AkPhA Legislative Update: Pertinent Pharmacy Legislative Issues - - PDF document

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AkPhA Legislative Update:

Pertinent Pharmacy Legislative Issues Purpose

• se State

tement: t:

To educat ate e pharmac acis ists ts on current ent Government/ ent/Regu gulator latory issues es on both the nation

• nal

al and state levels ls Objective tives:

1). Describe be potenti tial implicati tion

• ns to the practice of pharmacy

y from the passage ge of The Opioid d Crisis Response Act of 2018 . 2). Identi tify y nation

• nal and region
• nal regu

gulatory tory steps being g implemen mented ted

• r consider

dered d regardin ding g the opioid d crisis. 3). List t three legislati tive ve bills that AKPhA will be monitor

• ring

g in the 2019 Legislati tive ve Session

• n.

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 The 2019 session is the first session of the

31st Alaska State Legislature.

 Session convened on January 15, 2019.  Each legislature has two regular sessions.  Each session can go 90 days by law, plus

any extensions or special sessions.

 Could go the full 120 days allowed by the

Constitution.

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 Two Bodies – Senate and House composed of 20 state

senators & 40 state representatives.

 Each senator’s area is divided into 2 House districts.  2-year terms in House. 4 years terms in Senate – with

staggered election process, except during re- districting.

 Each body is further divided between two groups—the

majority and the minority. To be a part of the majority, a legislator is typically required to vote to approve the budget and on all procedural votes on the floor.

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• Sen. Cathy

y Giessel (R) Eagle RIver Presiden dent of the Senate She leads a 14 – member Major

• rity

ty Coaliti tion

• n

13 Republicans 1 Democrat. t.

9

Neal Foster (D) Nome Speaker Pro Tempore

Senate organized House has Speaker Pro Tem

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Majority Leader

• Sen. Mia Costello

Anchor

• rage

ge

Minority Leader Rules Chair

• Sen. Tom Begich

Anchor

• rage

ge

• Sen. John Coghill

North th Pole

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New Legislators ators for the 31st

st Legislatu

lature re

 House of Represe

sent ntat ativ ives

Andrea Story Laddie Shaw Sara Hannon Barton LeBon Sharon Jackson Benjamin Carpenter William Zach Fields Grier Hopkins Kelly Merrick Sara Rasmussen Josh Revak Sarah Vance

New Legislators ators for the 31st

st Legislatu

lature re

 Senat

ate

Familiar House Faces Now in the Senate

Lora Reinbold Elvi Gray-Jackson Jesse Kiehl Scott Kawasaki Chris Birch

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 Brings fairness to the unregulated and expanding

practice of pharmacy audits.

 Does not allow audits the first seven calendar days

• f each month because of the high patient volume,

unless the pharmacy and auditor agree otherwise.

 Is designed to prevent the targeting of minor

clerical or administrative errors where no true fraud, patient harm, or financial loss has occurred.

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 Establishes submission of data/medical record

standards to allow for clarification where discrepancies are identified.

 Establishes a reasonable time frame for the

announcement of an audit to allow proper retrieval of records under review.

 Establishes an audit appeals process for

pharmacies.

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 Establishes guidelines for PBM’s (Pharmacy

Benefit Managers) to follow regarding patient confidentiality.

 Extrapolation cannot be used in assessing

fees/penalties.

 Alaska pharmacists would not be penalized for

providing mail-order service to their customers. Local mail-order service keeps Alaskan dollars in Alaska.

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 Legislation does not prevent the recoupment of funds where fraud,

waste and abuse exist.

 40 other states have already enacted fair audit legislation  Bill will also include:

1). Registration of PBM’s 2). Set up guidelines for generic drug MAC pricing by PBM’s 3). Establish a mechanism for pharmacy to appeal MAC pricing

Sec. . 9. S Section ions 1, 3, 6 6(b), and 7 o

• f this Act take effect

immediately iately under r 13 A AS 01.10.070(c (c). ). 14 * S

• Sec. 10.

Excep ept t as provided ed in sec. 9 o

• f this Act, this Act takes effect

t July 1, 2 2019

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 The bills gives the the State Board of Pharmacy the authority

to license and inspect the facilities of wholesale drug distributors and outsourcing facilities located out side the state under AS 08.80.159.

 It also gives the board the authority to establish the

qualifications and duties of the administrator.

 Sec.

. 10. Section ions 1, 6 6, 8 8, and 9 o

• f this Act take effect

t immediately iately under r AS 01.10.070(c). ). 27 * * Sec. 11.

 Excep

ept t as provided ed in sec. 10 o

• f this Act, this Act takes effect

t July 1, 2 2018

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 An Act extending the termination date of

the Board of Pharmacy; and providing for an effective date.

 Board of Pharmacy (AS 08.80.010) –

June 30, 2022 [2018].

 Effecti

ective e Date e – June 2018

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 AkPhA Board Chair – Set-up Provider Status Working

• group. Named Colman Cutchins chair. Done

 Working Group met, educated members and discussed

• strategies. - Done

 Lobbyist discussed with Sen. Giessel/staff to develop a

draft bill. - Done

 AkPhA needs to educate legislators, and state

departments during 2019.

 Plans are to file 2020 Legislation if it can’t be worked out

through regulations.

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 With assistance from the CDC, the State of Alaska

DHSS, and the UAA/ISU Pharmacy Program, AKPhA is currently conducting a demonstration project to validate payment for pharmacist cognitive services.

 This is a huge step towards supporting provider

status, and even more importantly, demonstrating a sustainable business model for the future of our profession.

 Pharmacists in every practice setting will benefit from

recognition of pharmacists as billable providers.

 Stay tuned for more news on this exciting project.

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 Today, most women have to refill their birth

control every month.

 This can be burden for many women especially in

rural areas, and women who work in professions that require them to be gone extended periods of time.

 HB 21 helps ensures all women have consistent

access and it requiring that insurance cover one- year’s supply of birth control.

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2/4/2019 12 1). Mandates insurance companies to pay both private and Medicaid claims. 2). Reimburse health care providers for and initial 3 month supply (to gage adverse reactions). 3). Then followed by a 12 month supply of contraceptives, including but not limited to birth control pills and hormonal contraceptive patches.

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

The Alaska Department of Health and Social Services released the 2018- 2022 Statewide Opioid Action Plan.



The five-year action plan, compiled by the Office of Substance Misuse and Addiction Prevention (OSMAP).



A final community summit in August 2018, coordinated by the Advisory Board on Alcoholism and Drug Abuse (ABADA), the Alaska Mental Health Trust and DHSS, brought together nearly 100 Alaskans from over 80 agencies and community organizations to provide final input for the action plan.



Nationwide and in Alaska, the opioid epidemic has become known as this decade’s defining public health crisis.



During 2010-2017, with 623 identified overdose deaths, the opioid

• verdose death rate in Alaska increased by 77 percent (from 7.7 per

100,000 persons in 2010 to 13.6 in 2017).

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Preliminary data for 2018 indicate that the

• ngoing response may be having an impact:

 During the first six months of 2018, 29 Alaskans died

• f opioid overdose, compared with 44 opioid
• verdose deaths during the first six months of

2017.

 In July 2017, OSMAP was formed to lead the state’s

multi-agency response to the crisis under the direction of Alaska’s Chief Medical Officer.

 Six overarching goals are identified in the plan along

with specific objectives and actions to reach those goals.

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The plan’s broad public health approached fall into three areas:

 1). Stronger environmental controls and improved social

determinants which includes reducing the misuse of prescription opioids;

 2). limiting access to illicit drugs and promoting mental

wellness for all Alaskans;

 3). improved screening and management of opioid addiction

as a chronic disease combined with better access for all Alaskans to treatment and recovery services; and reventing

• pioid overdose deaths through widespread availability and

the appropriate use of naloxone and improved health provider and drug prescriber education.

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

The Alaska Department of Health and Social Services Section of Epidemiology released a report late 2018 on the "Health Impacts of Opioid Misuse in Alaska."



The report provides a broad overview of Alaska’s opioid epidemic and related trend data to help Alaskans better understand the scope of this serious public health crisis.



“While deaths caused by prescription opioids and heroin declined in 2017, we have seen more deaths caused by fentanyl, a more deadly synthetic opioid.”



Overall, opioid-related deaths in Alaska have risen in recent years, similar to national trends.



Between 2010 and 2017, 623 opioid overdose deaths were reported in Alaska, a 77 percent increase.



Use of synthetic opioids like fentanyl increased dramatically in Alaska last year. Nationwide, efforts to control this epidemic are complicated by the increased use of synthetic opioids.



In Alaska, the opioid epidemic has disproportionately impacted males, white and Alaska Native people, and persons aged 25-44 years.

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

Opioid deaths high, but data signals progress in Alaska's fight against opioids.



Economic impacts are also significant. Between 2016 and 2017, hospital visits in Alaska due to

• pioid overdoses cost more than $23 million.

While Alaska’s opioid epidemic continues, there are some encouraging findings in the report:



Use of prescription opioids declined among Medicare patients in recent years, suggesting Alaska doctors may be prescribing opioids with more caution;



Naloxone, a medication that can reverse the effects of an opioid overdose, is readily available statewide and is being used to save lives; and



Self-reported heroin use among traditional high school students dropped in 2013 and has not increased since then.



Controlling this epidemic requires many long-term strategies.



The DHSS Office of Substance Misuse and Addiction Prevention is working with communities across Alaska to limit the dosage of first-time opioid prescriptions, better understand opioid misuse as a chronic disease, improve access to treatment and recovery services, and more.

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1. PDMP 2. Naturopaths 3. Immunization 4. EpiPen counseling 5. Loan Forgiveness Program 6. Medicaid Reform 7. Opioid 8. Tramadol 9. Narcan

• 10. PBM Audit / MAC Pricing
• 11. Wholesaler Licensure Legislation

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 The association will host it’s annual

legislativ tive fly-in n on March ch 7th

th.

.

 All membe

bers rs are invited ted to partici cipa pate te

 Come meet

t your legislators rs and learn rn more about ut the legislativ tive e proces cess first t hand d

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