Association News

2017 Legislative Recap: Increasing Patient Access to Pharmacist-Provided Care

Pharmacy Legislation Enacted in 2017

2017 Tennessee “Pharmacists as Providers” Law – PASSED!

Recognition and reimbursement for pharmacists as providers of care remain among TPA’s top legislative priorities. In 2017, TPA worked with legislators, managed health insurance issuers, and key pharmacy advocacy groups to introduce and pass legislation which provides pharmacists with formal recognition as providers through managed health insurance issuers, including reimbursement and inclusion in medical networks as providers of care. This law establishes a pathway for pharmacists, acting within the scope of their license or certification under state law, to be credentialed with managed health insurance issuers; authorizes enrolled and credentialed pharmacists to participate in, receive referrals, and be reimbursed for covered services or indemnification; requires that managed health insurance issuers include pharmacists as providers to the extent necessary to meet the needs of the managed health insurance issuer’s plan and its enrollees; and supports the inclusion of pharmacists as members of the larger health care team, which will enhance communication, collaboration, and patient referrals to physicians and other health care providers.

• Legislation: HB 0405 / SB 0461
• Law: Public Chapter 82
• House Sponsor(s): Terry, Sexton C, Swann, Dunn, Byrd
• Senate Sponsor(s): Bell, Haile, Crowe, Overbey
• Effective Date: July 1, 2017
• Description: Effective July 1, 2017, this law expands current code to include pharmacists in the list of classes of providers which managed health insurance issuers are prohibited from discriminating against as providers in medical networks, with respect to participation, referral, reimbursement of covered services or indemnification, solely on the basis of their license or certification, if such providers are acting within the scope of their license or certification.
• What This Legislation Is Intended to Do:
  • This legislation adds “pharmacists” as providers of care in existing state insurance code (TCA 56-32-129).
  • This legislation provides a pathway for pharmacists who are acting within the scope of their license or certification under state law to be credentialed with managed health insurance issuers and enable them to participate, receive referrals, and be reimbursed for covered services or indemnification.
  • This legislation creates a mechanism for pharmacists to participate as members of the larger health care team, resulting in increased communication, collaboration, and patient referrals, as appropriate, to physicians and other health care providers for further assessment, management, and treatment.

Medication Therapy Management (MTM) Pilot Program for TennCare Patients – PASSED!

Pharmacist-provided MTM services have demonstrated significant value within the Medicaid population through improved patient health outcomes, increased quality of care, and decreased costs to taxpayers. In 2017, TPA worked with TennCare to introduce and pass a pharmacist-provided Medication Therapy Management (MTM) pilot program as a new service for TennCare beneficiaries. This two-year pilot program is funded by the state of Tennessee and will allow qualified pharmacists to provide MTM services to eligible TennCare patients. This legislation will provide approximately $5 million annually over the course of the pilot program to build the necessary infrastructure and to pay pharmacists for providing care to eligible TennCare beneficiaries. TennCare will monitor improved patient health outcomes achieved through the pilot program and prioritize any cost savings toward future expansion of the program.

• Legislation: HB 0628 / SB 0398
• Law: HERE
• House Sponsor(s): Kumar, Terry, Ragan, Brooks K, Holsclaw
• Senate Sponsor(s): Haile, Overbey\
• Effective Date: July 1, 2017 (program development) and January 1, 2018 (pilot program implementation)
• Description: As amended, this legislation establishes a pharmacist-provided Medication Therapy Management (MTM) pilot program within the TennCare program. By enacting this legislation and establishing this MTM pilot program, TennCare patients would gain access to pharmacist-provided MTM services. Pharmacist-provided MTM services have demonstrated significant value through improved patient health outcomes, increased quality of care, and decreased costs to taxpayers in other state Medicaid programs.

Pharmaceutical Reimbursement Cuts to the TennCare Pharmacy Program – FUNDING PERMANENTLY RESTORED!

In 2015 and 2016, the Bureau of TennCare proposed significant pharmaceutical reimbursement cuts to the TennCare pharmacy program. In each of these years, TPA and pharmacy advocacy groups worked successfully with the Tennessee General Assembly to prevent the implementation of the pharmacy cuts through the allocation of one-year (non-recurring) state funding. These successful efforts prevented a total reduction in payments to pharmacies in the amount of $17.4 million annually for brand name medications, generic medications, and specialty medications.

