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Legislative Update – May 20, 2019

On the eve of the Minnesota legislature being down to hours to finish their work, legislative leaders and the Governor announced a budget deal framework to complete the Minnesota 2019 budget session and set a two-year budget for fiscal years 2020 and 2021 for Minnesota. The deal came after days of negotiations behind closed doors between Governor Walz, Speaker Hortman and Senate Majority Leader Gazelka.

Those close to the budget negotiations and legislative leaders assume the legislative process will continue into a Special Session, beginning Thursday and potentially needing floor time through the Memorial Day weekend. Omnibus budget conference committees have been given a deadline of having their bill provisions agreed to by 5:00 PM today (HHS may need extra time to get done after that deadline).

A couple wrinkles still exist. First, House Minority Leader Daudt was not consulted on the budget deal and has shared his public “disgust” with the deal. This is important because any vote to suspend the rules in the House or to approve a bonding bill needs a 2/3rds vote to be passed. To get the budget bills and a bonding bill done, the House will need at least 6 Republican votes.

Second, once the legislature adjourns tonight, bills introduced or not having passed during the “regular” session do not transfer to a Special Session. So, all Omnibus budget bills will have to be reintroduced as “new” Special Session bills. Current budget conference reports can’t be amended on the floor, however, new bills introduced in the Special Session can be amended unless the House and Senate suspend their rules and declare the newly introduced budget bills not amendable.

While a big deal is being made about a Special Session, only 2 of the 9 previous budget years have not gone to a Special Session in the 21st Century. Only the Governor can call the legislature back into Special Session and he had agreed to do so as part of the budget framework. While Senate Minority Leader Bakk said that the budget agreement is fragile, most legislators and the Governor believe the deal will be completed.

Under the agreement, the Health and Human Services (HHS) budget target reduces overall spending by $357.9M in 2020-2021 and $557.2M in 2022-2023.  However, this is offset by $270M in 2020-2021 and $514 in spending on health care through the Health Care Access Fund (HCAF), which is funded by the wholesaler/provider tax.  This amounts to an actual reduction of approximately $87.9M in 2020-2021 and $43.2M in 2022-2023. It is not an apple to apples comparison because there are some General Fund shifts and vice versa from the HCAF.

Part of the framework included the repeal of the wholesaler/provider tax sunset law, which was effective December 31st, 2019, and would have eliminated the tax and its $700M in annual revenues. In exchange for the repeal, the Governor and House agreed to reduce the wholesaler/provider tax rate from 2% to 1.8% moving forward. They also agreed to maintain the current reinsurance program to buy down premium rates on the individual – MNSure market. 

The Health and Human Services Omnibus bill, SF2414, will now be considered and provisions adopted in earnest over the next 24-48 hours before being combined with one or more omnibus bills, introduced in both House and Senate during the Special Session and then sent to the Governor for his signature. It should be noted that the following pharmacy related/priority provisions are already included in the HF2414 Conference Report:

  • Authority for Emergency Prescription Refills
  • Prescription Drug Repository Program - LTC PDs recycling program
  • Recipient of Emergency Prescription Orders & Drug Coverage in Emergency Situations and payment
  • Patients Fair Practices – PBM licensure and regulation (will be removed now that SF278 has become law)
  • Many of the conforming provisions that the MN Board of Pharmacy wanted passed as well as wholesaler definitions, emergency veterinary compounding and other MBOP priorities.

While there is an overall budget deal, HHS funding decisions are still to be made under the agreed upon targets. The HHS Conference Committee is supposed to meet tonight. The Outpatient Drug Rule provisions, ingredient (NADAC) and $10.48 pharmacy dispensing reimbursement rate changes as well as the wholesaler/provider tax reimbursement for fee-for-service Medical Assistance and MNCare transactions language are slated for discussion. The Senate has yet to post their detailed HHS funding proposal. The House released their HHS budget details earlier today. We have encouraged the Senate and HHS Senate Committee Chair Benson to include the reimbursement language, including the provider tax reimbursement language in her proposal. We should know more about the exact HHS budget details in the next 48 hours.

The HF400, Opioid Stewardship Conference Committee convened this afternoon and adopted a final agreement just about an hour ago between House and Senate Conferees. The adopted Conference Report (SCH0400A25 (PDF); 5.20.19 Opioid CC Appropriation Proposal (PDF)) will now go to the House and Senate floor where it cannot be amended and will presumably be adopted by both houses of the legislature and be on the Governor’s desk for his signature before they adjourn midnight, tonight. The agreed to Opioid Stewardship legislation will appropriate $20 million annually for addiction prevention grants, county child protection funding and other direct appropriations to organizations like the Rummler HOPE Foundation. There is also funding to further improve the PDMP and will the first time mandate providers access and utilize the PDMP when prescribing opiates to patients in most situations.

Conferees also came to agreement on the “sunset” provision in the Opioid Stewardship bill that Senate Republicans moved towards in their last offer to House conferees yesterday. Under the agreement, any manufacturers or wholesalers settlement dollars that would be realized by the State would go to fund the $20 million annual Opioid Stewardship budget/expenditures called for in the legislation. A sunset on manufacturer and wholesaler fees mandated in the legislation would occur should a $250M threshold be reached through settlement proceeds.

Two provisions of import to Minnesota pharmacy that were also included in the Opioid Stewardship legislation included:

  • Limited medication administration of opioid or alcohol addiction or mental health treatment medications through sub Q and IM shots under a doctor’s prescriptive orders or a collaborative practice agreement.
  • Original language included in both the House and Senate Opioid legislation would have limited refills of all schedule III and IV opiates and would have required patients to see a provider/their doctor or APRN for any refill and had the dose limited to 30 days. However, after long detailed explanation work with legislators by MPhA leadership and the understanding by Senator Rosen and Representative Baker that a large patient population would be negatively impacted, compromise language was finally included and adopted in the Conference Report that will allow providers to prescribe patients multiple 30 day refills of schedule III and IV opioid medications for up to the 6 months (federal law limitation) before the patient would need to see their prescribing provider again for a new prescription.

Legislative Update – May 13, 2019

The Minnesota 2019 legislative session continued in earnest last week as legislators moved towards the finish line−the May 20th session adjournment date. There were House and Senate omnibus budget hearings where legislators and committee staff walked through differences contained in each budget bill. They continue those walk-throughs this week. There have been several heated discussions and a few tear jerker testimonials by Conferees. All omnibus budget conference committees/bills will need to adopt final budget and policy language before passing their Conference Report and sending the product to the Governor for his signature by the constitutionally mandated adjournment date.

The Governor and his team are now engaged in final budget negotiations with the House and Senate. After fishing together in Albert Lea this weekend at the Governor’s Fishing Opener, there was hope that something would move the parties closer. That did not happen during Sunday night’s scheduled meeting between the Speaker, Governor and Senate Majority Leader. The Senate did not have a counter offer to the Governor’s first crack at a compromise. Last week, the Governor made an initial offer of reducing the expenditures in his overall budget by $200 million as a “good faith effort” to start negotiations.

One of the major sticking points is the current 2% wholesaler/Provider tax law which is scheduled to sunset. The Senate and House Republicans are insisting that the sunset occur. The Governor and House DFLer’s are just as insistent that the State budget must have that taxes’ revenue, an estimated $700 million in the next biennium. There is also the question of reinsurance for the individual-MNSure health insurance marketplace.

In most instances, the House and Governor are far apart on budget targets and have drastically different approaches to funding and spending priorities. There are also many provisions and technical or conforming changes to Minnesota statute and policy that are included in each omnibus budget bill that remain undecided. These provisions will begin to be adopted into the various conference reports this week.

There are policy provisions included in the Health and Human Services Omnibus budget bill, HF2414,important to Minnesota pharmacy, including the outcome of the CMS Covered Outpatient Drug Rule on FFS Medicaid pharmacy reimbursement. The OPDR authorizing reimbursement changes language is included in both the Senate and House HHS omnibus budget bills, but the Senate version does not include the 2% wholesaler/Provider tax reimbursement or the hospitals 340B appropriations language.

Additional provisions included in the House version of HF2414 that are Minnesota pharmacy priorities or would impact Minnesota pharmacy are:

  • Authority for Emergency Prescription Refills
  • Prescription Drug Repository Program - LTC PDs recycling program
  • Recipient of Emergency Prescription Orders & Drug Coverage in Emergency Situations and payment
  • Patients Fair Practices – PBM licensure and regulation (still included until standalone-SF278 is adopted.)
  • The House version of the HHS Omnibus includes many of the conforming provisions that the MN Board of Pharmacy wants passed as well as wholesaler definitions, Emergency Veterinary Compounding and other MBOP priorities.

