|Advocacy Action News & Needs|
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MPhA’s current legislative tracking document may be accessed here.
Legislative Update – March 10, 2019
Last week was filled with Minnesota Pharmacy Alliance bills being heard in multiple committees in the Minnesota House and Senate. Patient's Fair Practices (PFP) legislation, HF728, HF149, HF687 and HF743 all made first deadline in the House because the bills have been heard and passed out of all House policy committees with jurisdiction. They now either move onto the House floor (General Register) - HF149-Gag or to a Ways & Means Finance Committee, the Health and Human Service Finance Committee. MPhA Past President Michelle Aytay, gave very thoughtful and example filled testimony in support of HF743 and HF687, lowest cost of medication to the patient and medication refill synchronization, on March 8th in the House Health and Human Services Policy Committee. HF687 was amended to include authorities for pharmacists to prescribe up to a 30 day refill of a prescription on an emergency basis. Both bills, as amended, were reported out the Committee favorably. The week of March 11th we will redouble our efforts to reach out to a broader number of House members about the Patient Fair Practices legislation. The next several weeks will be critical to meet with every member of the House of Representatives and remind or explain for the first time why these bills are so important. Please watch for Call-to-Action emails.
On March 7th, in the Senate Health and Human Services Committee, Senator Jensen's Patient Fair Practices - SF278 was "taken off the table" by Chair Benson and given its second, more technical, hearing to move the legislation in the Senate on to its next committee of jurisdiction and then to either a finance committee for inclusion in the Senate HHS Finance budget bill or to the floor and pass as an individual piece of legislation. Chair Benson and Senator Jensen indicated their intent was to move SF278 individually and outside the budget process. It was referred to the Senate Commerce Committee which will most likely hear SF278 bill in the next 10 business days. We will need to contact the Senate Commerce Committee members this week. Please look for a call to action.
The Minnesota Chamber of Commerce as well as Express Scripts (Cigna) and Prime Therapeutics testified in opposition to the bill, in its current form. They said that they appreciated the author and Committee members agreeing to revise Section 4 of SF278, the fiduciary duty provision, and stated that they still have substantial concerns with Section 7 of the bill, the conflict of interest disclosure and the mail-order and specialty steering prohibition provisions. SF278 as amended now includes a watered down version of Section 4 and eliminates the fiduciary duty in the bill. The new Section 4 Senate language contained in SF278 only describes the contractual duty. The amended version also includes language offered by Senator Marty that strengthens the anti-mail order steering and patient "choice of pharmacy" protections in the bill. The Marty amendment and ultimately the bill gained broad bi-partisan approval by Committee members. Although only a voice vote was taken, there was not an audible vote against the amended bill. Senator Jensen made closing statements that called on Committee members and members of the Senate to "show courage," convince your colleagues to support this very consequential legislation. "Let's shed light on the current broken drug pricing system...and enact patient and pharmacy fair practices..."
SF1959 & SF1960, Senator Jensen's medication administration and pharmacists prescribing was introduced early last week. The companion legislation in the House will be introduced this week by Representative Mann. Senator Rosen's SF751, the Opioid Stewardship legislation, also contains limited medication administration expansion language. SF751 is currently referred to the full Finance Committee, Chair Rosen's committee, and will most likely be heard next week or the following in Senate Finance Committee. The final details and mechanism for funding the $20 million stewardship program is significantly different in the House and Senate legislation, however, the Governor's budget proposal includes all provisions contained in both the House and Senate bills and adds a State controlled substance registry system and fee structure. The chance of an opioid stewardship bill with an assessment being enacted this year is still high. Details will not be finalized until both bills have passed their respective houses and a conference committee is convened.
One of the concerns raised by several MPA pharmacy members is that pharmacies will be the last stop on the "payment train" and will be financially underwater on all opioid scripts dispensed should either HF400 or SF751 be enacted. We are actively discussing potential ways to mitigate this outcome.
Finally, the MN Board of Pharmacy's Policy/Practices Act reform legislation has been introduced in the House and the Senate, HF1718 & SF2169. The identical legislation has not been scheduled for a hearing in either legislative body. The legislation modifies health definitions and adds additional language, Board of Pharmacy regulated businesses licensing requirements, compounding pharmacy requirements, new wholesaler definitions, veterinary office compounding uses allowed, clarifies disciplinary action grounds, practitioners, pharmacists, and pharmacies interactions prohibited and disclosure required; manufacture and wholesale drug distribution provisions changed; and obsolete language repealed.
This week is first deadline, so things will be very fluid with hearing schedules. We will post updates and calls to action.
Legislative Update – March 4, 2019
Last week the House Commerce Committee met and heard several Fair Practices bills, the PBM licensure and regulation legislation, HF728, and emergency prescription authority, among other bills relevant to the Minnesota Pharmacy Alliance's legislative agenda. We were able to have HF686 , Representative Elkins legislation, that would require any pharmacy (or health system pharmacy) with an on-line presence to be "verified" with the National Boards of Pharmacy removed from the House Commerce Committee's agenda in order to have MPhA and MPA representatives discuss on a conference call with stakeholders. We continue to oppose the legislation in its current form as it would not solve the intended problem and a business decision on pursuing verification for suppliers should be left to each pharmacy, not legislated.
In addition to PBM licensure and oversight legislation, gag order prohibition, lowest cost to patient/consumer and medication synchronization legislation all passed out of the House Commerce Committee. They will move to the HHS Policy Committee while the gag order prohibition, HF149, was placed on the general register/House floor. Representative Liebling's HF1297 - MDHS' Out Patient Drug Rule compliance legislation cleared its hearing in record time (about 17 minutes), and was laid over for inclusion in the House HHS Finance Omnibus legislation. Funding is included in the Governor's budget and Senator Benson has indicated she will include the funding and OPDR implementation in her Senate HHS Finance bill to be introduced later in the Session. Representatives Baker and Olson’s scaled down version of the Minnesota Board of Pharmacy's policy legislation, HF1718 has not been scheduled as of today.
Senator Jensen, Klein and Abeler introduced MPA's medication administration authorities expanded, SF1959, and pharmacists prescribing in three medication categories, SF1960, legislation today. Companion legislation is being worked on with House sponsors.
Important hearing this week for Minnesota Pharmacy:Thursday, March 7, 2019 - 3:00 PM
Committee on Health and Human Services Finance and Policy
Chair: Sen. Michelle R. Benson
Room 1200 Minnesota Senate Bldg.
If you wish to testify, please email Bailey Strand at firstname.lastname@example.org before 10am the day of the hearing. Testifiers should reference the bill for which they wish to testify and if they will be testifying for or against. Limit of one testifier per organization please. Testimony may be limited to 2 minutes due to time constraints or at the discretion of the Chair.
*SF 278 will be picked up from the table, public testimony was already taken on Jan. 31st.
Legislative Update – February 28, 2019
The Minnesota Management and Budget (MMB) released the February 2019 Budget & Economic Forecast on February 28th. The State is projected to have a $1.052 billion surplus over the next two-year budget cycle beginning on July 1, 2019.
Given the reduced surplus, Governor Walz and legislators will need to adjust figures previously forecasted in his budget proposal earlier this month. The two-year budget will need to be finalized by the end of the 2019 Legislative Session on May 20, 2019.
The full forecast can be found here.
Or visit the full MMB forecast website.
Legislative Update February 25, 2019
We are three weeks out from the first legislative deadline for the 2019 Minnesota legislative session. This past week, the Governor announced his 2020-2021 budget: "Governor Tim Walz announced his budget proposal for the biennium with a focus on making investments in education, health care, and community prosperity." The $49.5 billion, two-year plan released on February 19th pays for the Governor's priorities by using current tax revenues, a $1.5 billion budget surplus as well as new taxes. House Minority Leader Daudt called the budget "One expensive Minnesota" and Senate Majority Leader Gazelka and other Senate Republicans began their initial round of criticism and reaction to the budget proposal. The February forecast will be released by Minnesota Management and Budget next week, adding one more piece to the budget puzzle, after which both the House and Senate will begin crafting their own biennial budget plans.
The entire Walz Administration budget can be found here.