In 2017, TennCare permanently restored funding for the proposed pharmacy cuts on a recurring basis, thus eliminating any future consideration of the pharmacy cuts in Fiscal Year 2017-2018 and subsequent years.

Through persistent efforts by TPA and key pharmacy advocacy groups, this permanent restoration of funding by TennCare ensures that approximately $17 million ($6 million in state funds and $11 million in federal funds) will remain with pharmacies and protect the future viability of TennCare-participating pharmacies going forward.

Prescription Drug Donation Repository Program – PASSED!

TPA supported this legislation, which authorizes the Board of Pharmacy, in cooperation with the Tennessee Department of Health, to establish and maintain a prescription drug donation repository program under which any person may donate prescription drugs and supplies for use by an individual who meets eligibility criteria specified by the Board by rule. The law allows for donations of prescription drugs (in tablet or capsule form only) and supplies under the Prescription Drug Donation Repository Program to be made on the premises of a medical facility or pharmacy that elects to participate in the program and meets the requirements established by the Board. Prescription drugs are also limited to original sealed and tamper-evident packaging or unit dose or blister packaging, if the packaging remains intact. The law also allows the medical facility or pharmacy that receives prescription drugs or supplies to distribute the prescription drugs or supplies to another eligible medical facility or pharmacy for use pursuant to the program. It is important to note that participation in the program is voluntary, the law does not include controlled substances and REMS drugs, and it provides immunity for participating facilities, pharmacies, patients, and pharmacists.

• Legislation: HB 0137 / SB 0429
• Law: HERE
• House Sponsor(s): Sexton C, Terry, Hazlewood, Thompson
• Senate Sponsor(s): Kelsey, Haile, Harris
• Effective Date: January 1, 2018
• Description of legislation:
  • Authorizes the Department of Health, in cooperation with the Board of Pharmacy, to promulgate rules to establish and enforce a prescription drug donation repository program under which a person or organization may donate prescription drugs and supplies for use by a 501(c)(3) charitable organization that meets eligibility criteria specified by rule for administering the program.
  • Establishes requirements and guidelines for which a prescription drug or supplies may be accepted and dispensed under the prescription drug donation repository program.
  • Requires the Department of Health to adopt rules pursuant to the drug donation repository program.
  • Establishes that participation in the program is voluntary.
  • Does not restrict the use of samples, does not authorize the resale of prescription drugs by any person through this program, and does not authorize dispensing of prescription drugs after the expiration date of the drug.

Drug Disposal in Long-Term Care Facilities – PASSED!

TPA supported this legislation, which seeks to update rules specific to drug destruction in long-term care facilities. Current rules related to drug disposal in long-term care facilities require pharmacists to maintain responsibility for the proper disposal of controlled substance medications for that facility. This law directs the Board for Licensing Health Care Facilities to use emergency rulemaking to promulgate rules by January 1, 2018, to permit facilities licensed under this law to dispose of controlled substances and other prescription drugs by destruction using any means permitted by the federal Drug Enforcement Administration (DEA) or through disposal by donation or other means, including a drug donation repository program, of prescription drugs that are not controlled substances.

• Legislation: HB 0519 / SB 1320
• Law: HERE
• House Sponsor(s): Sexton C, Matheny, Hardaway
• Senate Sponsor(s): Crowe, Briggs
• Effective Date: May 12, 2017
• Description of legislation:
  • Authorizes a nursing home to participate in a drug donation repository program until the Board for Licensing Health Care Facilities (BLHCF) promulgates rules to effectuate such participation.
  • Directs the BLHCF to use emergency rulemaking to promulgate rules by January 1, 2018, to permit facilities to dispose of controlled substances and other prescription drugs by destruction using any means permitted by the Federal Drug Enforcement Administration.
  • Directs the BLHCF to use emergency rulemaking to promulgate rules by January 1, 2018, to permit the disposal by donation or other means, including a drug donation repository program, of prescription drugs that are not controlled substances.

