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June 2, 2017
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Breaking News

Legislative Recap: Some Wins, Some Losses for Pharmacy in Minnesota

By Pharmacy Advocacy Task Force Lobbyist Buck Humphrey

Gov. Mark Dayton once again demonstrated the political shrewdness of his legislative operation along with his disdain for the Minnesota Legislature. Facing both a constitutional and self-imposed deadline to sign or veto the budget bills passed in both the Regular and Special Session, the governor held a press conference on Tuesday, May 30, to announce his decision on the budget bills and an outstanding policy issue. Several issues of concern to pharmacy were affected by the Legislature’s and the governor’s actions.

The governor decided he would sign the budget bills totaling more than $46 billion for the next biennium. Many of his progressive allies were urging him to veto the entire budget and start over again in negotiations with the GOP Legislature. The governor wisely realized the deal he had in hand was likely better than anything he could possibly accomplish in yet another Special Session. The governor also recalled the 20-day government shutdown in 2011, when he was unable to reach a budget agreement with the GOP-controlled legislature. In 2011, the governor ended the stalemate by caving to GOP demands to not raise taxes to address a $5 billion deficit. This year should have been much easier for compromise, with a $1.6 billion surplus.

The governor also announced he would allow the GOP Omnibus Tax Bill to become law without his signature; however, after consulting with Minnesota’s attorney general, he signed the tax bill. The tax bill provides nearly $650 million in tax cuts. The bill provides tax cuts to seniors and students — and among other reforms, eliminates the automatic escalator on tobacco and commercial industrial property taxes. The governor wanted to veto the legislation. However, GOP legislative leaders (who felt burned by the governor’s veto of the tax bill in 2016) inserted a provision in the Omnibus State Government Finance bill voiding funding for the Department of Revenue if the tax bill failed to become law.

While the governor has the option of allowing a bill to become law without his signature during the first year of a two-year session, bills passed in a Special Session that adjourns “Sine Die” do not come with the same options. The governor’s legal team originally suggested because the bill passed within three days of adjournment of the Regular Session, the Special Session rules did not apply.

In response to the legislative “poison pill” included in the tax bill, the governor line-item vetoed the budget for the Minnesota Legislature. In his nearly three-page Governor's Letter to Leaders, read at his press event, Dayton suggested he would call the legislature back for another Special Session to restore their funding. However, he would only do so once they agreed to remove items that (according to legislative leaders) the governor agreed to during the final budget negotiations. Those demands included removal of the repeal of the automatic inflators on tobacco and property taxes, reforms to the estate tax and adjustment of the tax on premium cigars. The governor also demanded changes to language he had agreed to regarding teacher licensing and limiting access to driver’s licenses for illegal immigrants.

As of June 1, legislative leaders have suggested they have no intention to re-start any budget negotiations with the Dayton Administration. They have indicated they plan to raise a legal objection to the governor’s decision to line-item their budget for the next two years. Legal experts are suggesting the legislature likely has a convincing argument the governor has violated the separation of powers between the legislative and administrative branch when he virtually eliminated their existence with his veto.

The House and Senate have roughly $10 million in budget reserves that would allow them to continue operations until mid-August. The veto not only cancels legislative pay, but also cancels pay for all employees of the legislature, partisan and non-partisan staff, legislative councils and the legislative auditor. In 2011, during the 20-day government shutdown, the court-appointed special master ruled the legislature was an essential service and ordered its operations be funded even without the existence of a state budget. Many legal experts believe at a minimum, the courts would come to a similar conclusion if the stalemate with the Dayton Administration cannot be overcome.

The governor’s actions have clearly created a constitutional crisis, which will not likely be resolved without the intervention of the Minnesota Supreme Court. The legislature will continue to be funded through June 30, 2017, from the budget adopted in 2015. It is likely lay-off notices will be sent to all legislative employees in the coming days.

Health Care and Pharmacy Provisions

The HHS Omnibus bill signed by the governor includes the opioid bottle warning label mandate language. The bill contains the revised language that is acceptable to the Minnesota pharmacy community. The original vetoed HHS omnibus bill (SF800) language contained provisions that included the CMS compliance/pharmacists reimbursement (increase) language; however, in final negotiations the legislature had to come up with an additional $400+ million in additional HHS budget savings. While much of the needed savings was taken from the Medical Insurance Action funding that funds MinnesotaCare, the legislature needed additional savings from its originally passed/vetoed HHS budget bill. One casualty was the CMS reimbursement provision that had been scored at a $7 million expense for the biennium. We will work hard next year to see that these provisions are adopted and funding appropriated.

