Tennessee Pharmacists Association

You Have a Voice: TPA109th GENERAL ASSEMBLY (2015-2016) LEGISLATIVE SESSION



2016 OVERVIEW AND PRIORITIES

MEDICATION THERAPY MANAGEMENT IN MEDICAID – BEING CONSIDERED!

TPA has worked with bill sponsors to support HB 2398 by Littleton, Shepard, Sexton C and SB 1882 by McNally, Crowe, Overbey, Haile in 2016. This legislation requires TennCare, in collaboration with the various Managed Care Organizations administering the medical benefits on behalf of TennCare, to develop and incorporate a Medication Therapy Management program. As a reminder, in 2015, TPA worked with Chairman Randy McNally to support Senate Joint Resolution 104 (SJR104), a resolution which urges the Bureau of TennCare to incorporate Medication Therapy Management (MTM) to benefit patients, improve quality, and control costs. This was a very positive resolution, and TPA was heavily engaged in supporting this effort. According to information provided by the Bureau of TennCare in conjunction with this resolution, the underlying purpose of Medication Therapy Management is to improve quality and cost effectiveness, and the TennCare pharmacy team has been evaluating MTM as a potential cost savings measure which may be implemented with or without the resolution. According to the state’s Fiscal Note attached to SJR104 in 2015, if Medication Therapy Management were mandated, it could be implemented in a manner that is, at worst, revenue neutral.

  • Senate: Scheduled for Senate Finance, Ways, and Means Committee – 3/22/2016
  • House: Scheduled for House Health Committee – 3/23/16
  • TPA Summary: MTM in Medicaid Legislation

STATE-WIDE COLLABORATIVE PHARMACY PRACTICE AGREEMENT FOR THE DISPENSING OF OPIOID ANTAGONISTS BY PHARMACISTS – PASSED AND SIGNED INTO LAW BY GOVERNOR HASLAM ON MARCH 10, 2016!

TPA has worked with bill sponsors to support HB 2225 by Terry, Williams, Sexton C, Doss, Dunlap, Howell, Hazlewood and SB 2403 by Overbey, Haile in 2016. This legislation seeks to increase patient access to life-saving opioid antagonist therapy through a state-wide collaborative pharmacy practice agreement (CPPA) with the Chief Medical Officer for the Tennessee Department of Health. As enacted, pharmacists can enter into a CPPA to dispense opioid antagonists, effectively reducing barriers to this important medication, effectively reducing the number of opioid overdose deaths and saving the lives of many Tennesseans.


AUTHORIZATION OF PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS TO FILE MAC APPEALS ON BEHALF OF CONTRACTED PHARMACIES – PASSED AND AWAITING SIGNATURE BY GOVERNOR HASLAM!

HB 1697 by Shepard and SB 1789 by Overbey, McNally, is a joint effort between TPA, Southern Pharmacy Cooperative, and other pharmacy organizations to clarify language in the maximum allowable cost (MAC) legislation from 2014 and grant a pharmacy the right to designate a pharmacy services administrative organization (PSAO) or other agent to file and handle its appeal of the maximum allowable cost of a particular drug or medical product or device.


PHARMACIST-PROVIDED CONTRACEPTIVE THERAPY – BEING CONSIDERED!

HB 1823 by Hazlewood and SB 1677 by Dickerso, has been introduced in 2016. The overall goal of this legislative initiative is to increase patient access to contraceptive therapy through the use of pharmacists. TPA is currently working with bill sponsors on language which is in the best interest of our patients and our providers in Tennessee. This legislative effort is similar to efforts which have been enacted in Oregon and California.


PHARMACY ROBBERY LEGISLATION – BEING CONSIDERED!

Tennessee ranked 4th per capita in the United States in pharmacy robberies, and 5th in number of pharmacy robberies, in 2013. TPA worked with Senator Ferrell Haile and Representative David Shepard to support HB 0587 and SB 0593 which, if enacted, would allow courts to apply enhancing factors if an individual commits robbery, aggravated robbery, or especially aggravated robbery involving controlled substances on the premises of a licensed pharmacy. Because this legislation is expected to increase costs to the state of Tennessee for enhancing penalties and extending the length of incarceration for these criminals, this legislation received a substantial fiscal note. This legislation was passed by the House Criminal Justice Subcommittee and Criminal Justice Committee, as well as the Senate Judiciary Committee, but did not receive funding necessary to enact it during the 2015 legislative session. TPA will work with members of the Tennessee General Assembly to seek funding to support this legislation during the 2016 session.

  • Senate: Scheduled for Senate Finance, Ways, and Means Committee
  • House: Scheduled for House Finance, Ways, and Means Committee 
  • TPA Summary: Enhancing Factor for Pharmacy Robberies Position Statement
  • TPA has worked with legislators to file the appropriate budget amendments in the House and Senate.

RESTORATION OF PROPOSED AWP-BASED CUTS TO THE TENNCARE PHARMACY PROGRAM – BEING CONSIDERED!

