Ohio Pharmacy Advocacy Creative Commons , accessed 9-15-16

Introduction and Objectives By the end of this presentation, the listener should be able to : Identify the recent Ohio advocacy successes Discuss current issues for pharmacist advocacy support Outline the importance of corporate advocacy support

Recent Ohio Successes

Legislative Action: OPA Perspective Ernest Boyd, R.Ph., Pharm. D (hon), Executive Director, Ohio Pharmacists Assn

New laws in effect from last year! HB 326: Pharmacists & pharmacy interns can now fit diabetic shoes HB 394: Pharmacists & pharmacy interns can now Administer all CDC-recommended vaccines to patients 13+ without a prescription Administer all CDC-recommended vaccines to patients 7-12 with a prescription Administer the flu vaccine to patients 7+ without a prescription SB 258: PBMs now must adhere to new audit guidelines No audits older than 2 years, no takebacks for typos or insignificant errors, can’t use extrapolation, etc.

State Issues Of Note HB 4: Naloxone Dispensing HB 64: MAC Transparency/PBM Regulation HB 116: Medication Synchronization HB 188/SB 141: Consult Agreement Expansion HB 285: 90-day prescriptions at retail HB 421: Pharmacist administration of certain long-acting meds Limited Pharmacy Networks Medical marijuana

HB 4: Naloxone Dispensing Sponsors: Reps. Robert Sprague (R-Findlay) & Jeff Rezabek (R- Clayton) Authorizes a pharmacist or pharmacy intern to dispense naloxone without a prescription to a person at risk of an opioid-related overdose, or to another person in a position to assist that person if the drug is dispensed in accordance with a physician’s protocol. Passed House & Senate unanimously. Signed into law; effective 7/16/2015

HB 4: What now? Visit www.ohiopharmacists.org for information on how to dispense naloxone under the new law.

HB 116: Medication Synchronization Sponsors: Reps. Tim Brown (R-Bowling Green) & Tim Ginter (R-Salem) Medication synchronization (med sync) is the process of lining all of a patient's medications to be refilled on the same day. Patients will make a single trip to the pharmacy to pick up prescriptions each month, making it convenient to stay on track with their long term medications. Passed House unanimously Signed by Governor in May, in effect 1/1/17

HB 116: Medication Synchronization Currently, several insurers & pharmacy benefit managers (PBMs) refuse to cover a partial fill of a prescription for a patient, which prohibits a pharmacist from “syncing” new prescriptions with already prescribed medications that the patient is already taking. Besides benefitting patients and pharmacies, med sync can help reduce overall health care costs by making a dent in the costs associated with of non-adherence which are estimated to be as high as $290 billion. NCPA study showed med sync boosted adherence rate by more than 30%.

HB 116: Medication Synchronization Having patients pick up all of their medications on the same day also allows the pharmacist to sit down with the patient to review all their medications and counsel them on their regimen, which is another benefit to the patient and makes them more comfortable with their therapy. OPA believes that is in the best interest of the patient to have their medications synchronized. Increased adherence means decreased hospitalizations. Further, if an insurer or PBM is already covering a full month of medication for a patient, legislators should close this loophole that allows some to avoid covering medications that should be covered.

HB 116: Medication Synchronization HB 116 will give the patient the option to sync their medications at their pharmacy. The med sync will be a one-time sync for a new drug added to a regimen. The bill does not apply to schedule II controlled substances, substances containing opiates, or benzodiazepines. The bill will require the insurer/PBM to cover the drugs with a pro-rated copay, as well as keep the pharmacy whole with their customary dispensing fee.

HB 188/SB 141: Consult agreement legislation Sponsors: Sens. Dave Burke (R-Marysville) & Gayle Manning (R-North Ridgeville), Reps. Stephen Huffman (R-Tipp City) & Nathan Manning (R-North Ridgeville) This bill will expand pharmacists’ capabilities to work with physicians to manage the treatment of patients. This bill will eliminate much of the hurdles and red tape associated with many current consult agreements and allow the physician the choice of tapping a pharmacist’s pharmacological expertise to manage the drug therapy of patient with a chronic illness. Similar to SB 240 from 130th General Assembly. HB 188 passed both chambers unanimously, signed by Governor Kasich in December.

HB 188: Consult agreement legislation Will expand pharmacists ability to have relationship with physician including: Instead of one agreement for every individual physician-pharmacist agreement, this legislation will allow for multiple physicians to have agreements with multiple pharmacists to manage a drug therapy under a consult agreement. The pharmacist will be allowed to order blood & urine tests. This law will also allow pharmacists to manage & modify the medication therapy of a patient under the guidance of a physician and only if a physician so chooses. Manage & modify = remove a drug, add a drug, alter a drug

HB 188: Consult agreement legislation The physician is the expert on the diagnosis, and the pharmacist is the expert on the drugs. With 6-8 years of doctorate level education, pharmacists receive more pharmacological training that any other health care professional. This law will allow physicians to tap a pharmacist’s expertise to better facilitate better patient outcomes. Pharmacists are more than qualified to take on this expanded role as a key member of the health care team.