This week is very important to the Minnesota Pharmacy Alliance’s advocacy agenda. The House Commerce Committee will meet Wednesday at 6:30 PM to hear 12 bills related to pharmacy, including several Patient Fair Practices bills, the PBM licensure and regulation legislation, HF728, and emergency prescription authorities among other bills. One of the bills that we are trying understand more about and may possibly have to oppose is HF686 , Representative Elkins legislation, that would require any pharmacy (or health system pharmacy) with an on-line presence to be "verified" with the National Boards of Pharmacy which may also include a ".pharmacy" website URL mandate and potentially a fee of up to $250.
MPA representatives met with Representative Elkin about his bill and the other bills before the Commerce Committee. Representative Liebling introduced the MDHS' Covered Outpatient Drug Rule compliance legislation, HF1297. As mentioned previously, the funding is included in the Governor's budget and Senator Benson has indicated she will include the funding and OPDR implementation in her HHS Finance bill to be introduced later in the Session. Also introduced on Monday by Representatives Baker and Olson is a scaled down version of the Minnesota Board of Pharmacy's policy legislation, HF1718.
Later this week, Senators Jensen, Klein and Abeler will introduce the Alliance's medication administration and pharmacists prescribing in three medication categories bills. Meetings are scheduled with Representative Mann and Morrison this week and we should have the companions to the Senate legislation introduced in the House late this week or early next. We are also working with Senator Rosen on her limited medication administration language currently contained in SF751, the Senator's Opioid Stewardship legislation.
Legislative Update February 19, 2019
The week of February 11th marked the 6-week point of the legislative session, with 4 weeks remaining until 1st legislative deadline on March 15th. Committees have been regularly meeting, passing out bills or laying them over for possible inclusion in an Omnibus finance bill. Committee action important to Minnesota pharmacists included hearings on Representatives Olson and Baker’s Opioid Stewardship legislation HF0400, Senators Rosen and Eaton’s Opioid Stewardship legislation SF 751 (significantly different than current House version). Representative Lippert’s Prescription Drug Repository Program, HF 182 had its second and final hearing in the House. The Repository Program legislation has met 1st deadline because it has been laid over for possible inclusion in the Health and Human Services Omnibus Finance bill.
This coming week will see the first significant step in the budgeting process when Governor Tim Walz submits his 2020-2021 State budget to the legislature on 2/19. Eight days later a second important piece to the budget puzzle will be known when the State releases its updated budget forecast. The November forecast showed the State of Minnesota with a $1.5 billion surplus over the next two years. Both the Governor’s budget request and the February forecast will begin to define the parameters of the budget debate. Legislative budget targets in the House and Senate will follow.
Finance Committees in the House and Senate will work with the Governor’s request, however, the DFL led House is more likely to adopt the Governor’s request than the Republican led Senate. Governor Tim Walz, House Speaker Melissa Hortman, and Senate Majority Leader Paul Gazelka have agreed, in a signed letter, to additional objectives:
If this process is followed, leaders hope to avert a Special Session and the usual end of session show down.
Minnesota Pharmacy Alliance priorities are moving forward at the legislature. This week will see the first hearing for Representative Mann’s PBM Licensure and Regulation legislation/ Patients Fair Practices legislation, HF728, on Wednesday at 2:30 PM in the House Health and Human Services Policy Committee. HF728 is the companion legislation to Senator Jenson’s SF0278, which was heard in the Senate HHS Finance Committee two weeks ago. Significantly, like the Senate legislation, both the HHS Finance and Commerce chairs are co-authors of the bill in the House. HF728 has bi-partisan support. Once HF728 is voted out of the HHS Policy Committee on Wednesday, it most like will be referred to the House Commerce Committee and then on to the House HHS Finance Committee for possible inclusion in the HHS Finance Omnibus. Work is being done with the Department of Commerce and MN Management and Budget (MMB) to hopefully minimize any potential for a fiscal note.
Minnesota Pharmacy Alliance legislative agenda topics and bills:
The Alliance’s medication administration legislation will be introduced by Senators Jensen and Klein this week in the Minnesota Senate and we are working with Representative Mann, Baker and others on the House HHS Policy Committee to introduce their version this week or next in the House. An interesting development occurred this past week at the Senate HHS Finance Committee hearing that took up and amended SF751, Senator Rosen’s Opioid Stewardship legislation. Included in an author’s amendment that changed the funding original mechanism of the legislation was a limited form of expanded medication administration authorities for pharmacists in Minnesota.
The current version, as amended, of Senator Rosen’s Opioid Stewardship legislation, SF 751 would allow Minnesota pharmacists to give Sub-q and IM shots used to administer drugs for the treatment of alcohol or opioid dependence and treatment of mental health conditions. [SF75 language: “intramuscular and subcutaneous administration of drugs used for the treatment of alcohol or opioid dependence and treatment of mental health conditions.”]
While some see this as a move in the right direction, both the Alliance and the MN Board of Pharmacy would prefer the medication administration “deletion” language be included/adopted: by deleting the following highlighted language from current Minnesota statute: “…for first dosage and medical emergencies; drug regimen reviews; and drug or drug‐related research;…”
This preferred language will provide pharmacists with the authority to administer medications that would help perinatal patients who use Makena and other long-acting injectable patient medications. Increasing access to medication administration services across Minnesota is the goal, not only in mental health care.
We are working with Senator Rosen and others in the Senate to see if the limited language could be amended to include the “deletion language” instead of the limited language currently included in the bill. Senator Rosen’s legislation has at least two more committee stops.
Pharmacists Prescribing in three medication categories:
Pharmacists prescribing legislation should be introduced this week in the Minnesota Senate by Senators Jensen and Klein. In the House, it is still being determined who will end up authoring the companion legislation. Representatives Morrison, Mann and other have expressed interest. The next step will be to have the legislation heard in House HHS Reform (policy) and the Senate HHS Reform or Finance Committees.
CMS-Outpatient Drug Rule (OPDR) compliance and MN pharmacy reimbursement changes legislation:
Representative Liebling will introduce the OPDR legislation this week in the House and Senator Benson is working to introduce the legislation in the Senate this week or next. Currently OPDR draft legislation is going through the State’s fiscal note process to determine the actual cost of implementation for this biennium and the 2021-2022 budget. We will know this week whether the OPDR in Minnesota may be included in the Governor's budget.
Stakeholders, including the Alliance, the MN Hospital Association (MHA) and the MN Department of Human Services, Chad Hope's division and team, as well as the MN Retailers Association and the MN Grocers Association all gained consensus on legislation that would bring the State of Minnesota into compliance with the CMS-Covered Outpatient Drug Rule. The legislation would change the fee-for-service Medical Assistance and MNCare reimbursement equation to NADAC for ingredient cost reimbursement and a dispensing reimbursement rate of $10.48 for Minnesota pharmacies. It would also help Minnesota hospitals impacted by the CMS 340B portion of the rule and include an additional 2% to cover the MN Wholesaler-Provider Tax, should the tax not sunset per current Minnesota statute, this coming December 31st ('19).
Prescription Drug Repository Program, HF 182 had its second and final hearing in the House. The Repository Program legislation has met 1st deadline because it has been laid over for possible inclusion in the Health and Human Services Omnibus Finance bill. Supporters of the legislation would like to have it clear the Senate Committee process over the next two weeks and then have it laid over for inclusion in the Senate HHS Omnibus Finance bill.
Tues. Feb. 19th
Chair: Sen. Warren Limmer
Wed. Feb. 20th
Room: 200 State Office Building
HF733 (Tabke) – Security screening systems added to ionizing radiation-producing equipment, and money appropriated
HF 4 Authors: Reps. Lesch; Acomb; Bahner; et al.