TPA successfully worked with members of the Tennessee General Assembly, in collaboration with several other pharmacy-related organizations, to restore funding for the proposed AWP cuts to the TennCare pharmacy program for FY 2015 – 2016. These cuts would have reduced AWP-based reimbursements to pharmacies by over $17.4 million (total state and federal funding) for brand, generic, and specialty medications. If implemented, these AWP-based cuts would have affected all pharmacy providers that currently accept TennCare patients, so this is a win for our patients and the entire profession of pharmacy. The legislature did not allocate funding to restore the proposed cuts to buprenorphine and compounding for the TennCare program, and these cuts will go into effect on July 1, 2015. Funds to restore these proposed TennCare AWP cuts are not earmarked in the FY 2016 – 2017 Governor’s Budget, so TPA will continue to work with legislators over the 2016 session to restore these cuts going forward.

  • TPA has met with Governor Haslam about these cuts and has worked with legislators to file the appropriate budget amendments in the House and Senate.

AUTHORIZATION FOR MAINTENANCE DISPENSING BY PHARMACISTS – PASSED!

HB 1768 by Sexton C, Terry and SB 1786 by Overbey authorizes a pharmacist to dispense up to a 90-day supply of medication, including any refills, and up to the total number of dosage units as authorized by the prescriber on the original prescription including any refills, unless the prescriber has specified on the prescription that dispensing a prescription for a maintenance medication in an initial amount followed by periodic refills is medically necessary. This legislation does not apply to controlled substances.

  •  Result: Passed House and Senate – Awaiting signature by Governor Haslam 

RENEWAL OF THE PRESCRIPTION SAFETY ACT – BEING CONSIDERED!

In 2016, the Tennessee General Assembly will seek to renew the Prescription Safety Act of 2012 through HB 2571 by McCormick, Brooks K, Hawk and SB 2552 by Norris, Yager. The Prescription Safety Act is scheduled to sunset on June 30, 2016, unless the Prescription Safety Act is renewed during this legislative session. TPA has been heavily engaged with the Department of Health on this legislative initiative and continues to advocate for the professional responsibility of providers in preventing prescription drug abuse while ensuring that the burden on pharmacists is minimal.

  • TPA continues to work with bill sponsors and the Tennessee Department of Health to ensure appropriate oversight of the database and minimal burdens on pharmacists through this legislation.

REPEAL OF THE PROFESSIONAL PRIVILEGE TAX – BEING CONSIDERED!

TPA has joined a coalition of multiple professional groups that are affected by this tax to work together toward a legislative solution which phases out or reduces the financial burden on all health professionals subject to this tax.

  • Summary Statement: As introduced, phases out the privilege tax on persons engaged in certain occupations by annually decreasing it by 20 percent over the next five years; eliminates the tax in 2019 and thereafter.
  • Legislation: HB 0678 by VanHuss, Matheny, Butt, Hill M, Keisling, Holt, Womick / SB 0556 by Bowling
  • Result: Introduced in 2015 – Action Pending

ORAL CHEMOTHERAPY PARITY

  • Summary Statement: 
    • 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.
  • Legislation: HB 2239 by Lamberth,  Casada, Littleton, Powers, Kumar, Brooks K, Terry, Powell, McCormick, White M, Butt, Farmer, Towns, Beck, Doss, Akbari, Camper, Kane, Fitzhugh, Johnson, Shepard, Hill M / SB 2091 by Ketron, Green, Beavers, Jackson
  • Result: Failed to Pass

MEDICATION SYNCHRONIZATION

This bill was brought by the American Cancer Society, and seeks to require that a contract or policy of an insurer that provides benefits for prescription drugs must include certain provisions to allow for medication synchronization. These provisions would apply to all insurers that are not preempted by federal law, including TennCare. TPA continues to support and advocate for the role of the pharmacist in improving medication adherence for patients, including the incorporation of medication synchronization programs into daily practice. However, due to the mandates and requirements that this bill proposed to place on insurers, including TennCare, this bill received a significant fiscal note from the state of Tennessee, and action on this legislation has been deferred to 2016.

  • Legislation: HB 0475 by Shepard, Clemmons, Shaw, Terry, Jernigan, Williams, Durham /SB 0497 by Haile, Dickerson, McNally, Harris, Massey
  • Result: Introduced in 2015 – No action taken in 2016

REGULATION OF DRUG MANUFACTURERS AND PRICES BY DEPARTMENT OF HEALTH

  • Summary Statement: As introduced, authorizes the department of health to require certain prescription drug manufacturers to disclose price and cost information; authorizes the department of health to set maximum prices for certain prescription drugs.
  • Legislation: HB 2206 by Mitchell / SB 2442 by Harris
  • Result: Introduced in 2016 – Pending

REGULATION OF PHYSICIAN DISPENSING OF OPIOIDS AND BENZODIAZEPINES

  • Summary Statement: As introduced, establishes requirements for the dispensing of opioids and benzodiazepines by physicians and other healthcare providers.
  • Legislation: HB 2126 by Terry / SB 2060 by Briggs
  • Senate: Passed
  • House: Scheduled for House Health Committee – 3/23/16

LISDEXAMFETAMINE DIMESYLATE FOR BINGE EATING DISORDER

  • Summary Statement: As introduced, supersedes rules of the board of medical examiners to permit the prescription, order, sale, or other distribution of the drug lisdexamfetamine dimesylate for any currently accepted medical use in the United States.
  • Legislation: HB 1856 by Terry, Kumar, Armstrong, Matheny, Littleton / SB 1765 by Massey
  • Senate: Passed
  • House: Scheduled for House Health Committee – 3/23/16

