Tennessee Pharmacists Association
February 8, 2019

2019 Pharmacy-Related Legislative Priorities
Legislation Supported by TPA
Pharmacy Contract and Audit Protections, Ban on Retroactive Fees, and Increased PBM Transparency

TPA has worked with state legislators to introduce comprehensive PBM reform legislation that includes pharmacy contract and audit protections, a ban on PBM use of retroactive fees, and increased PBM transparency.

Legislation:

Summary: As introduced, makes various changes to law concerning pharmacy benefits managers; requires the comptroller of the treasury to perform an annual audit of all pharmacy benefits managers providing services funded by the state.

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

  • Strengthens audit protections regarding pharmacy’s right to amend claims prior to recoupment.
  • Prohibits PBMs from recouping the cost of the drug or dispensed product through audit, except in cases of fraud, excess dispensing, and dispensing outside of prescriber’s orders.
  • Prohibits PBMs from charging retroactive fees (e.g., DIR fees) to pharmacists or pharmacies at the state level.
  • Prohibits PBMs from using contractual language to require a pharmacist to dispense a drug or product to a patient.
  • Establishes notification requirements for PBMs regarding a pharmacy’s network status.
  • Establishes prohibitions on PBMs from notifying patients until the pharmacy has received notification of removal.
  • Requires PBMs to disclose any material change to contracts to a pharmacy or pharmacist in its network at least thirty (30) days before the effective date of the change.
  • Requires the state Comptroller’s office to perform an audit of all state-funded PBMs and report audit results to certain legislative committees.
  • Establishes certain contract standards and prohibitions between PBMs and pharmacies.
  • Establishes that PBMs shall not reimburse a pharmacy or pharmacist less than it would reimburse itself or an affiliate for providing the same drug or dispensed product.
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. The state of West Virginia removed their PBM and managed pharmacy benefits through a non-profit structure involving one of their colleges of pharmacy, resulting in an estimated savings of $70 million 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.
TN Together Opioid Reform Clean-Up Legislation

Pharmacists are well-aware of the requirements in Governor Haslam’s TN Together legislation, including some of the more onerous requirements in the legislation that have been reported to the association. TPA has worked with the Tennessee Medical Association and key pharmacy advocates to introduce legislation which mitigates some of the pharmacy-related headaches and burdens that were caused by this legislation, without materially impacting the overall intent of TN Together.

Legislation:

Summary: As introduced, makes various changes concerning the prescription of certain Scheduled controlled substances.

Here’s how this legislation affects the pharmacy profession:

  • Modifies mandatory partial fill of opioid prescriptions to authorize prescribers to voluntarily request partial fills of opioids for patients while encouraging providers to write for the lowest effective amount.
  • Requires pharmacy dispensing software systems to be compliant with the partial fill requirement originally passed last year by January 1, 2020.
  • Establishes that the partial fill provisions of TN Together are not intended to supersede existing DEA rules allowing for partial fill of schedules III-V, or partial fill for long-term care or terminally ill patients, which are already permitted under federal DEA rules.
  • Establishes that the opioid limits of TN Together do not apply to codeine and opioid-containing cough syrups that have been approved by the Food and Drug Administration to treat upper respiratory symptoms or cough.
  • Aligns Tennessee electronic prescribing requirements set to take effect in 2020 to include all controlled substances and be consistent with federal e-prescribing regulations by January 1, 2021.
  • Grants peer review committees at hospitals and medical group practices access to reports from the state’s Controlled Substance Monitoring Database, so they can better monitor and improve their internal prescribing patterns.
  • Clarifies the surgery provision in the current law to better distinguish between major and minor surgeries.
  • Defines the palliative care exemption so patients with terminal illness can have full access to effective pain management.
Professional Privilege Tax Repeal

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. The coalition worked with legislators to introduce legislation that would phase out the tax over a multi-year period (similar to the recent Hall Tax repeal strategy). Although the Professional Privilege Tax repeal legislation was not passed in 2018, TPA continues to work with the coalition to support and advocate for its passage.

Legislation:

  • Multiple Bills Filed

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

  • Similar to the repeal of other state taxes, including the inheritance tax and the Hall tax, this legislation would take a multi-year, phase-out approach by repealing the professional privilege tax over the next few years.
Establishing the Pharmacist’s Role in Medical Cannabis

TPA continues to work with House and Senate members to advocate for the importance of patient interactions with pharmacists in any legislation that proposes to legalize cannabis for medical use. As the medication experts, pharmacists are best positioned to manage patients using medical cannabis, including the identification of treatment success, as well as side effects, drug interactions, dosing standards, and other key metrics needed to ensure optimal outcomes for patients. Several pieces of legislation have already been filed regarding the legalization of cannabis, including full legalization for recreational purposes.

