 SAVE THE DATE!
PharmedOut 2013 |
PharmedOut 4th Annual Conference Washington, DC June 6-7
PharmedOut's 4th annual conference "Medical Behavior in a Commercial World: Who Is Responsible?" will be our best yet! Please join Marcia Angell, Carl Elliott, Joel Lexchin, Virginia Barbour, and other luminaries on June 6-7, 2013 at Georgetown University. Two ghostwriters will discuss tricks of the trade, and we'll have a surprise guest speaker: a former pharma executive from a top 5 company.
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From the Director:
Most state legislatures are either deep into their respective 2013 sessions, or closing in on the end date, with the exception of a few full-time legislatures. Thus we have a pretty good idea at this point what the key issues are, and the scope of bills introduced this year.
While this overview is by no means comprehensive, some trends and topics are clear. As expected, regulation of compounding pharmacies is showing up in many legislatures, including California, Maine, Minnesota, New Hampshire, New Jersey, Oklahoma, South Carolina, Utah, Virginia. Read more here.
Specialty drugs and oral cancer drugs, where the prices continue to escalate, are also of interest. States continue to consider pricing and mandated benefit legislation related to both, including bills in Maine and Massachusetts. Read more here.
Pharmacy Benefit Managers (PBMs) continue to come under scrutiny by state legislators including in California, Kentucky, Maine, New York, North Dakota, Oklahoma and Oregon; in Maryland there is a PBM/specialty drug bill of interest. Read more.
As expected, legislators continue to address concerns about over-prescribing of psychiatric drugs to children, particularly children in state care, foster children and Medicaid patients. Bills have been considered this year in Maine, New Mexico, and Texas. Read more.
Vermonters continue to be on the cutting edge of prescription drug policy; pending legislation there requires direct to consumer education about medicines. Legislation would also continue efforts that were unsuccessful last year to limit exemptions for children's vaccinations. Read more.
Legislators around the country have encouraged generic drug substitution and strongly opposed pay-for-delay schemes. NLARx joined in the AARP amicus brief in FTC v. Activis, argued in the Supreme Court earlier this week, challenging pay-for-delay. You can read our brief and other documents in that case, and listen to a post-argument policy forum, at American University's Washington College of Law here and read a blog post explaining the case from the Prescription Access Litigation Project.
For the most up-to-date news about state pharmaceutical policy, be sure to follow us on Twitter (@nlarx) and Facebook. We also regularly post news stories and links to reports and testimony on our website.
 
Check out the list of Reports You Really Need to Read, and the interesting conferences scheduled in the next few months.
Best wishes,
Sharon Treat, Executive Director
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States Address Compounding Pharmacies
The National Conference of State Legislatures has put together a handy summary of state action on compounding pharmacies in 2013, as well as a compendium of existing laws and other resources on the issue. According to NCSL, as of March 10, 2013 there have been 16 bills related to the regulation of compounding pharmaceuticals proposed in 11 states.
Virginia's legislation and Utah's legislation has passed through committee and been sent to their respective Governors. House Bill 3161 and senate bill 183 are similar and pending in South Carolina; you can research S. Carolina bill status here. Bills are also pending in California, and the Massachusetts House and Senate. Three bills are pending in Minnesota, and House and Senate bills are in committee in New Jersey. The New Hampshire bill has been reported positively out of committee in amended form, and the Oklahoma bill has passed the House and been sent to the Senate. Maine's legislation will be printed next week. Mississippi's legislation died in committee and Hawaii's legislation may also not be enacted according to this database.
Compounding pharmacies, unfortunately, continue to be in the news; last week the FDA warned of another recall, this time of Avastin compounded by a Georgia pharmacy, reported here.
As NCSL points out, some of the issues addressed in the state bills include clarifying which compounded drug orders meet the state-regulated standard and which cross into a manufacturing regulatory category; updating definitions for compounding, wholesale, specialty and hospital-based pharmacies, and clear language about "sterile" and "non-sterile" compounding; inspection of facilities; enforcement responsibilities; funding; and transparency of records.
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Out-of-Control Specialty and Oral Cancer Drugs Get Legislators' Attention
Here's a report everyone should read: "Clear Evidence Of US Specialty Drug Price Collusion Ignored For Years," a study of specialty drug prices and PBMs. State legislators have focussed on specialty drug issues in several ways. Maryland House bill 736
requires the State Board of Pharmacy to specify the prescription drugs that may be considered specialty drugs by a PBM, which would be prohibited from requiring a specialty drug to be dispensed by mail order and must instead allow any licensed pharmacy or pharmacist to fill a prescription for a specialty drug if the pharmacy or pharmacist meets specified requirements.
More typical are bills to require insurance coverage of oral cancer drugs. Legislatures in 19 states and the District of Columbia enacted such "parity" laws in 2012, and this trend has continued in 2013. Massachusetts recently enacted this legislation, SB 2363, signed into law by Governor Patrick over the objections of business groups concerned about treatment costs of as much as $115,000 per patient per year. LD 627, still in committee in Maine, is typical of bills being introduced across the country.
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Pharmacy Benefit Managers Scrutinized
Every year, more states regulate PBMs. Even Maine, which repealed a sweeping PBM law in a party-line vote in 2011, continues to address concerns that PBMs can be unfair and coercive, see LD 44, recently reported out of committee unanimously in amended form. Other states enacting or considering PBM legislation, in addition to the Maryland specialty drug bill discussed above, include Oklahoma, Oregon, North Dakota, California, and New York. The New York bill is particularly of interest because it establishes a fiduciary duty on the part of the PBM, which was a central component of the repealed Maine law. Though challenged by the PBM industry in the courts, the fiduciary responsibility established in Maine law was upheld by the federal courts with the US Supreme Court refusing review. |
Psychotropic Drugs and Children
Those interested in this issue may want to review the reports commissioned by the District of Columbia collecting and analyzing data of payments to doctors in the District. A study released in July,
"Impacts of Pharmaceutical Marketing on Healthcare Services in the District of Columbia,Focus on Use of Antipsychotics in Children" showed that drug companies making antipsychotic drugs gave a disproportionate amount of gifts and payments to District psychiatrists who treat Medicaid patients. Close ties between the drug companies and psychiatrists might have led to inappropriate prescribing for Medicaid patients, and particularly for children, according to D.C. Council Member David Catania, a longtime NLARx board member, who held a hearing on the issue in November. The District recently released its 2013 report on drug marketing costs which found $83.7 million on spending for payments to doctors overall.
In 2013, at least three states have pending legislation relating to prescribing these drugs to children:
- Texas, where HB 473 requiring pre-approval to prescribe psychotropic drugs to young children has been voted favorably out of committee; watch the committee hearing here (at the 28 minute mark) and read the Grits for Breakfast Blog here, quoting testimony that "About 49,000 prescriptions for antipsychotic and neuroleptic drugs are currently given to children under five years old through the Texas Medicaid program, many of whom are in foster care..."
- New Mexico, where Senate Joint Memorial 44 seeks investigation of the "deleterious effects of overmedication of children in the state."
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Maine, where LD 716 directs the Department of Health and Human Services to adopt a program regarding prescription medications for children that consists of a prescription medication protocol, monitoring and prior authorization for reimbursement under the state Medicaid program.
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Vermonters Tackle Multiple Issues
Vermont legislators are trying again to limit the exemption available to parents seeking to avoid vaccinating their children. Read more. Pending legislation, H.391, would expand the state academic detailing program to provide direct-to-consumer education. |
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Join NLARx on Facebook and Twitter!
For up-to-the-minute posting of news of interest and events, become a fan of NLARx on Facebook here and follow us on twitter here. |
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