TPA ReLaunches Vaccine Newsletter: Sign-up Now
Pharmacists are trusted information providers for vaccines.  Texas pharmacists are well positioned to help improve vaccination rates, especially in adults.  As October and American Pharmacists month comes to an end, celebrating pharmacy and innovative pharmacist-provided services should not.  If patients and customers have a vaccine question, they should ask their pharmacist.  To help you be in the know of the latest vaccine news and insights sign-up for TPA’s Vaccine Insights newsletter.  You’ll find research-based news that is vetted for commercial bias, clinical relevance, and ‘main-street’ comprehension by the providers patients trust the most... doctors, nurses and pharmacists.  Given today’s "fake vaccine news" debate, it is important for patients to rely upon their pharmacist as the trusted source for the latest vaccine news.

Pharmacy Summit:  Leaders Meet for Pharmacy Unity on Issues
The 2018-2019 Texas Pharmacy Summit held its first meeting on October 24 in Austin to begin preparation for pharmacy priorities for the 2019 Texas Legislative Session.  The Texas Pharmacy Summit, established in 2014, is a coalition of the various state pharmacy organizations’ elected pharmacist leaders with the purpose to discuss legislative priorities and determine those issues where pharmacy can speak with one voice.  Pharmacy unity has been and will continue to be important to the success of pharmacy’s public policy agenda in both the regulatory and legislative arena.  This first meeting was more organizational in nature to discuss the purpose, structure and expectations of the attendees and outline the Summit process and issue development.

The Texas Pharmacy Summit meetings will continue in 2018.  TPA looks forward to the opportunity to have open meaningful discussions with all of the organizations representing the interests of pharmacy in Texas.

Texas State Board of Pharmacy Meets on November 7th
The Texas State Board of Pharmacy will meet for their final Board meeting of 2017 on November 7th. The meeting will cover the final adoption of rules, proposal of new rules and a number of other discussion items, such as the final report by Baylor Scott & White Pharmacy on the pilot project concerning automated storage and distribution devices and dispensing dangerous drugs to patients in long term care facilities.
Click Here for a complete copy of the Board’s agenda.   

Lt. Governor Dan Patrick and Speaker Joe Straus Released Interim Charges This Week
This week Lt. Governor Dan Patrick released his first and second sets of interim charges and House Speaker Joe Straus released his complete list of interim charges.

Key Senate Health and Human Services Committee charges from Lt. Governor Patrick include:

• Substance Abuse/Opioids:  Review substance use prevention, intervention, and recovery programs operated or funded by the state and make recommendations to enhance services, outreach, and agency coordination.  Examine the adequacy of substance use, services for pregnant and postpartum women enrolled in Medicaid or the Healthy Texas Women Program and recommend ways to improve substance use related health outcomes for these women and their newborns.  Examine the impact of recent legislative efforts to curb overprescribing and doctor shopping via the prescription monitoring program and recommend ways to expand on current efforts.
• Medicaid Managed Care Quality and Compliance:  Review the Health and Human Services Commission’s efforts to improve quality and efficiency in the Medicaid program, including pay-for-quality initiatives in Medicaid managed care.  Compare alternative payment models and value-based payment arrangements with providers in Medicaid managed care, the Employees Retirement System, and the Teachers Retirement System, and identify areas for cross-collaboration and coordination among these entities.  Evaluate the Commission's efforts to ensure Medicaid managed care organizations' compliance with contractual obligations and the use of incentives and sanctions to enforce compliance.  Assess the Commission's progress in implementing competitive bidding practices for Medicaid managed care contracts and other initiatives to ensure the best value for taxpayer dollars used in Medicaid managed care contracts.
  

Senate Business and Commerce Committee charged with:

• Health Insurance Market Stability:  Study the factors affecting health insurance markets in Texas, particularly the individual market, including federal and state law.  Make recommendations that would result in increased stability in the markets and enhance value and affordability for individual consumers and businesses.  Examine what steps the state needs to take to allow out-of-state health insurance sales. In developing its recommendations, the committee should consider the flexibility afforded to states by 1332 "state innovation" waivers, which allow states to modify or eliminate tax penalties associated with individual and employer coverage mandates; modify requirements for benefits and subsidies; and find alternative ways to provide benefit plan choices, determine eligibility for subsidies, and enroll consumers.
  

