NCAP Legislative Update March 2021

North Carolina Association of Pharmacists Advancing Pharmacy. Improving Health.

Legislative and Policy Update March 17, 2021 At the General Assembly Time for an update on the status of our Legislative Agenda. Here are how things stand.

Pharmacy Benefits Manager Senator Perry, one of our champions has introduced Senate Bill 257 the “Medication Cost Transparency Act.” Senators Britt and Johnson join him as Primary Sponsors with Senators Corbin, Edwards, Lazzara and Lowe as co-sponsors. The bill is designed to put an end to many of the most egregious PBM practices threating pharmacy in our state. The bill can be found at the following url: https://www.ncleg.gov/Sessions/2021/Bills/Senate/PDF/S257v0.pdf “Improving Patient Outcomes and Access to Care” This is the new title of our “Collaborative Practice” legislation. The bill is drafted and will be introduced by Rep. Wayne Sasser. We are seeking to introduce a companion Senate bill as well. It is likely that we will hold this bill in committee while we focus our efforts on the PBM and Medicine Administration bills first, then concentrate on it next.

“Medicine Administration” This bill has a couple of avatars. You may see one version that limits what pharmacists can administer to “long acting injectables.” This language appears in H196: “2021 COVID-19 Response & Relief.” However, another bill with broader permissive language has also been introduced. This bill is House 96 and is called: “Allow Pharmacists to Administer Injectable Drugs” This bill refers to all “injectable drugs” rather than “long acting injectables.” The versions are not competing with one another. Rather, the language appearing in the COVID-19 bill is a fallback bill in case the second bill runs into issues.

House Bill 96 is scheduled to be heard in the House Health Committee next Tuesday. You can find House 96 at: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H96v1.pdf.

“Public Health” This legislation will allow pharmacists to both prescribe and administer a specific list of medications, including smoking cessation products, hormonal contraceptives, post-exposure prophylaxis (PEP) for HIV, and others. The bill also has a provision to allow for test-and-treat for non-chronic, common ailments such as influenza. This bill will be introduced shortly by Senator Burgin.

“Pay Parity” We are currently trying to finalize sponsors for this bill. We have run into some headwinds regarding it, with members needing to be convinced that it will not increase health care costs. We may have to take the approach of Kentucky, which recently passed their legislation, with no dissenting votes. Kentucky was able to succeed by focusing on commercial health insurance. The National Alliance of State Pharmacy Associations is working with our Executive Director to help with supportive materials and information.

Other Legislation Two other pharmacy-related bills, not on NCAP’s advocacy agenda, have been introduced. Rep. Sasser has put forward the following: House Bill 93 “Allow Naloxone Scripts with Opioid Scripts” This bill would direct doctors to prescribe Naloxone in addition to prescribing opioid type medications of 50 or more morphine milligram equivalents. The bill passed out of the House Insurance Committee and is headed to the House Rules Committee. Bill language can be found here: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H93v2.pdf House Bill 178 “Access to Prescription Drug Cost Information” would require “access to accurate prescription drug benefit cost information at the time of sale. The bill language can be found here: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H178v1.pdf

Regulatory News North Carolina Medicaid for Outpatient Pharmacy Clinical Coverage Policy No: 9, has published proposed amendments now open for public comment. The amendments, center around dispensing and maximum dayssupply, and would allow for up to 12 months of oral birth control medications to be dispensed. Also, for noncontrolled maintenance medications has a proposed change from ‘may’ to ‘shall’ obtain 90-day supply, under one co-pay and one dispensing fee. NCAP plans to submit official comments and we will be providing talking points to help our members write and submit their own comments. Comments are to be submitted to Medicaid.public.comment@dhhs.nc.gov by April 12, 2021.

NOTE, IMPORTANT UPDATE AS OF MARCH 18, 2021: Angela Smith, Pharmacy Director for NC Medicaid contacted NCAP this morning and stated that it was NOT DHHS’s intent to require 90-day supplies for Medicaid maintenance prescriptions. The provision is meant to be optional, and they are in the process of removing the word ‘shall’ from the amendment. Subsequent to this change, NCAP will no longer see a need to provide official comment on the proposed amendments for the dispensing and maximum days-supply in the Outpatient Pharmacy Clinical Coverage Policy No: 9.

Next Steps: We expect all our legislation to be filed shortly and to begin moving through the legislative process. We will keep you informed about this in future updates. Meanwhile, we ask that you begin to organize pharmacists, technicians and student pharmacists at your place of work to get them ready to respond to alerts and calls to action. If you would like to serve as a point of contact for your group, please email NCAP’s Executive Director, Penny Shelton at penny@ncpharmacists.org, and provide your contact information and place of work.

Your Role It is VERY IMPORTANT for you to thank the legislators who are going to bat for pharmacy. A short phone call or note saying thank you for introducing these bills would be greatly appreciated. We can forget to let legislators know we are grateful for their work. Here is the contact information: Senator Jim Perry: Senator Jim Burgin: Rep. Wayne Sasser:

919-722-5621 919-733-5748 919-733-5908

Important: Supporting Those Who Support Pharmacy You will be glad to know that PILL PAC, the Political Action Committee that NCAP supports made some significant contributions to General Assembly members prior to election day. We have been saying that we have to support those who support pharmacy and we have done that this year. NCAP has two members on the 4-member board. I and Mike James provided them with the information they needed to make their decisions.

Donating to “PILLPAC” is the way that pharmacy can support current legislators who have supported us and elect individuals who will be good for the profession.

As we move forward, we will be making improvements to PILL PAC that will make it easier to contribute. And, we need to broaden out those who contribute. This last year about a dozen pharmacist donated the brunt of what PILL PAC gave out. Obviously, that is not a sustainable model. All must do their part and it is not fair to ask a small number of colleagues to do what we all should be doing. We ask you to keep this in mind as we move forward in our overall advocacy plans.

You can also help by donating to the NCAP advocacy fund. NCAP’s fund helps to support the work of your lobbyist and grassroots efforts. To donate visit www.ncpharmacists.org and click on donate under the advocacy tab.

Contributions to PILL PAC can be sent to this address: 209 Fayetteville Street: Raleigh, NC 27601 No amount is too small and every dollar counts.

As always, send your thoughts, input and suggestions to me at solarigovernmentsolutions@gmail.com