Drug Testing for Health Care Professionals – PASSED

While not a TPA initiative, TPA was able to work with sponsors to amend this legislation on pharmacists’ behalf. As amended, it sets up new requirements for employers to report a healthcare practitioner to the Department of Health and the practitioner’s licensing board, when the practitioner either a) refuses to submit to a drug test or b) tests positive for any drug on any government or private sector pre-employment or employer-ordered confirmed drug test for an employer, when the practitioner does not have a lawful prescription for using the drug or a valid medical reason for using the drug. The practitioner who either refuses or tests positive will have three (3) business days from notification of the confirmed test result to either produce a lawful prescription for the drug or a valid medical reason for using the drug to the employer, or report to the substance abuse peer assistance or treatment program of the appropriate board for the practitioner. However, as long as the practitioner obtains and maintains the advocacy of the substance abuse peer assistance or treatment program, unless otherwise required by law, the employer is not required to notify the appropriate board for the practitioner of the violation of the practitioner’s practice act.

• Legislation: HB 1067 / SB 1309
• Law: HERE
• House Sponsor(s): Holsclaw, Faison
• Senate Sponsor(s): Crowe
• Effective Date: July 1, 2017

Other Legislation Related to Pharmacy Practice

• Needle Exchange Program – PASSED
• Reporting Requirements for Controlled Substances and Neonatal Abstinence – PASSED
• Immunity for Persons Seeking Treatment for Drug Overdose – PASSED
• Coverage for Prescription Eye Drops – PASSED
• Naloxone Access in Schools – PASSED
• Clarification of Relationship Between APRNs and Physicians – PASSED
• Buprenorphine Treatment Guidelines – PASSED
• Dialysate Distribution – PASSED

Pharmacy Legislation Not Enacted in 2017 or Deferred to 2018

Professional Privilege Tax Repeal – ACTION DEFERRED TO 2018

For several years, TPA has participated as a member of a coalition of affected professionals and has actively advocated for a repeal of the Professional Privilege Tax. Last year, the coalition’s efforts produced a Tennessee Advisory Commission on Intergovernmental Relations (TACIR) study, which outlined the tax and also provided more detail about the tax relative to other states. In 2017, the coalition worked with legislators to introduce legislation that would phase out the tax over a 5-year period (similar to the recent Hall Tax repeal strategy). Although the Professional Privilege Tax repeal legislation was not passed in 2017, TPA will continue to work with the coalition to support and advocate for its passage in 2018.

• Legislation: HB 0041 / SB 0132 / (5-Year Repeal)
• House Sponsor(s): VanHuss, Matlock, White D, Lynn, Casada, Goins, Butt, Hulsey, Hill M, Crawford, Calfee, Hill T, Kane, Lovell, Holsclaw, Ragan, Rudd, Rogers, Howell, Sparks, Holt, Brooks K, Gant, Zachary, Swann, Eldridge
• Senate Sponsor(s): Bowling, Lundberg, Kyle, Gresham, Gardenhire, Watson, Johnson, Beavers, Southerland, Niceley, Norris, Massey, Bailey, Yager, Kelsey, Briggs, Green, Hensley, Ketron, Harris, Bell, Dickerson
• Description: As introduced, phases out the professional privilege tax over a five-year period for tax years that begin on and after June 1, 2017.

Direct and Indirect Remuneration (DIR) Restrictions and Licensing of Pharmacy Benefits Managers (PBMs) – ACTION DEFERRED TO 2018

TPA and key pharmacy advocacy groups worked with legislators to introduce this legislation, which would seek to ensure greater transparency by establishing that a covered entity or PBM may only assess, charge, or hold a pharmacy responsible for fees related to the adjudication of a claim, if that fee is apparent to the pharmacy at the time of claim processing, reported on the remittance advice of the adjudicated claim, or set out in contract between the PBM and pharmacy. The legislation would also require all PBMs operating in Tennessee to license with the Tennessee Department of Commerce and Insurance. During the 2017 session, TPA staff and members provided testimony to the Senate Investigations and Oversight Committee on February 14, 2017, regarding DIR and its impact on patients and pharmacy practice. CLICK HERE to view a video recording of this testimony.

TPA will continue to work to educate legislators regarding the impact of DIR fees within the Medicare program. However, because federally funded plans like Medicare are not required to comply with any state laws, TPA will continue to work with our national pharmacy organizations to support federal-level changes to the Medicare program.

