HF Session Objectives. Minnesota Pharmacy Legislative Day 2/16/2017. Minnesota Pharmacy Advocacy Agenda: Issue Briefing & Status

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1 Minnesota Pharmacy Advocacy Agenda: Issue Briefing & Status Jill Strykowski, Tammy Bezdicek PATF Co-Chairs Buck Humphrey PATF Lobbyist Jeff Lindoo & Michelle Aytay MPhA Public Affairs Committee Co Chairs Melissa Carlson, PharmD, MSHP Please track and follow HF Session Objectives List the MPhA, MSHP and Pharmacy Advocacy Task Force's 2017 legislative initiatives. Describe for each initiative the present and future process it will need to go through toward passage. Explain what action is desired for legislator visits. Minnesota Pharmacy Legislative Day 1

2 Pharmacy Advocacy Task Force (PATF) * note the name change! MN Pharmacists Association MN Society of Health System Pharmacists U of MN College of Pharmacy American Pharmacists Association American Society of Health System Pharmacists National Association of Chain Drug Stores THANK YOU! MN College of Clinical Pharmacy Duluth Area Pharmacists MN Retailers Association MN Board of Pharmacy Legislative Wins 2014 Participation in the initiation, management, modification, and discontinuation of drug therapy according to written protocol or collaborative practice agreement. Collaborative practice: means patient care activities., engaged in by one or more pharmacists who have agreed to work in collaboration with one or more practitioners.. Collaborative practice agreement: means a written signed agreement between one or more pharmacists and one or more practitioners that allows the pharmacist or pharmacists to engage in collaborative practice. Legislative Wins 2015 Immunizations Age Access and reporting requirements Technicians Definition Ratios 2016 Pharmaceutical Waste Extended Medication Supply Prescription Monitoring Program (PMP) Naloxone Minnesota Pharmacy Legislative Day 2

3 Naloxone and Community Health Boards: Still a significant issue Deaths due to opioid use in MN: 2014:319, 2015:338, 2016 data not in. MN BOP developed an opiate antagonist protocol The Commissioner of Health provides the protocol to Community Health Board consultants. The consultants enter into agreements with pharmacists to prescribe naloxone per protocol. The language is restrictive and does not add value beyond a collaborative practice agreement. MN does not have progressive naloxone prescribing 2017 Legislative Priorities Task Force: Patient Access to Pharmacist Provided Medications Opiate antagonists Travel medications Nicotine replacement products Self - administered hormonal contraceptives Mental Health MPhA Other DHS Pharmacy Reimbursement, following numerous others MSHP Other Technician Tiering Minnesota Pharmacy Legislative Day 3

4 Please track and follow HF Patient Access to Pharmacist- Provided Medications Opioid antagonists Travel medications Nicotine replacement products Self administered hormonal contraceptives Our fabulous lobbyist: Buck Humphrey Buck, partner Todd Hill and a team have met with: Sen Abeler Rep Freiberg Lauren Gilchrest Sr Health Cr Policy Sen Benson Rep Liebling Rep Albright Sen Lourey Rep Schultz* Sen Rosen* Sen Hoffman Rep Kiel Sen Lourey* Sen Fishbach Sen Nelson Sen Tomassoni Rep Baker* Sen Jensen Rep Schomacker Rep Peterson* Rep Albright* Rep Hamilton* Rep Franson* Rep Zerwas Rep Murphy* *Indicates Sponsor/Co-Sponsor of PATF bill Minnesota Pharmacy Legislative Day 4

5 Overview CMS Role in Addressing Public Health Issues January 2017: CMS calls for states to facilitate timely access to drug therapy by expanding scope of pharmacy practice CMS advocates for Standing Orders, Protocols or Collaborative Practice agreements CMS allows states to be flexible to expand access to medications by pharmacists including dispensing based on independently initiated prescriptions. Scope expansion authorized through legislation, or implemented via Dept. of Health and/or Board of Pharmacy CMS calls out: Naloxone, nicotine replacement and tobacco cessation medications, emergency contraception CMS recognizes parallels to influenza vaccine administration. Overview Proposed PATF approach Naloxone, travel meds, self-administered hormonal contraception, smoking cessation Provide via protocol developed by Board of Pharmacy (BOP) BOP will consult with MN Board of Medical Practice and MN Board of Nursing, Commissioner of Health Training program developed by a College of Pharmacy, ACPE CE or approved BOP program Self-administered Hormonal Contraception- Key Points in Draft Language: Pharmacist can prescribe To a person that is at least 18 years of age If under 18, only if a previous prescription from a non-pharmacist practitioner If an approved training program has been completed If protocol is followed A fact sheet and a written record of the contraception is given out Minnesota Pharmacy Legislative Day 5

