|Advocacy Action News & Needs|
Get the latest news each weekday on the MPhA Twitter feed! Follow us at @MinnPharmAssoc
MPhA’s current legislative tracking document may be accessed here.
April 6, 2018 - Update
We have taken a significant step forward in making law, with the pharmacists prescribing authority language in House File 2692 and its companion Senate File 3015. In the House, the prescribing legislation took the next step to final passage. HF 2962 was heard in the House Health and Human Services Finance Committee where the bill was amended, received a fiscal note and ultimately was laid over for inclusion in the House HHS Finance supplemental budget bill that will be deliberated and put together after the Easter/Passover legislative recess. To summarize, the bill as amended has made it through all its stops in the House and will now move through the finance legislative process there.
HF 2962 would mean:
The final amendments included:
This was after an amendment to the House bill last week that tightened up the tobacco cessation products provision by adding:
HF 2962 is now in a very good place to be included in the House Finance Supplemental Omnibus bill that will ultimately be conferenced with a similar omnibus piece of legislation from the Senate. Sen. Julie Rosen, one of the authors of the pharmacist prescribing legislation, will put together the Senate Finance bill as Senate Finance Chair.
While the pharmacists prescribing legislation has made it through all policy and finance committees in the House, it was dealt a significant blow in the Senate last week. Senate HHS Finance Chair Michelle Benson indicated she will not hear the companion to HF 2962, SF 3015. While this does not “kill” the pharmacists prescribing legislation, SF 3015 did not meet second deadline in terms of making it out of the Senate HHS Finance and Policy Committee, the policy committee scope bills are heard in. Sen. Benson questions whether pharmacists should prescribe and also is keenly aware of opposition to the bill by the Minnesota Medical Association.
The legislation is not dead because it could be heard in Senate Finance, Sen. Rosen’s committee, and be included in the Senate Supplemental budget bill — where it could be conferenced with the House legislation. Even if it’s not included in the Senate Supplemental budget bill, it still could become part of the final Supplemental budget bill if the Senate and House conferees accept the House pharmacists prescribing legislation with the fiscal note of $14,000 in ’19 and $6,000 in the next biennium.
Only the next two months will tell the ultimate fate of the pharmacists prescribing legislation. The legislature is set to adjourn no later than May 21.
March 26, 2018 - Update
This past week, Pharmacy Advocacy Task Force co-chair, Jill Strykowski, and her colleague, Dr. Brian Sick, testified in support of Representative Roz Peterson’s HF2962/SF3015 before the Minnesota House Health and Human Services Reform Committee. Dr. Sick gave convincing testimony and urged members of the Committee to support the legislation that would have the Board of Pharmacy determine through protocol how pharmacists will be able to prescribe in three medication categories: opioid antagonist for the treatment of overdose, all tobacco cessation medications other than buproprion and travel medications recommended by the CDC and for use when traveling abroad.
After several questions for the testifiers and Representative Peterson, the House HHS Reform Committee members voted overwhelmingly to pass out of Committee HF2962 and send its final House committee before hopefully heading to the General Register, the House Floor. HF2962, the PATF legislation, will be heard on Tuesday, March 27th in Room 200 of the State Office Building (SOB) in the HHS Finance Committee.
The companion legislation to HF2962 is not yet confirmed for a hearing in the Minnesota Senate, as of this update. However, we are optimistic that SF3015 will get heard by the legislature’s 2nd deadline, Thursday, March 29th.
SF3015 and SF3014 are bills that will go a long was to expanding health care access and increase patient adherence by utilizing one of the most trusted and often times, most convenient health professional - a Minnesota pharmacist to:
There are several other important pharmacy bills moving through the Minnesota legislative process at the Capitol in St. Paul this week. HF3024 & HF3012 will go a long way to allow pharmacists to inform their patients of their medication purchasing options and require that the lowest allowable cost/price be offered to patients in Minnesota, even if it is the cash price.