Legislative Update February 3, 2019
Both House and Senate policy and finance committees are meeting regularly and hearing bills they hope to enact this legislative session. With 1st committee deadline still on the horizon (March 22nd) and the February forecast and release of Governor Walz's first budget still yet to have happened, the Minnesota legislative session is still in its early stages. However, the Senate and House are already working on legislation that is important to Minnesota pharmacy. Chair Benson’s Senate HHS Finance Committee held a hearing on SF0278, the Patients Fair Practices legislation this past Thursday and the House is poised to have its first hearings on PBMs and PBM reforms next week. The House and Senate are also working on the CMS-Outpatient Drug rule/MN pharmacy and 340b reimbursement legislation as well as enacting legislation that would establish a Prescription Drug Repository program. In addition, the House heard legislation introduced by Representatives Olson and Baker HF0400, which would establish an Opioid Stewardship Advisory Council, opioid stewardship account, and opiate product registration fee; opioid addiction prevention, education, intervention, treatment, and recovery provisions in Minnesota statute. The legislation is gaining momentum and could be passed on the floor of both houses soon.
The drafting of medication administration as well as pharmacists prescribing legislation is to be finalized early next week and then introduced in the Senate either late next week or early the following. In the House, it is still being determined who will end up authoring the companion legislation. The next step will be to have the legislation heard in House HHS Reform (policy) and the Senate HHS Reform or Finance Committees.
CMS-Outpatient Drug Rule Compliance
Stakeholders, including the Minnesota Pharmacy Alliance, the MN Hospital Association (MHA) and the MN Department of Human Services, as well as the MN Retailers and the MN Grocers all gained consensus on draft legislation this past January that would bring the State of Minnesota into compliance with the CMS-Out Patient Drug Rule (OPDR). The legislation would change the Medical Assistance and MNCare reimbursement equation to NADAC for ingredient cost reimbursement and a dispensing reimbursement rate of $10.48 for Minnesota pharmacies. It would also help Minnesota hospitals impacted by the CMS 340b portion of the Rule and include an additional 2% to cover the MN Wholesaler-Provider Tax, should the tax not sunset per current Minnesota statute, this coming December 31st ('19). Currently OPDR draft legislation is going through the State’s fiscal note process to determine the actual cost of implementation for this biennium and the 2021-2022 budget. Once that is determined, the legislation will either move expeditiously through both chambers or the Senate Finance Chair and the Chair of the House Ways and Means Committee may insist that the legislation be a part of the overall budgeting process that must meet targets established by each body later in February or Early March. The cost to implement the OPDR in Minnesota may be included in the Governor's budget.
The introduced legislation gives the State of Minnesota oversight authority over the unregulated PBM industry. It would require PBMs to obtain a license from the Minnesota Commerce Commissioner and allows the Commissioner to review and audit PBMs to ensure compliance with the legislation's provisions. It would also provide the Department of Commerce with the authority to adopt rules that promote, preserve, and protect public health, safety, and welfare through effective oversight of PBMs as well as establish that PBMs have a fiduciary duty to the health carrier acting on behalf of the beneficiary.
The legislation also prohibits gag clauses in contracts with pharmacies, guarantees lowest cost of medication for patients and allows pharmacists to synchronize patient prescription medication refills. The legislation also puts in place a statutory framework that will increase transparency by requiring PBMs that operate in the State of Minnesota disclose all direct or indirect payments related to the dispensation of prescription drugs or classes or brands of drugs and sets out rules that the Commerce Commissioner may adopt, including network adequacy requirements, compensation/MAC lists, MLR abuses, and other prohibited market conduct practices. The bill would also require a PBM to notify the covered entity in writing of any activity, policy or practice of the pharmacy benefits manager that directly or indirectly presents any conflict of interest and would provide the Department of Commerce with the authority and resources to investigate and adjudicate violations.
The Patients Fair Practices legislation, SF278 was introduced by Senators Jensen, Benson, Drahms, Drahiem and Wiklund earlier in January and had its initial hearing in the Senate HHS Finance and Reform Committee this past Thursday, You may access the video by visiting the Senate archives.
Testimony was given by Pharmaceutical Care Management Association (PCMA): Ms. Melodie Schrader, Jessica Astrup Ehret: Pharm D with Astrup Companies, a 3rd generation community pharmacist at Sterling Drug in Northfield, MN, Gary W. Boehler, R.Ph. a pharmacist consultant for third party contracting and pharmacy operations, and the Minnesota Medical Association (MMA): Dave Renner: Director of State and Federal Legislation testified in support of S278.
The Chair “tabled” the bill so that all stakeholders and interested parties could assess the bill’s impacts and get back to her and Senator Jensen with concerns or changes to be made prior to the Committee taking the bill up for a vote. Chair Benson indicated that the Committee will take the bill up again in the next two weeks.
In the House, Representative Dr. Mann has indicated that she will be introducing the companion Patient Fair Practices legislation to SF278 next week in the Minnesota House. Access the bills here:
MN House hearings taking place Tuesday, February 5th:
Minnesota 2019 Session Preview
The only split-party Legislature in the nation will begin Tuesday, January 8th, 2019. Minnesota’s 91st Legislature must complete their work by midnight on May 21st. The odd-year session will primarily be focused on adopting the 2020-2021 biennial budget. In addition, Governor-elect Walz will be sworn into office on January 7th. The incoming Governor will give his State of the State Address in late January and must present his budget to the Legislature by mid-February.
Governor Dayton will leave Governor-elect Walz with a budget surplus of more than $1.544 billion for the 2020-2021 biennium. In addition to the budget surplus, the state’s budget reserves are now at a record setting $2.075 billion, following a statutory transfer from the budget surplus of $491 million. The state’s economic advisors suggest Minnesota’s long-term economic outlook remains sound. However, the State will face slower long-term growth than had previously been projected. Current economic indicators project the state will have a $456 million surplus in the 2022-2023 biennium.
Beyond setting the biennial budget, the Walz Administration and Minnesota Legislature will attempt to address a handful of more complex policy and financial issues as well as issues central to Minnesota pharmacy and their patients. The larger issues, while not limited to the following, will most likely include:
Issues that will likely be addressed by the legislature that will affect Minnesota Pharmacy include:
The House DFL has announced their committee structure and chairs, and right before the Holidays released the complete list of House Committee Membership along with an updated committee schedule. House Committee Membership and Schedule as well as the 2019-20 House committee membership by committee. One reason for the delay in the committee membership lists was the post-election announcement by four renegade GOP members of a newly formed, New House Republican Caucus. GOP Representatives Drazkowski, Miller, Bahr and Munson are the founding members of the new caucus.
It is unclear what led to the GOP break-up, however, following the November elections, Rep. Miller lost to outgoing Speaker Daudt in a race for Minority Leader. Speaker-elect Hortman’s decision to provide staff to the renegade caucus in a better ratio than other Republicans also led to further complications and contributed to the delay in committee announcements.
In the Senate, former House Rep. Jeff Howe was sworn in following his victory in the November Special Election. The Senate under GOP control with a slim 34 to 33 advantage. The Minnesota Senate made changes to Committee Chairs and Membership. The biggest change will be Senator Jeremy Miller moving into the role of Senate President and relinquishing his Chairmanship of the Senate Jobs, Economic Growth Policy and Finance Committee. Senator Eric Pratt will be taking over the Jobs Committee Chairmanship from Senator Miller. Senator Pratt’s E-12 Policy Committee will be merged with the Senate E-12 Finance Committee creating a new E-12 Policy and Finance Committee, Chaired by Senator Carla Nelson the current E-12 Finance Committee Chair. In a rare move, a freshman member of the Senate will be assuming the Chairmanship of a major committee. Senator Paul Anderson will be taking over as chair of the Higher Education Finance and Policy Committee. This change became necessary when the Chairmanship was vacated by the resignation of Senator Fischbach. According to Senate Majority Leader Paul Gazelka, the Senate has also made a handful of changes to their committee membership which is available in their recently updated Senate Election Directory. 2018 Senate Election Directory/Revised Committee Membership
In late December and again this past week, Governor-elect Walz and Lt. Governor-elect Flannagan began releasing the first of their Administration’s Commissioners. The Walz-Flanagan Administration has 24 commissioner positions to fill. Of note, State Senator Tony Lourey, DFL-Kerrick, was appointed commissioner of the Minnesota Department of Human Services and one holdover, Department of Health Commissioner Jan Malcolm, was re-appointed to the post to assist with the transition process. Governor Walz said the length of Malcolm’s term had not yet been determined.
