Washington State Legislation
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Washington State Legislation
04.03.14 - Governor Inslee Signs Pharmacy Benefit Manager Legislation – Protects Patient Access to Medications
The Washington State Pharmacy Association (WSPA) and the Washington State Pharmacy Legislative and Regulatory Affairs Council (LRAC) announced today that Governor Jay Inslee (D) signed into law ESSB 6137 - Pharmacy Benefit Manager (PBM) Registration, Audits and Maximum Allowable Cost Standards.
ESSB 6137 does the following:
- Requires PBMs to register with the Department of Revenue and pay an annual fee.
- Establishes standards for PBMs, insurers, and third-party payors when auditing pharmacy claims including process, timing, and payment.
- Prohibits the use of extrapolation methods. Clerical errors cannot be the basis of recoupment costs and allows for only a 24 month look back audit period.
- Establishes standards for PBMs to use when developing lists of drugs with associated maximum allowable costs, including the availability of drugs, distribution of lists, and appeals of maximum allowable costs.
- Requires PBMs to notify pharmacies in their networks when MAC prices change and must adjust those prices promptly. In addition, the bill requires an appeals process with timely response.
The audit provisions in the bill are similar to legislation already enacted by 29 other states and the MAC transparency provisions are similar to those enacted in 5 other states and currently being considered or drafted in roughly 15 other states.
ESSB 6137 passed both houses of the legislature with overwhelming support.
“Our goal this Legislative Session was to protect patient access to medications through PBM reform and position pharmacists as patient care providers in healthcare reform efforts. After more than a decade of attempts at various Pharmacy Benefit Manager (PBM) reform, we finally succeeded,” said WSPA Chief Executive Officer Jeff Rochon, Pharm.D. “The success of this bill is largely due to the influence of grassroots efforts put forth by LRAC members. The WSPA and LRAC would like to extend a special thank you to Senator Steve Conway and Senator Linda Parlette for their support and proactive measures. We would also like to recognize the efforts of Representatives Joe Schmick and Dan Kristiansen who took the lead in the House. We couldn’t have done this without their support.”
LRAC members who participated in the passage of ESSB 6137:
- Kirk Heinz – Pharmacist/Owner - Kirk’s Pharmacy
- Kari VanderHouwen – Pharmacist/Owner - Duvall Family Drugs
- Bridgett Edgar, Owner/Technician - Pharm-A- Save, Monroe
- Holly Whitcomb-Henry - Pharmacist/Owner - Rxtra Care, Inc.
- Brian Beach – Pharmacist /Owner, Kelly-Ross Pharmacy
- Rick McCoy, Pharmacist/Owner Lopez Island Pharmacy
- Jenny Arnold, Pharmacist, Director of Practice Development, WSPA
- Matthew J. DiLoreto - Senior Director – State Government Affairs
- National Community Pharmacists Association (NCPA)
- Dedi Little – Lobbyist for the WSPA/LRAC
- Carolyn Logue – Lobbyist WA Food Industry
- Holly Chisa – Lobbyist NW Grocers Association
- Jim and Kathryn Hedrick – Lobbyist Walgreens
- Stu Halsan – Lobbyist Rite Aid
- Mark Johnson – Vice President Government Relations, Retail Association
Bill Sponsors :
- Senator Steve Conway, Democrat from the 29th Legislative District
- Senator Linda Parlette, Senate Majority Caucus Chair from the 12th Legislative District
- Senator Kirk Pearson, Republican from the 39th District
- Senator Karen Keiser, Democrat from the 33rd Legislative District
Key lawmakers who helped make the bill a reality:
- Senator Randi Becker, Chair of the Senate Health Care committee from the 2nd Legislative District
- Senator Bruce Dammeier, Senate Majority Caucus Vice Chair from the 25th Legislative District
- Representative Joe Schmick, Republican Ranking Chair of the House Health Care committee from the 9th District
- Representative Eileen Cody, Democrat, Chair of the House Health Care committee from the 34th Legislative District
- Representative Paul Harris, Republican Majority Whip from the 17th Legislative District
- Representative Shelly Short, Republican Minority Caucus Vice Chair from the 7th Legislative District
- Representative Dan Kristiansen, Republican Minority Caucus Chairman from the 39th Legislative District
01/14/14 - Washington State Legislature Convenes its 63rd Legislative Session
On January 13th, the Washington State Legislature convened its 63rd Legislative Session.
In 2014, based on LRAC member survey results, the steering committee is focusing on protecting patient access to medication through PBM reform legislation as well as ensuring pharmacy is appropriately positioned and engaged in Health Care Reform, specifically collaborative team approaches to improve access to pharmacist-provided patient care services and provider recognition by payers.
