Texas Legislative Update on Pharmacy Issues

1. Texas Legislative Update on Pharmacy Issues The Pharmacy Agenda During the 2017 Texas Legislative Session

3. Who Represents Pharmacy in Texas • Texas Society of Health System Pharmacists • Texas Federation of Drug Stores • Texas Pharmacy Association • Texas Pharmacy Business Council • Academy of Independent Pharmacists • Texas Independent Pharmacy Association • Texas True Care

4. 2017 - Pharmacists Standing Shoulder-to-Shoulder

5. In the Past…. Not so much !!! More Voices in the Choir…..

6. Diversity within Pharmacy Workplace led to less Collaboration…

7. Preparing for the 2017 Legislative Session….

8. Pharmacy groups participating

9. Collaboratively developing proposals for… • Enhanced Access for Patient Services; • Protocols for CLIA Waived Tests • Collaborative Practice Agreements • Expanded pharmacist services • PBM Reforms; • Increased regulation of marketing practices • Reimbursement transparency • Transaction fees • Medicaid Managed Care • Formularies • Technician Training: PTCB 2020 • No legislative Recommendations….

10. Game Changer….. Chaired by; Sen. Leticia Van de Putte

11. So… In January of 2017 The Texas Legislative Session Began…

12. 2017 Pharmacy Legislation… These are the major pharmacy related bills being considered…

13. New Pharmacy Issues… • Expansion of Pharmacist scope of practice. • Providing meds for CLIA waived tests, • Providing Smoking cessation and travel drugs, • Provider status for insurance payments.

14. New Pharmacy Issues… • Medicaid Managed Care. • Adopts NADAC drug pricing, • Requires dispensing fee study, • Sets minimum dispensing fee, • Requires generic drug utilization.

15. New Pharmacy Issues… • Regulation of PBMs • defines PBMs as “insurance entity” • Regulates contracting provisions • Prohibits transaction fees • Prohibits “Claw-back fees”

16. New Pharmacy Issues… • Medication Synchronization • Allowing a pharmacist to synchronize a patients refills. • Telepharmacy • Expanded automated dispensing sites tied to a Class A pharmacy located in rural areas, • Remote supervision of Techs accessing a pharmacy “system” from home.

17. Other New Pharmacy Issues… • Enhanced Penalties for Pharmacy Theft • Doctor Dispensing • Allowing a physician to sell drugs to patients. • Co-Prescribing • Requires the TMB to set standards for physicians prescriptions for Opioids.

18. Other New Pharmacy Issues… • E-Prescribing • Requiring physicians and pharmaciststo use e-prescribing for all schedule II drugs. • Nurse Practitioner Prescribing & Dispensing • Independent practice by ANPs

19. Other New Pharmacy Issues… • Prescription Monitoring Program • Mandatory registration for doctors and pharmacists, • Mandatory look-up for both prescribers and dispensers for opioids, benzodiazepines, barbiturates, and carisoprodols, (20 million scripts) • Start date - ???

20. Other New Pharmacy Issues… • Pharmacy Sunset Bill • Reauthorization of the TSBP • Pharmacy Clean-up Bill • Discipline of pharmacy - Shortage • Definition of compounding, • Required technician training, • Closed pharmacy rules

21. The Session ended May 29th…. So …. What Happened

22. Here’s what PASSED… • Pharmacy Sunset Bill • Reauthorized the TSBP, but also added… • Prescription Monitoring Program Changes; • Dispensing reported next business day, • Four categories of drugs … • Mandatory look-up for both prescribers and dispensers – STARTING SEPTEMBER 1st, 2019, • Push notifications, • Wholesalers must now report. • Unused Drug Donations to Medical Facilities

23. Here’s what PASSED… • Pharmacy Sunset Bill (Cont.) • Pharmacist Exclusive Authority – to dispense or not. • New Tele-Pharmacy Laws; • Allows a Class A pharmacy to create a “remote dispensing site” in medically underserved areas staffed by only a technician under “remote supervision.” (Rules to be developed.) • Technicians may access the pharmacy system from “outside the pharmacy” while under constant supervision. • Authorizes the TSBP to establish CE requirements for technicians.

24. Here’s what PASSED… • Medication Synchronization • Guidelines for Co-Prescribing • Enhanced Penalties for Theft • Irma Rangel School of Pharmacy

25. Here’s what PASSED… • Step Therapy Prohibited • Insurance “Clawback” Prohibited • Medicaid Drug Formulary stays with the state.

26. Here’s what DID NOT PASS… • Independent Practice for APNs, • Physician Dispensing of drugs, • Expanded Practice for Pharmacists, • E-Prescribing of Sch. II Drugs, • Clean-up of Compounding Definition – Hospitals • Immunizations by pharmacists for students,

27. Here’s what DID NOT PASS… • Medicaid Drug Pricing – MAC to NADAC, • PBM Reforms – TDI Registration as “entity”, • PBM Reforms – Transparency of pricing.

28. A Special Session Starts Next Week So …. What will Happen

29. A Special Session Starts Next Week … Important Stuff • Medical Board Sunset, then • Bathroom Bill, • Property Tax Relief • School Finance Reform, • Abortion funding, • Austin Tree Ordinances, • City Annexations….

30. We Need New Friends…. Please…. Let us know if you know a pharmacist-friendly legislator who is serving in the legislature !!!

31. Time to invest in your profession… The most regulated profession on Earth… is under attack Get involved NOW !!!

32. Time to invest in your profession… Freedom isn’t free… Please Give the TSHP-PAC