OUT-OF-NETWORK NOTICE AND BILLING BY PROVIDERS

  • Summary Statement: As introduced, authorizes balance billing by out-of-network healthcare providers only after certain notice is given.
  • Legislation: HB 2005 by Kumar / SB 2232 by Hensley
  • Result: Introduced in 2016 – Action Pending

STOCKING AND ADMINISTRATION OF EPINEPHRINE AUTO-INJECTORS

  • Summary Statement: As introduced, authorizes certain entities to stock epinephrine auto-injectors on their premises; authorizes employees, agents, and laypersons to provide or administer an epinephrine auto-injector under certain circumstances.
  • Legislation: HB 2054 by Kumar, Sexton C, Williams, Littleton, Hill M / SB 1989 by Green, Tracy, Crowe, Hensley, Dickerson, Briggs, Massey, Watson, Bailey, McNally, Overbey, Jackson
  • Result: Passed in House and Senate – Awaiting signature by Governor Haslam

EPINEPHRINE ADMINISTRATION BY LAW ENFORCEMENT PERSONNEL

  • Summary Statement: As introduced, authorizes law enforcement officers to administer epinephrine in emergency situations if the officer’s law enforcement agency has adopted a protocol governing the administration of epinephrine; authorizes physicians to prescribe and pharmacists to dispense epinephrine to a law enforcement agency for use by officers in emergency situations.
  • Legislation: HB 2445 by Williams / SB 1767 by Bailey
  • Senate: Passed
  • House: Scheduled for House Finance, Ways and Means Committee

APPLICATION OF MANDATED HEALTH BENEFITS TO ALL MANAGED CARE ORGANIZATIONS/INSURANCE PROGRAMS IN TENNESSEE

  • Summary Statement: As introduced, requires that any mandated health benefit that takes effect on or after the effective date of this act shall apply not only to private health insurance issuers but also any managed care organization contracting with the state to provide insurance through the TennCare program and state or local insurance program.
  • Legislation: HB 1955 by Kane / SB 1619 by Johnson
  • Result: Passed by House and Senate – Awaiting signature by Governor Haslam

PROHIBITION OF INSTITUTIONAL DISCIPLINE FOR STUDENTS SEEKING MEDICAL ASSISTANCE FOR DRUG OVERDOSES

  • Summary Statement: As introduced, prohibits institutions of higher learning and senior high schools from disciplining students who seek medical assistance for drug overdoses; prohibits such institutions and schools from sanctioning any student organization or team in which the student who is experiencing the overdose or seeking medical assistance for another is a member.
  • Legislation: HB 2070 by Daniel / SB 2206 byBriggs
  • Result: Deferred to Summer Study

LICENSURE REVIEW OF PROVIDERS AFTER CONVICTION OF FELONY

  • Summary Statement: As introduced, allows licensing authorities for certain state regulatory agencies to consider whether a person’s conviction for the commission of a felony bears directly on the person’s fitness to practice competently when making determinations regarding the person’s licensure status.
  • Legislation: HB 2496 by Akbari, Love / SB 2594 by Norris
  • Senate: Passed
  • House: Scheduled for House Consideration – 3/24/16

EXPIRED LICENSEE REINSTATEMENT PROCESS

  • Summary Statement: As introduced, permits licensees whose licenses from a health-related board have expired to obtain reinstatement on the basis of a plan developed by the department of health for periodic payment of past due renewal fees and unattained continuing education instead of the current requirement of payment of all past due fees before reinstatement.
  • Legislation: HB 2153 by Ragan / SB 1574 by McNally
  • Senate: Scheduled for Senate Health and Welfare Committee – 3/21/16
  • House: Scheduled for House Health Committee – 3/23/16

CANNABIS USE IN CLINICAL RESEARCH STUDIES

  • Summary Statement: As introduced, excludes from the definition of marijuana, the cannabis plant, with less than 0.9 percent THC, including seeds, resins, and oils, if used by a four-year institution of higher education in the state as part of certain clinical research studies.
  • Legislation: HB 2144 by Faison / SB 2125 by Niceley
  • Result: Introduced in 2016 – Action Pending

REGULATIONS FOR ERECTILE DYSFUNCTION DRUGS

  • Summary Statement: As introduced, imposes requirements on physicians who prescribe drugs to treat erectile dysfunction; excludes erectile dysfunction drugs from coverage under state employee group insurance plan; prohibits state fund being expended on those drugs unless required by federal law.
  • Legislation: HB 1927 by Jones / SB 2292 by Kyle
  • Result: Failed to Pass

MEDICATION AIDES

  • Summary Statement: As introduced, changes terminology from “medication aides certified” to “medication aide”; revises training and other requirements for medication aide program.
  • Legislation: HB 2013 by Hill M / SB 2383 by Bell
  • Senate: Scheduled for Senate Consideration on 3/21/16
  • House: Scheduled for House Health Committee – 3/23/16

BOARD OF PHARMACY RENEWAL

  • Summary Statement: As introduced, extends the board of pharmacy two years to June 30, 2018; requires the board to appear before the government operations joint evaluation committee on education, health and general welfare no later than November 18, 2016, to provide an update on the board’s progress in addressing the findings set forth in the October 2015 performance audit report issued by the division of state audit.
  • Legislation: HB 1611 by Faison, Ragan / SB 1507 by Bell
  • Senate: Passed
  • House: Scheduled for House Consideration

