texaspharmacy.org  Friday, May 17, 2019 View Archive
Association News

Pharmacy Testifies in Support of PBM Reform Legislation

Pharmacists testify for PBM reform
Carter High, John Hickman, Duane Galligher, and Miguel Rodriguez testify in support of PBM reform legislation.

Pharmacy showed up in force at the State Capitol twice this week to testify in support of PBM reform, as Tuesday's Senate Business and Commerce Committee hearing on HB 2817 was postponed until Thursday, May 16. The bill, sponsored by Rep. Eddie Lucio III and Sen. Bryan Hughes, incorporates several provisions from HB 2231 by Rep. Tom Oliverson. The bill requires description on how reimbursement is calculated; prohibits post-adjudication reduction of payments or recoupment of claims; prohibits PBMs from paying their affiliated pharmacies more; allows access to contract; provides legal protections for pharmacies against retaliatory actions by PBMs for lodging appeals; prohibits PBMs from prohibiting pharmacies from delivering or mailing prescriptions; and prevents PBMs from requiring pharmacies to obtain additional accreditations and certifications beyond what is required by the Texas State Board of Pharmacy.

The legislation easily passed the House and is the strongest commercial PBM reform bill ever to make it this far in Texas. The Senate committee is expected to consider a vote on the bill today, needed before it can move to the full Senate for a vote. Please contact your state Senator and ask that they co-sponsor HB 2817.

Texas Pharmacy Association Members Carter High and John Hickman, along with Duane Galligher (representing the Texas Independent Pharmacies Association) and Miguel Rodriguez (representing the Texas Pharmacy Business Council) spoke about the PBM challenges faced by independent pharmacies. High, president-elect of the Alliance of Independent Pharmacists of Texas, explained his challenges with patient steering to preferred and/or mail-order pharmacies, post-adjudication fees, and restrictions on mailing prescriptions. Hickman, representing TPBC, outlined how his pharmacy, founded in 1931, is “still family-owned, but today we’re totally PBM-controlled.” Galligher and Rodriguez addressed PBM contract transparency and onerous PBM accreditation requirements.

TPA Board Member Jay Bueche of H-E-B Pharmacy noted that "regional chains experience many of the same issues as independent pharmacy owners," saying that HB 2817 "provides minimal, common-sense oversight and adds a degree of transparency to an industry, pharmacy benefit managers, that is practically unregulated in Texas."

The Texas Association of Health Plans and CVS Health testified against the bill.

Jay Bueche testifies in support of HB 2817.
TPA Board Member and H-E-B Pharmacist Jay Bueche explains the challenges that regional pharmacy chains face with PBMs.

Senate Committee Advances Medicaid Reform Bill

Debbie Garza testifies in support of Medicaid reform
TPA CEO Debbie Garza testifies before the Senate Health and Human Services Committee in support of Medicaid payment reform.

Medicaid payment reform for pharmacy is headed to the floor of the Texas Senate. HB 3388 was voted favorably from the Senate Health and Human Services Committee Wednesday evening, May 15. The bill, which easily passed the House May 3, requires PBMs in Medicaid managed care to establish a reimbursement floor for pharmacies, which guarantees pharmacies will be paid the Medicaid fee-for-service rate of the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee.

Texas Pharmacy Association CEO Debbie Garza testified Tuesday, May 14 before the Committee on behalf of all pharmacy groups in Texas in support of the bill. “All of pharmacy—big or small pharmacies, mid-size and in between, chains and independents, in rural and urban locations, YOUR pharmacists—appreciate the Legislature adding this new and refined tool to Medicaid Managed Care to establish a more robust and accountable payment methodology for prescription drugs in Texas Medicaid,” Garza said. “We appreciate the Texas Association of Health Plans working with pharmacy stakeholders to find a compromise that still provides an accurate and transparent system.”

Chairwoman Lois Kolkhorst, who sponsored the Senate companion bill, noted that this legislation has been worked on for many years in Texas. “I believe that this will lead to greater transparency and help us actually control costs,” she said. “My problem with PBMs has always been the 'black box'--an opaque system that we don't always get to look into.” Pharmacy thanks Senator Kolkhorst for her leadership and thoughtfulness on this important issue and thanks Rep. J.D. Sheffield for authoring the legislation.

