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March/April 2022 - Public Policy: Finding Your Voice

06 Apr 2022 10:26 AM | Anonymous

By: Annie Kliewer, PharmD, BCPS

Legislative advocacy can be an intimidating endeavor. It requires that you know what bills have been introduced to the legislature and if they are important for your profession. Then, it is important to know what those pieces of legislation say and what this means for your profession. The bills up for discussion during the 2022 Missouri Legislative Session affect all of us. They affect our profession as pharmacists and the level of care that can be provided to our patients. The following are the pharmacy/healthcare related bills of MSHP, MHA and MPA’s advocacy focus for this 2022 Legislative session:

HB 2305
Creates provisions relating to insurance coverage of pharmacy services
Sponsored by: Representative Dale Wright, represents portions of St. Francois, Ste. Genevieve, and Perry counties

  • Amends chapter 376 by adding three sections pertaining to insurance coverage of pharmacy services
  • Summary: A health carrier, PBM or any of their agents or affiliates shall not impose any penalty on participating providers, covered persons, or any pharmacy, including hospital pharmacies, for dispensing medically necessary clinician-administered drugs regardless of if the participating provider obtains the drugs from a source that is in network
  • What this means: Previously patients had 2 options when it came to medications administered by their provider in an office or clinic if they wanted it to be covered by insurance.
  1. Patients would have to work with their provider to ensure that the medication was obtained through one of the entity’s covered by their insurance
  2. The patient would have to go pick up a medication from a covered entity and take it to the providers’ office for the provider to then administer it.
This bill would eliminate that barrier, ensuring that a health carrier, PBM or one of their agents cannot penalize or provide less reimbursement to a provider, patient or pharmacy based on whether the clinician-administered medication came from one of the carrier’s covered entities.

SB 921 and HB 1677
Enacts provisions relating to payments for prescription drugsSponsored by: Senator Bill White, represents Jasper, Dade and Newton counties and Representative Dale Wright, represents portions of St. Francois, Ste. Genevieve, and Perry counties

  • Repeals sections 338.015, 376.387, and 376.388, and to enact in their place five new sections relating to payments for prescription drugs
  • Summary:
  1. Pharmacy benefits managers (PBM) utilized by the Missouri consolidated health care plan shall file reports with the plan for the immediately preceding year contain information regarding:
    • The aggregate dollar amount of all rebates the PBM collected from pharmaceutical manufacturers that manufactured outpatient prescription drugs
    • The aggregate dollar amount of all rebates, excluding any portion of the rebates received by the plan, concerning drug formularies that the PBM collected from pharmaceutical manufacturers that manufactured outpatient prescription drugs.

    That were covered by the plan during that calendar year and were attributed to the utilization of such drugs during said calendar year.

  2. The plan shall establish a form for the PBM to report the information required under the above-mentioned section 
  3. No documents, materials or other information submitted to the plan under the aforementioned section shall be subject to disclosure under chapter 610, except ones that are required under subsection 4 of this section.
  4. Starting July 1, 2024, and annually thereafter, the plan shall submit a report to the standing committees of the general assembly having jurisdiction of health insurance matters containing the information stated above in section 1, subsection a from the preceding year. In addition, the plan shall prepare a report for the same time period, describing rebate practices of the plan and its PBM.
  5. The plan may impose a penalty of no more than $7,500 on its PBM for each violation of the sections to follow. 
    • What this means: PBMs will be required to provide information regarding their MAC prices for medications, rebates obtained from manufacturers and business practices in relation to individual pharmacies. A PBM cannot pay a pharmacy less than the cost to purchase a drug or reimburse less for pharmacist services than they would for a PBM affiliate providing the same service. If violations of this bill are found then the PBMs will be held responsible by paying a violation fee.
    • See the bills in their entirety here: https://www.senate.mo.gov/22info/pdf-bill/intro/SB921.pdf and https://house.mo.gov/billtracking/bills221/hlrbillspdf/4311H.02C.pdf

SB 1126 and HB2452
Modifies provisions relating to the administration of medications by pharmacists
Sponsored by: Senator Holly Thompson Rehder, represents Bollinger, Cape Girardeau, Madison, Perry, Scott, and Wayne counties and Representative Bennie Cook, represents Texas, Phelps, Pulaski and Howell Counties.

  • Repeals sections 338.010 and 338.165, and enacts in lieu thereof three new sections relating to the administration of medications by pharmacists
  • Summary: 
    • This bill repeals language defining the practice of pharmacy as including the administration of specific vaccines for specific patients by written physician protocol and adds language defining the practice of pharmacy as including the ordering and administering of US FDA-approved or authorized vaccines to persons at least 7 years of age or the CDC-approved age, whichever is older.
    • This act permits a pharmacist with a certificate of medication therapeutic plan authority to provider medication therapy services pursuant to a statewide order issued by the Department of Health and Senior Services. Medication therapy services may be provided by a pharmacist for patients of a hospital pursuant to a statewide standing order issued by the Department or pursuant to a physician protocol.
  • What this means: Pharmacists authority to order and administer vaccinations will not be limited to certain kinds of vaccines and will be pursuant to rules promulgated by the Board of Pharmacy and Board of Registration for the Healing Arts or rules promulgated under a state of emergency instead of requiring a written physician protocol for specific vaccinations.
  • See the bills in their entirety here: https://www.senate.mo.gov/22info/pdf-bill/intro/SB1126.pdf and https://house.mo.gov/billtracking/bills221/hlrbillspdf/5157H.02C.pdf

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