Our Pharmacy Benefit Manager (PBM) reform efforts will focus on several related issues.
• Anti-mandatory mail order
• Maximum Allowable Cost (MAC) transparency
• PBM oversight
This lack of Pharmacy Benefit Manager regulation has been an area of concern for several years and due to its complexity and the powerful opponents, it has been difficult to advance our bills. We need to be vocal in Olympia.
If you have legislative questions or suggestions about furthering these efforts, please contact:
Dedi Little at 360-480-9671 or e-mail her at email@example.com
07/11/13 - LRAC Update
Washington lawmakers passed the State’s 2013-15 Operating Budget and adjourned June 29, 2013, avoiding a massive government shut down. Governor Inslee signed the budget on June 30.
Good news the drug wholesaler tax preferential tax rate remains intact! Thank you to those who contacted lawmakers expressing your concern. If increased, the cost of purchasing drugs would have also gone up.
A budget proviso that would have had a negative impact on pharmacy was vetoed by Governor Inslee prior to signing the budget into law. LRAC expressed its concern over this proviso and fortunately, the Health Care Authority agreed that not only would this proviso negatively impact pharmacy, the cost savings it projected was false. See below budget language.
Health Care Authority – Budget Proviso
Section 213 (35)The authority shall purchase a brand name drug when it determines that the cost of the brand name drug after rebates is less than the cost of generic alternatives and that purchase of the brand rather than generic version can save at least $250,000. The authority may purchase generic alternatives when changes in market prices make the price of the brand name drug after rebates more expensive than the generic alternatives.
Highlights of the State’s Operating Budget
Washington Lawmakers added $1 billion into the basic education of the state's 1 million public school students. This is in response to the Washington State Supreme Court recent decision that found Washington State was not meeting its constitutional obligation to fully fund K-12 education.
Lawmakers expanded our State’s Medicaid program, which is expected to cover an additional 300,000 children and adults in the next two years. With the federal government covering the additional costs, it wasn't a hard decision to agree to expand the program.
On taxes, neither party can claim total victory. House Democrats and Inslee did not get the $1.3 billion tax package they wanted and Republicans did not completely block all tax increases as they vowed to do. In the end they all agreed on measures closing a loophole in estate tax law and ending a tax break for users of landline telephones.
The pressure for tax increases was relieved when the middle of June the State’s economic forecast added $321 million in projected tax-revenue for the coming year.
In the end, the two parties finally agreed on a budget that preserved social services while increasing funding to higher education, allowing colleges and universities to freeze college tuition for at least a year.
The final agreement reached on government spending amounts to $33.54 billion during the next two years.
06/27/13 - No Goverment Shutdown for Washington State
Washington State Governor Jay Inslee has announced that lawmakers have finally come to an agreement on the State’s Operating budget, averting a government shutdown that would have furloughed thousands of state government workers on July 1 and impacted services to Medicaid clients.
“Washington will be at work on Monday,” Inslee said.
The House and Senate will likely vote on the budget by the end of the day Friday.
Pharmacies who service Medicaid clients can rest assured that reimbursement for your services will not be interrupted, nor will the issuance of professional licenses be delayed.
Details of the actual budget have yet to be revealed. Those details will be forthcoming once reviewed.
05/02/13 - Washington State Pharmacy LRAC has Unprecentented Success in 2013
LRAC had a tremendous year! We successfully passed ALL of our bills that we were lead on and passed a number of others that we worked to modify to benefit the profession.
HB 1182 – Including Pharmacists in the Legend Drug Act – Passed the legislature and signed into law by Governor Inslee
HB 1609 – Renaming the Board of Pharmacy - Passed the legislature and signed into law by Governor Inslee
HB 1565 – Funding Source for the Prescription Monitoring Program from the Medicaid Fraud Penalty account - Passed the legislature and signed into law by Governor Inslee
SB 5149 – Crimes Against Pharmacy – Passed the legislature and is waiting to be signed by the Governor.
SB 5213 – RX Review for Medicaid Managed Care Enrollees – Passed the legislature and is waiting to be signed by the Governor
SB 5267 – Prior Authorization Task Force – Passed the legislature and is waiting to be signed by the Governor
SB 5416 – E-Prescribing Controlled Substances – Passed the legislature and is waiting to be signed by the Governor
SB 5459 – 90 Days RX Supply – Passed the legislature and is waiting to be signed by the Governor
The regular legislative session has adjourned and lawmakers were unable to reach an agreement on a final operating budget. Governor Inslee has called a special session and lawmakers will be back in Olympia May 13 for another 30 days.
