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November Legislative Update

Medicaid Managed Care Plans, HB 524, Ohio's Best Rx Program, 2007 Def. Auth. Bill

Legislative Update
Kelly Vyzral, Director of Government Affairs

Medicaid Managed Care Plans Selected
The Ohio Department of Job and Family Services has announced that seven managed care plans were selected for the statewide Medicaid managed care program for the Aged, Blind or Disabled (ABD). There will be three managed care plans in each of the eight regions to provide services for the approximately 125,000 ABD Medicaid consumers. Enrollment of the ABD Medicaid consumers is expected to begin in December of 2006. The managed care plans in each region are as follows:
Northwest region: Anthem Blue Cross/Blue Shield, Inc, Buckeye Community Health Plan, Care Source
Northeast region: Anthem Blue Cross/Blue Shield, Inc, Buckeye Community Health Plan, Wellcare of Ohio, Inc.
Northeast Central region: Anthem Blue Cross/Blue Shield, Inc, Care Source, Unison Health Plan of Ohio, Inc.
East Central region: Anthem Blue Cross/Blue Shield, Inc, Buckeye Community Health Plan, Unison Health Plan of Ohio, Inc.
Southeast region: Care Source, Molina Healthcare of Ohio, Inc., Unison Health Plan of Ohio, Inc.
Central region: Anthem Blue Cross/Blue Shield, Inc, Molina Healthcare of Ohio, Inc., Unison Health Plan of Ohio, Inc.
Southwest region: AMERIGROUP Ohio, Inc., Molina Healthcare of Ohio, Inc., Buckeye Community Health Plan
West Central region: Anthem Blue Cross/Blue Shield, Inc, Care Source, Molina Healthcare of Ohio, Inc.

If you would like more information, go to $$Link

HB 524: Pharmacists Immunization
Sponsored by Rep. Earl Martin (R- Avon Lake), HB 524 expands the Pharmacy Practice Act in the area of immunization administration. The bill was passed unanimously by the Ohio House in May, and was assigned to the Senate Health, Human Services and Aging Committee. HB 524 would make the following changes to current statute:

1. include diphtheria, pertussis and meningitis in the list of adult immunizations pharmacists are allowed to administer;
2. allow pharmacists to administer the flu vaccine to those 14 and older;
3. allow pharmacists to administer epinephrine and diphenhydramine to a patient in the event of an anaphylactic reaction;
4. expand the list of qualified professionals able to administer vaccinations to include trained pharmacy interns acting under the direct supervision of a trained pharmacist;
5. remove the requirement for pharmacists to notify the patient's primary care physician or local Health Department within 30 days after providing the influenza immunization except in the case of persons under age 18.

We have a very short time frame to get this important legislation through the Senate and to the Governor's desk. We need to make sure the committee chairman and the members of the Senate Health Committee understand how important this legislation is to pharmacists and to the citizens of Ohio.

I would encourage all of you to contact Senate President Bill Harris and Senate Health Committee Chairman Kevin Coughlin, and urge them to schedule hearings and a full Senate vote for the bill as soon as possible given the shortened legislative season. To obtain contact information for Ohio senators, go to $$Link

We also urge you to contact all the members of the Senate Health Committee, educate them about the bill and its importance, and encourage them to vote for the bill when it comes before them in November. The committee can be found at $$Link

Ohio's Best Rx Program Expansion
The Ohio legislature is planning to move legislation expanding the Best Rx program during the lame duck session. HB 468 sponsored by Rep. John Hagan, and SB 251 sponsored by Sen. Bob Spada propose to expand enrollment in the program to 300% of poverty. OPA will continue to fight expansion of this program until the burden of the program is taken off pharmacies, and pharmacists are more fairly reimbursed. The Best Rx program is already costing jobs in Ohio. As of September 2006, the program has taken nearly $6 million in salaries and profits from our local pharmacies, while costing the brand name pharmaceutical manufacturers a mere $600,000. Meanwhile, the brand name manufacturers have increased their prices at least 7% since this legislation passed. On top of that, the "discounts" taken have come from our lower-price generics, where we were able to make some profit, and the public got low prices. Now, those prices are at rock-bottom, destroying the profitability of that part of our business. OPA has suggested the following fixes for the Best Rx program.

1. We do not support increasing the eligibility to 300 percent of poverty. That makes a government price control program for nearly our entire cash population of middle class people. The more affluent people have insurance cards, which leaves us with no cash business where we set our own prices at all.
2. We would like to propose a new formula for reimbursing pharmacists participating in the program that we feel would be fair and reasonable to pharmacy and not affect the bottom line discount that is received by program participants.

Our formula has two parts:
a) adjust the actual reimbursement and dispensing fee formula to a higher dispensing fee and higher product reimbursement;
b) increase our fee yearly on January 1 at the same rate of inflation as the manufacturers' prices for that year, thereby lifting the price controls placed on retail pharmacy at the inception of this program.

3. We strongly object to language being proposed that requires that the PBM selected be the one having the most current state business. Also, that PBM can establish the prices paid to both the local pharmacy and whatever mail order program is implemented. We see no need for any mail order program created by statute.

OPA will vigorously oppose this legislation unless changes are made within the bill to make the legislation more pharmacy-friendly. We have shouldered the burden of this program for a year, and we will not sit by and allow more money to be taken from pharmacy while everyone else involved in this program makes a profit.

2007 Defense Authorization Bill - (H.R. 5122/S. 2766) Update
The 2007 Defense Authorization Bill which contained several changes to the TRICARE Military Health System was deliberated in Conference Committee and an agreement was reached. Community pharmacy made considerable progress through the deletion of two provisions which would have negatively impacted pharmacy: mandatory mail and significantly higher retail co-pays.

  • The Senate provision requiring mandatory mail order has been stricken.
  • The House and Senate provisions that would have raised co-pays for retail have been stricken. In their place, the conference report adds a new section 708, which freezes retail co-pays until September 30, 2007. However, the conferees made a non-binding recommendation that the Department of Defense (DoD) should eliminate co-pay for generic drugs dispensed by mail order, and should create a broad range of incentives for beneficiaries to use mail order. 
  • The Senate language which authorized Federal Supply Schedule (FSS) rebate pricing for the retail pharmacy piece was also removed. However, the conference report states that this FSS pricing provision was deleted because "The conferees concluded that there is no need for additional legislation at this time because prescriptions dispensed by the Department of Defense Retail Pharmacy Program qualify for discounted drug prices under section 8126." In other words, the conferees agreed with DoD that discounted pricing should already apply to retail pharmacy under existing law.
  • Section 705 of the conference report calls for a demonstration project for coverage of select OTC drugs.

Thank you to everyone who contacted their Congressperson and educated them on the importance of military families being able to access their local pharmacy. OPA will continue to monitor the issue of unfair co-pays for retail pharmacy.

Medicare Open Enrollment Period began November 15
The Centers for Medicare & Medicaid Services (CMS) says that seniors and people with disabilities who are satisfied with their current Medicare prescription drug coverage will not have to take any action when the Medicare Open Enrollment period begins November 15, but those who wish to make a change will find new options available for 2007. In Ohio, CMS says that nearly all beneficiaries enrolled in Medicare prescription drug plans will be able to remain in the plan on which they enrolled for 2006, since almost all Part D sponsors are either continuing their current plans in 2007 or streamlining and consolidating their 2006 plans. For more information on drug plan options in Ohio, check the link below. $$Link

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

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