TENNCARE PHARMACY ADVISORY COMMITTEE RENEWAL

  • Summary Statement: As introduced, extends the state TennCare pharmacy advisory committee four years to June 30, 2020.
  • Legislation: HB 1577 by Faison, Ragan / SB 1541 by Bell
  • Result: Passed House and Senate – Signed by Governor Haslam as Public Chapter 564

CSMD ADVISORY COMMITTEE RENEWAL

  • Summary Statement: As introduced, extends the controlled substance database advisory committee two years to June 30, 2018; requires the advisory committee to appear before the government operations joint evaluation committee on education, health and general welfare no later than November 18, 2016, to provide an update on the advisory committee’s progress in addressing the findings set forth in the October 2015 performance audit report issued by the division of state audit.
  • Legislation: HB 1605 by Faison, Ragan / SB 1513 by Bell
  • Result: Passed House and Senate – Signed by Governor Haslam as Public Chapter 546

CLARIFICATION OF NOTIFICATION OF GENERIC EQUIVALENT BY PHARMACIST

  • Summary Statement: As introduced, clarifies that under the present requirement that a pharmacist attempt to notify a prescriber if a generic equivalent has become available since the last dispensing of a prescription, the pharmacist may make such notification by phone, e-mail, or other method.
  • Legislation: HB 2262 by Hicks / SB 1802 by Niceley
  • Result: Introduced in 2016 – Action Pending

TENNCARE PHARMACY POSTING

  • Summary Statement: As introduced, requires pharmacies contracting with TennCare to post in a conspicuous place seen by pharmacists and pharmacy technicians a printed notice regarding reporting TennCare fraud and abuse.
  • Legislation: HB 1012 by Shepard / SB 0914 by Johnson
  • Result: No Action Taken

Other Health-Related Legislation Being Monitored by TPA in 2016

LICENSURE AND CERTIFICATE OF NEED FOR PAIN MANAGEMENT CLINICS

  • Summary Statement: As introduced, imposes licensure and certificate of need requirements on pain management clinics.
  • Legislation: HB 1731 by Sexton C / SB 1466 by McNally, Yager, Crowe, Briggs
  • Senate: Scheduled for Senate Finance, Ways, and Means Committee – 3/22/16
  • House: Scheduled for House Health Committee – 3/23/16

MANAGED CARE ORGANIZATION RECOUPMENT LIMITS

  • Summary Statement: As introduced, prohibits managed care organizations that participate in the TennCare program from recouping overpayments based on a mistake made by the management care organization if more than 120 business days have passed since the managed care organization reimbursed the provider based on a proper clean claim; prohibits managed care organizations from reducing or withholding pending payments to recover any overpayment of fees.
  • Legislation: HB 2446 by Weaver, Keisling / SB 2233 by Hensley
  • Result: Introduced in 2016 – Action Pending

MANAGED CARE ORGANIZATION NETWORK ADEQUACY

  • Summary Statement: As introduced, reduces the allowable travel distance for certain medical services covered by managed health insurers.
  • Legislation: HB 1745 byKumar / SB 2237 by Hensley
  • Result: Introduced in 2016 – Action Pending

ANNUAL REPORT ON TREATMENT GUIDELINES AND PAIN CLINIC GUIDELINES

  • Summary Statement: As introduced, requires the commissioner of health to annually report to the health committee of the house and the health and welfare committee of the senate concerning revisions to the treatment guidelines and pain clinic guidelines.
  • Legislation: HB 2351 by Williams / SB 2192 by Crowe
  • Senate: Scheduled for Senate Commerce and Labor Committee – 3/22/16
  • House: Scheduled for House Health Committee – 3/23/2016

SUBMISSION OF DEATH CERTIFICATES TO LICENSING BOARDS FOR INVESTIGATION

  • Summary Statement: As introduced, requires the office of vital records to forward death certificates of possible prescription opiates to the controlled substances monitoring database for investigation and referral of associated prescribers to appropriate licensing boards for investigation.
  • Legislation: HB 2447 by Williams / SB 1850 by Bailey
  • Senate: Scheduled for Senate Consideration
  • House: Scheduled for House Health Committee – 3/23/16

MANDATED PRESCRIBER CHECK OF THE CSMD PRIOR TO EACH PRESCRIPTION

  • Summary Statement: As introduced, requires prescribers to check the controlled substances [monitoring] database prior to each prescription of one of the controlled substances which triggers a check of the database.
  • Legislation: HB 2361 by Stewart / SB 2050 by Bowling
  • Result: Introduced in 2016 – Pending

OFFICE-BASED OPIATE TREATMENT ACT

  • Summary Statement: As introduced, enacts the “Office-Based Opiate Treatment Act.”
  • Legislation: HB 2083 by Dunn / SB 2025 by Briggs
  • Result: No Action Taken

PRE-ARREST DIVERSION PROGRAM FOR MINOR DRUG CHARGES

  • Summary Statement: : As introduced, authorizes the commissioner of mental health and substance abuse services, in consultation with the commissioner of health, to establish a pre-arrest diversion program from minor drug charges.
  • Legislation: HB 2081 by Dunn / SB 1981 by Massey
  • Result: No Action Taken