The Patient’s Fair Practices (PFP) legislation, SF278 in the House, took another giant step forward in the legislative process as it was passed on the House floor by an 87-42 vote. SF278 will be conferenced on Tuesday, May 14th, with several controversial provisions still to be worked out. The Senate version would not require a PBM to be a fiduciary, the House bill would. The House bill language calls for transparency reporting based on de-identified claims level date, the Senate version only requires aggregated data reporting. We are urging Conference Committee members to adopt the House language in both instances.

Assuming the SF278 Conference Committee finishes their work on Tuesday, the Conference Report legislation would then need to be passed again by both the House and Senate. These votes will most likely take place between Tuesday and Thursday.

The Senate and House Opioid Stewardship (OS) Conference Committee met twice last week. The Senate presented their initial offer Monday, the House Conferees countered with an offer on Friday and a curve-ball was thrown into the mix when Representative Baker and Senator Eaton articulated yet a third alternative.

In addition to the impasse over the “sunset” provision that Senate Republicans are insisting on, there was a conflict over how the $20 million should be spent and how to fund the Opioid Stewardship account. In the Senate version of HF400, the sunset would occur if there were settlements with manufacturers. The settlement proceeds would fund the $20 million annual Opioid Stewardship budget/funding and a sunset on manufacturer and wholesaler fees would occur. Democrats on the Conference Committee and the Governor do not support a sunset. The Conference Committee will meet again this week. It is unclear if the HF400 Conferees will come to agreement before next Monday when the legislature must adjourn for the year.


Legislative Update – May 3, 2019

SF278, the Patient’s Fair Practices – PBM licensure and regulation legislation, was heard in the House Ways & Means and Rules Committees this week and is now set for a vote on the House floor next Tuesday or Wednesday, May 7th or 8th. All pharmacists should contact their state legislators (House and Senate members) and encourage them to vote for SF278.

The House and Senate continued their work on separate Health and Human Services Omnibus (HHS) budget legislation, each adopting their versions of the HHS budget. The 2-year budget must be balanced and enacted for FY 20 & 21 spending. The HHS Conference Committee will begin meeting today and plan to finish their work by next week so a final HHS budget bill can be sent to the Governor for signature. There is skepticism on the Hill that final budget deals will be completed before the May 20th constitutionally mandated adjournment date, including the HHS budget. Many see a Special Session on the horizon.

There are significant differences in the House and Senate budget bills with the health and human services areas particularly far apart. The Senate bill would continue the individual market premium subsidies through the current reinsurance model, the House would not. The House would provide tax credits and a direct subsidy to the patients utilizing the individual health insurance market through HMOs. The Senate bill does not include a repeal of the 2% Provider/Wholesaler tax. The House does and uses the Health Care Access Fund to fund a large portion of MDHS and other HHS programs included in the House budget. Both House and Senate members have said they were not interested in compromising on these and other impactful areas of the budget.

Significant to Minnesota pharmacy is that although both bills would put the state in compliance with the CMS Covered Outpatient Drug Rule, the Senate language does not include a provision that is in the House bill to reimburse pharmacists the 2% wholesaler tax on fee-for-service MDHS transactions. The Senate language also does not include the provisions listed below that are all contained in the House Omnibus budget bill.  MPhA and the Minnesota Pharmacy Alliance are working hard to make sure these provisions are included in the final HHS Conference Report that goes to the Governor.

  • Patients Fair Practices – PBM licensure and regulation,
  • Emergency prescribing for pharmacists, 
  • Minnesota Board of Pharmacy's "policy" provisions,
  • The LTC medication repository/recycling bill language, and
  • The CMS Covered Outpatient Drug Rule (OPDR) implementation legislative language and appropriation.

The Senate and House Opioid Stewardship (OS) Conference Committee, HF400, did not meet this week. Those close to the negotiations report that there is an impasse over the “sunset” provision that Republicans are insisting on. The sunset would occur if there is a settlement with manufacturers that would fund the $20 million annual Opioid Stewardship budget/funding called for in the legislation. Democrats on the Conference Committee and the Governor do not support a sunset. Conference members are also said to be in disagreement about the ultimate funding mechanism for the annual $20 million stewardship account appropriations. The Conference Committee will most likely meet again next week.


Legislative Update – April 29, 2019

Last week was among the most productive at the Capitol in terms of passing a significant amount of the budget legislation that will end up being enacted this year. Much of the Governor/House DFL and Senate Republican’s policy proposals included in the Omnibus spending bills will most likely not become law, such as the Governor's OneCare buy-in proposal and Senate's direct subsidy to health insurers.  However, the framework and the budget parameters included in the House and Senate Health and Human Services spending bills was defined this past week. The rest of the Omnibus spending bills are to be passed out of their respective floors by Wednesday, May 1st , before the final budget conference committee process begins.

Last Thursday, April 25th, after a 9 hour floor debate and considering over 100 amendments, the House passed on a party -line vote their HHS budget legislation, HF2414, which includes relevant pharmacy legislation such as:

  • Patients Fair Practices – PBM licensure and regulation;
  • Emergency prescribing for pharmacists;
  • Minnesota Board of Pharmacy's "policy" provisions;
  • The LTC medication repository/recycling bill language; and, 
  • The CMS Covered Outpatient Drug Rule (OpDR) implementation legislative language and appropriation.

The Senate Finance Committee also met last Thursday to combine the HHS Reform and HHS Finance budget bills into a single Senate HHS Omnibus budget, SF2452. The bill was significantly amended and now includes a bare-bones version of the OpDR implementation language and appropriation. Consequential to pharmacies and hospitals in Minnesota is that neither the 2%-Wholesaler/Provider tax reimbursement or the 340B fix language and funding was included in the Senate bill. The OpDR language would move fee-for-service reimbursement to an ingredient cost variable of the NADAC and a dispensing rate of $10.48.

The Senate HHS Omnibus budget legislation will be taken up on the Senate floor either today, Tuesday or Wednesday. The House and Senate bills will then be conferenced next week after the budget conference committees receive their fiscal targets. The conference committee process is where we will work to have all the non-controversial Minnesota pharmacy legislative priorities that are contained in the House Omnibus bill included in the final HHS Omnibus budget bill sent to Governor Walz.

The Senate and House Opioid Stewardship (OS) Conference Committee did not meet last week. Those close to the negotiations report that there is an impasse over the “sunset” provision that Republicans are insisting on. A sunset would occur if there is a settlement with manufacturers that proceeds would fund the $20 million annual Opioid Stewardship budget/funding called for in the legislation. Democrats on the Conference Committee and the Governor do not support a sunset. The Conference Committee will most likely meet again late next week.

The Patient’s Fair Practices (PFP) legislation, SF278, took another step forward in the legislative process as the House version of the PBM licensure and regulation bill was included and passed as part of the House HHS Omnibus budget bill, HF2414. As a fall back, this guarantees that the PFP legislation can be a part of the final HHS budget conference process. The House Ways and Means Committee will also hear the stand-alone PFP bill, SF278, this Wednesday, May 1st at 9:30 AM. The bill would then be sent to the General Register/to the House floor for a vote most likely late next week or sometime the following. It will then be conferenced with the Senate SF278 language unanimously passed three weeks ago. Information on the hearing follows.

Wednesday, May 01, 2019 at 9:30 AM

Chair: Rep. Lyndon Carlson
Location: 200 State Office Building
Agenda:

SF278 (Mann) Minnesota Pharmacy Benefit Manager Licensure and Regulation Act; appropriations
HF2542 (Hausman) Omnibus Housing Policy bill
HF 2849 (Bernardy) Argosy University closure student relief provided, and report required.

Other bills may be added

Bills:
SF278 - (Mann) - Pharmacy benefit managers licensure and regulations created, and rulemaking authorized.


Legislative Update – April 16, 2019

The Minnesota legislature is officially on recess-Spring break. Using a football analogy, the legislature will be starting the 4th quarter of the game when they return on Tuesday, April 23rd. This past Friday was the legislature’s 3rd committee deadline: when all finance, bonding and tax bills must have been heard by their respective committees and be either passed out to the House Ways and Means Committee or in the case of the Senate, a bill would need to be to the Finance Committee.

