Ohio legislation

Ohio lawmakers begin new push for drug price transparency legislation

Reps. Scott Lipps, R-Franklin, and Thomas E. West, D-Canton, have reintroduced legislation aimed at increasing price transparency for both consumers and pharmacists (Source: “Lawmakers resume push for transparency, end to gag rules by pharmacy middlemen,” Columbus Dispatch, Feb. 12, 2019).

The House passed the legislation unanimously last year, but after receiving an initial hearing in December, it failed to clear the Senate before the two-year session ended Dec. 31.

Legislators' efforts to rein in pharmacy benefit managers, or PBMs, come a week after Gov. Mike DeWine ordered the Department of Medicaid to rebid contracts with managed care companies that hire PBMs to negotiate drug prices with manufacturers and rates paid to pharmacists to fill prescriptions.

Ohio legislators consider bill to end ‘step therapy’ for prescription drugs

Lawmakers are pushing measures that would enable patients to obtain medicine that their insurers wouldn’t normally cover unless they tried cheaper drugs first and were unsuccessful (Source: “Ohio bills would make it easier for patients to get more costly meds,” Cleveland Plain Dealer, Nov. 13, 2018).

With only weeks left before the General Assembly session ends, the bipartisan sponsors of Senate Bill 56 and House Bill 72 -- which are identical -- hope that one of the bills prevails. Sixty patient and physician groups back the effort to regulate what managed care organizations call “step therapy,” since patients begin with the most cost-effective and widely proven drug and progress to more expensive and riskier drugs only when the cheaper ones are unsuccessful.

Health insurers, however, oppose the legislation. They note patients are grouped together in insurance pools, and the costs of the more expensive drugs will be passed on to everyone if the legislation passes. Prescriptions currently account for 23 cents of each dollar people pay on their premiums. Ohio Medicaid has cautioned the legislation could cost the state tens of millions of dollars a year.

“The insurance plans have been the primary and virtually sole opponent,” said sponsor Sen. Peggy Lehner, a Dayton-area Republican. “Medicaid hasn’t taken a position against it but they have expressed concerns. One of those are the costs that might be incurred."

However, 18 states have already passed similar “patient protection laws” on step therapy and none have reported major price hikes, Lehner said.

State leaders looking to move quickly after Issue 1 rejected

After voters statewide rejected Issue 1 this week, state lawmakers are ready to move forward on criminal justice reforms, legislative leaders said Thursday (Source: “After Issue 1 fails, state leaders vow to take up criminal justice reform,” Springfield News Sun, Nov. 8, 2018).

Ohio’s “big three” political leaders — Senate President Larry Obhof, House Speaker Ryan Smith, and Gov.-elect Mike DeWine — each applauded the failure of State Issue 1, a ballot initiative that would have created a constitutional amendment to implement criminal justice reforms and redirect funding currently used in the criminal justice system to community addiction treatment. Voters rejected it 36.6 percent to 63.4 percent, according to unofficial results.

Obhof, R-Medina, said Thursday he will introduce a bill in the upcoming weeks that calls for reducing low-level drug felony offenses to misdemeanors; install a presumption for probation over prison if the offender agrees to drug treatment; allow people currently incarcerated for certain drug crimes to petition the court to be re-sentenced.

The bill will be based on a proposal developed by Franklin County Prosecutor Ron O’Brien, a Republican, and Columbus City Attorney Zach Klein, a Democrat.

Obhof wants to take quick action on the bill, before Gov. John Kasich leaves office and the current legislative session ends. However, if it doesn’t get through by the end of the year, he plans to bring it back next year.

Ohio House bill calls for cabinet-level drug policy post

Ohio Rep. Richard Brown, D-Canal Winchester, on Thursday unveiled a bill that would create a cabinet-level post to coordinate drug policy in Ohio (Source: “Ohio drug policy office proposed,” Columbus Dispatch, Aug. 30, 2018).

More than 4,900 Ohioans between January 2017 and January 2018 died from  drug overdoses. That figure has risen rapidly in recent years and is expected to rise further when the Ohio Department of Health releases statistics for all of 2017.

Brown’s bill, which he plans to introduce in November after the election, was developed in collaboration with the bipartisan Ohio Mayor’s Alliance. The office would be tasked with coordinating drug-related efforts across state and local agencies, serve as an information clearinghouse and it would seek funding for the fight from private and public sources.

Ohio bill would allow APRNs to practice independently

A new Ohio General Assembly bill would allow advanced practice registered nurses to work independently of physicians, an idea the Ohio State Medical Association calls potentially dangerous to patients  (Source: “Ohio bill would give advance practice registered nurses independence from doctors,” Cleveland Plain Dealer, Aug. 30, 2018).

Rep. Theresa Gavarone, a Bowling Green Republican, said House Bill 726 addresses primary care physician shortages throughout the state. But the medical association disputes there are shortages.

Advanced practice registered nurses, called APRNs, diagnose and treat diseases and can prescribe medicine. APRNs must enter mandatory collaboration agreements with doctors under current Ohio law. 

More than 20 U.S. states and the Veterans Administration allow APRNs to practice independently of doctors, Gavarone said.

The medical association, on the other hand, argues that physicians undergo expensive, intensive training to understand the human body. APRNs provide a valuable service, but physicians need to lead medical teams because of their extensive knowledge, said Reggie Fields, a spokesman for the medical association.

Kasich signs bill stiffening fentanyl penalities

Ohio Gov. John Kasich has signed a bill that increases penalties for drug trafficking and some other drug offenses when the drug involved is a fentanyl-related compound (Source: “Gov. John Kasich signs bill increasing drug penalties involving fentanyl,” Dayton Daily News, Aug. 2, 2018).

