November Legislative Update: AFL-CIO Rx Program Update
Freedom of Access, Uniform Rx Drug Card, Diabetes Coverage
Legislative Update November 2003
Kelly Vyzral, Director of Government Affairs
As predicted, the summer hiatus ended and the fall legislative session began with a bang. The end of September brought the roll-out of the Governor’s long awaited “Golden Buckeye Prescription Drug Card Program.” In answer to the Governor’s program, a coalition including PhRMA (Pharmaceutical Research and Manufacturers of America) and the AFL-CIO proposed their own prescription drug program called “Ohio’s Best Rx.” It should be noted that there was no pharmacy participation in the formation of this program, and as you can imagine, it is wrought with problems for pharmacists. November promises to be a busy time as legislators try to finish up business before the December holiday.
New Legislation
HB 253, the Freedom of Access.
As reported in the October issue, Rep. Tom Patton has introduced HB 253, the Freedom of Access bill. This bill would allow nonparticipating pharmacies to enter into contracts if they will accept the same terms and conditions. It would also require equal co-pays, equal days supply, and open access to any pharmacy. The bill was recently assigned to the House Health Committee. Because state employee health plans require mail order, your state representative and state senator may not be able to patronize your pharmacy...call them and let them know this is important and it concerns
them. If you have any examples of inconvenience, loss of business, or danger to patients due to loss of choice, please contact Kelly Vyzral at OPA at 614.798.0037 or
kvyzral@ohiopharmacists.org.
SB 43, the Uniform Rx Drug Card.
Another piece of legislation that we have been following is SB 43, the Uniform Rx Drug Card legislation. This will allow one card to be used for insurance as well as prescriptions. There will be a substitute bill introduced soon that will bring medical information into the language. We will keep you updated on the progress of this legislation.
HB 146, Diabetes Coverage.
The House Health Committee held its fourth hearing this legislative session on the Diabetes Cost Reduction Act (DCRA), House Bill 146. Representative Michelle Schneider publicly requested that Chairman Jolivette bring HB 146 up for a vote at the next meeting of the House Health Committee. Opponents of the bill offered testimony that this legislation would be too costly and that Ohio health plans already provide coverage for diabetes under a pharmacy rider. Chairman Jolivette indicated that the Diabetes Cost Reduction legislation would receive a committee vote before the end of the calendar year. We will continue to update you as the process continues.
“Ohio’s Best Rx” Prescription Drug Program.
HB 311 and SB 138, is the result of negotiations between PhRMA, AFL-CIO and other advocacy groups; no pharmacy representatives were present during these negotiations. This program would include anyone at or below 250 percent of poverty and anyone over the age of sixty, regardless of income. As introduced, this legislation would do the following:
.Set your reimbursement on this formerly cash business at a $3.00 fee and the average reimbursement from state employee plans.
.Fee cannot go higher than Medicaid.
.Charges the 5 percent administrative fee to pharmacists.
.Doesn’t require electronic claim submission.
.Sets up a 12-member oversight committee: PhRMA has three representatives on the committee, pharmacy has none. All meetings, reports, etc. are secret and not subject to public records laws.
.Only updates the prices you are paid once a month, but places no restrictions on how often manufacturers can change their prices.
Our solution:
.Set the reimbursement at usual and customary minus 10 percent.
.Delete all Medicaid references.
.5 percent administration fee must come from rebate, not pharmacist.
.Need anti-coercion language.
.Add any willing pharmacy language.
.Claim submission must be electronic.
.Pharmacy must have representative on oversight committee.
.Prices updated nightly, at the very least weekly, and claims paid within two weeks.
.Prohibit PBM from charging transaction fee.
The Senate co-sponsors are Sen. Robert Spada (R-Parma) and Sen. Robert Hagan (D-Youngstown). The House sponsors are Rep. John Hagan (R-Alliance) and Rep. Dale Miller (D-Cleveland).
We encourage you to contact your legislators and tell them the bill, in its current form, is price-fixing at the retail level. Let them know how it will affect your pharmacy; remind them of the special services you offer, and the importance of pharmacists to individuals.
Future Legislation
Joint Negotiations.
We are currently part of a coalition that is working on drafting legislation to allow you to join together with other pharmacists to negotiate your contracts. This is currently illegal under anti-trust law.
PBM Regulation.
We hope to introduce legislation to regulate PBMs soon. PBMs are currently completely unregulated in Ohio. They control 70 percent of the drug benefits in the U.S. Studies have shown that regulating PBMs can lower health care costs.
Here are some of the important elements for PBM legislation:
.They must have bond money to pay claims.
.Must be licensed by the Dept. of Insurance.
.Contracts must have anti-coercion language.
.Transparency agreement should include incentive arrangements/programs, financial terms with manufacturers, and revenue sharing with mail order/internet pharmacies.
.No discrimination in contracting with pharmacies on the basis of co-pays or days supply.
.All savings must be passed on to covered entity or individual.
.Pharmacists should be paid for each drug dispensed.
.Pharmacists must have contract approval.
If you have any questions or comments, please contact Kelly Vyzral at the OPA office at 614.798.0037 or
kvyzral@ohiopharmacists.org.
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