CHANGE IN PAIN MANAGEMENT SPECIALIST DESIGNATION

  • Summary Statement: As introduced, removes board certification by the American board of interventional pain physicians as a path to becoming a pain management specialist for pain management clinics after June 30, 2016.
  • Legislation: HB 1982 by Ramsey / SB 2057 by Briggs
  • Senate: Passed
  • House: Scheduled for House Health Committee – 3/23/16

DRUG COURT ACCESS TO CSMD

  • Summary Statement: As introduced, permits personnel of any drug court treatment program to access the controlled substance database to the extent the information relates specifically to a current participant in the drug court treatment program; extends the drug court treatment pilot project created by Public Chapter 791 of 2014 to June 30, 2018.
  • Legislation: HB 1864 by Farmer / SB 1834 by Overbey
  • Result: No Action Taken

PAIN MANAGEMENT SPECIALISTS IN PAIN MANAGEMENT CLINICS

  • Summary Statement: As introduced, adds certain addiction specialists certified by the American board of addiction medicine to list of those physicians who may be a pain management specialist for a pain management clinic.
  • Legislation: HB 2464 by Camper / SB 1794 by Kelsey
  • Result: No Action Taken

TENNCARE OVERSIGHT COMMITTEE

  • Summary Statement: As introduced, reestablishes the legislative oversight committees on TennCare and on children’s services.
  • Legislation: HB 0982 by Hill M, McCormick / SB 1295 by Hensley
  • Result: No Action Taken

HEALTHCARE IMPROVEMENT ACT (TEAM-BASED CARE)

  • Summary Statement: As introduced, enacts the “Tennessee Healthcare Improvement Act of 2015″ to establish physician-led patient care teams to oversee the practice of advanced practice registered nurses.
  • Legislation: HB 0861 by Harrison / SB 0521 by Hensley
  • Result: No Action Taken

NURSING SCOPE OF PRACTICE

  • Summary Statement: As introduced, changes the title of advance practice nurses to advanced practice registered nurses and changes references to their credentials from certificates to licenses; revises other provisions governing the practice of advanced practice nursing.
  • Legislation: HB 0456 by Favors, Goins / SB 0680 by Massey, Bowling
  • Result: No Action Taken

ABUSE-DETERRENT OPIOID ANALGESIC

  • Summary Statement: As introduced, requires all health insurance coverage to provide coverage for abuse-deterrent opioid analgesic drugs at the same price as other opioid analgesic drugs.
  • Legislation: HB 0746 by Harrison, Lamberth, Lundberg, Weaver, Hill T / SB 0601 by Dickerson
  • Result: No Action Taken

90 DAY OPIOID/BENZODIAZEPINE EXCEPTION

  • Summary Statement: As introduced, creates an exception to the prohibition against prescriptions of opioids or benzodiazepines in quantities greater than a 30-day supply when certain conditions are met; if an exception applies, the prescription quantity may not be greater than a 90-day supply.
  • Legislation: HB 0723 by Pody, VanHuss / SB 0021 by Beavers
  • Result: No Action Taken

RESTORATION OF TAG GROUPS

  • Summary Statement: Requires the Bureau of TennCare or the Division of Health Care Finance and Administration (HCFA) of the Department of Finance and Administration to continue to use technical assistance groups (TAGs) of healthcare providers in developing any episode of care and to maintain the use of TAGs throughout the period of implementation of any episode of care when developing or implementing any payment reform initiative involving the use of episodes of care with respect to medical assistance.
  • Legislation: HB 1977 by Ramsey / SB 1722 by Crowe, Watson
  • Senate: Scheduled for Senate Consideration
  • House: Scheduled for House Health Committee – 3/23/16

CAPTION BILL

  • Summary Statement: Not available.
  • Legislation: HB 2267 by Faison / SB 1982 by Niceley
  • Result: No Action Taken

CAPTION BILL

  • Summary Statement: Not available.
  • Legislation: HB 1988 by Sanderson / SB 1914 by Jackson
  • Result: No Action Taken

CAPTION BILL

  • Summary Statement: Not available.
  • Legislation: HB 1784 by Sexton C / SB 2607 by Norris
  • Result: No Action Taken

2015 REVIEW

RESTORATION OF PROPOSED AWP-BASED CUTS TO THE TENNCARE PHARMACY PROGRAM – Funding Restored for FY 2015 – 2016!

TPA successfully worked with members of the Tennessee General Assembly, in collaboration with several other pharmacy-related organizations, to restore funding for the proposed AWP cuts to the TennCare pharmacy program. These proposed TennCare AWP cuts would have reduced AWP-based reimbursements to pharmacies by over $17.4 million (total state and federal funding) for brand, generic, and specialty medications. The budget, as adopted by the House and the Senate, earmarked funds to restore these AWP-based cuts to pharmacy, effectively removing them from consideration in this upcoming Fiscal Year 2016 budget. If implemented, these AWP-based cuts would have adversely affected all pharmacy providers that currently accept TennCare patients, so this is a win for our patients and the entire profession of pharmacy. The legislature did not allocate funding to restore the proposed cuts to buprenorphine and compounding for the TennCare program, and these cuts went into effect on July 1, 2015.


