Friday, May 13, 2016
One Week to Go; Still Waiting for Global Agreement
With the May 23 Constitutional deadline just over a week away it is still unclear whether the Legislature will reach an agreement on the major bills all sides have said much get addressed. There is agreement that additional money is needed for roads, bridges and transit, but there is not an agreement on how to pay for it. There is agreement for the need of a bonding bill for capital projects throughout the state, but there is not an agreement on how large the price tag should be. There is an agreement that the state's $900 million budget surplus must used, but there is not an agreement on how much is for new spending and how much is for tax cuts.
Agreement must be reached on these three issues before the Legislature can complete its work and have a successful session.
With the number of remaining days tick down outside observers are beginning to question whether we are headed for the proverbial train wreck. More seasoned Capitol veterans say there is still plenty of time for the Governor, Senate Majority Leader, and Speaker of the House to set differences aside and reach a deal.
HHS Budget Issues Await the Global Deal
There are a number of health and human services budget items that are important to organized medicine that are stalled until the global deal is reached. Most of these are in either the House or Senate budget bills that are now in a 10 member conference committee that is working to reconcile the differences in the two bills. Items of importance include:
The language to fix the flawed medication prior authorization process is in the Senate bill but not in the House bill. It provides more transparency for patients on what drugs are covered, it provides more real-time information to prescribers on what drugs require PA, it limits how often a patient can be required to get PA for the medications that are working for them, and it shortens the timelines for insurers to approve or deny a PA request.
Additional funding for rural family medicine residency programs is included in both bills. The Senate increases funding by $1 million while the House increases it by $3 million.
The Senate increase Medical Assistance reimbursements to physicians for primary care and mental health services by 5 percent. The House does not include any increase.
The House increases funding for the Medical Education Research Cost (MERC) program by over $3 million. This money is used to fund training programs for physicians and other practitioners. The Senate does not include any increase.
The Senate increases MinnesotaCare eligibility to 274 percent of the federal poverty level, from the current 200 percent. The House does not increase eligibility.
Increased Access to Naloxone through Pharmacies
Following action two years ago to increase the availability to Naloxone by authorizing EMTs and First Responders to administer the opioid antagonist under a physician's standing order, the Legislature is working to allow more access through pharmacies. Language to allow greater access to Naloxone was added to a bill that made it easier for pharmacies to collect unused medication. Both the amendment and bill were passed and returned to the Senate for its consideration.
Current law allows pharmacists to dispense naloxone if they have in place a standing order or protocol with a licensed prescriber (including physicians, APRNs, PAs). In fact, all Minnesota CVS stores already make naloxone available using this mechanism now. This bill adds two other mechanisms to allow pharmacists to dispense naloxone by allowing them to enter into standing orders with either 1) a local public health board’s medical consultant or 2) with a practitioner designated by the Minnesota Commissioner of Health. The author of the legislation, Rep. Bob Barrett (R – Lindstrom), had originally planned to pursue language allowing pharmacists to independently prescribe naloxone. This created controversy over pharmacists prescribing and he was urged to take advantage of the means already available under current law.
In addition, the bill tasks the Board of Pharmacy and other stakeholders (including the BMP and physician groups) with crafting a model protocol which pharmacies can use to craft these agreements. A model protocol will help ease the process of establishing these relationships.
The underlying bill expands the authority of pharmacies to collect and dispose of legend drugs. Under the bill, individuals and family members of those in long term care facilities would be able to turn in unused or expired pharmaceuticals to a pharmacy for proper disposal. The bill was sought in an effort to reduce the volume of unused pharmaceuticals that are being diverted for abuse. The Senate version of the bill is authored by Sen. Julie Rosen (GOP – Vernon Center).
Registration Required for the Prescription Monitoring Program
Legislation has passed the Senate and will be acted on Monday in the House to strengthen Minnesota’s Prescription Monitoring Program (PMP). The PMP is a tool for prescribers and pharmacists to check a person's history with narcotic prescriptions to address "doctor shopping" and drug diversion.
The bill requires all prescribers who have a DEA number to register with the PMP to have an account. Currently only 35 percent of prescribers are registered with a PMP account. The bill does not require a prescribers to check the PMP prior to writing a prescription but they will be required to register. It is hoped that by requiring registration is will result in more use of the PMP and further reduce doctor shopping.
Medical Cannabis Registry
Legislation to allow treating physicians to access the state's medical cannabis registry to determine if your patient is taking cannabis is included in the Senate budget bill but not in the House bill. If passed this will be a tool any physician can check, even if that person is not certified to recommend medical cannabis.
Physicians have been asking that medical cannabis be included in the PMP so when that is checked it will show if the patient is using cannabis. This turned out to be unworkable because of the fact that cannabis is a Schedule I drug and does not have a tracking number that can be used.
Bill Allows More Osteopathic Physicians to Serve on BMP
Legislation allow more osteopathic physicians to serve in the state's Board of Medical Practice passed the House on a unanimous 127-0 vote on May 2, and a similar unanimous vote by the Senate six days later and is soon headed to the Governor for his likely signature. The bill was sought by the Board of Medical Practice.
Authored by Rep. Tony Albright (R - Prior Lake) and Sen. Melissa Wiklund (DFL - Bloomington), the bill removes the cap in state statute that sets at one the number of DOs who may serve on the BMP. The bill also adds an additional member to the BMP, raising the number of members to eleven. Technical changes are also included in the bill to the licensing requirement for osteopathic physicians, including updated terminology and making physician testing requirements more uniform.