Your Pharmacy and Government Relations: Hot Issues in Federal and State – Part Two
In part one of this two-part series, we discussed some federal-level regulatory topics that are poised to cause some waves in 2019 and impact the daily operations of pharmacies, hospitals, practices, and other healthcare entities.
Today, we’ll look at a handful of state-level legal issues, including:
- Arkansas’s new licensing and oversight rules for PBMs
- Ohio’s new bill that allows pharmacists to contract directly with payers
- Florida’s 2019 bills allowing “advanced directives” for patients to refuse opioid prescriptions
- Kentucky’s bill to prohibit prior authorization for opioid addiction treatments
- New Jersey’s bill to prevent PBMs and insurance companies from charging more than a drug’s cash value
Let’s explore these issues and how they might be game for local pharmacists and other healthcare providers.
In January 2019, the Arkansas Insurance Department began licensing and overseeing PBMs, in an effort to regulate and stabilize the nature of these relationships as they vary among entities. Part of the law requires mandated reporting on PBM charges, which will help to improve transparency and reliability for pharmacies in the state.
Senate Bill 265 is projected to become effective in April 2019. It will authorize Ohio’s health plans, including Medicaid sponsors, to pay pharmacists directly. Essentially, the bill argues that pharmacists are on the same playing field as any other service provider, giving them the same responsibilities and rights as doctors, nurses, and others.
Ohio pharmacists can expect to have more direct relationships with payers, making them able to work on a contractual basis.
As one of the six states in 2017 to declare opioid abuse as a public health emergency, Florida is working on a series of efforts to help fight the epidemic. There are several pre-filed bills for 2019, including Senate Bill 630 and its companion House Bill 451. These bills allow patients to refuse opioid prescriptions from hospitals or doctors via an “advanced directive.”
House Bill 121 passed through Kentucky’s legislative committee and the full House, aiming to prevent Medicaid insurance companies from requiring prior authorization for prescriptions like buprenorphine, which helps treat patients with opioid addictions.
Pharmacists can expect that this category of drugs, called medication-assisted treatments (MAT), may be more readily available for the patients who need them most.
In February 2019, the New Jersey Senate unanimously approved a bill that would prevent PBMs and insurance carriers from charging copayments higher than the cash price of the prescriptions themselves.
The bill also would ban these entities from restricting what pharmacists are permitted to tell customers about generics and other lower-cost options, which would complement October 2018 federal protections from the Trump administration that banned these “gag orders” on pharmacists.
Across the United States, pharmacies and other healthcare entities are seeing big changes on both the federal and state level. This has been exacerbated by the 2018 election in which Democrats gained control of the House of Representatives.
To navigate all of these expected – and unexpected – changes, community pharmacies should partner up with companies like AlliantRx. We’re dedicated to helping you maintain the health of your patients, keep your stakeholders satisfied, and improve your pharmacy’s bottom line.
If you’re not a member yet, join us. If you are a member, make sure you’re leveraging your benefits and maximizing your pharmacy’s success.