2/4/2019 AkPhA Legislative Update: Pertinent Pharmacy Legislative Issues Purpose ose 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 onal al and state levels ls Objective tives: 1). Describe be potenti tial implicati tion ons to the practice of pharmacy y from the passage ge of The Opioid d Crisis Response Act of 2018 . 2). Identi tify y nation onal and region onal regu gulatory tory steps being g implemen mented ted or consider dered d regardin ding g the opioid d crisis. 3). List t three legislati tive ve bills that AKPhA will be monitor oring g in the 2019 Legislati tive ve Session on. 2 1
2/4/2019 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. 3 2
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2/4/2019 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. 4
2/4/2019 Senate organized House has Speaker Pro Tem Sen. Cathy y Giessel (R) Neal Foster (D) Nome Eagle RIver Speaker Pro Tempore Presiden dent of the Senate She leads a 14 – member Major ority ty Coaliti tion on 13 Republicans 1 Democrat. t. 9 Majority Leader Minority Leader Rules Chair Sen. Mia Costello Sen. Tom Begich Sen. John Coghill Anchor orage ge Anchor orage ge North th Pole 10 5
2/4/2019 New Legislators ators for the 31 st st Legislatu lature re House of Represe sent ntat ativ ives Benjamin Carpenter Sharon Jackson Sara Hannon William Zach Fields Grier Hopkins Barton LeBon Laddie Shaw Kelly Merrick Sara Rasmussen Josh Revak Andrea Story Sarah Vance New Legislators ators for the 31 st st Legislatu lature re Senat ate Jesse Kiehl Elvi Gray-Jackson Familiar House Faces Now in the Senate Chris Birch Scott Kawasaki Lora Reinbold 6
2/4/2019 Brings fairness to the unregulated and expanding practice of pharmacy audits. Does not allow audits the first seven calendar days of 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. 13 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. 14 7
2/4/2019 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. 15 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 of 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 of this Act, this Act takes effect t July 1, 2 2019 16 8
2/4/2019 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 of 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 of this Act, this Act takes effect t July 1, 2 2018 17 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 18 9
2/4/2019 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. 20 10
2/4/2019 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. 21 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. 22 11
2/4/2019 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. 23 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 overdose death rate in Alaska increased by 77 percent (from 7.7 per 100,000 persons in 2010 to 13.6 in 2017). 24 12
2/4/2019 Preliminary data for 2018 indicate that the ongoing response may be having an impact: During the first six months of 2018, 29 Alaskans died of opioid overdose, compared with 44 opioid overdose 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. 25 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 opioid overdose deaths through widespread availability and the appropriate use of naloxone and improved health provider and drug prescriber education. 26 13
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