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Texas lawmakers are halfway through the 81st legislative session and although some pharmacy proposals have received hearings, none had yet gone to the floor of either the Texas House or Senate for a vote.
“We are working closely with our Texas lawmakers to ensure that the bills we support will get a up or down vote in the legislature,” said TrueCare government affairs director John Heal. “We are optimistic about the chances for passing legislation related to transparency, prompt pay and audit standards and hopeful that a mail-order parity bill related to state health plans will be successful.”
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One of those bills, House Bill 2250, by Rep. Todd Hunter of Corpus Christi received a hearing in the House Insurance Committee on March 24. Hunter, who chairs the House Judiciary and Civil Jurisprudence Committee, is a member of the House leadership team and is considered one of the most knowledgeable lawmakers on insurance issues in the legislature.
“Todd Hunter is a longtime friend to community pharmacy,” said Steve Ray, TrueCare’s public affairs director who was Hunter’s chief political strategist in the 2008 election campaign. “In addition, one of his constituents is Bill Moore, the president of the Texas Pharmacy Association, and one of the interns in his office is the daughter of a TrueCare pharmacist in Corpus Christi. That pretty much keeps him in the loop on pharmacy related issues.”
HB 2250 amends the Insurance code to change the requirements ofa pharmacy audit and to decrease the time frame for insurance.
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Additionally, the bill creates a dispute resolution process for the Texas Department of Insurance to resolve disputes regarding claims payments by health maintenance organizations or insurers under preferred provider benefit plans. Texas Pharmacy Association President Bill Moore, RPh. who has pharmacies in Beeville and Sinton, drove to Austin to testify to the House Insurance Committee.
PBA Health/TrueCare legislative team members were at the hearing in the House Insurance Committee and signed affidavits of support for Hunter’s bill. The bill is identical to another bill by Sen. Leticia Van de Putte in the Texas Senate. Van de Putte is one of two Texas pharmacists in the Texas legislature.
The House bill is still pending in committee and the Senate bill has been referred to the Senate’s State Affairs Committee.
“TrueCare is joining other community pharmacy supporters in pushing for important legislation that will benefit us in the future,” said Robert Culley, TrueCare’s chief legislative advocate. “The mail order parity bill that passed the House last year is back on the table after getting caught in a end-of-the-session delay in the Senate last session and we hope that bill will be passed by both houses of the legislature and signed by the governor.”
Culley, said the bill, HB 2293, by Rep. Dan Gattis, R-Georgetown, is scheduled for an 8 am hearing on April 1 in the Pensions, Investments and Financial Services Committee. It’s companion bill SB 1416 by Sen. Kirk Watson, D-Austin, has been referred to the State Affairs Committee.
Culley noted that a similar bill by Gattis during the last legislative session was one of pharmacy’s top priorities. “When PBMs operate their own mail order pharmacies it puts them in the position of being both negotiator and provider of a plan’s prescription drug services and puts most community pharmacies out in the cold,” Culley said. “Passing this again in the House and getting it through the Senate will be a huge win for patients and community pharmacies.”
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The bill would allow community pharmacies to be reimbursed at an identical rate as mail order pharmacies using the same nationally recognized price benchmarks and other standards. It also requires the Employees Retirement System (ERS) and Teacher Retirement System of Texas (TRS) to offer a pharmacy benefit that allowed beneficiaries access to the same types of medicine at a community retail pharmacy for the same co-pay and supply limits as the PBM’s mail order pharmacy.
“TrueCare’s legislative team is working hard to pass important legislation to improve the outlook for community pharmacy in Texas,” said TrueCare CEO/President Nick Smock. “Passing mail order parity legislation will help level the playing field for patients who need to utilize the personal and professional services our community pharmacies. Prompt pay and audit standards will have a positive direct affect on pharmacy cash flow and help ensure that patients have access to a supply of stable and consistent community pharmacy outlets.” |
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We encourage you to contact your representative and voice support for HB 2293-Mail Order Parity. Here are some suggestions on issues you should emphasize with your representative.
- HB 2293 will level the playing field and allow community retail pharmacies the opportunity to compete fairly with mail order pharmacies.
- HB 2293 will improve pharmacy benefits for active and retired state employees and public educators by giving them access to community retail or mail order pharmacy services at the same cost.
- HB2293 will provide ERS and TRS with transparency in their contracting with pharmacy benefit managers and will require the PBMs to pass along the drug manufacturer rebates they receive back to the state.
- HB 2293’s transparency and rebate provisions will offset any cost to the state and help keep drug benefits affordable for our active and retired state employees and teachers.
- HB 2293 will give active and retired state employees and teachers the choice to get the same supply (number of days, amount of drug) of a prescription filled at the same co-pay at either their community retail pharmacy or through mail order.
- The value of a pharmacy “home” and continuity of care is undeniable in successful health care protocol. Patients should be able to have face-to-face interaction and medical advice that come with visiting a community pharmacist.
- Texans should be able to support their local businesses without being penalized with higher co-pays and shorter supply limits.
