July Legislative Update: Federal and State Issues
S. 1058 and H.R. 1971: Pharmacy Competition and Consumer Choice Act of 2011
S. 1058 was introduced by Sens. Mark Pryor (D-Ark.) and Jerry Moran (R-Kan.). A companion measure, H.R. 1971, was introduced in the House by Reps. Cathy McMorris Rodgers (R-Wash.).
S. 1058 and H.R. 1971 would:
give patients a true choice of pharmacy by protecting them from having limited access or being financially punished for having their prescriptions filled at a community pharmacy rather than one owned by their plan’s PBM;
allow legitimate oversight for fraud, not abusive pharmacy audits conducted by commission-driven bounty-hunters over minor typographical or clerical errors;
help eliminate wasteful pharmaceutical spending generated by PBMs switching patients to costlier drugs, hoarding manufacturer rebates, and billing plans inflated amounts for prescription claims;
level the playing field among pharmacies by allowing “any willing provider” that agrees to accept a health plan’s terms and reimbursement rates to participate in that plan.
H.R. 1946: Preserving Our Hometown Independent Pharmacies Act of 2011
Introduced by Rep. Tom Marino (R-Pa.), this legislation would allow groups of independent community pharmacies an antitrust exemption to negotiate contract terms with health plans and PBMs.
H.R. 1936: Medicare Access to Diabetes Supplies Act
H.R. 1936 was introduced by Reps. Aaron Schock (R-Ill.) and Peter Welch (D-Vt.). The legislation would exempt most independent community pharmacies from the Medicare competitive bidding program for diabetes testing supplies. The bill also permits small, community pharmacies with 10 or fewer locations to continue providing home delivery of these products without them being subject to the future national mail order competitive bidding program.
H.R. 891 and S. 274: Medication Therapy Management Benefits Act
H.R. 891 and S. 274 would improve access for seniors to MTM benefits by lowering the eligibility criteria. This bill would also:
allow a senior suffering from any chronic disease that accounts for high spending in the Medicare program, and first time dual-eligibles and individuals in transitions of care, to be eligible for MTM services;
improve patient choice by allowing Medicare beneficiaries to use the pharmacy of their choice so long as the pharmacy has agreed to participate;
address payment and quality by ensuring that drug plans reimburse pharmacies and other qualified MTM providers based on the time and resources necessary to provide MTM care.
House Community Pharmacy Caucus
NCPA has reported that the House has reestablished the caucus to protect constituents’ access to the vital medication counseling and other health services that local pharmacists provide. Second, the caucus will preserve and expand the role that pharmacists can play in the health care system to improve outcomes and lower costs. The caucus will be a venue for members of Congress and their staff to exchange ideas and pursue legislative and other solutions toward those ends.
In addition, Sen. Jerry Moran (R-Kan.) is continuing to work on establishing the first ever Senate Community Pharmacy Caucus.
Please ask your member of Congress to consider joining the Congressional Pharmacy Caucus.
Prescription Transfer Rule Change
The Ohio Board of Pharmacy has made a change to the prescription transfer rule that went into effect January1, 2011. On January 1, 2011, the Board of Pharmacy changed the prescription transfer rule to allow for only one transfer of a prescription, both control and non-control. The change was met with resistance from both consumer groups and pharmacists. The Board has reconsidered the new language and has decided to change the prescription transfer rule back to the original language allowing for unlimited transfers of non-controlled substance prescriptions. The new language took effect on June 16, 2011.
Congratulations Rep. Burke and Rep. Terry Johnson on Pain Clinic Regulation
Governor Kasich signed HB 93 into law May 20, 2011. Congratulations to Rep. Dave Burke and Rep. Terry Johnson on this important piece of legislation. HB 93 requires prescribers to check OARRS before dispensing a controlled substance; creates a $150 Terminal Distributor License with a Pain Management Clinic classification; defines “pain management clinics” with an exemption for hospitals, medical and dental schools, and hospice; requires that all pain management clinics be wholly owned by a physician or physicians; authorizes the State Board of Pharmacy to suspend a terminal distributor license if there is clear and convincing evidence that the provider presents a danger of immediate and serious harm to others; prohibits prescribers from dispensing controlled substances that exceed a 72-hour dosage; restricts prescribers’ ability to dispense controlled substances that exceed 2,500 dosage units in any 30-day period; requires Medicaid recipients who are found to have obtained drugs that are not medically necessary to fill prescriptions at a single pharmacy.
We are currently awaiting rules from the Board of Pharmacy. It is expected that the rules will address when pharmacists must check OARRS when filling a prescription for a controlled substance.
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 email@example.com.