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TPA’s 2020 Pharmacy Legislative Priorities

March 6, 2020

2020 Pharmacy Legislative Priorities
Legislation Supported by TPA

The bills below are scheduled to be heard as soon as Monday, March 9. TPA urges members to reach out to your legislators and ask them to support these key pharmacy priority bills. To find the contact information for your State Representative and State Senator, click on the button below or visit the Tennessee General Assembly website. Thank you for your engagement and support!

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Patient Coinsurance Reduction and Spread Pricing Prohibition

The Tennessee General Assembly is debating several bills that would cap patients’ out-of-pocket coinsurance payments for prescription drugs, and most notably, insulin. Reducing patients’ out-of-pocket costs for prescription drugs is a very important issue and one that continues to be at the top of the list of priorities for voters. One of the most important points to consider, with regard to prescription drug costs, is the overall complexity of the prescription drug distribution system and the various entities that contribute to the cost of a prescription drug. Pharmacists are in an optimal position to educate decision-makers on the complexity of the drug distribution system, because we live in this world every day and understand the process more than most. Click here for a detailed visual chart outlining the drug distribution process to educate your legislators.

Legislation:

Summary: As amended, this legislation would require covered entities (insurers, employers, etc.) and pharmacy benefits managers (PBMs) to calculate patients’ coinsurance based on the allowable amount for the drug (cost of the drug or device after discounts are applied) as opposed to the list price for that drug or device, and would prohibit PBMs from charging covered entities more for a drug or device than what the PBM pays a pharmacy for that same drug or device.

Here’s how this legislation would affect the pharmacy profession:

  • Requires a pharmacy benefits manager or a covered entity to base the calculation of any coinsurance for a prescription drug or device on the allowed amount of the drug or device.
  • Defines “allowed amount” as the cost of a prescription drug or device after applying the pharmacy benefits manager or covered entity’s discounts.
  • Prohibits a pharmacy benefits manager from charging a covered entity an amount greater than the reimbursement paid by a pharmacy benefits manager to a contracted pharmacy for the prescription drug or device.
Pharmacist’s Role in Medical Cannabis

The Tennessee General Assembly is debating legislation that would authorize the use of medical cannabis through research facilities. In accordance with Resolution 18.3 adopted by the TPA House of Delegates, TPA is supporting one piece of medical cannabis legislation which would require that dispensing facilities make pharmacists available to patients to provide consultations at least annually, when those patients are enrolled in the medical cannabis research program. TPA remains opposed to medical cannabis legislative proposals that do not require pharmacist involvement, as well as legislative proposals that legalize cannabis for recreational purposes.

Legislation:

Summary: As amended, this legislation establishes a research framework through which patients may receive medical cannabis, including ensuring that patients have access to pharmacists for consultation.

Here’s how this legislation would affect the pharmacy profession:

  • Requires that clinical cannabis centers ensure that every cardholder has received a medication therapy management consultation from a qualified pharmacist annually, at a minimum, or more frequently upon request by the patient.
  • Qualified pharmacists must be licensed to practice in Tennessee, must register and renew annually with the cannabis commission as proposed in the legislation, and complete at least two (2) hours of continuing education on clinical cannabis biennially.
  • Pharmacist consultations may be in person or via telephone or other live electronic communication.
  • Provides immunity for qualified pharmacists acting in good faith and with reasonable care in the provision of consultation services pursuant to this section from disciplinary or adverse administrative actions for acts or omissions during the provision of consultation services, as well as immunity from civil liability for actions authorized by this section in the absence of gross negligence or willful misconduct.
Patient Access to Specialty Pharmacy

State insurers, including BlueCross BlueShield of Tennessee, are in the process of implementing changes to their provider-administered specialty drug benefit. This new process will require certain provider-administered specialty medications to be dispensed through specialty pharmacies rather than allowing physicians to “buy-and-bill”. TPA has heard from specialty pharmacy providers and health-system pharmacies expressing concerns about this new process and is working with insurers to gain greater insight and convey pharmacists’ concerns.

Legislation:

Summary: As amended, this legislation would allow the patient to have the choice of using a specialty pharmacy or where they currently receive the drug.

Here’s how this legislation would affect the pharmacy profession:

  • Defines “Specialty Drug” as a prescription drug that:
    • Is prescribed to a person with a chronic, complex, rare, or life-threatening medical condition;
    • Has limited or exclusive distribution; or
    • Requires specialized product handling, administration, or clinical care.
  • Establishes that a covered entity or a pharmacy benefits manager shall not require a person covered under a group medical benefit contract, or a pharmacy benefit contract, that provides coverage for prescription drugs to:
    • Obtain prescription drugs from a specialty pharmacy in order to receive benefits for the prescription drugs; or
    • Pay an additional fee, second copay, second coinsurance, or any other penalty for failing to utilize a designated specialty pharmacy.
State Authority to Contract with PBMs

The state of Ohio’s Medicaid audit recently discovered that PBMs retained over $224 million in spread pricing in one year. By removing pharmacy benefits managers from state-funded plans, the state of Tennessee could realize significant savings which could be better used to support mental health and substance abuse prevention and treatment.