Upcoming Events and Important Dates
Minnesota House DFL News Release November 21, 2018
Minnesota House DFL Majority Announces Committee Structure and Leadership Staff
St. Paul, Minnesota — Today, the Minnesota House DFL announced the committee structure and chair assignments for the 2019-2020 biennium.
“We’ve streamlined the committee structure by creating fewer stops for bills in the areas of agriculture, transportation, and civil law,” said Speaker-designate Hortman. "We’re also creating committees to give attention to issues that affect Minnesotans’ lives but which have not received enough consideration previously, adding finance committees in the areas of Energy and Climate, Housing, Greater Minnesota Jobs and Economic Development, and Criminal Justice Reform. Senior members of the caucus will give much-needed attention to these critical areas.
“In the new committee areas and in many others, we expect to bring the Legislature out into communities throughout Minnesota.
“Finally, the legislative failures of the past four years have revealed that the Legislature needs to reform the way it conducts business, and I’m especially grateful to Representative Gene Pelowski for his willingness to serve Minnesotans by heading up our efforts to implement legislative process reforms. I am hopeful the Minnesota Senate will partner with us to make the legislature more efficient, effective, and transparent.
“Our caucus and our chairs represent communities from all geographic areas of the state, from the Iron Range to Austin, Eden Prairie to White Bear Lake, and the Twin Cities to Dilworth. Our committee structure and our membership will serve the interests of all Minnesotans as we consider legislation to build a Minnesota that works better for everyone.”
Speaker-designate Hortman also appointed the following leadership staff to serve the DFL Caucus:
Sean Rahn, Executive Director, Majority Caucus
Minnesota Election Update November 12, 2018
The Election Day dust has settled, and the wheels of government have begun the process of moving ahead. Following his record-breaking victory, Governor-elect Walz officially opened his transition office, Attorney General-elect Ellison announced his transition team and the House and Senate began their process of organizing. Here are a few of the highlights from the past week.
As of today, the DFL was successful in flipping 18 seats in the Minnesota House. The current results include the DFL victory in the northern Minnesota House District 5A. The race between current GOP Rep. Matt Bliss and the DFL member he defeated in 2016, Rep. John Persell, was decided in Persell’s favor by a mere 8 votes. The margin will likely trigger a state paid recount. However, the recount cannot take place until after the State Canvassing Board certifies the results on November 27th. If the results in 5A stay the same, the DFL will enter the 2019 Session with 75 members to the GOP’s 59. This will give the DFL a 7-seat cushion in the upcoming session and the ability to allow their new suburban members the opportunity to pass on voting for potentially controversial proposals.
The House DFL caucused on Thursday and elected their current Minority Leader Rep. Melissa Hortman (Brooklyn Park) as the next Speaker of the House. The caucus also selected Rep. Ryan Winker (St. Louis Park), who is returning to the House following his retirement in 2015 and aborted campaign for Attorney General, as Majority Leader. Second term Rep. Liz Olson (Duluth) was selected as the House Majority Whip. House DFL Leadership is now working to establish the number and structure of legislative committees for the upcoming session. Committee Chairs will be announced in the coming weeks. While it has not been officially announced, incoming Speaker Hortman did disclose in a local media interview over the weekend, 10-term Rep. Paul Marquart (Glyndon) will be Chair of the House Tax Committee when the session begins in January.
The Speaker-elect has made it very clear the DFL plans to hit the ground running in January. The goal will be to wrap up work on several items, they view as non-controversial, which were included in the 900-page omnibus bill vetoed by Governor Dayton at the end of the 2018 Session. Those items will likely include an effort to address the opioid crisis, the MNLars failures and passage of a federal tax conformity bill.
The House GOP also caucused last week. Outgoing Speaker Kurt Daudt was selected as the House Minority Leader. His unanimous selection followed a one ballot attempt by 3-term Rep. Tim Miller (Prinsburg) to gain the leadership position. The outgoing Speaker in a media scrum on Friday made it clear the House GOP feels the election outcome wasn’t as much a vote against their members who lost, but more the result of national headwinds which were ultimately out of their control. He also suggested the House GOP will oppose efforts by Governor-elect Walz and the House DFL to raise any taxes. The outgoing Speaker specifically called into question Governor-elect Walz’s proposal to raise the gas tax for transportation funding, when the state is likely to see multi-billion-dollar surpluses in the upcoming fiscal forecast.
Senate Republicans maintained their majority with a victory in the Senate District 13 Special Election also held an organizing caucus last week. With Senate President Michelle Fischbach’s decision to end her legal challenges and accept the position of Lt. Governor, the GOP needed to elect a new Senate President. Senator Jeremy Miller (Winona) was selected by his Republican colleagues as the next Senate President. It remains unclear if Sen. Miller will continue to serve as the Chair of the Jobs and Economic Growth Finance and Policy Committee. The Senate GOP also selected Sen. Karin Housley (St. Mary’s Point) and Sen. John Jasinski (Faribault) to join Sen. Michelle Benson (Ham Lake) and Sen. Gary Dahms (Redwood Falls) as Assistant Majority Leaders.
It does not appear as though any changes will be coming to the Senate DFL Leadership team. As always, with a new administration its possible current members of the Minnesota Legislature may seek positions in the new Walz Administration. It would be unlikely for members of the legislature to be chosen if they represent a potential swing district in a special election.
On Thursday, Governor-elect Walz and Lt. Governor-elect Flanagan officially opened their temporary quarters on the third floor of the State Capitol. At a quickly arranged press conference it was announced attorney Chris Schmitter will serve as the Governor’s Chief-of-Staff. Schmitter is close to the incoming governor and served as an aide in his congressional office. Rep. Flanagan will be responsible for managing the transition team.
In public comments over the last week, Governor Walz has stressed the success of his campaign and the fact no other candidate for Governor in the history of the State has received anywhere near his nearly 1.4 million votes. The Governor also remained committed to his campaign pledge to push for an increase in the gas tax, to expand a public health insurance option and to legalize recreational marijuana. He has yet to announce how large an increase in the gas tax he will try to advance during the upcoming legislative session. The Governor hopes to have his budget released prior to the constitutionally required date of February 19th. He plans to release his budget proposals as they become available. This week Governor-elect Walz also claimed he hasn’t made any decisions regarding whether he will retain any current commissioners from the Dayton Administration.
Upcoming Events and Important Dates
At the Capitol May 22, 2018
MPhA Legislative Alert – Urge Governor Dayton to sign the Supplemental Finance legislation Now!
Many of you have been following the proceedings at the Minnesota legislature this year. On May 21, the legislature adjourned for the year and the end of the two-year session. With moments to spare, the Republican House and Senate sent Gov. Dayton several important pieces of legislation that he now has 14 days to sign or veto.
Two of the most consequential bills to Minnesota pharmacy and many other stakeholders across the State are the Omnibus Supplemental Finance bill SF 3656 and the final bill passed by both Houses of the legislature, 2018.0-ccrsf0799d. SF 3656 must be signed for SF 799d to be enacted. Both bills have been sent to Gov. Dayton, who now has 14 days to act (until midnight, June 3).
We need everyone’s help NOW to call and write emails to the governor urging him to sign both these bills TODAY!
Consequential pharmacy provisions of SF 3656 & SF 779d:
Please contact Gov. Dayton as soon as possible and let him know why this is so important to sign.
Dear Governor Dayton:
On behalf of myself, XXXX Pharmacy and thousands of pharmacists and pharmacies as well as the patients we serve across Minnesota, I urge you to sign both the supplemental finance bill (SF 3656) and the related bill, SF 799d, that passed the House and Senate Sunday night.
These two bills, while not perfect, would ensure greater medication cost transparency by making sure that pharmacists are not prohibited from letting their patients know what is the lowest cost for the medication, even if it is out of pocket and outside their pharmacy benefit. The legislation would provide further transparency by requiring pharmacists to provide a patient the lowest cost for their medication, especially if their co-pay is higher than the actual drug cost. It would also allow for patients to synchronize their prescription drug refills, which currently is not allowed through many benefit plans in Minnesota.
