October Legislative Update
Kelly Vyzral, Director of Government Affairs
It's October and that means the legislature is back to business for two months before their holiday break and the start of "the silly season," better known as campaign season.
HB 66: Budget Bill
We have already seen several issues of importance to pharmacists race to the forefront; the most important being the Medicaid reimbursement cut that was passed in the HB 66, the Budget Bill. Your Medicaid reimbursement for product cost fell from WAC + 9% to WAC + 7% effective on October 1, 2005. The new co-payment requirement is scheduled to become effective on January 1, 2006. The structure is as follows:
- $3.00 co-payment for non-PDL drugs;
- $2.00 on branded drugs on the PDL;
- no co-payment for generic drugs on the PDL.
Sub. S.B. 53: Pseudoephedrine Sales
Currently the bill requires that:
A violation of this law is the offense of "unlawfully selling a pseudoephedrine product," a misdemeanor of the first degree "on a first offense" and a felony of the fifth degree on each subsequent offense.
We have met with the sponsor of the bill, Sen. John Carey, as well as the chairman of the Senate Judiciary, Criminal Justice Committee, Sen. Jim Jordan, and made several suggestions that we feel will make the bill better legislation, while at the same time making it easier and less costly for pharmacists to comply.
S.B. 154: P.A. Prescribing
Sponsored by Sen. Lynn Wachtmann, this bill was introduced in June. This bill would give physician assistants (P.A.) physician-delegated prescriptive authority. This bill was introduced last General Assembly as well, but died in committee. The sponsor and interested parties made changes in the formulary, and added more stringent educational requirements to shore up support for this bill. OPA is opposing this bill because of a provision that allows advanced practice nurses (APNs) to provide complete or partial supplies of drugs and therapeutic devices on their formulary directly to patients. The bill also lifts restrictions on the locations where the supplies may be furnished, and specifies that the supplies are to be provided only when pharmacy services are not reasonably available, when it is in the best interest of the patient, or when it is an emergency.
Ohio Best Rx program
The prescription drug discount program for the uninsured has thus far failed to meet expectations. Only 34,000 persons have signed up for the program since January, compared with the 100,000 which supporters had anticipated, so lawmakers are considering expanding the program. The Coalition for Affordable Prescription Drugs has proposed a three-prong approach to expand the program.
a. increasing the income threshold from 250% to 300% of the federal poverty level. Such a change would mean a family of four making up to $58,068 a year could qualify for the discounts, making an additional 101,000 persons eligible to participate;
b. covering otherwise eligible people whose only insurance coverage for drugs is workers' compensation, as well as individuals who are temporarily or permanently discharged due to business downsizing, "rightsizing," relocations or other management decisions;
c. permitting Medicare beneficiaries to use Best Rx for drugs that are not covered or discounted by their Medicare plan;
d. permitting ODJFS to develop certification systems to enable online and telephone enrollment processes.
a. permitting ODJFS to establish a process for referring eligible Best Rx enrollees to patient assistance programs operated by participating manufacturers, which may provide free prescriptions for some drugs;
b. requiring the full amount of manufacturer rebates to be passed on to Best Rx enrollees, instead of retaining a portion to pay the state's administrative costs.
a. State programs that meet federal criteria for exclusion from Medicaid financial requirements generally have obtained better discounts from manufacturers. One criterion for exclusion relates to the state's contribution. The proposed amendment to Best Rx assures an ongoing state contribution of administrative funds.
OPA opposes the expansion of the income threshold for the Best Rx program. As we predicted from the beginning, the market is saturated with discount programs, several providing better discounts than Best Rx. Also as predicted, pharmacies have provided an overwhelming majority of the savings that the program has provided. Since the program's inception, pharmacies have provided $1.648 million, while brand name manufacturers, who were a major force behind not only this program but now the expansion of the program, have provided a meager $147,000. We will continue to fight expansion of this program on the grounds that it is unnecessary and that the program unfairly sits on the shoulders of pharmacists, and will do so to an even greater extent if it is expanded.
If you have any questions or comments, contact Kelly Vyzral, Director of Government Affairs, at 614.586.1497 or email@example.com.
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