These two bills will go a long way to rein in some of the egregious practices required in many pharmacy benefit manager contracts. SF2596 (gag order prohibited) was laid on the table for possible inclusion in the Senate HHS omnibus last week. Language providing for partial fill/medication synchronization for patients in benefit contracting was amended onto Dr./Senator Jensen’s SF2596 bill and is currently included in the Senate version of this bill. There are several access and affordability bills that are making their way through the Senate and the House and will probably be included in one final omnibus bill.
If you do not know who your legislators are, please see: Who Represents Me? Please continue to write your Representatives and Senators. PLEASE remember to carbon copy HHS Chairs, Senator Benson and Representative Dean.
Senate HHS Policy and Finance Chair, Michelle Benson:
House HHS Finance Committee Chair:
March 23, 2018 - Update
The Pharmacy Advocacy Task Force — a coalition made up of members from MPhA, the Minnesota Society of Health-System Pharmacists (MSHP), The Minnesota College of Clinical Pharmacy (MCCP), The Duluth Area Pharmacists and the University of Minnesota College of Pharmacy — continues its review of the pharmacy practice act with the intent of advancing legislation that removes barriers to the expansion of pharmacy practice.
These bills aim to improve patient access to critical medications in three categories by allowing pharmacists to prescribe these through a statewide protocol. The three medication categories are naloxone, tobacco cessation medications, and travel medications.
Tuesday evening (3/20/18), HF 2962 received a hearing in the Health and Human Services Reform Committee and has passed.
What We Need Now
I am writing to ask that you please help ensure SF 3015 receives a Senate committee hearing.
This bill (along with companion HF 2962, which passed the Health and Human Services Reform Committee) aims to improve patient access to critical medications in 3 categories by allowing pharmacists to prescribe these through a statewide protocol.
We know that:
Use of the medications above does not require a diagnosis and is a matter of choice for the patient, so prescribing these are within the scope of a pharmacist's practice. In the 8 years of training to obtain a doctorate degree in pharmacy, pharmacists obtain extensive clinical knowledge and become experts in medication therapy management.Pharmacists are often the first (and sometimes only) access that patients utilize to the healthcare system. Often, patients may be more comfortable in sharing the need for these medications with their pharmacist vs. other health professionals.
March 15, 2018 - Update
Long-time Minnesota Pharmacists Association member Eric Slindee of Sterling Pharmacy testified before the Minnesota House Health and Human Services Reform Committee on behalf of all pharmacy in Minnesota in support of two bills, H.F. 3012 and H.F. 3024. The first bill would prohibit benefit contracts provisions that don’t allow a pharmacist to inform their patients about the lowest cost of medications and potentially much more affordable medication options even if for a cash purchase of medications outside of benefit networks if that option is less expensive.
The second bill would prohibit pharmacy benefit manager and insurer pharmacy contracts from requiring an individual (patient) make a payment in an amount greater than the allowable cost to consumers, as defined by (1) the applicable co-payment for the prescription medication, (2) the allowable claim amount for the prescription medication, or (3) the amount an individual would pay for the prescription medication if the individual purchased the prescription medication without using a health plan benefit. This would ensure that the patient is only paying the lowest amount possible for the medication they seek, even if that price is lower than their co-pay or Usual and Customary price.
Please call, write or email your legislator today and ask them to support the following two bills that will next be headed to the Minnesota House Commerce Committee:
Peterson, Hamilton, Zerwas, Gruenhagen, Frieberg and Liebling; Jensen, Klein, Franzen, Utke, Nelson introduced:
In addition to these two bills, Representative Roz Peterson as well as Senator Jensen Chief authored and introduced HF 3783 that when enacted would provide reasonable fair practice protections for patients that allow pharmacists to provide the best care and advice at the lowest costs to patients. These provisions would also ensure greater patient choice and access which leads to greater adherence and better health outcomes.
We are still hoping that the legislature will hear and act on the following bills and we urge you to contact your Senator and Representative to ask them to support and call for a hearing on:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
We are also watching and providing input to legislators and the authors of several legislative proposals related to the opioid crisis. One of the bills, Senator Rosen’s SF 730, would place an Opiate Stewardship fee (some say tax) on manufacturers and wholesalers of opioid medications. It would also require pharmacists to report monthly the previous month’s deliveries and distributions of opioid medications and would create an Opiate Stewardship Advisory Council.
