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February Legislative Update: 132nd General Assembly in Review

132nd General Assembly in Review

Three key pharmacy bills that were in the process of advancing through the legislature at the end of 2018 landed on the desk of Governor John Kasich and were signed into law! Those bills (SB 119, SB 265, HB 101) add to other impressive pharmacy-related legislation that became law during the 132nd General Assembly. Let’s take a look back, where we made significant progress on PBM reform, pushed back on several harmful bills, and got most of our high-priority bills signed into law!

Successful Legislation

HB 101: Epinephrine Accessibility Act

On January 7, Governor John Kasich signed HB 101, sponsored by Representative Derek Merrin, which better utilizes pharmacists to ease access barriers to epinephrine auto-injectors. It allows pharmacists to substitute a prescribed, brand-name epinephrine auto-injector with a pharmaceutically equivalent epinephrine auto-injector. For example, if a physician prescribes EpiPen that can retail for more than $600, a pharmacist could substitute a less expensive brand alternative, with the patient’s consent, that can cost hundreds of dollars less and still meet the patient’s pharmaceutical needs. Epinephrine auto-injectors are not substitutable from brand to brand under current state law in most instances.

The second part of HB 101 enables pharmacists to dispense epinephrine auto-injectors to adults 18 years of age or older without a prescription, under a physician’s protocol, once the pharmacist establishes that the patient has already received an initial prescription for epinephrine. So essentially, once a patient gets an initial prescription for epinephrine, as an adult, he/she would not need to contact the physician annually for a new prescription.

“In my practice, I encounter patients on a daily basis who cannot afford their medications. Patients commonly tell me they are going without medications or taking less than the prescribed amount of medication to try to make their medications last longer,” said OPA member Kelli Barnes, clinical pharmacist at The Ohio State University Wexner Medical Center Department of Internal Medicine. “HB 101 is excellent legislation. It decreases cost for patients and the healthcare system, and it increases access to life-saving medication.”

HB 286: Palliative Care Commission

On December 18, Governor Kasich signed HB 286, sponsored by Representative Sarah LaTourette, which made several reforms intended to improve access to quality palliative care in Ohio. Those reforms include enhancing identification of patients and residents who could benefit from palliative care, authorizing hospice care programs to provide palliative care in their inpatient facilities or units to non-hospice patients, and creating the Palliative Care and Quality of Life Interdisciplinary Council.

OPA was successful in securing a spot for a palliative care pharmacist on the Council, which will issue recommendations to the legislature and state agencies on how to expand access to palliative care for Ohioans. These recommendations will likely become rules and laws in the future, making a pharmacist’s voice on the Council incredibly important.

“The healthcare landscape is changing. We are transitioning from volume-based care, to value-based care. Palliative care fits very nicely in the model of value-based care, and expanding access and knowledge around what can be offered is important,” said OPA member Jessica Geiger-Hayes, palliative care clinical pharmacist at OhioHealth Riverside Methodist Hospital. “HB 286 will create a serious focus for increased access to quality palliative care for patients in the state of Ohio.”

SB 119: Naltrexone Access Expansion

On December 19, Governor Kasich signed SB 119, sponsored by Senators Bob Hackett and Jay Hottinger, which ensures access to the addiction treatment drug naltrexone. The legislation was a replica of HB 167, which was sponsored by Representative Jay Edwards.

The impetus for SB 119 was to ensure that patients who are stabilized on Vivitrol (long-acting naltrexone) are not left stranded if access to a provider is compromised or difficult. First, the new law will track oral and long-acting naltrexone in OARRS so that pharmacists can verify treatment. Upon verification of treatment, SB 119 will allow pharmacists to administer Vivitrol without a prescription in instances of gaps in care. Additionally, if the pharmacist does not have Vivitrol in stock, or if administration is inappropriate, the pharmacist can dispense a five-day supply of oral naltrexone in times of patient need or to bridge the patient to their next injection.

“With limited access for Vivitrol, SB 119 is a common sense reform to ensure that no patient is left without options when seeking the treatment they need to stay sober and safe,” said OPA Past President Jeff Bartone, president of the Hock’s Pharmacies in the Dayton area. “Ohio is leading the way on new innovative methods for pharmacists to fill gaps in patient care.”

SB 265: Pharmacist Provider Status

On January 4, Governor Kasich signed SB 265, sponsored by Senator Matt Dolan, which formally recognizes pharmacists as providers in Ohio law.

OPA worked extensively with lawmakers and stakeholders to evolve the perception of the profession of pharmacy beyond its traditional roles in order to reflect its more service-oriented value. Now, with SB 265, we have changed key provider definitions and insurance laws to catch up to the growing role of the pharmacist.

The impetus for better utilization of all members of the healthcare team has never been greater. Ohio suffers from an alarming list of medically underserved areas, and physician shortages are expected to worsen in the coming years. As the demand for healthcare services grows, the need for tapping into “physician extenders” and the full healthcare team increases exponentially.

The role of the pharmacist has evolved considerably in recent years. While the scope of practice has increased, barriers to effective utilization of pharmacists in the field persist. Much of the barriers are due to old laws, antiquated billing models, and regressive attitudes on healthcare delivery. But enactment of SB 265 is a significant opportunity to change this. In light of the opioid crisis, increased costs associated with chronic disease, and growing behavioral health demands, SB 265 will help knock down the barriers that have stood in the way of health plans, hospitals, and healthcare teams from integrating and utilizing the pharmacist’s expertise.

“The signing of SB 265 is a landmark victory for the profession of pharmacy,” said OPA President and University of Findlay College of Pharmacy associate professor Ryan Schneider. “This begins the next chapter in the evolution of the profession as pharmacists will now be recognized as providers of healthcare in the State of Ohio, and compensated for cognitive services. I would like to thank OPA members, OPA staff, and various leaders in the profession for their efforts in providing testimony and lobbying support to make this possible. This brings us one step closer to more fully recognizing the value of pharmacists as integral members of the healthcare team.”

Neutralized and Defeated Legislation

The following pieces of legislation as introduced had varying degrees of inappropriateness for patient safety or pharmacy practice. Ultimately, we were able to erode language to neutrality or defeat.

HB 73 required ID checks and tracking of all sales of dextromethorphan.

HB 231 required pharmacists to dispense all controlled substances in locking prescription vials.

HB 642 required tracking of all purchases and sales of diabetic testing strips, and would have required special ordering procedures, that if not followed, would have resulted in actions against pharmacist licenses.

HB 689 and SB 16 added new, niche continuing education mandates on pharmacists.

SB 253 resurrected key flawed proposals from the Ohio Drug Price Relief Act that would have compromised pharmacy economics even further.

What about all the PBM stuff?

In 2018, OPA was victorious when the Ohio Department of Insurance used their regulatory authority to issue emergency edicts prohibiting PBM co-pay clawbacks and gag orders at pharmacies. These actions were in large part due to our public relations efforts to shed light on the harmful practices, as well as the instrumental work of Representatives Scott Lipps and Thomas West. We plan to codify these provisions and others through legislation in 2019.

Additionally, OPA was extremely successful in setting off what has now become a national movement for PBM reform in state Medicaid managed care programs. OPA’s work to expose spread pricing profiteering in cooperation with reporters at The Columbus Dispatch resulted in a series of unprecedented actions: a complete audit of pharmacy claims from April 2017–March 2018, a shocking discovery of $224 million in hidden PBM pricing spreads, immediate termination of all PBM contracts to institute complete PBM transparency requirements, and an explicit prohibition on spread pricing that took effect January 1, 2019.

While all of these reforms were necessary and positive, we believe that the state still needs to complete the fix by instituting a standardized payment methodology, a set-pricing floor, and a pathway toward value-based payments. With pharmacy closures increasing and further reductions in pharmacy staffing resources, fixing the Ohio PBM problem will be OPA’s #1 goal in 2019.

In all, it was a fantastic 132nd General Assembly, and our members should be proud of all the work they did to help advance these important legislative priorities. We’re not going to stop there. OPA is already busy fine-tuning our efforts for the 133rd General Assembly, and we hope you’ll continue to support our work through your membership, PAC donations, Legislative Defense Fund (LDF) contributions, and participation in the advocacy process.

Please help us continue our work to advance the profession of pharmacy. More good things to come. Stay tuned!

For more information, contact Antonio Ciaccia at aciaccia@ohiopharmacists.org  or 614.389.3236.

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February 26, 2019
8:30AM-4:00PM

2019 Pharmacy Student Legislative Day

March 6, 2019
7:30AM-5:15PM

APhA's Diabetes Care Certificate Training Program for Pharmacists

OPA Office, 2674 Federated Blvd, Columbus, OH 43235

March 21, 2019

Pharmacist Training Program for Long-Acting Injectables

OPA Office - 2674 Federated Blvd, Columbus, OH 43235

April 12-14, 2019

141st OPA Annual Conference & Trade Show

Greater Columbus Convention Center, Columbus, OH

May 16, 2019
11:00AM

Live Webinar: Required OSHA Training for Immunizing Pharmacists