NCAP Legislative Update July 2021

North Carolina Association of Pharmacists Advancing Pharmacy. Improving Health.

Legislative and Policy Update July 2, 2021 Medicaid Transformation Yesterday was the go-live for NC Medicaid managed care.

The following resources to help with the Day One transition that we encourage you to share with your partners:  What Beneficiaries Need to Know on Day One fact sheet – English | Spanish 

Provider Day One Quick Reference Guide and Fact Sheet

More information on NC Medicaid Managed Care can be found on the NC Medicaid website medicaid.ncdhhs.gov/transformation.

Medicaid recently sent NCAP the following information from AmeriHealth regarding payment information (evidence of payment-EOPs). Pharmacies can register on the Abarca portal and they will have access to their pharmacy remittances, which will detail claims for AmeriHealth North Carolina.

To access the portal: Click on the following link: https://prx.darwinrx.com/operational 1. If you don't have a username and password, click ‘Register’ and follow the self-registration process.

2. Once registered, you will be able to access the following tools at your convenience: • EOP. Here you can view and download the explanation of payments related to the checks or automatic clearing house (ACH) payments received from Abarca Health for processed claims.

• 835 Transactions. On this module you can download 835 files and upload them to your pharmacy system for reconciliation of transactions.

• Financial Information Document. Here you can enter the banking institution information.

In addition to these tools, pharmacies will have access to the payer sheets and provider notifications.

At the General Assembly A lot of work at the General Assembly since our last update. Good movement on three of our bills and challenges on our other two. Here is a detailed update.

“Medication Cost Transparency Act”

Senator Perry, one of our champions 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 cosponsors. This bill will require PBM’s to be licensed by the Insurance Commissioner. That will allow the commissioner to police these groups and hopefully prevent them from many of the practices they engage in that damage the practice of pharmacy. https://www.ncleg.gov/Sessions/2021/Bills/Senate/PDF/S257v3.pdf Current status: This bill passed has made significant progress. The bill has been heard in the Senate Health, Commerce and Finance Committees. Each committee passed the bill on unanimous votes. The Senate passed the bill on a 45-0 vote. The bill went to the House and was sent to the Rules Committee, and then yesterday, June 30th the Senate Insurance Committee passed the bill with unanimous vote. The bill next heads to the Senate Health Committee.

House 96: “Allow Pharmacists to Administer Injectable Drugs” and Senate 575: “Pharmacists Improve Public Health Needs” We need to now talk about these bills together, for the following reasons. These two bills were moving on parallel tracks. Representative Sasser, the sponsor of H96 and Senator Burgin, the sponsor of S575 met to discuss strategy.

It was decided, for a number of reasons, to combine these bills into one. The vehicle to do so was House 96, which had already passed out of the House by a vote of 111-0 and had gone to the Senate. Of the two bills, it was furthest along in the legislative process.

As a result of combining the bills it is more complex. We have worked hard with the NC Medical Society and other groups to address concerns. This has taken a lot of effort, but it appears that all parties are happy with the result.

The bill will allow pharmacists to administer a number of medications, injectable and otherwise, subsequent to protocols to be developed by the boards of medicine and pharmacy.

The latest version of the bill can be found here: A word of caution. This bill is still a work in progress and is being tweaked on a daily basis. https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H96v3.pdf Current status: This bill passed the House by a vote of 111-0. It was sent to the senate, where Senate 575 was added to it. The bill was heard in the Senate Health Committee on June 16th and voted out unanimously. It is now awaiting a hearing in the Senate Commerce and Insurance Committee.

House 896: “Fair and Equitable Reimbursement/Pharmacists” This is the official title of what we have called the “Pay Parity” Bill. It would provide for the fair and equitable reimbursement of health care services or procedures that are performed by a pharmacist within that pharmacist’s scope of practice and that are equivalent to services performed by other health care professionals.

