2015 Legislative Session in Review
Friday, July 17, 2015
Posted by: Kathleen Goodner
This year’s Washington State Legislative session has been one for the ages. We have had an amazing year! The legislature has gone into triple overtime grappling with how to fund the state’s two-year operating budget. With minutes left before the July 1 deadline and potential government shut down, Washington’s Governor Jay Inslee signed the biennial operating budget. As some lawmakers were patting each other on the back over the operating budget agreement, other agreements started falling apart quickly. Deals were made early on a handful of bills were broken. A lot of last minute work was done including a proposed 16 year transportation budget which includes an 11.9 cent gas tax increase for Washington drivers, the delay of implementing the initiative reducing K-12 class sizes, a waiver for the biology student assessment test and our Pharmacy Benefit Manager (PBM) enforcement bill.
The WSPA and LRAC have continued to fight the powerful PBMs to get laws in place to regulate their practices that limit patient access to medication by not fairly auditing or inadequately reimbursing for medications. In 2014, the Washington State Legislature overwhelmingly passed ESSB 6137 creating regulations for the Pharmacy Benefit Manager (PBM) industry. However, the PBMs have blatantly ignored the legislature’s directive, and have not complied with the law. Enforcement of laws regulating PBMs is needed. The PBMs have continued their harmful and unfair practices. ESSB 5857 would have fixed this problem by addressing the lack of regulatory enforcement in the previous bill, which allowed the PBMs to sidestep the legislative directive. In addition, recent changes to the bill, at the request of the Washington State Health Care Authority (HCA) meant the bill had zero fiscal impact to the HCA. LRAC fought hard to keep this bill alive and work for its successful passage, however it was not passed this year.
Pharmacy bills already passed and signed into Washington law:
ESSB 5557, Pharmacists in Provider Networks, is the first of its kind in the nation. This landmark law requires a health carrier to recognize pharmacists in the same way as other providers. Carriers must include some pharmacists in their participating provider networks and reimburse for covered services provided within his or her scope of practice. The implementation dates are tiered. Health plans issued or renewed on January 1, 2016, that delegate credentialing to contracted health care facilities must accept credentialing for pharmacists employed or contracted by those facilities, and must reimburse facilities for covered services provided by network pharmacists, as long as those services are within the pharmacists’ scope of practice. Health plans issued January 1, 2017, must include an adequate number of pharmacists in their participating provider networks and allow the payment for benefits for health care services performed by a network pharmacist within their scope of practice.
The bill also created advisory committee. The Insurance Commissioner has designated One Health Port to establish and facilitate the advisory committee. One Health Port and the advisory committee will develop best practice recommendations on standards for credentialing, privileging, billing, and payment processes to ensure pharmacists are adequately included and appropriately utilized in participating provider networks of health plans. The committee will discuss topics as they relate to implementation including current credentialing requirements for health care, existing processes of similarly situated health care providers, pharmacist training, care coordination, and the role of pharmacist prescriptive authority agreements.
By December 1, 2015, the advisory committee will present initial best practice recommendations to the insurance commissioner and the department of health. The advisory committee will remain intact to assist the insurance commissioner or department of health in rule making.
Votes on Final Passage: Senate 48 0 House 93 4 (House amended) Senate 47 0 (Senate concurred)
Bill signed into law May 11, 2015
ESSB 5441, Patient Medication Coordination (Med Synchronization), requires a health benefit plan issued or renewed after December 31, 2015, that provides coverage for prescription drugs to implement a medication synchronization policy for the dispensing of prescription drugs to the plan’s enrollees. EFFECTIVE DATE: July 24, 2015
ESHB 1671, Concerning Access to Opiod Overdose Medications, authorizes prescribing, dispensing, distributing, and delivering opioid overdose medications to a person at risk of experiencing a drug overdose, as well as to a first responder, family member, or other person in a position to assist a person at risk. It requires a pharmacist dispensing an opioid overdose medication to provide instructions on the proper response to an overdose. Permits any person or entity to possess, store, deliver, distribute, and administer opioid overdose medications with a practitioner’s prescription or order. EFFECTIVE DATE: July 24, 2015
ESSB 5460, Allowing Practitioners to Prescribe and Distribute Prepackaged Emergency Medications to Emergency Room Patients When a Pharmacy is Not Available, allows for the prescription and distribution of prepackaged emergency medications at times when a hospital pharmacy is closed and a community pharmacy is not available within 15 miles, or when a practitioner determines that a patient has no reasonable ability to reach a local pharmacy. EFFECTIVE DATE: May 11, 2015
ESB 5935, Concerning Biological Products, amends regulations around pharmacy requirements for substitution of generics to include biological products. This law requires pharmacies to notify prescribers when an interchangeable biosimilar product has been substituted for a biological product. EFFECTIVE DATE: July 24, 2015
The law also establishes policy standards for the types of emergency medications that may be distributed and the circumstances under which distribution is appropriate. Furthermore, it allows a hospital pharmacy to engage in intra-company sales as well as the sale, purchase, or trade of a drug for emergency medical reasons, regardless of whether it has a wholesale distributor license. EFFECTIVE DATE: July 24, 2015
ESSB 5084, Modifying the All Payer Claims Database to Improve the Health Care Quality and Cost Transparency by Changing Provisions Related to Definitions Regarding Data, Reporting Data and Pricing Products, expands E2SHB 2572, which directed the Office of Financial Management (OFM) to establish a statewide all-payer health care claims database to support transparent public reporting of health care information. It requires OFM to select a lead organization and a data vendor to administer and create the database. In addition, it requires the Medicaid program, the Public Employees Benefits Board program, all health insurance carriers operating in this state, all third-party administrators paying claims on behalf of health plans in this state, and the state Labor and Industries program, to provide claims data. It also requires OFM to report to the Legislature December 2016 and December 2017 on the development, costs and technical progress of the database. EFFECTIVE DATE: July 24, 2015
SB 5293, Concerning the Use of Hydrocodone Combination Products by a Licensed Optometrists in Washington State. Allows optometrists to use, prescribe, dispense, purchase, possess, or administer Schedule II hydrocodone combination products. The Board of Optometry may include Schedule II hydrocodone combination products in its list of approved oral controlled substances and oral legend drugs. EFFECTIVE DATE: July 24, 2015
HB 1652, Concerning Medicaid Managed Health Care System Payments for Health Care Services Provided by Nonparticipating Providers, moves the July 1, 2016 expiration of provisions requiring Medicaid managed health care systems to maintain adequate provider networks, and to pay nonparticipating providers no more than the lowest amount paid for the same services under contracts with similar providers in the state to July 1, 2021. Requires managed health care systems to make good faith efforts to contract with nonparticipating providers before paying the lowest amount paid for the same services under contracts with similar providers in the state.
Want to get more involved in the legislative process?
Please show your support for the profession by becoming an LRAC member. To become a member, click the “Membership” tab at the top of our homepage.