Friday, March 20, 2015
Prior Auth Reform Continues to Move Forward
The bill to provide more transparency and standardization to the prior authorization process cleared another hurdle as the Senate Commerce Committee passed the bill on a voice vote on Wednesday, March 18.
SF 934 (Franzen – DFL, Edina) continues to move through the process with strong support from many medical and patient groups, and opposition from health plans and companies who serve as pharmacy benefit managers (PBMs). Senator Franzen has tried to address some of the concerns raised by opponents without gutting the major components of the bill. As the bill now stands health plans would be required to disclose to consumers ahead of open enrollment time what drugs are covered and what patient cost-sharing would be required. It also prohibits health plans and PBMs from adding new restrictions on their drug coverage during the enrollment year.
The bill does not prohibit the use of prior authorization for medications but it requires the use of standardized prior authorization request forms and requires health plans and PBMs to develop mechanisms to inform prescribers in real time why a drug was denied and what alternatives are recommended. It also cuts in half the timelines for utilization review organizations to make initial coverage determinations and respond to appeals.
The House companion bill, HF 1060 (Albright – R, Prior Lake) is still awaiting its first hearing in the House. For the bill to remain alive as a standalone bill, it must pass one or two House committees next week before the final policy committee deadline. There is resistance to the bill from some House members because of accusations that it will result in increased drug costs for insurers and employers.
Legislators need to continue to hear from physicians and others on the need for this bill. The fixPAnow.com website now lists 38 different physician, patient, and advocacy organizations that support the PA bill. It also lists news coverage of the effort to pass the bill, along with patient stories of problems caused by PA.
Prescription Monitoring Program Changes Proposed
Changes to the state Prescription Monitoring Program (PMP) are included in bills making their way through both the House and Senate in recent days. The bills,HF 1652 and SF 1440, authored by Rep. Dave Baker (R - Willmar) and Sen. Julie Rosen (R - Vernon Center) adopt many of the recommendations that were developed by the PMP Task Force, a group established by the 2014 legislature on which MAFP Past-President David Thorson, MD, had a seat.
The House and Senate versions of the bill differ in several ways. The Senate version of the bill strikes current requirements that a patient provide consent before a prescriber may access the patient's data when providing medical treatment, though that provision is retained in the House bill. Both bills allow the Board of Pharmacy to use prescribing data for the purposes of trend analysis. Notably, the Senate version of the bill requires all prescribers with active DEA licenses to register for a PMP account, though this provision was struck from the House bill. Neither bill would require a prescriber check the PMP before issuing a prescription to a patient.
In a related bill intended to address abuse of prescription drugs, Sen. Rosen also introduced SF 1425, a bill that gives pharmacies greater latitude to serve as depositories for pharmaceutical waste in the form of old, expired medication. Participating pharmacies would have to comply with all federal laws that govern the destruction of legend drugs.
Medicaid "Payment Bump" Extension Gets Hearing
A bill to renew the recently lapsed payment increase for services performed under Medical Assistance received its first hearing in the House HHS Finance Committee on March 18. Testifying in support ofHF 1729 (Rep. Zerwas - R, Elk River) was Susan Berry, MD, president of the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). She testified on behalf of the AAP, MMA, and MAFP.
The ACA required states to raise their reimbursements for certain primary care services under Medicaid (known as Medical Assistance in Minnesota) to the Medicare level, and it provided federal funding to do so. Those enhanced rates, however, expired at the end of 2014. This bill would reinstate those increases, with half of the increase paid for with state dollars.
In her testimony, Dr. Berry noted that Minnesota ranks 47th in the nation in reimbursement rates under MA. At least 15 states – as diverse as Iowa, Maryland, Alabama, Mississippi, and Colorado – have seen the benefit to patients of the improved primary care payment levels and have acted to continue the Medicare-equivalent payment rates.
The bill was laid over for possible inclusion in the Omnibus HHS Finance Bill. The Senate File, SF 1576, has not yet been scheduled for a hearing and is carried by Sen. Kathy Sheran (DFL - Mankato).
Bill to Tighten Vaccine Exemption Heard in Senate
Members of the Senate HHS Policy Committee were kept at the Capitol late on the evening of March 18 as they consideredSF 380, a bill designed to increase vaccine levels authored by Sen. Chris Eaton (DFL - Brooklyn Center). After a lengthy debate and extensive public testimony, the bill passed and was referred to the Senate floor.
Under the bill, parents who choose to not vaccinate their children would be required to submit to the child's school a form signed by a physician stating that the physician discussed the benefits and risks of the immunizations. Current law allows parents to opt out the required vaccinations by simply submitting a notarized form attesting to "religious or conscientious beliefs," a standard considered amongst the weakest in the country. While vaccine advocates have long sought a tighter law, the issue has taken on more urgency in light of the outbreak of vaccine-preventable diseases across the country in recent months.
Testifying in support of the bill were Dawn Martin, MD, a pediatrician at HCMC, Patsy Stinchfield, the Director of Pediatric Infectious Disease and Immunology at Children's Hospital and Clinics, and Kris Ehresmann, the director of the Infectious Disease, Epidemiology, Prevention & Control Division at the Minnesota Department of Health. Two parents, one of whom is an activist in the Somali-American community, also testified in support. Testifying in opposition were a Chicago-based physician, a parent of a disabled child, and a chiropractor. The opponents allege that the bill would require physicians to have "coercive" conversations with parents, that vaccines - particularly MMR - cause grave injuries, and that many physicians are unaware or unconcerned about the dangers of immunizations.