DIABETES SALES TAX – Passed!

After many years of working on this legislation, TPA was successful in working with Senator Doug Overbey and Representative David Shepard to enact Public Chapter 274 in 2015. As a reminder, under the Durable Medical Equipment Act [TCA 67-6-102 (34)(A)], glucometers used for diabetic testing are defined as durable medical equipment and are exempt from sales tax pursuant to a prescription order [TCA 67-6-314(2)]. However, the lancets and strips that are essential to utilize these glucometers had not been exempted. While nearly all health insurance companies pay for these supplies, the pharmacy reimbursement has not included sales tax. This legislation amends Section 67-6-314(7) to exempt the sale of diabetic testing supplies from state and local tax, including any syringe used to dispense insulin for human use and diabetic testing supplies for human use, including lancets, test strips for blood glucose monitors, visual read test strips, and urine test strips. This legislation had a $2.4 million fiscal note this year.


PHARMACY DRUG DISPOSAL – Passed!

TPA was successful in working with Representative David Shepard and Senator Doug Overbey to enact Public Chapter 40, the “Ensuring Patient Access to Pharmacy Drug Disposal Programs Act of 2015”. This legislation obtained unanimous support from state legislators and the Governor’s office. This legislation has three primary points: 1) pharmacist participation in drug disposal programs shall be voluntary, 2) the pharmacist in charge shall be responsible for deciding whether the pharmacy participates in a pharmacy drug disposal program, and 3) the pharmacy practice site shall be held harmless and shall not be held liable for any theft, robbery, or other criminal activity related to its participation in the pharmacy drug disposal program, as long as the site is acting in good faith and operating in compliance with all state and federal rules and regulations regarding drug disposal.

  • Legislation: Public Chapter 40 (HB 0229 by Shepard, Windle, Love, Pitts, Terry, Shaw, Clemmons, Howell, Favors, Sexton C, Lamberth, Hardaway / SB 0409 by Overbey, McNally, Yarbro)
  • TPA Summary of Legislation
  • Effective Date: July 1, 2015

PHARMACY ROBBERY LEGISLATION – Ongoing Effort in 2016

Tennessee currently ranks 4th per capita in the United States in pharmacy robberies, and 5th in number of pharmacy robberies. During the 2015 session, TPA worked with Senator Ferrell Haile and Representative David Shepard to introduce legislation which would allow courts to apply enhancing factors if the individual commits robbery, aggravated robbery, or especially aggravated robbery involving controlled substances on the premises of a licensed pharmacy. Because this legislation is expected to increase costs to the state of Tennessee for enhancing penalties and extending the length of incarceration for these criminals, this legislation received a substantial fiscal note. This legislation was passed by the House Criminal Justice Subcommittee and Criminal Justice Committee, as well as the Senate Judiciary Committee, but did not receive funding necessary to enact it during the 2015 legislative session. Although not enacted, this legislation did provide TPA with a very important opportunity to educate legislators and the public about the dangers facing our patients, pharmacists, and pharmacy professionals every single day with respect to the rising trend in pharmacy robberies occurring in Tennessee and across the nation. TPA will work with members of the Tennessee General Assembly to seek funding to support this legislation during the 2016 session.

  • Legislation: HB 0587 by Shepard / SB 0593 by Haile
  • Senate: Passed by Senate Judiciary Committee; Deferred to 2016 in Senate Finance, Ways, and Means
  • House: Passed by House Criminal Justice Subcommittee and Committee; Deferred to 2016 in House Finance, Ways, and Means
  • TPA Summary of Legislation

MEDICATION THERAPY MANAGEMENT IN MEDICAID RESOLUTION – Passed (Ongoing Effort in 2016)

TPA worked with Chairman Randy McNally to support Senate Joint Resolution 104, a resolution which urges the Bureau of TennCare to incorporate Medication Therapy Management (MTM) to benefit patients, improve quality, and control costs. This was a very positive resolution and TPA was heavily engaged in supporting this effort. According to information provided by the Bureau of TennCare in conjunction with this resolution, the underlying purpose of Medication Therapy Management is to improve quality and cost effectiveness, and the TennCare pharmacy team has been evaluating MTM as a potential cost savings measure which may be implemented with or without the resolution. The Bureau of TennCare also noted that if Medication Therapy Management was mandated, it could be implemented in a manner that was, at worst, revenue neutral.


DEXTROMETHORPHAN REGULATIONS – Passed

Statistics from the National Survey on Drug Use and Health (NSDUH) show that abuse of dextromethorphan is at its highest prevalence among 12-to-17-year-olds. In order to combat the abuse of dextromethorphan for this population, this law prohibits the sale of products containing dextromethorphan to anyone less than 18 years of age. TPA worked with the sponsors of this legislation to ensure that pharmacists can continue to provide care to all patients. TPA worked with legislators to exclude pharmacist-generated prescriptions, ensure that all retailers that sell dextromethorphan, including non-pharmacies, are required to comply with this law, move the implementation date back from July 1, 2015, to January 1, 2016, exempt hospitals and other institutional facilities, and reduce the penalty from a misdemeanor to a civil penalty.

