Legislative Update: ACT NOW on Medicare Prescription Drug Benefit
Uniform Rx Drug Card Introduced, OH Discount Rx Card in State Budget Bill
Legislative Update - July 2002
Alyson Welsh, Director of Government Affairs
Congress Continues to Debate Medicare Prescription Drug Benefit: Act Now !
The U.S. House of Representatives is expected to unveil the House GOP Medicare Prescription Drug bill any day. Pharmacists around the country have been contacting their representatives to express their concern on this proposal and its negative effects on community pharmacy. At publishing time, there was not a bill number associated with this proposal, as it was still in the drafting stages. When contacting your Congressional representatives, you may refer to the proposal as the “House GOP Medicare Prescription Drug Benefit.” Your representatives in the U.S. Congress will likely be voting on this proposal sometime over the summer, and they need to hear from the pharmacists in their districts about the negative ramifications a proposal like this will have on the businesses in their hometowns!
Phone calls, emails and/or letters are vital parts of the unified pharmacy voice against this proposal! Please visit the OPA website at www.ohiopharmacists.org to find out who your Congressman is and how to contact his/her office! Please act quickly and help raise the awareness about the rights for their constituents to choose a pharmacy and not be forced into mail order! Other points of discussion can be focused on the unregulated world of Pharmacy Benefits Managers (PBMs) and the low profit margins of community pharmacy! Explain to your Congressman that community pharmacy isn’t the reason for the escalating pharmaceutical costs, and that this approach to a Medicare Prescription Drug Benefit will only lower your margins as a community business while providing minimal savings to Americans!
As always, please feel free to contact the OPA office at 614.798.0037 if you would like additional information on the federal proposal.
Ohio’s Discount Prescription Drug Card
(HB 4) Incorporated in State Budget Bill !
May was a busy month for Ohio’s legislators as they grappled with how to come up with an additional $9 billion to balance the state’s budget. Along with increasing the sales tax on cigarettes 31 cents, the Ohio Legislature incorporated House Bill 4 into the budget bill, Senate Bill 261. HB 4 is the Governor’s proposal to create the Golden Buckeye Prescription Discount Card, and was introduced in the Ohio House of Representatives during Governor Taft ’s State of the State address in 2001. The specific version of HB 4 that is contained in the budget bill is the 10th version of the bill. Out of the 12 versions that had been debated, this form contains legislative language that requires the pass-through of a portion of rebate monies from the administrator of this program to both senior citizens and participating pharmacies. Additionally, the bill states that the Ohio Department of Aging is required to complete an annual survey of the program, and look at the effectiveness of the program and the cost implications on participating pharmacies.
After 18 months of extensive lobbying and negotiating on HB 4, the Taft Administration was anxious to have HB 4 enacted in Ohio. Before being incorporated in the state budget bill, HB 4 was in the Ohio Senate Health & Family Services Committee where it received hearings. The process to create the Senior Prescription Drug Card in Ohio will be a lengthy one, as rules for the program will be created by the Ohio Department of Aging, and then must be approved by the Joint Committee on Agency Rule Review (JCARR). Additionally, the State Controlling Board must approve all bids for the administration of the program before the Ohio Department of Aging can initiate the program.
Although OPA continues to oppose discount drug cards, we were successful in the adoption of the following amendments into the version of HB 4 that has been enacted. These provisions will be extremely important as the Ohio Department of Aging considers bid proposals on the program:
- “any willing pharmacy” language that will permit any pharmacy to participate in the Golden Buckeye program if they choose;
- “Strong Arm” language that prohibits the administrator of the program from threatening elimination from participation in other programs with them if a pharmacy chooses not to participate in the Golden Buckeye program;
- specific language that would prohibit the administrator of the program from using any personal information it obtains through the program to promote or sell a program or product offered by the administrator.
OPA will continue to monitor the implementation of HB 4 language in the budget bill.
The debate over what items were ultimately going to be placed in SB 261 was not open for discussion. Most of the discussions on this legislation were between top administration officials behind closed doors, often into the late evening hours. During the two-week long process, the Speaker of the Ohio House of Representatives searched for yes votes among his Republican members, while rumors circulated around the Statehouse at a fast rate. In the end, both the Ohio Senate and Ohio House of Representatives passed a bill that was signed by Governor Taft. The Governor did utilize his veto powers for several items, though none of those were related to HB 4 language.
In addition to HB 4 being included in SB 261, the bill also contains language that permits the Ohio Department of Jobs and Family Services Director to establish a supplemental rebate program under which drug manufacturers may be required to provide the department a supplemental rebate as a condition of having their drug products covered without prior approval. This proposal provides an exemption for any drugs used to treat mental illness and HIV/AIDS. Governor Taft vetoed the definition of supplemental rebate in SB 261, and stated that the inclusion of that language would hinder the Ohio Department of Jobs and Family Services’ ability to create the most comprehensive program for the state.
Lastly, SB 261 contains a provision that authorizes the Ohio Department of Jobs and Family Services to examine instituting a co-payment program under Medicaid. The Department will examine federal restrictions on co-payments and analyze if a co-payment program would reduce inappropriate use of medical goods and services in Ohio’s Medicaid program.
Uniform Prescription Drug Card Introduced !
Ohio State Senator Robert Spada (R-Parma) introduced Senate Bill 271, the Uniform Prescription Drug Card legislation. He also presented sponsor testimony on the bill to the Ohio Senate Health & Family Services Committee. SB 271 requires that the following information be contained on any insurance card if it is required for the proper adjudication of a claim:
- the health insuring corporation’s name;
- the enrollee’s name, group number and identification number;
- a telephone number for pharmacy-related inquiries;
- the issuer’s international identification number or ANSI BIN” number, labeled as “RxBIN;”
- the processor’s control number, labeled as “RxPCN;”
- the enrollee’s pharmacy benefits group number if different than the enrollee’s medical group number, labeled as “RxGrp.”
Under SB 271, health insurance companies can issue “stickers” to update their insurance cards, and would not be required to issue cards more than once every year. This legislation was modeled after the Indiana law. OPA has been working behind the scenes with other pharmacy groups and representatives of the insurance industry to create a proposal that will gain quick approval by the Ohio Legislature. The Ohio Senate Health & Family Services Committee will continue hearings on SB 271 when they reconvene.