June 9, 2018Hyatt Hill Country Resort, San Antonio

Michael Wright, Executive Director

512‐992‐1219mwright@txrxcouncil.org

2018 Legislative & PMP UpdateACPE # 0130‐9999‐18‐153‐L03‐P&T

Accredited for 1.75 CE Hours 

Describe the major bills that passed in the 2017 Texas session & their impact on Texas pharmacy;

Describe the major bills that passed in the 2018 NM session & their impact on NM pharmacy;

Identify the ongoing issues, challenges & priorities for community pharmacy in Texas & NM; and

Describe new regulations & developments in the Texas PMP program concerning the monitoring of controlled drugs and the impact on pharmacy operations and PMP data reporting.

Disclosure & Session ObjectivesPaid employee of TX Pharmacy Business Council.  Conflict of interest:  NonePaid Consultant of NM Pharmacy Business Council. Conflict of Interest:  None

Learning ObjectivesAt the end of this session; you will be able to:

The Leading Texas Advocatefor Independent Pharmacy

Texas Pharmacy Business Council is the highly successful advocacy arm of 

American Pharmacies. It is unique in the U.S. as the first full‐time, separate 

advocacy organization for a buying group.

TPBC Board of Directors

ChairmanBruce Rogers, R.Ph., Victoria Vice ChairAlton Kanak, R.Ph., HoustonSecretary/TreasurerDoug Eakman, R.Ph., San Angelo

DirectorsLynn Everett, R.Ph., WacoBen McNabb, Pharm.D., Eastland

Bill Moore, R.Ph., SintonJoe Ochoa, R.Ph., Edinburg 

TPBC Legislative Team

Executive Director:Michael Wright

Attorneys:  Communications:Amanda Fields Chuck WatersMiguel Rodriguez

Consultants:Stephanie Gibson

Jerry Valdez

TPBC Guiding Principles

Focus on Achievable Goals You Can Build on. Take a Long‐term View: Alliances & Foundations Built 

Today Reap Future Cooperation & Success. Always Be Willing to Discuss & Negotiate Differences.  Always Honor Your Commitments. Credit Those Who Help – and Expect Credit for Your Help. Advocate the Value of Your Own Objectives & Efforts 

Rather Than Attacking Others. We Are the Advocacy Leader for Texas Independents.  

Our Board & Our Members Expect Us to Lead.

New Mexico Board

ChairmanDanny Cross, R.Ph.Carlsbad, NM

Vice ChairDavid Lansford, R.Ph.Clovis, NM Secretary‐TreasurerAshley Seyfarth, Pharm.D.Bloomfield, NM

Directors

Neal Dungan, R.Ph.Carlsbad, NM

Harvey McCroskey, R.Ph. Ret. Santa Fe, NM 

LobbyistMinda McGonagleAlbuquerque, NM

NM Pharmacy Business Council

Moving the Needle!

Like TPBC, an independent subsidiary funded 100% by American Pharmacies

Big win in 2017 with passage of transaction fee bill

Momentum in 2018 working with Office of the Superintendent of Insurance on more visible & enforceable PBM compliance

Set new bar with Human Services Dept. (Medicaid) requiring MCOs be responsible for PBM compliance with NM PBM Regulation Act; and ongoing Rx reimbursement negotiations

TPBC providing guidance & support

Looking to 2019

Laying the Groundwork

Educating state level policy makers on the               consequences of PBM profiteering power 

Providing policy and lobbying leadership on behalf of Independent Community Pharmacy

Increasing PBM oversight within Office of the Superintendent of Insurance and the Human Services Department (Medicaid)

Actively engaging on all available aspect of reimbursement issues 

New Mexico Legislature 2019

Legislative Package Themeso Strengthening PBM Rules of Engagement & Oversight o Audit Reformso Prompt Payo Pharmacy Patient Fair Practice Act

The Force is with you!

We’re Fighting for All of You!

TPBC works to advance and defend the 

interests of all independent 

pharmacists, not just members

of APRx.

American Pharmacies pays NCPA annual dues for all active shareholders

Michael Wright:  Newest Member of NCPA State Legislative Affairs Committee

NCPA Congressional Legislative Fly In: April 2018Directors Joe Ochoa , Vance Oglesbee, Steve Hoffart, Ben McNabb,   Communications Director Chuck Waters, TPBC Ex. Director Michael Wright. Ten (10) Congressional events

TPBC actively engaged with TX Congressional Delegation on Federal Bills on DIR Transparency, Drug Pricing Transparency, Provider Recognition

>

NCPA/TPBC Congress

June 8‐10, 2017La Cantera Resort, San Antonio

DIR Fees/Transaction Fees Gag Rules/Clawbacks Audits MAC Transparency Narrow Networks Any Willing Provider

Michael J. Wrightmwright@txrxcouncil.orgCell: 512‐636‐8110

TPBC Expertise —Affiliate Member Support: Other States

June 8‐10, 2017La Cantera Resort, San Antonio

Your Education & Licensing Requirements.

How You Buy, Store & Dispense Products You Sell.