• Legislation: HB 0569 / SB 0392
• House Sponsor(s): Powers, Sexton C, Ragan
• Senate Sponsor(s): Haile, Dickerson
• Description: As amended, this legislation would seek to ensure greater transparency by establishing that a covered entity or PBM may only assess, charge, or hold a pharmacy responsible for fees related to the adjudication of a claim if that fee is apparent to the pharmacy at the time of claim processing, reported on the remittance advice of the adjudicated claim, or set out in the contract between the PBM and the pharmacy. This legislation would also require all PBMs operating in Tennessee to license with the Tennessee Department of Commerce and Insurance.

Oral Chemotherapy Parity – ACTION DEFERRED TO 2018

This legislation would have prohibited a health benefits contract delivered, issued for delivery, or renewed on or after January 1, 2017, that provides benefits for anti-cancer medications that are injected or intravenously administered by a healthcare provider and anti-cancer medications that are patient-administered, from requiring a higher copayment, deductible, or coinsurance amount for a patient-administered anti-cancer medication than the contract requires for injected or intravenously administered anti-cancer medication.

• Legislation: HB 1059 / SB 0922
• House Sponsor(s): Lamberth, Casada, Powers, Terry, Brooks K, Hill M, Carr, Matheny, Kane, White M, Littleton, McCormick, Hazlewood, Johnson, Farmer, Butt, Kumar, Fitzhugh, Stewart, Camper, Hill T, Faison, Hicks, White D, Akbari, Calfee, Gilmore, Swann, Jernigan, Powell, Ramsey, Pody, Love, Windle, Sargent
• Senate Sponsor(s): Ketron, Jackson, Dickerson, Massey, Briggs, Yager, Haile, Beavers, Bowling
• Description: As introduced, prohibits an insurance policy that provides benefits for anti-cancer medications that are injected or intravenously administered by a healthcare provider and anti-cancer medications that are patient administered from requiring a higher copayment, deductible, or coinsurance amount for the patient administered anti-cancer medication than for the injected or intravenously administered anti-cancer medication.

Non-Medical Switching of Prescription Drugs – VOTED DOWN

As introduced, this legislation would have prohibited, outside of open enrollment periods, a health insurance entity providing health insurance coverage and coverage for prescription drugs from removing any covered prescription drug from its list of covered drugs during the health plan year, reclassifying a drug to a more restrictive drug tier or moving a drug to a higher cost-sharing tier, or reducing the maximum coverage of prescription drug benefits. This law would not have prohibited the addition of prescription drugs to a policy’s list of covered drugs during the health plan year, and also would not have applied to a grandfathered health plan under the federal Patient Protection and Affordable Care Act, TennCare, CoverKids, or any plan managed by the Health Care Finance and Administration Division of the Department of Finance and Administration.

• Legislation: HB 0960 / SB 0991
• House Sponsor(s): Terry, Casada, Hill T, Hawk, Matheny, Williams, Towns, Hill M, Pitts, Kumar, Akbari, Ramsey, Jernigan, Brooks K
• Senate Sponsor(s): Green, Hensley, Watson, Briggs, Ketron, Dickerson, Kyle
• Description: As introduced, this legislation would have prohibited a health insurance entity from taking certain actions with respect to coverage of prescription drugs outside of open enrollment periods.

Medication Synchronization – VOTED DOWN

TPA continues to support pharmacist-led medication adherence initiatives such as medication synchronization. Many of our pharmacists have been providing medication adherence and medication synchronization services for years. This legislation would have prohibited health insurance policies from using prorated dispensing fees or denying coverage for dispensing of medication in accordance with the synchronization of medication, and would have required health insurance policies to apply prorated cost-sharing to dispensing of medication in accordance with synchronization of medication.

• Legislation: HB 0139 / SB 0799
• House Sponsor(s): Sexton C
• Senate Sponsor(s): Dickerson
• Description: As introduced, prohibits health insurance policies from using prorated dispensing fees or denying coverage for dispensing of medication in accordance with the synchronization of medication; and requires health insurance policies to apply prorated cost-sharing to dispensing of medication in accordance with synchronization of medication.