Texas Senate Passes Pharmacy Legislation

Pay Parity and Provider Status Bills Pass Texas Senate

On Wednesday, May 15, the full Texas Senate unanimously passed two pharmacy bills increasing patients' access to care. HB 3441 ensures pharmacists are paid for services that are within a pharmacist's scope of practice and that other providers are paid for providing (payment parity). HB 1757 to add pharmacists to the list of practitioners in the Insurance Code. Pharmacy thanks Rep. Eddie Lucio III and Sen. Charles Schwertner (the only pharmacist in the Texas Legislature) for their support of this important pharmacy legislation. These two bills are now on their way to the governor's desk.

Pharmacy Working to Move Bills Before End of Session

Texas CapitolWith just over a week left in the 2019 Texas Legislature, a variety of pharmacy priority bills are still making their way through the legislature. TPA and other pharmacy organizations are working hard to advance the following:

  • SB 1056 (collaborative practice) by Sen. Judith Zaffirini, which has already passed the Senate, was passed out of the House Public Health Committee last week and awaits the Calendars Committee and consideration on the House floor.
  • SB 420, which would remove the requirement for pharmacists to check the Prescription Monitoring Program (PMP) for refill prescriptions, was voted out of the House Public Health Committee this week; it now awaits the Calendars Committee and consideration on the House floor.
  • HB 1455, regarding wholesale audits, passed the House and was reported favorably from the Senate Business and Commerce Committee this week; it has been recommended for the Senate local/uncontested calendar.
  • HB 1905, regarding due process protection before termination from a health plan, was amended onto HB 1914 on the House floor last week. HB 1914 passed the House and has been received in the Senate
  • HB 2174, mandating electronic prescribing of controlled substances, passed the House and is expected to be reported favorably from the Senate Health and Human Services Committee.

Follow Pharmacy-Related Bills Using TPA’s Online Bill TrackerView TPA's online bill tracker.

There is so much going on at the State Capitol right now that it’s hard to keep up. What’s a busy pharmacist to do? The Texas Pharmacy Association is here to keep you informed and to make it easy for you. Follow pharmacy-related bills TPA is tracking using our online bill tracker (updated regularly).

Garza Speaks at CAPA Meeting

TPA CEO Debbie Garza speaks to CAPA members Jenny Dau and Crystal Riggs 
 TPA CEO Debbie Garza addresses CAPA members.
 CAPA President Jenny Dau and Past President Crystal Riggs.

Texas Pharmacy Association President Mark Comfort and CEO Debbie Garza attended the May 2019 meeting of the Capital Area Pharmacy Association (CAPA) Thursday evening, May 16, at Truluck's in northwest Austin. Garza provided a legislative update with the status and specifics of pharmacy’s priority legislation and asked members to contact their state senator to cosponsor HB 2817, pharmacy’s top priority. Jenny Dau, CAPA president, encouraged members to attend the TPA Conference & Expo in August. Special thanks to Eli Lilly for sponsoring the event and to Dr. Kerem Ozer for providing an overview of type 2 diabetes treatment and Jardiance. 

Register Today for 2019 Conference & Expo

Early Bird Deadline May 24Don't miss this lineup at the 2019 TPA Conference & Expo, August 2-4 in Irving, including:

Keynote speaker Tom Menighan, Executive Vice President and CEO, American Pharmacists Association (APhA), will focus on the state of the profession.

Keynote speaker Chris Dimos (President, McKesson Retail Solutions) will discuss pharmacy self-disruption and then moderate an all-star panel with industry insights from:

  • Craig Norman (Senior Vice President, H-E-B Pharmacy)
  • Nimesh Jhaveri (President, Health Mart Pharmacy)
  • Rex Swords (Group Vice President, Centralized Services, Walgreens)
  • Ben McNabb (independent pharmacy owner, CPESN luminary, and the sole pharmacist on Texas HHSC Value-Based Purchasing Advisory Committee)

View the full tentative educational schedule and speakers online. Earn 17+ hours of CE credit! Register today to take advantage of special early-bird pricing! The discount deadline is May 24.