Legislation:

Summary: As introduced, removes the use of state-funded pharmacy benefits managers.

Here’s how this legislation would affect the pharmacy profession: 

  • Removes the state’s authority to contract with pharmacy benefits managers for any state-funded insurance plans, including plans for state employees and the TennCare program.
  • Establishes that the state’s citizens would be better served by using the public money currently expended on state-funded pharmacy benefits managers to instead fund efforts to curb substance abuse.
Prohibition Against PBM Discrimination in 340B
Legislation:

Summary: As introduced, prohibits a pharmacy benefits manager and certain other third parties from taking certain actions against entities and pharmacies participating in the federal 340B drug discount program; creates a private cause of action against violators.

Here’s how this legislation would affect the pharmacy profession:

  • Prohibits a PBM from discriminating against a 340B entity in a manner that prevents or interferes with the patient’s choice to receive those drugs from the 340B entity.
  • Prohibits a PBM from discriminating against a pharmacy participating in a health plan as an entity authorized under federal 340B regulations in a manner that prevents or interferes with the patient’s choice to receive those drugs from the pharmacy.
  • Prohibits a PBM from discriminating against a 340B entity regarding reimbursement for pharmacy-dispensed drugs by reimbursing at a rate lower than paid for the same drug to pharmacies that are not 340B entities, and shall not assess any fee or other adjustment upon the 340B entity on the basis that the 340B entity participates in the federal 340B program.
Tobacco 21 Initiative

Building on recent federal changes which have raised the minimum age to purchase tobacco products to 21 years of age, TPA has joined forces with NashvilleHealth, the American Cancer Society, and the American Heart Association to support legislation that makes important changes regarding nicotine-containing products. As health care providers, pharmacists and pharmacy professionals understand the risks involved in tobacco use and are committed to seeking ways to reduce the health complications and risks associated with tobacco use.

Legislation:

Summary: As introduced, increases age of persons allowed to use tobacco and smoking hemp products from 18 years of age to 21 years of age; requires licensure for the retail sale of tobacco products; levies a tax on electronic smoking device cartridges.

Here’s how this legislation would affect the pharmacy profession:

  • Amends state law by deleting “eighteen (18) years of age” and changing to “twenty-one (21) years of age”.
  • Amends state law by deleting “vapor products” and substituting instead the language “electronic smoking devices”.
  • Requires licensure for the retail sale of tobacco products.
  • Establishes a tax rate levied on cartridges used in electronic smoking devices, including vape devices.
Board of Pharmacy Study on Workplace Conditions

TPA has been monitoring workplace conditions in pharmacies for several years. Most notably, the TPA House of Delegates adopted Resolution 19.1, “A Resolution Advocating for Pharmacy Working Environments that Promote Optimal Patient Care,” as well as an open letter to the pharmacy community. Earlier this year, TPA released its inaugural Pharmacy Practice Environment Study. Through this study, TPA is requesting participation from every pharmacist, pharmacy technician, and pharmacy professional in Tennessee (regardless of current TPA membership status), to evaluate best practices and determine issues that affect the well-being of pharmacists, pharmacy technicians, and pharmacy professionals. This session, the Tennessee Senate adopted SJR 505, which urges the Board of Pharmacy to study the pharmacy work environment with regard to patient safety.

Resolution:

Summary: As introduced, this resolution requests the Tennessee Board of Pharmacy to study the work environment of pharmacies to determine if rules should be promulgated to promote patient safety.

Here’s how this resolution would affect the pharmacy profession:

  • This resolution urges the Tennessee Board of Pharmacy to study the work environment of pharmacies in Tennessee in order to determine if rules should be promulgated to promote patient safety.
  • Resolutions are not state law, and no action is required as a result of this resolution.
Legislation Being Monitored by TPA
Updates to Compounding Law and Regulations

United States Pharmacopeia (USP) is in the midst of updating its USP Chapters 795, 797, and 825. While the updates have been delayed, it is anticipated that USP will release these finalized Chapters in the near future. This legislation seeks to update existing compounding laws to allow for regulation of all compounding pharmacies.

Legislation:

Summary: As introduced, makes changes with regard to compounding pharmacies, including a) allowing out-of-state pharmacy practice sites to provide certain inspections, equivalent to what are currently required, if accepted by the Tennessee Board of Pharmacy and b) removing the requirement that pharmacies engaging in sterile compounding have to make certain quarterly reports to the Board.

Here’s how this legislation would affect the pharmacy profession:

  • Expands current law regarding regulation of sterile compounding pharmacies by the Board of Pharmacy to extend to all compounding pharmacies.
  • Requires that any pharmacy engaged in compounding must comply with relevant United States Pharmacopeia (USP) guidelines as adopted by the Board by rule or policy.

This list is only a summary of key pharmacy-related bills being considered in 2020 and is not intended to be inclusive of all healthcare-related legislative proposals. TPA is actively monitoring hundreds of pieces of legislation that have been filed and has worked to prevent enactment of several bills thus far this session. TPA will update members as additional important issues arise throughout the session.

TPA routinely sends out legislative action alerts during each Tennessee General Assembly legislative session, to request action from members and facilitate communications between members and legislators regarding key pharmacy advocacy priorities.


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