Equally as important, and perhaps more so to local pharmacists throughout Greater Minnesota, is the interim fix for stakeholders affected by the CMS Covered Outpatient Drug Rule implementation. The State of Minnesota is currently out of compliance with the CMS Rule, as of April 2017. This is jeopardizing $190 million in Medicaid/Medical Assistance drug spend funding for the state’s most vulnerable citizens. It is also delaying the implementation of pharmacy reimbursement to a National Acquisition Cost model and the wholesale/provider tax – 2% reimbursement to be paid by MDH.
For all these reasons, I urge you to sign SF 3536 and SF 799d. Please do the right thing and sign these bills into law.
[*Make sure to include on letterhead if mailing or faxing. If emailing or calling, please identify yourself, your employer or affiliation and your home address.]
Governor Mark Dayton:
At the Capitol May 18, 2018
As this update was written, both the House and Senate have yet to pass their massive Omnibus Finance spending bill that includes both policy for many stakeholders and supplemental funding adopted for all departments of the Minnesota state government. The Conference Committee met on Thursday night to hopefully pass the spending bill. However, there have been many indications that the governor will veto the bill — and then another round of negotiations will begin to come up with a spending bill he can support. This is all happening with four days left in the legislative session. The governor, in both his letters to the legislature, has stated that he does not need to sign a supplemental funding bill to make sure the government is functioning.
On May 16, the Minnesota Department of Human Services (MDHS) convened a conference call with stakeholders, including several representatives of Minnesota pharmacy, to let them know that the Centers for Medicare & Medicaid Services (CMS) has officially determined that Minnesota is out of compliance with the HHS-CMS Covered Outpatient Drugs Final Rule or the pharmacy outpatient reimbursement ruleand that in order to have Minnesota in compliance, action is needed now. Being out of compliance could potentially jeopardize millions of dollars in Medicaid drug spend funding for Minnesota.
Readers will recall that stakeholders, including Minnesota pharmacy, worked with the MDHS to come up with a consensus legislative pharmacy reimbursement proposal that would put the state in compliance with the rule; in the process, pharmacy reimbursement in Minnesota would move to a NADAC + $11.35 reimbursement rate. It also covered the 2% wholesale/provider tax donut hole on all fee-for-service MA prescriptions; without that, Minnesota pharmacists would dispense these fills at a substantial loss. The fiscal note associated with the implementation of the rule was estimated to cost approximately $3.8 million to the state annually. However, the MDHS is proposing a “revenue neutral” interim fix that would be adopted this week. It would have a NADAC +$10.48 reimbursement rate and would not include the 2% reimbursement language among other considerations to get to a “no-cost” solution.
This is unacceptable. We are working with the Minnesota Retail Association, the Minnesota Grocers Association, the National Association of Chain Drug Stores as well as other stakeholders to address our concerns. Minnesota pharmacy is opposed to the current proposal, but is working to find a solution much closer to the 2017 consensus reimbursement rate and language. A letter has been sent this morning to Senator Rosen and Representative Knoblach outlining our concerns and encouraging them to include the 2% tax reimbursement.
Other provisions that are currently included in the Supplemental Finance Omnibus important to Minnesota pharmacy include:
At the Capitol May 1, 2018
The Minnesota legislature has 20 days left until they are mandated to adjourn by the State constitution. The Senate will take up their Omnibus Tax bill by the end of this week. The next two weeks (May 7th and May 14th) will be spent working on conference committee reports, the bonding bill, any tax conformity legislation that may be considered and several stand-alone bills.
On Monday, April 30th, the Senate passed SF2836, Senator Jensen’s bill that would require that pharmacy benefit contracts with pharmacies do not prohibit a Minnesota pharmacist from providing their patients with the information on the lowest cost of medication. It also included language for the synchronization of patient medication refills in Minnesota.
Several provisions addressing the opioid epidemic in Minnesota were adopted as part of the Senate Finance bill earlier in the week. However, the Senate opioid stewardship fee and grant legislation, Senator Rosen's SF730, is still yet to see a floor vote. The good news is her opioid legislation had its final hearing in Senate Finance Committee on May 1st and was amended into final form for a Senate vote. The legislation would charge a licensing fee to opioid manufacturers and wholesalers operating in Minnesota based on the product volume distributed/sold of up to $20 million ($12million in aggregate from manufacturers; $8million in aggregate from the wholesalers). The fee revenue generated would fund a new Opiate Stewardship account; a special revenue fund that will pay for the Minnesota Dept. of Health grants as well as Prescription Monitoring Program upgrades.
Both the House (HF1440) and Senate bills also include limitations the number of days a schedule II-IV opiate prescription refill is valid (45 days in the House and 30 days in the Senate). If the House or Senate is going to take up the opioid stewardship legislation, they will need support from House and Senate majority leadership. House leadership has indicated they are not interested in a new fee/tax and have included $10 million in appropriations from the State General Fund to address the opioid crisis. It is anticipated that both bills will pass their respective chambers and then be conferenced to determine what, if any, fee will be assed in Minnesota.
At the Capitol April 19, 2018
The Minnesota legislature spent the past week putting its finance bills together. Both the House and Senate are still working through their own legislative provisions that will ultimately be included in final House and Senate finance omnibus bills. The legislative process to move these bills to the House and Senate floor will be put together over the next two weeks. Significant action has been taken on several bills/provisions included in the omnibus legislation affecting Minnesota pharmacists and pharmacy.
Legislation, which has been modified at each committee stop along the way, would allow Minnesota pharmacists to prescribe in three medication categories. The bill was laid over for possible inclusion in the House HHS finance bill last week. However, the legislation has not been included in the current House omnibus legislation because it received a small fiscal note, meaning it costs the State to implement. While the legislation was heard and passed out of both House Committees it was referred to, there is still work to be done to find the funding to implement the legislation. In an April 19 House HHS Finance Committee hearing, the legislative language was offered as an amendment to the Finance Omnibus bill, but was then withdrawn because of the fiscal note. The fate of the pharmacists prescribing legislation in the House will most likely be decided in the next two weeks.
In the Senate, pharmacy prescribing did not receive a policy hearing before the spring recess; however, the bill may be brought up in the Senate Finance Committee during the conference committee process. Senate leadership and the authors of the legislation are working to have pharmacists prescribing in three medication categories included in the final finance legislation that will be conferenced between the House and Senate before the end of the Minnesota legislative session, which ends May 21.
Minnesota pharmacists prescribing:
Peterson, Baker; Jensen, Klein, Lourey, Rosen introduced:
Minnesota pharmacists expanded medication administration legislation was introduced as a stand-alone bill in both the House and Senate early in the legislative session. Neither HF 3250 nor its companion, SF 3014, were heard in the HHS policy committees in the House and Senate. However, Rep. Baker, at the behest of several MPhA members, agreed late in the process to have the medication administration language (deletion) included in his opioid disposal bill that was heard by the House HHS Finance Committee.
The Medication administration amendment to Rep. Baker’s bill became controversial for several members of the HHS Finance Committee and was opposed by the HHS Finance DFL ranking member because the legislation was not heard in the House HHS Reform Committee, the House committee where all health care-related scope of practice legislation is to be heard. While the amendment was adopted and laid over for possible inclusion in the HHS Finance Omnibus legislation, there is still controversy surrounding this authority modification. The medication administration bill is less than likely to be included in the House bill.
In an effort to work with nursing interests as well as members who are concerned with a broad scope of practice change, the following amendment language has been offered and worked on as a compromise.
MN, 151.01, Subd. 27 to be amended to:
Leadership and members of the House HHS Committee have committed to trying to include the amended language in any final finance bill. However, they have asked that more work be done to get the bill in the shape they desire in the House.
In the Senate, bill author Sen. Jensen has worked with Sen. Rosen (the Senate Finance Committee Chair and a great friend of pharmacy) over the past 10 days to include medication administration modifications in her legislation addressing the opioid crisis, SF 730. As of this update, there is a commitment by Senate leadership to adopt the medication administration amendment early next week.