Register Today for 2019 TPA Conference & Expo

In the State

April 2019 Drug Utilization Review Board Meeting Summary

The Texas Drug Utilization Review Board met Friday, Apr. 26 to make recommendations about clinical prior authorizations and drugs to be included on the Texas Medicaid Preferred Drug List. Available online are a recording of this meeting’s webcast, a report of this quarter’s clinical prior authorization and PDL recommendations, approved minutes from the Jan. 25, 2019, meeting, and the PDL drug class review schedule for the July 26 meeting.

Texas Vendor Drug Program (May 10, 2019)

Texas Medicaid: Updated Crosswalk and Drug Labeler File Available

HHSC published an update to the Texas National Drug Code (NDC)-to-Healthcare Common Procedure Coding System (HCPCS) crosswalk. It’s important to note that inclusion of a HCPCS code on the crosswalk does not guarantee coverage or payment. Utilize the Fee Schedule to confirm that the procedure is payable. Clinician-administered drug (CAD) processing instructions and frequently-asked questions are also available.

Texas Vendor Drug Program (May 16, 2019)

Members Sought for the Value-Based Payment and Quality Improvement Advisory Committee

If you are interested in promoting public-private, multi-stakeholder collaboration in support of quality improvement and value-based payment initiatives for Medicaid, other publicly funded health services and the wider health care system, you may want to apply to be a member of the Value-Based Payment Quality Improvement Advisory Committee. Currently, only one pharmacist serves on the committee. The Texas Health and Human Services Commission executive commissioner will appoint members to the committee to serve a term expiring Dec. 31, 2022, unless otherwise noted. Applications are due by 11:59 p.m., May 29. Review the application letter to find out who the board is seeking as representatives and if you qualify. To apply, submit the application.

Texas Health and Human Services Commission (May 10, 2019)

Texas Senate Approves Hemp Bill

After a relatively short, amiable debate, the Texas Senate approved House Bill 1325 by state Rep. Tracy King. The bill would legalize hemp and hemp-derived extracts like CBD oil as long as they contain no more than 0.3% of the psychoactive element in marijuana known as THC. If the bill becomes law, marijuana would still be illegal.

Texas Tribune (May 15, 2019) Samuels, Alex

Drug that Reverses Opioid Overdoses Now for Sale Online in Texas

State agencies have focused on getting the life-saving medication naloxone, which reverses the effects of an opioid overdose, into the hands of police and emergency workers. But addiction experts say the drug should go first to drug users and the people close to them. On Tuesday, one company made that goal much easier by selling naloxone online in Texas. Fiduscript is now selling two doses of the medication at a cost between $116 and $178. Customers only have to watch a short training video on how to use the drug before they place an order through the Naloxone Exchange online marketplace, then wait for the drug to be discreetly delivered to their door.

Austin American-Statesman (May 14, 2019) Huber, Mary

Texas Moves to Bring Clarity to Drug Pricing

Texas lawmakers are showing overwhelming support so far for legislation that AARP says would be one of the strongest drug-price transparency measures in the country. House Bill 2536 is in the hands of a Senate committee after passing the House without opposition. It calls for drug manufacturers, pharmacy benefit managers and health benefit plans to provide certain drug-cost information to be shared on a public, state website. The state would have to be notified if the wholesale price of a drug increased more than 10% in a year, or more than 40% over five years.

Public News Service (May 15, 2019) Kuhlman, Mary Schuermann

A&M, Project ECHO Unveil Telehealth Program for Opioid Addiction Treatment

Texas A&M University Health Science Center in Bryan is teaming up with a telehealth teaching model for clinicians on a program to address the opioid epidemic. Enhancing Mental Health Practice, Organization and Workforce through Education and Readiness will help educate rural healthcare providers in Texas on how to combat the opioid epidemic in their communities. “EMPOWER allows us to extend the capacity of care out beyond our walls and into these communities, providing valuable education and resources that can save lives, design recovery structures for each individual, all while educating rural health care providers at the exact same time,” said TPA Member Joy Alonzo, PharmD, clinical assistant professor at the Texas A&M College of Pharmacy.