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House Bill 2250, Rep. Todd Hunter (R-Corpus Christi)
Senate Bill 1106, Sen. Leticia Van de Putte (D-San Antonio)
HB 2250 was filed on March 3 and is the companion bill to SB 1106 introduced
earlier by Senator Leticia Van de Putte (D.-San Antonio). This bill has to do with
prompt pay and audit standards specifically relating to payment of claims to pharmacies and pharmacists.
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House Bill 2581, Rep. Yvonne Gonzalez-Toureilles (D.-Alice)\
This bill will ensure the application of existing regulations relating to discount health care programs and discount health care program operators to those entities that do not charge fees or other consideration for their programs, but that do receive alternate consideration in the form of access to patient data. The amendments contained in this bill will require the Texas Department of Licensing and Regulation to enforce existing law as to these operators who are not charging fees, but are in fact receiving another form of consideration for the operation of the discount health care program.
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House Bill 2293, Rep. Dan Gattis (R-Georgetown)
Senate Bill 1433, Sen. Kirk Watson (D-Austin)
HB 2293 and Senate Bill 1433 were filed on March 3. The Senate bill is currently in the State Affairs Committee and the House bill has been referred to the Pensions, Investments & Financial Services committee. The proposals relate to the delivery of prescription drugs for certain state health plans by mail order; providing an administrative penalty. After being passed by the House during the last legislative session, it was caught in the end-of-session rush and failed to make it out of the Senate.
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House Bill 4596, Rep. Lois Kolkhorst (R-Brenham)
Senate Bill 1416, Sen. Glen Heger (R-Katy)
Filed on March 5, this bill lays out the need for transparency in PBM contracts held by the state. Specifically it relates to certain contracts between pharmacy benefits managers and the Employees Retirement System of Texas, the teachers Retirement System of Texas, The Texas A&M University System, or The University of Texas System. It was referred to the State Affairs Committee on March 17.
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Pharmacists added to federal legislation for DME accreditation exemption
Senate Bill 511, sponsored by Senators John Tester (D-MT) and Sam Brownback (R-KS) have introduced the Access to Durable Medical Equipment Act of 2009. This bill adds pharmacists to the list of medical professionals that are exempted from new accreditation requirements for Medicare Part B durable Medical Equipment, Prosthetics, Orthotics and Supplies.
If pharmacists stop participating in the Medicare Part B program, patients may have to travel longer distances to get equipment. This is especially problematic in rural communities with sparse population density where the local pharmacy is often the sole health care provider in a community. In some cases, patients would be forced to using mail order and internet options where fraud is more prevalent – which undermines the primary purpose of accreditation.
Community pharmacists are professionally trained with the expertise and government oversight as state-licensed medical professionals and businesses that can be sanctioned for any violations of Medicare regulations. The accreditation fees and implementation costs are between $5,000 to $7,000 per pharmacy and reoccur every three years.
A companion bill, H.R. 616, was introduced in the U.S. House of Representatives by Rep. Marion Berry (D.-AR) and Jerry Moran (R.-KS) late in January. It currently boasts 45 sponsors.
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One-sided PBM contracts could end with Fair Contracts Measure
Reps. Anthony Weiner (D-NY) and Jerry Moran (R-KS) were joined by 32 other bipartisan sponsors on H.R. 1204, the Community Pharmacy Fairness Act of 2009. This bill will effectively level the playing field between more than 23,000 community pharmacies and the giant PBMs by creating a narrow antitrust exemption.
“Current law prevents community pharmacists from having the same leverage as large chains in negotiating the terms of their contracts with PBMs, said NCPA Executive Vice President and CEO, Bruce T. Roberts, RPh. “As a result, community pharmacies are given the Hobson’s Choice of signing unfair contracts that don’t benefit patients, or lose their patients altogether. That is why we applaud Congressmen Anthony Weiner and Jerry Moran for introducing the Community Pharmacy Fairness Act of 2009, and we urge the House Judiciary Committee to take action on the bill and hope the Senate will also introduce a companion bill soon.”
We can be proud of Texas Representatives Ruben Hinojosa (D-TX) and Ron Paul (R-TX) for being original
co-sponsors. |
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The narrow margin of Texas Pharmacist Chuck Hopson’s victory is another example of how one election can make a difference in independent pharmacy’s ability to get its message to the decision makers of the future. We must be ready and able to work with both political parties and with a variety of different lawmakers to ensure that our voice will be heard. Today we must decide if we want to be participants, or spectators in the legislative and regulatory arenas. Participants have a say in their destiny. Spectators watch from the sidelines and read tomorrow’s newspaper to find out what happened. We must be proactive, and not reactive.
In the past, many of you have shown a commitment to the future of pharmacy by supporting the Texas Pharmacy Survival Fund, which has been instrumental in protecting the interests of independent pharmacy. Today pharmacies continue to reap the rewards from the work of the Survival Fund as it expands its grassroots efforts to educate legislators, opinion makers and the general public on issues important to independent pharmacy. We need your help again. In January we will face another legislative session and we cannot afford to wait two months to begin getting out pharmacy’s message to new legislators and legislative leaders. There is much work to be done and pharmacy needs your help to ensure that we maintain our momentum. Our voices must be heard in Austin. Please make a contribution to the future of independent pharmacy through the Pharmacy Survival Fund. The stakes have never been so high.
Respectfully,
The TrueCare Legislative Council
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