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2016 Legislative Session Ends: Big Wins for Patient Care and Pharmacy Practice!

You Have a Voice: TPA
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Pharmacy-Related Legislative Initiatives Passed in 2016

Detailed information about the provisions of the following new laws, including the ways each of them will affect pharmacy practice, can be found in the TPA Summary links provided below.

The Tennessee Pharmacists Association (TPA) greatly appreciates the ongoing support and assistance from all of our TPA members and pharmacy advocates in contacting legislators and advocating for pharmacy practice in Tennessee. In addition to the numerous calls and text messages sent to legislators, TPA members sent more than 670 letters to state legislators in support of specific pharmacy-related legislative initiatives during the 2016 legislative session.

TPA would like to also thank all our state legislators, and specifically the legislators listed below, who worked so diligently during this session to support these laws, thus increasing patient access to pharmacist-provided care and services and advancing the profession of pharmacy!

Proposed AWP Cuts to the TennCare Pharmacy Program – Funded for FY 2016-2017

For background, the Bureau of TennCare proposed significant average wholesale price (AWP) cuts to the TennCare Pharmacy Program last year. These cuts were proposed for fiscal year 2015 – 2016 and would have gone into effect on July 1, 2015. If implemented, these cuts would have resulted in a total reduction in payments to pharmacies in the amount of $17.4 million for brand name medications, generic medications, and specialty medications. TPA was successful in working with our legislators and pharmacy partners to restore these cuts for fiscal year 2015 – 2016. However, the cuts during the 2016 session, were only restored with non-recurring dollars in 2015, meaning that if funds were not allocated to prevent these cuts, they would go into effect for fiscal year 2016 – 2017. TPA was successful again this year in working with pharmacy partners and legislators to restore these cuts for fiscal year 2016 – 2017, thus preventing a reduction in pharmacy payments in the amount of approximately $17 million ($6 million state funds and $11 million in federal funds) to pharmacies.

Enhanced Penalties for Criminals Who Commit Robberies Involving Controlled Substances on the Premises of Licensed Pharmacies – Passed

TPA worked with legislators to introduce and pass this legislation in 2016. This legislation creates a new sentencing enhancement factor when the defendant committed the offense of robbery, aggravated robbery, or especially aggravated robbery on the premises of a licensed pharmacy in an effort to unlawfully obtain, sell, give, or exchange a controlled substance, controlled substance analogue, or other illegal drug. With an increased focus on reducing the number of controlled substances that are prescribed and dispensed, pharmacy robberies involving controlled substances continue to increase in Tennessee and across the nation. This legislation is a step in the right direction to protect pharmacists, pharmacy staff members, and patients from the dangers of pharmacy robberies involving controlled substances. TPA’s full summary of the legislation may be found by clicking on the link below.

Increased Patient Access to Pharmacist-Provided Opioid Antagonist Therapy through State-Wide Collaborative Pharmacy Practice Agreements – Passed

TPA worked with legislators to introduce and pass this legislation in 2016. This legislation seeks to increase patient access to life-saving opioid antagonist therapy by authorizing a state-wide collaborative pharmacy practice agreement (CPPA) between pharmacists and the Chief Medical Officer for the Tennessee Department of Health. As enacted, the Chief Medical Officer for the Tennessee Department of Health is authorized to enter into a CPPA with pharmacists for the dispensing of opioid antagonists, effectively reducing barriers to this important medication, effectively reducing the number of opioid overdose deaths and saving the lives of many Tennesseans. TPA’s full summary of the legislation may be found by clicking on the link below.

  • TPA Summary: State-Wide CPPA for Opioid Antagonist Dispensing
  • Legislation: SB 2403 / HB 2225
  • Specific Language: Public Chapter 596
  • Effective Date: March 10, 2016
  • House Sponsors: Terry, Williams, Sexton C, Doss, Dunlap, Howell, Hazlewood, Kevin Brooks, Ramsey, Swann, Matlock, Gilmore, Jerry Sexton, Kumar, Mark White, Smith, Byrd, Matthew Hill, McManus, Zachary, Windle, Favors, Eldridge, Littleton, Kane, Sparks, Weaver, Goins, McCormick, Ragan, Towns, Moody
  • Senate Sponsors: Overbey, Haile, Yarbro

Authorization of PSAO’s to File MAC Appeals on Behalf of Pharmacies – Passed

This legislation was a joint effort supported by TPA, Southern Pharmacy Cooperative, and other pharmacy organizations to clarify existing language in the maximum allowable cost (MAC) legislation passed back in 2014. This legislation grants a pharmacy the right to designate a pharmacy services administrative organization (PSAO) or other agent to file and handle its appeal of the maximum allowable cost of a particular drug or medical product or device. TPA’s full summary of the legislation may be found by clicking on the link below.

