MAO Legislative Update
March 20, 2015
Eric Dick, MAO Lobbyist
Prior Auth Reform Clears Two Committees
The bill to provide more transparency and standardization to the prior authorization process cleared another two hurdles as the Senate Commerce Committee passed the bill on a voice vote on Wednesday March 18. It also cleared the Senate State & Local Government Committee on Friday, March 20. The effort is being led by the MMA, and the MAO has joined dozens of physicians groups and patient advocacy groups in supporting the proposal.
SF 934 (Franzen – DFL, Edina) continues to move through the process with strong support from many medical and patient groups, and opposition from health plans and companies who serve as pharmacy benefit managers (PBMs). Senator Franzen has tried to address some of the concerns raised by opponents without gutting the major components of the bill. As the bill now stands health plans would be required to disclose to consumers ahead of open enrollment time what drugs are covered and what patient cost-sharing would be required. It also prohibits health plans and PBMs from adding new restrictions on their drug coverage during the enrollment year.
The bill does not prohibit the use of prior authorization for medications but it requires the use of standardized prior authorization request forms and requires health plans and PBMs to develop mechanisms to inform prescribers in real time why a drug was denied and what alternatives are recommended. It also cuts in half the timelines for utilization review organizations to make initial coverage determinations and respond to appeals.
The House companion bill, HF 1060 (Albright – R, Prior Lake) is still awaiting its first hearing in the House. For the bill to remain alive as a standalone bill it must pass one or two House committees next week before the final policy committee deadline. There is some resistance to the bill because of accusations that it will result in increased drug costs for insurers and employers.
Legislators need to continue to hear from physicians and others on the need for this bill. The fixPAnow.com website now lists 38 different physician, patient, and advocacy organizations that support the PA bill. It also lists news coverage of the effort to pass the bill, along with patient stories of problems caused by PA.
Changes to PMP Proposed
Changes to the state Prescription Monitoring Program (PMP) are included in bills making their way through both the House and Senate in recent days. The bills, HF 1652 and SF 1440, authored by Rep. Dave Baker (R - Willmar) and Sen. Julie Rosen (R - Vernon Center) adopt many of the recommendations of the PMP Task Force, a group established by the 2014 legislature on which the MMA has a seat.
The House and Senate versions of the bill differ in several ways. The Senate version of the bill strikes current law's requirement that a patient provide consent before a prescriber may access the patient's data when providing medical treatment, though that provision was removed in the House. Both bills allow the Board of Pharmacy to hold prescribing data longer for the purposes of trend analysis. Notably, the Senate version of the bill requires all prescribers with active DEA licenses to register for a PMP account, though this provision was struck from the House bill. Neither bill would require a prescriber check the PMP before issuing a prescription to a patient.
In a related bill intended to address abuse of prescription drugs, Sen. Rosen is also the author of SF 1425. Under the bill, pharmacies would have greater latitude to serve as depositories for pharmaceutical waste in the form of old, expired medication. Participating pharmacies would have to comply with all federal laws that govern the destruction of legend drugs.
Physician Compact Marches On
The effort to enroll Minnesota in a newly formed compact to ease licensure burdens for physicians who wish to practice in multiple states cleared its last two policy committee hurdles in the House in recent days. The bill had passed the needed policy committees in the Senate earlier in the session.
The Interstate Compact for Physician Licensure establishes a commission that will serve as a clearinghouse for licensure of physicians who wish to hold licenses in multiple states.
Participation in the process is entirely voluntary for physicians. The compact only becomes active once approved by at least seven states, though already two states have signed the compact into law and it's moving through legislatures in more than a dozen more.
The House bill, HF 321, authored by Rep. Tara Mack (R - Apple Valley), cleared all three necessary committee stops (HHS Reform, State Government Operations, and Civil Law) in the House in just the last week and with virtually no opposition. Both the House bill and the Senate File, carried by Sen. Kathy Sheran (DFL - Mankato) await action in each body’s HHS Finance Committee.
All Payer Claims Database Bill Moves in the Senate
A bill to allow an additional use for the state's All Payer Claims Database (APCD) was heard in the Senate HHS Policy Committee on March 18. The bill, SF 1818, authored by Sen. Melissa Wiklund (DFL - Bloomington), passed with little discussion and was referred to the Senate Judiciary Committee.
The bill would require Minnesota Department of Health to make available to the public for no or minimal cost public data sets or tables. Language in the bill makes clear that the data contain no individual, payer, or provider identifiers. It is anticipated that researchers, non-profits, and academic institutions will be able to use the data to study cost and utilization trends and other purposes. The MMA testified in support of the bill, as did the Minnesota Hospital Association and MDH.
The bill's House companion, HF 1961, authored by Rep. Melissa Hortman (DFL - Brooklyn Park), has not been scheduled for a hearing.
First Deadline’s Arrival Narrows Field of Bills
Friday, March 20th brings the first policy deadline, the first in a series of self-imposed deadlines that help weed out viable bills from those with less support. It's by today that a bill has to have passed the needed policy committee stops in one body to remain viable. That same bill's companion will have to clear its policy committee stops by next week Friday, March 27. A final deadline comes April 7, the date by which bills must have passed the needed finance or tax committees.
With the deadline, a number of bills will be considered dead (or close to it) for the remainder of the year. While these bills will have not “made deadline,” it’s worth remembering that a bill is never truly dead until the end of the biennium, or “sine die.” A creative lawmaker still has many tools available to them to try to move legislation forward even after the deadline, though it becomes more difficult.
A number of interesting or notable bills have not made the first policy deadline, including:
SF 178 This bill would repeal not only the ban on smoking in public places, but would also repeal the entirety of the state’s Clean Indoor Act.
HF 1253/SF 1135 These bills would add e-cigarettes to the state’s Freedom to Breathe law, barring their use in most indoor spaces. Current law prohibits e-cigarette “vaping” in all government-owned buildings, clinics, hospitals, day care, and other spaces, though they still may be used in bars and restaurants.
HF 1141/SF 545 These bills would add chronic pain to the statutory list of conditions which give eligibility to patients who wish to participate in the medical marijuana program. Under current law the Commissioner of MDH has that authority. A separate bill still moving does accelerate the timeline by which MDH has to rule regarding chronic pain from July 2016 to January 2016.
HF 1038/SF 917 Under these bills, health plans would be required to offer coverage for tamper-resistant or “abuse deterrent” versions of uploads if the plans covers prescription drugs.