Tennessee Pharmacists Association

Tennessee State Capitol

April 13, 2018

TPA Needs Your Help TODAY!

Below are several important pieces of pharmacy-related legislation being considered by the Tennessee General Assembly. Please take a few minutes to contact your state legislators about the specific bills listed below!

Click the individual buttons below to locate your legislators’ email addresses and phone numbers, or if you don’t know your legislators, CLICK HERE to look up the contact information for your elected state Representative and state Senator.

PBM Licensing Through TN Dept of Commerce and Insurance

Action Needed: Contact your state Representative and express your support for this legislation TODAY! This legislation was passed by the full Senate unopposed (29-0) on March 12. The House version will be considered by the full House on Tuesday, April 17. TPA needs all members to contact your state Representatives and ask them to vote in favor of House Bill 1857.

Senate Sponsor(s): Haile, Crowe, Bell, Yager, Jackson, Reeves
House Sponsor(s): Powers, Matlock, Keisling, Weaver, Calfee

Summary:
  • Requires all pharmacy benefits managers (PBMs) to obtain licensure and renew biennially through the Tennessee Department of Commerce and Insurance (TDCI)
  • Requires PBMs to demonstrate that they are able to transact in this state, are financially responsible, and have not had a prior license denied or revoked within five (5) years of the date the license is sought
  • Requires PBMs to provide TDCI with the person or entity’s name, address, telephone number, and website address
  • Requires PBMs to notify TDCI within 60 days of any change in PBM information

PBM Anti-Gag Clause

Action Needed: Contact your state Representative and state Senator TODAY and express your support for this amended legislation! This legislation will be considered by the full House on Tuesday, April 17, and the full Senate on Wednesday, April 18. TPA needs all members to contact your state Representatives and ask them to vote in favor of House Bill 2219 and Senate Bill 2362 as amended.

This legislation would prohibit so-called “Gag Clauses” in PBM contracts with pharmacies. These “Gag Clauses”, highlighted in a recent New York Times Article, are arbitrarily placed on pharmacists through contracts with Pharmacy Benefits Managers (PBMs) and prevent pharmacists from discussing lower cost medication therapies with patients.

Senate Sponsor(s): Haile, Crowe, Bell, Yager, Jackson
House Sponsor(s): Sexton C, Kumar

Summary as amended by the House:
  • Enacts annual hospital reporting and inspection requirements
  • Establishes that a pharmacy or pharmacist shall have the right to provide an insured information regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the insured if one is available.

Professional Privilege Tax Repeal

Action Needed: Contact your state Representative and express your support for this legislation TODAY! TPA is supporting SB 364 by Kelsey, Roberts and HB 13 by Reedy, White D, Matlock, which would remove pharmacists and other professionals from the list of those required to pay the privilege tax.

Legislation: Senate Bill 364 / House Bill 13
Senate Sponsor(s): Kelsey, Roberts
House Sponsor(s): Reedy, White D, Matlock

Summary: For several years, TPA has participated as a member of a coalition of affected professionals and has actively advocated for a repeal of the Professional Privilege Tax. In 2016, the coalition’s efforts produced a Tennessee Advisory Commission on Intergovernmental Relations (TACIR) study, which outlined the tax and also provided more detail about the tax relative to other states. TPA continues to work with the coalition to support and advocate for the removal of the professional privilege tax in 2018.


Governor Haslam’s TN Together Opioid Reform

Governor Haslam’s TN Together legislation, with TPA’s amendments included, was passed by the full House on Monday, April 9. This legislation is scheduled to be considered by the full Senate on Monday, April 16. The state has prepared an infographic summarizing the amended legislation. TPA has also prepared a summary of the amended legislation below.

Legislation: House Bill 1831 / Senate Bill 2257
Senate Sponsor(s): Norris, Haile, Yager, Massey
House Sponsor(s): Hawk, Casada, Kumar, Johnson, Sexton C, Terry, Powers, Coley, Daniel, Eldridge, Holsclaw, Favors, Hardaway

Summary as Amended:

Required Dispenser CSMD Checks:

  • Requires all dispensers (or their delegates) to check the Controlled Substance Monitoring Database (CSMD) prior to dispensing an opioid or a benzodiazepine the first time that human patient is dispensed a controlled substance at that practice site
  • Requires all dispensers (or their delegates) to check the CSMD again at least once every six (6) months for that human patient after the initial dispensing, for the duration of time the controlled substance is dispensed to that patient
Prescriber Documentation Requirements:
  • Requires prescribers to document specific elements prior to prescribing opioids, including informed consent and reasons for prescribing opioids
  • Dispensers have been removed from above documentation requirements
Opioid Prescriptions Written for 3-Day Supply or Less:
  • No required CSMD checks for prescribers or dispensers
  • No additional documentation requirements or partial fill restrictions
  • ICD-10 Codes are not required to be written on prescriptions
  • Maximum of 180 cumulative morphine milligram equivalents (MME)
Non-Exempt Opioid Prescriptions:
  • Must be partially filled with no more than a 5-day supply (for a 10-day prescription), or partially filled with no more than half the prescribed day supply limit (for prescriptions written for more than 10 days)
  • ICD-10 Codes (and “medical necessity” or “surgery”, if applicable) must be written on all non-exempt opioid prescriptions
  • General script limits: No more than a 10-day supply and a maximum of 500 cumulative MME
  • Surgery: No more than a 20-day supply and a maximum of 850 cumulative MME
  • Medical necessity: No more than a 30-day supply and a maximum of 1,200 cumulative MME
Exempt Opioid Prescriptions:
  • Partial fill requirements do not apply.
  • MME limits do not apply.
  • ICD-10 Codes and “Exempt” must be written on all Exempt Opioid Prescriptions
  • Exempt conditions: active or palliative cancer treatment, hospice care, diagnosis of Sickle Cell Disease, inpatients of a licensed healthcare facility, patients seen by pain management specialists, patients treated with opioids for 90 days or more in the last year OR who are subsequently treated for 90 days or more, patients on methadone, buprenorphine, or naltrexone, or patients with severe burns or major physical trauma