  • Legislation: Public Chapter 82 (HB 0039 by Lamberth, Ragan, Powers, Keisling, Williams, Casada, Sexton C, Travis, Sargent, Shepard, Terry, Sexton J / SB 0045 by Haile)
  • TPA Summary of Legislation
  • Effective Date: January 1, 2016

INTERCHANGE OF BIOLOGICALS – Passed

This legislation was brought by a coalition consisting of brand and generic biological drug manufacturers. This bill authorizes a pharmacist to substitute an interchangeable biological product for a prescribed biological product if certain requirements are met. TPA was very supportive of the intent of this legislation but did express concerns with the language as originally introduced. TPA was able to successfully work with bill sponsors to incorporate several key changes into this legislation. TPA worked to exempt vaccines, incorporate collaborative pharmacy practice agreement language as one accepted method of communication back to the prescriber, remove requirements for notification if the pharmacist dispenses a “new” prescription which has not been changed from the previously dispensed prescription, incorporate a sunset provision for notification requirements if the state mandates electronic medical records, and require notification only after dispensing (within 5 business days). TPA appreciates the efforts of the bill sponsors in working with TPA to make these important changes to ease the notification requirements. However, the impact of this legislation is not yet known, due to the fact that there are no interchangeable biological products currently on the market.

  • Legislation: Public Chapter 371 (HB 0572 by Sexton, Hazelwood / SB 0984 by Norris)
  • Effective Date: May 4, 2015

ELECTRONIC RECORDS IN PUBLIC HEALTH THREATS – Passed

In response to recent outbreaks that have threatened the health of those around the country, legislation was brought by the Department of Health to gain quick access to medical records for patients. Access to these records shall be given in the most efficient and expedient means possible in order to facilitate investigations and inquiries while responding to an immediate threat to public health. Electronic access shall be limited to the minimum necessary for the duration of the outbreak, event, or time in which the public health is under immediate threat as determined by the commissioner.

  • Legislation: Public Chapter 154 (HB 0087 by McCormick, Brooks K, Ramsey, Hardaway / SB 0098 by Norris, Hensley)
  • Effective Date: April 16, 2015

CONTROLLED SUBSTANCE SCHEDULING – Passed

This legislation updates the schedule of some controlled substances, such as hydrocodone containing products, as well as adding some new illicit substances to the list of schedule I substances that had been discovered in the past year. Please see Public Chapter 302 for a full list of controlled substances with their corresponding schedule.

  • Legislation: Public Chapter 302 (HB 0287 by McCormick, Brooks K, Powers / SB 0318 byNorris, McNally, Bowling, Briggs)
  • Effective Date: July 1, 2015

LOW-THC CANNABIDIOL OIL – Passed

This law decriminalizes patients or their caregivers who possess oil that contains the substance cannabidiol, with less than nine-tenths of one percent (0.9%) of tetrahydrocannabinol (THC). The oil must be labeled by the manufacturer that it contains less than the limit of THC. The patient also must be in possession of proof that they were allowed to purchase the oil, such as a registration card, from the state where the oil was obtained. The patient also must have documentation of intractable seizures or epilepsy by a medical doctor or doctor of osteopathic medicine who is licensed to practice medicine in the state of Tennessee.

  • Legislation: Public Chapter 352 (HB 0197 by Faison, Jernigan, Parkinson, Carter, Hawk, Jones, Daniel, Goins, Sexton J, White M, Akbari, Miller, Hulsey, Clemmons, Favors, Durham, Gravitt, Kane, Hardaway / SB 0280 by Massey, Niceley, Kyle, Bowling, Gardenhire, Tate, Yarbro)
  • Effective Date: May 4, 2015

PSEUDOEPHEDRINE LEGISLATION – Passed

This legislation provides clarifying language regarding the formula for calculating daily, monthly, and yearly limits on the weight of pseudoephedrine products sold.

  • Legislation: Public Chapter 59 (HB 0100 by McCormick, Brooks K, Powers, Windle / SB 0111 by Norris, Haile, Bowling)
  • Effective Date: April 22, 2015

ADDICTION TREATMENT ACT – Passed

The Addiction Treatment Act was brought by the Tennessee Medical Association to provide protection and help for those who are suffering from the disease of addiction. As enacted, this legislation provides Good Samaritan protections for an individual who is having a drug overdose or in good faith seeks medical assistance for a person experiencing or believed to be experiencing a drug overdose. It also limits the prescribing of buprenorphine/naloxone to a healthcare provider with a DEA X license and only in circumstances in which the FDA has approved the use of the drug. This law also repeals a section of the code that allows an insurer to prohibit payment to a provider if the patient seeks treatment and it is determined that the patient is under the influence of alcohol or illegal drugs.

  • Legislation: Public Chapter 396 (HB 1036 by Dunn, Haynes, Ramsey, Powell, Hardaway / SB 0871 by Dickerson, Yager)
  • Effective Date: July 1, 2015

“TENNESSEE RIGHT TO TRY ACT” – Passed

The “Tennessee Right to Try Act” allows Tennessee prescribers to prescribe drugs that have already undergone phase 1 U.S. Food and Drug Administration clinical trials. People with an advanced illness, which is considered as a ‘progressive disease or medical or surgical condition that entails significant functional impairment, that is not considered by a treating physician to be reversible even with administration of current federal drug administration approved and available treatments, and that, without life-sustaining procedures, will soon result in death’, would be allowed to take these medications. These medications would come directly from the manufacturer to the patient.