The next, less certain, legislative deadline agreed to by Senate Majority Leader Gazelka and Speaker Hortman earlier in the legislative session requires both the Senate and House to have all of their budget bills passed off their respective floors and budget bill conferees named by May 1st. The Governor, Senate Majority Leader, and Speaker of the House will then provide agreed upon fiscal targets to the chairs of conference committees by May 6th, and conference committee chairs will complete conference committee reports to the house of origin by May 13th. The legislature then has until May 18th or so to send their passed budget legislation to the Governor for signature or veto.

Republican and DFL leaders as well as Governor Walz have all publicly promoted bi-partisanship and compromise. Yet, the Governor/House's DFL budget is vastly different than the Senate Republican budget legislation, both of which passed before the break. It is unclear at this time if a Special Session will be needed or if all final conferenced budget bills (compromises) will get signed by the Governor by the constitutionally mandated end of this year of the session, May 20th.

This past week, both the House and Senate moved their HHS Omnibus budget spending bills through the relevant committees to meet the 3rd legislative deadline requirements. The House HHS budget legislation, HF2414, was voted out of the House Ways and Means and Taxes Committees this past Tuesday and Thursday and was then referred to the General Register/the House floor for a vote, which will most likely take place the week the legislature returns.  It includes:

  • The Patients Fair Practices – PBM licensure and regulation;
  • Emergency prescribing for pharmacists;
  • Minnesota Board of Pharmacy's "policy" provisions;
  • The LTC medication repository/recycling bill language;
  • The CMS Covered Outpatient Drug Rule (OPDR) implementation legislative language and appropriation; and,  
  • A few other pharmacy related provisions

The Senate HHS budget legislation, SF2452, which stands in stark contrast to the House bill, does not include any Minnesota pharmacy legislative priorities. However, this is not an indication that pharmacy priorities contained in the House HHS Omnibus legislation will not end up in the final HHS Omnibus Budget Conference Report and ultimately be signed by Governor Walz. The Senate HHS budget bill was meant to send a message to the DFL House and Administration that many of the HHS provisions the DFL would like to see enacted will have to be considered in the context of the Republican HHS priorities too. Other broader health care funding issues such as the Senate Republican's insistence on continuing the individual market premium reductions through reinsurance as opposed to a direct patient subsidy and tax credit that the DFL favors along with the DFL's insistence on a repeal of the Wholesaler/Provider 2% tax sunset and the Senate wanting the sunset to remain in place, are just two of the most visible issues that the bills highlight.  The Senate Omnibus budget bill met 3rd legislative deadline by being heard by the Senate HHS Finance Committee last Wednesday and favorably sent to the full Senate Finance Committee.

Presumably the House and Senate HHS Omnibus budget bills will be adopted in their respective Houses by May 1st. Because the Senate conducted hearings on all provisions included in the House HHS Omnibus legislation, other than the Minnesota Board of Pharmacy Senate Legislation, SF2169, those provisions already given a Senate hearing will most likely end up in the final Senate and House HHS Budget Conference Report that will be sent to the Governor. The Minnesota Board of Pharmacy legislative language did not receive a hearing in a Senate HHS committee, so it faces an uphill battle to be included in the final HHS Omnibus Budget Report. Executive Director  Wiberg and other stakeholders are working to have the language included.

The Senate and House Opioid Stewardship (OS) Conference Committee held their initial meeting last week to combine the House and Senate versions of HF400 (2nd Unofficial Engrossment ). Most important among the difficult issues yet to be tackled are the very different funding mechanisms adopted by the House and Senate to raise $20M revenue for the opioid stewardship account. One of the few conference report provisions adopted by the conferees Monday night was the Senate’s limited medication administration authority for pharmacists language.  The conferees plan to meet again the week of the 23rd to continue adopting Report provisions. Unless there is a major change to the current Report, the medication administration section/authorizing language should be included as a provision of the final enacted OS legislation.

The Patient’s Fair Practices (PFP) legislation, SF278, took another step forward in the legislative process.

The House HHS Finance Committee held a hearing to procedurally move the House PFP legislative language in HF728 into SF278, which had been received earlier in the week from the Senate. The House Ways and Means Committee, the bill-SF278's next stop, will take up the PFP legislation after the recess. The bill would then be sent to the General Register/to the House floor for a vote. Once passed by the House the bill language will then be ready to be conferenced with the Senate SF278 language.


Legislative Update – April 9, 2019

Last week was another successful one for Minnesota pharmacy’s legislative priorities. Wednesday, the Senate Finance Committee heard the Patient’s fair Practices-PBM licensure and regulation legislation, SF278, and voted it out favorably to the Senate floor. The legislation was then given a vote Thursday in the Senate where it was adopted unanimously (67-0). Thursday’s Senate floor session included incredible testimony from Senate members who spoke about holding PBMs accountable, leveling the playing field for Minnesota pharmacies and pharmacists, reining in out of control drug prices through transparency and prohibiting several egregious PBM practices impacting care and Minnesota pharmacy. You can access the video of the Senate floor session at the link below.

Senate Passes Bills to Bring Transparency to Health Care Costs
Link to Senate video: https://www.youtube.com/watch?v=tHXpPPqnC08#action=share

While adoption of the legislation in the Minnesota Senate is a milestone, the Senate bill will need to be conferenced with its House companion, HF728, or potentially with the House HHS Finance Omnibus budget legislation. The House HHS Omnibus currently contains the Patients Fair Practice (PFP) language, HF728. According to Chair Liebling, who mentioned at the House leadership health care press conference last week, the House now plans to “duel track” the PFP legislation by keeping the language in the House HHS Omnibus bill and also hearing HF728 in the House HHS Finance Committee this week, then sending it to the House Ways & Means, where the bill will need to be heard by Friday to make the third legislative deadline. The legislation would presumably then be put on the General Register/to the House floor for a vote, which could take place the week of the 22nd, the week the legislature returns from Spring recess.


Legislative Update – April 2, 2019

Last week ended with both the House and Senate releasing their budget targets, which were about $2 billion apart. DFLers, and the Governor are sticking to numbers that they say will “catch the State up” on underfunded programs. Senate Republicans issued their budget targets, “returning” the $1.5 billion projected surplus to the tax payers in the form of no gas tax raise, spending more out of the General Fund on transportation and other infrastructure investments while making modest investments across the board on other budget related items, including health care spending.

This week, the various House and Senate finance committees will begin to hear and pass out their FY 20-21 biennium budget bills. The 3rd legislative deadline, the deadline for all tax, bonding and budget bills to be heard, is next Friday, April 12th. The House HHS budget bill contains med-synchronization, pharmacists’ emergency prescribing, medication repository recycling, the CMS Covered Outpatient Drug Rule implementation, the Minnnesota Board of Pharmacy legislative language and several other non-priority health care and pharmacy related issues. The Senate bill contains most of the same language.

This is another critical week for Minnesota pharmacy legislative priorities. The Senate Finance Committee will hear the Patient’s fair Practices-PBM licensure and regulation legislation, SF278, and then the bill will be referred to the Senate floor/general orders for a floor vote on Thursday. The House bill has been laid over for possible inclusion in the House HHS budget legislation, however, House leadership may move the bill to Ways & Means and then to the floor for a vote as soon as next week.

Limited medication administration (MA) for pharmacists − contained in the Senate Opioid Stewardship legislation SF751 − moved another step forward yesterday. After emotional testimony on the Senate floor, the Senate voted on and passed their version of the legislation by a 59 to 6 vote.  Recall that the House Opioid Stewardship legislation, HF400, which does not contain the limited MA language, was previously passed off the House floor, 94-34. Both opioid bills are to be conferenced in the coming weeks. The House named their conferees yesterday, which include Representatives Halverson, Olson and Baker. All three Representatives were medication administration bill sponsors in previous sessions. We will be reminding them of this fact this week and next as well as that the Senate bill language has consensus limited MA language in it.

