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That's a wrap! Solid results for pharmacists in the 132nd General Assembly!

If you've been a member of OPA for the last two years, you should be well aware of the many legislative issues we tackled in the 132nd General Assembly. We ended up finishing the year on a high note, where three key pharmacy bills advanced through the legislature and to the desk of Governor John Kasich in the final weeks. We are pleased to report that each of those bills were signed into law!

That batch of bills now add to another big heap of pharmacy legislation that advanced in the 132nd General Assembly. In total, OPA was tracking and engaging on more than 40 pieces of legislation, in addition to a litany of proposals that either never got formally introduced or will be refined and introduced this year.

Let's take a look back at that stretch of 2017-2018, where we pushed back on several harmful bills, made significant progress on PBM reform, and got most of our high-priority bills signed into law!

First, here’s what we were able to defeat

In November 2017, OPA and massive group of stakeholders were successful in defeating Issue 2, the inaccurately-named Ohio Drug Price Relief Act. OPA worked extremely hard to defeat the dangerous measure that could have had serious negative consequences for pharmacies, payers, employers, veterans, and patients. While the initiative created a great opportunity to discuss the flaws with pharmaceutical pricing, unfortunately Issue 2 would have likely make matters worse. Defeating the measure was a top priority for our association, and we thank all of our members who helped make the case for its well-deserved thrashing at the polls.

Over in the Statehouse, while every bill is a work in progress, the following pieces of legislation as introduced had varying degrees of hassle and inappropriateness, but ultimately, we were able to erode language to the point of our neutrality or we were able to completely defeat the legislation.

These bills include:

  • HB 73, which would have required ID checks and tracking of all sales of dextromethorphan.
  • HB 231, which would have required all pharmacists to dispense all controlled substances in locking prescription vials.
  • HB 642, which would have 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, which would have added new, niche continuing education mandates on pharmacists.
  • SB 253, which would have resurrected key flawed proposals from the Ohio Drug Price Relief Act that would have compromised pharmacy economics even further than they are today.

We will keep you informed this year if any of these bills or others are resurrected.

Here's what we were able to get passed

HB 101: Epinephrine Accessibility Act

On January 7, Governor John Kasich signed HB 101, sponsored by Representative Derek Merrin, which will better utilize pharmacists to ease access barriers to epinephrine auto-injectors.

House Bill 101 allows pharmacists to substitute a prescribed, brand-name epinephrine auto-injector for 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, they would not need to go back to the doctor each year for a new prescription; they could simply get it at the pharmacy without the new physician order.

Currently, Ohio pharmacists & pharmacy interns can dispense/administer naloxone and all CDC-recommended vaccines without a prescription, as long as they are acting within a physician protocol. HB 101 will add epinephrine auto-injectors into the same category, thus eliminating the need to visit or contact the doctor for a new prescription every year.

“In my practice, I encounter patients on a daily basis that 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.”

For complete details on HB 101, click here.

HB 286: Palliative care commission

On December 18, Governor Kasich signed HB 286, sponsored by Representative Sarah LaTourette, which would make 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 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 to Ohioans. These recommendations will likely become rules and laws in the future, making having 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 aims to ensure 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 5-day supply of oral naltrexone in times of patient need or to bridge the patient to their next injection point.

 “With limited access points for Vivitrol, SB 119 is a commonsense 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.”

For complete details on SB 119, click here.

SB 265: Pharmacist provider status

On January 4, Governor Kasich signed SB 265, sponsored by Senator Matt Dolan, legislation to formally recognize 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 roots in order to reflect the reality of its more service-oriented role. 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 utilizing all members of the health care team has never been greater. Ohio suffers from a litany of medically underserved areas, and doctor shortages are expected to get even worse in the coming years. As the demands for health care services grows, the need for tapping into "physician extenders" and the full health care team increases exponentially.

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

"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, which will allow for compensation for cognitive services. I would like to thank OPA members, OPA staff, and the various leaders in the profession for their efforts to provide testimony and lobbying support to make this possible. This brings us one step closer to more fully recognizing the value of pharmacists as an integral member of the healthcare team."

For complete details on SB 265, click here.

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 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 on 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 towards 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. Please be sure to share stories from the Columbus Dispatch Side Effects series with your lawmakers.

 

In all, it was a fantastic two-year stretch, and our members should be proud of all the work they did to help advance these important legislative priorities.

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

For more information on any of these issues please contact OPA’s Antonio Ciaccia at (614) 389-3236 or aciaccia@ohiopharmacists.org.

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