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Karmen Hanson, MA

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Title: Karmen Hanson, MA


1

Karmen Hanson, MA Senior Policy
Specialist National Conference of State
Legislatures
340B Drug Purchasing Options for States
Overview of State Rx 340B Legislation August 5,
2005
  • Over 600 bills in all 50 states.
  • What's new and different?
  • Future for states and 340B?

2
2005 Rx Legislation Overview
  • As of late June, over 600 bills in 50 states
  • Approx. 33 states PASSED legislation (a few
    vetoes)
  • Approx. 350 bills in both 2003 2004
  • Some familiar topics Medicaid, SPAPs, Rx
    importation, bulk purchasing, and 340B
  • New topics MMA, clinical trials, Rx monitoring,
    access to brand name Rx, and liability
    protection

3
2005 Rx Legislation Examples
4
2005 Rx Law Examples
  • As of early July, laws include
  • 340B, access to brand name Rx, bulk purchasing,
    Rx clearinghouses, Rx discounts, Rx importation,
    labels, manuf. liability, mail order, marketing,
    Medicaid, MMA, PBM, PDL, pricing, Rx
    recycling/reuse, subsidies, clinical trails and
    wholesalers
  • 340B still gets attention

5
States 340B Growing!

6
States get creative with 340B
  • States may
  • fund services
  • encourage or expand use
  • systematically evaluate options
  • provide loans to FQHCs for pharmacies
  • 2005 Law Examples CO (vetoed), ME, NY, UT
  • Bills CA, HI, MA, MN, NM, RI
  • 2004 Law Examples NM, VT
  • Bills CO, CT, KY, MD, MN, VA
  • 2003, etc

7
State Activities Encouraging 340B
8
2005 340B Laws
  • ME LD 1324 Establishes the Pharmacy Cost
    Management Council to develop measures to
    control the cost of Rx and . research
    purchasing and coordination of benefits related
    to maximizing use of federal programs (Medicare,
    340B)...
  • NY A 7298 Implements the 340 B pharmacy savings
    program.  Prohibits state from reimbursing 340B
    covered entities or contracted pharmacies at
    Medicaid price for drugs that are for 340B
    outpatients. Payment must be for 340B price plus
    reasonable administrative cost.
  • UT HB 33 Creates a five-year pilot program for
    disease and pharmaceutical management of bleeding
    disorders permits enrollees in the pilot program
    to participate in 340B and reporting of costs to
    state.

9
2005 340B Legislation
  • CA AB 76 Would pursue "all opportunities for the
    state to achieve savings through the federal 340B
    program including individuals receiving
    prescription drugs through state programs. It
    would ensure that hospitals, clinics, and other
    eligible entities participate in the program.
    (passed Assm. 6/2/05)
  • CA AB 77 Would allow pilot project for
    contracting for inmate health care to use 340B
    and reduce health care costs. (passed Assm.
    6/2/05)
  • CO HB 1152 Would require state to maximize Rx
    discounts through the utilization of 340B in
    order to receive the maximum state budget
    savings.  (VETOED by gov. 6/1/05)
  • HI HB 1058/SB 868 Would appropriate funds to the
    DOH for FQHCs and the Medicine Bank to provide
    pharmacy services and supplies to low-income
    patients. (Did not pass by end of session)

10
2005 340B Legislation cont.
  • MA H 2700 Would require all programs, clinics,
    hospitals and other health-related centers and
    entities that are eligible under Section 340B to
    participate in the federal prescription drug
    price discount program, unless they demonstrate
    greater savings through other purchasing. (In
    committee)
  • MN HF 1422 Would require Hemophilia drugs to be
    obtained from a 340B approved health facility.
    (Passed both chambers, but did not pass
    conference committee)
  • NM SB 11 Would expand pharmacy services in
    primary care clinics. (Did not pass by end of
    session)
  • RI S 806 Would create a coordinated
    pharmaceutical contracting system or multi-state
    Rx program on behalf of all individuals served or
    covered by state programs and expanded use of
    340B discounted pricing. (In committee)

11
Other 340B laws/actions NM
  • 2002- SJM 35 (Memorial) Requests . (to)
    "identify all avenues to maximize prescription
    drug discounts that may be achieved by using the
    federal 340B program.
  • 2003- SB 338, now Chapter 315 Requires
    Medicaid to identify entities that are eligible
    to participate in 340B. Range of General Fund
    Savings 500,000-1.5M.   
  • 2004- HB 88 Ensures that all eligible entities
    participate in the federal drug pricing program
    under Section 340B of the federal Public Health
    Service Act.  Allows entities receiving greater
    discounts to opt out.

12
More Laws ME and CT- 2003
  • Maine Requires the Department of Human Services
    to study and report to the Joint Standing
    Committee on Health and Human Services the
    benefits that could be recognized by the state
    through prescription drug discount programs
    available under Section 340B of the federal
    Public Health Services Act used to provide
    prescription drugs in Maine.
  • Connecticut Provides loans to FQHCs for the cost
    of establishing a pharmacy facility or a
    partnership with a community pharmacy to serve as
    a centralized prescription drug distributor for
    FQHCs that have established affordable
    pharmaceutical drug programs for their patients.
    The Commissioner of Social Services would assist
    any FQHC that is applying for a loan by providing
    non-individual identifying information concerning
    potential participants in the affordable
    pharmaceutical drug program.

13
More LawsAR, MD and TX- 2001
  • Arkansas HB 2498 of 2001 authorizes expanded use,
    creation or designation of FQHCs to get
    "substantially discounted prescription drug
    prices."
  • Maryland HB 6 of 2001 requires the state to study
    the feasibility of purchasing prescription drugs
    through FQHCs.
  • Texas HB 915 of creates the Interagency Council
    on Pharmaceuticals Bulk Purchasing, which must
    investigate options for using the 340B program
    ...for better purchasing power, including ...
    using rebate programs, hospital disproportionate
    share purchasing, and health department and FQHC
    purchasing."
  • Texas SB 347 of authorizes TX to provide
    prescription drug services to the prison
    population through the 340B program. Establishes
    a contract with two university hospital pharmacy
    systems that are qualified providers within the
    340B program.

14
States Rx Future ?
  • Future of state assistance plans?
  • Medicare Part D? Changes coming!
  • AWP ? ASP Price changes for 340B?
  • States are still in this to stay.
  • Information
  • Pharmacy Services Support Center http//pssc.apha
    net.org/
  • www.ncsl.org/programs/health/drug340B.htm

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