Minnesota pharmacists expanded medication administration (original language/bills):
Fair Practices and pharmacy contract reform legislation:
While the Senate adopted similar language, that bill did not include the guarantee of lowest cost of medication to the patient. The Senate legislation includes gag order prohibitions and also includes provisions that would require plans to allow pharmacists and providers to synchronize medication refills (med-synch) and to pro-rate co-pays for prescriptions that are filled with a partial month supply for the purpose of synchronization. HF 3024 has been included in the House Omnibus Bill (HF 3138). SF 2836 will be voted on seperately in the Senate. The fair practices legislation will be included in both the House and Senate finance bills that will be conferenced later this session. There is a high level of confidence that these provisions will be enacted.
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
At the Capitol April 6, 2018
We have taken a significant step forward in making law, with the pharmacists prescribing authority language in House File 2692 and its companion Senate File 3015. In the House, the prescribing legislation took the next step to final passage. HF 2962 was heard in the House Health and Human Services Finance Committee where the bill was amended, received a fiscal note and ultimately was laid over for inclusion in the House HHS Finance supplemental budget bill that will be deliberated and put together after the Easter/Passover legislative recess. To summarize, the bill as amended has made it through all its stops in the House and will now move through the finance legislative process there.
HF 2962 would mean:
The final amendments included:
This was after an amendment to the House bill last week that tightened up the tobacco cessation products provision by adding:
HF 2962 is now in a very good place to be included in the House Finance Supplemental Omnibus bill that will ultimately be conferenced with a similar omnibus piece of legislation from the Senate. Sen. Julie Rosen, one of the authors of the pharmacist prescribing legislation, will put together the Senate Finance bill as Senate Finance Chair.
While the pharmacists prescribing legislation has made it through all policy and finance committees in the House, it was dealt a significant blow in the Senate last week. Senate HHS Finance Chair Michelle Benson indicated she will not hear the companion to HF 2962, SF 3015. While this does not “kill” the pharmacists prescribing legislation, SF 3015 did not meet second deadline in terms of making it out of the Senate HHS Finance and Policy Committee, the policy committee scope bills are heard in. Sen. Benson questions whether pharmacists should prescribe and also is keenly aware of opposition to the bill by the Minnesota Medical Association.
The legislation is not dead because it could be heard in Senate Finance, Sen. Rosen’s committee, and be included in the Senate Supplemental budget bill — where it could be conferenced with the House legislation. Even if it’s not included in the Senate Supplemental budget bill, it still could become part of the final Supplemental budget bill if the Senate and House conferees accept the House pharmacists prescribing legislation with the fiscal note of $14,000 in ’19 and $6,000 in the next biennium.
Only the next two months will tell the ultimate fate of the pharmacists prescribing legislation. The legislature is set to adjourn no later than May 21.
At the Capitol March 26, 2018
This past week, Pharmacy Advocacy Task Force co-chair, Jill Strykowski, and her colleague, Dr. Brian Sick, testified in support of Representative Roz Peterson’s HF2962/SF3015 before the Minnesota House Health and Human Services Reform Committee. Dr. Sick gave convincing testimony and urged members of the Committee to support the legislation that would have the Board of Pharmacy determine through protocol how pharmacists will be able to prescribe in three medication categories: opioid antagonist for the treatment of overdose, all tobacco cessation medications other than buproprion and travel medications recommended by the CDC and for use when traveling abroad.
After several questions for the testifiers and Representative Peterson, the House HHS Reform Committee members voted overwhelmingly to pass out of Committee HF2962 and send its final House committee before hopefully heading to the General Register, the House Floor. HF2962, the PATF legislation, will be heard on Tuesday, March 27th in Room 200 of the State Office Building (SOB) in the HHS Finance Committee.
The companion legislation to HF2962 is not yet confirmed for a hearing in the Minnesota Senate, as of this update. However, we are optimistic that SF3015 will get heard by the legislature’s 2nd deadline, Thursday, March 29th.
SF3015 and SF3014 are bills that will go a long was to expanding health care access and increase patient adherence by utilizing one of the most trusted and often times, most convenient health professional - a Minnesota pharmacist to:
There are several other important pharmacy bills moving through the Minnesota legislative process at the Capitol in St. Paul this week. HF3024 & HF3012 will go a long way to allow pharmacists to inform their patients of their medication purchasing options and require that the lowest allowable cost/price be offered to patients in Minnesota, even if it is the cash price.
These two bills will go a long way to rein in some of the egregious practices required in many pharmacy benefit manager contracts. SF2596 (gag order prohibited) was laid on the table for possible inclusion in the Senate HHS omnibus last week. Language providing for partial fill/medication synchronization for patients in benefit contracting was amended onto Dr./Senator Jensen’s SF2596 bill and is currently included in the Senate version of this bill. There are several access and affordability bills that are making their way through the Senate and the House and will probably be included in one final omnibus bill.
If you do not know who your legislators are, please see: Who Represents Me? Please continue to write your Representatives and Senators. PLEASE remember to carbon copy HHS Chairs, Senator Benson and Representative Dean.
Senate HHS Policy and Finance Chair, Michelle Benson:
House HHS Finance Committee Chair:
At the Capitol March 23, 2018
The Pharmacy Advocacy Task Force — a coalition made up of members from MPhA, the Minnesota Society of Health-System Pharmacists (MSHP), The Minnesota College of Clinical Pharmacy (MCCP), The Duluth Area Pharmacists and the University of Minnesota College of Pharmacy — continues its review of the pharmacy practice act with the intent of advancing legislation that removes barriers to the expansion of pharmacy practice.
These bills aim to improve patient access to critical medications in three categories by allowing pharmacists to prescribe these through a statewide protocol. The three medication categories are naloxone, tobacco cessation medications, and travel medications.
Tuesday evening (3/20/18), HF 2962 received a hearing in the Health and Human Services Reform Committee and has passed.
What We Need Now
I am writing to ask that you please help ensure SF 3015 receives a Senate committee hearing.
This bill (along with companion HF 2962, which passed the Health and Human Services Reform Committee) aims to improve patient access to critical medications in 3 categories by allowing pharmacists to prescribe these through a statewide protocol.
We know that:
Use of the medications above does not require a diagnosis and is a matter of choice for the patient, so prescribing these are within the scope of a pharmacist's practice. In the 8 years of training to obtain a doctorate degree in pharmacy, pharmacists obtain extensive clinical knowledge and become experts in medication therapy management.Pharmacists are often the first (and sometimes only) access that patients utilize to the healthcare system. Often, patients may be more comfortable in sharing the need for these medications with their pharmacist vs. other health professionals.
At the Capitol March 15, 2018
Long-time Minnesota Pharmacists Association member Eric Slindee of Sterling Pharmacy testified before the Minnesota House Health and Human Services Reform Committee on behalf of all pharmacy in Minnesota in support of two bills, H.F. 3012 and H.F. 3024. The first bill would prohibit benefit contracts provisions that don’t allow a pharmacist to inform their patients about the lowest cost of medications and potentially much more affordable medication options even if for a cash purchase of medications outside of benefit networks if that option is less expensive.
The second bill would prohibit pharmacy benefit manager and insurer pharmacy contracts from requiring an individual (patient) make a payment in an amount greater than the allowable cost to consumers, as defined by (1) the applicable co-payment for the prescription medication, (2) the allowable claim amount for the prescription medication, or (3) the amount an individual would pay for the prescription medication if the individual purchased the prescription medication without using a health plan benefit. This would ensure that the patient is only paying the lowest amount possible for the medication they seek, even if that price is lower than their co-pay or Usual and Customary price.
Please call, write or email your legislator today and ask them to support the following two bills that will next be headed to the Minnesota House Commerce Committee:
Peterson, Hamilton, Zerwas, Gruenhagen, Frieberg and Liebling; Jensen, Klein, Franzen, Utke, Nelson introduced:
In addition to these two bills, Representative Roz Peterson as well as Senator Jensen Chief authored and introduced HF 3783 that when enacted would provide reasonable fair practice protections for patients that allow pharmacists to provide the best care and advice at the lowest costs to patients. These provisions would also ensure greater patient choice and access which leads to greater adherence and better health outcomes.
