the state is also embarking upon unchartered territory by participating in the “catalyst program” with long term care pharmacy.

OPA will continue to work with the Medicaid Department and state legislators to inform them of other options for cost savings for the Medicaid program, as well as provide them information on retail pharmacies’ current reimbursements and why those need to be increased, not decreased. OPA will also continue to inform legislators and the department on the importance of retail pharmacists as an integral part of patient care and cost containment in the state’s Medicaid system.

Get Involved Politically !
Join other pharmacists and become a “key legislative contact” for your area. This is a great way to establish and/or maintain relationships with key state officials.
To register online as a Legislative Contact, $$Link,AWS_SSL:DisplayInputForm&FormID=18,CLICK HERE!$$
Or you may contact Alyson Welsh at awelsh@ohiopharmacists.org to get involved!

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, $$Link,AWS_SSL:DisplayInputForm&FormID=37, CLICK HERE!$$

For more information about the Ohio Pharmacy PAC, $$Link,www.ohiopharmacists.org/opapac.html, CLICK HERE!$$

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