04/15/13 - HCA has terminated development and implementation of a formulary
Effective April 2, 2013, the Health Care Authority terminated development and implementation of a formulary. Creating a Medicaid formulary under federal requirements is not the most effective use of the agency’s resources. HCA has decided to shift its resources to other cost-containment efforts to achieve utilization management and savings goals more quickly and effectively.
If you or your patients received letters stating they are currently prescribed a non-formulary drug, changing the medication or submitting a Non-Formulary Justification Form is no longer necessary.
For more information, please click here.
04/11/13 - Prescription Monitoring Program Upgrades Including Changing Reporting Format to ASAP 4.2
Upgrades including an American Society for Automation in Pharmacy Format (ASAP) change
Last fall the Washington State Department of Health was awarded a federal grant to improve our Prescription Monitoring Program (PMP), including connecting to our health information exchange and implementing interstate data sharing. The new features will allow our providers using the system to have access to PMP data from other states and to access PMP data directly from the electronic health record systems they currently use.
The PMP currently uses ASAP Version 4.1 for data collection of the required data elements found in WAC 246-470. The grant requires the department to upgrade our system to use ASAP Version 4.2 as part of our other improvements. There are some slight differences between Versions 4.1 and 4.2 in field lengths and some characters used. The department is not changing any requirements regarding which data fields are required to be reported.
An updated Dispenser Implementation Guide is available online at www.wapmp.org from our vendor, Health Information Design, so that dispensers can make the necessary changes in order to report in Version 4.2.
The department plans for dispensers to begin reporting in Version 4.2 on October 1, 2013.
Technical Assistance & Policy Related Questions
The Washington State PMP is hosted by Health Information Designs, Inc. (HID). If you need technical assistance as you prepare to begin data submission using the new format, please call their Helpdesk at 877-7193121 or send an email to firstname.lastname@example.org.
For policy-related questions please contact the Washington State PMP Director, Chris Baumgartner, at 360-236-4806 or at email@example.com.
02/21/13 - LRAC Update
LRAC is very busy in Olympia! Here’s a recap of recent events in Olympia:
- Two bills of interest, SB 5213, comprehensive medication review for Medicaid managed care enrollees and SB 5267, creating standard forms for the PA process, had their public hearings in the last few weeks. Both bills have been voted out of their respective policy committees. LRAC members, Julie Akers, The Everett Clinic, Don Downing, U of W and Jeff Rochon, WSPA CEO, traveled to Olympia and testified on behalf of pharmacy in support of both these measures. LRAC successfully amended SB 5213 to include a licensed Washington State pharmacist and defined what the comprehensive medication managed would be.
- Two of our bills, SHB 1182, including pharmacists in the legend drug act and SB 5149, crimes against pharmacies, were passed unanimously out of their respective policy committees.
- A PBM audit fairness proposal has been dropped. However, the bill did not receive a hearing. We owe a big thank you to Senator Conway for taking the lead on this issue for pharmacy.
- HB 1609, renaming the Board of Pharmacy to the Pharmacy Quality Assurance Commission, received its public hearing. Don Williams and Jeff Rochon testified in support of the bill. Executive Director for the Board for 23 years, Don Williams was able to provide legislators with his historical perspective. Thank you, Don and Jeff
As we move forward, LRAC will continue to amend bills as necessary and work on those bills we support. Please see the bill tracking list. This list is a compilation of LRAC bills and other bills that LRAC is working on.
If you have any questions or comments, please feel free to contact Dedi Hitchens, Director of Government Affairs.
Thank you for your support.
01/11/13 - Washington State Legislature Begins 105-Day Session Janary 14th
The Washington State Legislature will begin its 105 day session January 14.
The Senate must decide who will be in power. After a very close race in the 17th District with the incumbent, Republican Don Benton retaining his Senate seat, the margin between the Democrats and the Republicans is very close 26-24. Two of the democrats Senators Rodney Tom, Medina and Tim Sheldon, Shelton, have sided with the republicans in support of creating a new Majority Coalition Caucus that has set out goals to address our States’ budget crisis with a promise of no new taxes.
This is an unprecedented move and a one that needs to be voted on by the Senate before any work can begin.
LRAC’s priorities for the 2013 session will depend upon the outcome of what happens in the Senate. We will be pursuing legislation that aims to include pharmacists in Washington State’s Legend Drug Act and increase penalties for crimes against pharmacies. We will also be supporting efforts to authorize electronic prescription transmission of CII’s and standardization and simplification of prior authorization processes.
