Comments from the Capital
Monday, March 13, 2017
March 13, 2017
Week 1 of the 2017 Legislative Session
The 2017 Session of the Florida Legislature is off to an uncharacteristically fast start with five-hour committee meetings and lengthy agendas. Three of the priority pharmacy issues being actively supported by FSHP and other pharmacist organizations this session are outlined below.
First, a little history on this issue . . . last session we obtained sponsors to file this provider status bill as the "Access to Pharmacist Services Act.” After encountering strong opposition from physician groups during the bill’s first hearing, a decision was made to postpone further consideration of the bill until we could work out the differences with representatives primarily of the Florida Medical Association. Led by Dan Buffington, PharmD., past president of FSHP, a series of meetings were held in the spring and summer in which the leadership of the FMA became supportive of the collaborative intent of the bill. Ultimately, however, this effort broke down over the issue of collaborative practice by pharmacists in community pharmacies. While there was consensus regarding this practice in hospitals, physicians’ offices, prisons and other institutional settings, the FMA was unalterably opposed to collaborative practice in a community pharmacy setting.
This session SB 1180 has been filed by Senator J.J. Rodriguez (R-Miami) and represents a refinement of last year’s bill resulting from the dialogue with FMA representatives during the interim since last session. It is felt that "collaborative practice” is the title that best captures the spirit of this provider status bill. The heart of the bill is found in amendments to s. 465.0125 which expand the role of consultant pharmacists from limited in-patient settings (nursing homes and home health) to all practice settings. When authorized by a medical director or within the context of a patient-specific order, treatment protocol or at the request of the patient’s treating health care provider, a consultant pharmacist is authorized under this bill to—
(a) Order and evaluate laboratory and clinical tests to promote and evaluate patient health and wellness, as well as monitoring medication therapy and treatment outcomes;
(b) Administer medications; and
(c) Initiate, modify, or discontinue medications.
In addition the bill updates the definition of the "practice of the profession of pharmacy” to include health care products and by authorizing recommendations in communication with the patient’s prescribing health care practitioner and adds treatment of influenza to s. 465.189, F.S. We are currently awaiting the first committee hearing on this bill.
Exclusion of Florida Pharmacies from Medicaid Plans
Current law (s. 409.975, F.S.) authorizes managed care plans to limit the providers in their Medicaid networks based on credentials, quality indicators and price. Many pharmacies are being excluded from Medicaid networks creating a serious access problem for patients, particularly in rural areas. SB 670 by Sen. Aaron Bean, R-Jacksonville) and HB 675 by Rep. Heather Fitzenhagen (R-Ft. Myers) amends this law to "prohibit a Medicaid managed care plan from excluding any pharmacy from its provider network if the pharmacy meets the credentialing requirements, complies with the agency standards, and accepts the terms of the plan. The managed care plan must offer the same rate of reimbursement to all pharmacies in the plan’s network. In addition the bill authorizes the Agency for Health Care Administration to adopt rules necessary to administer the provisions of this bill, which includes rules establishing credentialing requirements and quality standards for pharmacies. This bill cleared its first committee of reference during week 1 of the Session.
Stabilization of Prescription Drug Plan Formularies
SB 182 by Senator Debbie Mayfield (R-Vero Beach) and HB 95 by Rep. Ralph Mazullo (R-Beverly Hills) seeks to stabilize prescription drug plan formularies. Many patients find themselves in the position of purchasing a prescription benefit plan only to have the formulary changed in mid-year without their knowledge or consent. This is problematic on several levels. First and foremost is the risk that patients who are stable on a prescription drug may have to readjust to a new medication that may not achieve the intended clinical results. Pharmacists are often burdened with the responsibility of informing patients when these changes in their medications occur. Oftentimes the pharmacist is not aware of the changes until the point of sale. In some cases this also results in higher costs to patients and to the pharmacy as fees are assessed when an insurance claim is filed, whether or not the claim is successful. As patients cannot change their health plans throughout the coverage year, this legislation would ensure stable formularies that provide coverage throughout the plan year. This bill has already cleared two of its three committees of reference.
Pharmacy Days at the Capital
Each year the pharmacists of Florida join forces to sponsor two days of legislative training and advocacy in the Florida Legislature. This includes both pharmacists and pharmacy students from around the state converging on the Capitol to seek legislative support for beneficial legislation and opposition to bills that would adversely affect patient care and/or the profession of pharmacy. Pharmacy Days will occur this year on March 14 & 15. If past experience is an indicator, this will again be a strong expression of the voice of pharmacists in seeking better health care access and outcome through laws that enable pharmacist to practice to the full extent of their training—hope you can join us at the Capitol!