Becker’s Hospital Review (May 15, 2019) Dress, Jackie

National News

Medicare Part D Rule Fails to Reform Pharmacy DIR

The Department of Health and Human Services released a final drug pricing rule that unexpectedly failed to reform pharmacy direct and indirect remuneration (DIR) fees. In response, the National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS) issued a joint statement saying that they are “disappointed and frustrated that this final rule fails to finalize pharmacy DIR reform as proposed, to the detriment of seniors and community pharmacies. Our organizations have been joined by many pharmacists, pharmacy stakeholder groups, patient advocacy organizations, patients, and members of Congress in advocating that all pharmacy price concessions be included at the point of sale – or eliminated altogether – to provide senior patients with lower costs and pharmacies with more certainty.”

U.S. Department of Health and Human Services (May 16, 2019)

CMS Guidance Eliminates Spread-Pricing in Medicaid

CMS on Wednesday issued guidance for Medicaid and CHIP managed care plans clarifying that the amount retained from a pharmacy benefit manager under “spread pricing” must be excluded from the amount of actual claims used in calculating Medicaid and CHIP managed care plans’ Medical Loss Ratio.

Center for Medicaid and CHIP Services (May 15, 2019) Traylor, Chris

Pharma Companies, PBMs Play Blame Game over Drug Prices at Hearing

Pharmaceutical companies and pharmacy benefit managers pointed the finger at one another in a hearing last week on lowering drug prices. At the center of the debate: the role rebates negotiated by PBMs play in pricing and the lack of transparency around the system.

Fierce Healthcare (May 9, 2019) Minemyer, Paige

FDA Finalizes Guidance to Spur Biosimilar Availability

The Food and Drug Administration on Friday gave clear suggestions for drugmakers to make it easier for patients to obtain biosimilars, treating them similarly to generic drugs. In the final guidance, FDA gave drugmakers some clarity on the studies they need to show their biosimilar is interchangeable with a biologic.

Modern Healthcare (May 10, 2019) King, Robert

US Measles Cases Still Climbing, Topping 800 for Year

In all, 23 states have reported cases this year. The vast majority of illnesses have been in New York — most of them among unvaccinated people in Orthodox Jewish communities. That pattern continued last week, with most of the 75 new cases coming from New York.

Associated Press (May 13, 2019) Stobbe, Mike

More Than 700 Cases of Mumps in the US This Year, CDC Says

As of April 26, 736 cases of mumps had been reported in the United States this year, according to CDC. The number of cases in the past month increased by more than 300 cases. Mumps cases have been reported in 41 states and Washington, DC, CDC said. CDC notes that the vaccine is 88% effective when two doses are given.

CNN (May 9, 2019) Goldschmidt, Debra

Amid Measles Outbreak, Little Effort to Kill Vaccine Exemptions

Despite the worst measles outbreak in decades, few state legislatures this year have reconsidered the exemptions that families use to avoid inoculating their children. As many legislative sessions wind down, only Washington state, which has had one of the highest numbers of measles cases, has sent a measure to the governor’s desk.

Stateline (May 10, 2019) Ollove, Michael

States Bring Price Fixing Suit against Generic Drug Makers

Attorneys general from more than 40 states are alleging the nation's largest generic drug manufacturers conspired to artificially inflate and manipulate prices for more than 100 different generic drugs, including treatments for diabetes, cancer, arthritis and other medical conditions. The lawsuit also names 15 individual senior executives.

Associated Press (May 11, 2019) LeBlanc, Steve and Crutsinger, Martin

Even Democrats Lament Partisan Approach to Drug-Pricing Legislation

Two top Democratic lawmakers are questioning Speaker Nancy Pelosi’s strategy to couple legislation to lower prescription drug costs with far more contentious Obamacare bills, saying the tactic nixes potential for a bipartisan win. Democratic leadership planned to hold a floor vote Thursday on the combined package of health care bills.

