Legislative Update

MAO Legislative Update
May 6, 2018
Eric Dick, MAO Lobbyist 

Step Therapy Reforms Moving
An bill to enhance the authority for physicians to override step therapy requirements set by pharmacy benefit managers (PBMs), (HF 3196)  cleared the Senate Finance Committee on May 1 and awaits action on the Senate floor.  The bill has shown equally strong progress in the House, where it is set to be considered by the full body on May 7.

Under the bills authored by Sen. Paul Utke (R – Park Rapids) and Rep. Kelly Fenton (R – Woodbury), physicians may seek an override of a health plan’s step therapy requirement in certain instances, including when a patient has previously tried and failed a step requirement, when the patient is currently receiving a positive therapeutic outcome on a particular medication, and when a drug is medically contraindicated, or the required drug will “decrease the ability of the enrollee to achieve or maintain reasonable functional ability in performing daily activities.”  Additionally, the bill requires that health plans’ enrollees and providers have access to a clear, readily accessible, and convenient process to request a step therapy override.

In a parliamentary move to increase the chances of passage, the bill’s authors are seeking passage of their proposals both as “stand alone” bills as well as including the language in the omnibus budget bills.

Bill to Prohibit “Gag Clauses” in Pharmacy Clears Senate
An MMA-led effort to protect consumers from inflated costs for pharmaceuticals passed the Senate by a unanimous 67-0 vote on May 1.  The bill (SF 2836) , authored by Sen. Scott Jensen, MD (R – Chaska), would preclude pharmacy benefit managers (PBMs) from prohibiting pharmacists from telling patients that their prescription drug may be cheaper if purchased with cash rather than using their insurance benefit.

Legislators have expressed increasing concern with the role of PBMs, with many arguing that they interfere with patient care while adding significant administrative burdens to physicians and clinics. 

The House companion is authored by Rep. Roz Peterson (R – Lakeville).  Her bill awaits action on the House floor, and the language of her bill is also included in the budget omnibus.

Opioids Continue to be Dominant Health Care Issue
Members of both parties and in both legislative bodies continue to debate efforts to reduce the harms of opioids. Several proposals are moving through different vehicles. 

Much of the discussion during the 2018 session has focused upon a bill (SF 730)  authored by Sen. Julie Rosen (R – Vernon Center) and Rep. Dave Baker (R – Willmar).  The original version of the legislation, dubbed the “penny-a-pill bill,” levied a fee on opioid manufacturers based upon the morphine milligram equivalent (MME) of the drug, with the goal of funding additional treatment, enhancements to the prescription monitoring program (PMP), and to offset the costs of drug abuse for the state and counties.  Given fierce opposition from drug manufacturers, anti-tax advocates, the Minnesota Chamber of Commerce, and others, the authors have been forced to consider alternate funding sources.  The Senate has proposed an increase in the licensing fee for opioid manufacturers and opioid wholesalers, while the House has proposed using the state’s General Fund.  Advocates, including many in the physician and hospital community, have strongly urged legislators to make certain that manufacturers bear some of the cost that opioid abuse and addiction has caused. 

In addition to the funding source, several policy provisions remain in discussion.  The House has included in their omnibus proposal a requirement that all prescribers receive two hours of CME related to opioids.  The Senate includes a mandate that prescribers check the PMP before prescribing opioids, though it offers several exceptions, including emergencies, hospice care, and cancer-related pain.  Importantly, this provision does not take effect until 2020.  Legislators have delayed the effective date to allow the Board of Pharmacy to work with its vendors to integrate the PMP into electronic health records.   The bill’s authors have committed to working with the prescribing community to include other appropriate exceptions.

The Senate is also considering a seven-day dose limit for opioid prescriptions to treat acute pain.  Physicians groups are arguing forcefully that the dose limit must include language to allow prescribers to deviate from the limit if in their professional medical judgement, a patient requires a longer prescription.  

Health Cost Transparency Passes Senate Floor
Legislation to increase price transparency for consumers (SF 3480)  passed off the Senate floor on May 1. The first part of the bill amends current law that says that a provider or a health plan, upon request from a patient, must give a “good faith estimate of the allowable payment the provider has agreed to accept” from the health plan for a service.  The bill states that the estimate must be provided within 10 days of the request.  It also clarifies that a health plan cannot prohibit a provider from disclosing this payment information in their provider contract.

The second part of the bill requires primary care providers to post in their reception area a list of their services that cost more than $25 that correspond with the provider’s top 25 most frequently billed CPT codes.  Included in the list must be the top 10 most frequently billed E & M codes and 10 most frequently billed preventive service codes.  The list must include four payments:  The average reimbursement rate received from the commercial payers, the Medicare allowable payment, the Medical Assistance fee-for-service rate, and the provider’s charge for a patient who is paying cash.

The House companion bill is awaiting final action on the House floor.  If signed into law it would become effective July 1, 2019.

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