Friday, February 20, 2015
Prior Authorization Reform Package Unveiled—SF 934/HF1060
Major legislation drafted by the MMA to reform the prior authorization (PA) system for prescription drugs was introduced in the House and Senate on February 19th. Authored by Sen. Melisa Franzen (DFL – Edina) and Rep. Tony Albright (R – Prior Lake),SF 934/HF 1016 represent significant reform of the law that governs how health insurers use utilization review and impose prior authorization requirements. This is an effort to reduce medication delays, disruptions and confusion for patients.
The legislative package was unveiled at a St. Paul press conference with the two legislative authors and representatives of a number patient advocacy groups including the Minnesota AIDS Project, the Epilepsy Foundation, and the Arthritis Foundation. George Schoephoerster, MD, MAFP Past President participated with the two legislative authors. Dr. Schoephoerster has worked with the MMA for nearly two years gathering information related to the use of medication PA. He also worked with a workgroup of physicians over the course of more than nine months in the development of the legislation. Included in that work group were MAFP members Randy Rice, MD, and Glen Nemec, MD.
The legislation was the drafted after many months of work to partner with health plans and payers resulted in very little interest on the part of the health plans to work collaboratively to even share metrics on prior authorization.
The proposal has a number of key elements, including:
• Improved patient understanding and comparisons of medication coverage. The bill standardizes the disclosure of pharmaceutical coverage, including providing information to consumers on what drugs are on the formulary or preferred drug list and what their cost-sharing arrangements are. This would be provided at least 30 days prior to open enrollment. This is similar to Medicare Part D requirements already in place.
• Limit changes during enrollment year. Drugs could be added to a plan’s formulary at any time, though no formulary limitations or patient cost changes may occur within an enrollment year. Authorizations for non-formulary coverage remain valid for duration of a patient’s continuous enrollment. This is also similar to the current law governing Medicare Part D. All too often, physicians who have been prescribing a given drug to a patient for years are suddenly told that the drug is no longer covered.
• Create 60-day transition period to prevent gaps in ongoing medication needs. Patients changing to a new plan via a change or annual renewal must be provided 60 days of ongoing coverage to accommodate transition to a new covered medication if their current drug is no longer covered. Again, this is similar to Medicare Part D requirements.
• Transform medication PA to a retrospective QI function. Drugs on a plan’s formulary could not be subject to prior authorization requirements. Health plans would still be able to work with prescribers to modify prescribing patterns after the fact for quality improvement purposes.
• Improve state oversight and transparency. The bill creates an advisory committee within the Minnesota Department of Health to monitor changes in pharmaceutical coverage, formulary design, and benefit design. Health plans and pharmaceutical benefit managers would need to report certain prior authorization metrics such as the volume of approvals, denials, appeals, response time, etc. to the department.
• Simplify administrative process. When drug request claims are denied by the payer, the plan would be required to inform the prescriber of covered alternatives. The bill also shortens the time frame for plans to consider requests for coverage, and deems as approved those requests that exceed the timeframes.
The bills have drawn a strong and bipartisan group of coauthors. Joining Senator Franzen on the Senate bill are Senators Kathy Sheran (DFL – Mankato), Jim Metzen (DFL – South St. Paul), Julie Rosen (R – Vernon Center), and John Marty (R – Roseville). Representative Albright is joined by Reps. Nick Zerwas (R – Elk River), Erin Murphy (DFL – St. Paul), Glenn Gruenhagen (R – Glencoe), Matt Dean (R – Dellwood), Rod Hamilton (R – Mountain Lake), Dan Schoen (DFL – Cottage Grove), and Tina Liebling (DFL – Rochester).
A growing coalition of physician specialties and advocates for patients have announced their support for the bill, including the American Heart Association, Midwest Affiliate; Arthritis Foundation, Upper Midwest Region; Clay-Becker Medical Society; Epilepsy Foundation of Minnesota; Lake Superior Medical Society, Mental Health Association of Minnesota; Minnesota Academy of Family Physicians, Minnesota Academy of Ophthalmology, Minnesota AIDS Project; Minnesota Psychiatric Society, Minnesota Rural Health Association; Minnesota State Grange; Minnesota Society of Neurologic Sciences, National Alliance for the Mentally Ill--Minnesota, Stearns Benton Medical Society; Twin Cities Medical Society; Upper Mississippi Medical Society and Zumbro Valley Medical Society. The bills are likely to draw significant opposition from health plans and pharmacy benefit managers, and their opposition is likely to focus on PA as a necessary tool for cost containment and for correcting physician errors.