Provisions that survived the negotiation process and were signed into law included the reimbursement of injectables through PBM language, a scaled-down opioid abuse reduction grants provision and the 4-day maximum opiate prescription mandate. Additionally, the legislature adopted and the governor signed the Biosimilars bill, SF1184 and HF712. The statute puts Minnesota in compliance with similar laws across the U.S.

Pre-emption

While much recent news from the governor dealt with the budget, Gov. Dayton also announced his decision to veto the Uniform State Labor Standards Act, also known as pre-emption. The legislation was a GOP and business community legislative priority. Supporters of the legislation hoped the decision to combine the proposal with several Dayton Administration legislative priorities would convince the governor to sign the bill. The legislative package included the governor’s proposals for paid parental leave for state employees, the ratification of an outstanding contract, a version of the governor’s wage theft proposal and much-needed reforms to Minnesota’s public employee pension system. The governor’s veto of the legislation demonstrates the influence Minnesota’s labor unions have over the Dayton Administration.

The veto also means the Minneapolis and St. Paul Paid Sick Leave Ordinances will go into effect on July 1, 2017. Those ordinances will create numerous challenges to Minnesota employers. Because the two cities were unable to pass identical ordinances, employers with employees in both cities will need to create and manage separate benefit programs.

If other Minnesota cities move ahead with their own ordinances, Minnesota will become a patchwork of local labor laws. Minnesota employers continue to hold out hope the courts will throw out the Minneapolis ordinance. Legal arguments in the Minneapolis case are scheduled for later this summer. In the meantime, last week the Minneapolis City Council directed their staff to prepare an ordinance to create a $15/hour minimum wage for businesses with employees working in the city.

Adding more fuel to constitutional questions regarding the governor’s actions, the Dayton Administration is also arguing the legislature approved the contract and benefit provisions included with the pre-emption proposal. The administration is suggesting the mere fact they were included in legislation adopted by both the House and Senate is enough, regardless of whether the governor signed or vetoed the bill with the provisions. This decision by the governor will also likely face a constitutional challenge in the courts. The decision could create a situation where future labor agreements could be passed by the legislature when opposed by an administration. The decision could eliminate the role the administration plays in negotiating future labor agreements. While the decision by the Dayton Administration clearly benefits labor this time, future contracts could be at risk if they were dealt with in a comparable manner.

News From MPhA

Just Announced: June 21 Virtual Coffee Break Webinar

Leveraging Continuous Quality Improvement (CQI)

In this one-hour intensive review of continuous quality improvement (free for all MPhA members), we will dive into why it’s crucial for pharmacists to understand CQI and use it to promote value-based care and advance pharmacy practice. Participants will also learn how this should be employed to analyze problems, test and study interventions and create sustainable change. We will review what CQI looks like when applied to a real-world health care problem.

Read more

Wednesday, June 21, 2017 • Online Webinar
FREE for all MPhA Members • Non-member cost: $25 per person


Nominate a Friend or Colleague Today for MPhA Awards and Recognition

Do you know a pharmacist or pharmacy technician who goes above and beyond the usual? The Minnesota Pharmacists Association wants to hear from you! Help us recognize these pharmacy leaders and inspirations by nominating a pharmacist or pharmacy technician for one of our awards. Nominations are now open.

Nomination form(s) and letters of support must be submitted to the MPhA office by Monday, June 26.

Minnesota News

Minnesota e-Health Summit

June 15, 2017 • Earle Brown Heritage Center, Brooklyn Center

Join the Minnesota Department of Health on Thursday, June 15, 2017 for the 13th annual Minnesota e-Health Summit to hear how Minnesota's health providers are using e-health to achieve this year's theme: Connectivity. Equity. Health.

Come hear Dr. Karen DeSalvo, former Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS), former National Coordinator for Health Information Technology and former Commissioner of Health for the City of New Orleans, share her perspectives on health in this era of rapid transition for health care and public health.

During a special lunch plenary session, an interactive panel will discuss the Minnesota e-Health 2030 Project and engage the audience in thinking about the future. We want your feedback during the session on improving the Minnesota e-Health Initiative to assure a more agile Initiative that can better lead, influence, anticipate, and respond to future challenges, opportunities, and uncertainties that are significant to e-health. Breakout sessions include practical tips on topics such as overcoming barriers to health information exchange, consumer engagement, population health, quality improvement and accountable health.

Registration information and the full brochure are online.


New Minnesota Law May Help Prevent Pharmacy Errors

From Modern Medicine Network: A new Minnesota law may help reduce the number of errors that are caused by pharmacist fatigue. The law requires that pharmacists and pharmacy techs not work more than 12 hours per day and have reasonable time for breaks.

