January Legislative Update: 2021 OPA Legislative Day | Legislation to watch in 2022
By Lobbyists Ernest Boyd, Michelle Fitzgibbon, and Dan Fitzpatrick
2021 OPA Legislative Day Recap
On November 17, OPA held the 2021 Pharmacist Legislative Day in downtown Columbus adjacent to the Ohio Statehouse. It was an opportunity for OPA members from across the state to come to Columbus and learn more about pending legislation and interact directly with members of the Ohio General Assembly.
A panel discussion was held with State Representatives Scott Lipps and Thomas West regarding their work as members of both the House Health Committee and the Joint Medicaid Oversight Committee. Both legislators have been leaders in Columbus on issues that directly impact Ohio pharmacists, including a significant amount of work on PBM reform.
Attendees also heard from State Senator Matt Dolan, who sponsored and passed legislation to allow pharmacists to obtain Medicaid provider status, and from Senator Steve Huffman who spoke about his work as Chair of the Senate Health Committee.
It was an important day for pharmacists to reconnect with legislators from their area, but also a valuable day for the legislators who attended the OPA hosted luncheon to continue to hear about the legislative issues that pharmacists are most concerned about.
Pending Legislation of Interest
House Bill 37 – Emergency Prescription Refill
Sponsored by Representative Gayle Manning, HB 37 passed the Ohio House in May 2021 on a vote of 92-3. It has had three hearings in the Senate Health Committee and appears likely to pass the Senate in the near future.
The bill builds upon current law that allows for a single emergency refill. HB 37 increases the number of times that a pharmacist may dispense certain drugs as an emergency refill without a prescription to a specific patient from one to three, non-consecutively, within a 12-month period. Importantly, the bill requires a health plan to cover the dispensing, if the plan already covers the drug, and must charge a copay no higher than normal.
There is also language in the bill regarding the length of time that the prescription may be dispensed under this emergency provision. HB 37 authorizes the pharmacist to dispense or sell, not more than once during any 12-month period, a 30-day supply of the drug based on the original prescription or, if the drug’s standard dispensing unit is greater than a 30-day supply, not more than the standard unit. For the 2nd or 3rd emergency dispensing, it may not exceed a seven-day supply, or if the drug is packaged in a manner that provides more than a seven-day supply, the lowest available supply.
House Bill 135 – Co-Pay Accumulators
HB 135 has been voted out of the House Health Committee, but is awaiting a vote on the House floor. Sponsored by Representatives Susan Manchester and Thomas West, the goal of House Bill 135 is to help patients reduce their out-of-pocket costs by ensuring that payments from copay assistance programs or other financial assistance programs will count toward a patient’s deductible and coinsurance.
HB 135 requires health insurers to apply amounts paid by, or on behalf of, covered individuals toward cost-sharing requirements. The bill exempts situations where a generic version of a brand name drug exists, but the prescribing physician prescribes the brand name drug without it being medically necessary.
House Bill 336 – PBM Reforms
Sponsored by Representatives Scott Lipps and Thomas West, HB 336 is still early in the legislative process having been referred to the House Insurance Committee where it has received one hearing for the sponsors to describe the bill and explain why the committee should support it. This bill seeks to address numerous areas that would be beneficial to Ohioans who need to obtain lifesaving medications. Areas addressed in the bill include:
- Ensuring that patients can receive a prescription within 72 hours
- If an in-network pharmacy is unable to provide the prescription, allows patients to receive the prescription from any willing pharmacy
- Prohibiting ordering or directing a patient to an affiliated pharmacy
- Prohibiting transferring or sharing records with an affiliated pharmacy
- Prohibiting changing the cost-sharing requirement based on which pharmacy the patient uses
- Requiring an insurer to provide a written explanation for any decrease in reimbursement for a claim
HB 336 is important legislation that will be a major focus of OPA’s legislative efforts in 2022.