The law could add as many as eight years to sentences of drug offenders convicted of serious crimes involving drugs containing fentanyl. Increased penalties wouldn't apply if the defendant didn't know a compound contained fentanyl.

When a fentanyl-related drug conviction is connected to a homicide conviction, the law would require that prison sentences for each conviction run consecutively.

Gov. Kasich signed Senate Bill 1 on Wednesday and the law will go into effect after 90 days.

Ohio voters to decide on drug punishment, treatment reform amendment in November

Ohioans will vote on whether to change the state Constitution in November to reduce penalties for nonviolent drug offenders, Ohio Secretary of State Jon Husted's office announced Monday afternoon (Source: “Ohio voters will decide a drug treatment and rehab ballot measure in November,” Cleveland Plain Dealer, July 23, 2018).

The drug treatment and rehabilitation amendment will be known as Issue 1, Husted's office said.

The proposal -- backed by a bipartisan coalition of civic, law enforcement, faith and business leaders -- would do the following:

  • Make possessing, obtaining or using a drug or drug paraphernalia a misdemeanor offense, with a maximum punishment of 180 days in jail and $1,000 fine. First and second offenses within a two-year period could only be punished with probation.
  • Give convicted people a half day credit against their sentence for each day of rehabilitative work or programming, up to 25 percent of the total sentence.
  • Spare individuals on probation from a felony offense for non-violent violations of that probation.
  • Allow people convicted of such crimes to petition a court to reclassify the offense as a misdemeanor, which could result in their release from prison.

Report finds Medicaid pharmacy benefit managers charging triple the going rate

A study commissioned by Medicaid officials found that pharmacy benefit managers are charging Ohio's Medicaid program three times the recommended rate (Source: “Drug middlemen charging Ohioans triple the going rate — or more,” Columbus Dispatch, June 27, 2018).

According to the study, CVS Caremark billed the state about $5.60 per script, while Optum Rx charged $6.50 per script, yet the report released last week said the “fees should be in the range of 95 cents to $1.90 per prescription.” 

That means that Ohio Medicaid’s two pharmacy benefit managers, known as PBMs, received as much as $187 million above the typical cost of administering such programs in one year — $130 million to $164 million more for CVS Caremark and $19 million to $23 million for Optum Rx.

Last week, Medicaid officials announced the results of what is believed to be the first attempt by any state to determine “spread pricing,” or the difference between how much pharmacy benefit managers are billing the state and what they are reimbursing pharmacists to fill prescriptions. It found that PBMs made $223.7 million to process nearly 40 million prescriptions from April 1, 2017, through March 31, 2018.

Meanwhile, the Ohio House on Wednesday took aim at PBMs, unanimously approving bipartisan legislation aimed at increasing transparency of drug prices and lowering prescription costs. House Bill 479, sponsored by Reps. Scott Lipps, R-Franklin, and Thomas E. West, D-Canton, would prohibit health insurers and PBMs from charging consumers co-pays amounting to more than they would pay if the drugs were purchased without insurance or more than the pharmacy was being reimbursed to fill a prescription.

It would also ban “gag rules” that prevent pharmacists from telling their customers about cheaper options for acquiring medications, such as paying out of pocket.

Ohio House committee hears from supporters of prescription price transparency bill

Calls intensified this week for the General Assembly to force more transparency from pharmacy middlemen accused of billing Ohio’s Medicaid managed-care plans for much more than they reimburse pharmacists (Source: “Ohio legislators hear support for bill seeking transparency in prescription pricing,” Columbus Dispatch, April 10, 2018).

Ten witnesses — cancer patients, representatives of national consumer groups and others — appeared before the House Government Accountability and Oversight Committee to testify in favor of House Bill 479, which would require that pharmacy customers be told about and receive the cash price for medicine whenever it’s cheaper than an insurance co-payment.

Ohio pharmacists have said that their contracts with pharmacy-benefit managers in some cases include clauses that prohibit them from telling customers that the cash price for drugs is cheaper than their co-payments.

The Ohio Department of Insurance ordered the PBMs last week to stop enforcing any gag rules. But Heather Free, pharmacy director for the nonprofit Equitas Health, told the committee on Tuesday that the legislation it’s considering remains essential “to ensure that PBMs do not engage in the harmful clawback practice.”

Pharmacy-benefit managers say they negotiate better prices from drugmakers and pharmacies than customers would otherwise receive.

Ohio bill aims to streamline school vaccination data collection

Ohio lawmakers are considering changes to standardize the way schools collect data on student vaccinations — including requiring that a doctor sign off when a parent wants to opt out — as many schools still struggle to meet state standards for immunizations (Source: “Lawmakers seek changes as school vaccination rates remain low,” Dayton Daily News, March 22, 2018).

Medical professionals backing the effort say Ohio needs a more streamlined process to ensure health professionals and parents have accurate data on vaccination rates. But the proposal is already drawing criticism from some parents, who want to protect their ability to choose not to vaccinate without interference from a doctor.

Schools are required to report that information for all students in kindergarten, seventh and twelfth grades, and for students who enter a new school. House Bill 559 would create a standardized form that every school in Ohio would use to collect vaccine information from each student at the required grade levels. A health care professional — whether a physician, nurse practitioner or health department nurse — would complete the form to show what vaccines the child has received.

Parents wishing to opt their child out of certain vaccines would still be able to do so for religious or personal beliefs, but they would need a health care professional to fill out the same form, acknowledging that they had a conversation prior to opting out. The bill also calls for the school-level data collected by the Ohio Department of Health each year to be published online, so that public health officials, stakeholders and parents can know the opt-out rate by school building.