Here is how the fee would be calculated:
The board must calculate the fee that is to be paid by each manufacturer by using a base rate for all drugs listed in subdivision 1, and multipliers of the base rate for certain drugs and dosage forms as specified in this subdivision.
House and Senate leadership are opposed to a new tax at this time. Stakeholders, including MPhA, have weighed in with Senator Rosen and legislators to let them know the current proposal could increase by two to three fold opioid medication costs and that the fee will ultimately be paid by the patient/consumer.
The Minnesota legislature convened February 20 and went straight to work on the bonding or short year of the two-year session. The House and Senate quickly put a period on the end of the 2017 session by passing the Legislature’s 2018-19 budget that Gov. Mark Dayton vetoed last May. The 2018 legislative session was met with a new wrinkle when US Sen. Al Franken resigned in early January and Gov. Dayton appointed his Lt. Gov., Tina Smith, to fill out the US Senate term until the next election can fill the seat.
Because Lt. Gov. Smith is now Sen. Smith, the Minnesota Constitution clearly indicates that the President of the Minnesota Senate, in this case Sen. Michelle Fischbach, shall ascend to become the lieutenant governor when there is a vacancy. The Constitution is not so clear on whether the lieutenant governor can serve as a state senator at the same time. This question still remains. As of this update the lieutenant governor has acted in her capacity as both a state senator and the President of the Senate while being lieutenant governor for the past two and a half weeks.
The Ramsey County Court, where a case had been filed by a constituent of Sen. Fischbach prior to the start/reconvening of the legislative session this year, said the case “wasn’t ripe.” It is not clear if the case has now ripened since the senator has taken a vote as a member of the Legislature while she is at the same time acting in her capacity as lieutenant governor. This is all critical because the Minnesota Senate stands at a 34-33 seat majority for the Republicans. If the Court would rule that Sen. Fischbach cannot serve in both branches/both capacities, it could open her seat for a special election being called and presumably a 33-33 tie in the Senate would occur. Stay tuned…
For the month of March, the legislature is focused on hearing bills introduced this year and last year and moving them through the legislative process. The first committee deadline is March 22, the second deadline is March 29, and the third deadline is April 20. Bills must be heard and passed out of one house by the first deadline, both houses by the second deadline and clear any necessary Finance Committees by third deadline to be considered this session.
Legislative Day and the PATF Agenda
On Feb. 27, MPhA – in conjunction with the Minnesota Society of Health-System Pharmacists (MSHP), the Minnesota Retailers Association (MnRA), the Minnesota Grocers Association (MGA) and the Pharmacy Advocacy Task Force (PATF) – had its most successful Legislative Day in recent memory. Nearly 200 pharmacists and student pharmacist participants made over 75 visits. The meetings were a huge success, including getting commitments from Sens. Scott Jensen (R) and Matt Klein (DFL), both physicians, to chief and co-author the PATF legislation that will be introduced the week of March 5 in the Senate as a companion to the PATF legislation recently introduced in the House, HF2962. The key distinction between HF 2962 and HF1140 (PATF legislation introduced last year) is, HF2962 does not include the hormonal contraceptive prescribing authorizing language. The legislation and its companion in the Senate call for prescribing authority for pharmacists in three medication categories: naloxone, smoking cessation medications and travel medications.
The same Senate co-sponsors have also agreed to co-author legislation that would provide for broad medication administration for pharmacists in Minnesota, another priority of the PATF. Reps. Roz Peterson (R) and Dave Baker (R) introduced the companion medication administration expanded authority for pharmacists in the House, HF3250 (check back for updated Senate bill numbers soon).
Patient Fair Practices/PBM Reform
Additionally, several bills that are gaining steam and beginning to gather a lot of attention were introduced in the House and Senate; they would protect patients and pharmacists from unfair practices by health insurers and pharmacy benefit managers (PBMs).