Rep. Mike Freiberg is the author of the House companion, HF 393. It remains uncertain if the bill will receive a hearing in the House.
Physician Compact Marches On
The MMA-led effort to enroll Minnesota in a newly formed compact to ease licensure burdens for physicians who wish to practice in multiple states cleared its last two policy committee hurdles in the House in recent days. The bill had passed the needed policy committees in the Senate earlier in the session.
The Interstate Compact for Physician Licensure establishes a commission that will serve as a clearinghouse for licensure of physicians who wish to hold licenses in multiple states. Participation in the process is entirely voluntary for physicians. The compact only becomes active once approved by at least seven states, though already two states have signed the compact into law and it's moving through legislatures in more than a dozen more.
The House bill, HF 321, authored by Rep. Tara Mack (R - Apple Valley), cleared all three necessary committee stops (HHS Reform, State Government Operations, and Civil Law) in the House this week and with virtually no opposition. Both the House bill and the Senate bill, carried by Sen. Kathy Sheran (DFL - Mankato) await action in each bodies’ HHS Finance Committee.
All Payer Claims Database Bill Moves in the Senate
A bill to allow an additional use for the state's All Payer Claims Database (APCD) was heard in the Senate HHS Policy Committee on March 18. The bill,SF 1818, authored by Sen. Melissa Wiklund (DFL - Bloomington), passed with little discussion and was referred to the Senate Judiciary Committee where it passed on March 20.
The bill would require the Minnesota Department of Health to make available public data sets or tables from the APCD for no or minimal cost to be used for research work. Language in the bill makes clear that the data contain no individual, payer, or provider identifiers. It is anticipated that researchers, non-profits, and academic institutions will be able to use the data to study cost and utilization trends and other purposes. The MMA testified in support of the bill, as did the Minnesota Hospital Association and MDH.
The bill's House companion, HF 1961, authored by Rep. Melissa Hortman (DFL - Brooklyn Park), has not been scheduled for a hearing.
MMA Day at the Capitol a Big Success
More than 85 physicians and medical students attended the 2015 MMA Day at the Capitol on March 11 and had the chance to meet individually with their legislators. The MAFP was one of the partner organizations with this event. This was a great opportunity for physicians to share their personal stories on how the prior authorization processes have resulted in difficulties of their patients getting the medications they need.
Because of the major renovation work at the Capitol, portions of the event were held at the DoubleTree Hotel in downtown St. Paul. The day was started with a luncheon speech by Sen. Melisa Franzen (DFL - Edina), the chief author of the Fix PA Now bill, who told attendees that this bill is needed to ensure patients get the drugs they need in a timely manner.
Following a review of the key issues before the legislature, attendees took the light rail train to the Capitol for their individual meetings and the chance to sit in on the House HHS Reform Committee meeting. Following those meetings, there was a reception back at the hotel where Rep. Nick Zerwas, a member of the House HHS Reform Committee spoke to the group.
For those who were able to stay, many physicians attended the Senate HHS Policy Committee where the Fix PA Now bill passed its first hearing. Overall, it was a very successful day.
Legislators Take an Easter/Passover Break
Even if you did not get the chance to attend the Day at the Capitol, you still have the chance to meet with your Legislators when they are home for the Easter/Passover break. All legislators will be on break from Friday, March 27 until Tuesday, April 7. Now is the time to reach out about meeting with your legislators over break. Consider meeting them for coffee, inviting them to tour your clinic, or telling them some of the PA nightmares your practice and patients have been putting up with.
Legislators need to hear from physicians about the importance of PA reform, because they are certainly hearing from the health plans and PBMs about why things should stay the way they are.
First Deadline's Arrival Narrows Field of Bills
Friday, March 20th brings the first policy deadline, the first in a series of self-imposed deadlines that help weed out viable bills from those with less support. A bill has to have passed all policy committees in one body by March 20 to remain viable. That same bill's companion will have to clear its policy committee stops by the second deadline, Friday, March 27 to remain alive. A final deadline comes April 7, the date by which bills must have passed the needed finance or tax committees.
After the deadline, a number of bills will be considered dead (or close to it) for the remainder of the year. While these bills will have not “made deadline,” it’s worth remembering that a bill is never truly dead until the end of the biennium, or “sine die.” Creative lawmakers still has many tools available to them to try to move legislation forward even after the deadline, though it becomes more difficult.
A number of interesting or notable bills have not cleared the first policy deadline, including:
SF 178 This bill would have repealed not only the ban on smoking in public places, but would also repeal the entirety of the state’s Clean Indoor Act.
HF 1253/SF 1135 These bills would have added e-cigarettes to the state’s Freedom to Breathe law, barring their use in most indoor spaces. Current law prohibits e-cigarette “vaping” in all government-owned buildings, clinics, hospitals, day care, and other spaces, though they still may be used in bars and restaurants.
HF 1141/SF 545 These bills would have added chronic pain to the statutory list of conditions which give eligibility to patients who wish to participate in the medical marijuana program. Under current law, the Commissioner of MDH has that authority. A separate bill still moving does accelerate the timeline by which MDH has to rule regarding chronic pain from July 2016 to January 2016.
HF 1038/SF 917 Under these bills, health plans would have been required to offer coverage for tamper-resistant or “abuse deterrent” versions of uploads if the plans covers prescription drugs.
HF 979/SF 1202 These bills would have established a task force to study the impact of adverse childhood events. The task force would include three health care professionals with experience in the neurobiology of childhood development, public health, mental health, and primary health.
HF 102/SF 221 These bills would have effectively rendered as voluntary the “Safe Schools for All” anti-bullying bill enacted in 2014.