  • Legislation: Public Chapter 376 (HB 0143 by Lundberg, Goins, Butt, Weaver, McManus, Terry, Daniel, Rogers, Holt, Carter, Lynn, Kumar, Jernigan, Shepard, Powell, Hardaway, Byrd, Eldridge, Powers, Coley, Turner, Armstrong, Hazlewood / SB 0811 by Hensley, Haile, Stevens)
  • Effective Date: July 1, 2015

BOARD OF PHARMACY LICENSURE – Passed

  • Summary Statement: As enacted, clarifies and adds to present law licensure requirements for persons who provide warehousing or third-party logistics services with regard to controlled substances.
  • Legislation: Public Chapter 293 (HB 0086 by McCormick, Brooks K, Williams / SB 0097 by Norris, McNally)
  • Effective Date: April 24, 2015

PRESCRIBING BY NURSE ANESTHETISTS – Passed

  • Summary Statement: As enacted, revises definitions of prescription order and professional nursing in pharmacy and nursing statutes to include certain orders and activities of certified registered nurse anesthetists.
  • Legislation: Public Chapter not available yet (HB 0629 by Littleton / SB 1014 byDickerson, Green)
  • Effective Date: May 20, 2015

PAIN MANAGEMENT CLINIC REQUIREMENTS – Passed

As prescription drug abuse continues to affect the lives of Tennesseans, our legislators have been trying to tackle the issue from every angle. In 2015, one of the approaches was to revise the requirements for medical directors and those participating in the operation of pain management clinics. Before this legislation was passed, any licensed physician could be the medical director of a pain management clinic. This legislation requires that medical directors of pain management clinics hold a specialty license in pain management.

  • Legislation: Public Chapter 475 (HB 1157 by Ramsey, Doss, Stewart, Dunn, Smith, Ragan, Lundberg, Hazlewood, Todd, Travis, Sargent, Powers, Brooks H, Johnson, Weaver, Howell, Lynn / SB 1266 by Yager, Briggs, Crowe, Massey, McNally, Bowling)
  • Effective Date: July 1, 2015

CONTROLLED SUBSTANCE PRESCRIBING – Passed

Under present law, the top 50 prescribers of controlled substances were required, at the discretion of the Tennessee Department of Health, to submit to the department within 15 business days, through registered or electronic mail, an explanation justifying the amounts of controlled substances prescribed in the relevant period of time. This legislation added to this provision the top 10 prescribers of controlled substances in all of the counties combined having a population of less than 50,000 according to the 2010 census.

  • Legislation: Public Chapter 476 (HB 1216 by Doss, Lamberth, Farmer / SB 1287 byHensley)
  • Effective Date: May 18, 2015

DELETION OF THE INTRACTABLE PAIN ACT – Passed

  • Summary Statement: As enacted, deletes the Intractable Pain Act.
  • Legislation: Public Chapter 26 (HB 0031 by Williams, Kumar, Keisling, Dunn, Lundberg, Doss, Powers, Butt, Ragan, Rogers, Carr , Carter, Holsclaw, Terry, White M, Reedy, Byrd, Brooks H, Haynes, Smith / SB 0157 by Bowling, McNally, Yager, Watson, Jackson, Bailey, Haile, Kyle)
  • Effective Date: July 1, 2015

TELEHEALTH – Passed

  • Summary Statement: As enacted, establishes requirements and protections for healthcare providers that practice telehealth.
  • Legislation: Public Chapter 261 (HB 0699 by Sexton C, Terry, Ragan, Carr, Gravitt, Weaver, Moody, Littleton, Carter, Powers, Byrd, Reedy, Forgety, Keisling, Hazlewood, Wilburn, Lamberth, Daniel, Rogers, Ramsey, Camper, Hardaway, Fitzhugh, Butt, Powell, Kane, Parkinson, McManus, Akbari / SB 1223 by Bell, Green, Overbey, Gardenhire, Haile, Stevens, Yager)
  • Effective Date: July 1, 2015

MEDICAL MALPRACTICE REGULATIONS – Passed

  • Summary Statement: As enacted, provides that a healthcare provider’s disclosure of relevant information in response to a court order, including, but not limited to, protected health information, opinions as to the standard of care of any defendant, compliance with or breach of the standard, and causation of the alleged injury, will be deemed a permissible disclosure.
  • Legislation: Public Chapter 268 (HB 1003 by Lundberg / SB 0892 by Kelsey)
  • Effective Date: April 24, 2015

PHYSICIAN ASSISTANT REGULATIONS – Passed

  • Summary Statement: As enacted, deletes statement that a physician assistant’s supervising physician have complete and absolute authority over the physician assistant’s actions while retaining language that the physician assistant function under the control and responsibility of the physician.
  • Legislation: Public Chapter 189 (HB 1101 by Hill T / SB 0201 by Crowe, Yarbro)
  • Effective Date: July 1, 2015

The legislative summary above has been provided to TPA members for informational purposes only. The information in this summary is subjective, and members are encouraged to review the language in each law and make individual determinations based on their review. Members are encouraged to visit http://www.legislature.state.tn.us/ for a complete listing of all legislation.