Key House Human Services Committee Charges from Speaker Straus include:

• Review the history and any future roll-out of Medicaid Managed Care in Texas.  Determine the impact managed care has had on the quality and cost of care.  In the review determine initiatives that managed care organizations (MCOs) have implemented to improve quality of care; whether access to care and network adequacy contractual requirements are sufficient; and whether MCOs have improved the coordination of care.  Also, determine provider and Medicaid participants’ satisfaction within STAR, STAR Health, Star Kids, and STAR +Plus managed care programs.  In addition, review the Health and Human Services Commission's (HHSC) oversight of managed care organizations, and make recommendations for any needed improvement.
• Monitor the HHSC's implementation of Rider219 in Article II of the General Appropriations Act related to prescription drug benefit administration in Medicaid.  Analyze the role of pharmacy benefit managers in Texas Medicaid.
  

House Insurance Committee charged with:

• Examine the impacts of changes in prescription drug coverage and drug formularies on patients, particularly those with chronic conditions.
• Evaluate recent efforts in Texas and in other states to enhance transparency regarding the practices of pharmacy benefit managers.
  

Speaker Joe Straus Establishes Select Committee on Opioids and Substance Abuse
Included in the list of interim charges by Speaker Straus is the creation of a select committee to study opioids and substance abuse in the state of Texas.  The directions for the committee include reviewing policies and guidelines used by state agencies to monitor for and prevent abuse of prescription drugs in state-funded and state-administered programs. Click Here for the proclamation creating the committee.

The committee will be chaired by Rep. Four Price (R – Amarillo) who also serves as the Chair of Public Health and will be vice chaired by Rep. Joe Moody (D – El Paso), other members include Rep. Carol Alvarado (D – Houston), Rep. Garnet Coleman (D – Houston), Rep. Jay Dean (R – Longview), Rep. Ina Minjarez (D – San Antonio), Rep. Andy Murr (R – Junction), Rep. Poncho Nevarez (D – Eagle Pass), Rep. Kevin Roberts (R – Houston), Rep. Tony Rose (D – Dallas), Rep. J.D. Sheffield (R – Stephenville), Rep. Gary VanDeaver (R – New Boston), and Rep. James White (R – Dayton).

Political Earthquake Strikes the Texas House: Texas House Speaker Joe Straus Announces He Will Not Seek Re-election
In a surprise announcement on Wednesday October 25th long time Texas House Speaker Joe Straus (R - San Antonio) announced that he will not seek re-election.  In a letter to his supporters announcing his decision, Speaker Straus said “just as my ascension to the Speaker’s office was unconventional and my approach to governing is unusual in these divisive times, I know this is also an unexpected decision.  It’s been decades since someone has left the Speaker’s office on his own terms.” Speaker Straus’ announcement shocked many because it means he will voluntarily end his tenure as Speaker just one term shy of holding the distinction as the sole longest-serving Speaker in Texas history.  Instead, he will leave having served as the longest serving Republican Speaker and in a three-way tie with two former Democrat Speakers.  Speaker Straus’s retirement now leaves a power vacuum for one of Texas’ most powerful and influential leadership positions.

Shortly after Speaker Straus’ announcement, one of his top lieutenants, Representative Byron Cook (R - Corsicana), also announced that he will not seek re-election either.  Other lieutenants like Representative John Zerwas (R – Fulshear), who currently serves as Chair of House Appropriations, announced his bid for Speaker, while Representative Charlie Geren (R – Fort Worth) expressed he is only running for re-election.

One thing is for sure, we better expect many more changes to come as the aftershocks from this earthquake continue to ripple through the political world in Texas.