“We are concerned that pharmacies are being asked to do more work and that the prescription volumes are increasing. Even the best of pharmacists, if you put them in the environment where there are hundreds of prescriptions to fill…and they are working 12 hours without a break, [mistakes can occur],” said Minnesota Board of Pharmacy Executive Director Cody Wiberg, PharmD.

“We worked with NACDS [National Association of Chain Drug Stores] and reached some compromise on the language of the rule,” Wiberg said. Read the full article.

Use Your Member Benefits

Special Offer for MPhA Members: Individual Subscriptions to PharmacyLibrary Online References for You and Your Practice

MPhA is pleased to partner with the American Pharmacists Association to offer MPhA members a discounted subscription rate for the PharmacyLibrary — the leading collection of online pharmacy resources, updated monthly. The cost of even two of the more than 30 leading references for pharmacy is more than the discounted rate for the entire online library! A few of the references include:

  • Pharmacy Ethics: A Foundation for Professional Practice
  • Pharmacy Research: A How-To Guide for Students, Residents and New Practitioners
  • Pharmacy: An Introduction to the Profession, 2nd edition
  • Physiology Case Studies in Pharmacy
  • Principles of the Human Genome and Pharmacogenomics

To take advantage of the special rate of $224.99 — a 40% discount off the regular rate — MPhA members should go to https://store.pharmacylibrary.com and enter promo code MPhA at checkout.

National News

Showcase Your Successful Pharmacy Practice Innovations

Showcase your pharmacy practice innovations at the APhA2018 Annual Meeting & Exposition, March 16-19 in downtown Nashville, Tennessee.

Be part of something great! PharmTalk, APhA’s dynamic education platform, showcases the latest innovative ideas created and developed by pharmacists for pharmacists —nowhere else will your discoveries reach such a wide-ranging pharmacy audience from every area of pharmacy.

PharmTalk sessions are TED-style talks that feature a 10-minute presentation of an innovation followed by a 5-minute Q&A to make the session as interactive as possible. Watch an example of a PharmTalk presentation.

APhA is currently accepting submissions for the APhA2018 PharmTalk Series. Complete your submission by Friday, July 17, 2017. Questions may be directed to Judy Lofton.


Sodium Bicarbonate Injection Shortage

From ASHP Website, May 26: Amphastar has sodium bicarbonate injection on shortage due to increased demand. Pfizer has sodium bicarbonate injection on shortage due to manufacturing delays related to obtaining glass syringe components. Few alternatives are available. Clinicians should make every effort to reserve supplies for critical care uses.

Sodium bicarbonate injection is commonly used in critical care settings during advanced cardiac life support (ACLS). The product is also used to manage metabolic acidosis and hyperkalemia and to increase urinary pH. Sodium bicarbonate injection may be used as an antidote for selected products such as tricyclic antidepressants, methyl alcohol, phenobarbital, or salicylates.

Some centers have used the injectable product to prepare extemporaneous oral solutions of omeprazole or lansoprazole. Read the full notice.

MPhA Events

Help Set the Direction for Your Association at MPhA’s 2017 Leadership Summit and House of Delegates Event

Early Registration Deadline is Tuesday, June 6

Join Minnesota pharmacists, student pharmacists and pharmacy technicians for a day of inspiration, information, influence building and crafting MPhA’s policy agenda at the 2017 MPhA Leadership Summit and House of Delegates meeting on Tuesday, June 20, at Midland Hills Country Club in Roseville, Minn. The program, themed, “Building Influence to Advance Patient Care & Practice,” is open to all members and non-members, in addition to those who will serve as delegates to the MPhA House of Delegates meeting. Non-delegates are welcome to stay and observe the policy deliberations that will lay the groundwork for MPhA’s policy agenda for the next year. MPhA seeks delegates — you will be asked if you are willing to serve and for which constituency during the registration process. MPhA will strive to assign delegates to their desired constituency but retains the right to assign delegates as needed to ensure all groups are represented. Nearly 60 people have registered for the event so far — this is always one of our most popular programs!

Registration Information

The registration fee for the event is $45 for MPhA members, $60 for MPhA non-members and $20 for student pharmacists and includes breakfast, lunch and reception appetizers. Prices go up on Tuesday, June 6. Register now!

Register Online


Sponsor/Exhibitor Registration Now Open!

2017 newtowrking event logo

2017 MPhA Annual Learning Networking Event

September 7–8, 2017 | St. Paul RiverCentre

Register now as a sponsor or exhibitor!

Register Online

Did You Know?

Information about Shingles Vaccine to Share with Patients

The Centers for Disease Control and Prevention (CDC) recommends one dose of shingles (zoster) vaccine for adults age 60 and over. Get more information at the CDC website.