Interim work has been happening with respect to pharmacy benefit manager reform, however, those efforts are still going on.
Washington State is still in a budget crisis and LRAC will be constantly monitoring legislation that would have negative impacts on your patients and your pharmacy.
We will be having two Pharmacy Days on the Hill this year. Please SAVE THE DATES – February 27 and March 25. If you can, please take the time to come to Olympia and help advocate our issues.
03/12/14 - WSPA Commends Federal Legislation Recognizing Pharmacists as Providers
On March 11, 2014, HR 4190 was introduced in the US House of Representatives to recognize pharmacists as providers under Medicare Part B.
The current legislation, introduced by Representatives Brett Guthrie (R-KY), G.K. Butterfield (D-NC), and Todd Young (R-IN), will enable patient access to, and reimbursement for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Pharmacists, as the most accessible health care professionals, are uniquely positioned to provide patients in medically underserved communities access to health care services that are already within their scope of practice. By providing for a payment mechanism under Medicare Part B, the bill will allow pharmacists to help fill the gaps in care that have been created by shortages of health care professionals and increases in the number of Americans who are now eligible to gain health insurance under the Patient Protection and Affordable Care Act.
Although provider status has been a profession-wide goal for many years, activity began picking up in early 2013 and have come to a head with the formation of the Patient Access to Pharmacists’ Care Coalition (PAPCC). The coalition currently represents over 20 organizations and is continuing to grow. Members include organizations representing patients, pharmacists, pharmacies, and other interested stakeholders.
This coalition is focused on developing and helping to enact a federal policy proposal that will enable patient access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. Their primary goal is to expand medically underserved patients’ access to pharmacist services consistent with state scope of practice law.
Getting HR 4190 passed may be a long term effort (possibly even multiple years) that will require grassroots advocacy from all pharmacists. Get ready for action alerts asking you to send letters and emails and make phone calls to your legislators! The WSPA will continue to work with our national partners to make sure that you are kept up to date on the progress of HR 4190 and PAPCC. To read the press release from PAPCC, click here: http://bit.ly/1ix4RQQ.
10/01/13 - House Passage of Drug Quality and Security Act (Federal Compounding Legislation)
The U.S. House of Representatives passed the Drug Quality and Security Act on Saturday, Sept. 28. This legislation addresses pharmaceutical compounding and the prescription drug supply chain.
This bill would:
- Distinguish compounders engaged in traditional pharmacy practice from those making large volumes of compounded drugs without individual prescriptions.
- Define the Food and Drug Administration's role in oversight of outsourcing facilities.
- Offer providers and patients more information about compounded drugs.
- Clarify current federal law regarding pharmacy compounding.
- Develop a workable pathway to unit-level tracking.
- Strengthen licensure requirements for wholesale distributors and third-party logistics providers.
- Establish nationwide drug serial numbers.
Full bill text.
Some of the national associations have distributed additional information regarding this Act. For your convenience, we have provided briefs and links to this information for your viewing.
ASHP Statement on Draft of Drug Quality and Security Act
“Overall, ASHP is supportive of this proposal. The addition of the outsourcing facility category will help promote the safety of products that health care providers and the public receive from compounding outsourcers,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP. “However, we were disappointed that the bill did not go further to require compounding outsourcing facilities to register with the FDA, and create clearer risk-based criteria to help the FDA identify outsourcers that are operating outside the scope of traditional pharmacy compounding.”
View full text.
NCPA's Analysis of the Drug Quality and Security Act
This analysis is specific to Title I of the Act which addresses pharmaceutical compounding of human drugs and provides a myth and fact sheet.
View full text. (This information is limited to NCPA member only and login is required to access the document.)
NACDS Expresses Support for Congressional Agreement on Comprehensive Supply Chain and Compounding Legislation
NACDS endorses the act and states the legislation will make strong efforts to ensure the health and safety of the American public. They specifically note that the act establishes one national standard for supply chain regulation as opposed to an unworkable patchwork of state laws and regulations.
View full text.
HR 3204 the Drug Quality and Security Act: What Does It Say? What Does It Mean? What Happens Now?
IACP breaks down the compounding section of this Act and highlights several sections that raise concern for them.
View full text.
PCCA Response to HR 3204
PCCA believes the bill could have unintended consequences; however, they also believe opposing or delaying the bill would give other interests the opportunity to negatively influence the bill even further. Therefore, PCCA has decided to be neutral regarding the "Drug Quality and Security Act."
View full text.