DEA and Local Law Enforcement Partners Take Back Unwanted Prescription Drugs
DEA and its local law enforcement, community, and tribal partners are holding a prescription drug take back day this weekend. On Saturday, October 28, individuals can take expired, unused, and unwanted solid forms of medication to one of nearly 5,000 collection sites nationwide. The sites can be located by searching online at www.DEATakeBack.com or by calling 800-882-9539.
DEA (October 24, 2017)

Advice for Providers Treating Patients In Or Recently Returned From Hurricane-Affected Areas
CDC has issued a health alert network advisory to remind clinicians assessing patients in or recently returned from hurricane-affected areas to be on the lookout for certain infectious diseases. These include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. CDC noted that "post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas."
CDC (October 24, 2017)

Trump Declares Opioids a Public Health Emergency
President Trump declared Thursday afternoon that the opioid crisis is a public health emergency. "As Americans, we cannot allow this to continue," Trump said. "It is time to liberate our communities from the scourge. We can be the generation that ends the opioid epidemic."
CNN (October 26, 2017) Merica, Dan

FDA Approves GSK's Shingles Vaccine
GlaxoSmithKline's Shingrix was approved by the FDA for the prevention of shingles in patients at least 50 years old. A clinical trial demonstrated more than 90% efficacy of Shingrix in all age groups.
Reuters (October 20, 2017)

Expert Panel Recommends New Shingles Vaccine That Gives Increased Protection
In a rare move, the Advisory Committee on Immunization Practices also recommended, by an 8-to-7 vote, that the new Shingrix vaccine be preferred over the existing Zostavax vaccine because it provides far greater protection and is expected to prevent significant disease, especially among the elderly.
The Washington Post (October 25, 2017) Sun, Lena

FDA’s Gottlieb Calls For Greater Use Of Medication-Assisted Treatment To Fight Opioid Epidemic
Scott Gottlieb, commissioner of the Food and Drug Administration, called Wednesday for the expanded use of medication-assisted treatments for opioid addiction, saying they could reduce overdoses and deaths. During a House hearing on the federal response to the opioid epidemic, Gottlieb said the agency will issue new guidance to manufacturers to promote the development of novel therapies, including ones that treat a wider range of symptoms. Medication-assisted treatment (MAT) combines drugs and counseling to combat addiction.
The Washington Post (October 25, 2017) McGinley, Laurie

Bipartisan Drug-Price Task Force Might Be In The Works
White House officials are discussing the formation of a bipartisan task force to investigate high prescription drug prices, according to people familiar with the conversations.
Roll Call (October 20, 2017) Williams, Joe

Budget Plan Would Slash Medicare, Medicaid Funding
The 2018 budget and tax reform plan narrowly approved by the Senate last week lays the groundwork for changes that would cut Medicare funding by $473 billion and Medicaid by about $1 trillion over the next 10 years. Republicans have proposed converting Medicaid to a block grant program and Medicare to a premium support program.
Healthcare Finance (October 23, 2017) Morse, Susan

NACDS Supports New Public Policy to Bolster Opioid Abuse Solutions
In a letter to President Donald Trump, representatives of the Administration, and members of the United States Congress, NACDS today formally announced support for four new public policy proposals intended to build on existing collaborative efforts to address the opioid abuse epidemic while providing quality patient care.
NACDS (October 24, 2017)

Amazon Gets Pharmacy Licenses In At Least 12 States
Tech giant Amazon is expanding into the pharmacy business, according to a Thursday report from the St. Louis Post-Dispatch. The popular shopping website has allegedly received approval for wholesale pharmacy licenses in at least 12 states: Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, Idaho, New Hampshire, Oregon and Tennessee.
The Hill (October 26, 2017) Bowden, John

Screening For Diabetes Is Working Better Than We Thought
Undiagnosed diabetes may not be as big of a public health problem as thought. That's the takeaway from a study published Monday in the Annals of Internal Medicine that says that some previous efforts have likely overestimated the number of people with undiagnosed diabetes because they relied on a single positive test result.
NPR (October 23, 2017) Hobson, Katherine