6 Self-administered Hormonal Contraception Cont. A pharmacist is prohibited from: Prescribing/dispensing if there is no evidence of a practitioner visit within 3 years following original pharmacist prescription Delegating the prescribing to another person. Self-administered protocol elements: Patient completes a self-screening tool for risk factors Instructions for pharmacists on how to evaluate self-screening tool Pharmacist assessments prior to providing Instructions for contraindications Instructions for referral to PCP or hospital/clinic Additional elements board deems necessary Opiate Antagonist, Travel Medications, Smoking Cessation Must complete an approved training program Must follow a standardized protocol Must provide a fact sheet to patients that includes appropriate method for using. Must provide a record of the medication dispensed. Minnesota Pharmacy Legislative Day 6

7 NGA/NCSL Scope of Practice Tool Minnesota one of five states Thanks to Kent Bridgeman, Lara Kerwin, Anjoli Punjabi, Tony Olson, Laura Vollmer, Brooke Schooler, Rowan Mahon Legislators have been educated about the tool and its use is expected for any scope of practice change NGA/NCSL Scope of Practice Tool Public Safety and Well Being Access, Cost, Quality, Care Transformation Implications Regulation Education/Professional Qualifications Finance Issues Reimbursement, Fiscal Impact to state,etc. Workforce Impacts Supporters/Opponents Where Are We at in Process? Introduced Monday, February 13 th HF 1140 (Rep Peterson) Must make it out of the House Committees (1 st house of origin) by March 10 th Submitted to the Senate this week (Sen Loureyauthor, Rosen, Abeler, Hoffman) Must pass Senate HHS Reform Committee (2 nd house) by March 17th Once bill has passed both houses, it may need to be conferenced or if identical, bills would go straight to the House and Senate floors for votes. (There are many pitfalls along the way.) Minnesota Pharmacy Legislative Day 7

8 Other stakeholder meetings MN Medical Association (MMA) Lauren Gilchrist, Governor Dayton s Senior Health Policy aide (Gov would consider signing) MN Nurses Association MN Nurse Practitioners MN Clear Way (anti-tobacco group) MN ACOG MN BOP HF1140 Language Highlights For purposes of sections ; , subdivision 3; and , practitioner also means a pharmacist who is prescribing self-administered hormonal contraceptives, nicotine replacement products, opiate antagonists, and travel medications. HF1140 Language Highlights (11) prescribing self-administered hormonal contraceptives, nicotine replacement products, opiate antagonists, and travel medications pursuant to section Minnesota Pharmacy Legislative Day 8

9 HF1140 Language Highlights Sec. 5 Pharmacist Prescribing Self-administered contraceptives 18 or older regardless of prior prescription Under 18 with evidence prior prescription Training program Follow standard protocol Provide patient fact sheet HF1140 Language Highlights Nicotine replacement products, opiate antagonists, and travel medications. (a) A pharmacist is authorized to prescribe nicotine replacement products approved by the federal Food and Drug Administration, opiate antagonists, and travel medications Key Points Training program Provide patient fact sheet Contraindications, proper use, need for medical follow up, additional information Provide patient written record Minnesota Pharmacy Legislative Day 9

10 Draft language: Insurance Coverage: All state and federal laws governing insurance coverage of self-administered contraceptive drugs, nicotine replacement products, opiate antagonists, and travel medications shall apply when those products are prescribed by a pharmacist under this section. Board of Pharmacy The board approved the PATF proposed language on February 2 nd. Executive Director can now move beyond technical assistance and can work to support the legislation. Pharmacists as Mental Health Providers Randy Seifert, PharmD Opportunities with HF 737, SF 564 Minnesota Pharmacy Legislative Day 10

11 Other MPhA Issues Tracking DHS Pharmacy Reimbursement Biosimilars HF 712 Board of Pharmacy Policy Bill Drug refill without a prescription HF443 SF536 Direct injectable drugs reimbursement SF563 Various Opioid-related Bills Mandatory PMP use with all CS SF753 Mandatory collection receptacles HF897 SF795 Limiting time to fill prescriptions SF751 Naloxone standing order compliance HF1136 SF750 Opioid stewardship program SF730 Dispensed meds additional information required HF1135 SF751 Other MSHP Issues Technician Tiering Looking Ahead Overall goal is to move the patient across the continuum of care: focus is on patient care Minnesota Pharmacy Legislative Day 11

12 On the Horizon Priorities & Beyond Scope of Practice Provider status Rule changes Technician tiers Thank You! Minnesota Pharmacy Legislative Day 12