General Pharmacy News

Legislative Alert: Urgent Call to Action!

Legislation is moving forward next week on all three TPA Top Priority issues – Collaborative Pharmacy Practice (SB1992/HB2139), PBM regulation of MACs (SB1991/HB 1554) and Increased Penalty for Pharmacy Robbery (SB1716/HB 2158).

TPA urges all pharmacists to contact their legislators – both Senators and Representatives – if they are on the committees that will be considering our legislation next week. Also, if your Senator or Representative has signed on to our legislation as a sponsor as identified with each bill below, please THANK them for their important support.

Names of the committees and the committee members who will be considering each bill are listed below, followed by information on each legislative issue. Brief talking points are also provided.

TAKE ACTION: If your legislators are members of the key committees listed below, please contact them about each bill prior to the date and time that each committee meets to consider our legislation.  Get the commitment from your legislator to support YOUR priority issues.  Let TPA know if you receive any negative responses.

COME TO NASHVILLE: Plan to come to Nashville on the dates of the following key committee meetings to support these bills addressing your critical issues. Call TPA for information. A room full of pharmacists makes a big difference!

Information about each legislative issue follows the committee information listed below. Please contact the TPA office if you have questions or need more information.

We look forward to receiving responses from our members regarding the feedback they receive from their legislators.

NOW, LET’S ALL GET TO WORK!

Committee Hearing Schedule for
COLLABORATIVE PHARMACY PRACTICE LEGISLATION: 

Senate Health & Welfare Committee – Monday March 17, 2014 – 2:00 pm

House Health Committee – Wednesday, March 19, 2014 – 1:30 pm

Committee Hearing Schedule for
MAC LEGISLATION:

Senate Commerce & Labor Committee – Tuesday, March 18, 2014 – 1:30 pm

House Insurance and Banking Subcommittee – Wednesday, March 19, 2014 – 3:00 pm

Committee Hearing Schedule for
PHARMACY ROBBERY LEGISLATION: 

Senate Judiciary Committee – Tuesday, March 18, 2014 – 3:30 pm

House Criminal Justice Subcommittee – Tuesday, March 18, 2014 – 3:00 pm 

COLLABORATIVE PHARMACY PRACTICE: SB 1992 Overbey, McNally, Haile, Crowe, Yager/HB 2139 Shepard, Odom, Ramsey, Sexton – Amends the Tennessee Pharmacy Practice Act to authorize collaborative pharmacy practice. Amends Title 63, Chapter 10, Chapter 6, and Chapter 9.

MESSAGE: Support passage of SB1992 and HB 2139 as amended.

• PURPOSE:  This bill amends the Tennessee Pharmacy Practice Act in Title 63 Chapter 10 to facilitate collaboration of pharmacists with physicians and other prescribers as members of patient care teams to improve coordination and efficiency in the delivery of quality patient care services and health outcomes in Tennessee.
• WHO SUPPORTS: The Tennessee Pharmacists Association has worked over six months with the Tennessee Medical Association in developing this legislation.  It is supported by the Tennessee Medical Association and the Tennessee Hospital Association and has been approved by the Tennessee Nursing Association.
• BACKGROUND:  The proposed changes in the Pharmacy Practice Act would bring Tennessee in line with 44 other states and the District of Columbia which have already enacted legislation permitting Collaborative Pharmacy Practice between pharmacists and other health care providers.
  • Collaborative Pharmacy Practice has been shown to:
    • Support team-based care
    • Enhance the efficient delivery of patient care services
    • Enhance safety and quality of care
    • Produce annual health care savings

REGULATION OF PBM’S USE OF MACs: SB1991 Overbey, Haile, Bell, Yager/HB1554 Shepard, Mike Turner, Gloria Johnson, Jernigan, Exton, Odom, Sanderson, Watson, Goins, Powers, Ragan, Ramsey, Jones, Shaw, Fitzhugh, Swann, Alexander, Pitts, Weaver, Littleton, Lundberg – Regulates the use of maximum allowable cost lists by pharmacy benefits managers and covered entities. Amends TCA Title 56, Chapter 7, Part 31.

MESSAGE: Support passage of SB 1991/HB1554 as amended.

• PURPOSE:  This bill amends the statute governing Pharmacy Benefit Managers (PBMs), which was first passed by the Tennessee General Assembly in 2007 and then amended in 2011, to include regulation of maximum allowable cost (MAC) lists utilized by PBMs to determine the amount paid to a pharmacist for particular generic drugs dispensed by the pharmacist.
• WHO SUPPORTS:  All independent community pharmacies and most chain pharmacies that do not have PBMs.
• BACKGROUND:  PBMs administer the pharmacy benefits portion of the coverage provided by health insurers.  A PBM ultimately determines the amount paid to a pharmacist for a drug dispensed to a person enrolled in a particular health plan for which that PBM administers the pharmacy benefits. The current statute (T.C.A. §§ 56-7-3101 through 56-7-3105) regulates contracts between PBMs and health insurers and the audits of pharmacies conducted by PBMs.
• BILL SPECIFICS: The bill defines a “MAC list” as “a list of multi-source generic drugs, medical products and devices for which a maximum allowable cost has been established” by a PBM.  The “maximum allowable cost” is the maximum amount a PBM will pay a pharmacy for a particular drug or device which has been dispensed to a patient.

