Pharmacy Wins:

Medication Synchronization Receives Tremendous Support Throughout the Process

House Bill 1296 establishes a process through which the plan, the enrollee, the prescribing physician or health care provider, and a pharmacist could jointly approve a medication synchronization plan for medication to treat an enrollee's chronic illness. CSHB 1296 will apply only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1. 2018. Pharmacists will now be able to assist their patients through the use of medication synchronization and be appropriately compensated for it.

Pharmacy Benefit Managers Prohibited from Utilizing Patient “Clawbacks”

Senate Bill 1076 addresses Pharmacy Benefit Managers (PBM) use of the process often called “Clawback”, by prohibiting a health benefit plan issuer from requiring a covered patient to make a copayment for a covered prescription drug at the point of sale in an amount greater than the lesser of, the applicable copayment; or the allowable claim amount for the prescription drug; or the amount the individual would pay for the drug without using a benefit plan or any other source of drug benefits or discount. CSSB 1076 will apply only to a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1. 2018. This bill is truly about protecting the patients that pharmacists serve from the inappropriate and unethical practices of PBMs.

Oversight of Pharmacy Benefit Managers by the Texas Department of Insurance

House Bill 3218 provides statutory authority for PBMs to contract with HMOs, and also established the bases for TDI oversight the PBMs in the state of Texas. This is an important step as we continue to fight to assure that PBMs are oversighted and regulated by our states regulators, so that we can address the many unethical practices of PBMs such as Clawbacks.  The law will take effect on September 1, 2017.      

Enhanced Penalties for the Burglary and Theft of Controlled Substances

House Bill 1178 addresses this issue by establishing penalties for a certain burglary or theft offense involving a controlled substance. Sadly, the practice of pharmacy break-ins have become all too common, particularly with the inclusion of organized crime now engaging in these burglaries and thefts. This bill will hopefully help to deter those criminal activities or remove those offenders from the street. This law will take effect on September 1, 2017.

Pharmacy Sunset Legislation

House Bill 2561 addressed the continuation of the Texas State Board of Pharmacy (TSBP) for an additional twelve years. Changes related to the continuation of TSBP were generally minor in nature, due to the way TSBP is managed and operated. Key Policy Issues Amended to the Sunset bill:

• Established that all prescribers and dispensers (other than Veterinarians) check the Prescription Monitoring Program (PMP) when prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol beginning on September 1, 2019. Additionally, pharmacies will now be required to send all required information by electronic transfer or other form approved by the TSBP no later than the next business day after the prescription is filled. (This amendment was based off of Senate Bill 316 which was heavily negotiated by TPA, other pharmacy organizations and prescriber groups. The negotiated language in Senate Bill 316 was significantly improved from the original plan that the Sunset Commission sought to force on pharmacy. The original direction from the Sunset Commission would have required pharmacists to check the PMP before dispensing all controlled substances beginning on September 1, 2018. After hearing from some of our software providers in the fall of 2016 TPA led much of the effort to extend the implementation date to September 1, 2019, knowing that this will give our software providers enough time to automate the processes, thereby making it fit within the pharmacist’s current workflow. Additionally, pharmacy will have another legislative session to addresses any outstanding issues or concerns.)
• Establishes remote technician dispensing. Under this amendment technicians will now have the ability to work at a remote location dispensing medications. Technicians working at a remote location will be under the supervision of a pharmacist working at a separate Class A pharmacy through a telecommunication system. (TPA opposed this amendment, as well as, Senate Bill 1633, which we will discuss further under the loss category.) 

Texas Medicaid Formulary to Remain with the State

House Bill 1917 keeps the Texas Medicaid Formulary with the state until August 31, 2023. This critical legislation helps to assure that patients and pharmacists are not negatively impacted by the bureaucracies that would be established by the MCOs and PBMs. This bill takes effect immediately.

Patient Protection Provisions Established for Plans Using Step Therapy

Senate Bill 680 establishes that step therapy protocols are based on widely-accepted clinical guidelines so that medicine – not cost – dictate requirements. This is a big win for patients in Texas who suffer from chronic health conditions. This bill takes effect September 1, 2017.

Pharmacy Losses:

Enhanced Patient Access to Services Has a Tough Session

House Bill 2444 sought to establish authority for pharmacists to furnish a limited list of medications based on results of CLIA Waived test. Pharmacists would have had the authority to also furnish those medications that do not require a diagnosis such as prenatal vitamins.  The bill also addressed a requirement that pharmacists receive payment for the services they provide.

Medicaid Reimbursement Transition to NADAC Fails Despite Tremendous Support

House Bill would have reformed Medicaid pharmacy reimbursements by requiring Medicaid PBMs to use NADAC as the basis for reimbursement. This would have removed the extremely opaque MAC system.

Provider Recognition Meets Early Demise

House Bill 2608 sought to clearly recognize pharmacists as health care providers and able to provide services within the pharmacy section of the Occupation Code. Texas over the years has recognized pharmacists as providers throughout Texas statute, though the recognition is speckled throughout those statutes and is not clear. Sadly, this recognition has not resulted in the insurance companies paying pharmacist as providers.  The purpose of the bill was to make it clear once and for all that pharmacists are health care providers, though the bill would have done little to immediately change the insurance reimbursements issue (HB 2444 sought to address this issue).

Remote Technician Dispensing Passes as Senate Bill 1633 and on TSBP Sunset Bill

Senate Bill 1633 as noted previously allows a technician to work at a remote location dispensing medications. Technicians working at a remote location will be under the supervision of a pharmacist working at a separate Class A pharmacy through a telecommunication system. (As mentioned previously, TPA opposed Senate Bill 1633, as well as the amendment. While TPA shares the desire to address pharmacy related access issues in the remote areas of Texas, we have significant concerns with technicians, having the ability to dispense medication without a pharmacist on site.  While we have some amazing technicians throughout the state playing important roles in pharmacies, it is critical that a pharmacist have the ability to be on site supervising them in order to assure that pharmacies primary goal is upheld, which is to ensure the health and safety of the patients that the pharmacy serves.)   

Patient Safety and the Workplace Fails to Be Filed

The bill that TPA tried to have filed sought to prohibit pharmacies from requiring their pharmacists to work more than 12 continuous hours in a day filing medications. Additionally, the pharmacist would be required to take two 15 min breaks shift.  Unfortunately, due to Texas’ longstanding history of not getting involved in labor related issues as a right to work state, this bill proved extremely challenging.

The Stopped:

Pharmacists Again Stopped Bill Allowing Physicians to Dispense Aesthetic Drugs

Senate Bill 1606 would have allowed physicians and optometrists to prescribe AND dispense certain aesthetic drugs.  Following significant opposition from TPA and the other pharmacy advocates both Senate Bill 1606 and House Bill 2420 never received a hearing.

Pharmacists Stopped Bill Allowing Physicians to Dispense All Dangerous Drugs  

House Bill 1482 would have allowed physicians to dispense all dangerous drugs directly to patients.

House Bill 3480 would have allowed therapeutic optometrist to dispense all dangerous drugs, within their scope-of-practice, directly to patients.

Thankfully, following the significant opposition by TPA and the other pharmacy advocates these bills also failed to receive a hearing.

Next Steps….

The Texas State Board of Pharmacy and other state agencies now will begin drafting regulations to implement the various laws that have been passed. TPA will follow the rulemaking process and offer input and feedback on proposed regulations to ensure pharmacy remains protected.