Submitted by Thomas Buckley, RPH, MPH; CSHP Legislative Chair
The 2019 Connecticut General Assembly came to a close in early June, and finished with a flurry of bills passed that affects pharmacy practice. In addition to monitoring over 3000 bills introduced in this session, CSHP raised and coordinated the effort for 2 specific bills. Both of these bills had numerous live and written testimony in support of passage from CSHP members, and we can be very proud of our efforts to raise the awareness of pharmacy practice in legislators’ minds.
Our bill to permit pharmacists to prescribe tobacco cessation therapy was raised and received a public hearing, but it ran out of time on the legislative calendar to come to a vote in the public health committee. However, our bill to expand collaborative drug therapy management to include APRNs, in addition to physicians, did pass and will become effective October 1, 2019 (Senate Bill 921). The language to expand collaborative practice was included in the overall APRN bill that affects their scope of practice, as Section 22 of SB 921. The impact of granting APRNs authority to collaborate with pharmacists through protocols will be reflected primarily in ambulatory care clinic settings, where APRNs are having an increasing role in primary care. This bill should result in significantly more protocol-driven medication management by pharmacists in various settings around the state.
Of the many legislators who supported this bill, these legislators should be thanked for their efforts – please make an effort to email or call them to thank them for their support of pharmacy practice:
Senator Mary Abrams: http://www.senatedems.ct.gov/abrams-contact
Rep. Chris Perone: Chris.Perone@cga.ct.gov
Rep. Jonathan Steinberg: Jonathan.Steinberg@cga.ct.gov
Rep. William Petit: https://www.cthousegop.com/Petit/
Rep. Vincent Candelora: https://www.cthousegop.com/Candelora/
Note: The flu vaccine bill to administer to age 12+ did not pass. If you've questions, please contact Tom Buckley. Thomas.firstname.lastname@example.org
submitted by Thomas Buckley, CSHP Legislative Chair
With one month to go in the Connecticut legislative session, there are a number of bills that we are following and are close to being at the end of their journeys. SB 921, the APRN scope of practice bill that includes allowing pharmacists to collaborate with APRNs (in addition to physicians) in the current collaborative practice (CDTM) law, has passed the Senate and is awaiting action in the House. You can help assure this bill is passed by calling or emailing your State House member and urge them to pass it in the House chamber. Here is the link to the legislation, which includes the history of the bill and the bill language. The pharmacist/APRN collaborative practice language in this bill is Section 22. https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2019&bill_num=921
HB 6543, the bill allowing pharmacists to prescribe tobacco cessation products, received a public hearing in the Public Health Committee. Despite outstanding oral testimony and presence at the hearing by our members, and numerous written testimonies submitted, due to the Public Health Committee’s full agenda, the bill failed to make it out of committee, and we will advocate for prescriptive authority next year.
Two other bills we are following are ready to be voted on in the Senate. SB 94 allows pharmacists to administer influenza vaccine to children ages 12-17, with the consent of their parent or guardian. SB 48 requires brand name drug manufacturers to make available samples to generic drug manufacturers so they can conduct testing required to support an application for generic drug approval.
The effort to legalize recreational marijuana is comprised of multiple bills in various committees. We continue to monitor this activity and its potential impact on current medical marijuana pharmacist dispensaries. As of early May, three legislative committees have passed companion bills that would legalize, regulate and tax cannabis for use in ages 21 and older. There is still a great deal of policy details that needs to be worked on, and it’s unclear if full passage would occur before the end of the regular session. The legislative session ends on June 5, and we will be continually apprised of legislative updates.
CSHP has become a member of Patient Access to Pharmacists’ Care Coalition (PAPCC), a coalition spearheaded by ASHP that is working to obtain nationwide provider status for pharmacists in the Medicare program. For information about PAPCC, go to http://pharmacistscare.org To see who are current members of the coalition (more being added each day), go to http://pharmacistscare.org/about-papcc/
Submitted by Thomas Buckley, RPh, MPH, CSHP Legislative Chair
The Connecticut General Assembly has begun with a new Governor, many new Commissioners, and many new legislators and legislative committee chairs. This represents an opportunity for pharmacists to make their voices heard to improve their professional workplace and their ability to serve patients.
CSHP has been working with Fred Knous and Knous Associates as their legislative lobbyist for the past 18 years, assisting us in shepherding new laws, such as collaborative practice authority and immunization administration, and monitoring all proposed bills related to our profession that may affect us in a positive or negative way. Over 3,000 new bills will be proposed this session, with perhaps 300 leading to a new or revised law by the time the legislative session ends in early June. Each week the bill monitoring service Fred provides releases a brief review of current bills of interest in the legislative pipeline (Click to read the first “bill book” for this session).
CSHP, working in collaboration with other interested pharmacy entities in the state such as CPA, will be working on three significant new legislative initiatives this session, in addition to closely monitoring other health care and pharmacy-related bills.