In accordance with Medical Cannabis policy 18.3 adopted by the TPA House of Delegates in 2018, TPA ONLY supports legislative approaches that establish a true medical infrastructure for medical cannabis requiring routine patient interactions with pharmacists, in order to ensure optimal medication therapy. TPA remains opposed to any legislation that proposes legalization of cannabis for medical use without patient interactions with pharmacists or that proposes to legalize cannabis for recreational use.

Legislation:

Summary: As introduced, would create the “Tennessee Responsible Use of Medicinal Plants Act”.

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

  • Requires dispensing facilities to ensure that every patient receives a medication therapy management consultation with a qualified pharmacist prior to the first time cannabis products are dispensed to the patient and annually thereafter.
  • Requires dispensing facilities to ensure that a patient is offered the opportunity to consult with a pharmacist prior to each time cannabis products are dispensed.
  • Consultations with qualified pharmacists may be in person or via telephone or other live electronic communication.
  • Establishes certain liability protections for pharmacists who provide consultations to patients as part of a medical cannabis program.
Raising the Minimum Age to Purchase Tobacco Products

TPA has joined forces with NashvilleHealth, the American Cancer Society, and the American Heart Association to support legislation that would, among other things, raise the minimum age to purchase tobacco products from 18 years old to 21 years old in Tennessee. 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 the age of persons allowed to use tobacco and vapor products from 18 years of age to 21 years of age.

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

  • Prevents early access to nicotine-containing products by raising the minimum age of persons allowed to use tobacco and vapor products from 18 years of age to 21 years of age.
Legislation Opposed by TPA
Mandatory Lockable Plastic Vials for Controlled Substances

While this legislation is well-intended, mandating that pharmacists dispense all Schedule II opioids, Schedule II stimulants, and Schedule IV benzodiazepines in easily breakable plastic vials with unique 4-digit codes will impose significant burdens on our seniors and patients with physical disabilities or mental illness, will not fix our state’s substance abuse issues, and will greatly hinder pharmacists’ ability to have meaningful interactions with patients.

TPA opposed this legislation in 2018 and was successful in preventing its passage. However, it has been reintroduced in 2019 and has been advertised by the local news media. With the enactment of TN Together, Tennessee has one of the strictest opioid laws in the country, and pharmacists and physicians have shouldered an enormous burden through this law.

Legislation:

Summary: As introduced, requires that Schedule II opioids, Schedule II stimulants, and Schedule IV benzodiazepines be dispensed in a lockable vial; provides exceptions where it is not practicable to dispense the controlled substance in a lockable vial or there is a request from the user not to do so.

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

  • This legislation would place additional requirements for pharmacists to dispense schedule II opioids and stimulants, as well as schedule IV benzodiazepines, in a vial with a lockable cap.
  • This legislation would create burdensome and unnecessary requirements on pharmacists and patients, requiring pharmacists to keep up with and track millions of different combinations for caps.
  • This legislation would add significant burdens on patients who are elderly and those who suffer from hearing loss, memory loss, mental illness, physical disabilities, arthritis, and other serious health conditions.
  • These requirements would not reduce the diversion and misuse of opioids and would take time and effort away from pharmacists that could be better spent having important conversations with patients about reducing the amount of opioids and other controlled substances.
  • This legislation is anti-free market and attempts to legislate a business concept into law. The business should instead market to pharmacies to encourage voluntary uptake of the product.

This list is only a summary of key pharmacy-related bills that have been introduced thus far in 2019 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, including many that are caption bills. 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.

TPA utilizes the Tennessee Pharmacists Legislative Action Network (T-PLAN) to make it simple for you to engage on key legislative priorities.


OPPORTUNITIES FOR MEMBERS

  • Get to Know Your State Legislators
    Use this simple tool to find your State Representative and State Senator: Click HERE
  • Set Up Legislative Meetings for Pharmacy Day on the Hill (Tuesday, Feb 26)
    Find the contact information for your State Representative and State Senator: Click HERE
  • Attend the TPA Winter Meetings / Pharmacy Day on the Hill
    TPA Winter Meetings (Feb 23-26)
    TPA Legislative Reception (Feb 25)
    Pharmacy Day on the Hill (Feb 26)

PharmPAC

TPA Legislative Advocacy Coalition
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