Updates on the push for prior authorization reform will be regularly posted to a new website, www.fixPAnow.com. Physicians are encouraged to contact their legislators to ask them to support the bills, SF 934 and HF 1060.
Physician Licensure Compact Continues to Advance in Senate
The Interstate Compact for Physician Licensure took another step towards becoming law when it passed the Senate State & Local Government Committee on February 16. The bill,SF 253, received unanimous support and was re-referred to the Senate Judiciary Committee, the final policy committee with jurisdiction in the Senate. It will be heard there on February 24.
Under the bill, sponsored by Sen. Kathy Sheran (DFL - Mankato), Minnesota would participate in a newly created interstate compact that would expedite the process by which physicians who practice in multiple states can be licensed. Completely voluntarily for physicians, the commission established under the bill would serve as a "clearinghouse" that would ease the burden of seeking licensure in multiple states. The commission only becomes functional once passed by at least seven states, though the identical bill has now been introduced in 13 state legislatures.
The bill has seen no organized opposition thus far and has been very well received by legislators. Supporters have thus far included the Board of Medical Practice, the Minnesota Hospital Association, Mayo Clinic, Allina Health, Sanford Health, and Gundersen Health. The House bill, HF 321, is authored by Rep. Tara Mack (R - Apple Valley). It is expected to receive its first hearings in the House in early March.
Legislative Auditor Report Very Critical of MNsure
Key committees in both the House and Senate held hearings on the Office of Legislative Auditor’s (OLA) report on the first year of operations of MNsure, the state’s insurance exchange. The report did not hold back any punches as it was very critical of MNsures’ website, its lack of customer service, its flaws in establishing enrollment targets, and its governance.
In four separate hearings before the House Joint HHS Committees, House Commerce Committee, Senate Joint HHS Committees, and Senate Commerce Committee, Legislative Auditor James Nobles and OLA staff Joel Alter presented. Among their findings:
- MNsure website had serious technical problems that were not adequately tested prior to launch;
- MNsure staff withheld information from the MNsure Board and other officials before enrollment was launched;
- While MNsure announced it met its first enrollment target, that target was seriously flawed in how it was developed;
- MNsure failed to provide adequate customer service through its call center causing long wait-times and customer frustration.
Joining the Legislative Auditor at the hearings were Scott Leitz, MNsure CEO; Brian Beutner, MNsure Board Chair; and Lucinda Jesson, DHS Commissioner. Legislators from both parties expressed a great deal of frustration with MNsure and the challenges it continues to have.
The Legislative Auditor report also recommended changes to the governing structure to shift ultimate accountability from the Board to the Governor, to require MNsure to utilize the expertise of the Office of Minnesota IT Services, and to implement mechanisms to reward insurance brokers for enrolling consumers in MNsure.
Tobacco Tax Changes Under House Bill
A bill to roll back a component of the 2013 landmark tobacco tax increase was considered in the House Taxes Committee on February 18. Under the bill sponsored by Rep. Greg Davids (R - Preston), the automatic annual inflationary increase on tobacco products would be repealed. The automatic inflator was included in the 2013 tax bill that increased the state's tobacco tax by $1.60. That language served to increase the tax on a pack of cigarettes by seven cents on January 1, 2015.HF 700 would cap the state's tax at its current rate of $2.90 per pack.
Testifying in opposition to the bill were representatives from Clearway Minnesota and the "Raise it for Health Coalition.” Supporters of the bill include the Minnesota Chamber of Commerce, the Minnesota Grocers Association, and associations that represent gas stations and convenience stores.
As is customary in the Tax Committee, the bill was laid over for possible inclusion in a larger tax omnibus package to be unveiled later in the session. The bill's Senate companion, SF 777, is carried by Sen. Lyle Koenen (DFL - Clara City) and has yet to receive a hearing.
Child Seat Tax Breaks Considered
Legislation introduced by Rep. Lyndon Carlson (DFL - Crystal) would exempt car seats for infants and adolescents from state sales taxes.HF 404 was heard in the House Transportation Committee and passed and was re-referred to the House Tax Committee. The law change would be effective on US Department of Transportation approved cars seats purchased after July 1, 2015.
Current state sales taxes are levied on car seats at a rate of 6.875 percent. The bill's author noted that many car seats cost over $100, and that the additional expense on an item required under state law is a burden for many low-income families.
The Senate companion, SF 389, is authored by Sen. Ann Rest (DFL - New Hope) and has yet to be scheduled for a hearing.