Representative Mitch Setzer sponsored the bill and it was assigned to the House Commerce & Insurance Committee. We were told this week that the bill will not be heard due to opposition from Blue Cross and Blue Shield of NC. When asked why they opposed the bill, their representative said “We don’t support legislation that regulates the private market.” Given that BCBS is a virtual monopoly in NC, this response is disingenuous at best.

When asked if BCBS leadership would be willing to come to the table with NCAP to discuss pharmacist’s role (and payment for services) in the care of their beneficiaries, we were met with disinterest. Your NCAP legislative

team is discussing strategy and tactics for this important legislation. We are not giving up and will continue to push. https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H896v1.pdf Current status: This bill has real challenges ahead of it and we will work on trying to find a way forward. We believe that this is a bill that we can rally a number of allies beyond pharmacy. We will be seeking to build support from our state’s medical associations and the NC Hospital Association.

H 862: “Improve Access to Patient Care” This is our “Collaborative Practice” legislation. This bill was assigned to House Health and has not moved. There are challenges. First, our legislative champions have spent a LOT of time on our other legislation. Second, the Senate has said they are not happy with the number of House bills they are being asked to consider. Our best chance for getting traction for this legislation would to find another vehicle (another bill) to add this one to: A bill that is already well along in its legislative progress. We are looking for such a bill and will try to pursue this avenue.

Current status: Uncertain.

The bill can be found at: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H862v1.pdf “Pharmacists Allowed to Administer Long-acting Injectables” On March 11 the Governor signed into law House Bill 196 “2021 COVID-19 Response & Relief.” With that legislation qualified NC pharmacists are authorized to administer “long-acting injectable medications.” That legislation can be found here: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H196v8.pdf NCAP has put together educational programming to help prepare pharmacists in the provision of long-acting injectables for behavioral health. We are working on additions to this program to include other indications for LAIs and rules-related information (that is currently under development by NC BOP). NCAP will begin offering this programming as we get closer to the October effective date.

Other Legislation Two other pharmacy-related bills of particular note have been introduced by Rep. Sasser.

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. Since our last reporting, the bill has been voted on by the House and has been sent to the Senate and assigned to the Rules Committee. The bill can be found here: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H93v3.pdf Current Status: This bill has not moved since our last update on it.

House Bill 178 “Access to Prescription Drug Cost Information” would require “access to accurate prescription drug benefit cost information at the time of sale. Since our last reporting, this bill has also cleared the House and been sent to the Senate where it is currently awaiting a hearing in the Senate Rules committee. The bill language can be found here: https://www.ncleg.gov/Sessions/2021/Bills/House/PDF/H178v2.pdf Current Status: This bill has not moved since our last update on it.

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’t forget to let legislators know we are grateful for their work, and we can tell you that these legislators have worked hard and tirelessly with us to move our legislation forward. Here is their contact information: Senator Jim Perry: Jim.perry@ncleg.net 919-722-5621 Senator Jim Burgin: jim.burgin@ncleg.gov 9197335748 Rep. Wayne Sasser: Wayne.sasser@ncleg.gov 919-733-5908

Money Talks One reason BCBS and other groups, like the Medical Society, are successful at the General Assembly is that they have well-funded Political Action Committees. Money is the life blood of politics and well financed groups are able to get people elected and keep people in office who will look out for their interests. Legislators pay attention to well-funded PACs. Well-funded PACs open doors to important meetings, and we are determined to make pharmacy a powerhouse in this state. BUT WE NEED YOUR HELP! Donating to “PILLPAC” is the way that pharmacy can support legislators who have supported us and elect individuals who will be good for the profession.

PILLPAC has now made it super easy to give. Just text the word ‘PILLS’ to (704) 396-5553, to receive a link to donate. You can make a one-time donation or set up a monthly contribution.

Pharmacy Summit NCAP is planning a Summit to be held in August. The purpose of the Summit is to bring together thought-leaders in the profession to engage in discussion about work force and work environment issues for pharmacists and technicians. The Summit will be by invitation, but NCAP has developed a survey that we will soon share. Please stay tuned for more information and if you receive the survey, we hope that you will take time to share your input.