The Stores You Own and Work in.

Why You Must Engage! Your Profession & Business Are Highly Regulated:

The Patient Records You Keep.

How You Get Paid; How Much You Get Paid. What You Can or Cannot Do as a Health‐care Professional ― Now or in the Future.

TPBC 2018 Honoree – John Hickman

John Hickman,  RPhTDyer Drug Store, Farmersville, TX

John hosted a Legislative Update in Farmersville with State Rep. Justin Holland as speaker. Texas Sen. Craig  Estes and U.S. Rep. John Ratcliffe also represented. Rep. Holland returned to John’s store twice and used it as backdrop for photo shoot. He is a major supporter of APRxPAC and also supports the campaigns of his elected representatives.

John has also been engaged with  new TSBP Director Allison Benz on a variety of policy issues.

AdvocacyLeadership

Award

Elections Harvey‐$$$$$ School Funding: $$$$ Tax Relief:  Property: $$$$ Immigration: Border/NAFTA:$$$$ Medicaid: $$$$ Child & Protective Services:$$$$ TXDOT Funding: $$$$ Opioids: $$$$

Major Statewide Issues

Conservative Control  = Greater Fiscal Focus + Less Government Spending + No New Taxes 

Less Government Spending = Limited Funds for Social Programs= Limitations/Reductions in Health Care = Reductions/Caps Provider payments

The Texas Legislature Key Legislative Allies31 Senators ─ 1 Pharmacist 

Charles Schwertner, R.Ph., Georgetown)Sen. Juan Hinojosa (D‐McAllen)

151 Representatives ─ No Pharmacists   

Rep. T  Todd Hunter  (R‐Corpus Christi)John Kuemple  (R‐Seguin)

2017: 6,000+ Bills Filed —70+ Were Pharmacy‐Related2019: 50‐60 Pharmacy related Bills‐Estimate

Senate Bill 1076:  PBM ClawbacksSB 1076 prohibits health plan/PBM from requiring a co‐payment for a covered medication that exceeds the lessor of: The standard copayment; The allowable claim amount for the medication; or The pharmacy's cash price.

NCPA survey: 83% of surveyed pharmacists                           experience 10 or more per month Deceptive Profiteering on Medications Pharmacies Are Unwilling Participant PCMA, TAHP, UNITED/OPTUM,CVS, PRIME,                  

EXPRESS, HUMANA,BC/BS all opposed 

House Bill 1178: Pharmacy Crime 

HB 1178: Increased Criminal Penalties for break‐ins targeting controlled drugs

Commercial Buildings: Pharmacies, Clinics, Doctors offices, Hospitals, wholesalers(Vehicles)

Opioid Abuse, Monitoring & Crime:  #1 Issue Texas ranks #1 in Pharmacy Break‐ins from 2011‐16 Driven by Organized Gangs Like Fifth Ward Circle Txopioidcrisis.org

HB 2561: Texas PMP Checks & Reports

HB 2561: TSBP Sunset Bill TPBC position to treat All Prescribers/Dispensers in PMP and all at the same time

Pharmacy:  Report to PMP 1 Business Day: Sept 2018 Mandatory Check of PMP before Prescribing 2019 Mandatory check before dispensing ‐ 2019

2018 Interim TPBC Priority Issues Opioids — Multiple Hearings, Lawsuits-

Manufacturers, PMP enhancements/expansion, prescribing restrictions, wholesalers

PBM Oversight-Texas Dept. of Insurance

PBM Oversight-Health & Human Services Commission

Health & Human Services: Networks, Any Willing Provider, Increase in generics –Medicaid Managed Care Formularies

OIG- PBM Oversight, Audits, Networks

TPBC Legislative Priorities Economic viability of Independent Pharmacy

PBM Practices Exposure:FeesAuditsNetwork accessAppeals processTransparency

How Can You Get Involved? Become Politically Active

Be Informed on Pharmacy Legislative Issues. Invite Candidate to YOUR Pharmacy               

or Local Meeting. Support His/Her Election                     

Campaign. Visit District Office. Offer to Be a Resource on                     

Pharmacy Issues. Be Prepared to Come to Austin to Testify.

TPBC needs your support, starting with your relationships with elected leaders. Your involvement is vital:

Testify on key issues  Call/email/visit elected 

officials Leverage relationships to 

influence outcomes

Join Our Grassroots Network!

www.txrxcouncil.org

Please welcome Scott Brunner, Senior VP for Communications & State Government Affairs 

State Advocacy – A National View

To Your Profession,

Your Career,

Your Patients,

YOUR FUTURE!

Thank You for Your Dedication Effective Use of the Prescription Monitoring Program

American PharmaciesAPEX Conference

San Antonio, Texas

Allison Vordenbaumen Benz, R.Ph., M.S.Executive Director

June 9, 2018

Goals

Review appropriate use of the Prescription Monitoring Program (PMP) in Texas

Discuss legislation regarding the PMP passed by the 2017 Texas Legislature

Discuss the use of professional judgment/ ethics when accessing PMP data

January 1, 1981

The Texas Legislature passed Senate Bill 394, requiring prescriptions for Schedule II medications to be issued on triplicate form.

