Drug Topics - March 10, 2008 - (Page 44) 44 DRUG TOPICS MARCH 10, 2008 www.drugtopics.com Government and Law Despite election year, states have a lot on their legislative plate Reid Paul ittle meaningful healthcare legislation is expected out of Congress in this election year, but that is not stopping state legislatures from taking the lead. According to the National Conference of State Legislatures, more than 500 bills have been introduced in 44 states that have a legislative session this year. Much of the legislation is directed towards either expanding patient access to care or improving public safety, noted Hrant Jamgochian, director, congressional and state relations at the American Pharmacists Association. A number of states have bills focused on pharmacy-specific issues, such as ensuring that pharmacists are protected for generic substitution (see page 45) and allowing pharmacists to offer vaccines. Many states are also tackling more thorny questions, including comprehensive healthcare reform, regulation of pharmacy benefit managers, and prescription drug marketing. “There is really more variation and experimentation on the state level,” said Richard Cauchi, program director, health program at the National Conference of State Legislatures. “The cliché of states as laboratories of democracy really does play out.” THE HEALTHCARE For pharmacists the AGENDA challenge is working with ccording to the National Conference legislators so that they of State Legislators, healthcare understand the role of policy is a major area of activity in the pharmacists in the healthstates. Here are a few of the areas care system. “The biggest states are focusing on: Access to health care: Many states piece isn’t a specific bill,” have subsidy or discount programs that Jamgochian explained, supplement Medicare Part D. In 2008 “but educating legislators 15 states are proposing to expand or on the role that pharmachange their programs. cists can play.” Prescription drug reuse/Recycling: One area that has seen Nine states passed cancer drug rea great deal of movement pository and other reuse programs has been efforts to restrict in 2006 and this year 10 states have similar bills. drug marketing. At least Electronic monitoring and Internet 20 states have proposed prescribing: Fourteen states are considlegislation that forces ering legislation that would encourage pharmaceutical come-prescribing. panies to disclose more Comprehensive health reforms: Six about their marketing. In states are currently proposing “comaddition 15 states have prehensive” health expansions that focused on limiting the include pharmaceutical policies as a ability of drug companies visible component. L A to use data on physician prescribing. The Washington State Pharmacy Association is supporting such legislation in its state. “We are not opposed to commercial use of prescribing data, but it needs to be 'unidentifiable,'” insisted Rod Shafer, R.Ph., WSPA CEO. “There is a lot of action,” noted Cauchi. “States are trying to see what can be done, in terms of disclosure and determine the role of marketing.” In addition, a number of states are focusing on regulating pharmacy benefit managers. In 2007, 28 states offered such legislation and Connecticut, Iowa, Maine, Tennessee, Vermont, and Washington all passed some form of legislation. So far this year only 13 states have filed similar legislation. Some of the bills are also focused on fixing specific problems. “We had some bad legislation passed last year that said the state of California could apply average manufacturer price to brands as well as generics,” explained Lynn Rolston, California Pharmacists Association’s CEO. The group is also hoping to pass legislation to delay implementation of California’s epedigree rules. Still those problems pale in comparison to the potential impact of budget negotiations. In California, Governor Arnold Schwarzenegger has proposed an across-the-board 10% cut for the entire state budget to make up for a projected $14.5 billion deficit. According to Rolston, the cuts could mean that every brand-name drug would be dispensed at a loss in the Medi-Cal program. “The cuts are so draconian, that the governor, the senate, and assembly are hoping to find other sources of revenue,” Rolston said. The final version of the budget agreement will not be released until May. In the New York budget Governor Eliot Spitzer proposed creating a prescription drug discount card for the uninsured and exploring bulk purchasing of prescription drugs by the state. Still, “this is one of the better budgets we’ve seen,” commented Craig Burridge, Pharmacists Society of the State of New York executive director. The budget includes increases in brand and generic Medicaid dispensing fees as well as reductions in some copays. In addition the budget contains provisions to expand disease state management, medication therapy management, and moves the drug benefit for the Family Health Plus program away from managed care facilities to community pharmacy. DT http://www.drugtopics.com
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