We are still hoping that the legislature will hear and act on the following bills and we urge you to contact your Senator and Representative to ask them to support and call for a hearing on:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
We are also watching and providing input to legislators and the authors of several legislative proposals related to the opioid crisis. One of the bills, Senator Rosen’s SF 730, would place an Opiate Stewardship fee (some say tax) on manufacturers and wholesalers of opioid medications. It would also require pharmacists to report monthly the previous month’s deliveries and distributions of opioid medications and would create an Opiate Stewardship Advisory Council.
Here is how the fee would be calculated:
The board must calculate the fee that is to be paid by each manufacturer by using a base rate for all drugs listed in subdivision 1, and multipliers of the base rate for certain drugs and dosage forms as specified in this subdivision.
House and Senate leadership are opposed to a new tax at this time. Stakeholders, including MPhA, have weighed in with Senator Rosen and legislators to let them know the current proposal could increase by two to three fold opioid medication costs and that the fee will ultimately be paid by the patient/consumer.
The Minnesota legislature convened February 20 and went straight to work on the bonding or short year of the two-year session. The House and Senate quickly put a period on the end of the 2017 session by passing the Legislature’s 2018-19 budget that Gov. Mark Dayton vetoed last May. The 2018 legislative session was met with a new wrinkle when US Sen. Al Franken resigned in early January and Gov. Dayton appointed his Lt. Gov., Tina Smith, to fill out the US Senate term until the next election can fill the seat.
Because Lt. Gov. Smith is now Sen. Smith, the Minnesota Constitution clearly indicates that the President of the Minnesota Senate, in this case Sen. Michelle Fischbach, shall ascend to become the lieutenant governor when there is a vacancy. The Constitution is not so clear on whether the lieutenant governor can serve as a state senator at the same time. This question still remains. As of this update the lieutenant governor has acted in her capacity as both a state senator and the President of the Senate while being lieutenant governor for the past two and a half weeks.
The Ramsey County Court, where a case had been filed by a constituent of Sen. Fischbach prior to the start/reconvening of the legislative session this year, said the case “wasn’t ripe.” It is not clear if the case has now ripened since the senator has taken a vote as a member of the Legislature while she is at the same time acting in her capacity as lieutenant governor. This is all critical because the Minnesota Senate stands at a 34-33 seat majority for the Republicans. If the Court would rule that Sen. Fischbach cannot serve in both branches/both capacities, it could open her seat for a special election being called and presumably a 33-33 tie in the Senate would occur. Stay tuned…
For the month of March, the legislature is focused on hearing bills introduced this year and last year and moving them through the legislative process. The first committee deadline is March 22, the second deadline is March 29, and the third deadline is April 20. Bills must be heard and passed out of one house by the first deadline, both houses by the second deadline and clear any necessary Finance Committees by third deadline to be considered this session.
Legislative Day and the PATF Agenda
On Feb. 27, MPhA – in conjunction with the Minnesota Society of Health-System Pharmacists (MSHP), the Minnesota Retailers Association (MnRA), the Minnesota Grocers Association (MGA) and the Pharmacy Advocacy Task Force (PATF) – had its most successful Legislative Day in recent memory. Nearly 200 pharmacists and student pharmacist participants made over 75 visits. The meetings were a huge success, including getting commitments from Sens. Scott Jensen (R) and Matt Klein (DFL), both physicians, to chief and co-author the PATF legislation that will be introduced the week of March 5 in the Senate as a companion to the PATF legislation recently introduced in the House, HF2962. The key distinction between HF 2962 and HF1140 (PATF legislation introduced last year) is, HF2962 does not include the hormonal contraceptive prescribing authorizing language. The legislation and its companion in the Senate call for prescribing authority for pharmacists in three medication categories: naloxone, smoking cessation medications and travel medications.
The same Senate co-sponsors have also agreed to co-author legislation that would provide for broad medication administration for pharmacists in Minnesota, another priority of the PATF. Reps. Roz Peterson (R) and Dave Baker (R) introduced the companion medication administration expanded authority for pharmacists in the House, HF3250 (check back for updated Senate bill numbers soon).
Patient Fair Practices/PBM Reform
Additionally, several bills that are gaining steam and beginning to gather a lot of attention were introduced in the House and Senate; they would protect patients and pharmacists from unfair practices by health insurers and pharmacy benefit managers (PBMs).
Additional co-sponsors in the House and Senate for both PATF bills as well as fair practices form will be sought over the coming days and weeks. The PATF prioritized legislation and all but the Department of Commerce-PBM regulation bill have been referred to the House and Senate Health and Human Services Committees, where the legislation will need to be heard and passed out of before either heading to an additional committee(s) before being sent to the House or Senate floors.
CALL TO ACTION:
PLEASE call or write your Senator or Representative today - Who Represents Me? - Use the district finder to retrieve a list of your representatives with contact information. Ask them to support and co-sponsor the PATF legislation (HF2962/SF3015 & HF3250/SF3014). Also, please ask them to support patient and pharmacy fair practice protections!
Peterson, Baker; Jensen, Klein, Lourey, Rosen introduced:
Patient Fair Practices/PBM Reform Bills:
Peterson, Hamilton, Zerwas, Gruenhagen, Miller and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
Zerwas, Hamilton, McDonald and Peterson; Jensen, Nelson, Draheim, Wiklund introduced:
Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
The 2018 Legislature – Pharmacists: Part of the Solution
The Minnesota House and Senate legislative session was gaveled in on Tuesday, Feb. 20. The start of the second year of the Minnesota Legislative Session is known as the “short” and/or “bonding” session/year. The legislature must adjourn by May 21. Only the Governor can call the legislature back into a special session after the May adjournment date. (The state constitution limits the legislature to meeting 120 legislative days during each biennium. In addition, the legislature may not meet in regular session after the first Monday following the third Saturday in May of any year.)
There are many uncertainties as we head into the 2018 session. First, the legislature must pass and the Governor sign into law the legislature’s biennial budget. The Governor, in an attempt to force the Legislature back to the negotiating table, line-item vetoed the funding after the legislature adjourned in 2017. It appears that the Governor and the legislature have agreed the first order of business will be to pass and sign into law a clean funding bill for the legislature.
Gov. Dayton’s appointment of Lt. Gov. Tina Smith to Sen. Al Franken’s seat has created a new constitutional crisis for the Minnesota Legislature. According to the Minnesota Constitution, current Senate President and GOP Sen. Michelle Fischbach is now the Lieutenant Governor. There are differing opinions on whether Sen. Fischbach may retain her senate position and serve as Lieutenant Governor. A case was filed in the courts making the case she could not serve in both roles, however, the courts have said the case “is not ripe” because Lt. Gov. Fischbach has not yet taken a vote in the Senate. It is the Senator’s intention to do both and likely the Senate DFL’s intention to force the courts to decide whether that decision is legally sound.
Currently, the GOP controls the Minnesota Senate by a 34-33 margin after a special election DFL victory in early February to retain Sen. Dan Schoen’s seat, which he resigned last fall. Because the DFL retains the seat, the one-seat margin could move the Senate temporarily into a 33-33 tie, if the court says Lt. Gov. Fischbach cannot serve in both capacities. Presumably in this case, a special election would be necessary to fill the Fischbach seat. Given the likelihood the issue will be resolved by the courts, it’s not likely the seat would be filled until later in the 2018 Session. A 33-33 tie would likely throw the 2018 session into complete turmoil. Hopefully, this is all resolved soon.
This is all to say that there are a number of moving pieces — but with all things being equal and a Legislative Session going forward as planned, the Legislature will adjourn in late May.
The Pharmacy Advocacy Taskforce (PATF) Agenda:
This year the PATF is putting on a full-court press to help Minnesota pharmacists have the opportunity to practice at the top of their license. We hope to have a hearing, see movement and hopefully enactment of legislative proposals that the PATF is advocating for. The PATF’s legislative agenda includes:
Pharmacists Expanding Healthcare Access: Legislative Summary: MN HF1140‐SF1049
EXPANDING PATIENT ACCESS TO CARE:
Amid growing concern about lack of access to primary care providers, pharmacists are an untapped resource. Underserved populations have many barriers to receiving adequate health care needs, such as transportation and cost. Rural and economically disadvantaged urban areas have less than half the rate of primary care physicians as wealthier urban areas, meaning that patients often have to travel long distances or wait for months to see their doctor. Ninety‐three percent of Americans live within five miles of a community pharmacy, many of which are open 12 to 16 hours a day, seven days a week. According to the World Health Organization:
“Community pharmacists are the health professionals most accessible to the public.”
