2018 Colorado Mid-Session Legislative Updates and Impact on Pharmacists

1. 2018 Colorado Mid-Session Legislative Updates and Impact on Pharmacists Emily Zadvorny, Pharm D, BCPS Colorado Pharmacists Society Legislative Committee & Clinical Associate Professor, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Katie Wolf Senior Associate, Michael Best Strategies

2. Program Outline • Overview of the 2018 Legislative Session • Overview of the Colorado Pharmacists Society (CPS) legislative approach • Overview of pertinent 2018 Colorado bills (the good, the bad and the dead) • National Provider Status legislative initiative • Other regulatory issues pending in Colorado • How to get involved!

3. Colorado Pharmacists Society (CPS) Legislative Committee • Chair: Gina Moore, PharmD, MBA • 23 members • 4 CPS Board Members • Meets every 2 weeks starting prior to session and continues until end • Ad hoc smaller CPS Board members & lobbyist meet PRN • Lobbying agreement: Michael Best Strategies • Katie Wolf, Senior Associate

4. CPS approach to legislative session • Decision to run our own bills? • Other Bills • Screened and vetted by our lobbyist • A position is taken: • Strongly Support – lobby & testify • Support • Monitor • Oppose • Strongly Oppose - lobby & testify

5. https://copharm.org/advocacy/legislative-committee/

6. Colorado Civics 101 • 2018 General Assembly • Convened on January 10, 2018 for 120 days • House: 65 Representatives (Democratic Majority) • Senate: 35 Senators (Republican Majority) • Website: www.leg.colorado.gov • Governor John Hickenlooper (Democrat)

10. Bills for CPS

11. Pharmacists to Serve as Practitioners (aka 135 Fix) • Background: SB 16-135 • Clarification on prescribing under Statewide Protocols (SWPs) • Prescriptive authority clarification • No change to scope of practice already approved • Not yet introduced – will need your support!

12. Pharmacist Healthcare Services Reimbursement (HB 18-1112) • Requires commercial plans to pay a pharmacist for health care services if: • The services are provided within a health professional shortage area AND; • The plan provides coverage for the same services if provided by physician or advanced practice nurse • * Does NOT require plans to contract with pharmacists • * Does NOT change current scope of practice

13. Pharmacist Healthcare Services Reimbursement (HB 18-1112) • Position: Strongly Support • Current Status: • House Committee hearing: CPS provided testimony • Passed 9-3 • House as a whole passed 48-16 • On to the Senate! • Please support and contact your Senators!

14. Bills of Interest to Pharmacy Not introduced by CPS

15. Opioid Bills • Opioid and Other Substance Use Disorders Interim Study Committee • HB 18-1003 (Position: Support) • HB 18-1007 (Position: Support) • HB 18-1136 (Position: Support) • SB 18-022 (Position: Amend) • SB 18-024 (Position: Support) • SB 18-040 (Position: Support) - died

16. How might the Opioid Bills affect pharmacy as a profession? • Quantity Limits (SB-022) – 7 days, 1 refill • Exceptions • CPS: Documentation of reason for exception on RX? • Mandatory PDMP checks (SB-022) • Position: Amend

17. How might the Opioid Bills mainly affect pharmacy as a profession? • Payment for MAT (HB 1007, SB168) • Medication Assisted Therapy (MAT) • Under a CPA: Receive an administration or “enhanced dispensing fee” for injectables • Easing of PA and ST issues (HB 1007) • (intranasal naloxone, buprenorphine) • Position: Support

18. Patient Choice of Pharmacy (HB 18-1097) • Prohibits carriers/PBMs from: • Restricting a patient’s ability to select a pharmacy • Imposing financial disincentives for any pharmacies • Imposing other conditions that dissuade pt’s choice • Exceptions: Inpt, ER, managed care, state/federal, self-funded plans • Position: Support • Passed the House

19. E-prescribing (Still in Draft Form) • Requires all controlled substances to be prescribed only electronically • All providers unless dentists (later), rural providers, and veterinarians • There will be exceptions allowed • Position: Support

20. Other miscellaneous • Drug Transparency Bills • HB 18-1260: Position is Support • Requires more transparency of health plans data along with pharmaceutical manufacturers prices and reasoning and notification • Accountable to insurance commissioner and enforceable by the SBOP • Widely supported except by pharma • HB 18-1009 (Diabetes specific): Position is Monitor

21. Other miscellaneous • Price Gouging (HB 1179) • Position: Monitor

22. Bills still to come… • Gag order / claw back

23. Bills that Died • Off label promotion by manufacturers (SB 18-023). • Position: Strongly Opposed • Canadian wholesale importation of pharmaceuticals for resale in Colorado (SB 18-080) • Position: Monitor • Prohibition of price gouging (SB 18-152) • Position: Monitor

24. National Legislation

25. National Provider Status • Pharmacy and the Medically Underserved Areas Enhancement Act (H.R.592 and S.109) • This bill amends title XVIII (Medicare) of the Social Security Act to provide for Medicare coverage and payment with respect to certain pharmacist services that: (1) are furnished by a pharmacist in a health-professional shortage area, and (2) would otherwise be covered under Medicare if furnished by a physician. • Leaves scope of practice up to individual states

26. National Provider Status • Passing national Medicare legislation would pave the way for states to get reimbursement on many levels • Support this: • http://pharmacistsprovidecare.com/

27. Colorado Regulatory Issues

28. State Board of Pharmacy Rule Revisions • Rule 6: Update to Collaborative Drug Therapy Management (CDTM) language based off SB 16-135 • Multiple pharmacists, providers and patients for a protocol • Initiate, modify or discontinue medications • Allows more than one drug to be used in a protocol • Rule 17: CE requirements for SWPs • Ensures comprehensiveness of training

29. Technician Regulation • Intent is to have all technicians registered in CO • This follows an increase in pharmacist:tech ratio law that passed last year (1:6) • Application submitted to DORA for a sunrise process • Decision from DORA Oct 2018, possible legislation in 2019

30. How Do I Get Involved?

31. CPS Legislative Committee • Please join us! • Help provide input from your practice perspective • Opportunity to meet with legislators for stakeholder meetings and/or testify if you’d like to!

32. As an individual pharmacist… • Contact your state senator or representative • Voice your support or opposition on important legislation as their constituent • Individual webpages with contact information • Leg.Colorado.Gov or just Google their main web page

33. Questions or Comments? Emily.Zadvorny@ucdenver.edu kewolf@michaelbeststrategies.com

34. Things on the Dossier I didn’t include • HB 1032 • HB 1045 • HB 1205 • HB 1207 • HB 1211 • HB 1219 • HB 1224 • HB 1229 • SB 104 • SB 115 • SB 126 • SB 139 • SB 146 • SB 155

35. Medicaid coverage of extended-release opioid antagonist (SB 18-168) • Requires medication assistance program to cover one product (Vivitrol) • Requires payment of pharmacist with an “enhanced dispensing fee” if done through a CPA.