1. We will work toward expanding collaborative practice authority (CDTM) legislation to include APRNs, in addition to physicians, with whom pharmacists can collaborate on protocol-driven prescriptive authority.
2. We have proposed HB 6543, a bill that focuses on a major issue of the public health committee this legislative session, tobacco and e-cigarettes, by advocating for pharmacist prescriptive authority for tobacco cessation treatment. There are currently 8-10 states that have some form of pharmacist prescriptive authority for tobacco cessation treatment, and Connecticut will likely pursue legislation similar to Indiana and Idaho that have created state-wide protocols for pharmacist treatment management. This could result in a practice similar to our current immunization administration law, in which pharmacists provide treatment management per protocol upon patient request of services. Click for a good graphic summary of the pharmacist's role in tobacco cessation.
3. The third area of focus for this session and beyond is pharmacist provider status recognition by Medicaid and commercial payers, thereby opening the door for potential reimbursement of pharmacist services from all payers in Connecticut. This initiative will likely require a coalition of pharmacy entities, such as the professional organizations, pharmacy schools, health-system administrators, and other policymakers that understand the cost-effective impact of pharmacists on patient health care outcomes. A law similar to what was recently passed in Ohio provides a potential roadmap of how this initiative could proceed, enabling pharmacists to be on the same playing field as any other provider rendering a service, creating a direct contractual payer/provider relationship.
All of these issues will require a coordinated, active engagement of our members. Please be receptive to reach out to your legislator, particularly if they are a member of a specific committee that oversees our legislative initiatives. CSHP may contact you to advocate directly to your legislator, or through collective advocacy in events such as Pharmacy Day at the Capitol on March 7th at the Legislative Office Building in Hartford. More information will be forthcoming on this event, and talking point documents will be produced for each active legislative initiative of interest to us. This event will be in collaboration with CPA, so we anticipate a large turnout of pharmacists from throughout the state, both at the evening reception from 4:30 – 7:00 p.m., and for one-on-one meetings with legislators from 9 a.m. to 4 p.m.
Submitted by Thomas Buckley, CSHP Legislative Chair
Advocacy isn’t just about what happens in Washington, D.C. It’s about what you can do close to home as you build relationships with elected officials, policymakers and colleagues. The CSHP Legislative Committee works with the CSHP Board, the CSHP lobbyist and other interested parties around Connecticut to advocate for issues specifically relevant to pharmacy practice. Our lobbyist is Fred Knous, a veteran healthcare lobbyist in Hartford and a former state Senator from Portland, CT. He has tremendous relationships with all legislators and other key policymakers, and is more than willing to help any CSHP member work legislative chair of CSHP, Tom Buckley, was a hospital pharmacist for 18 years, then worked as a medical outcomes researcher with Pfizer, and has been a full-time UConn Pharmacy faculty member for the past 9 years, coordinating their public health curriculum.
CSHP works closely with other pharmacy entities in Connecticut, including CPA, CT-ASCP and other health care entities with interest in legislative or policy initiatives affecting pharmacy practice. CSHP was a leader in developing and passing collaborative drug therapy management (CDTM) legislation, starting with the publication of a White Paper in 1994, through the initial passing of the CDTM bill in 2002, and ultimately the current version of the law in 2012, enabling pharmacists in any practice setting to develop and manage collaborative practice protocols with physicians for any medication or medical condition. CSHP also was very active in immunization administration legislation, allowing pharmacists to provide any immunization on the CDC adult immunization schedule.
CSHP has been continually involved in provider recognition and reimbursement policies for pharmacy practice. This includes working with CT Medicaid and all commercial payers in the state, and with Medicare on the federal level, particularly with the current bill in Congress. Becoming a “provider” in the Social Security Act means that pharmacists can participate in Part B of the Medicare program and bill Medicare for services that are allowed under their state scope of practice. The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592/ S. 109) is bipartisan legislation that will amend section 1861 (s) (2) of the Social Security Act to include pharmacists on the list of recognized healthcare providers. CSHP asks all members to discuss this legislation with their members of Congress (both House and Senate), and ask them to become co-sponsors. Currently in Connecticut, H.R. 592 has 3 co-sponsors (DeLauro, Larson, Courtney), while S. 109 has only Senator Blumenthal as a co-sponsor.
CSHP works closely with our lobbyist especially when the General Assembly is in session. Connecticut has a part-time legislature, meeting during odd years from January to June, while in even years from February to May. However, if CSHP is strongly advocating for new or current legislation that may be seeking a change, the advocacy work required to push legislation to a successful conclusion typically can be a year-round endeavor. This is where the CSHP legislative committee and the CSHP Board cannot possibly accomplish advocacy gains without the grassroots efforts of practicing pharmacists and the CSHP membership. When the word goes out through email alerts or other communication vehicles that an important initiative is occurring that may affect pharmacy practice, your voice, your action in clinical practice, your email, your phone call, or just your interactions with your neighbors play a critical role in advancing pharmacy practice initiatives in our state. Connecticut is blessed to have a very tight pharmacy community, meaning it is a small state with active practitioners and pharmacy leaders. Therefore, very simple actions can create major change.