Last week the Provider/Wholesaler Tax issue was discussed in a House HHS Finance hearing and testimony was also given on the subject in a Senate HHS Finance Committee walk through of the Governor's HHS budget yesterday. The Governor's budget calls for the repeal of the Provider Tax "sunset" set to take place December 31st of this year, 2019. Over the past week, the commissioners of Commerce, Revenue, MDHS and MDH all made statements in support of the Provider Tax and gave in depth testimony about the consequences of no longer having Health Care Access Fund (HCAF) revenue. Stakeholders such as the MN Hospital Association, several patient advocacy groups, including AARP and other interests, all testified in support of continuing the Provider Tax. The slight variation was the MN Medical Association, who this past December proposed a smaller percentage "access fee" − claim based tax that would fund the MA and MNCare outlays that are currently being funded by the HCAF. The Senate maintains the 2019 sunset of the Provider Tax and does not use HCAF funding for State health care programs in the next biennium when the HCAF, if no longer in place, would run out of funding.. This will become a bigger issue as the budget process moves forward.

Wednesday evening will see a joint House and Senate meeting to hear Governor Walz’ first State of the State address where he will reflect on Minnesota’s current state and his vision for the future.


Legislative Update March 25, 2019

This is the last week policy bills can be considered in the Minnesota legislature. Legislation that met the 1st legislative deadline of March 15th have until this Friday to meet the Legislature’s 2nd legislative deadline of March 29th. The 3rd legislative deadline−the deadline for all tax, bonding and budget bills to be heard−is April 12th.

Four Minnesota Pharmacy Alliance (MPA) legislative priorities will move forward this week. Expanded limited medication administration by pharmacists, the long term care and other medication recycling legislation S.F. 66 (Jensen) and emergency prescribing authority for pharmacists HF687 (Bahner) are all  moving forward through the legislative process. Limited medication administration for pharmacists-contained in the Senate Opioid Stewardship legislation SF751 and the medication recycling program legislation are up this week for consideration. The House Opioid Stewardship legislation, HF400, which does not contain the limited medication administration language, was passed off the House floor, 94-34, last week. Both Opioid bills are to be conferenced now that the Senate bill, SF751, has been heard in the Senate Committee on Rules and Administration Committee. We have been working with the National Alliance of Mental Illness (NAMI) on consensus limited medication administration language and ensuring it remains in the final Opioid Stewardship legislation to be signed by Governor Walz. Representatives Mann and Morrison introduced the companion pharmacists prescribing in three medication categories legislation HF2635 to the Senate bill, SF959.

Last week ended with Governor Walz announcing his revised-supplemental budget which took into consideration the revised budget forecast which came in $500 million less than the November state budget forecast of approximately $1.5 billion. The adjustments to his budget include:

  • Claiming $142 million in unspent money targeted for the individual markets (MNSure) reinsurance plan to reduce risk for health insurers in the individual market and returning it to the state's general fund. Republican legislative leaders had planned to use the money to extend the reinsurance program. Walz instead has a plan to subsidize insurance premiums by 20 percent.
  • Reducing spending increases by $131 million from his original budget proposal across a variety of areas. Those savings are slightly offset by $37 million in spending for a number of items not in the governor's original proposal.
  • Tax changes for businesses that add $65 million to the two-year budget.
  • Instead of leaving $789 million unspent as his original plan did, Walz now leaves $562 million on the bottom line.

Overall Walz's revised budget totals $49.35 billion for the coming biennium, $121 million less than his original proposal.

Last week the legislature moved several MPA priorities forward. The Senate Commerce Committee amended and passed out their version of the Patients Fair Practices Act, SF278 (2nd Engrossment). Negotiations and considerations were made with the Minnesota Chamber of Commerce who had opposed the legislation based on the requirement that a PBM be a fiduciary (Section 4), and concerns with Section 7, which would require ownership of specialty and preferred network pharmacies be disclosed as well as other anti-steering and patient protection provisions.

Earlier in the legislative process, the Senate HHS Finance Committee modified Section 4, the fiduciary provisions of the legislation. Section 7 was modified last week in Senate Commerce to accommodate both MPA and the Chambers wants and concerns. Because these two sections were amended in the Senate, the MN Chamber has dropped their opposition to the Senate bill. However, they still have concerns with the House legislation where both Sections 4 and 7 remain intact as originally introduced.

The House or Senate bill language may be further negotiated during a presumed conference committee that will be formed to put a final bill together that will be passed in both Houses and Signed by Governor Walz. Section 6 of the legislation, the all-important drug pricing and fees transparency provisions, will also be a point of negotiation as the House (preferred) language calls for reporting aggregate – claims level (deidentified) information to a plan sponsors and the Commissioner of Commerce/Dept of Commerce in an annual reports. The Senate Section 6 language is weaker. The next two to four weeks will be critical to the outcome and final legislative language.

SF278 now moves to its last committee, the Senate Finance Committee, where it should be voted out to the Senate floor or could be laid over for possible inclusion in the Senate HHS Finance budget bill. Our understanding from Chairs Rosen, Benson, Dahms as well as author Senator Scott Jensen, is that they would like to move the bill alone and soon on the Senate floor for a vote. The House legislation is scheduled to be heard in its final committee, the HHS Finance Committee, on March 26th before either being laid over for possible inclusion in the House HHS Finance budget bill or heading to the floor for a vote with possible amendments. We are encouraging House leadership and Representative Mann to pass out HF728 to the House floor for a vote soon.

Below is a recap of legislation we are working on that are a part of or impact pharmacy’s priorities at the Minnesota legislature.

Priorities

  • Med Admin SF1959 (Introduced in the Senate. To be introduced in the House).
    • Senators: Abeler, Dr. Jensen, Dr.  Klein
      • Has been introduced.
    • Representatives: Dr. Mann & Dr. Morrison
      • Expected to be introduced next week.
    • MPA’s goal ultimately is broad medication administration authorities for Minnesota pharmacists that they have been trained to administer. However, the only way forward this year is through language included in the Senate’s opioid legislation, SF751. This language would limit the medication administration expansion to IM and SubQ shots for the administration of metal health, drug and alcohol dependency treatment.
  • Prescribing Authority SF1960 & HF2635
    • Authors same Med Admin (Senators and Representatives)
    • Hoping for hearing but not likely to move ahead this year. Overall, scope bills not likely to move forward this year.

  • Patient Fair Practices (HF728 Mann; SF278 Jensen)
    • Passed first deadline in the House and has been laid over for possible inclusion in the HHS budget/finance legislation; will have to meet 2nd deadline in the Senate by 3/29
    • The Senate Commerce Committee favorably heard, as amended, and was sent to its last stop in the Senate before being laid over for inclusion in the Senate HHS budget/finance bill or going to the Senate floor, making 2nd deadline.)
    • “Fiduciary” taken out but “contractual obligated” remains; Sec. 7 modified to agreeable changes offered by the MN Chamber.
    • Bills
      • HF149 (Bahner) - Health plan company prohibited from contractually preventing a pharmacist from informing a patient of a price differential.
        • On general register, can be taken on floor at any time
      • HF743 (Bahner) SF1907 (Jensen) - Prescription drug co-payments limited. (lowest cost mandate)
        • Last hearing cleared and laid over for inclusion in the House finance bill
      • HF688 (Bahner), [which was HF923 (Howard), SF1610 (Jensen)]   - medication synchronization and emergency prescription refill bills have  been combined, pharmacists allowed to provide drug refills without prescriptions as well as insurance coverage.
        • HF688 was passed out of House Commerce and has been referred to the House HHS Finance Committee.
        • Representative Bahner also amended the language in HF688 onto HF687 which has a companion in the Senate, SF1610.
  • Opioid Stewardship (HF0400; SF0751)
    • Fee structure proposals include:  assessment/tax on opioid manufacturers, $5k fee in Senate for wholesalers, tax in House on wholesalers; Gov’s proposal includes both House and Senate approach and also includes creating a State controlled substance registry that would require any entity with DEA license would have fee/licensure.
      • Both the House and Senate bills call for $20M in revenue to the State to address epidemic.
    • Surmise that: Manufacturers will raise prices accordingly, PBMs will not consider increased costs in MN, fees ultimately passed onto pharmacies.
    • Senate includes language for SQ, IM admin by RPhs for meds to treat alcohol or drug addiction
  • Outpatient medication pharmacy reimbursement rates HF1297 (Liebling)
    • House: laid over for possible inclusion in HHS Budget finance legislation
    • Senate: told OPDR will be a part of the Chair’s HHS Finance bill
    • Governor Walz’ budget included funding for implementation of the OPDR
  • Medication Repository (MPA supports)
    • Made 1st deadline in House, may have hearing in Senate in next 2 weeks, bipartisan support
  • Pharmacogenomics: expand pharmacogenomic clinical services statewide (Quam, Zerwas, Gruenhagen, Schultz, Lippert, Morrison, Cantrell and Percell - bipartisan support)
    • HF 1023 –(made 1st deadline and has been referred to HHS Finance.
    • HF 1047-(did not make 1st deadline)
    • HF 1048 -(did not make 1st deadline) (Quam, Zerwas, Gruenhagen, Schultz, Lippert, Morrison, Cantrell and Percell - bipartisan support).
    • SF 1881, SF 1882, SF 1883 (Jensen, Klein, Abeler)
  • HF0485 (Howard) - Pharmaceutical assistance program for insulin; bill has been heard in all House policy committees and has been referred to the HHS Finance Committee where it will be heard for possible inclusion in the House HHS budget finance bill this Tuesday at 9:45 AM.
  • MN Board of Pharmacy's policy/ Practices Act reform legislation has been introduced in the House and Senate. The House version received its first hearing two weeks ago. The Senate will take up the legislation sometime in the next few weeks as part of the Senate HHS Finance budget bill, HF1718 & SF2169:  
    • The MBOP legislation will be heard in the House HHS Finance Committee this Tuesday where it will most likely be laid over for possible inclusion in the House HHS Finance budget bill.