Prescriptions were required to be filled no later than the end of the second day on which the prescription was issued.

The program was administered by the Texas Department of Public Safety (DPS).

February 23, 1982

DPS adopted rules regarding the Triplicate Program.

September 1, 1999

House Bill 1070 was passed by the Legislature amending the Controlled Substances Act.

The triplicate prescription form was replaced with an official prescription form. The forms were required to be sequentially numbered and were still issued by DPS.

September 1, 1999 (Continued)

Senate Bill 254 required pharmacies to electronically submit Schedule II prescription information to DPS.

September 1, 2008

The Controlled Substance Act is amended to include Schedule III through V medications to the Prescription Monitoring Program.

Schedule II prescriptions may be dispensed up to 21 days after issuance.

2015

In 2015, the 84th Texas Legislature voted to transfer the PMP from DPS to the Texas State Board of Pharmacy.

2015

Senate Bill 195 moved the Prescription Monitoring Program from the Department of Public Safety (DPS) to the Board of Pharmacy; and

Eliminated the Texas Controlled Substance Registration program.

Timeline for Transfer of the PMP Program

November 2015 – RFP for the new PMP issued by TSBP.January 2016 – Appriss selected as the vendor.February – May 2016 – System installation at TSBP.May/June 2016 –Testing of program.September 1, 2016 – NEW PMP goes live.

PMP Account Setup

PMP AWARxE

Go to the PMP Website:texas.pmpaware.net

ORGo to the TSBP Website:

www.pharmacy.texas.gov

53 54

5556

61 62

Threshold Alerts

63

Legislation Passed by the 2017 Texas Legislature

64

Effective September 1, 2017, HB 2561 Amended the Texas Controlled Substances Act

The bill: requires pharmacies to send all required information for Schedule II – V prescriptions to the PMP not later than the next business day after the date the prescription is completely filled; specifies that after 9/1/2019, a pharmacist or prescriber authorized to access the PMP, other than a veterinarian, shall access the PMP for the patient before prescribing or dispensing: Opioids; Benzodiazepines; Barbiturates; or Carisoprodol;

65

HB 2561 (cont.)

specifies that a regulatory agency that issues a license to a prescriber or dispenser shall provide TSBP with any necessary information, including contact information to register the prescriber or dispenser with the PMP; and

adds a new Sec. 481.0764 to require wholesalers to report to TSBP the sale of controlled substances made by the distributor to a person in this state.

66

Total Controlled Substances Dispensed FY2017

67

Number of Patient SearchesFY2017

68

Controlled Substances Dispensed by Type FY2017

69

Registered Users in FY 2017

70

License Number ofRegistered Users

Dentist 3,291Medical Resident with Prescriptive Authority 191Advanced Practice Registered Nurse 6,786Optometrist 16Pharmacist 18,460Pharmacist Delegate (Pharmacy Technician) 918Physician (MD, DO) 22,737Physician Assistant 2,989Podiatrist  221Prescriber Delegate  1,642Other Prescriber 86Veterinarian 109Other 138TOTAL 57,584

Push Notifications

71 72

HB 2561 (cont.)

The bill amends the TCSA to require each regulatory agency that issues a license, to a prescriber to promulgate specific guidelines for prescribersregulated by that agency for the responsible prescribing of opioids, benzodiazepines, barbiturates, or carisoprodol.

Guidelines

Texas Medical Board §170.3Board of Pharmacy §291.29

Wholesaler Reporting

185 wholesalers reportingMore than 600,000 records

75

Enhancing the Prescription Monitoring Program

E-prescribingClinical AlertsNarxCareSystem Integration

76

Benefits of E-Prescribing

Adds safety and securityImproves patient care and outcomeReduces errors

77

Potential Forged Paper Prescriptions in 2017

Data from self-reported drug abusers suggest that between 3% and 9% of diverted opioid prescriptions are tied to forged prescriptions.

If those statistics hold true across the state of Texas, that would mean that from 304,786 to 914,359 pre-scriptions were potentially forged prescriptions.

78

E-Prescribing map

79

Clinical Alerts

Prescriber & Dispenser ThresholdsOpioid & Benzodiazepine ThresholdOpioid Consecutive Days ThresholdDaily Active MME ThresholdDaily Active Methadone Threshold

80

NarxCare is also available within PMP AWARE

• Provides full access to state of the art tools and assessments regardless of integration status

• Sets the stage for incremental data addition (determined by the State)

• i.e. non‐fatal overdose, drug court participation, naloxone administration data

www.facebook.com/TexasPMP

• The Texas PMP Facebook and Twitter pages will offer news and updates specific to the program.

• Both accounts will contain the same information.

Texas Prescription Monitoring ProgramSocial Media

twitter.com/TexasPMP

Texas PMP ContactEMAILtexaspmp@pharmacy.texas.gov

PHONE(512) 305-8050

Thank you!