Increased Patient Access to Contraceptive Therapy through Pharmacist-Provided Care – Passed

TPA supported this legislation and worked with legislators on language authorizing the provision of contraceptives by pharmacists pursuant to a collaborative pharmacy practice agreement, provided that certain conditions are met. A full summary of the legislation may be found by clicking on the link below.

Renewal of the Prescription Safety Act – Passed 

The Tennessee General Assembly passed the renewal of the Prescription Safety Act in 2016. TPA supported the renewal of the Prescription Safety Act, and was heavily engaged with the Tennessee Department of Health on this legislative initiative. TPA worked with the Department and other pharmacy partners to advocate for the professional responsibility of pharmacist providers in preventing prescription drug abuse while ensuring that the burden on pharmacists is minimal. Of note, this legislation adds a new provision requiring pharmacists to check the controlled substances monitoring database once annually for patients who are dispensed opioids or benzodiazepines (including tramadol). TPA’s full summary of this legislation may be found by clicking on the link below.

Authorization for 90 Day Dispensing By Pharmacists for Maintenance Medications – Passed

TPA supported this legislation which authorizes a pharmacist to dispense up to a 90-day supply of medication, including any refills, and up to the total number of dosage units as authorized by the prescriber on the original prescription, including any refills. For example, if a prescription is written for a 30-day supply with 2 refills, a pharmacist can dispense a 90-day supply without additional authorization from the prescriber, if all allowed conditions are met. As it relates to this law, the total number of dosage units of the prescription may never be increased by the pharmacist, and the total units dispensed at one time may not exceed a 90-day supply. This authorization for 90 day dispensing does not apply to controlled substances, or any medication which is reported to the controlled substance monitoring database, and also does not apply if a prescriber has specified on the prescription for a maintenance medication that dispensing it in an initial amount followed by periodic refills is medically necessary.

Repeal of the Professional Privilege Tax – Amended legislation passed but tax not repealed

In 2016, TPA joined a coalition of multiple professional groups affected by this tax to work together in support of a legislative solution which phases out or reduces the financial burden on all health professionals subject to this tax. According to the associated fiscal note, a full repeal of the professional privilege tax will cost the state of Tennessee approximately $77 million dollars annually in lost revenue. While the amended legislation does not repeal the professional privilege tax, it directs the Tennessee advisory commission on intergovernmental relations (TACIR) to study the history of the professional privilege tax in this state, the intent of the professional privilege tax, other states’ laws imposing a professional privilege tax or similar tax, and alternatives for eliminating or phasing out the professional privilege tax, and to make recommendations to the speakers of the Senate and the House of Representatives and the chairs of the Finance, Ways and Means committees of the Senate and the House of Representatives, on or before January 1, 2017, relative to the professional privilege tax.

  • Legislation: HB 0678 / SB 0566
  • Specific Language: Public Chapter 1024
  • Effective Date: TACIR study due on or before January 1, 2017
  • House Sponsors: VanHuss, Matheny, Butt, Hill M, Keisling, Holt, Womick, Terry, Zachary, Travis, Sexton C, Byrd
  • Senate Sponsors: Bowling, Roberts

Regulation of Physician Dispensing of Opioids and Benzodiazepines – Passed

This legislation establishes new requirements for the dispensing of opioids and benzodiazepines by physicians. This legislation requires a physician practice that provides healthcare services and dispenses opioids and benzodiazepines, as directed by the patient’s prescription, to dispense opioids and benzodiazepines in safety-sealed, prepackaged containers stamped with the manufacturer’s national drug code number, administer and record pill-counts for opioids or benzodiazepines, dispense non-controlled substances amounting to at least fifty percent (50%) of the prescriptions filled annually from the practice, and submit the dispensing information to the controlled substances monitoring database

  • Legislation: SB 2060 / HB 2126
  • Specific Language: Public Chapter 973
  • Effective Date: Pending (effective upon Governor Haslam’s signature)
  • House Sponsors: Terry, Hicks, Powers, Smith
  • Senate Sponsors: Briggs, McNally, Hensley, Haile, Bowling, Massey, Yager, Kyle, Bailey, Green, Jackson

Licensure and Certificates of Need for Pain Management Clinics – Passed

This legislation adds to the present law requirements for the operation of a pain management clinic (PMC), including a licensure requirement and a requirement that a PMC obtain a certificate of need.

  • Legislation: SB 1466 / HB 1731
  • Specific Language: Public Chapter 1033
  • Effective Date: July 1, 2017
  • House Sponsors: Sexton C, Lamberth, Clemmons
  • Senate Sponsors: McNally, Yager, Crowe, Briggs, Bowling, Bailey

Updated Requirements for Certificates of Need Related to Hospitals – Passed

This legislation revises present law provisions governing certificates of need for hospitals and other institutions.

  • Legislation: SB 1842 / HB 1730
  • Specific Language: Public Chapter 1043
  • Effective Date: July 1, 2016
  • House Sponsors: Sexton C, Daniel, Matheny, Clemmons
  • Senate Sponsors: Gardenhire, Watson

Stocking and Administration of Epinephrine Auto-Injectors – Passed

This legislation authorizes entities or organizations at which allergens capable of causing anaphylaxis may be present, including, but not limited to, a recreation camp, college, university, place of worship, youth sports league, amusement park, restaurant, place of employment, and sports arena, to stock epinephrine auto-injectors on their premises. This legislation also authorizes prescribers to prescribe and pharmacists to dispense epinephrine auto-injectors in the name of an authorized entity. This legislation further provides pharmacists with immunity from civil liability in the absence of gross negligence for any action authorized by this section or the failure to take any action authorized by this legislation.

  • Legislation: SB 1989 / HB 2054
  • Specific Language: Public Chapter 805
  • Effective Date: July 1, 2017
  • House Sponsors: Kumar, Sexton C, Williams, Littleton, Hill M, Favors, Terry, Hardaway, Byrd, Windle, Daniel, Armstrong, Powell, Smith, Hazlewood, Sparks, Brooks K, Dunlap
  • Senate Sponsors: Green, Tracy, Crowe, Hensley, Dickerson, Briggs, Massey, Watson, Bailey, McNally, Overbey, Jackson, Haile, Roberts, Ketron

Epinephrine Administration by Law Enforcement Personnel – Passed 

This legislation authorizes law enforcement agencies to develop an epinephrine-administration protocol for the purpose of an officer administering epinephrine in an emergency situation to treat anaphylactic reactions. This legislation authorizes a healthcare prescriber to prescribe epinephrine kits in the name of the law enforcement agency and a pharmacist to dispense epinephrine kits to the law enforcement agency pursuant to a prescription issued in the name of the law enforcement agency. As originally proposed, the legislation did not contain immunity for pharmacists from civil liability, but TPA worked with bill sponsors to add immunity from civil liability for pharmacists based on any injury to an individual who is harmed by the administration of the epinephrine dispensed by the pharmacist and prescribed by a physician pursuant to this law.

  • Legislation: SB 1767 / HB 2445
  • Specific Language: Public Chapter 801
  • Effective Date: July 1, 2017
  • House Sponsors: Williams, Travis, Reedy, Byrd, Terry, Gravitt, Hazlewood, Carter, White M, Eldridge, Hardaway
  • Senate Sponsors: Bailey, Bowling

Board of Pharmacy Renewal – Passed

This legislation extends the Board of Pharmacy two years to June 30, 2018, and requires the Board to appear before the Government Operations Joint Evaluation Committee on Education, Health and General Welfare no later than November 18, 2016, to provide an update on the Board’s progress in addressing the findings set forth in the October 2015 performance audit report issued by the Division of State Audit.

  • Legislation: SB 1507 / HB 1611
  • Specific Language: Public Chapter 773
  • Effective Date: Pending (effective upon Governor Haslam’s signature)
  • House Sponsors: Faison, Ragan
  • Senate Sponsor: Bell

Renewal of the TennCare Pharmacy Advisory Committee – Passed

This legislation extends the state TennCare Pharmacy Advisory Committee for four more years (to June 30, 2020).

Renewal of the Controlled Substance Monitoring Database Advisory Committee – Passed

This legislation extends the Controlled Substance Monitoring Database Advisory Committee two years to June 30, 2018, and requires the Advisory Committee to appear before the Government Operations Joint Evaluation Committee on Education, Health and General Welfare no later than November 18, 2016, to provide an update on the Advisory Committee’s progress in addressing the findings set forth in the October 2015 performance audit report issued by the Division of State Audit.

Updates to the Current  Medication Aide Law – Passed
Reinstatement of Expired or Revoked License – Passed
Lisdexamfetamine Dimesylate for Binge Eating Disorder – Passed
Change in Pain Management Specialist Designation – Passed
TennCare Omnibus Act of 2016 – Passed
Application of State-Mandated Health Benefit to All Health Plans – Passed
Medical Cannabis Use in Clinical Research by Four-Year Institutions – Passed

Pharmacy-Related Legislative Initiatives Considered But Not Passed in 2016

Medication Therapy Management in Medicaid – Did Not Pass

TPA worked with legislators to introduce Senate Bill 1882 and House Bill 2398. If implemented, this legislation would have required TennCare, in collaboration with the various Managed Care Organizations administering the medical benefits on behalf of TennCare, to develop and incorporate a Medication Therapy Management (MTM) program for TennCare beneficiaries. The underlying purpose of any Medication Therapy Management program is to improve patients’ lives, ensure high quality of care, and reduce overall costs for health care. According to the state’s Fiscal Note for this legislation, the state would have realized an increase in state expenditures of approximately $4.75 million per year, but did not recognize any cost savings or return on investment (ROI) associated with such a program, despite significant return on investment realized by numerous other states which have implemented similar MTM programs.

TPA will continue to work with TennCare, and the Managed Care Organizations which administer the TennCare program, to identify opportunities for pharmacists to integrate and deliver care as providers in the program. TPA urges pharmacists to continue to speak with your legislators about the positive impact of pharmacist-provided patient care services, such as MTM, as a measure to improve patient health outcomes and reduce overall costs to the health care system.

  • TPA Summary: MTM in Medicaid
  • Legislation: SB 1882 / HB 2398
  • House Sponsors: Littleton, Shepard, Sexton C, Swann, Carr
  • Senate Sponsors: McNally, Crowe, Overbey, Haile, Bowling

Oral Chemotherapy Parity – Did Not Pass

As introduced, this legislation would have prohibited 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.

  • Legislation: SB 2091 / HB 2239
  • House Sponsors: Lamberth, Casada, Littleton, Powers, Kumar, Brooks K, Terry, Powell, McCormick, White M, Butt, Farmer, Towns, Beck, Doss, Akbari, Camper, Kane, Fitzhugh, Johnson, Shepard, Hill M, Carr , Jernigan, Miller
  • Senate Sponsors: Ketron, Green, Beavers, Jackson, Haile, Yager, Dickerson, Massey

Medication Synchronization – Did Not Pass

This legislation was brought by the American Cancer Society, and sought to require that a contract or policy of an insurer that provides benefits for prescription drugs must include certain provisions to allow for medication synchronization. These provisions would have applied to all insurers, including TennCare, that are not preempted by federal law. TPA supports and advocates for the role of the pharmacist in improving medication adherence for patients, including the incorporation of medication synchronization programs into daily practice. However, due to the mandates and requirements that this bill would have placed on insurers, including TennCare, this bill received a significant fiscal note from the state of Tennessee and did not pass in 2016.

  • Legislation: SB 0497 / HB 0475
  • House Sponsors: Shepard, Clemmons, Shaw, Terry, Jernigan, Williams, Durham
  • Senate Sponsors: Haile, Dickerson, McNally, Harris, Massey

Regulation of Drug Manufacturers and Prices by Department of Health – Did Not Pass
Out-Of-Network Notice and Billing by Providers – Did Not Pass
Abuse-Deterrent Opioid Analgesics – Did Not Pass
90 Day Opioid / Benzodiazepine Exception – Did Not Pass
Nursing Scope of Practice – Did Not Pass
Healthcare Improvement Act – Did Not Pass
Pre-Arrest Diversion Program for Minor Drug Charges – Did Not Pass
Restoration of TennCare Oversight Committees – Did Not Pass
Prohibition of Institutional Discipline for Students Seeking Medical Assistance for Drug Overdoses – Did Not Pass

Tennessee Pharmacists Association

1732 Lebanon Pike Circle, Nashville, TN 37210
phone: 615-256-3023 fax: 615-255-3528
email: tpa@tnpharm.org