Pharmacist Anti-Gag Clause: Voids agreements which limit the pharmacists’ ability to discuss any issue related to the dispensing of a controlled substance, including risks, effects, and characteristics of the controlled substance; what to expect and how the controlled substance should be used; reasonable alternatives to controlled substance; and any applicable cost sharing for a controlled substance or any amount an individual would pay for a controlled substance if that individual were paying cash.

Effective Date: This law would become effective on July 1, 2018. However, the partial fill requirements of this law are not mandatory prior to January 1, 2019, for dispensers who have not updated the dispenser’s software system.


Other Pharmacy-Related Legislation Being Considered in Tennessee

Authorization for Partial Filling of Controlled Substances

This legislation was passed by the full Senate unopposed on March 26, and the full House passed a different version of this legislation on April 12. There is a fundamental divide on the topic of prorated patient co-payment requirements. TPA will continue to work with members of the House and Senate as each state body considers this issue.

Summary as Amended: As introduced, authorizes a partial fill of a prescription of a controlled substance under certain conditions.

Pharmacist Dispensing of Prescription Drugs Prior to Authorization in Emergency Situations

Thanks to your support and advocacy, this legislation has been passed by both the Senate and House unanimously and has been signed by Governor Haslam as Public Chapter 615!

Summary as Amended: Authorizes a pharmacist in this state, in good faith, to dispense to a patient without proper authorization or a valid prescription, the number of dosages of a prescription drug necessary to allow the patient to secure proper authorization or a valid prescription from the patient’s prescriber. Prohibits the amount of the prescription drug being dispensed from exceeding a 20-day supply. Allows prescription information to be obtained from a prescription label, verbal medical order, verbal prescription order, or any other means determined to be legitimate in the professional judgment of the pharmacist.

Mandatory Electronic Prescribing for Schedule II Controlled Substances

This legislation was passed by the full House on April 9. This legislation will be considered by the full Senate next week.

Summary as Amended: Requires certain prescriptions, on or after January 1, 2020, for a Schedule II controlled substance in this state to be made as an electronic prescription from the person issuing the prescription to a pharmacy.

Rescheduling of Controlled Substances (including Gabapentin as Schedule V)

This legislation was passed by the full House on April 9. This legislation will be considered by the full Senate next week.

Summary: Revises various provisions of law regarding the scheduling of controlled substances and their analogues and derivatives, including updated identifications of drugs categorized in Schedules I–V; authorizes sentence reduction credits for prisoners who successfully complete an intensive substance use disorder treatment program.

Medical Cannabis Only Act

This legislation was taken off notice in the Senate Health and Welfare Committee and will not be considered in 2018.

Summary: The amended legislation would expand Tennessee’s existing decriminalization law which was enacted in 2015 for patients diagnosed with epilepsy. This amendment decriminalizes the possession of cannabinoid oils and other dosage forms for patients who have a diagnosis from a licensed physician for one of more than 10 additional diagnoses and evidence that they lawfully obtained the product from a state where it is legalized.


National-Level Pharmacy Legislative Priorities

New Initiative: U.S. House Energy and Commerce Committee Hearing on Combatting the Opioid Crisis

The U.S. House of Representatives Energy and Commerce (E&C) Committee, the committee with jurisdiction over our provider status legislation, held its third hearing on opioid-related legislation earlier this week. TPA staff attended this hearing in Washington, DC. This hearing contained significant discussion. Pharmacists are uniquely positioned to help fight the opioid epidemic and improve access to care for patients living with chronic pain. Unfortunately, since pharmacists’ services are not currently covered under Medicare Part B, pharmacists aren’t recognized for their important role on the health care team and beneficiaries can’t access all their services. Please act now to tell your Member of Congress that pharmacists’ services should be part of the upcoming opioid discussion.

New Initiative: Federal PBM Anti-Gag Clause Legislation

The “Prescription Transparency Act of 2018” has been introduced at the federal level to nullify certain contractual provisions prohibiting or penalizing a pharmacist’s disclosure of the availability of therapeutically equivalent alternative drugs, or alternative methods of purchasing the prescription drug, that are less expensive, and for other purposes. This Anti-Gag Clause legislation is an important step in increasing transparency by empowering pharmacists to disclose medication-related information to patients regarding more affordable prescription drug options at the federal level. H.R. 5343 has been introduced in the House, and S. 2553 and S. 2554 have been introduced in the US Senate

Action Needed: Please contact your US Representative and US Senators TODAY and ask them to SUPPORT these important pharmacy initiatives!


TPA greatly appreciates your continued pharmacy advocacy and thanks you for your action in response to these specific legislative initiatives! For a more complete list of 2018 TPA Pharmacy-Related Legislative Priorities, CLICK HERE or visit the TPA website at https://tnpharm.org/get-involved/legislative-advocacy-center/tpa-announces-2018-legislative-priorities/.