From Cody with MBOP: What remains is the language that conforms state drug wholesaling law to federal law, a provision allowing emergency compounding for veterinary office use, a provision that allows pharmacists to take and process orders outside of a licensed pharmacy in certain situations, language The Baxter provisions were passed in the House this past week and are moving forward in the Senate HHS Finance Committee, HF892 & SF1351. (Baxter wants changes to current MN statute in order to comply with MN law and operate a facility in Champlin. This requires changes in licensing for out-of-state facilities. The MBOP legislation also has a repeal of cancer drug repository program and some other technical changes.

    • Note that the legislation removes the language that would have placed gabapentin in schedule V. What remains is mostly the addition of illicit substances to Schedule I.
    • Other provisions that were in the Board's bill are traveling in separate bills - most notably Rep. Bahner's bill to allow emergency dispensing. A version of emergency dispensing is also included in the MBOP legislation.

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
3 p.m.
Room 1200 Minnesota Senate Bldg.

If you wish to testify, please email Bailey Strand at bailey.strand@senate.mn 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. 
The figure is $492 million less than the November forecast, due to Minnesota’s weakened economic outlook.  MMB stated “a slightly lower expenditure forecast partially offsets the overall reduction to the projected balance”.  They also stated that slower growth and projected spending will outpace revenue growth into FY 2022-23.

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 Governor's robust budget includes a $274 million for Health Care, including the Minnesota Department of Human Services (MDHS) budget, 2019 DHS Budget Recommendations_Senate (PDF). Today, Commissioner Lourey began making the rounds to present the MDHS budget to the legislature. This afternoon he gave his budget presentation to a joint Senate Reform and Finance HHS Committee. The Governor's health care budget would, among other proposals, include $815,000 for the CMS Covered Outpatient Drug Rule implementation and would collect $25 million annually from the drug manufacturers, drug wholesalers, pharmacies and providers to fund opioid stewardship and other programs to tackle the opioid and mental health situation in Minnesota. It also repeals the sunset of the 2% Provider/Wholesaler tax that is set to blink off December 31st, 2019. The budget also calls for $4 million for the first phase of the ONECare – a public buy-in option for Minnesotans purchasing their health insurance through the MNSure exchange and includes one-time tax credits to individuals and families purchasing health insurance through MNSure designed to lower premiums. 

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:

  • the House and Senate will pass all major finance bills off their respective floors and leadership will appoint conference committees by May 1st;
  • the Governor, Senate Majority Leader, and Speaker of the House will provide fiscal targets to the chairs of conference committees on major finance bills by May 6th; and,
  • conference committee chairs shall provide completed conference committee reports to the house of origin by May 13th.

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:

Medication Administration:

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.
                               
Hearings related to MN pharmacy taking place in the MN legislature the week of February 18th:

Tues. Feb. 19th
9:45 AM      
Judiciary Finance and Civil Law Division
Room: 10 State Office Building
Chair: Rep. John Lesch
Agenda:
HF400 (Olson) Opioid Stewardship Advisory Council, opioid stewardship account, and opiate product registration fee established; opioid addiction prevention, education, intervention, treatment, and recovery provisions modified; and money appropriated

1:00 PM 
Committee on Judiciary and Public Safety Finance and Policy

Chair: Sen. Warren Limmer
Room 1100 Minnesota Senate Bldg.

SF 751 received an extensive hearing with general testimony in the HHS Committee, which is the committee with primary jurisdiction. As a re-referral, the Judiciary Committee will take testimony only on matters specifically within the Judiciary Committee's jurisdiction.

Agenda:

 

S.F. 751

Rosen

Opiate epidemic response; registration fee; response advisory council; response account; appropriation; provisions modifications (pending re- referral).

S.F. 766

Ingebrigtsen

Driving while intoxicated (DWI) modifications; ignition interlock device contract with manufacturer modification.

Wed. Feb. 20th           
2:30 PM
Commerce
Room: Basement Hearing Room
Chair: Rep. Laurie Halverson
Agenda:
HF4 (Lesch) Drug manufacturer or wholesale distributor prohibited from charging unconscionable prices for prescription drugs; Board of Pharmacy, commissioner of human services, and health plan companies required to notify the attorney general of certain prescription drug price increases; attorney general authorized to take action against drug manufacturers and wholesalers related to price increases; and civil penalties imposed.

2:30 PM      

Health and Human Services Policy

Room: 200 State Office Building
Chair: Rep. Rena Moran

Agenda:

HF733 (Tabke) – Security screening systems added to ionizing radiation-producing equipment, and money appropriated
HF85 (Brand) – Emergency Medical Services Regulatory Board required to propose guidelines authorizing patient-assisted medication administration
HF831 (Halverson) – Health records released without patient consent circumstances modified
HF728 (Mann) – Pharmacy benefit managers licensure and regulations created, and rulemaking authorized

2:30 PM
Education Policy
Room: 5 State Office Building
           
HF 575            Authors: Reps. Huot; Davnie; Erickson; et al.
Unclaimed Drugs or Medications In Schools Disposal Provided.                 

2:30 PM          
Commerce
Room: Basement Hearing Room

HF 4    Authors: Reps. Lesch; Acomb; Bahner;  et al.
Drug Manufacturer or Wholesale Distributor prohibited from charging unconscionable prices for Prescription Drugs; Board Of Pharmacy, Commissioner Of Human Services, And Health Plan Companies Required To Notify The Attorney General Of Certain Prescription Drug Price Increases; Attorney General Authorized To Take Action Against Drug Manufacturers And Wholesalers Related To Price Increases; And Civil Penalties Imposed.


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.
 
Medication Administration and Pharmacists Prescribing:

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.

Patients Fair Practices legislation (SF0278, SF 278 Summary (PDF)):

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:
·       SF 278 (PDF)
·       SF 278 Summary (PDF)
·       SF 278 A-3 Amendment (PDF)

MN House hearings taking place Tuesday, February 5th:
12:45 PM      
Health and Human Services Finance Division
Room: 200 State Office Building
Chair: Rep. Tina Liebling
Agenda:
Pharmaceutical Overview
Dr. Stephen Schondelmeyer, Professor, Pharmaceutical Economics, University of Minnesota
Cody Wieberg, Executive Director, Board of Pharmacy
___________________________________________

2:30 PM      
Health and Human Services Policy
Room: 200 State Office Building
Chair: Rep. Rena Moran
Agenda:
HF149 (Bahner) – Health plan company prohibited from contractually preventing a pharmacist from informing a patient of a price differential

HF182 (Lippert) – Prescription drug repository program established

HF4 (Lesch) – Manufacturer or wholesale drug distributor price gouging prohibited; Board of Pharmacy, commissioner of human services, and health plan companies allowed to notify attorney general of prescription drug price increases; attorney general authorized to obtain drug pricing information and take action against drug manufacturers and wholesalers; and civil penalties imposed.