Opioids have killed more than 2,700 Minnesotans in the last 15 years. More than 80% of these deaths involved prescription drugs, and nearly 60% have occurred in the past 5 years. There were 355 deaths in 2015 and a 31% increase in 2016. Hennepin County saw a record 144 opioid‐related deaths in 2016. A study by the National Bureau of Economic Research found that legislation that expanded the access of naloxone to the public was “associated with a 9 to 11 percent reduction in opioid‐related deaths....” This study also states that there was “little evidence that these laws increase the recreational use of prescription painkillers.” Increased access to naloxone can save lives.
In Minnesota in 2010, the federal and state governments spent $332.6 million on unintended pregnancies; of this, $203.9 million was paid by the federal government and $128.7 million was paid by the state. The total public costs for unintended pregnancies in 2010 was $318 per woman aged 15-44 in Minnesota, compared with $201 per woman nationally. Increasing the scope of pharmacist practice to prescribe oral hormonal contraceptives can increase access to care for many patients, and help reduce the negative effects of unintended pregnancies on an individual and community level by removing unnecessary and inefficient barriers.
TOBACCO CESSATION TREATMENT
According to the Minnesota Department of Health, smoking causes 5,900 deaths and over $2.5 billion in medical costs every year in Minnesota. A study found that community pharmacist intervention led to a 12.7% increase in smoking cessation rates through interventions related to nicotine replacement.
International tourists are estimated to reach 1.6 billion by 2020, with an increasing proportion visiting the developing world. Providing Minnesota pharmacists with the ability to prescribe medications according to the CDC for travel abroad would enhance access to recommended medications and be a practical convenience for thousands of Minnesotans. It also will help Minnesotans stay healthy while traveling and returning home. Travel medications include: vaccines, medications for traveler’s diarrhea and malaria prevention.
We are seeking changes to Minnesota pharmacy medication administration law. A bill will be introduced the first week of session with changes that would provide Minnesota pharmacists with broader authority to administer medications. Currently in Minnesota, pharmacists can only provide prescription drug medication administration for first dose and on an emergency basis. Minnesota pharmacists can also provide vaccinations. However, unlike in 29 other states, pharmacists in our state cannot provide pharmacy-based medication administration services (MAS). Pharmacy-based MAS improves public health by facilitating patient access to care, supporting patients with improved access to needed services, decreasing stigma, and enhancing collaboration with the health care team.
Patients who can benefit from MAS may encounter challenges such as scheduling conflicts with prescribers, difficulty with medication adherence, and a lack of knowledge of the medication or administration of the medication. In the provision of MAS, pharmacists meet with patients regularly to provide education on medications, help patients manage all prescribed medications, support interventions that improve the quality of care, engage as part of the health care team, and ensure that patients are receiving the expected benefits from treatment. Pharmacy-based MAS can also assist patients who struggle with self-injection by providing initial education and support on medication self-administration, ensuring appropriate follow-up to monitor proper technique, reporting any adverse events, and addressing barriers to adherence.
The PATF, in conjunction with MPhA, has begun meeting with and educating legislators about our legislative agenda and learning about House and Senate member priorities for the session. Feb. 27 is Pharmacy Legislative Day at the Capitol in St. Paul. We hope to have as many pharmacist attendees as possible meet with a majority of the legislative members on the Senate and House Health and Human Services Committees.
Other Impactful Legislation:
Thousands of bills are introduced each session; only a small percentage of those proposals will impact Minnesota pharmacy. Here are several of the bills and executive branch initiatives we are following during the session this year.
SF593/HF747 [Hamilton/Nelson]: Prescription Drug Coverage Prior Authorization; drug transparency and disclosure requirement. The prior authorization bill would, among other things, prohibit “mid-year” drug switching by health plans and/or their PBMs. In the Senate, the HHS Policy and Finance Committee laid the bill over last year for possible inclusion in the Senate Finance Omnibus. It was not included. The bill was not heard in the House Commerce Committee, where it has been referred. Technically it’s still alive, but at this point it does not look like the proposal will make it through the House this year.
SF1509/HF1819 [Zerwas/Abler]: The legislation that contains the pharmacist reimbursement rate increase and Medicaid decrease was heard and passed out of both the Senate and House and was included in the final Senate HHS Finance Omnibus legislation, SF 800, which was ultimately vetoed. Although the bill was also included in the Governor’s supplemental ’17 budget, it did not make the final negotiation cuts to the HHS Finance bill. Also, there is a fiscal note of $4.7 for the ‘17-18 biennium and tails for the ‘19-20 biennium. We assume there will be a supplemental budget bill this year, but what will include is not known. We have made it clear to Committee staff and members that we want to see the reimbursement rate changes passed last year enacted this year.
State law makers and the public want to do something, anything, to try to reverse the trends in addiction and overdose deaths; this issue is front and center as session begins. The Governor and a bipartisan group of lawmakers have proposed a package to help bring relief to affected Minnesotans. The proposal includes a “penny per pill” tax (the current proposal would be a tax per pill to the manufacturer at a graduated rate based on quantity). The proposal would generate approximately $20 million a year. Those dollars would be spent on treatment services, wide distribution of naloxone and potentially pay for needed technical upgrades to the current PMP. There are several other ideas about how to tackle the opioid crisis at the legislature left over from last year and yet to be proposed this session.
Here are the opiate related bills that are currently introduced that have some chance of passing:
Finally, the legislature may be poised to act on reforms proposed to protect patients and providers from unfair Pharmacy Benefit Managers (PBMs) practices and policies. Growing frustration with pharmacy benefit managers, health insurers and pharmaceutical companies has driven legislators of all stripes as well as Gov. Dayton to call for reforms to our current health care system. The 2017 Session began with a hearing in the House Health and Human Services Finance Committee on health care network access and the Senate looked poised to pass prior-authorization protections/reform, but ultimately meaningful reforms did not occur in 2017.
Over the past 7 months, Sens. Jensen and Klein have led a senate effort to examine health care access and affordability with their colleagues. We don’t know yet what, if anything, will come from the Select Committee on Affordability and Accessibility’s deliberations this past summer and fall. Last year, Sen. Jensen introduced bipartisan legislation to ensure any health care provider willing to agree to the same contractual terms and conditions as in-network providers would be guaranteed access to the network for their patients. The legislation did not receive a vote in committee, but started a conversation and debate about the rights of patients and their providers versus insurer and payers of health care services and medications.
The Minnesota Legislature’s focus on the topic over the past 12 months has grown acute with the level of mistrust and anger voiced by patients toward their insurers (including the State of Minnesota). Constituents of rural legislators are voicing concerns about limited access to care and challenges getting their prescriptions from their local pharmacy.
Some legislators, such as Reps. Hamilton and Peterson, believe Minnesotans have grown tired of being told by their insurers they have to switch medications prescribed by their doctors mid-year, pay high deductibles, multiple co-pays or more for their medications in-network than they could pay with cash down the street. They have also been mandated to receive their medications from mail-order specialty pharmacies owned by their insurers and providers are being limited and regulated by insurers in terms of treatment, diagnosis and medication options.
All this is having an undesirable effect on patient health outcomes as well. However, while it appears that the legislature will move forward this year to broaden access and rein in affordability, there are still powerful interests — and legislators who support those interests — standing in the way of legitimate reform legislation. As a consequence, no significant patient protections have made it to either floor of the House or Senate in the past 3 years. In addition, state agencies such as DHS have sided with insurers in terms of the “cost” debate surrounding these proposals. To date, all patient and provider protections in proposed legislation have been issued a fiscal note with fairly significant cost estimates to the state. We will see if 2018 is any different.
There are and will be additional bills that surface that may affect Minnesota Pharmacy. We will be sure to add those bills to our next update. Look for another legislative update as we approach committee deadlines in March. If you have any questions or would like to get in touch with our PATF Government Affairs representative, Buck Humphrey, he can be reached at: