Transcript 0508340bhanson

Karmen Hanson, MA
Senior Policy Specialist
National Conference of State Legislatures
340B Drug Purchasing: Options for States
Overview of State Rx & 340B Legislation
August 5, 2005
Over 600 bills in all 50 states.
What's new and different?
Future for states and 340B?
2005 Rx Legislation Overview
 As of late June, over 600 bills in 50 states
– Approx. 33 states PASSED legislation (a few vetoes)
– Approx. 350 bills in both 2003 & 2004
 Some familiar topics: Medicaid, SPAPs, Rx
importation, bulk purchasing, and 340B
 New topics: MMA, clinical trials, Rx
monitoring, access to brand
name Rx, and liability protection
2005 Rx Legislation Examples
2005 Rx Law Examples
 As of early July, laws include:
– 340B, access to brand name Rx, bulk
purchasing, Rx clearinghouses, Rx
discounts, Rx importation, labels, manuf.
liability, mail order, marketing, Medicaid,
MMA, PBM, PDL, pricing, Rx
recycling/reuse, subsidies, clinical trails
and wholesalers
 340B still gets attention
States & 340B = Growing!
States get creative with 340B
 States may:
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fund services
encourage or expand use
systematically evaluate options
provide loans to FQHCs for pharmacies
 2005 Law Examples: CO (vetoed), ME, NY, UT
– Bills: CA, HI, MA, MN, NM, RI
 2004 Law Examples: NM, VT
– Bills: CO, CT, KY, MD, MN, VA
 2003, etc…
State Activities Encouraging 340B
2005 340B Laws
 ME LD 1324: Establishes the Pharmacy Cost Management Council
… to develop measures to control the cost of Rx and …. research
purchasing and coordination of benefits related to maximizing use
of federal programs (Medicare, 340B)...
 NY A 7298: Implements the 340 B pharmacy savings
program. Prohibits state from reimbursing 340B covered entities
or contracted pharmacies at Medicaid price for drugs that are
for 340B outpatients. Payment must be for 340B price plus
reasonable administrative cost.
 UT HB 33: Creates a five-year pilot program for disease and
pharmaceutical management of bleeding disorders; permits
enrollees in the pilot program to participate in 340B and reporting
of costs to state.
2005 340B Legislation
 CA AB 76: Would pursue "all opportunities for the state to achieve
savings through the federal 340B program including individuals
receiving prescription drugs through state programs. It would
ensure that hospitals, clinics, and other eligible entities participate
in the program. (passed Assm. 6/2/05)
 CA AB 77: Would allow pilot project for contracting for inmate
health care to use 340B and reduce health care costs. (passed
Assm. 6/2/05)
 CO HB 1152: Would require state to “maximize Rx discounts
through the utilization of 340B” in order to receive the maximum
state budget savings. (VETOED by gov. 6/1/05)
 HI HB 1058/SB 868: Would appropriate funds to the DOH for
FQHCs and the Medicine Bank to provide pharmacy services and
supplies to low-income patients. (Did not pass by end of session)
2005 340B Legislation cont.
 MA H 2700: Would require “all programs, clinics, hospitals and
other health-related centers and entities that are eligible under
Section 340B” to participate in the federal prescription drug price
discount program, unless they demonstrate greater savings
through other purchasing. (In committee)
 MN HF 1422: Would require Hemophilia drugs to be obtained from
a 340B approved health facility. (Passed both chambers, but did
not pass conference committee)
 NM SB 11: Would expand pharmacy services in primary care
clinics. (Did not pass by end of session)
 RI S 806: Would create a coordinated pharmaceutical contracting
system or multi-state Rx program on behalf of all individuals
served or covered by state programs and expanded use of 340B
discounted pricing. (In committee)
Other 340B laws/actions: NM
 2002- SJM 35: (Memorial) Requests …. (to)
"identify all avenues to maximize prescription drug
discounts that may be achieved by using the federal
340B program.“
 2003- SB 338, now Chapter 315: Requires …
Medicaid to “identify entities that are eligible to
participate in 340B.” Range of General Fund
Savings $500,000-$1.5M.
 2004- HB 88: Ensures that all eligible entities
participate in the federal drug pricing program
under Section 340B of the federal Public Health
Service Act. Allows entities receiving greater
discounts to opt out.
More Laws: ME and CT- 2003
 Maine: Requires the Department of Human Services to
study and report to the Joint Standing Committee on
Health and Human Services the benefits that could be
recognized by the state through prescription drug discount
programs available under Section 340B of the federal Public
Health Services Act used to provide prescription drugs in
Maine.
 Connecticut: Provides loans to FQHCs for the cost of
establishing a pharmacy facility or a partnership with a
community pharmacy to serve as a centralized prescription
drug distributor for FQHCs that have established affordable
pharmaceutical drug programs for their patients. The
Commissioner of Social Services would assist any FQHC
that is applying for a loan by providing non-individual
identifying information concerning potential participants in
the affordable pharmaceutical drug program.
More Laws:
AR, MD and TX- 2001
 Arkansas HB 2498 of 2001 authorizes expanded use,
creation or designation of FQHCs to get "substantially
discounted prescription drug prices."
 Maryland HB 6 of 2001 requires the state to study the
feasibility of purchasing prescription drugs through FQHCs.
 Texas HB 915 of creates the Interagency Council on
Pharmaceuticals Bulk Purchasing, which must investigate
options for using the 340B program: ”...for better
purchasing power, including ... using rebate programs,
hospital disproportionate share purchasing, and health
department and FQHC purchasing."
 Texas SB 347 of authorizes TX to provide prescription drug
services to the prison population through the 340B program.
Establishes a contract with two university hospital pharmacy
systems that are qualified providers within the 340B
program.
States + Rx + Future = ?
 Future of state assistance plans?
 Medicare Part D? Changes coming!
 AWP  ASP = Price changes for 340B?
 States are still “in this to stay.”
 Information:
– Pharmacy Services Support Center
http://pssc.aphanet.org/
– www.ncsl.org/programs/health/drug340B.htm