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:

  • Federal Tax Conformity The Minnesota Legislature sent Governor Dayton a version of federal conformity in the waning days of the 2018 Legislative Session.  The Governor vetoed the bill believing the legislation did little to support individual taxpayers and favored corporations.  Given the DFL flipping the House in 2018 and a new DFL Governor, the federal conformity issue will not be addressed early in the session.  The DFL House and GOP Senate are certain to take much different approaches to federal conformity and finding a resolution of those differences will be difficult.
  • Transportation Funding Governor-elect Walz campaigned on a message of raising the gas tax.  While he has yet to identify the level of the increase, his administration is committed to finding more revenue for roads, bridges and transit.  The gas tax was last raised in 2008.  In 2018, the GOP controlled Legislature sent Governor Dayton a transportation proposal which used taxes generated from vehicle repairs and maintenance to fund transportation needs.  Governor Dayton opposed using general fund revenues for transportation and vetoed the legislation.  The GOP Senate has indicated they will oppose any efforts to raise taxes when the state has more than $1.5 billion in the budget surplus.  Fuel retailers would likely support the proposal if it prohibits credit card transaction fees from being applied to any portion of a transaction related to sales or gas taxes.  Fuel retailers have suggested they are already spending millions of dollars annually to cover transaction fees related to taxes.
  • Opioids In 2018, the GOP controlled Legislature came close to passing legislation which would have levied a one-cent per morphine milligram equivalent tax on manufacturers and wholesalers. The Minnesota approach was comparable to legislation adopted in New York.  With the House now under DFL control, support from Governor-elect Walz and in the GOP controlled Senate, it would appear in addition to providing funding for addiction treatment, the legislature will be looking at ways to assess additional revenue from the supply chain. 

Issues that will likely be addressed by the legislature that will affect Minnesota Pharmacy include:

  • CMS-Covered Outpatient Drug Rule – On January 21, 2016 CMS issued the Covered Outpatient Drugs final rule with comment that addresses key areas of Medicaid drug reimbursement and changes made to the Medicaid Drug Rebate Program by the Affordable Care Act. Central to the rule was the changes to Medicaid fee for service pharmacy reimbursement among other provisions. The Minnesota legislature in 2017 and 2018 adopted new statutory language that would have assured Minnesota would be in compliance and the pharmacy reimbursement calculation in Minnesota would have been changed to NADAC + $11.45 (or $10.48 from the 2018 legislation). Both bills would have reimbursed for the 2% wholesaler/pharmacy tax. Unfortunately, both pieces of legislation were vetoed as part of omnibus Finance bills. Stakeholders are working with the MDHS to enact consensus legislation during the 2019 session. This is a priority for the House, Senate and Walz Administration.
  • Pharmacists Prescribing – Pharmacists in Minnesota believe they can provide patients with better access to needed medication and health services. They know, and research has shown, that pharmacists can be a larger part of the solution for patients. One of the ways to greatly improve health in Minnesota would be to give Minnesota pharmacists the authority to prescribe and dispense medications to patients in three medication categories. Under legislation sought during the last session and legislation that will be introduced again this year, pharmacists in Minnesota would be able to prescribe Naloxone to prevent death from an opioid overdose, smoking and tobacco cessation medications to help Minnesotans quit smoking as well as hormonal contraceptives to prevent unintended pregnancies and improve overall female health.
  • Medication Administration – Pharmacists can also play a greater role in improving the mental and physical health of their patients by having the authority to do what their colleagues in all states surrounding Minnesota can do, provide medication administration services. Under a specific patient order from their physician, Minnesota pharmacists would be able to provide medication services to patients beyond the current limitation of administering 1st does and medication on an emergency basis. Minnesota pharmacy as well as allies in the mental health, perinatal and broader health community will be advocating for these changes at the legislature this year.
  • Patients Fair Practices – In a truly bi-partisan fashion, the Minnesota House and Senate passed and included in the 2018 Omnibus Supplemental spending bill 3 provisions that would have prohibited pharmacy benefit managers (PBMs) from “gaging” pharmacists they contract with from providing patients with information on how to receive their medications at the lowest cost, guaranteed “the lowest cost” of medications to consumers and mandated that PBMs allow medication synchronization of a patient’s prescription refills. Unfortunately, these provisions were not enacted because Omnibus bill was ultimately vetoed last year. This year there is bi-partisan support to pass these provisions and additional legislation that would attempt to correct the gross imbalance in the patient, health care professional and benefit payer relationships.

Legislative Activity

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

Walz Administration

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

January 7th Swearing-in Ceremonies MN Constitutional Offices 12pm
January 8th Start of the 2019 Legislative Session  12pm
January 9th MN Chamber of Commerce Session Priorities – River Centre 4-9pm
January Governor-elect Walz State of the State Address TBD
March February Forecast Released TBD
April 13 – 22 Legislative Recess – Easter Break (return 8am 4/23)   
May 20th Constitutional Deadline for Completion of the 2019 Legislative Session Midnight

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.”

Committee Name

Chair

Agriculture and Food Finance & Policy Division

Poppe

Capital Investment Division

Murphy

Commerce

Halverson

Education Finance Division

Davnie

Subcommittee on Early Childhood Finance & Policy

Pinto*

Education Policy

Youakim

Environment and Natural Resources Finance Division

Hansen

Subcommittee on Water

Fischer

Energy and Climate Finance & Policy Division

Wagenius

Environment and Natural Resources Policy

Persell

Ethics

Murphy

Government Operations

Freiberg

Subcommittee on Elections

Dehn

Subcommittee on Local Government

Masin

Greater Minnesota Jobs and Econ Dev Finance Division

Pelowski

Health and Human Services Finance Division

Liebling

Subcommittee on Long Term Care

Schultz

Subcommittee on Early Childhood Finance & Policy

Pinto*

Health and Human Services Policy

Moran

Higher Education Finance & Policy Division

Bernardy

Housing Finance & Policy Division

Hausman

Jobs & Economic Development Finance Division

Mahoney

Judiciary Finance & Civil Law Division

Lesch

Labor

Sundin

Legacy Finance Division

Lillie

Public Safety and Criminal Justice Reform Finance & Policy Division

Mariani

Subcommittee on Corrections

Considine

Rules and Legislative Administration

Winkler

Subcommittee on Legislative Process Reform

Pelowski

State Government Finance Division

Nelson

Taxes

Marquart

Property and Local Tax Division

Loeffler

Transportation Finance & Policy Division

Hornstein

Veterans and Military Affairs Finance & Policy Division

Ecklund

Ways and Means

Carlson, L.

* Subcommittee of two divisions

Speaker-designate Hortman also appointed the following leadership staff to serve the DFL Caucus:

Sean Rahn, Executive Director, Majority Caucus
Susy Bates, Legislative Director to the Speaker
Brynn Hausz, Executive Assistant to the Majority Caucus
Susie Merthan, Director of Communications & Public Affairs
Ted Modrich, Press Secretary to the Majority Caucus
Kevin Labenz, Coordinator of Legislative Outreach


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.

The Legislature

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. 

Walz Administration

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. 

Miscellaneous Notes

  • Attorney General-elect Keith Ellison announced Donna Cassutt will be his Chief-of-Staff when he assumes the AG office in January.  Cassutt is currently serving as Chief-of-Staff in Ellison’s Congressional office.
  • Minnesota Congressman Tom Emmer (6th District) is viewed as the early favorite in the race for Chair of the National Republican Campaign Committee.  The NRCC is the campaign arm of the House Republicans.  House Republicans will be meeting in Washington on Wednesday to select their new leadership team.
  • With 64.2% statewide voter turnout, Minnesota appears to once again lead the nation in election participation.
  • In a truly amazing fact, in 2019 the Minnesota Legislature will be the only Legislature in the nation with control split between two parties.
  • The Grassroots Legalize Cannabis Party with a candidate in the Attorney General race and Legal Marijuana Now Party with a candidate running for State Auditor appear to have met the thresholds to qualify for Major Party Status in Minnesota.  The Secretary of State will need to certify their status after the November 27th State Canvassing Board meeting.  This will allow their candidates and parties access to public funding and enable their donors to qualify for the political contribution refund program. 

Upcoming Events and Important Dates

December 5th The HRCC Annual Holiday Party – Town & Country Club 5-8 pm
December 6th The Fredrickson & Byron 2019 Session Outlook – InterContinental 8-10:30 am
December 10th November Fiscal Forecast Released by MMB  TBD
December 10th Sen. Bakk, Annual Stock the Food Shelves Event – Holman’s Table 4-6 pm
December 11th Senate Republican Caucus Holiday Party – Midland Hills 3-5:30 pm
January 8th Start of the 2019 Legislative Session 12 pm
January 9th MN Chamber of Commerce Session Priorities – River Centre 3-8 pm
March February Forecast Released Date and Time TBD
May 20th  Constitutional Deadline for Completion of the 2019 Legislative Session 11:59 PM

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:

  • CMS Covered Outpatient Drug Rule for FFS Medicaid: pharmacy reimbursement rate, NADAQ + $10.48 and the 2% provider-wholesale tax fix; Task Force created to recommend to the legislature by February 1, 2019, a long-term solution to the outpatient prescription drug rule implementation.
  • Would prohibit Pharmacy benefit manager gag orders in pharmacy contracts in Minnesota.
  • Pharmacies required to provide patient with the lowest cost of medication at the point of sale (co-pay claw-back prohibited).
  • Patient refill medication synchronization allowed/PBM pharmacy contract prohibition eliminated.
  • Emergency fill and data input/output allowed remotely.
  • Minnesota Opioid Stewardship Council – includes MN pharmacy representative.

Please contact Gov. Dayton as soon as possible and let him know why this is so important to sign.

Example communication

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.

Sincerely,

XXXX

[*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:
The Honorable Mark Dayton 
130 State Capitol 
75 Rev Dr. Martin Luther King Jr. Blvd. 
St. Pau, MN  55155

Email 
Send your questions and comments to Governor Dayton 

Telephone Numbers 
Telephone: 651-201-3400 
Toll Free: 800-657-3717 
Minnesota Relay: 800-627-3529 
Fax: 651-797-1850


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:

  • Fair Practices/PBM contracting reform in the form of:
    • A gag-order prohibition;
    • Lowest cost of medication to the patient provided; and,
    • medication synchronization on refills allowed.
  • Pharmacist medication administration (IM/SubQ shots) for alcohol and opioid addiction treatment medications.
  • Emergency pharmacy fulfillment and remote data/systems access.
  • Statewide prescription drug repository established.
  • 30-day opioid prescription limit and 45 days on refills of opioids (schedule 2-4).
  • Opioid stewardship grant, pilot project, education and other various provisions (it is not known at the time of this writing if a manufacturer and wholesaler of opioids will see a fee as proposed in several bills including Senate Finance Chair Julie Rosen’s bill).
  • The bill does not include the language that would have authorized pharmacists in Minnesota to prescribe Naloxone, tobacco and smoking cessation medications as well as travel medications.
The legislature is constitutionally mandated to adjourn by Monday, May 21. Any legislation to be acted upon by the governor must be sent to him by midnight on Sunday, May 20. The governor already vetoed the House and Senate tax bill, calling for $180 million in “emergency school funding” before entering into any negotiations or signing a revised tax bill. On Wednesday, the Senate voted down the proposed bonding bill (a two-thirds vote is needed). There is much uncertainty around how the 2018 legislative session will come to a close.

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.

  • The House passed the Health and Human Services (HHS) Finance Omnibus legislation on Tuesday, May 1:
    It includes gag order & claw-back pharmacy contracting reform, pharmacist emergency dispensing language, and much of the opioid crisis solution provisions, It does not include pharmacists prescribing or medication administration at this point. However, stakeholders, including MPhA, are still working hard to have one or both of these provisions included in the final HHS Omnibus legislation.
  • Early in the week, the Senate passed their Finance Omnibus bill which included all State government agencies and appropriations/supplemental budget legislative language. To date, neither pharmacy prescribing or medication administration have been included in the Senate legislation. However, the bills will not be finalized until they are conferenced in the next two weeks.

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:
HF 2962, SF 3015
A bill for an act relating to health; authorizing pharmacists to prescribe tobacco and nicotine cessation products, opiate antagonists and travel medications.

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:
(4) participation in drug and therapeutic device selection; drug administration for first dosage and medical emergencies, except that, administration by subcutaneous or intramuscular injection or patch are not limited to first dosage and medical emergencies; drug regimen reviews; and drug or drug-related research;

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):
HF 3250; SF 3014, A bill to pharmacists license practice of pharmacy modified. Medication administration authority broadened.

Fair Practices and pharmacy contract reform legislation:
As was reported earlier during the legislative session, the Minnesota legislature has seen multiple bi-partisan bills introduced that would define fair practices for both the patient and pharmacists/pharmacies benefit contracts. Legislation supported by a broad coalition of providers, patient advocacy groups and the Minnesota pharmacist community was adopted by both the Senate and House HHS committees. It includes prohibitions in benefit contracts that prevent a pharmacist in Minnesota from informing patients when the co-pay from their insurance is more than the pharmacy’s cash price for the prescription (commonly referred to as gag order reform). The House also included legislative language that would compel prescription plans to charge patients the lower of usual benefit co-pay amount and the pharmacy’s usual and customary cash price. This provision, commonly referred to as claw-back prohibition, is included in the House legislation and is being heard this week as part of the House HHS Finance Omnibus legislation committee process.

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.

Dean; Jensen, Kiffmeyer, Sparks, Frenz
HF 3024; SF 2836
Health plan company prohibited from contractually preventing a pharmacist from informing a patient of a price differential.

Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
HF 3012, SF 2596
A bill for an act relating to health; modifying payment for certain prescription medications; amending Minnesota Statutes 2016, section 151.71, by adding a subdivision. The bill was read for the first time and referred to the Committee on Health and Human Services Reform.


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:
Pharmacists would be able to prescribe:

  • Opioid antagonist for the treatment of overdose – currently only Narcan/Naloxone (the Pharmacy Advocacy Task Force worked with the Steve Rummler Hope Foundation, Rep. Dave Baker and others);
  • Smoking cessation medications, excluding bupropion and only FDA approved (after working with ClearWay and the Minnesota Psychiatric Society);
  • Travel medications recommended by the CDC specifically for patients/residents traveling abroad (the MBOP protocol will maintain a specific list of these travel medications and update them periodically).

The final amendments included:

  • Provisions that tighten up the Travel Medication language in HF 2962 by including language that says:
    • “…"Travel medication" means a medication that is recommended by the federal Centers for Disease Control and Prevention for individuals traveling outside of the United States…”
  • Provisions that spell out how pharmacists are to be paid for services (in addition to the dispensing fee and product cost). The original bill language included a provision that would have stated all federal and state laws concerning insurance coverage would apply to prescribing under the bill. After receiving technical assistance from Chad Hope at the Minnesota Department of Human Services (DHS), the amendment language placed in MN 256b, under the Medication Therapy Management (MTM), a 9th qualifying service under MTM for MA coverage (fee for services & managed care) service will be covered.
    • “…#9) Prescribing products or medications as permitted under section 151.216, in accordance with standardized protocols developed by the board of pharmacy…” The health plans also agreed to this language and agreed with DHS, that paying for the pharmacist service would not increase costs.
  • A provision for Veterinary Emergency compounding: allows a pharmacist in Minnesota to compound and provide drug product for veterinary use without a specific patient prescription. (Rep. Roz Peterson authored for MBOP.)

This was after an amendment to the House bill last week that tightened up the tobacco cessation products provision by adding:

  • “…only FDA approved tobacco cessation medications… and excluding bupropion...” (includes Chantix).

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:

-SF3015: be able to prescribe in 3 medication categories - Naloxone, tobacco cessation medications and travel medications;
-SF3014: have the Minnesota Board of Pharmacy decide what medication administration pharmacists can offer to their patients.

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.

Both these bills have made the 1st deadline by passing out of the House HHS Reform and Commerce & Regulatory Reform Committees this past week, however, only HF 3012, SF 2596 – gag order prohibited is currently scheduled in House HHS Finance for Wednesday, March 28th at 1:00 PM in Room 200 of the Senate Office Building. We anticipate HF 3012 being scheduled by March 30th.

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.

We are urging all MPhA members to contact their legislators and the Senate and House Chairs to encourage them to hear and support MPhA and Minnesota pharmacy legislation at the Capitol this week:

  • SF3015
  • SF3014
  • HF2962
  • HF3012

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:
Michelle R. Benson (31, R)
3109 Minnesota Senate Bldg.
95 University Avenue W.
St. Paul, MN 55155
651-296-3219

House HHS Finance Committee Chair:
Matt Dean (R) District: 38B
401 State Office Building
100 Rev. Dr. Martin Luther King Jr. Blvd.
St Paul, MN 55155
651-296-3018
E-mail: rep.matt.dean@house.mn


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.

Currently, two companion bills have been introduced.

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.

Good News!

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

  • TODAY: We need pharmacists, pharmacy technicians, and friends of pharmacy to call and/or email their MN Senator today and ask them to request a committee hearing for SF 3015! It has been referred to the Senate Health and Human Services Finance and Policy Committee (Chaired by Senator Michelle Benson). Please share with pharmacy staff at your site, as we need to have a first hearing scheduled ASAP or the legislation dies. Use the information provided below to craft your message.

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:

  • Opioids have killed more than 2,700 Minnesotans in the last 15 years. Most of these deaths involved prescription drug use. The pharmacist is very accessible and has a chance to intervene and provide a life-saving medication.
  • According to the MDH, smoking causes 5,900 deaths each year in MN. Pharmacist intervention has been shown to increase smoking cessation rates by 12.5%.
  • International tourism continues to grow. A large portion of our population in MN has family roots outside of the United States, resulting in frequent travel. Assuring access to appropriate vaccinations and travel medications can protect our citizens from diseases that are still common outside of the U.S. Improving access to these medications will impact all Minnesotans.

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:
HF 3012, SF 2596
A bill for an act relating to health; modifying payment for certain prescription medications; amending Minnesota Statutes 2016, section 151.71, by adding a subdivision. The bill was read for the first time and referred to the Committee on Health and Human Services Reform.

Dean, Loonan; Jensen, Kiffmeyer, Sparks, Frenz
HF 3024; SF 2836
Health plan company prohibited from contractually preventing a pharmacist from informing a patient of a price differential.

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.

  • Pharmacy delivery service restrictions. This would require a PBM to allow a community pharmacy to deliver or mail a reasonable number of prescriptions to their customers, maintain the patient-pharmacist medication management relationship, while still allowing the PBM to prevent a pharmacy from setting up a full-blown mail-order pharmacy.
  • Anti-mandatory mail order. This would prohibit a PBM from requiring patients to use mail order for their prescriptions. These provisions still allow for financial or other incentives for using the PBM’s mail order.
    • Partial fill/medication synchronization for patients.

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:
HF 3011, SF 2598
A bill for an act relating to health; prohibiting the use of incentives or disincentives for using certain pharmacies; amending Minnesota Statutes 2016, section 151.71, by adding a subdivision. The bill was read for the first time and referred to the Committee on Health and Human Services Reform

Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
HF 2950, SF 2597
A bill to enact legislation relating to insurance; providing for the licensing of pharmacy benefit managers; amending Minnesota statutes 2016, section 60A.23. This bill was referred to the House and Senate Commerce Committees.

PATF legislation:
Peterson, Baker; Jensen, Klein, Lourey, Rosen introduced:
HF 2962, SF 3015
A bill for an act relating to health; authorizing pharmacists to prescribe tobacco and nicotine cessation products, opiate antagonists, and travel medications; amending Minnesota Statutes 2016, section 151.01, subdivisions 23, 27, by adding a subdivision; proposing coding for new law in Minnesota Statutes, chapter 151.

HF 3250; SF 3014, A bill to Pharmacists license practice of pharmacy modified. Medication administration authority broadened.

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.

(b) The base rate shall be $0.01 per unit distributed or dispensed. A unit is each capsule, tablet, milliliter, gram, or other such amount, as defined by board.
(c) An active ingredient multiplier of 10 shall be applied to the base for schedule II opium derivatives and opiates, as defined in section 152.02, subdivision 3, except as further defined below:
(1) oxycodone: 15; (2) oxymorphone: 15; (3) hydromorphone: 15; (4) methadone: 20; and (5) fentanyl: 20.
(d) In addition to the active ingredient multiplier, a dosage form multiplier shall be applied to the base as follows:
(1) liquid: 0.2; and (2) patch: 20.

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.


At the Capitol March 4, 2018

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.

Pharmacy:

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.

Medication Administration

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).
The legislation would, among other things, prohibit gag orders that don’t allow pharmacists to provide patients with the least expensive medication information and PBM co-payment take-backs, provide for PBM incentives reform; one bill would provide PBM transparency requirements and regulation by the Minnesota Department of Commerce (Minnesota’s insurance regulator). For the first time, legislation introduced would also put in law the right for patients to choose a local pharmacy for their medications instead of mail-order or specialty medication pharmacy, often owned by a PBM, now required by many pharmacy benefit contracts/plans.

Current Activity

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!

If you have any questions, please email PATF and MPhA Lobbyist Buck Humphrey at hubert4@gmail.com or MPhA Interim Executive Director Marsha Millonig at marsham@mpha.org.

PATF legislation:

Peterson, Baker; Jensen, Klein, Lourey, Rosen introduced:
HF2962, SF3015
A bill for an act relating to health; authorizing pharmacists to prescribe tobacco and nicotine cessation products, opiate antagonists, and travel medications; amending Minnesota Statutes 2016, section 151.01, subdivisions 23, 27, by adding a subdivision; proposing coding for new law in Minnesota Statutes, chapter 151.

HF3250; SF3014, A bill to Pharmacists license practice of pharmacy modified. Medication administration authority broadened.

Patient Fair Practices/PBM Reform Bills:

Peterson, Hamilton, Zerwas, Gruenhagen, Miller and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
HF3010, SF2599
A bill for an act relating to health; prohibiting penalties to pharmacists for sharing certain information with individuals; amending Minnesota Statutes 2016, section 151.214, by adding a subdivision.The bill was read for the first time and referred to the Committee on Health and Human Services Reform.

Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
HF3011, SF2598
A bill for an act relating to health; prohibiting the use of incentives or disincentives for using certain pharmacies; amending Minnesota Statutes 2016, section 151.71, by adding a subdivision. The bill was read for the first time and referred to the Committee on Health and Human Services Reform.

Peterson, Hamilton, Zerwas, Gruenhagen and Freiberg; Jensen, Klein, Franzen, Utke, Nelson introduced:
HF3012, SF2596
A bill for an act relating to health; modifying payment for certain prescription medications; amending Minnesota Statutes 2016, section 151.71, by adding a subdivision. The bill was read for the first time and referred to the Committee on Health and Human Services Reform.

Zerwas, Hamilton, McDonald and Peterson; Jensen, Nelson, Draheim, Wiklund introduced:
HF3016, SF2669
A bill for an act relating to health care; prohibiting a health plan company from contractually preventing a pharmacist from informing a patient of a price differential; amending Minnesota Statutes 2016, section 151.214. The bill was read for the first time and referred to the Committee on Health and Human Services Reform.

Hamilton, Zerwas and Gruenhagen; Jensen, Klein, Franzen, Utke introduced:
HF2950, SF2597
A bill to enact legislation relating to insurance; providing for the licensing of pharmacy benefit managers; amending Minnesota statutes 2016, section 60A.23. This bill was referred to the House and Senate Commerce Committees.


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.)

Uncertainties

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 HF1140SF1049

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.”

OPIOID ANTAGONISTS

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.

HORMONAL CONTRACEPTIVES

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.

TRAVEL MEDICATIONS

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.

Medication Administration:

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:

  • HF1440/SF730: Opiate stewardship program established, report required, and money appropriated. (Baker/Rosen) Hearings last week, laid over for inclusion in the Senate Omnibus bill; this was the milligram tax bill that was introduced last year. While the milligram tax idea is out, the penny per pill idea is in and moving.
  • HF1219/SF843: Minnesota prescription monitoring program restrictions on a prescriber's authority to prescribe controlled substances identified. (Baker/Eaton)
  • HF1136/SF750: Naloxone standing orders compliance required. (Baker/Eaton)
  • HF 1137/SF753: Requires check of the PMP. At the end of last year in the House, Rep. Baker removed the requirement for pharmacists, only requiring prescribers to check. Also, Rep. Peggy Scott refused to hear the bill in the Civil Law and Data Practices Policy Committee or let it be referred to another committee, so unless this has changed, this bill most likely will not move.
  • HF2066/SF1868: Opiates prescribed for acute dental and ophthalmic pain quantity limits placed. (Baker/Benson)
  • HF 0897/SF795: Requires all pharmacies to maintain pharmaceutical waste collection receptacles. Rep. Baker has now said he may revive this in the House if there is a source of revenue to fund a program run potentially by the Board of Pharmacy as it is in Iowa and North Dakota. We did not see this proposal move in the Senate last year; however with a potential new source of revenue (from the opioid tax) we could see this legislation/idea move forward.

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:
hubert4@gmail.com, 612.889.6515.

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