Additional co-sponsors in the House and Senate for both PATF bills as well as fair practices form will be sought over the coming days and weeks. The PATF prioritized legislation and all but the Department of Commerce-PBM regulation bill have been referred to the House and Senate Health and Human Services Committees, where the legislation will need to be heard and passed out of before either heading to an additional committee(s) before being sent to the House or Senate floors.
CALL TO ACTION:
PLEASE call or write your Senator or Representative today - Who Represents Me? - Use the district finder to retrieve a list of your representatives with contact information. Ask them to support and co-sponsor the PATF legislation (HF2962/SF3015 & HF3250/SF3014). Also, please ask them to support patient and pharmacy fair practice protections!
Peterson, Baker; Jensen, Klein, Lourey, Rosen introduced:
Patient Fair Practices/PBM Reform Bills:
Peterson, Hamilton, Zerwas, Gruenhagen, Miller and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Zerwas, Hamilton, McDonald and Peterson; Jensen, Nelson, Draheim, Wiklund introduced:
Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
The 2018 Legislature – Pharmacists: Part of the Solution
The Minnesota House and Senate legislative session was gaveled in on Tuesday, Feb. 20. The start of the second year of the Minnesota Legislative Session is known as the “short” and/or “bonding” session/year. The legislature must adjourn by May 21. Only the Governor can call the legislature back into a special session after the May adjournment date. (The state constitution limits the legislature to meeting 120 legislative days during each biennium. In addition, the legislature may not meet in regular session after the first Monday following the third Saturday in May of any year.)
There are many uncertainties as we head into the 2018 session. First, the legislature must pass and the Governor sign into law the legislature’s biennial budget. The Governor, in an attempt to force the Legislature back to the negotiating table, line-item vetoed the funding after the legislature adjourned in 2017. It appears that the Governor and the legislature have agreed the first order of business will be to pass and sign into law a clean funding bill for the legislature.
Gov. Dayton’s appointment of Lt. Gov. Tina Smith to Sen. Al Franken’s seat has created a new constitutional crisis for the Minnesota Legislature. According to the Minnesota Constitution, current Senate President and GOP Sen. Michelle Fischbach is now the Lieutenant Governor. There are differing opinions on whether Sen. Fischbach may retain her senate position and serve as Lieutenant Governor. A case was filed in the courts making the case she could not serve in both roles, however, the courts have said the case “is not ripe” because Lt. Gov. Fischbach has not yet taken a vote in the Senate. It is the Senator’s intention to do both and likely the Senate DFL’s intention to force the courts to decide whether that decision is legally sound.
Currently, the GOP controls the Minnesota Senate by a 34-33 margin after a special election DFL victory in early February to retain Sen. Dan Schoen’s seat, which he resigned last fall. Because the DFL retains the seat, the one-seat margin could move the Senate temporarily into a 33-33 tie, if the court says Lt. Gov. Fischbach cannot serve in both capacities. Presumably in this case, a special election would be necessary to fill the Fischbach seat. Given the likelihood the issue will be resolved by the courts, it’s not likely the seat would be filled until later in the 2018 Session. A 33-33 tie would likely throw the 2018 session into complete turmoil. Hopefully, this is all resolved soon.
This is all to say that there are a number of moving pieces — but with all things being equal and a Legislative Session going forward as planned, the Legislature will adjourn in late May.
The Pharmacy Advocacy Taskforce (PATF) Agenda:
This year the PATF is putting on a full-court press to help Minnesota pharmacists have the opportunity to practice at the top of their license. We hope to have a hearing, see movement and hopefully enactment of legislative proposals that the PATF is advocating for. The PATF’s legislative agenda includes:
Pharmacists Expanding Healthcare Access: Legislative Summary: MN HF1140‐SF1049
EXPANDING PATIENT ACCESS TO CARE:
Amid growing concern about lack of access to primary care providers, pharmacists are an untapped resource. Underserved populations have many barriers to receiving adequate health care needs, such as transportation and cost. Rural and economically disadvantaged urban areas have less than half the rate of primary care physicians as wealthier urban areas, meaning that patients often have to travel long distances or wait for months to see their doctor. Ninety‐three percent of Americans live within five miles of a community pharmacy, many of which are open 12 to 16 hours a day, seven days a week. According to the World Health Organization:
“Community pharmacists are the health professionals most accessible to the public.”
Opioids have killed more than 2,700 Minnesotans in the last 15 years. More than 80% of these deaths involved prescription drugs, and nearly 60% have occurred in the past 5 years. There were 355 deaths in 2015 and a 31% increase in 2016. Hennepin County saw a record 144 opioid‐related deaths in 2016. A study by the National Bureau of Economic Research found that legislation that expanded the access of naloxone to the public was “associated with a 9 to 11 percent reduction in opioid‐related deaths....” This study also states that there was “little evidence that these laws increase the recreational use of prescription painkillers.” Increased access to naloxone can save lives.
In Minnesota in 2010, the federal and state governments spent $332.6 million on unintended pregnancies; of this, $203.9 million was paid by the federal government and $128.7 million was paid by the state. The total public costs for unintended pregnancies in 2010 was $318 per woman aged 15-44 in Minnesota, compared with $201 per woman nationally. Increasing the scope of pharmacist practice to prescribe oral hormonal contraceptives can increase access to care for many patients, and help reduce the negative effects of unintended pregnancies on an individual and community level by removing unnecessary and inefficient barriers.
TOBACCO CESSATION TREATMENT
According to the Minnesota Department of Health, smoking causes 5,900 deaths and over $2.5 billion in medical costs every year in Minnesota. A study found that community pharmacist intervention led to a 12.7% increase in smoking cessation rates through interventions related to nicotine replacement.
International tourists are estimated to reach 1.6 billion by 2020, with an increasing proportion visiting the developing world. Providing Minnesota pharmacists with the ability to prescribe medications according to the CDC for travel abroad would enhance access to recommended medications and be a practical convenience for thousands of Minnesotans. It also will help Minnesotans stay healthy while traveling and returning home. Travel medications include: vaccines, medications for traveler’s diarrhea and malaria prevention.
We are seeking changes to Minnesota pharmacy medication administration law. A bill will be introduced the first week of session with changes that would provide Minnesota pharmacists with broader authority to administer medications. Currently in Minnesota, pharmacists can only provide prescription drug medication administration for first dose and on an emergency basis. Minnesota pharmacists can also provide vaccinations. However, unlike in 29 other states, pharmacists in our state cannot provide pharmacy-based medication administration services (MAS). Pharmacy-based MAS improves public health by facilitating patient access to care, supporting patients with improved access to needed services, decreasing stigma, and enhancing collaboration with the health care team.
Patients who can benefit from MAS may encounter challenges such as scheduling conflicts with prescribers, difficulty with medication adherence, and a lack of knowledge of the medication or administration of the medication. In the provision of MAS, pharmacists meet with patients regularly to provide education on medications, help patients manage all prescribed medications, support interventions that improve the quality of care, engage as part of the health care team, and ensure that patients are receiving the expected benefits from treatment. Pharmacy-based MAS can also assist patients who struggle with self-injection by providing initial education and support on medication self-administration, ensuring appropriate follow-up to monitor proper technique, reporting any adverse events, and addressing barriers to adherence.
The PATF, in conjunction with MPhA, has begun meeting with and educating legislators about our legislative agenda and learning about House and Senate member priorities for the session. Feb. 27 is Pharmacy Legislative Day at the Capitol in St. Paul. We hope to have as many pharmacist attendees as possible meet with a majority of the legislative members on the Senate and House Health and Human Services Committees.
Other Impactful Legislation:
Thousands of bills are introduced each session; only a small percentage of those proposals will impact Minnesota pharmacy. Here are several of the bills and executive branch initiatives we are following during the session this year.
SF593/HF747 [Hamilton/Nelson]: Prescription Drug Coverage Prior Authorization; drug transparency and disclosure requirement. The prior authorization bill would, among other things, prohibit “mid-year” drug switching by health plans and/or their PBMs. In the Senate, the HHS Policy and Finance Committee laid the bill over last year for possible inclusion in the Senate Finance Omnibus. It was not included. The bill was not heard in the House Commerce Committee, where it has been referred. Technically it’s still alive, but at this point it does not look like the proposal will make it through the House this year.
SF1509/HF1819 [Zerwas/Abler]: The legislation that contains the pharmacist reimbursement rate increase and Medicaid decrease was heard and passed out of both the Senate and House and was included in the final Senate HHS Finance Omnibus legislation, SF 800, which was ultimately vetoed. Although the bill was also included in the Governor’s supplemental ’17 budget, it did not make the final negotiation cuts to the HHS Finance bill. Also, there is a fiscal note of $4.7 for the ‘17-18 biennium and tails for the ‘19-20 biennium. We assume there will be a supplemental budget bill this year, but what will include is not known. We have made it clear to Committee staff and members that we want to see the reimbursement rate changes passed last year enacted this year.
State law makers and the public want to do something, anything, to try to reverse the trends in addiction and overdose deaths; this issue is front and center as session begins. The Governor and a bipartisan group of lawmakers have proposed a package to help bring relief to affected Minnesotans. The proposal includes a “penny per pill” tax (the current proposal would be a tax per pill to the manufacturer at a graduated rate based on quantity). The proposal would generate approximately $20 million a year. Those dollars would be spent on treatment services, wide distribution of naloxone and potentially pay for needed technical upgrades to the current PMP. There are several other ideas about how to tackle the opioid crisis at the legislature left over from last year and yet to be proposed this session.
Here are the opiate related bills that are currently introduced that have some chance of passing:
Finally, the legislature may be poised to act on reforms proposed to protect patients and providers from unfair Pharmacy Benefit Managers (PBMs) practices and policies. Growing frustration with pharmacy benefit managers, health insurers and pharmaceutical companies has driven legislators of all stripes as well as Gov. Dayton to call for reforms to our current health care system. The 2017 Session began with a hearing in the House Health and Human Services Finance Committee on health care network access and the Senate looked poised to pass prior-authorization protections/reform, but ultimately meaningful reforms did not occur in 2017.
Over the past 7 months, Sens. Jensen and Klein have led a senate effort to examine health care access and affordability with their colleagues. We don’t know yet what, if anything, will come from the Select Committee on Affordability and Accessibility’s deliberations this past summer and fall. Last year, Sen. Jensen introduced bipartisan legislation to ensure any health care provider willing to agree to the same contractual terms and conditions as in-network providers would be guaranteed access to the network for their patients. The legislation did not receive a vote in committee, but started a conversation and debate about the rights of patients and their providers versus insurer and payers of health care services and medications.
The Minnesota Legislature’s focus on the topic over the past 12 months has grown acute with the level of mistrust and anger voiced by patients toward their insurers (including the State of Minnesota). Constituents of rural legislators are voicing concerns about limited access to care and challenges getting their prescriptions from their local pharmacy.
Some legislators, such as Reps. Hamilton and Peterson, believe Minnesotans have grown tired of being told by their insurers they have to switch medications prescribed by their doctors mid-year, pay high deductibles, multiple co-pays or more for their medications in-network than they could pay with cash down the street. They have also been mandated to receive their medications from mail-order specialty pharmacies owned by their insurers and providers are being limited and regulated by insurers in terms of treatment, diagnosis and medication options.
All this is having an undesirable effect on patient health outcomes as well. However, while it appears that the legislature will move forward this year to broaden access and rein in affordability, there are still powerful interests — and legislators who support those interests — standing in the way of legitimate reform legislation. As a consequence, no significant patient protections have made it to either floor of the House or Senate in the past 3 years. In addition, state agencies such as DHS have sided with insurers in terms of the “cost” debate surrounding these proposals. To date, all patient and provider protections in proposed legislation have been issued a fiscal note with fairly significant cost estimates to the state. We will see if 2018 is any different.
There are and will be additional bills that surface that may affect Minnesota Pharmacy. We will be sure to add those bills to our next update. Look for another legislative update as we approach committee deadlines in March. If you have any questions or would like to get in touch with our PATF Government Affairs representative, Buck Humphrey, he can be reached at: