Federal Programs

2017 TPA Priority Legislation Requiring Immediate Action

• Legislation: HB 0405 / SB 0461
• House Sponsor(s): Terry, Sexton C, Swann, Dunn, Byrd
• Senate Sponsor(s): Bell, Haile, Crowe, Overbey
• 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.

Take Action – www.votervoice.net/TNPA/campaigns/44786/respond

• Legislation: HB 0628 / SB 0398
• House Sponsor(s): Kumar
• Senate Sponsor(s): Haile
• Description: As amended, this legislation would establish 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.

Take Action – www.votervoice.net/TNPA/campaigns/50145/respond

• 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
• Senate Sponsor(s): Bowling, Lundberg, Kyle, Gresham, Gardenhire, Watson, Johnson, Beavers, Southerland, Niceley, Norris, Massey, Bailey, Yager, Kelsey, Briggs, Green, Hensley, Ketron, Harris
• 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.

Take action now! This legislation could be heard on the House and Senate floors as early as this week!

• Legislation: HB 0137 / SB 0429
• House Sponsor(s): Sexton C
• Senate Sponsor(s): Kelsey
• Description: As introduced, this legislation would establish a prescription drug donation repository program.

Take action now! This legislation is scheduled to be heard in the Senate Health and Welfare Committee and the full House as early as this week.

• Legislation: HB 0519 / SB 1320
• House Sponsor(s): Sexton C, Matheny
• Senate Sponsor(s): Crowe
• Description: As amended, 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. Further 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.

Action deferred to 2018. TPA provided testimony to the Senate Investigations and Oversight Committee on February 14, 2017, regarding DIR fees and their detrimental effect on patients and community pharmacies. DIR fees are currently being assessed by PBMs through the Medicare program, which is outside the jurisdiction of any state legislature. TPA will continue to discuss the negative impact of these fees on patients and community pharmacies.

• 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.

• 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.

• 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.

This legislation was voted down by the Senate Commerce and Labor Committee last week. No further action in 2017.

• 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..