State Legislation 2009:

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03/31/09 Update on MPA bills: SB 174 – Our bill to create the professional classification of Advanced Pharmacist Practitioner was passed out of the House Business Committee on March 24 by a vote of 18 to 0 and is now headed to the full House for floor debate and a vote.   Rep. Elsie Arntzen (R) of Billings will carry the bill on the House floor for MPA. SB 275 – Our bill to add a Pharmacist to the Board of Pharmacy was also passed out of the House Business Committee on March 24 by a vote of 18 to 0 and heading to the House floor as well for floor debate and a vote.  Rep. Tim Furrey (D) of Missoula will carry the bill on the House floor for MPA.   SB 445 - A bill that, if passed, will authorize a medical practitioner to dispense drugs at an employer-based onsite clinic pursuant to a written prescription from a medical practitioner, remains waiting for action by the House Human Services Committee.  MPA strongly opposes this bill and we understand the Committee will take action on this measure on March 30th.  Click here for a list of House Members you know or from your area to support SB 174 and SB 275: http://www.leg.mt.gov/content/sessions/61st/2009HouseMembers.txt Click here to send an e-mail to House Members: http://www.leg.mt.gov/css/About%20the%20Legislature/Lawmaking%20Process/contact%20legislators.asp

• 3/15/09 Please Take ACTION NOW and OPPOSE SB 445: Please write to your House of Human Services Committee Members (see below)

  House Human Services Committee Members – Oppose SB 445

  Arlene Becker, Billings	Chair
  Mary Caferro, Helena	Vice Chair
  Pat Ingraham, Thompson Falls	Vice Chair
  Bill Beck, Whitefish	Member
  Julie French,  Scobey	Member
  Timothy Furey, Missoula	Member
  David Howard, Park City	Member
  Chuck Hunter, Helena	Member
  Dave McAlpin, Missoula	Member
  Michael More, Bozeman	Member
  Pat Noonan, Butte	Member
  Ken Peterson, Billings	Member
  Diane Sands, Missoula	Member
  Cary Smith, Billings	Member
  Ron Stoker, Darby	Member
  Jeffery Welborn, Dillon	Member

• SB 445, Passed Senate, remitted to House - This is a bill requested by EBMS, a full-service employee benefit management company located in Billings, and is the same bill MPA helped to defeat in 2007.  MPA is opposed to SB 445, which if passed will authorize a medical practitioner to dispense drugs at an employer-based onsite clinic pursuant to a written prescription from a medical practitioner.   The bill cleared the State Senate and MPA will be seeking the help of all MPA members to contact members of the House and oppose this bill during the second half of the session. 
• SB 445 is the same bill as the last 2007 legislation (SB 397: AN ACT AUTHORIZING A MEDICAL PRACTITIONER TO DISPENSE DRUGS AT EMPLOYER-BASED ONSITE CLINICS PURSUANT TO A PRESCRIPTION WRITTEN BY A MEDICAL PRACTITIONER) which also made it through the Senate quickly and MPA and other pharmacists stopped SB 397 in the House...as we must do again for the safety of our patients!

• REASONS TO OPPOSE SB 445:
  • The typical patient uses multiple providers or specialists and the risks of drug interactions could greatly be enhanced. The bill fails to address a mechanism by which the patient's pharmacy could be alerted to new medications dispensed by a practitioner as well as no mechanism alerting other members of healthcare to share dispensing information, compromising the wellfare of the patient by bypassing our current checks and balances system.
  • The safety net of patient counseling does not exist in the provisions of this bill.  SB 445 does not mandate that written material be given to the patient with regard to their medications.  This may be a positive step toward EBMS’s bottom line and it may save some patients time and money, but it is a step backwards for patient safety.
  • The patients we serve and strive to protect on a daily basis are also your constituents.  They deserve to be protected by the series of checks and balances presently in place.  SB 445 would remove those checks and balances, essentially the safety net under our patients, and they simply deserve better.

 

• 3/15/09 Please Take ACTION NOW and SUPPORT SB 174 and SB 275: Please write to your House Business Committee Members (see below)

Bill Wilson, Great Falls	Chair
Michele Reinhart, Missoula	Vice Chair
Elsie Arntzen, Billings	Member
Shannon Augare, Browning	Member
Paul Beck, Red Lodge	Member
Tom Berry, Roundup	Member
Carlie Boland, Great Falls	Member
John Fleming, St. Ignatius	Member
Timothy Furey, Missoula	Member
Pat Noonan, Butte	Member
Chuck Hunter, Helena	Member
Harry Klock, Harlowtown	Member
Mike Milburn, Cascade	Member
Scott Reichner, Bigfork	Member
Cary Smith, Billings	Member
Gordon Vance, Bozeman	Member
Jeffery Welborn, Dillon	Member
Bill Beck, Whitefish	Vice Chair

• 3/15/2009 SB 174 – Passed Senate, remitted to House Business Committee– The bill would create the professional classification of Advanced Pharmacist Practitioner.  The pharmacist practitioner would be a licensed pharmacist in good standing who is certified by the board, in consultation with the board of medical examiners, to provide drug therapy management, including initiating, modifying, or discontinuing therapies, identifying and managing drug-related problems, or ordering tests under the direction or supervision of a prescriber.  The person would have additional education, experience, or certification as required by the Board and would have a collaborative pharmacy practice agreement in place. Senator Gary Perry (R) of Manhattan is sponsoring the bill for MPA and he has done an excellent job in working with our organization to move this bill forward.  The bill passed the State on a vote of 50 to 0.  