Biosimilars Could Cut Billions From US Health Care Spending, Analysis Shows
A RAND Corp. analysis found that development of biosimilar versions of complex biologic drugs -- which accounted for 38% of spending on prescription drugs in 2015 -- could reduce health care spending by $54 billion from 2018 through 2027. The study also found that biosimilars could lower US biologics spending by 3% over the next decade.
Healthcare Finance (October 23, 2017) Lagasse, Jeff

U.S. Hospitals Wrestle With Shortages Of Drug Supplies Made In Puerto Rico
One of the workhorses of Clarke County Hospital, a 25-bed facility in rural Osceola, Iowa, is an unassuming product known as a Mini-Bag. It is a small, fluid-filled bag used by nurses to dilute drugs, like antibiotics, so that they can be dripped slowly into patients’ veins. The bag’s ease of use has made it popular in small facilities like Clarke County, where the pharmacy is closed on nights and weekends, as well as at nationally known hospitals like the Cleveland Clinic, which uses 34,000 of the bags every month.
The New York Times (October 23, 2017) Thomas, Katie

App Known As The ‘Uber For Birth Control’ Sparks Ire In Conservative States
It’s a telemedicine app that seems rather innocuous — enter your info, have it reviewed by a physician, and get a prescription. The California-based company behind it has raised millions to support its mission of expanding access to the pill, ring, or morning-after pill with minimal hurdles. But that last option is now starting to attract pushback from anti-abortion activists, who consider the morning-after pill equivalent to abortion — and who say lax telemedicine laws are enabling access to this drug with insufficient oversight.
STAT News (October 24, 2017) Blau, Max

CVS Caremark Unveils Performance-Based Rx Network
CVS Health on Tuesday announced plans to roll out a new 30,000-store pharmacy network next year anchored by CVS Pharmacy and Walgreens. The CVS Caremark performance-based network also will include up to 10,000 independent community pharmacies nationwide. Performance measures for participating pharmacies will include demonstrated medication adherence for chronic conditions that impact to client costs.
Chain Drug Review (October 24, 2017) Redman, Russell

Startup Firm Plans to Bring Heart Drug Propranolol to a Mass Audience
A San Francisco startup called Kick is planning to make the beta blocker propranolol easily available to a mass market. For decades, doctors have written off-label prescriptions for the cardiac drug to help people calm themselves before a big event, such as a public speech. Kick wants to become a telemedicine platform that makes it easy for nearly anyone who needs a confidence boost to get a prescription for propranolol.
STAT News (October 25, 2017) Robbins, Rebecca

The NBC Clawback Story: A Deeper Dive
Did you catch the recent NBC Nightly News investigative story about clawbacks? Here's a longer, online version of the story featuring comments from an NCPA member pharmacist and NCPA CEO Doug Hoey.
NBC News (October 17, 2017) Breslauer, Brenda; Thompson, Anne; Abou-Sabe, Kenzi

ISMP Launches First High-Alert Medication Safety Self-Assessment
The new ISMP Medication Safety Self Assessment for High-Alert Medications can help hospitals, certain outpatient facilities, and long-term care facilities evaluate their best practices for high-alert medications, identify opportunities for improvement, and track experiences. Participants who submit assessment findings to the Institute for Safe Medication Practices anonymously via the secure internet portal will be able to obtain their weighted scores so they can compare themselves to demographically similar organizations.
Institute for Safe Medication Practices

Walking May Reduce All-Cause Mortality Risk, Study Finds
Researchers found that adults who did moderate-intensity walking for 120 minutes or less per week were at a reduced likelihood of dying prematurely from all causes, compared with inactive individuals, while higher levels of walking were tied to a 20% lower mortality risk. The findings in the American Journal of Preventive Medicine, based on data on more than 139,000 adults enrolled in the Cancer Prevention Study II Nutrition Cohort, showed that the age-standardized overall death rate among those who walked less than the recommended amount of physical activity was 2,851 per 100,000, compared with 4,293 per 100,000 among inactive participants.
Medscape (October 19, 2017) Mulcahy, Nick