Transcript Ohio Pharmacy Advocacy

Ohio Pharmacy Advocacy
Creative Commons , accessed 9-15-16
Introduction and Objectives
By the end of this presentation, the listener should be able
to :
• Identify the recent Ohio advocacy successes
• Discuss current issues for pharmacist advocacy support
• Outline the importance of corporate advocacy support
Recent Ohio Successes
Legislative Action: OPA
Perspective
Ernest Boyd, R.Ph., Pharm. D (hon), Executive Director, Ohio
Pharmacists Assn
New laws in effect from last year!
 HB 326: Pharmacists & pharmacy interns can now fit diabetic shoes
 HB 394: Pharmacists & pharmacy interns can now
 Administer all CDC-recommended vaccines to patients 13+ without a
prescription
 Administer all CDC-recommended vaccines to patients 7-12 with a
prescription
 Administer the flu vaccine to patients 7+ without a prescription
 SB 258: PBMs now must adhere to new audit guidelines
 No audits older than 2 years, no takebacks for typos or insignificant errors,
can’t use extrapolation, etc.
State Issues Of Note
 HB 4: Naloxone Dispensing
 HB 64: MAC Transparency/PBM Regulation
 HB 116: Medication Synchronization
 HB 64: MAC Transparency/PBM Regulation
 HB 188/SB 141: Consult Agreement Expansion
 HB 285: 90-day prescriptions at retail
 HB 421: Pharmacist administration of certain long-acting meds
 Limited Pharmacy Networks
 Medical marijuana
HB 4: Naloxone Dispensing
 Sponsors: Reps. Robert Sprague (R-Findlay) & Jeff Rezabek (RClayton)
 Authorizes a pharmacist or pharmacy intern to dispense naloxone
without a prescription to a person at risk of an opioid-related
overdose, or to another person in a position to assist that person if
the drug is dispensed in accordance with a physician’s protocol.
 Passed House & Senate unanimously.
 Signed into law; effective 7/16/2015
HB 4: What now?
 Visit www.ohiopharmacists.org for information on how to dispense naloxone under the
new law.
HB 116: Medication Synchronization
 Sponsors: Reps. Tim Brown (R-Bowling Green) & Tim
Ginter (R-Salem)
 Medication synchronization (med sync) is the
process of lining all of a patient's medications to be
refilled on the same day. Patients will make a single
trip to the pharmacy to pick up prescriptions each
month, making it convenient to stay on track with
their long term medications.
 Passed House unanimously
 Signed by Governor in May, in effect 1/1/17
HB 116: Medication Synchronization
 Currently, several insurers & pharmacy benefit managers (PBMs)
refuse to cover a partial fill of a prescription for a patient, which
prohibits a pharmacist from “syncing” new prescriptions with
already prescribed medications that the patient is already taking.
 Besides benefitting patients and pharmacies, med sync can help
reduce overall health care costs by making a dent in the costs
associated with of non-adherence which are estimated to be as
high as $290 billion.
 NCPA study showed med sync boosted adherence rate by more
than 30%.
HB 116: Medication Synchronization
 Having patients pick up all of their medications on the same day also allows the
pharmacist to sit down with the patient to review all their medications and
counsel them on their regimen, which is another benefit to the patient and
makes them more comfortable with their therapy.
 OPA believes that is in the best interest of the patient to have their medications
synchronized. Increased adherence means decreased hospitalizations.
 Further, if an insurer or PBM is already covering a full month of medication for a
patient, legislators should close this loophole that allows some to avoid covering
medications that should be covered.
HB 116: Medication Synchronization
 HB 116 will give the patient the option to sync their medications at
their pharmacy.
 The med sync will be a one-time sync for a new drug added to a
regimen.
◦ The bill does not apply to schedule II controlled substances,
substances containing opiates, or benzodiazepines.
 The bill will require the insurer/PBM to cover the drugs with a prorated copay, as well as keep the pharmacy whole with their
customary dispensing fee.
HB 188/SB 141: Consult agreement legislation
 Sponsors: Sens. Dave Burke (R-Marysville) & Gayle Manning (R-North Ridgeville), Reps.
Stephen Huffman (R-Tipp City) & Nathan Manning (R-North Ridgeville)
 This bill will expand pharmacists’ capabilities to work with physicians to manage the
treatment of patients.
 This bill will eliminate much of the hurdles and red tape associated with many current
consult agreements and allow the physician the choice of tapping a pharmacist’s
pharmacological expertise to manage the drug therapy of patient with a chronic illness.
Similar to SB 240 from 130th General Assembly.
 HB 188 passed both chambers unanimously, signed by Governor Kasich in December.
HB 188: Consult agreement legislation
 Will expand pharmacists ability to have relationship with physician including:
◦ Instead of one agreement for every individual physician-pharmacist
agreement, this legislation will allow for multiple physicians to have agreements
with multiple pharmacists to manage a drug therapy under a consult
agreement.
◦ The pharmacist will be allowed to order blood & urine tests.
◦ This law will also allow pharmacists to manage & modify the medication
therapy of a patient under the guidance of a physician and only if a physician
so chooses.
 Manage & modify = remove a drug, add a drug, alter a drug
HB 188: Consult agreement legislation
 The physician is the expert on the diagnosis, and the pharmacist is the expert on
the drugs.
 With 6-8 years of doctorate level education, pharmacists receive more
pharmacological training that any other health care professional.
 This law will allow physicians to tap a pharmacist’s expertise to better facilitate
better patient outcomes.
 Pharmacists are more than qualified to take on this expanded role as a key
member of the health care team.