• 3/15/2009 SB 275 – Passed the Senate, remitted to House Business Committee – This bill would add a Pharmacist to the Board of Pharmacy.  Currently the Board of Pharmacy is made up of 6 members including 3 pharmacists, 1 pharmacy technician and 2 members of the public. The bill would increase the board from 6 to 7 members with the stipulation that the new person be a licensed pharmacist.  We believe the pharmacy profession and the issues surrounding pharmacy are very technical and in order to protect the public and fairly regulate the profession the Board needs additional input from a licensed professional.  Senator Carolyn Squires (D) of Missoula is sponsoring the bill for MPA and she has been a strong advocate for our profession this session.  The bill passed the State Senate on a vote of 34 to 16.

• HB 257 – Died in House Committee -This bill if passed would have allowed a medical practitioner to dispense drugs or devices when they were not available at a community pharmacy.  In addition the bill would have created a new category called “auxiliary” and defined as a non-pharmacist adult employed by a licensed pharmacy who could assist in the practice of pharmacy or telepharmacy.  MPA representatives strongly opposed the bill as too broad and in particular for provisions in the bill calling for a new “auxiliary” position instead of using existing laws to utilize pharmacy technicians.

• HB 284, Died in House Committee – This bill revised the laws on a pharmacist’s duty to dispense.  The bill stated a pharmacist has a duty to properly fill prescription orders for drugs or devices that it carries for customers without undue delay.  In addition, it called for the Board of Pharmacy to establish additional conduct standards for pharmacists.  MPA representatives opposed this bill as too broad and for adding needless and duplicative standards to the Pharmacy Practice Act.

• HB 267 – Fails in House Committee - This bill called for the establishment of a “Prescription Monitoring Program (PMP)” and would have created a centralized database to collect controlled substance prescription information submitted by pharmacies licensed in the State.  The bill was sponsored by Rep. Teresa Henry (D) of Missoula at the request of MPA and other members of the PMP Coalition.  Unfortunately, the bill did not fare very well in the House Human Services Committee.  The committee held an extensive discussion on the bill in Executive Session and Committee members voiced numerous objections dealing with the database security, the cost to the State if the $400,000 grant did not come through, the concern that the bill was a law enforcement bill (the opposite concern was expressed from law enforcement advocates), and concerns about the immunity clause.   In the end HB 267 was voted down by the Committee and is dead for this session. 

Special thanks to all those at the Montana Pharmacy Association who are working so dilligently on these bill and securing our future. Please show MPA your support and join today at www.rxmt.org

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Federal Legislation 2009:

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03/19/08 Demise of AWP? First Databank Settlement Approved

Tuesday March 17th, Judge Patti Saris approved the settlement in the long-running First Databank Average Wholesale Price (AWP) litigation, rejecting objections raised by the pharmacy industry. Judge Saris also offered some damning words about AWP as a pricing benchmark for pharmacy reimbursement, adding further urgency to the need for an alternative model. 

The suit was brought against Fist DataBank, Medi-Span, and McKesson by union and consumer groups. It accuses them of conspiring to inflate the spread between WAC and AWP to increase pharmacy profits and business for McKesson and resulting in higher costs for third-party payers and patients. 

McKesson had settled its pending lawsuit last November to the tune of about 351 million dollars.  The money will go to health plans that pay for drugs and consumers who paid co-pays for their medicines.  According to Drug Channels, “If we assume $20 million in future legal costs and take the plaintiff’s original estimated damages of $5 billion, then the $351 million settlement implies a 6% probability of losing the case.  Put another way, McKesson settled even though the numbers suggest a more than 90% chance of winning.”

The WAC-to-AWP spread will be rolled back to 1.20 from 1.25 (a 4% reduction) for many drugs, on 1,442 products by National Drug Code (NDC).  First Databank will stop publishing Blue Book AWP values within the next two years.

NCPA's intervention in the suit, when the first proposed settlement would have reduced AWPs on nearly 8,500 products by NDC, has prevented an average of $291 a day in losses for every community pharmacy since October 2006.

NCPA, which opposed the settlement, and other groups plan to appeal the decision to the First U.S. Circuit Court Appeals. A hearing is not expected for more than a year, during which time the rollback cannot take effect. If NCPA wins the appeal, the settlement would be voided.   

SPECIAL THANKS to NCPA, IPC, FMI, and NACDS as well as LTCPA, ASCP, and PCMA for all their efforts in preventing the rollback thus far.

Orignal material to view:
1. Final Order granting settlement (03/17/09)
2. Response from NACDS (03/17/09)
3. First Data Bank Statement to customers (03/17/09)
4. Drug Channels, "Farewell AWP" (03/17/09)

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3/15/09 DMEPOS Accreditation Exemption Introduced in Senate
Sens. John Tester (D-Mont.) and Sam Brownback (R-Kan.) are the chief sponsors of a bill that would add pharmacists to a list of 17 medical professions that already are exempt from new accreditation requirements for Medicare Part B DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies ) providers.

S. 511, the Access to Durable Medical Equipment Act of 2009, was introduced last week. It is similar to H.R. 616, introduced in the House by Reps. Marion Berry (D-Ark.) and Jerry Moran (R-Kan.) Jan. 21. That measure currently has 45 bipartisan supporters.

"The accreditation fees and implementation costs are at least $5,000 to $7,000 per pharmacy, reoccur every three years, and are totally unneeded and unwarranted for pharmacists and pharmacies already licensed and regulated by their state and DEA (the Drug Enforcement Administration),” commented Bruce T. Roberts, RPh, NCPA executive vice president and CEO.

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3/15/09 H.R.1204 In an effort to permit community pharmacies to negotiate better contracts, Reps. Anthony Weiner (D-NY) and Jerry Moran (R-KS) recently introduced legislation designed to level the playing field between community pharmacies and pharmacy benefit managers (PBMs).

The bill, the Community Pharmacy Fairness Act of 2009, would create a narrow exemption to current antitrust law.

Drug Topics Article March 3, 2009