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Ohio Senate passes legislation to expand patient access to pharmacist services!

Senators Steve Huffman and Nathan ManningToday, in a flurry of legislative activity aimed at better positioning Ohio to combat the COVID-19 pandemic and the collateral damage it has caused throughout the state, the Ohio Senate pushed through recently-introduced legislation that would help deploy pharmacists to assist in the care for patients suffering from chronic conditions – a growing need as more patients with more traditional disease needs forego routine care.

Specifically, the Ohio Senate unanimously passed SB 303, legislation sponsored by Senators Stephen Huffman (R-Tipp City) and Nathan Manning (R-North Ridgeville) that would expand the current laws that allow physicians to enter into "consult agreements" with pharmacists for the purposes of allowing those collaborating pharmacists to manage drug therapy for patients suffering from with chronic diseases. Current law authorizes physicians to allow collaborating pharmacists to order & analyze blood and urine tests; administer medications; and discontinue, change, or add medications for their patients. 

SB 303 will expand a physician's ability to delegate pharmacist consults to their other collaborating partners: clinical nurse specialists, certified nurse-midwives, certified nurse practitioners, and physician assistants. This extension will significantly open up patient access to vital clinical services focused on chronic disease management.

This is especially important during the current pandemic, as the CDC reports that 78% of COVID-19 patients requiring admission to the intensive care unit had at least one underlying health condition. Additionally, the CDC found that 94% of hospitalized patients who died as a result of COVID-19 also had an underlying health condition.

The CDC stated that "persons with underlying health conditions or other recognized risk factors for severe outcomes from respiratory infections appear to be at a higher risk for severe disease from COVID-19 than are persons without these conditions."

Chronic diseases like diabetes, hypertension, and asthma carry high mortality rates as it is, but the fact that underlying health conditions, when paired with COVID-19, can be such a driver for intensive care and death, the need to manage those conditions effectively is vital.

Further, because of the serious threat of a "second wave" of COVID-19 that could be even more devastating than what we've experienced thus far, it is imperative that Ohio addresses as many of the chronic illness needs as possible to minimize the severity of the continued threat. Pharmacists are ideally positioned to meet these needs, while working in collaboration with other members of the health care team, as proposed in SB 303.

The current laws governing pharmacist consult agreements came as a result of OPA's work in the 131st General Assembly on HB 188, which was carried by Senators Huffman and Manning when they were serving in the Ohio House of Representatives. SB 303 essentially takes the pillars of those laws and broadens their use beyond physicians to other mid-level providers.

SB 303's passage, which was prioritized by Senate President Larry Obhof (R-Medina), comes on the heels of recent emergency rules implemented by the State of Ohio Board of Pharmacy that temporarily expanded pharmacist consult agreements to mid-level providers in a more limited fashion. Enacting SB 303 would ensure that more seamless pharmacist collaboration with physicians, nurse practitioners, and physician assistants would become permanent in Ohio

Antonio CiacciaDuring the Wednesday morning hearing on SB 303, Senators Huffman and Manning provided testimony in support of the bill, and OPA Director of Government & Public Affairs Antonio Ciaccia provided the sole live proponent testimony on the bill. In his testimony before the Senate Local Government, Public Safety and Veterans Affairs Committee, he stated, "This ability to tap pharmacists to manage chronic diseases is essential, especially in the face of the current pandemic, where many patients and healthcare practices have seen traditional care delivery disrupted. Across Ohio, as COVID-19 has added new pressures that have up-ended the typical workflow in healthcare facilities, and the need to engage and collaborate with other healthcare professionals has never been greater."

SB 303 also earned backing by a number of major healthcare players in Ohio, including the chief medical officers at the Cleveland Clinic, Nationwide Children's Hospital, MetroHealth, AxessPointe Community Health Center, and more.

To view the proceedings from today's hearing, click here. To view other testimony submitted in support of the bill, click on the following:

The Buckeye Institute also submitted testimony that was supportive of the proposed concepts in SB 303, which passed committee unanimously, and in a rare move, was immediately taken up for consideration on the Senate floor just two hours later.