  Many generic drugs and devices are placed on MAC lists by PBMs. Currently, pharmacists have no way of knowing what sources the PBM relied upon in establishing the MAC prices for these drugs and devices.

  The purpose of establishing MAC prices is to force pharmacists to purchase generic drugs and medical devices from wholesalers that sell them at the lowest price.  But if pharmacists do not know which wholesalers sell the drugs and devices for the amounts established by the PBM as the MAC prices, they are unable to buy the drugs and devices at these low prices.

  In many cases, pharmacists are buying drugs and devices from a wholesaler at prices that are higher than the amount of reimbursement they receive from the PBM.  So the pharmacist loses money on the drugs and devices dispensed to patients in those cases.

  The purpose of this bill is to ensure that the MAC pricing system is fair to both pharmacists and PBMs.  The bill contains the following specific provisions:

1. Before a drug may be placed on a MAC list by a PBM, there must be at least 3 generically equivalent versions of that drug available for purchase by Tennessee pharmacies from national or regional wholesalers, and the drug must not be obsolete, temporarily unavailable, or on a drug shortage list.
2. If a drug which has been placed on the MAC list ceases to meet the above requirements, the drug must be taken off the MAC list within 3 business days after the PBM becomes aware that the drug no longer meets these requirements.
3. A PBM must provide to each pharmacy with which the PBM or health insurer has a contract:
   • Each MAC list used by the PBM, and
   • The methodology and sources used to determine the MAC prices for the drugs and devices on each MAC list.
4. Every PBM must update the MAC prices on each of its MAC lists on its secure website at the same time the PBM updates the prices on these lists for its own use.  Every contracted pharmacist must have access to the updated MAC lists at all times on the PBM’s secure website, and the PBM must use the prices on the updated lists to calculate payments to pharmacies.
5. A PBM is prohibited from establishing any price on a MAC list in an amount which is below the amount found in the source used by the PBM to set the price.
6. The pharmacist’s dispensing fee shall not be included by the PBM in the MAC price set by the PBM for a particular drug or device.
7. Each PBM must establish a clearly defined appeal process allowing a pharmacist to contest the placement of a particular drug or device on the MAC list or the establishment of a price for a particular drug or device in violation of this bill.  The PBM must resolve the appeal within 7 calendar days of its receipt of the appeal and must state the reason for the denial of the pharmacist’s appeal if it is denied.
8. If the basis of a pharmacist’s appeal is determined to be valid, the MAC price for that drug or device shall be adjusted for the appealing pharmacy and all other similarly situated pharmacies in that network, and the adjustment shall be effective from the date the appeal was filed.
9. A violation shall subject the violator to any of the penalties provided by current laws (T.C.A. § 56-2-305) enforced by the Department of Commerce and Insurance.

INCREASED PENALTY FOR PHARMACY ROBBERY: SB 1716 Niceley, Bowling/HB2158 Roach – As amended, creates an enhancement factor for robbery and aggravated robbery. Allows a judge to enhance a sentence for robbery or aggravated robbery if the offense occurred on the premises of a licensed retail pharmacy and was committed for the purpose of obtaining a controlled substance. – Amends TCA Title 39.

MESSAGE: Support SB 1716/HB 2158 as amended.

• PURPOSE:  Establishes an enhancement factor for robbery and aggravated robbery offenses if the offense occurred on the premises of a licensed retail pharmacy and was committed for the purpose of obtaining a controlled substance.
• WHO SUPPORTS:  All community pharmacists and pharmacy technicians and their patients.
• BACKGROUND:  The National Association of Drug Diversion Investigators (NADDI) records show that, from 2007 to 2011, pharmacy robberies increased 199% nationwide (from 194 to 386) and increased 417% in Tennessee (from 6 to 25).  The dangers for pharmacists, their patients, patrons and employees continue to increase due to the worsening prescription drug abuse crisis and the limited access to effective treatment options for Tennesseans and the nation.

  In the small Tennessee town of Bean Station, a tragic incident occurred on May 23, 2013, when an armed man walked into the Down Home Pharmacy, demanded and obtained controlled substances, and then murdered the pharmacist, Steve Lovell, and his patient, Richard Alexander, and wounded pharmacy employees Alexia Gail Wilson and Janet Cliff.

  Currently, in Tennessee, Robbery is classified as a Class C Felony with a sentencing range of 3-15 years and up to a $10,000 fine, Aggravated Robbery is a Class B Felony with a sentencing range of 8-30 years and up to a $25,000 fine, and Especially Aggravated Robbery is a Class A felony with a sentencing range of 15-60 years and up to a $50,000 fine.

Thank you for your involvement in these important issues!