HB 188: Consult agreement legislation Also… The law will address emergency dispensing of medications when a patient is out of refills on life-saving medicine. Patient in Cleveland died last year when pharmacy didn’t dispense insulin to him when out of refills Physician did not call in new prescription in time The law will create a grace period for a pharmacist to dispense limited “refill” of medication for life threatening disease, in the event a physician cannot be reached.

Consult agreement legislation: What’s next? House & Senate passed HB 188 unanimously Governor Kasich signed HB 188 in December Effective in March 2016 Board of pharmacy has rules Need health plans to cover new pharmacist services

HB 285: 90-day prescriptions at retail Rep. Robert Sprague (R-Findlay) introduced HB 285, which would allow pharmacists to combine refills of non-controlled substances, in order to save patients multiple trips to the pharmacy. If the patient chooses, and the pharmacist feels that it is appropriate for the patient, this bill would allow for patients to receive larger quantities of their maintenance medications without having to come to the pharmacy every month. The bill has been referred to the House Health & Aging Committee, where it awaits further testimony and a vote.

HB 285: 90-day prescriptions at retail Pros Added efficiency for pharmacies & lighter workload Improved adherence for patients Pharmacists should have expanded discretion to combine refills Cons Lower reimbursement for 90-day supplies Concern that chains could press pharmacists to combine refills Patients may expect 90-day supply, but pharmacist may not think it would be appropriate

New laws in effect from last year! HB 326: Pharmacists & pharmacy interns can now fit diabetic shoes HB 394: Pharmacists & pharmacy interns can now Administer all CDC-recommended vaccines to patients 13+ without a prescription Administer all CDC-recommended vaccines to patients 7-12 with a prescription Administer the flu vaccine to patients 7+ without a prescription SB 258: PBMs now must adhere to new audit guidelines No audits older than 2 years, no takebacks for typos or insignificant errors, can’t use extrapolation, etc.

Participate – Wherever you practice! Eboyd@ohiopharmacists.org

Status of Current Legislation Affecting Pharmacists Rebecca A. Taylor, PharmD, MBA, BCPS Ohio Society of Health-System Pharmacists (OSHP) Division Director, Legal Affairs Email: taylorr3@ccf.org @RTaylorPharmD (Twitter)

Presentation Outline HB 523 Medical Marijuana Position Statement Consult Bill Rules & Operational Questions HB 421 Pharmacists give certain drugs by injection Sponsor: Sarah LaTourette SB 332 Commission on Infant Mortality-implement recommendations Sponsor: Shannon Jones & Charleta Tavares SB 319 Drugs/pharmacy practice/addiction services Sponsor: Senator John Eklund

HB 523 Medical Marijuana The Ohio Society of Health-System Pharmacists Position Statement on the Legalization of Medical Marijuana The Ohio Society of Health-System Pharmacists (OSHP) is in agreement with American Society of Health-System Pharmacists 2011 Policy Position 1101 Medical Marijuana. The Ohio Society of Health-System Pharmacists opposes the legalization of medical marijuana until there is sufficient evidence to support its safety and effectiveness. It is also the position of the OSHP that medical marijuana should be a standardized product that would be subject to the same regulations as other prescription drug products, and OSHP opposes the procurement, storage, preparation, or distribution of medical marijuana by licensed pharmacies or health care facilities for purposes other than research. Adopted by the House of Delegates May 4, 2012

HB 523 Medical Marijuana Revising position statement Impact for Health Systems How to treat a patient that is stabilized on substance DEA impact Risk/Liability Encourage research and safety, encourage legislation to protect healthcare providers, encourage potency standards, recommend dispensaries to dispense in childproof containers with appropriate labeling, recommend counseling for patients receiving

Consult Bill Rules So excited—great collaboration between all organizations Barriers Adjudication insurance claims Credentialing and Privileging Processes in places without the infrastructure Gaps in referring provider

HB 421 Pharmacists give certain drugs by injection Passed by the house in spring Major positives: access, Medications covered: long acting injectable antipsychotics (Invega Sustenna, etc.), opioid antagonist in long-acting form for treatment of drug addiction, hydroxyprogesterone caproate, medroxyprogesterone acetate, cobalamin Also covers emergency medications for reactions Diphenhydramine, epinephrine Course in drug administration/BLS

SB 332 Commission on Infant Mortality-implement recommendations Only covers medroxyprogesterone and hydroxyprogesterone caproate

SB 319 Drugs/pharmacy practice/addiction services Technician registration Naloxone availability Suboxone clinic regulation

The Importance of Corporate Advocacy Support Sue Fosnight RPh, CGP, BCPS Ohio College of Clinical Pharmacy, Steering Committee Chair Email: fosnighs@summahealth.org All pictures from Creative Commons , accessed 9-15-16

It takes a team

Does your place of employment have a professional advocacy department? Yes No I don’t know

Have you worked with your corporate office on advocacy issues in the past? Yes No

Why should you be involved with advocacy efforts in your organization?

STEPS to Becoming Involved with Advocacy Efforts in your Organization If you are not a director or head of your department , work with the director or head of the department to contact Department of Government Affairs, Government Liaisons, or Government Relations Set up meetings to discuss pharmacy advocacy issues Discuss how you may help with other organizational advocacy issues Follow-up with quarterly meetings?