In a joint letter to lawmakers, OPA member and Cleveland Clinic interim chief pharmacy officer Sam Calabrese and Cleveland Clinic chief medical operations officer Dr. Robert Wyllie stated, "In ambulatory settings and inpatient settings, pharmacists have, for years, been highly effective in managing chronic conditions live congestive heart failure, hypertension, diabetes, dyslipidemia, and COPD by collaborating through consult agreements with our physicians. The passage of SB 303 will ensure that pharmacist collaboration with physicians, nurse practitioners, and physician assistants can be agnostic of practice setting, and it will make it a permanent fixture of Ohio law."

According to Dr. Wilfred Ellis, a physician at Infectious Diseases, Inc. in Lima, Ohio, "I have worked with very closely with pharmacists in my practice and find them to be efficient, reliable, data-driven and a very important team member. By increasing access to care by pharmacists through consult agreement reform we can decrease burden to primary care providers and improve care to our patients."

Senator Steve Huffman

"It is imperative now more than ever that we protect patients and healthcare providers," said Senator Huffman, who is also a physician. "Protection includes removing burdensome requirements of physicians that can be removed and still provide patients with the quality care management they deserve. I believe this commonsense legislation will solve this problem with regard to pharmacist consult agreements."

"This is important legislation to ensure that patients are receiving the most accurate representation of their specific care management," said Senator Manning. "Pharmacists are highly effective at managing chronic diseases like diabetes, asthma, and hypertension, so by authorizing expanded collaboration with doctors and nurses, SB 303 will significantly expand patient access to quality care."

In addition to all the support for the legislation, several organizations stressed the need for the Ohio Department of Medicaid to implement Ohio's provider status law, to allow pharmacists to be able to bill and be reimbursed for clinical services like the ones authorized in SB 303.

In remarks sent to the Senate, MetroHealth chief clinical officer Bernard Boulanger and chief operating officer Michael Stern said, "Unfortunately, payment models in Ohio do not support reimbursement for pharmacist medication management services. With the advent of Ohio law allowing pharmacists to enter into consult agreements with practitioners and the designation of the pharmacist as a medical provider in Ohio, opportunities to improve patient safety and health outcomes exist with greater pharmacist involvement as medication managers. Reimbursement for services is necessary to expand patient access to the pharmacist and continuity of care. We encourage you to consider removing these barriers by requiring reimbursement for pharmacist-provided patient care services under Ohio Medicaid and commercial contracts."

Senator Nathan Manning

OPA would like to thank Senators Huffman and Manning for their ongoing support and their dedication for evolving and elevating the role of the pharmacist in order to expand patient access to quality care in Ohio. We would also like to thank Senate President Obhof for his quick action on SB 303 as a means to meet the unique challenges facing Ohioans during the COVID-19 pandemic.

"The Senate identified a clear gap in patient care, and in light of the current pressures on the health care system, they acted swiftly to address it," said OPA Executive Director Ernie Boyd. "We applaud them for prioritizing this crucial piece of legislation that will expand access to care when it's needed most."

SB 303 now moves to the Ohio House of Representatives, where it awaits deliberation. OPA recommends contacting your state representative to ask for their support for SB 303.

Media

Ohio Senate unanimously passes consult agreement bill - The Chronicle-Telegram, 5/7/20

Senate passes Huffman, Manning bill to ensure effective patient care management, remove barriers for providers - Office of Senator Steve Huffman, 5/6/20

Ohio Senate OKs $350 million from feds to local governments for coronavirus response - Columbus Dispatch, 5/6/20

Ohio should allow pharmacists to provide the medical care they are trained to provide - The Buckeye Institute, 5/6/20

Despite legislators’ frustrations, Dr. Amy Acton’s role safe in Ohio Senate - Columbus Dispatch, 5/4/20

Manning, Huffman introduce legislation to ensure effective patient care management - The Morning Journal, 4/25/20

Manning, Huffman introduce legislation to ensure effective patient care management, remove barriers for providers - Office of Senator Nathan Manning, 4/23/20

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