HB 188: Consult agreement legislation
 Also…
 The law will address emergency dispensing of medications when a patient is
out of refills on life-saving medicine.
Patient in Cleveland died last year when pharmacy didn’t dispense insulin
to him when out of refills
Physician did not call in new prescription in time
 The law will create a grace period for a pharmacist to dispense limited “refill”
of medication for life threatening disease, in the event a physician cannot be
reached.
Consult agreement legislation: What’s next?
 House & Senate passed HB 188 unanimously
 Governor Kasich signed HB 188 in December
 Effective in March 2016
 Board of pharmacy has rules
 Need health plans to cover new pharmacist services
HB 285: 90-day prescriptions at retail
 Rep. Robert Sprague (R-Findlay) introduced HB 285, which would allow
pharmacists to combine refills of non-controlled substances, in order to save
patients multiple trips to the pharmacy.
 If the patient chooses, and the pharmacist feels that it is appropriate for the
patient, this bill would allow for patients to receive larger quantities of their
maintenance medications without having to come to the pharmacy every
month.
 The bill has been referred to the House Health & Aging Committee, where it
awaits further testimony and a vote.
HB 285: 90-day prescriptions at retail
 Pros
 Added efficiency for pharmacies & lighter workload
 Improved adherence for patients
 Pharmacists should have expanded discretion to combine refills
 Cons
 Lower reimbursement for 90-day supplies
 Concern that chains could press pharmacists to combine refills
 Patients may expect 90-day supply, but pharmacist may not think it would be
appropriate
New laws in effect from last year!
 HB 326: Pharmacists & pharmacy interns can now fit diabetic shoes
 HB 394: Pharmacists & pharmacy interns can now
 Administer all CDC-recommended vaccines to patients 13+ without a
prescription
 Administer all CDC-recommended vaccines to patients 7-12 with a
prescription
 Administer the flu vaccine to patients 7+ without a prescription
 SB 258: PBMs now must adhere to new audit guidelines
 No audits older than 2 years, no takebacks for typos or insignificant errors,
can’t use extrapolation, etc.
Participate – Wherever you practice!
 [email protected]
Status of Current Legislation Affecting
Pharmacists
Rebecca A. Taylor, PharmD, MBA, BCPS
Ohio Society of Health-System Pharmacists (OSHP)
Division Director, Legal Affairs
Email: [email protected]
@RTaylorPharmD (Twitter)
Presentation Outline
• HB 523 Medical Marijuana Position Statement
• Consult Bill Rules & Operational Questions
• HB 421 Pharmacists give certain drugs by injection
▫ Sponsor: Sarah LaTourette
• SB 332 Commission on Infant Mortality-implement
recommendations
▫ Sponsor: Shannon Jones & Charleta Tavares
• SB 319 Drugs/pharmacy practice/addiction services
▫ Sponsor: Senator John Eklund
HB 523 Medical Marijuana
• The Ohio Society of Health-System Pharmacists Position Statement on the
Legalization of Medical Marijuana
• The Ohio Society of Health-System Pharmacists (OSHP) is in agreement with American
Society of Health-System Pharmacists 2011 Policy Position 1101 Medical Marijuana. The
Ohio Society of Health-System Pharmacists opposes the legalization of medical marijuana
until there is sufficient evidence to support its safety and effectiveness. It is also the
position of the OSHP that medical marijuana should be a standardized product that would
be subject to the same regulations as other prescription drug products, and OSHP opposes
the procurement, storage, preparation, or distribution of medical marijuana by licensed
pharmacies or health care facilities for purposes other than research.
• Adopted by the House of Delegates May 4, 2012
HB 523 Medical Marijuana
• Revising position statement
• Impact for Health Systems
▫ How to treat a patient that is stabilized on substance
▫ DEA impact
▫ Risk/Liability
Consult Bill Rules
• So excited—great collaboration between all organizations
• Barriers
▫ Adjudication insurance claims
▫ Credentialing and Privileging Processes in places without the
infrastructure
▫ Gaps in referring provider
HB 421 Pharmacists give certain drugs by injection
• Passed by the house in spring
• Major positives: access,
• Medications covered: long acting injectable antipsychotics
(Invega Sustenna, etc.), opioid antagonist in long-acting form for
treatment of drug addiction, hydroxyprogesterone caproate,
medroxyprogesterone acetate, cobalamin
• Also covers emergency medications for reactions
▫ Diphenhydramine, epinephrine
• Course in drug administration/BLS
SB 332 Commission on Infant Mortality-implement
recommendations
• Only covers medroxyprogesterone and hydroxyprogesterone
caproate
SB 319 Drugs/pharmacy practice/addiction services
• Technician registration
• Naloxone availability
• Suboxone clinic regulation
The Importance of Corporate Advocacy Support
Sue Fosnight RPh, CGP, BCPS
Ohio College of Clinical Pharmacy, Steering Committee Chair
Email: [email protected]
All pictures from Creative Commons , accessed 9-15-16
It takes a team
Does your place of employment have a professional
advocacy department?
•Yes
•No
•I don’t know
Have you worked with your corporate office on
advocacy issues in the past?
•Yes
•No
Why should you be involved with advocacy efforts in
your organization?
STEPS to Becoming Involved with Advocacy Efforts
in your Organization
1. If you are not a director or head of your department , work with the director or head
of the department to contact Department of Government Affairs, Government
Liaisons, or Government Relations
2. Set up meetings to discuss pharmacy advocacy issues
3. Discuss how you may help with other organizational advocacy issues
4. Follow-up with quarterly meetings?