Stat (May 16, 2019) Facher, Lev

Trending News

CVS Health to Require Third-Party Testing of Vitamins, Supplements

CVS Health Corp. said its pharmacies will require third-party testing on all of the vitamins and supplements sold online and in its stores. CVS said Wednesday that the third-party testing would seek to verify the accuracy of the ingredients listed on the supplement facts panel of vitamins and supplements and to ensure the products are free from certain additives and ingredients.

Wall Street Journal (May 15, 2019) Chin, Kimberly

Vaccines For Adults: What You Should Know

We're used to kids needing lots of shots to ward off lots of illnesses, but what about adults? The CDC recommends that adults get multiple vaccines for conditions ranging from tetanus to influenza to cervical cancer. The shots can be a bit trickier to keep track of, as many adults go to the doctor less frequently than kids do.

National Public Radio (May 15, 2019) Gordon, Mara

Nearly All Medications Contain Potentially Allergenic Inactive Ingredients, Analysis Shows

Researchers say almost all solid oral drugs, whether prescription or OTC medications, include one or more inactive ingredient capable of triggering an allergic reaction. Certain components, such as peanut oil or chemical dye, can trigger allergic reactions ranging from urticaria to anaphylaxis. One of the worst offenders is lactose, present in 45% of solid oral medications.

Journal of the American Medical Association (May 8, 2019) Voelker, Rebecca

Hospital Drug-Making Venture Picks Antibiotics as First Products

Two critical antibiotics will be the first products supplied by a group of hospitals trying to overcome high drug prices and short supplies by producing the medicines themselves. Civica Rx, the nonprofit drugmaking venture established by the hospitals, plans to begin distributing vancomycin hydrochloride and daptomycin before the end of September.

Wall Street Journal (May 15, 2019) Evans, Melanie

New Naloxone Laws Seek to Prevent Opioid Overdoses

At least 46 states and the District of Columbia have enacted laws that allow pharmacies to provide private citizens with naloxone without a prescription. However, some states are going even further by requiring doctors to give or at least offer a prescription for the overdose rescue drug to patients taking high doses of opioids.

Pew Charitable Trusts (May 1, 2019) Vestal, Christine

Glucosamine Tied to Heart Benefits

Glucosamine, the dietary supplement widely used for arthritic pain, may reduce the risk for cardiovascular disease, researchers report. Scientists looked at 466,039 British men and women, ages 40 to 69, who were free of cardiovascular disease at the start of the study. Nearly 19 percent reported regular use of glucosamine.

New York Times (May 14, 2019) Bakalar, Nicholas

Statins May Cut Glaucoma Risk

Cholesterol-lowering statin drugs may also help reduce the risk for glaucoma. Researchers followed 136,782 health care workers for up to 15 years. Every 20-point increase in total cholesterol was associated with a 7% increased risk of glaucoma. Five or more years of statin use led to a 21% reduction in the risk after adjusting for other factors.

New York Times (May 9, 2019) Bakalar, Nicholas

PDX, DrFirst Collaborate to Reduce Rampant Prescription Abandonment

By best estimates, 20 to 30 percent of prescriptions are abandoned by patients pharmacies. To tackle this widespread, preventable issue, PDX Inc. and DrFirst announced a joint effort to provide pharmacies with solutions designed to boost first-fill rates for new prescriptions and increase medication adherence.

PR Newswire (May 8, 2019)

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Texas Pharmacy Today
Editor: Brian Sparks, Division Director, Communications and Marketing
(512) 615-9140 • bsparks@texaspharmacy.org

Texas Pharmacy Association

Debbie Garza, R.Ph., Chief Executive Officer • (512) 615-9170

Disclaimer: Texas Pharmacy Today is a weekly e-newsletter for members of the Texas Pharmacy Association, 3200 Steck Avenue, Suite 370, Austin, TX 78757. According to Texas Government Code 305.027, portions of this material may be considered "legislative advertising." Authorization for its publication is made by Debbie Garza, CEO, Texas Pharmacy Association.
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