December Legislative Update: Dispensing Fee Decrease & HB 293
Dispensing Fee Decrease Update
Effective January 1, 2010, your reimbursement fee under Medicaid will drop from $3.70 to $1.80.
Effective February 1, 2010, pharmacies in Ohio will become responsible for Medicaid co-pays.
The managed care companies did not collect these co-pays, but ODJFS has indicated to us that they intend to collect co-pays. Federal law states that Medicaid patients may simply indicate that they do not have the copay and we must still provide the drug. In Ohio this equates to $3 for brand name drugs and $2 for non-formulary drugs.
The State instituted co-pays in the 2005 budget. At that time, OPA was successful in adding Right of Refusal language which allows pharmacists the right 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.
Please contact your state representative and state senator, and let them know how this will affect your pharmacy, your employees, and the services you offer. OPA continues to fight for your dispensing fee on both a state and federal level, but it is crucial that pharmacists engage their legislators to help in this fight.
HB 293: Assistance for Pregnancy Prevention
Primary Sponsor: Rep. Tyrone Yates
In regards to pharmacy, this legislation would require a pharmacy that stocks contraceptives to ensure that the contraceptives are made available without delay when requested by its customers. Under the bill, without delay refers to a pharmacy providing contraception, providing a referral for contraception, ordering contraception, or transferring the prescription. If the contraceptive is not in stock and the pharmacy in the normal course of business stocks contraception, the pharmacy must offer the customer the following options:
(1) If the customer prefers to obtain the contraceptive through a referral or transfer, the pharmacy must locate a pharmacy of the customer's choice or the closest pharmacy confirmed to have the contraceptive in stock, and refer the customer or transfer the prescription to that pharmacy.
(2) If the customer prefers to order the contraceptive through the pharmacy, the pharmacy must obtain the contraceptive under the pharmacy's standard procedure for expedited ordering of drug products and notify the customer when the contraceptive arrives.
Exceptions. The bill allows a pharmacy to refuse to provide a contraceptive to a customer in any of the following circumstances:
(1) if it is unlawful to dispense the contraceptive to the customer without a valid, lawful prescription and no such prescription is presented;
(2) if the customer is unable to pay for the contraceptive;
(3) if the pharmacy employee refuses to provide the contraceptive on the basis of professional judgment, which the bill defines as the use of professional knowledge and skills to form a clinical judgment in accordance with the prevailing medical standards.
Penalties. The bill permits a person to file a complaint with the State Board of Pharmacy. If the Board determines a violation occurred, it must impose a fine of not more than $5,000 for each violation. The bill also permits the Board to use its existing authority to take disciplinary actions against the individual's license to practice pharmacy.
Attorney General Actions. The Attorney General is authorized by the bill to commence a civil action to force compliance. In such action, the court is permitted to award compensatory damages and punitive damages, not exceeding $5,000 for each violation.
There is quite a lot of work to be done on this bill. While OPA feels that it is important that patients have access to legally prescribed medications, we feel that this bill undermines the professional and business judgment of the pharmacist. We will fight to have all fines taken out of the bill.
Updates on HB 267 (Ohio Official Prescription Program), SB 119 (Pharmacy Reporting of Suspected Dispensing Errors) and SB 154 (Pharmacy Relationship) may be found in the November 2009 Ohio Pharmacist journal and on the web at www.ohiopharmacists.org.
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 firstname.lastname@example.org.