General Pharmacy News

URGENT: Collaborative Practice Passes Senate! Contact Reps NOW!

SENATE PASSES SB 1992-PHARMACY COLLABORATIVE PRACTICE LEGISLATION

On Thursday morning, April 3, 2014, the full Senate considered and passed SB1992, the legislation enacting Collaborative Pharmacy Practice, by a vote of 32 ayes and 0 nays.  Pharmacists and pharmacy students were present in the Senate gallery observing the bill presentation and vote by the Senators.

Many Senators commented they heard from their pharmacists back home. TPA thanks all who took action and contacted their Senators to get them to support this important legislation!

This legislation will now be considered by the full House of Representatives on Wednesday, April 9, 2014.

The full House of Representatives will now vote on the Collaborative Pharmacy Practice legislation (House Bill 2139) during the session that begins Wednesday, April 9, 2014, at 9:00 a.m. Central. Note that at this time of year, Committee calendars can change at any time. CLICK HERE for updated Calendar information. CLICK HERE to find out who your Representative is and how to contact him or her. 

TAKE ACTION: It is urgent that all pharmacists contact their Representatives NOW and get their commitment to SUPPORT House Bill 2139 when it comes before the full House on Wednesday.

COME TO NASHVILLE: Plan to come to Nashville on Wednesday to support House Bill 2139. A room full of pharmacists makes a big difference!

Information about the Collaborative Pharmacy Practice legislation follows:

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 SB 1992 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

Legislation continues to move forward next week on PBM Regulation of MACs (SB1991/HB 1554).

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

TAKE ACTION: If your legislators are members of the key committees listed below, please contact them about the MAC 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 MAC issue.  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 issue. Call TPA for information. A room full of pharmacists makes a big difference!

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.

THANK YOU FOR ALL YOUR EFFORTS THUS FAR… BUT THERE’S STILL MORE WORK TO BE DONE!

PLEASE NOTE AS THE SESSION WINDS DOWN, ALL COMMITTEE MEETINGS IN BOTH THE SENATE AND HOUSE ARE SUBJECT TO CHANGE!

MAC LEGISLATION (SB 1991/HB 1554): SUPPORT as amended by amendment #015578! 

REGULATION OF PBM’S USE OF MACs: SB 1991 Overbey, Haile, Bell, Yager/HB 1554 Shepard, Mike Turner, Gloria Johnson, Jernigan, Exton, Odom, Sanderson, Watson, Goins, Powers, Ragan, Ramsey, Jones, Shaw, Fitzhugh, Swann, Alexander, Pitts, Weaver, Littleton, Lundberg, Doss– Regulates the use of maximum allowable cost lists by pharmacy benefits managers and covered entities. Amends TCA Title 56, Chapter 7, Part 31.

• 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:

  • 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.
  • This bill requires a PBM to make available to each pharmacy with which the PBM has a contract:
    • Each MAC price used by the PBM for patients served by that pharmacy;
    • The sources used to determine the MAC prices for the drugs and devices on each MAC list; and
    • Upon request, each MAC list used by the PBM for patients served by that pharmacy.
  • Every PBM must update the MAC prices on each of its MAC lists on its secure website at least every three (3) business days and must use the prices on the updated lists to calculate payments to pharmacies.
  • A PBM is prohibited from establishing any price on a MAC list in an amount which would result in reimbursement to a pharmacy that is below the price found for the product in any source used by the PBM to set the MAC price.
  • Every 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 pharmacy must file its appeal within 7 business days of filing its claim for payment.  The PBM must resolve the appeal within 7 business days of its receipt of the appeal and must state the reason for the denial of the pharmacist’s appeal if it is denied.
  • 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 effective from the date the appeal was filed.  The adjusted MAC price shall be effective for all similarly situated pharmacies from the date the appeal is determined to be valid.

  Senate – Finance Committee – April 8, 2014@8:30 am CT – Location: 12LP – Can’t make it to Nashville? Click here to view the live hearings. 

House – Finance Subcommittee – Monday evening, April 7, 2014, immediately following the full House session.  This is estimated to be at approximately 6 pm CT but could much earlier or later. Click here to view the live hearing.

If MAC Legislation passes out of the House Finance Subcomittee, it goes on to the full House Finance Committee:

House – Finance Committee – Tuesday, April 8, 2014 @1:00 (TBA) CT – Location: 16 LP – Can’t make it to Nashville? Click here to view the live hearings.

The Pharmacy Robbery Legislation is no longer moving forward for this legislative session.  HB 2158 was recommended for passage by the House Criminal Justice Committee at its meeting in March 26, 2014.  However, after being on the agenda for consideration for weeks by the Senate Judiciary Committee, SB 1716 was finally considered on April 1, 2014.  After a brief discussion, the Committee members made no motion on the bill so it became inactive at that time.

Concern was repeatedly mentioned during conversations with individual members of the Senate Judiciary Committee that the bill gave a special protection to pharmacists that would not be afforded to other citizens in Tennessee and many believed that was problematic.

Even with the legislation not moving forward, this effort provided TPA with an opportunity to raise awareness of the significant increases in pharmacy robberies and the inherent risk for pharmacy staff and the general public who are patients of those pharmacies.