Lobbying comes in all shapes and sizes, dispositions and attitudes. We lobby because we are the best representative of pharmacy. Legislators cannot possibly be informed of every issue, therefore a responsibility of our job of being a “good steward” of our profession, is to inform legislators about pharmacy. When told the President is a lobbyist for the people, Harry Truman responded: “God knows they need it!” Making an impact in a small state like Connecticut can come from a simple phone call, email, letter, and most effectively through a one-on-one visit – whether it’s at a legislative office, or at your practice site. The CSHP legislative committee and Board will guide you through the process, provide you with all the background information you will need for a specific issue, and set up appointments for you with influential policymakers. There is an old adage on how a legislator interprets communication from a constituent that is particularly relevant in Connecticut: one letter received is “a kook”, 2 letters received is “a kook with a friend”, 3 letters received means “someone had a meeting”, while 4 letters received is considered “a movement.”
Pharmacy advocacy means creating that movement – for your practice, your profession, and most importantly for your patients. The CSHP legislative committee has a long history of understanding health care issues and their relevance to pharmacy practice, and stands poised to work with you to open new doors for pharmacists to use your extensive clinical knowledge to care for your patients.
Submitted by Thomas Buckley, RPh, MPH; CSHP Legislative Chair
The Connecticut General Assembly ended their 2018 session on May 8th with a number of bills that included pharmacists and/or pharmacy practice. While there were at least 50 bills that we were actively monitoring that did not pass, the following bills did pass which may affect pharmacy practice, although in some cases not affecting hospital inpatient practice.
AN ACT CONCERNING PRESCRIPTION DRUG COSTS: HB 5384
This bill will impose additional disclosure and reporting requirements on pharmacy benefits managers, health carriers, pharmaceutical manufacturers, the Office of Health Strategy and the Insurance Department concerning prescription drug rebates and the cost of prescription drugs.
PHARMACY AND DRUG CONTROL STATUTES: SB 195
This bill will require pharmacists to maintain perpetual inventories of Schedule II controlled substances.
AN ACT CONCERNING BIOLOGICAL PRODUCTS: SB 197
This bill will add biological products to existing law regarding substitution of generic drugs. The pharmacist may dispense an interchangeable biological product, which is therapeutically equivalent – must notify patient and prescriber within 48 hours of change (exempts hospital inpatients)
AN ACT CONCERNING PHARMACIST AND PRACTITIONER COMPLIANCE RATES AND THE ELECTRONIC PRESCRIPTION DRUG MONITORING PROGRAM: HB 5241
This bill requires the Commissioner of Consumer Protection to review pharmacists’ compliance with PMP requirements.
AN ACT LIMITING AUTO REFILLS OF PRESCRIPTION DRUGS COVERED UNDER THE MEDICAID PROGRAM: SB 246
This bill is intended to prevent unnecessary costs and clinical outcomes associated with prescriptions that are unnecessarily automatically refilled.
AN ACT CONCERNING TELEHEALTH SERVICES: SB 302
This bill adds pharmacists as providers who can administer telehealth services and modifies and clarifies patient consent procedures.
In addition to state legislative activity, ASHP has released their analysis of the Administration’s “Drug Pricing Blueprint” which was announced on May 11th. An ASHP issue briefdescribes the Administration’s drug pricing policy proposals, includes their stance on the proposals (including what is promising and what is concerning), and their next steps in working with the Administration in addressing drug costs. HHS has released a site soliciting ideas for reducing drug costs: (https://www.gpo.gov/fdsys/pkg/FR-2018-05-16/pdf/2018-10435.pdf) ASHP will be submitting comments reinforcing the necessity of engaging pharmacists in these efforts.
submitted by Tom Buckley, RPh, MPH, CSHP Legislative Chairperson
The Connecticut General Assembly is entering their "short session" year, meaning the regular session will run from February 7 through May 9; however, a special session is being held in January to tackle restoring funding for the Medicare Savings Program. Given that this is a short session year and the state's current fiscal situation, there will not be many, if any, opportunities to offer new legislation affecting pharmacy practice, unless there was a fairy tale promise of saving the state millions of dollars.
CSHP will continue to be active, however, in monitoring any legislation that has an impact on pharmacy practice through our "bill book" reviews done by our lobbyist Fred Knous. If you would like to see the bill book as it's produced (initially every few weeks, then weekly as the session produces proposed legislation), please notify the CSHP office.
Note: Our legislative chair, Tom Buckley, is on sabbatical in Cambodia until June 2018, organizing a grant project for patients with diabetes and mental health conditions. In his absence, Eric Tichy has graciously offered to be the local liaison with our lobbyist, Fred Knous, to coordinate any local responses should the need arise. Please contact Eric Tichy anytime with questions on either state or federal legislative activities.
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