Medical Privacy the Subject of House Hearing
The House Civil Law Committee held a hearing to discuss a number of issues related to data privacy in health care on February 17, 2015. The hearing was called by the chair, Rep. Peggy Scott (R – Andover).
Twila Brase, the president of the Citizens Council for Health Freedom (CCHF), spoke for much of the hearing. The CCHF has long been a vigorous opponent of HIPAA as not being strong enough on patient privacy, the state’s newborn screening program, MDH-led cancer surveillance efforts, and other activities that the group has considered a threat to individual privacy. Ms. Brase and other speakers were critical of electronic health records (EHRs), and urged legislators to roll back efforts to expand their use.
The MMA and others have asked legislators to consider aligning Minnesota’s health records law with HIPAA. One of only two states that have a different standard than the federal rule, Minnesota’s health record law predates the advent of interoperable electronic health records. The MMA, the Minnesota Hospital System, the Minnesota Council of Health Plans, and many hospital/clinic systems, have argued that the different standard adds unnecessary and duplicative costs to the health care system. As a result, patients are routinely subject to unnecessary tests and procedures due to the burdensome state standard for securing consent to share records.
MMA Day at the Capitol Date Approaching Fast-- March 11
This is another reminder to attend the annual MMA Day at the Capitol for which MAFP is a partner. The date of March 11, 2015 is fast approaching. This day of advocacy and fellowship is an important effort in advancing policies that help physicians and patients, and is a great opportunity for you to directly engage with your legislators on the issues facing organized medicine. Following presentation from key legislative leaders, individual meetings will be scheduled for you and your local colleagues with your Senator and Representative.
This day is especially important this year because of the concerted effort all of medicine is doing to pass needed PA reform legislation. Come and share the horror stories you and your patients have experienced because of drug PA delays.
With most of the Capitol closed to the public due to construction, the 2015 Day at the Capitol will be a little different than years past. This year we’ll start our day with a noon lunch at the DoubleTree by Hilton St. Paul Downtown where we’ll hear from key legislative leaders (including the Senate author of the prior authorization reform bill) and MMA advocacy staff. From there we’ll take the light-rail Green Line to the Capitol for meetings with your own elected officials before returning to the DoubleTree for a late afternoon reception and debriefing.
The “White Coats Day” at the Capitol is a key piece of the MMA’s advocacy strategy, and your participation is important to our efforts. Please make plans to join us for this fun and enjoyable day. More information and registration details are available here.
Over 2,100 Bills Await Consideration
With the legislative session now well into the second month and the first policy deadlines looming in late March, 2,108 bills have been introduced in the House and Senate. The vast majority of these bills will not receive a hearing and even fewer will become law. Some of the more interesting and noteworthy health care bills introduced in the last two weeks include the following:
- HF 979 (Rep. Rena Moran; DFL – St. Paul): Creates a task force to study the impact of adverse childhood experience (ACES) on children’s development. Included in the DHS-led task force are at least three health care professionals with expertise in the neurobiology of childhood development. The bill has bipartisan support in the House, but no Senate companion has yet been introduced.
- SF 719 (Sen. John Marty DFL – Roseville): , Requires that county and regional jails to continue to provide to inmates any prescribed antipsychotic medications. The bill comes in response to reports of self-harm committed by inmates who were denied their prescribed drugs.
- HF 777 (Rep. Rod Hamilton, R – Mountain Lake and Sen. John Hoffman, DFL – Champlin): Creates a spinal cord injury and traumatic brain research grant program. Grants would be made available to small businesses conducting research on innovative treatments and rehabilitative efforts for the functional improvement of people with spinal cord and traumatic brain injuries.
- HF 917 (Sen. Jeff Hayden DFL – Minneapolis and Rep. Dave Baker R – Willmar) Requires health plans to cover abuse-deterrent opioid drugs. Abuse-deterrent opioid analgesic drug products are defined as a brand or generic opioid analgesic drug product approved by the United States Food and Drug Administration (FDA) with abuse-deterrence labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse of opioids.
- HF 1087 (Rep. Joe Atkins, DFL – Inver Grove Heights): Requires all hospitals to establish and make available to staff a violence prevention and response plan. The bill also instructs the Department of Health to create a database of violent acts committed in health care settings to allow better data gathering.
- SF 981 (Sen. Julie Rosen, R -- Vernon Center): Requires health insurers to cover services provided telemedically similarly to how they cover them if provided in-person.